ABIM FOUNDATION FORUM
IN MEDICAL EDUCATION AND TRAINING
Monday, August 2, 2010
Table of Contents
n About the FormAt 2
n Assessment Processes 3
n comPetencies beyond Knowledge 9
n overAll redesign 23
n ProFessionAlism/culture 31
n settings 37
n reFerences 42
Dear Forum Participants:
As part of day 2 of the 2010 Abim Foundation Forum, we are pleased to welcome you to a special plenary session,
entitled “description of early Adopters and Presentations.” is session will feature the work of 20 early adopters
of innovation in medical education and training. e term “early adopters” originates from everett roger’s book
Diﬀusion of Innovations which describes those individuals who are among the ﬁrst to adopt a new idea or process.
to identify these early adopters, the staﬀ of the American board of internal medicine and Abim Foundation
drew on the expertise of the Forum Planning committee, Abim Foundation trustees and directors, medical
board and society leaders, and other education and training experts. ese innovations span both undergraduate
and graduate medical education and training, and represent internal medicine, family medicine, pediatrics, surgery
and anesthesiology, as well as interprofessional collaborations. ese innovations also span a wide range of topics:
Assessment Processes, competencies beyond Knowledge, overall redesign, Professionalism/culture, and settings.
we would encourage you to read the guide prior to the session so that you can familiarize yourself with these
impressive innovations and make the most eﬀective use of your time. Page 2 provides further explanation of the
session format. Following the explanation of the session format, innovation categories are arranged alphabetically,
and within each category, the innovation abstracts are listed alphabetically by title. Abstracts are accompanied by
biographies of the early adopters. relevant references for each category can be found on pages 42-44. copies of
all of the articles listed are provided on your usb key.
we look forward to your active engagement in a stimulating session.
DANIEL WOLFSON ERIC HOLMBOE BEVERLY WOO
ABIM Foundation Session Speaker Session Facilitator
2010 Abim FoundAtion Forum 1
About the Format
PLENARY – DESCRIPTION OF EARLY ADOPTERS REFLECTIONS ON PRESENTATIONS BY EARLY
10:00 - 11:30 am ADOPTERS: SMALL GROUP DISCUSSION
Facilitator: beverly woo 11:30 am – 12:35 pm
eric holmboe Facilitator: barry egener
After introductory remarks, the early adopters will present in Goals:
two 30-minute rounds. Forum participants will select one early n explore how to integrate innovations across the
adopter per round (two total) whom they wish to hear present, continuum of education and training and promote
and coordinate with other table members to ensure that each collaboration among organizations working on reform.
early adopter is heard by at least one table member.
n examine how to promote and spread new ideas.
Goals: n discuss how to ensure accountability for education and
n introduce typology and framework of early adopters training goals.
of innovations in medical education and training.
n identify ways to continue to advance the state of the
n invite participants to explore multiple innovations art in teaching and assessment.
through small group presentations.
each early adopter will deliver a brief presentation about
their poster and then engage in discussion with their audience
members. After 30 minutes, participants will rotate to hear their
second early adopter present. At the end of these two rounds,
participants will return to their tables and share their observations
with fellow attendees. e next session will involve reﬂecting
on the presentations related to the “spread” of innovations and
integration along the continuum.
2 innovAtive AdvAnces in medicAl educAtion And trAining
Evaluation of Core Competencies at Baseline:
How Can This Information be Used?
Presented by monica lypson RESULTS
the PoA overall score represents a moderate, statistically
significant predictor of the American board of Pediatrics board
BACKGROUND Percent correct score (r=0.398, p=0.044, n=26). we have
in order to determine competence or assess milestone achieve- identified a trend that the PoA overall score is a predictor of
ment, baseline measures of performance must be established. performance on the in-training examination in Physical medicine
the university of michigan developed a Post-graduate & rehabilitation, although not statistically significant (r=.546,
orientation Assessment (PoA) to determine intern p=0.066, n=12).
OBJECTIVES hospital orientation proves to be an ideal time to gather initial
since 2002 there have been 1,342 residents who have taken the performance data on entering post-graduate trainees, and baseline
PoA, of which 1,255 were interns. the PoA focuses on know- performance on the Accreditation council on graduate medical
ledge and skills needed during the first six to 18 weeks of their education (Acgme) general competencies maybe a predictor of
residency and emphasizes clinical situations that are often future board performance.
encountered without formal supervision.
METHODS many institutions/programs have adopted an intern assessment.
Assessments include verbal/written handoff (university of Further work is needed on the predictive value of the PoA.
chicago model), informed consent, geriatric functional curriculum efforts must be adjusted to reflect intern deficits.
assessment (or pediatric history taking), aseptic technique,
evidence-based medicine, diagnostic images, critical laboratory
values, cross-cultural communication and Joint commission
requirements such as surgical fire safety and pain assessment.
Assessment measures include standardized patients as well
as computer-based and multiple-choice questions.
4 innovAtive AdvAnces in medicAl educAtion And trAining
dr. lypson, a board certified internist, is dr. lypson received her undergraduate degree from brown
Associate Professor of internal medicine university and her medical degree from case western reserve
and Assistant dean of graduate medical university school of medicine. Following medical school, she
education (gme) at the university of completed her residency in internal medicine – primary care at
michigan health system (umhs). she the brigham and women’s hospital followed by a robert wood
practices at the vA Ann Arbor healthcare system (vAAhs) and Johnson clinical scholars program at the university of chicago.
is also the Faculty Advisor for the umhs standardized Patient
Program. she is currently pursuing her masters in health professions
education at the university of illinois.
dr. lypson most recently served as the sociocultural curriculum
director and as a Faculty Facilitator in the Family centered
experience program; prior to that she served as Associate chief
of staff for Ambulatory care at the vAAhs from 2003 to 2005.
dr. lypson’s research interests include trainee assessment, leader-
ship and the under-representation of minorities in academics.
she has developed and led the implementation of an orientation
objective standardized examination for all incoming interns at
umhs. she serves on the national board of medical examiners
integrated case development task Force and is active in the
Association of American medical colleges (AAmc) group on
resident Affairs, a member of the national steering committee,
central group on educational Affairs – gme section leader and
national secretary of the society of general internal medicine.
