A longitudinal interprofessional faculty development program: Adds meaning to work and builds resilience

Alice Fornari, EdD, RDN Program Director VP, Faculty Development afornari@northwell.edu

Cicy George, BA Program Manager cgeorge1@northwell.edu

I do not have an affiliation (financial or otherwise) with a pharmaceutical, medical device or communications organization.

Je n’ai aucune affiliation (financière ou autre) avec une entreprise pharmaceutique, un fabricant d’appareils médicaux ou un cabinet de communication.

Mentoring and Professionalism in Training (MAP-IT)

1. Describe the Mentoring and Professionalism in Training (MAP-IT) program.

2. Review program structure and implementation, content, logistics, and outcomes data.

3. Consider this longitudinal professional development program as a resilience strategy to address burnout and increase staff engagement.

Learning Objectives

We Are Northwell Health

4 Regions within Northwell-MAP-IT is in each region

Setting the stage for a resilience building Mentoring and

Professionalism program (MAP-IT)

More than 1/3 of physicians have lost touch with the humanism & empathy, which is the heart of our profession

Tait D. Shanafelt et al. (2015). Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clinic Proceedings, 90(12): 1600-1613.

Burn-out Humanism The depersonalization rate among U.S. physicians (aka health professionals):

Why Humanism in Medical Practice?

Key drivers of burnout and engagement in physicians. Executive Leadership and Physician Well-being Shanafelt, Tait D., MD, Mayo Clinic Proceedings, Volume 92, Issue 1, 129-146 Copyright © 2016 Mayo Foundation for Medical Education and Research

Meaning in Work

Control & Flexibility

Work-life Integration

Social Support & Community at Work

Organizational Culture & Values

Efficiency & Resources

Workload & Job Demands

Less Optimal

Burnout • Exhaustion • Cynicism • Inefficacy

More Optimal

Engagement • Vigor • Dedication • Absorption

Driver Dimensions

Burnout thus imperils the

Triple Aim.

Quadruple Aim, adding the goal of improving the work life of health care providers, including clinicians and staff.

MAP-IT = Care-Team Wellbeing

Bodenheimer, T., Sinsky, C. (2014). From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider. Annals of Family Medicine. 12(6): 573-576.

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The Triple to Quadruple Aim

The Mentoring and Professionalism in Training (MAP-IT) program

Definitions

a learning relationship, which helps learners take charge of their own development, to release their potential and to achieve results which they value (Lakhani, M).

Mentoring

brings to the learning relationship compassion, respect, & sensitivity to the values, autonomy, cultural and ethnic backgrounds of others.(Blatt, Fornari, Wolpaw)

Humanistic Mentoring

“Mentors are guides. They lead us along the journey of our lives. We trust them because they have been there before. They embody our hopes, cast light on the way ahead, interpret arcane signs, warn us of lurking dangers, and point out expected delights along the way.” (Daloz, LA)

Definitions for mentoring…

01

Compassion

02

Caring

03

Empathy

04

Respect

05

Integrity

06

Justice

07

Altruism

08

Honesty

Program Vision: Increase participants’ knowledge, skills, and resilience specific to mentoring of early-career professionals they come in contact with in their daily work environments.

MAP-IT Core Values

Program Goal: To implement a curriculum that will incorporate humanism and professionalism as a core value in the development of health professionals throughout the health system.

Program Director

Add Text Simple

PowerPoint

Clinical Leader

ship

Feinstein Research

Leader ship

Culture of Care Leaders Regional HR, CLI

Dept. Chairs, GME & Physician Leaders Nursing Leaders Clinical Division Leaders

Corporate Leader

ship

The 3 Arms of the MAP-IT Community at Northwell Health

Advisory Council

Program Manager

Beginning with Appreciative Inquiry (conceptual framework)

Discovery Appreciating “The Best of

What Is”

Dream Envisioning

“What Could Be”

Positive Top

Choice

Design Co-constructing “What Should

Be”

Destiny Create

“What Will Be”

Your Text Here

Experiential Learning of

Skills

Critical Reflection

Learners/ Clinicians

Supportive Group

Process

Longitudinal Nature of the Program

Adapted from Teaching professional and humanistic values: Suggestion for a practical and theoretical model Theoretical Model Supporting Resilience

10-Month Curriculum Topics

OCTOBER

Session 2 Session 3 Session 4 Session 1

Active Role Modeling in Academic Setting

Appreciative Inquiry (related to culture formation)

DECEMBER NOVEMBER

Team Building: Dealing with Differences & Conflict

JANUARY

Feedback in Challenging Circumstances

Medical Error I (Disclosure & after the error)

Diversity & Inclusion

Medical Error II (Choosing Wisdom)

Cynical Humor in the Healthcare Setting

Building Resilience Through Self-Care

End of program evaluation/OSTE assessment

FEBRUARY

Session 7 Session 8 Session 9 Session 6

MARCH APRIL MAY JUNE JULY

Session 5

Session 10

*“Passing the Torch: Fostering Medical Humanism through Faculty Role Models” William Branch Jr., MD

Graduation July/August

Session Format

• No pre-work or post work is required of participants.

