After Karishma Popli, MD, MBE, learned that her grandmother had suffered a posterior circulation stroke, she found herself having the kind of complex care discussions that even attending physicians find challenging.
“My grandparents both suffered strokes on both sides of the family, unfortunately,” she said. “But when my grandmother suffered her stroke … it affected her balance. And because of that, she suffered falls and had fractures in her spine, and she became bedbound.”
In conversations with her grandmother, Dr. Popli not only provided information, but also sought it, exploring a treatment path that incorporated her prognosis but also her wishes about how she wanted to live. She asked her grandmother: “Would you want to continue all these aggressive medical therapies, lifesaving interventions and going to the hospital? Or do you want us to focus more on comfort care and being comfortable?”
As a fourth-year chief resident in neurology at Johns Hopkins Hospital in Baltimore, Dr. Popli was intimately familiar with the fact that physicians sometimes need to deliver tough news and present options about whether and when to change the goals of care. But her formal training had not provided a framework for how skilled physicians should approach those tricky conversations, and she did not have an opportunity to practice them.
“We don’t have the opportunity to formally practice these conversations in the hospital and are instead just expected to learn by doing or observing how other doctors bring these difficult topics up in conversation. It varies so much,” Dr. Popli said.
As a result of her experience as the loved one of a stroke patient and her master of bioethics training, she was inspired to pursue a research project that would result in her receiving a People’s Choice recognition in the 2025 AMA Research Challenge for her work developing a simulation-driven palliative care curriculum for neurology residents and subspecialty fellows.
The project, “Development, Implementation and Evaluation of a Novel Neuropalliative Care Education Curriculum” (PDF), was recognized for Outstanding Poster Design in the challenge. Her fellow researchers were: S. Ian Borison, DO; Ashley Paul, MD, MEd; Corey X. Tapper, MD, MS; J. Ricardo Carhuapoma, MD, and Ambereen K. Mehta, MD, MPH.
For medical students, residents and international medical graduates looking to hone their research skills, the AMA offers resources and programs that bring you from the basics all the way to the AMA Research Challenge, where you too can compete for the People’s Choice Recognitions and a $10,000 prize presented by KeyBank.
The 2025 AMA Research Challenge Finals show is available to watch, and the call for abstracts is open for the 2026 AMA Research Challenge. The submission deadline is July 16.
Developing a framework for learning
Dr. Popli said that step one of the project was looking at how physicians in specialties such as palliative care and neurocritical care approached these conversations with patients. She said those experts were already “doing this on the ground, daily.” Then, they created strategies that would work for training purposes.
“What are the things that are standard approaches across the board that we can implement, not just in our residency but even across the country?” she said. Physicians were already conducting simulations to practice brain-death exams, for example. “There are a set of collaborators across the country who are working on this.”
Creating a formal curriculum entailed developing a yearlong didactic component that involved online modules, followed by four simulation-based training sessions to reinforce the information. Dr. Popli said the researchers began with a pilot study for neurocritical care fellows, who reported higher confidence after the training in their ability to share serious news with patients and family members, as well as to discuss their code status, life expectancy and prognosis—among other topics. Dr. Popli and her fellow researchers are now creating a novel, yearlong curriculum on neuropalliative care for residents.
The neurocritical care fellows were surveyed before and after the training about their degree of confidence in eight key areas:
- Sharing serious news with patients and their families.
- Discussing prognosis or life expectancy.
- Discussing code status with clinic patients.
- Discussing code status with inpatients.
- Recommending hospice care.
- Responding when a patient or family member becomes emotional.
- Documenting medical orders for life-sustaining treatment (MOLST) in the health record.
- Documenting advanced directives in health record.
Across the eight domains, 37 preintervention responses showed that the fellows felt “very” or “extremely confident.” That share rose to 44 after the yearlong training, a nearly 20% rise. Generally speaking, the fellows’ confidence shifted higher, as shown in the bar charts created for the AMA Research Challenge presentation.
Other visuals in the presentation recognized for its design convey the key competencies identified by program directors in those areas and display how well-prepared neurocritical care fellows felt about delivering serious news, prognostication and withholding therapies.
“I initially chose neurology because I find the brain just absolutely fascinating,” Dr. Popli said. A great deal of her training entails learning how to care for patients after stroke “and working with them through that initial post-stroke recovery process.”
The project tapped into the difficult emotions that arise when living with a neurological condition and how physicians can help patients, families and caregivers who are on that journey.
“The way we discuss that with patients is something that I find really fascinating and not something that we’re ever taught,” she said. “There’s no course on how to maintain our humanity, on how to prognosticate or tell people that there’s so much uncertainty in medicine, actually, and in neurology, when people have devastating illnesses. We really don’t know what the course of their trajectory is going to be.”
The AMA GME Competency Education Program delivers education to help institutions effectively meet ACGME common program requirements, including courses on end-of-life care. The program provides an award-winning virtual experience, with quality education designed for residents on the go. It’s easy to use, saves time and cuts administrative burdens with simple reporting tools. Learn more.
Being part of “an extraordinary group”
Dr. Popli said she was “absolutely elated” when she heard that her project had been honored.
“I did not expect that at all, especially when they told me there were 1,400 abstracts that were submitted,” she said. “I just submitted it thinking, well, we’ll see what happens, but I did not expect to be a finalist or to have the kind of support and recognition for this project and this work that we did have.”
The Outstanding Poster Design Award is one of the People’s Choice recognitions given to finalists in the AMA Research Challenge. Dr. Popli joined grand prize winner Addison Shenk, as well as fellow finalists Bijoya Basu, Tiffany Bellomo, MD, and Anthony Wong.
AMA President Bobby Mukkamala, MD, called the entire slate of finalists “an extraordinary group whose work represents the innovative thinking that moves medicine forward.”
“It’s been hard to just get funding for research in general, so that's one of the reasons why the AMA Research Challenge is great, because it gives us a platform to share this type of research,” Dr. Popli said. “The nice part about the AMA Research Challenge is that your audience is anyone in medicine. It's open to medical students, residents. It's not specialty-specific.”
Learn more with the AMA about how to get started in research as a medical student.
