Transformational Ideas Initiative (TI2)
The annual initiative funds projects proposed by MCW faculty, staff, students, residents and fellows that focus on innovating medical education aligned with one or more of the Triple Aims of Medical Education: Character, Competence and Caring.
In these projects, collaboration and partnerships within MCW and with other institutions, community members and organizations are encouraged. Accepted ideas get refined through a human-centered design process led by experienced facilitators who help teams scope and finalize their project implementation plans for success.
2022-2023 Transformational Ideas Initiative Projects
Empathy is a key component to providing quality care and has been found to correlate with improved health outcomes; however, medical students’ empathy often declines during their clinical rotations, and it has been found that pharmacy students also experience declines in empathy. In our pilot program last year, we found that having students compose reflective tweets after a patient experience is beneficial in developing empathy for patients and influencing students’ professional practice. We hope to refine and expand our project this year to understand how tweets could inform students’ character development, and how faculty could use student tweets as a way to start conversations regarding the humanization of care.
Wisconsin’s refugee population has been growing since the 1970’s and Milwaukee has become the new home for refugees from over 50 different countries. Refugees have complex health needs that may be difficult to manage, so future health care providers must develop knowledge and skills to provide care for these refugee populations. Our project will pilot 5 learning modules for students: 1.) Brief Overview of Refugee Resettlement, 2.) Bridging Language Barriers with Interpreters, 3.) Cultural Humility, 4.) Clinical Considerations, and 5.) Local Resources. We will co-develop each module with the help of faculty and/or community members with experience working with refugee populations. Our hope is to improve medical trainees’ confidence and insight in providing cross-cultural care and improve their knowledge of the refugee experience, health, and barriers to care.
Training on how to address conflict is lacking in most medical schools, and few, if any schools provide training in mediation. Recent scholarship theorizes that mediation training enhances emotional well-being, emotional intelligence, and empathy, which are key aspects of professionalism. Our project will train medical students to identify sources of conflict and dynamics that can lead to conflict, understand their own conflict style, communication style, and listening competencies, apply facilitative mediation skills to various conflict situations, address conflicts in ways that preserve relationships, and engage in reflective practices. We hope our participants will develop key conflict resolution skills, increased emotional intelligence, increased self-awareness regarding professional development, and the capacity to work with others to resolve conflicts in various settings.
There are very few opportunities for students to learn about Asian American, Native Hawaiian, and Pacific Islander (AANHPI) health disparities. The ‘model minority’ myth that portrays AANHPIs as healthy and successful overshadows the socioeconomic, cultural, and linguistic barriers that continue to persist and exacerbate health disparities among AANHPIs. Unlike for other U.S. racial groups, cancer is the leading cause of death among AANHPIs. Multiple barriers contribute to this disparity including, but not limited to, aspects of cancer screening, treatment, survival, and end-of-life care. Our project hopes to enhance learner knowledge of cross-cultural values, beliefs, and attitudes to function more effectively in diverse healthcare settings and to showcase and educate learners on AANHPI health. We hope to improve learner confidence, cultural knowledge, and cultural practice.
With Islam being the fastest-growing religion in the U.S. and the recent Muslim refugee resettlement in Milwaukee, medical student cultural competency resources are imperative in developing knowledgeable patient advocates. Our project will focus on helping students understand clinically relevant aspects of the Islam, such as dietary restrictions, religious observances, such as Ramadan, and respectful social etiquette during clinical interactions with Muslim patients. This project will provide students with tips and strategies for interacting with Muslim patients, including an opportunity to practice with a Muslim standardized patient. Overall, we hope this will improve the Muslim patient experience by equipping future physicians in providing healthcare sensitive to Islamic beliefs.
6.5 million people in the United States, and 1-3% of the global population, has an intellectual disability (ID). Despite this statistic, medical schools don’t train on how to treat people with intellectual disabilities. This project will increase medical students understanding of ID, their comfort level working with patients with ID, and their knowledge regarding the unique medical concerns and screening schedules for patients with ID. Students will learn how to communicate directly and respectfully with patients with disabilities, know how best to include them in the decision-making process, and understand under what circumstances caregivers should and should not be included in the decision-making process. We hope to develop more prepared, inclusive, empathetic, and well-trained physicians who can confidently provide high-quality care to patients with ID.
