1. Session #F5A
October 6, 2012
Team-Based Patient Care: Community Mentors as Role Models for Medical Students
Kathy L. Bradley-Klug, Ph.D.
Emily Shaffer-Hudkins, Ph.D.
Kira Zwygart, M.D.
Lisa Bateman, M.A.
Collaborative Family Healthcare Association 14th Annual Conference
October 4-6, Austin, Texas U.S.A.
Collaborative Family Healthcare Association 12th Annual Conference

2. Faculty Disclosure
We have not had any relevant financial relationships during the past 12 months.
CFHA requires that your presentation be FREE FROM COMMERCIAL BIAS. Educational materials that are a part of a continuing education activity such as slides, abstracts and handouts CANNOT contain any advertising or product‐group message.
The content or format of a continuing education activity or its related materials must promote improvements or quality in health care and not a specific propriety business interest of a commercial interest.
Presentations must give a balanced view of therapeutic options. Use of generic names will contribute to this impartiality. If the educational material or content includes trade names, where available trade names for products of multiple commercial entities should be used, not just trade names from a single commercial entity. Faculty must be responsible for the scientific integrity of their presentations. Any information regarding commercial products/services must be based on scientific (evidence‐based) methods generally accepted by the medical community.
Collaborative Family Healthcare Association 12th Annual Conference

3. Objectives
Identify the critical components of a community based mentoring curriculum designed to improve patient care
Describe the importance of interdisciplinary collaboration in the development of this training curriculum
Discuss the importance of action research skills in training medical students for community based, collaborative healthcare practice
Understand the outcomes of this curriculum to date and engage in a discussion of “lessons learned” for future development of training in integrated care
Include the behavioral learning objectives for this session
Collaborative Family Healthcare Association 12th Annual Conference

4. Learning Assessment
A learning assessment is required for CE credit. Attention Presenters: Please incorporate audience interaction through a brief Question & Answer period during or at the conclusion of your presentation. This component MUST be done in lieu of a written pre- or post-test based on your learning objectives to satisfy accreditation requirements.
Collaborative Family Healthcare Association 12th Annual Conference

5. Presentation Outline Background of the SELECT program
The Community-Based Clinical Mentoring (CCM) experience
CCM content and clinical activities
Team-based observation and interview
Action research project
Assessment of the CCM experience
Collaborative Family Healthcare Association 12th Annual Conference

6. The SELECT MD Program Scholarly Excellence, Leadership Experiences, Collaborative Training
Partnership between the University of South Florida & Lehigh Valley Health Network

7. The SELECT MD Program
Focus on Health Systems, Leadership and Patient-Centered Care
Admissions based on leadership potential and emotional competencies
Various didactic and clinical experiences
Prologue, Professional Development Coaching, Doctoring, Community-Based Clinical Mentoring, and Summer Immersion
Collaborative Family Healthcare Association 12th Annual Conference

8. Basis for the SELECT Community-Based Clinical Mentoring Experience
Medical students often lack understanding of
team-based patient care, including conceptual understanding of
Patient Centered Medical Home (PCMH)
Care of individuals with chronic health conditions
Positive psychology
Quality of life concepts
Public Health model

9. The SELECT Community-Based Clinical Mentoring (CCM) Experience
Pairs of students are assigned to clinical mentors in interdisciplinary care teams within Florida communities
Visits to a patient’s home or workplace helps students to appreciate how quality of life is affected by health status
Action research projects developed in collaboration with the community care team
Student pairs visit preceptor sites ½ day each week for 14 weeks
Integrated into their course schedule at USF, students engage with each other and their mentors for an in-depth analysis of the CCM experience
Each pair designs and completes a project that addresses something observed at their site--a particular aspect of the public health model of care.
Collaborative Family Healthcare Association 12th Annual Conference

10. Goals of the CCM Experience
Demonstrate knowledge and assessment skills related to the concept of positive psychology
Gain understanding of the quality of life concept as it applies to patients and their families
Learn and apply the public health model
Develop communication and collaboration skills to work effectively across disciplines
Understand clinical care models
Understand how to facilitate values based, patient-centered care at the interpersonal level
Demonstrate knowledge of action research through direct application

