National award to medical residents emphasizes patient care in era of increased demands from electronic management

BUFFALO, N.Y. — No one becomes a doctor to spend the day staring at a screen. But with electronic medical records now ubiquitous, providers are spending increasing amounts of time at the computer, time they would much rather spend with patients.

That imbalance is felt acutely by medical residents — recent medical school graduates now training in the nation’s hospitals and clinics.

To address these concerns, members of the internal medicine residency program in the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo have been awarded a grant from the Accreditation Council for Graduate Medical Education (ACGME), the body that accredits medical residency programs.

With mentorship from their faculty, the UB residents applied for and received one of 30 grants issued nationally by the ACGME’s Back to Bedside program, which was developed to address some of the challenges facing medical residents today.

“The move to electronic medical records makes patient care safer,” said Regina Makdissi, MD, assistant professor in the Department of Medicine and associate director of the internal medicine residency program at UB, “but it also makes it harder for physicians and residents to spend more time away from the computer screen. The initiative that this award supports will make it easier for residents to spend more time providing patient care and communicating with patients and their caregivers at the bedside.”

The changes are being implemented through multidisciplinary rounds with residents, nurses, discharge planners and everyone who is involved in taking care of the patients during their hospitalization at both Erie County Medical Center and Buffalo General Medical Center.

Led by AnneMarie Laurri, MD, an internal medicine resident in the Jacobs School, the new effort emphasizes resident well-being by focusing on the resident-patient relationship.

Laurri and her team will address these issues through two methods. The first is “Close the Loop rounds,” in which interns, residents and faculty meet at the patient’s bedside to educate patients about their diseases, connect with families of patients and answer outstanding questions.

“The idea is that establishing a meaningful relationship with the patient is critical for medical residents to develop as physicians and to counter professional dissatisfaction issues, such as burnout and depression,” said Laurri.

The second method is “the Attending of the Day,” recently implemented by UB’s medical residency program, which emphasizes the primary role that the medical resident plays in patient care and autonomous care decisions, with the faculty member present only in a supervisory role.

“This award recognizes the innovative ways our residents — the next generation of physicians — are thinking about how to overcome challenges in the health care system that they have recently entered and to integrate them more with the whole system. They are dedicated to providing the best care for their patients and giving back to the community,” said Makdissi.

“Electronic medical records are here to stay,” she added. “The point is to bring everyone together — doctors, nurses, faculty members — and to emphasize face-to-face communication among them, instead of allowing for everyone to be siloed.”

To realign patient care and residency training along these lines, UB’s internal medicine residency program is taking concrete steps to allow for better communication and more time at the bedside. For example, the program is restructuring the educational conferences residents must attend so that there is more time for residents to revisit the bedside and refocus on patient care.

“We’re making a huge change from a small grant,” Makdissi concluded. “We are very grateful for the opportunity and extremely proud of our residents.”