Director of Award-Winning Residency Program Driven by Heart of Service

by U.S. Medicine

March 12, 2012

By Steve Lewis

JACKSONVILLE, FL— The residency program at the Naval Hospital-Jacksonville was named  Clinical site of the year by the Uniformed Services University of the Health Sciences in 2011, but the program’s director scoffs at taking personal credit.

Cmdr. James Keck

“I stand on the shoulders of giants; I walk in the footsteps of the program directors before me,” insisted Cmdr. James Keck, MD, MBA, FAAFP. “They set up the model; I’m just trying to live up to it.”The Florida hospital’s family medicine training program — one of six in the Navy — trains about 36 residents a year — 12 in each of the program’s three years. “It’s one of the largest in the Navy — along with Pendleton,” said Keck. The personnel includes 14 full-time family medicine teaching faculty (10 military and four civilians), three associate faculty and the other subspecialties in the hospital that engage with the residents, including cardiology, internal medicine, gastroenterology and orthopedics.

Despite his modesty, Keck, who assumed his position in January 2011, said he is “always working on new initiatives,” which often have been successful. Research has been one of his areas of emphasis, and those efforts have borne fruit. “We’ve seen it in acceptances and research competitions we’ve won — and our research products have more than doubled,” he said.

Continuous Improvement

The residency program, Keck said, has a culture of continuous process improvement. “We get feedback from the staff, ideas on how to solve problems, and, when new standards come out, we consider how best to implement them,” he explained. In recent years, for example, the number of hours residents are allowed to work has been reduced, “and we’ve been creative with scheduling,” Keck added.

This culture is engendered by constantly talking about improvement, Keck noted. “We always ask for feedback — both formal and informal. We get written evaluations at the end of every rotation. We also evaluate the program as a whole, and the faculty takes all that feedback to see what needs to continue, what resources ought to be added and where we need to change course.”

In addition, Keck said, the program has reached out to other family medicine programs in Jacksonville, building a collaborative. “We’ve leveraged the community resources so that the overall education of students is top-notch, innovative and progressive.”

The program also has moved forward with simulation training in cooperation with Shands Jacksonville Medical Center and the University of Florida Science Center. “We go over there a number of times a year to hone skills on key procedures — not only code situations but chest tube, intubation, central lines and other skills our residents may need on the battlefield,” Keck pointed out.

Looking Ahead

Keck’s concerns extend well beyond the time the medical residents spend in his program. “Our vision is shaped by what it is we do — not only here but what we do later. We take care of our nation’s heroes; when the residents leave here, they will go all over the world, taking care of our shipmates and their families. We continue to impress that. We want the best family medicine physicians prepared here, so they can go out and make a difference.”

What makes the program both unique and strong is the people who work and study in it, Keck said, adding, “We are blessed with a great group of people, and I am blessed to work with them.”

Keck has strong opinions about what a director should look for in the hiring process. “The best teachers can come from many walks of life, and I value diversity in operational settings — people who’ve been deployed, people who’ve worked in hospitals clinics. I like staff members who’ve had experience in all of those, so they can then mentor our residents. I look for those qualities when I interview, because we seek to take care of a broad range of problems and patients, from birth through retirement.”

When it comes to interviewing prospective residents, Keck looks for individuals who “are really committed to the mission, who have a heart of service to take care our men and women in uniform.”

Ultimately, it is this “heart of service” that forms the foundation of the program.

“I want folks who do not mind giving of themselves,” Keck said, noting that this is his motivation on a daily basis. “It fits well with teamwork and with our mission. For me, personally, I will often hear one of my mentors or other folks I look up to say it’s all about giving back. I’ve walked in the shoes of those who’ve gone before me, who’ve taken the time to train me and mentor me. Now, I just want to give back to the next generation.”

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