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A New Approach to Chronic Care Education: A Review of a Novel Chronic Care Course for Second-Year Medical Students Alexandra Schieber DO, Munish Bakshi, MD, Susanna Evans, MD, Dennis Novack, MD, Daniel DeJoseph, MD Drexel University College of Medicine, Philadelphia PA COURSE OBJECTIVES 1. Appreciate the complexity of chronic disease management, and the burden chronic disease places on our health care system and society. 2. Become familiar with the CDC's six principles of effective chronic care. Use these principles as a foundation to observe and comment on the challenges faced by your own patient. 3. Understand the principles of disease prevention--- including the concepts of primary vs secondary prevention, surrogate disease markers, and number needed to treat vs number needed to harm. 4. Learn the factors that contribute to medication adherence vs nonadherence, and the factors that put patients at risk for drug-drug interactions and adverse medication events. 5. Refine your approach to evidence-based medicine, and put that approach into practice when researching your patient report. 6. Appreciate the concepts of "multimorbidity" and the special challenges and approaches necessary when a patient suffers from multiple chronic conditions. 7. Understand the principles and benefits of palliative medicine, and the importance of incorporating these into chronic care management, especially when patients are approaching the end of life. 8. Incorporate patient encounters into a well-written patient report, following the provided rubric. COURSE DESIGN STUDENT FEEDBACK CONCLUSION AREAS FOR IMPROVEMENT Introductory didactic and case based session Patient office encounter follow up community encounter: Small group session Written assignment: (<1500 Words) addressing how CCM applies to their patient. This course relays valuable and current concepts that are crucial to training the next generation of physicians to treat chronic illness,. Students rated this course overall similarly to other new courses, with an average of 2-3 on a scale of 1-5 The major strength of this course seemed to be the small group case sessions The predominant weakness of this course was logistics including preceptor coordination and readiness for medical students and arranging follow up encounters with patients. Patient interactions, when well coordinated, were well received and garnered positive feedback. Educating community preceptors Goals and Objectives CCM Streamlining flow of precepting session Coordination Consider eliminating introductory session Teach course content via a case-based, small group format Emphasize small group learning Eliminate redundancy Eliminate subject areas to better use time Discussion on Palliative care Narrow Focus TOPICS COVERED IN INTRODUCTORY SYLLABUS AND DIDACTIC SESSION Chronic vs. Acute Care: Epidemiology, cost burden The Chronic Care Model Medical Complexity: homeostensosis Multimorbidity Medications in Chronic Care Endpoints: surrogate vs. clinical Palliaitive care and chronic disease Chronic disease prevention EBM Basics: POEM’s, Guidelines, NNT vs NNH
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