The goal of this project was to develop a patient-centered care plan (PCCP) within an electronic medical record and evaluate its impact. The PCCP focused on respecting patient values/preferences, care coordination/integration, and information/communication. An experimental group used the PCCP while a control group did not. Experimental patients had more documentation of goal setting and showed higher activation levels. Providers, patients, and staff found the PCCP useful for engagement, self-management, and teamwork. Results were presented and the grantee plans to publish findings.

1. Picker/Gold Graduate Medical Education
Challenge Grant Program Cycle: 2009-2010
Communication in Family Meetings: Developing and Assessing a Curriculum for Residents
Principle investigator: Julie T. Irish, Ph.D.
Beth Israel Deaconess Medical Center
Project goals are to develop a medical education research agenda to investigate optimal educational
strategies to enhance physician-family and inter-professional communication behaviors and to correlate
them with outcomes of interest. The more immediate goals of the project are: 1) to develop an innovative
curriculum to enhance residents’ communication skills and interactions during family meetings; and 2) to
assess the impact of the curriculum through family members’ satisfaction with family meetings. The
specific objectives of the project are to: 1) deliver the communication curriculum to second year internal
medicine residents; 2) demonstrate that the residents have acquired proficient communication skills using
a rating instrument based on the Kalmazoo Essentials of Communication; and 3) assess and demonstrate
improvement in family members’ satisfaction with family meetings. Project successes will be shared with
other Harvard affiliated teaching hospitals as well as the larger GME community; either through the
ACGME or other accrediting organizations so that they too will have the tools teach these much needed
skills. This curriculum will likely be of interest to other residency programs as it aligns with several of
the ACGME competencies. Results will be published in peer-reviewed journals.
Final Analysis: The grantee was successful in ensuring that the 3-week curriculum was delivered to all
(over 40) residents who rotated through the selected ICU. They worked closely with staff in the
simulation center to create two realistic and accurate clinical simulations. The family meeting
communication pocket card was finalized and distributed to house-staff. This pocket card summarized the
key elements of the FAMCAT and provided useful phrases or scripts that were suggested by the critical
care faculty core. With the input of the members of the project team, a draft manuscript, that describes the
development and delivery of the curriculum, was developed.
Improving Patient Communication Skills Among Surgical Residents
Principle investigator: Rajiv Y Chandawarkar MD
University of Connecticut Health Center
The goal of this project is to teach surgical-residents to incorporate communication skills that focus on
patient-centeredness. Surgical and non-surgical residency programs will benefit by helping residents
incorporate patient needs and opinions into the care team’s decision-making process. Clear and empathic
communication builds stronger relationships between physicians and patients (3-5). The need for
preparing surgical-residents to communicate effectively is high. Mostly, surgical-residents are not
formally taught patient-communication and are expected to acquire these skills ‘on the job. Results from
this study are important for implementation of the educational tools in surgical and non-surgical residency
programs. Dissemination will be achieved in two ways: intra-institutional implementation, within
UCONN and Yale; and inter-institutional implementation, via presentation at national meetings and
publication.
Final Analysis: Results showed that there is an overall improvement in residents’ communication skills
by using a simple, interactive educational program, easily accomplished within the time allotted to

2. didactic teaching in the educational curriculum. -Case-specific scores showed a statistically significant
improvement. General communication skills (as measured by MIRS) also improved but this improvement
was not statistically significant. Several factors could explain this discrepancy between measured
improvement in case-specific communication skills, and measured improvement in general
communication skills. The first possibility is that while problem-specific skills can -be taught and
reinforced in a single day’s training (e.g., through the use of checklists, as recommended by Gawande11in
a different context), this may not suffice to ensure improved performance on all MIRS items. Factors such
as lack of jargon, verbal facilitation skills, and summarizing can be taught. However, factors such as
empathy, body language and concern for the patient’s viewpoint may have a much larger innate
component, making it harder to dissemble over the course of a sustained series of encounters.
Develop Health Care Transitions, a Resident Learning Module on Building Bridges
Principle investigator: Suzanne McLaughlin, MD
Alpert School of Medicine, Brown University
Rhode Island & Hasbro Hospitals
The goal of this project is to develop a transition curriculum for medical residents that will enhance
residents’ knowledge base of transition issues, develop clinical skills to assess, plan and support transition
for adolescent and young adult patients and promote residents’ self-efficacy in the integration of patients
and families in the decision-making process through close mentoring of the transition process by faculty
and patients who have experienced challenges and success in transition. Dissemination will include peer-
reviewed medical education journals and posting to national residency program curriculum websites. On-
going work will include the development of ambulatory residency curriculum modules and presentation
of curriculum workshops at national meetings.
Final Analysis: Throughout the implementation of this transition curriculum, the grantee has been
successful in offering transition services in multiple settings and using the experiences to establish a
committed group with regular interactions and successful collaboration on curriculum as well as engaging
administrators at Rhode Island Hospital and the Rhode Island Department of Health to invest in this
process. Overall residents reported high levels of satisfaction with the curriculum and clinical
experiences; residents demonstrated improved knowledge of transition services. This initiative has been
quite successful and with the help of the Rhode Island Department of Health and the Department of
Pediatrics at Hasbro Children’s Hospital this initiative will continue for the upcoming year; including
support of the community peer support and the transition coordinator positions.
Teaching Family-Centeredness in the PICU: a novel approach using medical simulations
Principal investigator: Ira M. Cheifetz, MD
Duke Children's Hospital
The focus of the project is to implement a mock code training program in the PICU to provide
multidisciplinary training in crisis resource management. An important component of this program will
be to teach strategies that integrate families into these difficult acute care situations. In regards to the
Picker Institute’s principles of patient-centered care, this proposal will primarily address the involvement
of family and friends, but will also include the principles of respect for patient’s values, preferences, and
expressed needs and information, communication, and education. While this curriculum will be focused
initially on the PICU, it will be easily generalized to other clinical care areas. We plan to collaborate with

