The Challenge Grant Project is intended to establish an
innovative way to engage graduate medical education programs in Picker
Institute’s patient-centered healthcare mission by supporting
projects that integrate successful patient-centered care initiatives
and best practices into the education of future practicing physicians.
The grants program focuses on helping teaching hospitals and residency
programs introduce and maximize the impact of patient-centered care
on residents and their training programs in the expectation that this
will exert a positive influence on the entire medical education system
and healthcare community.
John
M. Tarpley, M.D.
Vanderbilt Medical Center
Vanderbilt University
“Cultural Sensitivity Initiative for Medical Education”
Patient-centered care requires knowledge of and sensitivity to cultural
and faith-related issues. Dr. Tarpley’s research revealed the
degree to which people in the medical profession are surrounded by
these issues, and the subsequent need to educate medical personnel
to understand and respond to patients’ cultural and spiritual
concerns.
His findings include a proposal for the development of a graduate
medical education curriculum focusing on teaching healthcare professionals
how to respond to patients in a culturally appropriate manner.
Cultural and spiritual sensitivity is “useful in all eight
of Picker Institute’s dimensions of patient-centered care,”
Dr. Tarpley concludes, and essential in these six”:
• Respect for patient’s values, preferences and expressed
needs
• Information, communication and education
• Physical comfort
• Emotional support and alleviation of fear and anxiety
• Involvement of family and friends
• Transition and continuity
Click here to
read Dr. Tarpley’s final report in its entirety.
William H. Hester, M.D., Principal Project Director
Richard R. Howell, M.D.
Cindy Lawrimore, F.N.P.
McLeod Family Medicine Residency Program
“Improving Patient Compliance and Outcomes in Hypertension
Management in the ‘Stroke Capital’ of the World”
Hypertension is the most common primary diagnosis in the United States.
Primary care physicians manage the majority of hypertensive patients.
Effective communication between patient and physician is important
for adequate blood pressure control.
Patients with uncontrolled hypertension were enrolled in the
McLeod study. Each patient received education regarding
hypertension through the use of four specific tools and was also instructed
in the DASH diet. Medications were adjusted to attain a systolic blood
pressure of 140 mm Hg or less. Patients’ comprehension of each
educational tool was measured with a brief questionnaire after each
visit.
The average initial systolic blood pressure was 160 mm Hg; the average
final blood pressure was 139 mm Hg. Forty percent of patients attained
goal blood pressure by the second visit and 67 percent by the third
visit. The average number of visits for patients who attained goal
was 4.6; the average number for patients who did not attain goal was
2.8.
Ninety-six percent of patients completed at least one tool. Sixty-one
percent of patients who attained goal blood pressure completed three
tools compared to only 45 percent of patients who did not attain goal.
Twenty-seven percent of patients who attained goal completed all four
tools, compared to none of the patients who did not attain goal.
Patient education can be an important factor in treating hypertension.
Simple educational tools can improve physician-patient communication.
Effective communication between patient and physician improves blood
pressure control.
Click here
for the McLeod Family Medicine report in its entirety.
Pamela
J. Boyers, Ph.D.
Riverside Methodist Hospital
“Simulation Used to Measure the ACGME Core Competencies
and Patient-Centered Care”
In 2002, the Accreditation Council for Graduate Medical Education
(ACGME) introduced competency-based education into the institutional
and program requirements for all U.S. allopathic residency programs.
The six core competencies—medical knowledge, communication,
professionalism, practice-based learning and improvement, systems-based
care and patient care—comprise a set of standard principles
by which residents can be evaluated and a general framework for curriculum
development.
At present, there are no uniform guidelines to measure the successful
integration of these core competencies into residency education or
resident progress toward proficiency. By “simulating”
doctor-patient scenarios involving such common complaints as retinal
detachment, colon cancer and low back pain. Prior to and after each
simulation, residents were asked to assess their own level of expertise,
as was a physician who had observed the simulation.
An examination of these scores indicated that “it is possible
to objectively measure the principles of patient-centered care embodied
in the ACGME Core Competencies,” Dr. Boyers concluded. The multifaceted
evaluation process, which includes residents’ self perceptions,
recorded observations by attending-level physicians, 360-degree evaluations
by standardized patients and an objective examination, has the specific
advantage of measuring and recording the data generated by multiple
separate observations of a given skill set. Dr. Boyers concludes that
“we must continue to work to better define and measure skill
sets within each competency, and to demonstrate that mastery of each
competency translates into excellence in patient-centered medical
care.”
