Byron Joyner, MD, MPA

UWMC-ML is scheduled for a 3-day Clinical Learning Environment Review (CLER) site visit from 30 July to 1 August. Over the next few weeks, I will outline the progress we have made at UW Medicine and UWMC-Montlake (UWMC-ML), specifically in the 6 CLER domains following our last CLER site visit.

The CLER program consists of 6 domains that have evolved to reflect the current state of GME and the world of health care. All 6 domains are closely related and define how the hospital system functions. By performing CLER site visits, the ACGME hopes to provide feedback to enhance physician education and improve patient care quality in these organizations. This report focuses on Patient Safety, the first and most scrutinized CLER domain.

During our last (2019) CLER site visit, CLER site visitors explored several areas of Patient Safety, including 1) Patient Safety Education 2) participation in the patient safety event reporting system, 3) feedback on patient safety event reports, 4) participation of trainees in patient safety event investigations, and 5) the clinical learning environment’s role in monitoring patient safety. We have made the following progress in these areas.

Patient Safety Education

The CLER Pathways to Excellence, version 2.0 provides a framework for hospital leadership, in partnership with GME, to optimize the clinical learning environment by creating and integrating better education and opportunities for better patient care. As such, in addition to training provided by individual programs, GME ensures that all trainees have multiple exposures to patient safety education throughout their time at UW Medicine. There are many examples:

1. Patient Safety Orientation – In June of every year, the UW GME Orientation provides introductory educational sessions in Patient Safety.
2. A Patient Safety e-Learning module is delivered in the fall of every academic year.
3. Housestaff Quality and Safety Committee (HQSC) hosts a boot camp for trainees desiring in-depth training in special topical areas of patient safety and quality.
4. Program Level QI Training – The ACGME Common Program Requirements (CPRs) set expectations for all program directors (PD) to train their residents/fellows in QI practices and provide practical experience in patient safety activities. This training has been variable in our system. We have high hopes for the new GME Foundations course.
5. GME Foundations in Quality and Patient Safety – At its inception, this two half-day intensive course enrolled 23 programs and over 200 trainees. In AY24, GME and the Center for Scholarship in Care Quality and Safety received funding to expand this 5-hour, standardized training to all trainees and faculty. This should increase quality of care and patient safety.

Patient Safety Event Reporting

2019 CLER Feedback: Low rate of participation in PSN (now Safety Net) reporting.

Goal to Achieve: 50% increase in the number of Safety Net reports submitted by trainees.

Intervention(s): Over the last 3 years:

1. Improved feedback to faculty and trainees through the medical director’s office
2. Education during UW GME Orientation and the fall Patient Safety E-learning
3. Trainee inclusion in adverse event reviews
4. Safety Event Classification (SEC), a new addition to Safety Net (formally PSN), has made it easier for UWMC-ML leaders to detect patterns of events and filter by frequency and seriousness which helps to prioritize efforts of prevention

Current Status: Met 1.8% baseline reporting rate for trainees (trainee reports/total reports), 3.6% for Q2 of AY 24

Data collected from UWMC-ML Patient Safety Net.  Note, data does not include staff injury events.  Events categorized as “Harm” denote that harm actually reached the patient, as opposed to only posing a risk to a patient.

Revised Goal: 5% rate of reporting for trainees (trainee reports/total reports) and faculty (faculty reports/total reports)

Overall, trainees feel that hospital leadership promotes a culture of patient safety and makes every effort to deliver safe and error-free care to patients. Trainees reported that error prevention is discussed and that positive change results from acknowledging and acting upon safety concerns.

Patient Safety Intensive Review (Event Investigation/Adverse Event) Participation

2019 CLER Feedback: Low rate of participation in Patient Safety Intensive Reviews (Event Investigations).

Goal to Achieve: 50% of Intensive Reviews (Adverse Event Reviews) each quarter should include trainee participation.

Intervention(s): Over the last 3 years, we devised an elegant solution:

1. In partnership with GME and Patient Safety Leadership team at UWMC-ML, trainees have been invited to attend intensive (event) reviews.
2. Copies of the invitations were sent to trainees’ PDs who could remove barriers to attending the Intensive Review (Event Investigations).

Current Status: 100% of Patient Safety Intensive Reviews (Event Investigations) Q1 – Q3 of AY24 had trainees in attendance. Q2* data is not yet complete.

Monitoring of the numbers of individuals participating in patient safety event investigations and Safety Net report submissions is done monthly by UMWC-ML’s Center for Clinical Excellence (CCE). Additionally, this data is reported to the GMEC. 

Conclusion:

This work has had a notable impact on our trainees’ perception of our institution’s culture of safety. On our most recent culture of safety survey by Press Ganey, our trainees rated UWMC-ML’s patient safety culture well above the national average at 4.18 (+0.21 above the national average for other academic medical centers) and the faculty rating was also better than the national average (4.01).

