Applying the National Family Medicine Curriculum for Clerkship Evaluation and Development Maureen Gecht-Silver, MPH Richard Stringham, M.D. Sagina Hanjrah, M.D. Department of Family Medicine University of Illinois at Chicago, College of Medicine

Goals To describe a process to assess coverage of the National FM Curriculum in the UIC family medicine clerkship To stimulate participants to review their own family medicine clerkship activities

The National Family Medicine Curriculum Structure Five Principles The Biopsychosocial Model Comprehensive Care Contextual Care Continuity of Care Coordination/Complexity of Care Core Presentations for Acute Care Chronic Diseases Health Promotion and Disease Prevention

Didactic Structure of the UIC FM Clerkship Required Activities Orientation Dermatology Solving Common Problems FM Cases Selectives (5-6) Selectives   Small group, interactive seminars, multi-disciplinary faculty Students “select” sessions that match their personal interests

Selectives Acupuncture Communication with Adolescents Complimentary and Alternative Medicine Counseling and Managing Adults with HIV Diabetes Management Engage People with Intellectual/Developmental Disability (IDD) thru Education GI: Top to Bottom Immunizations Low Back Pain Narrative Medicine: Why Doctors Should Read Fiction Occupational and Environmental Medicine Orthopedics Self-Management Support: Encouraging Pts to Manage Their Health Over-the-Counter Medications Trauma Survivors 

Question that Led to This Project To what extent do our selectives address the scope of the National Family Medicine Clerkship Curriculum? We are teaching a number of selectives and the question that led to this project is: To what extent do our selectives address the scope of the National FM clerkship curriculum

Data Collection This is the chart we used to collect data from our review. Along the top is the list of current selective offerings. Along the left side is the 5 principles and the three core presentation as outlined in the curriculum. Let me review the steps of the process we went through Divided list of current selectives between three reviewers Each reviewer indep Read selective write up and objectives Discussed objectives listed under principles and core presentations with selective instructor to determine areas instructor addresses In some cases observed selective Reviewer tentatively rated 5 principles and core presentations acute, chronic, and preventive Three reviewers met to review preliminary ratings and identify challenges

Challenges To ensure inter-rater reliability To differentiate the terms “describe” and “demonstrate” used in the curriculum To accurately measure the National FM Curriculum components addressed in each selective Each principle had a different number of supporting objectives and each reviewer rated differently. We discussed several options (Initially +/- rating, didn’t work, tried # of objectives, impossible to compare) by group consensus decided that a 0-2 rating scale would allow better inter rater reliability. Defined as follows 0=not covered 1=covered less than half of objectives under related to principle 2=half or more points covered. Some objectives stated describe while others demonstrate. When objective stated demonstrate, even if all objectives under the principle were addressed, selective could not be rated higher than 1 To accurately measure components addressed we: Talked with instructor Rated individually Reviewed one another’s ratings esp when score seemed too high or low

Data Collection Again this is the chart we used to collect data for our review. Along the top is the list of current selective offerings. Along the left side is the 5 principles and the three core presentation as outline in the curriculum.

Analysis of Biopsychosocial Model Component Here is an analysis of the Biopsychosocial Model component as an example of what we reviewed. Notice there were three subcategories each with objectives under the BPS principle. The total score is the sum of subcomponents Gives you an example of the scoring challenges, e.g. PCCS has 10 items, PA has 2 items, Pt Ed has 6 items

Scope of National Curriculum Covered This slide includes the scores from all of the subcomponents of each principle. Note that QI under coordination was not addressed in any of the selectives The totals illustrate that some principles have more subcategories than others. This makes it difficult to compare scores. What we learned is that: The principles and core presentations are covered to varying degrees in our group of selectives The results offer opportunities for future selective development

Implications Help faculty maximize their selective(s) to better cover the National FM curriculum principles and core presentations Reorganize the process of assigning students to selectives Review our coverage of the National FM curriculum content throughout the Family Medicine Clerkship

Questions?

Contact Information Maureen Gecht-Silver, MPH, OTR/L mgecht@uic.edu Rik Stringham, M.D. rstring@uic.edu Sagina Hanjrah, M.D. hanjrah@uic.edu