Program for Medical Education Innovations & Research Projects
The Program for Medical Education Innovations and Research (PrMEIR), part of NYU Langone’s Division of General Internal Medicine and Clinical Innovation, is dedicated to advancing medical education scholarship and developing best practices for patient-centered, evidence-based medical education. Our research initiatives strengthen the links between physician training and patient health and wellbeing.
At PrMEIR, we’ve earned a national reputation for our medical education outcomes research, innovative use of standardized patients, and development of performance-based assessments to measure core competence in medical training programs. Our researchers also participate in a number of other research focus areas and are involved with conducting clinical trials and hospitalist quality improvement and safety initiatives. For more information, email firstname.lastname@example.org.
Research on Medical Education Outcomes Unit
How do we know that medical education prepares healthcare providers to deliver high-quality care? An interdisciplinary team of doctors, nurses, researchers, educators, and psychologists at NYU Langone conducts research on medical education outcomes, an initiative known as ROMEO.
Our goal is to link strategies for medical education and training to patient health outcomes to ensure that medical students, residents, and fellows are prepared to deliver excellent patient care.
We use ROMEO to inform innovative medical education curricula that emphasize health literacy, patient activation, and professionalism in treatments for conditions such as obesity and substance use. A rich interdisciplinary collaboration has resulted in the development of the Educationally Sensitive Patient Outcome (ESPO) Theoretical Model, which identifies important health outcomes that are tied to a healthcare provider’s level of experience and skill. The framework has become a model for medical education researchers around the world.
In order to accomplish this, we created the Database for Research on Academic Medicine to collect assessment and performance data from medical students, residents, fellows, and practicing physicians and integrate this information across the continuum of lifelong learning.
Database for Research on Education in Academic Medicine
Our Database for Research on Education in Academic Medicine (DREAM) is a Framingham-style, longitudinal database that researchers can access to study relationships between medical education, residency, and fellowship programs and patient outcomes.
With data from more than 3,000 medical students, residents, and fellows collected for more than 10 years, DREAM holds great promise for overcoming challenges that limit the development of evidence-based medical education and training programs.
DREAM’s strengths include the following:
- the ability to link information over the full span of medical education, from medical school through residency to actual practice
- data collection from a variety of sources and methods
- the use of gold standard performance-based measures, such as observed structured clinical exams and unannounced standardized patient visits
- integration with electronic medical records, patient charts, and patient exit interviews
Researchers have implemented 70 studies that assess medical school and training curricula, quality of patient care, provider competency, skills development, the transfer of skills to practice, and the effects of education on patient outcomes.
Identifying Burnout on Medical Teams
Medical centers across the United States report burnout as a problem among staff, but few programs train residents to recognize and respond to distressed colleagues. At NYU Grossman School of Medicine, we designed an objective structured clinical examination (OSCE) that trains frontline interns to recognize colleagues who are in distress and learn about appropriate resources to stem burnout.
Our publication in the Journal of General Internal Medicine, “I Cannot Take This Any More! Preparing Interns to Identify and Help a Struggling Colleague,” coauthored by Sondra R. Zabar, MD, Colleen C. Gillespie, PhD, Kathleen Hanley, MD, Margaret R. Horlick, MD, Patrick M. Cocks, MD, Lisa Altshuler, PhD, and Adina L. Kalet, MD, MPH, analyzed DREAM data from a 5-year study that involved 145 resident interns in the fields of medicine, orthopedics, and surgery who participated in the OSCE between 2013 and 2017. Findings show that the OSCE-prepared interns and faculty supported resident wellbeing and reinforced policies and processes that improved access to resources for combating burnout and fatigue. More than 10 residencies participate annually in this educational activity.
Unannounced Standardized Patient Program
As part of the Unannounced Standardized Patient Program, developed by Sondra R. Zabar, MD, skilled medical educators train actors to recognize certain hallmarks of high-quality healthcare that should be present during a standard patient encounter. The actors then go undercover as patients at ambulatory clinics where our general internal medicine residents train.
The actors engage with medical teams, assess how responsive our healthcare providers are to patient needs, evaluate the experience from a patient perspective, and provide feedback to medical teams on performance.
Improving Referrals for Social Determinants of Health
Social determinants of health like socioeconomic status, education, employment, and social support networks can influence patient access to healthcare as well as health outcomes. Although often overlooked in clinical practice, social determinants of health have a substantial impact on patient wellbeing.
A team of researchers including Dr. Zabar, Colleen C. Gillespie, PhD, Lisa Altshuler, PhD, Kathleen Hanley, MD, Barbara Porter, MD, and Andrew B. Wallach, MD, use unannounced standardized patients at NYC Health + Hospitals/Bellevue and NYC Health + Hospitals/Gotham Health Gouverneur ambulatory care clinics to assess how healthcare providers respond to patients with social determinants of health–related needs.
The team assessed how these needs were communicated within the clinical team and, in an effort to contribute to a learning health system, used the findings to develop strategies to improve care.
Because unannounced standardized patients gather data from the time they walk into the clinic until the time they leave, they offer unique insights into the patient experience. This project was funded by the Agency for Health Care Research and Quality.
Role Transitions in Medical Education
In collaboration with the New York Simulation Center for the Health Sciences (NYSIM), Adina L. Kalet, MD, MPH, Sondra R. Zabar, MD, Thomas S. Riles, MD, Kinga Eliasz, PhD, and Ruth M. Crowe, MD, PhD, developed Night-On-Call and First Night-On-Call, two simulation tools designed to improve periods of role transition during medical education, which are known to be stressful for medical students and staff. PrMEIR faculty are also investigating a new area, professional identity formation in medical education research.
