GRADUATE MEDICAL EDUCATION CHALLENGE GRANT PROGRAM

Picker Institute, Inc. & The Arnold P. Gold Foundation

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Graduate Medical Education Challenge Grants Program

The purpose of the Picker Institute/Gold Foundation Challenge Grant Pro-

gram is to support the research and development of successful patient-

centered care initiatives and best practices in the education of our coun-

try’s future practicing physicians. The Picker Institute/Gold Foundation

Graduate Medical Education Challenge Grant Program funds proposals

that illustrate specific interventions and innovations in graduate medical

education programs regarding patient-centered healthcare and/or human-

ism in medicine. The expected outcome of a grantee’s project will be a

demonstration, including a robust dissemination plan, of the measurable

effects and sustainability of the effort to enhance compassionate, patient-

centered-care in residency education. For more information and to visit

the GME toolbox go to: http://cgp.pickerinstitute.org

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Picker Institute Mission

Picker Institute Inc. is an independent nonprofit organization dedicated to

the global advancement of the principles of patient-centered care. Picker

Institute sponsors research and education in the fields of patient-centered

care in support of and in cooperation with educational institutions and

other interested entities and persons. The Institute’s mission is to foster a

broader understanding of the concerns of patients and other healthcare

consumers, and of the theoretical and practical changes needed to facili-

tate a more patient-centered approach. Picker Institute supports the ad-

vancement of the patient-centered care approach through a variety of

education programs, awards, research and dissemination of evidence-

based knowledge focused entirely on fostering continued improvement in

healthcare from the patient’s perspective.

Gold Foundation Mission

The Gold Foundation is a nonprofit organization dedicated to the ad-

vancement of humanism in medicine, restoring a balance between the

science of medicine and compassionate, respectful patient care. The

Foundation is a proponent of medical care that is as humanistic in its de-

livery as it is sophisticated in its technology to improve healing and health-

care outcomes. The Gold Foundation supports the development and dis-

semination of innovative medical education that furthers this mission.

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“Through the patient’s eyes.”

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The Arnold P. Gold Foundation criteria to

advance humanistic, patient-centered care:

Shows respect for the patient’s viewpoint Displays effective & empathetic communication & listening skills Demonstrates sensitivity in working with patients and family mem-

bers of diverse cultural and social backgrounds Is sensitive to and effectively identifies emotional and psychological

concerns of patients and family members Engenders trust and confidence Adheres to professional and ethical standards Displays compassion and respect throughout the patient interaction

Picker Principles of Patient-Centered Care:

Respect for patients’ values, preferences and expressed needs Coordination and integration of care Information, communication and education Physical comfort Emotional support and alleviation of fear and anxiety Involvement of family and friends Continuity and transitions Access to care

Advancing Excellence in Patient-Centered Care Through Education,

Research and the Dissemination of Best Practice Strategies

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2011/2012 Graduate Medical Education

Challenge Grant Initiatives

Children’s National Medical Center

Principal Investigator: Dale Coddington, MD, MA

Project Title: Caring for Children with Special Health Care Needs: An Online Medical Home Pro-

fessionalism Curriculum for Pediatric Residents Objective: This initiative is an experiential and online curriculum to help pediatric residents acquire the necessary knowledge, attitudes, and skills to deliver effective, patient‐centered care to children with special health care needs. This initiative will utilize direct experience in care delivery, individual and collective reflections, and collaboration with a broad health care and community team, all in the setting of residency continuity clinic experience. A component of this initiative is for residents to engage in reflective blogging with feedback from faculty and peers as an innovative method to learn professionalism in the context of caring for children with special healthcare needs in resident continuity clinic. This initiatives Al-ways Event will be that, at the close of each clinical encounter, the physi-cian and patient/family agree on next steps and on the specific responsi-bilities of the physician and the patient/family.

