Straight TalkA weekly update from management on the issues that matter most. Nov 8, 2018 NCH’s graduate medical educational (GME) program continues to grow and thrive. Our twenty-nine residents include twelve first-year, twelve second-year, three chief residents and two pharmacy residents are changing our culture. I had the pleasure of meeting with each individually to understand their progress, career goals, and thoughts about our programs. Universally, these competent and ambitious physicians and pharmacists shared that our patients have been welcoming, our professional staff supportive, and the educational experience superlative. They are working hard—both day and night—as they combine clinical experience with didactic learning. The growth curve is enormous because the internal medicine and hospital pharmacy knowledge bases are massive. Healing can be very personal, and most physicians, nurses, and other care-givers have memorable reflections of an early patient who has had an impact on their development. The reverse is also true—namely patients have especially fond memories of a new care-giver who took special care of them when they were in need. Program Director Dr. Charles Graeber shared the following titled, “Just a good story.” “Dr. Lesly Silva [second year internal medicine resident] took care of a 71 y/o female in the hospital a few weeks ago. The patient, a Cuban who does speak English, was wary of physicians and hospital care. She had an axillary DVT (armpit clot) and a recently discovered breast mass. The patient was reluctant to go for a biopsy, but Lesly convinced her to do so. After the biopsy, she was referred to the clinic for follow-up. In the clinic this past Wednesday, Lesly came to me, noting this was the first time she was going to tell a patient she had cancer. We discussed this for a while and Lesly did a great job. We set up an appointment with Dr. Sharla Gayle Patterson [Fellowship trained breast surgeon] for the next morning. I suggested Lesly go to Dr. Patterson’s grand rounds, where she met Dr. Patterson and then go to the office to be the patient’s advocate. It proved to be a very positive experience for Lesly and the patient.” The art of medicine, in this case how to share bad news while developing a therapeutic trusting relationship, is a nuanced learning experience. Our clinical learning environment’s foundation is medical science. An equally important component is human interaction as beautifully shared by Dr. Graeber about Dr. Silva and her patient. In the past, an almost ignored element in the therapeutic relationship is the health of the care-giver. In 2012, the Accreditation Council for Graduate Medical Education established the Clinical Learning Environment Review (CLER) Program to improve patient care while optimizing the clinical learning environment. CLER’s focus on six goals improves care for all—patients and physicians: (1) patient safety; (2) health care quality (including health care disparities); (3) care transitions; (4) supervision; (5) fatigue management, mitigation, and duty hours; and (6) professionalism. As NCH’s GME program matures, we continue to embrace the CLER values and goals not only for our residents but also for our entire system. Having fresh, young, energetic learners asking questions, stimulating discussion, and bringing new energy enhances our cultural transformation as we help everyone live a longer, happier, and healthier life. P.S. DO YOU HAVE A COLLEAGUE OR FRIEND WHO WOULD BE INTERESTED IN UPDATES? Please enter their email address at nchmd.org/straighttalk, and we will add them to our complimentary mailing list.