​PHRONESIS PROJECT

Phronesis Project

Syllabus, 2016-2017
Class of 2019

 

Instructors/Mentors:

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

Ira Helenius, MD                      (ih4b@virginia.edu)

Natalie May, PhD                     (nlb7r@virginia.edu)

Susanna Williams, PhD             (sw9uw@virginia.edu)

Carolyn Engelhard, MPA          (cengelhard@virginia.edu)

 

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.

 

Course Textbooks:

King TE, Wheeler MB. Medical Management of Vulnerable and Underserved Patients:  Principles, Practice, and Populations.  New York: McGraw-Hill Medical Pub, 2007.

 

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.

 

Longitudinal 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 and in January, a pediatric patient. Typically, both of these patients 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 these patients’ care throughout your four years of medical school.

 

Phronesis Workshops

We will hold 9 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 12 Phronesians in your class will meet together, and whenever possible, your mentors, too. This year, we will hold two combined workshops (October & December) with the Phronesis class of 2018.

 

Clinical Professional Development (CPD)
You will meet with your mentors for the weekly CPD sessions. At the start of each CPD session, we will devote approximately 15 minutes to one of the following:  (1) reflective practice; (2) narrative medicine; or (3) patient-related activities. Phronesis Student Directed Learning (SDL) topics in the CPD sessions will have a general focus on the physician’s role in society to foster the greater good.

 

Social Issues in Medicine Requirement

This year, we have negotiated with the SIM directors, and Phronesis students are no longer required to participate in community setting placements. You will learn about the role of community programs through your advocacy work with your patients and their families. However, you will be required to attend SIM workshops 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 with Natalie May

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, reflective writings, SIM essays, and even emails. If you have a great day with a patient, shoot Natalie an email or even a text.  (804-512-3208) Or let your mentor know about it.  If you are struggling with a patient and wondering about next steps, please let us know. 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.

 

At the end of 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 and March to review your portfolio and identify any needs you may have in terms of Phronesis work, your patients, etc. You will receive a Sign-up Genius email from Natalie to schedule these meetings.

           

 

October 23 – Empathy & Patient-Centered Care (Gene Beyt, MD MS, Executive Director, the Positive Healthcare Network)

 

Workshop:

Friday, October 23
2:00 – 5:00 pm

Biomedical Ethics Conference Room

 

Learning Objectives:

• Describe key features of patient-centered care and how it can be fostered in our health care system.

• Appraise the health care system through patients’ eyes.

• Create improvements in the healthcare system to enhance patient-centered care based on observations.

 

Videos:

https://www.youtube.com/watch?v=cDDWvj_q-o8

 

https://www.youtube.com/watch?v=1e1JxPCDme4

 

Readings:

 

Haidet P et al. Not the same everywhere. Patient-centered learning environmnets at nine medical schools. J Gen Intern Med 2006;21:405-9.

 

Hojat M, Vergare MJ, et al. The devil is in the third year: a longitudinal study of erosion of empathy in medical school.  Acad Med. 2009;84:1182-91.

 

Krupat E et al. When patients and physicians think alike: patient-centered beliefs and their impact on satisfaction and trust. J Fam Pract 2001;50:1057-62.

 

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

 

Chapters 6-7 in Choosing Wisdom

Chapter 7 in Practical Wisdom

 

Patient activity (do before workshop):

Shadow the 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. For more detailed instructions, click here.

 

Portfolio Assignment:

• Continue narrative interviews

• Written assignment: Based on your observations of the patient experience, in what ways could we make our health system more patient-centered?

 

Individual meetings with Natalie May

 

November 13 – Mindfulness in Medicine (Susanna Williams, PhD)

 

Workshop:

Friday, November 13 
2:00 – 5:00 pm

Biomedical Ethics Conference Room

 

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:

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

 

Chapter 8 in Choosing Wisdom

Chapters 8 & 9 in Practical Wisdom

Portfolio Assignment:

• Reflective writing: Describe how your own practice of mindfulness influence your practice of medicine? More information here. Due on Friday, November 20th.

• Complete narrative interview summaries, if you have not done so already.

• Continue your mindful and reflective practices with these exercises from Susanna Williams.

