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NARCCIM 2009

NARCCIM 2009. Successes and Challenges in Developing & Implementing a Comprehensive Research-Driven Curriculum in Residency Education. Integrative Medicine in Residency. Objectives. Learn about the research processes to develop a competency based curriculum in Integrative Medicine

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NARCCIM 2009

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  1. NARCCIM 2009 Successes and Challenges in Developing & Implementing a Comprehensive Research-Driven Curriculum in Residency Education Integrative Medicine in Residency

  2. Objectives Learn about the research processes to develop a competency based curriculum in Integrative Medicine Identify the findings of the needs assessment survey at participating residencies Describe the competencies and curriculum components Learn about the evaluation plan and baseline assessment results Discuss challenges and successes of implementation

  3. What is the Integrative Medicine in Residency Program? 200-hour online curriculum developed by University of Arizona Center for Integrative Medicine Pilot Partners: 8 family medicine residencies Purpose: Create and deliver competency-based online integrative medical training to residents Goal: Expand to other primary care and subspecialty training programs

  4. IMR Program Locations Maine-Dartmouth Maine Medical Center Hennepin County University of Connecticut Beth Israel Carolinas Medical Center University of Arizona University of Texas Medical Branch

  5. Unique Features of IMR Competency-based, based on ACGME outcome project Needs Assessment driven process Web-based and on-site small group activities Common curriculum for multiple residencies Modular format allows maximum flexibility Capacity to create a community of learners beyond the individual residency programs Built-in evaluation

  6. Needs Assessment Survey • Key content areas • Preferences for Length • Format • Perceptions of IM • Curriculum Challenges

  7. Sample Characteristics No IM Exposure IM Exposure

  8. Top IM Content Areas Needed to Enhance Curriculum

  9. Comments Related to Curriculum Inclusion by Them Centrality of Curricular Focus Value to the Profession

  10. Challenges for Integrating IM Content into Curriculum

  11. Rationale for IM competency base ACGME outcome project set domains for GME. Guide the learning objectives and determine outcomes to be evaluated. Process for IM competency development Initial draft after literature review and ACGME defined domains Used consensus process to arrive at 27 competencies Selected via nominal consensus process 14 competencies to direct learning objectives and evaluation process * STFM group on IM reviewed the competencies to forward to the FM RRC to include language in requirements IM Competencies

  12. Year 1 Content • Foundations of IM • US Preventive Guidelines • Nutrition and Diet • Supplements • Physical Activity • Stress and Mind-Body • Sleep and Health • Spirituality in Health Care • Clinical Integration • Motivational Interviewing

  13. Years 2 and 3 Content Year 2 Pediatric Topics Women’s Health Acute Care Botanicals Mind-Body Medicine IM intake Year 3 Chronic Illness Special Topics Manual medicine Whole systems IM treatment plans Practice Management

  14. IMR Class Page

  15. Multi-method Approach Quantitative and Qualitative Mix of standardized and customized tools Observations, surveys, tests, portfolio Evaluation of IMR Success Level • Educational Proficiency • Curriculum Design • Program Outcome • IM Competency • Learner Satisfaction & Ease • Enhanced Resident Recruitment • Resident Well-being

  16. Major Evaluation Design Challenges Blendingresearch design with applied curricular evaluation • Rigor vs. Reality Designing competency assessment process • Following ACGME outcome project recommendations • Review results: lack of reliability and consistency of measures and processes Developingnew measures and methods • Self-Assessment, Observation, MC Tests, Reflective Questions, Portfolio • Feasibility in design and/of implementation • Standardization of use by faculty and time frame

  17. Competency Measurement

  18. Tracking of IMR Evaluation: The Portfolio

  19. IMR & Site Program Evaluation Measures Enhanced Residency Recruitment • Surveys to program director to assess ratings of resident Candidate and match Success • Slots taken • Incoming resident survey to assess IM interest and residency program attraction Resident Well-Being • Standardized Scales of Depression, Burn-out, Stress, Anxiety, Stress, Satisfaction with Life

  20. Baseline Findings:Self-Assessment of IM Knowledge/Skills(n=65)

  21. Self-Assessment: Major Themes (n=228)

  22. Self-Assessment: IM Sub-Themes

  23. Percent Correct by Site N=65 15 multiple choice questions IM Medical Knowledge

  24. Year 1 Completion Status April 2009

  25. IMR Year 1 Course Evaluation by Residents

  26. Time to Complete Courses (self-report) Time to Complete Y1 Curriculum Minimum Time = 3.5 hours Maximum Time = 36 hours Average Time = 13.5 hours

  27. IM Interest by Residents Entering Pilot Programs in 2008

  28. Program Site Perspective: IMR Challenges • Faculty labor/time limits • Resident time limits • Faculty buy-in • Faculty development • Need for IM trained faculty • Time to complete direct observations • Limited resident interaction • IMGs somewhat “risk averse”

  29. Program Perspective: IMR Successes • Residents are excited, participating, and giving excellent feedback • Online community is a good way to connect residents • Monthly integrative medicine case conference • Residents are completing content as expected • Residents are using medical knowledge and skills learned in the outpatient setting • Faculty impressed by selection and IMR impact

  30. Strategies to Engage Online Learning • FOOD---Internship dinner • Introducing IMR during orientation • Identify for residents time periods where they can complete curriculum • Completing course as a group in computer lab • Monthly sessions/small group activities on IM topics • Wellness session with residents and faculty • Regular email contact with residents • Thank–you email when residents complete courses • Tip of the month/article with link to the curriculum

  31. Questions and Conclusions

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