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Using the LIFE Curriculum

Residency Program Connection, December 3, 2007

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Although most residency programs work hard to meet the ACGME's resident duty-hour requirements, it still remains a tricky issue for program directors and coordinators to manage. In fact, Residency Program Alert reported in October 2006 on a study published in the September 2006 issue of the Journal of the American Medical Association (JAMA) that revealed more than 80% of interns surveyed violated the duty-hour requirements.

Confronting a resident about the amount of hours he or she works or whether he or she is feeling fatigued can be difficult. However, the recently-updated LIFE Curriculum can be a helpful resource for directors and coordinators who must deal with this situation and many other thorny issues.

The LIFE Curriculum is a case-based free curriculum consisting of three CD-ROMs and two teacher's guides about resident issues such as fatigue, impairment, depression, substance abuse, boundary violations, burnout, and disruptive behaviors. ACGME has discussed its use in two sections of the Program Director's Guide to the Common Program Requirements, specifically to support teaching in the competencies of communication and professionalism.

Funded in part by the Josiah Macy Jr. Foundation, MedEDPortal accepted the LIFE Curriculum "with acclamation." The National Board of Medical Examiners (NBME) uses parts of it in its professionalism materials. A national advisory group consisting of faculty and residents from various specialties, program sizes/structures, medical students, physician assistants, and nursing educators helped create the LIFE Curriculum.

Topics are organized around 12 different prototypical cases of difficult resident interaction as well as generational challenges, remediation, legal issues in graduate medical education (GME), "staying in the program director role," and recruiting the right applicant.

Trailers on the LIFE Curriculum website introduce each of the 12 topics (see the tab: Program Tour), and program directors and coordinators can use them as triggers to stimulate discussion and facilitate role play responses. The module presents two scripts-one that is an optimal strategy more likely to succeed, and one that is not.

Over 2,500 participants report attending a seminar that included a presentation on the LIFE Curriculum, and more than 4,000 sets have already been mailed. For those of you already using this tool, 30 new trigger tapes (see the tab: Lounge) are available. Each video consists of an actor reading a few sentences; choose three to four different actors (the response of people to the trigger frequently varies based on the actor's ethnicity and gender) and use them to stimulate a conversation or encourage role play. Twenty-seven of the triggers involve resident issues such as: 

• Being honest in reporting duty hours
• Responding to a family who presents you with a gift
• Empathizing when dealing with patients whose moral choices may differ from the residents
• Dealing with a romantic interest with a medical student on the team

Other triggers illustrate challenging patient situations such as confronting an accusatory family member, and disclosing an error to a patient.

Order the materials free or download many of them directly from the Web site at www.lifecurriculum.info.

All the best,

Kathryn M. Andolsek, MD, MPH
Associate director for GME
Duke University Medical School
Durham, NC

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