EXPERIENCE BASED CURRICULUM TO ACHIEVE COMPETENCE IN ...
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EXPERIENCE BASED CURRICULUM TO EXPERIENCE BASED CURRICULUM TO ACHIEVE COMPETENCE IN ACHIEVE COMPETENCE IN
PALLIATIVE MEDICINEPALLIATIVE MEDICINE
RODNEY TUCKER, MDRODNEY TUCKER, MD
PALLIATIVE MEDICINE FELLOWSHIP DIRECTORPALLIATIVE MEDICINE FELLOWSHIP DIRECTOR
UAB CENTER FOR PALLIATIVE CAREUAB CENTER FOR PALLIATIVE CARE
OBJECTIVESOBJECTIVES
Introduce the evolved process of Introduce the evolved process of developing a traditional experience-based developing a traditional experience-based curriculum to achieve competence in curriculum to achieve competence in palliative medicinepalliative medicine
Review a tailored training sequence for a Review a tailored training sequence for a 12 month fellowship emphasizing 12 month fellowship emphasizing increasing autonomyincreasing autonomy
Description of UAB site specific rotations Description of UAB site specific rotations and subsequent assessment methodsand subsequent assessment methods
Future challengesFuture challenges
History of the UAB PMFTPHistory of the UAB PMFTP
First fellow completed training in 2000First fellow completed training in 2000 Currently training 9Currently training 9thth and 10 and 10thth fellows fellows 100% ABHPM pass rate (6/8 have taken)100% ABHPM pass rate (6/8 have taken) 9/10 faculty are ABHPM certified (6/10 9/10 faculty are ABHPM certified (6/10
faculty also boarded in Geriatrics)faculty also boarded in Geriatrics) Received 2 year AAHPM and NHF award Received 2 year AAHPM and NHF award
in 2005in 2005 ABHPM voluntary accred in 2006ABHPM voluntary accred in 2006
Palliative Care SectionPalliative Care Section
Christine Ritchie, MDChristine Ritchie, MD Director of Center for Director of Center for
Palliative CarePalliative Care Rodney Tucker, MDRodney Tucker, MD
Medical Director- UAB Medical Director- UAB PM ProgramsPM Programs
Amos Bailey, MDAmos Bailey, MD Medical Director- Medical Director-
BVAMC Safe HarborBVAMC Safe Harbor Elizabeth Kvale, MDElizabeth Kvale, MD
Out-patient Medical Out-patient Medical DirectorDirector
Cynthia Baker, MDCynthia Baker, MD Charlotte Williams, MDCharlotte Williams, MD Carol Griffin, MDCarol Griffin, MD Tracey Humbert, MDTracey Humbert, MD Sandra Broeren, MDSandra Broeren, MD Heather Herrington, Heather Herrington,
MDMD
Experience Based- What does Experience Based- What does that mean to us?that mean to us?
Rotational, didactic, and special Rotational, didactic, and special seminars designed to expose fellows seminars designed to expose fellows to a wide variety and mixture of to a wide variety and mixture of clinical and classroom experiences clinical and classroom experiences necessary to achieve competence in necessary to achieve competence in palliative medicine domainspalliative medicine domains
STEP ONESTEP ONE
Determine core experiences Determine core experiences to provide clinical to provide clinical
opportunities for training opportunities for training purposespurposes
Rotational experiencesRotational experiences
In-patient PM In-patient PM consultationconsultation UAB PM Consult UAB PM Consult
ServiceService BVAMC PM Consult BVAMC PM Consult
ServiceService Children’s Hospital Children’s Hospital
of Alabama PM of Alabama PM consultationconsultation
In-patient careIn-patient care UAB Palliative and UAB Palliative and
Comfort Care UnitComfort Care Unit BVAMC Safe Harbor BVAMC Safe Harbor
UnitUnit
6-8 months per 6-8 months per yearyear
Interdisciplinary Interdisciplinary team focusteam focus
Rotational Experiences Rotational Experiences
Out-patient Out-patient Continuity clinics Continuity clinics (Average one clinic (Average one clinic per week)per week) UAB Supportive and UAB Supportive and
Palliative Care ClinicPalliative Care Clinic 2 sessions per month2 sessions per month
UAB HIV/AIDS UAB HIV/AIDS Treatment ClinicTreatment Clinic
2 sessions per month2 sessions per month
BVAMC clinic BVAMC clinic consultation serviceconsultation service
12 months continuity 12 months continuity experienceexperience
Development of own Development of own patient populationpatient population
Multi-disciplinary Multi-disciplinary teamteam
Rotational ExperiencesRotational Experiences
Out-patient/ Home Hospice Out-patient/ Home Hospice Community Based Hospice Organizations Community Based Hospice Organizations
with educational agreementswith educational agreements 2-3 months/year- Focused rotation2-3 months/year- Focused rotation Ongoing Hospice Patient management Ongoing Hospice Patient management
by fellows with 12 month continuityby fellows with 12 month continuity IDT focusIDT focus Majority observed home visits done Majority observed home visits done
during these monthsduring these months
Rotational ExperiencesRotational Experiences
Pain management rotationPain management rotation Out-patient and in-patient interventional Out-patient and in-patient interventional
focusfocus 1 month per year1 month per year Undisciplinary with some IDT component Undisciplinary with some IDT component
in out-patient sectionin out-patient section
Rotational ExperiencesRotational Experiences
ElectiveElective Fellow specific depending on area of Fellow specific depending on area of
interestinterest Can be Heme/Onc consult, Geriatric Can be Heme/Onc consult, Geriatric
Psychiatry, long term care setting, Psychiatry, long term care setting, Neurology, clinical visitorship to another Neurology, clinical visitorship to another institution, research and writing, etc.institution, research and writing, etc.
