Reimagining the Transition to Residency: Implications of Proposed Innovations

The transition to residency is a high-stakes, pivotal step in the medical education continuum, yet the process has become increasingly congested, creating a system that does not effectively serve applicants, medical schools, residency programs, or the public good. Significant efforts are being dedicated towards reimagining the systems underlying this transition to create a more equitable and effective process. However, any innovation carries meaningful implications for each stakeholder group. In this session, the presenters will describe several proposed innovations that specifically target the growing number of applications, followed by a panel discussion of how these innovations will affect applicants, medical school advisors, and residency programs. This will be followed by time in breakout rooms to brainstorm how to approach current and potential changes to the transition to residency at Stanford.

Learning Objectives:
At the end of this session, participants will be able to:

• Compare and contrast various proposed methods to reduce application burden in the transition to residency
• Discuss the implications of various proposed changes to the transition to residency for applicants, medical schools, and residency programs

Presented by:
Grant Lin, MD/PhD, is a resident physician in Child Neurology at Stanford Health Care/Lucille Packard Children’s Hospital. He earned his MD/PhD from Stanford University, where he performed his thesis research with Dr. Michelle Monje on the neuroimmunology of pediatric brain tumors and the rational design of combination chemotherapeutic strategies in diffuse intrinsic pontine glioma. He is also a passionate trainee advocate and has served in multiple national leadership roles throughout medical school and residency, including contributing to the Invitation Conference on USMLE Scoring (InCUS) and the Coalition for Physician Accountability’s UME-GME Review Committee.

Jesse Burk-Rafel, MD, MRes (he/him/his) is an assistant professor of medicine at NYU Grossman School of Medicine in New York City, USA. In his role as Assistant Director of UME-GME Innovation within the NYU Institute for Innovations in Medical Education, Jesse is conducting multiple studies at the intersection of informatics, artificial intelligence, health services, and medical education that explore how trainees’ educational performance across the UME-GME continuum maps to their clinical outcomes, both in training and in future practice. By understanding the relationship between training and clinical care, he hopes to develop evidence-informed medical training programs and to perform translational studies of educational interventions to improve patient care. Jesse lives with his wife and two exuberant young children in Manhattan.

Sylvia Guerra, MD, MTS, is a first-year preliminary general surgery resident at Dartmouth Hitchcock Medical Center. Prior to enrolling in medical school at Dartmouth, Sylvia graduated from Harvard Divinity School where she studied comparative theology. She is interested in medical education, diversity equity and inclusion, and in improving the UME to GME transition for learners and patients. In her free time, Sylvia enjoys spending time with her wife, their three cats, and six chickens.

Dr. Lahia Yemane serves in numerous local and national roles related to diversity, equity, and inclusion (DEI) and mentorship, including inaugural Assistant Dean for Diversity in GME within the Stanford Office of Diversity in Medical Education. Dr. Yemane's scholarship focuses on building and evaluating innovative diversity programs and studying barriers and facilitators for recruitment, inclusion, and retention of underrepresented in medicine (UIM) trainees. She is one of the founding co-directors for the Stanford Medicine Leadership Education in Advancing Diversity (LEAD) Program, which is a 10-month longitudinal leadership program for residents and fellows across GME to develop leadership and scholarship skills in addressing issues related to DEI, to produce leaders in academic medicine dedicated to DEI and to improve the culture of medicine. She is also the founding director of the Association of Pediatric Program Directors’ Advancing Inclusiveness in Medical Education Scholars (AIMS) Program, which is a national mentorship and professional development program for UIM pediatric residents interested in careers in pediatric medical education leadership.

Dr. Knox has been involved in basic science, translational and clinical research. She has mentored numerous medical students, residents, graduate students, and both post-doctoral and clinical fellows in the clinic and laboratory. She has been an Academic Advising Dean since 2002, and has served as the Associate Dean for Academic Advising since 2019.

Building the Plane as we Flew It, and Teaching the Flight Manual as we Wrote it: Teaching Primary Care During Covid-19 (and Teaching Covid-19 in Primary Care)

In a few brief weeks in March 2020, Covid-19 transformed primary care…and has continued to transform it ever since. Routine care went virtual, then returned to clinic, then went hybrid amid new surges, strained resources, and evolving concerns for patient safety and clinician wellbeing. Evolving Covid care—new respiratory tents, new vaccine clinics, new testing & treatment protocols—required high-speed assimilation and dissemination of changing clinical and institutional knowledge. Meanwhile, a firehose of evolving science tested providers’ learning curves and patients’ trust alike. Keeping the ship afloat required rapid adaptation, lifelong learning, and intentional team-building. Maintaining educational quality required these same skills, and more.

