Interdisciplinary Teaching in Health Professionals - PowerPoint

							 University of Pennsylvania
       Interdisciplinary
Geriatric Fellowship Program
     Division of Geriatric Medicine
    Section on Geriatric Psychiatry
     Department of Oral Medicine
             July 6th, 2009
Departments, Principal Faculty

Division of Geriatric Medicine
• Dr. Jerry Johnson, PI
Section of Geriatric Psychiatry:
• Dr. Joel Streim, Co-PI
Department of Oral Medicine:
• Dr. Martin Greenberg, Co PI
          Administration
Sangeeta Bhojwani, MA, MS
215-573-7293
Sangeeta.bhojwani@uphs.upenn.edu

Natasha Charles
215-573-7219
Natasha.Charles@uphs.upenn.edu
    What does Title VII Geriatrics Health
     Professions Funding Support?

    The geriatric health professions program is financed under the
       interdisciplinary, community-based linkages section of the
     Health Resources and Services Administration (HRSA) and
                   currently supports three initiatives.

• The Geriatric Academic Career Award (GACA) supports the
  development of newly trained geriatric physicians into academic
  medicine
• The geriatric faculty fellowships are designed to train physicians,
  dentists, and behavioral and mental health professionals who decide
  to teach geriatric medicine dentistry and psychiatry.
• The Geriatric Education Center (GEC) program provides grants to
  support collaborative arrangements involving several health
  professions schools and health care facilities to provide
  multidisciplinary training in geriatrics.
      Overall Goal and Objectives

 Overall Goal: Prepare fellows for roles as clinician
  educator faculty and for certification in geriatric
  medicine or psychiatry.
 Aims
    Exhibit the clinical, teaching, administrative and
     research knowledge and skills needed to function
     in the academic medical center setting.
    Exhibit the ability to care for ethnically and socio-
     economically diverse patient populations
    Exhibit the ability to educate trainees from diverse
     backgrounds to practice culturally appropriate
     geriatric care
               What is it?
• Two year fellowship training program for
  prospective clinical educator faculty
• Integrated program with core, shared
  curriculum as well as discipline-specific
  curriculum
• Interdisciplinary including medicine,
  psychiatry, dentistry
          Who? The Trainees
•   Geriatric Internal Medicine or Family Practice
    Physicians
•   Geriatric Dentists
•   Geriatric Psychiatrists


Those planning academic careers as educators
         Why This Program?
• Acute faculty shortages in all 3 Disciplines

• Demographic Imperative

• Substantial patient need at the intersection
  of these disciplines
Medicine, Psychiatry, Dentistry:
       Odd Partners?
• How does a dentist learn to care for a patient with AD?

• Many psychotropic medications cause dry mouth that
  then leads to dental problems

• A person unable to chew is at risk of malnourishment or
  tube feeding and associated problems

• Is weight loss due to disease process, mood, or
  problems in eating?
          UPenn GIF Program

• 126 conference hours in a year spread
  across the themes of the curriculum.
• Weekly conferences covered 7 curriculum
  themes and one sub-theme.
• Faculty recruited from the Division of
  Geriatric Medicine, across the University
  and from collaborating institutions and
  agencies.
               GIF Conferences
• Typically 2 one hour conferences are held each
  Monday afternoon
  – Monday 3:00-3:45 PM
  – Monday 4:00-4:45 PM
• 1 one hour conference on Friday afternoons.
  – Friday 1:30-2:30 PM
     •   Cases
     •   Board Review
     •   Fellow Presentation
     •   Faculty/Outside Speaker Presentation
            Major Themes and Skills

• Health Equity and            • Educational Expertise
  Literacy
                               • Administrative skill
• Interdisciplinary Care and
  Teaching                     • Research Skills

• Clinical competency, core    • Communication (crosses
  and discipline specific        all themes) Skills

• Palliative Care
            Health Equity
• Introductory seminar on culture and its relevance
• Health education in the community seminar
• Visit to West Philadelphia communities
• U Penn Geriatric Education Center sponsored
  annual conference (2008 and 2009) - Health
  Equity and Literacy
• Complementary/alternative medicine and belief
  systems
• Cultural differences in preferences for advance
  planning directives, and palliative care
• Spirituality
 Collaboration with Geriatric Education Center
                    Course

