EXPERIENCE BASED CURRICULUM TO ACHIEVE COMPETENCE IN ...

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EXPERIENCE BASED CURRICULUM TO ACHIEVE COMPETENCE IN ...

  1. 1. EXPERIENCE BASED CURRICULUMEXPERIENCE BASED CURRICULUM TO ACHIEVE COMPETENCE INTO ACHIEVE COMPETENCE IN PALLIATIVE MEDICINEPALLIATIVE MEDICINE RODNEY TUCKER, MDRODNEY TUCKER, MD PALLIATIVE MEDICINE FELLOWSHIP DIRECTORPALLIATIVE MEDICINE FELLOWSHIP DIRECTOR UAB CENTER FOR PALLIATIVE CAREUAB CENTER FOR PALLIATIVE CARE
  2. 2. OBJECTIVESOBJECTIVES  Introduce the evolved process of developing aIntroduce the evolved process of developing a traditional experience-based curriculum totraditional experience-based curriculum to achieve competence in palliative medicineachieve competence in palliative medicine  Review a tailored training sequence for a 12Review a tailored training sequence for a 12 month fellowship emphasizing increasingmonth fellowship emphasizing increasing autonomyautonomy  Description of UAB site specific rotations andDescription of UAB site specific rotations and subsequent assessment methodssubsequent assessment methods  Future challengesFuture challenges
  3. 3. History of the UAB PMFTPHistory of the UAB PMFTP  First fellow completed training in 2000First fellow completed training in 2000  Currently training 9Currently training 9thth and 10and 10thth fellowsfellows  100% ABHPM pass rate (6/8 have taken)100% ABHPM pass rate (6/8 have taken)  9/10 faculty are ABHPM certified (6/109/10 faculty are ABHPM certified (6/10 faculty also boarded in Geriatrics)faculty also boarded in Geriatrics)  Received 2 year AAHPM and NHF awardReceived 2 year AAHPM and NHF award in 2005in 2005  ABHPM voluntary accred in 2006ABHPM voluntary accred in 2006
  4. 4. Palliative Care SectionPalliative Care Section  Christine Ritchie, MDChristine Ritchie, MD  Director of Center forDirector of Center for Palliative CarePalliative Care  Rodney Tucker, MDRodney Tucker, MD  Medical Director- UAB PMMedical Director- UAB PM ProgramsPrograms  Amos Bailey, MDAmos Bailey, MD  Medical Director- BVAMCMedical Director- BVAMC Safe HarborSafe Harbor  Elizabeth Kvale, MDElizabeth Kvale, MD  Out-patient MedicalOut-patient Medical DirectorDirector  Cynthia Baker, MDCynthia Baker, MD  Charlotte Williams, MDCharlotte Williams, MD  Carol Griffin, MDCarol Griffin, MD  Tracey Humbert, MDTracey Humbert, MD  Sandra Broeren, MDSandra Broeren, MD  Heather Herrington, MDHeather Herrington, MD
  5. 5. Experience Based- What does thatExperience Based- What does that mean to us?mean to us?  Rotational, didactic, and special seminarsRotational, didactic, and special seminars designed to expose fellows to a widedesigned to expose fellows to a wide variety and mixture of clinical andvariety and mixture of clinical and classroom experiences necessary toclassroom experiences necessary to achieve competence in palliative medicineachieve competence in palliative medicine domainsdomains
  6. 6. STEP ONESTEP ONE Determine core experiences toDetermine core experiences to provide clinical opportunities forprovide clinical opportunities for training purposestraining purposes
  7. 7. Rotational experiencesRotational experiences  In-patient PMIn-patient PM consultationconsultation  UAB PM ConsultUAB PM Consult ServiceService  BVAMC PM ConsultBVAMC PM Consult ServiceService  Children’s Hospital ofChildren’s Hospital of Alabama PMAlabama PM consultationconsultation  In-patient careIn-patient care  UAB Palliative andUAB Palliative and Comfort Care UnitComfort Care Unit  BVAMC Safe HarborBVAMC Safe Harbor UnitUnit  6-8 months per year6-8 months per year  Interdisciplinary teamInterdisciplinary team focusfocus