There is more work to do. Supporting this work requires multidisciplinary collaboration between our GME leadership, hospital leadership, quality improvement and patient safety leaders, and our nursing colleagues. Dr. Strizich, Director of Quality & Patient Safety for CLER, has chaired our GMEC CLER Subcommittee for the past three years. This committee has representation from our GME team, PDs, program administrators, trainees, our medical director’s office, patient safety leadership, risk management, as well as from our nursing colleagues and is tasked with monitoring and supporting our efforts to improve our clinical learning environment.

We are excited to continue to expand this work and find new ways to enhance the culture of safety within our clinical learning environments.

Be on the lookout for more updates on CLER in the following weeks. Meanwhile, check out our UW GME CLER website.

Byron Joyner, MD, MPA

The ACGME Clinical Learning Environment Review (CLER) team has invited us to participate in a 3-day CLER Site Visit between July 30th and August 1st. This is a wonderful opportunity for UW Medicine, and UWMC-ML, specifically, to learn more about developing and sustaining an optimal clinical learning environment.

In this rapidly evolving health care environment, it is critical that hospitals support training of residents and fellows in communication, systems-based practices and interprofessional teamwork. Residents and fellows are the front line of patient care in our hospitals, and they should have opportunities to learn about diversity, disparities, social determinants of health and participate in quality care and patient safety.

The ACGME CLER program, created in 2012, was established to encourage hospitals to focus on continuous quality improvement. To this end, CLER site visits provide GME leaders, hospital executives and the local medical community feedback in 6 critical and cross-cutting areas:

Patient Safety Health Care Quality Teaming Supervision Professionalism Well-being

In addition to the general CLER Site Visit, we have volunteered for the new Patient Perspective Subprotocol. Through this subprotocol, the ACGME hopes to learn more about the patient voice. To do so, a separate set of site visitors will visit simultaneously the in-patient wards at UWMC-ML to ask 14 standard questions regarding their satisfaction with our health system. Examples of questions will be:

1. Please tell me who is the doctor in charge of your care.
2. Do doctors and nurses go over your plan of care so that you understand it?
3. Do you feel that doctors encourage you to ask questions?
4. Did you feel when there was lack of coordination in planning your care?
5. Did you receive conflicting information from doctors and nurses?
6. Do doctors and nurses seem to treat each other with respect?
7. Do nurses and residents treat each other with respect?

All of the questions can be found on the ACGME site. These questions are substantive and remind us of how teamwork can affect patient expectations.

Although CLER site visits are not graded, there is a requirement that each institution sponsoring graduate medical education has a periodic CLER site visit. These site visits allow a sponsoring institution to qualify for an accreditation status. There are two expectations. First, each sponsoring institution should develop action plans based on the feedback received from the CLER site visitors and implement improvements to address any identified deficiencies. Second, faculty, housestaff, nurses and pharmacists should be invovled in working to improve hospital quality and patient safety. You can learn more about what we are doing in GME by reviewing our CLER website.

During our last 3-day CLER site visit in 2019, CLER field representatives collected information through observations of and interviews from executive leadership, program directors, residents, fellows, nurses, and faculty about the six CLER domains. In the weeks ahead, I will be sharing with you changes and improvements that UW Medicine has made based on the feedback from the last CLER site visit, priorities set by feedback from you and securing resources to make improvements.

Before our CLER site visit, Hadar Duman, Director of GME Accreditation will send requests to many of you to participate in interviews with members of the CLER Site Visit team. Thank you for responding promptly to her requests. And, thank you for cooperating in this exciting opportunity to be better!

Byron Joyner, MD, MPA
Vice Dean for GME &
Designated Institutional Official
University of Washington
School of Medicine

Byron Joyner, MD, MPA

One of the joys of this DIO blog is that we can celebrate the accomplishments and amazing work of our residents and fellows.  This month, I’ve invited Drs. Mariam Alam, R4 Dermatology, and Caitlin Crimp, Acting Instructor, Department of Dermatology (and 2023 graduate of the Dermatology residency program) to reflect on their ACGME Back to Bedside project, “Mitigating Bias and Burnout Through Patient-Centered Narrative Medicine.”  In June 2022, Drs. Alam and Crimp received a Back to Bedside grant to develop a narrative medicine curriculum for dermatology residents, with the goal of improving residents’ understanding and connection to patients and mitigating both bias and burnout.

Byron Joyner, MD, MPA
Vice Dean for Graduate Medical Education, Designated Institutional Official

Drs. Mariam Alam and Caitlin Crimp, in front of their Back to Bedside poster with Steph Timm (Manager, Education and Training Programs, Department of Dermatology) at the Annual ACGME Conference

Every person has a story. But often, as doctors, we miss that story. Our days get filled with frenetic clinic schedules, heaps of notes, endless computer clicks, prior authorizations, prescription refills…our patients themselves get lost. Busy, tired, overworked, we stop seeing our patients. A vicious cycle starts. Losing human connection contributes to burn out. Not understanding our patients reinforces biases. The gap between the doctor and the patient widens.

