Ten years ago, thanks to a generous and visionary gift from philanthropist Aliki Perroti, the Aliki Initiative was launched at Johns Hopkins Bayview Medical Center by the Center for Innovative Medicine, creating a new model for the way young doctors today should be trained.
The goal of the Aliki Initiative is beautiful in its simplicity: to give medical trainees the time they need to get to know their patients as people. By talking with patients and their families, by calling and making home visits once these patients are discharged from the hospital, Aliki trainees and medical students can see just how patients are doing – and make it more likely for them to get and stay well.
In the decade since it was launched, the Aliki Initiative has flourished, and its impact has come to be felt well beyond Johns Hopkins Bayview. To celebrate the program’s anniversary, we bring you 10 highlights of the Aliki Initiative’s first 10 years:
1. More than 100,000 patients have been touched
Each member of the internal medicine house staff at Bayview (about 15 to 20 doctors per year) participates at some point in his or her training in the Aliki Initiative. These medical residents then carry what they learn to all other experiences, including the other general medical services and intensive care units.
“So basically, the Aliki experience touches every internal medicine house officer here at Bayview,” says cardiologist Roy Ziegelstein, who is co-director of the program. “If you think about it that way, the Aliki Initiative has permeated the entire teaching service and affected all patients admitted to the Department of Medicine over the past 10 years.”
And Ziegelstein doesn’t stop there: “I would say the impact is even greater than 100,000 patients,” he says. “Because the graduates who leave our residency programs take with them what they’ve learned to other institutions and practice settings. So the true number of patients impacted is almost impossible to estimate.”
2. New collaborations have broadened the Aliki Initiative’s impact on medical education
“An important part of knowing a patient as an individual is understanding his or her spiritual needs as well,” notes Cynthia Rand, a professor of medicine and also co-director of the Aliki Initiative. Toward that end, members of the chaplaincy trainee program at Bayview have begun serving on the Aliki team, together with medical residents. “It’s a natural alliance for a program that is focused on the whole patient,” says Rand, since chaplaincy trainees – who talk closely with patients about their spiritual concerns – gain insights into a patient’s life that can then be shared with the medical team.
More recently, components of the Aliki model were applied in the training program for medical house staff in the ICU and cardiac ICU. When patients are critically ill and often unable to communicate, their stories can get lost. Through this new initiative, trainees learn the importance of including family members when discussing the patient’s goals of care, Rand explains. Just as important, she says, “the trainees learn to document that information in the medical record so that it doesn’t get lost as the patient moves to the next point of care.”
Nursing, too, has been drawn into the Aliki program, with the addition of a “nurse attending” on the patient care team during medical rounds. Because nurses are on the front lines of patient care, “nursing has a great deal to teach the medical team,” says Rand.
“So basically, the Aliki experience touches every internal medicine house officer here at Bayview. If you think about it that way, the Aliki Initiative has permeated the entire teaching service and affected all patients admitted to the Department of Medicine over the past 10 years.” – Roy Ziegelstein
3. Aliki faculty have become leaders across Johns Hopkins Medicine
Faculty members who train young doctors in the Aliki Initiative curriculum also hold important leadership positions across Johns Hopkins. Consider the case of Laura Hanyok, who completed her residency training at Bayview and now directs the faculty development program of the Aliki Initiative. She was recently appointed assistant dean for graduate medical education. She is just one of many faculty members who are extending the reach and impact of the patient-centered Aliki mission across Johns Hopkins.
“Whenever people become leaders in medical education or clinical care, they have the potential to influence how medicine is practiced and how it’s taught to the next generation of doctors,” says Ziegelstein, who himself is the vice dean for education at the school of medicine.
4. The Aliki Initiative has gained honor in Greece
Earlier this year, the prestigious Pro Bono Humanum Award was bestowed upon Aliki Perroti “for her domestic and international contribution in the fields of Health, Social Medicine and Education.” The humanitarian award, which comes under the auspices of Prix Galien Greece (an international awards program that promotes significant advances in pharmaceutical research), recognized Mrs. Perroti’s important contributions in her home country, where her philanthropy made possible the Konstantopoulio General Hospital N. Ionia and the expansion of the American Farm School.
