Teaching health policy to residents--three-year experience with a multi-specialty curriculum.
Ontology highlight
ABSTRACT: Introduction
Most residents have limited education or exposure to health policy during residency.Aims
We developed a course to (1) educate residents on health policy topics applicable to daily physician practice; (2) expose residents to health policy careers through visits with policy makers and analysts; (3) promote personal engagement in health policy.Setting
Residents registered for a 3-week elective offered twice annually through the George Washington University Department of Health Policy.Program description
The course format includes: daily required readings and small-group seminars with policy experts, interactive on-site visits with policy makers, and final team presentations to senior faculty on topical health policy issues.Program evaluation
One hundred thirty residents from 14 specialties have completed the course to date. Seventy completed our post-course survey. Most participants [59 (84%)] felt the course was very or extremely helpful. Participant self-ratings increased from pre- to post-course in overall knowledge of health policy [2 (3%) good or excellent before, 58 (83%) after], likelihood of teaching policy concepts to peers [20 (25%) vs. 62 (86%)], and likelihood of pursuing further health policy training [28 (37%) vs. 56 (82%)].Conclusions
This 3-week elective in health policy improves self-reported knowledge and interest in health policy research, advocacy, and teaching.
SUBMITTER: Greysen SR
PROVIDER: S-EPMC2787946 | biostudies-literature |
REPOSITORIES: biostudies-literature
Similar Datasets
Project description:BackgroundDespite significant teaching responsibilities and national accreditation standards, most residents do not receive adequate instruction in teaching methods. Published reports of residents-as-teachers programs vary from brief one-time exposures to curricula delivered over several months. A majority of interventions described are one or two-day workshops with no clear follow-up or reinforcement of skills. A three-year longitudinal teaching skills curriculum was implemented with these goals: 1) deliver an experiential skill-based teaching curriculum allowing all residents to acquire, practice and implement specific skills; 2) provide spaced skills instruction promoting deliberate practice/reflection; and 3) help residents gain confidence in their teaching skills.MethodsOne hundred percent of internal medicine residents (82/82) participated in the curriculum. Every 10 weeks residents attended a topic-specific experiential skills-based workshop. Each workshop followed the same pedagogy starting with debriefing/reflection on residents' deliberate practice of the previously taught skill and introduction of a new skill followed by skill practice with feedback. Every year, participants completed: 1) assessment of overall confidence in each skill and 2) retrospective pre-post self-assessment. A post-curriculum survey was completed at the end of 3 years.ResultsResidents reported improved confidence and self-assessed competence in their teaching skills after the first year of the curriculum which was sustained through the three-year curriculum. The curriculum was well received and valued by residents.ConclusionsA formal longitudinal, experiential skills-based teaching skills curriculum is feasible and can be delivered to all residents. For meaningful skill acquisition to occur, recurrent continuous skill-based practice with feedback and reflection is important.
| S-EPMC8207581 | biostudies-literature
Project description:Introduction:Physicians recognize the importance of clinical documentation for accuracy of coding and billing, but it is emphasized little in residency curricula, with an even smaller emphasis on oncology-specific documentation. We developed an educational curriculum to teach residents about clinical documentation for cancer patients. Our tool kit includes didactics, simulated history and physical (H&P) documentation, and personal feedback. Methods:A preintervention survey was first administered to gauge baseline knowledge. A simulated H&P was developed that required participants to complete their own assessment and plan. We delivered a 25-minute lecture regarding billing and coding along with documentation tips and tricks specific to hematology/oncology. Thereafter, we handed out a second H&P, and participants had to once again complete their own assessment and plan. These H&Ps were graded by three reviewers using a rubric. We then gave residents personalized feedback using the above data and administered a postintervention survey. Results:The postintervention survey revealed that 100% of the residents surveyed found this activity helpful, 83% noted that further knowledge of diagnosis codes was helpful to their learning, 100% noted that that this activity taught them to improve documentation, 91% said they were more likely to use cancer-specific diagnoses, and 91% said they would benefit from direct feedback-based education. Discussion:Didactic and formal education is more effective when combined with hands-on examples and direct personalized feedback.
| S-EPMC6346345 | biostudies-literature
Project description:IntroductionThe debate format has been infrequently used in resident education. We used the panel debate format as a tool to improve health care professionals' knowledge of the Patient Protection and Affordable Care Act (PPACA).MethodsSix physical medicine and rehabilitation resident physician debaters led a 60-minute panel debate about the PPACA. Outcome measures included a survey of the spectators with validated questions on physician attitudes towards health care reform in the US and open-ended questions regarding Americans' views on the US health care system.ResultsTwenty-nine physician and nonphysician faculty and staff participated as spectators. Responses to the questions on attitudes toward reform of the health care system indicated that zero spectators rated the current US health care system (i.e., the PPACA) as "Excellent," 25% rated it as "Good," 42% "Average," 25% "Poor," and 8% "Failing." Half of the respondents indicated they support a US president who advocates making the US health care system more like those of other countries. The majority of respondents (89%) expressed the idea that the US does not have the best health care system in the world.DiscussionApproaching a topic as broad as health care reform with the debate format promoted knowledge, reflection, and interaction with both the opposing debaters and audience.
