Staff Physician & Resident Physician Toolkit Display this slide as participants are entering. Welcome participants, guide them to seating. Before we get started, let me just cover a few practical matters such as: Where the restrooms are. Lunch if available. If there will be breaks. Registration paperwork that must be completed and other logistics. PFCC and Clinical Teaching Effectiveness

Patient- and Family-Centered Care and Clinical Teaching Effectiveness Today, we are going to discuss effective, clinical teaching and how patient- and family-centered concepts and teaching strategies can enhance teaching effectiveness for residents and more experienced staff physicians. PFCC and Clinical Teaching Effectiveness

The Center for Medical Education Research and Development at the Cleveland Clinic developed a reliable and valid clinical teaching effectiveness tool with many practical applications for advancing the practice of patient- and family-centered in an academic medical center. Copeland, H. L., & Hewson, M. G. (2000). Developing and testing an instrument to measure the effectiveness of clinical teaching in an academic medical center. Academic Medicine, 75(2), 161-166. Discuss the key points on this slide. PFCC and Clinical Teaching Effectiveness

Clinical Teaching Effectiveness Tool . . . Establishes a good learning environment (approachable, nonthreatening, enthusiastic, etc.) Stimulates me to learn independently Allows me autonomy appropriate to my level/experience/competence Organizes time to allow for both teaching and care giving Offers regular feedback (both positive and negative) Copeland, H. L., & Hewson, M. G. (2000). Developing and testing an instrument to measure the effectiveness of clinical teaching in an academic medical center. Academic Medicine, 75(2), 161-166. The Clinical Teaching Effectiveness Instrument has 15 items. This slide and the next two list the 15 items included in the instrument. Highlight some of the items listed. PFCC and Clinical Teaching Effectiveness

Clinical Teaching Effectiveness Tool . . . Clearly specifies what I am expected to know and do during this training period Adjusts teaching to my needs (experience, competence, interest, etc.) Asks questions that promote learning (clarifications, probes, Socratic questions, reflective questions, etc.) Gives clear explanations/reasons for opinions, advice, actions, etc. Adjusts teaching to diverse settings (bedside, view box, OR, exam room, microscope, etc.) Highlight some of the items listed. PFCC and Clinical Teaching Effectiveness

Clinical Teaching Effectiveness Tool . . . Coaches me on my clinical/technical skills (interview, diagnostic, examination, procedural, lab, etc.) Incorporates research data and/or practice guidelines into teaching Teaches diagnostic skills (clinical reasoning, selection/interpretation of tests, etc.) Teaches effective patient and/or family communication skills Teaches principles of cost-appropriate care (resource utilization, etc.) Highlight some of the items listed. PFCC and Clinical Teaching Effectiveness

Clinical Teaching Effectiveness Evaluation Scale 1-Never/Poor 2-Seldom/Mediocre 3-Sometimes/Good 4-Often/Very Good 5-Always/Superb Don't Know/Not Applicable (DK/NA) There are five points on the evaluation scale for the clinical teaching effectiveness tool for observers and the opportunity to record “don’t know” or “not applicable.” . The following slides will illustrate how this tool might be used to encourage and support clinical teaching to advance the practice of patient- and family-centered care. PFCC and Clinical Teaching Effectiveness

Patient- and Family-Centered Approaches The following slides highlight patient- and family-centered concepts and specific teaching strategies that relate to the items listed in this teaching effectiveness instrument. Articles from recent medical education literature will be mentioned as well. PFCC and Clinical Teaching Effectiveness

Patient- and Family-Centered Care Core Concepts People are treated with respect and dignity. Health care providers communicate and share complete and unbiased information with patients and families in ways that are affirming and useful. Individuals and families build on their strengths through participation in experiences that enhance control and independence. Collaboration among patients, families, and providers occurs in policy and program development and professional education, as well as in the delivery of care. Just as a reminder . . . To underscore our shared understanding of patient- and family-centered care. Patient- and family-centered care is an approach to the planning, implementation, and evaluation of health care that is grounded in mutually beneficial relationships. This approach to care emphasizes communication and relationships. There are four core concepts: Respect and Dignity; Information Sharing; Participation; and Collaboration. PFCC and Clinical Teaching Effectiveness

Patient- and Family-Centered Approaches Report of 2009 ACGME Design Conference: “Across this diverse group of participants, an overarching consensus was that for PFCC to be sustainable, it has to be a fundamental expectation for resident learning and attainment of competence. Participants strongly concurred that improving the environment for patients has an enormous positive impact on the environment for learners” (p. 278). Philbert, I., Patow, C., & Cichon, J. (2011). Incorporating patient and family-centered care into resident education: Approaches, benefits, and challenges, Journal of Graduate Medical Education, 3(2), 272-278. The ACGME is the organization that accredits residency training programs. This article summarizes the process and findings of a design conference that brought together 74 people from diverse educational settings and experts in patient- and family-centered practice and other health care leaders to examine current practices and opportunities and challenges for including patient- and family-centered care as part of residency education. Briefly discuss the findings shown on the above slide. This presentation provides information about how to integrate patient- and family-centered concepts and teaching strategies into residency programs. The Toolkit has many resources that can be used as educational resources for trainees and staff physicians. PFCC and Clinical Teaching Effectiveness

