Welcome to our 11th annual Top Hospitalists issue! The profiled physicians were nominated by their colleagues and chosen by ACP Hospitalist's editorial board for their accomplishments in areas of hospitalist practice such as patient care, quality improvement, and medical education. Read on to learn about their achievements and innovations.
Note: ACP Hospitalist's Top Hospitalists feature is not part of the ACP National Awards Program.
Bringing hospital medicine to the Middle East
Mahmoud Alhawamdeh, MD, MBA, FACP
Medical school: Jordan University of Science and Technology Faculty of Medicine, Irbid
Residency: New York Medical College program at Metropolitan Hospital Center, New York City
Mahmoud Alhawamdeh, MD, MBA, FACP, loves to try new things in new places.
After moving from Jordan to New York City to complete his internal medicine residency, he moved even farther west to Kennewick, Wash., where he started his first job as a hospitalist. “The concept of hospitalists was very new to the country, so I helped cofound the first hospital medicine program in the town where I worked in 2001,” said Dr. Alhawamdeh.
Over the next 10-plus years, he served as director of the hospital's stroke center and director of the chest pain center, as well as program director for a new internal medicine residency program, all while growing the hospital medicine program. Then, in 2012, when Dr. Alhawamdeh learned that a new branch of Cleveland Clinic was opening in Abu Dhabi, United Arab Emirates, and recruiting physicians, he traveled across the world for an interview.
“It is in me that I like to start new projects, get them going, and move on to help start others,” he said.
Overall, about 8,000 applicants vied for 200 initial positions at the brand-new hospital, said Dr. Alhawamdeh, whom administrators selected as chair of the hospital medicine program. The luxury hospital, which opened to the public in May 2015, is certified as a LEED Gold (Leadership in Energy and Environmental Design) energy-efficient green building. “It's an amazing structure,” he said. “It was built on Al Maryah Island.”
For eight months, Dr. Alhawamdeh, who is also a clinical assistant professor of medicine, helped set up policies, procedures, and clinical services until the hospital began seeing patients in 2015. At that time, he had hired nine hospitalists.
Since then, the hospital medicine program has grown to 35 clinicians, and it will have 44 by the end of 2018, Dr. Alhawamdeh said. Nurse practitioners and physician assistants, the first advanced practitioners employed in the United Arab Emirates, make up about 10% of the group. “This was a brand-new thing for the whole country . . . because before that, they were not recognized,” he said.
Although his experience in Washington helped him start the new hospital medicine group, there are new challenges, such as a lack of a primary care network in the country and language barriers (although he speaks Arabic in addition to English). The region also has a very low number of nursing homes and rehabilitation centers, he said, so inpatients tend to stay in the hospital longer than those in the U.S. To address this issue, the hospital medicine group created a postdischarge clinic, where hospitalists care for their patients within a week of discharge. “That helped quite a bit in patient satisfaction, as well as the readmission rate,” Dr. Alhawamdeh said.
When starting a hospital medicine program, the most important component is recruiting and engaging the right people, according to Dr. Alhawamdeh. “Currently, we have 56 different committees that we are members of in the hospital. You cannot find a hospitalist that is only doing their shift and going home,” he said, adding that a new internal medicine residency program, directed by a hospitalist, launched in September 2018 with its first three residents.
The hospital currently has about 364 beds (with capacity to expand in the future) and is a tertiary and quaternary care center that receives complex cases from across the country, Dr. Alhawamdeh said, adding that locals used to travel to the U.S. or Germany for specialized care. “One of the goals of this hospital is to bring those specialized care services to the Emirati people close to home in this country so they don't have to travel abroad,” he said.
As quality officer for the hospital's medical subspecialty institute, Dr. Alhawamdeh received the annual Safety Champion award in 2018 and said he is proud of the progress made on this front in the past four years. “We're reaching a point right now where our standards and metrics are not compared only to local hospitals here, but are compared to the best hospitals in the U.S.,” he said.
To spread the concept of hospital medicine throughout the Middle East, he helped launch the Society of Hospital Medicine Middle East chapter in 2016 and currently serves as its president. “I go around to different hospitals and give presentations, and I see a growing interest in this American model of hospital medicine,” Dr. Alhawamdeh said.
