Innovative Initiatives in Intellectual & Developmental Medicine or Collaborative Development of an "Orphan Curriculum"
On September 19, 2011, Caryl J. Heaton made this presentation at the 2011 Annual Conference. Select to access the PowerPoint® presentation (2.3 MB). Plugin Software Help.
Slide 1
Innovative Initiatives in Intellectual & Developmental Medicine or Collaborative Development of an "Orphan Curriculum"
Slide 2
My Goals for Today
- The participant will be able to provide an overview of U.S. efforts to incorporate developmental disorders and intellectual disabilities into medical training.
- The participant will be able to list details of the proposed curriculum content for medical residency training developed by the National Curriculum Initiative in Developmental Medicine (NCIDM).
- The participant will be able to discuss strategies, mechanisms and incentives to pilot the proposed curriculum at select primary care residency programs.
Slide 3
An Orphan Curriculum?
Slide 4
The Society of Teachers of Family Medicine (FM) has approx. 48 "Groups on"—interest groups who promote a specific curriculum in FM training
- Abortion Training.
- Addiction Medicine.
- Adolescent Health Care.
- Evidence Based Medicine.
- Genetics.
- Global Health.
- HIV/AIDS.
- Integrative Medicine.
- LGBT Health.
- Minority & Multicultural Health.
- Musculoskeletal/Sports Medicine.
- Nutrition Education.
- Oral Health.
- Pain and Palliative Medicine.
- Rural Health.
- Spirituality.
- Violence Education.
Slide 5
What Do These Curricula Have in Common?
- They have no specific "time" in the residency curriculum.
- They have no specific specialty organization that has stressed the importance of the curriculum time.
- Although most primary care educators would agree these topics are important—the requirements for teaching these topics are vague and weak.
- There are no large business or pharmaceutical organizations promoting CME around these topics—so no free lunches.
Slide 6
The NCID Curriculum—and Unlikely Partnering of Organizations—Not the Usual Suspects
- American Academy of Developmental Medicine and Dentistry (AADMD).
- Health Education Center (M-AHEC) Mini-fellowship in Adult Developmental Medicine.
- Family Medicine Educational Consortium (FMEC).
Slide 7
AADMD
American Academy of Developmental Medicine and Dentistry
Founded 2002: "to improve the health of individuals with intellectual disabilities and neurodevelopmental disorders (ID/ND) through patient care, teaching, research and and advocacy."
- Interdisciplinary network for clinicians.
- Advocacy for health care system change to create improved access and quality.
- "Disseminate specialized information to families".
Slide 8
Curricular Assessment of Needs
CAN Project—AADMD 2005
- Medical School graduates not competent to treat ID population (Deans 52%, Students 56%).
- Residency graduates not competent—(Directors 32%).
- Clinical training in ID not a high priority—(Deans, 58%).
- Most students don't receive any clinical experience—(Students, 81%).
- Most residency programs are not providing clinical training—(Directors, 77%).
- 80% of medical students and 90% of residents reported less than 1 hour of training in the care of patients with ID/DD.
Slide 9
CAN Report
The Good News
- Students were interested in treating patients with ID as part of their career—(Students, 74%).
- Deans said that students should receive significant clinical experience patients with ID—(Deans, 67%).
- Programs are interested in implementing a curriculum regarding ID—(Deans 100%, Directors 90%).
Slide 10
Mountain Area Health Educational Center—Mini-fellowship
Mini-fellowship began in 2004 funded by North Carolina Council on Developmental Disabilities
- 1st year— literature review, statewide surveys, focus groups, CME programs (Jurczyk).
- 2nd year—Content development / no established model / many questions, no clear answers.
- 3rd year—initial cohort of 8 physicians.
Slide 11
MAHEC Mini-fellowship
What We Learned
- Good people and innovative programs across the country devoted to this population.
- Strong desire for sense of community, shared vision, purpose, and training.
- Despite growing consensus in understanding the vast needs—no mandate to take action.
- Overarching recognition of need for educational models to train physicians.
Slide 12
Family Medicine Educational Consortium
- Affiliated with Northeast Region Society Teachers Family Medicine (STFM).
- Mission: To build strategic relationships that transform medical education and health systems.
- 14 states / 130 Residency programs / 50 Departments FM / 350 faculty & residents/practice groups/FQHCs.
- Promote medical student interest, stimulate faculty recruitment / development, and leadership skills.
Slide 13
FMEC Developmental Disabilities Collaborative Project
- Mission: Support availability and quality of medical care for people with DD.
- Collaborate with interested external organizations.
- Link to Future of Family Medicine Report—redesign care for patients with ID/DD into 'medical homes'.
- Create relationships with community/service/ advocacy organizations.
- Explore curricular models to improve training.
Slide 14
Medical Homes for People with Intellectual/Developmental Disabilities—FMEC
- DD Collaborative pre-conference at the annual meeting since 2003 —funding from multiple sources—AHRQ, programs:
- Initially focused on issues in clinical care.
- Recurring themes:
- Lack of information about I/DD medical issues, lack of training for physicians.
- Recognition of scattered "champions" for this population.
Slide 15
National Curriculum Initiative in Developmental Medicine
FMEC Pre-conference
October 28, 2010
Slide 16
Acknowledgements—
Support Provided By
- The Walmart Foundation—AADMD.
