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
a case & a question
in practice “Clinical Jazz” was successfully implemented among
four different residencies in different clinical and
"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
patient centered medical home, dealing with cases of
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. email@example.com
4. Conclude with a “clinical pearl” 2008 July “Clinical Jazz” was adapted to Kenichi Yokobayashi M.D. firstname.lastname@example.org
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)