We will begin shortly…

Welcome

1

Using Zoom

Turn your webcam on!

Please remember to mute yourself during the presentations.

Please send in your attendance via the CHAT box

Organizational Overview

Shout out to the Coaches!

HEALTH CENTER COACH

Avenal Community Health Center Veronica Vo Lumley

Central City Concern- Lauren Land

CHAS Health Marcus Riccelli

Lamprey Health Care Evalie Crosby

Lyon Martin Health Services Nina Soares

Menominee Tribal Clinic Diane Hietpas

Montbello Health Center Lisa Wanger

Johnson City Community Health Center- Betsu Kappes

Rutgers Community Health Center Mary DiGuilio

The Children’s Clinic Jack Tsai

AGENDA- Learning Collaborative Session 3November 9 3:00-4:30pm (EST)

Welcome- Review Agenda and Assignments Program Curriculum

Curriculum Development Schedules and Resources

Marketing, Recruitment, Applications Western North Carolina Community Health Services

QI Theory Burst- Process Mapping Action Period Items (Assignments)

Ask Questions!

Gatherin

g and Usin

g Data

Skills

Using E

ffective

Meeting S

kills

Using I

mprovement S

kills

Applying T

eamwork

Skills

9193959799

9694

100

94

Team Skills Self-Assessment (N=39)Percentage Strongly Agree or Agree

% S

tron

gly

Agre

e or

Agr

ee

feel confident that the organization can support people as they adjust.

will do whatever it takes.

want to implement.

feel confident that they can handle the challenges that might arise.

feel confident that they can keep the momentum going.

are motivated.

are determined.

are committed.

feel confident that they can coordinate tasks so that implementation goes smoothly.

feel confident that they can manage the politics.

feel confident that they can keep track of progress.

feel confident that the organization can get people invested.

0 10 20 30 40 50 60 70 80 90 100

90

90

90

90

90

80

80

80

80

70

70

60

How the People Who Work at Your Organization Feel About Implementing a Post-Graduate Residency Program (N=10)

% of Teams Agree or Somewhat Agree

Using the Progress ChecklistPurpose

1. To help you track your progress on the items you have selected to work on

2. To help us identify where you need more help

3. To help your coaches identify areas in which you need more encouragement and reminders

What to do….• Can be completed during a team meeting or

the coach can complete it separately based on conversations with team members

• Just check the box or color it in • Display it as you work• You will do this again midway through and at

the very end of the Learning Collaborative• Complete both tabs

Curriculum Development

Part 2 Elements of your curriculum

11

Plan going forward

• Session 3: Elements of your curriculum

• Session 4: Mapping content

• Session 5: Organizing the curriculum into a cohesive whole

• Session 6: Evaluation of the learner

• Session 7: Evaluation of the program

• Session 8: Crosswalking the curriculum and evaluation

• Session 9: Feedback loops and QI for revising the curriculum and evaluation

Your outcome for this session Describe the key elements of a curriculum – Topics (example): domain: Patient-centered Care (NP)– Topics (example): Theories of assessment, diagnosis,

intervention (Psych)– Clinical v. didactic activities and topics– KSAs– Resources– Schedule

NP Standard 2: Curriculum5 Required Elements and 8 Competencies

Elements• 1. clinical-based care and

patient care experiences;• 2. regularly scheduled didactic

sessions;• 3. systems based learning and

quality improvement;• 4. population-based health

focus;• 5. leadership and professional

development, especially in inter-professional practice.

Competencies• 1. patient-centered care;• 2. knowledge for practice;• 3. practice-based learning and

improvement;• 4. interpersonal and

communication skills;• 5. professionalism;• 6. systems-based practice;• 7. interprofessional collaboration;• 8. personal and professional

development.

What we have covered so far…..

Mission

Goals

Objectives

Mission Goals ObjectivesBroad statement of purpose and reason

Long term target, what you want to accomplish

Presents the overall program domains, i.e., the outline of what content will be offered

Gives rise to the goals

Gives rise to the objectives

Gives rise to learner outcomes

Should remain consistent over time

Should remain consistent with minor modifications

Can be modified as needed, measured at a program level

Definitions

Curriculum Objectives vs. Learner Outcomes

• Curriculum objectives are general and measured at a program level. They present the overall outline of what the program will offer. The objectives introduce the curricular domains, of the program, eg: Patient-Centered Care, Professionalism, Clinical Practice

• Learner outcomes are a measurable benchmark, the intended results within each curricular domain. They demonstrate what the learner will actually do, and often use Bloom’s taxonomy of action verbs. How you measure their achievement of outcomes is your evidence that your residents are learning and doing what you said they would learn and do. These are sub-domains in the guidelines.

