‘Pathways’: A Fresh Take on Residency Training

Published in Aequanimitas - Fall 2015
From the age of 5, Sarah Johnson wanted to become a doctor. But as an undergraduate at Harvard, she found economics fascinating. So she majored in business and worked on Wall Street briefly before realizing it wasn’t her calling. 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 a new tracklike update to the Osler residency program—called the Pathways 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, the program 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.
“It’s our biggest structural change since the Firm system debuted in 1975,” says Desai. “We want to leverage everything Hopkins, as an institution, has to offer to each of our residents.”
To that end, Desai has appointed faculty to oversee each area of focus. Neil Aggarwal, Osler program associate director, leads the scientific discovery pathway and oversees the broader program as a whole; Sara Keller directs the patient safety/QI pathway; and Yuka Manabe, the global health pathway.
“There’s a lot of enthusiasm for identifying more modern career paths,” says Aggarwal. “We’re not aware of any one program in the nation that offers all these options.”
Johnson, one of several residents focusing on patient safety/QI, is tackling skyrocketing medication costs in the hospital, by using more generic drugs, for example. “This pathway,” she says, “gives me more exposure to administrative issues and how to rein in costs.” It also provides an opportunity to formalize her interest in patient safety, she adds, giving her a leg up for a career combining academic, administrative and clinical medicine.
For third-year resident Jessica Briggs, 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. Interested in infectious diseases, Briggs is working to find ways to decrease the time between diagnosis and treatment for Ugandan patients with tuberculosis.
Briggs is working to set up a four-week rotation for a Pathway elective in Uganda. “It’s amazing what you can learn from residents who work in extremely resource-limited environments,” says Briggs. “Pathways makes the Osler attract more people interested in global
Since Pathways debuted in July, about five of the 149 residents have
expressed an interest in patient safety/QI; eight in global health; and six to 10 in the scientific discovery pathway.
“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 relationships that will go beyond this extra course of study.”
Interest is growing in all three arenas, says Aggarwal, even as more potential elective tracks are under consideration, like health administration. Meanwhile, research projects run the gamut—from
how to streamline care for patients on warfarin who resist follow-up, to encouraging heart failure medication adherence, to managing scant medical resources overseas.
For Johnson, the experience has already proven enriching. “Pathways shows that this residency program is very responsive to change,” she says. “It’s exciting to be a part of it.”