(Editor’s Note: Back in 2010, we published an article on a program at Drexel University concentrating on physician re-entry. Following is an editorial by a physician who recently completed that program and is now back in the field practicing medicine.)
By Joseph A. Berrang, M.D.
The Drexel University Physician Refresher Program is an exceptional opportunity for physicians like me who pursued careers outside of clinical practice but heed the inner voice that calls us back to providing patient care.
I am a family physician and in my initial years of clinical practice after completing residency I saw patients in an outpatient office setting, in skilled nursing facilities for post-acute care, and also served as a hospitalist. I greatly enjoyed the diversity of this type of clinical medicine but I was also intrigued by what was then a relatively small company very close to my family and my wife’s family which helped hospitals identify which admissions were per CMS guidance more appropriate for inpatient and which were more appropriate for outpatient / observation.
As a physician adviser for hospitals throughout the United States, I helped case managers navigate the challenges in interpreting CMS guidance. I greatly enjoyed speaking with the attending physicians providing the care for the patients referred to me for CMS compliance reviews. As I spoke with the attending physicians more and more, I developed a greater desire to return to the front line and provide care instead of offering guidance how the crew should be categorized on the orders sheet. I learned how to be an advocate for the hospitals, the case managers, and the physicians but I wanted to take step forward and advocate for the elderly.
The Drexel Physician Refresher Program provides a comprehensive assessment of each participant’s proficiencies as well as opportunities for improvement. It became very quickly apparent (initially by hunch and soon confirmed by videotape) that my opportunity for greatest improvement before I returned to clinical practice was to be found in the under-recognized and under-appreciated skill sets necessary to meaningfully participate in “difficult” conversations. By “difficult” conversations I mean the following:
- addressing domestic violence,
- explaining poor prognosis,
- informing family members of patients’ deaths, and
- acknowledging medical errors.
There are myriad other “difficult” conversations that physicians have with patients, even on a daily basis, but the above particularly spoke to me in my plans to return to geriatric care.
I improved considerably during my preceptorship. The “DocCom” modules (of which there are over 40) provided video and text vignettes addressing humanistic components of patient care, such as the above “difficult” conversation topics as well as teaching the value of the pause (which permits patients time to absorb what the doctor just said), the setting of the office visit agenda upfront, the elicitation of the patient’s understanding of the pathophysiology of her/his disease / diagnosis, and the firm but supportive manner in which a patient can be told she or he has an addiction.
The Physician Refresher Program also provides opportunities for participants to have videotaped office visits with “standardized” patients. These office visits provide the opportunity to demonstrate and develop one’s skills in history taking, physical examination, diagnosing, and care planning. Most of the patient encounters are straightforward but some do have unexpected clinical twists (which, to permit future participants to have the same learning opportunities I enjoyed, I won’t disclose here) which proved to be very educational.
It was tough for me to watch and listen to my standardized patient office visit performances on videotape, and even more so to watch these recordings in front of colleagues, but the gain I achieved in insight via the post-video discussions has been immense. The doc.com modules and the standardized patient encounter analyses have greatly assisted me in my current clinical practice. I find that when I reflect upon the “difficult” conversations I’ve had since I’ve returned to clinical practice I’ve seamlessly incorporated lessons I learned during this excellent preceptorship.
I hope the above stands as a sincere attestation of the merits of the Drexel Physician Refresher Program. It would be a great underrepresentation of the strengths of the program, however, for me to conclude this note without drawing attention to the truly exceptional team members of the Program.
The support begins with the first communication of interest with the Program and continues during the days and weeks after Program completion to coordinate communications with state medical boards. I would like to provide a very positive professional and personal endorsement of Dr. Nielufar Varjavand. She is, by title, the director of the Program. However, by experience, I can say she is an exceptionally thoughtful mentor. Her candor and her support continue to have a very positive impact in my clinical practice though I completed the Program months ago.
Dr. Varjavand is the type of mentor one always hopes to someday have, cherishes when one meets, and aspires to emulate in future opportunities to serve as a teacher. It was a sincere privilege and pleasure to learn from and work with Dr. Varjavand. The Program has helped me become a better clinician, and Dr. Varjavand has helped me become a better educator. On a daily basis I find myself referring to a very helpful insight I gained in the Program or asking myself, “What would Dr. Varjavand do in this situation?” I am immeasurably grateful.