What if we had time and space to just hear our patient’s story? And, could stories in art and literature help us to understand and connect with our patients? With each other? With ourselves?

We received funding and mentorship through the Accreditation Council for Graduate Medical Education (ACGME) Back to Bedside program to develop, implement and evaluate the impact of a narrative medicine curriculum for the dermatology residency program at the University of Washington.

Our curriculum centers around four narrative sessions per academic year, each of which focuses on an identity or disease group relevant to dermatology. Some of the topics we have focused on include hidradenitis suppurativa, skin of color, hair loss, psoriasis and gender identity. During each session, a patient is invited to come and talk with residents and share their story and answer questions informally.

Following this conversation, residents are asked to read a piece of literature or poetry, look at a piece of art or listen to spoken word relevant to the session topic, and then complete a journal entry in response to a written prompt. For example, following our psoriasis session, residents read an excerpt from “From the Journal of a Leper” by John Updike and responded to the prompt “Write about a patient’s suffering who moved you.” This writing exercise is followed by discussion among the residents, reflecting on their conversation with the patient and the associated narrative medicine exercise.

We hypothesized that bias and burnout would decrease through implementation of this curriculum, and asked resident participants to complete a survey, the Maslach Burnout Inventory and Harvard Implicit Association (IAT) tests at baseline, midpoint and following completion of the curriculum, and we have data for our first half of the two-year curriculum.  Although Harvard IAT scores remained stable, self-reported bias and experienced bias increased, perhaps suggesting increased awareness of bias and self-reflection. Self-reported burnout increased over the course of the academic year, however more residents reported using writing and self-reflection as tools for coping with burnout and combatting bias.

Residents also provided overwhelmingly positive feedback for the curriculum. As one resident wrote, “This was an incredible experience. I felt I was able to ask questions during the panel that I wouldn’t necessarily ask in the constraints of a patient visit. It has prompted me to ask more questions to patients regarding the impact of their condition on their daily lives.”

As we develop year three of the curriculum, we aim to create a sustainable, long-standing narrative medicine curriculum for dermatology residents. Our long-term goals include expansion of the curriculum to UW dermatology faculty, outside dermatology programs and adaptation of our model for non-dermatology specialties.

Listening to each other, sharing our stories connects us. And, over time, it may chip away at burn out and bias. It’s a simple plan: time, space, someone to tell a story, and someone to listen.

Mariam Alam, MD and Caitlin Crimp, MD

Mariam Alam, MD

Caitlin Crimp, MD

See other articles on Dr. Alam’s and Crimp’s projects:

Drs. Alam & Crimp Receive Funding for ACGME Patient Engagement Project

Narrative Medicine Patient Panels Combat Bias & Burnout Through Storytelling

Back to Bedside Project Summaries

Byron Joyner, MD, MPA

There are many things that are changing besides the weather.

With the imminent departure of Dr. Lindee Strizich, the current GME Director of Quality & Patient Safety at UWMC-ML, we are thinking about ways to improve our efforts and efficiency around the Clinical Learning Environment Review (CLER) site visit. We haven’t had one since January of 2019. Since then – and considering the COVID-19 pandemic, the ACGME has developed better procedures and practices to provide hospitals with feedback in the six CLER domains: patient safety, healthcare quality, teaming, supervision, well-being, and professionalism.

In addition, the ACGME recently introduced the new CLER domain of Diversity, Equity, and Inclusion (EDI), recognizing that these qualities are essential to improving patient and learner experiences –and achieving equity in healthcare. EDI replaces supervision as a stand-alone domain.

The ACGME CLER program is built upon the concept of continuous quality improvement. The purpose of the CLER site visit is to ensure that GME programs, in partnership with their hospital leadership, are meeting the demands of a rapidly evolving healthcare environment and are collectively aligned with the six cross-cutting domains listed above, including the new EDI domain.

Under Dr. Strizich’ leadership of the CLER committee, we have continued to develop ways to engage residents and fellows in quality and patient safety activities. These activities are critical to our learning environment and are mutually beneficial: housestaff learn from adverse events during intensive reviews and the hospital leadership, including risk management, learns about resources that are central to create safer learning environments for residents, fellows, and patients.

Three years ago, as the chair of the Graduate Medical Education Committee (GMEC), I charged an EDI subcommittee to help improve all aspects of EDI in our learning environment. But EDI is not just a clinical issue; it is a systems issue. As a result, we have been thinking of better ways to align our goals with those of the hospital leadership so that we are not duplicating efforts but working together to boost those efforts.

Nationally, most hospitals have been making improvements in the six CLER domains, as demonstrated by the ACGME’s annual report on CLER. With these positive changes, and given that EDI is now folded under the CLER framework, we have decided to consolidate the work of our EDI subcommittee within the GMEC CLER Subcommittee. This group will consist of trainees and faculty with expertise to address EDI needs for our community.  In addition, we will establish an ad hoc EDI workgroup.  This new group will collaborate with other individuals and entities in our organization, improving the work we are already doing to deliver care that demonstrates cultural humility for all patients and their families.

