Branch Plenary ICCH09 PowerPoint

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This plenary took place on Wednesday, October 7, at 8:30 am at the International Conference on Communication in Healthcare (ICCH) in Miami Beach, Florida, USA.

The Road to Professionalism: Reflective Learning and Reflective Practice

William T. Branch, Jr., M.D, is the Carter Smith, Sr., Professor of Medicine and Director of the Division of General Internal Medicine at Emory University School of Medicine. He founded the Primary Care Residency at the Brigham and Women’s Hospital in 1974. He was a key leader of the New Pathway project at Harvard Medical School. Dr. Branch served as a member of the SGIM Council and later served as Secretary. He was the second recipient of SGIM’s National Award for Career Achievements in Medical Education. He subsequently co-edited the first JGIM Education Issue.

He is a faculty member for AACH and is the immediate Past President. In 1995 he started at Emory University School of Medicine and became Director of the Division of Internal General Medicine. He more than tripled the size of the Division, and founded a Primary Care Residency Program and a Faculty Development Program for young faculty members. He is author of numerous papers published in peer reviewed journals and is the editor of five textbooks.

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Branch Plenary ICCH09 PowerPoint

  1. 1. The Road toThe Road to Professionalism:Professionalism: Reflective Learning andReflective Learning and Reflective PracticeReflective Practice WILLIAM T. BRANCH, JR., MD, FAACH, MACPWILLIAM T. BRANCH, JR., MD, FAACH, MACP Director, General Internal MedicineDirector, General Internal Medicine Emory University School of Medicine, Atlanta, GAEmory University School of Medicine, Atlanta, GA ICCH – MIAMI ‘09 11
  2. 2. 22 . If I was Going to Die If I was going to die, And I just had a couple of weeks, Or months, Or whatever, I would just have to, You know, Prepare. You know, Because we all going, You know, All my loved ones, You know, I just don't want mine to be suffering. Branch WT, Jr, Torke, AM. If I Was Going to Die. J Gen Inter Med. 2006; 21: 96-98
  3. 3. TEACHINGTEACHING PROFESSIONALPROFESSIONAL VALUESVALUES “In theory, this cannot be“In theory, this cannot be done in practice…”done in practice…” 33
  4. 4. THE PATIENT-DOCTOR COURSETHE PATIENT-DOCTOR COURSE Harvard Medical School, 1985 - PresentHarvard Medical School, 1985 - Present  Small-groups meet weekly, years 1 and 3Small-groups meet weekly, years 1 and 3  8 students, 2 – 3 faculty per group8 students, 2 – 3 faculty per group  Total 240 students and over 100 facultyTotal 240 students and over 100 faculty  Semi-structured, problem-based learningSemi-structured, problem-based learning  Faculty development componentFaculty development component Branch WT Jr, Pels RJ, Calkins D, Forrow L, Harper G, Mandell F, Maynard E, Peterson L, Arky RA. A new educational approachBranch WT Jr, Pels RJ, Calkins D, Forrow L, Harper G, Mandell F, Maynard E, Peterson L, Arky RA. A new educational approach for supporting the professional development of third year medical student. JGIM 1995; 10:691-694for supporting the professional development of third year medical student. JGIM 1995; 10:691-694 Branch WT Jr, , Arky RA, Woo B, Stoeckle JD, Levy DB, Taylor WC. . Teaching medicine as a human experience: A patient-Branch WT Jr, , Arky RA, Woo B, Stoeckle JD, Levy DB, Taylor WC. . Teaching medicine as a human experience: A patient- doctor relationship course for faculty and first-year medical students. Annals of Intern Med. 1991;114(6):482-9.doctor relationship course for faculty and first-year medical students. Annals of Intern Med. 1991;114(6):482-9. 44
  5. 5. CURRICULUM OF PATIENT-DOCTORCURRICULUM OF PATIENT-DOCTOR COURSECOURSE Harvard Medical School, 1985 - PresentHarvard Medical School, 1985 - Present Year 1Year 1 (Examples)(Examples)  Listening to patients’Listening to patients’ storiesstories  Patient-interviewing skillsPatient-interviewing skills  Reflection on interviewsReflection on interviews -- building a relationshipbuilding a relationship -- biopsychosocial modelbiopsychosocial model -- alcohol and substancealcohol and substance abuseabuse -- sexual history-takingsexual history-taking -- difficult relationshipsdifficult relationships Year 3Year 3 (Examples)(Examples)  Communication issuesCommunication issues -- giving bad newsgiving bad news  