  8. 8. Rotational ExperiencesRotational Experiences  Out-patient ContinuityOut-patient Continuity clinics (Average oneclinics (Average one clinic per week)clinic per week)  UAB Supportive andUAB Supportive and Palliative Care ClinicPalliative Care Clinic  2 sessions per month2 sessions per month  UAB HIV/AIDSUAB HIV/AIDS Treatment ClinicTreatment Clinic  2 sessions per month2 sessions per month  BVAMC clinicBVAMC clinic consultation serviceconsultation service  12 months continuity12 months continuity experienceexperience  Development of ownDevelopment of own patient populationpatient population  Multi-disciplinaryMulti-disciplinary teamteam
  9. 9. Rotational ExperiencesRotational Experiences  Out-patient/ Home HospiceOut-patient/ Home Hospice  Community Based Hospice OrganizationsCommunity Based Hospice Organizations with educational agreementswith educational agreements  2-3 months/year- Focused rotation2-3 months/year- Focused rotation  Ongoing Hospice Patient management byOngoing Hospice Patient management by fellows with 12 month continuityfellows with 12 month continuity  IDT focusIDT focus  Majority observed home visits done duringMajority observed home visits done during these monthsthese months
  10. 10. Rotational ExperiencesRotational Experiences  Pain management rotationPain management rotation  Out-patient and in-patient interventional focusOut-patient and in-patient interventional focus  1 month per year1 month per year  Undisciplinary with some IDT component inUndisciplinary with some IDT component in out-patient sectionout-patient section
  11. 11. Rotational ExperiencesRotational Experiences  ElectiveElective  Fellow specific depending on area of interestFellow specific depending on area of interest  Can be Heme/Onc consult, GeriatricCan be Heme/Onc consult, Geriatric Psychiatry, long term care setting, Neurology,Psychiatry, long term care setting, Neurology, clinical visitorship to another institution,clinical visitorship to another institution, research and writing, etc.research and writing, etc.  Specific career objectivesSpecific career objectives  One month/yearOne month/year
  12. 12. STEP TWOSTEP TWO Determine core subject matter andDetermine core subject matter and format in which to cover topic areas informat in which to cover topic areas in palliative medicine knowledge domainpalliative medicine knowledge domain
  13. 13. Core DidacticsCore Didactics  UNIPAC “Crash Course”- Covered by programUNIPAC “Crash Course”- Covered by program director in July- Tuckerdirector in July- Tucker  Classic article readings- Discussion lead byClassic article readings- Discussion lead by faculty and guestsfaculty and guests  Once weekly/ led by Fordham, et alOnce weekly/ led by Fordham, et al  Directed readings- Assigned text readingsDirected readings- Assigned text readings (Oxford and Palliative Care & Supportive(Oxford and Palliative Care & Supportive Oncology) and discussion with attendingsOncology) and discussion with attendings  Once weekly/ led by Bailey, et alOnce weekly/ led by Bailey, et al
  14. 14. Core DidacticsCore Didactics  Fellows Case Conference- Case presentationsFellows Case Conference- Case presentations with pertinent article centered on symptomwith pertinent article centered on symptom managment, ethics, or self caremanagment, ethics, or self care  Once monthly, InterdisciplinaryOnce monthly, Interdisciplinary  Palliative Medicine Journal Club- Critical reviewPalliative Medicine Journal Club- Critical review of current literature articles using standardof current literature articles using standard review instruments (Consort, etc.)review instruments (Consort, etc.)  Once monthly, casual setting- Led by Kvale, et alOnce monthly, casual setting- Led by Kvale, et al  InterdisciplinaryInterdisciplinary
  15. 15. STEP THREESTEP THREE Determine supplemental activitiesDetermine supplemental activities to cover gaps or expanded topicsto cover gaps or expanded topics in palliative medicinein palliative medicine
  16. 16. Palliative Care Research ForumPalliative Care Research Forum  Discussion time for PM faculty, visitors,Discussion time for PM faculty, visitors, fellows, and other housestaff to discussfellows, and other housestaff to discuss potential or ongoing research topicspotential or ongoing research topics  Twice monthly, optional for palliative careTwice monthly, optional for palliative care fellowsfellows  MultidisciplinaryMultidisciplinary
