Photo: JFDP Deliver Scholarly Projects

Back in February, we wrote about the Junior Faculty Development Program. This is a program that provides networking, social opportunities, and peer mentoring among colleagues who are at a similar stage in their career; promotes the development and advancement of junior faculty through seminars and mentored scholarly projects; and facilitates mentoring relationships between senior and junior faculty.

On April 19, the first cohort of 12 junior faculty members presented their scholarly projects.

From left to right:

  • Kelly G. Gwathmey, MD, Assistant Professor of Neurology
  • Kelly B. Mahaney, MD, Assistant Professor of Neurological Surgery
  • Laahn H. Foster, MD, Assistant Professor of Medicine
  • Michael K. Keng, MD, Assistant Professor of Medicine
  • Jeanetta W. Frye, MD, Assistant Professor of Medicine
  • Jonathan S. Black, MD, Assistant Professor of Plastic Surgery
  • Sana F. Khan, MBBS, Assistant Professor of Medicine
  • Amanda M. Kleiman, MD, Assistant Professor of Anesthesiology
  • Gilbert R. Kinsey, DPHARM, PhD, Assistant Professor of Medicine
  • Simon J. Lehtinen, MD, Assistant Professor of Medicine
  • Sula Mazimba, MD, Assistant Professor of Medicine
  • Anuj Singla, MBBS, Instructor of Orthopaedic Surgery

Congratulations to all!

Slides: Spring General Faculty Meeting

If you missed the April 20 General Faculty Meeting — or if you attended and just want to review! — you can find a PDF of the presentation slides here.

How did you celebrate St. MATCHrick’s Day?

UVa_SOM_Match_Day_17_e4636On St. Patrick’s Day, March 17, 149 members of the UVA School of Medicine’s Class of 2017 tore open envelopes and learned where they would be heading for additional training as residents.

I could not be more proud of them. Every year seems to be more and more competitive and yet our students always rise to the challenge. The below list shows how the residency spots filled out, by specialty:

  • Anesthesiology | 6
  • Dermatology | 2
  • Emergency Medicine | 11
  • Family Medicine | 9
  • General Surgery | 11
  • Internal Medicine | 36
  • Interventional Radiology | 2
  • Neurological Surgery | 3
  • Neurology | 3
  • Obstetrics and Gynecology (incl prelim) | 7
  • Ophthalmology | 4
  • Orthopaedics | 4
  • Otolaryngology | 4
  • Pathology | 3
  • Pediatrics | 18
  • Physical Med/Rehab | 2
  • Plastic Surgery | 1
  • Psychiatry | 4
  • Radiology/Diagnostic | 10
  • Radiology Oncology | 2
  • Urology | 2

This list represents many great matches to top-rated institutions such as Duke, Mass. General, Yale, Stanford, Northwestern, Brigham & Women’s, Vanderbilt, UCSF, Cornell, Beth Israel Deaconess, University of Washington, and Johns Hopkins. While our students do all of the heavy lifting during their medical education career, I would like to thank our faculty and staff for training and supporting them for four years. Results from Match Days like this should make you feel great — it certainly does for me.

While I will miss the students who are leaving, I find comfort in knowing that 21 of our graduates chose to stay in Charlottesville, doing all or part of their residency program here at the University of Virginia. I look forward to seeing them around the School and the Medical Center.

Please join me in thanking our colleagues at the Medical Alumni Association for hosting such a terrific Match Day event and in congratulating these 149 students!

R.J. Canterbury, MD
Senior Associate Dean for Education

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Med + Architecture Team Up on Human-Centered Design Program

Like many great programs at the School of Medicine, it started with the students.

A few years ago, three medical students expressed interest in “design thinking.” Design thinking is a creative problem-solving tool, a systematic way of looking at challenges, a mindset that teaches how to ask the right questions, to tackle the real problem. This is often used to produce the products and experiences we use every day. Think Apple’s iPad. Why not apply this type of innovation to medicine? Design thinking uncovers latent desires or unmet needs, ultimately answering the question, “What is best for the user?”

humancentereddesign9_03212017Or, in our case, it could be translated to “What is best for our patients?” As its name implies, design thinking began in design-oriented professions but it has grown significantly and is now successfully applied to business, engineering, and social issues. There are only a handful of schools applying it to medicine — and we’re one of them.

