Incorporating a Web-based, Integrative Medicine Curriculum into 8 Family Medicine Residencies: Keys

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.

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.

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.

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

Tools in Integrative Medicine

Prevention and Wellness

Women’s Health

Chronic Illness

Pediatrics

Acute Care

IMR Curriculum Units

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 Courses

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

.

IMR User Interface

Online portfolios

Flexible modular format

Resources and Links

Direct Observation Checklists

Reflections

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 survey

As of March 19, 2010

Yr 01 Course Completions

Classes of 2011 and 2012

As of March 19, 2010

Yr 02 Course Completions

Class of 2011

Clinical Utility of the Course?

Year 01 Content

*Currently, indicators are available for 4 courses for the 2012 class.

Meet Learning Objectives?

Clinical Utility?

Year 02 Course Evaluations

Courses currently at 50% threshold

Year 02 Course Evaluations

Courses currently at 50% threshold

Smooth Online technology?

Medical Knowledge Test

Mean percent correct at baseline – All groups

ns

Medical Knowledge Test

Sub group differences at baseline – Class of 2011Sex

Medical School Status

Medical Knowledge Test

Pre-/Post Test Class of 2011 – Yr. 01

Post Match

1

Match Results 2011, 2012, 2013

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)

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)

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)

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)

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 topics

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.

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

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

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.

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 sessionsU Texas

Stress and M-B

Lecture and acupuncture experience

Maine GenClinical IntegrationPatient joins

the IMR case staffing