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Helping doctors help themselves

Yale Medicine Magazine, 2016 - Winter


Rows upon rows of manila file folders sit like soldiers on the credenza behind the desk of DeWitt “Bud” C. Baldwin Jr., M.D. ’49, where they have a bird’s-eye view of Chicago’s urban landscape and Lake Michigan. Their contents fuel the research that the 93-year-old Baldwin conducts as a scholar in residence at the Accreditation Council for Graduate Medical Education (ACGME). Every day and often on weekends too, he reads, thinks, and writes in his 24th-floor office, often about job burnout. Not for his personal well-being, but for the growing number of trainees pushed to the brink by their chosen profession.

Ironically, doctors—who are drawn to helping others—suffer high rates of depression, substance abuse, divorce, and suicide. Some 40 percent of medical residents report feelings of depression. As many as a dozen take their own lives every year, said Baldwin.

“Medicine today has become too complex for the still-rigid way we train physicians, leading to an intense, nonsupportive learning environment,” said Baldwin, who joined the American Medical Association in the mid-1980s to head the Office of Education Research. There he launched pioneering studies that revealed disturbing findings: Medical students and residents routinely endured a great deal of mental and physical abuse. “Years ago I said, ’It’s not just the hours [residents work] but what goes on in those hours that matter.’ ”

Hired by the ACGME in 2002, Baldwin focuses on better understanding the resident experience. His research helps to develop strategies and guidelines that allow young physicians to heal themselves or at least let others help them. To that end, Baldwin encourages trainees to speak up via a variety of methods, including anonymous surveys to measure satisfaction and define the best learning methods.

“Bud has provided a venue for the voice of residents,” said Nick Yaghmour, M.P.P., a research analyst at the ACGME who assists with Baldwin’s studies. “He has brought the importance of physician communication and self-care into the discussion.”

A noted champion of humanism in medical education, Baldwin has long advocated reforming medical school curricula. For him, such soft sciences as sociology and psychology are as important to shaping future physicians as the hard sciences of biology and chemistry. He promoted the once-radical notion that budding practitioners must learn to appreciate that many factors influence health, from socioeconomic status and cultural differences to gender and race. A maverick throughout his more than 60-year career, Baldwin practiced what he preached at four traditional and two new medical schools he helped to establish in Connecticut and Nevada. One of the founders of the Association for the Behavioral Sciences and Medical Education, he received the organization’s lifetime achievement award in 2007.

This physician educator didn’t stop at enhancing the development of well-rounded compassionate doctors. He also introduced the concept of interprofessional teamwork: teaching physicians and other health providers to care for patients with a collaborative team approach, for which he has received two honorary doctorates. “I learned to think health instead of disease,” said Baldwin, who applied this model at the University of Washington in Seattle in the 1950s. “When it comes to disease, doctors are the experts. When it comes to health, doctors don’t know much. It’s the nurses, social workers, nutritionists, dentists, and occupational therapists who help make people healthy.” His tenure in the Northwest also proved personally satisfying, as he met his wife, Michele. A French native, she was studying in the United States on a Fulbright scholarship. The couple has two daughters and four grandchildren.

Baldwin credits much of his passion for education to his parents, who believed in experiential, small-group, and problem-based learning. They were educational missionaries in Burma (now Myanmar), where Baldwin lived until age 10. When they returned to the United States in 1933, he said, “They came back with the belief that ’We have as much to learn as we have to teach’ and were promptly fired by their mission board.”

While Baldwin’s ideas for educational reform for physicians may have started decades ago, they remain relevant to graduate medical education. In early 2016, the ACGME will bestow the first DeWitt C. Baldwin Jr. award to an academic institution that demonstrates a humanistic culture and fosters a respectful and supportive environment for medical education.

“Bud has taken the temperature of the soul of American residents in ways no one else has,” said Timothy P. Brigham, M.Div., Ph.D., chief of staff and senior vice president for education at the ACGME. “He has touched the lives of literally thousands of physicians and, by extension, thousands of patients who have benefited from the impact of his work.”

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