Year 1: “Let’s try this …?”
David Chen, MBA
, Coulter Program Director, Department of Biomedical Engineering; Erik Hewlett, MD, Professor of Medicine, Infectious Diseases and International Health; and Matthew Trowbridge, MD, MPH, Associate Professor of Emergency Medicine and Public Health Sciences, ran with the idea and — with support of colleagues like Megan Bray, MD, Associate Dean for Curriculum — have grown it into something wonderful.

(l-r) Matthew Trowbridge, MD, MPH; David Chen, MBA; and Erik Hewlett, MD

(l-r) Matthew Trowbridge, MD, MPH; David Chen, MBA; and Erik Hewlett, MD

Last year, David and Matt co-instructed a program called Human-Centered Design that had 10 first-year medical students field trip to the Be Safe Situation room, where they learned the True North issues of the Health System. While Be Safe was using Lean problem-solving to tackle the Big 6 issues, the students broke into two groups and decided if they could positively affect the “patient falls” and “readmissions” categories. Using design thinking, the students uncovered aspects of patient stories that were a surprise to even the most knowledgeable in the Health System. More importantly, their interviews and enquiries resulted in actions at the patient-care level. (A special thank you to Paul Helgerson, MD, who was vital to their access and Be Safe education.)

My takeaway from this first year is almost Seussian: A healer’s a healer no matter how small their med-school training is. They cared to make a difference and they did. (Additionally: They did it on their own time!)

Year 2: “Let’s partner with Architecture.”
For the 2016-2017 year, the 15 first-year medical students participating in Human-Centered Design are tackling the Emergency Department expansion project — and they’re doing so by partnering with School of Architecture students across Grounds in Elgin Cleckley’s class. (Cleckley, a recent hire, is an Assistant Professor of Architecture and Design Thinking.) Together, the students in both schools are discovering how an emergency room should be designed with a patient-centered focus. They’re challenging themselves to discover the factors that would improve the patient experience. Their goal is to promote a more informed conversation within the Health System by bringing the patients’ voices, ideas, and desire more clearly into view. They’re reframing the question for the rest of us. Can they propose a radical re-imagining of what an emergency room should be? How radical will we let it change? Design thinking teaches that true innovation can sometimes come from examining the extreme ends of the bell-curve. And they’re doing just that.

humancentereddesign5_03212017The program is experimental and dynamic and, itself, a product of design thinking. For the ED Expansion Project, the students gathered thoughts on essential elements for an emergency room, from the patient perspective, and provided it as output to the A-School students. At a recent Friday-afternoon session, the architecture students replied with visual prototypes and video presentations describing improvements. Broad concepts like “chaos” and “comfort” and “uncertainty” and “normal” were considered. No idea was too ridiculous. Nothing was dismissed. As med students watched these videos, they wrote initial impressions in a group-shared Google Doc, after which Matt recorded on-the-spot videos with his phone. All of this became more input data for the architecture students’ design projects.

humancentereddesign8_03212017It is a whirlwind of creativity and out-of-the box thinking. In an institution steeped in tradition and within a Health System governed by necessary protocol and critical procedure, witnessing pure creation and co-inspiration is something to behold.

The Future Is Full of Challenge
Erik, David, and Matt all freely admit this is an experiment. But one worth trying, as design thinking is an emerging area in education. Their goal is to use this small program as a prototyping space for development of relevant additions and new approaches to the core medical school curriculum at UVA (and nationally). For example, Matt recently delivered to the second-year class a workshop on empathy-based interview techniques from design thinking. The idea was to help them develop a diverse set of interview skills — rather than a purely clinical interview — as they transition into their clinical clerkships and onto their full medical careers. Adding this tool to our already vast educational toolbox is yet another differentiator for UVA. We’re only one of a handful of schools in the country who is offering a program like this.

humancentereddesign2_03212017There are grand challenges (not to mention changes!) in healthcare, issues which medical and science knowledge alone cannot solve. The most pressing issues of the day are complex and physicians have a definite role to play in solving them, but it is not a purely clinical role. Alongside their regular medical education, design thinking is helping our medical students learn the language of other fields and cultures, such as technology, business, and design. With this added tool, our med students can cross-cut different spaces to find the common ground. In the future, this will enable them to translate public health and medical knowledge into those fields, which will in turn deliver a broad impact.

