Project ECHO-Geriatrics: Training Future Primary Care Providers to Meet the Needs of Older Adults

Project ECHO-Geriatrics: Training Future Primary Care Providers to Meet the Needs of Older Adults  

K.A. Bennett, T. Ong, A. M. Verrall, M. V. Vitiello, Z. A. Marcum, and E. A. Phelan

Journal Club entry by Annabelle Rae C. Norwood, MD, MMP Geriatrics

Tele and video conferencing are now becoming more acceptable methods in providing medical care, especially in remote or rural areas where specialist care is scarce. However, it is also now becoming a tool to provide education, such as disseminating specialist knowledge to primary care providers, as what the Extension for Community Health Outcomes (ECHO) model has done. However, there has previously been no ECHO program designed especially for residents. This innovative educational program had used case-based video conference sessions to teach geriatrics topics to family medicine residents in 9 programs that are part of a regional residency network in the northwest area of the US. This study had showed that this teaching method significantly increased self-reported geriatrics knowledge after these sessions.

Discussion Questions:

What are the advantages of this model of teaching?

What are the disadvantages and possible challenges?

Do you think this educational model can be applied to other kinds of specialist teaching during residency training?

MMC is already an ECHO hub for autism and diabetes care. How do you think we can expand this more and apply this to graduate medical education and even undergraduate medical education?



Bennett KA, Ong T, Verrall AM, Vitiello MV, Marcum ZA, Phelan EA. Project ECHO-Geriatrics: Training Future Primary Care Providers to Meet the Needs of Older Adults. J Grad Med Educ 2018;10:311-5.

Assessing Residents’ Competency at Baseline: How Much Does the Medical School Matter?

Assessing Residents’ Competency at Baseline: How Much Does the Medical School Matter?

This month’s Journal Club post was written by Kaylee Underkofler, Maine Track ’18, based on the following article: Assessing Residents’ Competency at Baseline: How Much Does the Medical School Matter? by Gollehon, Stansfield, Guppen, Colletti, Haftel, Woolliscroft, and Lypson.

As medical education shifts focus from time-based curricula to competency-based curricula, there is growing interest in how competency is measured and the factors that influence it. Motivated by a concern that new doctors may be entering residency unprepared, or incompetent, Gollehon et al. studied the relationship between interns’ medical schools of origin and their baseline competency as measured by objective structured clinical examinations (OSCE) during residency orientation. The study was performed from 2002-2012 and measured the clinical performance of all 1,795 first year residents at the University of Michigan Health System in that timeframe. Using linear mixed models, the researchers found that 4.19% of variance in overall clinical performance on the OSCE was attributable to medical school of origin. These findings suggest that where an individual attends medical school does influence their baseline competency upon entering residency. More studies are needed to characterize which features of a medical school have the greatest impact on developing competent new physicians.


Discussion Questions:

  1. How can medical schools better prepare their students for residency? What features of different medical schools might explain the observed variance in clinical performance?
  2. Should medical students undergo summative evaluation of standardized competencies as a requirement for graduation? How would this be done? Which competencies should be tested?
  3. Do you think the investigators should release the individual medical schools’ performance results? If the results were to be released, would it be acceptable for residency programs to use the data when ranking prospective trainees for the match?



  1. Gollehon NS, Stansfield RB, Gruppen LD, Colletti L, Haftel H, Woolliscroft JO, Lypson ML. Assessing residents’ competency at baseline: how much does the medical school matter? J. Grad. Med. Educ. 2017 Oct;9(5):617-621.

Medical Student Perceptions of Global Surgery at an Academic Institution: Identifying Gaps in Global Health Education

Medical Student Perceptions of Global Surgery at an Academic Institution: Identifying Gaps in Global Health Education

A. Metha, T. Xu, M. Murray, K. Casey

Journal Club Entry by Nicholas Knowland, TUSM-Maine Track Program, M18

It is well established that there are disparities between the healthcare available to developed countries and those in low-and middle- income countries (LMICs).  Less well appreciated but of increasing focus in the discussion of global health disparities is the lack of access to safe, affordable and timely surgical care that affects up to 5 billion people across the world.  This lack of care could cost up to 12.3 trillion dollars in Gross Domestic Product in LMICs from 2015-2030.  Does global health medical education adequately inform students of the public health benefit and long-term impact of surgical services in a global setting?  In this survey of 365 medical students at Johns Hopkins medical school Mehta et al. attempt to elucidate the accuracy of student perceptions of global surgery and its critical role in global public health.

