Access and Continuity: A Multidisciplinary Education Workshop to Teach Patient-Centered Medical Home (PCMH) Principles.
ABSTRACT: Introduction:As more practices move to patient-centered medical home (PCMH) models, future health care professionals must train to work in collaborative settings. We implemented a 3-hour workshop for multidisciplinary trainees on the PCMH principles of access and continuity based on the EFECT framework (eliciting a patient-centered narrative, facilitating an interprofessional team discussion, evaluating the clinical evidence, creating a shared care plan, and tracking outcomes). Methods:Participants included internal medicine residents and medical, physician assistant (PA), and clinical psychology students. The workshop incorporated reflective activities identifying patient and provider health care delivery priorities, plus a PCMH presentation and group activities focusing on access and continuity. Evaluations were analyzed qualitatively and quantitatively. Results:The workshop had 39 participants (seven physicians, one PA, one educator, one psychologist, three staff, nine residents, one PA student, one psychology extern, and 15 medical students). On a 0-10 Likert scale (0 = don't agree at all, 10 = completely agree), learners reported higher knowledge of PCMH principles (M = 8.8), feeling better prepared for PCMH work (M = 8.6), and having obtained real-world skills (M = 8.3). Open-ended responses describing the workshop's take-home message included the role of patient-centeredness in clinical redesign, the value of the multidisciplinary team in optimizing access and continuity, and how to use a quality improvement approach for access and continuity. Discussion:This workshop increased PCMH-related knowledge and encouraged discussion of professional roles within the team. Learners recognized the benefits of team-based rather than provider-centric approaches to access and continuity.
Project description:<h4>Introduction</h4>Interprofessional collaboration improves patient outcomes. Many institutions lack access to learners from other health care professions, limiting the feasibility of many published interprofessional curricula. We created a video-based workshop to fill the need for an introductory interactive interprofessional activity for third-year medical students (MS 3) in their internal medicine clerkship, in which other health care students and standardized patients were not readily accessible.<h4>Methods</h4>This session introduced medical students to the interprofessional model of care through a video workshop. Learners engaged in reflective observation as a video presented a physician interviewing a patient. The training and roles of interprofessional providers were discussed with the aid of video demonstrations. Learners completed postworkshop and postmedicine clerkship surveys with responses indicated using a Likert scale (1 = <i>strongly disagree</i>, 5 = <i>strongly agree</i>).<h4>Results</h4>Sixty-seven MS 3s participated in this workshop; postworkshop survey response rate was 82%. Of students who responded to the surveys, 87% agreed that the video increased their understanding of when it would be beneficial to consult interprofessional team members. Students' confidence in interacting with interprofessional team members improved from a mean of 3.0 before the workshop to 3.7 after the workshop. At the end of the medicine clerkship, 71% indicated that the video improved their ability to work with interprofessional team members at least moderately.<h4>Discussion</h4>This video-based workshop improved students' self-rated understanding of interprofessional team members' roles and increased their confidence interacting with other members of the interprofessional health care team.
Project description:Introduction:Transgender patients frequently experience discrimination within health care settings due to provider lack of knowledge and bias resulting in poor service delivery. Team-based interprofessional collaboration is becoming a best practice for health professionals to improve patient-centered care and address these health disparities. Methods:A team-based interprofessional education simulation activity was developed as a teaching activity at a university for graduate health care learners in medicine, nursing, occupational therapy, physical therapy, physician assistant, social work, and health care administration programs over 2 years (N = 494). The simulation focused on a transgender patient brought to the emergency department (ED) after a workplace assault. Students were placed in interprofessional teams and asked to critique the initial ED interaction with the patient and then complete a team huddle and discharge planning meeting with a standardized patient. Student preparedness to engage in the Interprofessional Education Collaborative (IPEC) competencies was assessed through a posttest measure. Results:Student learners reacted overwhelmingly positively to the activities of the workshop. The averaging of 2 years of data yielded students responses of strongly agree and agree at 90% or higher for all IPEC core competencies, as well as for educational objectives of the workshop. Discussion:Reducing the structural, interpersonal, and individual stigma experienced by transgender patients requires institutions to offer experiential learning opportunities for future health care providers. This interprofessional education simulation experience focusing on transgender patients calls attention to the negative impact of stigma while also promoting competency in interprofessional practice.