11. Examples of CCM Objectives
Understand how patients perceive health, quality of life, and their impact on disease
Actively participate in a clinical program that incorporates a team-based approach to medical care or a Patient Centered Medical Home
Develop communication skills aimed at effective collaboration across interprofessional systems and disciplines
Create interpersonal strategies to facilitate improved care of patients
Collaborative Family Healthcare Association 12th Annual Conference

12. Student Participants
19 SELECT students (1st year medical students)

13. Community Participants
Clinical preceptors in the community who exemplify interdisciplinary and team-based care
A pair of students is assigned to each site to observe all facets of care
Each student pair visits a patient outside of the clinic
(e.g., at patient’s home, workplace, community activity)
Students represent an extension of the care team
Gain insight into how health/illness impacts a patient’s life outside of the clinical setting
Collaborative Family Healthcare Association 12th Annual Conference

14. Clinical Preceptor Sites: Examples
Complex Chronic Pediatric Center at St. Joseph’s Children’s Hospital
Dunedin Primary Care
Neonatal Intensive Care Unit (NICU) at Tampa General Hospital
Turley Family Health Center (BayCare, Morton Plant Mease Hospital)
USF Parkinson's Disease & Movement Disorders Center Byrd Alzheimer’s Institute
Collaborative Family Healthcare Association 12th Annual Conference

15. Student CCM Activities
Assessment of communication among their clinical team and development of ideas to improve team practices
Assessment of quality of life and/or positive psychology constructs among their patients
Discussion of the above findings within small groups in class
Completion of action research projects developed in collaboration with their clinical preceptors
Just some examples
Collaborative Family Healthcare Association 12th Annual Conference

16. Team Communication Interview
SELECT CCM: Evaluating Communication Aspects of Teamwork in Healthcare
10-item observation tool followed by an interview with one or more team members
How does communication typically occur within the team?
What are your team’s strengths regarding communication?
What do you see as limitations regarding optimal communication in the team?
What could be done differently to improve communication in this team?
Just some examples
Collaborative Family Healthcare Association 12th Annual Conference

17. Team Communication Interview
When you think about ideas for future direction of the practice and/or changes to current systems, how does communication among team members play a role?
How would you describe the support you give one another on this team?
Who comprises the team, in your eyes? Is there anyone who isn’t currently on the team but who you think could play a valuable role?
Is there anything we haven’t discussed about
communication in your team that would be important for me to know?
Just some examples
Collaborative Family Healthcare Association 12th Annual Conference

18. Action Research Project
Purpose:
To develop a project focused on improving community practices at your community preceptor site using CCM goals and objectives
Process:
Plan: Work with your community preceptor to identify an issue or area in need of empirical investigation
Act: Assess the current situation and develop applied strategies to address the identified issue
Share: Use data to demonstrate effectiveness of applied strategies
Reflect: Consider implications, limitations, and develop a plan for continued improvement
Just some examples
Collaborative Family Healthcare Association 12th Annual Conference

19. Timeline
Identify Issue to Study

20. Examples of Completed Projects
End of Visit Care and Its Effect on Patient Compliance
Explorations of Team-Based Communication
Multidisciplinary Care & Parkinson’s: Miracle or Mess?
Proactively Preparing Interns for their NICU Rotation
There is No ‘I’ in Team: A Quality-Improvement Survey
USF Healthy Weight Clinic Intake Form
For instance, one student pair developed a patient-needs survey in collaboration with their mentor to determine whether patients would find it useful to have health care providers from additional specialties added to a medical-home care team.
At a different community site, a student and his mentor asked patients to confidentially rate the physician’s effectiveness in communicating their follow-up care and current health status at the end of a visit.
Additional topics included observation and assessment of the health care team’s communication strategies and cohesiveness with one another, development of one, cohesive intake form for patients instead of multiple forms to complete in the waiting room, and improvement of bone health screening for premature infants.
Collaborative Family Healthcare Association 12th Annual Conference