2010 Abim FoundAtion Forum 5
Milestones of Competency in Graduate Medical Education
Presented by richard bell and eric holmboe RESULTS
internal medicine initially defined 142 discrete behavioral-based
milestones and is now exploring implementation and assessment
BACKGROUND strategies focused around key developmental points in training.
with the launch of the Accreditation council for graduate in contrast, general surgery first identified critical domains of
medical education (Acgme) outcomes Project in 2001, the practice and then points and skills in development within those
framework of graduate medical education (gme) shifted from a domains and subsequently populated those points with narrative
time and process model to an outcomes-based model. goals for descriptions of milestones defining competence. both of these
this transition include better assessment and evaluation of trainees approaches include the identification of critical points for focused
and reassuring the public that the gme community is training assessment using more discrete behavioral milestones.
physicians who are capable of providing safe and effective care
to the u.s. population. CONCLUSION
developing specialty-specific milestones of competency can
OBJECTIVES provide a framework for enhancing the assessment and evaluation
to advance the outcomes Project, the Acgme has launched of physicians in training and can foster the development of shared
a gme community-wide initiative to define milestones of approaches to competency-based medical education across all
competency and identify assessment tools that document the specialty training programs. initial work developing milestones
achievement of milestones. by definition, milestones identify has identified potential synergies in development and
significant points in development that should allow the trainee, implementation strategies.
the program and the certification board to identify an individual’s
trajectory in acquiring competencies.
the internal medicine and general surgery gme communities
have developed draft milestones documents and are currently
working on implementation strategies. while each specialty
approached this task differently, their work includes common
6 innovAtive AdvAnces in medicAl educAtion And trAining
Richard Bell Jr. Eric Holmboe
dr. bell, a board certified general surgeon, dr. holmboe, a board certified internist,
is the Assistant executive director of the is chief medical officer and senior
American board of surgery, inc. he vice President of the American board
chairs the surgical council on surgical of internal medicine and the Abim
education, founded in 2006, a consortium Foundation. he is also Professor Adjunct
of seven surgical organizations whose mission is to improve of medicine at yale university, and Adjunct Professor at the
graduate surgical education. uniformed services university of the health sciences.
dr. bell was the loyal and edith davis Professor and chair of Previously, he was Associate Program director, yale Primary care
the department of surgery at the Feinberg school of medicine internal medicine residency Program, and director of student
of northwestern university in chicago. Prior to joining the clinical Assessment, yale school of medicine. before joining
faculty at northwestern, he served as vice-chair of surgery at yale, he was division chief of general internal medicine at the
the university of washington and division chief of general national naval medical center.
surgery at the university of cincinnati.
his research interests include interventions to improve quality
he is chair of the Accreditation council of graduate medical of care and methods in the evaluation of clinical competence.
education milestones Project working group in general A frequently-requested speaker, he is the author of more than
surgery. he currently chairs a joint project of several surgical 100 peer-reviewed articles in professional journals. dr. holmboe
boards to define competencies expected of surgeons in the care is a member of the boards of the national board of medical
of geriatric patients. he is a member of the national Advisory examiners and medbiquitous, and is a consultant for the drug
committee for the robert wood Johnson clinical scholars safety and risk management subcommittee of the Pharmaceuti-
Program. dr. bell has served as President of the central cal science Advisory committee for the u.s. Food and drug
surgical Association and the Association for Academic Administration. he is a Fellow of the American college of
surgery and vice-President of the society for surgery of Physicians and an honorary Fellow of the royal college of
the Alimentary tract. Physicians in london.
dr. bell received his undergraduate degree at Princeton dr. holmboe is a graduate of Franklin and marshall college
university, and he received his medical degree from and the university of rochester school of medicine. he
northwestern university. completed his residency and chief residency at yale-new haven
hospital, and was a robert wood Johnson clinical scholar at
2010 Abim FoundAtion Forum 7
Achieving the Systems-Based Practice (SBP) Competency by
Implementing a Web-Based Business of Medicine Curriculum
Presented by Paul taheri RESULTS
A total of 99 residents from university of michigan, henry Ford
health system, banner good samaritan and the American board
BACKGROUND of surgery completed the curriculum. mean pre-test score was
the focus of the sbP competency is to encourage physicians to 55+ 11 and mean post-test was 75+ 11.6. on average, residents
leverage health system assets to provide optimal care to patients. completed modules in 35 minutes. the vast majority of residents
heath systems are complex, capital-intensive businesses that (>90%) rated the curriculum well organized, relevant, an excellent
typically are poorly integrated, have diffuse governance structures learning experience and overall a positive experience, with the
and are increasingly bottom-line focused. Physicians often content not taught elsewhere in training.
manage these complex business entities with little or no formal
business training. Physicians are in need of an understanding of CONCLUSIONS
the fundamental principles of business applied to health care. the findings of this analysis demonstrate that this business
curriculum is easy to use, cost effective, demonstrates learning
OBJECTIVE and provides a credible platform for achieving the systems-based
to assess the learning outcome and satisfaction of a web-based Practice competency.
business curriculum specifically developed for house officers.
METHODS this business curriculum can be easily disseminated to any and all
Access to a curriculum of 28 web-based modules covering topics interested programs. recently, the curriculum was incorporated
such as economics, finance, operations management, leadership into the American board of surgery online score curriculum.
and other business disciplines, was provided to 99 house officers
in multiple training programs across the united states. Pre- and
post-testing was performed at the outset and after curriculum
completion. overall satisfaction with the curriculum was also Additional Authors:
assessed. Deborah Harkins, RN, MBA, General Manager
and Senior Consultant, MDContent; David Butz, PhD,
Founder and Co-Director, Center for Health Care Economics,
University of Michigan
10 innovAtive AdvAnces in medicAl educAtion And trAining
dr. taheri, a board certified general dr. taheri is President-elect for the group on Faculty Practices
surgeon, is a Professor of surgery at the of the Association of American medical colleges. he is an
university of vermont, sr. Associate dean examiner for the American board of surgery. he has delivered
for clinical Affairs and President of the numerous presentations to hospitals and physician groups on
Faculty Practice at Fletcher Allen health various business topics including cost of care, physician leadership
care in burlington, vt. he oversees and manages a 500 member and system optimization.
multispecialty practice with approximately $250 million in annual
revenue. he also holds teaching positions at the university of dr. taheri is a graduate of st. lawrence university and earned
michigan ross school of business and the university of vermont his medical degree from new york university. he completed his
school of business. residency at tulane university.
From 1996 to 2007, dr. taheri led the university of michigan
division of trauma burn and emergency surgery. during his
tenure, he became the Associate dean for Academic business
development. in that role, he oversaw the intellectual property
management and technology transfer at the school of medicine,
and he developed a comprehensive leadership development course
for the medical school faculty with the ross school of business.
he also served as vice chair, department of surgery and, as a
joint initiative between the university of michigan business
and medical schools, developed the center for health
2010 Abim FoundAtion Forum 11
An Assessment of an Educational Intervention on Resident
Physician Attitudes, Knowledge and Skills Related to Adverse
Presented by david mayer RESULTS
Following the intervention, the number of adverse event
reports increased from zero per quarter to almost 30 per quarter.