Medical mistakesMedical mistakes  Difficult relationshipsDifficult relationships  Health policyHealth policy  Ethical issues for studentsEthical issues for students -- informed consentinformed consent -- DNR decisions-DNR decisions-  Critical incident narrativesCritical incident narratives Branch WT Jr, Pels RJ, Calkins D, Forrow L, Harper G, Mandell F, Maynard E, Peterson L, Arky RA. A new educational approach for supporting the professional development of third year medical student. JGIM 1995; 10:691-694 Branch WT Jr, , Arky RA, Woo B, Stoeckle JD, Levy DB, Taylor WC. . Teaching medicine as a human experience: A patient- doctor relationship course for faculty and first-year medical students. Annals of Intern Med. 1991;114(6):482-9. 55
  6. 6. LEARNING THEORY OF PATIENT-LEARNING THEORY OF PATIENT- DOCTOR COURSEDOCTOR COURSE - Experiential learning of communication skillsExperiential learning of communication skills - Skills “open the door” to reflective learningSkills “open the door” to reflective learning - Topics related to the communication issuesTopics related to the communication issues - Topics address issues students encounterTopics address issues students encounter - Narrative writingNarrative writing - Critical reflectionCritical reflection - Transformative learningTransformative learning 66 Branch WT Jr, Pels RJ, Calkins D, Forrow L, Harper G, Mandell F, Maynard E, Peterson L, Arky RA. A new educational approach for supporting the professional development of third year medical student. JGIM 1995; 10:691-694 Branch WT Jr, , Arky RA, Woo B, Stoeckle JD, Levy DB, Taylor WC. . Teaching medicine as a human experience: A patient- doctor relationship course for faculty and first-year medical students. Annals of Intern Med. 1991;114(6):482-9.
  7. 7. TRANSFORMATIVE LEARNING By Reflection Empathic Identification with Patients (Philosophy of Caring) While drawing blood for gas measurements from a dying non-English-speaking man, a student communicated with him “through the anguish on my face” so that he would know “that I was suffering along with him.” Branch WT Jr, Pels RJ, Lawrence RS, Arky RA. Becoming a doctor: “critical-incident” reports from third-year medical students. N Engl J Med. 1993;329:1130-2. 77
  8. 8. TRANSFORMATIVE LEARNING Reflection on Students’ Narratives Moral Dissonance With the Team’s Values (Moral Development) An indigent woman refused to see a medical student in the walk-in clinic. The attending physician explained that it was a teaching unit” and the patient “had no choice.” The patient stormed out. The student wondered “how this patient, who fit the bill for the type of person I had always seen myself helping, actually saw me aligned with Dr. N. against her.” Branch WT Jr, Pels RJ, Lawrence RS, Arky RA. Becoming a doctor: “critical-incident” reports from third-year medical students. N Engl J Med. 1993;329:1130-2. Branch WT Jr. Supporting the Moral Development of Medical Students. J Gen Intern Med. 2000;15:505:510. Branch WT Jr. Use of Critical Incident Reports in Medical Education: A Perspective, J Gen Intern Med, 2005; 20: 1063-67. 88
  9. 9. A Paradigm for Professional Growth MORAL DEVELOPMENT IN MEDICAL STUDENTS Post conventional morality (young adults) conventional morality conventional morality (adolescents) (medical trainees) Branch WT Jr. Supporting the moral development of medical students. J Gen Intern Med 2000;15:505-510 Kay J. Traumatic deidealization and the future of medicine. JAMA. 1990;263:572-573. Hundert EM, Hafferty FW, Christakis D. Characteristics of the informal curriculum and trainees’ ethical choices. Acad Med, 1996;71:624-630. 99
  10. 10. SOCIALIZATION IN MEDICAL TRAINEES THE INFORMAL AND HIDDEN CURRICULA •Informal interactions between students, residents, teachers, and administrators at an institution transmit strong messages •These messages may have more educational impact than the formal curriculum Hundert EM, Hafferty FW, Christakis D. Characteristics of the informal curriculum and trainees’ ethical choices. Acad Med, 1996;71:624-630. 1010
  11. 11. THE INFORMAL CURRICULUM INFLUENCES ATTITUDES TOWARD ETHICS AND PROFESSIONALISM • In a survey of medical students, the majority felt their moral values were eroded • Widespread abuse of medical students by those in positions of power over them • 74% of residents directly observed mistreatment of patients Freudtner C et al. Acad. Med.1994;69:670-9 Sheeham KH et al. JAMA.1990;263;533-7 Balwin DC. West.J.Med.1991;158:140-5 Balwin DC, et al. Acad.Med.1998;73:1195-200 1111
