Field of Work: Aligning the training of physicians and nurse practitioners with the demands of 21st-century clinical practice.
Problem Synopsis: In the 1990s, managed care became one of the dominant forces in health care. Physicians and nurse practitioners (NP's) were expected to know how to manage patients' health, often within a fixed budget. Although care was increasingly taking place in outpatient settings, physicians continued to receive most of their training in hospitals rather than in ambulatory care centers. They also received little training in preventive care, or in interprofessional collaboration.
Faculty and staff at the University of Virginia Health System were formulating ways to teach quality improvement.
Synopsis of the Work: Partnerships for Quality Education (PQE) (April 1999 through January 2009), was initially funded by the Pew Charitable Trusts (during which time it focused on physicians only) and then by RWJF (which expanded it to include NP's). The program sought to improve a core set of skills in physicians and nurse practitioners, including interprofessional collaboration, chronic illness management, systems-based care and practice-based quality.
The University of Virginia participated in the Achieving Competency Today (ACT) component of PQE.
- If you pick examples relevant to a medical resident's work, even the most jaded resident can be motivated to learn about systems-based care and practice-based learning and improvement.
- With learners, you need to communicate repeatedly what the required competencies are and remind learners why faculty are teaching these.
- Learn the value of and methods to obtain institutional and departmental support for education in the new competencies.
- Bring faculty along in terms of educational development as you engage learners so that they can master and/or apply the curriculum.
- Start talking to the learners four to eight weeks ahead of an elective that is as demanding as ACT.
- Use small groups (four or so members) as a learning setting and require accountability from all participants.
- Make initiatives like this mandatory for students.
- Be flexible in how a curriculum like this can fit into your educational program.
While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
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