• Main expectation is that

participants attend, contribute and be present in the moment.

Story sharing based on question prompt for session topic

Narrative Writing

STEP 1 STEP 2 STEP 3 STEP 4

Use Appreciative Inquiry framework to explore session topic

Reflection

Use curriculum specific articles

Role Play/Article discussions

Session takeaways/ synthesize themes

Debrief

MAP-IT Program Themes: 2 year Out Data

Self-Care

Team Building Conflict Resolution

Mindfulness

Mentorship

Professionalism Humanism

Inter-professional Collaboration

Appreciate Inquiry

What principles were incorporated

into Clinical Practice ?

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HPM scores on CD-RISC and MBI across time points

Assessment Mean Standard Deviation Mean Standard

Deviation *P value

CD-RISC 79.3 11.9 82.8 9.9 0.031

MBI

Emotional Exhaustion (EE)

2.7 1.1 2.6 1.1 0.358

Depersonalization (DP) 1.8 0.9 1.8 0.9 0.634

Personal Accomplishment (PA)

6.1 0.8 6.4 0.5 0.005

Time 1 Time 2 *Note: HPMs Values highlighted indicate significance

Findings from 2 Scales: MBI and CDR-RISC

Leaders scores on CD-RISC and MBI across time points

Assessment Mean Standard Deviation Mean Standard

Deviation

CD-RISC 81.4 10.3 *82.7 (NS)

9.6 0.618

MBI

Emotional Exhaustion (EE)

2.5 1.0 2.5 1.0 0.904

Depersonalization (DP) 1.4 0.05 1.5 0.7 0.494

P l

Time 1 Time 2

Name of Scales

Maslach Burnout Inventory (MBI) Human Services Survey for Medical Personnel Connor-Davidson Resilience Scale (CD-RISC)

No. of Participants

87 No. of Tests

2 Pre/Post Burnout & Residence

Increase in Resiliency (CD-RISC) HPMs Statistically Significant

Increase (p<0.0.5) in HPMs

Burn out (MBI)

HPMs Statistically Significant increase (p<0.01) in Personal Accomplishment

Testimonials

From the Lead Facilitators

“…This program allowed me to create discussions on common goals allowing the healthcare provider to improve patient outcomes. Collaborative efforts allow us to share our professional work environments and views as well as we are able to share skills and knowledge to improve the quality of patient care.”

“Sharing with one another how it felt when we first started in our professions and how we were treated-really helped open discussions among the group and foster understanding of professional roles in the group dynamic.”

92% of leaders in Cohort 5 felt confident that the HPMs, upon completing of the curriculum, will be able to mentor others; and 100% would recommend MAPIT to their colleagues for professional development.

Testimonials

From the High Potential Mentors

“The program provided a guided and open exploration of how to get the most out of the caregiving experience. It was wonderful to share experiences with my cohort and listen to what was most important to them and their patients. The rich curriculum allowed us to highlight areas many do not openly discuss, bias, medical error. Overall the course served to promote wellness for the patient and the caregiver.”

”The MAP-IT program helped me remember why I entered the field of medicine in the first place and allowed me to appreciate the privilege of what we do on a daily basis. It also helped me learn to be a better mentor to our trainees and reminded me that every interaction matters.”

92% of high potential mentors in Cohort 5 surveyed felt the program enhanced their humanistic mentoring skills.

Essence of the MAP-IT Program

“My participation in the MAP IT program has allowed me to apply the techniques of appreciative inquiry, active role modeling, and

team building to optimally deliver feedback in challenging circumstances; more ideally mentor others; deal with medical

errors; and help others learn to pay attention to their unconscious and conscious behaviors that may limit or improve diversity and inclusion in their day to day activities so as to enhance self care

and overall well being in a mindful manner” -

MAP-IT Leader@ Graduation Cohort #5

HONOREE

Mentoring and Professionalism in Training (MAP-IT)

Northwell Health System, Office of Academic Affairs, New Hyde Park, NY

Mentoring and Professionalism in Training (MAP-IT) was honored as an exemplary programs at the 2019 Corman IMPACT Honors reception at the 2019 Schwartz Compassion in Action conference for making a transformational impact on staff, patients and their families while promoting compassionate, collaborative care.

Arnold P. Gold Foundation – for their support of this program and inaugural funding

Dr. William T. Branch – for collaboration on the MAP IT Program Curriculum (adapted from “Passing the Torch” and his on-going consultation).

Northwell Health MAP- IT Advisory Council Members

Northwell Health Leaders and HPMs – for trusting the program & fully participating

Special Thanks To -

Outcomes Change Growth

Thank you! Questions?

Help us improve. Your input matters.

Aidez-nous à nous améliorer. Votre opinion compte!

Download the ICRE App, or

Go to: www.royalcollege.ca /icre-evaluations to complete the session evaluation.

Téléchargez l’application de la CIFR

Visitez le www.collegeroyal.ca /evaluationscifr afin de remplir une évaluation de la séance.

