Duke Internal Medicine Residency Program: Education Innovation Project

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Duke Internal Medicine Residency Program
Education Innovation Project

• Patient-Centric Care
• Individualized Resident Education

Sheri Keitz Diana McNeill Pam Riley
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If the facts dont fit the theory, change the
facts.

• Albert Einstein

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Patient-Centric Systems
Patient Needs
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Where we areWhere we want to be

• 2005
• Fragmented Care

• 2015
• Patient Centric Care

Identifying the evidence
Enacting the evidence
Competitive disciplines
Collaborative disciplines
Individual shifts (handoff)
Teamwork (shared ownership)
Inconsistent approach to quality measurement
Systematic approach to quality measurement
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Individualized Resident Plan
Individualized Learning
CORE Content
Intern JAR SAR
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Individualized Resident Plan
Individualized Learning
CORE Content
Intern JAR SAR
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Individualized Resident Plan
Individualized Learning
CORE Content
Intern JAR SAR
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Where we areWhere we want to be

• 2005
• Time in training standard

• 2015
• Competency-based standard

Uniform Curriculum
Individualized Curriculum
Core Curriculum
Core Career / Leadership
Mentoring as a focus
Mentoring as a focus
Inconsistent approach to faculty development
Systematic approach to faculty development
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Demonstration Projects

• Practice Partnerships
• Teams of residents across years of training
  partner to provide care for continuity patients
• During clinic rotations, immersion in the clinic
  setting without an inpatient component
• During inpatient rotations, immersion in the
  acute setting without weekly continuity clinic
• Curriculum on team building to foster
  communication and shared ownership
• Program-wide project

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Practice Partner Team Schedule
Key Blue months immersion experiences in
clinic White months immersion experience in
acute / inpatient setting Green blocks
rotations with traditional ½ day per week
clinic  
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Demonstration Projects

• Durham VAMC Collaborative Care Consults
• Development of a VA Hospitalist Service
• Collaborative Care Consult Service inpatients on
  surgical service
• Communication / Consultation Skills
• Multidisciplinary Team Building with trainees
  from other services (Surgical Service, Nursing)

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Demonstration Projects

• Outpatient Clinic Chronic Care Model
• Optimizing Chronic Care in residency training
• Disease Specific interventions and measures
• Comparisons of care across all ambulatory sites
• Initial Chronic Disease Diabetes Management
• Subsequent HTN, Prevention, Asthma, CHF
• Provider and the patient level interventions
• Multidisciplinary Team Project

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Measurement Overview

• Quality and Safety
• Team Measures
• Utilization of Services / Cost
• Satisfaction
• Including Learners Perception Survey
• Office of Academic Affiliations

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Potential Barriers

• Faculty level
• Time for teaching, mentoring, faculty
  development
• Funding of faculty salary
• Trainee level
• Balance of education to service
• Duty limits remain

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Potential Barriers

• Culture shift
• No longer have trainees on every service
• Different faculty roles
• Additional team members
• Shift from individual to Team-based systems
• One-to-one relationships to team based
• Need for effective communication across
  disciplines, departments, continuum of care

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Potential Barriers

• Move to outcomes measurement
• Cultural acceptance of QI process
• Systems and infrastructure to support data
  management
• Move to competency-based trainee evaluation
• Lack of tested tools for measurement
• Faculty development needed for effective
  implementation

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The significant problems we face can not be
solved at the same level of thinking we were at
when we created them.

• Albert Einstein

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