Master of Academic Medicine
Competencies in Academic Medicine and Health II
ACMD 512
January, 2014
COURSE SYLLABUS
Instructors – Dr. Wood and Dr. May are the instructors of record
Dr. Olson and Dr. Vincent are co-instructors
Beverly P Wood, MD, PhD Win May, MD, PhD Michelle M Olson, MD, MACM Dale Vincent, MD,MPH, MACM
Home: 818-952-2876, Home: 626-447-4113 Work/cell: 217-552-5025 Home/mobile: 808-741-0793
Work: 909-558-4281 Work: 323-442-2381 Cell: 570-394-3588 Work: 808-433-6793
Cell 818-209-7748 Cell 626-617-8073
Course Overview
ACMD 512 - Competencies in Academic Medicine and Health II (3 units): The focus is on the clinical competencies related to interpersonal and communication skills, practice-based learning and improvement, systems based practice, and patient care. In relation to these competencies, the course will address the conceptual framework and teaching and assessment techniques. Development and use of learner portfolios to reflect skill levels and skill development is an important adjunct to training in the competencies. Onsite skills development sessions will address teaching skills for small groups, large groups, groups on rounds, feedback, microskills of teaching, empathy in patient care, developing standardized patients for learning and assessment, case-based teaching, teaching and learning portfolios and dealing with learners in difficulty.
COURSE GOAL AND OBJECTIVES
Goal: By the end of the course the participants should be able to:
Plan a learning program that incorporates the competencies into the teaching of medicine and the health professions in their specialty areas.
Objectives: After attending class sessions, reading the assigned materials and completing assigned exercises the participants should be able to:
Define professional competence and proficiency.Relate professional competence to health care outcomes.
Identify trust as an essential element in diagnosis, treatment, and healing
Use competencies as a basis of training for practice
Define the established guidelines for health literacy in doctor-patient communication.
Discuss the reasons for communication breakdown between health professionals and patients
Apply the principles of the microskills in teaching situations.
Formulate specific feedback for learners.
Develop cases for learning: practice in problem solving.
Formulate a case for student skills assessment.
Develop cases for scenario based learning
Define and illustrate the levels of professional development
Discuss the role of experiential learning in Practice based learning and improvement
Discuss PBLI as it relates to physician self-directed learning
Design strategies for teaching and assessment of PBLI
Define the factors that constitute systems based practice.
Discuss incorporation of quality improvement in SBP.
Discuss the skills utilized in SBP
Design strategies for teaching and assessment of SBP
Describe the components of a learning portfolio and how portfolios are used in training programs.
Define the development and utilization of a learning plan
Face to Face sessions are on February 25-27 at USC, Keck School of Medicine
Analyze the advantages and challenges to the learner of collaborative learning and small group learning.
Develop learning experiences for small groups and for large groups.
Experience active and engaged learning
Develop and deliver an interactive teaching activity
Define the microskills of teaching
Utilize the microskills in a simulated teaching activity
Develop a patient case to be used for teaching and/or assessment of learner skills.
Explain the use of standardized patients in teaching and assessment situations
Describe active listening as a teaching method
Develop skills in dealing with learners in difficulty and needing remediation.
Identify the elements of difficult conversations and apply the skills of reflective listening.
Apply the principles of case development to create teaching cases
Develop and utilize learning portfolios in counseling and evaluating learners
Describe methods for assessing a) professionalism, b) interpersonal & communication skills c) practice-based learning and improvement and d) systems-based practice.
Design and implement learner reflection and self-assessment exercises within a clinical context.
Create personal teaching portfolios for academic development
Discuss conceptual frameworks to define professionalism
Design strategies for teaching and assessment of professionalism
SCHEDULE*
(Activities, Session Objectives, Required Reading, Assignments Due)
Session # / Session Topic/Activities / Session objectives / Reading / Assignment at each session /
1
Jan 14 / Introduction of participants and the course ACMD 512 / Discuss competence, proficiency, and the next accreditation system in medicine / Readings #1
2
Jan 21 / Competence and proficiency / 1. Define professional competence and proficiency.
2. Relate professional competence to health care outcomes.
3. Use competencies as a basis of training for caring practice. / Readings #2 / Assign #2
Select one area of competency and describe how you would develop a teaching plan for your learners.
3
Jan 28 / Health Literacy / 1.Define the established guidelines for health literacy in doctor-patient communication.
2. Discuss the reasons for communication breakdown between Health professionals and patients / Readings #3 / Assign #3
Discuss two reasons for communication breakdown between health professionals and patients and how they would be addressed
#4
Feb 4 / Patient care and empathy / 1. Describe strategies to teach and assess patient care.
2. Describe an approach to help physicians recognize empathic opportunities
3. Reflect on the relationship between empathy and quality of patient care. / Readings #4 / Develop a case to use for learners to demonstrate empathic responses to a patient encounter or similar non-patient oriented experience.
Outline some strategies that you would use to teach and assess patient care in your area of specialty.
