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Mentoring and Professionalism in Training (MAP-IT) Alice Fornari, EdD, RDN Program Director VP, Faculty Development [email protected] Cicy George Program Manager [email protected]
Mentoring and Professionalism in Training
(MAP-IT)
Alice Fornari, EdD, RDNProgram Director
VP, Faculty [email protected]
Cicy GeorgeProgram Manager
1. Describe the Mentoring and Professionalism in Training (MAP-IT) program.
2. Review program structure and implementation, content and logistics.
3. Integrate MAP-IT into the framework of professionalism in the work place.
4. Consider this longitudinal professional development program as a resilience strategy to address burnout and increase staff engagement.
5. “Experience a live MAP-IT session”.
Learning Objectives
2
We Are Northwell Health
3
MAP-IT Advisory CouncilAlice Fornari, EdD, RDVP, Faculty DevelopmentAssociate Dean,Educational Skills Development,Hofstra Northwell School of Medicine*Principal Investigator
Andrew Yacht, MD, MSc, FACPSVP, Academic AffairsAssociate Dean, Graduate Medical Education, Hofstra Northwell School of Medicine
M. Isabel Friedman, DNP, MPA, RNDirector, Clinical InitiativesDepartment of Clinical Transformation
Donna Tanzi, MPS, BSN, RN-BC, NE-BCDirector, Nursing Education & InnovationMagnet Project Director, Huntington Hospital
Andrew W. Menzin, MD, FACOG, FACSAssociate Chief, OBGYNProfessor,Hofstra Northwell School of Medicine
Bruce E. Hirsch, MD, FACP, AAHIVSAttending Physician Division of Infectious DiseasesNorth Shore University Hospital
Patti Adelman, EdD, MSEd, MSWVP, Center for Learning and Innovation & Physician Leadership Institute
Cicy George, BAProject ManagerOffice of Academic Affairs
4
Setting the stage for a resilience building Mentoring and Professionalism program (MAP-IT)
5
Mentoring and Professionalism
in Training
(MAP-IT)
6
-Active Role Modeling-Feedback-Diversity & Inclusion
-Team Building
-Appreciative Inquiry-Third Thing-Mindfullness
-Medical Error -Appreciative Inquiry
-Active Role Modeling
-Third Thing-Mindfulness-Appreciative Inquiry
MAP-IT
7
MAP-IT as Professional Development Program
MAP-IT Small Group Sessions to Build Skills and Reflective Capacity
IMPACT
8
making lists of desirable professional
characteristics is necessary and
useful for teaching and assessment
it is not, by itself, sufficient either to
fully define professionalism or to
capture its social functions.
MAP-IT
Wynia, M.K., Papadakis, M.A., Sullivan, W.M., Hafferty, F.W. (2014). More Than a List of Values and Desired Behaviors: A Foundational Understanding of Medical Professionalism. Academic Medicine. 89(5):712-4. 9
10
Wynia, M.K., Papadakis, M.A., Sullivan, W.M., Hafferty, F.W. (2014). More Than a List of Values and Desired Behaviors: A Foundational Understanding of Medical Professionalism. Academic Medicine. 89(5):712-4.
“Experiential process, in particular cultivating and strengthening a culture of a collaborative network. Tools and experience gained through the 10-session program increase the sense of community, bringingpeople working in silos together.”
Tsoh, J.Y., Kuo, A.K., Barr, J.W., Whitcanack, L., Merry, I., Alldredge, B.K. 2019. Developing faculty leadership from ‘within’: a 12-year reflection from an internal faculty leadership development program of an academic health sciences center. Medical Education Online. 24(1).
11
The Triple Aim—enhancing patient experience, improving population health, and reducing costs—is widely accepted as a compass to optimize health system performance.
Yet physicians and other members of the health care workforce report widespread burnout and dissatisfaction. Burnout is associated with lower patient satisfaction, reduced health outcomes, and it may increase costs.
Burnout thus imperils the Triple Aim. Quadruple Aim, adding
the goal of improving the work life of health careproviders, including clinicians and staff.
MAP-IT = Care-Team Wellbeing
Bodenheimer, T., Sinsky, C. (2014). From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider. Annals of Family Medicine. 12(6): 573-576.