The future of healthcare is full of change, too, and design thinking allows us to provide future physicians — alongside their traditional clinical skills — with a structured approach to managing that change. It will aid their ability to work in interdisciplinary teams and tackle systems-level problems. In the end, it will also make them better physicians and researchers.

humancentereddesign4_03212017David, Erik, and Matt tell me that design thinking is fun, as it allows students (and the faculty who are teaching them) to open up their minds, refresh themselves, and think creatively about the field to which they’ve devoted their lives.

I am proud of what David, Erik, and Matt have accomplished just as I am proud of the students and their efforts. UVA is already emerging as a national leader in the conversation of applying design thinking to medicine — Matt recently spoke at Stanford about our program. (Click here to see a clip from that talk.) I look forward to seeing the role UVA can play in using design thinking to improve the human condition.

R.J. Canterbury, MD
Senior Associate Dean for Education

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Do You Know About the JFDP?

Last October the School of Medicine welcomed its first cohort into the Junior Faculty Development Program (JFDP). Modeled after successful programs at Pennsylvania State University and the University of Massachusetts, the UVA program is designed to:

  • provide networking, social opportunities, and peer mentoring among colleagues who are at a similar stage in their career;
  • promote the development and advancement of junior faculty through seminars and mentored scholarly projects; and
  • facilitate mentoring relationships between senior and junior faculty.

Each participant in the JFDP works on a scholarly project over course of the program and has access to a mentor who will answer questions, provide resources, and assist in their growth. Our junior faculty have devised an amazingly diverse set of topics for their projects, such as “Regulatory T Cells in Cardiac Surgery-Associated Acute Kidney Injury,” “Individualizing the Care of Children with Facial and Skull Birth Defects using computer-based simulation for surgical optimization,” “Quality improvement project focused toward improved care of peritoneal dialysis patients in the ER,” and many others. All participants will make a presentation on their project at the end of the JFDP.

The first cohort of 12 junior faculty members come to the program from a variety of departments — medicine, neurology, anesthesiology, plastic surgery, neurosurgery, orthopaedics — and they meet twice a month for two hours. (While the current cohort does not represent every department, I do want to make it clear that this program is open to all clinical and basic science faculty.) The JFDP is organized through my office and spans a large portion of the academic school year.

This is a wonderful opportunity for our junior faculty to learn and grow and for our senior faculty to pass along vital knowledge and experience. The inaugural cohort will be finishing in the next couple of months and I look forward to their feedback. If you’re interested in applying for the 2017-18 program, more information will be provided this spring. If you have questions, please contact either me or Troy Buer, PhD, Director of Faculty Development, or visit the website.

Susan M. Pollart, MD, MS
Ruth E. Murdaugh Professor of Family Medicine
Senior Associate Dean for Faculty Affairs and Faculty Development

Degrees Changing by Degrees

As of June 1, 2017, UVA’S Biomedical Sciences (BIMS) and Public Health Science (PHS) graduate students will receive their degrees from the School of Medicine (SOM). The main reason for this move: It makes sense.

Our graduate students currently receive their degrees from the Graduate School of Arts and Sciences (GSAS); however, the BIMS program has been fully supported by the SOM since its inception, the majority of BIMS students perform their research under SOM mentors, and most of the PHS courses are taught by SOM faculty. Even though the School of Medicine provided the lion’s share of the education, these graduate students were not technically “ours.”

Once this move occurs, the SOM will be the home for all three of its major education programs (undergraduate medical education, biomedical sciences PhD programs, and PHS graduate programs). Moreover, governance will be made easier, as we will be able to provide direct oversight of our students and their wellbeing. An added benefit is that the School of Medicine’s philanthropic initiatives will now be able to focus on our BIMS and PHS alumni.