#5
Feb. 11 / Practice Based Learning and Improvement / 1. Describe the levels of professional development
2. Discuss the role of experiential learning and informal learning in Practice based learning and improvement
3. Discuss the basic knowledge and skills required for successful PBLI
4. Design strategies for teaching and assessment of PBLI / Readings #5 / Assign 5
Design a strategy for teaching and assessment of PBLI for learners in your specialty.
Relate the activity to teaching the skills of lifelong learning.
In groups of 2-3, develop an interactive exercise to teach an ACGME competency of your choice. You will present this in our face-to-face session.
Face to Face Sessions are from Feb. 24-26 (11:30 am) at Keck School of Medicine, USC
#6
March 11 / Patient Safety and Quality Improvement / 1. Evaluate patient care using the Institute of Medicine’s six dimensions of quality health care.
2. Identify methods to reduce medical errors.
3. Understand the planning and execution of a PDSA cycle and other standard methods.
4. Understand the implementation of an interdisciplinary care team and recognize the ways the allied health professions, social work, and nursing dovetail with the physician practice. / Readings #6 / Assignment #6
Design a strategy for teaching Patient Safety and QI to your learners.
#7
March 18 / Systems Based Practice / 1. Define the major factors that constitute systems based practice.
2.Discuss the role and anticipated outcome of quality improvement in SBP.
3.Discuss the skills utilized in one aspect of SBP
4.Design strategies for teaching and assessment of SBP / Readings #7 / Assignment #7
Design a strategy for teaching and assessment of Systems Based Practice for your learners.
Presentations on April 8 and April 15 / Post your class plan by April 1
Post your comments by April 7 / Develop a class for your learners in which one of the competencies of Patient Care, Practice Based Learning and Improvement, Systems Based Practice, Patient Safety and Quality Improvement are taught and assessed. Include Goals, Learning Objectives, Content to be included, Teaching and learning strategies, and Evaluation of learners and the course. How will you evaluate outcomes?
Post on the Wiki by April 1.
Please read the online postings, and choose one to critique and add comments by April 7.
REQUIRED READINGS
Class 1: Jan 8: Readings:
1.Dolmans DHJM, Tigelaar D. (2012). Building bridges between theory and practice in medical education using adesign- based research approach: AMEE Guide No. 60. Medical Teacher, 34; 1-10
2. Cutting MF, Saks NS. Twelve tips for utilizing principles of learning to support medical education. Medical Teacher, 34: 20-24
3. Hicks, PJ, Englander R, Schumacher DJ. (2010). Pediatrics Milestone project: next steps toward meaningful outcomes assessment. J.Grad Med Educ, 2(4): 577-584
4. Carraccio C, Burke AE (2010). Beyond Competencies and milestones: adding meaning through context. J.Grad Med Educ, 2(4): 419-422.
5. ten Cate O, Scheele F. Competency Based Postgraduate Training: Can we bridge the gap between theory and clinical practice? Acad. Med 2007, 82:542-547
Readings 2: Competence and Proficiency
1, Epstein R, Hundert E. (2002) Defining and Assessing Professional Competence. JAMA, 287 (2): 226-235
2. Chapter 1 in Evaluation Of Clinical Competence
3. http://www.acgme.org/outcome/e-learn/e_powerpoint.asp (ACGME project - informational)
4. Fraser, S ( 2001). Coping with complexity: educating for capability. BMJ 323: 799-803
5. Jones MD, Rosenberg AA, Gilhooly JT, Carraccio CL (2011) Perspective: Competencies, Outcomes, and Controversy—Linking Professional Activities to Competencies to Improve Resident Education and Practice. Acad. Med.86: 161-165.
6. Nasca TJ, Phillibert I, Brigham T, Flynn TC. (2012). The Next GME Accreditation System — Rationale and Benefits. NEJM. 366: 1051-1056.
7. Swing SR, Clyman SG, Holmboe ES, Williams RG. (2009). Advancing resident assessment in graduate medical education. J Grad Med Educ 1:278-286.
Readings 3: Health Literacy
1) 1. DeWalt DA, Callahan LF, Hawk VH, Broucksou KA, Hink A, Rudd R, Brach C. Health Literacy Universal Precautions Toolkit. AHRQ Publication No. 10-0046-EF. Rockville, MD. Agency for Healthcare Research and Quality. April 2010.
http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/literacy-toolkit/healthliteracytoolkit.pdf
2) http://www.health.gov/communication/Default.asp
3) Deledda G, Moretti F, Rimondini M, Zimmermann C. How patients want their doctor to communicate. A literature review on primary care patients’ perspective. Journal of Patient Education and Counseling, 2012; 90(3):297-306.
4) Paasche-Orlow M. Caring for Patients with Limited Health Literacy. JAMA. 2011; 306(10): 1122-1129
5) Mayer G, Villaire M. Enhancing Written Communications to Address Health Literacy. The Online Journal of Issues in Nursing, 2009; 14(3).