12
The Mentoring and Professionalism in Training (MAP-IT) program
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Definitions
Mentoring: a learning relationship, which helps learners take charge of their own development, to release their potential and to achieve results which they value (Lakhani, M).
Humanistic mentoring: brings to the learning relationship compassion, respect, and sensitivity to the values, autonomy, cultural and ethnic backgrounds of others.(Blatt, Fornari, Wolpaw)
“Mentors are guides. They lead us along the journey of our lives. We trust them because they have been there before. They embody our hopes, cast light on the way ahead, interpret arcane signs, warn us of lurking dangers, and point out expected delights along the way.” (Daloz, LA)
14
MAP-IT Program Overview
Program Goal:
To implement a curriculum that will incorporate humanism and professionalism as a core value in the development of health professionals throughout the health system.
15
MAP-IT Core Values
Compassion Caring Empathy RespectIntegrity Justice Altruism Honesty
Program Vision: to increase participants’ knowledge, skills, and resilience specific to mentoring of early-career professionals they come in contact with in their daily work environments.
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MAP-IT Community
Program Director
Feinstein Research
Leadership
Non-Clinical
Leadership
Dept. Chairs, GME & Physician Leadership & PA
Leadership
Institute for Nursing
Leadership & Fellowship
CLI, Culture of Care Leaders & Corporate
Division Leaders
Advisory Council Program Manager
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10-Month Curriculum
Session #1-October
Appreciative Inquiry
(related to culture formation)
Session #2-November
Active Role Modeling in Academic Setting
Session #3-December
• Team Building: Dealing with Differences
and Conflict
Session #4-January
Feedback in Challenging Circumstances
Session #5-February
Medical Error I (Disclosure and after the error)
Session # 6-March
Medical Error II (Choosing Wisdom)
Session #7-April
Diversity & Inclusion
Session #8-May
Enhancing Well Being, Self Care & Resilience-Third Thing (#9 on reference list)
Session #9-June
Mindfulness
Session #10-July
End of program evaluation/ assessments/reflections
Graduation – July
*“Passing the Torch: Fostering Medical Humanism through Faculty Role Models” William Branch Jr., MD 18
Professional Development Sessions
*“Leaders” are a MD and RN or MD and non-MD pair MD RN
**“High Potential Mentors (HPMs)” are MD/DO/PhD, RN/NP, PA, SW, PharmD, Chaplain
* HPMs are mid- career level healthcare professionals
RN
MD
RN MD
RNMD
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Theoretical Model
Learners/
Clinicians
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Positive Top Choice
Discovery-Appreciating “the best of
what is”
Dream-Envisioning “what could
be”
Design-Co-
constructing “what should
be”
Destiny-Create “what
will be”
Beginning with Appreciative Inquiry (conceptual framework)
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Session Format
• No pre-work or post work is required of participants.
• Main expectation is that participants attend, contribute and be present in the moment.
Reflection
Use Appreciative Inquiry
framework to explore session
topic
Role Play/Article discussions
Use curriculum specific articles
Debrief
Session takeaways/synthesize
themes
Narrative Writing
Story sharing based on
question prompt for session topic
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Program Logistics
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Program Operations Program Director as leadership (partial FTE)
Manage recruitment process partnering with core clinical leaders
Allocate appropriate program funds
Liaison between program and advisory council
Raise program awareness within Northwell Health
Review monthly curriculum and edit as needed
Program Manager to manage all daily operations and routine program management (a part-time FTE)
Co-manage recruitment process
Coordinate small group schedules and assignment
Coordinate curriculum delivery to Leaders
Track graduation eligibility
Funds to purchase AI books and other miscellaneous materials, as needed, as well as funds to host a program graduation
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Successful Program Completion
Entails:-satisfactory participation in monthly sessions, a goal of 80% attendance is required, with opportunity for make-ups within month at an alternate session on same topic
-completion of pre and post assessments
-completion of an end of program evaluation
A formal certificate of program completion is issued to all participants who have met these course requirements
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MAP-IT’s Growth and Expansion
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Outcomes: Connection and Engagement
Across cohorts, both HPMs and facilitator leaders strongly agreed that the MAP-IT program met its objectives, was administered well, and was relevant to clinical practice.