Night On-Call (NOC) is a four-hour immersive simulation that provides final-year medical students with the opportunity to assume the on-call responsibilities of a resident intern while rotating through a series of clinically authentic scenarios. NOC supports and empowers graduating medical students to practice “putting it all together,” while receiving standardized feedback from the perspective of many different healthcare providers (nurses, attending physicians, etc.). The experience is designed to prepare medical students for the transition to internship.
NOC began as a research project in 2016. Due to exceptionally positive feedback from both students and faculty, NYU Grossman School of Medicine integrated the NOC experience into the MD curriculum in 2018. Since then, we’ve presented NOC at various international and national conferences for the health professions education community. The NOC simulation has been incorporated into the curriculum at four different U.S. medical schools as both in-person and virtual experiences.
First Night On-Call
First Night On-Call (FNOC) is an immersive four-hour simulation that is part of orientation for incoming interns at NYU Langone to ensure they are ready for common patient safety challenges on day one of residency. During FNOC, new interns collaborate with one another as they rotate through a series of patient safety–related role-playing scenarios in small groups. These scenarios focus on specific actions that enhance patient safety, such as escalation of care to a superior and medical error reporting.
We developed and implemented FNOC in 2017 to address the need to improve escalation and cultivate a culture of safety at NYU Langone. FNOC has been consistently well received among the approximately 200 NYU Langone residents who complete the program each year.
Our institutional performance on the Agency for Healthcare Research and Quality’s Culture of Safety Survey has also demonstrated improvement. The program has received international, national, and local recognition, winning prestigious awards such as the Best Patient Safety and Quality Presentation at the Society of General Medicine and the Best Medical Education Research Poster at NYU Langone’s Medical Education Innovations and Scholarship Day.
Professional Identity Formation
We believe that being a doctor involves more than just providing clinical care. At NYU Grossman School of Medicine, professional identity formation—the process of internalizing a profession’s core values and beliefs—is an explicit goal of medical education and key to the safety and quality of patient care.
The Division of General Internal Medicine and Clinical Innovation is pioneering a new area of research to better understand physicians-in-training and what we can do to assist them in developing a professional identity.
In partnership with Adina L. Kalet, MD, MPH, of the Kern Institute for the Transformation of Medical Education at the Medical College of Wisconsin; Lisa Altshuler, PhD; and other NYU Langone faculty, we are building culture change through open dialogue aimed at recognizing professional identity as part of the growth process necessary to become a physician.
Education for Healthcare Professionals
Our faculty are involved in several research initiatives to improve education for healthcare providers in areas that include expanding substance use disorder treatment, recruiting more diverse patients into research studies, incorporating behavioral health into primary care, and improving the quality of virtual healthcare.
Opioid Education for Community-Based Primary Care Providers
Community-based primary care health providers care for vulnerable patient populations with a high prevalence of substance use. However, little time is devoted to training primary care residents and practicing primary care providers in the management of substance use disorders. To tackle this knowledge gap, researchers Kathleen Hanley, MD, Alessandra Calvo-Friedman, MD, Lisa Altshuler, PhD, and James A. Schmidtberger, MD, created a substance use disorder module to be included in NYU Grossman School of Medicine’s primary care residency track.
As part of the module, the researchers designed and established a clinical service at our community-based primary care residency training site—NYC Health + Hospitals/Gotham Health Gouverneur—to provide care, including medication assisted treatment, for patients with substance use disorders. All primary care professionals at this site now receive training in opioid use disorder diagnosis, prevention, and treatment. This initiative was funded by the Health Resources and Services Administration.
Engagement in Longevity and Medicine Research Collaborative
Sondra R. Zabar, MD, Lisa Altshuler, PhD, Joshua Chodosh, MD, Scott E. Sherman, MD, and Chau Trinh-Shevrin, DrPH, established the Engagement in Longevity and Medicine (ELM) Research Collaborative to narrow the knowledge gaps in behavioral and biomedical research for racial and ethnic minorities and low-income older adult communities.
The interdisciplinary research team brings expertise in healthcare team training, geriatric medicine, and population health to develop a training and assessment program with the goal of improving study participant recruitment and retention from these vulnerable populations. Our researchers are developing a subject recruitment training and assessment program for research teams using objective structured clinical examination (OSCE)–like experiences for groups (GOSCEs). The ELM Research Collaborative is funded by a National Institutes of Health R01 grant.
Behavioral Health in Primary Care Training
As subinvestigators for a pilot proposal awarded by Health Resources and Services Administration (HRSA) to the Mayo Clinic, faculty members Mack Lipkin, MD, and Lisa Altshuler, PhD, are developing a model to integrate psychosocial rounds into primary care residency programs.
The researchers hope these efforts can improve the ability of residents to understand patient context in medical encounters, including trauma experiences, and create integrated behavioral health settings—an environment that recognizes that factors including mental health, life stressors and crises, and substance use affect patients’ health and wellbeing. The model includes the development of a workbook and assessment guide to encourage effective communication skills within an integrated behavioral health model of primary care.
Standardized Patient Visits in Virtual Urgent Care
Advances in technology such as NYU Langone’s Virtual Urgent Care and other virtual patient visits offer efficient and effective ways to deliver healthcare services to patients in the comfort of their own home or workplace, but little is known about how healthcare providers perform in virtual care settings. To address this need, Sondra R. Zabar, MD, and Daniel Sartori, MD, have expanded the Standardized Patient Program to assess healthcare provider performance in these settings.
Together with Paul A. Testa, MD, and Viraj Lakdawala, MD, they have designed a standardized patient encounter to be delivered through the NYU Langone Health app during Virtual Urgent Care visits. These encounters are designed to assess core skills that many physicians aren’t trained to perform in virtual settings and provide opportunities for physicians to receive immediate feedback on their performance.