Distinction Pathways: All About the Resident Experience
For trainees in Yale’s Department of Internal Medicine residency programs, one of the benefits of training is the educational opportunities and the opportunity to learn from mentors in the areas of clinical care, research, and education.
In addition to the regular curriculum, the programs offer other educational and training opportunities, one of which is the Distinction Pathways.
The Distinction Pathways were designed to foster interest and development of those in the program. While the residency programs offer training of practitioners, educators, and/or investigators in the broad field of internal medicine, the Distinction Pathways provide trainees with the opportunity to dive deeper into learning, development, and building of skill sets in the areas of medical education, global health, research, quality improvement, and race, bias and advocacy.
“The Pathways provide trainees with the opportunity to find a community of like-minded people—both faculty and residents. The collaborations that are fostered and the connections to mentors are a huge contribution to their developing careers and wellness,” said Tracy Rabin, MD, associate professor of medicine (general medicine) and co-director of the Global Health & Equity Distinction Pathway with Sheela Shenoi, MD, MPH.
The distinctions emerged from a discussion in the Traditional Residency Program’s Executive Council, which consists of residents and program leadership.
“We were discussing whether we should develop new ‘tracks’ in the program akin to the research-scientist track, but decided that we favored creating opportunities for residents which would not be restrictive and/or require different durations or components of training,” said Mark D. Siegel, MD, professor of medicine (pulmonary, critical care, and sleep medicine) and program director of Internal Medicine Traditional Residency Program.
The first pathway was launched in the fall of 2016, and currently there are five distinctions offered. Most recently the Race, Bias, and Advocacy in Medicine (RBAM) Distinction Pathway was developed and launched this year.
“Prior to the distinctions starting, there had always been residents who had strong interest in these areas and were doing quite a bit of work extracurricularly to develop themselves and to keep these passions alive,” said Rabin. “Part of the impetus for this whole idea was to take those activities out of the extracurricular space and provide some framework so that the residents could get formal credit for such things. And this is not just in terms of an output, like a paper being published, but also in terms of having participated in something that builds specific skills. So when they apply to fellowship or when they go on to the next job, they can say to their employer, ‘I have an interest in global health’ or ‘I have an interest in clinical education and that's what this means at my institution.’”
“In residency, a lot of the focus is on clinical medicine, and the initial idea with the distinctions was to focus attention to how one develops into a career, especially in the academic field,” said Charles Dela Cruz, MD, PhD, associate professor of medicine (pulmonary, critical care and sleep medicine) and co-director of the Investigation Distinction Pathway with Erica Spatz, MD, MHS.
Each distinction is unique, has its own curriculum, and requirements. However, the faculty leads worked to harmonize the expected time requirements for successful completion across the distinctions and all expect approximately 90-120 credit hours.
The Clinician Educator Distinction Pathway was designed to give residents insight into their education, hone their teaching skills, and help them understand what it means to cultivate a career in medical education.
“It’s sort of like peeling back the curtain. Many of our trainees have worked with clinician educators because that's who does all the teaching, but a lot of our trainees don't know what a clinician educator does when they're not face-to-face with a trainee. The pathway gives insight into administration, curriculum design, and scholarship,” said Katie Gielissen, MD, MHS, assistant professor of medicine (general medicine) and pediatrics and co-director of the Clinician Educator Distinction Pathway. “The goal of the track is to expose them to what we do when we're not on the wards teaching. Many of our trainees enter into the track with the goal of trying to be a better teacher, and most of them exit the track with a better idea of what that means and what that could mean for their career.”
Residents are exposed to methodologies used in education, such as survey design, qualitative research, and a structured evening curriculum.
“We have structured the direct observation and feedback teaching sessions so that trainees have an opportunity to teach a conference or other type of forum. They get direct observation and feedback on their teaching, which, uniformly, all of our trainees have said is the most valuable experience of the distinction,” said Gielissen.
Global Health & Equity
The Global Health & Equity Distinction Pathway has a main focus on the multidisciplinary and collaborative field of global health.
“The definition of global health that we promote is one that is not bound by location, and one that focuses on achieving health equity for all people. Thus, ‘global health’ encompasses work with vulnerable communities within the United States, as well as those outside of the boundaries of the U.S. We wanted to make it clear from the title that ‘global health’ isn’t something you have to leave the country to be involved in, so the word ‘equity’ is an important piece of the title,” said Rabin.
A major component of the pathway is providing trainees with access to resources across Yale University that are focused on global health, like discussions and community-building activities in other departments and at other schools. In addition, the pathway hosts events and op-ed writing workshops focused on global health throughout the year.
The pathway requires residents to do an immersive rotation in another community. Many of the collaborative sites are outside of the U.S., while one is in rural Tennessee and the other is with the Indian Health Service in Chinle, Arizona. Since the pandemic hit and travel has been restricted, the pathway developed an immersive opportunity for residents to work with marginalized communities locally in New Haven.
The Investigation Distinction Pathway is designed for those interested in pursuing research as part of their academic career.
“The investigation distinction is an adjunct to the research-in-residency program. One of the core areas is scholarly content. Residents participate in research, either through the research-in-residency or unofficially through something on their own, then they have opportunities to present their work to us. We have forums where the residents present their work before they graduate to get feedback, and then peer evaluations and also faculty evaluations,” said Charles Dela Cruz, MD, PhD.