| S-EPMC6338139 | biostudies-literature
Project description:IntroductionInternal medicine (IM) residents must be capable of performing ambulatory procedures required of a competent internist regardless of their career plans. Unfortunately, many IM residents may feel uncomfortable in the ambulatory setting and with ambulatory procedures as the bulk of residency training focuses on inpatient experiences.MethodsThe session described here is a 1.5-hour case-based, interactive module for residents of all training levels centered on key ambulatory procedures, featuring experienced faculty demonstrating said procedures on a realistic, full-body manikin patient care simulator followed by direct observation of resident competence by that faculty member. Four students per group is optimal. As clinician educators serve as facilitators, faculty training is limited to a walk-through of each session. The materials associated with this publication include the session protocol, cases, direct observation procedure checklists, preparticipation surveys, and postparticipation surveys.ResultsFrom July 2014 to June 2015, 66 residents of all training levels at Northwell Health-Lenox Hill Hospital in New York City, NY, completed this session. Upon completion, participant performance of breast and pelvic exams improved at every step of each procedure. Additionally, participant comfort, confidence, and intent to perform breast and pelvic exams increased.DiscussionGiven the success of this session, this educational experience was expanded to include modules on other key ambulatory procedures to promote the development of independent, competent, proficient, and professional IM practitioners who provide high-quality, patient-centered care while fulfilling the program requirements set forth by the ACGME.
| S-EPMC6464411 | biostudies-literature
Project description:IntroductionAlthough sustainability is a key component in the evaluation of continuous quality improvement (CQI) projects, medicine resident CQI projects are often evaluated by immediate improvements in targeted areas without addressing sustainability. AIM/SETTING: To assess the sustainability of resident CQI projects in an ambulatory university-based clinic.Program descriptionDuring their ambulatory rotation, all second year internal medicine residents use the American Board of Internal Medicine's Clinical Preventive Services (CPS) Practice Improvement Modules (PIM) to complete chart reviews, patient surveys, and a system survey. The residents then develop a group CQI project and collect early post data. Third year residents return to evaluate their original CQI project during an ambulatory rotation two to six months later and complete four plan-do-study-act (PDSA) cycles on each CQI project.Program evaluationFrom July 2006 to June 2009, 64 (100%) medicine residents completed the CQI curriculum. Residents completed six group projects and examined their success using early (2 to 6 weeks) and late (2 to 6 months) post-intervention data. Three of the projects demonstrated sustainable improvement in the resident continuity clinic.DiscussionWhen residents are taught principles of sustainability and spread and asked to complete multiple PDSA cycles, they are able to identify common themes that may contribute to success of QI projects over time.
| S-EPMC3019318 | biostudies-literature
Project description:BACKGROUND: Under the Accreditation Council for Graduate Medical Education (ACGME) Outcome Project, residency programs are required to provide data on educational outcomes and evidence for how this information is used to improve resident education. OBJECTIVE: To teach and assess systems-based practice through a course in health care policy, finance, and law for radiation oncology residents, and to determine its efficacy. METHODS AND MATERIALS: We designed a pilot course in health care policy, finance, and law related to radiation oncology. Invited experts gave lectures on policy issues important to radiation oncology and half of the participants attended the American Society for Therapeutic Radiation and Oncology (ASTRO) Advocacy Day. Participants completed pre- and postcourse tests to assess their knowledge of health policy. RESULTS: Six radiation oncology residents participated, with 5 (84%) completing all components. For the 5 residents completing all assessments, the mean precourse score was 64% and the mean postcourse score was 84% (P = .05). Improvement was noted in all 3 sections of health policy, finance, and medical law. At the end of the course, 5 of 6 residents were motivated to learn about health policy, and 4 of 6 agreed it was important for physicians to be involved in policy matters. CONCLUSIONS: Teaching radiation oncology residents systems-based practice through a course on health policy, finance, and law is feasible and was well received. Such a course can help teaching programs comply with the ACGME Outcome Project and would also be applicable to trainees in other specialties.
