Click here for a list of the Picker Institute/Gold Foundation Challenge Grant projects.

Picker Institute/Gold Foundation
Challenge Grant Program 2010/2011: An Overview

Project PARIS (Parents And Residents In Session)
Principal investigator: Joel Forman, MD, Pediatrics and Preventative Medicine Associate Director, Residency Program Director and Vice-Chair      for Pediatric Education, Mount Sinai School of Medicine
Always Events™:
This intervention will allow for the development of a core set of AE (key points to focus on when providing PFCC).
About the project:
PARIS will implement and test a novel approach to teach pediatric residents about patient- and family-centered care (PFCC). The approach calls for a supervised meeting between a family member of a previously hospitalized child and a resident in the context of a pediatric residency rotation (behavioral and developmental pediatrics). For this “proof-of-concept” phase, meetings will be conducted with all pediatric residents in our institution. The meeting is standardized and is supplemented by a discussion with a faculty member. At the end of this study, we expect to have accomplished the following:
1. Develop and modify a manual setting out core required content and procedural guidance.
2. Develop a checklist that can be used to evaluate such encounters based on the above.
3. Collect data about the effect of the intervention on the following:
a. Trainees’ knowledge of PFCC
b. Parents’ acceptance of PFCC
c. Implementation of PFCC in the institution
d. Influence of the intervention on a standard measurement of patient care.
Dissemination:
Within institution: Results will be presented at an existing multidepartmental forum to support PFCC. It is expected that the approach will be implemented by other departments.
Nationally: Results will be published and presented in national forums devoted to PFCC and to more generalized forums. The PI intends to work through committees in professional organizations, such as the American Academy of Pediatrics, in order to work towards including a component similar to the project in training pediatric residents, as a way to accomplish the ACGME mandates.
Grant amount: $25,000.00
Match from grantee institution: $70,390.00

Development and Implementation of a Patient-Centered Discharge Curriculum
Principal investigator: Roy C.   Ziegelstein, MD, Chairman,  Diversity Council of the Department of Medicine; Executive Vice-Chair, Department of Medicine; Deputy Director of  Education, Johns Hopkins University
Always Events™:
The patient and the patient’s perspective should always be included in discharge communication, and the discharge summary should always be provided to the patient.
About this project:
In this project, a patient-centered discharge curriculum will be developed and the effects studied in an effort to ensure better care coordination, communication and patient education at the time of either discharge home or transfer to a post-acute setting. This project will be implemented on the Aliki Team, a 4-week rotation aimed at solidifying the importance of getting to know one’s patient as a person. If this project is found to improve trainees’ knowledge, attitudes and practice, and to improve patients’ health outcomes, it will be implemented throughout the department and then in other departments as well. The overall goal of this curriculum will be to teach interns and residents the skills and attitudes necessary to facilitate safe, effective, patient-centered transitions of care. It is hypothesized that an additional critical element for safe, effective transitions of care is the inclusion of the patient and significant others as full partners in discharge planning. This project proposes that the inclusion of the patient, and the patient’s perspective, in the discharge communication be an Always Event™.
Dissemination:
1. Web-based dissemination on Johns Hopkins Web site and the AAMC’s  MedEdPORTAL.
2. Publication in target journals such as the Journal of Hospital Medicine, Journal of General Internal Medicine, Medical Education and Academic Medicine.
3. Presentation at national scientific meetings, such as the American Academy on Communication in Healthcare, Society of General Internal Medicine and Society of Hospital Medicine.
Grant amount: $25,000.00
Match from grantee institution: $25,000.00

Humanism in the Perioperative Environment
Principal investigator: Danielle Perret, MD, Assistant Professor, Department of Anesthesiology & Perioperative Care, Director of the Fellowship Training Program in Pain Medicine, The Regents of the University of California
Always Events™:
1. Always determine the patient’s view of the perioperative experience, including preferences, needs and wishes, and use this to develop a personalized plan for care of that patient.
2. Always use empathic communication in all patient interactions.
3. Always identify and mitigate each patient’s level of anxiety using empirically based techniques that specifically target the individual.
4. Always pay close attention to pain and anxiety, before as well as after surgery, and develop a specific plan to address physical discomfort, keeping emotional factors in mind.
5. Always communicate empathically and clearly with the patient’s family and friends.
About this project:
Over a 19-week curriculum, this program will train first-year anesthesiology residents in compassion, communication and empathetic care in addition to technical care. The curriculum centers on the patient’s entire perioperative experience, with close attention to the patient’s fears, pain and anxiety. The goal is for residents to develop perioperative Always Events™ that integrate and promote patient-centered medicine, resulting in a personalized patient perioperative experience. The program’s comprehensive curriculum is designed to give anesthesia residents the skills to identify and address a patient’s pain, anxiety and personal needs in the perioperative setting.
Dissemination: The grantee institution has committed to replicating the program with their 2011-2012 residents. Picker Institute is currently in conversations with sister residency programs to include all or parts of the curriculum. The results and sessions will be broadly disseminated through presentations and workshops at ACGME and resident education and anesthesiology meetings, as well as in medical education and anesthesia peer-reviewed publications.
Grant amount: $25,000.00
Match from grantee institution: $27,539.00

