Allison
Vise MD
Resident
in the Internal Medicine Residency Program at BWH/HVMA
PGY2
03/01/2020
Residents
on the inpatient medical service must provide high quality care for acutely ill
patients, lead interdisciplinary rounds, communicate with patients and
families, and supervise a team of junior residents and students. Residents are
expected to be proficient at participation in such high stakes clinical events
and sometimes even lead them, without any dedicated training or overt support.
Currently, post-event debriefings are happenstance, unstructured, and any
debriefing typically focuses on aspects of the clinical setting and management
rather than the emotions of clinicians. The emotional burden that accompanies
acute patient care, especially among young trainees, is a recipe for
consequences associated with burnout.
I
am interested in teaching my peers how to facilitate debriefings well, and I am
eager to study the effects of such a program. My Partners Center of Expertise-funded
medical education research project is called PAUSE, which stands for Prepare,
Analyze, Understand, Sentiment, Educate, the five steps of the PAUSE
debriefing. PAUSE is an educational program that includes: 1) Creating a brief
and interactive educational session about debriefing challenging situations
(mistakes, codes, patient deaths, a week of inpatient work, or any other
stressful situation), 2) Producing a physical tool that providers can use to
facilitate such conversations, 3) Implementing the tool in our residency program
and hospital, and 4) Studying the usefulness of the tool through both
qualitative and quantitative methods.
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| Allison facilitating a PAUSE in the new PAUSE training video |
Over
the past six months since I was awarded the COE grant, I have made progress on developing
PAUSE, with the support of my Scholars in Medical Education Pathway
co-residents and my mentors in the Departments of Medicine and Palliative Care.
Specifically, I announced PAUSE to my residency program in December, to great excitement
and support from my co-residents. A co-resident and I wrote and directed a
training film, featuring other co-residents as actors who had just been at an
imagined Code Blue. This film models a PAUSE, and is part of our training
program (see image). And, with COE funding, I have created the physical tool, an
easy to carry badge that will conveniently attach to providers’ ID lanyards in
the hospital. I have solicited and been given permission by the medical
director of the Shapiro Levine Cardiac Intensive Care Unit to roll-out our
program there, given the high rate of intense events that occur, and the
incredibly intimate work environment between nurses, pharmacists, PCAs, and
physicians there. All in the program are excited to start using PAUSE in our
hospital.
My
biggest obstacle to implementation so far has been IRB approval. I have been
waiting to roll-out the tool on the hospital floors until I have IRB final
approval, so that I can proceed with surveys and focus groups as planned. I
have learned much about the IRB process while working on PAUSE. Specifically, I
have learned about the components of an education project IRB proposal that
matter most. After several rounds of edits, I recently re-submitted my IRB, and
eagerly await its approval.
Going
forward, I am looking forward to teaching PAUSE to select groups of Internal
Medicine program residents for this pilot phase. And, I am writing a curriculum
to teach it to all outgoing Internal Medicine interns at the end of this year
during their retreat that prepares them for their PGY-2 year. This will mean
that all PGY-2 Internal Medicine residents will be ready to lead PAUSE
debriefings when they become team leaders in a few short months.
I
am most grateful for the support I have received from the Partners Center of
Expertise in Medical Education, and I am excited to implement PAUSE soon.
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