Teaching about health disparities and social justice
Mobola Campbell-Yesufu, MD, MPH, ACP Member
Medical school: Georgetown University School of Medicine, Washington, D.C.
Residency: Northwestern Memorial Hospital program, Chicago
Born and raised in Nigeria, ACP Member Mobola Campbell-Yesufu, MD, MPH, was in medical school in Washington, D.C., while the HIV epidemic was raging in Africa. She chose to enter medicine to help people on the continent, and she ultimately completed a fellowship in infectious diseases with intentions of returning to Africa as a researcher.
When her plans changed, however, Dr. Campbell-Yesufu returned to Northwestern University in Chicago, where she is director of medical education for the division of hospital medicine, associate program director for the internal medicine residency program, and assistant professor of medicine. She shifted focus to particular issues affecting patients in the U.S. “Those were issues of health disparities and social determinants of health,” she said, adding that she pursued a Master of Public Health degree to help her be effective in teaching trainees about these problems.
For example, readmitted patients may have faced transportation difficulties or issues with their home environments that make it hard for them to maintain their health. “If we don't start to try to get to the root of these issues and work in collaboration with their outpatient doctors, we will unfortunately only be putting a Band-Aid on these issues, and they will return to the hospital,” she said.
To build these subjects into her teaching, in February 2017 Dr. Campbell-Yesufu launched a curriculum within the residency program that focuses on health disparities and social justice. “We see the patients in the hospital, but there's so much more affecting their health that's outside of the hospital,” she said. “How can we make an impact so that they have the best possible health outside of the hospital?”
The curriculum received positive feedback, with residents enjoying both participating in the small-group discussions and working with social workers to address patients' social determinants of health, said Dr. Campbell-Yesufu, who also codirects the department of medicine's Diversity and Cultural Affairs Council.
“They enjoy the fact that there is a dedicated formal curriculum and a time set aside to talk about these issues that aren't commonly discussed in any of their other rotations. . . . Soon after we started, news got across the institution, and other residents in different specialties also mentioned they were interested,” such as surgery, neurology, and physical medicine and rehabilitation, she said.
Most recently, in September 2018, Dr. Campbell-Yesufu helped launch the McGaw Health Equity and Advocacy Clinical Scholars Program and now serves as program director. The institution-wide clinical scholars program aims to improve education about health disparities among residents and fellows from any specialty. She also serves as a college mentor for the Northwestern University Feinberg School of Medicine class of 2020, a role in which she advises 40 students throughout their four years of medical school. Dr. Campbell-Yesufu is now working on a Master of Education and said that her passion for teaching trainees stems from the fact that she is always learning.
“Whenever I start my two-week service with the residents, I tell them, ‘Look, you guys are going to teach me just as much as I will teach you—maybe even more’ and that I don't know everything, but I'm so excited to learn from them,” she said.
Leading as a team
María (Gaby) Frank, MD, FACP
Medical school: University of Buenos Aires School of Medicine, Argentina
Residency: Hospital General de Agudos Dr. Cosme Argerich internal and emergency medicine program, Buenos Aires, Argentina; University of Colorado Hospital internal medicine program, Aurora
The joy of being a hospitalist lies in the possibility of doing different things, Gaby Frank, MD, FACP, said on a call from the cadaver lab at the University of Colorado School of Medicine, Aurora, where she teaches anatomy to medical students as associate professor of medicine and director of the Human Body Block. “It's weird for an internist to be in the cadaver lab, but here I am,” she said.
For instance, after three months of teaching anatomy and no clinical shifts, Dr. Frank usually feels the need to go see patients. “So it's a great combination of different things,” she said. “You get the opportunity to play many different roles and always be satisfied with what you're doing.”
Team leadership is another component of Dr. Frank's varied hospital medicine career. Before becoming associate director of the department of medicine for Denver Health, she served as associate chief of hospital medicine for five years, then as interim chief from 2017 to 2018.
While serving as interim chief, Dr. Frank felt a need to bring the hospitalist group together. After a large exodus of advanced practitioners several years before, physicians grossly outnumbered nurse practitioners and physician assistants. With such a small pool of advanced practitioners, if one called out of work sick, there was no system in place to cover the clinician for the day, she said.