DRIVERS LEADERSHIP/BOARD/FINANCES

MARKETING, RECRUITMENT

CURRICULUM

Domains/subdomainsSpace/equipment Space/equipmentPoliciesPatients DIDACTIC

Preceptors Faculty

EVALUATION OF LEARNER SCHEDULE EVALUATION OF LEARNER

REMEDIATION OF LEARNER REMEDIATION OF LEARNER

ACCCREDITATION GRADUATES WHO FULFILL YOUR MISSION

CLINICALTOPICS/KSAs

MISSION

Program goals/objectives

Learner outcomes/competencies

Some definitions• Curriculum: All activities—didactic, clinical, learner evaluation—that

provide the structure, content, and processes to ensure that your residents achieve learner outcomes and fulfill your mission

• Domains/subdomains (competencies): from your accreditation standards; these help to identify topics in clinical practice that will be incorporated into didactic and clinical activities, e.g., Patient-Centered Care: “treatment of health problems”

• Topics: What do your residents need to know? What do they need to know how to do? What values do they need to embrace and demonstrate?– KSA: Knowledge, Skills, Attitude

Definitions cont.• Clinical: Any activity that involves direct

patient care by the resident– Providing care in clinic with and without a

preceptor (NP)– Treatment sessions with patients/Supervision with

senior psychologist (Psych)– Documentation of care– Ordering tests, referrals, etc.– Consultation with care team/peer about a patient

Definitions cont.• Didactic: Any activity outside of direct care in

which preceptors and “faculty” formally engage in teaching, training, or informing residents about topics in clinical practice, policies and procedures in your setting; can include orientation

• Evaluation of the Learner: a formal process in which learners evaluate their own learning and practice, and faculty/preceptors evaluate the residents; this can include reflective journaling

Definitions cont.• Schedule: A planned outline of the timing and

topics of didactic, clinical and evaluation activities over the course of the residency– Use hours, not “days” or “sessions” to quantify time

spent on learner activities– A full-time job (40hrs/wk/50 wks) is 2000 hours– Accreditation standards do not set a minimum or

maximum amount of time– For NP programs, 1500-1600 structured hours is typical– For PhD programs, minimum 1500 hours

Resources• Space/equipment: office, exam room, computers,

etc.• Patients: do you have enough of the type you need?• Faculty: anyone involved in didactic activities• Preceptor/supervisor: professional peer responsible

for oversight of resident’s practice• Financial resources• Policies: any policies/procedures that may need to

be revised to accommodate resident practice

Questions to ask yourself:1. How/why did you decide on “primary care clinic?”2. What happens in primary care clinic?3. What does your resident need to know to care for

these patients?4. What does your resident need to know how to do to

care for these patients?5. What values, attitudes, behaviors do you want your

resident to demonstrate? Knowledge (know), Skills (do), Attitude

(behave)

You have a pile of pieces. Start separating them into groups.

Have a small team start to put them together.

Build from the outside in, or the inside out.

Every site will have a different looking puzzle because every site has different resources and patient populations.

Later, we will show you how to crosswalk your curriculum with accreditation standards.

CHCI’s Program Schedule - Month

Needed Resources • Preceptors and Mentors - staff• Didactic Presenters – staff and external • Specialty Rotations – what does your program

want to include? What is your patient population?– CHC’s Specialty Rotations – pediatrics, geriatrics,

newborn nursery, women’s health, HIV/Hep C, orthopedics, dermatology, adult psychiatry, child psychiatry, healthcare for the homeless

CHCI’s Program Schedule - Week

ProgramResources

Yakima Valley Farm Workers Clinic

Post Doc Psychology Program• Weekly schedule

Example: Start with a domain: Patient-centered care

1. Patient-centered care2. Knowledge for practice3. Practice Based

Learning and Improvement

4. Interpersonal and Communication Skills

5. Professionalism6. Systems-based

Practice7. Inter-professional

Collaboration8. Personal and

Professional Development

Competency/Domain: Patient Care

• Patient Care: Provide patient-centered care that is compassionate, valued, appropriate and effective for the treatment of health problems and the promotion of health.

• What health problems are most prominent in YOUR population of patients?

Sub-domains: outcomes/competencies1.1 Perform all screening, diagnostic assessments and procedures for patients with _________. 1.2 Gather essential and accurate information about patients with _________ through review of records, history-taking, physical exam and assessment, and review of data derived from laboratory and imaging testing. 1.3 Organize and prioritize responsibilities to provide care to patients with _________ that is safe, effective and efficient. 1.4 Interpret laboratory data, imaging studies, other tests required for the care of patients with _________.1.5 Make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, evidence based information and clinical judgment 1.6 Develop and carry out management plans for patients with _________.

