In recent years, the medical profession has sharpened its focus on mental health, well-being, and burnout among medical students, residents, and doctors, taking more steps to combat the problem and help those affected return to the important and rewarding work that inspired them to join health care in the first place. One such initiative is the Accreditation Council for Graduate Medical Education (ACGME)’s Back to Bedside program. The initiative’s goal is to “empower medical residents and fellows to generate innovative strategies that will allow them to engage on a deeper level with what is at the heart of medicine: their patients.” As a successful first year of the program comes to a close, Back to Bedside recently launched the application cycle for its second year and plans to use its $260,000 to fund up to 30 new projects. The deadline for proposals is March 15, 2019.
To better understand how the program has benefited residents and patients, AACOM interviewed several members of the Back to Bedside initiative. Kathryn Haroldson, MD, third-year internal medicine resident at University of North Carolina (UNC) Medicine; Owen Kahn, MD, third-year pediatric resident at Connecticut Children’s Medical Center; and Dink Jardine, MD, Chair of the ACGME’s Back to Bedside Work and Advisory Group, shared their experiences with the initiative over the last year.
The idea for the program came from the Council of Review Committee Residents (CRCR) at the ACGME during a focus group session. Members were given several uninterrupted hours to discuss how residents can find value in their work, discuss what motivates them, and identify obstacles that have impeded their ability to find meaning. The group decided that finding meaning in their work would have the greatest positive impact on their well-being.
The CRCR members read When Breath Becomes Air by Paul Kalanithi. The book describes a resident who is diagnosed with lung cancer and faces the choice of continuing his training or pursuing other goals in light of his diagnosis. In the book, he decided to continue his medical training, and this choice is what drove the residents’ conversation about how to find meaning in their work—and it is this question that the Back to Bedside projects aim to further explore.
The residents encountered several recurring obstacles to finding meaningful work: data entry and other monotonous but critical tasks were taking too much time and they weren’t spending as much time with their patients as they wanted. These and other underlying themes laid a foundation for the initiative, but the project’s first application cycle encouraged open conversations about other obstacles and challenges, as well as new, innovative ideas for how residents could foster joy and meaning in their learning environments.
The response to Back to Bedside’s initial call for proposals was overwhelmingly positive. While the original plan was to run five projects in its first program year, the ACGME ended up supporting 30. The second Back to Bedside program year is now looking for up to 32 more projects to fund, and the ACGME hopes to see proposals from across the GME community, including from osteopathic programs.
In our interview with Dr. Jardine, she expressed interest in seeing project proposals from osteopathic physicians, particularly those in community health centers and out-patient/ambulatory environments, since a majority of the first cycle projects were completed in in-patient and hospital settings. “Osteopathic medicine presents an approach that is currently underrepresented in the Back to Bedside program. There are many osteopathic residents who work in community out-patient centers or in rural, medically-underserved settings, and these environments come with their own unique challenges and diverse obstacles to finding joy and meaning in residency work. I look forward to the ideas put forth in proposals from osteopathic programs and hope to be able to add a stronger osteopathic voice to Back to Bedside this cycle,” she said.
A Closer Look: Two Current Back to Bedside Projects
Dr. Haroldson was one of two team leads for the first cycle of the Back to Bedside project. Her project addressed rounding—specifically, the disconnected approach to creating a care plan without involvement of the patient. The solution was to bring rounds into the patient’s room rather than discussing plans externally, thereby avoiding repeating the care plan to the patient and now engaging them in rounds. The change cut down rounding time by up to an hour each day and allowed for more interactive care between resident and patient.
Surprised by the reach of the change, she says that the benefits affected not only residents, but also patients, attendings, and nurses who participated in multidisciplinary bedside rounds. The Back to Bedside project improved communication between all health care staff and allowed residents to have more meaningful and frequent engagements with their patients more often. “[Through the Back to Bedside project] we are able to learn who our patients are, their names and hobbies and family, rather than first thinking of them as ‘the heart attack in room 203’ and then as the person who is in our care,” says Dr. Haroldson.
Dr. Kahn is one of the team leads for his institution’s Back to Bedside initiative. His project started with a resident meeting to generate ideas to improve communication efficiency in the hospital and resident flow, as every aspect of the hospital revolved around proper communication and documentation. They then heard about the Back to Bedside program, which provided additional resources and a community to discuss their project.
Through the initiative, Dr. Kahn and his fellow residents decided on two interventions to improve communication and documentation: 1) an improved note documentation system and 2) moving from a paging system to a phone app. Optimizing the note documentation system allowed residents more time to meet with their patients, check in with previous care physicians, and create a more rewarding work balance. The second intervention upgraded an outdated paging system between residents. Dr. Kahn oversaw the implementation of a phone app that quickly relayed pertinent information between hospital staff and residents.
Dr. Kahn believes that the program has shown that resident-run well-being programs are not only successful, but necessary: “Residents are at the frontlines of experiencing burnout and they should be integral in the decisions being made about what would best help create meaningful and rewarding work.”
Back to Bedside is a groundbreaking, iterative program that aims to utilize the perspectives, ideas, successes, and obstacles of each year’s participating residents to continue to advance the growing program. Current participants have attended two conferences where they were invited to share their ideas and discuss the program with others—not only to promote and develop the program, but also to raise awareness about the importance of physician well-being.
If you are interested in participating, visit the ACGME’s Back to Bedside webpage to learn more and apply.