Discussion Questions:

  1. How many medical students do you think would be aware that trauma causes more death international than obstetric complications or the combination of HIV/AIDS, TB and Malaria?
  2. Do you think that the importance of timely access to surgery as a fundamental part of a medical system is adequately emphasized in medical school curricula?
  3. What is the value of studying global health surgery systems or barriers in medical school training?
  4. Do you support any of the suggested additions to global health curricula found in the discussion section?

Well-Being in Residency: A Systematic Review

Well-Being in Residency: A Systematic Review

Kristin S. Raj, MD

Citation: Kristin S. Raj (2016) Well-Being in Residency: A Systematic Review. Journal of Graduate Medical Education: December 2016, Vol. 8, No. 5, pp. 674-684.

Journal Club entry by: Karyn King, TUSM-MMC, M18


The rates of physician burnout in the United States have been observed to be higher than those of the general population, in one study by Shanafelt et al (2012) burnout values were determined to be as high as 60% in certain specialties.1 Over the recent years, with increased concern for resident burnout, interventions to address resident wellness have been increasingly incorporated into graduate medical education curriculums across the United States. The objective of this well-being systematic review by Raj (2016) was to review the current literature on resident well-being and identify factors associated with well-being, identify interventions being used to address resident well-being, and provide goals for future resident well-being research. After a review of 26 articles that met inclusion criteria, the author found that several important well-being themes emerged including: sleep, coping mechanisms, resident autonomy, building of competence, and enhanced social relatedness. However, due to the fact that research on resident well-being is in its infancy and that there isn’t one widely accepted and validated tool for measuring resident wellbeing it is difficult to assess the efficacy of current interventions. The author believes that future work in the realm of resident well-being should focus on formation of a validated assessment tool so as to evaluate the broad array of interventions currently being implemented in residencies across the United States.

Discussion questions:

  • What is it about graduate medical education as it stands currently that makes residency such a difficult and stressful time for residents?
  • Did your residency have any interventions to promote well-being and if so, were they effective?
  • Do you feel it is appropriate to put so much effort and funding into resident well-being if for many years residents have progressed through residency and into life as an attending physician without such interventions?
  • If you were building a well-being assessment tool to evaluate resident well-being and the efficacy of well-being interventions what would this tool look like?
  • Do you think it is fair to allocate well-being interventions differently across different residencies based on their generally reported levels of resident burnout?
    1. For example, psychiatry physicians report burnout rates of about 41% while emergency medicine physicians report burnout rates of >60%. Would it be fair to provide more interventions for emergency medicine physicians than their psychiatry colleagues?

For information on a virtual discussion of this article, please see: JGME-ALiEM Hot Topics in Medical Education: An Analysis of a Virtual Discussion on Resident Well-Being

Additional references:

Results of a Flipped Classroom Teaching Approach in Anesthesiology Residents

Results of a Flipped Classroom Teaching Approach in Anesthesiology Residents

By John Gilboy, MS4 Tufts- Maine Track

Given the competing responsibilities of residents to patient care and professional growth, program directors must critically contemplate the most effective means of providing formal learning opportunities. Sparked by Educating Physicians: A Call for Reform of Medical School and Residency1 and fanned by increased student motivation, task value, and engagement, the UGME curriculum has transitioned from the traditional passive transfer of content-centered knowledge to a flipped classroom model emphasizing self-paced asynchronous learning and learner-center activities.2 Despite this fundamental shift, passive lectures still dominate formal education opportunities in weekly resident conferences.

Aiming to optimize knowledge and skill transference to residents, modern researchers are applying flipped classroom principles to graduate medical education.  In a prospective controlled multicenter educational research study of anesthesiology residents, educational content was delivered by either flipped classroom or traditional lecture for a given topic. Residents were assed for knowledge transfer via 40 item multiple choice test, including benchmark (pretest), acquisition (posttest), and retention (4-month retention) tests. Residents’ attitudes towards the flipped classroom were measured with a survey before and after the intervention. Results indicated that the teaching style did not impact knowledge acquisition (posttest adjusted mean = 5%, P= .06; d= 0.48), but that the flipped classroom demonstrated improved retention compared to traditional lectures (retention adjusted mean =6%, P= .014, d= 0.56). In addition to knowledge retention, residents preferred the flipped classroom modality (pre= 46%; post =82%, P< .0001).3

Questions for Discussion

  • Does implementing a flipped classroom model for resident didactics present unique logistical barriers to the residents, teaching attending, and program directors?
  • What aspects of the flipped classroom correspond to increased resident preference? Could similar elements be introduced our current lecture-based of resident curriculum?
  • Does the flipped classroom model present additional opportunities for attending to assess and provide feedback on clinical reasoning, professionalism, and/or teamwork?
  • Does the pre-assignment present a barrier to implementation and resident engagement?


