Program cycle 2008–2009“Transitioning Adolescent Patients (TAP) from Pediatric to Adult Care”Principal investigator: Emily von Scheven, MD, MAS, Pediatric Rheumatology,University of California-San FranciscoThe TAP project is developing an institution-wide program to facilitate the transition ofadolescent patients with chronic health care needs from pediatric- to adult-centeredcare. There are two core initiatives: resident training in core competencies fortransitional care, and the development of a “transition handbook,” to be provided as athree-ring binder to adolescent patients in order to teach self-management skills. Thecontent of the transition handbook will be reviewed and critiqued by a group ofadolescent patients prior to distribution. Investigators expect the handbook will improvequality of care, as measured by surveys of provider knowledge and patient reports.“Improving Patient Rounds (IPR)”Principal investigator: Walter J. Moore, MD, Center for Patient- and Family-CenteredCare, Medical College of GeorgiaThe IPR project will initiate patient- and family-centered care rounds in adult medicaland surgical rounds. Project will initially follow and measure improvement of one serviceteam, practicing patient- and family-centered rounds, on the inpatient medicine unit, withattention to patient, family, staff and physician satisfaction; unit costs; resident and unitefficiency; and quality and safety. Educational effectiveness and team performance inPFCC rounds will also be evaluated through student/faculty culture survey (pre/post),written evaluations and student debriefing and videotaped session(s). Project resultsinclude identifying steps and strategies applicable to other adult-care units, anddiscovering and overcoming specific obstacles in PFCC rounds. Results will bedeveloped into a blueprint for use in MCG units and other institutions.“Resident Performance from the Patient’s View”Principal investigator: Dick M. Wardrop, MD, PhD, FAAP, Director of ResidentResearch, Internal Medicine, Carilion Clinic, Roanoke, Va.The Resident Performance project intends to adapt an existing attendant-basedevaluation into a patient-centered prototype tool that is concise, valid and reliable, andthat enables patients to accurately assess resident performance on 4/6 ACGMEcompetencies. Performance with regard to ACGME core competencies of residents whoreceive feedback and coaching using the patient-centered tool will be compared to thatof those who received attending-only feedback.
“Patient-Centered Training of Residents on a Medical Ward”Principal investigator: Robert C. Smith, MD, MS, Internal Medicine,EW Sparrow Hospital/Michigan State University College of Human MedicineThe patient-centered training project intends to establish integrated patient-centeredcare teams of project faculty and nursing staff to direct residents on a dedicated patient-centered care ward. Project includes two visits from outside consultant Dr. RichardFrankel for the purpose of developing integrated-care teams and a method for deliveringpatient-centered care. Dr. Frankel will work with project faculty, nurse teachers andhospital administration, with a focus on strategies for becoming successful changeagents. Success of patient-centered care delivery will be determined by descriptive andpatient-specific data.Program cycle 2007–2008 “Emergency Medicine Resident Trainingin Interprofessional Skills: Evaluatinga Needs-Based Curriculum”Sondra Zabar, M.D., Principal InvestigatorAssociate Professor of MedicineLinda Regan M.D., Co-InvestigatorNew York University School of MedicineSince the 1960s, Emergency Medicine (EM) researchers have worked to demonstratethe importance of patient-centered doctor-patient communication, only acknowledgingdecades later that advancing such patient-centered care will require increased andeffective provider education. Having had experience with the development andimplementation of a controlled study on the impact of a comprehensive, integratedclinical communication skills curriculum on students’ patient-centered skills, Section ofPrimary Care faculty at New York University School of Medicine were prepared andeager to partner with Emergency Medicine faculty on this very important topic. With thecommitment of NYUSOM-Bellevue Emergency Medicine Residency leadership, wecreated the Emergency Medicine Professionalism and Communication Training(EMPACT) Project.EMPACT aims to expand on previous work by assessing and improving EM residentcompetency in communication and professionalism through the development,implementation, and evaluation of new curriculum and assessment measures. Ourobjectives are to:
1. Design, implement and evaluate a patient-centered healthcare curriculum for all 60EM residents.2. Evaluate the predictive validity of Objective Structured Clinical Examinations(OSCEs) by assessing the correlation of OSCE performance with actual residentperformance in emergent care setting for cohort of PGY2 residents (n=15).3. Disseminate this Patient-Centered Care educational program to EM programsnationally.We plan to complete EMPACT in four phases:Phase I: Establish baseline competency of EM interns using a 5-station OSCE.Phase II: Integrate an interactive skills-based series of five workshops focusing oninterpersonal and professionalism skills into monthly required EM seminar series.Phase III: Conduct post-curriculum OSCEs to evaluate the impact of the curriculum.Phase IV: Develop and implement a 2-case “unannounced” standardized patient (USP)program.Click here to read Dr. Zabar’s final report in its entirety.Program cycle 2006–2007John M. Tarpley, M.D.Vanderbilt Medical CenterVanderbilt University“Cultural Sensitivity Initiativefor Medical Education”Patient-centered care requires knowledge of andsensitivity to cultural and faith-related issues. Dr.Tarpley’s research revealed the degree to whichpeople in the medical profession are surrounded bythese issues, and the subsequent need to educatemedical personnel to understand and respond to Dr. John M. Tarpleypatients’ cultural and spiritual concerns.
