Results of CERA Clerkship Director Survey: Practice Based Learning and Improvement in Family Medicine Clerkships Deanna R Willis, MD, MBA Betsy G Jones, EdD Ian Bennet, MD, PhD Scott Renshaw, MD Matthew Holley, MA, MS Mary E Dankoski, PhD Presented at the Society of Teachers of Family Medicine Annual Conference May 2013

Join the conversation Twitter: #STFM13 Background Increased requirements for practicing physicians to participate in Quality Improvement (QI) activities Performance measurement and improvement is a key principle of Patient Centered Medical Home Literature has suggested that medical students should participate in Practice Based Learning and Improvement (PBLI) activities 1 Little is known about QI education in medical school and family medicine clerkships 1. Neeman N, Sehgal NL. A Road Map for Academic Department to Promote Scholarship in Quality Improvement and Patient Safety. Academic Medicine Feb 2012; 87(2):

Join the conversation Twitter: #STFM13 Objective Examine attitudes and practices of family medicine clerkship directors (FMCDs) regarding the curricula and curricular experiences in their clerkships related to PBLI.

Join the conversation Twitter: #STFM13 Methods Part of a Council of Academic Family Medicine (CAFM) Educational Research Alliance (CERA) omnibus survey of FM clerkship directors Approved by the American Academy of Family Physicians Institutional Review Board (IRB) Reviewed and considered exempt by the IRB of Indiana University School of Medicine

Join the conversation Twitter: #STFM13 Methods Conducted between July 2012 and September 2012 Initial invitation for participation initiated by the Society of Teachers of Family Medicine (STFM). Non-responders were sent up to two follow- up s encouraging participation.

Join the conversation Twitter: #STFM13 Results 90 of 134 possible FMCD (67% Response Rate) FMCD Characteristics: – average of 2.7 years of experience as clerkship director – 13 in first year as director – 22 had greater than 11 years experience as director – 61% within 10 years of their own residency graduation – 51% had more than 20% protected time as director

Join the conversation Twitter: #STFM13 Results School/Clerkship Characteristics: – 66% public medical schools – 64% less than 150 students per class – 94% mandatory – 89% in one block of time – 57% greater than 4 weeks duration – 58% send students to a regional campus – 52% centralized teaching at least once a week – 49% require students to complete self assessment

Join the conversation Twitter: #STFM13 Results Presence/Characteristics of PBLI: – 29% (n=24) include PBLI in clerkship curriculum 67% student participate in or lead QI project 25% didactics on PBLI topics

Join the conversation Twitter: #STFM13 Results FMCD attitudes about developmental stage at which competency should be achieved: PBLI Measures % Disagree or Strongly Disagree % Neutral % Agree or Strongly Agree Students must achieve competency 40%36%24% Residents must achieve competency 6%18%76% Competency is extremely important to practicing physicians 4%24%72% p<0.01

Join the conversation Twitter: #STFM13 Results FMCD attitudes about role and potential outcome: PBLI Measures % Disagree or Strongly Disagree % Neutral % Agree or Strongly Agree Students able to participate in PBLI projects 17%28%55% Students able to lead a PBLI project 23%32%46% PBLI project in a clerkship can improve clinical outcomes 10%46%44%

Join the conversation Twitter: #STFM13 Results FMCD attitudes about barriers to PBLI: PBLI Measures % Disagree or Strongly Disagree % Neutral % Agree or Strongly Agree Adequate time 57%29%14% Faculty and preceptors have sufficient knowledge 51%27%23% Deploying patient centered medical home (PCMH) at adequate levels to include PBLI concepts 45%26%29%

Join the conversation Twitter: #STFM13 Independent Associations with PBLI in Curriculum P=<0.001 p=0.07 Frequency of centralized teaching

Join the conversation Twitter: #STFM13 Duration of Clerkship

Join the conversation Twitter: #STFM13 Independent Association with Intent to Increase PBLI in next 12 mos p=0.05

Join the conversation Twitter: #STFM13 Discussion Less than 1/3 rd of FMCDs offer PBLI >50% of FMCDs agree that students are developmentally able to participate >40% of FMCDs agree that students should be able to lead PBLI projects with support What is adequate support?

Join the conversation Twitter: #STFM13 Discussion FMCDs perceive that current practice environments inadequately support PBLI Consistent with PCMH literature 2 Practicing new model of care is faculty development need Ability to teach and practice PBLI adds to complexity 2. Rogers JC. The patient-centered medical home movement—promise and peril for family medicine. J Am Board Fam Med. 21(5):370-4, 2008 Sep-Oct.

Join the conversation Twitter: #STFM13 Discussion Most FMCD think students should not achieve competency in PBLI FMCD who do think students should achieve competency are more likely to offer PBLI Despite lack of time being a barrier to PBLI, no relationship between length of clerkship and offering PBLI Additional research needed: – Developing consensus about PBLI learning expectations – How and why do shorter clerkships offer PBLI

Join the conversation Twitter: #STFM13 Limitations Attributes based on FMCD perceptions FMCD may not be aware of PBLI activities in large/decentralized clerkships PBLI is not a commonly used term in UME – Different interpretations of the meaning of the term PBLI