Teaching the New Model to Residency Faculty: Addressing the Fuzzy Reality of Curriculum Development Walt Mills MD Santa Rosa Family Medicine Residency Consortium Jessica Muller PhD Department of Family & Community Medicine UCSF STFM Denver, CO May 1, 2009

Preview Describe development & implementation of PCMH curriculum in a faculty development fellowship program Discuss fellows’ evaluations of the new curricular module Identify lessons learned

Question How do we train residency program faculty to prepare learners to practice in patient centered medical homes?

PCMH “Start with the End in Mind” The Seven Habits of Highly Effective People: Foundation for the PCMH

Definition The medical home is a point of access to health care that is organized around the patient’s needs built on a relationship between a patient and a physician. It is a primary health care base capable of providing 90% of health needs but also coordinating specialty referrals, and ancillary services. The medical home is a source of first contact care and comprehensive care across a continuum of preventive, acute and chronic health care needs. It is a place where they get to know you. (Grumbach and Bodenheimer 2002) Dr Rosenthal’s report to the NY State legislature. Advancing Medical Homes: Evidence-Based Literature Review to Inform Health Policy. November 8, 2007 NYS Primary Care Coalition Thomas C. Rosenthal MD 5

Relationship between a It is a place where they get to know you. KISS Relationship between a patient and a physician. Providing 90% of health needs It is a place where they get to know you.

Goal Develop a PCMH curriculum for residency program faculty-fellows participating in the 2008-09 Northern California Faculty Development Fellowship in Family Medicine (FDFFM)

FDFFM Part-time fellowship for faculty in FM residency programs primarily serving underserved populations 3 components: 8 3-day sessions at central retreat center Practicum: application of learning at home Scholarly project Experiential, small group, case-based learning

UCSF Northern California FDF

FDFFM Fellows Teaching Skills Feedback Leadership Curriculum Design Four years ago, the PBL curriculum at UCSF was moved from a stand-alone curriculum into the two-year doctoring course (Foundations of Patient Care) which teaches basic clinical skills:xxxxx. Once moved into this course, we determined to make the PBL curriculum more consistent with the goals of the course Curriculum Design Career Planning Scholarship

1. Problem Identification and General Needs Assessment* Residency faculty lack knowledge, skills and attitudes to teach/model the Patient Centered Medical Home to their learners *from Kern DE et al. Curriculum Development for Medical Education: A Six-Step Approach, 1998.

2. Needs Assessment of Targeted Learners* Item N=11 Mean Identifying the fundamental elements of the PCMH ? Developing innovative ways to teach the PCMH model Working with a learner in difficulty Designing & implementing a curriculum *Survey: 1-5 where 1 = low priority & 5 = high priority

2. Needs Assessment of Targeted Learners* Item N=11 Mean Identifying the fundamental elements of the PCMH 3.36 Developing innovative ways to teach the PCMH model 3.37 Working with a learner in difficulty 4.36 Designing & implementing a curriculum 4.90 *Survey: 1-5 where 1 = low priority & 5 = high priority

3. Goal To enable residency program faculty to prepare learners for practice in patient-centered medical homes

3. Objectives Discuss rationale for the PCMH Identify building blocks of PCMH model Describe NCQA certification for residencies Articulate benefits & challenges of using EMR’s Create a personalized action plan to implement in home programs Utilize change management and sustainability theory to aid redesign process

More than any time in history family medicine is at a crossroads. One Path leads to despair and utter hopelessness, the other leads to total extinction. Let us pray that we have the wisdome to choose correctly. Woody Allen

Santa Rosa Free Clinic

4. Educational Strategies: Homework Residency Program Solutions Future-Focused Complete Solutions for Program Excellence 2008 “Criteria for Excellence” Podcast (Dr. John Rogers) Video Clip (Health Policy re: PCMH) Self Assessment Transformed MHIQ www.transformed.com

4. Educational Strategies: Teaching Methods Individual reflection Didactic presentations Small groups Pair and share

5. Implementation Three presentations: Small groups Theoretical Concepts of the PCMH Nuts and Bolts: Advanced Access, Huddles, Teamlets Introduction to PCMH Certification of Residency Programs Small groups Discuss Assessments Design Action Plans

6. Evaluation Data Item* Mean 4.3 4.0 2.1 N=11 I have a better understanding of the rationale for PCMH & how this model differs from current practice 4.3 This session provided useful information about different components of PCMH 4.0 This session addressed some of the challenges we face in trying to implement the new model 2.1 * 1-5 scale where 5=strongly agree

Evaluation Data (cont.) Item* Mean I have a better idea of how to teach learners to practice in PCMHs 2.5 Coming up with a 90 day action plan was a useful way to plan how to implement a PCMH curriculum at my home program 1.8 * 1-5 scale where 5=strongly agree

6. Group Feedback Helpful aspects of session: “Broad view of PCMH was insightful” “Review of concepts of medical home; each time I hear it I understand it better” Session could be improved by: “More small group discussion” “Transformed was a waste of time” “Action plan not helpful”

Group Feedback “Discussion of barriers to implementation” “This is not my practice!” “Disconnect between model and our underserved populations” “We need to send a message– you need to tailor this to our programs!”

Lessons Learned Better Needs Assessment Survey of targeted learners Not enough detail Learners at different stages and styles Better preparation – teaching methods & content - to meet those needs No good survey tool for residency programs Change is hard Teaching it is even harder!

THANK YOU!

Contact Information Walt Mills, MD, MMM, FACPE Family Medicine Leadership Institute UCSF-Santa Rosa Family Medicine Residency Consortium 3324 Chanate Road Santa Rosa, California 95404 707-328-7059 walter.w.mills@kp.org Jessica Muller, PhD Department of Family and Community Medicine Box 0900 University of California San Francisco San Francisco, CA 94143 (415) 476-5175; mullerj@fcm.ucsf.edu