Some of our current EDI efforts include support of the Network of Underrepresented Residents and Fellows (NURF), which is involved with the recruitment of new residents and fellows. We also work collaboratively with the Office of Healthcare Equity (OHCE) to expand awareness of education in, and policies that will create an antiracist environment in the SOM. The GME EDI Workgroup will be engaged in deciding which of the many projects we need to pursue aligned with these and other groups.

There is a lot to do – and GME wants to be involved by partnering with other UW Medicine entities to engage residents, fellow, nurses, staff, and faculty in developing a just culture where everyone is treated better.

Byron Joyner, MD, MPA
Vice Dean for GME and DIO

Byron Joyner, MD, MPA

This month, we celebrate the incoming class of residents and fellows who will join us this summer! For the fourth year in a row, our residency and fellowship programs virtually recruited the most competitive medical students from around the country – and the world!  This year, 91 of our 200+ total ACGME and non-ACGME training programs participated in the National Residency Matching Program (NRMP) and 23 participated in the San Francisco Match.

Both the NRMP Main Residency and Specialties (Fellowship) Matches were the largest on record, with 41,503 positions available in the Main Residency Match and 13,365 positions in the Specialties Match.  Each year the NRMP publishes comprehensive reports on results of the Main Residency and Specialties Match, drilling down to data on results by state, specialty, individual program and institution.  These reports can be found in the Match and Data Analytics section of the NRMP website.

This year, the UWSOM offered, 296 positions in the Main Residency Match and 196 in the Specialties Match.

Main Residency Match

• In the Main Residency Match, the 27 participating UWSOM residency programs had a match rate of 95.5% (and 99.7% after the Supplemental Offer and Acceptance Program, or SOAP) compared to 93.8% nationally.
• From 2019-2022 we saw small year-to-year decreases in the number of UWSOM graduates matching to our residency programs, followed by an increase in UWSOM graduating residents matching in 2023.  We saw a slight drop this year (49 graduates), but this reflected 17% of matched applicants and a higher match percentage than in 2021 and 2022.

Specialties Matching Program

• In the Specialties Match, the 64 participating UWSOM fellowship programs offered 196 positions with a match rate of 86.7% compared to 83.7% nationally.
• The Match outcomes for some of our UW fellowship programs appear reflective of national trends in several specialties that have seen an increase in positions offered in the Match (e.g., Addiction Medicine, Infectious Diseases and many of the Pediatric fellowships), coupled with a decrease in the number of active Match applicants.
• Of the 23 UWSOM positions unfilled in the Match this year, 17 have been filled post-Match.
• 41 of the 170 spots filled in the Match were filled by UWSOM residents, a slight increase over last year.

Increasing Diversity in our Training Programs

UW Medicine is creating a healthcare system that works for everyone. To that end, it is essential that we prioritize diversifying the medical workforce. This is not just a moral imperative. It is a practical one, as diversity can lead to better health outcomes and a more effective healthcare system overall.

This year our programs reported increases in both Black, Indigenous and People of Color (BIPOC), as well as Underrepresented in Medicine (URM) candidates who matched in our medical and dental programs. As we work together to increase and, more importantly, sustain inclusivity and diversity in our workforce, we can continue to model, teach and actually provide better equity for all patients in our community.

For the third year, the GME Office and NURF hosted Town Halls to help our programs attract underrepresented and vulnerable minority candidates. One of the NURF Town Halls had more than 600 participants. I want to congratulate program and department leadership, residents and fellows, and the Network of Underrepresented Residents and Fellows (NURF) for their tremendous efforts in our journey to diversify our learning community.

Byron Joyner, MD, MPA
Vice Dean for GME and DIO

Byron Joyner, MD, MPA

It’s time to celebrate our amazing learning community. I am excited to share the results of a recent survey of our residency and fellowship program alumni. This survey is an initiative included in our new GME Strategic Plan which will enhance our expertise in analyzing data, bridging information systems and delivering better reports. This month, I’ve asked Allison Shults, GME Residency Management System (RMS) and Information Systems Manager, to write about the alumni survey findings. I salute our alumni!

Byron Joyner, MD, MPA
Vice Dean for Graduate Medical Education, Designated Institutional Official

Allison Shults

As RMS & Information Systems Manager with the GME Office, I oversee our community’s use of MedHub, which is our Residency Management System (RMS). I work closely with the data it collects from our users. In my role, I have the unique privilege of supporting many GME Strategic Plan initiatives by analyzing and sharing data that reflects our amazing learning community. Whether highlighting GME’s long history (our first accredited training program was 1952!) or the portfolio of programs and trainees we support (200+ programs and 1600+ trainees each year!), there is a myriad of data that tells the story of GME and illustrates how far and deep our community reaches. I would like to share our story with you.

I’m excited to focus here on our incredible resident and fellow alumni. They represent the best in medical education and serve as leaders in their communities. They are engaged during their training and remain engaged – whether through learning in CME courses, staying on as faculty, practicing in the WWAMI region, or being recognized for their contributions to public health and well-being.