  12. 12. EXAMPLE OF THE “INFORMAL” EXPERIENCES OF A 2ND YEAR RESIDENT When I was in the MICU, I was called by cross-cover to evaluate a patient for transfer. She had a slightly altered mental status and was hypotensive….We were giving her fluids, blood, pressors; it was around midnight. I got another admission and went to the ER to start seeing him. The first patient coded, and I went up to take care of her again. It was a terrible, endless, isolated night. I went back to the ER to see the new admission, and another code as called. I went to that. I was the only resident who responded. That patient died. I went back ot the ER, but another code was called in the MICU…..When I got to the MICU, my intern was running the code, and then we called and the patient was dead….. Brady, D, Branch WT, et al The Use of Narratives Ann of Inter Med,2002;137:220 1212
  13. 13. EXAMPLE OF THE “INFORMAL” EXPERIENCES OF A 2ND YEAR RESIDENT (Cont’d) ….The next morning on rounds, my attending asked how many had survived. He said we didn’t need to talk about any that had died….It was a hellish night of nearly unbearable stress and in the morning it was never acknowledged, as if it had never happened, as if (my patients) had never existed….. What bothers me most about it, was that I felt completely flat. They were dead, and I didn’t feel anything at all. Brady, D, Branch WT, et al. The Use of Narratives Ann Inter Med 2002;137:220 1313
  14. 14. WHAT LIES BEHIND THE INFORMAL CURRICULUM Interns begin by seeking their professional identities The middle years: potential burnout and disillusionment Possible defenses: -distancing (loss of empathy) -in-group behavior (sardonic humor) -loss of moral sensitivity The final year of training: reconciliation and rediscovery of professional and moral values Brady D, Branch WT Jr. et al The Use of Narratives Ann Intern Med. 2002;137:220-223. Konner M. Becoming a Doctor: A Journey of Initiation in Medical School New York: Viking Penguin. 1987. 1414
  15. 15. Critical Incident ReportCritical Incident Report Three Years on the FacultyThree Years on the Faculty  I laid my pen down carefully, placed both palms down onI laid my pen down carefully, placed both palms down on thethedesk, and made eye contact with my patient. Withoutdesk, and made eye contact with my patient. Without wastingwastingtime, I directly broached the subject of HIV risktime, I directly broached the subject of HIV risk and testing.and testing.  I felt a smile creeping across my face as I triumphantlyI felt a smile creeping across my face as I triumphantly completedcompletedthe consent form. It was as if I’d sold her athe consent form. It was as if I’d sold her a new carnew car 1515 Manning, KD. A person of status. JAMA. 2009; 300:483-84
  16. 16. Critical Incident ReportCritical Incident Report Three Years on the FacultyThree Years on the Faculty - cont’d -- cont’d -  ThatThatday, I resolved to take my first everday, I resolved to take my first ever voluntary HIV test atvoluntary HIV test at a local communitya local community AIDS outreach center.AIDS outreach center. 1616 Manning, KD. A person of status. JAMA. 2009; 300:483-84
  17. 17. Critical Incident ReportCritical Incident Report Three Years on the FaculThree Years on the Facultyty - cont’d -- cont’d - - As I took myAs I took myseat in the waiting area. My palmsseat in the waiting area. My palms became sweaty as I grippedbecame sweaty as I gripped the laminatedthe laminated fuchsia card tightly in my hand. I looked aroundfuchsia card tightly in my hand. I looked around at the other people in the room and somehowat the other people in the room and somehow felt we were kindredfelt we were kindred spirits. What were theirspirits. What were their thoughts, their risks, their fears?thoughts, their risks, their fears? The simple truthThe simple truth was thatwas thatI was afraid.I was afraid. 1717Manning, KD. A person of status. JAMA. 2009; 300:483-84
  18. 18. Critical Incident ReportCritical Incident Report Three Years on the FacultyThree Years on the Faculty - cont’d -- cont’d -  Finally, the counselor prepared to give meFinally, the counselor prepared to give me my firstmy first"real" HIV test result. The ear-"real" HIV test result. The ear- pounding returned full throttlepounding returned full throttle as I bracedas I braced myself for information that could changemyself for information that could change life aslife asI knew it forever.I knew it forever. 1818 Manning, KD. A person of status. JAMA. 2009; 300:483-84
