Meeting the 130 Continuity Clinic requirements. APDIM (AAIM) Workshop: October Workshop Outline:

Transcription

1 Meeting the 130 Continuity Clinic requirements APDIM (AAIM) Workshop: October 2009 Workshop Outline: I. Introductions & Workshop goals (5 mins.) Dr. Stephanie Wang Welcome and introduction of panel Workshop Goals 1. Review the history/philosophy behind the evolution of current ACGME requirements for ambulatory internal medicine continuity training 2. Explore participants successes/barriers with implementation of increase in continuity clinic requirements 3. Describe our journey at in incorporating the new requirements into our residency program 4. Elicit participants perspective on the future of ambulatory training in internal medicine Workshop Objectives By the end of the workshop, participants will: 1. Design opportunities to more effectively teach and assess the six ACGME core competencies in resident continuity clinics using the new 130 clinic week requirement. 2. List barriers and create solutions to implementing this new continuity clinic requirement. 3. Share advice about lessons learned to date. II. Warm up (5 10 mins.) Dr. Andy Ekpenyong Activity: How has meeting the 130 continuity clinic requirement helped or hindered your residency training program/clinic? 1

2 III. How did we get to this point? (10 mins.) Dr. Richard Abrams Year Evolution of IM Continuity Clinic Requirements Requirement 1980 Weekly half day continuity clinic 1990 Continuity preferred for 3 years, but block is acceptable 1998 Continuity all three years, ½ day per week 2004 Continuity all three years, at least 108 continuity clinic sessions 2009 Continuity at least over 30 month period, at least 130 sessions RRC Program Requirements for Continuity Clinic July Must include a minimum of 130 distinct half day outpatient sessions, extending over at least a 30 month period. 2. Must include evaluation of performance data for each resident's continuity panel relating to both chronic disease management and preventative health care. Residents must receive faculty guidance for developing a data based action plan and evaluate this plan at least twice a year. 3. Must include resident participation in coordination of care across health care settings. 4. Must include supervision by faculty who develop a longitudinal relationship with residents throughout the duration of their continuity experience. 5. Must maintain a ratio of residents or other learners to faculty not to exceed 4:1. 6. Other faculty responsibilities must not detract from the supervision and teaching of residents. IV. Break out #1 (15 mins.) Dr. Richard Abrams What is the goal? V. Break out #2 (15 mins.) Dr. Andy Ekpenyong Develop a list of barriers/solutions 2

3 VI. Solutions (20 mins.) Dr. Stephanie Wang Our Journey 1. Describe structure/capacity of continuity clinic prior to ACGME changes 2. Describe response to increase in required sessions from no stipulations regarding content of sessions opportunity to solidify curricular gaps by implementing casebased sessions around ambulatory topics 3. Describe response to requirement for evaluation of performance data for residents continuity panel relating to both chronic disease management and preventative care. each resident participates in a standardized chart review of a colleagues chart, looking at specific items such as flowsheets for diabetic care and preventative health this data is then attached to the chart for the primary resident to review (and complete if necessary) at the patient s next visit 4. Describe response after ACGME clarified guidelines in July 2009, stating that longitudinal clinic must include a minimum of 130 distinct half day outpatient sessions, extending over at least a 30 month period, devoted to longitudinal care of the residents panel of patients. filled in openings in schedule (created by residents being absent for rotations such as ER, etc.) with additional sessions (total of seven per resident per year) during non call blocks preserved resident to patient continuity, but interrupted continuity with attending 5. Describe successes and failures Successes: able to accommodate requirements all residents are projected to have completed 130 sessions over a three year period. 3

4 Failures: while feasible on paper, clinics are congested, running at capacity every session, resulting in longer wait times for residents to present, and patients to receive timely care. 6. Future plans - Open up a ninth half day session on Friday afternoons staffed by three attendings will be exclusively used for additional sessions won t affect residents standing half day sessions will allow for continued resident/patient continuity and will decongest existing clinic sessions VII. Wrap up (10 mins.) Dr. Andy Ekpenyong Where do you think we re headed? Presenters contact information: Andy Ekpenyong, M.D. Associate Program Director Andem_Ekpenyong@rush.edu Stephanie Wang, M.D. Associate Program Director Stephanie_Wang@rush.edu Richard Abrams, M.D. Program Director Richard_I_Abrams@rush.edu 4

5 Potential Opportunities 1. Teach the core competencies in greater depth esp. practice based learning, communication skills, systems based practice etc. 2. Assess residents clinical skills in greater depth with respect to the core competencies 3. Use innovative teaching formats in the ambulatory setting e.g. workshops, book clubs, etc. 4. Create special appointments e.g. for family conferences, in depth patient counseling etc. 5. Gain resident buy in in their continuity clinic experience 6. Perform practice improvement projects 7. Formally set learning goals and revisit them 8. Give detailed feedback to residents 9. Promote self directed learning 10. Introduce residents to other members of the health care team e.g. nutritionists, physical therapists, 5