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May 26, 2019
by Mark David Siegel

Hi everyone,

I’m kvelling. In other words, I’m bursting with pride because we did so well on this year’s ACGME resident survey, especially on the most important question:

If 93% of our residents feel positive or very positive about the program, we must be okay. Kudos to the faculty, chiefs, and especially the residents. You’re phenomenal!

But enough with the kvelling. We’re far from perfect, and at last Thursday’s Executive Council meeting, we discussed the parts of the survey that need work. We need to:

  • Provide better feedback: We repeatedly remind faculty and residents to give in-person and written feedback after each rotation. The reminders have helped, but not entirely. Going forward, we plan to reach out to those individuals who fail to give feedback. We will also work to elevate the quality of feedback. Let’s also remind ourselves to give routine daily feedback, for example after presentations and procedures. (NB, here’s some feedback for everyone: many people have noted that not all feedback is recognized as such, so when you plan to give feedback, label it. For example, say, “let’s give each other feedback,” or something like that. Use the word).
  • Show how the program uses feedback to improve: We get many great suggestions from residents on ways to improve the residency, particularly through the PEC, but we could more effectively close the loop so you know how we’ve responded. We can’t make every change suggested (i.e., we can’t easily make expensive infrastructure improvements), but we can definitely do a better job showing that we’ve listened and explaining what we can and cannot do and why. We can also devote more attention to highlighting improvements made because of resident feedback. For example, the request for more ultrasound education led to the creation of a working group, a curriculum, multiple teaching sessions, and the purchase of several Butterflies.
  • Provide more instruction on fatigue management: Although we’ve gotten excellent lectures on this topic, we can do more. For example, we could ask the Wellness Committee and Program Leadership to collaborate on teaching sessions and workshops. We could also standardize our procedure for calling backup when fatigue occurs.
  • Improve the balance between clinical demands and education: We need to do more to protect education time. For example, we could optimize our communication with nursing in order to decrease the number of texts sent during teaching conferences.
  • Ensure education isn’t compromised by excess non-physician obligations: We get outstanding support from non-physician staff, but we clearly need more help in some areas- for example scheduling appointments and completing forms. We will keep advocating for more clerical help.
  • Provide feedback on practice habits: All residents can get feedback on their practice habits in clinic, but the experience has been inconsistent. Council members suggested creating a more formal process, for example generating individual reports and setting time aside to review panel management. We should also seek opportunities to provide feedback on inpatient practice.
  • Create more opportunities to participate in quality improvement: To date, our QI focus has been geared towards upper year residents, but Council members recommended that we begin QI projects during internship. We should also offer QI opportunities on the inpatient side.
  • Expand rheumatology education: Residents would like more rheumatology education, for example providing more instruction on the musculoskeletal exam during ambulatory blocks. We can do this.

In summary, we did well on this year’s ACGME resident survey. Clinical training remains outstanding, scholarly opportunities abound, morale is high, and most residents are happy to be here. But we’re still not exceptional in every domain and that should be our goal. Then we’ll really have something to kvell about.

Enjoy your Sunday, everyone. I’m biking in to do pulmonary consults,


PS Congratulations to Solmaz and her fiancé, Kasra, who are getting married today!


Submitted by Mark David Siegel on May 26, 2019