Dana Farber Cancer Institute

Principal Investigator: Kristen G. Schaefer, MD Project Title: Teaching Patient‐ and Family‐Centered Care in the Setting of Life‐Threatening Illness: A Resident Outpatient Palliative Care Rotation

Objective: This initiative is a competency‐based, clinical rotation in a variety of interdisciplinary palliative care outpatient specialty settings, with emphasis on addressing the physical, emotional, social, spiritual and exis-tential dimensions of suffering that accompany advanced illness. Through outpatient clinical encounters, individualized feedback about patient-centered communication skills, and mentored self-reflection exercises, residents will learn about the importance of humanism in patient care and professional development.

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Geisinger Medical Center

Principal Investigator: Michelle Thompson, MD

Project Title: Employing a Patient-Centered Approach to Develop a Medical Passport to Improve Transitions and Educate

Health Care Providers

Objective: This initiative is designed to gather patient preferences through focus groups, refine the medical passport using a patient-centered approach and pilot its use, emphasizing training of healthcare providers in maintaining a patient-centered approach during its implemen-tation.

Jacobi Medical Center

Principal Investigator: Kenneth Rivlin, M.D., Ph.D.

Project Title: Experiential Learning of Patient/Family-Centered Care

Objective: This initiative addresses a critical question: “how do we moti-vate residents to practice patient/family-centered care?” Building upon a successful model for resident-run quality improvement, the project team will introduce the practice of PFCC by partnering our residents with pa-tient/family advisors to solve patient and resident identified problems (gripes). It is believed that this program will alter resident perspectives because the value of PFCC will be experienced not merely taught.

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New York Presbyterian Hospital

Principal Investigator: Nicholas H. Fiebach, MD

Project Title: The Patient’s Voice: Institution-wide Training for House staff in Patient-Centered Care

Objective: This initiative targets resident interactions with patients at the key transition points of hospital admission and discharge. Guidance for house staff will be developed and disseminated to promote Always Events at these critical junctures, including clear introductions and orientation, assessment of patients’ language and communication needs, empathic communication, eliciting questions and concerns from patients’ and their families, and checking on patients’ preferences and understanding. This project will integrate three distinct components that will serve to identify the “voice of the patient,” develop and pilot strategies for delivering patient-centered care that grows out of residents’ experiences with patients; and, design a half day intensive workshop on patient-centered practices inte-grating lessons learned from the first two components.

SUNY Upstate Medical University

Principal Investigator: Stephen Knohl, MD

Project Title: Learning to Talk

Objective: This initiative will build on and enhance the established "Learning to Talk" program at SUNY Upstate Medical University with the addition of the Always Event of "Discharge Guides". The "Discharge Guides" will be firmly grounded in respect, clarity, and education and will improve physician-patient communication skills. This initiative will intro-duce residents to hand-written "Discharge Guides" for outpatient cases. “Discharge Guides” will foster the patients’ comprehension of, and comfort with, their discharge plan and will be portable to follow-up appointments to ensure quality continuity of care.

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University of Chicago Principal Investigator: Vineet Arora, MD

MAPP Project Title: Engineering Patient Oriented Clinic Handoffs

(EPOCH) Project Objective: To truly design a patient‐centered clinic handoff, understand-ing the patient experience is imperative. The goals of this initiative in-clude: (1) To understand how patients cared for in a resident clinic per-ceive the end of year handoff process, with a particular focus on barriers and challenges that they face; (2) To develop a patient‐centered end of year clinic handoff process for internal medicine training; (3) To evaluate the impact of this patient‐centered end of year clinic handoff process on resident satisfaction, patient satisfaction, and relevant patient outcomes.

University of California San Francisco /

VA Medical Center, San Francisco

Principal Investigator: Calvin L. Chou, MD, PhD Project Title: Development of Interprofessional Team-based Observed

Structured Clinical Examinations to Ensure Patient-Centeredness in Primary Care Teams

Objective: We propose to construct an Interprofessional Team-based Observed Structured Clinical Examination (ITOSCE): an assessment that uses standardized patients and team members to ensure that a trainee explicitly incorporates the patient’s goals of care and illness perspective into a comprehensive care plan.

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University of South Florida Principal Investigators: Deanna Wathington, MD ,

MPH and Charles N Paidas MD, MBA (DIO) Project Title: Enhancing Medical Resident Cultural and

Linguistic Competency

Objective: This project evaluates the efficacy of two unique training inter-ventions to enhance cultural and linguistic competency among a diverse group of trainees and program directors across a variety of specialties in a large urban residency program. The project seeks to evaluate potential best practice interventions/curriculum for residents to enhance patient centered and humanistic care.

