Team-Based Patient Care: Community Mentors as Role Models for Medical Students

1. 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.

2. Faculty Disclosure We have not had any relevant financial relationships during the past 12 months.

3. 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

4. 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.

5. 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

6. The SELECT MD ProgramScholarly Excellence, Leadership Experiences, Collaborative Training • Partnership between the University of South Florida & Lehigh Valley Health Network

7. 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

8. 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

9. 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

10. 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

11. 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 CenteredMedical Home • Develop communication skills aimed at effective collaboration across interprofessional systems and disciplines • Create interpersonal strategies to facilitate improved care of patients

12. Student Participants • 19 SELECT students (1st year medical students)

13. 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

14. 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

15. 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

16. 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?

17. 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?

18. 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

20. 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

21. 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

22. 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

23. 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

24. 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.”

25. 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

26. 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

27. 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.”

28. 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.”

29. 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.

30. 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.

31. 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 .

32. Session Evaluation Please complete and return theevaluation form to the classroom monitor before leaving this session. Thank you!