More than a century after being shaped by the Flexner Report, medical education in the United States is in the midst of change and the time is ripe for educators to embrace the change, said Kelly Caverzagie, M.D., a noted author and speaker on medical education.
A number of external factors have spurred a transition in traditional medical education to competency-based medical education since the 1970s, said Caverzagie, a hospitalist and associate vice chair for quality and physician competence in the Department of Medicine at the University of Nebraska Medical Center. Caverzagie delivered the 27th annual William Goodson Lecture on Oct. 25 at the School of Medicine and said now is an exciting time to be involved in medical education.
“There is great opportunity for us right now to redefine our profession, to redefine who we are, what it is we do and define what the next century will look like for physician education,” Caverzagie said.
In his lecture, “Achieving the Promise of Competency-Based Medical Education,” Caverzagie said a redesign of medical education is imperative in order to meet the needs of the nation’s health care system.
Caverzagie encouraged medical educators to “embrace change as an opportunity to improve our profession.”
The UMKC School of Medicine will joint sponsor the 43rd annual presentation of the Dr. Robert D. Conn Heart Conference on Dec. 12-13 at the Westin Kansas City at Crown Center.
This year’s conference will focus on improving the quality of care for patients with cardiovascular disease using evidence-based medicine and a multidisciplinary approach to patient care. It is intended for general practitioners; internal/family physicians; cardiologists; nurses; physician assistants; and other health care professionals.
Denise Davis, M.D., ’81, has spent the past year looking at women physicians’ lives from a unique perspective: the vantage point of their daughters. Davis presented the 2013 Marjorie S. Sirridge, M.D., Outstanding Women in Medicine Lectureship on Sept. 19 at the School of Medicine to UMKC faculty, staff and students, as well as other members of the community, about “Pride and Presence: Narratives of Women Physicians and their Daughters.
She has been working on the study, which explores the relationships and feelings between mother physicians and their daughters, for a year after being inspired by her invitation to deliver the lecture and her relationship with her own daughter.
“This lecture on the narratives of women physicians and their daughters was inspired by some of the paradoxes my daughter said she observed in me,” Davis said. “She said when she heard me on the phone with patients I displayed patience … she also tells me that sometimes in communicating with her, I come off as demanding and short-tempered. And yet, not only is my daughter surviving, she’s thriving. This peaked my curiosity.”
Davis, an internist, is an associate clinical professor of medicine at the University of California San Francisco, a member of the core faculty for the Center of Excellence in Primary Care, San Francisco VA Medical Center and a member of the American Academy on Communication in Healthcare. At UCSF, she currently serves as an attending for residents, nurse practitioners and nurse practitioner fellows in ambulatory care.
Along with medical student remediation, Davis is involved in faculty development workshops and teaches topics that range from basic communication skills, including improving doctor-patient communication, obtaining informed consent, working with angry patients and negotiating cultural differences in clinical relationships, to giving effective feedback to learners and coaching learners through remediation. Davis has received the Kaiser Foundation Award for Excellence in Teaching for her work with students at UCSF School of Medicine.
She consistently received awards as one of “America’s Top Doctors” and has received many Patients’ Choice Awards during her 20 years in a successful private practice. Consumer Checkbooks rated her as one of the finest physicians in the East Bay and the J magazine readers twice voted her as one of two favorite primary care physicians in the Bay Area.
Communication is a pillar on which her career has been based. Davis has been involved with the American Academy on Communication in Healthcare for 10 years. Through education, research and training, the organization helps caregivers improve the health care setting. Her love of communication led to her interviewing the sample of women physicians and their daughters for the study she presented at the Marjorie Sirridge Lecture.
“Even if this lecture had been cancelled [for any reason], it would have been worth it to me to pursue this journey of listening to other women and their daughters talk about their experiences, their strengths, their joys,” she said. “And some of the women said this interview process has led them to talk more with their daughters about the meaning of their work.”
Davis said she plans to continue interviewing and see what themes continue to emerge. “It would be great to speak with a more diverse group of women and single mothers,” she said. “I also do a lot of work with residents and would like to learn more about young women, what their thoughts are on becoming mothers and what they think would be supportive for them.”
Mary Sirridge, Ph.D., daughter of Marjorie and William Sirridge, M.D., welcomed Davis on behalf of her mother and her other family members.
“My mother has watched Dr. Davis’ career since she graduated over 30 years ago from UMKC with great fondness and great interest,” she said. “Like my mother, Dr. Davis has moved back and forth between being a skilled and caring physician to being someone who’s very involved in passing the baton to the next people in line.”