BACKGROUND we identified several categories of harm events, near misses
reporting and learning from patient harm, near misses and unsafe and unsafe conditions, including reports of disruptive providers.
conditions is critical to improving patient safety. Programs that of the events associated with invasive procedures, more than
engage resident physicians in adverse event reporting can enhance half were associated with lack of attending physician supervision.
patient safety and simultaneously address all six competencies we also observed significant progress in the residents’ ability to
of the Accreditation council for graduate medical education appropriately file a report, improved attitudes regarding the value
(Acgme). however, fewer than 60 percent of physicians know of reporting and available emotional support and a reduction in
how to report adverse events and near misses, and fewer than 40 perceived impediments to reporting.
percent know what to report.
OBJECTIVE An educational intervention with residents can result in improved
to evaluate the effect of an educational intervention on anesthesi- attitudes toward adverse event reporting, and increased reporting.
ology residents’ attitudes, knowledge and skills related to adverse
event reporting and the associated follow-up.
in a prospective study, anesthesiology residents participated in
a training program focused on the importance of patient event
reporting in patient safety and reporting methods. Quarterly
adverse event reports were analyzed retrospectively for two years
prior to the intervention and prospectively for seven quarters
following the intervention. residents also completed a survey
prior to and one year after the intervention, evaluating their
attitudes, experience and knowledge regarding adverse event
12 innovAtive AdvAnces in medicAl educAtion And trAining
dr. mayer is Associate dean for schools, two Anesthesia Patient safety Foundation grants on
curriculum, vice-chair for safety and resident training for handoffs and a local anesthetic toxicity rescue
Quality, co-executive director of the training program. in 2007, dr. mayer was awarded the university
institute for Patient safety excellence of illinois American Association of medical colleges/Pfizer
and curriculum director for the masters humanism in medicine Award for his commitment to teaching,
in Patient safety leadership program at the university of illinois service, patient advocacy and patient care.
at chicago. he is board certified in general anesthesiology.
dr. mayer earned his medical degree from the university of
A pioneer in patient safety curricula, dr. mayer founded the illinois and completed his residency and fellowship at michael
telluride, colorado invitational roundtable on designing reese hospital in chicago.
Patient safety curricula. the annual multidisciplinary roundtable
brings together leaders from the American medical Association,
American nurses Association, the Joint commission, national
board of medical examiners, Accreditation council of graduate
medical education, American board of internal medicine,
lucian leape institute and health science education with
patients, residents and students.
dr. mayer is a member of the national Quality Forum Patient
safety advisory board, a consultant to the new south wales’
national task Force addressing safety, quality and education, and
a member of the lucian leape institute patient safety educational
roundtable. he is principal investigator on a number of grants
including three u.s. department of education grants on the
design and assessment of patient safety education for medical
2010 Abim FoundAtion Forum 13
Milestones to Teach and Evaluate Handoffs
Presented by vineet Arora and holly humphrey RESULTS
third-year students receive training on how to transform clinical
data into a written signout ensuring hiPAA compliance. rising
BACKGROUND senior students are taught how to conduct verbal signout during
with reduced resident duty hours, improving handoffs is their subinternship orientation. using case-based workshops and
paramount to patient safety. tools to teach and evaluate handoffs simulation, graduating students and incoming medical interns
are lacking. the university of chicago’s vertically integrated practice giving and receiving handoffs. residents receive training
undergraduate and graduate medical education structure enables in supervising and evaluating handoffs. Faculty development in
the development and implementation of innovative education how to incorporate handoff teaching into daily rounds is ongoing.
and evaluation across the continuum of medical training.
OBJECTIVE using handoff milestones, it is possible to develop and implement
to develop and implement handoff teaching and evaluation that handoff teaching and evaluation across learner levels from medical
address milestones in handoff education from medical student to student to faculty.
METHODS disseminate findings via national meetings, publications,
A needs assessment was conducted to assess clinical student mededPortal, speaking engagements and web-based platforms
exposure and participation in handoffs. milestones for handoff to house tools (website, youtube channel, slideshare).
education and evaluation were developed and reviewed by external
experts for content validity. education and evaluation tools were
created to address each milestone. working with curriculum
committees for the medical school and internal medicine
residency, education and evaluation for learner levels is being
Jeanne Farnan, MD, Assistant Professor of Medicine,
Department of Medicine, University of Chicago
14 innovAtive AdvAnces in medicAl educAtion And trAining
Vineet Arora Holly Humphrey
dr. Arora, a board certified internist, is dr. humphrey, a board certified internist,
an Associate Professor of medicine and is Professor of medicine and dean for
the Associate Program director for the medical education at the university of
medicine residency and Assistant dean chicago. she served as chief medical
for scholarship and discovery at the resident before joining the faculty as
university of chicago Pritzker school of medicine. an Assistant Professor in 1989.
dr. humphrey was promoted to Professor in 2000 and was
dr. Arora’s scholarly work on resident duty hours, patient hand- the first clinician-educator at the university of chicago awarded
offs, medical professionalism, and quality and safety has appeared tenure. dr. humphrey is a member of the board of trustees of
in The Journal of the American Medical Association, Academic the Abim Foundation and she previously served on the board
Medicine and Annals of Internal Medicine and has been covered by of directors of the American board of internal medicine from
The New York Times, cnn and Abc news. she testified to the 2001 to 2007, including a term as chair from 2006 to 2007.
institute of medicine on resident duty hours and handoffs and to
congress on the need for physician payment reform to revitalize Prior to accepting her current position as dean, she spent 14 years
primary care. dr. Arora served on the American board of as director of the internal medicine residency Program.
internal medicine (Abim)’s hospital medicine subcommittee
and internal medicine Question writing committee. she was dr. humphrey was recently elected a master by the American
the site champion for the Abim care of the vulnerable elderly college of Physicians (AcP). in 2009, Crain’s Chicago Business
Pim study and is Principal investigator for the Abim Founda- featured her as one of their “women to watch.” she is a former
tion’s Putting the charter into Practice project grant. President (1995) of the Association of Program directors in
internal medicine and later received the dema c. daley Founders
dr. Arora has received numerous awards, including the society Award from that same organization. dr. humphrey has authored
of general internal medicine’s milton hamolsky Award and more than 60 articles and edited three books, including Mentoring
the American college of Physician’s walter J. mcdonald Award. in Academic Medicine.
in 2009, ACP Hospitalist named her among the top 10 hospitalists
in the united states. An honors graduate of the Pritzker school of medicine,
dr. humphrey completed her residency and pulmonary-critical
dr. Arora earned her medical degree from washington university care fellowship at the university of chicago.
in st. louis. she completed her residency, chief residency and
master’s degree in public policy at the university of chicago.
2010 Abim FoundAtion Forum 15
Patient Safety: Internal Medicine Residents as Agents of Change
Presented by noelle sinex standardized format, and selected one to formally present at a
multi-disciplinary conference. A new chief resident position
for quality improvement and patient safety was developed to
BACKGROUND champion the curriculum and consultative rotation.