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2010/2011 Graduate Medical Education Challenge Grant Initiatives

Dartmouth-Hitchcock Medical Center

Principal Investigator: Marc L. Bertrand, MD

Project Title: Integrating Patient and Family-Centered Care Principles into a Simulation-Based Institutional Curriculum

Overview: This project will develop a curriculum and simulation-based training experience for DHMC residents that will improve physician-patient communication related to patient safety. We propose to develop an insti-tution-wide curriculum based on the key principles of PFCC that will iden-tify “always events”- observable behaviors that ensure all patient care experiences are firmly grounded in dignity, respect, and information shar-ing. The curriculum will specifically include simulations focused on in-formed patient choice and breaking bad news.

Hebrew Rehabilitation Center/ Beth Israel Deaconess Medical Center

Principal Investigator: Jennifer Rhodes-Kropf, MD

Project Title: “How Do You Have the Conversation?” A Curriculum for Residents.

Overview: The goals of this initiative are to, 1) Develop an innovative curriculum that will teach internal medicine residents how to discuss with families the natural progression of dementia and what their options are for the goals of care for their loved ones; 2) To increase internal medicine residents comfort levels and knowledge for discussion of living wills with patients. Each resident will be better able to work positively and effectively with patients and their families, and end-of-life discussions will become an Always Event during the taking of a patient’s history and physical exami-nation.

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Johns Hopkins University

Principal Investigator: Roy C. Ziegelstein, MD

Project Title: Development and Implementation of a Patient-Centered Discharge Curriculum

Overview: The overall goal of this curriculum is to teach interns and resi-dents the skills and attitudes necessary to facilitate safe, effective, patient-centered transitions of care. It is hypothesized that an additional critical element for safe, effective, transitions of care is the inclusion of the patient and significant others as full partners in discharge planning. This project proposes that the inclusion of the patient, and the patient’s perspective, in

Mount Sinai Medical Center

Principal Investigator(s): Joel Forman, MD & Christine Low, LCSW

Project Title: Project PARIS (Parents And Residents In Session)

Overview: The goal of this initiative, which was implemented during the 2010/2011 grant cycle, is to implement and test a novel approach to teach pediatric residents about patient and family-centered care (PFCC). The approach calls for a supervised meeting between a family member of a previously hospitalized child and a resident in the context of a pediatric residency rotation (behavioral and developmental pediatrics).

Project Title: Project PARIS: Parents and Residents In Session – the

next generation Overview: This 2011/2012 initiative builds on the previous results and extends them to provide the PARIS intervention to a large group of medi-cal students while performing a controlled trial of its efficacy in promoting knowledge and improving attitude about patient and family centered care (PFCC). The goal of this initiative is to implement a meeting between fam-ily faculty and medical students who are on their pediatric rotation in the medical center. The meeting will be standardized to include discussions of the core components (core tenets of family centered care) that were iden-tified in the pilot study.

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Riverside Methodist Hospital/ Ohio Health Foundation

Principal Investigator: Sara Sukalich, MD

Project Title: Teaching Disclosure: A Patient-Centered Simulation Training for the Crucial Conversation

Objective: This project will attempt to close the gap by providing a robust training and competency assessment for medical residents on how to disclose medical errors and improve communication skills, using the Na-tional Quality Forum’s guidelines. The goal of this project is to ensure that the skills needed to provide full disclosure of medical errors are taught to trainees, and assessment of trainees’ competence in these skills is evalu-ated.

The Regents of the University

of California

Principal Investigator: Danielle Perret, MD Project Title: Humanism in the Perioperative Environment

Objective: This curriculum centers on the patient’s entire perioperative experience, with close attention to the patient’s fears, pain, and anxiety. The goal is for residents to develop perioperative Always Events that inte-grate and promote patient-centered medicine, resulting in a personalized patient perioperative experience. The program creates an overt and com-prehensive curriculum that gives anesthesia residents the skills to identify and address a patient’s pain, anxiety and personal needs in the pe-rioperative setting.