Davis mentioned her gratefulness for the mentorship she received from Marjorie Sirridge and what it meant to her to come back to the School as the Marjorie S. Sirridge, M.D., lecturer.
“It connects me with her nurturing of me and how that made a difference and continues to make a difference in my life, not only as a physician, but also as a mother and as a person.”
This conference will focus on new approaches for the diagnosis and treatment of common and “not so common” neurological disorders. It is intended for primary care physicians, family physicians, neurosurgeons, neurologists, neurointensivists, psychiatrists, nurses, case managers/social workers, and other health care professionals.
Doctors, nurses, pharmacists and dentists collaborate to treat a patient. Doesn’t it make sense for collaboration to be part of their education as well?
That’s the idea behind interprofessional education (IPE), an emerging priority in the education of health care professionals.
“In the workplace, the students we train become part of a medical care team. It makes sense that for the best patient-centered care, health professional students need to begin that training while in School,” said Dean Betty Drees, M.D. “This workshop brings together national experts and internal collaborators, helping the Schools move forward with more IPE collaboration.”
On Tuesday Nov. 27, national leaders in health professional education gathered at the Hospital Hill Campus to discuss progress, challenges and advances in the process of weaving IPE into the fabric of educating future doctors, nurses, dentists and pharmacists. External panelists included the following:
Carol Aschenbrener, M.D., chief medical education officer, Association of American Medical Colleges
Lucinda Maine, Ph.D., R.Ph., executive vice president and CEO, American Association of Colleges of Pharmacy
Jane Kirschling, D.N.S., R.N., F.A.A.N., president, American Association of Colleges of Nursing
Melissa J. Robinson, M.B.A., (Patient Advocate), president, Black Health Care Coalition
Leo Rouse, D.D.S., dean, Howard University College of Dentistry
The panel agreed that bringing health professional schools together to learn has many dimensions, but four critical components: leadership support, managing change, establishing and maintaining trust, and being honest.
“Change happens at the speed of trust,” was the quote by Gary Gunderson that Maine used in describing how quickly IPE is implemented.
However, it was patient advocate, Robinson, who captured the benefit of IPE. “It puts the patient at the center,” she said. “It helps the medical team listen to patients, and keeps the patient first.”
The program also included an internal panel discussion among faculty members from all four UMKC health science schools to discuss how IPE may be implemented here. The panelists included the following:
Stefanie Ellison, M.D., associate dean of curriculum, School of Medicine
Jolene Lynn, Ph.D(c), R.N., clinical associate professor and BSN program director, School of Nursing
Susan J. Kimble, D.P., R.N., A.N.P.-B.C., clinical associate Professor and MSN and DNP program director, UMKC School of Nursing.
Pam Overman, Ed.D., professor and associate dean for academic affairs, School of Dentistry.
Jennifer Santee, Pharm.D., clinical associate professor, Division of Pharmacy Practice and Administrations, School of Pharmacy.
This panel reported on the collaboration toward IPE experiences at UMKC. They have been meeting quarterly for the past year and attended the IPEC Institute last year where core competencies for interprofessional education were discussed.
“Through our discussions we found some core competencies we had in common. We have looked at what type of experiences we need to formalize in curriculum,” Ellison said. “We believe we need to focus on both extracurricular events and required curriculum for this to be effective,”
The internal panel also acknowledged this was a large task. In order to make progress, they plan to start small with things the schools were already doing, expand those and persist so they could begin implementing IPE experiences at UMKC.
The Quality Oncology Practice Initiative Certification Program (QOPI) has recognized Truman Medical Center-Hospital Hill’s Oncology Center for its commitment to excellence and quality of care for oncology patients with its three-year certification for outpatient hematology/oncology practices and requires ongoing participation in the QOPI program throughout the three-year term. Jill Moormeier, M.D., M.P.H., associate dean of Graduate Medical Education, is the program director for the UMKC Hematology/Oncology Fellowship and TMC Hematology/Oncology section chief. All of the physicians in the practice are UMKC faculty or fellows.
The American Society of Clinical Oncology’s QOPI is an oncologist-led, practice-based quality improvement program, which began in 2006. Launched in 2010, the QOPI Certification Program (QCP) awards practices the meet rigorous safety measures established by the ASCO and Oncology Nursing Society with a certification.
Eligible candidates for the certification agree to an evaluation of their practice and documentation standards. Along with their application, they provide data that include documentation of care, chemotherapy planning, administration and treatment summary, pain assessment and control, smoking cessation, and psychosocial support.
The UMKC School of Medicine and Truman Medical Centers (TMC) have joined medical schools and teaching hospitals around the country in a multi-year initiative aimed to improve the quality and safety of health care. The initiative, Best Practices for Better Care, is sponsored by the Association of American Medical Colleges (AAMC), University HealthSystem Consortium (UHC), an alliance of academic medical centers, and the Centers for Medicare and Medicaid Services through their Partnership for Patients Program.
