1. Teaching the New Model to Residency Faculty: Addressing the Fuzzy Reality of Curriculum Development
Walt Mills MD
Santa Rosa Family Medicine Residency Consortium
Jessica Muller PhD
Department of Family & Community Medicine
UCSF
STFM Denver, CO
May 1, 2009

2. Preview
Describe development & implementation of PCMH curriculum in a faculty development fellowship program
Discuss fellows’ evaluations of the new curricular module
Identify lessons learned

3. Question
How do we train residency program faculty to prepare learners to practice in patient centered medical homes?

4. PCMH “Start with the End in Mind”
The Seven Habits of Highly Effective People: Foundation for the PCMH

5. Definition
The medical home is a point of access to health care that is organized around the patient’s needs built on a relationship between a patient and a physician.
It is a primary health care base capable of providing 90% of health needs but also coordinating specialty referrals, and ancillary services. The medical home is a source of first contact care and comprehensive care across a continuum of preventive, acute and chronic health care needs. It is a place where they get to know you.
(Grumbach and Bodenheimer 2002)
Dr Rosenthal’s report to the NY State legislature.
Advancing Medical Homes: Evidence-Based Literature Review to Inform Health Policy.
November 8, 2007 NYS Primary Care Coalition Thomas C. Rosenthal MD 5

6. Relationship between a It is a place where they get to know you.
KISS
Relationship between a
patient and a physician.
Providing 90% of health needs
It is a place where they get to know you.

7. Goal
Develop a PCMH curriculum for residency program faculty-fellows participating in the Northern California Faculty Development Fellowship in Family Medicine (FDFFM)

8. FDFFM
Part-time fellowship for faculty in FM residency programs primarily serving underserved populations
3 components:
8 3-day sessions at central retreat center
Practicum: application of learning at home
Scholarly project
Experiential, small group, case-based learning

9. UCSF Northern California FDF

10. FDFFM Fellows Teaching Skills Feedback Leadership Curriculum Design
Four years ago, the PBL curriculum at UCSF was moved from a stand-alone curriculum into the two-year doctoring course (Foundations of Patient Care) which teaches basic clinical skills:xxxxx. Once moved into this course, we determined to make the PBL curriculum more consistent with the goals of the course
Curriculum
Design
Career Planning
Scholarship

11. 1. Problem Identification and General Needs Assessment*
Residency faculty lack knowledge, skills and attitudes to teach/model the Patient Centered Medical Home to their learners
*from Kern DE et al. Curriculum Development for Medical Education: A Six-Step Approach, 1998.

13. 2. Needs Assessment of Targeted Learners*
Item
N=11
Mean
Identifying the fundamental elements of the PCMH ?
Developing innovative ways to teach the PCMH model
Working with a learner in difficulty
Designing & implementing a curriculum
*Survey: 1-5 where 1 = low priority & 5 = high priority

14. 2. Needs Assessment of Targeted Learners*
Item
N=11
Mean
Identifying the fundamental elements of the PCMH
3.36
Developing innovative ways to teach the PCMH model
3.37
Working with a learner in difficulty
4.36
Designing & implementing a curriculum
4.90
*Survey: 1-5 where 1 = low priority & 5 = high priority

15. 3. Goal
To enable residency program faculty to prepare learners for practice in patient-centered medical homes

16. 3. Objectives Discuss rationale for the PCMH
Identify building blocks of PCMH model
Describe NCQA certification for residencies
Articulate benefits & challenges of using EMR’s
Create a personalized action plan to implement in home programs
Utilize change management and sustainability theory to aid redesign process

17. More than any time in history family medicine is at a crossroads.
One Path leads to despair and utter hopelessness, the other leads to total extinction. Let us pray that we have the wisdome to choose correctly.
Woody Allen

18. Santa Rosa Free Clinic

19. 4. Educational Strategies: Homework
Residency Program Solutions Future-Focused Complete Solutions for Program Excellence “Criteria for Excellence”
Podcast (Dr. John Rogers)
Video Clip (Health Policy re: PCMH)
Self Assessment Transformed MHIQ

20. 4. Educational Strategies: Teaching Methods
Individual reflection
Didactic presentations
Small groups
Pair and share

21. 5. Implementation Three presentations: Small groups
Theoretical Concepts of the PCMH
Nuts and Bolts: Advanced Access, Huddles, Teamlets
Introduction to PCMH Certification of Residency Programs
Small groups
Discuss Assessments
Design Action Plans

22. 6. Evaluation Data Item* Mean 4.3 4.0 2.1 N=11
I have a better understanding of the rationale for PCMH & how this model differs from current practice
4.3
This session provided useful information about different components of PCMH
4.0
This session addressed some of the challenges we face in trying to implement the new model
2.1
* 1-5 scale where 5=strongly agree

23. Evaluation Data (cont.)
Item*
Mean
I have a better idea of how to teach learners to practice in PCMHs
2.5
Coming up with a 90 day action plan was a useful way to plan how to implement a PCMH curriculum at my home program
1.8
* 1-5 scale where 5=strongly agree

24. 6. Group Feedback Helpful aspects of session:
“Broad view of PCMH was insightful”
“Review of concepts of medical home; each time I hear it I understand it better”
Session could be improved by:
“More small group discussion”
“Transformed was a waste of time”
“Action plan not helpful”

25. Group Feedback “Discussion of barriers to implementation”
“This is not my practice!”
“Disconnect between model and our underserved populations”
“We need to send a message– you need to tailor this to our programs!”

26. Lessons Learned Better Needs Assessment Survey of targeted learners
Not enough detail
Learners at different stages and styles
Better preparation – teaching methods & content - to meet those needs
No good survey tool for residency programs
Change is hard
Teaching it is even harder!

27. THANK YOU!

28. Contact Information
Walt Mills, MD, MMM, FACPE
Family Medicine Leadership Institute
UCSF-Santa Rosa Family Medicine Residency Consortium
3324 Chanate Road
Santa Rosa, California 95404
Jessica Muller, PhD
Department of Family and Community Medicine
Box 0900
University of California San Francisco
San Francisco, CA 94143
(415) ;