His findings include a proposal for the development of a graduate medical educationcurriculum focusing on teaching healthcare professionals how to respond to patients ina culturally appropriate manner.Cultural and spiritual sensitivity is “useful in all eight of Picker Institute’s dimensions ofpatient-centered care,” Dr. Tarpley concludes, and essential in these six”:• Respect for patient’s values, preferences and expressed needs• Information, communication and education• Physical comfort• Emotional support and alleviation of fear and anxiety• Involvement of family and friends• Transition and continuityClick here to read Dr. Tarpley’s final report in its entirety.Pamela J. Boyers, Ph.D.Riverside Methodist Hospital“Simulation Used to Measure theACGME Core Competencies andPatient-Centered Care”In 2002, the Accreditation Council for GraduateMedical Education (ACGME) introducedcompetency-based education into the institutionaland program requirements for all U.S. allopathicresidency programs. The six core competencies—medical knowledge, communication,professionalism, practice-based learning and Dr. Pamela J. Boyersimprovement, systems-based care and patientcare—comprise a set of standard principles by which residents can be evaluated and ageneral framework for curriculum development.At present, there are no uniform guidelines to measure the successful integration ofthese core competencies into residency education or resident progress towardproficiency. By “simulating” doctor-patient scenarios involving such common complaintsas retinal detachment, colon cancer and low back pain. Prior to and after each
simulation, residents were asked to assess their own level of expertise, as was aphysician who had observed the simulation.An examination of these scores indicated that “it is possible to objectively measure theprinciples of patient-centered care embodied in the ACGME Core Competencies,” Dr.Boyers concluded. The multifaceted evaluation process, which includes residents’ selfperceptions, recorded observations by attending-level physicians, 360-degreeevaluations by standardized patients and an objective examination, has the specificadvantage of measuring and recording the data generated by multiple separateobservations of a given skill set. Dr. Boyers concludes that “we must continue to work tobetter define and measure skill sets within each competency, and to demonstrate thatmastery of each competency translates into excellence in patient-centered medicalcare.”Click here to read Dr. Boyers’s final report in its entirety.William H. Hester, M.D.McLeod Family MedicineResidency Program“Improving Patient Complianceand Outcomes in HypertensionManagement in the ‘Stroke Capital’of the World” Dr. William HesterThe study was conducted at the McLeod Family Medicine Residency Program from March 1,2006, to Dec. 31, 2006. The residency program is a 21-resident (eight PGYIII, six PGYII andseven PGYI) community-based, stand-alone program affiliated with McLeod Regional MedicalCenter in Florence, S.C. The six PGYII residents enrolled eligible patients from their practices.Patients with uncontrolled hypertension (systolic blood pressure greater than 140 mm Hg) wereeligible for the study. Only patients who requested not to participate in the study were excluded.At the initial visit, enrolled patients received introductory information (Appendix A). At eachsubsequent visit, one of the four patient education tools was discussed. These tools were usedto trigger resident physician discussion of an important aspect of the need for hypertensionmanagement. These tools were as follows: Appendix B Tool #1: Nutrition Modification (Food: Stay away from the salt "sodium")
Appendix B Tool #2A: Creatinine (Blood Test) Appendix B Tool 2b: Urinalysis (Urine Test) Appendix B Tool 3: Cholesterol Appendix B Tool #4: EKG (Electrocardiogram)Click here to read Dr. Hester’s final report in its entirety.Anthony A. Meyer, M.D., Ph.D.Renae E. Stafford, M.D., M.P.H.Trauma and Critical Care Services/The University of North Carolinaat Chapel Hill“Development and Implementation ofan Interdisciplinary Palliative CareEnd-of-Life Education Program forResidents Who Rotate through theSurgical Intensive Care Unit” Dr. Renae StaffordDrs. Meyer and Stafford prepared for their study by surveying 28 surgical residents onend-of-life issues and bioethics and by administering to them a standardized palliative-care knowledge examination. Survey data and exam scores “clearly elucidated the needfor further education.”The doctors then instituted an educational program that involved the surgical residents in formallectures, role playing, experiential learning with participation in family meetings, grand roundspresentations and journal clubs. Residents were also exposed to discussions about end-of-lifeand palliative care in morbidity and mortality conferences and in surgical intensive-care-unitdaily rounds.While the study has not yet been formally concluded, it has led to several initiatives thathave enhanced patient-centered care at UNC, according to Drs. Meyer and Stafford.These include inclusion of surgical ICU nurses and students in the educational program;
an enhanced relationship with the palliative-care service; and the institution of a “familycenter” near the surgical ICU to provide a place for family meetings and a quiet, restfulspace where families can gather, process information and grieve as loved ones face theend of their life.Click here to read Drs. Meyer’s and Stafford’s final report in its entirety.