  19. 19. Critical Incident ReportCritical Incident Report Three Years on the FacultyThree Years on the Faculty - cont’d –cont’d –  I pushed open the glass door, stoppedI pushed open the glass door, stopped withwith closed eyes, and felt the warm sun on my face.closed eyes, and felt the warm sun on my face. WithoutWithoutwarning, I began to cry. It surprised me.warning, I began to cry. It surprised me. Tear after tear fellTear after tear fell as I thought of every singleas I thought of every single HIV-positive patient I’dHIV-positive patient I’d ever encountered.ever encountered. 1919 Manning, KD. A person of status. JAMA. 2009; 300:483-84
  20. 20. 2020 TRANSFORMATIVE LEARNINGTRANSFORMATIVE LEARNING  Transformative learning is the expansion ofTransformative learning is the expansion of consciousness through the transformation of basicconsciousness through the transformation of basic worldview and specific capacities of the self.worldview and specific capacities of the self.  Individuals change their frames of reference by criticallyIndividuals change their frames of reference by critically reflecting on their assumptions and beliefs andreflecting on their assumptions and beliefs and consciously making and implementing plans that bringconsciously making and implementing plans that bring about new ways of defining their worlds.about new ways of defining their worlds.  It is also a profound experience that can be described asIt is also a profound experience that can be described as emotional or spiritual transformations as wellemotional or spiritual transformations as well Boyd RD, Gordon MJ. Transformative education. Int. J. of Lifetime Educ.1988; 7: 261-284 Mezirow J. Transformative dimensions of adult learning. San Fran: Jossey-Bass 1991
  21. 21. SEMINAL EVENT circa 1965 • “I remember going with a mentor regularly on bedside rounds even before I entered medical school. Rounds were quite a pageant with the great professor, his fellows, the residents, and finally the medical students trailing behind. I became increasingly fascinated with the patients’ stories, which came tumbling out as my mentor seemingly magically opened some a lock around the patient’s heart. Branch WT Jr, Kern D, Haidet P, Weissmann P, Gracey CF, Mitchell G, Inui T.. Teaching the Human Dimensions of Care in clinical Settings. JAMA 2001;286:1067-1073. 2121
  22. 22. SEMINAL EVENT • “……The professor began exploring what the patient thought had triggered these life-threatening events. She told the story of her life in Germany and survival in a concentration camp, her attempts to smuggle food to her parents and siblings, and her despair and guilt when they were exterminated. When she was done, he turned slowly to face the group. Tears were streaming down his face. I will never forget that moment. I know he was teaching me what it meant to be a doctor. Branch WT, Jr., Kern D, Haidet P, Weissmann P, Gracey CF, Mitchell G, Inui T. Teaching the human dimensions of care in clinical settings. JAMA 2001; 286:1067-1074. 2222
  23. 23. ACTIVE ROLE MODELING Teachable Moment - SEMINAL EVENT • “A new third year student was assigned to my office. The patient was a thirty-eight year old woman who was just coming in to establish care. The student found that the patient had lost twenty pounds in the previous four months which she had attributed to working hard and eating less. We ordered an HIV test, which came back positive.” Branch WT, Jr., Kern D, Haidet P, Weissmann P, Gracey CF, Mitchell G, Inui T. Teaching the human dimensions of care in clinical settings. JAMA 2001; 286:1067-1074. 2323
  24. 24. SEMINAL EVENT Active Role Modeling with Reflection • “I told the student that I wanted her to come with me when the patient returned. I also gave her an article on delivering bad news and we talked about the strategies mentioned. The student was with me when I told the patient the results. We sat and listened as the patient started to digest the news. We had quite a long wait during which both the patient and the student began crying. After the patient left we discussed how we felt about the visit. Branch WT, Jr., Kern D, Haidet P, Weissmann P, Gracey CF, Mitchell G, Inui T. Teaching the human dimensions of care in clinical settings. JAMA 2001; 286:1067-1074. 2424
