The goal of this presentation was to prioritize Milestones for resident education in population health, and identify gaps in materials for teaching and assessment. The Institute of Medicine has warned: “The traditional separation between primary health care providers and public health professionals is impeding greater success in meeting their shared goal of ensuring the health of populations.” The implementation of the Accountable Care Act expedites the nation’s need to bridge that divide. The ACGME has required elements of population health training through the Common Program Requirements addressing professionalism and systems-based practice, expecting residents to demonstrate “sensitivity and responsiveness to a diverse patient population,” and “incorporate… cost-awareness and risk-benefit analysis in… population-based care.” The Clinical Learning Environment Review program emphasizes additional components through its focus on Transitions in Care. The Centers for Disease Control (CDC), and the American Association of Medical Colleges (AAMC) awarded Duke a project to improve residents’ training in population health, building on the work of the Duke-CDC population health model, but modified to meet the needs of different specialties and programs. Listservs of program directors in family medicine, internal medicine, and pediatrics have been used to solicit collaborators. A “starter set” of Milestones has been created, and curricular and assessment materials are being mapped to them. This presentation significantly advanced this effort, adding the “wisdom from the crowd” of graduate medical education thought leaders representing an even broader audience. Session participants contributed in developing these population health Milestones, and shared materials and resources, such as those from the Practical Playbook, with opportunities for further engagement.

1. DISCLOSURE: No conflicts of
interest to report

3. February 28, 2015
@PracPlaybook
SES129 When the population is “the patient”:
Developing Population Health Milestones to teach
essential skills for tomorrow’s clinicians
Lloyd Michener, MD lloyd.michener@duke.edu
Denise Koo, MD MPH dkoo@cdc.gov
Kathy Andolsek, MD MPH kathryn.andolsek@duke.edu
Accreditation Council for Graduate Medical Education Conference | San Diego,
CA

4. Who are you?
• Geography: NE (5) SE (4) SW (1) Mid-Atlantic (1)
Midwest (3) outside US (1) n/a (1)
• Specialty: IM (2) Peds (2) FM (6)
Psych (1) Plastic Surgery (1)
• Profession: MD (10) DO (1) MPH (2) PhD (1) Masters
Education (3) MA (1) Bachelors (1)
• Role: DIO (1) PD (3) Core faculty (6) RAC (1)
Div chief (1)

5. Who are you?
• How long in GME
– 1-2 year 1
– 3-5 years 3
– 6-10 years 1
– 11-15 years 2
– > 16 years 9
• Population Health Curriculum?
– Institution Yes (5) No (8) don’t know (2) n/a (1)
– Program Yes (3) No (11) don’t know (2)

6. Please seat yourself at a table
based on the milestone placard you
are most interested in.
Placard 1: Applies principles of public health to improve
the health of populations (BLUE)
Placard 2: Applies principles of community engagement
to improving the health of populations (RED)
Placard 3: Utilizes critical thinking to improve the health
of populations (GREEN)
Placard 4: Utilizes team and leadership skills to
improve the health of populations (PURPLE)

7. Goals and Objectives
• Prioritize milestones in population health
• Identify gaps in available curricular materials
• Recognize solutions to common challenges

8. What is population health?

9. Definition of population health
“The health outcomes of a group of
individuals, including, the distribution
of such outcomes within a group”
David Kindig and Greg
Stoddart

10. Why does population health
matter?

11. Why does population health
matter?

13. Why does population health
matter?

14. Why does population health
matter?

15. Why does population health
matter?

16. SIM Awardees

17. Medical education:
Flexner’s principles
• The training, quality, and quantity of physicians
should meet the health needs of the public
• Collaborations between the academic medicine
and public health communities… benefits both

18. Why does population health
matter?
http://macyfoundation.org/docs/macy_pubs/JMF_GME_Conference2_Monograph%282%29.pdf
Conclusions and
Recommendations
Conclusion 1 GME must
meet the needs of – and be
accountable to – the public.