6) McCarthy DM, Waite KR, Curtis LM, Engel KG, et al. What did the Doctor Say? Health Literacy and Recall of Medical Instructions. Medical Care, 2012; 50(4): 278-282.
Readings 4: Empathy in Patient care
1.Neumann M, Edelhauser F, Tauschel D, Fischer MR, Wirtz, M, Woopen C, Haramati A, Scheffer c. (2011) Emapthy decline and its reasons: A systematic review of studies with medical students and residents. Acad Med 86:996-1009.
2. Hojat M, Louis, DZ, Markham F, Wender R, Rabiowitz C, Gonnella J. (2011). Physicians’ empathy and clinical outcomes for diabetic patients. . Acad Med 86: 359-364.
3. Colliver, J A. ,Conlee, M J., Verhulst, S J. ,Dorsey, J. K . (2010). Reports of the decline of empathy during medical education are greatly exaggerated: a reexamination of the research. . Acad Med.85: 588-593
4. Epstein RM, Hadee D, Carroll J, et al. (2007) “Could this be something serious?” Reassurance, uncertainty, and
empathy in response to patient’s expressions of worry. J Gen Intern Med; 22 (12); 1731-1739
5. Morse DS, Edwardsen EA, Gordon HS. (2008) Missed opportunities for interval empathy in lung cancer communication. Archives of Internal Medicine; 168 (17): 1853-1858
6. Shanafelt TD, West C, Zhao X, et al. (2005) Relationship between increased personal well being and enhanced empathy among internal medicine residents. J Gen Int Med; 20 (7): 559-564
7. Larson EB, Yao Y. (2005) Clinical empathy as emotional labor in the patient–physician relationship. JAMA 293:1100 –1106.
Readings 5: Practice-Based Learning and Improvement
1. Ogrinc G, Hedrick LA, Morrison LJ, Foster T. Teaching and assessing resident competence in Practice Based Learning and Improvement. (2004) J of General Internal Medicine; 19:496-500.
2. Varkey, P, Karlapudi, S, Rose S, Nelson, R, Warner M. (2009). A systems approach for implementing practice-based learning and improvement and systems-based practice in graduate medical education. Acad Med 84: 335-339.
3. Varkey P, Natt, N, Lesnick T, Downing S, Yudkowsky, R (2008). Validity Evidence for an OSCE to Assess Competency in Systems-Based Practice and Practice-Based Learning and Improvement: A Preliminary Investigation. Acad Med 83:775-780.
4. Tomolo AM, Lawrence RH, Aron DC. (2009). A case study of translating ACGME practice-based learning and improvement requirements into reality: systems quality improvement projects as the key component to a comprehensive curriculum. (2009). Postgrad Med J. 85: 530-537.
5. Chapter 11 in Evaluation of Clinical Competence
Readings 6: Patient Safety and Quality Improvement
1) George WW, Denham CR et al. “Leading in Crisis: Lessons for Safety Leaders.” J Patient Saf 2010; 6
(1):24-30.
2) Weinstein MC and Skinner JA. “Comparative Effectiveness and Health Care Spending--Implications
for Reform” New Eng J Med 2010; 362(5):460-5.
3) Botwinick L, Bisognano M, Haraden C. Leadership Guide to Patient Safety. IHI Innovation Series white
paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2006. (Available on
www.IHI.org)
4) “Healthcare Costs: A Primer” Kaiser Family Foundation. March 2009. (Available online at: http://
kff.org/insurance/upload/7670_02.pdf)
Readings 7: Systems-based Practice
1. Dunnington GL, Williams RG. (2003) Addressing the new competencies for residents surgical training. Acad Med;78 (1): 14-21.
2. Ziegelstein RC, Fiebach N. (2004). "The Mirror" and "The Village": A New Method for Teaching Practice-Based Learning and Improvement and Systems-Based Practice. Acad. Med. 79: 83-88.
3. Davison SP, Cadavid JD, Spear SL.(2007) Systems based practice; education in plastic surgery. Plastic and reconstructive surgery. 119 (1): 410-415.
4. Moskowitz EJ & Nash DB (2007). Accreditation Council for Graduate Medical Education Competencies: practice based Learning and systems-based practice. Am J Med Qual.22: 351-382
5. Chapter 10 in Evaluation of Clinical Competence
6. Lurie S J, Mooney, C J, Lyness, J M (2009). Measurement of the General Competencies of the Accreditation Council for Graduate Medical Education: A Systematic Review. Acad Med 84: 301-309
7. Kocher and Sahni. (2010) Physicians versus Hospitals as Leaders of Accountable Care Organizations NEJM, 2579, Dec 30
8. Hawkins RE, Weiss KB. Building the Evidence Base in Support of the ABMS MOC Program (2011). Acad. Med. 86:6-7
Assignments (Performance and Written)
Session # / Points /Session 1 / 8
Session 2 / 8
Session 3 / 8
Session 4 / 8
Session 5 / 8
Session 6 / 8
Session 7 / 8
Face-to-face / 20
Final Project / 14
Total / 90
Grading