Medical Education Across the Continuum: A Snapshot in Time
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1 2014 MMS Annual Oration Medical Education Across the Continuum: A Snapshot in Time Michele P Pugnaire MD Senior Associate Dean for Educational Affairs UMass Medical School Massachusetts Medical Society Interim Meeting December 5, 2014 Disclosure I have no relevant financial relationships to disclose. My roles Senior Associate Dean for Educational Affairs Executive Director, interprofessional Center for Experiential Learning and Simulation (icels) Professor, Family Medicine and Community Health UMass Medical School Family Physician, Health Alliance Fitchburg Family Practice 1
2 Disclosure Confluence of Interest Education of medical students Training the next generation of future physicians.our replacements Disclosure Confluence of Interest 2
3 What We Will Learn How changes in medical school curriculum impact residency; how residency training influences clinical practice, and how clinical practice informs continuing professional development. How interprofessional education is embraced across the educational continuum. How investments in educational assets (simulation) benefit physicians across the continuum of lifelong learning. How. The MAP of change : where we are now, where we have been and may be going overview, not a systematic review The MODEL of change: A visual model as conceptual framework for change The DRIVERS of change: Key Educational Innovations Examples: what s new, what s cutting edge in educational innovation PREVIEW 2024: The interview of the future 2024 Reflect back and preview forward Today informing tomorrow Tomorrow informing today 3
4 SNAPSHOT IN TIME, ALONG THE CONTINUUM THEN NOW TOMORROW U G C SNAPSHOT IN TIME, ALONG THE CONTINUUM THEN NOW TOMORROW Stand alone U G C IOM To Err is Human: Building a Safer Health System 2001 IOM Crossing the Quality Chasm: A New Health System for the 21 st Century 2002 IOM Health Professions Education: A Bridge to Quality ACGME: launch 6 GME competencies ABMS: endorses the 6 competencies for assessment of practicing physicians (acgme.org) 4
5 SNAPSHOT IN TIME, ALONG THE CONTINUUM THEN NOW TOMORROW Stand alone 2004 Contiguous U G C U G PD ACCME Report Competency and Continuum (accme.org) Adoption of 6 competencies as CME accreditation criteria Collaboration w/other health professions Promoting lifelong learning and self assessment 2006 & beyond: ABMS MOC required in all 24 certified specialties (abms.org) Part I: Licensure & Professional Standing Part II: Lifelong learning and Self assessment (CME becomes CPD) Part III: Cognitive Expertise Part IV: Practice Performance Assessment and Improvement Boards picking up where GME leaves off ( LE Peterson Acad Med 2014) 2010 and ongoing: FSMB proposes Maintenance of Licensure concept (fsmb.org) In coordination with ABMS and still evolving SNAPSHOT IN TIME, ALONG THE CONTINUUM THEN NOW TOMORROW Stand alone 2004 Contiguous U G C U G PD 2014 Integrated Educating Physicians: A Call for Reform of Medical School and Residency Carnegie Foundation report (D Irby, Acad Med 2010) Standardizing outcomes/individualizing learning: Competency based vs time based Multiple forms of integration: IPE & teamwork Habits of inquiry & improvement: Self assessment & improvement, PS/QI Professional identity formation:, Commitment to excellence 2011 Core Competencies for Interprofessional Collaborative Practice report of an expert panel, IPEC (AAMC Interprofessional Education Collaborative Expert Panel, 2011) Nursing, osteopathy, dentistry, public health, medicine, pharmacy U G PD 2012 AAMC CEI: Continuing Education & Improvement ( Transforming CME to QI and Performance Improvement principles 5
