Found in transition: applying milestones to three unique discharge curricula

Abstract

Introduction. A safe and effective transition from hospital to post-acute care is a complex and important physician competency. Milestones and Entrustable Professional Activities (EPA) form the new educational rubric in Graduate Medical Education Training. “A safe and effective discharge from the hospital” is an EPA ripe for educational innovation.Methods. The authors collaborated in a qualitative process called mapping to define 22 of 142 Internal Medicine (IM) curricular milestones related to the transition of care. Fifty-five participant units at an Association for Program Directors in Internal Medicine (APDIM) workshop prioritized the milestones, using a validated ranking process called Q-sort. We analyzed the Q-sort results, which rank the milestones in order of priority. We then applied this ranking to three innovative models of training IM residents in the transitions of care: Simulation (S), Discharge Clinic Feedback (DCF) and TRACER (T).Results. We collected 55 Q-sort rankings from particpants at the APDIM workshop. We then identified which milestones are a focus of the three innovative models of training in the transition of care: Simulation = 5 of 22 milestones, Discharge Clinic Feedback = 9 of 22 milestones, and TRACER = 7 of 22 milestones. Milestones identified in each innovation related to one of the top 8 prioritized milestones 75% of the time; thus, more frequently than the milestones with lower priority. Two milestones are shared by all three curricula: Utilize patient-centered education and Ensure succinct written communication. Two other milestones are shared by two curricula: Manage and coordinate care transitions across multiple delivery systems and Customize care in the context of the patient’s preferences. If you combine the three innovations, all of the top 8 milestones are included.Discussion. The milestones give us a context to share individual innovations and to compare and contrast using a standardized frame. We demonstrate that the three unique discharge curricula in aggregate capture all of the highest prioritized milestones for this discharge EPA.

Teaching plain language to medical students: improving communication with disadvantaged patients

“…Our program follows Kripalani and Weiss [34] recommendations for teaching health literacy education, including meeting patients and receiving feedback for the communication they practice, and contains the two main milestones for safe transition in care identified by Meade et al [23] i.e. patient-centeredness and use of succinct written communication.…”

“…Directed at another doctor and using language rich in medical terminology and jargon, it is indecipherable to most lay people. Intervention programs aimed at improving the safety and quality of transition in care address this gap by emphasizing the importance of clear communication [22,23] and through design of personalized discharge letters [24].…”

Pediatricians’ Perspectives on Introducing Transitional Care into Handover Between Pediatric Intensive Care Units and General Wards

“…Previous interventions have taught transitions from hospital to home to a range of learners, from preclinical medical students to attending physicians and allied health professionals. 18,[20][21][22] Most of them found that a clinically oriented curriculum for medical students improved their interdisciplinary collaboration and transitional care knowledge. 21,22 However, there have been few curricular on how to transition critically ill children from PICU to wards.…”