Patient safety literature offers few practical solutions on the
implementation of an integrated, system-wide application of RESULTS
patient safety approaches to clinical practice, let alone graduate the success was evaluated by surveys of the patient safety culture
medical education. graduate medical education seems to be a and evaluation of the qualitative reflections of participating
critical partner in patient safety given that residents provide residents. Quantitative data including the number and nature
direct patient care and should understand the concept of patient of safety consults was collected and processed. chief residents
safety and the institutional methods that support patient safety and faculty provided evaluation of the end-of-rotation safety
practices. conference presentations. Patient outcomes data related to safety
and quality demonstrated positive change from resident-driven
OBJECTIVE improvement projects. the chief resident for Quality and safety
to create an explicit shift in graduate medical education toward completed multiple projects and presented three posters and two
patient safety and shared accountability while driving improve- workshops from her work.
ment in the indiana university school of medicine (iu som)
hospital system. researchers sought to teach key patient safety CONCLUSIONS
and quality improvement concepts to internal medicine residents, involving residents in the process of analyzing errors and critical
and to instill and reinforce the habit and culture of patient safety. incidents and then enlisting them to find solutions to prevent
future events is a powerful tool. Providing a focused experience
METHODS in patient safety and appropriate mentorship produces outcomes
iu som researchers developed a curriculum to teach both key that residents identify as valuable and important to their career.
patient safety concepts and their practical application to internal
medicine residents. A patient safety consultative rotation was NEXT STEPS
developed that included key readings and didactics, participating the team plans to launch this service in their county hospital
in hospital committees and quality improvement initiatives, and beginning July 2010 and make this rotation a graduation require-
conducting “safety consultations” on patient cases. residents ment for residents in the iu som’s internal medicine residency
researched and evaluated key incidents for errors using a program.
16 innovAtive AdvAnces in medicAl educAtion And trAining
dr. sinex, a board certified internist, dr. sinex has a professional interest in teaching ambulatory
serves as Associate Program director for medicine, women’s health, quality improvement and patient
Ambulatory care and as medical director safety. she has received multiple teaching awards from iu’s
of the women’s health Program at the department of medicine and its internal medicine residency
richard l. roudebush veterans Affairs program, including the indiana school of medicine trustee
medical center (roudebush vAmc), in indianapolis. there, she teaching Award in 2008.
participates in the educational innovations collaborative through
the office of Academic Affiliations. Previously, she served as dr. sinex received her bachelor’s degree from centre college,
Ambulatory chief resident at the roudebush vAmc from and she earned her medical degree from indiana university
2003 to 2004, and worked in the dedicated teaching clinic. school of medicine.
dr. sinex is also Associate Program director for the internal
medicine residency program at indiana university (iu). iu
is one of nineteen programs designated as an educational
innovations Project (eiP) program. As a leader in this project,
she has been involved in educational innovations in patient safety
and ambulatory education. dr. sinex’s participation in the eiP
collaborative is through the office of Academic Affiliations at
the roudebush vAmc.
2010 Abim FoundAtion Forum 17
Training Interprofessional Teams of Students and Health
Professionals in Quality Improvement
Presented by leslie hall teamwork in health care and helped them appreciate contributions
of other health professionals. student skills in Qi, as assessed by
the Quality improvement Knowledge Assessment tool (QiKAt),
BACKGROUND increased as a result of the training, and were significantly better
in 2006, university of missouri health care began jointly than Qi skills in control groups of students who did not complete
training health care students and professionals in quality improve- the Qi training.
ment (Qi) skills, as members of interprofessional teams.
OBJECTIVE health care students trained in the improvement of health care as
to determine (1) if health care students perceive value from part of interprofessional teams view the process as valuable. their
participating in interprofessional Qi team training and (2) if Qi skills improve significantly following the experience.
health care improvement skills increase as a result of this
experience. NEXT STEPS
replication of this model at other academic health centers should
METHODS be considered.
each team included health care workers, students and at least
one Qi facilitator. large group interactive learning sessions,
which focused on fundaments of Qi process, were complemented
by small group work on an improvement project over a five-
month period. improvement project results were presented to
health system leaders at the end of training.
twenty-four teams comprised of 147 unique individuals (81
health care workers and 66 students) completed this training
from 2006 to 2010. satisfaction with the training was high, with
participants expressing agreement that the training developed
their Qi skills, helped them gain a greater understanding of
18 innovAtive AdvAnces in medicAl educAtion And trAining
dr. hall, a board certified internist, is teaching quality improvement skills to medical and nursing
the senior Associate dean for clinical trainees who were imbedded within system improvement teams.
Affairs at the university of missouri – in 2007, he received the distinguished Quality Professional
columbia school of medicine, and the Award of the missouri Association for healthcare Quality. he
chief medical officer for university received the national Award for excellence in teaching from the
of missouri health care. national Association of inpatient Physicians (now society of
hospital medicine) in 2001.
From 2002 to 2008, dr. hall served as the director of the office
of clinical effectiveness, overseeing quality improvement and dr. hall received his medical degree from washington university
patient safety initiatives throughout university of missouri in st. louis, and completed his internal medicine residency at
health care. he has led several curricular innovations in the bethesda naval hospital in bethesda, maryland.
areas of quality improvement, patient safety and teamwork in
health care. he co-leads the university of missouri Performance
improvement leadership development course.
For the past two years, dr. hall has served as co-chair of the
Academy for healthcare improvement Professional education
resource committee. he served as a physician advisor for
Quality and safety education in nursing, a national robert
wood Johnson initiative, from 2005 to 2008. From 2004 to
2008, dr. hall served as the primary investigator at the university
of missouri for the Achieving competence today program,
2010 Abim FoundAtion Forum 19
Patients and Families as Advisors:
Enhancing Medical Education Curricula
Presented by Janice hanson RESULTS
the parents in the initial group described physician behaviors and
attitudes in four categories: self-awareness (e.g., acknowledgement
BACKGROUND of limits, attitudes about people with disabilities), communication
Patients and caregivers bring a perspective to medical education (with patients, families and health professionals), shared medical
that informs the development of curriculum activities and helps decision-making and advocacy (for individuals and at the system
build a patient-centered, family-centered approach to care among level).
to date, a diverse group of more than 200 patients and family
OBJECTIVE members have participated in the development of medical
by using patients and families as advisors, the group sought to education curriculum activities and teaching over 10 years. early
enhance the medical education curricula at the uniformed curriculum activities included a pediatric home visit with parents,
services university of the health sciences in bethesda, md. children and young adults as teachers, small-group discussions
about ethical decision-making, patients and parents coaching
METHODS students in communication skills, and a workshop about
initially, 12 parents of children with chronic health conditions advocating for patients and families.
were convened to describe physicians who had been most helpful
to their families. the group met for four months to learn CONCLUSIONS AND NEXT STEPS
about medical school, describe physician behaviors and attitudes, Activities from early efforts have been progressively revised to
group behaviors and attitudes in categories, and draft curriculum fit different places in the curriculum and adjusted curricular goals.
activities. new activities (e.g, a health supervision curriculum) have been
developed with advisor participation. Activities are currently
Following the initial effort, the patient and family advisory developed and co-taught with advisors in four academic
program was expanded. small groups of advisors meet to departments. the advisor group provides consultation to four
address focused topics and specific curricular materials. with committees that are working on curriculum reform. new focus
a facilitator, they share experiences, write behavioral descriptors, groups will reconsider the original four categories of physician
draft materials and develop activities. Advisors with relevant behavior for possible revision.
experience teach with other medical school faculty.
