How to transform a traditional lecture based family medicine curriculum to a Patient Centered Medical Home focused, interactive, skills based clerkship experience. Edwin W. Dennard, MD Kiernan A. Smith, MD Tulane University School of Medicine New Orleans, Louisiana

Disclosures “This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under Grant Number: D56HP20685; Grant Title: Tulane Medical Home Curriculum Project; Total Award Amount: $1,072,898. This information or content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.”

Goal and Objectives 1. Link PCMH model to transformation of FM to meet US healthcare goals for public health in the 21 st century. 2. Identify potential barriers and solutions to implementation of an interactive skills-based curriculum. 3. Share best practices and develop new ideas for teaching and evaluating a skills- based curriculum.

PCMH as Vehicle for Public Health Goals Public health goals require population and outcomes-based primary care. PCMH provides a model of care to achieve public health goals. Specific new skill sets required in addition to traditional curriculum.

Transition to Skills-based Curriculum One goal of our grant was to introduce skill sets helpful to students learning primary care and essential to master to participate in a fully-functioning PCMH We chose patient-centered communications and the chronic disease management and quality improvement models

Obstacles/Solutions for the Communications Seminar Finding 2 hours time Choosing a didactic model Avoiding redundancy Obtaining student buy-in Faculty Development

Obstacles/Solutions for the Communications Seminar Made lecture material an online resource Adopted the 5 Step Methodology Required pre-session reading and video Group session to cover 5 steps in detail JTL to confirm grasp of essential points Role playing with students in dual roles Faculty involvement in construction and dress rehearsal

Results: Communications Seminar Design Session Preparation and testing on-line for live-session JTL Live Session: Brief 20 minute Group Overview with JTL Break-out into groups of 6 – 8 students with one faculty moderator for role-playing – 1.5 hours

CDM and CQI – goals of the sessions and techniques Goals: enhanced skill set for delivering care to populations with chronic illnesses Teaching CQI enables delivery of CDM –Characteristics: Proactive Guidelines based Population based Comprehensive Accountable Goal: shift framework from reactive individual based care to proactive population based care

CDM and CQI – obstacles and solutions in developing the seminar. Obstacles –Choosing a teaching model –Faculty Development –Limited classroom time to teach both topics –Some students felt classroom based activity not enough

CDM and CQI – obstacles and solutions in developing the seminar. Solutions –Team Based Learning chosen –Sourced most studied effective models of CDM –Curriculum writing workshops –Combined two topics into 1 seminar –Pre seminar prep –Continuous revising of TBL based on feedback –Created additional student project

Results: CDM/CQI Seminar Design CCM article/IHI CQI module pre seminar preparation Seminar: TBL: individual test, group test, group application exercise Clerkship Project option: patient registry/mini CQI proposal

Assessments PCMH pre and post-clerkship testing Session evaluations by the Department Clerkship evaluations by the SOM

PCMH pre and post-clerkship testing

Strength – tests acquisition of knowledge Weaknesses: 1.No discrimination among sessions 2.Unreliable on the issue of knowledge acquisition Conclusion – better design could improve both reliability and discrimination

PCMH pre and post-clerkship testing Suggestions for Improvement of Pre/Post Test: Align content of pre/post questions with clerkship objectives regarding PCMH Create enough questions to ensure that results are reliable Use well-structured multiple-choice questions Avoid factoid recall type questions Use questions that require knowledge application/ integration/synthesis.

Departmental Session Evaluation Strength: student perspective on value and perfectly discriminating among sessions Weaknesses: no assessment of knowledge or skill acquisition Conclusion: knowledge acquisition assessment would require adding to our clerkship testing

SOM Clerkship Evaluation Strength: student perspective on entire clerkship experience Weakness: doesn’t address PCMH or discriminate among PMCH pieces Conclusions: the school’s standard evaluation would need modification to better understand the contribution of PCMH teaching to professional development

Discussion Questions How would you assess skill-based sessions? What student perceptual issues would be important to assess? Is student buy-in important?

Please evaluate this session at: stfm.org/sessionevaluation