EDUCATIONAL INNOVATION IN THE AUGUSTA UNIVERSITY INTERNAL

MEDICINE RESIDENCYBy: Thaddeus Y. Carson, FACP, MD

Clerkship Director, Associate Program Director and

Assistant Professor in the Department of Internal Medicine

at Augusta University

Disclosure

■ Dr. Carson reports no actual or potential conflicts of interest in relation to this

program or presentation.

CME Information■ Completion and submission of the evaluation with identification of take home strategies are required for CME

credit awards.

■ This activity requires one hour for completion.

■ This CME activity was planned and produced in accordance with the ACCME Essentials.

■ The GRU Medical College of Georgia is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

■ The GRU Medical College of Georgia designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

■ Other Health Care Professionals: This course offers 1 Continuing Education Contact Hour by the Georgia Regents University.

■ Original release date: 12/6/2016

■ Expiration date: 12/6/2017

Objectives of Presentation

■ Determine what makes an effective noon conference curriculum

■ Define and explain the advantages of a 4+2 scheduling system

■ Describe the Internal Medicine Residency’s Medical Economics Curriculum

■ Recognize the advantages of a blended learning environment on the Internal

Medicine inpatient wards

IMPLEMENTING AN ACCESSIBLE AND EFFECTIVE INTERNAL

MEDICINE RESIDENCY NOON CONFERENCE CURRICULUM

By: Thaddeus Y. Carson, MD, FACP

Clerkship Director, Associate Program Director and

Assistant Professor in the Department of Internal Medicine

at Augusta University

Background

■ Board Pass Rate

■ Variability in Noon Conference Educational Value for Board Preparation

■ Missing Nightfloat Education

3 Part Plan for Addressing Accessibility and Effectiveness

■ Part 1: Standardization of Noon Conference

Lecture Material

■ Part 2: Accessibility

■ Part 3: Measures of Effectiveness/

Accountability

3 Part Plan for Addressing Accessibility and Effectiveness

■ Part 1: Standardization of Noon Conference

Lecture Material

Part 1: Standardization of Noon Conference Lecture Material

■ Now based on American Board of Internal Medicine board certification examination

blueprint.

ABIM Blueprint

ABIM Blueprint

Part 1: Standardization of Noon Conference Lecture Material

■ Now based on American Board of Internal Medicine board certification examination blueprint.

■ Moved to 18 month curriculum so the entire curriculum repeats twice during residency and gives more time to spend covering the ABIM topics

■ Coordination of Lecturers by Division Chiefs.

■ Strong Departmental “buy-in”.

3 Part Plan for Addressing Accessibility and Effectiveness

■ Part 1: Standardization of Noon Conference

Lecture Material

■ Part 2: Accessibility

Part 2: Accessibility

Part 2: Accessibility

■ Possible Future project:

– Allowing attendance credit to those who watch noon conferences online.

3 Part Plan for Addressing Accessibility and Effectiveness

■ Part 1: Standardization of Noon Conference

Lecture Material

■ Part 2: Accessibility

■ Part 3: Measures of Effectiveness/

Accountability

Part 3: Measures of Effectiveness

■ Continue Annual ABIM In-Service Exams and tracking ABIM Board Certification pass

percentages.

■ 2nd/3rd Year MKSAP Reading/Questions

■ End of Block MedStudy Quizzes

Part 3: Measures of Effectiveness

Quiz Results

Part 3: Measures of Effectiveness

■ Continue Annual ABIM In-Service Exams and tracking ABIM Board Certification pass

percentages.

■ 2nd/3rd Year MKSAP Reading/Questions

■ End of Block MedStudy Quizzes

3 Part Plan for Addressing Accessibility and Effectiveness

■ Part 1: Standardization of Noon Conference

Lecture Material

■ Part 2: Accessibility

■ Part 3: Measures of Effectiveness/

Accountability

4+2 SCHEDULING SYSTEM

By: Thaddeus Y. Carson, MD, FACP

Lee Ann Merchen, MD, FACP

Distinctives that set GRU apart: 4 + 2

How’d we come up with 4 + 2?

■ IV.A.1.b) Residency training is primarily an educational experience in

■ patient-centered care. The educational efforts of faculty and

■ residents should enhance the quality of patient care, and the

■ education of the residents. At least 1/3 of the residency training

must occur in the ambulatory setting and at least 1/3 must occur in

the inpatient setting. Emergency medicine may count for no more

■ than two weeks toward the required 1/3 ambulatory time. (Detail)

Pop Quiz: What is 4 + 2?

■ A: Six

■ B: Trick question…..

■ C: Schedule that allows dedicated

outpatient time for “real life”

experience

■ D: Something Merchen made up....

