Joe Schwenkler, MD Medical Director UMDNJ PA Program Educating FPs and PAs for Shared Medical Decision Making: Promoting the “team” in the PCMH Joe Schwenkler, MD Medical Director UMDNJ PA Program Dave Keahey, PA-C, MSPH Associate Dir. of Graduate Studies University of Utah Dept. of Family and Preventive Medicine

Our Goals Explore the role of the “team” in the Patient Centered Medical Home Discuss how the Physician Assistant profession can help alleviate the primary care shortage Understand the significance of Shared Medical Decision Making Share ideas on how to teach the team approach to Shared Medical Decision Making

“Shortage of Doctors an Obstacle to Obama Goals”

The Problem Health Care Reform depends on access to primary care Primary Care Physicians are in short supply Medical school graduates are following the $$$ Family Physicians are forced to see more patients Lack of time to do the job correctly Increased “job” stress Decreased “job” satisfaction

One Possible Solution Promoting the “team” in the PCMH “Patient care in the New Model will be provided through a multidisciplinary team approach and will be dependent on a deep understanding of the population served by the practice.” The Future of Family Medicine: A Collaborative Project of the Family Medicine Community. Annals of Family Medicine 2:S3-S32 (2004).

American Academy of PAs Policy on Team Practice November, 2008 “The Physician-PA team relationship is fundamental to the PA profession and enhances the delivery of high quality health care.” “As the structure of the health care system changes, it is critical that this essential relationship be preserved and strengthened.”

Why Partner with Physician Assistants? Shared interests from their origin forty years ago PAs see themselves as partnering with Family Doctors to occupy the PCMH model together No Family Doctor, No Physician Assistant This team shares medical decision making with their patients

How do you teach Shared Medical Decision Making? Train FP Residents and PAs Together

Training Physician Assistants in Family Medicine Residencies: Results of a Residency Director Survey Eighty-seven (19%) program directors responded. In this sample, 20 (23%) train residents in settings that include PA students. Respondents who train PA students described the experience as “somewhat valuable” (40%), “valuable” (20%), or “very valuable” (10%). One third plan curriculum with PA programs.

Representative Comments From Residency Directors About Training PA Students Team based care...the future. Also, we need help in primary care, there are not enough of us physicians. Team care provided at the site. We are a true medical home for our patients and team care is paramount to this. Residents can see skill set of PA students and opportunities for future collaboration.

Conclusions The Patient Centered Medical Home requires a team approach with family physicians as leader of the interprofessional team. The majority of respondents felt that when residents and PA students train together they gain valuable experience. An increase in paired training experiences may better prepare Family Medicine residents to lead the PCMH team that includes physician assistants.

Future Directions Develop a competency-based framework for teaching SMDM Further research Increase grant support

Creating a culture for SMDM Role clarification Role valuing Teamwork Attitude & Skills Partnership Developed by Anita Glicken, MSW Program Director University of Colorado at Denver Child Health Associate Physician Assistant Program

Teamwork Attitude & Skills Role Clarification Understands... Knowledge Constraints Responsibilities Roles Role Valuing Developing Trusting Relationships Teamwork Attitude & Skills Communication Partnership Interdependency Empowerment Importance of the output as a whole

Building Collaborative Competencies Describe roles, responsibilities, skills clearly to others Recognize and observe constraint’s of one’s role, responsibilities and competence –contextualize patient needs in a wider context Recognize and respect roles, responsibilities and competence of other profession in relationship to own. Understand how other profession enhances quality and safety of care Work with other profession to develop strategies for communicating about and resolving conflict in decisions related to care and treatment Work with other profession to assess, plan, provide and review care related to shared medical decision making support model of interdependent practice

Educational Strategies Discussions of examples of effective teamwork using case-based learning Presenting elements of teamwork competencies; small group learning experiences or case conferences, problem-based learning Case based discussions clarifying roles, responsibilities, knowledge and constraints of professions Shadow profession different from own, critical evaluate opportunities for shared decision-making

Strategies (cont.) Use simulated patient scenarios and case studies to provide experience with interdependent practice and shared medical decision-making focus on communication, safety and error reduction, crisis situations Facilitate interprofessional learning by promoting case conferences and team meetings in real time to discuss shared medical decision making