1. Joe Schwenkler, MD Medical Director UMDNJ PA Program
Educating FPs and PAs for Shared Medical Decision Making: Promoting the “team” in the PCMH
Joe Schwenkler, MD
Medical Director
UMDNJ
PA Program
Dave Keahey, PA-C, MSPH
Associate Dir. of Graduate Studies
University of Utah Dept. of Family and Preventive Medicine

2. Our Goals
Explore the role of the “team” in the Patient Centered Medical Home
Discuss how the Physician Assistant profession can help alleviate the primary care shortage
Understand the significance of Shared Medical Decision Making
Share ideas on how to teach the team approach to Shared Medical Decision Making

3. “Shortage of Doctors an Obstacle to Obama Goals”

4. The Problem Health Care Reform depends on access to primary care
Primary Care Physicians are in short supply
Medical school graduates are following the $$$
Family Physicians are forced to see more patients
Lack of time to do the job correctly
Increased “job” stress
Decreased “job” satisfaction

5. One Possible Solution Promoting the “team” in the PCMH
“Patient care in the New Model will be provided through a multidisciplinary team approach and will be dependent on a deep understanding of the population served by the practice.”
The Future of Family Medicine: A Collaborative Project of the Family Medicine Community.
Annals of Family Medicine 2:S3-S32 (2004).

6. American Academy of PAs Policy on Team Practice
November, 2008
“The Physician-PA team relationship is fundamental to the PA profession and enhances the delivery of high quality health care.” “As the structure of the health care system changes, it is critical that this essential relationship be preserved and strengthened.”

7. Why Partner with Physician Assistants?
Shared interests from their origin forty years ago
PAs see themselves as partnering with Family Doctors to occupy the PCMH model together
No Family Doctor, No Physician Assistant
This team shares medical decision making with their patients

9. How do you teach Shared Medical Decision Making?
Train FP Residents and PAs Together

10. Training Physician Assistants in Family Medicine Residencies: Results of a Residency Director Survey
Eighty-seven (19%) program directors responded.
In this sample, 20 (23%) train residents in settings that include PA students.
Respondents who train PA students described the experience as “somewhat valuable” (40%), “valuable” (20%), or “very valuable” (10%).
One third plan curriculum with PA programs.

11. Representative Comments From Residency Directors About Training PA Students
Team based care...the future. Also, we need help in primary care, there are not enough of us physicians.
Team care provided at the site. We are a true medical home for our patients and team care is paramount to this.
Residents can see skill set of PA students and opportunities for future collaboration.

12. Conclusions
The Patient Centered Medical Home requires a team approach with family physicians as leader of the interprofessional team.
The majority of respondents felt that when residents and PA students train together they gain valuable experience.
An increase in paired training experiences may better prepare Family Medicine residents to lead the PCMH team that includes physician assistants.

13. Future Directions
Develop a competency-based framework for teaching SMDM
Further research
Increase grant support

15. Creating a culture for SMDM
Role clarification
Role valuing
Teamwork Attitude & Skills
Partnership
Developed by Anita Glicken, MSW
Program Director
University of Colorado at Denver
Child Health Associate
Physician Assistant Program

16. Teamwork Attitude & Skills
Role Clarification
Understands...
Knowledge
Constraints
Responsibilities
Roles
Role Valuing
Developing Trusting Relationships
Teamwork Attitude & Skills
Communication
Partnership
Interdependency
Empowerment
Importance of the output as a whole

17. Building Collaborative Competencies
Describe roles, responsibilities, skills clearly to others
Recognize and observe constraint’s of one’s role, responsibilities and competence –contextualize patient needs in a wider context
Recognize and respect roles, responsibilities and competence of other profession in relationship to own.
Understand how other profession enhances quality and safety of care
Work with other profession to develop strategies for communicating about and resolving conflict in decisions related to care and treatment
Work with other profession to assess, plan, provide and review care related to shared medical decision making
support model of interdependent practice

18. Educational Strategies
Discussions of examples of effective teamwork using case-based learning
Presenting elements of teamwork competencies; small group learning experiences or case conferences, problem-based learning
Case based discussions clarifying roles, responsibilities, knowledge and constraints of professions
Shadow profession different from own, critical evaluate opportunities for shared decision-making

19. Strategies (cont.)
Use simulated patient scenarios and case studies to provide experience with interdependent practice and shared medical decision-making
focus on communication, safety and error reduction, crisis situations
Facilitate interprofessional learning by promoting case conferences and team meetings in real time to discuss shared medical decision making