Victoria Maizes MD Victor Sierpina MD John Woytowicz MD Selma Sroka MD Sally Dodds PhD amp Patricia Lebensohn MD Presentation Objectives The objectives of this presentation are ID: 320011
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Slide1
Incorporating a Web-based, Integrative Medicine Curriculum into 8 Family Medicine Residencies: Keys to Success
Victoria Maizes, M.D., Victor Sierpina, M.D., John Woytowicz, M.D., Selma Sroka, M.D., Sally Dodds, Ph.D., & Patricia Lebensohn, M.D.Slide2
Presentation Objectives
The objectives of this presentation are:Recognize the steps in creating competency-based education including the evaluation methodology.
Understand program strategies used in incorporating a new curriculum into existing residency training.Review key outcomes of courses completed and change in IMR medical knowledge.
Review individual program successes and challenges in implementation methodology. Slide3
Integrative Medicine in Residency (IMR) is…
Competency-based
, online, 200-hour, curriculum.In-depth training in
Integrative Medicine
.
Incorporated
through all 3 years of Family Medicine residency.
Piloted at 8 residencies
nationwide.Seamless, online evaluation of the curriculum and the residents.Responds to ACGME competency requirements.Evaluation developed simultaneously with the curriculum.Slide4
University of Arizona
University of Texas Medical Branch
Hennepin County
Carolinas Medical Center
Beth Israel
Maine-Dartmouth
Maine Medical Center
University of Connecticut
IMR Program Locations
Moses H. Cone
Alaska Family Medicine
Univ. of
Minn
A. Einstein
Montefiore
Control sitesSlide5
Tools in Integrative Medicine
Prevention and Wellness
Women’s Health
Chronic Illness
Pediatrics
Acute Care
IMR Curriculum UnitsSlide6
Introduction to Integrative Medicine
Prevention and Wellness:
U.S. Preventive Health Services
Nutrition and Diet
Supplements for Prevention
Physical Activity
Sleep
Stress and Mind-Body Medicine
Spirituality
Clinical Integration
Tools in Integrative Medicine:
Integrative Medicine Intake and Care Plan
Botanicals
Mind-Body Medicine
Manual Medicine
Introduction to Energy Medicine and Whole Systems
Practice Management
Motivational Interviewing for Behavioral Change
Acute Care:
Acute Back Pain,
Urinary Tract Infection,
Gastroenteritis,
Otitis
Media,
Vaginitis
,
Atypical Chest Pain,
Upper Respiratory Infection
Pediatric Topics:
ADD/ADHD
Chronic Pain Syndrome
Asthma and Allergies
Women’s Health Topics:
PMS/PMDD
Dysmenorrhea
Menopause
Fibromyalgia
Osteoporosis
Depression
Eating Disorders
Pregnancy and Lactation
Chronic Illness:
Cardiovascular Disease
Type II Diabetes
Osteoarthritis
Rheumatoid Arthritis
Obesity
Irritable Bowel Syndrome
Chronic Back Pain
Special Topics:
HIV/AIDS
Cancer SurvivorshipEnvironmental Medicine
Units and CoursesSlide7
IMR: Educational Methods
Needs assessment
informed curriculum design.
Web-based
curriculum written and edited by Integrative Medicine educators.
Competencies aligned with the
ACGME
Outcomes Project.
Flexible modular format to meet the needs of residency schedules.Case-based
, interactive learning and streaming video.
Experiential exercises
and process-oriented group activities at the residency sites.
A
community of learners
through online dialogues with faculty and peers.
Emphasis on teaching and
promoting physician well-being and self-care
.Slide8
IMR User Interface
Online portfolios
Flexible modular format
Resources and Links
Direct Observation Checklists
ReflectionsSlide9
What is Evaluated in the IMR?
Curriculum:Residents evaluate each course after completionResidents’ competencies
:Medical Knowledge testSelf AssessmentDirect Observation Checklist
Reflections
Residents’ wellness & well-being:
Behavioral assessments
Residency recruitment:
Match results and post match surveySlide10
As of March 19, 2010
Yr 01 Course Completions
Classes of 2011 and 2012 Slide11
As of March 19, 2010
Yr 02 Course Completions
Class of 2011 Slide12
Clinical Utility of the Course?
Year 01 Content
*Currently, indicators are available for 4 courses for the 2012 class.
Slide13
Meet Learning Objectives?
Clinical Utility?