28

Pop Quiz: What is 4 + 2?

■ A: Six

■ B: Trick question…..

■ C: Schedule that allows dedicated

outpatient time for “real life”

experience

■ D: Something Merchen made up....

29

Benefits of 4 + 2

From our residents:

■ No more interruptions in the

outpatient practice

■ I have clear, dedicated outpatient

elective time

■ The ability to have a block of time

dedicated to outpatient care! I love

the curriculum

From our patients:

■ I know I can see my doctor in the

morning or the afternoon

■ My results are given to me right

away!

■ My care is thorough and detailed

■ Firms of “Care” mean someone can

always take care of me.

31

Challenges of 4 +2

Schedules!

■ Within groups, schedules can be

tight

■ Complete equality is not possible;

some will have more outpatient plus

2 than others

■ The only “back up” resident is on

+2

Outpatient

■ Are two days every six weeks

adequate outpatient care?

Residents interested in primary care

are seeking more time

■ Is patient follow up reasonable in

this “tempo” of training?

MEDICAL ECONOMICS AND PRACTICE MANAGEMENT

12.6.16

David J. Fallaw, MD

Chief Medical Information Officer

Medical Economics

• How do I negotiate a contract?

• When do I learn coding and

billing?

• What percentage of the GDP is

spent on health care in the US?

• How much is that MRI?

• Why does that Band-aid cost

$15?

I didn’t know

insurers could do

that!!

Yes I can

negotiate like

that!

Medical Economics CurriculumHealth Policy

• Medical Terminology

• US Healthcare System—Overview

• US Healthcare System—HMO/MCOs/Insurance

• US Healthcare System—CMS and the RUC

• International Healthcare Systems

• Accountable Care Organizations

• Healthcare Reform/Affordable Care Act

• Core Measures

• Pay for Performance

• Meaningful Use/MACRA/MIPS

• Fraud and Abuse Law

The Cost Conundrum

• Value Based Medicine

• Cost of Medicine

• Value Based Purchasing (HCAPS & Quality

Measures)

Medical Legal

• Medical Errors and Sentinel Events

• Quality Improvement

• Tort Liability and Risk Management

• Contract Law

• Employment Law

Practice Management

• Billing and Coding

• RVUs/DRGs

• Basic Accounting and Practice Expense

• Measuring Physician Productivity

• EHRs & the Impact of Technologies in Practice

• Choosing a Practice: Market Analysis and

Projecting Practice Success

• Patient Centered Medical Home

• The Medical Interview

• Credentialing

• Curriculum Vitae

• Employee Benefits

• VA vs. Private Practice Medicine

• Academic Medicine

• Hospital Medicine

• Alternative Practices (Concierge)

• Time Management and Improving Efficiency

• Recruiting and Keeping Staff

• Scheduling and Front Desk Operations

• Healthcare Informatics

Financial Planning

• Future Financial Planning

• Managing Medical School Loans

Medical Economics CurriculumACP Legislative Day at the Capital

Practice Site Visits/Discussions as available

• Center for Primary Care

• Southern Family Care

• Christ Community Clinic (FQHC)

• University Hospitalists

• Aiken Internal Medicine

• Nephrology Associates of Augusta

Exercises in Billing and Coding Improvement

Future

• Collaborate with TRP to initiate a resident driven Quality Improvement Research Project

New Patient Visit (Outpatient)

CPT 99201 99202 99203 99204 99205

CC

HPI

ROS

PFSH

1 1

1

1-3/1-2 pb*

2-9

1

4/3+ prob*

10+

3

4/3+ prob*

10+

3

Exam 1 2+ 5+ 8+ 8+

MDM 2/3

#Dx

Data

Risk

1

0

No meds

1

0

No meds

2

2

1 stable prob

2+ minor

prob

1 new no w/u

or 3 stable

3

Rx med; refer

to Risk List

1 new c W/U,

2+ worse, 4+

4

Life

threatening

MDM Straight-

forward

Straight-

forward

Low Moderate High

Time 10 20 30 45 60

3/3 Parts needed; *”status of”

Return Patient Visit (Outpatient)

CPT 99211 99212 99213 99214 99215

CC

HPI

ROS

PFSH

1 1 1/1-2 prob*

1

4/1-2 prob*

2-9

1

4/3+ prob*

10+

3

Exam 1 2+ 2+ 5+ 8+

MDM 2/3

#Dx

Data

Risk

Nurse

Visit, Does

Not Need

MD

1

0

No meds

2

2

1 stable prob

2+ minor

prob

1 new no w/u

or 3 stable

3

Rx med; 2+

chronic; refer

to Risk List

1 new c W/U,

2+ worse, 4+

4

Life

threatening

MDM Straight-

forward

Straight-

forward

Low Moderate High

Time 5 10 15 25 40

2/3 Parts needed; *”status of”