“I felt that there was this conflicting message: ‘The work you do is very important. However, if you're sick and you don't come to work, nobody will cover for you, so we don't need you in a way,’” said Dr. Frank. “We had to do the work without them. Those were terrible days.”
She proposed and implemented a new system that added advanced practitioners to the backup schedule, which previously provided two backup physicians per day only for each physician position. “If any of them get sick, then a physician will come and do that work,” Dr. Frank said. “I feel like that was a huge achievement because 1) we have better coverage, and 2) we have a more cohesive message within our group. I didn't receive a single complaint from physicians about having to cover for them.”
In her current role, she is now creating a quality database for the department of medicine to try to identify any patterns in morbidity and mortality “because right now, it feels like every division is very compartmentalized in what they do for quality.” To do this, Dr. Frank created a committee with one faculty member per division to set quality metrics that align with national standards.
“The good thing about this kind of project is that nobody can tell you they don't really care about quality and safety,” she said. “It's a big project, but we have the right support to make it happen.”
Partnering with difficult patients
Carrie Herzke, MD, MBA, FACP
Medical school: Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond
Residency: Medicine-pediatrics program at Duke University School of Medicine, Durham, N.C.
Carrie Herzke, MD, MBA, FACP, often says she has made a career out of doing the unpopular. “I oversaw the outside hospital transfers for the department first and have done a number of things that I think many physicians would not have naturally gravitated to,” said Dr. Herzke, director of clinical operations for the hospitalist program and associate vice chair for inpatient operations for the department of medicine at Johns Hopkins Hospital in Baltimore.
One such task is collaborating with difficult patients. While in college, Dr. Herzke worked the front desk at a YMCA branch, which taught her valuable people skills. “When you work with people, you have to master things like the blameless apology and learn not to take things personally,” she said.
These lessons came in handy when Dr. Herzke became a new faculty member at Johns Hopkins and served as the first clinical director of the MEG service, which treats patients with gastrointestinal diseases who are often quite ill and have had long, complicated histories of health problems, including chronic pain. “It was on that service when I really got to practice how to partner with patients who have behavioral difficulties or medical problems that we can't always fix,” she said.
After spending about 10 years at Hopkins, Dr. Herzke now oversees almost 270 inpatient beds, serves as assistant professor of medicine and pediatrics, and is a clinical mentor to the hospitalists, helping to solve problems when inpatient challenges arise. When she teaches clinicians how to deal with patients whose behaviors (e.g., substance use in the hospital, self-harm, and threatening staff members) compromise the safety of themselves and their care teams, she tells them to frame the issue around the patient's best interests and set limits to encourage open dialogue.
“A lot of it is just about framing and trying not to take things personally as providers, and also trying to think of ways that we can partner and negotiate with patients,” said Dr. Herzke.
To do that, she formed a multidisciplinary group of physicians, nurses, social workers, and the Hopkins legal team to create and implement a formal policy for handling patients with behavioral challenges. The policy, which aims to standardize the hospital's approach to these patients, encourages nurses to initiate behavior contracts. It began rolling out across the entire department of medicine in August 2018.
“When we set the rules and then we change them, that can lead to a lot of frustration, both on the patient side and the provider side,” said Dr. Herzke. “So [the policy] is trying to teach people strategies on how to have respectful communication while setting limits.”
She views spending time with patients during their most stressful and vulnerable moments as a blessing and an opportunity to provide good care. “I think it's important as hospitalists that we do that well . . . and then finding problems and being able to work within the hospital system to try to fix those, which is another thing that I really enjoy doing,” Dr. Herzke said.
Although she envisioned becoming an associate program director after residency, she said she ended up falling in love with managing clinical operations. “The thing I like is that I'm able to take a problem that a lot of us experience and try to work on real solutions to those problems,” Dr. Herzke said. “Sometimes that can be really frustrating, but it's really rewarding when it works.”
Bringing people together
Chi-Cheng Huang, MD, FACP
Medical school: Harvard Medical School, Boston
Residency: Combined internal medicine-pediatrics program at Brigham and Women's Hospital, Boston Children's Hospital, and Massachusetts General Hospital, Boston
Despite his title as executive medical director of general medicine and the hospital medicine service line, Chi-Cheng Huang, MD, FACP, said he will always spend at least 25% of his time seeing patients at Wake Forest Baptist Health System in Winston-Salem, N.C.