Like I said: It makes sense.

How does this affect faculty and staff?
The short answer is that it doesn’t. While there are some operational items to iron out with the registrar’s office, financial services, and student information services, the educational programs themselves will remain the same, as will the current leadership and management of each of the programs. So, for example, the PHS Master of Public Health Program and Master of Clinical Research Program will continue to be taught and led by Department of Public Health Sciences faculty, and the BIMS programs will continue largely as they have done in the past. One new change, however, is that an Executive Steering Committee for Education, comprised of the leaders of the three programs (UME, BIMS, PHS), has been established to address common features of all of the programs.

Change that does not feel like change is a rare event. This is a positive move, as it’s allowing us to get all of our students and programs together in the School of Medicine and provides us with the means to connect the undergraduate medical, BIMS, and PHS programs. I am now meeting bi-weekly with Ruth Gaare Bernheim, JD, MPH, the William Hobson Professor and chair of the Department of Public Health Sciences and director of the Master of Public Health Program, and Amy Bouton, PhD, Harrison Distinguished Teaching Professor in Microbiology, Immunology and Cancer, and Associate Dean for Graduate and Medical Scientist Programs, to coordinate educational issues and to ensure alignment within the School. One early activity that highlights the tremendous value of this educational realignment is an interprofessional values seminar that has brought together BIMS, medical education, and PHS students to discuss professional values via literature and film. We expect to launch more of these kinds of creative initiatives moving forward into the future.

It is important to note that our interactions with GSAS have been, and will continue to be, strong. Indeed, this move has been greatly facilitated with the help of GSAS leadership, for which I am very appreciative. These strong bonds will continue through our interdisciplinary programs in biophysics and neuroscience and through our numerous collaborations and educational initiatives. Meanwhile, I look forward finally to have all our students “officially” here!

Sincerely,
R.J. Canterbury, MD
Senior Associate Dean for Education

CQI’ing Before It Was Cool to CQI

QualityThe Liaison Committee on Medical Education (LCME) checks in on us every 8 years. To prepare properly for these accreditation site visits, like many schools, we start two years in advance. Gathering materials. Performing a self-study. Building a database. If you recall the last go-round, the preparation for the site visit can be intense. But this hurry-hurry two-year scurry is not in the spirit of what the LCME wants of schools.

To avoid this two-years on, six-years off cycle, the LCME recently added an element requiring schools to perform Continuous Quality Improvement (CQI). CQI provides schools the opportunity to do more than just meet the minimum standards. It requires processes to be put in place whereby schools continuously track how they’re doing on the accreditation standards and how they’re working toward improving the quality of their program.

The good news is that we’ve been performing CQI for years, though we have not called it CQI. Our faculty have always looked to find new ways to make UVA’s School of Medicine better than it was the day, week, month, or year before. The bad news is that we have not always documented it — so that is something we’ll need to work on.

How will this change things for you? The answer is evolving. Right now, we’re in the process of figuring out how to formalize our CQI process. What will it be? How will we implement it? These are questions we need to sort out. The LCME is not prescriptive in how we perform CQI, save that we have documentation of our processes that have measurable outcomes to improve programmatic quality and that we are monitoring them to meet accreditation standards.

Last summer we formed a steering committee and convened a few half-day retreats where we closely examined each LCME standard, looking for gaps and areas of improvement. We are now prioritizing them and determining the necessary resources to address them.

If you have any questions about CQI or the LCME standards, please contact Lesley Thomas, JD, Assistant Dean for Medical Education at llt6p@virginia.edu.

Stayed tuned for more on CQI in the months to come!

Sincerely,

R.J. Canterbury, MD
Senior Associate Dean for Education

Teaching Wisdom: Phronesis Project Expands

Close up of older woman and caretaker holding handsTwo years ago the School of Medicine piloted a program called the Phronesis Project — “phronesis” being the Greek word for “practical wisdom.” Spearheaded by Dr. Margaret Plews-Ogan, the pilot was designed to foster wisdom and empathy in our medical students.