Click here for Dr. Boyers’s
final report in its entirety.
Anthony A. Meyer, M.D., Ph.D.
Renae E. Stafford, M.D., M.P.H.
Trauma and Critical Care Services/
The University of North Carolina
at Chapel Hill
“Development and Implementation of an Interdisciplinary
Palliative Care End-of-Life Education Program for Residents Who Rotate
through the Surgical Intensive Care Unit”
Drs. Meyer and Stafford prepared for their study by surveying 28
surgical residents on end-of-life issues and bioethics and by administering
to them a standardized palliative-care knowledge examination. Survey
data and exam scores “clearly elucidated the need for further
education.”
The doctors then instituted an educational program that involved
the surgical residents in formal lectures, role playing, experiential
learning with participation in family meetings, grand rounds presentations
and journal clubs. Residents were also exposed to discussions about
end-of-life and palliative care in morbidity and mortality conferences
and in surgical intensive-care-unit daily rounds.
While the study has not yet been formally concluded, it has led to
several initiatives that have enhanced patient-centered care at UNC,
according to Drs. Meyer and Stafford. These include inclusion of surgical
ICU nurses and students in the educational program; an enhanced relationship
with the palliative-care service; and the institution of a “family
center” near the surgical ICU to provide a place for family
meetings and a quiet, restful space where families can gather, process
information and grieve as loved ones face the end of their life.
Sondra Zabar, M.D., Principal Investigator, Associate Professor of Medicine
Linda Regan M.D., Co-Investigator, Assistant Professor of Emergency Medicine
New York University School of Medicine
Since the 1960’s, Emergency Medicine (EM) researchers’ efforts have worked to demonstrate the importance of patient-centered doctor-patient communication, only acknowledging decades later Having had experience with the development and implementation of a controlled study on the impact of comprehensive, integrated clinical communication skills curriculum on student patient-centered skills, the Section of Primary Care faculty at New York University School of Medicine were prepared and eager to partner with Emergency Medicine faculty on this very important topic. With the commitment of NYUSOM-Bellevue Emergency Medicine Residency leadership, we created the Emergency Medicine Professionalism and Communication Training (EMPACT) Project.
EMPACT aimed to improve EM resident competency in communication and professionalism through the development, implementation, and evaluation of new curriculum and assessment measures. Our objectives were to: 1) design, implement and evaluate patient-centered healthcare curriculum for all 60 EM residents; 2) evaluate predictive validity of Objective Structured Clinical Examinations (OSCEs) by assessing correlation of OSCE performance with actual resident performance in emergent care setting for cohort of PGY2 residents (n=15); and 3) disseminate this Patient-Centered Care educational program to EM programs nationally. We addressed EMPACT in four phases:
Phase I) established baseline competency of EM interns using a 5 station OSCE;
Phase II) integrated an interactive skills-based series of five workshops focusing on interpersonal and professionalism skills—into monthly required EM seminar series;
Phase III) conducted postcurriculum OSCE to evaluate impact of curriculum; and
Phase IV) developed and implemented two “Unannounced” Standardized Patient (USP) cases.
In completing all four phases of the EMPACT Project, we learned a lot about our residents, how to improve our OSCEs, and how to implement another USP project in the future. Residents agreed that the curriculum helped them to improve on the strengths and weaknesses identified by the OSCE. Our comparison of the residents’ pre- and post-OSCE performances has shown significant improvement in overall Communication, Relationship Development, and Patient Education Skills. Also, through our USP pilot, we learned that we will need a better understanding of the system in which we practice before embarking on such an endeavor and more USP cases to better gauge how residents perform in reality.
Even having taught communication skills in other disciplines, teaching the same skills in EM provided rich learning opportunities for us as curriculum innovators, evaluators and administrators. It is clear that learners need and appreciate curricula that are interactive and role model key patient-centered skills. Performance-based assessment, OSCE and Unannounced Patients, though time intensive, are meaningful assessment tools for both learners and programs.