Specific career objectivesSpecific career objectives One month/yearOne month/year
STEP TWOSTEP TWO
Determine core subject matter Determine core subject matter and format in which to cover topic and format in which to cover topic
areas in palliative medicine areas in palliative medicine knowledge domainknowledge domain
Core DidacticsCore Didactics
UNIPAC “Crash Course”- Covered by UNIPAC “Crash Course”- Covered by program director in July- Tuckerprogram director in July- Tucker
Classic article readings- Discussion lead by Classic article readings- Discussion lead by faculty and guestsfaculty and guests Once weekly/ led by Fordham, et alOnce weekly/ led by Fordham, et al
Directed readings- Assigned text readings Directed readings- Assigned text readings (Oxford and Palliative Care & Supportive (Oxford and Palliative Care & Supportive Oncology) and discussion with attendingsOncology) and discussion with attendings Once weekly/ led by Bailey, et alOnce weekly/ led by Bailey, et al
Core DidacticsCore Didactics
Fellows Case Conference- Case Fellows Case Conference- Case presentations with pertinent article centered presentations with pertinent article centered on symptom managment, ethics, or self careon symptom managment, ethics, or self care Once monthly, InterdisciplinaryOnce monthly, Interdisciplinary
Palliative Medicine Journal Club- Critical Palliative Medicine Journal Club- Critical review of current literature articles using review of current literature articles using standard review instruments (Consort, etc.)standard review instruments (Consort, etc.) Once monthly, casual setting- Led by Kvale, et alOnce monthly, casual setting- Led by Kvale, et al InterdisciplinaryInterdisciplinary
STEP THREESTEP THREE
Determine supplemental Determine supplemental activities to cover gaps or activities to cover gaps or
expanded topics in palliative expanded topics in palliative medicinemedicine
Palliative Care Research Palliative Care Research ForumForum
Discussion time for PM faculty, Discussion time for PM faculty, visitors, fellows, and other housestaff visitors, fellows, and other housestaff to discuss potential or ongoing to discuss potential or ongoing research topicsresearch topics Twice monthly, optional for palliative Twice monthly, optional for palliative
care fellowscare fellows MultidisciplinaryMultidisciplinary
Special SeminarsSpecial Seminars
2-3 hour focused 2-3 hour focused seminars/workshopseminars/workshopss
Mandatory Mandatory attendanceattendance
Topics:Topics: Communication Communication
Style Preference and Style Preference and How to AdaptHow to Adapt
Academic Academic Presentation SkillsPresentation Skills
Topics:Topics: Hospice Financing Hospice Financing
and Administrationand Administration Building the Case Building the Case
for a Palliative Care for a Palliative Care ProgramProgram
Research Funding Research Funding and Grants 101and Grants 101
Media Relations & Media Relations & AdvocacyAdvocacy
STEP FOURSTEP FOUR
Match each activity with Match each activity with ACGME Competency DomainACGME Competency Domain
Curriculum & Competency Curriculum & Competency Cross ChecklistCross Checklist
Matches each activity/topic/seminar Matches each activity/topic/seminar with ACGME competency domainwith ACGME competency domain
Defines global objectives for each Defines global objectives for each activityactivity
See attached exampleSee attached example
STEP FIVESTEP FIVE
Determine appropriate Determine appropriate training sequence progressiontraining sequence progression
Training Sequence for Training Sequence for progressive fellow autonomy progressive fellow autonomy
and responsibilityand responsibility See attached training sequenceSee attached training sequence Divided into three sections to assist in Divided into three sections to assist in
providing theoretical structure to training providing theoretical structure to training experienceexperience 11stst sequence: Months 1-2 (Observe and question) sequence: Months 1-2 (Observe and question) 22ndnd sequence: Months 3-6 (Observe, question, sequence: Months 3-6 (Observe, question,
initiate)initiate) 33rdrd sequence: Months 7-12 (Initiate, question, sequence: Months 7-12 (Initiate, question,
complete)complete) Reviewed with fellows at onset of program Reviewed with fellows at onset of program
and at each quarterly reviewand at each quarterly review
STEP SIXSTEP SIX
Determine and Refine Determine and Refine evaluation processes and evaluation processes and
assessment toolsassessment tools
Evaluation/Assessment Tools Evaluation/Assessment Tools Current statusCurrent status
Monthly fellowship & Monthly fellowship & education committee education committee meeting that reviews meeting that reviews fellow progressfellow progress
Monthly Preceptor Monthly Preceptor evals- All facultyevals- All faculty
Monthly Rotation evals- Monthly Rotation evals- All fellowsAll fellows
Quarterly Quarterly documentation review- documentation review- Program DirectorProgram Director
Seminar evalsSeminar evals Filmed media interviewFilmed media interview
Procedure logs for Procedure logs for home visits, IDT home visits, IDT leadership, first 25 leadership, first 25 consults and family consults and family meetings, vent meetings, vent withdrawals, palliative withdrawals, palliative sedation, paracentesissedation, paracentesis
In-service exam at 6 & In-service exam at 6 & 12 months12 months
Grand Rounds Grand Rounds presentation-Once yearpresentation-Once year
End of year global End of year global program evaluationprogram evaluation
STEP SEVENSTEP SEVEN
Pray that all this will satisfy Pray that all this will satisfy ACGME requirementsACGME requirements
Evaluations and Assessements Evaluations and Assessements for the futurefor the future
360 degree evaluation to include 360 degree evaluation to include members of IDTmembers of IDT
Direct observation exercise (CEX)Direct observation exercise (CEX) Filmed mock patientFilmed mock patient Selection of two assessment Selection of two assessment
methods for each domainmethods for each domain