AMA Update covers a range of health care topics affecting the lives of physicians, residents, medical students and patients. From private practice and health system leaders to scientists and public health officials, hear from the experts in medicine on COVID-19, medical education, advocacy issues, burnout, vaccines and more.
Featured topic and speakers
What happens in residency orientation? How long does it take to onboard a resident? What's resident onboarding like? Why is cultural competence important in health care?
Our guest today is Jimmy Stewart, MD, associate dean for graduate medical education and designated institutional officer at the University of Mississippi Medical Center.
Dr. Stewart will talk about an innovative orientation program for new residents that’s designed to improve culturally competent care. AMA Chief Experience Officer Todd Unger hosts.
- Watch AMA Update for health care news for physicians, residents and medical students.
- Not a physician? Join the Patients Action Network.
- Learn more about the AMA Health System Program.
- Access The AMA Road to Residency Guide.
- Explore the AMA Resident and Fellow Section (RFS).
- Find leadership programs for medical residents and fellows.
- The AMA is your powerful ally, focused on addressing the issues important to you, so you can focus on what matters most—patients. We will meet this challenge together. Join us.
- Learn more about our AMA advocacy priorities, including:
- Reforming Medicare payment
- Fighting scope creep
- Fixing prior authorization
- Reducing physician burnout
- Making technology work for physicians
Speaker
- Jimmy Stewart, MD, associate dean for graduate medical education and designated institutional officer, University of Mississippi Medical Center
Transcript
Dr. Stewart: To us, that really means connecting well with your patients and giving them all of the things necessary to really treat that patient, not just when you see them in the office or in the hospital, but how you connect with them in ways that can impact their health care and their lives.
Unger: Hello, and welcome to the AMA Update video and podcast. Today, we're talking about an innovative orientation program for new residents that's designed to improve culturally competent care. Here to talk about that is Dr. Jimmy Stewart, associate dean for graduate medical education and designated institutional officer at the University of Mississippi Medical Center in Jackson, Mississippi. I'm Todd Unger, AMA's chief experience officer in Chicago. Dr. Stewart, welcome.
Dr. Stewart: Thank you, Todd. Good to be here.
Unger: Well, I'm very excited to learn more about your orientation program. Why don't we just start with a brief overview of what it's all about and why you did it in the first place.
Dr. Stewart: Sure. So as part of our Reimagining Residency grant that we shared with Vanderbilt, the GOLLD grant, we were looking for ways to really orient both our residents here and the residents at Vanderbilt to inform them about the community that they're going to practice and learn from for the next four, five, six years, however long their residency is, and maybe even a fellowship after that.
And community's very important to me. It's one of our cultural values here. We really talk about how other people inform us and how we inform them, and how we work and how we live. So we want to make sure that people connect well when they get here.
And the orientation process seemed like a great place to start that, particularly for our residents that are coming from other places or even if they've been here for medical school and continued their training here. So we were looking for novel ways to do that, and we were fortunate enough, with the support of the AMA grant, to do that in ways that we couldn't quite do it before.
Unger: Now, you hear that term culturally competent care a lot. A little bit of a buzzword. What, in your own words, for folks out there that may not be familiar with it, does that mean to you and your program?
Dr. Stewart: To us, that really means connecting well with your patients and giving them all of the things necessary to really treat that patient. Not just when you see them in the office or in the hospital, but how you connect with them in ways that can impact their health care and their lives as they go back to their communities. What are the things that they're bringing from those communities with them for their experiences in the past, and how can that impact their care right now and in the future.
Unger: Now, that seems like a pretty important thing to do and to know how to do. Why is this novel at this point?
Dr. Stewart: I think we've, for a long time we've concentrated, and we only have a limited amount of time to train residents, so we've concentrated on those—all the different requirements that we have, the ACGME requirements or other requirements, specialty-specific requirements, and then the needs that we have within our programs to really meet those patient care needs with our residents and fellows.