Empowering Patients to Optimize Their Medication
Regimens: A Multidisciplinary Approach
Principal investigator: Susan D. Wolfsthal, MD, Professor of Medicine, Associate Chair of Education, Residency Program Director, University of Maryland School of Medicine
Always Events™:
1. The patient will always feel safe expressing his/her values, preferences and needs to the healthcare plan so that it aligns with the patient’s psychological framework.
2. The patient must always receive care generated by an integrated care plan developed through an interdisciplinary approach.
3. The patient must always be informed of and understand the benefits, potential side effects, cost and effective alternatives to treating and preventing illness.
4. The patient must always be relieved of fear and anxiety by providing an environment where the practitioners listen without judgment or prejudice. About this project:
This initiative will provide residents with skills in assessing their continuity patients’ barriers and adherence with medication use. Residents will gain knowledge through a series of seminars and evaluate their own clinical practice through a practice-based learning (PBL) exercise. Through an interdisciplinary partnership with a clinical pharmacist, residents will utilize existing resources to assist patients to cope with increasing economic pressures. Development of a self-efficacy process, a patient-centered evaluation instrument and a PBL exercise dealing with medication and financial issues will provide enduring materials for the residency program. Through a process of self-analysis, residents will reflect on the humanistic aspects of caring for diverse patients with complex medication needs in the face of economic hardship. It is anticipated that residents will utilize the principles learned to enhance healthcare delivery in future patient encounters.
Dissemination: The project will be able to be replicated in other training programs by utilizing the handouts, slides, instruments and PBL exercises through Blackboard. The project will be disseminated through abstracts and workshops at national meetings of graduate medical education, such as the Alliance of Academic Internal Medicine and the Association of Program Directors of Internal Medicine. The plan includes publishing findings in peer-reviewed journals and making the PBL exercises available to other educators through the institution’s open-access Blackboard site; in addition, the materials will be submitted to MedEdPORTAL.
Grant amount: $25,000.00
Match from grantee institution: $25,095.00

The Native American Cultural Competency Curriculum
Principal investigator: Eric Brody, MD, FACC, Clinical Services Director, Native American Cardiology Program Associate Director, University Medical Center Foundation Arizona
Always Events™:
1. The provider will always inquire about the patient’s desire for traditional blessing/healing ceremonies.
2. The provider will always make clinical decisions with input from the patient and family.
3. The provider will always delay surgical procedures, if possible, until the patient’s family members have arrived for support.
About this project:
The project will developed a cultural competency curriculum that will include, but not be limited to, eight hours of lecture time to explore topics such as: an overview of health issues among Native Americans; language/translation issues in providing care for Native American patients; culture and spirituality of Native American peoples (particularly in the Southwest); presentation/discussion of multiple case studies underscoring specific points regarding clinical care for Native American patients; a session of resident case presentations; and a session of concluding remarks/wrap-up. The project method will include October 2010 and April 2011 NAC-MSP trips to northern Arizona for residents and fellows to provide them with a hands-on clinical experience in seeing the provision of and participating in the delivery of culturally competent cardiology care to Native American patients. Assuring that these patients will be seen by cardiology providers who are culturally competent will:
1. Lower some of the barriers that Native American patients have traditionally encountered in seeking healthcare.
2. Encourage Native Americans to access essential cardiology care.
3. Raise the level of overall care provided to Native American patients.
4. Reduce the disparities in cardiology care/other care and mortality experienced by Native Americans.
Dissemination:
1. Work with the Arizona Medical Association and its accredited Continuing Medical Education providers to have the work/outcomes approved for CME for Arizona physicians
2. Work with the Arizona Nurses Association to have the work/outcomes approved for CE for Arizona nurses.
3. Present the project and outcomes at a national HIS meeting.
4. Provide the work/outcomes for CME/CE credit via the NAC-MSP’s telemedicine capability—for Arizona medical providers in rural/remote areas of the state.
5. Develop a podcast of the work/outcomes for national access via iTunes.
6. Develop articles regarding the work/outcomes for publication in local, regional, and national medical journals.
Grant amount: $25,000.00
Match from grantee institution: $25,000.00
“How Do You Have the Conversation?” A Curriculum for Residents