The course focused on:
• Available methods for the assessment of health
  literacy skills
• Culturally based misunderstandings that
  complicate care
• Teaching strategies for effective communication
  with older patients and families that lead to
  improved health outcomes
• Selection and assessment competencies for
  health professionals in responding to patients
  with limited health literacy in clinical practice
      Interdisciplinary Care and
               Teaching
• Five seminars on methods issues:
   – Teams and teamwork
   – Team member roles and responsibilities
   – Team communication and conflict resolution
   – Care-planning in team practice
   – Multiculturalism
• Five seminars on the site-specific aspects of team
  practice in: the acute care hospital, the outpatient
  practice, home care practices, day care, and the nursing
  facility.
• An eleventh seminar will focus on teaching skills
  required to present team materials in presentations to
  residents and students.
• Once a month clinical presentations by a fellow
                  Theme: Education

•   Adult Education/Models and Framework
•   Models of Medical Education
•   Evaluation
•   Teaching in Clinical Settings
    – Small Group Learning
       • bedside or walking rounds
       • how to identify “teachable moments”, reinforce and correct
         trainees’ concepts and information
• Stanford Clinical Teaching Curriculum
             Theme: Administration

This portion of the curriculum will use bi-monthly seminars
and precepted experiences. Topics covered are:
   Administration of long-term care: medical
    directorships, Reporting (MDS), and external
    monitoring (egJCAHO)
   Quality improvement approaches – inpatient,
    outpatient, nursing homes
   Evidence from health services and epidemiologic
    research
   QI project
           Theme: Collaborator Rounds

• Purpose: To gain an understanding of the assessment
  approaches and interventions used by collaborating
  professionals.
• The professionals would include: social worker, physical
  therapist, audiologist, speech therapist, low vision
  specialist, neuropsychologist, pharmacist, occupational
  therapist, nurse, dietician, and others as identified.
• In each case, the rounds would include:
   –   Introduction to the training and functions of the discipline
   –   Overview of patient assessment
   –   Observation/shadowing in clinic
   –   Exposure to basic treatment modalities
   –   Case presentation and discussion
            Theme: Research

Bi-monthly seminars and precepted
experiences together with conduct of a research
project. Topics include:
   Introduction to research methods: clinical,
    quantitative, qualitative study design
   Issues re research on aging; generalizing
    from studies on younger population
   Principles of community participatory
    research
     Communications Skills (across all
               themes)
• Tailoring communication for older adults
• Delivering bad news by telephone
• Communicating with older adults with sensory loss
  communicating with cognitively impaired elders
• Conflict resolution modes with elders and their families
• Cultural competence in discussing advanced directives
• Death and Dying
• Family discussion of futile treatment in patients with
  advanced dementia
• Sexuality
• Health Equity and Literacy
                    Other
• Clinical
  – Core clinical competency topics: 6 topics
  – Palliative care 6 seminars
  – Liaison Rounds with collaborating
    professionals
Fellow Evaluations of Didactics

Evaluation through Survey Monkey:
 Topic and faculty
 Achievement of objectives for the theme
 Timing of topic within curriculum
 Faculty – teaching across sessions and in
  clinical rotations
 Additions/changes to curriculum
Fellow Focus Group (mid year and at end
            of Fellowship)
 Sample comments:
  ”[t]his experience has broadened our thinking,
   made it more likely that we will think of other
   contributors to [solving] patient problems,
   made the learning more interesting.”
  “[my] history taking is more inclusive”
  Fellows report they consult each other more
   often and more readily than they would have
   without the shared time and learning.
              Conclusions

 Interdisciplinary fellowship expands scope of
  clinical thinking and improves facility with
  referral and consultation
 Fellows discover previously neglected
  opportunities for improved diagnosis and
  management, especially with collaborating
  professionals
 Exposure of non-funded fellows to the
  curriculum increases interest in teaching and
  academic careers