Best Practices for Better Care will help put patient safety and quality methods into widespread use at teaching hospitals and health systems in the United States, combining academic medicine, education, research and clinical care. The goal is to put the power and skills of the academic medical center behind solving some of the common patient quality and safety problems through education, research, and clinical care.
“The School identified this as an important initiative and was very excited to participate,” said Jill Moormeier, M.D., M.P.H., associate dean of Graduate Medical Education, who is coordinating the efforts by the School of Medicine with TMC. “We are a really good location to do stuff like this. Our students and residents are intimately involved in the care of patients and patient outcomes.”
The initiative began in June 2011 with participating medical schools and teaching hospitals gathering data during its first year.
The campaign recently released a progress report to the participating organizations that showed most hospital systems have in place well-established systems to improve patient care in the United States. But, Moormeier said, it was also clear there is some work to be done in educating students, residents and faculty in quality improvement.
Participating institutions, according to the AAMC, have committed to teaching quality and patient safety to the next generation of doctors; ensure safer surgery through use of surgical checklists; reduce infections from central lines using proven protocols; reduce hospital readmissions for high-risk patients; and research, evaluate, and share new and improved practices.
The School of Medicine and TMC will first tackle the preventable hospital readmissions component. Alan Salkind, M.D., professor of internal medicine, will be leading this endeavor.
According to Salkind, nearly 20 percent of Medicare hospitalizations are followed by readmission within 30 days, with 75 percent of these considered preventable. Readmissions within 30 days account for $15 billion of excess Medicare spending.
“Common reasons leading to hospital readmission are inadequate explanation to the patient about how to use medications after hospital discharge, recognition of warning signs that warrant a call to the patient’s physician, and lack of a timely post-discharge physician visit, all of which are preventable by clearly conveying information to patients and confirming understanding before discharge from the hospital,” Salkind said. “Another important objective of this project is to teach students and physicians the elements of discharging a patient from the hospital with appropriate and understandable instructions for their continued care.
“We want to determine and then fix the pitfalls in our discharge process that lead to preventable readmissions to the hospital. We will share that information with other medical schools and hospitals to develop best practices that reduce hospital readmissions.”
This project is scheduled to last for about six months, but as the School and TMC gather data, it may be extended. The campaign is ongoing.
John A. Spertus, M.D., M.P.H., F.A.C.C., Lauer/Missouri Endowed Chair and professor of internal medicine, and Shauna Roberts, M.D., ’84, professor of internal medicine, are members of Research on Care Community (ROCC), the research division of the Best Practices for Better Care initiative, established to serve as a home for academic leaders and their teams. Through webinars, peer-to-peer learning and other resources, members of ROCC will share strategies for building institutional effectiveness and implementation research.
Rear Adm. Patrick O’Carroll, M.D., M.P.H., visited the School of Medicine on June 5 to deliver his lecture titled “Public Health and Prevention in the Age of Healthcare Reform,” as part of the Health Care Policy Grand Rounds Lecture series presented by the Department of Biomedical and Health Informatics.
O’Carroll is an assistant surgeon general of the United States, the regional health administrator for U.S. Public Health Service Region X, and an affiliate professor at the University of Washington schools of Public Health and Medicine. He has also worked at the Centers for Disease Control and Prevention, giving him a unique perspective on issues of public health and ways to prevent disease, said Bill Lafferty, M.D., Merl & Muriel Hicklin/Missouri Endowed Chair in Medicine during his introduction of O’Carroll.
The lecture outlined the 10 most effective public health interventions of the 20th century. These included vaccines, motor-vehicle safety, safer work places, control of infectious disease – huge improvements in infant mortality, for example – a decline in heart disease and stroke mortality, safer and healthier foods, healthier mothers and babies, family planning, fluoridation of drinking water, and reduction in tobacco use – still the No. 1 cause of preventable mortality.
O’Carroll stressed the importance of prevention when it comes to public health outcomes. “Medicine can be thought of as a reaction if a system fails,” he said.
Preventative care is practiced on multiple levels. At the individual level, it includes wellness visits and new private plans. At the business level, there’s workplace health, for example, and at the state level, there are many initiatives regarding community health plans. More than 12 federal agencies have developed a National Prevention and Health Promotion Strategy and a Prevention and Public Health Fund.
O’Carroll also discussed the Affordable Care Act, the Consumer Bill of Rights, and the CDC’s bioterrorism preparedness and response initiative.