Patient- and Family-Centered Approaches Greeting new residents at the beginning of their rotation and conveying to them that: You care about them as people; and You care about them as learners and developing patient- and family- centered clinicians. Establishing a positive learning environment where faculty are approachable, non-threatening, and enthusiastic is the first criteria listed on the effectiveness tool. A group of residents began their clinical rotation at the VA in Atlanta earlier this year. They were greeted by a hospitalist with warmth and concern for them as individuals and as medical learners. This genuine respect and commitment set a positive tone for learning during the rotation. Briefly discuss concepts listed on the slide. Ask participants how they have greeted residents or ask residents how they have been greeted. The hallways throughout the Atlanta VA have posters with messages illustrating patient- and family-centered practice, one way to reinforce to staff and trainees that this is the way care is provided at this medical center. This posters convey information about the standard of care to patients and families. PFCC and Clinical Teaching Effectiveness

Patient- and Family-Centered Approaches Patients and families have important and unique perspectives to bring to all levels of medical education. The patient in this picture is a former middle school principal who talks about her experiences with radiation therapy. She helps trainees understand health from the patient and family perspective and how their attitudes and style of communication make a difference. Briefly discuss concepts listed on the slide. Physician educators support the development of "patient and family faculty" programs that train interested patient/family advisors to be partners in the medical education process and expand teaching resources for learners at different levels. PFCC and Clinical Teaching Effectiveness

Patient- and Family-Centered Approaches The Uniformed Services University of the Health Sciences in Bethesda, MD, has had a patient and family advisor medical education program since 2000. More than 200 patient and family advisors have participated in this program. They helped guide the planning, implementation, and evaluation of the program from its inception. The program involves students and trainees in the health professions in learning from patient and family advisors in a variety of ways—in home visits; in small group discussions about medical ethics; and in presentations taught and co-taught by these family faculty. Uniformed Services University of the Health Sciences PFCC and Clinical Teaching Effectiveness

Patient- and Family-Centered Approaches The Medical College of Georgia in Augusta, and the Georgia Department of Human Resources developed, implemented, and evaluated a recovery model curricula for practitioners and assessed the impact on knowledge and attitudes. Among the findings were those related to consumer involvement in teaching. "… the successes in attitude change were primarily observed following the second workshop that highlighted consumers and practitioners who had successfully embraced recovery-based care…Based on our findings, it is proposed that competent consumers articulating their recovery stories are essential in positively impacting practitioner’s attitudes toward those they serve.” Peebles, et al. (2009). Immersing practitioners in the recovery model. An educational program evaluation. Community Mental Health Journal, 45, 239-245. Briefly discuss example shown on the slide that describes a recovery program, a model for behavioral health, that involves peer specialists (individuals who have experienced mental health services.) Emphasize the study findings that suggest that “… competent consumers articulating their recovery stories are essential in positively impacting practitioner’s attitudes toward those they serve.” PFCC and Clinical Teaching Effectiveness

Patient- and Family-Centered Approaches Faculty modeling and teaching about patient- and family-centered care, followed by encouragement of learners to take progressively greater responsibility for promoting the collaborative process with patients and families, promotes independence and autonomy appropriate to the learner's stage of training. Providing clear expectations and regular feedback about learner skills in effectively collaborating with patients and families, consistent with ACGME competencies—interpersonal and communication skills, professionalism, and systems-based practice—assists learners to improve and also communicates to them that this is a priority. Briefly discuss concepts listed on the slide. BILL, COULD YOU PROVIDE A BRIEF CLINICAL EXAMPLE OR TWO HERE>>>>CAN BE VERY BRIEF… OR WE COULD invite participation … might be a good idea…. What would this look like? Can you share some examples from your own clinical or teaching experiences? For example: PFCC and Clinical Teaching Effectiveness

Patient- and Family-Centered Approaches In grand rounds, noon conferences, bedside rounds, and ambulatory supervision, effective physician educators: Share information about the evidence-base for patient- and family-centered practice; Highlight literature for communication best practices, for patient- and family-centered rounds, and self- management support; and Provide evidence that patient and family engagement leads to better outcomes, enhances safety, and improves quality. Briefly discuss examples of teaching strategies listed on the slide. One of the indicators on the clinical teaching effectiveness instrument relates to the incorporation of research data and/or practice guidelines into teaching. Note to trainers: the Toolkit contains a handout on Evidence-Based Communication: Highlights of the Literature. You might want to use this as a handout for this session and discuss how you can integrate some of this data in clinical or classroom settings. PFCC and Clinical Teaching Effectiveness

