really good stuff
Off to a good start Ann Danoff, Michael Garabedian, Victoria Harnik & Melvin Rosenthal What problems were addressed? Today’s medical school graduates are entering a complex, fast-paced, technologically and economically driven health care system. Programmes that mitigate the dehumanisation and burnout that may be inherent in such an environment are needed. What was tried? For the past 6 years, the incoming class at New York University School of Medicine has been welcomed on their first day of medical school with an exciting programme aimed at sustaining and enhancing the most humanistic qualities of entering students, while simultaneously emphasising and integrating the basic and clinical sciences. To highlight the central role of the physician–patient relationship, on the first morning of the first day, students have an opportunity to observe highly skilled faculty members as they interview real patients. Patients are selected to represent each of four disease exemplars that serve as ‘pillars’ of the curriculum: atherosclerosis; colon cancer; diabetes, and tuberculosis. These pillars have been introduced into the curriculum to serve as scaffolding upon which increasingly complex layers of material are introduced in a manner that links basic science to clinical medicine. The patient interviews, which are designed to highlight psychosocial, cultural and economic influences, and related ethical concerns, are complemented by relevant didactic material aimed at underscoring the critical contribution of excellence in basic and clinical sciences to the highest quality patient care. In preparation for the afternoon session, students are asked to bring to class an item (a photograph, book, poem, song) they can share with the group that best represents the factors that motivated them to become physicians. The profoundly moving stories that emerge not only help the students to calibrate their individual moral compasses as they begin their formal entry into their chosen profession, but also serve to facilitate an important teambuilding experience that unifies the group in shared recognition of the mystery and sanctity of the profession they are entering. This is followed by an exploration of the importance of non-verbal communication and cultural context in the physician–patient encounter, facilitated by faculty members and students from the Drama Division of the Juilliard School. The afternoon concludes with a
514
panel of faculty members describing the deep personal satisfaction (as well as some of the challenges) associated with their professional activities. What lessons were learned? Student tracer reports indicate that the policy of welcoming students on the first day of medical school with a programme that demonstrates and emphasises the complementary virtues of scientific inquiry and humanism may help neophyte physicians to value and nurture a professional identity that embraces inquisitive and altruistic professional behaviour. Qualitative feedback also suggests that the programme serves as an important ritual marking and facilitating transition into the medical profession. Although the long-term impact will require additional investigation, such a programme may help physicians of the 21st century sustain a patient-centred approach to care. At minimum, as noted by one of the participating students, this innovative programme ‘set an inspirational tone for the beginning of classes’. Based on such favourable reception and reports, we encourage other institutions to consider introducing and evaluating similar programmes. Correspondence: Ann Danoff, Endocrinology Unit, Department of Medicine, Veterans Affairs New York Harbor Healthcare System, 423 East 23rd Street, New York, New York 10010, USA. Tel: 00 1 212 263 8060; E-mail: [email protected] doi: 10.1111/medu.12700
Concerns about raising concerns Janice S Ellis, Heidi Bateman, J Mark Thomason & John Whitworth What problem was addressed? The Mid-Staffordshire National Health Service (NHS) Foundation Trust Public Inquiry (Francis Report) 2013 recommended that providers ‘encourage openness on behalf of trainees (students) and protect them from any adverse consequences in relation to raising concerns’ and ‘ensure that providers of clinical placements take appropriate action to ensure that any concerns relating to patient safety are properly addressed’.1 What was tried Newcastle University’s School of Dental Sciences responded by establishing a programme of targeted learning and teaching activities. The programme comprised induction workshops allowing students to explore their understanding of and beliefs about professional behaviours, a requirement to read and annually accept our Raising Concern policy, annual mid-year lectures reinforcing
ª 2015 John Wiley & Sons Ltd. MEDICAL EDUCATION 2015; 49: 513–541
Copyright of Medical Education is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Off to a good start Ann Danoff, Michael Garabedian, Victoria Harnik & Melvin Rosenthal What problems were addressed? Today’s medical school graduates are entering a complex, fast-paced, technologically and economically driven health care system. Programmes that mitigate the dehumanisation and burnout that may be inherent in such an environment are needed. What was tried? For the past 6 years, the incoming class at New York University School of Medicine has been welcomed on their first day of medical school with an exciting programme aimed at sustaining and enhancing the most humanistic qualities of entering students, while simultaneously emphasising and integrating the basic and clinical sciences. To highlight the central role of the physician–patient relationship, on the first morning of the first day, students have an opportunity to observe highly skilled faculty members as they interview real patients. Patients are selected to represent each of four disease exemplars that serve as ‘pillars’ of the curriculum: atherosclerosis; colon cancer; diabetes, and tuberculosis. These pillars have been introduced into the curriculum to serve as scaffolding upon which increasingly complex layers of material are introduced in a manner that links basic science to clinical medicine. The patient interviews, which are designed to highlight psychosocial, cultural and economic influences, and related ethical concerns, are complemented by relevant didactic material aimed at underscoring the critical contribution of excellence in basic and clinical sciences to the highest quality patient care. In preparation for the afternoon session, students are asked to bring to class an item (a photograph, book, poem, song) they can share with the group that best represents the factors that motivated them to become physicians. The profoundly moving stories that emerge not only help the students to calibrate their individual moral compasses as they begin their formal entry into their chosen profession, but also serve to facilitate an important teambuilding experience that unifies the group in shared recognition of the mystery and sanctity of the profession they are entering. This is followed by an exploration of the importance of non-verbal communication and cultural context in the physician–patient encounter, facilitated by faculty members and students from the Drama Division of the Juilliard School. The afternoon concludes with a
514
panel of faculty members describing the deep personal satisfaction (as well as some of the challenges) associated with their professional activities. What lessons were learned? Student tracer reports indicate that the policy of welcoming students on the first day of medical school with a programme that demonstrates and emphasises the complementary virtues of scientific inquiry and humanism may help neophyte physicians to value and nurture a professional identity that embraces inquisitive and altruistic professional behaviour. Qualitative feedback also suggests that the programme serves as an important ritual marking and facilitating transition into the medical profession. Although the long-term impact will require additional investigation, such a programme may help physicians of the 21st century sustain a patient-centred approach to care. At minimum, as noted by one of the participating students, this innovative programme ‘set an inspirational tone for the beginning of classes’. Based on such favourable reception and reports, we encourage other institutions to consider introducing and evaluating similar programmes. Correspondence: Ann Danoff, Endocrinology Unit, Department of Medicine, Veterans Affairs New York Harbor Healthcare System, 423 East 23rd Street, New York, New York 10010, USA. Tel: 00 1 212 263 8060; E-mail: [email protected] doi: 10.1111/medu.12700
Concerns about raising concerns Janice S Ellis, Heidi Bateman, J Mark Thomason & John Whitworth What problem was addressed? The Mid-Staffordshire National Health Service (NHS) Foundation Trust Public Inquiry (Francis Report) 2013 recommended that providers ‘encourage openness on behalf of trainees (students) and protect them from any adverse consequences in relation to raising concerns’ and ‘ensure that providers of clinical placements take appropriate action to ensure that any concerns relating to patient safety are properly addressed’.1 What was tried Newcastle University’s School of Dental Sciences responded by establishing a programme of targeted learning and teaching activities. The programme comprised induction workshops allowing students to explore their understanding of and beliefs about professional behaviours, a requirement to read and annually accept our Raising Concern policy, annual mid-year lectures reinforcing
ª 2015 John Wiley & Sons Ltd. MEDICAL EDUCATION 2015; 49: 513–541
Copyright of Medical Education is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
