Innovative Initiatives in Intellectual & Developmental Medicine or Collaborative Development of an "Orphan Curriculum"

Slide Presentation from the AHRQ 2011 Annual Conference

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.

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Innovative Initiatives in Intellectual & Developmental Medicine or Collaborative Development of an "Orphan Curriculum"

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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.

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An Orphan Curriculum?

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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.

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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.

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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).

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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".

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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.

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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%).

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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.

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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.

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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.

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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.

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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.

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National Curriculum Initiative in Developmental Medicine

FMEC Pre-conference
October 28, 2010

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Acknowledgements—
Support Provided By

  • The Walmart Foundation—AADMD.
  • The North Carolina Council on Developmental Disabilities.

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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

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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.

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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.

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So Where Is the Innovation?

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Three Tiers of a Curriculum for People with Intellectual Disabilities

Image: A chart for Patient Care is show.

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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.

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Immediate Goal Would for Every Residency to Teach and Support Core Competencies....

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Breakfast of Champions!

We need champions at each level:

  • Student.
  • Resident.
  • Faculty.
  • Residency.
  • University.
  • Association.
  • State.
  • Federal level.

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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.

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Three Tiers of a Curriculum for People with Intellectual Disabilities

Image: A chart for Patient Care is shown.

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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.

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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.

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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.

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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.

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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.

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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.

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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?

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Thank You

Caryl J. Heaton
Associate Professor of Family Medicine
New Jersey Medical School
heaton@umdnj.edu
973-972-7828

Current as of March 2012
Internet Citation: Innovative Initiatives in Intellectual & Developmental Medicine or Collaborative Development of an "Orphan Curriculum". March 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/events/conference/2011/heaton/index.html