  17. 17. Special SeminarsSpecial Seminars  2-3 hour focused2-3 hour focused seminars/workshopsseminars/workshops  MandatoryMandatory attendanceattendance  Topics:Topics:  Communication StyleCommunication Style Preference and HowPreference and How to Adaptto Adapt  AcademicAcademic Presentation SkillsPresentation Skills  Topics:Topics:  Hospice Financing andHospice Financing and AdministrationAdministration  Building the Case for aBuilding the Case for a Palliative CarePalliative Care ProgramProgram  Research Funding andResearch Funding and Grants 101Grants 101  Media Relations &Media Relations & AdvocacyAdvocacy
  18. 18. STEP FOURSTEP FOUR Match each activity with ACGMEMatch each activity with ACGME Competency DomainCompetency Domain
  19. 19. Curriculum & Competency CrossCurriculum & Competency Cross ChecklistChecklist  Matches each activity/topic/seminar withMatches each activity/topic/seminar with ACGME competency domainACGME competency domain  Defines global objectives for each activityDefines global objectives for each activity  See attached exampleSee attached example
  20. 20. STEP FIVESTEP FIVE Determine appropriate trainingDetermine appropriate training sequence progressionsequence progression
  21. 21. Training Sequence for progressiveTraining Sequence for progressive fellow autonomy and responsibilityfellow autonomy and responsibility  See attached training sequenceSee attached training sequence  Divided into three sections to assist in providingDivided into three sections to assist in providing theoretical structure to training experiencetheoretical structure to training experience  11stst sequence: Months 1-2 (Observe and question)sequence: Months 1-2 (Observe and question)  22ndnd sequence: Months 3-6 (Observe, question, initiate)sequence: Months 3-6 (Observe, question, initiate)  33rdrd sequence: Months 7-12 (Initiate, question,sequence: Months 7-12 (Initiate, question, complete)complete)  Reviewed with fellows at onset of program andReviewed with fellows at onset of program and at each quarterly reviewat each quarterly review
  22. 22. STEP SIXSTEP SIX Determine and Refine evaluationDetermine and Refine evaluation processes and assessment toolsprocesses and assessment tools
  23. 23. Evaluation/Assessment ToolsEvaluation/Assessment Tools Current statusCurrent status  Monthly fellowship &Monthly fellowship & education committeeeducation committee meeting that reviewsmeeting that reviews fellow progressfellow progress  Monthly Preceptor evals-Monthly Preceptor evals- All facultyAll faculty  Monthly Rotation evals-Monthly Rotation evals- All fellowsAll fellows  Quarterly documentationQuarterly documentation review- Program Directorreview- Program Director  Seminar evalsSeminar evals  Filmed media interviewFilmed media interview  Procedure logs for homeProcedure logs for home visits, IDT leadership, firstvisits, IDT leadership, first 25 consults and family25 consults and family meetings, ventmeetings, vent withdrawals, palliativewithdrawals, palliative sedation, paracentesissedation, paracentesis  In-service exam at 6 & 12In-service exam at 6 & 12 monthsmonths  Grand RoundsGrand Rounds presentation-Once yearpresentation-Once year  End of year globalEnd of year global program evaluationprogram evaluation
  24. 24. STEP SEVENSTEP SEVEN Pray that all this will satisfyPray that all this will satisfy ACGME requirementsACGME requirements
  25. 25. Evaluations and Assessements forEvaluations and Assessements for the futurethe future  360 degree evaluation to include members360 degree evaluation to include members of IDTof IDT  Direct observation exercise (CEX)Direct observation exercise (CEX)  Filmed mock patientFilmed mock patient  Selection of two assessment methods forSelection of two assessment methods for each domaineach domain

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