1. Using an Innovative Blended Learning Approach to Enhance Student Education in the PCMH Michele M. Doucette, PhD | David Gaspar, MD Bonnie Jortberg, PhD, RD, CDE Department of Family Medicine University of Colorado Denver, School of Medicine

2. Educational Goals & Objectives Discuss the use of the "7 Primary Principles of the PCMH" learning objectives (2010 PCMH Objectives) as a platform for a PCMH-centered curriculum. Describe changes to current MSE III curriculum incorporating elements of a blended learning model. Discuss the design and utilization of a blended learning approach focused on the 2010 PCMH Objectives to augment the students' learning experience. Discuss potential future enhancements to this learning model for PCMH training.

3. Medical Student Training…Gaps Evolving health care needs… medical school graduates must understand and have confidence in applying new models of Primary Care, such as the PCMH Survey of FM departments indicates less than 50% have specifically implemented an undergraduate PCMH curriculum – Didactic training used most frequently as a teaching methodology compared to a blended learning approach – Working with registries, assessing population health, and training in team-based care also integrated less frequently into undergraduate curriculum David A, Baxley L, ADFM. Ann Fam Med 2011;9:274-275

4. e-Learning as an Educational Approach Internet-based (e-)learning has been successfully used in medical student education – Meta-analyses of e-learning for medical education suggest that students perform similarly and in some cases, better than traditional face-to-face instruction – Best when incorporated as a “blended learning” model Potential benefits of e-learning: – Allows students to collaborate and share information without having to physically be in a central location – Allows group and longitudinal learning projects for rural clerkship curriculum JAMA. 2008;300(10):1181-1196 | US Dept. of Education. Means B. 2009.

5. 2010 PCMH Objectives 2010 “Joint Principles for the Medical Education of Physicians as Preparation for Practice in the Patient-Centered Medical Home” delineates learning objectives for the Seven Principles of the PCMH: – Personal Physician – Physician-Directed Medical Practice – Whole-Person Orientation – Coordinated Care – Quality & Safety – Enhanced Access to Care – Payment-Added Value www.acponline.org/running_practice/pcmh/understanding/educ-joint-principles.pdf

6. PCMH e-Learning 9 Colorado FM Residency Programs currently using a PCMH e-Learning platform launched in 2011 12 modules based on Seven Principles of the PCMH Residents State Liking… Convenience of on- demand learning Varied learning options One-hour module length Concise literature reviews Discussion forum Faculty State Liking… Effective faculty development tool Ready to go curriculum Ability to track resident learning progress Discussion forum

7. Primary Care Block Curriculum (previous) 8-week Primary Care Block → Rural & Community Care + Adult Ambulatory Care Orientation Intro Instruction Pre-Assess Team-based Care Prevention CDM Oral & Derm RCC Block Rural Primary Care Clinical Screens Assessments Service Learning Clinical Intrasession Small Group Learning Team-based care PPT Block transition AAC Block Urban Primary Care Clinical Preventive care Specialty care End-of-life care Didactics Clinical Final SP Cases Summative Final Effective curriculum, yet learning "siloed" especially for rural students

8. Blended Learning Design & Use Used online platform to connect students' learning throughout the two 4-week blocks: http://fmstudented.orghttp://fmstudented.org – Wordpress/Buddypress (freeware) Discussion Forums (integrates learning material with clinical and share personal insights/experiences) Blogs (reflect on/share community service experiences) Social network based on groups (students, faculty, community at large) Robust media delivery – Adobe In-Design (interactive flash PCMH e-learning modules)

9. Curriculum Components Seven Principles of PCMH Personal Physician Physician- Directed Medical Practice Whole- Person Orientation Coordinated Care Quality & Safety Enhanced Access to Care Payment- Added Value e-Learning Modules & Forum Discussions Intro to PCMH ●● Patient Centeredness ● ● Registries/Population Management ● ● Team Approach ● ●● Patient Self-Management Support ● Using Data to Improve Practice ● Evidence-Based Medicine ● Payment – Added Value ● Team-Based Care PPT – Small Groups ●●●●●●● Transitions of Care – Group Discussions ● ● Community Service Learning Blog ● MSE III Clerkship Curriculum Components & Associated PCMH Principles

10. Challenges & Future Directions Challenges: Initial design was time-consuming and required significant self-training in new technologies Unknown how extensively students will utilize resources Future Directions: Expand to 8 PCMH Modules (potentially provide CMEs) Engage clinical faculty to participate in online learning discussions & expand faculty resources Add patient registry exercise integrated into preceptors' practice settings

11. Thank You! Questions?