“It definitely grounds me and helps me understand the challenges that our frontline people have and . . . allows me to legitimize myself. If I'm going to implement a policy, it's going to affect me also on the front lines,” said Dr. Huang, who is also section chief of hospital medicine.
After spending many years in Massachusetts working at Brigham and Women's Hospital, Boston Medical Center, and Lahey Health, Dr. Huang moved to North Carolina in November 2017 for a new job. So far, his major responsibility is creating affiliations with other hospitals and building a system-wide hospital medicine service with about 100 total physicians and advanced practitioners.
“It helps not only the entire system, but also our patients and our patients' families, because I believe right patient, right place, right time,” said Dr. Huang. “If a patient really needs tertiary care, then they should go to the tertiary care center. But if they need nontertiary care, then it's probably best . . . to be at a community hospital and closer to home.”
He said the health system's mergers, which as of September 2018 include High Point Medical Center in High Point, N.C., are one of the biggest accomplishments from a hospital medicine standpoint. “It was a lot of long nights at times, but full transformation takes about three years,” said Dr. Huang.
Part of the process of merging hospitals is getting all physicians and advanced practitioners on the same page, which he does by stepping into their shoes and understanding the strengths and opportunities. “I always like to do my first week and see what it's like on the ground,” said Dr. Huang, who was in the middle of his first week at High Point. “You've got to learn what it's like in order to be able to lead.”
In addition to ensuring high-quality inpatient care at all sites, he makes sure the hospitals are doing what is best for patients and families, as well as the broader health system and population health standpoint. At Wake Forest Baptist, he and ACP Member Dan Beekman, MD, led the 15-by-10 initiative, which decreased length of stay by encouraging the hospitalist group to discharge 15 patients by 10 a.m. each day.
“If you can do that, then it doesn't clog up the ED, and patients get through the system better,” Dr. Huang said. “It's not more work for the physician or the advanced practitioner; it's just a different way of thinking about how we get patients taken care of well.”
In addition to his time in the boardroom and patient rooms, Dr. Huang has three daughters and spent 13 years volunteering with street children in Bolivia, building an orphanage and starting a nonprofit called Kaya Children International. For Dr. Huang, these disparate activities fit into a single larger goal.
“The joy that I have is making a small yet significant difference in people's lives that would probably not be alive right now,” he said. “That is very gratifying.”
Working across hospitals to increase patient access
Rafina R. Khateeb, MD, MBA, ACP Member
Medical school: Damascus University, Syria
Residency: St. Joseph Mercy Ann Arbor program, Michigan
For ACP Member Rafina R. Khateeb, MD, MBA, returning to St. Joe's, the hospital where she completed residency, has brought on déjà vu. “Every time I come here, I run into somebody I knew from 10 years ago, and I remember them as soon as I see their faces,” said Dr. Khateeb, who is a clinical assistant professor and director of clinical strategy for the division of hospital medicine at University of Michigan Medical School.
Dr. Khateeb returned to the hospital in September 2018 after the University of Michigan's hospital medicine division asked her to be medical director for the new Michigan St. Joe's service, 10 East Medicine Unit, because of her history with the institution and her expertise in clinical strategy. At Michigan Medicine (the health arm of University of Michigan), the inpatient facility is consistently at 95% capacity, with sometimes up to 60 patients in the ED waiting for a bed, so the hospital chose to collaborate with St. Joe's to launch an offsite hospital medicine program just five miles away. “The goal is to provide care for more patients in a comfortable setting that is appropriate for their level of care,” Dr. Khateeb said.
Admitted patients first come through the Michigan Medicine ED and must agree to transfer by ambulance to the new telemetry unit, where University of Michigan geriatricians and hospitalists care for them alongside St. Joe's nurses, staff, and consultants. The service built upon an already existing one, the Acute Care for Elders unit, which had five patients at the time of launch who received care on the new unit.
