The American Medical Association today announced that the Johns Hopkins University School of Medicine along with Stanford University and University of Alabama at Birmingham will share a $1.8 million award over the next five years as part of its Reimagining Residency initiative.

The project, called The Graduate Medical Training “Laboratory”: An Innovative Program to Generate, Implement and Evaluate Interventions to Improve Resident Burnout and Clinical Skill, will create a living laboratory to study the resident training environment so that medical educators can develop interventions to improve resident well-being and clinical skill.

“We think resident education should be approached with the same rigor and pursuit of evidence as fundamental science. This is the only way to ensure we are training residents using the best approaches. We need to measure burnout and clinical skill, and all of the variables that influence these important domains,” says Brian Garibaldi, M.D., associate professor of medicine and physiology at the Johns Hopkins University School of Medicine and associate program director of the Osler Internal Medicine Residency Program.

The health care landscape and technology have changed rapidly over the last 20 years, says Sanjay Desai, associate professor of medicine at the Johns Hopkins University School of Medicine and director of the Osler Medical Training Program, the country’s first residency program and one of the top medicine residency programs in the country. “It is crucial that we prepare our residents well for the future in which they will practice. And this has to be in an evidence-based environment that promotes well-being and bedside skills,” says Desai.

Garibaldi and other medical educators at Johns Hopkins joined forces with peers at Stanford University and the University of Alabama about four years ago in an effort to reinvigorate bedside training. “Currently, trainees spend as little as 12% of their time in direct contact with patients, which decreases our ability to truly practice patient-centered care.” This collaboration became the Society of Bedside Medicine, a nonprofit organization dedicated to reinvigorating the bedside clinical exam.

The team also piloted a new assessment that uses real patients and incorporates real-time feedback from faculty members on clinical and bedside skills, including taking patient histories and performing a physical exam. “Getting this feedback in real time provides the trainees with the confidence and skills necessary to provide outstanding bedside care. We think this has the potential to improve overall resident wellness as well as clinical skills,” says Garibaldi.

This award from the American Medical Association will enable the team to probe further to identify the key stressors for physicians in training and develop interventions that help alleviate those stressors, to improve physician performance as well as patient outcomes.

“Interns and residents face increasing challenges as they learn and begin to practice medicine, and it is our responsibility to make sure they take care of themselves as well as they take care of their patients,” says Roy Ziegelstein, M.D., the Sarah Miller Coulson and Frank L. Coulson, Jr., Professor of Medicine, Mary Wallace Stanton Professor of Education and Vice Dean for Education at the Johns Hopkins University School of Medicine. “We are thrilled that Brian and Sanjay are leading this project.”

Desai and Garibaldi’s project was one of eight selected through a competitive grant process by an advisory panel made up of leading experts in medical education. The projects were selected based upon how well they addressed the aims of the program: improving the transition from medical school to residency to preserve continuity in professional development, ensuring readiness for practice through modifications of residency curricula, and optimizing the learning environment to support well-being among trainees, mentors and staff.

On the Web:

• Osler Medical Housestaff Training Program

• AMA Reimagining Residency initiative