Overall, 94% of participants from both cohorts reported they would recommend the MAP-IT program to colleagues.
*High Potential Mentors – participants in the program**Leaders – those who facilitate/lead the groups
Cohort 1 Leaders Cohort 1 HP Grads Cohort 1 HP -->
Cohort 2 Leader
% Cohort 1 HP to
Cohort 2 Leader
Cohort 1 Leader -->
Cohort 2 Leader
% Cohort 1 Leader
to Cohort 2 Leader
29 62 10 16% 12 41%Cohort 2 Leaders Cohort 2 HP Grads Cohort 2 HP -->
Cohort 3 Leader
% Cohort 2 HP to
Cohort 3 Leader
Cohort 2 Leader -->
Cohort 3 Leader
% Cohort 2 Leader
to Cohort 3 Leader
33 81 13 16% 13 39%
Cohort 3 Leaders Cohort 3 HP Grads
Cohort 3 HP -->
Cohort 4 Leader
% Cohort 3 HP to
Cohort 4 Leader
Cohort 3 Leader -->
Cohort 4 Leader
% Cohort 3 Leader
to Cohort 4 Leader
29 99 12 12% 16 55%
Cohort 3 Leaders Cohort 4 HP GradsCohort 4 HP -->
Cohort 5 Leader
% Cohort 4 HP to
Cohort 5 Leader
Cohort 4 Leader -->
Cohort 5 Leader
% Cohort 4 Leader
to Cohort 5 Leader
29 87 15 17% 16 55%
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Clinical MAP-IT
High Potential Mentors
Lead Facilitators
Sites Participant Demographics
Cohort 1-42014-2017
329 graduates
52 CLI, Huntington,Plainview, Phelps, Southside, and SIUH
MDs, RNs, PAs, NPs, PharmDs, Chaplains, Social Workers, Researchers, Psychologists
Cohort 52018
120 participants 32
Corporate MAP-IT
High Potential Mentors
Lead Facilitators
Sites Participant Demographics
Cohort 12017
7 graduates 2 CLI Admin Director, Director, Senior Director, Assoc Exec Director, AVP, VP, SVP
Cohort 22018
19 participants 6 CLISyosset
MAP-IT Program Data
Feinstein MAP-IT
High PotentialMentors
Lead Facilitators
Site Participant Demographics
Cohort 12018
7 graduates 2
Feinstein
Elmezzi Scholar, Post Doc Research Trainee, Scientist
Cohort 22018
16 participants 4 Post Doc Instructors,Assistant Professors
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Program Evaluation
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Fornari, A., Tortez, L.M., Lay, M., Hirsch, B., Tanzi, D., Friedman, I., Ricardo, A.P., Pekmezaris, R., Branch, W. (2018). Mixed Methods Approach to Humanistic Interprofessional Faculty Development. Journal of Continuing Education in the Health Professions, 38(1), 66-72. doi: 10.1097/CEH.0000000000000184
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Program Evaluation1. Mixed Methods Approach to Humanistic Interprofessional Faculty Development
• Prep/Post study design of Humanistic Teaching Practices Effectiveness Scale
• Pre/Post study design of Mentoring Competency Assessment
• Programmatic Evaluation –quantitative and qualitative reflective questions
2. Focus Groups with a convenience sample of past participants (HPMs and Leaders who are RNs and MDs/DOs) 2 years out from the program using a semi-structured interview guide to assess longer term impact of MAP-IT
Themes
• Incorporation into clinical practice
• Self-care
• Team Building and Conflict Resolution
• Mindfulness
• Mentorship
• Professionalism
• Interprofessional Collaboration
• Humanism
• Appreciative Inquiry
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1
An interdisciplinary small-
group format facilitated
open communication and
meaningful interactions
that remained over time.
Providing patient-centered
care and raising empathetic
awareness to the
experiences and challenges
of other individuals.
Fosters a supportive, safe
environment that promotes
learning, even in the face of
medical errors.
Promoting professional
behaviors such as reporting
errors, discussing challenges
with peers, and leading ethically.
Providing constructive feedback
and positive role-modeling.
Recognizing the importance of
good mentorship.
Incorporating mindfulness
techniques for oneself while also
encouraging such practices in
others’ wellness routines.
