A Fresh Take on Residency Training

‘Pathways’ offers individualized training in such tracks as global health and patient safety.

Published in Dome - November 2015

A business major at Harvard University, Sarah Johnson worked briefly on Wall Street before realizing that she still felt called to her childhood dream of becoming a doctor. Shifting gears, she earned acceptance to the University of Pennsylvania School of Medicine and, in 2012, matched in medicine at Johns Hopkins.

Now, thanks to the Pathways Program, a new tracklike update to the Osler medicine residency program, the third-year resident finds herself reconnecting with her business brain.

Part of the strategic plan developed at the Department of Medicine’s 2014 educational retreat, Pathways aims to help create and nurture leaders across the health care spectrum, explains Osler program director Sanjay Desai. Senior faculty members identify second- and third-year residents with a strong aptitude in one of three areas: patient safety/quality improvement (QI), global health and scientific discovery. These trainees are offered a “pathway” to incorporate individualized coursework, hands-on experiences and sophisticated mentorship into their chosen field of interest, culminating with a research project.

Johnson, one of several residents focusing on patient safety/QI, is looking at ways to tackle the hospital’s skyrocketing medication costs, such as using more generic drugs. “This pathway gives me more exposure to administrative issues and how to rein in costs,” she says.

It also provides an opportunity to formalize her interest in patient safety, giving her a leg up for a career combining academic, administrative and clinical medicine.

“We want to leverage everything Hopkins, as an institution, has to offer to each of our residents,” Desai says.

Neil Aggarwal, Osler program associate director, leads the scientific discovery pathway and oversees the broader program. Sara Keller directs the patient safety/QI pathway, and Yuka Manabe, the global health pathway.

“We’re not aware of any one program in the nation that offers all these options,” he says.

Third-year resident Jessica Briggs says the program builds on her passion for global health. The Texas native lived in Uganda for a year on a clinical research scholarship and recently returned from a six-week stint there, aided by the Johns Hopkins Center for Global Health. Briggs is seeking ways to decrease the time between diagnosis and treatment for Ugandan patients with tuberculosis.

She’s also working to set up a four-week rotation for a Pathways elective in Uganda. “It’s amazing what you can learn from residents who work in extremely resource-limited environments,” she says. “Pathways makes the Osler program more competitive and will help attract more people interested in global health.” 

Since Pathways debuted in July, five of the residents have expressed an interest in patient safety/QI; eight in global health; and six to 10 in the scientific discovery track.

“A lot of our residents have a strong background in science—some have Ph.D.s,” Aggarwal says. “We want to enhance their experience and link them with mentors to develop long-term relationships.”

Interest is growing in all three arenas, says Aggarwal, even as more potential elective tracks, like health administration, are under consideration. Current research projects include how to streamline care for patients on warfarin who resist follow-up, how to encourage heart failure medicate on adherence and how to manage scant medical resources overseas.

For Johnson, the experience has already proven enriching. “Pathways shows that this residency program is very responsive to change.” 

Charting a Course Outside the Academy

The Biomedical Careers Initiative is helping graduate students learn about jobs beyond the faculty research posts that were once considered the logical next step for people with advanced degrees.

Illustration of a graduate student pondering her career opportunities.