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Phronesis Project

Syllabus, 2016-2017
Class of 2020

 

Instructors/Mentors:

 

Monday CPD Group

Mohan Nadkarni, MD              (mnn9y@virginia.edu)

Carolyn Engelhard, PhD          (cengelhard@virginia.edu)

 

Thursday CPD Groups

Margaret Plews-Ogan, MD       (mp5k@virginia.edu)

Susanna Williams, PhD             (sw9uw@virginia.edu)

 

Eve Bargmann, MD                  (eb2d@virginia.edu)

Beth Jaeger-Landis, RN            (baj9u@virginia.edu)

 

Natalie May, PhD                     (nlb7r@virginia.edu and 804-512-3208)

Lauren Kramer, RN                  (lk7u@virginia.edu and 434-297-7190)

 

Course Goal: 

The Phronesis Project focuses on professional identity formation, organized around the conceptual framework of wisdom. Our educational goal is to foster our capacity for wisdom development, setting the stage for wisdom development throughout our careers.

 

Optional, but recommended textbooks:

Plews-Ogan M, Owens JE, and May N. Choosing Wisdom:  Strategies and Inspiration for Growing through Life-Changing Difficulties.  Templeton Press. Templeton Press, 2012.

 

Schwartz B, Sharpe K. Practical Wisdom: The Right Way to Do the Right Thing. New York: Riverhead Books, 2010.

 

Tan, Chade-Meng.  Search Inside Yourself: The Unexpected Path to Achieving Success, Happiness (and World Peace). New York, NY: HarperOne, 2012.

 

Longitudinal Adult Patients

The Phronesis Project is designed so that all of your learning takes place within the context of patient care. In August, you will be assigned an adult University Medical Associates (UMA) patient. Typically, your patient will be medically complex, affording you the opportunity to see the health care system from many angles and to learn many facets of patient care. You will participate in your patient’s care throughout your four years of medical school with increasing responsibilities as you develop your skills.

 

Longitudinal Pediatric Patients

At the end of your first year or the beginning of your second year, you’ll have the opportunity to follow your own pediatric patient, identified through the Birdsong Clinic.  This year we are pilot testing a Reach Out and Read program with the SMD 2019 Phronesis class to facilitate their connection to pediatric patients and their families.  To learn more about Reach Out and Read, you may visit their web site.  http://www.reachoutandread.org 

 

Patient Contact Log

We ask that you complete a patient contact log, recording all of your contacts (by phone, in person, email) with your patient.  We will ask to review these logs during your individual meetings with Natalie May (fall) and Dr. Plews-Ogan (spring), and you will turn them in at the end of each academic year.  A copy of the log is in your Phronesis handbook and Google docs.

 

Phronesis Workshops

We will hold eight workshops throughout the year, opportunities for us to delve deeply into topics that we believe will help you grow in your role as a physician.  All 18 Phronesians in your class will meet together, and whenever possible, your mentors, too. This year, we will hold one combined workshop on August 15th with the Phronesis classes of 2018 and 2019.

 

Clinical Professional Development (CPD)
You will meet with your Phronesis mentors for the weekly CPD sessions. At the start of each CPD session, we will devote 10-15 minutes to one of the following:  (1) reflective practice/mindfulness and (2) Phronesis patient-related activities. Phronesis Student Directed Learning (SDL) topics in the CPD sessions will be topics of your choosing, but we do require that they have a general focus on (1) the physician’s role in society to foster the greater good; (2) the bigger picture; or (3) mindful and reflective practices.  Topic examples:  health disparities in the diagnosis and treatment of heart disease screening; the neuroscience of happiness; climate change; the role of the physician in the Holocaust; the impact of poverty on health outcomes; neuroscience of compassion; and burnout in healthcare professionals.

 

Social Issues in Medicine (SIM) Requirement

Phronesis students are not required to participate in community setting placements or the SIM service project. You will learn about the role of community programs through your advocacy work with your patients and their families. However, you are required to attend SIM classroom activities (content sessions and panel presentations) and submit the SIM reflective writing assignments that have been modified for Phronesians. Two primary goals of the SIM course are to provide 1st year medical students with an introduction to the social issues in medicine and the societal context in which medicine is practiced, and to encourage students to develop an ethic of service.  