Empowering individuals
to resolve conflict among
their team, address issues,
and improve relationships
with team members.
Adopting behaviors to
build resilience, cope with
stress, and ultimately
prevent burnout.
.
Applying skills and behaviors
learned in MAP-IT into practice.
Evidence of sustainable, long-
term impact of the program.
Program Evaluation-continued
Note: Cohort 1/2/3 indicated resilience as an unanticipated positive outcome of program participation.
3. Cohort 4 of clinical MAP-IT, 2017-2018 (N=87) was involved in new data collection on pre/post burnout and resilience using two validated instruments:
• Maslach Burnout Inventory (MBI) Human Services Survey for Medical Personnel and
• Connor-Davidson Resilience Scale (CD-RISC)
Both scales were used to assess if the program process and content could positively addresses burnout and builds resilience over the course of the 10 month program.
Preliminary Data:
• Increase in resiliency over time among Leaders and HPMs, with the HPMs having a statistically significant (p<0.05) increase.
• HPMs experienced a significant increase (p<0.01) in the “personal accomplishment” component of the MBI over the course of the program.
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Outcomes: Cohort 4 Qualitative Data
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Leaders High Potential Mentors
I have been with MAP-IT from the start yet each Cohort is an opportunity to take away and offer even more. It never gets old. The experience has been invaluable.
MAP-IT helped me to improve my teaching skills, by encouraging me to become a more active listener and develop more appreciation for what we are collectively doing to help others. Through the modules, I was able to learn about how to handle difficult scenarios, including acceptance of what was happening and what can be done to evoke change.
Over the past few years, the MAP-IT program has become one of the most treasured opportunities in my career. The curriculum and format are wonderful, and it is such a pleasure getting to know the high potential mentors and co-leaders. A meaningful moment that reflects the experience for me this year would be the feeling in the room immediately following our mindfulness session... Everyone just sat... Taking in the moment... And it felt as though no one wanted to leave. Thank you very much for this opportunity.
After learning these skills in MAP-IT, I now start each mentoring interaction by asking mentee their thoughts on a situation and really listening to their point of view first. In the past, I feel that I had a tendency to offer my opinion or share my experiences too quickly, before fully understanding the viewpoint of the mentee seeking my help. Encouraging them to talk to me about their impressions of a situation first, has allowed me to tailor my responses more effectively, and the interaction has become more of a conversation between two people - and as a result, the outcomes have been more positive.
Thank you! Questions?
35
Live Session
36
Active Role Modeling in Clinical SettingsLearning Objectives:
1. Reflect on the experiences with your own role modeling to learners (MD, RNs, students, or other health professionals) or observing others role model in the clinical setting.
2. Practice active role modeling, receive coaching and feedback from peers and Leaders
3. Reflect on what you can bring back to your clinical settings.
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How do we motivate and encourage learners to create an environment that is psychologically safe?
Recognize active role modeling as a core skill of professionalism and mentoring. We will reflect on situations where role modeling worked well to achieve a positive outcome.
Reflection
Use Appreciative Inquiry
framework to explore session
topic
38
Share a short/brief experience about role modeling, either being one or observing one, leading to a positive outcome. Describe the context, the person(s) involved and what the outcome was.
Narrative Writing
Story sharing based on
question prompt for session topic
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40
Poem, Denial from PULSE: Voices in the Heart of Medicine
http://pulsevoices.org/index.php/poems/545-denial
Read out loud and discuss the role modeling/mentoring qualities of the physician described.
Role Play/Article discussions
Use curriculum specific articles
Debrief role plays and collate thoughts: “what can you take back to your clinical settings with learners’ specific to role modeling?”
Debrief
Session takeaways/synthesize
themes
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Arnold P. Gold Foundation – for their support of this program and generous funding
Dr. William T. Branch – for collaboration on the MAP IT Program Curriculum (adapted from “Passing the Torch” and his on-going consultation).
Northwell Health MAP- IT Advisory Council Members
Northwell Health Leaders and HPMs – for trusting the program & fully participating
Special Thanks To -
Thank you! Questions?