Principal investigator: Jennifer Rhodes-Kropf, MD, BIDMC/Hebrew Rehabilitation Center–Hebrew SeniorLife
Always Events™:
Goals-of-care and end-of-life conversations for advanced dementia and terminal patients should always occur during the patient’s history and physical examination.
About this project:
The program is expected to generate  the “goal for care in dementia” and the companion module of “living will exercise” videos. The “living will exercise” will help residents master the skills that are important in discussions of end-of-life wishes and values. The companion teaching modules will be presented to multiple Harvard-affiliated residency programs and combine an evidence-based, interactive teaching module with an innovative video narrative. The project aims to:
1. Develop an innovative curriculum that will teach internal medicine residents how to discuss with families the natural progression of dementia and what their options are for the goals of care for their loved ones.
2. Increase internal medicine residents’ comfort levels and knowledge for discussion of living wills with patients. Each resident will be better able to work positively and effectively with patients and their families, and end-of-life discussions will become an Always Event™ during the taking of a patient’s history and physical examination.
Dissemination: Dissemination will begin at the inception of the project as the participants in five residency programs complete the companion modules. A faculty member at each site will be designated as the palliative medicine project champion to carry out the project each year. The PI and co-PIs will work with the champions to facilitate the adoption of the program into other departments.
1. Bedside Teaching summary cards will be disseminated to other teaching faculty.
2. The two videos and all other curriculum materials will be posted on the future Web site “Conversation Project” for national and international dissemination and replication. This Web site is part of a national campaign in which Harvard Medical School, the Harvard School of Public Health and IHI are partnering,, that will utilize Internet-based storytelling to explore how end-of life conversations can lead to more compassionate deaths.
The team expects to publish two papers describing the impact of these companion modules based on our analysis of the data in a medical education journal such as Academic Medicine.
Results will be presented and the curriculum will be submitted to be shared at national meetings such as the Society of General Internal Medicine, the American Geriatric Society, the American Association of Hospice and Palliative Medicine  and AAMC Gold Foundation session.
The modules will be produced by the PIs and Dr. Maureen Strafford’s medical students and interprofessional colleagues.
The videos and the curriculum will be posted on academic medicine teaching Web sites, such as Portal of Geriatric Online Education.|
Results will be presented at grand rounds and other departmental grand rounds at other institutions.
Grant amount: $25,000.00
Match from grantee institution: $25,000.00

Integrating Patient- and Family-Centered Care Principles into a Simulation-Based
Institutional Curriculum
Principal investigator: Marc L. Bertrand, MD, Associate Dean of Graduate Medical Education, Designated Institutional Official, Associate Professor of Anesthesiology, Dartmouth-Hitchcock Medical Center
Always Events™:
A curriculum based on key principles of PFCC will identify AE.
About this project:
This project will develop a curriculum and simulation-based training experience for DHMC residents that will improve physician-patient communication related to patient safety. We propose to develop an institution-wide curriculum based on the key principles of PFCC that will identify “always events”—observable behaviors that ensure all patient-care experiences are firmly grounded in dignity, respect and information sharing. The curriculum will specifically include simulations focused on informed patient choice and breaking bad news. The principles of effective communication and SDM will be the foundation for this curriculum; the simulations will provide an experiential component which will include structured debriefing. An understanding of and respect for individual patient needs, values and preferences will be the underpinnings of our proposed curriculum
Dissemination:
1. Incorporate the curriculum into early learning for all first-year residents at DHMC on an annual basis.
2. Share educational materials with Henry Ford Hospital.
3. Make resources available to interested institutions at no cost via a Web-based Learning Management System (including PowerPoint, integrated video clips, instructor notes for faculty moderators, recommended reading materials, simulated-patient scenario scripts and assessment tool).
4. Present results and curriculum at workshops such as at the AAMC and ACGME conferences, the Institute for Patient- and Family-Centered Care, the National Safety Foundation and IHI annual meetings.
5. Publish results in target journals such as the Journal of GME or Quality and Safety in Health Care.
Grant amount: $22,701.00
Match from grantee institution: $47,400.00