20 innovAtive AdvAnces in medicAl educAtion And trAining
Janice hanson, Phd, is Associate in 2002, dr. hanson, along with other members of the Pediatric
Professor of medicine, Pediatrics and education section at usu, received the Ambulatory Pediatrics
Family medicine at the uniformed Association 2002 national teaching Award. in 2010, she was
services university of the health sciences elected as the Putnam scholar by the American Academy on
(usu). with funding from the Josiah communication in healthcare to further her work in assessment
macy, Jr. Foundation and the health resources and services and teaching of communication skills in medical education.
Administration, dr. hanson developed a large, diverse and active
group of patient and family advisors to co-develop and co-teach dr. hanson holds degrees in education from western
curriculum activities in the medical education program. she now michigan university and east carolina university, as well as
directs this ongoing patient and family advisor program, involving both educational specialist and doctor of philosophy degrees
the advisors in courses and clerkships in four departments during from the university of michigan.
the entire span of the medical education program.
dr. hanson’s work focuses on communication and relationships
between patients, families and physicians, with a patient-
and family-centered orientation. usu recently began a
comprehensive curriculum reform effort, to which dr. hanson
will bring the patient’s voice. in addition to serving on the
assessment committee for curriculum reform, dr. hanson has
assembled a group of patient and family advisors to participate
in all aspects of curriculum reform, ensuring that faculty, students
and patient advisors will partner to design and implement the
new medical school curriculum at usu. the new curriculum will
more fully integrate science and clinical learning, with curricular
themes that include patient-centered care and patient safety.
2010 Abim FoundAtion Forum 21
Innovations in Residency Training – Mid-Stride Findings from
the P4 Project
Presented by larry green and James Puﬀer even though analysis of the project is still underway, we share
mid-stride results and lessons based on what the P4 evaluation
team has learned from site visits, standardized core data and a
BACKGROUND survey of the P4 programs concerning accreditation requirements.
the Preparing the Personal Physician for Practice (P4) project is
a six-year (2006 to 2012) national demonstration initiative of a CONCLUSIONS
spectrum of innovations in family medicine residency education. the P4 project will assist educators in preparing personal
the 14 participating programs form a comparative case study physicians to practice in the evolving models of advanced primary
of experiments that include changes in the length, structure, care and help guide necessary changes in the next set of revisions
content and location of training, and expanded measurements in the accreditation requirements for family medicine.
OBJECTIVE continue to disseminate important findings from the P4 Project
to answer questions such as how best to align residency to foster educational innovation and vital synergies in primary
training with the new model of practice and to clarify which care residency redesign.
educational methods are most effective in producing skilled
personal physicians for the Patient centered medical home.
evaluation of the innovations in the P4 project uses a mixed
method approach. the core data collected annually from all
programs are (1) Program data, (2) resident survey, (3)
continuity clinic data, (4) grad survey and (5) online diary
data. each program is using additional measures designed to
test their specific hypotheses.
24 innovAtive AdvAnces in medicAl educAtion And trAining
Larry Green James Puffer
dr. green, a board certified family dr. Puffer is President and ceo of the
physician, is Professor of Family American board of Family medicine
medicine and the epperson-Zorn (AbFm) in lexington, Ky. he is board
chair for innovation in Family medicine certified in family medicine and sports
and Primary care at the university of medicine.
Previously, dr. Puffer served as a faculty member of the university
Previously, he practiced medicine in van buren, Ariz., in the of california, los Angeles for over 23 years. during his tenure,
national health service corps. he joined the university of he was Professor and chief of the division of sports medicine
colorado faculty in 1977 and has served in various roles, in the department of Family medicine. he also served as Family
including department chair. he has championed practice based medicine residency director, chief of the division of Family
research for decades. in 1999, he became the founding director medicine and interim chair of the department of Family
of the robert graham center, a research policy center sponsored medicine, which he was instrumental in establishing.
by the American Academy of Family Physicians.
dr. Puffer was President of the Association of departments
dr. green served on the steering committee of the Future of of Family medicine. he was elected to the board of directors
Family medicine Project and directed the robert wood Johnson of American board of Family Practice, where he served as
Foundation’s Prescription for health national program. he is a vice President and on its executive committee. dr. Puffer
founding board member for Partnership 2040, and is chair of was also on the board of directors of the Pisacano leadership
the council overseeing the community engagement component of Foundation. he was editor-in-chief of Sports Medicine Digest,
the colorado clinical translational sciences institute, funded by and Associate editor of Medicine and Science in Sports and
the national institutes of health. dr. green is a member of the Exercise. he serves or has served on the editorial board of more
national committee on vital and health statistics, and co-chair than 10 journals. dr. Puffer has published a book and multiple
of the steering committee for Preparing the Personal Physician research articles and book chapters and has presented more
for Practice. he is the immediate past chair of the board of than 750 lectures.
directors of the American board of Family medicine, a member
of the board of directors of the American board of medical dr. Puffer completed his undergraduate, medical school and
specialties and a member of the institute of medicine. family medicine residency training at uclA.
dr. green is a graduate of the university of oklahoma. he
earned his medical degree at baylor college of medicine and
completed his family medicine residency at highland hospital
and the university of rochester.