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References1. Bodenheimer, T., Sinsky, C. (2014). From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider. Annals of Family Medicine. 12(6): 573-576. 2. 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; 84:117–126. 3. Branch WT Jr. Teaching professional and humanistic values: suggestion for a practical and theoretical model. Patient Education and counseling 98 (2015) 162-167. 4. Branch WT Jr. Kern, David, Haidet, Paul, Weissmann, Peter, Gracey, Catherine F., Mitchell, Gary, Inui, Thomas. Teaching the Human Dimensions of Care in Clinical Settings. JAMA, September 5, 2001- Vol 286, No. 9. 5. Branch WT, Jr., Kern D, Haidet P, Weissmann P, Gracey CF, Mitchell G, Inui T. The Patient-Physician Relationship: Teaching the human dimensions of care in clinical settings. JAMA 2001; 286:1067-1074. 6. Branch. WT, Jr. The road to professionalism: Reflective practice and reflective learning. Elsevier 2010; 80: 327-3327. Campbell-Sills, L, Stein, M. Psychometric Analysis and Refinement of the Connor–Davidson Resilience Scale (CD-RISC): Validation of a 10-Item Measure of Resilience. Journal of Traumatic Stress, December 6, 2007 – Vol 20, No. 6: 1019-1028.8. Doukas DJ, McCullough LB, Wear S Perspective: Medical education in medical ethics and humanities as the foundation for developing medical professionalism. Acad Med. 2012 Mar;87(3):334-41 9. Doukas DJ, McCullough LB, Wear S. Reforming medical education in ethics and humanities by finding common ground with Abraham Flexner. Acad Med. 2010 Feb; 85(2):318-23. 10. Fornari, A., Tortez, L.M., Lay, M., Hirsch, B., Tanzi, D., Friedman, I., Ricardo, A.P., Pekmezaris, R., Branch, W. (2018). Mixed Methods Approach to Humanistic Interprofessional Faculty Development. Journal of Continuing Education in the Health Professions, 38(1), 66-72. doi: 10.1097/CEH.0000000000000184.11. Gaufberg, Elizabeth, Batalden, Maren. The third thing in medical education. The Clinical Teacher 2007; 4: 78-81.
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References, continued
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12. Gordon Cohen, L, Ashraf Sherif, Y. Twelve tips on teaching and learning humanism in medical education. Medical Teacher 2014; 36: 680-684.13. Logio, LS, Monhan, P, Stump, T, Branch, WT Jr, Frankel, R, Inui, TS. Exploring the Psychometric Properties of the Humanistic Teaching Practices Effectiveness Questionnaire, an Instrument to Measure the Humanistic Qualities of Medical Teachers. Academic Medicine 2011; 86: 1019-1025.14. Shanafelt TD, Boone S, Tan L, Dyrbye LN, Sotile W, Satele D, West CP, Sloan J, Oreskovich MR. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012 Oct 8; 172(18):1377-85. 15. Shanafelt TD, Noseworhty, John H. Executive Leadership and Physician Well-being: Nine organizational Strategies to Promote Engagement and Reduce Burnout. Mayo Foundation for Medical Education and Research. January 2017: 92(1): 129-146. 16. Tsoh, J.Y., Kuo, A.K., Barr, J.W., Whitcanack, L., Merry, I., Alldredge, B.K. 2019. Developing faculty leadership from ‘within’: a 12-year reflection from an internal faculty leadership development program of an academic health sciences center. Medical Education Online. 24(1). 17. Wald HS. Guiding our learners in reflective writing: a practical approach. Lit Med. 2011 Fall; 29(2):355-75. 18. Weissmann PF, Branch WT Jr, Frankel R, Gracey CF, Haidet PM, Frankel R. Role modeling humanistic behavior: Learning bedside manner from the experts. Acad Med 2006; 81: 661-67.19. Windle, G, Bennett, K, Noyes, J. A Methodological review of resilience scales. Health and Quality of Life Outcomes 2011, 9:8.20. Wynia, M.K., Papadakis, M.A., Sullivan, W.M., Hafferty, F.W. (2014). More Than a List of Values and Desired Behaviors: A Foundational Understanding of Medical Professionalism. Academic Medicine. 89(5):712-4. 21. Lakhani M. When I say…Mentoring. Medical Education 2015; Volume 49, Issue 8: 757-758.