The path toward better health and quality of life for everyone must include sight-saving interventions. There is a lack of ophthalmologists and primary care physicians with competent ophthalmic knowledge who are caring for underserved communities. Our project will focus on a longitudinal strategy to increase eye health literacy among future physicians who work in underserved communities, integrating cultural competence and awareness, as well as creating a pipeline for URiM students to explore ophthalmology as a field. We hope to raise awareness of healthcare inequities related to eye care and encourage medical students to find ways to break barriers and define their role in sight preservation.
In the current medical education landscape, interpersonal training is underutilized, especially in the pre-clinical years. However, data shows the importance of communication training in pre-clinical years and its importance on clinical competence. Our project will improve the training of medical students through student-led role play, spaced learning, and reflection. Our project will assist pre-clinical students in developing and practicing critical conversation skills through navigating the nuances of difficult conversations relating to sexual health, mental health, stigmatized populations, and delivering serious or end of life news, among others.
Physicians-in-training need practical wisdom to make wise, context-sensitive decisions in complex situations that are rife with uncertainty, challenged by competing perspectives, and constrained by malignant social forces in healthcare. A physician who is a “phronimos” is a role model who embodies excellence in practical wisdom. Our project will create a learning community of MCWAH residents and MCW faculty centered around the theme of practical wisdom in medicine. We will recruit a cohort from various specialties who will explore foundational perspectives on practical wisdom, and discuss practical wisdom’s relevance in medical education and medical practice, particularly with respect to character and professional development.
The COVID-19 pandemic increased supply and demand for telehealth patient care. More than ever before, our medical students have participated in telehealth visits to observe the interactions between physicians and patients. However, there has not been an organized telehealth curriculum that emphasizes active patient care using standardized patients. Our project will utilize simulation sessions that include educational methodology with evidence in experiential learning. We hope this simulation curriculum can increase the exposure and awareness of patient care using a virtual platform, and assess their readiness and competency using the technology.
By Meredith A. Albrecht, MD, PhD; Christina D. Diaz, MD and Libby Ellinas, MD
MCW’s 4C program builds learning communities of students and faculty that foster longitudinal relationships and cultivate personal and professional growth, assisting medical students with stresses that lead to burnout and poor outcomes. Unfortunately, medical students are not the only group experiencing these stresses. High faculty turnover and burnout negatively affect both the faculty and the learning environment, especially in the high stress siloed environments like the operating room, leading many early career faculty (especially URiM faculty) to leave academics after 1-3 years. Our project will adapt the 4C model to develop a program for early career faculty, beginning with a pilot program in the Anesthesiology department. We hope to decrease burnout, increase job satisfaction, increase retention, increase academic productivity, and improve the teaching scores of junior faculty who participate in our project.
Appropriate expectations for a learning experience are critical to achieving goals and ensuring an educational experience during a clinical rotation. Every junior resident and medical student have had the experience of walking into a new rotation with little idea what to expect, and every senior resident has started a new rotation with learners whose skills and experience they aren’t familiar with, leading to frustration over unclear goals and expectations for all parties. Our project aims to develop training for senior residents to best prepare their team for safe, efficient, and educational patient care at the beginning of a new rotation. We hope our project will improve cohesiveness of medical teams by providing insight into the goals and objectives of each individual member which will translate into better patient care.
Medical school is a demanding academic environment requiring long hours of study. This sedentary lifestyle can have many negative effects, including burnout and deteriorating mental health. Physical activity declines as medical students feel pressured to prioritize their studies over exercising and other physical activities. Adding active learning resources to traditional study spaces will help those who struggle to study while sitting and will provide a study-friendly movement option for all students. Our team hopes to create a space on the Green Bay campus where students can study in an active fashion while not distracting those who choose not to utilize active learning. We hope to promote physical and mental well-being, as well as improve study habits of students by providing an active learning space.
Regardless of which specialty one matches into, all physicians interact with diverse populations, including those from different religious or spiritual groups. These various groups may ultimately refuse certain treatments or interventions due to their personal beliefs. Currently, MCW lacks a formal curriculum focused on religion and spirituality in relation to medicine. Our team plans to begin the work that will help inform the development of a future course to teach medical students how to best care for patients from different religious and spiritual backgrounds, while still emphasizing the importance of patient autonomy in making healthcare decisions.