But don’t just take my word for it – the data speaks for itself:

Alumni Practice Where They Trained

Studies repeatedly show that trainees are likely to practice in the same state as their residency program, and our alumni are no exception. We recently surveyed our graduates from the last 5 years (2018-2023) and found that 38% of 322 respondents are currently practicing in the WWAMI region (36% specifically in Washington)! In reality, this number is likely much higher considering our vast alumni base.

Reflecting GME’s mission to build physician-leaders that represent and enhance the communities we serve, it is exciting to see that our graduates also practice in diverse settings:

Not only do our alumni show a desire to work locally, but they also show a desire to lead. In our survey, 31% of respondents report holding a leadership position in their current organization. Multiple alumni have been recognized for their leadership in hospitals, research, mentorship, and much more.

Alumni Stay Engaged With GME

GME alumni recognize the impact of their training and continue to stay engaged in the UW community as both fellows and faculty. Over the last ten years, we have seen more than 700+ trainees stay on as UWSOM faculty, and 22% of UWSOM residents matched to UWSOM fellowship programs last academic year.

Our program leadership recognizes the many talents of our trainees and interviewed 82% of alumni who were interested in a further position at UWSOM [FIGURE 2].

GME is proud to have a community dedicated to supporting and enhancing the learning environment for our trainees, and the success of those efforts shined through in the survey. When asked whether our alumni felt their program prepared them for their position, a resounding 96% agreed (68% strongly agree and 28% agree) and 88% agreed that they would recommend their training program to others.

Alumni are Awarded for Their Impact

Given the data on our alumni’s success, it should come as no surprise that they continue to be recognized across the University and their communities. Alumni of UWSOM residency and fellowship programs have been recognized by the UW School of Medicine Alumni Association in each award category, including one Lifetime Achievement Award winner, one Lifetime of Service Award winner, and many more:

It’s clear from the data that UW GME alumni are shining examples of their training who represent their peers and UW School of Medicine well.

The GME Office celebrates the many contributions our alumni make and the successes they share with us. We are looking forward to continuing to receive valuable feedback from sources like our alumni survey. The GME Strategic Plan has created a renewed focus on advocating for our learning community and committing to enhancing the quality of the clinical learning environment, but we can only do this by first understanding the current landscape. We are implementing new initiatives to gain more insight which can help us navigate the future and create long-term successes.  Personally, I’m thrilled to be a part of it.

Allison Shults
RMS and Information Systems Manager

Byron Joyner, MD, MPA

I am very excited about our new, 6-year GME strategic plan  We’re excited about this plan, which shapes our priorities, guides our work and allows us to request resources.  It’s also an important way for GME to communicate to our stakeholders about the breadth and depth of our work on behalf of this community.  For the February DIO Blog, I’ve invited Cindy Hamra, Associate Dean for GME to share an update on the GME Strategic Plan.  We’ll continue to share updates a few times each year to keep you updated on our progress.

Byron Joyner, MD, MPA
Vice Dean for Graduate Medical Education, Designated Institutional Official

Cindy Hamra, JD, MA

In August, we introduced the new GME Strategic Plan, which will be effective from July 2023 through June 2029.  This is our fourth strategic plan since I have been in the GME Office and it’s by far been our most inclusive and robust process.  We learn from each iteration.

The process of developing the final version of our strategic plan took about 11 months and included a SWOT survey to GME stakeholders, data analysis by a group of GME team members, reviewing guiding documents including ACGME requirements, the UW Medicine Strategic Plan, and the Office of Healthcare Equity Blueprint.  We identified several themes and framed them according to our strategic values, which have guided our work since 2019.  Although contexts may change, our strategic values have not.  A snapshot of the resulting plan looks like this:

We’ve shared this resulting plan with many groups since July 2023, including this video.  Our team has simultaneously been working on implementation – planning out the projects and work that we want to accomplish.  I’m excited to share some of the many projects that are already complete or underway!

The table above reflects a fraction of the work that is underway.  We welcome input from and participation by our community.  If you’re interested in joining this work, feel free to reach out to me.

We’ll continue to share updates with you for the duration of the plan.  In the meantime, feel free to reach out if you have questions or feedback.  We believe this work will make our GME community stronger and the learning experience better for our residents and fellows.

Cindy A. Hamra, JD, MA

Associate Dean, Operations & Administration
Graduate Medical Education| UW Medicine

Byron Joyner, MD, MPA

The Names & Pronunciations Initiative (NPI) is a community project that aims to help people pronounce each other’s names correctly. All of us are many things. But our names define us. As our community becomes more diverse, NPI will help us correctly pronounce others’ names. NPI does this very simply: it makes physical pronunciation tags that can be layered behind our hospital ID badges.