 

Portfolios and Individual Meetings

All of your Phronesis materials throughout the four years will be kept as a portfolio. Natalie May will store your portfolios in her office, although you are encouraged to keep your own electronic and/or hard copy. The portfolio includes everything – patient logs, narrative interviews, behavior change table, SIM essays, and even emails related to your Phronesis experience. If you have a great day with a patient, shoot your mentor or Natalie an email or even a text. We hope you will consider your portfolio a creative repository of your work and documentation of your growth as a young physician.  The portfolio also helps us keep track of your progress working with your patient.

 

Each year, you will be asked to write a reflection highlighting your Phronesis experience – Am I gaining wisdom?

 

Each student will have a one-on-one meeting with Natalie May in October/November to review your progress and identify any needs you may have in terms of Phronesis work, your patient, etc. You will receive a Sign-up Genius email from Natalie to schedule these meetings. All students will also have individual meetings with Dr. Plews-Ogan in the spring.

​

 

August 15 2016  -- Introduction to Wisdom in Medicine (Peggy Plews-Ogan, MD)

 

Learning Objectives:

  • Be able to discuss the key elements of wisdom.

  • Apply the three elements of wisdom to the characteristics of doctoring.

  • Identify and reflect on formative experiences on their journey to becoming a doctor.

 

Readings – Required:

All PDFs are available on Google docs.

 

Chapter 1 in Choosing Wisdom

 

Kinghorn WA.  Medical education as moral formation:  an Aristotelian account of medical professionalism. Perspect Biol Med. 2010;53(1):87-105.

 

Readings – Optional:

Kaldjian L. Teaching practical wisdom in medicine through clinical judgment, goals of care, and ethical reasoning. J Med Ethics. 2010;36(9):558-62.
 

Kumagai AK. From competencies to human interests: ways of knowing and understanding in medical education. Acad Med. 2014;89(7):978-83.

 

Plews-Ogan M, May NB, Owens J, Ardelt M, Shapiro J, Bell S. Wisdom in medicine: What helps physicians after a medical error?  2016;Acad Med; 91:233-41.

 

Combined Workshop with SMD 2018 & 2019:

Monday, August 15

6:30 – 9:00 pm

Dr. Plews-Ogan’s home (1085 Tilman)

 

Patient Activity:

  • Get patient assignment

  • Talk with patient’s PCP

  • Review patient history in EPIC

 

Portfolio Assignment:

  • Reflective writing: What does a wise doctor look like?

 

 

September 6 2016 – Why Story? Narrative Medicine and Patient Care (Linn Harrison)

 

Learning Objectives:

  • Compare and contrast narrative history and the traditional medical history, considering how these differences might affect patient care.

  • Describe the relationship between narrative medicine and wise doctoring.

  • Conduct a narrative interview with a patient.

 

Reading -- Required:

 

Charon R. Narrative and medicine. N Engl J Med 2004;350:862-4.

​

Workshop:

Tuesday, September 6

5:30 – 8:00 pm

Biomedical Ethics Conference Room

5th floor Barringer Bldg, Room 5382

 

Patient activity:

Schedule patient home visit to conduct narrative interview

 

Portfolio Assignments:

  • Narrative interview summary

  • Begin keeping patient log

 

October 11 2016 – Mindfulness & Medicine Workshop (John Schorling & Susanna Williams)

 

Learning Objectives:

  • Be able to practice STOP and body scan techniques.

  • Develop reflective practice, metacognition, and self- awareness using mindfulness techniques.

  • Describe applications of mindfulness in medical practice.

 

Readings – Required:

Epstein R. Mindful practice. JAMA. 1999;282:833-9.

 

Krasner MS, Epstein et al. Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA 2009;302:1284-93.