  1. Dooley-Hash S. Educating Physicians: A Call for Reform of Medical School and Residency. 2010;304(11):1240–1241. doi:10.1001/jama.2010.1351
  2. Chen, Fei, Angela M. Lui, and Susan M. Martinelli. “A systematic review of the effectiveness of flipped classrooms in medical education.” Medical Education 51.6 (2017): 585-597.
  3. Martinelli, Chen, Dilorenzo, Mayer, Fairbanks, Moran, . . . Schell. (2017). Results of a Flipped Classroom Teaching Approach in Anesthesiology Residents. Journal of Graduate Medical Education,9(4), 485-490.

Empathy training in medical students – a randomized controlled trial

Empathy training in medical students – a randomized controlled trial

M. Wündrich, C. Schwartz, B. Feige, D. Lemper, C. Nissen & U. Voderholzer

Journal Club Entry by Anne Sprogell, TUSM-Maine Track Program, M18

It is well established that empathy is an important part of the doctor-patient relationship, ultimately leading to better patient satisfaction and outcomes. Given its positive impact on the patient experience, it seems logical that it should be a part of undergraduate medical education. But is empathy something that can be taught? Or is it an innate quality that you either have or you don’t? If it can be taught, what is the best strategy? In this randomized controlled trial of 158 third year medical students at a German university, Wündrich et al. attempt to answer these questions.

Discussion Questions

  1. How do you define empathy? How do you convey empathy in your own everyday practice?
  2. Do you make a delibrate effort to convey empathy to patients, or do you think it is an innate quality that you naturally portray? Is empathy a skill that you learned and that you continue to practice and develop?
  3. When giving feedback to medical students, how often do you include feedback on empathy? What concrete recommendations do you provide?

Nighthawk: Making Night Float Education and Patient Safety Soar

Nighthawk Making Night Float Education and Patient Safety Soar.

Brett W. Sadowski, Hector A. Medina, Joshua D. Hartzell, and William T. Shimeall

Journal of Graduate Medical Education: December 2017, Vol. 9, No. 6, pp. 755-758.

Journal Club Entry by Kimberly Dao, TUSM-Maine Track Program, M18

In 2003, the Accreditation Council for Graduate Medical Education (ACGME) adopted an 80-hour-workweek restriction for residents. In response, many residency programs have implemented night float rotations for patient coverage despite the numerous reports of its negative impacts on patient care and safety, education, and resident satisfaction. To address the educational void created by overnight training, the authors explored a pilot supervision program that sought to optimize patient safety and improve education.The authors found that establishing enhanced supervision, increased teaching, a must-call list, and reduced conflicting resident roles improved education and increased resident satisfaction.


Discussion questions:

  1. What is the night float culture like at Maine Medical Center (MMC)?
  2. What are the measures implemented by the MMC residency programs, if any, addressing patient safety and resident education? Which ones work and which ones don’t?
  3. Where is there an opportunity for improvement? Can MMC benefit from piloting a nighthawk system?
  4. What is the value in night float rotations? Does it still have a place in residency training?

Preparing Fourth-Year Medical Students to Teach During Internship by Haber, Bardach, Vedanthan, et al.

Preparing Fourth-Year Medical Students to Teach During Internship by Haber, Bardach, Vedanthan, et al.

Andy Biedlingmaier, Tufts M18 Student on Medical Education Elective

An important responsibility of the medical intern is to teach medical students, however new interns are not always prepared to assume the role of teacher.  There is a lack of training in teaching techniques at the medical school level, and courses in education are usually elective (i.e., not mandatory) for students. 