As physicians of all specialties will care for patients and families facing serious illness, it is imperative that the MCW curriculum closes the gap on a longitudinal approach for development of foundational end-of-life (EOL) and palliative care communication skills. Our project will identify key themes for EOL and palliative care medical student education as well as timing for experiential teaching methods. Recent work completed by the Kern National Network will serve as the foundation to identify innovative methods for building student character strengths in curiosity, empathy, and humility through the lens of palliative skill. Our team plans to pilot experiential small group sessions that focus on narrative reflection within existing preclinical (REACH/4C) programs and/or clinical clerkships. We will design student-centered approaches for integration into high impact rotations with intense exposure to death and dying. These approaches will incorporate self-care and wellness, addressing an essential element in caring for seriously ill and dying patients.
2021-22 Transformational Ideas Initiative Projects
Most medical students come from households with stable food, housing and security whereas a significant number of our patients do not. Currently, for our students at MCW, there is opportunity to expand formal teaching on social determinants of health (SDH), provide a safe space to practice crucial SDH assessments, and increase exposure to vulnerable patient populations and community resources in the preclinical years. Recently, virtual platforms have become widespread, enhancing opportunities to engage with vulnerable populations and community-based resources.
We propose a five-session curriculum for pre-clinical students to provide tools to effectively and holistically care for vulnerable patients using simulation, narrative and visualization complemented with a one-session training on providing effective feedback for residents and attending physicians. We will provide a safe space for students to practice and receive feedback on interview skills, engage with persons who have undergone housing, food or security crises, and “see” places in the community where these needs are addressed.
Key steps will be to 1) partner with key educational stakeholders at MCW and leaders with shared goals; 2) administer a needs assessment of students including baseline knowledge of SDH, personal familiarity with vulnerable groups, and familiarity with hospital and community-based resources; 3) finalize cases to practice SDH assessment; 4) finalize community partners, such as advocates and persons who have the life experience of housing, food or safety insecurity; 5) develop a high yield training session on providing effective feedback on SDH assessment skills; and 6) recruit faculty and resident advocates to assess SDH simulation as well as student’s final project in small groups.
Our goal is to help students ACCESS better care by enhancing Awareness of the importance of SDH to biologic health outcomes; Competence and Comfort interviewing patients on SDH, Empathy for vulnerable patient groups experiencing housing, food, or security crises through personal encounters; and Social Services awareness and referrals.
While the impact of racism and bias in medical education at MCW is beginning to be acknowledged, novel strategies are needed to ensure that confronting racism in medicine in the new curricular design process is prioritized.
To address the paucity of lessons about racial and health equity (including social determinants of health, health disparities and historical policies) in the medical school preclinical curriculum, our ultimate goal is to develop a list of actionable recommendations that we will propose to leadership making curricular re-design decisions. The current plan is a three-step process. First, we will build a diverse team comprised of faculty, students, and staff at MCW who will review published literature for successful implementation of an antiracist medical school curriculum. The second step is the creation and distribution of a survey based upon the aforementioned literature search in order to collect current student input on the future antiracist curriculum. Step three involves analysis and synthesis of the survey data to develop a list of actionable steps the team will present to leadership and those making decisions in curriculum redesign at MCW. The timing of this project aligns beautifully with curriculum redesign to be implemented in Fall 2022. As such, MCW has a unique opportunity to intentionally and thoughtfully design an antiracist medical school curriculum that emphasizes mattering and character. Our research team will focus on cultivating a culture of teamwork, kindness, and gratitude for one another and for student input. A key element of our proposal is to identify topics informed by current students that need to be more explicitly taught and learned early in the careers of student physicians. To do so will employ curiosity, love of learning, and humility. We are very excited to improve health equity and inform the future medical school curriculum at MCW!
By Leilani Hernandez, M3; Pinky Jha, MD; Brian Gooley, MD; Brady McIntosh, MD; and Sanjay Bhandari, MD
Emergency physicians and hospitalists have a shared responsibility in caring for the sickest patients while utilizing expensive hospital resources. However, there are few opportunities for collaboration. Our goal is to improve collaboration between providers in the ED and hospital floor using a novel approach. We will provide EM residents with follow-up information on patients they met after being worked up on the hospital floor. To decrease the burden on the hospital side, we will utilize medical students to summarize this information.
First, we plan to collaborate with medicine clerkship directors to ensure that student outcomes align with the clerkship. Medical students will write a succinct summary and review it with an attending/senior resident before sharing with EM resident.
