Hi everyone,
At Friday afternoon’s Q&A session with the applicants, Soumya called our program “change forward.” I love how that term captures our drive to improve.
It took me years to accept that we’d never reach perfection. I used to find our program’s shortcomings unsettling and took them personally- the duty hour violations, an under-resourced outpatient clinic, trainees struggling to find mentorship, and insufficient resident diversity. I’m a perfectionist at heart.
But let’s not exaggerate. We have a rich legacy stretching back decades. We’ve always recruited talented residents, trained them well, and launched them into excellent fellowships and faculty positions. But like all programs, we’ve faced shortcomings which we’ve embraced as opportunities to improve.
In the ambulatory setting, we adopted a 6+2 schedule, moved into a modern Federally Qualified Health Center on Long Wharf, created an innovative Center of Education at the VA, solidified our relationship with the Fair Haven Clinic, established longitudinal subspecialty electives, developed VA “selectives,” firmed up partnerships between residents and preceptors, instituted panel management and quality improvement projects, enhanced our relationship with the New Haven community, and developed educational half days and fall retreats.
On the inpatient side we created novel hospital medicine rotations and a new ED-based cardiology rotation. We established an 8:30 a.m. skill-building conference and simulation sessions devoted to procedural training, codes, and inter-professional communication. We added structure to noon conference and began recording sessions to accommodate residents who couldn’t attend. Working with the Firm Chiefs, we’ve bolstered structured teaching sessions and posted rotation prep materials on our SharePoint hub, developed by the Chiefs. With input from the residents, we created intern milestones so interns could chart their progress as they prepare to become seniors.
To meet our leadership needs, we expanded the number of Chiefs from five to eight, with new Chiefs assigned to the COE and NHPCC as well as a Chief for Quality and Safety at the VA. We added capstone rotations for PGY3s to prepare them for independent practice. We’ve created better MedHub forms for written evaluations and provided professional development sessions to improve resident and faculty feedback. We are doing a better job teaching the principles of quality improvement and patient safety, ensuring that all residents lead QI projects and participate in safety reviews, for example at Morbidity and Mortality Conferences.
Scholarship is flourishing. In addition to joining the Research-in-Residency Program, residents are taking academic scholarship electives, leading individual QI and advocacy projects, developing educational curricula, and participating in Writers’ Workshop. Our Physician Scientist Training Program has instituted quarterly research and career development meetings, and PSTP recruitment has become so strong that we expanded the program. Residents are presenting their work at national and international meetings, supported by departmental funding, and they are publishing in high impact journals. To allow residents to pursue their passions and develop advanced skills, we’ve created five Distinction Pathways: Medical Education; Quality Improvement, Patient Safety, and Leadership; Global Health and Equity; Investigation; and Race, Bias, and Advocacy. To ensure residents find mentors, we’ve identified faculty liaisons in every academic section and developed the Resident Research Repository (RRR). Residents interested in POCUS can develop advanced skills in the POCUS Superuser Pathway.
We’ve become a more diverse program with an influx of residents who identify as underrepresented in medicine as well as residents trained internationally. We’ve benefited from this new talent and we are working to foster belonging among all members of our community, in part by creating two APD positions focused on DEI.
We’ve made great progress promoting resident wellness. Through the GME office, the hospital provides robust medical and mental health resources as well as ample support for new parents and residents requiring temporary leave. Through the MAC Program, each resident is assigned a faculty member who serves as a confidant and support system for the duration of training. Lunch has undergone an upgrade with healthy, delicious offerings each day. We have an active Wellness Committee, with wellness leaders in each color block, and multiple social events each year, including our recent ugly sweater party and upcoming Arts Night and Winter Ball. And, of course, we’ve eliminated 28-hour call and greatly reduced duty hour violations.
This Note would be twice as long if I named the individual faculty and residents who pushed and developed these innovations- so thank you all. We’ve gotten generous support from the School of Medicine, the Department, VA-Connecticut, and Yale-New Haven Hospital. We are blessed with incredible faculty who serve as clinic preceptors, clinic directors, inpatient attendings, firm chiefs, ICU directors, MACs, Distinction Leaders, and scholarship mentors. And of course we’d be nowhere without our annual crop of phenomenal Chief Residents and world class Associate Program Directors.
The most important reason we’ve improved and continue to improve is because we embrace change and elevate the voices of residents who serve on so many committees: the Executive Council, Program Evaluation Committee, Welcoming Committee, Wellness Committee, Resident Procedure Team, Women in Trad IM, Arts Night Leadership, Education Committees, the Beeson Beat, the Resident Research Repository (RRR), and more. I’m grateful to the residents who fill my inbox each day with ideas, post suggestions on MedHub, submit SAFER and JPSR Reports, and raise issues at our monthly Program Director’s Meetings and biannual performance reviews. Your honesty and creativity ensures that we continue changing for the better.
We will never reach perfection and I’ve learned that there will always be ways to improve. For example, we are currently working on plans to improve procedural training, critical care didactics, AI education, nursing-resident partnerships, and patient distribution. Please keep the suggestions coming. As Soumya said, we’re a Change Forward Program- as we always have been and always will be.
Enjoy your Sunday, everyone. I’m getting over a non-COVID cold but may sneak out for a hike up East Rock.
Mark
What I’m reading:
- For Many of Us, Jan. 6 Never Ended By Aquilino Gonell
- Chris Hayes: I Want Your Attention. I Need Your Attention. Here Is How I Mastered My Own. By Chris Hayes
- The Household Chores You’re Avoiding Are Key to a Deeper Life By Lydia Sohn
- Evolution in the Dock By Adam Hochschild
- Hats By our very own Mason Montano
- Transitional Justice — A Politico-Legal Approach to Health Equity By our very own Emily McNeill et al.