3. other programs in our institution to supplement their educational curricula and bolster the teaching of
family-centeredness at Duke. Ultimately, we hope to supplement a number of educational curricula
throughout Duke and create a truly integrated simulation-enhanced curriculum that we will publish and
present on a national stage as a model for educational innovation in the area of family-centered care.
Final Analysis: This mock code educational initiative represents an important element of the overall
initiative, and it is clear from the grantee’s experience with this project that opinions of providers in the
PICU environment on the issue of family centeredness in the setting of code situations are diverse, and
often extremely passionate. The baseline data, along with further discussions surrounding our initiative,
continue to provide interesting insights into the perspectives that PICU providers have in regard to family
centeredness in the PICU, especially in the setting of acute resuscitations. The grantee has been able to
positively impact the multidisciplinary team by transforming misperceptions and hopefully improving the
care provided to critically ill children and their families.
Introduce a Family Centered Care Curriculum to a Pediatric Residency Program and Measure its Effects
on the Centeredness of Pediatric Residents
Principal investigator: Keith J. Mann, MD
Children’s Mercy Hospital
The goal of this project is to develop a curriculum that teaches pediatric residents the knowledge, skills
and behaviors of PFCC and measures the outcomes of physician ‘centeredness’ and family satisfaction.
Evidence regarding effective approaches to physician education on patient and family-centered care
(PFCC) and the impact on patients and families is needed. The CMHC Family Advisory Board (FAB),
the Pediatric Residents, and Medical Education leadership collaborated to create a PFCC curriculum.
Program goals and objectives address 4 core principles of the Picker Institute including: (1) respect for
patients’ values, preferences, and expressed needs, (2) information communication and integration, (3)
emotional support, and (4) involvement of family and friends. Other principles will be indirectly
addressed throughout the curriculum. The curriculum will be repeated for each class of residents, creating
a culture of PFCC within the residency program. The culminating ½ day retreat will be taped and/or
telecast for dissemination. We plan to publish our results and share our curriculum.
Final Analysis: The grantee successfully integrated family members into the intern orientation,
stimulating important discussions of patient and family centered care at the onset of training; also, a
communication workshop was developed and implemented at the intern retreat. The facilitator at the
intern retreat used results of the Myers-Briggs Type Inventory (MBTI) to stimulate discussion around
communication in the health care setting. The facilitator then taught and subsequently had the group
practice specific active listening skills. Overall, 26/28 residents rated it as excellent or above average, 2 as
average, and 0 as below average or poor. 13 families we recruited for the family as faculty program,
completed a teaching workshop and training session for the families, and paired the residents with the
families during a “Match Day Lunch” held on April 27th. The training session and lunch with the
residents was well received by the family members. The first two sets of residents (July and August) have
engaged in the patient home visit experience. After the experience the residents had a reflective session
with two of the employed family members. These sessions have been enlightening. A Hematology/
Oncology was implemented as a mid-rotation seminar that teaches residents the physician’s role and
provide effective communication skills while helping families deal with tragic medical events. To

