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“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.”

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.”



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.”


Director of Internal Medicine Residency Program,
Baylor College of Medicine

“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.”


Program Director
Internal Medicine and Pediatrics Residency Program
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

“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


The annual evaluation questionnaire also contained specific open-ended questions to assess ways to improve the program. Below is a sample of responses.

  • “This is an excellent program: I am incredibly appreciative of everyone’s hard work to help us. I hope the program never changes.”
  • “I enjoyed being a group leader; I feel that the MedRAP program is one of the strongest aspects of our program.”
  • “So glad this was a part of internship; it was a very valuable experience.”
  • “I found the MedRAP meetings to be incredibly useful and filled me with great perspective. I think MedRAP is one of the finest things Baylor provides for us and felt lucky to be at an institution that really works hard to ensure all its members are both physically and mentally doing well.”
  • “The program contributed to culture change in the department and system level change in the hospitals.”
  • “Overall great experience. Maybe meet with only interns at some point or meet with interns individually once or twice a year.”
  • “Hearing about other residents struggling to work efficiently. Getting advice from upper levels. Being able to have a mechanism for translating feedback into changes.”
  • “Overall a great program and a tremendous asset for the residents/interns.”
  • “Thanks! This program is an excellent way to help the transition through intern year and residency. MedRAP is truly one of the best aspects of our residency program.”