6 The 10 Year Snapshot of Med Ed 4 Drivers of Educational Innovation 1. IPE = Team based learning The need for persons trained in related health fields to work as members of the team under the leadership and coordination of the physician The Coggeshall Report, AAMC Simulation = Practice based learning Practice makes perfect No excuse today for the surgeon to learn on the patient William J Mayo, Competencies = Outcome based learning If you don't know where you are going, you might wind up someplace else Y Berra 4. Pt Safety and Quality = Improvement based learning Texas hospital apologizes for Ebola mistakes Boston Globe Oct hospital apologizes for ebola mistakes/qekeuduv0yusld7ox625en/story.html The 10 Year Snapshot of Med Ed IPE as a Driver of Educational Innovation IPE: (WHO 2010, IPEC report 2011) Students from two or more professions learn[ing] about, from, and with each other to enable effective collaboration and improve health outcomes A necessary step in preparing a collaborative practice ready health workforce that is better prepared to respond to local health needs. IPE : A new LCME accreditation requirement for (lcme.org) AAMC GQ of US grads (RR 80%): At Least Some IPE Experience = 71.1% % ALL % of those with IPE Nursing Pharmacy Physician Assistants Social Work Physical Therapists (Analysis in Brief AAMC Oct 2014) 6
7 The 10 Year Snapshot of Med Ed Simulation as a Driver of Educational Innovation Simulation... a technique not a technology Evokes/replicates substantial aspects of the real world in a fully interactive manner. (D Gaba, Qual and Safety in Healthcare 2004) Learning: From mistakes, safe to make mistakes Deliberate practice, til you get it right Technology enhanced simulation: improved outcomes compared to no intervention (Cooke, JAMA 2011) Across a range of health professions, clinical topics, and outcomes Large effect on clinician behavior Moderate effects on patient care Conclusion: Simulation works The 10 Year Snapshot of Med Ed Competencies as a Driver of Educational Innovation Competency: Observable personal ability or quality, for all physicians Allows outcomes based, time variable assessment In place across the continuum: UME, GME, CPD C BME limitations: Applicability to real world practice Attributes, not activities Specificity to specialties (Carraccio J Grad Med Ed 2010) Introduction of Entrustable Professional Activities: EPA s 7
8 The 10 Year Snapshot of Med Ed EPA s as a Driver of Educational Innovation EPA s: Routine professional activities of physicians in their specialty A bridge to professional practice: GME to CPD/MOC Pediatric hospitalist EPA : Serve as the primary admitting pediatrician for previously well child suffering from common acute problems (Carraccio J Grad Med 2010) Entrustable: unsupervised practice, can be trusted to independently perform the activity. (Carraccio J Grad Med 2010) Core EPA s for Entry into Residency: CEPAER s (AAMC 2014) A bridge from UME to GME What PGY1 s should do, day 1 of residency CEPAER example: Gather a history and perform a physical exam : Where We Are Now Education and Integration Across the Continuum G U PD Pt Safety/Quality= Improvement based learning IHI Triple Aim ( 8
9 todayspaper/2014/10/25 Education and Integration Across the Continuum Pediatrics Redesign Project (D Powell AcadMed 2011) A pilot for competencies/epa s across the UME, GME, CPD continuum Partnership with AAMC, ABP, ACGME and five med schools Progress across the continuum based on EPA s for general pediatrics Enter yr 2 of med school and finish residency with completion of board certification requirements Includes team based, IPE throughout 9
10 Education and Integration Across the Continuum Maintenance of Certification in Anesthesia (asa.org) MOCA Simulation as a part 4 (PPA and I) requirement, that includes: Participants experience being the Anesthesiologist in charge Managing difficult scenarios (e.g. hypoxemia) Teamwork and communication Post scenario debriefing with peer input The Simulation for MOCA video is rebroadcast with the permission of The American Board of Anesthesiology, Inc. MOCA Simulation The Simulation for MOCA video is rebroadcast with the permission of The American Board of Anesthesiology,Inc Insert video here 10
11 1910 Stand alone SNAPSHOTS ALONG THE EVOLUTION THEN NOW TOMORROW 2004 Contiguous U G C U G PD 2014 Integrated U G PD 2024 Systemized SNAPSHOT IN TIME, ALONG THE CONTINUUM 2024 The interview of the future 11
12 Thank You 12
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