Year 02 Course Evaluations
Courses currently at 50% thresholdSlide14
Year 02 Course Evaluations
Courses currently at 50% threshold
Smooth Online technology?Slide15
Medical Knowledge Test
Mean percent correct at baseline – All groups
nsSlide16
Medical Knowledge Test
Sub group differences at baseline – Class of 2011Sex
Medical School StatusSlide17
Medical Knowledge Test
Pre-/Post Test Class of 2011 – Yr. 01Slide18
Post Match
1
Match Results 2011, 2012, 2013Slide19
Post Match2IM/CAM Medical School Courses &Personal Use
Controls rated higher than 2012 group on all questions.
*
2011 more required IM/CAM courses in medical school than 2012 (
p
<.001).
*
2011 more electives in medical school than 2012
(p<.001).
*
Controls more electives than 2012 (
p
=.012).
*
2011 more personal IM/CAM use than the 2012 group
(
p
=.014).
2011 (n=57)
(
n=43)
Control (
n=30)Slide20
Post Match3Interest in Learning IM in Residency
High interest in both the 2011 and 2012 groups.
But, over half of the controls also had high interest.
*
2011 group had a higher interest than controls (
p
=.002).
2011 (n=57)
(
n=43)
Control (
n=30)Slide21
Post Match4Importance of the IMR in Ranking Decision
Very important/Important:
2011 – 53%2012 – 37%
Notes:
1.
Likert
scale revised to 5 points and accounts for differences in scores.
2. 2011 totals >100%– rounding error
.
2011 (n=57)
(
n=43)Slide22
Post Match5Interest in Applying IM in Practice
High to moderate interest in both the 2011 and 2012 groups.
Controls also had high to moderate interest.
*
2011 group had higher interest in applying IM in practice than controls
(
p
=.001)
.
Notes:
1. 2011 totals more than 100%– rounding error
2011 (n=57)
(
n=43)
Control (n=30)Slide23
I
mplementation Strategies
Individual activities:
Free blocks of time longitudinally
Use concentrated time in certain rotations (orientation, community medicine, integrative medicine, nursery).
Do content matched with rotations (e.g., outpatient pediatrics, maternal child health, GYN, EM
)
Group activities:
Wellness and self care
Videos
Motivational interviewing
Mind-Body skills training
Integration with behavioral health program
Field trips
Yoga, tai chi
OMT skills
Nutrition lecture series
Integrative approach to lecture topicsSlide24
Implementation Challenges
Finding the
time
in the curriculum.
Motivating
some residents to keep on track and progress through the curriculum.
Getting
faculty interested in participating
in the curriculum.
Incorporating an Integrative Medicine approach into
busy outpatient care sessions.Slide25
Implementation Successes
Most residents are progressing well through the curriculum.
Evaluations are very encouraging.
One sites from the 2011 class is requesting continued access to the curriculum after graduation.
The presence of the IMR attracts competitive residents to the pilot sites.
Residents’ medical knowledge has increased from Yr. 01 to Yr. o2.
Unknown:
Residents’ well-being
Patient centeredness
Patient outcomes
Practice patterns after graduationSlide26
Next Steps
Complete the Yr. 03 content
Analyze Behavioral Assessments/residents’ well-being and compare with control groups
Expand to other programs
5 early adopters in 2010
Medical Center of Central Georgia, Macon, GA
Tufts University Family Medicine, Malden, MA
Aurora Family Medicine Residency Program, Milwaukee, WI; Research Family Medicine, Kansas City, MO;
Internal Medicine Residency University of New Mexico, Albuquerque NM.
Build a stand alone course on Prevention and Wellness for residents and medical studentsSlide27
Discussion
Acknowledgements
University of Arizona
Pilot
Sites
Emily Sherbrooke
Mary Guerrera, M.D.
Paula
Cook
Ben Kligler, M.D., MPH
Rhonda Hallquist
Craig Schneider,
M.D.
Tieraona Low Dog, M.D.
Raymond Teets, M.D.
Dael
Waxman, M.D.Slide28
Teaching
Strategies
Site
Course
Teaching Strategy Examples
U of A
Physical Activity
Supplements
Yoga class
Visit
to health food store w/ cases & budget
Maine MC
Supplements
Nutrition
Visit to traditional
herbalist store
Trip to chicken processing plant
U Conn
Nutrition
Lecture with sampling
of various foods
Beth Israel
Nutrition
Evening dinner discussion
Hennepin
Stress
and M-B
Experience in PMR, hypnosis, breath work
CarolinasPhysical Activity
Stress and M-BRopes course
w/ faculty during orientationMindfulness meditation sessions
U TexasStress
and M-BLecture and acupuncture experience
Maine GenClinical IntegrationPatient joins
the IMR case staffing