STFM_Clinical_Jazz_Final

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					                                       Structured Group Reflection and Improvisation: Developing skills for the medical home in a variety of cultural settings
                                                           Daisuke Yamashita MD1, Kenichi Yokobayashi MD2, Morito Kise MD 3, Yasuki Fujinuma, MD2, Randall Longenecker, MD4
                            1. OHSU Family Medicine 2. HCA-JCCU Family Medicine Residency Program Tokyo 3. Kawasaki Municipal Tama Hospital Family Medicine Residency 4. The Ohio State University Rural Program


Background:                                                      HCA-JCCU Family Medicine Residency Program Tokyo          Diffusion of an innovation                          The Ohio State University Rural Program           Challenges:
-Patient-Centered Medical home (PCMH) is becoming                                                                         1998 Shaughnessy AF, Slawson DC,                                                                       1. Requires experienced facilitator to lead discussion.
  center piece of future practice                           Dr. Yasuki Fujinuma, Dr. Kenichi Yokobayashi                  Becker L. Clinical jazz: Harmonizing       Dr. Randall Longenecker                                     -Discussion may become scattered and unfocused.
-In PCMH we will expect to see followings.                  Setting: Based in Tokyo, Japan. Total of 11 residents         clinical experience and evidence-based     Setting: Mad River Family Practice, West Liberty, Ohio.     -A facilitator can avoid this by keeping the group
      1. Surprising problem but not limited to medical      with 10 faculties. Network of 6 urban clinics. Emphasis       medicine. J Fam Pract 1998;47:425-8.       A “2-2-2” integrated rural training track residency          focused on the original question.
         condition                                          on home care and geriatric care.                              1999 Birth of “Clinical Jazz” as
                                                                                                                                                                     Name: “Clinical Jazz” and “Faculty Jam”                     2. Difficulty formulating clinical pearls, i.e. taking the
      2. Complex, with multiple layers of socio-            Name: "Clinical Jazz"                                         introduced by Dr. Longenecker at Mad       When: Weekly, on Thursdays                                   “action turn”
         psychological meaning and involving multiple       When: Once a month at the residency conference.               River Family Practice in Ohio.             Time: 75 minutes, single case                               -Requires everyone’s participation to come up with
         relationships.                                     Time: 30 minutes x 2 cases                                                                               Who: Residents, Faculty (including residency                 pearls; forces improvisation
                                                                                                                          2005 April Dr. Fujinuma found Dr.
-Training in uncertainty and complex bio-socio-             Who: Residents and Faculty                                    Longenecker’s presentation on internet.    coordinator and clinical psycologist), and visiting         -Improves over time as group becomes used to this
  psychological is essential in the residency training to                                                                                                            students or other guests (“Faculty Jam” is for faculty       process.
  implement PCMH.                                                                                                         2005 May Dr. Yamashita met Dr.             only)                                                       3. Difficulty finding evidence in literature.
                                                                                                                          Longenecker at an STFM conference in
                                                                                                                          San Francisco


                                     Bring                                                                                                                                                                                       Discussion:
              Implement
                              a case & a question
              in practice                                                                                                                                                                                                        “Clinical Jazz” was successfully implemented among
                                                                                                                                                                                                                                 four different residencies in different clinical and
                                                                                                                                                                                                                                 cultural settings.
                                                                                                                                                                                                                                 "Clinical Jazz" promotes relationship centered
       Take away                           Clarify                                                                                                                                                                               medicine, reflective practice and balancing evidence
        a pearl                          the question
                                                                                                                                                                                                                                 and experience in different cultural contexts and
                                                                                                                                                                                                                                 provides a safe “educational home” for difficult cases
                                                                                                                                                                                                                                 This suggests that "Clinical Jazz“ may be useful in a
          Inter-textual
                                                                                                                                                                                                                                 patient centered medical home, dealing with cases of
                                       Refine
            reflection              the question                                                                                                                                                                                 great complexity and uncertainty.


                                                                                                                          2006 April “Clinical Jazz” was adapted
                                                                                                                          to the residency in Tokyo (Dr. Fujinuma                                                                Next steps:
                                                                                                                          and Dr. Yokobayashi)                       Dr. Daisuke Yamashita
“Clinical Jazz”                                             Dr. Kise Morito                                                                                          OHSU Family Medicine South Waterfront Clinic                -Share "Clinical Pearls" among residencies.
A semi structured small group process designed to           Based in Kawasaki, Japan. City next to Tokyo. The             2006 April “Clinical Jazz” was adapted     Based in Portland Oregon. In large academic medical         -Develop evaluation tools to measure effectiveness of
                                                            clinic is part of 300-bed community hospital. Total of 7      to the residency in Kawasaki (Dr. Kise)                                                                  the "Clinical Jazz" on promoting reflective practice.
promote reflection and develop skills working in a                                                                                                                   center. Part of OHSU FM residency. Total of 12
complex, relationship-rich environment.                     residents. Emphasis on inpatient, pediatrics and              2006 July Dr. Yamashita moved to           residents in this clinic. Urban setting and patients with   -Evaluate the impact upon patient care
1. Pick an emotionally moving case, prompting               emergency care.                                               OHSU, Portland Oregon for residency.       diverse ethic background.                                   -Incorporate other clinical staff in the setting of a
   surprise, sadness or confusion. (self reflection)        Title: “Clinical Jazz”                                                                                   Name: “Difficult Case Conference”                             patient centered medical home, further promoting
                                                            When: twice a month                                           2007 March Dr. Fujinuma and Dr.                                                                          team-based care.
2. Draw a Genogram (relationship centered)                                                                                Yokobayashi received “Best Teaching
                                                                                                                                                                     When: Once a month at the clinic
3. Open discussion with group. Everybody participate!       Time: 60 min x1 case                                          Pearl Award” at 15th Japan Society of      Time: 30 minutes x 2 cases
   EBM and experiences are woven in the discussion.         Who: Residents and Faculties.                                 General Medicine annual conference.        Who: Residents, faculties and a clinical psychologist                                  Contacts:
                                                                                                                                                                                                                                 Daisuke Yamashita M.D.     yamashid@ohsu.edu
4. Conclude with a “clinical pearl”                                                                                       2008 July “Clinical Jazz” was adapted to                                                               Kenichi Yokobayashi M.D.   yokobayashi@hotmail.co.jp
5. Reflect on the case and proceed to practice               Kawasaki Municipal Tama Hospital Family Medicine Residency   OHSU Family Medicine South                                   OHSU Family Medicine
                                                                                                                          Waterfront clinic (Dr. Yamashita)

				
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