In January we reported on a few of the innovative medical education-based projects that are underway thanks to the Department of Medicine Education Council’s Support for Excellence in Educational Development (SEED) Grants, one-year grants to support prjoects on medical innovation and prepare grantees to compete for larger grant funding. This month we take a look at two more SEED-funded projects, one on medical law and one on community-based care.


Where can housestaff learn the latest in medical law and policy issues that affect their patients and be sensitive to the needs of the local community? Especially when physicians spend so much time within Brigham walls? Aaron Kesselheim, MD, Mark Friedberg, MD and Alexandra Molnar, MD, have spent the past year working to solve this dilemma by embedding these issues into the residency training program. Aaron S. Kesselheim, MD, who came to the Brigham and Women’s Hospital with a law degree from the University of Pennsylvania, is a Clinical Fellow in Medicine and a senior resident. He has been involved with SEED-sponsored curricular innovation since his junior year, when he established a series of small and large group lectures to introduce basic principles of health law to medical housestaff. The response was so positive that Dr. Kesselheim teamed up with Mark Friedberg, MD to apply for a second year of funding, in a joint project to help provide housestaff with a better understanding of the various political, regulatory and legal issues affecting medicine today.

Dr. Friedberg is a junior year resident and also a Clinical Fellow in Medicine, with a degree in health policy from the John F. Kennedy School of Government at Harvard University. His health policy expertise enabled the pair to build a curriculum that focused on specific topics in the fields of health and politics, legal and ethical issues in medical practice, and health care financing policy. They instituted monthly small group discussions and concluded each educational module with a large lunchtime lecture featuring local experts on topics such as writing prescriptions, informed consent, and physician-patient communications.

Although these issues relate directly to their practice of medicine, housestaff in the past tended not to receive education on such information through the residency program; skimming the newspaper during a daily commute was more common. “Though residents hear about these important topics in the media, they generally don’t have the time or resources to develop an in-depth understanding, particularly as changes occur. This curriculum helps to provide that understanding in a reliable and unbiased way” says Rebecca Cunningham, MD, an Instructor in Medicine from the Division of General Medicine, who has mentored this team throughout the year. Residents have again been very enthusiastic about their curriculum and they see the importance of understanding these topics, as they affect their daily lives as physicians, say the pair.

Drs. Friedberg and Kesselheim also praise the support and guidance they have received from members of the Education Council’s Innovation Committee, who provided valuable feedback and encouragement throughout the development and implementation of this project. They especially laud Marshall Wolf, MD, Vice Chair of Medical Education, in directing them to valuable experts in the field and Dr. Cunningham, for mentoring and helping them develop their surveys.

Towards the end of the grant cycle, Drs. Kesselheim and Friedberg are working to ensure that the lunch-time lectures and small group discussions continue for future generations of residents. They helped build institutional relationships with local experts who will be willing to participate in discussion sessions on a regular basis in the future. They have also gathered data recording residents’ understanding of and interest in medico-legal and health policy topics, and will be using this information to analyze the effects of their curricular development for possible publication. “We are leaving behind a module that can be permanently plugged into the current educational curriculum,” says Dr. Kesselheim. “All that is needed are a couple of interested residents each year to lead the program, and it could perpetuate itself.”

Dr. Alexandra Molnar's SEED grant targets “knowing your neighbor,” particularly the neighboring urban communities closest to Brigham and Women's Hospital: Dorchester, Roxbury, Mission Hill and Jamaica Plain. A senior resident in Primary Care, Dr. Molnar emphasizes that a community-oriented physician “not just understand the scientific background of their patients’ diseases but also the community and cultural backgrounds of their illnesses” and that it is vital that “patients from these communities receive culturally and linguistically appropriate care.”

Dr. Molnar has focused her SEED grant project on providing residents with the skills they need to become physicians who know their neighbors and understand the societal issues that affect their patients’ health. Starting in July 2004, Dr. Molnar helped to implement a longitudinal curriculum for all primary care residents that includes the following: a few hours in each Ambulatory block dedicated to the core topics of community medicine; regular home visits; group activities in Community Needs Assessment and Patient Education; and a longitudinal project, many of which focused on community organizations.

Dr. Molnar gathered her ideas, materials and support from her previous experiences in community-based projects and from current leaders in Brigham and Women’s Hospital community programs and organizations. Two years ago, Dr. Molnar designed the Brigham Urban Intern Learning Day (BUILD), a one-day orientation session to educate new interns about their patients’ community. This innovative project was aimed to actively include an in-depth look into the heart of each community, in panel discussions, walking tours, and community service projects. As a result of BUILD, home visits were introduced in the primary care residency program, giving housestaff the opportunity to treat patients in that context where “the rubber meets the road” in all medical care: daily life and lifestyle issues.

Leaders such as Heidi Behforouz, MD, Director of the Partners in Health’s Prevention and Access to Care and Treatment (PACT) Project, have further helped Dr. Molnar gather ideas for didactic sessions in her curriculum to provide residents with the skills necessary to assess a community’s needs, begin to address those needs, evaluate effectiveness, and integrate results into practice. Judy Ann Bigby, MD, Director of Community Health Programs at Brigham and Women’s Hospital , was one of the first people Dr. Molnar approached to help her find ways to connect residents to leaders in the community. State representatives from Mission Hill, health care advocates from the Bromley/Heath Housing Development in Jamaica Plain, and leaders from the Boston Black Women’s Health Institute in Roxbury have all participated in panel discussions to give residents a better understanding of community issues and the disparities in health care within racial, ethnic and socio-economic boundaries. Dr. Molnar says that these connections, and many others, are now part of the longitudinal three year curriculum. She hopes that residents will emerge from the training program with “a strong background in community service and a true desire to continue that service through care for under-served communities.”

Applications for the 2005-2006 SEED grants are currently being accepted. Bruce Levy, MD, Chair of the Department of Medicine Education Council’s Innovation Committee, has this good news: “SEED projecs funded over the last two years have been so successful that the Department of Medicine has decided to increase the dollar amount available to $15,000 per project per year. We look forward to sponsoring the next in a series of projects from the Department’s creative faculty and trainees.”

Click here to access the 2005-2006 SEED grant Request for Application.

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The complete list of 2004/2005 Support for Education Development Grants Awardees are:

Ming Hui Chen (PI), Patricia Come and Marcus Cooper:
“Echoquest: An Interactive Web-Based Teaching Tool for Non-Invasive Imaging.”

Heather Gornik (PI), Marie Gerhard-Herman, Joshua Beckman, Mark Creager and Jeanne Doyle:
“An Initiative to Increase Awareness of Peripheral Arterial Disease Among
Medical Trainees and Practicing Internists.”

Aaron Kesselheim (PI), Mark Friedberg:
“Establishing a Permanent Medico-Legal and Health Policy Education
Curriculum for Department of Medicine Residents.”

Melissa Lee (PI):
“Reaching out to Teens: Introducing Internal Medicine Residents to Their Communities
Through the Development of a Preventive Medicine and Public Health Curriculum for Adolescents.”

Graham McMahon (PI), Joel Katz and Patricia Kritek:
“An innovative program to develop physical diagnosis teaching by residents:
Can education change behavior?”

Alexandra Molnar (PI):
“Constructing a Comprehensive Community Medicine Curriculum for Division of
General Internal Medicine Primary Care Residents.”

Peter Reese (PI), Sylvia McKean:
“The Social History Curriculum for Medical Students: Putting Illness in Context.”

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