Implementation of a novel population panel management curriculum among interprofessional health care trainees

Abstract

BackgroundGaps in chronic disease management have led to calls for novel methods of interprofessional, team-based care. Population panel management (PPM), the process of continuous quality improvement across groups of patients, is rarely included in health professions training for physicians, nurses, or pharmacists. The feasibility and acceptance of such training across different healthcare professions is unknown. We developed and implemented a novel, interprofessional PPM curriculum targeted to diverse health professions trainees.MethodsThe curriculum was implemented annually among internal medicine residents, nurse practitioner students and residents, and pharmacy residents co-located in a large, academic primary care site. Small groups of interprofessional trainees participated in supervised quarterly seminars focusing on chronic disease management (e.g., diabetes mellitus, hypertension, or chronic obstructive pulmonary disease) or processes of care (e.g., emergency department utilization for nonacute conditions or chronic opioid management). Following brief didactic presentations, trainees self-assessed their clinic performance using patient-level chart review, presented individual cases to interprofessional staff and faculty, and implemented subsequent feedback with their clinic team. We report data from 2011 to 2015. Program evaluation included post-session participant surveys regarding attitudes, knowledge and confidence towards PPM, ability to identify patients for referral to interprofessional team members, and major learning points from the session. Directed content analysis was performed on an open-ended survey question.ResultsTrainees (n = 168) completed 122 evaluation assessments. Trainees overwhelmingly reported increased confidence in using PPM and increased knowledge about managing their patient panel. Trainees reported improved ability to identify patients who would benefit from multidisciplinary care or referral to another team member. Directed content analysis revealed that trainees viewed team members as important system resources (n = 82).ConclusionsStructured interprofessional training in PPM is both feasible and acceptable to trainees across multiple professions. Curriculum participants reported improved panel management skills, increased confidence in using PPM, and increased confidence in identifying candidates for interprofessional care. The curriculum could be readily exported to other programs and contexts.Electronic supplementary materialThe online version of this article (10.1186/s12909-017-1093-y) contains supplementary material, which is available to authorized users.

Internal Medicine Resident Experiences With a 5-Month Ambulatory Panel Management Curriculum

“…Few studies have looked at panel management curricula in residency. [11][12][13][14]18 Most focused on clinical outcomes based on health metrics and processes of care measures, such as completion of laboratory tests, vaccinations, or visits. [11][12][13][14] In our study, residents reported increased processes of care, which is concurrent with previous work.…”

“…Previous studies have assessed learner outcomes, consisting of self-reported improvements in panel management skills, confidence in chronic care delivery, self-management goal-setting, and/or sustained behavior change, but most studies did not elaborate about what residents felt was successful about the curricula. 13,14,18 Our thematic analysis of residents' reflections on successes and barriers can inform further work by identifying particularly strong elements of a panel management curriculum as well as elements that may need improvement. In our case, the teamwork element of the curriculum and the positive effect on resident-patient relationships were key strengths identified by residents.…”

“…This may be attributable to the longitudinal, 5-month structure of our curriculum, which also differs from others. [11][12][13][14]18 Our panel management curriculum meets ACGME core competencies in patient care and practice-based learning and improvement in the Chronic Care Model, and it successfully engages residents in this work. The curriculum was well received by residents.…”

Perspectives of specialists and family physicians in interprofessional teams in caring for patients with multimorbidity: a qualitative study

“…The TIP Program provides a model to address the current lack of established methods for trainees to learn interprofessional collaboration across the primary-secondary-tertiary care divide. 22,[39][40][41][42][43] Consequently, the TIP Program can provide opportunities for trainees to move beyond the traditional consultant model and actively participate in interprofessional teamwork. Furthermore, the specialist physicians participating in the TIP Program provide a role model for successful interprofessional collaborations and, as such, provide learners exposure to a real-world model for caring for people with multimorbidity in the primary care context.…”

Black Ice: Five ways to get a grip on grouped self-assessments of competence for program evaluation

“…Of the 27 selected reports, 18 studies measured perceived confidence in or comfort with performing certain tasks. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] Six studies measured competency or ability, 10,13,[22][23][24][25] two studies measured readiness, 9,16 and five studies e92 lacked sufficient detail to determine what they used. [26][27][28][29][30] Measuring one's willingness to perform a task or one's confidence helps promote reflection of performance 3 but is not the most effective method of evaluating learning or performance.…”