The Pathway program provides Categorical residents the opportunity to develop an area of expertise in one of five tracks over the final two years of their training: Research, Point-of-Care Ultrasound, Clinician Educator, Health Systems Leadership, or Health Justice. Residents have three weeks of dedicated Pathway time during each year of their second and third years as well as two half-days during each ambulatory block (every fourth week) as protected time to complete their individualized Pathway work. This is a wonderful opportunity for obtaining professional development, mentorship, and scholarly activity in an area that interests you!
More about individual Pathways:
Point-of-care ultrasound (POCUS) is rapidly becoming an essential tool inpatient care. At Highland, many of us use POCUS to make quick, real-time decisions about patient care. Dr. Brandon Boesch, the POCUS Pathway lead, is a hospitalist and a national leader in helping shape POCUS guidelines and teaching POCUS at conferences. The Internal Medicine Ultrasound Pathway trains residents in the use of POCUS through hands-on instruction of obtaining standard POCUS windows, independent reviewing of ultrasound modules, self-practice, helping inpatient teams by answering clinical questions (eg, looking for right ventricular strain for a hypoxic patient with cancer on a wards team), and passing on POCUS skills via peer teaching during educational conferences. Residents are asked to create a portfolio of standard and unusual POCUS scans that they can use for their own future teaching. They are expected to pass an assessment to determine their proficiency in performing and interpreting cardiac, pulmonary, abdominal, and vascular studies through POCUS by graduation. Click here for more info about IM ultrasound training.
The Clinician Educator Pathway is designed for residents interested in pursuing a career in academic medicine with a focus on teaching and education. Dr. Davida Flattery, a primary care physician who has completed the Stanford Clinical Teaching Program and the SGIM TEACH Fellowship, developed and leads this Pathway. Through its rigorous “Resident as Teacher” curriculum, the Pathway provides opportunities for participants to apply theories of education in a real-world setting. The second year residents follow a structured curriculum with readings and reflections about teaching, including setting expectations and learning outcomes, learning styles, bedside teaching, teaching clinical reasoning, giving feedback, and assessment of learners. They teach medical students during didactic time and obtain structured feedback of their teaching from faculty members to develop advanced teaching skills. Under Dr. Flattery’s mentorship, the third year residents learn about curriculum design through creating an individualized longitudinal curriculum development project with the goal of improving the educational environment at Highland. Our goal is to prepare the next generation of clinician educators.
Health Systems Leadership
The Health Systems Leadership Pathway supports career development for residents interested in driving change and innovation at a systems level. It is led by Dr. Mini Swift, the former Associate CMO and current Vice President of Population Health at the Alameda Health System. A two-year reading curriculum with selections from the Harvard Business Review, the Institute for Healthcare Improvement, and the New England Journal will expose residents to the perspectives of thought leaders in the field of healthcare management and quality improvement. The residents in the Pathway select a project out of many hospital-wide quality and operational initiatives tied to institutional priorities and funding, such as improving medication reconciliation or reducing central line-associated bloodstream infections. They attend committee/workgroup meetings related to their project and learn about the process of developing an A2 and performing small tests of change through PDSA cycles. They offer their unique perspective as a front-line provider with their deep understanding of operational workflows. They have the opportunity to interface with organizational leaders through dedicated mentorship and interviews, and reflect on their own leadership style. The focal point of the pathway is the Legacy Project, a self-sustaining innovation to benefit our patients and healthcare system.
The Highland Hospital Internal Medicine Residency Research Pathway allows residents a more in-depth exposure to the fundamentals of clinical research. It is led by Dr. Farzad Moazed, a pulmonologist and intensivist who previously taught research design courses and led translational research projects at UCSF prior to coming to Highland. The program provides dedicated research time and mentorship with the steps of research, including creating a research proposal, obtaining IRB approval, collecting and analyzing data and writing an abstract and manuscript. Dr. Moazed leads a longitudinal research methods and design series to supplement your education in clinical research. It is expected that residents accepted into this program will disseminate their scholarly activity at Highland as well as regional and national meetings with the goal of producing a peer-reviewed published manuscript.