2010 Abim FoundAtion Forum 25
Structured Career-Centered Block Time in a Pediatric
Presented by m. douglas Jones Jr. this block includes inpatient experiences at both tch and
community hospitals with special instruction in conscious
sedation and common procedures. it also includes experience
BACKGROUND with ambulatory care of children with special health care needs
Four consecutive months in Pgy-3 are set aside to improve to provide a sense of the role of hospitalists in a medical home,
preparation for four different careers: primary care with and i.e., the importance of continuity between hospital and routine
without convenient access to subspecialty care, hospitalist and emergency ambulatory care. time is also set aside for
medicine and subspecialty medicine. All residents are individually instruction in principles of medical education.
mentored and monitored during the four-month block. blocks
include mentored, practice-based learning and improvement SUBSPECIALTY
projects. this block occurs at tch and varies by subspecialty. the intent
is to supplement rather than duplicate later training. it includes
PRIMARY CARE instruction in principles and practice of medical education, and
these blocks take place at the children’s hospital (tch) in either a quality improvement or research project.
denver and metropolitan or non-metropolitan community sites.
residents are able to schedule appointments according to patient
need rather than resident availability. All receive supplementary
experiences in health maintenance, telephone triage and advice,
concepts of the medical home, practice management, billing and
coding, and child advocacy. they are exposed to subspecialties
most relevant to primary care (mental health, sports medicine,
dermatology, allergy). those intending to practice in non-
metropolitan sites experience practice in such sites to acquaint
them with the particular blend of procedural and practice
skills needed for those sites. Additional Author:
Adam Rosenberg, MD, Professor of Pediatrics, Director of Pediatric
Residency Program, University of Colorado-Denver
26 innovAtive AdvAnces in medicAl educAtion And trAining
M. Douglas Jones Jr.
dr. Jones is Professor of Pediatrics at dr. Jones received his master’s and medical degrees from the
the university of colorado school of university of texas southwestern medical school at dallas.
medicine. he is involved with medical he completed his internship and residency in pediatrics at the
education at this institution as well as university of colorado health sciences center and a fellowship
nationally through the new initiative for in neonatal-perinatal medicine at the university of colorado
innovation in Pediatric education (iiPe). dr. Jones is board health sciences center and the children’s hospital in denver.
certified in pediatrics and neonatal-perinatal medicine.
until 2005, he was Professor and chair of the department of
Pediatrics at the university of colorado school of medicine
and Pediatrician-in-chief and l. Joseph butterfield chair of
Pediatrics at the children’s hospital in denver. Previously, while
at the Johns hopkins university school of medicine, dr. Jones
served as Professor of Pediatrics and Associate Professor of
Anesthesiology and critical care medicine and of gynecology
he is the immediate past chair of the board of directors of
the American board of Pediatrics and was recently chair of the
Accreditation council for graduate medical education review
committee for Pediatrics. he has been a leader of two major
initiatives sponsored by the American board of Pediatrics
Foundation: one resulted in revision of pediatric subspecialty
training, and the other was the recently completed three-year
residency review and redesign in Pediatrics (r3P) project, a
comprehensive self-study and strategic planning project that
has continued as the iiPe.
2010 Abim FoundAtion Forum 27
Impact of an Interprofessional Central Venous Catheter Insertion
Presented by elliot sussman RESULTS
Focus groups confirmed the need for a check-off run and that
nurses are helping ensure sterile conditions and challenging
BACKGROUND residents on the number of needle stick attempts. statistical
evidence suggests that central venous catheter (cvc) insertion quality control measures were used to track the effect of the
training (barsuk 2009; evans 2009), the use of ultrasound training process on the clAb rate for cvcs (peripherally
guidance (leung 2006; milling 2005), and compliance with the inserted central catheters, Picc lines, excluded), which improved
institute for healthcare (ihi) central line bundle (Pronovost from 3.4 to 0.8 per 1,000 line days (P=0.001). reduced variability
2006; team stePPs 2010) improve patient outcomes. in the downward trending rate was reflected by the standard
deviation decreasing from 1.45 pre-training to 0.40 post-training.
to reduce cvc complications including central line associated CONCLUSIONS
bloodstream infections (clAb). the clAb rate was successfully reduced. check-off
competency runs and nurse collaboration in the checklist
METHODS are plausible contributing factors to success.
the cvc course is required of all residents who place central
lines at lehigh valley health network (lvhn) upon entry into NEXT STEPS
residency. A pre-course e-learning module with video vignettes central line training paradigms, including bedside checklists,
sets behavioral and collaborative expectations among all providers interprofessional training protocols and registry methods for
surrounding the procedure. the course includes: a half-day performance tracking require refinement and broader application.
practical portion with manikin practice, ultrasound for target
vessel verification and a checklist based competency evaluation. Additional Authors:
nurses participate in the course and ensure that the bedside James P. Orlando, EdD, Director, Medical Education Development;
checklist, which includes the ihi bundle, is used as it would be Andrew Miller, DO, Emergency Medicine Physician; William Bond, MD,
at the bedside. Assessments included post-course surveys, focus MS, Director of Research; Valerie Rupp, RN, MSN, Clinical Trial
groups, pre-/post-/delayed- knowledge tests and registry data Investigator; Bryan Kane, MD, Emergency Medicine Physician; Cindy
that tracks compliance with the ihi bundle and clAb. Umbrell, RN, MSN, Director, Trauma Neuro Intensive Care Unit; Michael
Pasquale, MD, Trauma Director; Elizabeth Verheggen, PhD, Researcher
28 innovAtive AdvAnces in medicAl educAtion And trAining
dr. sussman, a board certified internist, dr. sussman holds a masters degree in business from the
serves as President and chief executive wharton school at the university of Pennsylvania, a medical
officer of lehigh valley health network degree from harvard university and a bachelor’s degree from
(lvhn). under dr. sussman’s leadership yale university. he completed residency at the hospital of the
since 1993, lvhn evolved into one of the university of Pennsylvania. he completed a fellowship in
nation’s leading academic community hospitals. he is also the general medicine and was a robert wood Johnson clinical
leonard Parker Pool Professor of health systems management, scholar at the university of Pennsylvania.
and Professor of medicine at the university of south Florida
college of medicine.
From 1989 to 1993, dr. sussman was Associate dean and
Associate Professor of medicine at the university of chicago,
division of the biological sciences, Pritzker school of medicine.
he also served as executive director for clinical Practices
and Associate Professor of medicine for the university of
Pennsylvania, and Associate Administrator and director of the
clinical effectiveness Program at the hospital of the university
he is the immediate past chair of the board of directors of the
Association of American medical colleges. dr. sussman serves
on the boards of the Allentown Art museum, lehigh university,
lehigh valley Pbs/wlvt tv, the ceo education 2010
leadership group and the lehigh valley Partnership.
2010 Abim FoundAtion Forum 29
The Miller-Coulson Academy of Clinical Excellence at
Johns Hopkins Bayview Medical Center
Presented by scott wright RESULTS
the definition of “excellence in patient care in academia” has been
published. the clinical portfolio has proven to be discriminative
BACKGROUND and reliable. there was excellent agreement among members of
Academic medical centers (Amcs) are committed to the the erb, and with the internal committee, about which of the
tripartite missions of research, education and patient care. nominees would be accepted for membership in the Academy
Promotion decisions are focused predominantly on research (nine of the 18 faculty physicians were admitted in 2010).
accomplishment, and there continues to be concern about how through interdisciplinary collaboration, the 15 members of the
to recognize clinicians who spend a majority of their time and Academy are producing and planning innovative educational,
excel in caring for patients. advocacy and clinical programs that “promote excellence in
patient care for the benefit of the patients and communities
OBJECTIVE that we serve.”
to define “clinical excellence in academia,” to develop an
instrument to identify the physicians who are outstanding in CONCLUSIONS
the delivery of patient care, and to launch an academy dedicated transforming the definition of clinical excellence in academia into a
to promoting excellence in patient care. measurement tool has allowed us to induct exceptional physicians
into the miller-coulson Academy of clinical excellence.
