Abstract Background: Purpose: Description: Conclusion: In 2006 both the American Academy of Physician Assistants and the Society of Hospital Medicine published the core competencies (TCC) in the practice of medicine. There is no published literature on the application of TCC for physician assistants (PAs) and there may be training gaps just as there are in Hospital Medicine. In their role as teachers, hospitalists can create a greater sense of learning for PAs on the multidisciplinary care team and promote job satisfaction. Brigham and Women’s Hospital (BWH) in Boston is the largest employer of PAs in New England with approximately 100 PAs making up the fastest growing population across the institution. Working with PAs to develop a CME program for PAs is one step hospitalists can take to foster professional development. Purpose: Our educational strategy has been to develop a monthly PA educational series for BWH and Dana Farber Cancer Institute (DFCI) PAs, provide opportunity for PAs to receive CME credits easily on-site, measure educational outcomes, and ultimately to improve patient care. Description: Funding for this initiative came from a BWH SEED Grant award, a Health Information/Technology award from the National Network of Libraries of Medicine New England Region as well as funding from the BWH CMO and DFCI CMO. A needs assessment was based on review of the literature, surveys of the target audience, PA focus groups, and expert consensus of PA chiefs. The goals and objectives were written to match real world job performance and to meet identified needs. PAs identified problematic cases that formed the basis for discussion. All teaching sessions begin with a case presentation by a PA followed by breakout sessions in small groups at portable computers. Hospitalists and a librarian worked with the PA presenter to facilitate discussion regarding how to write learning objectives, frame clinical questions, and then use information technology resources including Pubmed, clinical guidelines, and other electronic sources available through the hospital network. Conclusion: Developing habits for life-long learning are important ideals for professionals and a multidisciplinary PA Grand Rounds program which is a departure from passive didactic lectures is one way to effectively address these goals. In addition to evaluation forms circulated at the conclusion of each session, we are evaluating the impact of our curriculum by using an adapted Fresno Test of competence in evidence-based medicine and a job satisfaction questionnaire. Key questions remain whether an innovative, PA-centric, competency-based educational program can change clinical outcomes and improve PA job satisfaction.

Post = Midway through curriculum Physician Assistant-Hospitalist Curriculum Post = Midway through curriculum

Post = Midway through curriculum Physician Assistant-Hospitalist Curriculum Post = Midway through curriculum

Post = Midway through curriculum Physician Assistant-Hospitalist Curriculum Post = Midway through curriculum

Working with PAs, Hospitalists should ensure that: PAs can do their jobs smoothly and efficiently The needs of PAs are met PAs have a voice at their institution

Attitudes or Core Values Our core values shaped our educational strategy PAs are an integral part of hospital practice Team learning is professionally rewarding We want to facilitate learning for PAs so that they can evaluate and improve their patient care practices Hence, the format of the course is not the traditional lecture where attendees passively listen to a speaker PA centric curriculum based on educational needs identified by PAs Cases developed by PAs for PAs Constraints – available time for PAs working different schedules

Growth of Hospital Medicine SHM Established in 1997 Now with >6000 members ABIM commitment to focused recognition & certification (11/06) Maintenance of Certification process (as early as 2008 or 2009) Criteria likely to include: Practice focus in hospital care Knowledge of evidence-based hospital care Commitment to CQI in hospital care Source: Society of Hospital Medicine (www.hospitalmedicine.org)

A Work In Progress Ongoing evaluation like any QI project Rapid process improvement to facilitate change and improve care and/or outcomes Unambiguous, time-specific, and measurable

Transforming Hospital Care: Value of Curriculum Development Skills Practice Based Learning Systems Based Practice Patient Care Attitudes Professionalism Interpersonal and Communication Skills Structure and organization to teaching/training models Medical Knowledge

Dana-Farber Cancer Institute Mission The mission of Dana-Farber Cancer Institute is to provide expert, compassionate care to children and adults with cancer while advancing the understanding, diagnosis, treatment, cure, and prevention of cancer and related diseases. As an affiliate of Harvard Medical School and a Comprehensive Cancer Center designated by the National Cancer Institute, the Institute also provides training for new generations of physicians and scientists, designs programs that promote public health particularly among high-risk and underserved populations, and disseminates innovative patient therapies and scientific discoveries to our target community across the United States and throughout the world. Vision Dana-Farber Cancer Institute's ultimate goal is the eradication of cancer, AIDS, and related diseases and the fear that they engender. Core Values Above all else, we make a difference by relieving the burden of disease now and for the future through our research, clinical care, education, outreach and advocacy.

Brigham and Women’s Hospital Mission As part of the Partners HealthCare System, Brigham and Women’s Hospital (BWH) is dedicated to serving the needs of the community. It is committed to providing the highest quality health care to patients and their families, to expanding the boundaries of medicine through research, and to educating the next generation of health care professionals. Through the Partners HealthCare System, BWH will take a leadership role in the development of an integrated care network providing a full range of cost-effective, patient centered services. As part of its mission, BWH/Partners will seek to: Provide high quality and compassionate primary, secondary and tertiary services to patients in the most cost-effective settings possible within an integrated network. Improve the health status of the local Boston community through the direct operation of community health service, and the development of innovative public and school-based health programs Serve as one of the world’s premier resources for innovative research in biomedicine, health services and clinical epidemiology. Recruit the highest quality medical students, residents, fellows, nursing students, and other health care professionals and prepare them for leadership in clinical practice, research, and academic medicine. Address the urgent national need for leaders from the diverse groups that comprise the American population. Serve as a national leader in the demonstration and practice of clinical efficiency and continuous quality improvement. Provide all employees with appropriate working conditions and opportunities to achieve their full potential as individuals and as members of the BWH health care team. Manage and use information, through the most technologically advanced systems available, to enhance and improve patient care, doing so in a way that will protect confidentiality. Develop and implement biotechnologies which will improve patients’ care and reduce costs.

Funding Opportunities 1. SEED Grant – 6K BWH Department of Medicine Regional Medical Library Grant for PAs – 10K Preparing for submission BWH, CMO Funding – 5K Approved in FY07 Budget DFCI, CMO Funding – 1.5K Support Offered By Drs Shulman and Alyea Implement Curricula and Training Activities Budget Laptop including Accessories $ 1,700. Projector $ 1,350. Materials – Books $ 5,100. Printing $ 2,000. Total $ 10,150

Learner’s achievement of each objective The learner will be able to explain how to present a case study and how to frame specific questions relevant to a case. The learner will be able to describe different methods for conducting literature searches to suppose clinical decision making and practice based learning. The learner will be able to take advantage of resources within Partners and on the web relevant to the case discussion.

Next Steps: Like hospitalists, the role of PAs are changing and increasing Hospitalists can: Play a key role in working with PAs to develop a centric competency based curriculum Work with PAs to create a professional PA model consistent with other professional clinical groups Involve them in teaching activities, quality improvement and risk management.

Conclusions More work is needed to determine impact on clinical outcomes. Preliminary data positive relating to job satisfaction. The role of the hospitalist as teacher and learner as a member of multidisciplinary team is important for job satisfaction for both hospitalist and PAs.