  25. 25. PAUSE FOR REFLECTION  Ask reflective questions  Consider: What would the student say about this learning? If asked weeks or months after the event?  Consider: What would the teacher say about it? 2525
  26. 26. ACTIVE LEARNING IN CLINICAL SETTINGS • In bedside teaching of humanism, active learning generally coincides with teaching rounds. • A “teachable moment” is utilized by an attending who has won the team’s trust. • Learners are “primed” to observe and/or participate in the patient-interaction. • Feedback and reflection are key components, necessary in learning for psychological growth. o Examples of reflection: “What did we learn from this? How do you think the patient felt? What made this work for the patient?” “Can we spend this much time with our patients?” o Branch WT, Jr., Kern D, Haidet P, Weissmann P, Gracey CF, Mitchell G, Inui T. Teaching the human dimensions of care in clinical settings. JAMA 2001; 286:1067-1074. 2626
  27. 27. Faculty DevelopmentFaculty Development for Reflective Learning and Reflectivefor Reflective Learning and Reflective PracticePractice A longitudinal faculty development process toA longitudinal faculty development process to positively influence professional and personalpositively influence professional and personal growth in key faculty membersgrowth in key faculty members  Faculty development alternated experientialFaculty development alternated experiential teaching skills with reflective exercisesteaching skills with reflective exercises  We hypothesized that the group process overWe hypothesized that the group process over time would enhance faculty commitment totime would enhance faculty commitment to humanism and professionalismhumanism and professionalism 2727 Branch WT Jr, Frankel R, Gracey CF, Haidet PM, Weissmann PF, Cantey P, Mitchell GA, Inui TS. A good clinician and a caring person: longitudinal faculty development and the enhancement of the human dimensions of care. Acad Med 2009; 84: 117-25.
  28. 28. METHODSMETHODS  Groups of 8-12 faculty participants from 5Groups of 8-12 faculty participants from 5 medical schoolsmedical schools  18 months of weekly or bi-monthly sessions18 months of weekly or bi-monthly sessions  Experienced facilitator with promising and/orExperienced facilitator with promising and/or influential teachersinfluential teachers  6-months curriculum addressing key topics,6-months curriculum addressing key topics, following by 12 months of group-plannedfollowing by 12 months of group-planned sessionssessions 2828 Branch WT Jr, Frankel R, Gracey CF, et al. A good clinician and a caring person: longitudinal faculty development and the enhancement of the human dimensions of care. Acad Med 2009; 84: 117-25. Branch WT Jr, Frankel R, Gracey CF, Haidet PM, Weissmann PF, Cantey P, Mitchell GA, Inui TS. A good clinician and a caring person: longitudinal faculty development and the enhancement of the human dimensions of care. Acad Med 2009; 84: 117-25.
  29. 29. Internal Family Med/ > 5yr post Total Male Medicine Medicine Peds. Others residency, Baylor college of Medicine 7 70% 43% 14% 14% 28% 86% Emory University SOM 7 30% 100% 57% Indiana University 7 70% 15% 28% 28% 28% 42% University of Minnesota 5 60% 80% 20% 60% University of Rochester 8 87.5% 100% 33% 34 65% 68% 8% 12% 12% 55% Faculty Development Program Completers 2929 Branch WT Jr, Frankel R, Gracey CF, Haidet PM, Weissmann PF, Cantey P, Mitchell GA, Inui TS. A good clinician and a caring person: longitudinal faculty development and the enhancement of the human dimensions of care. Acad Med 2009; 84: 117-25.
  30. 30. Survey QuestionnaireSurvey Questionnaire EvaluationEvaluation  A humanistic teacher-evaluation questionnaireA humanistic teacher-evaluation questionnaire  Items based on “themes and domains” ofItems based on “themes and domains” of humanistic teaching identified from narrativeshumanistic teaching identified from narratives from early faculty development sessionsfrom early faculty development sessions  Responses to each item recorded on a linearResponses to each item recorded on a linear analog scaleanalog scale 3030 Branch WT Jr, Frankel R, Gracey CF, et al. A good clinician and a caring person: longitudinal faculty development and the enhancement of the human dimensions of care. Acad Med 2009; 84: 117-25. Branch WT Jr, Frankel R, Gracey CF, Haidet PM, Weissmann PF, Cantey P, Mitchell GA, Inui TS. A good clinician and a caring person: longitudinal faculty development and the enhancement of the human dimensions of care. Acad Med 2009; 84: 117-25.