But what we've neglected a bit is how when we finish that care here, what's going to happen? What's going to be the transfer of that patient back to their communities. So it's not just knowing about how diverse your state is. And we're the only academic medical institution in our state, so we truly, in a state of just shy of three million patients, that's our patient base.
So we serve them as a referral network throughout the state, knowing more about how they live. What do they bring to the table when we see them? How is a patient who is a Choctaw patient in eastern Mississippi differ from a patient who lives in the Mississippi Delta with socioeconomic disadvantages that really would impact how we care for them when we see them and after that.
Unger: Well let's talk a little bit more then in detail to the example that you just gave. Walk us through some of the specific topics that you would cover in the orientation.
Dr. Stewart: So we thought the best way to deliver this is not to—orientation traditionally was about a four- to six-hour event where we had 200 new individuals coming into our institution that would start their residency. They would sit in a room and listen to a lecture or multiple lectures. This created a lot of sleepiness, a lot of … loss of the information. It checked off a lot of boxes but it didn't seem like the best way to deliver that information.
So this was a team effort. We worked with, at the time our Chief Diversity Officer Dr. Juanyce Taylor, Dr. Victoria Gholar, Dr. Gabby Banks, and Dr. Jarrett Morgan helped develop a module system. So we have five modules.
The first module is just an intro to our patient population. Who are we in Mississippi? What do we look like? What are some of the historical and current issues that are facing different areas of our state and different patient populations in those areas? And who are we here at the medical center? As one of the largest employers in the state, we really have a very diverse group of people here, and to know more about who we are.
The second module really talked about defining terms and some of the things that we were going to talk about. And then the last three are really working through those social determinants of health, the differences in our state, and really putting a context to it on a local level. What is the historical things about Mississippi, including our literature. Faulkner, Eudora Welty, Willie Morris. How does that and their influence in the blues that we have a rich history of in the Delta.
So it's not just the landmark things that have happened here. The first lung transplant, for instance, by Dr. Hardy back in the ‘60s. But it's also the overlay of all the other historical events that might be impacting our patient population now.
Unger: Well, that sounds like the coolest orientation program I've ever heard about, and certainly not sleepy. So let's talk about how then you put that knowledge into practice. How might residents use the information that comes out of this orientation to effectively care for their patients in a way they might not have if they hadn't had the orientation?
Dr. Stewart: Sure. So the modules are deployed before they get here. So they are expected to go through those modules and complete those. We do have a live orientation day where we actually have a quick review, and then we break them up into different groups, and we actually mix up the different specialties.
So we'll have internal medicine residents with surgery residents and mix everybody up at different tables, and then have an application of that, sort of a flipped classroom model where they're going to go through a case, a patient case. And of all the things they learned, how would that impact how they deliver care? What are some of the barriers and hurdles for that?
We also give them very specific resources, both here at UMC and in the community, so that they'll have these tools in their tool belts to pull out. And we've integrated some of those into our Epic, our electronic health record, so that they can pull those out and connect to the resources that they'll need to meet those special needs, so that they'll be thinking about the patient in the Delta might have special needs that they wouldn't necessarily have in other areas of the state. And what resources can they give to them to accomplish that.
Unger: Now, you mentioned earlier the Reimagining Residency grant program from the AMA. Was this an outgrowth of that, or how did this process that you're describing come about in the first place? Did someone just say, hey, I have an idea here to do things differently? Tell me about that.
Dr. Stewart: So we were collaborating with Vanderbilt on other levels, and the DIO at the time, Dr. Donald Brady, had called me up and said, hey, Jimmy, would you like to work on an application to this Reimagining Residency grant? I'm thinking about submitting one, but I'd love to collaborate with Mississippi.
And our thought was we could really learn from each other. And the collaboration that we had during this six-year experience, and it's been an experiment in a lot of ways, we've learned a lot from Vanderbilt. I think they've learned a lot from us.