Although the unit has 26 to 29 total beds, not all of them are currently available as Dr. Khateeb and her team gradually get it up and running. “If we keep the unit full, we can take the full 26 to 29 beds, but we have to prove that we have the patients before we're given more beds,” she said.
The affiliation between the two hospitals is unique in the sense that it is a collaborative, not ownership-based, relationship, Dr. Khateeb noted, adding that she is working to merge the cultures between the hospitals and staff and maximize teamwork. Her goal is to continue to build the patient census and have the unit running at full capacity within six months, although the process has posed its share of challenges.
For instance, although she remembers many staff members, the building itself and the electronic health records are different. “I'm not familiar with either one of these things,” Dr. Khateeb said. “I'm running into the people, but the building and the system are different, so I'm having to relearn all of that.”
She is currently working with the hospitals' information technology teams to develop workarounds for differences in the medical records software and paging systems the hospitals use. Fortunately, Dr. Khateeb loves problem solving.
“I love learning about complicated processes and trying to streamline them or improve them or simplify them,” she said. “Being a hospitalist, you get engrained into that hospital system and you become the expert at how things run. You have the influence to change it, and you have the ability to build bridges and to collaborate. I enjoy all of that immensely.”
Devotion to the bedside
Nidhi Rohatgi, MD, MS, FACP
Medical school: Maulana Azad Medical College, Delhi, India
Residency: Case Western Reserve University/St. Vincent Medical Center program, Cleveland, Ohio
As research lead for the surgical comanagement group at Stanford University School of Medicine in Stanford, Calif., Nidhi Rohatgi, MD, MS, FACP, believes that being at the bedside is the ultimate privilege.
“Many of the answers are right in that patient's room—they are not sitting on any electronic medical record, they are not sitting anywhere else—because history taking really never stops,” she said.
Dr. Rohatgi, a clinical associate professor of medicine and (by courtesy) neurosurgery, provides medical care for patients on the neurosurgery service and (when on call) the orthopedic surgery service, including when she's outside the hospital. At night before going to sleep, she takes one last look at the charts of all patients on the neurosurgery service and checks for comorbidities that may affect postsurgical outcomes, flagging the patients she needs to see the following day.
Prevention is the main goal of medical management of surgical patients, she said. “As surgical patients are getting more and more complex, I do not want to wait for that rapid response team or a code blue to happen for a medical team to be consulted on that patient. The goal . . . is for that bad event not to happen to them,” said Dr. Rohatgi.
Surgical comanagement by hospitalists helps reduce medical complications, length of stay, 30-day readmissions, the number of consultants used, and costs of care, according to a large 2016 Annals of Surgery study on which Dr. Rohatgi was lead author. Being there for patients, answering questions, and making sure their medications are correct improves both outcomes after surgery and patient satisfaction, she said.
“You can see it in the patient's eyes. You can see that gratitude in the family,” she said. “It's just a very rewarding experience. I set my alarm in the morning, but I will always wake up before that because I'm excited to go to work.”
Preventing delirium is another of Dr. Rohatgi's passions. She noticed that while clinicians in many subspecialties treat patients with the condition, many do not see the whole spectrum. “What I wanted to do was really get all lines together so that we can pool that knowledge, do our best for our patients, and learn more in the process,” she said.
Therefore, in 2013, Dr. Rohatgi led a hospital-wide initiative to prevent delirium and promote safer management of the condition through nonpharmacological measures. Since the effort launched, the hospital has had more than 98% adherence to screening measures as well as a 25% per year decline in delirium among patients at high risk of delirium.
Although the processes are rigorous and involve reorienting patients multiple times a day and figuring out what is precipitating the delirium, Dr. Rohatgi said she is happy to see her patients so often. “Even as much as I progress in my career and my hierarchies and titles, I hope I am able to continue to be at the bedside for my patients,” she said.
Another project that Dr. Rohatgi has significantly contributed to is the Clinical Advice Service for after-hours patient calls at her tertiary care hospital. A team of about 30 nurses trained in more than 400 clinical protocols helps navigate patients through the system and provides clinical triage, while also reducing the burden on the on-call clinicians. To date, the service has received more than 480,000 calls from patients from 38 clinical specialties.