Another component is the content required for the academic research process and success. One of which is statistical support—how to do statistics, bioinformatics, and data management. Another important component is research career development in terms of discussion with faculty and experts on research presentations, grant writing, mentorship, and career networking.
“Faculty or experts are brought in to talk about a topic as a way to supplement their knowledge. Some of the topics include how one would become an independent investigator once they graduate, what would the fellowship, finishing fellowship, and looking for a job in research look like.”
Quality Improvement & Physician Leadership (QIPL)
The Quality Improvement & Physician Leadership (QIPL) Distinction Pathway is meant to give residents advanced exposure to quality improvement principles and practice and to teach them about excelling as a physician leader.
“What we wanted to do was couple advanced QI training and mentored projects with exposure to physician leaders and a high yield framework for physician leadership. We hope and expect that everybody gets exposure to QI and leadership during residency, but QIPL is designed to take that to another level,” said Jeremy Schwartz, MD, associate professor of medicine (general medicine), Yale School of Medicine; and epidemiology (chronic diseases), Yale School of Public Health; and co-director of the Quality Improvement & Physician Leadership (QIPL) Distinction Pathway with Naseema Merchant, FCCP, FACP.
The framework for the QIPL distinction pathway includes completion of the Institute for Healthcare Improvement (IHI) basic and advanced certificates; execution of a mentored QI project; and small group learning sessions with physician leaders.
“We hold monthly evening sessions where we invite physician leaders from inside and outside Yale New Haven Health System and across the state of Connecticut to share their leadership journey, teach leadership skills, and allow this small group of residents to have some intimate interactions with trusted, local physician leaders,” said Schwartz.
The pathway also engages colleagues from across the department’s sections to mentor residents in QIPL through a QI project to help build on the tool kits that they learn from the IHI training. Residents are encouraged to do projects in areas, both inpatient and outpatient focused, that are meaningful to them based on their experiences and their anticipated career trajectory.
Race, Bias and Advocacy in Medicine (RBAM)
The Race, Bias and Advocacy in Medicine Pathway aims to enhance the level of awareness and introspection around racial biases and other forms of discrimination that exist in societal and systemic structures.
RBAM was developed in response to racial unrest that occurred in the country in 2020 by chief residents Jana Christian, MD, and Rachel Schrier, MD who banded together with department leadership to establish the pathway.
“These events captured the national attention in a different way, and I think it really started to generate conversation among the chiefs of how to respond in a way that's sustainable, rather than demonstrating activism that isn’t long-lasting,” said Aba Black, MD, MHS, assistant professor of medicine (general medicine) and co-director of the Race, Bias and Advocacy in Medicine (RBAM) Distinction Pathway along with Isabel Bazan, MD, BA; Shaili Gupta, MBBS; Stephen Holt, MD, MS; Sharon Ostfeld-Johns, MD, and Lisa Puglisi, MD.
“Part of the pathway is to encourage citizenship and equipping the participants to be able to have the skills when they graduate to actually be change agents. The vision for the pathway is to say, whether you're interested in education or research or clinical work or administration, we want to be able to equip you with the skills to be a leader in DEI in that space after you graduate.”
The pathway recently developed its foundational structure and content, with the first cohort beginning this academic year.
Residents are also encouraged to get involved in leadership roles within the distinctions. This provides further opportunity for learning and the development of skills within each specific area.
“Most of the distinctions have resident leaders, and we are working on building residents to take on leadership roles with the co-directors to lead in each of these distinctions, and that also highlights opportunities for them to build this skill set,” said Dela Cruz.
Another added benefit of the pathways is that by exploring these areas, residents are able to decide what interests them. Since the pathways were established five years ago, past residents have been surveyed to gather information about their experience.
“Many have said when they move to the next step in their career it allowed them to have clarity to be able to differentiate what they wanted or did not want. It allowed them to see that ahead of time, rather than find out about it later,” said Gielissen.
The distinction pathways are introduced on interview days to prospective hospital residents. The newest distinction pathway, RBAM, will also be introduced at the 2022 recruitment dinner for potential underrepresented in medicine (URiM) residents.
“Not only do the pathways provide training opportunities in specific areas, but also allow for residents to co-lead with the faculty. Once mentioned, applicants become very interested in them, as they also see the benefits,” said Inginia Genao, MD, associate professor of medicine (general medicine); associate chair for diversity and inclusion, Internal Medicine; and graduate medical education director for diversity, equity, and inclusion.
“The pathways are one of the true jewels of the residency programs, as they have transformed our programs by allowing trainees to do deep dives into areas of special interest. We are especially fortunate to have so many dedicated faculty members in all the distinction areas who devote time and skill to enhancing residency education,” added Mark D. Siegel, MD.
Residents may join a distinction in the fall of their PGY-2 year. Prior to the second year, PGY-1s are offered the opportunity to be involved in a distinction and will receive credit for activities completed while in residency. Residents who graduate with their specific distinctions are acknowledged when they complete their residency during graduation.
For more information on the pathways, visit the Distinction Pathway’s website.