Drew Keister, MD Kira Zwygart, MD

 Define the audience  The USF primary care clerkship background & structure  The USF-LVH partnership  Addition of PCMH principles to the clerkship  Group work  Personal reflection  Discussion and closing

Defining the audience

1. Clerkship director 2. Medical school faculty member 3. Residency faculty member 4. Coordinator/staff 5. Other

1. Interdisciplinary primary care clerkship 2. Traditional family medicine clerkship 3. Other 4. Don’t work with clerkship students

1. Yes 2. No

 12 week course  Longitudinal experiences in pediatrics, family medicine, and internal medicine  Two 6-week blocks focusing on special populations ◦ Women and adolescents ◦ Geriatrics and patients with disabilities

 Didactics focusing on primary care topics as well as special populations  Interactive OSCE sessions to teach and assess: ◦ breast and gynecological examination skills ◦ examination/counseling of patients with disabilities and geriatric patients ◦ motivational interviewing

 Assessment ◦ Weekly quizzes ◦ NBME ambulatory exam ◦ In-house exam focusing on special populations ◦ Mini-CPX ◦ Clinical evaluations

 Integrated primary care clerkship in place for 5 years in this format  And then… Enter LVH

1100 miles Tampa, FL Allentown, PA

 Benefits ◦ Collaboration  Curriculum  Different perspectives  Educational expertise ◦ University umbrella  Ownership  Faculty appointments ◦ Financial

 Entering freshmen for this program start  Transition to 3 rd year at LVHN  Next steps……

 Challenge #1: ◦ Obtain buy-in from all disciplines ◦ Address the “why” ◦ Identify stakeholders ◦ Listen ◦ Don’t commit

 Challenge #2: ◦ Forming a team with unified goal ◦ Arrange a series of meetings with key reps ◦ Discuss the “why” ◦ Acknowledge difference ◦ Identify common ground

 Challenge #3: ◦ Look for advantages in the integration ◦ SCOT analysis

1. Yes 2. No

Strengths Strengths of our present situation Challenges Challenges in our present situation Opportunities Opportunities that this clerkship allows us to pursue in the future Threats Threats that could arise in the future to interfere with our ability to reach our desired goal

 Challenge #3: ◦ Look for advantages in the integration ◦ SCOT analysis ◦ Develop a united vision ◦ Find the silver lining ◦ Share the gold Creating an interdisciplinary clerkship

 Interdisciplinary team  Fewer silos  Shared goals and vision  Everyone is better as a result

 LVHN students will receive specific training in leadership principles  Developmentally appropriate education throughout the 4-year curriculum

 The idea of a leadership track led us to ask: What would we want to teach our primary care students about being a health care leader in primary care?  Adding PCMH principles to the clerkship

 The skills necessary for primary care leadership But what is it?

 Personal physician**  Physician directed medical practice**  Whole person orientation**  Care is coordinated and/or integrated**  Quality and safety**  Enhanced access to care  Payment recognizes value of primary care Primary Care Collaborative:

 First step is to create PCMH’s  Day- to-day observation

 Personal physician**  Physician directed medical practice**  Whole person orientation**  Care is coordinated and/or integrated**  Quality and safety**  Enhanced access to care  Payment recognizes value of primary care Primary Care Collaborative:

 First step is to create PCMH’s  Day- to-day observation  Specific experiences But how do you teach it?

 Primary Care Collaborative Rounds ◦ Monthly meetings of interdisciplinary faculty ◦ Team of students participate in the rounds ◦ Interdisciplinary provider-led discussion ◦ Faculty development

 Clinical Care Teams ◦ Teams of residents/faculty/nursing/NP’s ◦ All patients have personal physician ◦ QI projects for their patients ◦ Students assigned to a team for entire clerkship

 After participation in either activity  Reflection form  Reflections reviewed by faculty mentor

 USF to use our innovations as pilot

1. Interdisciplinary clerkships- ◦ Why should we consider interdisciplinary primary care clerkships? What’s the “gold” that could come from it? 2. Teaching PCMH principles- ◦ What activities should primary care clerkships offer students to allow them to observe and reflect on PCMH principles? 3. Creating student-friendly PCMH’s- ◦ How can students participate in a functional PCMH when they rotate through for 4-12 week clerkships?

◦ Individual think/write (5 min) ◦ Small group discussion (15 min) ◦ Report out (5 min per group)

Interdisciplinary clerkships- ◦ Why should we consider interdisciplinary primary care clerkships? What’s the “gold” that could come from it? Report out:  Three most agreed-upon pieces of "gold"  How will you change your clerkships to mine the gold?

Teaching PCMH principles- ◦ What activities should primary care clerkships offer students to allow them to observe and reflect on PCMH principles? Report Out:  In addition to the ideas presented, what other activities would allow students to observe and reflect on PCMH principles?  What change will you make to your clerkship to help students learn PCMH principles?

Creating student-friendly PCMH’s- ◦ How can students participate in a functional PCMH when they rotate through for 4-12 week clerkships? Report Out:  In what ways could we incorporate students into the PCMH?  How much time should be allotted for PCMH activities for students?

 What are you going to take from this to improve teaching at your site?  Write for 3 minutes

 What surprised you?  What inspired you?  What turned you off?

Drew Keister, MD, FAAFP Kira Zwygart, MD, FAAFP