#43 How to be a Change Agent: Leadership with Stefanie Brown, MD

June 12, 2024 | By Charlotte Chaiklin

Audio

Video

Transcript available via YouTube

Listen as our esteemed guest Dr. Stefanie Brown @Dr_B_UMJMHIM (University of Miami) discusses how to successfully lead a residency program through change.  Whether you’re looking to gain specific tips on how to navigate the transition to a new scheduling model or development of residency pathways, or just be inspired in your leadership journey, Dr. Brown will leave you with practical tips and ideas.

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Meet our Guest:

Dr. Stefanie Brown is an associate professor of Medicine and Pediatrics, the division chief of the University of Miami Medicine-Pediatrics division, and internal medicine residency program director at the University of Miami/Jackson Memorial Hospital residency program. She has received the hall of heroes award from the Student National Medical Association, excellence in mentorship award from the University of Miami Women in Academic Medicine, South Florida Top Black Educator award from the ICABA, and Most Accomplished Black Executives award from the ICABA. Her teaching interests include evidence-based medicine, leadership, and the business of medicine.

Show Segments

• Intro, disclaimer, guest bio
• Picks of the week 
• Case from Kashlack Memorial Hospital 
• Dr. Brown’s leadership journey 
• Residency schedule types 
• Creating residency pathways 
• Take-home points
• Outro

Change Agent Pearls

1. As a leader, keep your eye on the prize, aka the educational experience of the residency program.
2. Involve all stakeholders in the change process.
3. No one likes change.  Validate fears and concerns through the change process. 

How to be a Change Agent Notes 

Internal Medicine Residency Scheduling Models

Traditional Model 

The traditional model consists of a majority inpatient learning experiences with one or two electives per year.  While working inpatient, a resident goes to their continuity clinic every week for a half day regardless of the rotation they’re on (sometimes more intensive rotations like ICU can be an exception).  This residency training model causes the resident physician to be pulled in multiple directions; while in the clinic, the resident continues to be responsible for caring for patients in the hospital.  This model also deprioritizes ambulatory education due to competing demands. 

X+Y or Block Model 

In 2007 the Alliance for Academic Internal Medicine produced a consensus statement about the need for residency training to be redesigned (Meyers 2007).  This encouraged the creation of a schedule that allows learners to focus outpatient training without interruption by allotting protected time for the ambulatory experience.  It also allows space for ambulatory education that is not rushed by the demands of caring for patients in both the outpatient and inpatient setting at the same time. 

Block scheduling is also used in other health residencies such as pediatrics or family medicine and other professions such as nursing and pharmacy training.  

Advantages of an X+Y or Block Model

• The resident or learner can focus on their ambulatory practice 
• Improved ambulatory education
• Increased resident or learner satisfaction  
• Better modeling of an ambulatory experience (including the ambulatory experience as a subspecialist)
• Decrease fragmentation of care, as residents are not leaving the hospital team for clinic
• Improved experience for clinic staff (DeWaters 2019, Weymel 2024)

Leading through change

John Kotter’s Eight Steps for Leading Transformational Change is a helpful model:

1. Create a sense of urgency. 
2. Form a powerful coalition. 
3. Create a vision.
4. Communicate that vision. 
5. Remove obstacles. 
6. Create short-term wins. 
7. Build on the change. 
8. Anchor the change in the culture of the institution (Graves 2023). 

No one likes change. It takes time for individuals to become comfortable with change.  Validate people’s concerns and fears about change. 

Change in a residency program

 Dr. Brown recommends first answering the question, “why am I doing this (the change)?” or “what is the reason for change?” She then recommends reflecting on the following questions prior to embarking on change: 

• What are the goals for the program?
• What are the goals for the residents?
• What is the system mission? 

Get resident involvement! Then create lots of small wins for residents.

Keep your eyes on the prize (aka the end goal). 

Moving from a traditional schedule to a block schedule 

Dr. Brown recommends getting buy-in from relevant stakeholders (department leadership, residents, etc). One of the biggest obstacles that must be overcome is a reduction in resident service. Start with the educational dream meaning if you could design everything from the beginning, what would the program look like? And then look at what is currently being done with specific focus on duplications in the resident educational experience. Try to balance the educational value units (EVUs) or educational value of a clinical rotation with the relative value units (RVUs) or patient care services being provided (Shalaby 2014, Stehouwer 2022).  

Creating resident pathways 

Consider the educational needs and wants of the residents or learners in terms of career preparation. Design each pathway with clinical, mentorship, and scholarship experiences in mind. For fellowship based pathways, the goal should be exposure to all aspects of the specific specialty. As a leader, it is important to allow residents or learners and specialists in the specific specialty the space to vocalize what is needed for a successful pathway. 

Pathways help create lasting mentor-mentee relationships which leads to retention of trainees. 

Take Home Points:

As a leader, always keep your eye on the prize i.e. the educational experience of a training program and patient care. 

Links

1. Dr Brown’s show recommendation: Will Trent
2. Era’s show recommendation: Slow Horses
3. Charlotte’s book recommendation:   Out of Shape, Worthless Loser by Gracie Gould
4. Molly’s show recommendation: Queen’s Gambit 

Goal

Listeners will appreciate ways to successfully lead a residency program through change, specifically adapting an X+Y schedule and creating fellowship and career pathways. 

Learning objectives

After listening to this episode listeners will…

1. Compare and contrast modified traditional and X+Y residency schedules, evaluating the benefits and challenges associated with each.
2. Describe strategies to solicit buy-in from stakeholders when leading a residency program through change. 
3. List ways to overcome obstacles when leading a residency program through change. 

Disclosures

Dr. Stefanie Brown reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. 

Citation

Chaiklin C, Heublein M, Kryzhanovskaya E, Brown S, and Kopp, Z. “#43 How to be a Change Agent:Leadership with Stefanie Brown, MD. The Curbsiders Teach Podcast. https://thecurbsiders.com/teach.  June 12, 2024.