In partnership with the Office of Healthcare Equity – and many other UW Medicine groups, I am proud to support this project as it helps us to get to know each other better. This month I have invited the NPI project lead, UW 4th year UWSOM medical student Sudiptho (suh-dip-doe) Paul, to share NPIs’ origins.  It is my hope that NPI will help everyone feel welcome in our community.

Byron Joyner, MD, MPA
Vice Dean for Graduate Medical Education, Designated Institutional Official

Sudiptho Paul, MS4

The inspiration behind the Names & Pronunciations Initiative (NPI) stems from a personal journey marked by an awareness of the impact that mispronunciations can have on one’s sense of self and belonging. Having navigated predominantly white spaces in my youth, college, and work as a first-generation Bangladeshi-Thai American, I experienced firsthand both the subtle and significantly negative impacts of name mispronunciations on my educational and professional development and well-being—an “othering” experience common to many people.

This awareness continued during virtual medical school amid the challenges of the COVID-19 pandemic when particularly distressing mispronunciations of my name drove me to address the issue more proactively. Having successfully advocated for the integration of NameCoach—a program facilitating audio recordings of name pronunciations—into the medical school’s online systems, it became apparent during my clinical rotations that something more tangible was needed for the face-to-face clinical settings.

Hence, I started NPI, which involved the creation of physical name pronunciation tags as a simple communication aid. Designed to layer behind UW hospital ID badges, these tags function as a helpful tool to facilitate more accurate name pronunciations in-person. NPI empowers individuals to cultivate stronger interpersonal relationships for communication and collaboration in our community— connections start with our names.

Implementing NPI required perseverance and teamwork to translate awareness into action. Despite facing initial setbacks in grant applications, the project eventually secured support through the 2023 UW Resilience & Compassion Seed Grant. The setting was ripe for collaboration, as I came to learn that other students, residents, fellows, attendings, and staff had also had similar conversations about the importance of correct name pronunciations. Coming together, we designed the tags, developed strategies for their distribution across the Washington, Wyoming, Alaska, Montana, Idaho (WWAMI) region, and engaged with various UW Medicine affiliated groups to foster the project’s success in our community. I also built NPI’s website, which serves as an information hub where people can order pronunciation tags and find other resources. Beyond improving name pronunciations, I want these tags to also prompt us all to reflect more about our names’ role on our identities. Who named you and why? How does it feel when it is pronounced correctly versus incorrectly? What does your name mean to you and what does it represent?

NPI can be regarded as a grassroots initiative driven by our community’s collective commitment to inclusivity. I hope this project’s manifestation inspires others to act on other issues, regardless of how minor a problem may seem—it is about encouraging small steps that contribute to a larger improvement in culture within UW Medicine and beyond.

Sudiptho Paul
4th Year Medical Student
University of Washington School of Medicine

Byron Joyner, MD, MPA

Many members of our community are familiar with the GME Wellness Service, a vital part of the GME Team.  Our four amazing counselors provide tremendous support for our residents and fellows.  This month, Dipti Chrastka, Director of the GME Wellness Service, shares an update about the robust services that create a healthier learning environment for our trainees.

Byron Joyner, MD, MPA
Vice Dean for Graduate Medical Education, Designated Institutional Official

Our health and well-being have taken a toll over the last few years: the COVID-19 pandemic, which resulted in social isolation; racial unrest: and the more recent news of war and violence in Ukraine and the Middle East. We may experience feelings of fear, uncertainty, sadness, stress, and overall distress.

This season of shorter, cooler, darker days with less day light can also adversely impact our mood, sleep cycles, sap our energy and daily functioning.

Many of our medical professionals may face many stressors that affect their mental and physical health.

Resident and fellow well-being is a priority for UW GME which has been providing care to our community for over two decades.

Our GME Wellness Team provides a wide spectrum of services to build connection and foster a culture of holistic wellness. The GME Wellness team members are all licensed and skilled clinicians who bring their unique experiences in working with health care professionals.

Some of the many ways the Wellness Service supports you:

• Counseling support: Our services are free, unlimited, and completely confidential. We offer daytime, as well as evening wellness appointments to accommodate our trainees’ busy schedules. We are currently offering virtual sessions, which reduces barriers, and takes away the stress of commuting, parking, and finding time in your already packed day to get support.

In AY23, we supported 249 unique residents, fellows, and partners/spouses with a total of 1,734 visits. We provided individual counseling, couples counseling, and connected many trainees with referrals to in-house specialists (e.g., a psychiatric provider and learning specialist).

• We are proud to share that most of our clients are self-referred and many suggest our services to their colleagues.
• In July 2023, we were very proud to be able to expand our wellness services to non-ACGME We currently serve nearly 1660 residents and fellows as well as their partners and spouses.
• Facilitating presentations and group conferences: We partner with programs to understand the needs of our residents and fellows, facilitate discussion groups, share wellness tips and resources. In AY23, we presented to 12 programs and groups.
• Consultation and Advocacy: Our discussions with individuals and programs help us have a deeper understanding of trends and issues in the larger system so we can advocate for improvements. We brainstorm and dialogue with GME and UW Medicine leadership to provide our residents and fellows avenues to raise concerns. Some examples include: identifying quiet spaces at our hospital sites; reporting microaggressions in a group; advocating for lightboxes in closed, windowless spaces within our hospitals to combat Seasonal Affective Disorder (SAD); and generally enhancing well-being around our campuses.
• Community building: We host events for residents and fellows to meet and build social connections which allow networking to enhance well-being. We also publish a monthly newsletter, the Wellness Corner, to share local events, resources, and spotlight Wellness Wonders in our community.