19. Why does population health
matter?
http://www.iom.edu/~/media/Files/Report%20Files/2014/GME/GME-RB.pdf

20. GME links with population
health
• Graduate outcomes
• CLER
• Milestones

21. Graduate performance
• Historically: board pass rates
• Today: ?
% fulfilling US healthcare needs?
GME links with Population
Health

22. GME links with population
health:
CLER
• Patient Safety
• Health Care Quality
Disparities
• Care Transitions
• Supervision
• Fatigue Mitigation/Duty Hours
• Professionalism

23. GME links with population
health:
CLER
HQ Pathway 5: Resident/fellow, faculty education on
reducing health care disparities.
Focus
• Extent to which individuals receive education on clinical
site’s priorities/ goals for addressing health care disparities in
its patient population.
• Extent to which individuals receive training in cultural
competency relevant to patient population served.
• Proportion aware of clinical site’s progress in
meeting its goals/priorities.

24. How does this connect with
GME?CLER Pathways
https://www.aamc.org/download/419276/data/dec2014communityhealth.pdf

25. How does this connect with
GME?
Milestones
Our vision is to:
• Collaborate
• Align with what we’re already doing
• Identify/Develop Relevant Population Health
Milestones
• Match to available curricular, assessment, and
evaluation tools

26. What are you doing well?

27. What is your biggest
challenge?

28. Let’s tackle one or two together.

29. Q-Sort “Game”
We asked “your help” prioritizing
some potential population milestones
Where did we find them?
• Extracted from existing specialty milestones
• Identified from literature review
• Editorial license . . .
What is Q-Sort?

30. Q-Sort Findings

31. Competency Domains PH 1-4
• Applies principles of public health
• Applies principles of community
engagement
• Utilizes critical thinking to address
population health
• Demonstrates team and leadership
skills for population health

32. Competency Domains–What’s
missing?
• Applies principles of public health
• Applies principles of community
engagement
• Utilizes critical thinking to address
population health
• Demonstrates team and leadership
skills for population health

33. Please seat yourself at a table
based on the milestone placard you
are most interested in.
Placard 1: Applies principles of public health to improve
the health of populations (BLUE)
Placard 2: Applies principles of community engagement
to improving the health of populations (RED)
Placard 3: Utilizes critical thinking to improve the health
of populations (GREEN)
Placard 4: Utilizes team and leadership skills to
improve the health of populations (PURPLE)

34. Small Group Task
• You are seated within small
groups at your table by
“milestone”
• Introduce yourself
• Analyze/Edit your milestone
(use worksheet)

35. Small Group Task
Analyze/Edit your milestone (use worksheet)
• Is it relevant at some level for all/most resident specialties?
• Can you make it more so?
• Are levels appropriately progressive?
• Are levels sufficiently robust? Too hard? Too easy?
Is 5 “a stretch”; is 3-4 where “most residents might be at
program completion”?
• How might this be best “assessed”?

36. Debrief
“We cannot solve our
problems with the
same thinking we used
when we created
them”
— Albert Einstein

37. Resources

38. http://www.cdc.gov/policy/ohsc/desiredstate.html

39. Resources Used
• AAMC MedEd Portal - 3
• iCollaborative - 1
• American Teachers of
Preventive Med - 1
• CDC - 7
• Practical Playbook - 0
• Local and Duke - 1

40. Practical Playbook
http://practicalplaybook.org/

41. CDC Population Health
http://www.cdc.gov/

42. Invest in Your Community:
4 Considerations to Improve Health & Well-Being for
All

43. Examples of Teaching in the Community
http://www.mededportal.org/icollaborative/resource/2364

44. APTR
http://www.aptrweb.org/

45. Association of Schools & Programs of Public
Health
http://www.aspph.org/educate/models/population-health-across-all-professions/

46. Choosing Wisely
http://www.choosingwisely.org/doctor-patient-lists/

47. American Academy of Family Practices
http://www.aafp.org/dam/AAFP/documents/about_us/initiatives/choosing-wisely-fifteen-questions.pdf

48. Example of Assessment Resource
https://www.mededportal.org/about/initiatives/dream

49. Example of Evaluation Resource
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4266696/pdf/nihms615280.pdf

50. The Vision:

51. The Vision:

52. For more information,
connect with us on social media.
https://practicalplaybook.org/
Follow us: @PracPlaybook
Like our page: Practical Playbook
Follow us: Practical Playbook
Follow us: Practical Playbook