In our session, we tell the story of the outpatient Covid-19 response at VA Palo Alto, from the perspective of an educational leader (Matt) and a clinical leader (John). We discuss how our professional roles evolved and converged—specifically, how education, patient care, and leadership became more interdependent than ever. We describe how we modeled our changing roles for primary care trainees and colleagues. And we reflect on the clinical innovations that were demanded by the pandemic, and how we incorporated education—and trainees themselves—as an essential part of these evolving workflows.

Learning Objectives:

• Define the concept of a Learning Healthcare System, and describe its evolution during Covid-19, using principles such as Lean Management and the Chronic Disease Model 

• Describe several changes in primary care education—including content, style, methods, and communication tools—necessitated and fostered by the Covid-19 pandemic 

• Propose a framework to involve trainees in innovative responses to a public health crisis 

• Reflect, with our audience, on our shared experiences of the Covid-19 pandemic, through the lens of post-traumatic growth

Presented by:
Matthew Stevenson, MD
Clinical Assistant Professor, Affiliated
Primary Care and Population Health

Education Director - General Medicine Clinic
Medical Director – Palo Alto Respiratory, Covid Testing, and Covid Vaccine Clinics
VA Palo Alto Healthcare System

Matthew Stevenson is a 4th year physician and resident education director in the VA Palo Alto Healthcare System (VAPAHCS) General Medicine Clinic. As Education Director, he supervises over 50 internal medicine and psychiatry residents on continuity clinic and primary care outpatient rotations, focusing on population health, evidence-based medicine, and data-driven panel management. Before Covid, his major academic interests included use of Buprenorphine for high-risk opioid deprescribing and use of Narrative Medicine to improve physician wellbeing and patient satisfaction. During the Covid pandemic, he designed and implemented the standard work for VAPAHCS’ Respiratory and Drive-through Testing Clincs; built EHR note templates and order menus to support these clinics and capture epidemiologic data; and spearheaded integration of vaccines, oral antivirals, and pre-exposure prophylaxis into VAPAHCS primary care. He has served as executive editor of the Pegasus Review: a Medical Literary Journal, and as a judge for Stanford’s Paul Kalanithi Writing Award. He lives in Menlo Park, CA, with his wife Ilana and sons Sam (5) and Nate (3). 

John Chardos, MD
Clinical Assistant Professor, Affiliated, Stanford School of Medicine
Chief of Integrative Primary Care, VA Palo Alto Healthcare System

Dr. John Chardos is an Assistant Clinical Professor of Internal Medicine at Stanford and works full time at the VA Palo Alto Healthcare System, where he is Chief of Integrative Primary Care. After completing his Internal Medicine training and Chief Residency at UCSD, he served as Director of Telemedicine and Champion of Quality Improvement and System Reengineering at VA San Diego, where he supervised the implementation of telemedicine programs including Home Telehealth, Telemental Health and Teleretinal Imaging. In 2008, he joined the VA Palo Alto as Associate Chief of Staff for Ambulatory Care. His major clinical interests include post-combat care for recently returned veterans and safe Chronic Pain management for high-dose opioid patients. He has also led local and national efforts to implement Patient Aligned Care Teams—the VA’s version of the Patient Centered Medical Home—and to redesign them as iPACTs (Integrated PACTs) with embedded mental health services. In his free time, he enjoys spending time with his family including his 4 children Iggy (18), Franky (16), and Clara (13), and John Paul (8). He also really enjoys coffee.

Bridging the Gap: Medical Education Across Generations

• Understand salient characteristics of different generations in the workplace.

• Recognize common sources of intergenerational tensions.

• Highlight generational differences that impact both undergraduate and graduate medical education.

• Optimize strategies to enhance teaching and mentoring across generations.

Presented By:

Nichole Tyson, MD
Clinical Associate Professor, Obstetrics & Gynecology, Pediatric and Adolescent Gynecology

Rachel Chan Seay, MD
Clinical Associate Professor, Obstetrics & Gynecology

Speaker Bio:
Dr.'s Tyson and Seay are Ob/Gyn's and Dr. Tyson is one of the OB/GYN Program directors and Dr. Seay is the Ob/Gyn clerkship director for the medical students. Dr. Seay has worked tirelessly in low resource settings to train and partner with communities to promote women's health care and support medical education. She has one numerous teaching awards from her residents and time at Johns Hopkins and at a national level from APGO/CREOG-the premier educational organization for Ob/Gyn education. Dr. Tyson is a pediatric and adolescent gynecologist who comes from a 20+year background as an OB/GYN and PAG specialist at Kaiser Permanente and avid educator for faculty, residents and medical students. She is internationally recognized as a leader, educator and advocate in her field and is starting her 3 year tenure as Vice President of the North American Society of Pediatric and Adolescent Gynecology. She has won numerous teaching awards from her residents, created and hosts a podcast for the Journal of Pediatric and Adolescent Gynecology and will be welcoming the first West Coast Pediatric Adolescent Gynecology fellow to Stanford in July.