“It's not a pager service. They get their answers,” said Dr. Rohatgi, who is also medical director of patient education. “It is not, ‘OK, someone will call you in the next 24 hours,’ and then nobody calls you in 24 hours. We've all probably been on the other side of that phone, and it just does not feel great to not get your answer when you really need it.”
Delving into documentation
Amith Skandhan, MD, ACP Member
Medical school: Vinayaka Missions Medical College, Karaikal, Pondicherry, India
Residency: University of Pittsburgh Medical Center Mercy program, Pittsburgh, Pa.
When ACP Member Amith Skandhan, MD, joined the hospital medicine program of Southeast Health in Dothan, Ala., where he is now senior lead hospitalist, he noticed that the small group of six to nine physicians had room for improvement in their billing and coding methods. When he would discuss his group's practices with other hospitalists at various conferences and meetings, he realized something wasn't right.
Dr. Skandhan went to the administration and explained that the hospital might be losing a lot of money through poor billing practices. Indeed, a root-cause analysis revealed that the hospital was losing about $500,000 to $1 million per year, “just because we were not documenting and billing appropriately,” he said.
Although Dr. Skandhan, who is now medical director/physician liaison for clinical documentation improvement, had no specific training in documentation, he worked with a colleague to look for resources and create teaching modules for the group as part of a new clinical documentation improvement initiative. “Mind you, we were two new incoming hospitalists trying to change a group which is already set in its ways. . . . That process actually helped us learn the positive aspects and the negative aspects of culture change—what works, what does not work,” he said.
The first challenge was that the physicians did not see the big picture or understand why the administration wanted to improve documentation beyond improving the hospital's own finances, Dr. Skandhan said. “They didn't understand how it affected the patient or the physician or the group,” but explaining those points helped clinicians get on board, he said. “If insurance companies deny care based on our deficient documentation, the patients could end up with bills which could have been avoided. As physicians, we need to take charge and ownership of not only their clinical care, but also their financial care and social needs.”
Although group buy-in was key to the initiative's success, recent research suggests that culture change may require less buy-in than previously thought, said Dr. Skandhan. “Previously, they used to say 35% of people have to be bought in for a new idea to be implemented, but recent research is saying 10%,” he reported. “Ten percent is a doable number, but you need to sell your vision.”
Getting a few initial people into the fold helped more clinicians begin to understand and believe in the value of improved documentation, Dr. Skandhan said. “Now that our group has grown to a team of 27 hospitalists and seven advanced care providers, the financial implications are more pronounced,” he said. “By providing ongoing education, audits, and feedback, we are able to generate an additional revenue of $900,000 every year.”
When ICD-10 needed to be implemented, the hospital administration chose Dr. Skandhan to provide education to the entire hospital system. “Billing and coding is completely different from ICD codes, so I had to go learn that and then try to figure out . . . the best way to make these changes and make physicians understand what needs to be done,” he said.
Coders click boxes based on the specific words clinicians have documented, so those words change the severity of illness recorded, Dr. Skandhan explained to the group. Without proper documentation, the hospital's case-mix index might appear to be lower than it actually is, “So you might be treating a sicker patient, but if not properly documented, it reflects poor standard of care with relation to the care plan, severity of illness, and effectiveness of treatment,” he said.
Dr. Skandhan's efforts helped increase the hospital's baseline case-mix index from 1.6490 in October 2015 to 2.1860 in January 2018, surpassing the target goal of 1.7325.
He also emphasizes the importance of clinical documentation and high-value care while training residents and medical students in his role as assistant professor of medicine at Alabama College of Osteopathic Medicine. “In addition to affecting the hospital's bottom line, poor documentation leads to a poor continuum of care, and our future health care leaders need to know and understand this,” said Dr. Skandhan.
Promoting physician wellness
Richard M. Wardrop III, MD, PhD, FACP
Medical school: Ohio State University College of Medicine, Columbus
Residency: University of North Carolina (UNC) Hospitals combined medicine-pediatrics program, Chapel Hill
Back when he became program director of UNC's internal medicine-pediatrics residency program, Richard M. Wardrop III, MD, PhD, FACP, wasn't prepared to recognize burnout in trainees.
That changed in 2015, when he joined ACP's first group of Well-being Champions. Dr. Wardrop said the training empowered him to address burnout in both trainees and peers. “I finally felt like I had some better tools to deal with what I was seeing happening,” he said.