Project description:BACKGROUND: The patient-centered medical home (PCMH) model aims to provide patient-centered care, lower costs, and improve health outcomes. Medical students have not been meaningfully integrated in this model. AIM: To test the feasibility of a longitudinal clerkship based on PCMH principles and anchored by PCMH educational objectives. SETTING: Two community-based family medicine clinics, one academic internal medicine clinic, and one pediatric clinic affiliated with an urban medical school. PARTICIPANTS: 56 medical student volunteers. PROGRAM DESCRIPTION: We embedded student teams in existing faculty practices and recruited a high-risk patient panel for each team. Clinical education occurred through a traditional clinic preceptor model and was augmented by 3rd and 4th year students directly observing 1st and 2nd year students. Didactic content included monthly Grand Rounds conferences. PROGRAM EVALUATION: Students attended 699 clinics, recruited 273 continuity patients, and participated in 9 Grand Rounds conferences. Student confidence with PCMH principles increased and attitudes regarding continuity were highly positive. "Continuity," "early clinical exposure," and "peer teaching" were the most powerful themes expressed by students. Faculty response to the pilot was highly positive. DISCUSSION: An Education-Centered Medical Home (ECMH) is feasible and is highly rated by students and faculty. Expansion of this model is underway.
Project description:Introduction:Faculty development is important to developing skilled faculty members who are able to effectively design and deliver educational content. There has been an increase in courses designed to help faculty better teach at the bedside, but fewer options for those interested in developing their skills as simulation-based educators. Our goal was to create a workshop to train prospective simulation educators on the skills and knowledge necessary to design a clinical scenario. Methods:Learners participate in a 90-minute workshop utilizing short, didactic teaching and practical hands-on practice. Faculty guide learners through the process of developing targeted goals and learning outcomes, setting the scene for a clinical scenario, and storyboarding the main action. Learners work individually, but engage in peer-to-peer feedback, as well as instructor feedback, throughout the session. Results:We have run four iterations of this workshop at our institution in the past year, and developed a modified version for an international meeting. A total of 51 learners from our hospital have completed the workshop. Overall, learners agree that the workshop is informative and increases their knowledge. For each educational objective, more than 70% of participants indicated the workshop increased their competence in the area either "extremely" or "quite a bit." Discussion:This workshop provides learners hand-on practice in developing a scenario for simulation-based education. Learners leave with the tools and knowledge necessary to take the work developed in the session and create a complete scenario that can be used at our simulation center or at another facility.
Project description:<h4>Introduction</h4>Improved team communication is essential in preventing errors in patient care. Based on TeamSTEPPS concepts, we developed this simulation case scenario to engage learners from various health care professions in interprofessional teamwork. The case was developed for graduating medical, physician assistant, and nursing students with clinical experience, as well as pharmacy students just beginning clinical rotations.<h4>Methods</h4>Learners are evenly distributed into groups based on their professional training to provide an opportunity to function as a team. Faculty receive case materials prior to the day they will be volunteering and receive just-in-time training to refresh medical management knowledge and to prepare them for interprofessional facilitation, debriefing, and team skills. Faculty start by introducing interprofessional teamwork skills based on TeamSTEPPS concepts and providing an activity in which teams compete to create the longest paper chain. Next, faculty run a scenario featuring a standardized patient or high-fidelity manikin developing dyspnea in a simulated hospital setting. Learners can use skills from their profession-specific education as well as theoretical knowledge while demonstrating interprofessional communication skills during the simulation.<h4>Results</h4>Overall, 1,475 students have been trained with this resource over the last 5 years. Evaluations completed by learners postsimulation have rated this resource favorably. This resource has equivalent outcomes to two other scenarios also in the workshop series, indicating that using this resource alone will meet the workshop objectives.<h4>Discussion</h4>This simulation experience advances the work of interprofessional education in developing increased self-efficacy in learners to be able to implement team skills and work in an interprofessional team.