We hope that medical students will benefit because this will create more opportunities to demonstrate clerkship learning objectives such as gathering the appropriate amount of information, interpreting basic diagnostic tests, generating a prioritized differential diagnosis, and describing diagnostic and therapeutic plans. We hope that EM residents will benefit from learning more about patients’ course of illness, and it may help them realize certain biases in clinical decision-making, to act more cautiously in a similar scenario, as well as fostering a “no blame” culture for learning from patient errors.
By Melinda Pierdomenico, DO; Sarah Larsen, MD, MPH; Jessica Smoko, MS3; and Kevin Robertson, MD
On average, medical schools nationwide provide an average of two hours of pre-clinical lectures dedicated to LGBTQIA individuals, while these sexual and gender minorities (SGM) experience increased levels of alcohol and substance use disorder, homelessness, mental illness, HIV, certain cancers, and hate crimes compared to their cis, heterosexual counterparts. This project will focus on incorporating interactive, facilitated, case-based learning into pre-clinical curriculum to increase the awareness of unique disparities that SGM experience, as well as addressing the implicit bias that many have towards LGBTQIA individuals.
We plan to use an Implicit Bias test through Harvard of both the sexuality IAT as well as the transgender IAT for all students participating in case-based learning. Multiple cases will be generated centered around SGM as it pertains to well exams, cancer screenings, sexual history, hormone replacement therapy, and acute concerns. These cases will be based off of real-life scenarios that those who are LGBTQIA have experienced. Studies have shown that when facilitated, case-based learning is taught by someone who identifies as that patient population (in this instance, LGBTQIA) that students have greater empathy moving forward when working with those populations, so it will be imperative to recruit medical professionals to facilitate these cases who identify as LGBTQIA.
The primary outcome will be increasing the general awareness of pre-clinical students of the unique disparities that SGM face on a daily basis, especially in a doctor’s office which will hopefully lead to greater empathy and compassion towards this population.
By Harini Shah, M1; Kathlyn Fletcher, MD; Jessica Miller, M1; Tracy Bui, M1; Elizabeth Dominguez, M1; Aliyah Keval, M1; and Marisa Tobes, M1
Studies show that minority medical students experience racism that continues through residency, physician-hood, and leadership. Despite advancements in gender equity at the medical school level, progress is marginal or nonexistent for black, indigenous, and physician trainees of color. The AAMC has suggested that “non-inclusive learning environments…have profound implications for the well-being and academic success of students” and are implicated in higher attrition rates among minority physicians.
We propose the creation of an annual anti-racism pledge around the time of M1 orientation, modified to each incoming class’ specific goals, to serve as an intentional reminder to foster an inclusive environment for minority peers. We hope that this anti-racism pledge will instill a sense of personal diligence in creating a welcoming environment for everyone, especially for our minority colleagues and patients. In doing so, we aim to increase the sense of inclusivity felt by minority students, which will have profound implications for both academic success and career longevity.
By Chase LaRue, MEd, M2; Erica Chou, MD; Kerrie Quirk, MEd; Max Hershey, M1; Enrique Avila, M1
COVID-19 disrupted traditional methods of education delivery and pivoted teaching to virtual platforms. Teachers now need to address additional considerations in their teaching sessions, such as managing and utilizing technology, which takes practice, trial and error to learn what works. Medical education has been moving away from traditional lectures and is beginning to embrace a more student-centered pedagogy. In designing new educational sessions focused on active learning, teachers must consider how students will engage in these activities, but they don’t have the opportunity to seek feedback from students prior to implementing their sessions.
Currently, students provide feedback on courses and teaching sessions through end of course evaluations, which are not timely and doesn’t allow for changes to be implemented until the following year. This makes the educational quality improvement process slow and less effective.
Our idea is to develop a Teaching Test Kitchen which provides a forum for teachers to test teaching sessions with volunteer testers. The teachers can practice or perform a “dry run” of their sessions and receive real-time, low-stakes, constructive feedback on any or all aspects of the session, including content, instructions, timing, technology, logistics, etc. This process will allow teachers to improve and adjust their sessions as necessary and feel more confident when delivering their sessions to a real audience. This also allows students to contribute at their level of expertise and collaborate in co-designing curriculum, which provides both teachers and students with different perspectives.