21. Evaluation of CCM Competencies
Case presentation in Doctoring
Emphasis on prevention and quality of life in history-taking and plan of care
Action research project poster exhibit
Evaluation by patients, community preceptors, and USF faculty
Culminating case study integrating all CCM goals
Pass/Fail grading philosophy
Collaborative Family Healthcare Association 12th Annual Conference

22. Evaluation of CCM Action Research Projects
Rubric with competencies for each phase of action research and presentation quality
Each competency assessed from 0 (component is absent) to 4 (exemplary)
Examples of competencies:
Issue or area of need being addressed reflects one or more of the CCM objectives
Appropriate tools or measures are used to assess the current situation, with justification for their selection provided
The implications of the findings to the field (both with respect to practice and future action research) are stated
Collaborative Family Healthcare Association 12th Annual Conference

23. CCM Program Assessment
Faculty Feedback
Doctoring faculty
Professional Development coaches
Student Feedback
End of year student survey
Focus groups on patient-centered care and team-based practice
Next slides highlight quotes from the student feedback (this is one aspect of CCM program assessment that we currently have IRB approval to study and writeup)
Collaborative Family Healthcare Association 12th Annual Conference

24. Mid-Year Student Feedback
“The one-on-one mentoring with faculty. It means a lot to have the guidance and support of a successful faculty member as part of our curriculum. It makes me a better student.”
“My favorite part of the SELECT program is the focus on patient-centered care. I feel that it is essential to get to know your patients on a more personal level rather than viewing them as a list of signs and symptoms. The SELECT program teaches you to ways to foster these relationships with your patients and brings light to its importance in providing the highest quality care.”

25. End of Year Student Focus Groups
Describe how your impression of the impact of a chronic health condition has developed this past year
Home visits showed the importance of having a support system
Understanding non-compliance as needing self-empowerment
It’s about working with patients not working at them
Describe how your interactional style may have developed in the way that you approach and communicate with other medical professionals
Learned to value other positions
Know when to step back
It’s toxic to the team environment to think you can’t learn from others
Collaborative Family Healthcare Association 12th Annual Conference

26. Feedback for further development of CCM
Overall, students were ‘moderately satisfied’ to ‘very satisfied’ with the CCM experience. 
The most beneficial aspects of the CCM experience
Seeing how a strong interprofessional team interacts
Having the opportunity to interview patients
The home visit with patients and families 
The most challenging aspects of CCM:
Desire to have more time at the clinic site
Logistics of travel to and from sites
Site-specific limitations

27. End of Year Student Feedback
“SELECT does not create students in some image of what a leader should be, it provides the guidance and support to find and follow your own passions in medicine.”
“I would say the SELECT program is putting an emphasis on the factors that separate great physicians from simply competent physicians.”
“You learn the ins and outs of healthcare with a strong emphasis for leading healthcare change.”

28. End of Year Student Feedback
“Seeing how a strong interprofessional team interacts while at the same time trying to maintain the status quo. It showed the difficult uphill battle ahead of us for changing minds and behaviors in order to improve quality of care.”
Collaborative Family Healthcare Association 12th Annual Conference

29. SELECT Community-Based Clinical Mentoring is made possible through
Questions?
SELECT Community-Based Clinical Mentoring is made possible through
“Bringing Science Home,” a Patterson Foundation grant to the University of
South Florida to transform how societies and individuals manage chronic disease.

30. Special Thanks to the Bringing Science Home CCM Team:
Kira Zwygart, M.D.
Kathy Bradley-Klug, Ph.D.
Allesa English, M.D., Pharm.D.
Emily Shaffer-Hudkins, Ph.D.
Lisa Bateman, M.A.
Dawn Schocken, M.P.H.
Jennifer Hart, M.Ed.

31. Allesa English, M.D., Pharm.D. Director, SELECT Preclinical Curriculum
Contact Information:
Allesa English, M.D., Pharm.D.
Director, SELECT Preclinical Curriculum
Office of Educational Affairs
USF Morsani College of Medicine .
Collaborative Family Healthcare Association 12th Annual Conference

32. Session Evaluation Thank you!
Please complete and return the evaluation form to the classroom monitor before leaving this session.
Thank you!
This should be the last slide of your presentation
Collaborative Family Healthcare Association 12th Annual Conference