Medical educator has much to teach and much to learn from interns and residents

March 1, 2022

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CHRISTUS Health and Dr. Michael Finley believe that learning is a two-way street for its residents and fellows. His job is to open the flow of traffic and ensure it continues to run smoothly in both directions.

As system medical director and designated institutional officer for CHRISTUS Health facilities in the U.S., Dr. Michael Finley coaches hospital clinical leaders and manages compliance in medical training programs for 36 residents and graduate fellows. He is shown here with his wife Nancy at a car show.

Finley became system medical director and designated institutional official for CHRISTUS Health facilities in the United States in February 2021. As system medical director he coaches and mentors hospital clinical leaders in patient care delivery. The back end of his title means that he functions as liaison between CHRISTUS Health and the Accreditation Council for Graduate Medical Education. That non-profit, private council oversees all internship and residency medical training programs for physicians in the U.S.

Finley manages compliance for the medical education programs that CHRISTUS Health sponsors for residents at two family medicine practices and an emergency medical program, as well as graduate fellows in geriatrics, obstetrics and sports medicine. The programs include a combined total of 36 residents and graduate fellows. He works with on-site program directors to ensure the programs meet all guidelines and to standardize procedures.

Finley is the first to hold the title for CHRISTUS Health, which took over residency and internship sponsorship from local foundations and medical schools about seven years ago. He had gradually assumed the work over the past six years while he was chief medical officer at
CHRISTUS St. Michael Health System in Texarkana, Texas. His duties in medical education had expanded to take about 80% of his time when his title change became official.

"I like watching the residents and fellows grow into their next steps," he said. "You realize that everything's a transition."

A typical week
Finley meets by videoconference twice a week to twice a month with the CHRISTUS Health Graduate Medical Education Committee, the CHRISTUS Health System Clinical Leadership Group and en masse with the medical executive committees of the graduate medical education programs. He also checks in at least twice a week with program directors and his assistant designated institutional official, who is based at CHRISTUS Health headquarters in Irving, Texas.

"We huddle more than a football team," Finley said. From the regularly scheduled meetings stem calls or videoconferences with a chief resident or other official with extra questions or issues to discuss. He texts the program directors "individually, on schedule" every two or three days.

Nearly every week also includes conducting an educational workshop or mock site visit modeled after a visit from an inspector from the accreditation council. Finley and the three other members of the graduate medical education office, along with on-site program coordinators, monitor and report the issues around compliance with Accreditation Council for Graduate Medical Education regulations.

Compliance can carry a negative connotation for Finley, for the facility program directors and especially for the participants.

"Sometimes the residents think we're the bad cops," he said. "But we have a tremendous amount of documentation to file every week to show how we're making our residents safe, the environment safe and following duty limits for the residents. We need to cross every 't', every week."

The human touch
Despite handling an abundance of paperwork, Finley is primarily a relationship-builder. Before the pandemic, he spent much of his time on the road. Working from his home base in Texarkana, he traveled to meet on-site with program directors, residents and fellows. Though rarer throughout the pandemic, face-to-face interactions are the most rewarding for him. Last year, for example, he hosted three orientation programs in one week, two by Zoom, one in person in Corpus Christi, Texas.

He said the residents and fellows "want somebody to ask them how they're doing, and they want somebody to actually listen to them and be interested."

Last year, Finley traveled to San Antonio, where he met a first-year resident from a rural area. The resident expressed frustration that his rotation wasn't giving him what he'd eventually need in a rural practice.

"I gave him some pointers on how to get some value out of the program, rather than waiting for the program to give it to him," Finley said. "The whole thing about graduate medical education is that it belongs to you. You can go through rotations, take notes and go to the next rotation. Or you can dig deeper. You can ask for more."

A few weeks later, the resident thanked Finley for the advice and said he was doing better since their talk.

"I can't tell you how much that makes me feel that we got it right. And that makes me feel wonderful," he said.

To strengthen the connection between residents, fellows and staff, Finley partnered with CHRISTUS Health's health equity, diversity and inclusion group to conduct sessions with residents and faculty to explore their differences and commonalities. He said the sessions have proven "extremely rewarding."

Percolating through the system
The other part of Finley's title — system medical director — flows from the first. His mission is to develop programs and procedures for residents and fellows "that will cascade into our hospitals and medical staff." The partnership with health equity, diversity and inclusion has expanded in the residency programs to include a Diversity and Equity in Health Care workshop, which regional medical staff leadership will evaluate for including in their onboarding. Finley also hopes to expand throughout the system lessons he's learned on physician well-being.

"The pandemic has greatly increased the need to revisit how we assess physician well-being and active ways we provide to maintain personal and professional positivity, outlook and a sense of accomplishment and satisfaction," Finley said. "Physicians are experiencing higher rates of burnout, mental fatigue, depression and other stress-related issues, and we must accept the challenge to develop ways to address and help. We work very diligently with residents on this matter and are looking to pilot what we are learning to our medical staff."

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