We have worked with our Office of Clinician Support to increase awareness of existing mental health resources for our residents and faculty, especially during the pandemic with its attendant stress and social isolation. The Office of Clinician Support offers a voluntary opt-in program for residents to screen for anxiety, depression and burnout with confidential referrals for evaluation and treatment.
The BCRP takes pride in promoting activities and programs to enhance the personal and professional development of residents. As an example, we designated February as “Funuary” and created a series of fun, leisure activities that bring residents and program leaders together. We hope to bring back the Housestaff Association’s Winter Formal (if COVID cooperates) that features a dance competition among the classes.
Residency Program Training Committee
The residency program is constantly seeking to improve and innovate the way we train pediatricians and pediatrics subspecialists. The Residency Program Training Committee (RPTC) reviews all aspects of the program and proposes new content and rotations to the Executive Committee. The committee is made up of resident representatives, chief residents, program leadership and invited faculty from Boston Children’s Hospital and Boston Medical Center.
RPTC will have a major role in monitoring the major changes that we made to the schedule.
Noon Conference Series in this Academic Year will change: We will feature the best of our didactic teaching conferences and also incorporate other case-based teaching sessions from the Chief Residents and residents on the Teach Rotation. We are making the conference protected and mandatory for all residents except for those in the Brigham NICU and Birth and Transition Rotations, MSICU Rotation, ED Rotations and some Electives.
Work Family Balance Fund
Formed from a generous gift of a BCRP alum, the Work Family Balance Fund supports individual grants to facilitate the academic and professional development of residents who are juggling family needs while pursuing their professional careers. In addition, the fund supports family friendly activities such as movie nights, picnics, apple picking, and the like. A call for individual grants goes out each September.
BCRP Leadership Curriculum
We introduced a Leadership Curriculum spanning all three years that focuses on team leadership within the program and leadership roles in one’s future career with an annual housestaff-wide retreat focusing on leadership topics. In addition, each resident is assigned a leadership mentor to facilitate their leadership roles within the program such as on supervisory rotations, but also with attention to their ongoing leadership skills as they advance in their careers.
BCRP Diversity Council
This group’s activities focus on three important aims: 1) recruitment of individuals with diverse backgrounds, particularly those who are under-represented in medicine, to the BCRP; 2) providing mentorship through the Mentor Me program; and 3) promoting community. It is a priority of our program to attract people who bring diverse perspectives to enhance the program and serve our diverse patient population. The BCRP seeks to attract individuals from diverse backgrounds including, but not limited to race, ethnicity, disability, socioeconomic status, gender identity, and sexual orientation.
Behavioral and Mental Health Block
In light of the increasing prevalence of pediatric mental health disorders, a national movement towards integrated behavioral health in primary care, and a national shortage in child psychiatrists, the BCRP feels a strong responsibility to improve residency training in pediatric mental health. As such, the BCRP created a 2-week behavioral and mental health block for senior residents in conjunction with an intentional integration of a mental health curriculum over the three years of residency. The overall goal of the block is to improve resident comfort and competence in evaluating and treating pediatric populations with behavioral and mental health conditions with a focus on depression, anxiety, autistic spectrum disorder and ADHD. The rotation includes outpatient clinical work in varied integrated behavioral health settings as well as experiences with our city’s mobile emergency response team to learn skills in crisis management, behavioral de-escalation as well as behavioral health triage.
The I-PASS Handoff Curriculum
As part of our aim to improve communication and patient safety (reduction in medical errors), we piloted and implemented a standardized approach to resident handoffs on the inpatient units with the introduction of the I-PASS handoff process. We employ a standard language for our verbal handoffs to focus the discussion at evening sign-out. Using our electronic medical record, we developed an electronic handoff tool that imports medical information automatically and residents update text fields within the electronic handoff tool to provide timely information about:
- Illness severity
- Patient summary
- Action list
- Situation awareness and contingency planning
- Synthesis by receiver
This curriculum is evidence-based and ensures a shared mental model for the care of patients on the team. The pilot study demonstrated a 40% reduction in medical errors, a decrease of time at the computer (roughly 30 minutes per day), and increased time at the bedside (30 minutes per resident per day). On the basis of these results, we are implementing the I-PASS handoff process across our program. More information about the I-PASS study and the educational curriculum is available at the I-PASS website, and in several publications: Sectish 2010, Starmer 2012, O’Toole 2013 and Starmer 2013.
As we have always done, we continue to emphasize educational scholarship in our program and study the impacts of curricular change.
Bringing I-PASS to the Bedside: Standardizing Patient Centered Communication to Improve Understanding and Enhance Patient Safety
This initiative aims to reduce medical errors, improve the patient, family, and provider experiences, and promote a shared mental model of the plan of care. Based on pilot data that patients and families had a discordant understanding of the plan of care, Boston Children’s investigators Alisa Khan and Christopher Landrigan developed an Intervention Bundle and launched a multisite project across North America. They found impressive results, with a 38% reduction in preventable adverse events following implementation of the Intervention Bundle!
We have implemented the new approach to care at Boston Children’s Hospital and Boston Medical Center on the general inpatient units The Intervention Bundle consists of:
- Engaging and empowering patients and families with an orientation to Patient and Family Centered Rounds on admission (with a brochure)
- A new format of discussion on rounds based on the organizing framework of the mnemonic, I-PASS, plus a written Rounds Report that summarizes what we discussed
- Standardized communication techniques throughout the day and night shifts with an inter-professional Huddle at mid-shift
We have been training faculty at both sites this Spring and will do training at Rising Junior Orientation, Rising Senior Orientation and New Intern Orientation. Patients, families and nurses have responded positively to this enhanced rounds structure.