Innovations in Residency Training – Mid-Stride Findings from the P4 Project


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Innovations in Residency Training – Mid-Stride Findings from the P4 Project

  1. 1. Innovations in Residency Training: Midstride Findings from the P4 Project<br />Larry Green, MD1; Patricia Carney, PhD, Patrice Eiff, MD, Elaine Waller2 ; James Puffer, MD3 1University of Colorado Denver, 2Oregon Health & Science University, 3American Board of Family Medicine<br />BACKGROUND<br />MIDSTRIDE PRELIMINARY RESULTS<br /><ul><li>P4 is an Observational Case Series Study of Revisions</li></ul> to FM Residency Training<br /><ul><li>14 Representative Residency Programs are Participating and </li></ul> are Nearing the 4th Year of the 6 Year project<br /><ul><li>Key Innovations include:
  2. 2. 4 Years of Training
  3. 3. Different Ways of Teaching Elements </li></ul> of the Patient Centered Medical Home<br /><ul><li>Individualized Training
  4. 4. Early Establishment of a Panel of Continuity Patients</li></ul>Training Residents in a PCMH is in Evolution<br />Faculty Development Needs Are Paramount<br /><ul><li>It’s unclear which approach is better: immerse residents in a </li></ul>re-designed practice versus specific training to work in the PCMH environment <br /><ul><li>New skills required that have been identified:
  5. 5. Working in teams
  6. 6. Managing chronic care
  7. 7. Population management
  8. 8. Process improvement skills
  9. 9. Change fatigue and faculty burn-out are serious concerns
  10. 10. Faculty experience difficulty teaching the features of the PCMH when the concept is emerging and changing and they themselves are relative novices in practicing within a medical home
  11. 11. Residents are farther along than faculty in adopting new information technology & the EMR
  12. 12. There is a shift required from the traditional pedagogical approach to a “learning and discovering together” approach</li></ul>Shifting to Competency-based Assessment is Complex and Resource-Intensive <br />The Definition of Continuity of Care is Broadening Beyond <br />Face-to-Face Contact<br /><ul><li>Educational learner portfolios can be a useful tool to assess competency and enhance self-directed learning but are faculty and resident time-intensive</li></ul>NEXT STEPS<br />Flexible Training Options that Address Individual Needs of <br />Learners While Addressing Core Skills are Educationally Valid<br />Identifysite-specific variables/measures that could be pooled to provide more power to assess common thematic intervention areas.<br />Residency Re-design Requires Additional Financial Support <br />Disseminatethe results of the Project through publications, presentations at national meetings and quarterly newsletters.<br />Applicant and Match Experience of P4 Programs <br />Pre (2006/07) and Post (2008/09)<br />Rigorous Evaluation Must Accompany Innovation<br />Secureadditional funding to extend the project to years 6 and 7 to expand the number of cohorts of residents who have fully participated in the P4 project and for whom we have both core data and graduate survey data.<br /><ul><li>The mean number of US senior applicants increased more than national trends
  13. 13. % of positions filled by US seniors higher than national average </li></ul>(pre and post)<br /><ul><li>Programs that implemented customized training may have improved performance in the match</li></ul>Resident Attitudes About Importance of PCMH <br />Features at Baseline and Midstride<br />Continue to build the infrastructure necessary for a Primary Care Educational Research Network (PCERN) using P4 as the foundation to accomplish both practice transformation and translating research into practice via educational settings.<br />P4 Manuscripts in Progress<br /><ul><li>Effect of curriculum innovation on residency applications and match performance: A P4 report
  14. 14. Preparing the Personal Physician for Practice (P4): Baseline innovations, hypotheses, measures and project trajectory
  15. 15. Designing Measures for Educational Innovation for the Preparing the Personal Physician for Practice (P4) Project: A Model for Centers of Excellence in Medical Education research
  16. 16. A report from Preparing the Personal Physician for Practice (P4): midstride preliminary results and emerging themes</li></ul>P4 Recommendations to the FM-RC<br /><ul><li>Assess compliance with metrics other than time
  17. 17. Require continuing, comprehensive care to a panel of patients
  18. 18. Broaden definition of continuity beyond face-to-face contact in the clinic (e.g. EHR, email, care teams)
  19. 19. Sustain core skills and expect customization to meet the needs of individual learners
  20. 20. Allow more flexibility
  21. 21. Center FM training in the evolving model of the PCMH
  22. 22. Information management skills are essential</li></ul>METHODS<br />QUANTITATIVE CORE DATA<br /> Core Data are collected from all P4 sites: 1) Program Data; <br /> 2) Resident Survey; 3) Continuity Clinic Data; 4) Grad Survey<br />QUALITATIVE DATA<br />On-line diary entries from faculty, residents, staff<br />SITE SPECIFIC DATA<br />Each program is additionally using specific measures designed to test their innovation-specific hypotheses<br />For more information visit<br />*0=Don’t know, 1=Neutral/No Opinion; 2=Not at all important; 3=Somewhat important; 4=Moderately important; 5=Very important<br />