Project description:<h4>Introduction</h4>Shame is a powerful emotion that can cause emotional distress, impaired empathy, social isolation, and unprofessional behavior in medical learners. However, interventions to help learners constructively engage with shame are rare. This module educated medical students about shame, guided them through an exploration of their shame experiences, and facilitated development of shame resilience.<h4>Methods</h4>In this 2-hour workshop, clinical-year medical students were guided through the psychology of shame through didactic slides. Next, a small panel of volunteer students, recruited and coached prior to the workshop, shared reflections on the content, including their shame experiences during medical school. This was followed by didactic slides outlining strategies to promote shame resilience. Participants then broke into faculty-led small groups to discuss session content. The module included a small-group facilitator guide for leading discussions on shame, didactic slides, discussion prompts, an evaluation tool, and a film entitled <i>The Shame Conversation</i> that was created after the initial workshop.<h4>Results</h4>A retrospective pre/postsurvey revealed statistically significant increases in: (1) importance ascribed to identifying shame in one's self or colleagues, (2) confidence in one's ability to recover from a shame reaction, and (3) comfort in reaching out to others when shame occurs. Analysis of open-ended questions showed that students felt the seminar would enhance future resilience by helping them identify and normalize shame, distinguish shame from guilt, and reach out to others for help.<h4>Discussion</h4>This workshop appears to prepare students to more constructively engage with shame when it occurs in medical training.
Project description:Introduction:Burnout is prevalent among medical trainees and faculty. Resilience, the ability to cope well with stress and thrive during challenges, has been a focus of initiatives to combat burnout. However, curricula teaching resilience skills are needed. Since residents experience challenging and stressful clinical events often, and would like to discuss these events with their teams, resilience skills may help trainees cope after such events. Additionally, resilience skills may help trainees address other challenges they face as team leaders. Leadership training is an important component of physician professional development. Methods:This advanced resilience training curriculum consists of two interactive workshops that include didactics, skills practice, and reflection. The first workshop focuses on applying resilience skills to team leadership, while the second focuses on structured team debriefing after difficult clinical events. This curriculum is intended for learners who are health care team leaders, such as senior residents, fellows, or faculty. It may be used with learners who have completed introductory resilience training or with those without prior training. Results:The curriculum was rated highly by senior residents, who reported feeling more comfortable leading their teams after difficult clinical events and talking about these events following this curriculum. The majority of residents thought the workshops should be continued. Discussion:This novel curriculum teaches learners to apply resilience skills during team leadership and difficult clinical scenarios. It was well received by senior residents and may be used with a variety of learners across health professions and training levels.
Project description:Introduction:Few interprofessional (IP) learning opportunities are designed specifically for advanced health learners who are early in their training yet have already had some clinical experience. This group of learners requires activities that are didactic based but extend beyond the introductory IP curricula typically geared towards prelicensure students. This highly interactive curriculum aims to fill that gap in the literature. Methods:An interprofessional case-writing team created two unfolding video cases-a mother-infant dyad seeking care and an elderly non-English-speaking man experiencing disjointed care-for a large IP event with doctors of nursing practice (DNPs), pharmacy practice, and dental science, masters in social work, and physician assistant (PA) trainees, individualized to learner interest. The team also developed a highly detailed faculty guide, including specific talking points, to assist IP teams of faculty facilitators. Learners were evaluated using a Likert-scale postsession survey and open-ended questions. Qualitative data were analyzed for themes related to the objectives. Results:Survey results indicated that learning objectives were met and students were highly satisfied with the overall curriculum. Mean scores for organization, utility, and facilitation effectiveness were all above 4.6 (range: 1-5), with the DNP, pharmacy, and PA students indicating higher levels of satisfaction compared to the other professions. Faculty feedback was very positive, particularly with respect to the faculty guide. Discussion:Challenges were concentrated around implementation of the curriculum rather than the curriculum itself. This curriculum can be used with a variety of learners with minimal adaptation of discussion questions.
