Getting Out of Silos: An Innovative Transitional Care Curriculum for Internal Medicine Residents Through Experiential Interdisciplinary Learning

Abstract

Background Care transitions are common and highly vulnerable times during illness. Physicians need better training to improve care transitions. Existing transitional care curricula infrequently involve settings outside of the hospital or other health care disciplines. Intervention We created a curriculum to teach internal medicine residents how to provide better transitional care at hospital discharge through experiential, interdisciplinary learning in different care settings outside of the acute hospital, and we engaged other health care disciplines frequently involved in care transitions. Setting/Participants Nineteen postgraduate year-1 internal medicine trainees at an academic medical center in an urban location completed experiences in a postacute care facility, home health care, and outpatient clinics. Program Description The 2-week required curriculum involved teachers from geriatric medicine; physical, occupational, and speech therapy; and home health care, with both didactic and experiential components and self-reflective exercises. Program Evaluation The curriculum was highly rated (6.86 on a 9-point scale) and was associated with a significant increase in the rating of the overall quality of transitional care education (from 4.09 on a 5-point scale in 2011 to 4.53 in 2012) on the annual residency program survey. Learners reported improved knowledge in key curricular areas and that they would change practice as a result of the curriculum. Conclusions Our transitional care curriculum for internal medicine residents provides exposure to care settings and health care disciplines that patients frequently encounter. The curriculum has shown positive, short-term effects on learners' perceived knowledge and behavior.

Intern Transitions of Care Curriculum Through Posthospital Home and Skilled Nursing Facility Visits

“…Published reports of educational interventions have included postdischarge visits for patients that residents had treated in the hospital and postdischarge and sites of care visits occurring during the 2-to 4-week geriatric or transitions of care rotations. [17][18][19] Embedding the curriculum in the ambulatory schedule facilitated teaching larger groups of interns, and the block scheduling helped with scheduling home care nurses and SNF providers. Our approach did not allow interns to see patients for whom they had provided care in the hospital, but we demonstrated both the feasibility of the visits and the interns' self-reported learning of key transition issues, likely due to the strength of experiential learning with patients and health care teams.…”

“…[7][8][9][10][11] Residents are responsible for care transitions, yet feel they lack the knowledge of how to safely complete these tasks, and studies have found a need to increase resident knowledge in transitions of care. [12][13][14][15][16][17][18][19] Experiential learning theory suggests that learning is best done in the context in which it occurs, and that interactions are fundamental to gain understanding. 20,21 To address the need for experiential learning, we embedded an innovative curriculum in our existing postgraduate year 1 (PGY-1) ambulatory block.…”

Évaluation d’une structure gériatrique entre l’ambulatoire et l’hospitalier

“…Le taux d'occupation est encore insuffisant et des efforts sont désormais entrepris pour que l'hôpital adresse plus de patients lorsqu'un séjour en structure intermédiaire paraît indiqué et pour inviter les médecins de la région à suivre leurs patients dans cette structure. L'opportunité de développer une seconde structure intermédiaire dans le canton pour garder cette proximité des soins est à l'étude, tout en portant une attention particulière au curriculum des médecins responsables pour s'assurer qu'ils mettent l'accent sur la liaison avec les autres services ambulatoires [27].…”

Bedside nurses’ roles in discharge collaboration in general internal medicine: Disconnected, disempowered and devalued?

“…For example, social workers, pharmacists, occupational therapists and physiotherapists in GIM units have experienced changes in their roles in the healthcare division of labour with greater emphasis on discharge-related responsibilities (Galati, Wong, Morra, & Wu, 2011;Goldman et al, 2016;Neeman et al, 2017). Physicians in these settings have pressures to prioritize their decision-making around patient flow with an increasing emphasis on the value of teaching residents about safe discharge (Greysen, Schiliro, Horwitz, Curry, & Bradley, 2012;Schoenborn & Christmas, 2013). New discharge professional roles have been created to facilitate admissions and discharge in acute care medical units (Okoniewska et al, 2015).…”