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Improving Value-Based Care Education in a Fellowship by Incorporating ACGME Competencies.

ABSTRACT: Background:Most value-based care educational interventions teach knowledge of cost but fail to recognize the interrelatedness of the Accreditation Council for Graduate Medical Education (ACGME) competencies of medical knowledge, patient care, practice-based learning and improvement, and systems-based practice. Objective:We analyzed the impact on clinical decision-making of an educational curriculum that incorporated the spectrum of ACGME competencies. Methods:Five didactic sessions for a gynecologic oncology fellowship were modified to incorporate cost- and value-based care considerations for each clinical topic addressed. After discussion, the group of fellows identified 1 high-value and 5 low-value practices to target for improvement. The fellows then undertook a chart audit of clinical decisions occurring for patients seen in the outpatient clinics. The frequency of low- and high-value practices was compared before and after the educational intervention. Results:A total of 126 patients with a cervical cancer diagnosis were seen by participants in the outpatient setting during the entire observation period. After the intervention, the occurrence of 3 identified low-value practices was reduced by 13% to 33%, demonstrating modest effect sizes (effect size ? = 0.2-0.3). One high-value practice (smoking cessation counseling) increased 100% after a fellow-initiated quality improvement project was undertaken. Two low-value practices, including routine surveillance imaging, remained unchanged. Conclusions:Overlaying value-based concepts in didactic conference teaching resulted in measurable changes in decision-making behavior. Engaging learners in a subsequent, focused quality practice review served as a vital part of their educational experience and allowed us to assess learner competency in its practical application.

SUBMITTER: Zanotti K

PROVIDER: S-EPMC6919189 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

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Improving Value-Based Care Education in a Fellowship by Incorporating ACGME Competencies.

Zanotti Kristine K Somasegar Sahana S Hooper Monica Webb MW Hopp Elizabeth E

Journal of graduate medical education 20191201 6

<h4>Background</h4>Most value-based care educational interventions teach knowledge of cost but fail to recognize the interrelatedness of the Accreditation Council for Graduate Medical Education (ACGME) competencies of medical knowledge, patient care, practice-based learning and improvement, and systems-based practice.<h4>Objective</h4>We analyzed the impact on clinical decision-making of an educational curriculum that incorporated the spectrum of ACGME competencies.<h4>Methods</h4>Five didactic ...[more]

PMID: 31871567

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Project description:The University of Toronto - Department of Radiation Oncology (UTDRO) has had a well-established Fellowship Program for over 20 years. An assessment of its graduates was conducted to evaluate training experience and perceived impact on professional development. Graduates of the UTDRO Fellowship Program between 1991 and 2015 were the focus of our review. Current employment status was collected using online tools. A study-specific web-based questionnaire was distributed to 263/293 graduates for whom active e-mails were identified; questions focused on training experience, and impact on career progression and academic productivity. As a surrogate measure for the impact of UTDRO Fellowship training, a comparison of current employment and scholarly activities of individuals who obtained their Fellow of the Royal College of Physicians of Canada (FRCPC) designation in Radiation Oncology between 2000 and 2012, with (n = 57) or without (n = 230) UTDRO Fellowship training, was conducted. Almost all UTDRO Fellowship graduates were employed as staff radiation oncologists (291/293), and most of those employed were associated with additional academic (130/293), research (53/293), or leadership (68/293) appointments. Thirty-eight percent (101/263) of alumni responded to the online survey. The top two reasons for completing the Fellowship were to gain specific clinical expertise and exposure to research opportunities. Respondents were very satisfied with their training experience, and the vast majority (99%) would recommend the program to others. Most (96%) felt that completing the Fellowship was beneficial to their career development. University of Toronto, Department of Radiation Oncology Fellowship alumni were more likely to hold university, research, and leadership appointments, and author significantly more publications than those with FRCPC designation without fellowship training from UTDRO. The UTDRO Fellowship Program has been successful since its inception, with the majority of graduates reporting positive training experiences, benefits to scholarly output, and professional development for their post-fellowship careers. Key features that would optimize the fellowship experience and its long-term impact on trainees were also identified.

Project description:BackgroundEmergency medicine (EM) residents do not generally receive sex- and gender-specific education. There will be increasing attention to this gap as undergraduate medical education integrates it within their curriculum.MethodologyMembers of the Sex and Gender in Emergency Medicine (SGEM) Interest Group set out to develop a SGEM toolkit and pilot integrating developed components at multiple residency sites. The curriculum initiative involved a pre- and posttraining assessment that included basic demographics and queries regarding previous training in sex-/gender-based medicine (SGBM). It was administered to PGY-1 to -4 residents who participated in a 3-hour training session that included one small group case-based discussion, two oral board cases, and one simulation and group debriefing.AnalysisComponents of the developed toolkit (https://www.sexandgenderhealth.org) were implemented at four unique SGEM Interest Group member residency programs. Residents (n = 82/174, 47%) participated; 64% (n = 49) were male and 36% (n = 28) were female. Twenty-six percent (n = 21) of the residents reported that they had less than 1 hour of training in this domain during residency; 59% (n = 48) reported they had 1 to 6 hours and 16% (n = 13) reported they had >6 hours. The average preassessment score was 61% and postassessment was 88%. After training, 74% (n = 60) felt that their current practice would have benefited from further training in sex-/gender-based topics in medicine during medical school and 83% (n = 67) felt their clinical practice would have benefited from further training in this domain during residency.ImplicationsThe majority of EM residents who participated in this training program reported that they had limited instruction in this domain in medical school or residency. This initiative demonstrated a method that can be emulated for the incorporation of SGBM educational components into an EM residency training educational day. After training, the majority of residents who participated felt that their current practice would have benefited from further training in sex- and gender-based topics in residency.

Dataset Information

Improving Value-Based Care Education in a Fellowship by Incorporating ACGME Competencies.

Publications

Improving Value-Based Care Education in a Fellowship by Incorporating ACGME Competencies.

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