Throughout his lecture, O’Carroll acknowledged the challenges of public health because its boundaries constantly change. “There are multiple disciplines and cultures, and sometimes an uncomfortable blend of science, action, research, policy, advocacy and government,” he said. Although, there is one aspect that O’Carroll emphasized as a top priority.
“The upstream causes of death are what we need to be working on,” O’Carroll said. “Because, A) It’s the right place to go; it prevents disease in the first place and prevents human suffering, and B) it prevents the visit to the doctor and keeps this incredible cost curve, that I mentioned being unsustainable, from breaking the bank.”
Timothy P. Hickman, M.D., M.Ed., M.P.H., adjunct associate professor of the Department of Pediatrics, the Department of Biomedical and Health Informatics and the Department of Medical Education and Research, has been selected as a participant to the Robert Wood Johnson Foundation Workshop on Race and Health Disparities. Hickman, who has also served as medical director for continuing medical education and director of cultural competency at the School of Medicine was one of 25 faculty members, researchers and graduate students selected in a national competitive application process. The five-day workshop, which will be June 18-22 in Ann Arbor, Mich., will focus on increasing knowledge and skills in measurement and indicators, research methods and use of secondary data sources in health disparities research.
“Not only is this an opportunity to participate in a learning community with scholars who represent social sciences, population health and health sciences from around the nation, but a chance to establish relationships that can lead to collaborative projects,” Hickman said.
While sponsored by the Robert Wood Johnson Foundation, the workshop is part of the Inter-University Consortium for Political and Social Research (ICPSR) Summer Program in Quantitative Methods in Ann Arbor, Mich. The ICSPR was originally a partnership between the Survey Research Center at the University of Michigan and 21 U.S. universities, but now it includes a consortium of more than 500 universities worldwide. It provides access to social science data sources and training in quantitative analysis using the resources. The instructors for the workshop include David R. Williams (School of Public Health/ African and African American Studies- Harvard University); Paula A. Braveman, (Family and Community Medicine-University of California-San Francisco); Patrick M. Krueger (Department of Sociology- University of Colorado-Denver); Gabriel Sanchez (Department of Political Science- University of New Mexico), and John Garcia, Archive Director of the Resource Center for Minority Data ( RCMD) (University of Michigan – ISR).
Ray Fowler, M.D., F.A.C.P., presented the 2012 McNabney Lectureship on May 31 at the School of Medicine. The lectureship honors Kendall McNabney, M.D., who founded the Department of Emergency Medicine at Truman Medical Center and the UMKC School of Medicine in 1973. McNabney was also the first and longest serving chair of EM at the School and was the head of trauma services for many years.
Matthew Gratton, M.D., associate professor and chair of the Department of Emergency Medicine, who has been with the department since 1983, welcomed McNabney to the lecture and spoke about his great effect on EM in Kansas City before introducing Fowler.
Fowler’s lecture titled, “The Past, Present and Future of Cardiopulmonary Resuscitation,” focused on studies and trials of the Dallas arm of the Resuscitation Outcomes Consortium (ROC), for which Fowler is co-principle investigator.
Fowler has been involved in EMS as a leading educator, medical supervisor and political advocate for more than three decades. He currently serves as co-chief in the Section on EMS, Disaster Medicine, and Homeland Security for Southwestern Medical Center. He is chief of EMS Operations for the Dallas Area BioTel EMS System and an attending EM faculty member at Parkland Memorial Hospital in Dallas, Texas.
In addition to serving as president of the Georgia College of Emergency Physicians and as a perennial member (since 1980) of the State of Georgia EMS Advisory Council, he was the second elected president of the National Association of EMS Physicians. He was also a co-founder and senior faculty member of the National EMS Medical Director’s Course, helped found and was national program director of International Trauma Life Support, and was a member of the initial steering committee of the National Association of EMS Physicians.
During his lecture at the School of Medicine, Fowler stressed the importance of compression fraction – the number of seconds per minute of doing compressions – and its role in determining survival in patients with out-of-hospital ventricular fibrillation. Fowler also mentioned that evidence shows the ideal compression fraction is 40 seconds of every minute. These discoveries have increased the survival rate in cardiac arrest patients, “the sickest patients you will ever have,” according to Fowler.
He also stressed the importance of avoiding interruptions in compressions when administering CPR. This concept of Minimally Interrupted Cardiac Resuscitation (MICR) increased the survival-to-hospital discharge of patients with out-of-hospital cardiac arrest.
Fowler concluded with his vision for the future: “That all (who) can be prepared, would be. That all of us in clinical care sing as a well-rehearsed choir from the same sheets of music, and that research will light our paths as we maintain our commitment to the betterment of the human condition.”