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A 21 st Century CPD Challenge: Patient-Centeredness.. “Learn on Your Own and Leave Us Alone” Fahad Al-Ghimlas October 19, 2014 Session 1 : Continuous Professional.

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Presentation on theme: "A 21 st Century CPD Challenge: Patient-Centeredness.. “Learn on Your Own and Leave Us Alone” Fahad Al-Ghimlas October 19, 2014 Session 1 : Continuous Professional."— Presentation transcript:

1 A 21 st Century CPD Challenge: Patient-Centeredness.. “Learn on Your Own and Leave Us Alone” Fahad Al-Ghimlas October 19, 2014 Session 1 : Continuous Professional Development (CPD), Challenges & Evidence-based Approach Merits

2 My reply ‘That’s not the way we do things here. This is part of the education of doctors in the hospital, where all team (including residents or/and students) participate in your care’. ‘Session 1 : CPD, Challenges & Evidence-based Approach Merits’ – Fahad Al-Ghimlas – October 19, 2014

3 My reply ‘That’s not the way we do things here. This is part of the education of doctors in the hospital, where all team (including residents or/and students) participate in your care’. If you don’t want all team participating in your care, you should go somewhere else.’ ‘Session 1 : CPD, Challenges & Evidence-based Approach Merits’ – Fahad Al-Ghimlas – October 19, 2014

4 My reply ‘That’s not the way we do things here. This is part of the education of doctors in the hospital, where all team (including residents or/and students) participate in your care’. ‘Session 1 : CPD, Challenges & Evidence-based Approach Merits’ – Fahad Al-Ghimlas – October 19, 2014

5 Mrs. A 76 frail lady, in casualty Known to have “asthma” Admitted already, waiting for a bed Cough, febrile, and pancytopenia ‘Session 1 : CPD, Challenges & Evidence-based Approach Merits’ – Fahad Al-Ghimlas – October 19, 2014

6 Mrs. A She doesn’t want “student doctors” taking care of her. She wants “real doctors,” not ones who are “still learning.” ‘Session 1 : CPD, Challenges & Evidence-based Approach Merits’ – Fahad Al-Ghimlas – October 19, 2014

7 Today, most teaching hospitals.. Staff nonteaching services (including staff on locum) Admit more patients to nonteaching services (despite large government subsidies for their teaching status) ‘Session 1 : CPD, Challenges & Evidence-based Approach Merits’ – Fahad Al-Ghimlas – October 19, 2014

8 Staff nonteaching services (including staff on locum) ‘Session 1 : CPD, Challenges & Evidence-based Approach Merits’ – Fahad Al-Ghimlas – October 19, 2014 Today, most teaching hospitals.. due to.. o Restrictions on residents’ work hours tighten, o Caps on teaching census shrink, o Number of federally funded positions for graduate medical education remains fixed, and o Hospital executives (including many trained as physicians) value patient throughput more than medical education. Reilly BM. N Engl J Med Jul 24;371(4):293-5

9 My reply ‘That’s not the way we do things here. This is part of the education of doctors in the hospital, where all team (including residents or/and students) participate in your care’. ‘Session 1 : CPD, Challenges & Evidence-based Approach Merits’ – Fahad Al-Ghimlas – October 19, 2014

10 Differential “Treatment” for the “Demanding” Instead of saying ‘my way or the highway’, I would say.. ‘Not a problem, ma’am. I’ll make sure I will personally be responsible for your care.’ ‘Session 1 : CPD, Challenges & Evidence-based Approach Merits’ – Fahad Al-Ghimlas – October 19, 2014

11 Is It a Good Differential “Treatment”? Won’t she receive better care in an educational environment? Am I not learning myself?!! ‘Session 1 : CPD, Challenges & Evidence-based Approach Merits’ – Fahad Al-Ghimlas – October 19, 2014

12 Graduation is Just the Start of A Journey! Yet Should be Good One! ‘Session 1 : CPD, Challenges & Evidence-based Approach Merits’ – Fahad Al-Ghimlas – October 19, 2014

13 Junior Staff: they make me look better! I am a competent clinician but I remember by working with residents and students: Mrs. M. (Kuwait) – severe pernicious anemia explained her dyspnea as intern heard the diastolic rumble I had missed. Mr. R. (Kuwait) – raging illness stumped me cold until a junior staff taught me about FMF. Mrs. K. (Canada) – near-fatal drug addiction remained undiscovered until a medical student made the effort to bond with her family. ‘Session 1 : CPD, Challenges & Evidence-based Approach Merits’ – Fahad Al-Ghimlas – October 19, 2014

