Family Conferences: Teaching Residents Through a Competency Based Module Amy Odom DO Amy Romain LMSW, ACSW Sparrow/MSU FMRP

Objectives At the end of the session you will be able to: replicate and adapt an interactive didactic and supervised experiential model for teaching family conferences. use two tools, a pre-conference planning worksheet and a family meeting progress note to assist you in teaching family conferences at your institution. use and adapt an evaluation tool that documents resident competency in independently running a family conference.

Today’s Agenda Pre-conference Planning Facilitating a Family Conference Evaluation Expectations Discussion

Our Context: Amy Odom OU-COM ’02 Sparrow/MSU FMRP ’05 Primary Care Faculty Development Fellowship MSU ’07 Emphasis on curriculm development in family oriented care Faculty Sparrow/MSU FMRP Interests in Behavioral Medicine, Family Oriented Care and Chronic Disease Management

Our Context: Amy Romain Teaching Behavioral Science at Sparrow /MSU FMRP since 2002 Medical/clinical social work for 18 yrs. Special interests: behavioral science, family-oriented care, systems-based practice, ecomapping, collaborative teaching

Our Teaching Environment: Sparrow/MSU FMRP program Community hospital setting University Affiliated Use New Innovations to evaluate and track residents

Our Behavioral Science Curriculum Communications Psychiatric Diagnosis and Treatment Patients in Context

Instruction in psychosocial assessment and intervention Instruction in family-oriented skills Family-oriented interviewing Anticipatory guidance using the family-life cycle Caregiver care Family conferences

Approach to Teaching Family Conferences 2 part case-based didactic series Pre-conference Conference Supervised experience Evaluation

Resources for Family Conferences Family-Oriented Primary Care. Susan McDaniel et al. New York: Springer, Working with Families: Case-based Modules on Common Problems in Family Medicine. Toronto: The Working with Families Institute (2003).

Needs Assessment of Residents 100% of residents reported attending <5 FCs during their training 93% never in an out-pt setting Residents lacked confidence in Knowing when to hold a FC 60% Knowing how to plan for a FC 67% Leading a family conference 80% 40% of residents felt like they needed to observe more FC before leading one

Didactic Session #1 Pre-conference Planning Setting: didactic large group, with all levels of learners Time: 1 hour Resources: Pre-conference Worksheet and case presentation Prerequisites: Ecomaps/Genograms and Family Life Cycle Stages

Case: Emma Goodman 80 yo female with dx metastatic lung CA x 7 months Acute office visit for intractable back pain Admitted with concern for boney metastatic disease 1 week prior oncologist told family she was in remission and scheduled her for prophylactic intracranial radiation

Didactic Session # 2 How to Facilitate a Family Conference Setting: didactic large group, with all levels of learners Time: 1 hour Resources: pre-conference worksheet, family conference outline, family conference progress note, & case presentation (longitudinal) Prerequisites: pre-conference planning session

Family Conference Outline Five Phases of a Family Conference* Greeting Establish Mutual Goals Facilitate Discussion Identify Strengths, Resources, Supports Establish Plan *Adapted from McDaniel, SH; Campbell, TL; Hepworth, J; Lorenz, A (2005). Family Oriented Primary Care, 2nd edition. New York: Springer

Longitudinal Case Presentation Video Presentation of clips from Emma Goodman’s Family Conference representing each phase of the family conference

Supervised Experience Select an appropriate patient in one of three settings and an appropriate faculty to participate with you · Hospital (inpatient rounding faculty or Amy Romain) · Office (Amy Romain) · Pt Home (Any Faculty ) Fill out the Pre-Conference Worksheet and have it reviewed by one of the above faculty Pre-Conference Worksheet Facilitate a meeting with at least one family member and appropriate faculty present. Use Family Conference Outline.doc as guide for facilitating the meeting.Family Conference Outline.doc Fill out theFamily Conference Progress Note and put it with the medical recordFamily Conference Progress Note Alert Marcie to send evaluation form to faculty through New Innovations and to send you an evaluation of the experience form through New

Resident Feedback Increased confidence in When to have a conference Who to include Pre-planning process Ability to manage emotion expressed by participants Documentation

Resident Comments “This was a great experience as I got to see my patient in a completely different environment and got the opportunity to meet some of her family. It helped cement the bond that we had started forming in the office. She continues to tell me what a nice experience it was for her too” – 3 rd yr resident doing a FC in a home setting “ Overall it helped us understand the patient better, not only from our stand point of view, but also from the side of the family members… very rewarding” - 2 nd yr resident doing a FC in the hospital

Faculty Experience “Resident did a nice job of supporting both the patient and family concerns and continues to work with the patient regarding these issues” “I expected to be more involved, but was not needed, (he) was clearly the one running the conference”

Summary Intentional teaching and modeling of complex processes like Family Conferences through a structured evaluated experience Involvement of all faculty

Discussion How do you teach family conferences?