METHODS the members of this “working” Academy are committed to the
through meetings with institutional and national leaders, a primacy of patient care and to influencing institutional culture.
systematic review of the literature and research (both qualitative
and quantitative), a definition for clinical excellence in academia Additional Authors:
was developed. this definition was then operationalized into a Steven Kravet, MD, MBA, Assistant Professor of Medicine and President,
measurement tool, the “clinical portfolio.” the portfolios (30+ Johns Hopkins Community Physicians; Colleen Christmas, MD, Assistant
pages), assembled by those nominated by peers for membership Professor of Medicine and Director, Johns Hopkins Bayview Internal Medicine
Residency Program; Chris Durso, MD, MBA, Assistant Professor of Medicine,
in the Academy, were evaluated and scored by an external review
Johns Hopkins Bayview; Kathleen Burkhart, Manager, Miller-Coulson
board (erb; akin to a study section) that is made up of national
Academy of Clinical Excellence; David Hellmann, MD, Vice Dean,
leaders in clinical performance. Johns Hopkins Bayview Medical Center and Chair, Department of Medicine,
Aliki Perroti Professor of Medicine, Physician-in-Chief, Johns Hopkins
Bayview Medical Center
32 innovAtive AdvAnces in medicAl educAtion And trAining
dr. wright, a board certified internist, were recognized by Jhusom and he was elected a member
is Professor in the department of in the Alpha omega Alpha honor medical society.
medicine at the Johns hopkins
university school of medicine ( Jhu- dr. wright received his medical degree from mcgill university.
som). he has been involved with he completed his internal medicine residency at montreal
many educational programs there, as well as with several medical general hospital.
education activities at the national level including the initiative
to transform medical education, innovative strategies for
transforming the education of Physicians, and programs of
the Arnold P. gold Foundation (an organization from which
he was awarded a professorship).
with colleagues, he developed and launched the miller-coulson
Academy of clinical excellence. dr. wright serves as director
of the Academy, which is committed to recognizing and
promoting excellence in patient care. he has been published in
leading biomedical research journals including The New England
Journal of Medicine, The Journal of the American Medical Association,
Annals of Internal Medicine and The American Journal of Medicine.
in recognition of his research accomplishments, dr. wright
was elected to membership in the American society for clinical
investigation. his achievements in teaching and patient care
2010 Abim FoundAtion Forum 33
Transforming the Culture of a Large Academic Medical Center:
Where We’ve Been, Where We Are, Where We’re Going
Presented by d. craig brater, richard Frankel and METHODS
Penelope williamson with the help of two external facilitators, the rcci used
principles of emergent design and appreciative inquiry to guide
the change process. over the course of five years, 175 faculty
BACKGROUND and students initiated more than 30 change projects, including
in 1999, after eight years of planning, indiana university admissions criteria, faculty development, coaching for senior
school of medicine (iusm) adopted a competency curriculum administrators and developing new faculty hiring practices.
for undergraduate medical students. the nine competencies in
the curriculum are: effective communication; basic clinical RESULTS
skills; using science to guide medical decisions; lifelong significant cultural change has occurred as evidenced by
learning; self-Awareness; social & community contexts of AAmc exit questionnaire data, faculty vitality surveys and
health care; moral reasoning and ethical Judgment; Problem student narratives.
solving; Professionalism & role recognition.
despite this groundbreaking step, the school faced several large-scale cultural change is possible using emergent design,
ongoing challenges: a large, complex, intensely bureaucratic an appreciative approach and belief in the positive potential for
organizational structure; students’ dissatisfaction with their change. such change depends upon creating opportunities for
educational experience; significant gaps between the hidden individuals at all levels of the organization to create and sustain
curriculum and the formal competency curriculum; and a lack change over time.
of faculty development to implement the new curriculum.
OBJECTIVE many senior leaders have already, or will soon retire. rcci
in 2003, the relationship-centered care initiative (rcci) was principles in operation to ensure a smooth transition include
launched with the goal of changing the culture of the medical mindfulness about succession planning and continued evolution
school to better align the hidden and formal curricula. of appreciative practices that facilitate the change process.
34 innovAtive AdvAnces in medicAl educAtion And trAining
D. Craig Brater dr. brater attended undergraduate and medical school at
duke university. he completed his internship at duke and
his residency at ucsF, followed by a fellowship in clinical
dr. brater, a board certified internist,
is dean and walter J. daly Professor at
indiana university school of medicine,
where he is responsible for the second-
largest medical student body in the
united states. in 2006, dr. brater was appointed vice President
of indiana university with additional responsibility for life
sciences at the university level. richard Frankel, Phd, is Professor of
medicine and geriatrics and a senior
dr. brater was selected to chair the department of medicine at
research scientist at the regenstrief
indiana university (iu) in 1990. he joined the faculty in 1986
institute, indiana university school of
where he began the division of clinical Pharmacology. Prior to
medicine (iusm). he is also a senior
joining iu, he spent nine years on the faculty at the university
scientist in the center for implementing evidence based Practice
of texas southwestern medical school in dallas after a year as
at the roudebush veterans Association medical center, where he
a junior faculty member at university of california, san Francisco
directs the patient safety fellowship. currently, dr. Frankel is the
statewide director of the professionalism competency at iusm.
he is currently President of the Alliance for Academic internal
dr. Frankel previously co-directed the internal medicine residency
medicine and a member of the board of directors and the
program at highland hospital/university of rochester. while
executive committee of biocrossroads, an indiana consortium
he was at wayne state university, he developed and directed
of business, industry and academic organizations dedicated to
the behavioral medicine curriculum in the internal medicine
economic development through advancements in the life sciences.
he also serves on the boards of directors of clarian health
Partners and the riley children’s Foundation. in 2000, he was he has served on numerous national boards and committees,
awarded the duke medical Alumni Award in recognition of his including the national board of medical examiners, the Pew-
contributions to academic medicine. in 2008, he was awarded an Fetzer task Force on Psychosocial education and the national
honorary doctorate from Purdue university. in 2005, dr. brater committee for Quality Assurance. A longtime member of the
became a member of the ethics committee of the united states society of general internal medicine, he has served as co-chair
olympic committee. of the research committee, is currently a deputy editor, and sits
on the editorial board of the Journal of General Internal Medicine.
dr. Frankel has been a Fulbright Fellow. he has been the
2010 Abim FoundAtion Forum 35
recipient of the george engel Award and co-recipient of the dr. williamson was the founding executive vice President of the
lynn Payer Award for outstanding contributions to research and American Academy on communication in healthcare, a national
teaching given by the American Academy on communication in organization devoted to enhancing the doctor-patient relationship
healthcare. through improved teaching and clinical skills and promotion of
research. she also served as executive director of the national
dr. Frankel earned his doctoral degree in sociology at the sudden infant death syndrome Foundation and as Assistant
graduate school of the city university of new york. he Professor of Family medicine at the university of washington
did a post-doctoral fellowship at boston university and is a medical school.
founding Fellow of the American Academy on communication
in healthcare. dr. williamson brings to her work an ecological worldview;
belief in and attention to the inner life; expertise in the disciplines
of Appreciative inquiry, world café, open space and skilled
dialogue; and incorporation of the work of powerful creative
modalities including poetry, music and art.