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University of Maryland School of

Medicine

Principal Investigator: Susan D. Wolfsthal, MD

Project Title: Empowering Patients to Optimize Their Medication Regi-mens: A multidisciplinary approach.

Objective: This initiative will provide residents with skills in assessing their continuity patients’ barriers and adherence with medication use. Residents will gain knowledge through a series of seminars and evaluate their own clinical practice through a practice based learning (PBL) exer-cise. Through an interdisciplinary partnership with a clinical pharmacist, residents will utilize existing resources to assist patients to cope with in-creasing economic pressures.

University of Massachusetts Medical Center

Principal Investigator: Kathleen E. Walsh, MD, MSc Project Title: Home Medication Education and Support (HOMES): A

Resident Module on Home Care in Children

Objective: This study will address the challenges that families face, when caring for chronically ill children, by training new physicians to be sensitive and responsive to parents needs and to proactively provide parents with the support needed to successfully care for children with chronic condi-tions at home. The overarching goal is to develop a curriculum that will give residents the knowledge and clinical skills needed to support safe home medication use for children and families in their practice.

Wake Forest University

Health Center

Principal Investigator: Franklin Watkins, MD

Project Title: Improving Transitions of Care for Older Adults through Interdisciplinary Education for Medical Residents

Objective: This initiative will develop an Acute Care for the Elderly Unit Transitional Program (ATP) to teach optimal discharge planning and reinforce interdisciplinary communication through trainee home visits to vulnerable older patients after hospital discharge. The ATP will provide a “living laboratory” to enhance the medical trainees’ understanding of the importance of appropriate discharge planning, communication with the patient, family and caregivers, as well as impact a culturally and socio-economically diverse population. Successful hospital discharge and tran-sitions of care can be considered Always Events, as all patients experi-ence at least one (and often multiple) care transition following hospitaliza-tion.

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University Medical Center Foundation, Arizona

Principal Investigator: Eric Brody, MD, FACC Project Title: The Native American Cultural Competency Curriculum

Objective: This project will develop a cultural competency curriculum that will include, but not be limited to, eight hours of lecture time to explore topics such as: an overview of health issues among Native Americans, language/translation issues in providing care for Native American pa-tients, culture and spirituality of Native American peoples (particularly in the Southwest), presentation/discussion of multiple case studies under-scoring specific points regarding clinical care for Native American pa-tients, a session of resident case presentations, and a session of conclud-ing remarks/wrap-up.

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Train Pediatric Residents in the Delivery of News and the Discussion of Issues Related to Death and Dying in a Pediatric Population Principle investigator: Heather Huszti, PhD, Director of Training, Psychology Children’s Hospital of Orange County, CA Communication in Family Meetings: Developing and Assessing a Curriculum for Residents Principle investigator: Julie T. Irish, PhD, Beth Israel Deaconess Medical Center Improving Patient Communication Skills Among Surgical Residents Principle investigator: Rajiv Y Chandawarkar MD University of Connecticut Health Center Develop Health Care Transitions, a Resident Learning Module on Building Bridges Principle investigator: Suzanne McLaughlin, MD Brown University Alpert School of Medicine/Rhode Island Hasbro Hospitals Teaching Family-Centeredness in the PICU: a novel approach using medical simu-lations Principal investigator: Ira M. Cheifetz, MD Duke Children's Hospital Introduce a Family Centered Care Curriculum to a Pediatric Residency Program and Measure its Effects on the Centeredness of Pediatric Residents Principal investigator: Keith J. Mann, MD Children’s Mercy Hospital Transitioning from Pediatric to Adult .Centered Medical Care (the patients perspec-tive) Principal investigator: Niraj Sharma, MD, MPH Brigham & Women's/Boston Children's Hospitals/Harvard Medical School Screening and Managing Interpersonal Violence During Pregnancy at an Urban Teaching Hospital Principle investigator: Suneet Chauhan, MD Aurora Health Care, Inc. Create a patient-centered care plan (PCCP) within an electronic medical record; and evaluate the impact of PCCP use on patients and health-care team members Principal Investigators: Judith Pauwels, MD & Larry Mauksch, M.Ed Univ of WA Family Medicine Residency

