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, 2012 Austin, Texas U.S.A. Collaborative Family Healthcare Association 12th Annual Conference

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Timeline Identify Issue to Study

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

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

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

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

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.”

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

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

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.”

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

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.

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.

Allesa English, M.D., Pharm.D. Director, SELECT Preclinical Curriculum Contact Information: http://health.usf.edu/medicine/select/index.htm Allesa English, M.D., Pharm.D. Director, SELECT Preclinical Curriculum Office of Educational Affairs USF Morsani College of Medicine 813-396-9459 aenglis1@health.usf.edu . Collaborative Family Healthcare Association 12th Annual Conference

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