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A Visit to Yale School of Medicine

July 23, 2019
by Julie Parry

Recently, Dr. Philip Zochonis Ireland traveled from Liberia to Yale School of Medicine (YSM) to participate in a chief resident training program through the Department of Internal Medicine’s Office of Global Health.

From 2015 – 2019, Ireland worked as Chief Resident in the Internal Medicine residency program at John F. Kennedy Medical Center in Monrovia, Liberia, and was selected to travel to New Haven, Conn. for one month.

Funded by the U.S. Health Resources and Services Administration (HRSA), this Chief Resident  opportunity, overseen by Dr. Onyema Ogbuagu, faculty in the Section of Infectious Diseases, offered Ireland  training and career development in medical education, leadership, and administration and is a collaborative effort between the YSM’s Department of Internal Medicine and Office of Global Health, John F. Kennedy Medical Center, and the Liberia College of Physicians and Surgeons. 

During his visit to YSM, Ireland shadowed Internal Medicine chief residents, participated in leadership training, and attended the Association of Program Directors in Internal Medicine (APDIM) Conference. 

At the conclusion of the trip, Ireland wrote a first-person summary about his experience. The following content has been edited for length and accuracy.

Schedule 

After I arrived in New Haven, I was housed in a three-story set of apartments with other international guests who were visiting Yale. The HRSA grant covered my flights, ground transportation, accommodations, meals, sim card and data, and costs associated with the conference.

The first day I was picked up from my house by Laura Crawford, Senior Program Administrator for the Office of Global Health, and taken to Yale New Haven Hospital’s (YNHH) York Street Campus where bulk of my activities would be done. Crawford provided an orientation of the different buildings, conference rooms, and clinics that I would be attending and then took me to the Department of Occupational Health to update my vaccinations. Katherine Frumento, assistant director of clinical information services, gave me a tour of the Cushing/Whitney Medical Library as well as a full orientation to the digital libraries.

For the first two weeks, my daily schedule consisted of resident ward rounds on a variety of wards, morning reports, didactics, noon conferences, observing clinic work, library visits and attending weekly Medical Grand Rounds and chief resident meetings.

I attended ward rounds at both YNHH campuses for infectious diseases and general internal medicine. The two-hour rounds consisted of a well-structured “dry round” where EPIC was used to discuss and make clinical decisions on patients that had been cared for by the team on call. This was followed by bedside rounding where patients were presented by either a medical student or a resident to the rest of the team outside of the patient’s ward. The team then entered the patient room, communicated pertinent information to the patient, and performed focused physical examinations. This time was also used for bedside teaching. 

I attended infectious disease didactic sessions led by Dr. Vincent Quagliarello, Vice Chair of Education and Academic Affairs for the Department,  and Professor of Medicine (Infectious Diseases). I attended teaching sessions on neuro-manifestations in HIV, syphilis, use and interpretation of procalcitonin, emergency preparedness, and parasitology. Going forward, the infectious disease didactic sessions can be watched live from Liberia which should be a valuable resource for Liberia.

During my visit, I attended five of the Department of Internal Medicine’s Medical Grand Rounds on topics ranging from prescription drug pricing, to cardiovascular health and physician burnout.

During the afternoons, I either attended at the diabetes clinic with Dr. Tracy Rabin or the Nathan Smith HIV clinic with Drs. Onyema Ogbuagu and Charisse Mandimika. Alternatively, I went to the weekly chief resident meetings where the Traditional Medicine Residency Program chief residents met to discuss the progress of the residency as well as to troubleshoot problems. I also accompanied Drs. Asghar Rastegar and Tracy Rabin to the YSM campus to watch them teach medical students. 

In April, I travelled by train to Philadelphia to attend the annual APDIM conference. I was a part of the two-day meeting for incoming chief medical residents which introduces chiefs to the world of academic internal medicine and orients them to the challenges they will face in the upcoming year. The meeting was a mix of large group plenary sessions and small hands-on workshops. We learned about leadership, teaching skills, professionalism, and management issues. This was also an excellent networking opportunity.

My Observations

At YSM, five program chiefs manage the Traditional Internal Medicine Residency Program. They treat patients, teach residents and medical students, troubleshoot administrative and clinical problems, facilitate gatherings, supervise procedures, supervise junior clinicians, serve as confidantes, run morning reports, organize noon conferences, and attend in the outpatient clinics and inpatient service. This is very different from what we do in Liberia.

The YSM chief resident’s role, if replicated in Liberia, would be instrumental for the further development of the Internal Medicine Residency Program at the Liberia College of Physicians and Surgeons and the John F. Kennedy Medical Center. Currently, high-level medical educators are in short supply and those that exist are doing work that chief residents do in addition to other duties. With this heavy workload, goals are rarely achieved and burnout is prevalent amongst senior level clinicians. With a well-structured chief resident program, the burden borne by these senior level medical educators would be relieved and then they could have more time and energy to complete their yearly goals.

The position of chief resident in Liberia should be formalized, officially recognized by both the John F. Kennedy Medical Center and the Liberian College of Physicians and Surgeons, and structured like the YSM model.

My New Haven visit was a resounding success. Along with my medical duties, I was invited to many meals, religious services, and family gatherings which added to making my visit very memorable and meaningful. Overall, the exposure to the YSM system and wonderful learning environment made this experience a very positive milestone in the development of medical education in Liberia as well as in my individual career. 

Submitted by Julie Parry on July 23, 2019