At the 2025 ACGME Annual Educational Conference, members of the Back to Bedside Work and Advisory Group walked attendees through an appreciative inquiry exercise while sharing practical reflections from their own Back to Bedside projects, guiding an individual and group discussion in a session entitled Back to Bedside: An Appreciative Inquiry on Finding Meaning in Medicine. The goal was for participants to better understand this problem-solving framework and use it with their own residents and fellows.
Being a physician can be difficult physically and emotionally. The days can be long, the outcomes aren’t guaranteed. The time spent with patients, while rewarding, can be overshadowed by piles of paperwork and administrative responsibilities.
With these challenges in mind, in 2016 the residents and fellows from the ACGME’s Council of Review Committee Residents (CRCR) conducted an appreciative inquiry—a method of idea exploration that builds existing positive experiences into new ideas and solutions—on finding meaning in work. From this exercise, the members of the group discovered that their most rewarding experiences in medicine occur when building relationships with patients. From this exercise was born the ACGME’s Back to Bedside initiative. Since the first cycle in 2017, Back to Bedside has provided funding and education to residents and fellows developing transformative projects that foster meaning and joy in work by allowing them to engage on a deeper level with their patients.
Defining the Goal, Discovering the Scope
Rather than focusing on problems, appreciative inquiry focuses on previous success, said presenter Jeffrey J. Dewey, MD, associate program director and assistant professor of neurology at Yale School of Medicine.
“Appreciative inquiry seeks out the best of what is to help ignite the collective imagination of what could be,” he said.
When developing an appreciative inquiry session, the first step is to define the goal or target for change and then use a series of questions for the “define” and “discovery” phases. In the Back to Bedside example, the issue that was “defined” was burnout reduction and increasing the number of daily moments in when practicing medicine felt meaningful. The group “discovered” those moments through a series of questions.
Session presenters asked participants similar questions: When have you experienced deep meaning in your role in medicine? What did that feel like? What did that look like, feel like, smell like? For one attendee, it was a clinic day where she saw all her favorite patients. For another, it was developing a training program to teach a skill she had mastered but others had not. As moments were shared, smiles could be seen around the room as physicians and administrators connected with the best part of their profession.
Dreaming of Possibilities, Designing an Achievable Idea
Madeleine Ward, MD, assistant professor of medicine and pediatrics at Brown University, explained how her “dream” stage of developing her Back to Bedside project was finding a way to marry two seemingly disparate activities: participating in creative outlets like journaling and painting, and spending more time with her patients.
Dr. Ward looked for existing structures that could help shape an arts initiative in the program as part of the “design” step. She noted that her internal medicine program had several existing “tracks” (e.g., clinician educator, research), and so she leveraged those existing structures to create an arts and humanism track in the residency program, also relying on the arts-rich community of her city to build and expand her initiative.
Amogh Nadkarni, MBBS, a sleep medicine fellow at the University of Kansas Medical Center, said he felt the most meaning when he could effectively address a patient’s issue in clinic. He recalled a patient in her 80s who came in for chronic obstructive pulmonary disease; she could be treated but couldn’t afford the medicine. Dr. Nadkarni realized his patients often needed additional resources to fully address their health issues. Frequently, the resources existed, but the residents were either unaware of them or weren’t connecting the patient’s needs, the resource, and the health outcome. So, Dr. Nadkarni designed a project to make those connections.
“I learned to switch the way I’m approaching a problem,” he said. “We came up with pretty decent ideas to make things better with what we already have.”
Delivering the Dream
Once dreamed and designed, you need others to believe in your project to make it a reality, said Joshua A. Belfer, MD, an attending physician/assistant professor of clinical pediatrics at Children's Hospital of Philadelphia and current Chair of the Back to Bedside Work and Advisory Group.
For Dr. Belfer’s project, pediatrics residents created trading cards (like baseball cards) with more casual photos and information about themselves outside of their medical role. Patients were invited to make their own cards, and the cards could then be used as a discussion point with the patients. The card project was successful because the residency program saw value in it and the residents who were asked to participate also saw value in it.
By working with the program to encourage participation and by explaining to residents that it’s a way to establish better relationships with patients, Dr. Belfer was able to create a successful project with high participation.
“The individual is the most important person to get buy-in to your project,” said Dr. Belfer. “Most of your projects, you’re asking your residents to do more.”
The 2024-2026 Back to Bedside grant recipients are in the middle of implementing and evaluating their projects. Learn more about Back to Bedside, and access descriptions of the current projects on the ACGME website. Applications for the 2026-2028 Back to Bedside funding cycle will become available in fall 2025.