Defining Success Across the Stages of the Back to Bedside Cycle: Reflections From the Third Cohort

At the October 2023 meeting, members of the 21 projects for Cycle 3 recreated the exercise previously described by Belfer et al.³  A subgroup of 7 resident and fellow projects leads then analyzed the results from that exercise and compared the findings with Cycle 1 participants’ experiences. Several themes emerged as teams endeavored to define success at various timepoints across the project cycle, including peer feedback, best practices, outreach, sustainability, and the iterative process of project innovation (Figure). Here we highlight how these themes compared with the first funding cycle at various timepoints and discuss how these shifts may reflect the increased focus on sustainability and transition during this cycle’s collaborative sessions.

The final collaborative session emphasized the upcoming March 2024 ACGME Annual Educational Conference as a near-term project milestone, with teams expected to present posters showcasing their (possibly interim) results and conclusions.

As in prior Back to Bedside cycles, delivering a successful presentation at the conference was at the forefront of team goals. Teams identified preparation for the conference as a crucial step in solidifying gains and addressing barriers to completing project objectives. They expressed hope that trainees at their sponsoring institutions would feel more connected with patients by this timepoint, as project interventions would have been in effect for several months.

Given the proximity of the conference to the end of the funding cycle, initial identification of transition collaborators (future project leaders, institutional leadership, outside partners) and the refinement of dissemination strategies were designated as important sustainability milestones. Teams noted that the conference presentations would allow for broader networking and feedback on their projects, potentially leading to wider uptake of these ideas. Several teams also hypothesized that the deeper connection between project trainees and patients at this timepoint might prompt other interested trainees to engage as new team members.

At the time of the session, funding for this cycle of Back to Bedside projects was set to conclude in June 2024, but some teams planned to continue wrap-up activities into the following academic year.

Teams anticipated that by this timepoint they will have substantially completed data collection and analysis, begun translation of results into manuscript submissions, and made plans to disseminate their projects both virtually and in person at national conferences. While the themes of success at this timepoint were largely similar to those from the previous Back to Bedside cycle, teams in this cycle additionally conceived of these successes as a means to foster meaningful and larger cultural changes toward valuing time spent with patients, starting with their own health care systems.

Planning for sustainability was a highlight of discussion about this timepoint, with teams noting that, given the duration of training, most project teams faced a need to transition project leadership as residents and fellows complete training. Successful realization of this transition was expected to require promotion of the project within the training program to inspire new leaders’ engagement, and this cohort newly emphasized creating a direct mentoring strategy for incoming project leaders. Given the end of the funding cycle, teams discussed the importance of securing sustained institutional support via internal funding sources and protected research time. Project leaders universally recognized that sustainable culture change is challenging to enact. One respondent summarized this as “change is complex.” Participants noted that widespread cultural change would require leadership-wide buy-in for institutional implementation but identified opportunities to sustain project goals, both by positioning the projects as curricular innovations and best practices and by expanding implementation to reach nursing, ancillary staff, and other engaged hospital communities.

This timepoint will mark 5 years from the start of the funding cycle. In discussion of this timepoint, the definitions of project success and sustainability appeared to merge, as sustainability would only be possible with a successful project, and a truly successful project would likely lead to longer term sustainable cultural changes and dissemination to other institutions.

This cohort, like the previous one, focused on the theme of project legacy, with goals of having the project become a “defining feature” of their training program and a “highlight during recruitment.” Teams anticipated that securing ongoing funding would be challenging but essential for project sustainability and hoped that demonstrating improvement in trainee well-being would spark institutional buy-in. Third cycle teams envisioned that their projects would be replicated by training programs nationally. Like the first cohort, they recommended the development of a “playbook” for easier adoption and implementation. However, the third cycle teams also focused on the importance of generating on-demand digital resources, perhaps influenced by the shift from in-person learning to virtual learning that occurred during the COVID-19 pandemic. They also foresaw opportunities for the incorporation of their interventions into the electronic health record, allowing patient-centered information generated from the projects to remain an integral part of the patient’s health record. The opportunity for expanding previously successful projects, similar to the concept of a playbook, was a part of Cycle 3 in the multisite arm and will continue in Cycle 4 as the “Project in a Box” arm of the initiative. Project in a Box allows participants to leverage previous successful cycle projects and incorporate the lessons learned from implementation roadblocks as they recreate those projects in their own institution. It is worth noting that the multisite arm and the new initiatives did not appear to differ in their perceptions of components of success in Cycle 3.

Most importantly, the third cycle teams, like in the first cycle, hoped that their projects would inspire their co-trainees to continually go “back to bedside” and seek deeper and more meaningful relationships with their patients outside the confines of their projects.

By design, the 3 collaboration meetings, scheduled at the initiation, midpoint, and near the end of the funding period for Cycle 3, incorporated reflections on how the Back to Bedside projects affected individual participants, their immediate project team, and their larger community. Throughout this funding cycle, teams acknowledged challenging barriers that were difficult to overcome (and which, in some cases, had stalled projects or delayed project completion). Teams felt that by introducing their projects and sharing their difficulties, they obtained unique and creative solutions and could better anticipate and prepare for future barriers based on other groups’ perspectives and experiences.

Teams generally felt positively impacted by their project and by the collaborative experiences, enjoyed celebrating successes with the wider group, and were inspired to adopt successful aspects from other projects (cross-pollination). Teams expressed a desire to implement sustainability strategies that would ensure project maintenance in years to come and were appreciative of the early and intentional opportunities to discuss these strategies during the collective meetings. Overall, teams felt that collaboration with other teams in both the small and large group settings provided critical feedback that influenced next steps in project implementation and dissemination.

The Back to Bedside initiative has grown tremendously since its inception, assembling cross-national trainees from various specialties and postgraduate levels who are united in its mission: bringing meaning and joy back into the work we do as physicians in training throughout our clinical learning and work environments. Several themes emerged from the collaborative meetings during this funding cycle, including spearheading cultural change at home programs, ensuring project sustainability through recruitment and mentorship, and nationally disseminating projects across mixed forums that ideally leverage digital technology. Not surprisingly, projects aimed to continue inspiring future cohorts of trainees and to firmly uphold the mission of Back to Bedside.

This unique initiative continues to flourish with the recently commenced Cycle 4, which showcases 30 projects for the 2024-2026 cycle. This newest cycle brings forth the traditional “Open Innovation” projects with unique creative project ideas, as well as Projects in a Box. Throughout the course of the Back to Bedside initiative, over 110 projects have been funded and championed, with participation from more than 250 residents and fellows nationally and across several disciplines. The far-reaching implications of such innovations—both locally and nationally—are evident, as highlighted throughout this article.

The ACGME News and Views section of JGME includes data reports, updates, and perspectives from the ACGME and its review committees. The decision to publish the article is made by the ACGME.