Program-wide Initiatives

Leadership Program

Due to the ever-growing demands for exceptional physician leadership, both in developing a dynamic health care environment and managing the demands of modern clinical practice, the Mass General Internal Medicine Residency Program has developed a formal Leadership Program for all residents. Led by Meridale Baggett, MD, the Leadership Program is based on the case method created at Harvard Business School, and provides residents with hands-on learning around key leadership concepts that they can immediately bring to practice in their everyday care environments.

The Leadership Program’s goals are to:

1. Provide all residents with the essential tools to become effective clinical leaders
2. Foster an environment of support and understanding of clinical leadership
3. Continue ongoing research into effective physician-led leadership and clinical teams

Over the course of their training, residents are exposed to the key concepts of: Team Dynamics, Leadership Styles, Leading Clinical Teams, Emotional Intelligence, Negotiation, Conflict Management and Leading Change. These concepts are introduced through multiple settings, including noon conferences, small group discussions of case studies at program-wide retreats, and experiential learning embedded in the medical simulation and consult curriculums.

Leadership Research

A key component of the Leadership Program’s success is developing ongoing course assessment and research into concepts of clinician leadership development. Sample research concepts include:

1. Impact of the Leadership Program as an intervention on clinician professional development and clinical outcomes at Mass General and additional sites
2. Composition and work habits of effective clinical teams
3. The role of simulation in teaching and evaluation of leadership skills

Pathways

By allowing two weeks for residents to investigate a case that has puzzled even senior consulting physicians, residents on the Pathways Consult Service in the Department of Medicine at Massachusetts General Hospital are able to read primary literature and speak with world experts to inform their analysis.

Through piecing together complex medical histories, integrating the perspectives of multiple diverse experts and reading literature on the forefront of what is known, the Pathways Consult Service allows residents to hone and develop their critical thinking skills. Additionally, often the hypotheses the Pathways Consult Service teams propose settle on mechanisms very few people have studied in depth, affording exciting opportunities for subsequent research.

Residents learn more about disease mechanisms to which they may not have had prior experience. They benefit from working in an interdisciplinary team to break down traditional organ-based silos in their investigation.

The rotation culminates with a noon conference during which the Pathways team guides the audience through the questions and hypotheses they generated regarding the underlying biology of their patient’s disease process. Going a step further, the team also presents potential experiments and ways they may interrogate patient-derived samples to discover mechanisms of disease that might be affecting a much broader population of patients. Often, interested residents have subsequently collaborated with laboratories at Mass General and Harvard Medical School to pursue experiments motivated by this rotation. In addition, broad participation in Pathways by all residents has infused the residency program with a remarkable spirit of inquisition and investigation that extends far beyond this rotation.

Point-of-Care Ultrasound (POCUS)

Residents have access to 6 Butterfly iQ handheld ultrasounds in addition to the cart-based ultrasound machines on our procedural service and our intensive care units. We have a longitudinal curriculum of monthly bedside ultrasound rounds named Gel Rounds led by our ultrasound-trained faculty alongside residents which are open to all interested housestaff. Additionally, we have scheduled residency-wide POCUS Residents Reports and bimonthly meetings of our Ultrasound Interest Group though which opportunities exist to update and edit our new POCUS training manual (affectionally known as the Gray Book). 

Residents can also participate in a 2-week POCUS elective, during which they will have a unique experience designed to introduce them to the world of point-of-care technology in Internal Medicine. Using a low learner-faculty ratio, residents will take part in an integrated curriculum consisting of didactic sessions that will utilize large group content delivery and breakout small group scanning sessions in the mornings. Further image acquisition and interpretation will be enforced on real patients during dedicated afternoon scanning sessions with hopes to expose the learner to real pathology. Content delivery will be recapitulated by frequent rapid-fire image review and clinical integration sessions.

For residents heavily invested in developing ultrasound skills, we additionally have a POCUS concentration wherein interns are selected post-Match by expressing interest. They will participate in the POCUS elective during their internship and receive dedicated mentorship throughout all three years intended to produce longitudinal skill development in POCUS.

Simulation and Experiential Learning

The Internal Medicine Simulation and Experiential Learning program is a resident-led curriculum aimed at enhancing inpatient and ambulatory education through deliberate practice in a safe, collaborative learning environment. 

The PGY-1 inpatient curriculum is integrated into the Bigelow rotation and concentrates on clinical reasoning and management of common inpatient scenarios on general medicine services. The PGY-2 curriculum builds on the skills learned as an intern with an increased focus on critical care emergencies. Additional simulations with mixed learner groups take place in the Medical and Cardiac Intensive Care Units and on the oncology floors. Each sim session is led by a PGY-3 Simulation Chief Resident with near-peer facilitation by PGY-2 and PGY-3 residents, allowing these upper-level residents to practice their facilitation, debriefing, leadership, and clinical reasoning skills. Feedback to enhance teaching skills is provided by sim-trained faculty and the Simulation Chief Residents.

In addition to the inpatient core simulation curriculum, the sim team collaborates with the ambulatory training team to provide outpatient-centered experiences that align with the ambulatory curriculum. Recent cases developed include substance use disorder, sickle cell disease, sexual and gender-based health, psychiatry, and neurology.

The sim program also works with other divisions and programs to develop sessions focusing on core communication skills including code status discussions, managing aggressive/agitated patients, and gun violence prevention counseling. Additional 1-on-1 sessions tailored to specific learner needs can also be accommodated, typically led by a PGY-3 Simulation Chief Resident.

Interested residents can also participate in a 2-week simulation elective. This elective is an immersive, educational experience designed to expose residents to a range of simulation and teaching opportunities and provide an introduction to simulation-based research. Through these opportunities, residents:

• Participate in additional simulation facilitation and debriefs beyond the standard curriculum
• Learn and practice basic techniques in debriefing and the background behind them
• Obtain experience in case writing for simulation
• Develop new projects to advance the teaching and research missions of the residency simulation program