Natalie Tjota, MD; Regina Makdissi, MD; and Alysia V. Kwiatkowski, DO.

From left, Natalie Tjota, MD; Regina Makdissi, MD; and Alysia V. Kwiatkowski, DO, wrote the grant application for a DEI curriculum for internal medicine residents.

Internal Medicine Residency Receives DEI Training Grant

By. Dirk Hoffman

Published November 2, 2023

The Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo has received a $40,000 grant from the Alliance for Academic Internal Medicine (AAIM) for a novel addition to its internal medicine residency program.

“Teamwork has always been important to me and my clinical experiences have reinforced how interprofessional collaborations can enhance patient care and experience. ”
Natalie Tjota, MD
Third-year internal medicine resident

The grant was received through AAIM’s 2023 Building Trust Through Diversity, Health Care Equity, Inclusion and Diagnostic Excellence in Internal Medicine Training Grant Program.

Lack of trust in health care can have significant consequences for the health of diverse communities. To explore ways to address this challenge, a coalition of funders working toward improving trust in health care awarded $470,000 in grants to 20 projects at medical schools and teaching hospitals across the United States.

The grants ranged from $10,000 to $40,000, depending on the scope of the program, and will support interprofessional projects that are led by internal medicine residents, fellows and faculty focused on improving trust and advancing health equity. Several grants will also address diagnostic gaps that exacerbate inequity.

Incorporating IPE into Resident Curriculum

The Jacobs School grant application was submitted by the team of Regina Makdissi, MD; Alysia V. Kwiatkowski, DO; and Natalie Y. Tjota, MD.

The project is titled “Beyond Empathy: A Day in the Life of Our Patient, Bridging Care Gaps Through Interprofessional Education and Collaboration.”

It consists of a longitudinal curriculum for internal medicine residents that is designed to provide firsthand understanding of patient experiences through simulation, partnership with community-based organizations and interprofessional collaboration with the health care team.

Tjota, a third-year internal medicine resident, says she has had the opportunity to work on interprofessional education (IPE) since she was a medical student at the Jacobs School.

“The University at Buffalo has such a strong IPE curriculum on the medical student level and has been recognized nationally,” she says. “As a resident on the Curriculum Committee, my goal was to incorporate IPE into the resident curriculum to promote team building skills and a collaborative community.”

“Teamwork has always been important to me and my clinical experiences have reinforced how interprofessional collaborations can enhance patient care and experience.”

‘Walk in the Patient’s Shoes’

Together with Archana Mishra, MD, clinical professor of medicine, residents had created a series of half-day sessions called “Walk in the Patient’s Shoes.” The sessions encouraged residents to immerse themselves firsthand into simulations that fostered an understanding of what patients had to go through prior, during and after hospitalization. 

Makdissi, a clinical assistant professor of medicine and associate program director of curriculum development, brought the AAIM grant application to everyone’s attention as it dovetailed “perfectly with the curriculum we had already created,” Tjota says. 

“In addition to immersive half-day sessions, we are working on creating more electives for residents to learn about barriers to equality, community-based service organizations to bridge gaps within our community, and interprofessional care resources,” Tjota says.

The new curriculum aims to help residents better understand barriers to medical care equality, identify gaps in their care and self-reflect on practices that inadvertently widen those barriers, according to Makdissi.

“The curriculum will not only help increase patient empathy as the literature supports, but also help residents become advocates of change who improve clinical and social care pathways to break down barriers and provide optimal care for communities,” she says.

Simulating All Aspects of Patient Experience

The curriculum is broken down into the different phases of a patient experience.

The first session is focused on the patient’s experience prior to hospitalization. Residents will be given the opportunity to participate in the Asset Limited, Income Constrained, Employed (ALICE) experience hosted by United Way.

Residents will be divided into teams with varying economic backgrounds and tasked with obtaining an education, career, nutrition and housing. The residents will immerse themselves in a simulated medical experience of a challenge with making it to appointments, finding housing and transportation, and obtaining all medications with both financial and social limitations.

In the segment focused on the patient’s experience in the hospital, residents will have the opportunity to participate in an elective where they will work directly with members of the interprofessional team involved, including pharmacy, wound care, speech and swallow, physical therapy, occupational therapy, discharge planning and social work.

The final portion of the curriculum follows the patient experience outside of the hospital. Residents will work with community members (social workers, shelter directors, soup kitchen, food pantry, the C-suites in the hospitals and clinics, rehab centers) to see what resources are available to the community and what barriers currently exist to accessing these resources.

Improving Communication and Collaboration

Throughout their training, residents will participate in scavenger hunts designed to promote interprofessional collaboration and health equity understanding, says Kwiatkowski, assistant professor of medicine and director of the internal medicine residency program.

“They will also be directed to stop by a shelter such as City Mission where they will learn about social services and struggles patients go through to manage their own care post-hospitalization,” she says.

Based on survey results and experiences of the first academic year, residents will work with community partners to create a website geared towards addressing needs of the community. Community partners involved in the project are United Way, Food Bank of WNY, Buffalo City Mission, MedLaw and local church organizations.

The project ultimately aims to improve communication and collaboration among health care professionals from different disciplines — leading to better patient outcomes.

Another major goal is to create a comprehensive, evidence-based IPE program that can be replicated in various health care settings.

“We hope that this will be a sustainable curriculum that can be modeled at other institutions to connect patients to so many of the wonderful community/interprofessional resources that exist and to close the gap on health care inequalities,” Tjota says.

More Than $1 Million in Funding Dispersed

In addition to AAIM, other funding sources for the grant program are the American Board of Internal Medicine (ABIM), the ABIM Foundation, the American College of Physicians, the Gordon and Betty Moore Foundation and the Josiah Macy Jr. Foundation.

This year’s grants bring the total amount dedicated to addressing health inequities from sponsors to nearly $1.2 million. In 2023, sponsors received 105 requests for support from health systems across the United States.

“This initiative represents a significant step forward in promoting a more inclusive and equitable health care system,” said AAIM president and CEO Polly E. Parsons, MD. “The work of the grant recipients will help to improve patient outcomes by addressing health disparities so that ultimately all individuals can receive equitable and high-quality care.”