Public Schools as Teachers of Residents: Successfully Meeting ACGME Competencies Steve North, MD Director of School Based Programs, Dept. of Family Medicine Fellow, Division of Adolescent Medicine, Dept. of Pediatrics University of Rochester Steve North, MD Director of School Based Programs, Dept. of Family Medicine Fellow, Division of Adolescent Medicine, Dept. of Pediatrics University of Rochester

Why Rotations in Schools?  Kids spend ~30% of waking hours in school  Clear links between health and academics  Depression, ADHD, nutrition, chronic illnesses  Kids spend ~30% of waking hours in school  Clear links between health and academics  Depression, ADHD, nutrition, chronic illnesses

Why Rotations in Schools?  4-12% of 6-12 year olds have ADHD  Must work with teachers and schools to provide comprehensive care  Need to understand the assessment process to support families  Family issues impact school performance (Crosnore, 2004)  4-12% of 6-12 year olds have ADHD  Must work with teachers and schools to provide comprehensive care  Need to understand the assessment process to support families  Family issues impact school performance (Crosnore, 2004)

Pediatricians in Schools Nader, et al 2003  Two surveys: 1991 & 2001  10% of AAP general membership  45-48% response rate (n= 971 & 1120)  Odds Ratios of School Involvement  Rural Practice 3.6  Residency Training 2.9  Years since residency0.7  Two surveys: 1991 & 2001  10% of AAP general membership  45-48% response rate (n= 971 & 1120)  Odds Ratios of School Involvement  Rural Practice 3.6  Residency Training 2.9  Years since residency0.7

Roles of Pediatricians in Schools Nader, et al 2003  Sports Physicals  On the sidelines  Taught Health Class  Patient Care in SBHC  Faculty Inservice  Policy/Advocacy  Sports Physicals  On the sidelines  Taught Health Class  Patient Care in SBHC  Faculty Inservice  Policy/Advocacy  Consulting:  Physical Education  Health Classes  Exceptional Ed  Employee Health  Health Promotion  Consulting:  Physical Education  Health Classes  Exceptional Ed  Employee Health  Health Promotion

ACGME Requirements (2001) 7. Care of Neonates, Infants, Children, and Adolescents “In addition, the resident should be taught to recognize and manage behavioral, medical, and surgical problems of children and adolescents in home, school, ambulatory, and hospital settings.” 8. Community Medicine. “Community health resources that may be utilized in the care of patients and their families, including school health services and public health (including environmental health) services” 7. Care of Neonates, Infants, Children, and Adolescents “In addition, the resident should be taught to recognize and manage behavioral, medical, and surgical problems of children and adolescents in home, school, ambulatory, and hospital settings.” 8. Community Medicine. “Community health resources that may be utilized in the care of patients and their families, including school health services and public health (including environmental health) services”

U of R FM Experience  4 years at School 12, neighborhood elementary school  Ended due to high level of turnover, communication problems  First year at Urban Choice Charter School  Emphasis on community involvement, board members  Third year at Wilson Science and Technology High School  Complementing science curriculums, Health Careers Interest Group  4 years at School 12, neighborhood elementary school  Ended due to high level of turnover, communication problems  First year at Urban Choice Charter School  Emphasis on community involvement, board members  Third year at Wilson Science and Technology High School  Complementing science curriculums, Health Careers Interest Group

Working with Urban Schools Curriculum  Collaboration between Family Medicine, Pediatrics, and Medical School  Common goals and objectives  Shared resources/ practice sites  Online format - Blackboard  Ability for residents to select based on their interests  Collaboration between Family Medicine, Pediatrics, and Medical School  Common goals and objectives  Shared resources/ practice sites  Online format - Blackboard  Ability for residents to select based on their interests

Ambulatory Peds Schedule MONTUEWEDTHURFRI AM Office Develop Clinic Office Urban Choice Peds GI PM Peds Cards Urban Choice Threshold Teaching/ Urban Choice Option Office

