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"
• 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