Linking the Family Medicine Milestones to Your PCMH

Linking the Family Medicine Milestones to Your PCMH Curricula Rabin Chandran MD, David Ashley MD, Lauren Hedde DO, Judith Walker BA, Arnold Goldberg MD Brown/Warren Alpert School of Medicine/MHRI Lehigh Valley Health Network/Univ. of South Florida

Disclosures • None

Thinking of you • A special thanks to Judy Walker and her contributions to this presentation. • She was not able to travel with us to be here today after tragedy struck her family this year.

Overview • Intro – Milestones in perspective – (5 min) • Brainstorming - Prioritizing PCMH curricula – (10 min) • Two Examples – (5 min each) • Group work – applying Milestones to PCMH Curricula – (15 min) • Debriefing in as a large group – (20 min)

Introduction • • Competency Based Education The ACGME Core Competencies The Dreyfus Model Family Medicine Milestones

The ACGME Core Competencies • Patient Care (PC 1 -8) • Medical Knowledge (MK 1&2) • Problem Based Learning and Improvement (PBLI 1 -5) • Interpersonal and Communication Skills (ICS 1&2) • Professionalism (P 1 -3) • Systems Based Practice (SBP 1 -4)

ACGME Core Competencies Particularly Relevant to PCMH • PC – 2 Cares for patients with chronic conditions • SBP-1 Provides cost-conscious medical care • SBP- 2 Emphasizes patient safety • SBP-4 – Coordinates team-based care • PBLI – 3 Improves systems in which the physician provides care

The Dreyfus Model of Skill Acquisition • • • Novice – following rules, no responsibility Advanced Beginner Competent Proficient Expert – intuitive decision making, accountability (Dreyfus, H L and Dreyfus, S E (1986) Mind over Machine: the power of human intuition and expertise in the age of the computer, Oxford, Basil Blackwell)

Milestones Example SBP 4 – Coordinates Team Based Care • Level 1 – understands importance, respectful/effective team player • Level 2 – understands roles, accepts responsibility for coordination of care • Level 3 – engages appropriate teams, patient centered, seamless transitions/sustained relationship with patients • Level 4 – directs team to provide coordinated care • Level 5 – role models leadership, integration, and optimization of team based care.

Large Group Brainstorming • What are the Key PCMH skills and knowledge that should be prioritized when addressing the Family Medicine Milestones?

Curricular Element Group Medical Visits Where/How Taught PG Year Pertinent Milestone Level Specific Learning Objective SBP-4 Coordinates Team Based Care Level 4 : “Accepts responsibility for the coordination of care and directs appropriate teams to optimize the health of patients. ” Level 5: “Role models leadership, integration, and optimization of care team as to provide quality individualized care” How Assessed How Documented Direct Observation by the faculty PCMH team e. Value evaluation completed by faculty champion which specifically evaluates the R 3’s role in the visit Example Group Medical Visits PCMH Block 3 nd Rotation (2 Wed AM of the month) With guidance and supervision from faculty, PCMH R 3 runs the visit and leads the team to: prepare for and run the visit preview charts, review clinical markers set agenda, prepare for patient teaching complete notes, communicate with PCPs Lead a Group Medical Visit Provide educational topic to patients Manage group dynamics Practice motivational interviewing Help patients set self management goals Coordinate a team of the PCMH residents, faculty, and support staff

Curricular Where/How Taught PG Element Year Performance In the Administration 2, 3 Improvement & Leadership Projects Portfolio at the Continuity Care Site With help from the site’s team leadership & the residency team, the R 2: evaluates the needs of the practice proposes a PI project gathers data and presents results to the entire department and staff in November of the 3 rd year Work in a team with leaders at the practice site Participate in Learning Labs in the Administration and Leadership portfolio Attend various discussions and education presentations Pertinent Milestone PC – PC 1 Cares for acutely ill or injured patients in all settings SBP-4 coordinates team based care SBP-2 Emphasizes patient safety SBP- 1 provides cost conscious medical care Level Specific Learning Objective Pertinent Milestones Develops and Levels 4 implements a Practice PC-1 Improvement Arranges appropriate Project in their transitions of care Continuity Care SBP-4 Site Coordinates Team The residents Based Care learn the SBP-2 principles of the Emphasizing Patient Care Model, Safety rapid improvement PDSA cycles, and practice transformation LVHN Example How Assessed How Documented Evaluation by the leaders of each practice and the leaders of the Administration and Leadership Portfolio after a Grand Rounds presentation in November of their 3 rd year New Innovations evaluation completed by the faculty who lead the portfolio, the residency directors, the medical directors of the particular site, the resident’s advisor, and anyone in an On the Fly evaluation

Selection of Today’s PCMH Curricular Priorities • Which element of PCMH Curriculum will each group focus upon today?

Small Group Break Out • Each group will complete a matrix that links FM Milestones to a set of progressive PCMH learning objectives and evaluation strategies by year of training

Group Reports and Wrap-up • Sharing from each group • Discussion