| S-EPMC2951778 | biostudies-other
Project description:IntroductionAntiepileptic drugs, which are also called anticonvulsants, are used in the therapy and prophylaxis of epileptic seizures. The purpose of this paper was to investigate the relevant epidemiological data and to determine which of these drugs was the most frequent cause of intoxication. Another purpose of this study was to determine the neurological, cardiac, and biochemical problems caused by antiepileptics.Material and methodThis retrospective study included 95 consecutive patients under 18 years of age with antiepileptic intoxication, presenting to and being followed-up in, the Toxicology Unit between January 2010 and February 2013. The data were obtained by screening the patient files.ResultsOf the cases, 67 (70.5%) were self-poisoned by first generation antiepileptics (FGAEs) and 28 (29.5%) by second generation antiepileptics (SGAEs). The Glasgow Coma Scale (GCS) scores and the serum lactate levels of the patients poisoned by FGAEs and SGAEs on admission to emergency department were 15 (25th: 12; 75th: 15; 95th: 15; IQR: 3) and 1.9 (25th: 1.4; 75th: 3.1; 95th: 5.6; IQR: 1.7), and 15 (25th: 14.3; 75th: 15; 95th: 15; IQR: 0.75) and 1.07 (25th: 0.9; 75th: 1.6; 95th: 5.5; IQR: 0.71), respectively. The serum lactate levels of patients poisoned by FGAEs were significantly higher (p < 0.001). Among the cases poisoned by carbamazepine, the most frequent cause of intoxication, the GCS score was significantly lower and serum lactate level was significantly higher in the group with high serum levels of carbamazepine (p = 0.004 and p < 0.001, respectively). In cases poisoned by valproic acid (VPA), the second frequent cause of intoxication, there was neither a significant association between the serum VPA level and the GCS score, nor between the serum lactate level and the systolic blood pressure (p = 0.470, p = 0.897, and p = 0.088, respectively). However, there was a positive correlation between the serum VPA level and the serum ammonia level (kk = 0.742, p < 0.001).ConclusionFirst generation antiepileptics are more toxic than SGAEs. In patients with serum carbamazepine level, particularly those over 30 mg/L, serious disorders of consciousness, cardiovascular toxicity, and metabolic disorders may occur. In VPA intoxication, there is a positive correlation between the serum VPA levels and ammonia levels. On account of this finding, one should be more careful about hyperammonemic hepatic encephalopathy as the serum VPA level rises.
| S-EPMC5598106 | biostudies-literature
Project description:BackgroundPatient-centered communication is essential for successful patient encounters and positive patient outcomes. Therefore, training residents how to communicate well is one of the key responsibilities of residency programs. However, many residents, especially international medical graduates, continue to struggle with communication barriers.MethodsAll residents and faculty from a small community teaching hospital participated in a three-year, multidimensional patient-centered communication curriculum including communication training with lectures, experiential learning, communication skills practice, and reflection in the areas of linguistics, physician-patient communication, cultural & linguistically appropriate care, and professionalism. We evaluated the program through a multipronged outcomes assessment, including self-assessment, scores on the Calgary-Cambridge Scale during Objective Structured Clinical Examination (OSCE), a survey to measure the hidden curriculum, English Communication Assessment Profile (E-CAP),, the Maslach Burnout-Inventory (MBI), and residents' evaluation of faculty communication.ResultsSixty-two residents and ten faculty members completed the three-year curriculum. We saw no significant changes in the MBI or hidden curriculum survey. Communication skills as measured by Calgary Cambridge Score, E-CAP, and resident communication improved significantly (average Calgary-Cambridge Scale scores from 70% at baseline to 78% at follow-up (p-value < 0.001), paired t-test score from 68% at baseline to 81% at follow-up (p-value < 0.004), average E-CAP score from 73 to 77% (p-value < 0.001)). Faculty communication and teaching as rated by residents also showed significant improvement in four out of six domains (learning climate (p < 0.001), patient-centered care (p = 0.01), evaluation (p = 0.03), and self-directed learning (p = 0.03)).ConclusionImplementing a multidimensional curriculum in patient-centered communication led to modest improvements in patient-centered communication, improved language skills, and improved communication skills among residents and faculty.
| S-EPMC6245928 | biostudies-literature
Project description:OBJECTIVE: Women's health knowledge and skills are important for physicians, but training is often inadequate. The objective of this project was to develop, implement, and evaluate a women's health curriculum for an internal medicine residency program. METHODS: After assessing institutional factors, we developed a curriculum for a multidisciplinary clinical rotation with a web-based tutorial. We recruited faculty from several specialties relevant to the care of women to precept for the rotation and/or to provide teaching materials for the tutorial. RESULTS: The curriculum for the 1-month rotation covered most of the recommended women's health topics. Internal medicine residents worked in a variety of clinical settings and were assigned to a web-based tutorial and a pretest and posttest. A statistically significant increase was seen in participants' mean posttest (71.7%) versus pretest (61.1%) scores (difference, 10.7%; 95% confidence interval [CI]: 4.7-16.6; P = .0009). No difference was seen in controls' mean posttest (56.5%) versus pretest (57.2%) scores (difference, -0.7%; 95% CI: -12.1-10.7; P = .9). Mean rotation evaluation responses ranged from 7.09 to 7.45 on a 9-point scale. The majority (93%) of survey respondents agreed that the rotation increased their skills in caring for women, and all agreed the program was well organized and that it increased their awareness of women's health issues. CONCLUSION: A women's health curriculum using a web-based tutorial with a multidisciplinary clinical rotation can be successfully implemented in an internal medicine residency. The curriculum satisfied women's health training requirements, was associated with improvements in learning outcomes, and may be a model for women's health education.
| S-EPMC2951780 | biostudies-other
Project description: Not available
| S-EPMC6943949 | biostudies-literature