Challenge Grant Program Cycle: 2009-2010

Challenge Grant Program Cycle: 2005-2009

Transitioning Adolescent Patients (TAP) from Pediatric to Adult Care Principal Investigator: Emily von Scheven, MD, MAS, Pediatric Rheumatology, University of California San Francisco Improving Patient Rounds (IPR) Principal investigator: Walter J. Moore, MD, Center for Patient- and Family-Centered Care, Medical College Georgia

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Resident Performance from the Patient’s View Principal investigator: Dick M. Wardrop, MD, PhD, FAAP, Director of Resident Research, Internal Medicine, Carillion Clinic, Roanoke, Va. Patient-Centered Training of Residents on a Medical Ward Principal investigator: Robert C. Smith, MD, MS, Internal Medicine, EW Sparrow Hospital/Michigan State University College of Human Medicine “Emergency Medicine Resident Training in Interprofessional Skills: Evaluating a Needs-Based Curriculum” Principal investigator: Sondra Zabar, M.D., Associate Professor of Medicine Linda Regan M.D., New York University School of Medicine “Cultural Sensitivity Initiative for Medical Education” Principal investigator: John M. Tarpley, M.D. Vanderbilt Medical Center/Vanderbilt University “Simulation Used to Measure the ACGME Core Competencies and Patient-Centered Care” Principal investigator: Pamela J. Boyers, Ph.D., Riverside Methodist Hospital “Improving Patient Compliance and Outcomes in Hypertension Management in the ‘Stroke Capital’ of the World” Principal investigator: William H. Hester, M.D., McLeod Family Medicine Resi-dency Program “Development and Implementation of an Interdisciplinary Palliative Care End-of-Life Education Program for Residents Who Rotate through the Surgical Intensive Care Unit” Principal investigator: Anthony A. Meyer, MD, PhD & Renae E. Stafford, MD, MPH The University of North Carolina at Chapel Hill, Trauma and Critical Care Services/

Max Bassett, Georgia Health Sciences University Pamela J. Boyers, PhD, University of Toledo Jim Cichon, ACGME Virginia Collier, MD, Christiana Care Health System Nettie Engels, Georgia Health Sciences University Susan Frampton, PhD, Planetree Richard Frankel, PhD, Veterans Administration Medical Center Mary Joyce Johnston, ACGME Adina Kalet, MD, MPH, NYU School of Medicine Susan Edgman-Levitan, Executive Director, John D. Stoeckle Center for Primary Care Innovation Carl Patow, MD, MPH, MBA, FACS, University of Minnesota V. Seenu Reddy, MD, MBA, FACS, UT Health Science Ctr. - San Antonio Christopher Simien, ACGME Richard Wardrop III, MD, University of North Carolina School of Med. Mitzi Williams, MD, Georgia Health Sciences University

External Evaluation Committee Members

J. Mark Waxman, Esq., Chairman Stephen C. Schoenbaum, M.D., Vice Chairman Samuel Fleming, Treasurer and Secretary Sir Donald Irvine, MD, FRCGP, FRCP, F.Med.Sci David C. Leach, M.D., Former Executive Director, ACGME Gail L. Warden, MHA, President Emeritus, Henry Ford Health System

Picker Institute Board of Directors

Lucile Hanscom, Executive Director 11 Main Street, 4th Floor PO Box #777 Camden, Maine 04843 Tel 1.207.236.0157 1.888.680.7500 Fax 1.207.236.3570 Email lhanscom@pickerinstitute.org Website http://pickerinstitute.org http://alwaysevents.pickerinstitute.org Hannah Honor, Grants Coordinator, hhonor@pickerinstitute.org The Arnold P. Gold Foundation Barbara Packer, Managing Director, COO 619 Palisade Avenue Englewood Cliffs, NJ 07632 Tel 1.201.567.7999 Email goldfdtn@gold-foundation.org Website http://humanism-in-medicine.org Ann Bruder, Director of Programs