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--> MedRAP – Iris Mushin, What Hurts the Physician Hurts the Patient – Medical & Physician Training, Medical Residency Programs
COMING SOON… An updated, expanded edition of What Hurts the Physician Hurts the Patient is in progress, which will include the impact of COVID-19 on the medical training environment and strategies on how to most effectively address the current and future challenges presented by the pandemic.


A Comprehensive Approach to Improving Clinician Professional Development and Well-Being

“What Hurts the Physician Hurts the Patient” describes the MedRAP system in its entirety and details a clear path to implementation.
The MedRAP Facilitator Manual is a supplement to the book and provides step-by-step instructions for implementing individual topic sessions.

MedRAP responds to challenges common to medical training – such as a lack of effective communication, time management issues, and other onboarding difficulties – which are known to impact the quality of medical care.

Field-tested and proven for over two decades at Baylor College of Medicine in Houston, Texas, MedRAP is now publicly available for the first time.


  • Accelerated transition into the hospital work environment
  • Development of organizational communication and leadership skills
  • Reduced physician stress and burnout
  • Improved hospital and patient care efficiency
  • Assistance in meeting multiple Accreditation Council for Graduate Medical Education (ACGME) requirements

What people are saying about MedRAP
MedRAP has been described as a successful program by hospital management, faculty, and medical trainees.

What Hurts the Physician Hurts the Patient is the result of a career’s work and labor of love by Ms. Iris Mushin, who was an MBA student at the time she initiated the MedRAP program, while I was serving as Chair of Internal Medicine at Baylor College of Medicine in 1989. Subsequently, she directed the program over two decades. Ms. Mushin has now produced a wonderful publication describing MedRAP, which addresses training, professional development, and the well-being of medical residents. Ms. Mushin’s publication is comprehensive, clearly written, and will be of enormous value to all individuals, trainees, administrators, and directors of medical residency programs. This is an excellent contribution and reflects very positively not only on the author, but also on Baylor College of Medicine and its support of the MedRAP training program for many decades. I highly recommend this book to all medical residents, resident program directors, department chairs, and administrators who are connected with the training of new physicians. Ms. Mushin has made an enormous contribution not only to resident training at Baylor, but also to the overall training of residents in the United States.

Antonio Gotto, Jr., MD, DPhil

Dean Emeritus, Weill Cornell Medicine
Provost for Medical Affairs Emeritus, Cornell University

As Chief of Medicine at Ben Taub Hospital, Chair of the Internal Medicine Department, and Dean of Graduate Medical Education at Baylor College of Medicine (BCM) during the implementation of MedRAP, I came to appreciate the many benefits of such a program for any residency program or medical institution. During the 25 years of this program, I have also witnessed firsthand the benefits for resident morale and team building.

The Quality Improvement component was used to improve both education and patient care. With the introduction of the Core Competencies by ACGME, this program became essential to meeting the milestones expected for accreditation… This comprehensive and thoughtful book will be of valuable benefit for program directors, as well as for other institutional leaders and non–physician training programs. I highly recommend this excellent work.

Stephen B. Greenberg, MD, MACP

Chief, Medicine Service
Ben Taub Hospital
Distinguished Service Professor
Margaret M. and Albert B. Alkek Department of Medicine
Baylor College of Medicine

As the Program Director of the Internal Medicine residency program, I have witnessed the benefits MedRAP offers on multiple levels… Both one-off and systemic problems were more quickly identified, and the accelerated flow of information to management of the residency program and hospitals, coupled with potential solutions identified within the MedRAP process, resulted in more rapid implementation of many improvements… The cost of the entire MedRAP program was nominal in comparison to the significant return on investment it delivered… Not instituting a program such as MedRAP is actually the more expensive decision. I highly recommend not only reading this book, but also implementing its lessons in your program.

Amir Halevy, MD, JD

Director of Internal Medicine Residency Program,
Baylor College of Medicine

For too long, we as faculty have not given enough attention to how residents deal with stressful situations… Residents develop less feeling of insecurity, better relationships with mentors, and certainly improved care and support of patients. MedRAP is an important feature in the training of our future care-givers.

Edward C. Lynch, MD

Distinguished Service Professor, Retired
Department of Medicine
Baylor College of Medicine

As medical education continues to change and the focus on physician well-being evolves, a highly practical program such as MedRAP is an essential aspect of any medical residency or fellowship... As a faculty member in the Department of Medicine and Psychiatry at Baylor College of Medicine, and as a member of the initial review committee for MedRAP, I have found it tremendously fulfilling to watch the program grow and develop in response to the needs of our residents. I highly recommend this book describing in detail how to implement MedRAP and look forward to its impact on medical education.

William A. Myerson, Ph.D.

Assistant Professor, Medicine and Psychiatry
Training and Supervising Analyst, Center for Psychoanalytic Studies - Texas
Treasurer, American Psychoanalytic Association

I personally have had the opportunity to participate in the MedRAP program as an intern and a senior resident mentor, and have observed the benefits from afar as a residency program director. The benefits are numerous in addressing workplace issues that are beyond the reach of a program director or an institution. Communication, collaboration and self-reflection are key components for an individual to assimilate, adapt and excel in challenging workplaces such as the hospitals and clinic settings of residency training. Programs such as MedRAP provide a dedicated and protected space for medical residents to have an outlet to share their experiences in a productive and safe manner, receive support and advice from senior residents, and develop meaningful skills through facilitator- led workshops. They can also help residency programs meet numerous ACGME requirements while making a real difference in the lives of its residents. In an ideal world, all residency programs should make programs such as MedRAP a core offering of their residents' training.

Anoop Agrawal, M.D.

Program Director
Internal Medicine and Pediatrics Residency Program
Baylor College of Medicine

MedRAP is mutually beneficial for institutions and trainees. The benefits of improved
well-being and stress reduction for health care professionals mirror themselves in
corresponding institutional benefits of operational efficiencies and improved patient care.


Rather than only managing the symptoms, MedRAP provides tools to promote well-being and preemptively addresses problems that lead to stress and burnout.

MedRAP components teach professionalism explicitly and by example.

Participants are more likely to openly discuss and seek solutions for issues they encounter during their training, such as medical mistakes and problems on the hospital wards, when evaluators are not present.

MedRAP provides structured mentorship opportunities, so trainees benefit from strong, supportive, and consistent leadership and role modeling.

The MedRAP structure allows for early identification of trainees experiencing professional and personal difficulties and provides resources to assist them.



The Quality Improvement (QI) component of the program involves the entire health care team to facilitate collaboration and improve the efficiency of the hospital work environment and patient care.

Improving health care professionals’ well-being, organizational efficiency and communication skills ultimately impacts patient satisfaction.

The built-in feedback mechanisms inherent to MedRAP foster collaborative teamwork among medical trainees, faculty, and all health care team members.

Trainees receive information regarding best and most effective practices; collective knowledge is passed down from group leaders who serve as mentors.

MedRAP includes a leadership training component that positively impacts participants’ effectiveness as team leaders in the hospital work environment and thus patient care.

Milestones are addressed in the following competencies: interpersonal and communication skills, professionalism, systems-based practice, practice-based learning and improvement, and patient care.

The positive work and training environment fostered by MedRAP means health care professionals are more likely to be successfully recruited and stay in their jobs longer.

Who else benefits?
MedRAP can be easily tailored to the needs of a wide range of health care trainees.