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Getting on Track: Standardizing individualized curricula for six educational units

Aisha Barber Davis MD

Neha Shah MD MPH

Sandra Cuzzi MD

Cara Lichtenstein MD MPH

Ed Sepe MD

Dewesh Agrawal MD

Saturday, April 13, 2013

APPD Annual Spring Meeting

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After this workshop, participants will be able to:

• Describe the ACGME’s individualized curriculum

requirement

• Determine gaps in home programs which may be filled by

standardized individualized curricula in the form of tracks,

special curricula, or pathways

• Analyze home program’s resources to aid in the

development of standardized individualized curricula

Objectives

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• Overview & Introductions

• Background

• Examples

• Small groups assignments

• SWOT analysis

• Developing a curriculum framework

• Debrief

Agenda

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• What is the requirement?

• Why do it?

• How can we accomplish this?

Six Individualized Educational Units: Background

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[Program Requirement: IV.A.6.b).(1)]

IV.A.6.b) The overall structure of the program must

include: (Core)

IV.A.6.b).(1) a minimum of six educational units of

an individualized curriculum; (Core)

IV.A.6.b).(1).(a) The individualized curriculum must

be determined by the learning needs and career

plans of each resident and must be developed

through the guidance of a faculty mentor. (Core)

What is the requirement?

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What is an educational unit?

IV.A.6.a) The curriculum should be organized in

educational units. (Core)

IV.A.6.a).(1) An educational unit should be a block

(four weeks or one month) or a longitudinal

experience. (Core)

IV.A.6.a).(1).(a) An outpatient educational unit

should be a minimum of 32 half-day sessions.

(Detail)

IV.A.6.a).(1).(b) An inpatient educational unit should

be a minimum of 200 hours. (Detail)

What is the requirement?

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• Cookie cutters should be for cookies . . . not

pediatric residents

• Adult learning theory: meet the individualized

educational needs of learners

• Abraham Maslow: self-actualization is the

highest order need • help pediatric trainees reach their full potential

Why do it?

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Guidance offered by the ACGME in designing

and implementing such a curriculum…

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How can we accomplish this?

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How can we accomplish this?

Question: What is the expectation of the individualized curriculum?

Answer: The individualized curriculum should not be thought of as additional

“electives” for a resident. The curriculum can be unique for each resident or

designed as tracks within the program. The main focus should be on

providing experiences that will help each resident be better prepared for the

next step in his or her career after residency. Experiences can be inpatient,

outpatient, research, or other. They may be repeated experiences done

previously in the program, or experiences that are at a higher level with less

supervision, e.g., acting as a co-fellow on a subspecialty experience.

Educational units allow the experiences to be block or longitudinal. The timing

(year of residency) should also be determined by the program director.

Note: if the subspecialty experiences for the three additional

educational units required in Program Requirement

IV.A.6.b).(3).(d) are chosen based on needed experiences

for the individualized curriculum, then they may be counted

toward fulfillment of this requirement (a.k.a. “double

counting”).

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How can we accomplish this?

• Programs are expected to innovate and

implement curricula that take advantage of

local institutional strengths and opportunities

• The alignment of relevant patient care

activities with resident career plans is the aim,

with other resident-directed and program

constructed educational activities

supplementing the clinical experiences

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Summary

• 6 units over 3 years

• Determined by resident’s learning needs and career paths

• Mentored experience

• Unique for each resident or tracks within the program

• May include 3 units of subspecialty experience that may be “double

counted” for the additional subspecialty unit requirement

[IV.A.6.b).(3).(d)]

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Global Health

Inpatient Careers

Longitudinal Research

Immigrant Health

Comparative Primary Care

Tracks & Pathways: Examples from Children’s National

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Tracks: Examples from Children’s National

[40]

Categorical [28]

Primary Care Track [5]

Community Health Track [8]

