Incorporating a Web-based, Integrative Medicine Curriculum PowerPoint Presentation

Incorporating a Web-based, Integrative Medicine Curriculum PowerPoint Presentation

2016-05-15 103K 103 0 0

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Victoria Maizes, M.D., Victor Sierpina, M.D., John Woytowicz, M.D., Selma Sroka, M.D., Sally Dodds, Ph.D., & Patricia Lebensohn, M.D.. 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 sites

Slide5

Tools in Integrative Medicine

Prevention and Wellness

Women’s Health

Chronic Illness

Pediatrics

Acute Care

IMR Curriculum Units

Slide6

Introduction to Integrative MedicinePrevention and Wellness:U.S. Preventive Health ServicesNutrition and Diet Supplements for PreventionPhysical ActivitySleep Stress and Mind-Body Medicine SpiritualityClinical IntegrationTools in Integrative Medicine:Integrative Medicine Intake and Care Plan BotanicalsMind-Body MedicineManual Medicine Introduction to Energy Medicine and Whole Systems Practice ManagementMotivational 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/ADHDChronic Pain SyndromeAsthma and AllergiesWomen’s Health Topics: PMS/PMDD Dysmenorrhea Menopause Fibromyalgia Osteoporosis Depression Eating Disorders Pregnancy and LactationChronic Illness: Cardiovascular DiseaseType II DiabetesOsteoarthritis Rheumatoid ArthritisObesity Irritable Bowel SyndromeChronic Back PainSpecial Topics:HIV/AIDS Cancer SurvivorshipEnvironmental Medicine

Units and Courses

Slide7

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

Reflections

Slide9

What is Evaluated in the IMR?

Curriculum:Residents evaluate each course after completionResidents’ competencies:Medical Knowledge testSelf AssessmentDirect Observation ChecklistReflectionsResidents’ wellness & well-being:Behavioral assessmentsResidency recruitment:Match results and post match survey

Slide10

As of March 19, 2010

Yr 01 Course CompletionsClasses of 2011 and 2012

Slide11

As of March 19, 2010

Yr 02 Course CompletionsClass 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% threshold

Slide14

Year 02 Course EvaluationsCourses currently at 50% threshold

Smooth Online technology?

Slide15

Medical Knowledge Test

Mean percent correct at baseline – All groups

ns

Slide16

Medical Knowledge TestSub group differences at baseline – Class of 2011

Sex

Medical School Status

Slide17

Medical Knowledge Test

Pre-/Post Test Class of 2011 – Yr. 01

Slide18

Post Match

1Match Results 2011, 2012, 2013

Slide19

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 careVideosMotivational interviewingMind-Body skills trainingIntegration with behavioral health program

Field trips

Yoga, tai chi

OMT skills

Nutrition lecture series

Integrative approach to lecture topics

Slide24

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 graduation

Slide26

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 students

Slide27

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

Carolinas

Physical Activity

Stress and M-B

Ropes course

w/ faculty during orientation

Mindfulness meditation sessions

U Texas

Stress

and M-B

Lecture and acupuncture

experience

Maine Gen

Clinical Integration

Patient joins

the IMR case staffing

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