Teaching Residents About Continuity of Care Queen’s University Health Sciences Education Rounds November 15, 2007 Dr. Karen Schultz

Overview  Why teach this?  Why change?  Process to making changes  What we did  How we’re going to evaluate it

Why even teach this or What’s so important about continuity of care?  Increased patient satisfaction  Improved patient outcomes  Increased physician satisfaction

Why Change?  Continuity of care is good=the carrot  Because we were told we had to=the stick!

What we had been doing  4 months in first year  4 months in second year—often 2 x 2

What many other FM programs do  ½ day back

Queen’s and the ½ day back  Evidence?  Set up of the program

Queen’s Family Medicine Rotation Sites

Queen’s and the ½ day back  1=Evidence?  2=Set up of the program  3=Community rotations’ continuity of care  4=Residents’ reluctance =concern

Change. Oh so easy. Not!!  “Things change only when people change”  Buy in –“Change is difficult but often essential to survival” “Change can be the rule but not the ruler” –Informed –++ consensus building (ideas, brainstorm difficulties, solutions from within, not imposed…) Working group Rounds s Surveys  Pilot  evaluation  changes  program roll out  Evaluate  Feedback

What we are doing  Continuity of care clinics –~10 patients/resident Deliberate selection of pts –Clinic ~ every 2 months (minimum) Deliberate timing –1-3 years

Evaluation  1. Impact: –Surveys of all involved –Patients, staff (receptionists, nurses, doctors), residents  2. Is it achieving it’s educational objective?  Did they get “IT”? How to measure “IT”?

RESEARCH!!

Literature review  Types of continuity of care –Longitudinal, informational, geographic, multidisciplinary, interpersonal.  Interpersonal continuity of care –Patients—patient satisfaction surveys –Health care provider  Literature review IP C of C HCP=responsibility  Informal discussions

The Grand Plan  Objective: evaluate this change to our educational program  Step 1=gain an understanding of IP C of C from the doctors perspective  Step 2=take key concepts from 1, create a survey  Step 3=assess different ways of teaching about continuity of care  Step 4=save the world

Step 1: What are the components of IP C of C for the HC provider?  Qualitative research  What do I know of qualitative research?

The steps to step 1  Reading  Conferences –Workshops –Listening to others, looking at posters  Colleagues  Networking

What I’ve learned  Different types of qualitative research –Focus groups  Bias issues –Triangulate data –Saturation –Member checking  Get a grant (or typing a transcript hurts!)  Work with a colleague

Step 2: the Survey  Quantitative research  What do I know of quantitative research?

With a little help from Gary Larson What We Say To Dogs "Okay, Ginger! I've had it! You stay out of the garbage! Understand, Ginger? Stay out of the garbage, or else!" What They Hear "blah blah GINGER blah blah blah blah blah blah blah blah GINGER blah blah blah blah blah..." My understanding of Quantitative research

What I’ve learned so far  Get a stats degree  Collaborate

Discussion  Collaborating –Across disciplines  Getting grants in medical education  ??