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MAP-IT Publications

Toward the Quadruple Aim: Impact of a longitudinal professional development program designed to foster humanistic mentoring. Andrew Menzin, MD, Myriam Kline, PhD, Jaclyn Schindler, RN, Cicy George, BA, Andrew Yacht, MD, MSc, Alice Fornari, EdD

JCEHP, 2018

JECP, 2019

In submission

References 1. Bodenheimer, T., Sinsky, C. (2014). From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider. Annals of Family Medicine. 12(6): 573-576. 2. Branch WT Jr, Frankel R, Gracey CF, Haidet PM, Weissmann PF, Cantey P, Mitchell GA, Inui TS. A good clinician and a caring person: longitudinal faculty development and the enhancement of the human dimensions of care. Acad Med. 2009; 84:117–126. 3. Branch WT Jr. Teaching professional and humanistic values: suggestion for a practical and theoretical model. Patient Education and counseling 98 (2015) 162-167. 4. Branch WT Jr. Kern, David, Haidet, Paul, Weissmann, Peter, Gracey, Catherine F., Mitchell, Gary, Inui, Thomas. Teaching the Human Dimensions of Care in Clinical Settings. JAMA, September 5, 2001- Vol 286, No. 9. 5. Branch WT, Jr., Kern D, Haidet P, Weissmann P, Gracey CF, Mitchell G, Inui T. The Patient-Physician Relationship: Teaching the human dimensions of care in clinical settings. JAMA 2001; 286:1067-1074. 6. Branch. WT, Jr. The road to professionalism: Reflective practice and reflective learning. Elsevier 2010; 80: 327-332 7. Campbell-Sills, L, Stein, M. Psychometric Analysis and Refinement of the Connor–Davidson Resilience Scale (CD-RISC): Validation of a 10-Item Measure of Resilience. Journal of Traumatic Stress, December 6, 2007 – Vol 20, No. 6: 1019-1028. 8. Doukas DJ, McCullough LB, Wear S Perspective: Medical education in medical ethics and humanities as the foundation for developing medical professionalism. Acad Med. 2012 Mar;87(3):334-41 9. Doukas DJ, McCullough LB, Wear S. Reforming medical education in ethics and humanities by finding common ground with Abraham Flexner. Acad Med. 2010 Feb; 85(2):318-23. 10. Fornari, A., Tortez, L.M., Lay, M., Hirsch, B., Tanzi, D., Friedman, I., Ricardo, A.P., Pekmezaris, R., Branch, W. (2018). Mixed Methods Approach to Humanistic Interprofessional Faculty Development. Journal of Continuing Education in the Health Professions, 38(1), 66-72. doi: 10.1097/CEH.0000000000000184. 11. Gaufberg, Elizabeth, Batalden, Maren. The third thing in medical education. The Clinical Teacher 2007; 4: 78-81.

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References, continued

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12. Gordon Cohen, L, Ashraf Sherif, Y. Twelve tips on teaching and learning humanism in medical education. Medical Teacher 2014; 36: 680-684. 13. Logio, LS, Monhan, P, Stump, T, Branch, WT Jr, Frankel, R, Inui, TS. Exploring the Psychometric Properties of the Humanistic Teaching Practices Effectiveness Questionnaire, an Instrument to Measure the Humanistic Qualities of Medical Teachers. Academic Medicine 2011; 86: 1019-1025. 14. Shanafelt TD, Boone S, Tan L, Dyrbye LN, Sotile W, Satele D, West CP, Sloan J, Oreskovich MR. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012 Oct 8; 172(18):1377-85. 15. Shanafelt TD, Noseworhty, John H. Executive Leadership and Physician Well-being: Nine organizational Strategies to Promote Engagement and Reduce Burnout. Mayo Foundation for Medical Education and Research. January 2017: 92(1): 129-146. 16. Tsoh, J.Y., Kuo, A.K., Barr, J.W., Whitcanack, L., Merry, I., Alldredge, B.K. 2019. Developing faculty leadership from ‘within’: a 12-year reflection from an internal faculty leadership development program of an academic health sciences center. Medical Education Online. 24(1). 17. Wald HS. Guiding our learners in reflective writing: a practical approach. Lit Med. 2011 Fall; 29(2):355-75. 18. Weissmann PF, Branch WT Jr, Frankel R, Gracey CF, Haidet PM, Frankel R. Role modeling humanistic behavior: Learning bedside manner from the experts. Acad Med 2006; 81: 661-67. 19. Windle, G, Bennett, K, Noyes, J. A Methodological review of resilience scales. Health and Quality of Life Outcomes 2011, 9:8. 20. Wynia, M.K., Papadakis, M.A., Sullivan, W.M., Hafferty, F.W. (2014). More Than a List of Values and Desired Behaviors: A Foundational Understanding of Medical Professionalism. Academic Medicine. 89(5):712-4. 21. Lakhani M. When I say…Mentoring. Medical Education 2015; Volume 49, Issue 8: 757-758.