 

December 16 – Physician Well Being & Empathy (Julie Haizlip, MD)

 

Combined Workshop:

Wednesday, Dec 16

6:00 – 8:30 pm

Dr. Plews-Ogan’s home (1085 Tilman)

 

Learning Objectives:

• Discuss the connection between physician wellbeing and empathy.

• Identify the connection between positive emotion, wellbeing and wisdom.

• Describe 5 techniques for fostering positive emotions.

 

Video:

https://www.youtube.com/watch?v=O8V1ZS1tqOI#t=101

 

Readings:

Shapiro J. Does medical education promote professional alexithymia? A call for attending to the emotions of patients and self in medical training. Acad Med 2011;3:326-32.

 

Wallace JE, Lemaire JB, Ghali WA.  Physician wellness: a missing quality indicator. Lancet 2009;374:1714-21.

 

Zwack J, Schweitzer J. If every fifth physician is affected by burnout, what about the other four? Resilience strategies of experienced physicians. Acad Med 2013;88:382-89.

 

Chapter 9 in Choosing Wisdom

Chapter 10 in Practical Wisdom

Patient activity:
 

Portfolio Assignments:

• Reflective writing: What is the relationship between physician and patient well being?

• Gratitude journaling (2 weeks)

 

January 28 – Social Determinants of Health, Identifying Patient Strengths (Jim Plews-Ogan, MD & Carolyn Engelhard, MPA)

 

Workshop:

Thursday, January 28

5:30 – 8:00 pm

General Medicine Conference Room

 

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.

 

Readings:

Change C. Seven Lessons About Child Poverty. The Century Foundation, 2015.

 

Haizlip J, May N, Schorling J, Williams A, Plews-Ogan M. The negativity bias, medical education, and the culture of academic medicine: why culture change is hard. Acad Med 2012;87:1205-9.

 

Black JM, Hoeft F. Utilizing biopsychosocial and strengths-based approaches within the field of child health: what we know and where we can grow. New Dir Child Adolesc Dev 2015;2015:13-20.

 

Chapter 10 in Choosing Wisdom

Chapter 11 in Practical Wisdom

 

Patient activity:

• Meet with pediatric patient & conduct needs assessment

• Elicit and identify patients’ strengths through story listening.

 

Portfolio Assignment:

• Needs assessment for pediatric patient

• Reflective writing: What changed because of the story?

 

February 19 – Behavior Change & Motivational Interviewing I (Andy Wolf, MD)

 

Workshop:

Friday, February 19

2:00 – 3:30 pm

Biomedical Ethics Conference Room

 

Learning Objectives:

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

• Demonstrate collaborative goal setting.

 

Reminder card:

Motivational Interviewing Reminder card (Am I doing this right?)

 

Chapter 11 in Choosing Wisdom

Chapter 12 in Practical Wisdom

 

Patient activity:

Meet with patient and mutually set one behavior change goal

 

Portfolio Assignment:

Complete behavior change table

 

March – Patient Access to their Own Medical Record (Sigall Bell, MD)

 

Lecture:

Friday, March 11

12:30 – 1:30 pm

Medical Education Auditorium, 3rd Floor

 

April – Justice & Advocacy:  the Role of the Physician (Mary Francis Charlton)

 

Workshop:

Thursday, April 21 

1:00 - 3:00

 

Learning objectives:

Identify core elements of health care advocacy

Describe challenges to physician advocacy

 

Readings:

Chapter 41 in Vulnerable Populations

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.

Dobson S, Voyer S, Regehr G. Perspective: agency and activism: rethinking health advocacy in the medical profession. Acad Med 2012; 87:1161-4.

Earnest MA, Wong SL, Federico SG. Perspective: Physician advocacy: what is it and how do we do it? Huddle TS. Perspective: Medical professionalism and medical education should not involve commitments to political advocacy.Acad Med 2011;86:378-83 Kanter SL. On physician advocacy. Acad Med 2011;86(9):1059-60. Chapter 12 in Choosing WisdomChapter 13 in Practical Wisdom

 

Patient activity:Identify one advocacy goal for pediatric and adult patients

 

Portfolio Assignments:Advocacy goalsReflective writing: a physician’s role as an advocateAssessment of patient status re: targets for chronic illness management and prevention goals Individual meetings with Natalie.

 

May – End of Year Celebration TBA!