Care of the patient with _______

• Learner outcome: Provide appropriate and effective care for adult patients with _______ that is compassionate and consistent with patient preferences.

• Topics in subdomain: diagnostics, procedures, clinical decision-making, history and physical, management of treatment plan

• What is didactic, what is clinical? Other?

Start a list of topicsKnowledge

Describe, explain, apply…..• Diagnostics: which

tests for which conditions?

SkillsDemonstrate….• History and

physical

Attitudes

Demonstrate…• Compassion

You should not be re-teaching content/topics that the residents learned in graduate school. But you can remind them as you focus on the application of these topics in your clinical setting with your unique patient population.

You will notice: ! There is a lot of overlap in topics, e.g., between diagnostics and procedures! There is a lot of overlap as you decide which topics to put under which domain, e.g., Patient care and Knowledge for practice ! You can use some of the same language again and again-- Patient Care, e.g., change “patients with _____” to “patients with HTN,” or “patients with complex needs”!This is how you start to organize your curriculum!

Takeaways…. Start with whatever piece of the curriculum seems easiest to start

with for you: Schedule List of the subdomains/topics

What does the resident need to KNOW? What does the resident need to KNOW HOW TO DO? What behaviors do you want the resident to DEMONSTRATE? What belongs in didactic? In clinical? Other? There will be overlap—don’t worry for now

JUST START

Patient centered

care

Knowledge for practice

Marketing and Recruitment Strategy

Who? • Who will you be recruiting (local vs. national applicants)?• What are you looking for in a candidate?

Where? • Where will you recruit and advertise? (local schools,

partnering graduate programs, current NP students, career fairs, conferences)?

When? • When will you recruit ? – recruitment timeline

*Postdoc programs follow APPIC guidelines

Communications and Marketing Plan

Create Webpage

Program email address

NPResidency@

Press Release

Residency Application

Advertisement

Communications and Marketing Plan Grid

Developing Application Process• Recruitment timeline *Post Doc programs have shorter timeline for

Feb. 27th 2017 match date

• Create an Application– What kind of information do you want

to capture in your application?– What is your organizations current

process? • Post application and instructions• Process for reviewing applications

Interviewing and Selection• Focus next session:– Interviewing Process and Timeline

• Set your interview dates• Who will be involved in your interviews?• How will you choose who to interview?

– Selection Process and Timeline • Selection Criteria - What kinds of characteristics are you looking

for in your candidates?• Who will be involved in selecting your residents?

WNCCHS MARKETING

& RECRUITMENT

PROCESSSara Mertz, A/GNP, Residency Director

Scott Parker, Director of Collaboration and Development

Brief History• April 2014 CEO sent staff up to CHC, Inc. to take a look at

their Residency Program;• Integrated core pillars of CHC, Inc. program and

customized it to our patient population/regional needs as well as our FQHC structure;

• CEO and Board committed to funding the residency program via agency budget, not relying on grant/foundation funds;

• Built off our strong social media presence with currently 11,000 FB followers and over 40,000 hits per year to our agency website to promote the residency;

• Created our own APSNR website and FB page and began promoting to regional/state NP/PA schools

Marketing• 2015 BCBS Foundation $27,000 to brand,

promote, market program; as well as develop “white paper” on how to replicate a residency program in FQHC setting in NC; included professional video’s for marketing and imbedding in online PDF for email campaigns;

• Target social media ads to regional PA/NP schools e.g. Duke, UNC, Wake Forest, ETSU, WCU, etc.

• Contact staff at programs at each school via email bi-annually to remind them of program

• Attend many of the schools’ job fairs

Recruiting• New graduates from NP or PA schools• NPs and PAs who wish to transition to practice in

safety net primary care from other specialties• Start application process in early Spring• End application process usually before most have

completed their education;• Interview ALL applicants (web-based or in person); • Select residents for start in September to overlap

training with current residency “class”• Offer good benefits package and salary

Recruiting Road Bumps• On-call requirement• Due to regulations as an FQHC, ALL of our residents

must be fully credentialed before stepping in our building to start the residency (this may take month(s)

• PA schools in our region usually don’t graduate until August or December so we have had reduced numbers of PA applicants

• We did not overlap residency classes between the first and second years and had a month long “gap” in care so had to hire locums tenens for that gap ($$$$$) and providers had to orient the locums tenens creating significant additional workload

Questions?

Action Period Items1. Continue to work on Communications

and Marketing template2. Map out skeleton of schedule 3. Develop list of key clinical topics that

they want to cover in their curriculum4. Post on Discussion forum (new topic or

reply) Share successes/challenges

Next Session December 7th