MAS Dashboard and MU Reports

CMS Timeline for MIPS (Merit-Based Incentive Payment System)

Performance Year 1

50%

10%

15%

25%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

Pre Eval Post Eval

I have a good understanding of practice valuation

Strongly Agree

Agree

No Opinion

Disagree

Strongly Disagree

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

Pre Eval Post Eval

I have a good understanding of how to measure physician productivity

Strongly Agree

Agree

No Opinion

Disagree

Strongly Disagree

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

Pre Eval Post Eval

I have a good understanding of coding procedures

Strongly Agree

Agree

No Opinion

Disagree

Strongly Disagree

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

Pre Eval Post Eval

Understanding the different types of health care delivery (e.g. Medicare, Medicaid, VA,

Commercial/Traditional Indemnity, Self-pay) is an important factor in practicing medicine

Strongly Agree

Agree

No Opinion

Disagree

Strongly Disagree

Medical Economics Data

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

2011-2012 2012-2013 2014-2015 2015-2016

Medical Economics Data 2011-2016

Pre-Test

Post-Test

Overall Average Pre-Test Score 59.99%

Overall Average Post-Test Score 91.18%

IMPLEMENTING AN EFFECTIVE BLENDED LEARNING

ENVIRONMENT

By: Thaddeus Y. Carson, MD, FACP

Christos Hatzigeorgiou, DO, MPH, FACP

Tasha R. Wyatt, PhD

BackgroundThe notion of “anytime, anyplace” communication

is characteristic of the millennial population which has facilitated the growth of blended learning environments.

There is an increase in the use of web-based collaborative software in undergraduate & graduate education.

There are limited reports of use of this communication platform in medical education.

Study Hypothesis:

The integration of a collaborative software application in a high demand, inpatient clinical rotation will positively influence medical education and important components of the learning process.

Methods■ We compared the usefulness and functionality of several

software options: (1) Department hard-drive (2) Share-Point (3) Desire2Learn (4) Cerner social media application and (5) Box.

■ Of these choices, “Box” was chosen based on several factors:

■ - Ease of use (collaborative & interactive potential)

■ - Portability (smart phone / tablet operational)

■ - Alerts and HIPPA compliance

Methods

■ “Box” was implemented into Internal Medicine ward rotations and

learners were assessed on their acceptance of “Box” and its

perceived impact in the following areas:

■ - Learning environment

■ - Communication of goals

■ - Feedback

■ - Promotion of self-directed learning

Results: Preliminary Survey Data

8.3%

8.3%

50.0%

8.3%

8.3%

8.3%

33.3%

25.0%

16.7%

16.7%

8.3%

50.0%

8.3%

41.7%

33.3%

33.3%

25.0%

50.0%

25.0%

33.3%

66.7%

41.7%

16.7%

66.7%

66.7%

66.7%

33.3%

50.0%

41.7%

33.3%

25.0%

41.7%

25.0%

41.7%

41.7%

33.3%

16.7%

16.7%

16.7%

25.0%

8.3%

41.7%

16.7%

33.3%

41.7%

33.3%

16.7%

25.0%

25.0%

0 0.2 0.4 0.6 0.8 1

I liked using a social media tool to further ward communications.

I was an active user of this social media tool.

Using a social media tool took time away from my clinical responsibilities.

I would like to use a social media tool on future Internal Medicine wards.

I would like to use a social media tool on other rotations.

Using Box improved the learning environment.

Using Box motivated me to ask questions.

Using Box promoted additional opportunities for patient discussion.

With the inclusion of Box, my attending was more likely to respond to my questions.

With the inclusion of Box, my attending provided clearer performance goals.

Feedback with Box was more specific.

Box offered more opportunities to respond to attending feedback.

Concerning corrective feedback, I prefer it written with Box compared to verbal…

My experience with Box motivated me to read more about my patients.

Box helped me develop ownership over my own learning.

Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree

Results:Learners responded with the following trends regarding practical use of “Box” and its impact

on learning:

Most learners (>90%) thought that a social media tool offered more opportunities for communication and would like to use a social media tool on future clinical rotations (>70%).

The following areas were positively assessed (>60%):

* Improved learning environment and features of feedback

* Promotion of self-directed learning

* Clarity of expectations and goals

* Enhanced opportunities for patient discussion and attending

response to learners’ questions

* Development of ownership over personal learning

Box did not motivate learners to ask more questions (58%).

Questions?