1. General Preventive Medicine Practicum for Residents From Definition To Implementation FMEC September 22, 2011 Kelechi A. Uduhiri, MD,MPH,MS Medical Director Healthcare for the Homeless, Baltimore County Faculty, Franklin Square Hospital Center Family Medicine Residency Program Baltimore, Maryland

2. Agenda  Define Practicum  Goal of Practicum Core Preventive Medicine Competencies Public Health & General Prev Med Competencies  Design & Implementation of Practicum  Evaluating Practicum

3. What is a Practicum? ☆ prac·ti·cum (prak′ti kem) noun a course involving activities emphasizing the practical application of theory, esp. one in which a student gains on-the-job experience in a field of study Webster's New World College Dictionary prac·ti·cum (prăk ˈ tĭ-k ə m) noun A course, especially one in a specialized field of study, that is designed to give students supervised practical application experience Modified from The American Heritage® Dictionary of the English Language,The American Heritage® Dictionary of the English Language

4. Therefore, Practicum Is…  Practice-Based Education  Service Learning Includes the following components:  Clinical preventive medicine at the population level  Research at the population level  Health administration at the population level  Public Health Practice

5. Practicum Goals: Achieve Competency in 10 Core Preventive Medicine Competencies 1. Identification, coordination of resources to improve the community’s health 2. Identification of ethical, social and cultural issues relating to public health and prev med 3. Communication, program, needs assessment 4. Computer applications relevant to preventive medicine 5. Interpretation of relevant laws and regulations

6. Practicum Goals: Achieve Core Preventive Medicine Competencies 1. Identification of organizational and decision- making processes 2. Epidemiology and biostatistics 3. Management and administration 4. Clinical preventive medicine 5. Occupational and environmental health

7. Practicum Goals: Achieve Competency in 4 Preventive Medicine and Public health Principles 1. Public Health Practice 2. Clinical Preventive Medicine 3. Epidemiology & Biostatistics 4. Health Administration

8. Practicum Goals: Meets ACGME Competencies 1. Patient care/Population care 2. Medical Knowledge 3. Practice-Based learning and improvement 4. Interpersonal and Communication skills 5. Professionalism 6. Systems-Based Learning

9. Were other competencies met? FM Community Medicine Competencies  Violence, abuse and neglect risk assessment  Communicable disease reporting  Population epidemiology and stats  Environmental illness and injury  School health  Disease prevention  Disaster responsiveness  Community-based screening, prevention and health promotion  Sub-population disparities and associated factors

10. Were other competencies met? FM Community Medicine Competencies  Using community resources appropriately for individuals patients with unmet medical or social support needs  Structured interaction with the public health system  Occupational medicine including disability determination, employee health and job related illness and injury  Experience in community health assessment  Experience in developing programs to address community health priorities  Community-based health education of children and adults

11. Practicum Implementation – First Steps Prior to start of practicum :  Advisor Meeting, discuss GPM block(s), draft practicum  Submit to Drs. Uduhiri / Rixey for review  Meet before start with site supervisor to: - discuss project - goals and objectives - competencies and timeline for completion  Finalize GPM practicum with Drs. Uduhiri / Rixey

12. Example of Practicum Healthcare for the Homeless, Baltimore County

13. Healthcare for the Homeless (HCH)  Practicum Site Description: FQHC, Baltimore County (BC) Serving the homeless since Jan 2008 Located above largest homeless shelter, BC 1300 unique patients, ~ 6500 visits 3 pcp, 1 social worker, 2 MAs Primary care & preventive services, case management, mental health & substance abuse treatment referrals

14. Practicum Design: HCH-FQHC  Rationale: Provide access to quality health care for the underserved and persons experiencing health disparities  Process: Identified goals & objectives for practicum through researching relevant issues in homelessness  Outcome: Developed 5 learning modules

15. Module1- Fundamentals of Healthcare for the Homeless Objectives:  Homelessness in America, who, why & how many?  Understand national health priority goals as identified in Healthy People 2020  Understand burden of disease & health disparities in the homeless  Recognize barriers impacting care of the homeless

16. Module 2 - Psychosocial Issues Impacting the Homeless Objectives:  Demonstrate competence in obtaining a detailed social and occupational history  Demonstrate competence in assessment of domestic violence, smoking cessation, depression screen  Understand case management needs  Identify available community resources

17. Module 3 - Providing Clinical Preventive Services for the Homeless Objectives:  Provide culturally sensitive and competent care for persons experiencing homelessness and poverty  Adjust and apply evidence-based patient guidelines, including preventive screening, based on patient’s values and economic circumstances while preserving quality of care

18. Module 3 - Providing Clinical Preventive Services for the Homeless – Cont’d Objectives:  Review, identify and treat common chronic and communicable diseases prevalent in the homeless, or in shelters  Understand public health approaches to disease outbreak in a homeless shelter

19. Module 4 - Health Policy & Advocacy On Issues Pertaining to Homelessness Objectives:  Describe how economical, historical and political forces have combined to create and continue to create healthcare disparities  Understand the origins of HCH programs and sources of funding

20. Module 4 - Health Policy & Advocacy On Issues Pertaining to Homelessness – Cont’d Objectives:  Understand how the new Health Reform Law will impact health care for the homeless services and recipients  Recognize individual and community strengths of those living in poverty

21. Module 5 - Quality Improvement in Homeless Services & Health Outcomes Objectives:  Choose a chronic disease  Identify a quality of health indicator  Extract data using EMR  METRIC  Suggest intervention(s) for practice and quality improvement  Disseminate findings

22. Practicum Evaluation – Final Steps  Meet with supervisor to review performance  Complete practicum evaluation

23. Practicum Evaluation – HCH Example Core CompetencySpecific Activity for the Practicum Supervisor Evaluation Identification of ethical, social, and cultural issues relating to public health and preventive medicine. Recognition of cultural diversity and its impact on community health issues Determination of risk as it relates to ethnic and cultural identification Recognition of ethical issues related to interventions Conscientious use of human subjects review and informed consent Module 1: Review Handout on Culture of Homelessness, and site clinical case scenario where concept identified Review the following: Out of the Shadows: Exploring the Barriers to Mental Health, Prevention and Treatment at http://www.kaisernetwork.org/health_c ast/hcast_index.cfm?display=detail&hc =1870 http://www.kaisernetwork.org/health_c ast/hcast_index.cfm?display=detail&hc =1870 Module 4: Describe how economical, historical and political forces have combined to create and continue to create healthcare disparities Resident experience gained: []Performed: being responsible for a specific task directly related to the competency (alone or in conjunction with preceptor) []Observed: observed activities associated with the competency []Exposed: had discussions with preceptor or read literature related to the competency Other comments :

24. What does the final product look like?  Resident Portfolio Containing Project Assignments References and literature review documents Evaluation form Conferences, seminars attended Project summary, data analysis reports Plan methods for dissemination  Presentations, papers and posters

25. Thank You  Q & A