- The North Carolina Council on Developmental Disabilities.
Slide 17
Where Do We Go From Here?
Family Medicine Education in the Care of Patients with Intellectual Disabilities in the U.S.
Caryl J Heaton, D.O.
New Jersey Medical School—UMDNJ
IASSID Bethesda, MD
May 25, 2011
Slide 18
What Has Worked Before?
- Stealth Curriculum.
- Fellowships?
- Geriatrics, Sports Medicine, Adolescent Medicine.
- Infiltrate leadership of organizations.
- National curriculum vetted by all:
- Easily accessible tools.
- Free or cheap CME for practicing physicians.
- Mandated requirements.
Slide 19
Lessons Learned From International Initiatives
- Clinical Support Networks:
- Before curriculum.
- Tools:
- Before curriculum.
- Program Status from Colleges (Academies).
- Teaching through experience with patients is key.
- Trans-disciplinary training is ideal.
Slide 20
So Where Is the Innovation?
Slide 21
Three Tiers of a Curriculum for People with Intellectual Disabilities
Image: A chart for Patient Care is show.
Slide 22
How Would a Tiered Curriculum Work?
- Core Tier:
- Should be basic and so straightforward that any reasonable residency director would say—of course we should do that.
- More likely they will say "of course we already do that"—but wonder if they really do?
- Advanced Tier:
- Should be an expected goal for each residency and residency graduate.
- Exemplary Tier:
- Should be a level that suggests a graduate could be prepared to take responsibility for a large number complicated patients.
- Should be recognized as a center of excellence.
Slide 23
Immediate Goal Would for Every Residency to Teach and Support Core Competencies....
Slide 24
Breakfast of Champions!
We need champions at each level:
- Student.
- Resident.
- Faculty.
- Residency.
- University.
- Association.
- State.
- Federal level.
Image: A box of Wheaties cereal is shown.
Slide 25
Family Medicine Education in the Care of Patients With Intellectual Disabilities in the U.S.
Phase 1
- Recognize the excellent work that has been done internationally and incorporate it to....
- Create an excellent curriculum document.
- Create tools, methodology and evaluation to support the curriculum—match to objectives.
- Must have face validity.
- Establish curriculum "tiers".
- Create a repository of all curricular materials:
- Don't reinvent the curriculum wheel.
- Residency Faculty as the unit of intervention.
Slide 26
Three Tiers of a Curriculum for People with Intellectual Disabilities
Image: A chart for Patient Care is shown.
Slide 27
Family Medicine Education in the Care of Patients With Intellectual Disabilities in the U.S.
Phase 2
- Create a support network:
- Family Medicine Education Consortium.
- National network "partners"—NC, FL and CA.
- Connect with university department champions.
- Recognize "Advanced" and "Exemplary" residencies.
- Recognize Residency faculty champions:
- Connect residency faculty in some meaningful way.
- Move the curriculum through organized family medicine.
Slide 28
Family Medicine Education in the Care of Patients with Intellectual Disabilities in the U.S.
Phase 3
- Create advocacy support for residency and residency faculty champions network:
- Link patient self-advocates to network and individual residencies.
- Develop policy and funding initiatives:
- Health Resources and Services Administration (HRSA) priority for patients with ID/DD.
- Search out other funding partners.
- Accountable Care Organizations—Virtual ACO.
Slide 29
FMEC Champions Project—NCID
Preconference Oct. 20, 2011, Danvers MA
- Skills Building:
- OSCE (Objective Structured Clinical Evaluation) Development.
- Evaluation of Video-tape Reviews.
- Clinical Success Stories.
- Integrating NCID Curriculum into the Residency.
- Cultivating Curriculum Champions.
- Funding Curricular Initiatives—building partners in the Community.
Slide 30
FMEC Champions Project—NCID
Project Goals Oct. 20, 2011 Danvers MA
- Recruit first members of "Project"
- Residencies, Practice Groups, FQHC:
- .......One Champion.
- Recruit Mentors from AADMD, MAHEC, FMEC and STFM "group on"
- Residencies, Practice Groups, FQHC:
- Establish communication system and "learning community"
- Clinical information support.
- Teaching support.
Slide 31
FMEC Champions Project—NCID
Project Goals Oct. 20, 2011 Danvers MA
- Basic training in community advocacy:
- How do you get support in your institution.
- Basic training in "institutional advocacy"
- How do you get support in your institution.
- Dissemination and implementation of curriculum tools—for basic skills residency:
- Evaluation and improvement.
Slide 32
FMEC Champions Project—NCID
Challenges and Opportunities
- Piecing together the funding:
- Consider HRSA training application for Faculty Development.
- Create a Practice Based Research Network (PBRN)—pilot data, research questions.
- What if you build it and nobody comes?
- Faculty or residents or both?
- Question of Fellowship or Certificate of Added Qualification.
Slide 33
Final Thoughts
- Who are the other partners for these orphans curriculum?
- Medicine.
- Pediatrics.
- "Organized medicine."
- How can we find more inter-disciplinary partners?
- How do we sustain this effort?
Slide 34
Thank You
Caryl J. Heaton
Associate Professor of Family Medicine
New Jersey Medical School
heaton@umdnj.edu
973-972-7828