Presentation Transcript

1. Assessment of a Health Systems Rotation for Orthopaedic Residents Learning of the Systems Based Practice Competency

   AOA Annual Meeting June 15, 2013
2. Funded by the Woodward Endowment for Medical Science Education
3. Core Competencies
4. Systems Based Practice Requires residents to demonstrate an awareness of and responsiveness to the larger health care system and the ability to effectively call on system resources to provide care that is optimal and effective
5. Systems Based Practice Expectations Work effectively in various health care delivery settings and systems relevant to their clinical specialty Coordinate patient care within the health care system relevant to their clinical activity Incorporate considerations of cost awareness and risk-benefit analysis in patient and/or population-based care
6. Systems Based Practice Expectations Advocate for quality patient care and optimal patient care systems Work in interprofessional teams to enhance patient safety and improve patient care quality Participate in identifying system errors and implementing potential systems solutions
7. Systems Based Practice Care not provided in a vacuum Internal and external factors influence the health of their patients and the care they receive Familiarity with various factors Ability to interact with various facets and participants in health care system
8. “Evaluation Methods”
9. “Evaluation Methods”
10. Systems Based Practice Wasnick: Academic Medicine, 2010 73/193 4th year medical students reported having no knowledge of any of the core competencies 10% reported knowledge of SBP
11. Systems Based Practice David: Mt Sinai J Med, 2005 Residents focus more on medical knowledge and patient care; SBP viewed as less important
12. Systems Based Practice Harris: Int J RadiatOncolBiol Physics, 2009 Lack of knowledge among educators Uncomfortable with content, teaching and assessment
13. Chair’s Question COBRA violations RBRVS SNF vs. LTACH Informed consent DRG Not perfect! Important for the resident to know Measurable Recordable
14. 360’s and SBP? Does the resident demonstrate an appreciation for the role of all members of the health care team, and communicate the plan of care to them appropriately? Does the resident demonstrate an understanding of treatment options in the post acute continuum of care, and work with nursing, care coordination and social services to identify the most appropriate location for the patient?
15. 360’s and SBP Is the resident active in the discharge planning process and do they complete their discharge responsibilities accurately and in a timely manner?
16. “Key Questions” What must be learned? How to teach it? Optimal delivery method? How to assess resident performance?
17. Literature Review
18. Previous SBP Research Lecture (ARS): Mitchell, Varkey Morbidity/Mortality Conferences: Davison Group Projects: Delphin, Patterson Simulation: Larkin, Wang and Volzenilek Experiential Systems: Eiser, Buchmann, Sutkin, Turley
19. Previous SBP Research – Web Based Eskildsen: J Am Geriatr Soc, 2010 “Ideally, this product should be used in the context of a clinical rotation so that learners can expand their learning and acquire transferable skills using this online tool as a starting point.”
20. Systems Based Practice: Is It Being Taught?, How Is It Being Taught?, and How Is It Being Assessed? Survey Data Focus Group Sessions JBJS, 2012
21. Is It Being Taught?
22. How Is It Being Taught?
23. How Is It Being Assessed?
24. Focus Group Sessions Orthopaedic Non-Orthopaedic Nursing Allied health, Support Administrative Leadership Quality/Safety Ortho residents Ortho faculty Community ortho
25. Focus Groups “Faculty demonstrated poor understanding and frustration with this competency and largely focused upon efficiency in task completion”
26. SBP: Taught and Assessed? The most commonly reported method for teaching “Systems Based Practice” was “clinical observation”.
27. Focus Groups Excluding Orthopaedic Surgeons and Residents Communication Collaboration Understanding complex processes Hospital operations Finance Law Medical error Systems impact on patient care
28. Focus Groups Strong consensus to provide a standardized, experiential, learning experience for resident with assessment of knowledge and performance
29. The Penn State Hershey Orthopaedic Residency Experience
30. Next Step Need to prepare our residents and students to provide health care in the 21st century Quality and safety Collaboration in multidisciplinary team Managing disease in large populations Continuous improvement beyond your own individual care
31. SBP Education and Penn State Hershey Two, one week rotations during orthopaedic months in PGY-1 year Reading assignments Focus on experiential learning Patient assignments as an observer of health care through the eye of the patient What can be done, individually and collectively, to provide a safer, better and more efficient experience?
32. SBP and Penn State Hershey Focus Areas Weeks one and two: Quality/Safety Week two: E&M coding, IP documentation, Finance Week two: “Analysis of DRG report for 4 surgeons on the joint arthroplasty service” Supplemental reading: “Medicare and Hospital Prospective Payment System – How DRG Rates are Calculated and Updated”
33. SBP at Penn State Hershey Week One Interview and follow patients Morning nursing report Risk/Quality Conference Interview care coordinators, therapists, utilization review Operating room processes Transitions to OP care
34. How to measure the outcome?
35. Resident Feedback “I am hopeful that with more courses such as this, and the training of new interns about the pitfalls and dangers of the system, that we can, with time, create overdue and necessary changes to our healthcare system.”
36. Resident Feedback “The other two interns and I have already spoken amongst ourselves regarding ways in which we, as individuals and a small group who will progress through the ranks of the orthopaedic residency program at Penn State, can affect the necessary changes to our system.”
37. Holy Grail?
38. Challenges The Faculty and More Senior Residents
39. Challenges Labor Intensive
40. Challenges If the ultimate outcome is improvement in patient safety, quality and efficiency, there are countless other confounding variables
41. Summary SBP has evolved from a peripheral and frustrating nuisance to an integral component of resident education.
42. Systems Based Practice
43. Summary RVU’s, coding, insurance, malpractice are each important topics to understand, but ……
44. Summary 21st century health care requires the application of individual knowledge and skills to the excellence of a multidisciplinary team
45. Summary Based upon our two years of experience with this rotation we believe: This rotation is valued by the residents They are developing an improved understanding of the health care system in which they work They are developing an improved understanding of the roles of other members of the health care team
46. Summary Based upon our two years of experience with this rotation we believe: They are developing an improved understanding of issues pertaining to patient safety, quality and efficiency relative to health care They are developing an improved understanding of the need for efficient, consistent communication within the team
47. Summary We have a long way to go!
48. Thank you!