Mentoring and Professionalism in Training

(MAP-IT)

Alice Fornari, EdD, RDNProgram Director

VP, Faculty Developmentafornari@northwell.edu

Cicy GeorgeProgram Manager

cgeorge1@northwell.edu

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

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

Learning Objectives

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MAP-IT Advisory CouncilAlice Fornari, EdD, RDVP, Faculty DevelopmentAssociate Dean,Educational Skills Development,Hofstra Northwell School of Medicine*Principal Investigator

Andrew Yacht, MD, MSc, FACPSVP, Academic AffairsAssociate Dean, Graduate Medical Education, Hofstra Northwell School of Medicine

M. Isabel Friedman, DNP, MPA, RNDirector, Clinical InitiativesDepartment of Clinical Transformation

Donna Tanzi, MPS, BSN, RN-BC, NE-BCDirector, Nursing Education & InnovationMagnet Project Director, Huntington Hospital

Andrew W. Menzin, MD, FACOG, FACSAssociate Chief, OBGYNProfessor,Hofstra Northwell School of Medicine

Bruce E. Hirsch, MD, FACP, AAHIVSAttending Physician Division of Infectious DiseasesNorth Shore University Hospital

Patti Adelman, EdD, MSEd, MSWVP, Center for Learning and Innovation & Physician Leadership Institute

Cicy George, BAProject ManagerOffice of Academic Affairs

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Setting the stage for a resilience building Mentoring and Professionalism program (MAP-IT)

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Why Humanism in Medical Practice?

The depersonalization rate among U.S. physicians (aka health

professionals): • More than one-third of physicians have lost touch with the humanism & empathy, which

is the heart of our profession

Humanism Burn-Out

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.

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Meaning in Work

Organizat-ional

Culture and Values

Social Support

and Community

at Work

Work-Life Integ-ration

Efficiency and

Resources

Control and

Flexibility

Workload and Job

Demands

Less Optimal

More Optimal

Burnout• Exhaustion• Cynicism• Inefficacy

Engagement• Vigor• Dedication• Absorption

Key drivers of burnout and engagement in physicians.

Executive Leadership and Physician Well-beingShanafelt, Tait D., MD, Mayo Clinic Proceedings, Volume 92, Issue 1, 129-146

Copyright © 2016 Mayo Foundation for Medical Education and Research

Driver Dimensions

making lists of desirable professional

characteristics is necessary and

useful for teaching and assessment

it is not, by itself, sufficient either to

fully define professionalism or to

capture its social functions.

MAP-IT

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. 7

The Triple Aim—enhancing patient experience, improving population health, and reducing costs—is widely accepted as a compass to optimize health system performance.

Yet physicians and other members of the health care workforce report widespread burnout and dissatisfaction. Burnout is associated with lower patient satisfaction, reduced health outcomes, and it may increase costs.

Burnout thus imperils the Triple Aim. Quadruple Aim, adding

the goal of improving the work life of health careproviders, 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 Mentoring and Professionalism in Training (MAP-IT) program

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Definitions

Mentoring: 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).

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

“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)

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MAP-IT Core Values

Compassion Caring Empathy RespectIntegrity Justice Altruism Honesty

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

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.

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Program Director

Clinical Leadership

Corporate Leadership

Feinstein Leadership

Advisory

Council

Program Manager

Dept. Chairs, GME & Physician

Leaders

Nursing Leaders

PA Leaders

Culture of Care Leaders

Regional HR, CLI

The 3 Arms of the MAP-IT Community at NorthwellHealth

Theoretical Model

Learners/

Clinicians

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10-Month Curriculum

Session #1-October

Appreciative Inquiry

(related to culture formation)

Session #2-November

Active Role Modeling in Academic Setting

Session #3-December

• Team Building: Dealing with Differences

and Conflict

Session #4-January

Feedback in Challenging Circumstances

Session #5-February

Medical Error I (Disclosure and after the error)

Session # 6-March

Medical Error II (Choosing Wisdom)

Session #7-April

Diversity & Inclusion

Session #8-May

Enhancing Well Being, Self Care & Resilience-Third Thing (#9 on reference list)

Session #9-June

Mindfulness

Session #10-July

End of program evaluation/ assessments/reflections

Graduation – July/August

*“Passing the Torch: Fostering Medical Humanism through Faculty Role Models” William Branch Jr., MD 14

Positive Top Choice

Discovery-Appreciating “the best of

what is”

Dream-Envisioning “what could

be”

Design-Co-

constructing “what should

be”

Destiny-Create “what

will be”

Beginning with Appreciative Inquiry (conceptual framework)

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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.

Reflection

Use Appreciative Inquiry

framework to explore session

topic

Role Play/Article discussions

Use curriculum specific articles

Debrief

Session takeaways/synthesize

themes

Narrative Writing

Story sharing based on

question prompt for session topic

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Program Logistics

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• Several small groups meet during the month at various Northwell Health locations (discussing and reviewing the same content).

• Multiple sessions allow for makeups in case participants have to miss their regularly scheduled sessions.

Successful Program Completion

Entails:-satisfactory participation in monthly sessions, a goal of 80% attendance is required, with opportunity for make-ups within month at an alternate session on same topic

-completion of pre and post assessments

-completion of an end of program evaluation

A formal certificate of program completion is issued to all participants who have met these course requirements

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Clinical MAP-IT

High Potential Mentors

Lead Facilitators

Sites Participant Demographics

Cohort 1-42014-2017

329 graduates

52 CLI, Huntington,Plainview, Phelps, Southside, and SIUH

MDs, RNs, PAs, NPs, PharmDs, Chaplains, Social Workers, Researchers, Psychologists

Cohort 52018

120 participants 32

Corporate MAP-IT

High Potential Mentors

Lead Facilitators

Sites Participant Demographics

Cohort 12017

7 graduates 2 CLI Admin Director, Director, Senior Director, Assoc Exec Director, AVP, VP, SVP

Cohort 22018

19 participants 6 CLISyosset

MAP-IT Program Data

Feinstein MAP-IT

High PotentialMentors

Lead Facilitators

Site Participant Demographics

Cohort 12018

7 graduates 2

Feinstein

Elmezzi Scholar, Post Doc Research Trainee, Scientist

Cohort 22018

16 graduates 4 Post Doc Instructors,Assistant Professors

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“Thanks for all your coordination, organization and motivational efforts for our MAP-IT Cohort 5. I greatly enjoyed and benefitted from my participation in group 7. The attendance at all 10 sessions has enhanced and refined my better natures as a professional, a clinician and as a mentor.” – Cohort 5 HP

“This has truly been a wonderful experience. The curriculum covers a wide array of important issues and the course leaders have been excellent in facilitating meaningful discussions. I have learned so much, not only through the course content but even more so through the experiences and insights of other participants in the group. It has helped me become more self-aware as a clinician, and more humanistic as an educator/mentor.” – Cohort 5 HP

MAP-IT Accolade

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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 -

Thank you!

Questions?

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Next Steps:

• Please send an email to Cicy George (cgeorge1@northwell.edu) with your confirmation to join by August 15th.

• Those who confirm participation will receive a survey to indicate your day/time preference for monthly group meetings.

References1. 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: 327-3327. 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.