1. An affiliate of the Duke University Medical Center and in association with The North Carolina Area Health Education Centers Program Duke/SRAHEC Family Medicine Residency Program Fayetteville, NC Dan Marlowe, PhD, LMFT & Eron Manusov, MD

2. An affiliate of the Duke University Medical Center and in association with The North Carolina Area Health Education Centers Program During this session, participants will: 1.Understand how PCMH and ACGME requirements are used to construct an ICC 2.Learn how to design an ICC so that each rotation is both a longitudinal and developmental learner experience 3.Apply the team-based care concept to an integrated multi- discipline approach to family medicine residency training. 4.Learn how to create a curriculum that meets ACGME and PCMH requirements and competencies through the integrated care concept. 5.Discuss the benefits and issues of the meta-curriculum.

3. An affiliate of the Duke University Medical Center and in association with The North Carolina Area Health Education Centers Program Integrate - To combine (one thing) with another to form a whole made whole ORIGIN mid 17th cent.: from Latin integrat- ‘made whole’ integrate verb" Oxford Dictionary of English. Edited by Angus Stevenson. Oxford University Press, 2010. Oxford Reference Online. Oxford University Press. University of North Carolina - Chapel Hill. 13 April 2012

4. An affiliate of the Duke University Medical Center and in association with The North Carolina Area Health Education Centers Program

5. An affiliate of the Duke University Medical Center and in association with The North Carolina Area Health Education Centers Program Fragmentation in healthcare is ultimately a consequence of fragmentation in: – Payment structures – Care delivery systems – Treatment planning – Education Doctorate and “indoctrination” rhyme for a reason

6. An affiliate of the Duke University Medical Center and in association with The North Carolina Area Health Education Centers Program

7. An affiliate of the Duke University Medical Center and in association with The North Carolina Area Health Education Centers Program ACGME Practice Based learning and improvement Inter-personal communication skills Professionalism Systems based practice PCMH Enhance Access and Continuity Identify and Manage Patient Populations Plan and Manage Care Provide Self-Care Support and Community Resources Track and Coordinate Care Measure and Improve Performance

8. An affiliate of the Duke University Medical Center and in association with The North Carolina Area Health Education Centers Program Both standards emphasize: – Interdisciplinary collaboration – Team based care – Continuous Quality Improvement – Education/teaching

9. An affiliate of the Duke University Medical Center and in association with The North Carolina Area Health Education Centers Program When we say integrated we mean also integrating across: – Curriculums/rotations – Organizational structures – Practice structures – Community stakeholders

10. An affiliate of the Duke University Medical Center and in association with The North Carolina Area Health Education Centers Program Integrated care (IC) has traditionally been viewed as the embedding/involvement of MH in medical settings to address behavioral issues related to disease management But….

11. An affiliate of the Duke University Medical Center and in association with The North Carolina Area Health Education Centers Program Interprofessionality- “the process by which professionals reflect on and develop ways of practicing that provides an integrated and cohesive answer to the needs of the client/family/population… [I]t involves continuous interaction and knowledge sharing between professionals, organized to solve or explore a variety of education and care issues all while seeking to optimize the patient’s participation…(D’Amour & Oandasan, 2005, p. 9)

12. An affiliate of the Duke University Medical Center and in association with The North Carolina Area Health Education Centers Program A curricular experience that makes interprofessionality directly applicable to resident education and patient care through integration

13. An affiliate of the Duke University Medical Center and in association with The North Carolina Area Health Education Centers Program Needs to be – Developmental – Longitudinal – Standardized w/ room for individuation – Coordinated across and between FMR and FMC – Based on resident/faculty feedback

14. An affiliate of the Duke University Medical Center and in association with The North Carolina Area Health Education Centers Program Education Practice BehSci Practice M Family Med Comm Med HLTH Lit FMC QI Committee MH PharmD Community

15. An affiliate of the Duke University Medical Center and in association with The North Carolina Area Health Education Centers Program In order to do this successfully, what do you think should be emphasized?

16. An affiliate of the Duke University Medical Center and in association with The North Carolina Area Health Education Centers Program

17. An affiliate of the Duke University Medical Center and in association with The North Carolina Area Health Education Centers Program ICC emphasizes – Collaborative/integrated practice – Continuous Quality improvement – Teaching

18. An affiliate of the Duke University Medical Center and in association with The North Carolina Area Health Education Centers Program 1.Every rotation 2.Selected rotations in one year 3.Selected rotations in all 3 years 4.Outside of rotations

19. An affiliate of the Duke University Medical Center and in association with The North Carolina Area Health Education Centers Program Key: FMC- Family Medicine Clinic CC- Care Clinic BH- Better Health MB- Medical Board HV- Home visit Psych- Psychiatry QI- Quality Improvement Project LP- Lecture Prep BehSci- Behavioral Science Wayfinding: PGYI PGYII PGYIII Practice QITeaching

20. An affiliate of the Duke University Medical Center and in association with The North Carolina Area Health Education Centers Program

21. An affiliate of the Duke University Medical Center and in association with The North Carolina Area Health Education Centers Program 40 ½ Days – 16 FMC – 2 Care Clinic – 1 Better Hlth – 1 HIV/AIDS outreach – 1 NC Med Board – 2 Home visit – 3 CFVHS Psych – 4 CQI Project – 1 Fayetteville Children Clinic – 1 DSS – 1 Pain Clinic – 1 Hlth Dept. – 5 Resident Choice 40 ½ Days – 16 FMC – 4 Care Clinic – 1 Balint Facilitation – 1 HIV/AIDS outreach – 1 NC Med Board – 1 Home visit – 1 BehSci Precepting – 4 CQI Project – 2 Lecture Coordination – 1 Pain Clinic – 8 Resident Choice 40 ½ Days – 16 FMC – 4 Care Clinic – 1 HIV/AIDS outreach – 1 NC Med Board – 2 Home visit – 4 CQI Project – 1 Pain Clinic – 2 Lecture coordination – 9 Resident Choice

22. An affiliate of the Duke University Medical Center and in association with The North Carolina Area Health Education Centers Program Questions?

23. An affiliate of the Duke University Medical Center and in association with The North Carolina Area Health Education Centers Program Dan Marlowe, PhD, LMFT Director, Applied Psychosocial Medicine Daniel.Marlowe@sr-ahec.org Eron Manusov, MD Director, Family Medicine Residency Program Eron.Manusov@sr-ahec.org