The Health Justice Pathway supports residents seeking to develop special expertise in caring and advocating for the needs of marginalized and vulnerable populations. It is led by Dr. Nick Nelson, a former Highland graduate who is the medical director of the Human Rights clinic, which provides forensic medical evaluations of patients who are seeking asylum. Residents serve in clinics specializing in the care of each of these communities to give them a broad understanding of the unique needs of each group and perform home visits. Past clinics include mobile health van, Street Level Health, Human Rights Clinic, Kaiser specialty clinics, and migrant health clinics. Health Justice residents pursue a rigorous program of clinical, scholarly, and advocacy work under the supervision of a faculty member, and dedicate their Pathway time to a particular selected community. Past Health Justice residents have chosen to focus on the LGBTQ, Black, homeless, and immigrant/refugee communities. They select an Advocacy Project of their choice, which can include lobbying and advocacy on behalf of the needs of the community by speaking with local hospital, county, state, or national leaders or writing opinion pieces to raise awareness. They visit local community centers to promote awareness of the services available at Highland and participate in Patient Advisory Councils. The residency program is dedicated to helping Health Justice residents work with a section of our diverse community that they are impassioned to serve.
Can I become proficient in POCUS without doing the POCUS Pathway?Yes, you can choose to spend elective time with Dr. Boesch on a POCUS elective and develop your POCUS skills for 2-4 weeks. The multiple POCUS ultrasound machines in the MICU and ED can be used by any providers, so you can also practice your POCUS skills during inpatient rotations with some of our POCUS-trained residents and faculty, in order to answer clinical questions such as volume status in a patient with septic shock or CHF exacerbation or to guide the safe performance of bedside procedures. Some of our most POCUS-impassioned residents even choose to buy their own portable ultrasound probes which are cellphone-compatible so they can scan on their own devices whenever they like.
Can I do research without doing the Research Pathway?Yes, our residents have plenty of opportunities to select research mentors here at Highland or at nearby institutions including UCSF and pursue research projects during elective time.
Can I develop my teaching skills without doing the Clinician Educator Pathway?Yes, all residents have plenty of opportunities to develop their teaching skills in the following ways: On inpatient teams, as we always have a MS3 and MS4 on wards and on most of the subspecialty services. Interns are expected to teach and review the notes of MS3s and senior residents on wards are expected to teach the sub-intern and interns. During Academic Half Day, as all categorical and primary care residents receive Dr. Flattery’s Resident as Teacher curriculum and get to practice teaching skills and receive feedback from peers during workshops.
Can I develop my quality improvement skills without doing the Health Systems Leadership Pathway?Yes, all residents have the opportunity to develop their QI project during their R2 year. All R2s work on a group project with other residents in their cohort during protected time during Academic Half Day and identify a quality gap, conduct a process analysis, implement a small PDSA cycle, and present their projects at the Highland Quality and Safety Forum at the end of the year as well as regional conferences. Past projects have included improving provider compliance with goal directed medical therapy for CHF patients and creating a central line checklist. Our residents attend monthly M&M conferences where they learn about QI terminology and do a group root cause analysis of adverse events.
Can I do advocacy work or rotate with a specific community I have in mind without doing the Health Justice Pathway?Yes, our primary care and categorical residents have the option of rotating at clinics such as the Bridge Buprenorphine Clinic or Human Rights Clinic. We can also support you if you are interested in pursuing advocacy work.
I’m having a hard time choosing just one Pathway. Is it possible to do more than one Pathway?Yes, we will work with you to design an individualized experience with mentorship across Pathways. You can also consider selecting one Pathway as your area of expertise but gaining experience in the other skills in other ways – please see below.