ACGME Competencies  Patient care  Medical Knowledge  Practice based learning and improvement  Patient care  Medical Knowledge  Practice based learning and improvement  Interpersonal and communication skills  Professionalism  System based practice  Interpersonal and communication skills  Professionalism  System based practice

Patient Care  Learning ADHD assessment methods employed by schools  School Based Health Centers  Asthma treatment and maintenance programs  Learning ADHD assessment methods employed by schools  School Based Health Centers  Asthma treatment and maintenance programs

Medical Knowledge  Analytical skills developed and expanded to recognize the impact of school  Increase exposure to adolescent and pediatric health issues  Analytical skills developed and expanded to recognize the impact of school  Increase exposure to adolescent and pediatric health issues

Practice Based Learning and Improvement  Witness students in their “natural environment”  Serve as a health resource for the school  Recognize the advantages of School Based Health Center’s  Witness students in their “natural environment”  Serve as a health resource for the school  Recognize the advantages of School Based Health Center’s

Interpersonal and Communication Skills  Learning the language of schools  IEP, OHI, Section 540  Develop relationship with other influential individuals in a child’s development  Teaching skills for students and adults  Learning the language of schools  IEP, OHI, Section 540  Develop relationship with other influential individuals in a child’s development  Teaching skills for students and adults

Professionalism  Develop a greater understanding of the culture of kids and schools.  Provide role model and mentoring  Understanding privacy and protected communication  FERPA, HIPPA, Screening  Develop a greater understanding of the culture of kids and schools.  Provide role model and mentoring  Understanding privacy and protected communication  FERPA, HIPPA, Screening

Systems Based Practice  Provide understanding of complex school health system  Develop familiarity with CDC’s Coordinated School Health Model  Develop skills to interact with schools in “real world” setting  Provide understanding of complex school health system  Develop familiarity with CDC’s Coordinated School Health Model  Develop skills to interact with schools in “real world” setting

CDC’s Coordinated School Health Model

 A “Biopsychosocial” approach to school health  Provides framework for developing relationships and programs with schools  A “Biopsychosocial” approach to school health  Provides framework for developing relationships and programs with schools

Necessary tools  Champion within the department  Collaborating school  Centralized communication and plans  Reliable schedule  Champion within the department  Collaborating school  Centralized communication and plans  Reliable schedule

Translation to patient care  School performance screening questions  Responsible dosing  Asthma meds  Long acting ADHD meds  Increased resident comfort in calling schools  Families realize willingness to collaborate  School performance screening questions  Responsible dosing  Asthma meds  Long acting ADHD meds  Increased resident comfort in calling schools  Families realize willingness to collaborate

Measurement  Teacher surveys using myevaluations.com  Poor follow through  Qualitative responses from students - cards, overheard comments  Resident responses  Teacher surveys using myevaluations.com  Poor follow through  Qualitative responses from students - cards, overheard comments  Resident responses

Resident Responses  “I haven’t been in a grade school since I was in grade school.”  Strong desire to stay involved with students after rotations  Better understanding of schools and ways to help patients  “I haven’t been in a grade school since I was in grade school.”  Strong desire to stay involved with students after rotations  Better understanding of schools and ways to help patients

Challenges  Transition in school leadership  Resident lack of commitment  Scheduling  Transition in school leadership  Resident lack of commitment  Scheduling

Funding Challenges  Funding streams eliminated  Title VII, Pathways to Health Professions program  Not a revenue generating program  16% generated funds in Bradford article  Need for close management  Funding streams eliminated  Title VII, Pathways to Health Professions program  Not a revenue generating program  16% generated funds in Bradford article  Need for close management

Connection to FOFM Core Attributes Continuity of Care  Emphasizing commitment to the relationship First Contact  Advocate for the patient in educational setting Community  Increase visibility of specialty Continuity of Care  Emphasizing commitment to the relationship First Contact  Advocate for the patient in educational setting Community  Increase visibility of specialty

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