Residents within the pathway will engage in a series of clinical and didactic experiences around Boston aimed at developing their knowledge of both the clinical and philosophical aspects of global health. This will be joined with two global health trips in the second and third year, as well as networking with organizations and personnel working within global health.

Clinical exposure within a global health pertinent ambulatory location (refugee clinic, travel clinic, TB clinic, HIV clinic) will replace some of the specialty clinic slots for GHP residents during their ambulatory weeks.

Topics include but are not limited to: epidemiology of global health issues; data sources in global health; overview of donor and implementation organizations in global health; global health ethics; HIV; TB; malaria; neglected tropical diseases; non-communicable diseases; and building a career in global health.

Resident will complete a scholarly project (e.i. educational resource, clinical research, case report, etc) as part of their participation within the pathway. There will be afternoons granted within the primary care weeks towards this, as well as the potential of asking for an elective block PGY-3 year for projects with sufficient scope.

Visit the BUMC Global Health Blog to learn more about our residents’ Global Health experiences!

The HIV Pathway trains physicians in cutting-edge longitudinal care of patients with HIV. Caring for patients at the Center for Infectious Diseases at BMC is a unique opportunity to specialize in team-based HIV medicine as a resident.  Boston Medical Center has one of the largest and most diverse HIV clinics in the Boston area. Of over 1,450 HIV-infected individuals in 2012:

• 60% were black or African American
• 20% were Latino
• 37% were women
• 43% were foreign-born

Physicians trained in general medicine, infectious diseases, and other subspecialties continue to be vital to the care of patients with HIV; therefore, participants in the HIV pathway will also have a variety of career paths.

Residents will develop expertise in management of HIV including anti-retrovirals and HIV-associated co-morbidities and will also become adept at caring for patients in a team which includes care management, social work, addiction treatment, peer advocates, nursing, pharmacy, and mental health providers. Residents will devise and complete a mentored scholarly project related to HIV and obtain eligibility for AAHIVM certification as an HIV specialist.

The Medical Educator Pathway is designed for residents interested in becoming clinician educators. The curriculum is aimed at developing resident skills related to giving effective educational presentations and teaching clinical reasoning, while simultaneously guiding residents towards implementing educational initiatives on campus and producing scholarly work.

The pathway is directed by Dr. Robert C Lowe, an award winning medical educator. Dr. Lowe uses the literature on medical education and learning theory to guide practical discussions and workshops for the residents. He also selects other dedicated faculty who provide expertise in areas such as mentoring, providing feedback, and highlighting career paths for clinician educators to speak with the residents throughout the year.

Opportunities available to residents include teaching medical students in classroom settings and on the wards, developing curriculum used by the residency program, and being observed while presenting clinical cases followed by receiving feedback.

Previous Med Ed Projects

• Development of the Boston Medical Center Resident Initiated Guide to Discussing Goals and Expectations (BRIDGE) document, a guideline to help residents properly orient interns and medical students at the beginning of an inpatient rotation, with a focus on effective communication and regular feedback.
•  Drafting the Second Year Medical Student Cardiology Class Syllabus, which previously used only a commercial textbook.
• Developing a pilot program on mentoring MD/PhD Students prior to the transition from their research years to the beginning of their clinical rotations.

The Quality Improvement & Patient Safety (QIPS) Pathway is designed for those seeking leadership in improving our healthcare system. All internal medicine residents at Boston Medical Center participate in quality improvement projects in their second year. The project teams are usually headed by members of the QI Pathway. Many lead further projects in their senior year targeted towards their particular interests. Residents who are selected for the QIPS Pathway are those that want to take improvement further and truly make it a part of their career in medicine. The QIPS Pathway is designed to create the future leaders of medicine. It focuses on promoting the knowledge, teamwork, and teaching skills necessary to take on a leadership role in improving systems of care, both locally and abroad.

While in the pathway, residents become deeply involved in the operations of our medical center to promote exceptional care for our patients including the following:

• Joining various operations committees
• Working directly with the executive leadership and board of trustees
• Collaborating with the Massachusetts Medical Society and in the Massachusetts Chapter of the American College of Physicians Council of Residents.
• Serving in numerous roles in concert with the Institute for Healthcare Improvement (IHI), such as co-chairing the National Forum for Quality Improvement in Health Care
• Attending the Academy for Emerging Leaders in Patient Safety (formerly the Telluride Patient Safety Round Table) and being chosen as ACMQ National Quality Scholars and Lown Right Care Educators.

QI Projects

Residents frequently obtain funding for improvement projects. A $25,000 grant was recently awarded to a QIPS resident to improve transitions of care. Boston Medical Center is a leading hospital in supporting its residents in Quality Improvement both with financial resources and by encouraging and welcoming resident attendance at meetings with top hospital executives.

Recent Projects in the Pathway Include:

• Efforts to improve hand hygiene in the intensive care unit
• Smoking cessation in high risk patients
• Optimizing medication reconciliation
• Increasing adverse event reporting

QIPS Core Competencies

• IHI self-study certificate
• Completion of the ACP/APDIM Cost Conscious Care Curriculum
• Experience with the Boston Medical Center QIPS office including involvement in Root Cause analysis meetings, medical-legal meetings, and multi-disciplinary (RNs, IT, administration) project implementations
• Involvement in at least one QIPS and/or IT Committee at BMC
• Development and implementation of a QIPS project either by the individual or in conjunction with other members in the pathway
• VA Patient safety elective (At least 1 elective block)
• Mentoring with QIPS experts in the Department of Medicine, VA, and at BMC level

Human health and wellness are tightly linked with the communities in which we reside – our neighborhoods, our cultural communities, our built environment, and our socioeconomic realms.  The Urban Health and Health Equities Pathway is designed for residents interested in delving more deeply into the Boston-based urban communities in which so many of our BMC patients live.

Residents in this pathway will receive advanced training in health disparities and medical management of clinical issues frequently seen in underserved patient populations.  Residents will also gain exposure to a variety of urban health issues – including substance use, immigrant/refugee health, urban violence, hunger and food access, housing/homelessness and more.

Each year we accept two rising junior residents into the pathway after an application process.  Each resident will have a variety of elective clinical experiences, including exposure to addiction medicine clinics, refugee clinic, work at healthcare for the homeless, needle exchange, and more.  Residents also have one week of dedicated elective time to urban health.  Educational activities include didactics on health disparities, training in health advocacy methods, and site visits to relevant social services organizations including urban farms, local advocacy organizations, community health centers, respite hospitals, and more.

Current resident projects include:

• Improvement in cervical cancer screening in refugee populations
• Development of intern educational conference on local community resources

Sample Urban Health Elective Week Schedule

Sample Clinic Week Schedule

Please contact the Urban Health and Health Equities Pathway director, Jenny Siegel, MD, with any questions at jennifer.siegel@bmc.org.