Mary Thoesen Coleman

Introducing Practice-Based Learning and Improvement ACGME Core Competencies into a Family Medicine Residency Curriculum

BACKGROUND The Accreditation Council for Graduate Medical Education (ACGME) recommends integrating improvement activities into residency training. A curricular change was designed at the Department of Family and Community Medicine, University of Louisville, to address selected ACGME competencies by incorporating practice-based improvement activities into the routine clinical work of family medicine residents. METHODS Teams of residents, faculty, and office staff completed clinical improvement projects at three ambulatory care training sites. Residents were given academic credit for participation in team meetings. After 6 months, residents presented results to faculty, medical students, other residents, and staff from all three training sites. Residents, staff, and faculty were recognized for their participation. PROGRAM EVALUATION Resident teams demonstrated ACGME competencies in practice-based improvement: Chart audits indicated improvement in clinical projects; quality improvement tools demonstrated analysis of root causes and understanding of the process; plan-do-study-act cycle worksheets demonstrated the change process. CONCLUSIONS Improvement activities that affect patient care and demonstrate selected ACGME competencies can be successfully incorporated into the daily work of family medicine residents.

Teaching Medical Faculty How to Apply Continuous Quality Improvement to Medical Education

BACKGROUND An eight-hour workshop was conducted at a professional meeting in 1996 to introduce medical faculty to the principles of continuous quality improvement (CQI) as they relate to change in medical education and to provide participants with opportunities to use specific tools for applications to education. Four two-hour sessions focused on an introduction to CQI, understanding and mapping processes, identifying change ideas, and testing a change for improvement. TESTING A CHANGE FOR IMPROVEMENT The goals of the final session were to plan a pilot test of an improvement, identify the steps of the plan-do-study-act (PDSA) cycle, and consider change for improvement in the context of ones own organization. Working in small groups, participants chose a specific change one might try in the following example: improving student performance in a neuroscience course. POSTSESSION EVALUATION AND FOLLOW-UP: Immediately following the workshop sessions, participants represented by administrators in medical education and clinical and basic science teaching faculty completed evaluations on the usefulness and likelihood of their using CQI tools. One year later, of the 32 workshop registrants who were mailed surveys, 15 respondents rated their change in understanding of CQI and their use of CQI techniques. More than 60% of the respondents reported application of CQI principles at their organizations. CQI methods used most frequently included structured team meetings, prioritizing opportunities, and brainstorming. CONCLUSION The significant application of CQI principles and methods reported by participants one year after a brief intervention supports a need and utility for CQI principles and tools in medical education.

Teaching geriatric medicine through videoconferencing

Context and setting As a state in which health care delivery is predominantly rural and provider supply is insufficient, Kentucky has begun using electronic medical communications systems (EMCSs) (specially adapted cameras, stethoscopes, audio equipment) to permit delivery of health care across distances. The Kentucky Telehealth Network (KTN), combining the resources of the Universities of Kentucky and Louisville, is a consortium of health care facilities and providers committed to overcoming health care barriers of time and distance through the use of EMCS. Family medicine’s geriatric fellows and residents at the University of Louisville, at an affiliated rural Glasgow site, and at a rural Madisonville programme participated in geriatrics educational sessions that consisted of monthly consultations and related educational conferences. Why the idea was necessary The Institute of Medicine (IOM) has challenged health professions educators to incorporate patient-centred care, interdisciplinary teams, evidence-based medicine, practice improvement and information technology into the curriculum. Teleconferencing addresses all 5 areas and provides an efficient, effective way to incorporate case-based geriatrics learning into 3 residency curricula simultaneously. What was done Using videoconferencing, faculty members at 3 sites planned the scheduling logistics and format for monthly combined clinical consultation and educational sessions. On the day prior to the session, the rural team faxed patient information and questions of interest to the geriatrics team, which was composed of a pharmacist, a geriatrician fellow and faculty member, a nurse practitioner and a social worker. During the first hour of videoconferencing, a rural family medicine resident consulted with the Louisville interdisciplinary geriatrics team concerning the management of an elderly patient present on video for interview and examination. After the consultation during the second hour, the geriatrics team, directed by a faculty moderator, provided an interactive session with learners at the 3 sites, addressing issues and questions raised by the consultation. For each of the 6 patients, the geriatrics team emphasised the identification of curative, palliative or rehabilitative goals of care. Topics addressed included the management of anorexia, weight loss, anaemia, depression, dementia, pancytopenia, haematochezia, hyperlipidaemia, orthostasis and syncope, as well as the use of appropriate medications, oral health issues, treatment recommendations for depression, fall prevention, risks of coumadin therapy, discharge planning, interdisciplinary treatment plans, safety and functional status issues, and advanced directives. Evaluation of results and impact The programme engaged learners in the 5 areas prioritised by the IOM:

A campaign approach to medical school programme objectives

Context and setting Data on interns obtained during their 1-year pre-registration service were used to induce curriculum change. The initiative resulted in a 5-year, semi-integrated, organ system-based curriculum implemented in 1998. It is the third curriculum to be initiated since our medical school was established in 1965. Why the idea was necessary In 1994, Ministry of Health consultants who supervised our graduates indicated that, although the graduates excelled in knowledge and skills, they lacked leadership qualities, interpersonal and communication skills, teamwork skills, and knowledge of medical economics and recent advances in medicine. What was done A curriculum review carried out in 1996 resulted in the New Integrated Curriculum (NIC). This consisted of 3 vertical strands: