1. Incorporating Advocacy Education into a Family Medicine Residency Program Christopher Baumert, MD Montana Family Medicine Residency, Billings, MT 5/1/2016

2. Disclosures Nothing to disclose (other than my love for advocating for my patients!) All images mine or already available to the public

3. Why teach advocacy?  Personal reasons - desire to share my passion for advocating for patients State AFP chapter leadership roles – student AAFP leadership roles – student/resident Direct contact with legislators (AAFP FMCC, NACHC P&I)

4.  Rapid changes in health system and health policy - recent, current, future National Health care delivery and payment Graduate Medical Education reform Affordable Care Act-related issues (CHC funding, THC GME funding) NHSC funding Medicare SGR State Medicaid expansion and insurance coverage Immunization rules Scope of practice Local Community priorities – e.g. mental health care, Rx drug abuse, Complete Streets policy Why teach advocacy?

5.  Transferrable skill – advocating for patients can take many forms Outreach – Tar Wars, newspaper columns and op-eds Crossover into non-medical advocacy – e.g. school board involvement, community gardening Why teach advocacy?

6.  New ACGME requirements – effective July 1, 2014 Why teach advocacy?

7.  ACGME Milestones Why teach advocacy?

8.  CLER site visits – part of Next Accreditation System “…designed as expectations rather than requirements” Why teach advocacy?

9.  I decided to embark on a journey of making a project out of incorporating advocacy education into our residency program So…

10.  Identify…the problem  Examine…existing information/solutions  Create…an intervention  Implement  Test  Export I ExCITE Model

11.  No Advocacy curriculum currently in existence at MFMR… How did I know? 1. Identify the Problem (I)

12. 2. Assoc. director (also CCC member) tasked me with how to gather data on SBP-3

13. Identify the Problem (I) Gathering milestone data  2 ways to ensure program is meeting milestones: Adapt existing curriculum to allow evaluations that fit milestones Create new curriculum around milestones In some ways, nice to create new curriculum around milestone…then can expand upon it as specific resident experience allows (start basic)

14. Identify the Problem (I) Gathering milestone data – creating evaluations  Need to look at language of milestone Can direct what kind of feedback you’re looking for/evaluations you create Can help direct you to resources that may be helpful  Numbers? Is there something quantifiable that can tell you how resident progressing? (E.g. #clinic patients seen)  no specific required numbers related to SBP-3

15. Identify the Problem (I) Gathering milestone data – creating evaluations  Choose the right environment/rotation PC-1 more appropriate for ER and ICU curriculum PC-4 more inpatient medicine PC-2 and 3 - continuity clinic

16. Identify the Problem (I) Gathering milestone data – creating evaluations  Can then tailor your evaluations to those settings that best fit different milestones Can (and should) include staff, community attendings

17. Examine (Ex)  Settings for evaluation for advocacy? Clinical Community-based Systems-based

18. Examine (Ex)  What are other FM residency programs lacking? Alaska – survey of graduates regarding Community Medicine rotation

19. Examine (Ex)  What are other FM residency programs lacking? Alaska – responses of how to improve CM rotation More outreach Exposure to CNAs Public health integrated into rotation More Epi lectures

20. Examine (Ex)  What are other FM residency programs doing? Casper, WY – Community Medicine rotation

21. Examine (Ex)  What are other FM residency programs doing? Some had very specific ways to track…some didn’t “We run with global faculty impression on that one. No tool”

22. Examine (Ex)  Settings for evaluation for advocacy at MFMR? Clinical  Trick is to find rotations and evaluators that aren’t already saturated -First Prenatal clinic – nurse -Continuity clinic – care coordinators

23. Examine (Ex)  Settings for evaluation for advocacy at MFMR? Community-based MFMR – housed in a public health organization! (that performs a CNA) Outreach – Tar Wars, Billings Gazette ‘Health Matters’ column CM rotation – HIV clinic, jail, homeless shelters Healthy By Design – collaborative alliance between Billings hospitals and health systems to address CNA shortcomings through task forces

24. Examine (Ex)  Settings for evaluation for advocacy at MFMR? Systems-based ACGME now requires QI project (already part of our 3 rd year MHS rotation)

25. Create (C)

26.  Involve potential evaluators in process of eval creation  Standardize a format for all non-core faculty evals (paper form, AA entry)  Milestone on form for easy reference  KISS – Keep it simple, friend! Create (C)

27.  Decide frequency First prenatal nurses – every 1 st prenatal session CC’s – Q6 months (similar to others performing semi-annual eval) Frequency can help decide how to formulate verbage! Create (C)

28. Community Needs Assessment  How to incorporate into residency? Senior VP of Clinical & Educ Integration - introduce at 2 nd yr orientation Residents choose a topic of interest Present community plan (or lack of plan) to address topic at 3 rd yr MHS rotation …and perhaps stay involved! Create (C)

29. Tracked by CCC/Advisor:  Staff evaluations  CNA project (2 nd -3 rd year)  Tar Wars outreach (frequency, feedback from AAs who travel w/ resident)  Billings Gazette authorship (frequency)  Completion of Community Medicine Rotation  QI project completion (3 rd year) Additionally…set aside 2 Public Health/Advocacy didactic sessions/year (Wed afternoons) -Epi lectures (Hep C, Q fever, gonorrhea outbreak…new state med officer to come give didactics) -Advocacy lectures (pt safety/AE reporting, lead safe contractor practices) Implement (I)

30.  Need guinea pigs Test (T)

31.  APE 14-15 Test (T)

32. Future considerations: Community outreach  Develop additional outreach opportunities System improvement  Pod lead RNs - evaluate resident participation in pod meetings Identification of health trends in our pt population Discuss how to improve population care  Committee involvement (3 rd year) In-house (e.g. Public Health Policy Development Committee) Medical community (e.g. hospital Med Staff QI committee)

33.  You! Lessons learned:  Evaluation creation (meaningful!)  Blending existing rotations/mission of program with outside requirements vs creation of new learning experiences/opportunities Export (E)

34. Residents make great advocates!

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