Creating a Model Curriculum in the United States Samuel Keim University of Arizona

Where did we start? 1975  EM practice analysis of conditions and skills  Survey + Review by “expert panel”  Core Content List  22 categories

Core Content List – 1970’s Used to develop: Curriculum for training programs Certification tests Accreditation criteria for training programs Agenda for post-graduate education Agenda for political advocacy

Then chaos ensued… 1975 – 1997  No single organization in charge  List expanded from 5 pages to 20!  Lack of editing  No system of weighting or priority  Reflective of actual practice of EM?

Core Content Task Force Collaborative effort to create a single, accurate, common-source description of EM practice Curriculum for training programs Certification tests Accreditation criteria for training programs Agenda for post-graduate education Agenda for political advocacy

Core Content Task Force 4 Steps: 1) Practice Analysis 2) Advisory panel review 3) National Survey 4) Model preparation

A Model of Clinical Emergency Medicine 1) Model-based Practice Analysis NBME hired as consultant* Assumptions: Specialties are unique because of situations Task competency is driven by the situations Model is the set of appropriate Tasks + Situations Three categories of situations Critical Emergent Low acuity * La Duca et al, The design of a new physician licensure examination. Eval Health Prof. 1984; 7:115–40

1) Model-based Practice Analysis a) 1995 and 1996 National Hospital Ambulatory Medical Care Surveys (NHAMCS). >40,000 patient visits matched to reliably represent ~ 90 million visits b) Diagnoses sorted from most common to least common patient situations/encounters c) List 82% congruent with old “Core Content”

A Model of Clinical Emergency Medicine 2) Creation of Advisory Panel Practicing emergency physicians Not members of Task Force Reviewed List of Diagnoses and considered whether non-diseases, e.g., administration, procedural skills should be included

A Model of Clinical Emergency Medicine Advisory Panel created draft of Model containing Acuity Elements for list of most common diagnoses Task Force reviewed draft Sent to all sponsoring organizations for approval

A Model of Clinical Emergency Medicine 3) National Survey  Random sampling of 1084 certified emergency physicians  Specific questions and Comments requested regarding content and concepts  Overwhelmingly positive response that both Model was true representation of EM practice  Narrative comments reviewed and presented to the Task Force for consideration

A Model of Clinical Emergency Medicine 4) Preparation of EM Model Task Force revised Model based on survey and wrote descriptive preamble and recommendations for future: a) Future Task Forces should have some of old Task Force for continuity b) A one-year review should occur

A Model of Clinical Emergency Medicine Recommendations for future: c) Model reviewed every 2 yrs d) New practice analysis every 5 yrs

A Model of Clinical Emergency Medicine – What is it? 3 dimensional model List of conditions and components linked to a matrix composed of Physician Tasks Patient acuity frames

Model Patient Acuity Critical Life threat if immediate intervention not initiated immediately Emergent May progress in severity to high probability for morbidity if treatment not initiated soon Lower Acuity Low probability of progression to serious disease

Model List of Conditions 3.3 Cardiovascular Disorders CriticalEmergentLower acuity 3.1 Cardiopulmonary Arrest X 3.3 Arterial Thromboembolism X

Model Physician Tasks Diagnosis Develop a differential diagnosis; establish the most likely diagnoses in light of the history, physical, interventions, and test results.

Model Physician Tasks Therapeutic interventions Perform procedures and nonpharmacologic therapies, and counseling.

Model Physician Tasks Prevention and education Apply epidemiologic information to patients at risk; conduct patient education; select appropriate disease and injury prevention techniques.

Finally… Now possible to create a Curriculum based upon same common-model as Test and Program Requirements Weighting has been standardized Content will not change unless all organizations agree

Curriculum modification 2003 – 2004  Two major academic societies are collaborating to modify existing Model Curriculum to be consistent with the Model of Clinical Practice  Web-published

Existing Curriculum Based upon Pre-1997 List 23 Condition and Skill categories VERY long

Existing Curriculum Weighted according to importance of knowledge or skill to the practice of EM Mastery Proficiency Familiarity