 

Workshop:

Tuesday, October 11

1:00 – 2:30

Location TBA

 

Portfolio Assignment:

  • Complete narrative interviews

 

Individual meetings with Natalie May

 

 

November 4 – Social Determinants of Health (Mo Nadkarni & Carolyn Engelhard)

 

Learning Objectives:

  • Discuss social determinants of health and the physician’s role in influencing those determinants.

  • List social benefits programs in Charlottesville area.

  • Elicit and identify patient strengths.

  • Identify community strengths and resources that will have a positive impact on patient outcomes.

 

Video -- Required:

http://www.ted.com/talks/rishi_manchanda_what_makes_us_get_sick_look_upstream

 

Workshop:

Friday, November 4

2:00 – 3:30 pm

Location TBA


Patient Activity:

Interview your patient
using the social benefits screening tool
Come to workshop with questions & ideas about how to help your patient

 

 

January – Empathy & Patient Centered Care (Phronesis Mentors)

 

Learning Objectives:

  • Students will be able to describe why empathy matters in clinical care.

  • Students will be able to reflect on their embedded observation, identify examples of patient-centered care and examples of non-patient-centered care.

  • Students will imagine improvements in the healthcare system to enhance patient-centered care based on their observations.

  • Students will be able to identify two ways to foster empathy in clinicians.

 

Readings – Required:

Morhmann ME, Shepherd L.  Ready to listen: why welcome matters.  J of Pain and Symptom Management. 2012;43:646-9.

 

Singer T, Klimecki OM. Empathy and compassion. Curr Biol. 2014;24:R875-8.

 

Video – Required:

Roman Krznaric, “Empathy: Why It Matters and How to Get It”

https://www.youtube.com/watch?v=lN4MRYIoCS0

 

Workshop:

Date & time TBA

Location TBA

 

Patient activities (do before workshop):

 

Be an embedded observer with patient all the way through a clinic visit, ED visit, or part of the day in the hospital. See the experience as the patient sees it. Take notes. Observe what went well.

 

Come with 1 example of patient centeredness & 1 example that was not patient-centered.

 

 

February – Behavior Change & Motivational Interviewing I (Andy Wolf, MD)

 

Learning Objectives:

  • Demonstrate the use of motivational interviewing to assist a patient in achieving change.

  • Demonstrate collaborative goal setting.

 

Videos:

The Non-Effective Physician: Non-Motivational Approach

https://www.youtube.com/watch?v=80XyNE89eCs

 

The Effective Physician: MI Approach
https://www.youtube.com/watch?v=URiKA7CKtfc

 

 

Workshop:

Date & time TBA

Location TBA

 

Patient activity:

Meet with patient and mutually set one behavior change goal

 

Portfolio Assignment:

Complete behavior change table

 

 

March – Advocacy (Mohan Nadkarni & Carolyn Englehard)

 

Learning objectives:

  • Review social determinants of health and the physician’s role in influencing those determinants.

  • Identify core elements of health care advocacy

  • Describe challenges to physician advocacy

 

Readings – Required:

Gwandi A. The hot spotters: can we lower medical costs by giving the neediest patients better care?  New Yorker Magazine 2011;

http://www.newyorker.com/magazine/2011/01/24/the-hot-spotters

 

Dharamsi S, Ho A, Spadafora SM, Woollard R. The physician as health advocate: translating the quest for social responsibility into medical education and practice.  Acad Med 2011;86:1108-13.

 

Workshop:

Date & time TBA

Location TBA

 

 

 

April – Clinical Seminar (Peggy Plews-Ogan, MD)

 

Learning Objectives:

  • Use effective peer support techniques to brainstorm patient care issues

  • Discuss challenges and share strategies related to longitudinal patient care

 

Pre-seminar assignment:

Come to the seminar prepared to talk for 3-5 minutes, sharing a "snapshot" of one of your patients. Focus on (1) a gratifying experience with your patient/family; and (2) an issue or experience that has been challenging to you.

 

Workshop:

Date & time TBA

Location TBA

 

Patient activity:

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