14 But who has the time? Even if.. 1.evidence of superior quality of care in teaching hospitals was more convincing — 2.we could explain teaching hospitals’ lower patient-satisfaction scores would it matter in Mrs. A.’s case? Evidence Next Slide Evidence Next Slide ‘Session 1 : CPD, Challenges & Evidence-based Approach Merits’ – Fahad Al-Ghimlas – October 19, 2014

15 To compare the performance of U.S. teaching and nonteaching hospitals using a portfolio of contemporary, publicly reported metrics (2006–2009)  Teaching  Council of Teaching member (Half-Teaching)  Non-Teaching ‘Session 1 : CPD, Challenges & Evidence-based Approach Merits’ – Fahad Al-Ghimlas – October 19, 2014

16 To compare the performance of U.S. teaching and nonteaching hospitals using a portfolio of contemporary, publicly reported metrics (2006–2009)  Teaching  Half-Teaching  Non-Teaching ,684 ‘Session 1 : CPD, Challenges & Evidence-based Approach Merits’ – Fahad Al-Ghimlas – October 19, 2014

17 TeachingNon-TeachingHalf-Teaching Inpatient care Shahian DM, et al. Acad Med 2012; 87: ‘Session 1 : CPD, Challenges & Evidence-based Approach Merits’ – Fahad Al-Ghimlas – October 19, 2014 Teaching vs. Non-teaching: CC

18 TeachingNon-TeachingHalf-Teaching Education Personnel Shahian DM, et al. Acad Med 2012; 87: ‘Session 1 : CPD, Challenges & Evidence-based Approach Merits’ – Fahad Al-Ghimlas – October 19, 2014 Teaching vs. Non-teaching: CC

19 TeachingNon-TeachingHalf-Teaching Expense per case Shahian DM, et al. Acad Med 2012; 87: ‘Session 1 : CPD, Challenges & Evidence-based Approach Merits’ – Fahad Al-Ghimlas – October 19, 2014 Teaching vs. Non-teaching: CC

20 TeachingNon-TeachingHalf-Teaching Heart Attack Heart Failure Process Measure Shahian DM, et al. Acad Med 2012; 87: ‘Session 1 : CPD, Challenges & Evidence-based Approach Merits’ – Fahad Al-Ghimlas – October 19, 2014 Teaching vs. Non-teaching: CC I P<

21 Shahian DM, et al. Acad Med 2012; 87: TeachingNon-TeachingHalf-Teaching Process Measure Pneumonia Surgical care improvement project ‘Session 1 : CPD, Challenges & Evidence-based Approach Merits’ – Fahad Al-Ghimlas – October 19, 2014 Teaching vs. Non-teaching: CC I P<

22 TeachingNon-TeachingHalf-Teaching 30-day mortality Outcome Measure Shahian DM, et al. Acad Med 2012; 87: ‘Session 1 : CPD, Challenges & Evidence-based Approach Merits’ – Fahad Al-Ghimlas – October 19, 2014 Teaching vs. Non-teaching: CC I P<

23 Teaching vs. Non-teaching: CC TeachingNon-TeachingHalf-Teaching Patient experience measure Shahian DM, et al. Acad Med 2012; 87: ‘Session 1 : CPD, Challenges & Evidence-based Approach Merits’ – Fahad Al-Ghimlas – October 19, 2014 I P<

24 Patient-Centeredness Patient-centered care supports active involvement of patients and their families in the design of new care models and in decision-making about individual options for treatment. "Providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions." Institute on Medicine. Retrieved 26 November Patient-centered care is also one of the overreaching goals of health advocacy, in addition to safer medical systems, and greater patient involvement in healthcare delivery and design. Jo Anne L. Patient Advocacy for Health Care Quality. Given that non-consumer stakeholders often don't know what matters most to patients regarding their ability to get and stay well, care that is truly patient-centered cannot be achieved without active patient engagement at every level of care design and implementation. Sepucha, Karen; Uzogarra, Barry, O'Connor, Mulley (2008). Patient Educ Counsel. 73 (3): 504–510 ‘Session 1 : CPD, Challenges & Evidence-based Approach Merits’ – Fahad Al-Ghimlas – October 19, 2014