Penelope she received her doctorate in behavioral science and ecology from
Williamson the Johns hopkins university school of hygiene and Public
health and completed a one-year post-doctoral fellowship at the
Penelope williamson, scd, is an university of rochester, departments of medicine and Psychiatry.
internationally recognized facilitator,
educator and coach. she is a founding
consultant of relationship centered
health care and a part-time Associate
Professor of medicine at the Johns hopkins university school
of medicine. she is also a founding Facilitator and Advisor for
the national center for courage and renewal. she co-directs
two leadership programs: leading organizations to health, a
10-month institute for health care leaders who wish to create
and sustain relational cultures in their organizations, and
courage to lead®, an 18-month program for the personal
and professional development of leaders in health care and
other serving professions.
36 innovAtive AdvAnces in medicAl educAtion And trAining
Florida International University Herbert Wertheim
College of Medicine
Presented by david brown social contract of medicine, the curriculum is designed to integrate
students into medically underserved communities. the medicine
and society strand includes neighborhoodhelP tm (health
BACKGROUND education learning Program). this signature program organizes
coinciding with the 100th anniversary of the Flexner report medical, nursing, social work and other students into inter-
and sweeping health care reform legislation, the Florida inter- professional teams assigned longitudinally to neighborhoods and
national university (Fiu) herbert wertheim college of households in medically underserved communities. neighbor-
medicine (hwcom) is the first medical school to open in hoodhelP tm incorporates community-based participatory best
a major metropolitan area in 25 years. this occurs at a time of practices and a multi-method outcome evaluation. the goal is
an increased understanding of how the social determinants to educate students to form inter-professional, inter-cultural,
of health and illness are at the root of deeply ingrained collaborative partnerships to improve the health of patients,
health inequities. households and communities.
the curriculum is intended to transform medical education to
meet the needs of patients, medically underserved communities
and society, based on the Accreditation council for graduate
medical education (Acgme) general competencies and an
additional competency – social accountability.
the curriculum includes an enhanced emphasis on primary care,
behavioral and social sciences, and public health and incorporates
early community and clinical experiences that are integrated
longitudinally over the four years. the curriculum includes five
thematic strands that span the four years: human biology;
disease, illness and injury; medicine and society; Professional
development; and clinical medicine. to fulfill the implicit
38 innovAtive AdvAnces in medicAl educAtion And trAining
dr. brown is Founding chief of dr. brown attended the massachusetts institute of technology
Family medicine in the department of and received his medical degree from boston university school
humanities, health and society at the of medicine. he trained at the salinas Family Practice residency
herbert wertheim college of medicine in california.
at Florida international university
(Fiu). he oversees the four-year Family medicine curriculum,
integrated with the novel “medicine & society” curricula and
its community component neighborhoodhelP™ (health
education learning Program).
before joining Fiu, dr. brown practiced and taught at Jefferson
reaves, sr. health center in miami. As a board certified family
practitioner, he practices a full spectrum of health care for men,
women and children of all ages. Previously, he held faculty
appointments at the university of hawaii, the university of
california at san Francisco and the university of miami.
his research employs educational, qualitative, epidemiologic,
participatory and mixed methods. he has been published
in the American Journal of Public Health, American Journal of
Obstetrics and Gynecology and MedEdPORTAL, and has
publications in press at The Qualitative Report and
2010 Abim FoundAtion Forum 39
The Ambulatory Long Block
Presented by eric warm RESULTS
the long block has resulted in significant improvement in
multiple clinical process and outcome measures, as well as
BACKGROUND improved satisfaction among residents and patients. there has
historical bias toward service-oriented inpatient graduate medical also been a trend toward decreased emergency department visit
education experiences has hindered both resident education and rates and no show rates. Additionally, the long block resulted in
care of patients in the ambulatory setting. a robust multi-source evaluation that identified high, intermediate
and low performing residents, and suggested specific formative
OBJECTIVE feedback for each.
to describe and evaluate a residency redesign intended to improve
the ambulatory experience for residents and patients. CONCLUSIONS
An ambulatory long block can be associated with improvements
METHODS in quality measures, resident and patient satisfaction, no-show
the ambulatory long block was created as part of the rates and evaluation.
Accreditation council for graduate medical education
(Acgme)’s educational innovation Project. the long block NEXT STEPS
occurs from the 17th to the 29th month of residency and is a Further research should be done to determine which aspects
year-long continuous ambulatory group-practice experience of the long block most contribute to clinical and educational
involving a close partnership between the residency and a improvement.
hospital-based clinical practice. long block residents follow
approximately 120 to 150 patients, have office hours three half-
days per week and are responsive to patient needs (by answering
messages, refilling medications, etc.) daily. otherwise, long
block residents rotate on electives and research experiences with
minimal overnight call. residents receive extensive instruction
in chronic illness care, quality improvement and inter-
40 innovAtive AdvAnces in medicAl educAtion And trAining
dr. warm, a board certified internist, is (boost) program, and as a faculty member for the national-
Associate Professor of internal medicine residency education Project in improving end-of-life care
and the categorical internal medicine sponsored by the robert wood Johnson Foundation. he has
Program director at the university of received numerous teaching awards, most recently the clinical
cincinnati. there, he developed the Practice innovation Award from sgim.
Accreditation council for graduate medical education
educational innovations Project, including the creation of dr. warm earned his medical degree from the university of
the Ambulatory long block. cincinnati, where he also completed his residency and chief
dr. warm is the immediate past chair for the national
educational innovations Project council and recently completed
a term as vice President for the ohio chapter of the American
college of Physicians. he is interested in the interface between
education and quality improvement, as well as improving
doctor-patient communication skills.
currently the clinical management subcommittee chair for
the society of general internal medicine’s (sgim) Patient
centered medical home initiative, he has served as a member
of the advisory board for the society of hospital medicine’s
better outcomes for older adults through safe transitions
2010 Abim FoundAtion Forum 41
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