  31. 31. Inspires me to grow personally and professionallyInspires me to grow personally and professionally 10%10% .0018.0018 Actively uses teaching opportunities to illustrate humanisticActively uses teaching opportunities to illustrate humanistic carecare 15%15% <.0001<.0001 Stimulates reflection by the team on our approach to theStimulates reflection by the team on our approach to the patientpatient 13%13% <.0001<.0001 Serves as outstanding role model for how to build strongServes as outstanding role model for how to build strong relationships with learners as well as patientsrelationships with learners as well as patients 13%13% .0004.0004 Explicitly teaches communication and relationship-buildingExplicitly teaches communication and relationship-building skillsskills 14%14% .0014.0014 Results: Humanistic Teaching Evaluation InstrumentResults: Humanistic Teaching Evaluation Instrument Absolute Differences Subjects vs. Wilcoxon Qualities Controls p – Value Examples 3131 Branch WT Jr, Frankel R, Gracey CF, et al. A good clinician and a caring person: longitudinal faculty development and the enhancement of the human dimensions of care. Acad Med 2009; 84: 117-25. Branch WT Jr, Frankel R, Gracey CF, Haidet PM, Weissmann PF, Cantey P, Mitchell GA, Inui TS. A good clinician and a caring person: longitudinal faculty development and the enhancement of the human dimensions of care. Acad Med 2009; 84: 117-25.
  32. 32. Reflective Process:Reflective Process: Appreciative InquiryAppreciative Inquiry Appreciative inquiry identifies and worksAppreciative inquiry identifies and works from strengths and inspires thosefrom strengths and inspires those engaged in the process to emulate eachengaged in the process to emulate each other. It also enhances self awareness.other. It also enhances self awareness. We used appreciative inquiry as a facultyWe used appreciative inquiry as a faculty development tool.development tool. 3232
  33. 33. Appreciative InquiryAppreciative Inquiry ““Upon my return from clinic, I learned of aUpon my return from clinic, I learned of a reportedly seamless meeting with a patient’sreportedly seamless meeting with a patient’s family. They decided that no further heroic effortfamily. They decided that no further heroic effort should be made and that the patient’s comfort wasshould be made and that the patient’s comfort was the ultimate goal. That evening the patientthe ultimate goal. That evening the patient arrested. Her loved ones immediately panickedarrested. Her loved ones immediately panicked and frantically asked to have the “DNR” decisionand frantically asked to have the “DNR” decision reversed. Later the family told the ICU team thatreversed. Later the family told the ICU team that they did not know really what to expect and thatthey did not know really what to expect and that they felt afraid.they felt afraid. 3333 Branch WT Jr, Frankel R, Gracey CF, et al. A good clinician and a caring person: longitudinal faculty development and the enhancement of the human dimensions of care. Acad Med 2009; 84: 117-25. Branch WT Jr, Frankel R, Gracey CF, Haidet PM, Weissmann PF, Cantey P, Mitchell GA, Inui TS. A good clinician and a caring person: longitudinal faculty development and the enhancement of the human dimensions of care. Acad Med 2009; 84: 117-25.
  34. 34. Appreciative InquiryAppreciative Inquiry Less than five minutes before my next (teaching)Less than five minutes before my next (teaching) session, I decided to do something completelysession, I decided to do something completely different. I sat down and took a deep breath. Idifferent. I sat down and took a deep breath. I shared with them the case of a patient with ashared with them the case of a patient with a necrotic leg (a case I had as an intern). Inecrotic leg (a case I had as an intern). I explained to the team that this patient was notexplained to the team that this patient was not likely to have a satisfactory outcome, and that alikely to have a satisfactory outcome, and that a family meeting was needed to discuss this with herfamily meeting was needed to discuss this with her loved ones. The catch? I will be playing the roleloved ones. The catch? I will be playing the role of the patient’s loving daughterof the patient’s loving daughter 3434 Branch WT Jr, Frankel R, Gracey CF, et al. A good clinician and a caring person: longitudinal faculty development and the enhancement of the human dimensions of care. Acad Med 2009; 84: 117-25. Branch WT Jr, Frankel R, Gracey CF, Haidet PM, Weissmann PF, Cantey P, Mitchell GA, Inui TS. A good clinician and a caring person: longitudinal faculty development and the enhancement of the human dimensions of care. Acad Med 2009; 84: 117-25.