Your input is vital to our success. Qualitative and quantitative data helps us evaluate our impact and make programmatic modifications.

Here’s some valuable feedback we received from our community in July.

• “You value prioritizing mental health, wellness in residency training and our Wellness Services.”
• “Having an unbiased, non-judgmental human being to provide longitudinal support, resources: someone who understands the stresses of residency and fellowship is a strength of our wellness service.”
• “Emphasis on accessibility, removing barriers and offering evening hours for Wellness sessions.”

Connection is key and one antidote to isolation. The Wellness Team is honored to serve you and look forward to connecting with you. To read more about our service, visit our webpage.  Visit our scheduling page to schedule a wellness appointment or establish care.

Reach out to us – seeking support is an act of courage!  We are here to share in your joys, lighten your burdens, and celebrate you as we build a healthier community together.

GME Wellness Counselors

Byron Joyner, MD, MPA

The Network of Underrepresented Residents and Fellows (NURF) began its mission of community outreach, mentorship, recruitment and retention, 14 years ago.  This diverse resident-run group has consistently been a safe harbor community for many of our residents and fellows. I am very proud to sponsor this group with Office of Healthcare Equity.  This month I have invited Dr. Ivonne Beltran Lara to be the guest writer for the DIO blog. 

Byron Joyner, MD, MPA
Vice Dean for Graduate Medical Education, Designated Institutional Official

Ivonne Beltran Lara, MD

When I was searching for a residency program, I was looking for a program supportive of individuals underrepresented in medicine and with diverse identities and backgrounds – an institution that fosters diversity and values the integrity of hard work, as well as healthcare equity and inclusion of those who are historically disenfranchised. In 2020, deciphering which institution truly upheld this mission was especially difficult as we were faced with Zoom screens and the lack of human connection. It was the first year that residency interviews went virtual, and applicants would have to rank a list of programs based only on virtual encounters.

Humanity was facing a worldwide pandemic that was wreaking havoc in all communities especially in Black, Indigenous, people of color (BIPOC) communities.  The reality of the atrocious effects of inequities and structural racism in our society was on the forefront of every media outlet and in the conversations of everyone. This made it even more important for me to find a residency that would help me thrive and celebrate the various identities I hold: I am a woman, a person of color, a first-generation physician, an immigrant, and a Deferred Action for Childhood Arrivals (DACA) recipient. These identities made me the courageous and tenacious person I am today, and yet they are also vulnerabilities in environments where diversity, equity, and inclusion (DEI) efforts are not supported or celebrated.

During the process of my residency interviews, I was introduced to the Network of Underrepresented Residents and Fellows (NURF) at the University of Washington School of Medicine. Through NURF, I met residents and fellows who were part of the different training programs and who identified as underrepresented individuals in medicine (URiM).

I attended the first ever NURF Diversity Town Hall led by Drs. Ashley Eaves (Physical Medicine & Rehabilitation) and Joseph Nelson (Family Medicine), NURF’s 2020-2021 President and Vice President, respectively. I was impacted by the leaders who were at the forefront of DEI work and the community that it brought together. The community I met during this town hall surged my interest in UW.  NURF would be the organization and platform through which I could continue DEI work. It would shepherd and strengthen a community I could depend on when presented with challenges that underrepresented physicians experience in a historically exclusionary field.

As a resident, I became an active participant in NURF. For the 2023-2024 academic year, I have the privilege of serving as president of NURF. Dr. Jessica Sher (Physical Medicine & Rehabilitation, VP of NURF) and I partnered to lead this year’s Diversity Town Hall. We were grateful to have the support of Graduate Medical Education (GME) and the Office of Healthcare Equity (OHCE) once again.

During our town hall, we presented our commitment to anti-racism, healthcare equity, and diversity efforts. We introduced NURF as a community for residency applicants who identify as underrepresented in medicine and their allies. Our purpose is to ensure applicants know that NURF is committed to supporting medical trainees who need a safe space and who are looking for a community they can count on. We are also committed to holding our faculty leaders and the institution accountable to the dire need to recruit and retain diverse trainees and faculty. My hope is that via this Diversity Town Hall, we reassure future URiM residents that we are a network committed to the efforts that allow underrepresented groups in medicine to thrive and will advocate for their success.

Thanks to those who continue their work to support NURF and make this town hall an annual reality. I am continuously proud and inspired by the work my colleagues and past NURF members do to make sure our community continues to be a palpable presence.