25 Patient-Centeredness “Clinicians’ best, evidence-based professional judgment must take a back seat to patients’ wishes”. Dr. Donald Berwick This idea may have clinical and economic infeasibility – E.g. misplaced car keys might become an indication for brain MRI ‘Session 1 : CPD, Challenges & Evidence-based Approach Merits’ – Fahad Al-Ghimlas – October 19, 2014

26 Healthcare Professionals Should Gain In‐depth background of available diagnostic tests and therapeutic interventions Effective search tools Critical appraisal skills Ability to define and understand benefits/risks Ability to understand patients’ and cultural values and preferences ‘Session 1 : CPD, Challenges & Evidence-based Approach Merits’ – Fahad Al-Ghimlas – October 19, 2014 Fahad Al-Ghimlas

27 Should We Adopt Patient-Centeredness? Yes. But through a “Mature Dialogue”. Curiosity is a Requirement. – Why does Mrs. A. want what she wants? – Why rejecting residents and students before even meeting them? ‘Session 1 : CPD, Challenges & Evidence-based Approach Merits’ – Fahad Al-Ghimlas – October 19, 2014

28 Published Research NOT Address.. Do procedurists in teaching hospitals disclose who holds scalpels, scopes, or catheters in their case? Are answers reassuring to patients? How faithfully these promises are kept? ‘Session 1 : CPD, Challenges & Evidence-based Approach Merits’ – Fahad Al-Ghimlas – October 19, 2014

29 Disadvantages of Work-hour Restrictions Patients’ reluctance to serve as “teaching material” pose a similar threat to the quality of our future physicians. Might diminish their preparedness for independent practice. ‘Session 1 : CPD, Challenges & Evidence-based Approach Merits’ – Fahad Al-Ghimlas – October 19, 2014

30 Overall Conclusions and Take-Home Messages Next year will be more exciting.. I promise! Evidence of quality of care in teaching hospital environments is superior. Teaching hospitals may leave lower patient-satisfaction scores. Unanswered questions about lower patient-satisfaction may solve the puzzle. We should adopt patient-centeredness but through a “mature dialogue”. ‘Session 1 : CPD, Challenges & Evidence-based Approach Merits’ – Fahad Al-Ghimlas – October 19, 2014

31 It is Not the Start.. It is the Journey! ‘Session 1 : CPD, Challenges & Evidence-based Approach Merits’ – Fahad Al-Ghimlas – October 19, 2014

32 A 21 st Century CPD Challenge: Patient-Centeredness.. “Learn on Your Own and Leave Us Alone” Fahad Al-Ghimlas October 19, 2014 Session 1 : Continuous Professional Development (CPD), Challenges & Evidence-based Approach Merits THANKS!

33 EXTRA SLIDES

34 Clinical expertise doesn’t lend itself easily to objective measurement, much less controlled trials. (If I could prove it, I would ask patients to give informed consent for the nonteaching service.) Expertise vs. Updated I Can’t Prove It ‘Session 1 : CPD, Challenges & Evidence-based Approach Merits’ – Fahad Al-Ghimlas – October 19, 2014

35 Disadvantages of Work-hour Restrictions Patients’ reluctance to serve as “teaching material” pose a similar threat to the quality of our future physicians. Might diminish their preparedness for independent practice. Evidence Next Slide Evidence Next Slide

36 2003: Common Program Requirements established by the ACGME for residency programs. 2007: reports of sleep deprivation especially the most junior residents, recommending further limitation of residents’ work hours, increased supervision, fatigue-mitigation strategies, facilitation of care transitions, and increased federal oversight of the ACGME. N Engl J Med Dec 2;363(23):e34.

37 Past vs. Present Drolet BC, et al. N Engl J Med 2010;363(23):e34.

38 Demographic Characteristics Total = 2,561 Drolet BC, et al. N Engl J Med 2010;363(23):e34.

39 Demographic Characteristics Total = 2,561 Drolet BC, et al. N Engl J Med 2010;363(23):e34.

40 What Did They Say? Drolet BC, et al. N Engl J Med 2010;363(23):e34.

41 Authors Conclusions New rules are designed for “safe and humanistic educational environment”. Concerns: should study effect of changes on residents’ education and the quality and safety of patient care in teaching hospitals.

42 Extra Slides

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