By JULIE MINDA
Several times a year, Dr. Kyle Glienke steps away from the hectic pace of his residency training with the St. Vincent Family Medicine program in Indianapolis, to join about 20 of his fellow medical residents at St. Vincent Health's Seton Cove retreat center where they reflect on their work as healers and develop strategies and approaches for centering themselves and avoiding burnout.
Medical residents of the St. Vincent Health system in Indianapolis take part in a team-building experience as part of a formation program.
During a resident formation session in the spring, the group took time to consider "small moments that we've experienced that surprised us, touched our hearts and inspired us," said Glienke, a second-year resident in a combined family medicine and internal medicine program. "The goal with that is to help us find our connection to our meaning in medicine.
"It's easy for medicine to become an assembly line of 'next patient, cross all the T's, and dot all the I's and make sure all of the check boxes are clicked off in the computer system,'" he said. "But, at the end of the day, this should be a calling for us; and helping us stay connected to that is the end goal of what we're trying to do."
The Indianapolis program is among the formation experiences offered to medical residents by facilities within St. Louis-based Ascension. Leaders of these facility-level formation initiatives have joined system-level formation experts in a "Resident Formation Pilot Group" that is establishing a framework for Ascension hospitals with residency programs to evaluate and improve upon how they form medical residents. The goal, according to background materials on the group's work, is to help hospitals support residents in considering their calling, finding deeper meaning in their work, realizing their gifts and developing their skills in a way that serves human dignity and the common good. The hospitals aim to help the residents learn to nurture themselves and others physically, spiritually and emotionally, so the residents can better serve patients and communities.
While Ascension facilities will be able to choose whether and how they will form their medical residents (and residents at each facility can choose whether to participate in formation), the Resident Formation Pilot Group will lend its expertise to facilities and will offer interested hospitals a formation curriculum, now being finalized, that draws upon ideas from existing facility-level programs but also incorporates fresh ideas.
Formation group member Dr. Steven E. Minnick works with resident formation at Ascension's St. John Hospital and Medical Center in Detroit. "My hope is that as we develop this further, our residents will become more and more in tune with the joy of being a physician. Because (that joy) is infectious, and once it becomes clear that it's OK to talk about these things, it spreads," he said.
Different strokes
Not all Ascension facilities have formal approaches to resident formation; and, among facilities that do have formal approaches, the format, degree of formality and target group for programs vary widely.
About three years ago, Ascension facility-level and system-level leaders with expertise in formation began to assess the merits of the various approaches to formation. Three Ascension ministries – Indianapolis' St. Vincent Health; Detroit's St. John Hospital and Medical Center; and Genesys Health System of Flint, Mich. – had well-developed formation programs for family medicine residents. The leaders of the programs joined Ascension formation experts and other leaders to create the Resident Formation Pilot Group.
The family medicine practice area has a natural alignment with holistic health concepts that are important to formation, said Dr. Curt Ward. "As family physicians, we function in caring for the whole family – the whole person," and that holistic health mind-set is conducive to the type of mind-body-spirit thinking that is foundational to Ascension's resident formation work. Ward is physician formation leader for Ascension in Indianapolis where he directs St. Vincent Health's family medicine residency program; co-directs its joint internal/family medicine residency program; and is medical director of a primary care center.
Consistent standards
As Ascension was assembling the Resident Formation Pilot Group, the Accreditation Council for Graduate Medical Education and the American Board of Family Medicine were completing the Family Medicine Milestone Project, an effort to establish benchmarks for use semi–annually in reviewing medical resident performance and reporting the residents' progress back to the accreditation council. The milestones cover such areas as medical knowledge; professional conduct; communications skills; critical thinking; ability to help patients manage chronic conditions; awareness of health care cost concerns; ability to advocate for individual patients and community health; and the ability to maintain one's own emotional, physical and mental health.
The Ascension pilot group is developing prompting questions for residency directors to ask themselves about how their formation approaches advance certain council milestones. For example, one milestone from the accreditation council asks whether the resident "appropriately manages situations in which maintaining personal emotional, physical and mental health are challenged." Reflective questions from Ascension's group ask how the Ascension facility connects its formation approach to this milestone and what experiences the facility is offering residents, to advance their formation, as it relates to this milestone.
While all residency programs across Ascension will have to adhere to the accreditation council's milestones to be accredited, each Ascension facility can choose whether to accept Ascension's guidance and support in incorporating the Ascension framework into its local approach.
For now, the group is working with family medicine residency programs across Ascension as they express interest. The pilot group will be a resource for Saint Thomas Rutherford Hospital in Murfreesboro, Tenn., as it adopts the framework. The group has invited Via Christi Health of Wichita, Kan.; Providence Hospital of Washington, D.C.; St. Vincent's HealthCare of Jacksonville, Fla.; and Our Lady of Lourdes Memorial Hospital of Binghamton, N.Y., to work with it on resident formation. Once the program gains traction in family medicine residencies, the pilot group plans to bring the framework to internal medicine residency programs.
Celeste Mueller, Ascension vice president of spiritual and theological formation, is part of the Resident Formation Pilot Group. She said the work is "being developed very organically through the experience of the programs." She said residency program directors are excited about the prospect of learning from one another and having standards and ideas for forming residents. "What (this pilot program) makes possible is very profound," she said.
For the residents, Mueller said, the results of Ascension's work in this area could be life-changing, as they reflect on "who am I being and becoming as a physician. It's not about forming in a particular spiritual tradition, but about coming to a fundamental understanding of what it means to be human, to serve others and to be in community."