Ivonne Beltran Lara, MD
R3, Family Medicine
NURF President 2023-2024

The UW Medicine Huddle recently featured an article on NURF’s 2023 Diversity Town Hall: NURF Hosts Diversity Town Hall.

The Association of Hospital Medical Education (AHME) has designated August 18, 2023 as GME Professionals Day.

GME Professionals Day is an opportunity for ACGME Sponsoring Institutions and Residency and Fellowship programs to celebrate the important contributions made by the GME professionals staffing their programs and central GME offices. As defined in the ACGME Common Program Requirements (CPRs), program administrators manage the day-to-day operations of the program and serve as an important liaison with learners, faculty, other staff members, as well as the ACGME.  They serve as members of the leadership team, are critical to the success of the program, must possess skills in leadership and personnel management, and are expected to develop unique knowledge of the ACGME and Program Requirements, policies, and procedures. Sponsoring Institutions and programs are highly dependent on the knowledge, skills, and attitudes GME professionals possess and the dedication they exhibit in supporting the learning environment of the institution, their programs, and the success of their trainees.

And that’s just what the ACGME says.

We see you. We see your partnership with your faculty. We see you at educational sessions within our community – learning, growing, and challenging us with great questions. We hear your ideas. We know that you often serve as a safe and trusted confidante for residents and fellows and support them through the twists and turns of life and training. We see your commitment to planning events to bring people together to repair the disconnection of the pandemic years. We see your attention to deadlines and details, and there are oh-so-many of both in GME. And we know that your work may not be as visible or as visibly celebrated as that of the clinicians in your department.

We see you as experts. You are extraordinary. You truly make it all possible. 

Today, we celebrate and thank each one of you. We look forward to being together in person this coming year.

The UW Graduate Medical Education Office Team

Byron Joyner, MD, MPA

This month, I’ve invited Hadar Duman, GME Director of Accreditation, to share her thoughts about the importance of the annual ACGME Resident and Faculty Surveys.

Byron Joyner, MD, MPA
Vice Dean for Graduate Medical Education, Designated Institutional Official

Hadar Duman, MHI Director of Accreditation

The 2023 ACGME Survey results are out! As an accreditation enthusiast, I am filled with excitement. The Surveys are an annual assessment of the experiences and opinions of residents, fellows, and faculty in ACGME-accredited programs. They serve as a vital tool for the ACGME to monitor and improve the quality of graduate medical education, expand the scope of trainees’ input in the accreditation process, and make annual accreditation and policy decisions based on systematic data collection and analysis. These Surveys also give us an opportunity to make changes based on the feedback we receive. The ACGME has been administrating the survey since 2004, and it was revised twice, in 2011 and 2020, to reflect current requirements. The Surveys’ importance has only increased over the years. This is especially true since the move to the Next Accreditation System (NAS) in 2011, when the frequency of site visits was reduced to once per decade. Absent of site visits, ACGME increased their reliance on survey data to make accreditation decisions.

However, despite the high stakes of the survey, the ACGME keeps the survey questions confidential. Programs do their best to prepare trainees and faculty so they understand the meaning of the questions and content areas, but the truth is that programs go at it blind. This leaves the task of interpreting the questions to survey takers and they may get it wrong at times.

For example, in a recent conversation I had at a national conference with a Program Director of a military-based program, I learned that, despite his best efforts, trainees often interpret “service” in questions related to the “Appropriate balance between education and patient care” item as their military service, and automatically respond that service takes precedent, leading to citations.

The 2023 ACGME survey window closed on April 9, 2023, and all 118 programs in our institution scheduled to take the survey reached the required 70% completion rate, thanks to the participants’ efforts. We are grateful to all of you who participated in the 2023 ACGME survey. Your valuable feedback enables us to improve the overall clinical learning environment in our institution. Thanks to you we can identify struggling programs and offer support through the Special Review process. Through which we have been able to advocate and obtain more Advanced Practice Providers (APPs) for services in need, address issues of faculty professionalism, enhance resources such as sleep and lactation facilities, and much more. Thanks to you, we can also identify institutional trends that we need to work on. A good example is the recent launch of the “Prioritizing Ourselves When Fatigued” refresher, an eLearning module we created in response to scoring below our expectations on the item “Instruction on minimizing effects of sleep deprivation”.

On the flip side of all of this, when the survey goes unfilled, it leaves the ACGME without the necessary data to make decisions, leading to extended citations, issuing of new citations, and denying program expansion requests.

As you consider your feedback and review this year’s survey results, keep in mind the following ways in which you can help improve your program and the quality of our learning environment:

• Take the ACGME survey every year. Your feedback is crucial!
• Advocate for change in your program. If you identify areas that need improvement, share your concerns with your program director, other leaders in your program or UW GME through our Report a Concern
• Get involved in your program’s quality improvement efforts. All programs are required to conduct an annual program evaluation. Get involved and help to make your program the best it can be.

Thank you for your commitment to the continuous improvement of graduate medical education. The data suggest we could not do it without you!