We use sort of a leapfrog model to do that where one institution would move forward in an area. We would share that. Then the other institution would learn from it and modify that and adapt it for the next step. So it was a rapid sequence of improvements to that. But it was very much integrated into our GOLLD grant that we received through Reimagining Residency.
And beyond the funding of that, which really helped to develop the modules and provide funding for our faculty, it really showed the worth of that to our respective institutions. So we've had our CMO here at the hospital, our CEO have been very interested in what we're doing. And they're actually interested in maybe doing some similar things for faculty orientation as well now.
Unger: Excellent. What a great collaboration between you and Vanderbilt on this. When you look ahead, what do you see on the horizon in terms of improvements to the program?
Dr. Stewart: We're continuing this beyond the grant. We have had to make some adjustments, just with state and federal laws to make sure that we're following those. But we really want to continue to make those connections and to have touchpoints throughout their residency to do that as well.
As a different component of our GOLLD project, we have for instance, we have a psychiatry resident that was a GOLLD scholar, and she developed a cultural competency interaction through food so that residents would share their cultural heritage through food and talk about why that's important to them, and what it's connected to with other parts of their culture. It's been a great way to bring people together.
And that's a huge focus from our office, from the GME office here, is to not have silos of residency programs. Which, we have 65 residency and fellowship programs on campus, so about 700 residents and fellows.
We want to bring them together. We want to look for ways to do that not just within programs, but to have those programs really talking about issues that they're facing with patients, and to bring them together with the community. And we have great ways to do that. We have great museums and interactions throughout the city that we also encourage them to explore as well.
Unger: Now, important question. How have your residents reacted to this?
Dr. Stewart: They've been extremely excited. One of the hesitations I had is we give them a lot of information. This isn't the only information that we give them before they come here. So we're very sensitive to that, to the volume of information that we're requiring them to do. But they are really excited about it.
I had a conversation with a resident the first time we did our orientation. About three to four months after that, stopped me in the hallway and said, hey, thank you for what you did with the orientation materials, because it really impacted a patient that I took care of yesterday, and I was able to help them with some resources in the community. I knew about it, I knew how to access that, I knew how to connect that to the patient.
So those connections we make here with our residents extend, I would like to think, to our patients that we serve in the state. And not just the patients where it's convenient to provide care but the ones it's really hard to do that.
Because I don't know if you've known or anybody who's listening. You've probably heard about some things that we're number one in Mississippi that aren't things to brag about. So we have a lot of health care disparities. We have a lot of challenges here. But it's a great place to provide care, because we can make a difference.
Unger: And it's great because you answered my other question, which is, do you think it's translating to patient care, which obviously, it is. I have to imagine your phone is kind of ringing off the hook. Are people in other residency programs wanting to learn from what you're doing here and emulate it?
Dr. Stewart: We had a workshop about a year and a half ago where we presented this information and had a lot of follow-ups to other places. And there's a lot of great ideas and additions.
We had one orientation group that said, we're thinking about having a bus tour of the different neighborhoods in our patient catchment area. And so I think there's some extensions of this that we'd like to get out there the word that, hey, you can do this. You can identify what are the challenges in patient care in your area, and make it specific to that.
We broadcast how well our programs are and we try to recruit people to those programs. But once they get here, really, the rubber meets the road and there are challenges that they may not be aware of. So we want to do that day one, or really before day one, in giving them the information and the modules so that they can be prepared to do that.
Unger: Well, it sounds like such a great program and a really terrific addition to your organization. Dr. Stewart, thank you so much for joining us and telling us more about it. If you found this discussion valuable, you can support more programming like it by becoming an AMA member at ama-assn.org/joinnow.
That wraps up today's episode. We'll be back soon with another AMA Update. Be sure to subscribe for new episodes and find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today. Please take care.
Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
Subscribe to AMA Update
Get videos with expert opinions from the AMA on the most important health care topics affecting physicians, residents, medical students and patients—delivered to your inbox.
