1. Training Medical Assistants to Participate in the Patient-Centered Medical Home TMAP Dana Neutze, MD, PhD; Mark Gwynne, DO; Julea Steiner, MPH; Lindsay Stortz RN; Thomas Koonce, MD, MPH

2. No Disclosures or conflicts of interest

3. Objectives Utilize different health professionals to train staff in a multidisciplinary approach to setting health goals with patients. Design a standardized patient experience to train staff on best practices for patient check- in. Implement an auditing tool to reinforce changes in standard work.

4. Background Team-based approach is key to provide all necessary preventive and chronic disease care Medical assistants (MAs) were being used just for vitals The curriculum was designed to expand MA roles to become more involved in patient care Needed to overcome the theory-practice gap

5. Areas of focus Based on survey and focus group data and PCMH recertification needs Setting health goals with patients Standing orders 1:1 staffing model

6. Setting health goals w/ patients A series of training sessions: »During scheduled staff meetings »Voluntary lunch-and-learns An OSCE Weekly auditing

7. Training sessions Involved many different disciplines: »Physician »CMA educator »MCH coordinator (former L&D nurse) »Nutritionist »Pharmacist »Sports Ed Sessions were interactive, involved role play

8. Training Sessions DateTopicInstructor 3/12/14Intro to preventive healthSasha (CMA educator) 3/12/14 Importance of pneumovax & introducing the standing order Sasha 4/30/14Skills fair- DM foot exam, NST, EKG, urinary cath Sam (physician), Siobhan (MCH coordinator), visiting nurse 7/23/14Goal setting w/ patients and self-managementDana (physician) 7/30/14Talking to difficult patientsCarol (tobacco specialist) 7/30/14Assessing barriers to careAmy (care manager) 7/30/14OSCE Tommy (physician, course director for ICM), Lindsay (practice manager) 8/4/14Med reconciliationEmily (pharmacist) 8/11/14How to talk to pts re nutritionJudy (nutritionist) 8/29/14How to talk to pts re exerciseLeah (sports education degree) 9/4/14How to talk to pts re stress managementIrene (psychologist) 9/27/14Flu standing orderLindsay, Dana

9. Assessing staff confidence setting goals

10. Objective Structured Clinical Examination (OSCE) Advantages »Standardized »Focused on specific learning need »Feedback Disadvantages »Takes time to plan »Needs devoted time to do »Expense

11. OSCE 14 staff participated 4 clinical scenarios »Each staff member did 2 »Became progressively more challenging Those not with standardized patients watched Feedback given by both instructor and standardized patients

12. Assessing staff confidence setting goals

13. Assessment Weekly audit of charts Had staff member fill out the Kamishibai (Audit tool) Posted in the back clinical hall way

15. Percent of patients seen during a week who set a health goal OSCE NutritionExerciseStress Management

16. Summary When setting up training sessions think multi- disciplinary OSCEs are a novel way to train and evaluate staff On going auditing is essential to ensure the training sticks.

17. Work was supported by: UNC Innovation Pilot grant

18. Setting health goals w/ patients A series of training sessions: »How to set a SMART goal »How to talk to patients about nutrition, exercise and stress management An OSCE »Each MA had 2 standardized patient encounters Weekly auditing