As president-elect and later president of UNC School of Medicine's Academy of Educators, Dr. Wardrop took what he learned back to his institution and advocated for formal education. “If I was having trouble having the tools to deal with it and understand it, then I knew that other people were,” he said. “I felt like the best thing to do was . . . let the residents say it in their own words and on their own terms.”
For the 2016-2017 academic year, the medical school embraced the quadruple aim (which includes clinician satisfaction and wellness). For example, through a new “flipped classroom” format, residents taught faculty about trainee burnout. Since then, Dr. Wardrop, who is an associate professor of medicine and pediatrics, has noticed shifts in the culture, although he is quick to attribute the success to colleagues and leadership rather than himself.
“I definitely have seen more open discussions about actual operational issues that affect the lives of physicians at all levels,” he said. “This is a real, bona fide, funded part of our strategic plan that we have at UNC—not just in the medical school, but throughout the entire hospital system. Being part of that culture change has been awesome.”
Dr. Wardrop's newest wellness project is a faculty peer-coaching pilot program, which aims to bolster clinician wellness in the department of pediatrics. “It's not about fixing what's wrong with people; it's about making what's right with them better,” he said. “Hopefully, this will serve as a model for something that can be throughout the medical school for faculty.”
As an original Well-being Champion, Dr. Wardrop is working on growing and formalizing the program through his service on ACP's Physician Well-being and Professional Satisfaction Task Force. He also serves as a co-director of wellness programming for Internal Medicine Meeting 2020 and 2021. Through 2019, ACP will train a group of 120 new Well-being Champions, and each participating College chapter will have one or two Champions who serve an initial three-year term.
For Dr. Wardrop, the next step for ACP's commitment to physician wellness is to encourage a focus on well-being at the chapter level. He is Governor-elect for the College's North Carolina chapter.
“That's what I see as a challenge as a Governor coming in and as a Well-being Champion: It's going to be different based on your chapter culture,” he said.
Teaching the teachers
Roger Yu, MD, FACP
Medical school: David Geffen School of Medicine at the University of California, Los Angeles (UCLA)
Residency: UCLA-Olive View program
Roger Yu, MD, FACP, has focused on clinical education at several academic centers across the country: Beth Israel Deaconess Medical Center in Boston, the Mayo Clinic in Rochester, Minn., and Scripps Clinic in San Diego, where he currently serves as a hospitalist and chairs the Academic Hospitalist Committee.
In his current position, he and his collaborators introduced a clinical instructor program for Scripps Clinic's residents and teaching faculty. As part of the program, clinician educators utilize techniques based in adult learning theory during morning report conferences and each day on the inpatient wards.
The ability to diagnose is as important in teaching and mentoring as it is in clinical care, Dr. Yu said. “The skills required to diagnose a learner's needs are analogous to those used to determine the cause of a patient's health issue,” he said. “You need to be able to identify their knowledge or skill gap to be effective in helping them to bridge that gap.”
Graduate medical education is only one part of Dr. Yu's educational work. He is also active in organizing hospital medicine CME courses, including the hospital medicine precourse at Internal Medicine Meeting, which he has co-directed for the past few years. As part of this work, he uses a holistic, case-based approach.
“Our evaluations have shown that clinical context helps with the retention of knowledge, and our goal is to deliver information in a format that will be engaging, convincing, and memorable,” said Dr. Yu.
For example, the structure of a recent CME course featured a hospitalist coming on service to care for a typical panel of hospitalized patients. Lectures prepared by the speakers related directly to problems the hospitalist was managing on this simulated service, and course participants were able to follow along with a detailed service list.
“Feedback for the course was overwhelmingly positive,” said Dr. Yu. He added that he is looking forward to making further refinements in CME course design that will lead to even deeper audience engagement with evidence-based hospital medicine.
Even with the reach of these CME courses to national and international audiences, Dr. Yu says that his most rewarding teaching moments are still during direct mentorship of his learners—specifically when he can help them to flourish in their chosen field. “I enjoy helping people to realize their potential, to learn their craft and feel proud that they have accomplished something that requires dedication and persistence,” he said.