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Primary Care Track

• 5 residents accepted per year

• Separate match

• PL 1: Same schedule as categorical residents

• PL 2 & 3: Continuous 6 month MEGA-block of outpatient

clinic at one site

• Longitudinal electives (community, specialty, advocacy)

• Research (REACH) option

• Weekly conference series with resident-led seminars

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Community Health Track

• 8 residents accepted per year

• Separate match

• Community Health Rotations

• Continuity Clinic at Community Health Centers

• Required longitudinal community-based research project

Advocacy

Health Policy

Global Child Health

Child & Adol Protection

Community Building Blocks

THEARC/ Medical Homes

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Six Individualized units

Research Holy Cross

Ambulatory

Foggy

Bottom

Clinic

Elective

Elective

Elective Selective

Selective

Selective

REACH

REACH

REACH

Global

Health Community

Health

Policy

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• Global Health Pathway

• Inpatient Careers Pathway

• Longitudinal Research Pathway

Pathways: Examples from Children’s National

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• Pathway resources

• Global Child Health Checklist

• Inpatient Career Pathway

• Individualized Learning Plan

• Potential career plans

• Learning goals related to career choice or pathway

• Educational experiences to help meet goals

• Define goals and objectives for the academic year

including an action plan with timeline

Implementation Aids

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• Community health & advocacy

• Primary care

• Global child health

• Inpatient careers

• Longitudinal research

• Others?

Small Group Activities: Select an area of interest

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Finding & filling the gaps: Intro to SWOT Analysis

Activity #1

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Finding & filling the gaps: Intro to SWOT Analysis

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Finding & filling the gaps: Inpatient Careers SWOT

• Large Hospitalist Division • Multiple Hospitalist settings • Large PICU • Subspecialty inpatient services • Prominent hospitalist fellowship

program • Many interested trainees • Medically complex patient programs • Referral center • Hospitalist elective in existence • PL 2&3 elective time • Performance improvement

department • Protected research time for residents • Established inpatient event reviews/

M&Ms

• PL 3 year – 1 hospitalist month • Variable senior delivery room experience • Variable end of life care exposure • No routine dedicated time to medically

complex patients. • Variable exposure to inpatient QI/ PI • No transport experience • Limited airway experience

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Finding & filling the gaps: Inpatient Careers SWOT

• 6 educational units requirement • Emerging discussion re: ped hospitalist

board certification • Institutional focus on safety and

escalation of care for sick patients • Supervisory month requirements • PHM Core Competencies • ABP content specifications • Established services at nearby hospitals

(i.e. sedation)

• Spending cuts may impact training opportunities nationwide

• Uncertainty in hospitalist certification requirements

• Changes in duty hours more handoffs, potentially less patient exposure, compressed shifts.

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Small Group Activity 1

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Curricular Framework Template: GNOME

Goals Needs Objectives Methods Evaluation

The GNOME: A Linear Model for

Curriculum Development

Activity # 2

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Goals & Objectives: Community Health Track

• Resource: Dyson Initiative Community

Pediatrics Curriculum

• Goal: Understand the definition of medical home

and how a practice site meets components.

• Objectives:

• Describe strategy to overcome barriers to med home

• Implement QI project at continuity site

• Identify insurance programs available to population

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Needs Assessment: Community Health Track

• Survey of residents

• Self-assess performance in each

competency area

• Questions about specific rotations

• Input on what was missing

• Focus group of incoming residents

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Methods: Community Health Track

• Block Rotations

• Community-based continuity clinic

• Required longitudinal community peds research

project

• Pairing with Portfolio Advisor

• Bi-annual evening symposia

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Evaluation & Feedback: Community Health Track

• Electronic rotation evaluations

• Bi-annual meeting with advisor

• Regular meetings with research mentor

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Program Evaluation: Community Health Track

• Yearly program-wide evaluation includes CHT

component

• Self-assessment survey

• (Future) survey of graduates

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Small Group Activity 2

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