The award also praised Mrs. Perroti for her humanitarian work abroad, specifically mentioning the Aliki Initiative at Johns Hopkins Bayview, “which places the patient at the center of medical education, research and care.”
“Physicians-in-training must learn all aspects of precision medicine, and they must be provided the time, opportunity and resources needed to master personomics and to understand and appreciate its importance to patient care.” – Roy Ziegelstein
5. The Aliki Initiative has garnered notice in leading scholarly journals
Johns Hopkins faculty members have written many articles about the initiative, which have appeared in a wide variety of important publications – including the New England Journal of Medicine. Perhaps mostly notably, Roy Ziegelstein, the Sarah Miller Coulson and Frank L. Coulson, Jr. Professor of Medicine, coined the term “personomics” in a viewpoint piece he wrote for the Journal of the American Medical Association. Noting that “precision medicine” is the leading force in medicine today, with its reliance on genomics, proteomics and other so-called “-omics”, along with big data and cutting-edge technology, he emphasized the importance of adding “personomics” to the precision medicine toolkit – the study of the unique person at the heart of the data.
“Physicians-in-training must learn all aspects of precision medicine, and they must be provided the time, opportunity and resources needed to master personomics and to understand and appreciate its importance to patient care,” he wrote.
The personomics concept has caught on well beyond strictly medical circles. In fact, Johns Hopkins University President Ronald Daniels was so taken with it that he cited personomics and Roy Ziegelstein in his universitywide commencement address last spring. While it’s important to understand the “collective evidence” in all that you examine, Daniels told the Class of 2017, “you must never lose sight of the incredible richness of the human story.”
6. The Aliki Initiative was featured in an influential book by a prize-winning author
When Kenneth Ludmerer, M.D. ’73, set out to write a prescription for fixing the system for graduate medical education, the noted medical historian turned to the Aliki Initiative as a model. As Ludmerer has written: “The Aliki Initiative is the most important innovation in graduate medical education in a generation.”
In his book, Let Me Heal: The Opportunity to Preserve Excellence in American Medical Education, Ludmerer discusses how improving resident training in the United State is key to improving our broken health care system. Key to that training, he argues, is giving young doctors the time they need to get to know their patients as people. When discussing Let Me Heal at national meetings, says Cynthia Rand, “Dr. Ludmerer has said without any hesitation that the Aliki Initiative should be adopted by every hospital and medical school in the country.”
“Dr. Ludmerer has said without any hesitation that the Aliki Initiative should be adopted by every hospital and medical school in the country.” – Cynthia Rand
7. Hospitals and programs across the country have adopted elements of the Aliki Initiative
The Aliki curriculum is publicly available online through the MedEd Portal, making it widely accessible to medical training programs everywhere. In addition, Aliki faculty leaders and alumni are frequently called upon to give talks at leading medical conferences. Among those institutions that have already incorporated parts of the Aliki curriculum are the University of Virginia and Brown University. Aliki concepts have also been presented (or will soon be presented) at Grand Rounds at New York University, Yale University, Stanford University, Brown University, the University of Virginia and at Johns Hopkins All Children’s Hospital in Florida.
8. The Aliki Initiative has achieved a global reach with patients
Over the 10 years of the program, Aliki graduates have gone on to serve as doctors at hospitals and academic medical centers across the country – from Maine to California – and around the globe: in far-flung locations, including Nepal, South Africa and Thailand. Wherever they go, Aliki alumni take the patient-centric model they trained under with them to share with colleagues and to call upon in their care of patients.
99 percent of graduates report that the lessons of Aliki last for years beyond training.
9. Numbers speak to the success of the Aliki Initiative
Medical students, residents and patients uniformly give high evaluations to the program. In addition:
10. Aliki Scholars are pushing to advance and broaden the impact of the Aliki Initiative
Aliki Scholars are an integral part of the Aliki mission – a cadre of 18 doctors serve as attending physicians on the Aliki Service at Bayview. In addition to overseeing training and education for medical residents and medical students, the Aliki Scholars also meet four times a year to discuss and brainstorm ideas for new innovations in patient-centered care. Thanks to the fresh thinking, commitment and energy of the Aliki Scholars, we can rest assured that the Aliki Initiative will reach new and even greater heights over the next 10 years.