Patient- and Family-Centered Approaches During rounds and ambulatory supervisory visits, effective physician educators model for students and trainees the: Solicitation of and listening to patient and family observations and concerns about their illness; Sharing of thought processes with the patient and family; and Discussion of clinical tests, their purpose, and the results in terms understandable to the patient and family. Another important criteria on the clinical teaching effectiveness instrument relates to the teaching of diagnostic skills (clinical reasoning, selection/interpretation of tests, etc.). Briefly discuss examples of teaching strategies shown on the slide that further understanding of good clinical care and patient- and family-centered practice. There are a number of videos and video clips in this Toolkit that can illustrate some of these points. PFCC and Clinical Teaching Effectiveness

Patient- and Family-Centered Approaches During both inpatient and outpatient care, physician educators model effective patient- and family-centered communication by: Conveying respect and preserving dignity in all interactions; and Engaging the patient and family meaningfully in the conversation and in the decision-making process Effective physician educators teach communication skills explicitly by: Providing opportunities to explore and practice various approaches to communication; and Involving patient and family advisors in educational programs for trainees to develop communication skills. In many ways, the Staff Physician and Resident Physician Toolkit is a comprehensive set of resources for staff physicians and residents to teach effective patient and/or family communication skills, another important criteria in the effectiveness assessment instrument. Briefly discuss strategies shown on the slide and elicit specific examples from the audience. PFCC and Clinical Teaching Effectiveness

Patient- and Family-Centered Approaches While a medicine interdisciplinary team debriefed about their first effort to conduct patient- and family- centered rounds at the bedside, they clearly saw the learning advantages for conducting rounds in this manner. They identified other benefits, but the advantages for learning effective patient and family communication skills were quite powerful. Click on black box on slide to activate. PT TE slide 19 VC Teaching Effectiveness.wmv Hospitalist Faculty Member: I have a strong opinion on that actually. Because the teaching that occurs outside the room or at the table when those labs or whatever results come back, that doesn't go away. But so much of learning in medicine on the wards that happens with rounds is really the role modeling of the interactions with patients and that's the greatest thing that I can teach the people who train under me is how I've learned to interact with patients because that's really what successfully guides if you have great communication with the patient and develop that rapport and relationship, that all works to help get them better sooner. I think modeling is something that we don't always identify as a really powerful teaching tool. I think that's something trainees pay attention to maybe a little bit more than if I just start running my mouth about some random topic or some topic based on what the labs are. I don't know, as far as thoughts that you guys have? Male resident: Yeah, obviously medicine is an art at least as much as a science so we do a good job of focusing on the science all the times but not so much the art and this would be a great environment, great opportunity to focus more on the art and how to teach that art too. Female Intern: I think it also helps consolidate the learning as well because two years from now when I'm getting ready to take boards and trying to think about thyroid cancer, his face will be much more apt to come to my mind and help me remember the path of biology because not only did I just look at labs and follow him on a computer, but I spent time with him and I saw the other issues that came along with it. Does anyone else have other thoughts about the learning advantages for bedside patient- and family- centered rounds? Attending faculty and trainee perceptions of bedside patient- and family-centered rounds as an effective learning approach. PFCC and Clinical Teaching Effectiveness

Patient- and Family-Centered Approaches Briefly discuss text shown on the slide. The patient, who lives with a chronic condition, shown in the slide as the person with the microphone on the left side of the picture is demonstrating role plays with a clinician (on the right side holding a microphone). Physicians found participation of patients and families in these continuing medical education activities very helpful in changing and improving communication skills. As part of Team Up for Health, a California statewide initiative to advance self-management support in ambulatory settings, patients participated in communication skills training as part of continuing medical education. PFCC and Clinical Teaching Effectiveness

In teaching communication skills, include not only the choice of words and the use of partnership language, but also discuss body language and how to use the computer effectively. Discuss the text on the slide. You might ask the group to comment on the picture with the physician and the patient. Do they see any elements of partnership? The following are observations you can say or reinforce, depending on the audience response. Both the patient and physician are sitting down at the same level; The computer appears part of the conversation, not a barrier, and it is positioned well for sharing information with the patient; and The physician is looking at and engaging with the patient. Patient advisors with diabetes helped this clinic develop the diabetes checklist to use with patients during the clinic visit. The patient advisors suggested that the tasks most difficult to accomplish be placed at the end of the list so they could feel a sense of accomplishment at the beginning of the conversation about their “healthy behaviors.” PFCC and Clinical Teaching Effectiveness

Patient- and Family-Centered Approaches Shares information about how patient- and family-centered care can reduce resource utilization as part of the process of teaching about: New approaches to primary care New approaches to managing chronic conditions Involving patients and families in redesigning care processes, in medication reconciliation, in transition planning, in bedside rounds AND Shares information from the literature. Briefly discuss example shown on the slide and relate to the handout on Evidence-Based Communication: Highlights of the Literature or examples of current efforts within the VA that are leading to utilization improvement. Thank people for participating. Perhaps introduce the idea of follow-up conversations to strengthen clinical teaching effectiveness. PFCC and Clinical Teaching Effectiveness

PFCC and Clinical Teaching Effectiveness