Teaching Disclosure: A Patient-Centered Simulation Training for the Crucial Conversation
Principal investigator: Jennifer L. Beard, MD, Internal Medicine Residency Assistant Director, Center for Medical Education and Innovation Director, Riverside Methodist Hospital/OhioHealth Foundation
Always Events™:
Following a medical error, physicians will always provide an explanation to the patient and family regarding what happened, the potential implications or consequences of error, a commitment to investigate what went wrong, feedback regarding the findings of the investigation and an apology or expression of regret.
About this project:
This project will attempt to close the gap by providing a robust training and competency assessment for medical residents on how to disclose medical errors and improve communication skills, using the National Quality Forum’s guidelines. Subjects for this project will be PGY 1 residents in multiple disciplines training at Riverside Methodist Hospital. Training will include didactic sessions, standardized patient encounters involving disclosure of medical error and debriefing sessions following the encounter to provide formative feedback and performance evaluation. The goal of this project is to ensure that the skills needed to provide full disclosure of medical errors are taught to trainees, and to evaluate the assessment of trainees’ competence in these skills.
Dissemination:
1. Findings will be disseminated through presentations at GME conferences for all training programs in OhioHealth and sister hospitals.|
2. Results will be submitted for publication in medical and/or patient safety journal publications, as well as through oral or poster presentations at national conferences for medical education, patient safety and simulation.
3. Curriculum will be included in the simulation curriculum at the innovation training center to  allow for replication at sister hospitals.
4. A CME course for attending physicians, nurses, nursing students and allied healthcare personnel. will be developed.
Grant amount: $25,000.00
Match from grantee institution: $25,000.00

Home Medication Education and Support (HOMES): A Resident Module on Home Care in Children
Principal investigator: Kathleen E. Walsh, MD, MSc,  Professor of Pediatrics, University of Massachusetts Medical School
Always Events™:
Residents will always share with the patient and their family/caregivers the reason for each medication and instructions on how to administer each medication, and provide an opportunity for questions.
About this project:
This study will address the challenges faced by families with chronically ill children by training new physicians to be sensitive and responsive to parents’ needs and to proactively provide parents with the support they need to care successfully for children with chronic conditions at home. The overarching goal is to develop a curriculum that will give residents the knowledge and clinical skills needed to support safe home medication use for children and families in their practice. The proposed curriculum will be implemented within three pediatric resident rotations: primary care clinic, inpatient wards and hematology/oncology. Incorporating photos and testimonials from my home visits, the curriculum will include two didactic PowerPoint talks, one Web-based module, a resident-parent communication tool that will encourage residents to take what they have learned into their clinical encounters, experience teaching parents how to give medications and a “prescribing” Always Event™.
Dissemination:
1. Curriculum modules will be posted on the UMass Medical School Web site.
2. Curriculum and results will be submitted for presentation at the Association of American Medical Colleges and Pediatric Academic Societies and for publication.
3. The Cancer Research Network Cancer Communication Research Center Dissemination Core (CRN CCRC) will be utilized to distribute support tools and infrastructure developed by the CCRC to support dissemination of the curriculum.
4. The Brown/Rhode Island Hospital med-peds residency program has expressed interest in replicating the curriculum in their program as a second site.
Grant amount: $25,000.00
Match from grantee institution: $25,001.00

Improving Transitions of Care for
Older Adults Through Interdisciplinary
Education for Medical Residents
Principal investigator: Franklin S. Watkins, MD, Assistant Professor, Gerontology and Geriatric Medicine, Wake Forest University Health Sciences
Always Events™:
Successful hospital discharge and transitions of care can be considered an AE.
About this project:
We propose to develop an “Acute Care for the Elderly Unit Transitional Program” (ATP) to teach optimal discharge planning and reinforce interdisciplinary communication through trainee home visits to vulnerable older patients after hospital discharge. The ATP will provide a “living laboratory” to enhance the medical trainees’ understanding of the importance of appropriate discharge planning and communication with the patient, family and caregivers, as well as impact a culturally and socioeconomically diverse population. Additionally, the ATP will meet the stated missions of both the Picker Institute and the Gold Foundation and will provide an innovative educational curriculum for continued measurement of important markers of medical residents’ knowledge, their attitudes regarding both transitions of care and interacting with older adults and their families, and patient outcomes. Successful hospital discharge and transitions of care can be considered Always Events™, as all patients experience at least one (and often more than one) care transition following hospitalization.
Dissemination:
1. Publish in educational and geriatrics journals such as ACGME’s Journal of GME and the Journal of the American Geriatrics Society.
2. Post curriculum on the POGOe (Portal of Geriatric Online Education) Web site and submit to the MedEdPORTAL site.
3. Present curriculum and results at the annual meeting of the American Geriatrics Society (AGS) in May 2011 and a poster of results at the annual AGS meeting in May 2012.4. Present curriculum and outcome measures at the national Donald W. Reynolds Geriatrics Education Program meeting in the fall of 2011.
5. Identify an additional meeting that will allow for potential further dissemination to residency program directors nationally.
6. Post advertising flyers at national meetings where presentations will occur. Picker Institute and the Gold Foundation will be featured as partners in the ATP program in the Sticht Center newsletter at WFUSM, which is circulated to academic peers in all training programs.
Grant amount: $25,000.00
Match from grantee institution: $25,000.00