  35. 35. FOSTERING THE DEVELOPMENT OF YOUNGFOSTERING THE DEVELOPMENT OF YOUNG FACULTY MEMBERS:FACULTY MEMBERS: THE PROMISING YEARSTHE PROMISING YEARS Appreciative Inquiries, Five Years of Faculty DevelopmentAppreciative Inquiries, Five Years of Faculty Development  Assoc Prof: It was unpopular but I had to discipline a medical studentAssoc Prof: It was unpopular but I had to discipline a medical student for unprofessional conduct.for unprofessional conduct.  Asst Prof: I gained confidence from a mentor in my ability to lead myAsst Prof: I gained confidence from a mentor in my ability to lead my residency program. Now residents come to me for advice andresidency program. Now residents come to me for advice and encouragement.encouragement.  Assoc Prof: Was proven correct in her clinical judgment even whenAssoc Prof: Was proven correct in her clinical judgment even when the resident disagreed; resident later admitted he had learned anthe resident disagreed; resident later admitted he had learned an important lesson from her .important lesson from her .  Asst Prof: Successfully supported medical students having personalAsst Prof: Successfully supported medical students having personal difficulties interfering with their studies.difficulties interfering with their studies.  Asst Prof: Recognized when he needed to intervene to support aAsst Prof: Recognized when he needed to intervene to support a resident in his role as associate program director.resident in his role as associate program director.  Asst Prof: Experiences success as a role model of an empathicAsst Prof: Experiences success as a role model of an empathic teacher and physician.teacher and physician. 3535 Higgins S, Bernstein L, Manning K, Schneider J, Kho A, Brownfield E, Branch, W T Jr. Fostering the Development of Young Faculty Members: The Promising Years. Submitted for publication 2009
  36. 36. RANDOMIZED TRIALS SHOWING THAT EDUCATIONALRANDOMIZED TRIALS SHOWING THAT EDUCATIONAL INTERVENTIONS IMPROVEINTERVENTIONS IMPROVE COMMUNICATION SKILLS AND INFLUENCE VALUES ANDCOMMUNICATION SKILLS AND INFLUENCE VALUES AND ATTITUDESATTITUDES Smith RC. Lyles JS, Mettler JA, et al. A strategy for improving patient satisfaction bySmith RC. Lyles JS, Mettler JA, et al. A strategy for improving patient satisfaction by intensive training of residents in psychosocial medicine: a controlled randomizedintensive training of residents in psychosocial medicine: a controlled randomized study. Acad.Med.1995;70:729-32.study. Acad.Med.1995;70:729-32. -- Patients “more satisfied” with care by trained residents (P = .02)Patients “more satisfied” with care by trained residents (P = .02) Smith RC. Lyles JS, Mettler JA, et al. The effectiveness of intensive training for residentsSmith RC. Lyles JS, Mettler JA, et al. The effectiveness of intensive training for residents in interviewing: a randomized, controlled study. Ann.Inter Med. 1998;128:118-26.in interviewing: a randomized, controlled study. Ann.Inter Med. 1998;128:118-26. -- Trained residents had superior interviewing skills with patients (P< .05)Trained residents had superior interviewing skills with patients (P< .05) Moore GT, Block SD, Briggs-StyleC, Mitchell R. The influence of the new pathwayMoore GT, Block SD, Briggs-StyleC, Mitchell R. The influence of the new pathway curriculum of Harvard medical students. Acad Med.1994;69:983-9.curriculum of Harvard medical students. Acad Med.1994;69:983-9. -- Students in new pathway demonstrated better relationship skills andStudents in new pathway demonstrated better relationship skills and humanistic attitudes (P< .05)humanistic attitudes (P< .05) Alon PA. Margalit, MD, PhD, Shimon M. Glick, MD, Jochanan Benbassat, MD, AyalaAlon PA. Margalit, MD, PhD, Shimon M. Glick, MD, Jochanan Benbassat, MD, Ayala Cohen, PhD. Effect of a Biopsychosocial Approach on Patient Satisfaction andCohen, PhD. Effect of a Biopsychosocial Approach on Patient Satisfaction and Patterns of CarePatterns of Care.. JGIM. 2004; 19: 485-491.JGIM. 2004; 19: 485-491. -- Improved patient satisfaction after physicians received reflective/active learningImproved patient satisfaction after physicians received reflective/active learning compared to controls (received lectures) (P< .05)compared to controls (received lectures) (P< .05) 3636
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