Project description:<h4>Background</h4>Patient-centered medical home (PCMH) models of primary care have the potential to expand access, improve population health, and lower costs. Federally qualified health centers (FQHCs) were early adopters of PCMH models.<h4>Objective</h4>We measured PCMH capabilities in a diverse nationwide sample of FQHCs and assessed the relationship between PCMH capabilities and Medicare beneficiary outcomes.<h4>Design</h4>Cross-sectional, propensity score-weighted, multivariable regression analysis.<h4>Participants</h4>A convenience sample of 804 FQHC sites that applied to a nationwide FQHC PCMH initiative and 231,163 Medicare fee-for-service beneficiaries who received a plurality of their primary care services from these sites.<h4>Main measures</h4>PCMH capabilities were self-reported using the National Committee for Quality Assurance's (NCQA's) 2011 application for PCMH recognition. Measures of utilization, continuity of care, quality, and Medicare expenditures were derived from Medicare claims covering a 1-year period ending October 2011.<h4>Key results</h4>Nearly 88% of sites were classified as having PCMH capabilities equivalent to NCQA Level 1, 2, or 3 PCMH recognition. These more advanced sites were associated with 228 additional FQHC visits per 1000 Medicare beneficiaries (95% CI: 176, 278), compared with less advanced sites; 0.02 points higher practice-level continuity of care (95% CI: 0.01, 0.03); and a greater likelihood of administering two of four recommended diabetes tests. However, more advanced sites were also associated with 181 additional visits to specialists per 1000 beneficiaries (95% CI: 124, 232) and 64 additional visits to emergency departments (95% CI: 35, 89)-but with no differences in inpatient utilization. More advanced sites had higher Part B expenditures ($111 per beneficiary [95% CI: $61, $158]) and total Medicare expenditures of $353 [95% CI: $65, $614]).<h4>Conclusions</h4>Implementation of PCMH models in FQHCs may be associated with improved primary care for Medicare beneficiaries. Expanded access to care, in combination with slower development of key PCMH capabilities, may explain higher Medicare expenditures and other types of utilization.
Project description:<h4>Introduction</h4>Because many older adults lack dental insurance and have limited or no access to dental care, it is essential to train future physicians to conduct brief oral health assessments on them. Likewise, interprofessional educational experiences are crucial in teaching medical students the skills necessary to provide comprehensive, team-based care to complex and vulnerable populations. Thus, this workshop was designed to increase fourth-year medical students' knowledge and confidence in performing oral health examinations on older adult patients using an interprofessional and hands-on approach.<h4>Methods</h4>The curriculum includes an online presession self-study module followed by a 75-minute workshop. The workshop is comprised of a brief introduction (5 minutes), a lecture about the impact of oral health on older adults (30 minutes), a hands-on skill session practicing a focused oral exam led by dental students (30 minutes), and a large-group debrief and wrap-up (10 minutes).<h4>Results</h4>A pre-/postsurvey assessed learners' knowledge, attitudes, and confidence in oral health skills. The results were compared to a lecture-only format that was in place prior to the implementation of the workshop. In comparison to medical students who received the lecture-only format, those who participated in the workshop showed a greater increase in confidence and skills over time. The medical students also expressed interest in more frequent opportunities for collaborative learning experiences with dental students.<h4>Discussion</h4>This workshop was successful in introducing an interprofessional experience to medical students in order to ensure more comprehensive and coordinated care for older adult patients in the future.