Giving and Receiving Effective Feedback

Feedback is an essential type of communication executed by academic clinicians, and, as such, carries significant weight for the growth trajectory and experiences of both trainees and faculty. Many clinical educators find feedback challenging due to time constrains, concerns about discouraging learners, or uncertainty about when and how difficult topics should be addressed. The goal of this session is to provide frameworks and tools for creating a high-quality feedback culture which will benefit all team members and the patients for whom they are caring. The last portion of the talk will be devoted to 1-2 cases in which participants will articulate an approach to providing feedback for the scenarios.

Learning Objective

• Identify features a healthy feedback culture.

• Utilize the structure Ask-Tell-Ask.

• Recognize that unconscious bias can exert a negative impact upon feedback.

Presented by:

Julia Armendariz, MD
Clinical Assistant Professor (Affiliated),
Stanford University School of Medicine,
Internal Medicine,
Department of Hospital Medicine
VA Palo Alto Health Care System

Speaker Bio:
Dr. Armendariz is an academic hospitalist at the VA Palo Alto and a Clinical Assistant Professorship (Affiliated) within the Stanford School of Medicine (SOM). Her specific area of interest in medical education is teaching effective communication to trainees and faculty. She developed a yearly Communications Workshop for Stanford SOM, is a co-director of the Stanford Internal Medicine Med Ed Elective, and is a facilitator for the feedback topic of the national Teaching the Teacher Seminar for the Department of Veteran's Affairs. She holds a steadfast belief that effective communication upholds the experiences and stories of others, whether trainees, patients, or faculty.

Mentoring and Emotional Intelligence

Emotional Intelligence (EI) has been popularized as a core skill in leadership. In recent years, its relevance to the quality of mentoring started to gain attention. This workshop will introduce participants to the key dimensions of EI that influence mentoring and key studies in this area. The participants will have the opportunity to engage with each other in a discussion of their experiences on this topic and conceptualize how they may want to go about improving the quality of their mentoring experiences (as mentors or mentees) going forward.

Learning Objectives

• Understand the elements of EI that have shown to influence the quality of mentoring outcome
• Appreciate the diverse experiences of mentors and mentees in relation to EI and common mental states (e.g., mood)
• Consider the implications in their own mentoring behaviors (as mentees or mentors)

Presented by:
Rania Sanford, EdD, ACC
Director of Faculty Professional Development,
Office of Academic Affairs

Speaker Bio:
Rania Sanford is a co-lead of the OAA's Faculty Mentoring Initiative and is Executive Director of the newly-launched Stanford Physician Leadership Certificate Program. She has been writing, presenting and training on the topics of mentoring and of career development within Stanford and elsewhere (including in Academic Medicine, Nature Careers).  Her former roles at Stanford include Assistant Dean for Postdoctoral Affairs; and Associate Vice Provost for Faculty Development and Diversity.  She is a Columbia-trained certified executive coach, and studied communication, and organizational leadership for her MA and EdD degrees.

Development of a Virtual Flipped-Classroom Seminar Integrating Innovation and Pathophysiology

Pathophysiology and Design for Cardiovascular Disease is an IntroSem course, led in a fully online flipped-classroom model, in which undergraduate students learn about multi-factorial problems in heart disease. Students also learn about and practice applying design thinking to innovate in the context of healthcare.

In this seminar, Dr. Wang and Dr. Venook will present the model for this course, and they will discuss their experiences leading a virtual course that includes student innovation and early prototyping small group activities. They will also share how they have used a flipped classroom model in which pathophysiology is largely learned using recorded videos.

Learning Objectives:

• Describe how to run innovation-centered small group activities virtually
• Describe how to create and run a flipped classroom model for innovation-based teaching of pathophysiology

Presented by:

Paul Wang, MD
Director, Stanford Cardiac Arrhythmia Service
Professor of Medicine and, by courtesy, Bioengineering

Ross Venook, MS, PhD
Senior Lecturer, Bioengineering
Director, Stanford Byers Center for Biodesign

