Research & Publications
My scholarly work focuses on the exploration of ethical and professional behavior in medicine, how to evaluate it, and encourage its flourishing. Early in my career, I developed an interest in how to support ethical and professional behavior through attention to context and the environment. As a Robert Wood Johnson Clinical Scholar, I elucidated factors that created ethical discomfort among medical residents. This work has been a foundation of my ethics and professionalism teaching at Yale, and a contribution to the literature that had previously focused more on medical student ethical development and less on residency, arguably a distinct stage of training. This more recent publication has lead to my participation in the American Board of Internal Medicine Foundation’s Project on the Impact of Transitions of the Professional Development of Residents. My interest in articulating, establishing, and influencing the role of physicians and the pharmaceutical industry has led to my participation in two projects (including a systematic review of residency education) that evaluated efforts to teach residents about these crucial issues. Another area of focus has been effective end-of-life communication, including development and evaluation of a ward-based exercise for medical students.
Specialized Terms: Evaluation of efforts to improve ethics and professional education; Education to improve end of life communication; Clarification of appropriate relationships between physicians and pharmaceutical industry
Extensive Research Description
My scholarly work has two central areas of focus: one is the exploration of ethical and professional behavior in medicine, how to evaluate it, and encourage its flourishing. My goal has been to encourage residents to be aware of the personal, professional and systemic barriers to appropriate behavior, and through reflection and reaffirmation of important values and concerns, enhance their ability to meet their personal high ideals for professional behavior. The second focus of my work has been excellence in ambulatory medicine and dissemination of current, evidence-based updates for residency education and faculty development.
My background in medical ethics has served me well in this setting and has allowed me to participate in fascinating and important conversations about how to support ethical and professional development not only at the student but resident level. Early in my career, I developed an interest in how to support ethical and professional behavior through attention to context and the clinical environment. As a Robert Wood Johnson Clinical Scholar, I further elucidated the nature of and factors that created ethical discomfort among medical residents in my primary fellowship project. This work has been a foundation of my ethics and professionalism teaching at Yale, and a contribution to the literature that had previously focused more on medical student ethical development and less on residency, arguably a distinct and separate stage of training. This more recent publication lead to my participation in the American Board of Internal Medicine Foundation’s Project on the Hidden Curriculum. We are current analyzing qualitative data from 12 focus groups at 3 medical institutions to explore the effect of transitions on the professional development of medical trainees, as well as patient care.
My interest in articulating, establishing, and affecting the role of physicians and the pharmaceutical industry has led to my participation in two projects (including a systematic review of residency education) that have evaluated efforts to teach residents about these important issues of professional behavior. Another area of focus has been effective end-of-life communication, including development and evaluation of a new ward-based exercise for medical students, as well as seminars for the medicine residents.
As part of my interest in supporting resident development, I perceived a gap in information available to medicine residents each year as they began to look for jobs or fellowships. As a result, through a collaborative process, I guided the creation of Beyond Residency, an online career planning tool for Yale trainees and students which provides general information and access to additional resources on CV creation, how to search for a job, interviewing, the fellowship match process, and contract negotiation. We are also performing a controlled trial through the Yale Affiliated Hospitals to assess the effect of this resource on improving the success and decreasing stress on trainees during the application process for the step after residency.
As co-editor of the Yale Office-based Medicine Curriculum, I have the opportunity to shape an ambulatory medicine text which has broad dissemination nationally, including over 230 medicine, family medicine residencies, nursing, and physician assistant programs. With my co-editors Seonaid Hay and Laura Whitman, we take suggestions from our residents and faculty on topics and important clinical questions that help shape our case-based chapters. Our overall curricular structure covers core subjects in ambulatory medicine, while allowing tailoring to current important developments, including new therapies or policy issues. At many institutions our curriculum is used for a faculty-guided small group discussion, which allows us terrific opportunities for faculty development and influence, as well promoting Yale’s standard of excellence in up-to-date and high quality ambulatory medicine nationally.
In summary, my current position allows for a breadth of opportunity to teach and improve moral sensitivity, critical thinking, and, hopefully, professional behavior. In the future, I would hope to continue to delineate factors that support ethical and professional behavior and determine which most effectively protect trainees from some of the deleterious effects of the so-called hidden curriculum of medical training, with attention to such areas as pharmaceutical relations and end-of-life care. I hope to also continue to move the Yale Office-based Medicine to a new threshold as a high quality, comprehensive tool for ambulatory education while also seeking to enhance the evaluation of the Curriculum as a strategy for demonstrating an effective way to improve resident knowledge, skills, and behavior regarding ambulatory medicine.
American Board of Internal Medicine Foundation: Assessment of Impact of Transitions on Resident Professional Development and Patient Care
Beyond Residency: Assessment of Online Tool for Resident Career Planning
Assessment of Career Planning Needs for Internal Medicine Residents
Education, Medical; Ethics, Medical; Health Policy; Humanities; Internal Medicine; Patient Advocacy; Physicians, Primary Care
- Yale Primary Care CurriculumEditor-in-Chief, Yale Primary Care Curriculum. Produced semiannually, 26 chapter evidence-based, case-based primary care text, including resident and preceptor guide. Rotating 3 year curriculum of topics including relevant updates. Used by approximately 200 internal medicine residencies in US and abroad.
- DualityRosenbaum JR. Duality. Health Affairs 2008, 27:494-99.