I am pleased to announce that the project has been so successful that we are expanding it. The class entering UVA in August 2017 will double the size of the current project with the ultimate goal of having the entire incoming class in August 2018 gain “phronesis.”

What Does All of This Mean?
Our students will receive a longitudinal patient experience. Starting on their first day of school, they will be paired with patients whom they will follow, care for, and advocate for through all four years of medical school. Being paired with a patient with a chronic health condition early in medical school has an incredibly positive impact on both the student and the patient. Phronesis students receive insight into what a long-term doctor-patient relationship can be — a fulfilling aspect of primary care. Past Phronesis students have visited patients in the ICU and at home, helped patients sign up for benefits, and even dealt with their patient’s passing. These students come to understand early in their career the doctor-patient relationship and how to develop a professional identity.

Potential outcomes from Phronesis’ expansion include:

  • Students internalize characteristics, values, and norms of the profession through guided experience of a long-term relationship with a complex patient
  • Improved knowledge retention — concepts are retained better when seen in context of their own patient
  • Fewer professionalism concerns throughout training due to strong mentoring and role modeling from the beginning of medical school
  • Students see the trajectory of illness early in their training
  • Students have increased resilience and wisdom; reduced burnout, especially in the depersonalization domain; and improved tolerance of ambiguity
  • We graduate students with a deeper social commitment and understanding of the social determinants of health
  • Graduating students see themselves first and foremost as the patient’s advocate

It is important to note that the student isn’t the only beneficiary here. Phronesis is a two-way street. In this model, the patient is also a teacher. They benefit by having direct, personal access to a healthcare advocate and through their personal satisfaction of knowing they are contributing to the field of medical education. Relationships such as these have shown to have positive outcomes for the patients, who require less acute care because of these connections.

Faculty Gain a Champion, Too
In the coming years, clinicians are likely to see more of our students as they join patients at appointments on the patient-side of the exam table. Providers benefit from Phronesis as students are involved with patients by, for example, following up on scheduling tests, coaching patients on diets, and ensuring medical instruction is appropriately followed.

The expanded Phronesis Project will continue to promote interdisciplinary care, too. As the students learn and grow, they will be involved with the entire interdisciplinary care team. (This highlights one of our main Health System Goals: “To train heath care providers of the future to work in multi-disciplinary teams.”) We hope that, in the long run, we create doctors who have a high capacity for professionalism and who have the ability to nurture the doctor-patient relationship while avoiding burnout.

Thank you to Peggy Plews-Ogan for starting this program and Rachel Kon and Megan Bray for assisting in expanding Phronesis. Additional thanks to Natalie May, who has been instrumental from the beginning, and John Schorling, an original mentor who developed the reflective practice component which was further enhanced by Suzanna Williams. Pilot mentors include: John Schorling, Beth Jaeger-Landis, Ira Helenius, Mo Nadkarni, Carolyn Englehard, and Eve Bargman.

I look forward to seeing the fruits of their efforts for years to come, the effects of which will ripple positively across healthcare for decades.

Sincerely,
R.J. Canterbury, MD
Senior Associate Dean for Education

Drawing a Roadmap for Student Evaluation

While they say knowledge is power, they also say that actions speak louder than words. When it comes to medical education, knowledge is definitely important — however being able to do is equally important.

HealthcareStarting in March 2017, the School of Medicine will be piloting a program that will change the way we measure the competencies of medical students’ entrustable professional activities (EPA). EPAs cover basic skills a physician should have, such as taking a patient history, documenting an encounter, performing basic procedures (e.g., starting an IV), collaborating as part of an interprofessional team, and interpreting lab values. As it stands today, we assume that new residents have these skills because … well, they graduated from medical school!

But this may not always be the case.

We want to not only observe students doing EPAs, but observe them enough that we feel confident that they have the skills to perform competently as they care for patients on their first day as a resident. As such, we are incorporating EPA assessment changes into the curriculum, predominantly in the clerkship year, and ultimately rolling them out to all four years of medical school. This longitudinal education will provide the foundation for students to practice these skills in simulated settings and then in clinical settings while being observed and given real-time performance feedback. We want our graduates to be residents who can perform all 13 EPAs with limited supervision.