Speaker Bio: Dr. Wang
Dr. Wang is the Director of the Stanford Cardiac Arrhythmia Service and Professor of Medicine and of Bioengineering (by courtesy). Dr. Wang is an expert in the treatment of cardiac arrhythmias, including atrial fibrillation, atrial flutter, ventricular arrhythmias, supraventricular arrhythmias, and sudden cardiac death. He has practiced cardiac electrophysiology as an arrhythmia expert for over 26 years. He was a co-inventor of catheter cryoablation, which has been used to treat almost one million arrhythmia patients and has pioneered new techniques in the management of heart rhythm problems. He has co-authored numerous textbooks and book chapters on catheter ablation, implantable defibrillators, sudden cardiac death, cardiac resynchronization/ biventricular pacing therapy, and innovations in arrhythmia therapy. He is past Chair of the American Heart Association Council on Clinical Cardiology ECG and Arrhythmias Committee, a member of the American Heart Association Council on Clinical Cardiology, and the American Heart Association National Science and Clinical Education Committee. He is a former member of the Board of Trustees of the leading professional society in his field, the Heart Rhythm Society. He has helped write the examination used for certification of heart rhythm specialists in the U.S. He founded the annual Stanford Biodesign New Arrhythmia Technologies Retreat, focusing on new technological advances in arrhythmia management and diagnosis. He serves as the Editor-in-Chief of Circulation:Arrhythmia and Electrophysiology, one of the leading scientific journals in the field. 

Speaker Bio: Dr. Venook
Dr. Venook is a Senior Lecturer in the Bioengineering department and he directs Engineering at the Stanford Byers Center for Biodesign.
Ross co-leads several undergraduate courses at Stanford, including an instrumentation lab (BIOE123) and an open-ended capstone design lab sequence (BIOE141A/B), and he supports other courses and runs hands-on workshops in the areas of prototyping and systems engineering related to medical device innovation. He enjoys the unique challenges and constraints offered by biomedical engineering projects, and he delights in the opportunity for collaborative learning in a problem-solving environment.
An Electrical Engineer by training (Stanford BS, MS, PhD), Ross’ graduate work focused on building and applying new types of MRI hardware for interventional and device-related uses. Following a Biodesign Innovation fellowship, Ross helped to start the MRI safety program at Boston Scientific Neuromodulation, where he continues working across the MRI safety community to create and improve international standards and to enable safe MRI access for patients with implanted medical devices.

Health Technology and the Doctor-Patient Relationship: Scribes, Graphic Medicine and Telehealth

As health technology continues to advance,  physicians and patients are ever-evolving to adjust to the demands of electronic health records (EHRs), patient portals, telehealth and other emerging technologies. Dr. Lee will explore the impact of technology use on the patient-doctor relationship, physician well-being and health disparities.  She will highlight the innovative use of graphic medicine and scribes to engage patients with health technology use.

Learning Objectives

• Understand the impact of EHR use and telehealth on the patient-doctor relationship, physician well-being and health disparities.  
• Identify strategies to use graphic medicine and scribes to engage patients with health technology use.

Presented by:
Wei Wei Lee, MD, MPH
Associate Dean of Students and Professional Development
Department of Medicine
Section of General Internal Medicine
University of Chicago

Speaker Bio
Dr. Lee is the Associate Dean of Students and Professional Development at the Pritzker School of Medicine and an Associate Professor of Medicine. She earned her medical degree from NYU School of Medicine and a Masters of Public Health from the Harvard School of Public Health. She completed her residency in Internal Medicine at New York Presbyterian Hospital-Weill Cornell.  At the Pritzker School of Medicine, she is the Director of Wellness Program and her research focuses on the impact of technology use on the patient-doctor relationship and physician well-being.

An Approach to Publishing Your Medical Education Innovation

Are you ready to share your medical education innovation with the world?  Most medical educators struggle with publishing single institution, single topic innovations.  In this seminar, Dr. Srinivasan will share key concepts in considering if you should publish your work (yes, please share), and how to approach the manuscript preparation and publication process -- including planning for evaluation metrics, considering system impact, and journal selection.  During the seminar, participants will use a structured framework to plan to publish their innovation.

Learning Objectives

• Utilize objective criteria to determine if your innovation is ready for publication
• Develop and outline steps to publish your work, meaningfully, within a reasonable publication timeline
   

Presented by:
Malathi Srinivasan, MD
FACP, Clinical Professor of Medicine, Director, Stanford CARE Scholars
Department of Medicine
Primary Care and Population Health

Speaker Bio
Dr. Srinivasan is a Clinical Professor of Medicine at Stanford University, Associate Director at the Stanford Center for Asian Healthcare Research and Education (Stanford CARE), Director at Stanford CARE Scholars Research Program, Fellow at the Stanford Center for Innovation in Global Health (CIGH), board member at the Stanford Clinical Teaching Seminar Series, co-founder of Stanford I-POP (instructional peer observation), and member of the Stanford Teaching and Mentoring Academy (TMA).  She is co-Director of the One Health Teaching Scholars Faculty Development Program, an international program focusing on faculty development for health professions education around the world.  At UC Davis, she was awarded the Dean’s Award for Excellence in Education.  Dr. Srinivasan’s work in medical education has focused on improving learner’s clinical skills through simulation technologies, and building faculty development programs around medical education and educational scholarship.  She is also contributor to CBS-KPIX “Medical Mondays”.