Award to Medical Residents Emphasizes Direct Patient Care

With mentorship from their faculty, the UB residents applied for and received one of 30 grants issued nationally by the Accreditation Council for Graduate Medical Education (ACGME), the body that accredits medical residency programs.

The funding is through the ACGME’s Back to Bedside program, developed to address some of the challenges facing medical residents today.

With electronic medical records now ubiquitous, providers are spending increasing amounts of time in front of a computer rather than with patients.

Medical residents — recent medical school graduates now training in the nation’s hospitals and clinics — feel that imbalance acutely.

“The move to electronic medical records makes patient care safer,” says Regina Makdissi, MD, assistant professor of medicine and associate director of the internal medicine residency program, “but it also makes it harder for physicians and residents to spend more time away from the computer screen.”

“The initiative that this award supports will make it easier for residents to spend more time providing patient care and communicating with patients and their caregivers at the bedside,” she adds.

The changes are being implemented through multidisciplinary rounds with residents, nurses, discharge planners and everyone who is involved in taking care of patients during their hospitalization at both Erie County Medical Center and Buffalo General Medical Center.

Led by AnneMarie Laurri, MD, a third-year internal medicine resident, the new effort emphasizes resident well-being by focusing on the resident-patient relationship.

Laurri and her team will address these issues through two methods.

The first is “Close the Loop rounds,” in which interns, residents and faculty meet at the patient’s bedside to educate patients about their diseases, connect with families of patients and answer any questions they may have.

“The idea is that establishing a meaningful relationship with the patient is critical for medical residents to develop as physicians and to counter professional dissatisfaction issues, such as burnout and depression,” Laurri says.

The second method is “the Attending of the Day,” recently implemented by the school’s medical residency program, which emphasizes the primary role that the medical resident plays in patient care and autonomous care decisions, with the faculty member present only in a supervisory role.

“This award recognizes the innovative ways our residents — the next generation of physicians — are thinking about how to overcome challenges in the health care system that they have recently entered and to integrate them more with the whole system,” Makdissi says.

“They are dedicated to providing the best care for their patients and giving back to the community,” says Makdissi, noting electronic medical records are here to stay.

“The point is to bring everyone together — doctors, nurses, faculty members — and to emphasize face-to-face communication among them, instead of allowing for everyone to be siloed.”

To realign patient care and residency training along these lines, the internal medicine residency program is taking concrete steps to allow for better communication and more time at the bedside.

For example, the program is restructuring the educational conferences residents must attend so that there is more time for residents to revisit the bedside and refocus on patient care.

“We are very grateful for the opportunity and extremely proud of our residents,” Makdissi says.

The ACGME Council of Review Committee Residents designed the “Back to Bedside” initiative to empower residents and fellows to develop transformative projects that combat burnout by fostering meaning in their learning environments; engaging on a deeper level with what is at the heart of medicine: their patients.

This year’s grant process was highly competitive, as the ACGME received 223 proposals focusing on:

• creating opportunities for more time engaged in direct, meaningful patient care
• developing a shared sense of teamwork and respect among colleagues
• decreasing effort spent on non-clinical, administrative responsibilities
• fostering a supportive, collegial environment