Joshua A. Belfer, MD is an attending pediatric emergency medicine physician at the Children's Hospital of Philadelphia and an assistant professor of clinical pediatrics in the Division of Emergency Medicine within the Department of Pediatrics at the Perelman School of Medicine - University of Pennsylvania.
Dr. Belfer is the Chair of the Work and Advisory Group (WAG) for Back to Bedside, an ACGME initiative that provides funding for resident- and/or fellow-led teams to develop transformative projects that foster meaning and joy in work and allow them to engage with patients on a deeper level. When he was a pediatrics resident at Cohen Children’s Medical Center in New York, Dr. Belfer applied for and received a Back to Bedside grant.
In this Q and A, Dr. Belfer discusses his experience as a participant in Back to Bedside; how he has grown as a teacher, clinician, and leader through his involvement; and why he has continued being actively involved in the initiative after his residency.
ACGME: How did you become involved in the Back to Bedside initiative? How did you hear about the program and what made you want to apply?
Dr. Belfer: During my first year of residency, my co-resident, Kinjal Desai, and I wanted to create a project that we initially called “The Legacy Project.” It was an idea of a concept that would allow us to become more integrated in the community we were already working in, and to make even more of an impact on our [patients’ lives] than we already were. As we began to create what ultimately became the “Resident Trading Card Project,” our program director forwarded us an email from the ACGME announcing the first iteration of Back to Bedside. The goals of Back to Bedside aligned perfectly with what we were trying to do, and we were excited to apply for the first Back to Bedside grant.
ACGME: Briefly describe your initial project pitch for the program.
Belfer: Each resident was provided with a set of personalized trading cards templated like the traditional baseball card, including their name, photo, and several fun biographic facts – for example, their favorite food, their favorite game, or their favorite rainy-day activity. The intervention consisted of two interactions between the resident and patient. At the beginning of a patient’s hospitalization, residents used their trading card to introduce themselves to their patients. Patients were then provided with blank trading card templates and invited to create their own cards. During the second planned interaction, patients were encouraged to use their newly created cards to introduce themselves to the resident.
ACGME: As you went through the grant process and received direction and mentorship, how did the project evolve?
Belfer: The project became more robust in terms of optimizing interactions between the residents and their patients. We utilized the expertise of our child life specialists to allow us to create scripts from which the residents were able to learn tips and tricks about how to better engage their patients and to find commonalities and similar interests based on the trading cards. We really had to think critically about how to engage our stakeholders and, most importantly, get buy-in from the residents. We did this through frequent communications with the residents each month, inquiring about what worked and what didn’t, and creatively finding solutions to obstacles and challenges that we had not anticipated.
ACGME: What was the easiest part about the project?
Belfer: Perhaps a bit surprisingly, getting buy-in from the residents was one of the easier parts of the project. I think the residents enjoyed having their own trading cards, personalized with facts about themselves, and were excited about the opportunity to utilize these cards to get to better know their patients. Additionally, getting buy-in from stakeholders was sometimes less of an obstacle than we anticipated. I think that because our project was so creative, and because it was very relatable in terms of the simplicity of the concept leading to enhanced interactions between patients and residents, people felt strongly that this project was going to work and achieve its goals.
ACGME: What was the hardest part?
Belfer: The hardest part of the project, as we probably anticipated, was finding time for the residents to engage with their patients for the project. We were asking residents to engage in an extra task of sorts, that they would have to fit into their already busy day. We knew, and they knew as well, that these interactions were likely to be quite meaningful. But the challenge was figuring out when to include this in their day-to-day routine. We worked closely with them as we went through the project each month to figure out what the best times to do this were: Was it right after rounds? During rounds? At the end of the day? We paid a lot of attention to the feedback we were getting from the residents to figure out how best to seamlessly include this project into their very busy days.
ACGME: Why did you decide to join the WAG?
Belfer: The Back to Bedside experience as a grant recipient made a huge impact on me as I went through residency. I really enjoyed creating the project, solving challenges and obstacles that we encountered, and being a leader when it came to resident wellness and meaning in medicine in my residency program. I was very much impacted by the mentorship I received—both from my mentors in my program, Dr. Hayley Wolfgruber and Dr. Stephen Barone, and from those on the Work and Advisory Group [at the ACGME].
When they spoke to us at the Collaborative meetings about why Back to Bedside was created and the goal of the initiative, I felt strongly that they were in the process of really changing the environment of residencies nationally. When I had the opportunity to join the WAG myself, I knew it would be an incredible experience to be able to work alongside mentors of mine and to be able to join them in the incredible mission that they had. I knew I had learned a lot of lessons by going through the Back to Bedside process, and I felt I was able to bring that unique perspective and viewpoint to the WAG. I was happy to shed light on the experience of Back to Bedside through the eyes of a grant recipient, and to allow my perspective to continue to shape the way that Back to Bedside has been able to impact other residents.
ACGME: What do you think you bring to the WAG that’s been valuable for the current Back to Bedside cohort?
Belfer: I think because I've been in their shoes as a grant recipient, I bring a unique perspective to the current Back to Bedside cohort. I went through the process just like they are now, so I understand the challenges they are facing, the frustrations they may feel when certain obstacles are encountered, but also the excitement when it comes to creating and implementing a project they feel passionate about. Those of us who were previous grant recipients have the unique viewpoint of communicating to the WAG how certain workshops felt, how different lectures were taken, and how we can optimize the excellent educational experiences we are providing in the Collaborative meetings.
ACGME: How has your leadership evolved from those first days of the Back to Bedside initiative to now?
Belfer: Through Back to Bedside, I became a more confident leader, learning how to better communicate my vision and how to engage stakeholders effectively. From the skills I learned at Collaborative sessions and from the Back to Bedside WAG members, I have become more effective as a change agent, better understanding the process of creating a project and seeing it through to completion.
ACGME: What overarching advice do you have for the current Back to Beside cohort?
Belfer: The Back to Bedside experience is a unique one, not replicated in many other settings. It is an opportunity to learn from one another, collaborate, and really make an impact on your fellow residents and your patients. We in the WAG are here to support your incredible ideas, and to serve as a resource to help you ensure your project is as successful as it can be. Make the most of the experience, take chances, put yourself out there, buy into the mission – this will make your project even more successful, and will allow you to gain leadership skills that you will continue to use for the rest of your career.
The current cohort of Back to Bedside grant recipients is in the first year of the two-year grant cycle. They will have the opportunity to present their work to the graduate medical education community at the 2026 ACGME Annual Educational Conference.