Department of Medicine

Braddock Looks Back

Those who knew and worked with Clarence Braddock, MD, MPH, over the past 10 years will sorely miss his wisdom, leadership, dedication, and innovative ideas.  In the following interview, he reminisces with Rita Kennen, Department of Medicine, Public Relations Officer, on the high points of his decade-long career at Stanford, along with the personal growth, experiences, and memories he will take with him to his new position as Vice Dean for Education in the David Geffen School of Medicine at UCLA.

Rita Kennen: You have had a very busy ten years at Stanford. What will remain in your memory as the highlight of that part of your career?

Clarence Braddock: The most interesting thing for me has been the day-to-day work. Being at Stanford is being on a bigger stage even though
Clarence Braddock MD MPH
Clarence Braddock, MD, MPH
the things you are doing are the same work that others are doing elsewhere. There is considerable visibility, which adds a sense of responsibility given the leadership role that Stanford plays as a medical school and as an institution.  It is also rewarding in that it gives you a broader impact than you might have otherwise. And it is exciting because the work you do can have an influence that can be pretty profound.

For example, the Educators-4-CARE (E4C) program, established in 2008, which matches a medical student with a preceptor for their entire medical school career, is a unique program. We picked outstanding teachers and offered them 25% salary support to spend that time teaching medical students the art and craft of medicine over the whole 4 years, Educators-4-CARE where CARE is an acronym for compassion, advocacy, response, and empathy. At the time E4C began, only a handful of places had such a program and now about 20 schools have adopted it.

Another highlight is the scholarly concentration program, which is like a minor for the students. Every medical student has to complete a scholarly project, including taking some course work in an area of study. It might be a research area like molecular medicine, clinical research, or medical education or even bioethics. We launched it in 2003 as an embodiment of our commitment to assuring that our graduates are not only outstanding physicians but they also have a scholarly dimension to take to their future careers.

RK: Can doctors be taught to talk with their patients in a way that those patients can understand? Do you see sufficient emphasis in medical schools on improving doctor-patient communication?

CB: Yes, I do.  When I came to Stanford in 2003 and we launched a new curriculum, a major component was “The Practice of Medicine,” which I directed and ultimately handed over to Pree Basaviah, MD, when I became Associate Dean. That course was based on a foundation of patient-centered communication skills, such as the notion of active listening to promote better understanding of the patient. These were very specific skills to allow patients to be heard and treated like persons, to be involved in their own decisions, and to feel the respect of their clinicians in a partnership.  I think the next wave will be to assure all of our physicians, faculty, residents, and fellows also embrace those concepts.

That is why it is so wonderful that both our teaching hospitals have focused on communication. Stanford hospital has an initiative around the patient experience that includes those same elements of good communication for all staff.  And at Packard they have family-centered rounds where instead of the team rounding outside the room they actually come into the room with the family at the bedside, so the family has an opportunity to hear what is going on with their child, to ask questions, and to be part of that partnership.

These initiatives will bear fruit for Stanford in creating a much more patient-centered experience for our patient. And they will allow Stanford to graduate from our medical school and residencies and fellowships physicians who have ingrained those values of respect for the patient as a person, involving patients in decision making, and communicating in a way that invites questions to be asked and answered.

RK: How have you seen preclinical medical education change over the years since you finished your own medical degree in 1981?

CB: Today there is more recognition of the need to have medical students begin the clinical environment as early as possible in a way that is meaningful and authentic; to actually have some responsibility to engage with patients, interviewing them, helping to be involved in their care. This is incredibly rewarding and is a wonderful complement to what they are learning in the classroom.

The other thing that has changed is the need for the classroom to go from being primarily a lecture hall to being a more dynamic learning environment. This is true whether it is problem-based learning in small groups or newer approaches that allow for a more active role for the learner.

RK: What has been the focus of your research into medical education?

CB: The overarching focus has been to create innovative ways to teach particular topics and to rigorously evaluate the effect of those innovations.

For example, several years ago we launched a new cultural competence curriculum which included several things, including the use of film to stimulate the discussion of challenging topics such as health disparities or language access for non-English speaking patients. We also used standardized patients so that students could practice how to interview and interact with patients who may hold unique health beliefs.

As we used those innovations we were gathering data about how the students performed in those exercises and how that curriculum fundamentally could improve the skills and knowledge of those students. We’ve done the same thing in ethics and population health. The general approach has been to use emerging concepts and experience about more effective ways to teach and turn those into new curricular inventions that we can then evaluate in a way that is rigorous and worthy of scholarly publication.

RK: You have also been active in the American Board of Internal Medicine. Did you play a role in the development of the Maintenance of Certification (MOC) program?

CB: I’m very involved because I am on the board of directors for the American Board of Internal Medicine, which oversees the certification and recertification of internists and internal medicine subspecialists. I’ve been involved with that work for over 5 years. I am the Chair-elect for the board of directors for ABIM.

In that role I’ve been intimately involved in the evolving thinking about the parameters to use to determine whether an internist continues to meet the standards that we want to hold up to the public as meeting certification. One part of that is taking a traditional examination. The other part is committing to continuous education and improvement through ongoing learning, self-assessment, reflecting on performance and being constantly engaged in continuous practice improvement.

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