The medical school in this article sought to fill this knowledge gap by creating a mandatory course at the end of fourth year composed of four, one-hour classroom sessions over two separate afternoons.  The sessions were as follows:

Session 1:  Promoting understanding and retention in the clinical setting

Format:  Lecture with modeled behavior by speaker

Content: Understand that clinical teaching occurs through small, incremental   transfer of knowledge over many “teachable moments” throughout the day

Session 2:  Evaluating students fairly and giving feedback

Format:  Lecture with modeled behavior by speaker and role-play in pairs

Content:  Identifying educational goals, methods of evaluation, and criteria for effective formative and summative feedback

Session 3:  Q&A panel with residents identified as excellent teachers

Format:  Resident panel answers anonymous questions raised by students

Content:  Specific to the students’ questions

Session 4:  Small group discussions and role-playing

Format:  Discussion and role-play in groups of 6-8 students with 1-2 resident leaders per group

Content:  Clinical scenarios provide opportunity to practice teaching skills

The course was elective from 2000-2002 and mandatory from 2003-2005.  Overall course ratings from 2000-2005 had a mean of 4.4 out of 5 (5= excellent, 1=poor) from 224 completed student questionnaires (62% response rate).  The 2004 class was surveyed at the end of their intern year, and 84% of students agreed that the course helped them prepare for their role as teacher (n=45, response rate 60%). 

Questions for discussion:

1) Should a “teaching to teach” course be mandatory in undergraduate medical education? If so, when should the course occur and for how many classroom hours?

2) Do you agree with the overall content of the sessions? Are there any topics that should be omitted, added, or modified?

3) Other than as mentioned in the discussion, how could future research seek to objectively measure whether or not the course produces improved teaching in medical interns?


Haber, RJ, Bardach, NS, Vedantha, R, et al. Preparing fourth-year medical students to teach during internship.  J Gen Intern Med.  2006; 21: 518-520.

Damned If You Do, Damned If You Don’t: Bias in Evaluations of Female Resident Physicians

“Damned If You Do, Damned If You Don’t: Bias in Evaluations of Female Resident Physicians”-Esther K. Choo, MD, MPH

Journal Club Entry by Sarah Couser, TUSM-Maine Track Program, M18

For 20 years, medical schools have been accepting almost the same number of male and female students. Despite this important achievement, there remains significant gender bias when it comes to training female students and future physicians. The author of this paper discusses a recent study that identified gender bias in the evaluation of male and female third-year emergency residents. The study concludes that female residents receive “discordant feedback” regarding issues of autonomy and assertiveness, characteristically male traits. Esther Choo reflects on how this conflicting information may prevent female residents them from improving clinically.

To reference the study, please refer to this link:

“Gender Differences in Attending Physicians’ Feedback to Residents: A Qualitative Analysis”

Anna S. Mueller, Tania M. Jenkins, Melissa Osborne, Arjun Dayal, Daniel M. O’Connor, and Vineet M. Arora

Discussion questions:

1. Mueller et al. note that women only represent 38% of EM residents across the country. At Maine

Medical Center, women represent approximately ~36% of EM residents (10/28). Do you notice any

distinct differences regarding gender in your own department?

2. Can you think of any instances of gender bias in your workplace? Can you think of a situation in which

you might have been susceptible to bias?

3. What can you do to try and counteract implicit gender bias in the workplace? What can we be more

mindful of?

Are you interesting in learning if you have any implicit biases?

Take the quiz here:


Making the Case for History of Medical Education

Making the Case for History of Medical Education David Jones, Jeremy Greene, Jacalyn, Duffin, John Harley Warnert Journal of the History of Medicine and Allied Sciences. Vol 70, No.4 (2014).

Journal Club Entry by Michael P.H. Stanley, TUSM-Maine Track Program, M18

The history of history in medical education has waxed and waned since as far back as the 18th century. At its zenith in the 1950s and 1960s nearly half of all medical schools had some formal historical teaching, if not full-professorships and sometimes entire history of medicine departments.  In 2001, over 100 of 174 medical schools surveyed had no history offerings or were unsure if they did.  The authors of this paper diverge from more traditional arguments that history of medicine should be considered as one of a number of medical humanities offerings primarily in service of the core domain of Professionalism. Instead they propound that history of medicine is “an essential component of medical knowledge, reasoning, and practice.” The authors assert that by demonstrating how the history of medicine readily engages our competency-based educational objectives, the field can gain acceptance as a regular feature in medical educational curricula.

Discussion questions:

  1. If history of medicine has continued to thrive, why has its introduction and maintenance in medical school curricula waxed and waned so considerably over time?
  2. How is history of medicine different from and similar to other medical humanities (such as narrative medicine, medical ethics, medical aesthetics, etc?). How is it different from and similar to reductionist or natural science medical subjects (such as pathophysiology, biochemistry, etc?).
  3. Is trying to justify history of medicine’s inclusion in medical school curricula through competency-based education inappropriately ascribing reductive measurements to an unmeasurable field? How might programs measure competency or otherwise assess medical students in history of medicine?
  4. Where do you find opportunities for inclusion of history of medicine in your own experience of medical education?