We would like to have the Teaching Test Kitchen be an easily accessible resource that is available to all students, residents, fellows, faculty and staff who will be conducting teaching sessions.
Medical student dissatisfaction with their surgical clerkships, including the third year 8-week Surgery and the 2-week Gynecology rotations, is a long-standing problem for medical schools across the nation. Surgical rotations are unique in that students balance time between wards, clinics, and operating rooms. The exposure to high stress environment in the operating room, and the varying clinical environments, negatively impacts the students’ perception of mattering on the team. The concept of mattering, in which another person’s behaviors, actions, or words make you feel useful and valued, is important for medical students’ satisfaction in a learning environment.
Our project will expand on work from the KINETIC3 program where we explored mattering among Surgery Clerkship Students. This project extension will incorporate Gynecology, from the student perspective, as well as the entire interdisciplinary care team. We hope this project will motivate members of the interdisciplinary care team to recognize strengths in themselves and how to best connect with students, recognizing their value in the care team.
By Nathan Rosenberg, BSN, RN, CCTN; Andrew Cochran, PT, DPT; and Kurt Hammitt, MSN, RN
Medical students, residents, and nurses are required to practice and collaborate in the clinical environment. However, in the educational environment they are educated in isolated curriculums. We propose to integrate medical students and residents into the nurse residency program to enhance communication, role definition, and teamwork development through the chain of command and care needs.
We plan to develop a simulation curriculum for blended nurse residency and medical provider simulation scenarios with hands-on simulation for residents, nurses and medical students. We hope this project will increase self-reporting of feeling valued and respected by team members, increase understanding and use of team debriefing in the clinical environment and lead to improved patient outcomes.
By Emelyn Zaworski, M1; Sofie Kjellesvig, M1; Eric Weaver, M1; Eric Lee, M1; Meghan Peterson, M1; and Jesslyn Hendrickson, M1
First year didactic courses do not expose medical students to the realities of medicine. Unless students have had prior work experiences with healthcare delivery, they often have little knowledge regarding crucial components of their future practice. In order to provide more competent, patient-centered care, students need earlier exposure to topics such as interprofessional teamwork, care coordination, and healthcare financing early in their academic careers. This project aims to develop learning applications in Health Systems Science starting at the beginning of medical school.
Our team will create a series of exercises to better prepare first year medical students for residency and beyond. Instructional content will be developed collaboratively with current residents and social workers to ensure material is relevant and presented effectively. Exercises will include interprofessional education sessions with social workers and social work students. Students will also be provided a reference sheet for local resources (free clinics, transportation, diet programs, childcare, etc). For healthcare financing education, we will partner with the Benjamin Rush Institute.
By integrating Health Systems Science modules into the curriculum, we hope to:
- Increase interprofessional collaboration to foster systemic change
- Enable students to provide more compassionate care
- Improve student competence and comfort
- Improve quality of patient care
By Allison Carlisle, MPH, MS1 and Emma Lankey, RDN, MS1
Due to the COVID-19 pandemic, mental health has been tested in an unprecedented way. As first-year medical students, we have been unable to connect with our peers and faculty in a normative format and working to find our sense of mattering within this new community we’ve joined has proven difficult. Outside of the setting of a global pandemic, we saw a need for a community gathering space where people can come together to discuss health topics to supplement our formal medical training (personal wellness, nutrition, community, belonging, sustainability, social determinants of health) and establish a gathering place just to unwind with friends.
The MCW-Green Bay campus garden program aims to build community and provide an outdoor gathering space. In addition to garden maintenance, each gardening session will begin with conversation starter for participants to discuss topics related to personal and community wellness. “Wellness Minute” conversation starters may include gratitude, mindful movement, nourishing/fueling the body with garden products, mindfulness meditation, access to produce, and sustainability/environmental wellness. The social media arm aims to expand on the “Wellness Minute” topics and highlight the importance of the work with the broader community.
In addition to gardening, we hope to create a place of gathering for our peers. We intend to host events, barbecues, cooking classes, and other social activities in this community space. We also intend to expand our “space” into the greater De Pere/Green Bay area by taking group outing to the farmer’s market and other local outdoor events.
Overall, we hope the garden program builds a sense of community, improves student mental health/wellness, fosters a sense of belonging, and increases awareness of the impact that nutrition and social determinants of health have on overall wellness.
Medical College of Wisconsin
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