Learner Centered Curriculum Design Combining faculty and resident

Learner Centered Curriculum Design Combining faculty and resident expertise to create a patient centered curriculum Diana Coffa MD, Lydia Leung MD, Sarah Matathia MD, George Saba, Ph. D, Teresa Villela MD April 28, 2012

Isn’t all curriculum design learnercentered? Patient Centered? Learner Centered? • USPSTF centered • Physician skill centered • Clinic resource centered • RRC centered • Faculty expertise centered • Hospital and clinic resource centered

Educational Theory • Standard models – Adult Learning Theory – Reflective Learning Theory – Experiential Learning theory • All view the learner as a receptacle for information Novice Expert

Group Based Learning Theory

Educational Theory • Group-Based Learning Theory – New learners are not receptacles – They are influences on the team’s knowledge base Observatory Participatory – Most useful when new team members have knowledge that old team members do not

When is this approach appropriate? Learner as receptacle • Medical knowledge • Physical exam skills • Hospital, clinic and healthcare systems Learner as team contributor/teacher • Navigating information systems • Promoting well-being and preventing burnout • Community engagement • Creating a collaborative work environment • Optimizing communication within teams

Learner Centered Curricula and Patient Centered Medicine Both Require: • Shared agenda setting • Collaboration between team members with different knowledge sets and skills Content Context

The Opportunity

Needs Assessment • Gathered a team of residents “What do you wish you had learned, or what do you wish you had learned more of in residency? ”

Iterative Agenda Setting • • Met with faculty leaders Missing agenda items? Historical perspective Resource assessment – Resident time – Faculty time – Cost

Agendas • Earlier and more • community engagement • Curriculum on efficiency • • Earlier musculoskeletal medicine training • • More procedural training • • More health policy/leadership training • Early OB skill exposure • Curriculum on hand-offs and communication Greater engagement with the primary care role Self-care and burnout prevention Standard, early ACLS training Early exposure to family systems theory

Given that your residents are practicing in a changing world, – They will be expected to work in PCMHs – With EMRs – And team-based care Given that they will work in settings where there are more handoffs – And shift schedules Given that they are working in a world where specialization is highly valued and family medicine poorly understood

Final Vision: Introduction to Family and Community Medicine • Family – Help residents feel at home in the outpatient setting – Develop an identity as an outpatient PCP – Explore family systems approach • Community – Initiate the COPC curriculum and emphasize the importance of community engagement – Give residents opportunity to learn about the communities they serve • Medicine

Family • • • History Goal Setting EMR treasure hunt Outpatient Efficiency Panel Management Training • Self-care seminar • 2 -3 continuity clinics/week • Minor procedure clinic • Geriatrics clinic • Ice cream social with clinic staff

Community • Health Policy and Health Disparities Seminar • Community Tours • Patient Experience • Tours of community resources

Medicine • • Evidenced Based Medicine Musculoskeletal Medicine ACLS training Procedural Skills OB Skills Cardiovascular Health Inpatient Communication

Feedback • “This month confirmed that the program values the same things I value, and that it will support me in becoming the doctor I want to become. ” • “Made me feel like I was following in the footsteps of real leaders in Family Medicine”

What Residents Said We Should Add • Seminar on death and dying • Seminar on human sexuality • A second session to discuss long term goals as a group

Sustaining the Change • Biannual check-in about goals and progress • Focus groups with R 2 s recently begun to plan R 2 extension of the curriculum • Meeting planned with R 1 s next month to reflect on what they learned and what they would add for next year

Contact: dcoffa@fcm. ucsf. edu

Outpatient Efficiency

Outpatient Efficiency • Efficient and effective electronic notewriting workshop • Tips for managing clinic flow • Managing email • Managing voicemail • Managing patient follow-up tasks

Outpatient Efficiency • Efficient and effective electronic note-writing workshop – Bad note, then small group discussion – Good note example – Note writing tips • • Tips for managing clinic flow Managing email Managing voicemail Managing patient follow-up tasks

Outpatient Efficiency • Efficient and effective electronic note-writing workshop • Tips for managing clinic flow – How to chart while talking with patient – How to work effectively with team members – Agenda setting – Role play • Managing email • Managing voicemail • Managing patient follow-up tasks

Outpatient Efficiency • Efficient and effective electronic note-writing workshop • Tips for managing clinic flow • Managing email – Inbox Zero rule – Using Folders Effectively • Managing voicemail • Managing patient follow-up tasks

Outpatient Efficiency • Efficient and effective electronic notewriting workshop • Tips for managing clinic flow • Managing email • Managing voicemail • Managing patient follow-up tasks

Outpatient Efficiency • Efficient and effective electronic notewriting workshop • Tips for managing clinic flow • Managing email • Managing voicemail • Managing patient follow-up tasks Back to Family

Panel Management Training • Introduce residents to the quarterly panel reports they will receive • Introduce them to the concepts of panel management and team-based resources that are available to them

Highest Utilizers Complex Care Well Controlled Chronic Illness Healthy Patients Back to Family

Self-Care and Well-Being

Models of Well-Being

• Back to Family

Procedural Skills Training Back to Medicine

The Patient Experience: The Inspiration I got a letter � What time does the lab open? How much does that cost? that my insurance needs to be renewed. What do I do? 有人会说广东话吗 ？ Will it hurt? Can I eat breakfast? What about some coffee? Cuánto tiempo tomará?

The Patient Experience: Activity Objectives • Become familiar with many of the common tasks we ask our patients to complete • Improve our abilities to orient our patients to these tasks & answer their questions • Provide tips for our patients to decrease obstacles and help them navigate the system • Remind ourselves to be cognizant & efficient when ordering tests & consults

The Patient Experience: The Activity • A half-day intern curriculum during R 1 Intro Month • Facilitated by a recent residency graduate • R 1 s assume the role of patients and complete a list of tasks assigned following a visit at the Family Health Center • R 1 s split into two groups and complete one of two clinical scenarios

The Patient Experience: Clinical Scenario Family of a 38 y/o woman and her 16 y/o daughter and 2 y/o son whose doctor has instructed them to: • Enroll in WIC • Pick up prenatal vitamins • Call the nurse advice line • Enroll in “Family Pact” (statewide coverage of reproductive services) • Pay a co-pay for prescription medicine • Renew Medicaid

The Patient Experience: Evaluation • Qualitative – Immediate debriefing – Focus group (done several months after the activity) – Written reflections • Quantitative – Review the facts they learned as a group and have R 1 s teach other Additional Ideas: • Follow up survey to evaluate if information is retained over time Back to Community

Community Tours • Residents completed tours of three neighborhoods of San Francisco where many of our Family Health Center patients reside • Each tour took 2 -3 hours

Community Tours The Mission Visitation Valley

Community Tours Bayview Hunter’s Point Back to Community

Inpatient Communication • Sign-out curriculum and tools – SIGNOUT mnemonic – Digital voice recorder • Walk rounds curriculum – Goal setting – Role assignments – Interruption management • Oral presentation guidelines – Case-based practice

SIGNOUT mnemonic S Sick or not? Code status I ID data G General hospital course N New events of the day O Overall clinical status U Upcoming possibilities, rationale and plan T Tasks to complete overnight, rationale and plan ? Questions Back to medicine