4. support their learning, several standardized patients have been trained on four scenarios that involve
difficult communication and the first set of two residents went to the simulation center during late July for
their standardized patient experience.
Transitioning from Pediatric to Adult .Centered Medical Care (the patients perspective)
Principal investigator: Niraj Sharma, MD, MPH
Brigham and Women's and Boston Children's Hospitals
Harvard Medical School
The goal of the project is to develop a curriculum for medical residents on the transition of children with
chronic illnesses to adult-centered care. This project will utilize videotaped interviews with patients and
their families so that residents will learn directly from the patient’s point of view. This curriculum will
specifically address several Picker Institute’s principles: the families will be asked to discuss issues
related to access to care, coordination and integration of health care, sharing information between families
and providers, communication and education, involvement of family and friends, and transition and
continuity. The curriculum will be designed to teach these same components to residents. The initial
study will be conducted at Brigham and Women’s Hospital and Children’s Hospital Boston. After the
first session is completed, results will be presented as a workshop at a national program directors
association meeting (e.g. Association of Program Directors in Internal Medicine) to show its
effectiveness. The long-term goal is to develop the curriculum both on DVD and online so it can be
easily accessed nationally by medical students and faculty practitioners as well as residents at other
programs.
Current Status: This project has received a no cost extension until June 2012.
Screening and Managing Interpersonal Violence During Pregnancy at an Urban Teaching Hospital
Principle investigator: Suneet Chauhan, MD
Aurora Health Care, Inc.
Through this project, residents will be trained to consistently screen pregnant patients for IPV (intimate
partner violence) and, if it is present, refer them to violence intervention centers and other support
networks. Since the majority of patients are not victims of verbal or physicalabuse, the challenge is to
sensitively and effectively identify those who are. IPV screening takes skill and persistence on the part of
the healthcare provider, as it may take as many as six interactions with a healthcare provider for an
abused woman to disclose the violence. This project will help residents improve their skills and tune in to
their patients. At the completion of the study, results will be shared with the house staff, labor and
delivery nurses, midwives, and faculty at the teaching hospital. Results will also be shared with the nine
other hospitals within Aurora Health Care providing obstetrical services. Findings will be presented at the
next year’s American College of Obstetricians and Gynecologists (ACOG), May, 15 – 19, 2010 in San
Francisco, CA, to enable other OBGYN residency program directors to implement similar curricula.
Lastly, the results of the study will be published in a peer-reviewed journal such as the American Journal
of Perinatology.
Final Analysis: The grantee developed of a team approach to treating women experiencing IPV as the
attending staff, midwives, and labor and delivery nurses learned how to work with women experiencing
IPV to help them connect with patient-determined resources including legal advocacy, shelter, clothing,

5. and food, ancillary medical needs, and social services and counseling. The project team has completed
the data analysis and the manuscript to share with other resident programs. This project will ultimately
culminate with the presentation of the research at the ACOG 2011 National Convention and publication
in a peer reviewed journal. Data analysis reveals a total of 100 patients were screened with three patients
with positive screen results and subsequent follow-up with the Safe Mom Safe Baby Program. Sixty-
seven percent of the patients were African American, twenty percent Latino and ten percent Caucasian.
The average gestational age was thirty-nine weeks. The average birth weight was 3019 grams.
Create a patient-centered care plan (PCCP) within an electronic medical record; and evaluate the impact
of PCCP use on patients and health-care team members
Principal Investigators: Judith Pauwels, MD (Program Director), Larry Mauksch, M.Ed
Univ. of WA Family Medicine Residency
The project will focus on the following Picker Institute principles of patient-centered care: respect for
patients’ values, preferences, and expressed needs; coordination and integration of care; information,
communication, and education. These principles will be addressed through the formation of a new EHR
section called the Patient-Centered Care Plan (PCCP). This project’s goal is to use the PCCP to
restructure our current model of care to foster patient-centered care. This work will be distributed
through local, regional, and national presentations and through submission to academic and primary care
journals. This work will be distributed through local, regional, and national presentations and through
submission to academic and primary care journals.
Final Analysis: An equal distribution of faculty, and residents (equal distribution across three years) were
recruited for the experimental (8) and control groups (7). The grantee also recruited and trained the
medical assistant for the experimental group but no medical assistants were involved it the control group.
Patients with one or more chronic illnesses and a prior visit with the physician designated at their Primary
Care Physician were approached to participate. The grantee did not gather information about patients
who refused. Experimental group patients were younger and a higher percentage were female. Although
they had the same number of chronic conditions, they had twice as many reasons for the visit recorded
compared to control patients. This is probably the result of PCCP training for the medical assistant that
included upfront agenda setting. We recruited 28 experimental group patients across 8 providers and 30
control patients across 7 providers. The experimental group charts had significantly (p<.0001) more
documentation of all 8 goal setting criteria compared to control charts. The Experimental group patients
showed a trend on surveys to indicate higher levels of activation. The Experimental group providers, their
patients, and the medical assistant believe our training was effective and that the model was useful in
promoting teamwork, patient engagement, patient self-management, provider skill development and
continuity. A future improvement in the design and implementation of the PCCP needs to include new
EHR design, more time for medical assistants, training in patient selection and engagement. The project
was presented at the annual meeting of the Society of Teachers of Family Medicine. The grantee has
submitted a proposal to summarize the research findings at the 2011 Society of Teachers of Family
Medicine annual meeting. Further dissemination will occur through the Washington State Department of
Health and through publication in peer-reviewed journals.