I realize that this is a shift from tradition. But it’s an important shift. We are moving from a focus on “what do you know?” to one that includes “what can you do?” If we want residents to be ready to function at a higher level, we need to get students actively involved in clinical roles prior to graduation.

While this is a wonderful change for the student, it is even better for the patient. It highlights patient safety and keeps those we serve at the forefront of our education. No longer will we presume residents are skilled; we will know they are competent because we have data from directly observing them.

How will this affect our faculty?
The new system will be more transparent. Faculty will have more knowledge about their students, what skills they possess, and, more importantly, the skills they have yet to learn. We are building an electronic portfolio to provide information about the types of tasks the students have been observed doing, enabling our teachers to hit the ground running and engage students with a more complex conversation about what they still need to learn how to do. The advantage here: When observations and feedback are performed immediately, it is off the physician’s to-do list and the students learn in real time, which can be applied immediately to the next patient. The fact is that faculty already are evaluating EPAs implicitly; this shift merely makes those efforts explicit.

Faculty are not the only ones affected by this new modality of evaluating EPAs. We want staff to assist, too, because the best care comes from an interprofessional team. We want to incorporate evaluations from others in the clinical setting — nurses, IV team, or pharmacy, as just a few examples.

This is the beginning of something great. But it is a beginning with a roadmap of our own design. While this sort of shift in education is being talked about at the national and international level, no institution has yet created an ideal model. Part of the plan forward is to learn as we go and to improve continuously the systems we’re creating. We all need to be adaptable and engaged with our students as this rolls out.

Many thanks to Drs. Megan Bray and Maryellen Gusic for leading the charge in rolling out the spring 2017 pilot and the four-year curriculum changes. I look forward to seeing the fruits of their efforts.

Dr. Gusic has recently been appointed Professor of Medical Education and Senior Advisor for Educational Affairs. In this role, she will continue the work she began as our consultant around the teaching and assessment of EPAs. In addition, she will be the clinical director of the Clinical Skills Center and will engage in and mentor medical education research.

Sincerely,

R.J. Canterbury, MD
Senior Associate Dean for Education

Highlights: November MAC Meeting

Introduction of Anne Watkins

  • Dean Wilkes introduced Anne Watkins, Assistant Vice President and Chief Development Officer, School of Medicine. Anne will be meeting with the chairs in the coming weeks to discuss fundraising efforts.

Inova

  • Dean David Wilkes discussed Inova Health System and UVA’s agreement to form a comprehensive research and education partnership.
  • The full press release can be read on the Dean’s Office Blog, linked here.
  • Please direct colleagues to the FAQ, linked here. Many questions are answered here.

Leadership Curriculum Certificate and Other Collaborations with Darden

  • In March 2017, the School of Medicine and Darden will pilot a certificate program as part of its leadership curriculum. This pilot will be four, two-week courses covering “Medical Practice Today,” “Building Your Leadership Style,” “Leadership and Practice” and “Business Acumen for the Medical Profession.” Coursework will also be made available to residents.
  • The SOM will provide this opportunity to biomedical science students, as well. Some courses will be replaced with content more appropriate for BIMS students.
  • Darden is interested in scientific education and we have been asked to develop a course for their students in biomedical sciences.
  • There have been conversations to develop a new leadership degree program in collaboration with Darden. We could use this new degree internally to train Health System leaders of tomorrow.
  • Canterbury will send out more details as they become available.

Pivot/GrantForward

  • Peggy Shupnik reminded chairs of the new research intelligence tools, Pivot and GrantForward. You can read about them on the Dean’s Office Blog, linked here.

Strategic Hiring Committee

  • Shupnik shared that the Strategic Hiring Committee continues to be pleased with the candidates. Please encourage faculty to recommend colleagues who they would like to work with, the kind who nucleate new efforts.

Pinn Scholars

  • The first group of Pinn Scholars will be named in December. Reminder: Applications are due Nov. 15.
  • There are many young faculty who are worthy of this. We would like to take this occasion to reward them. Please nominate your colleagues.

The next meeting will be Tuesday, December 13, 2016, in the MEB Learning Studio.