Creating a Model Curriculum in the United States

Samuel Keim

University of Arizona

Where did we start?1975 EM practice analysis of conditions and

skills Survey + Review by “expert panel”

Core Content List 22 categories

Core Content List – 1970’s Used to develop:

Curriculum for training programs Certification tests Accreditation criteria for training programs Agenda for post-graduate education Agenda for political advocacy

Then chaos ensued…1975 – 1997 No single organization in charge List expanded from 5 pages to 20! Lack of editing No system of weighting or priority Reflective of actual practice of EM?

Core Content Task Force Collaborative effort to create a single,

accurate, common-source description of EM practice Curriculum for training programs Certification tests Accreditation criteria for training programs Agenda for post-graduate education Agenda for political advocacy

Core Content Task Force4 Steps:

1) Practice Analysis

2) Advisory panel review

3) National Survey

4) Model preparation

A Model of Clinical Emergency Medicine1) Model-based Practice Analysis

NBME hired as consultant* Assumptions:

Specialties are unique because of situations Task competency is driven by the situations Model is the set of appropriate Tasks + Situations

Three categories of situations Critical Emergent Low acuity

* La Duca et al, The design of a new physicianlicensure examination. Eval Health Prof. 1984; 7:115–40

1) Model-based Practice Analysisa) 1995 and 1996 National Hospital Ambulatory

Medical Care Surveys (NHAMCS). >40,000 patient visits matched to reliably

represent ~ 90 million visits

b) Diagnoses sorted from most common to least common patient situations/encounters

c) List 82% congruent with old “Core Content”

A Model of Clinical Emergency Medicine2) Creation of Advisory Panel

Practicing emergency physicians Not members of Task Force Reviewed List of Diagnoses and considered

whether non-diseases, e.g., administration, procedural skills should be included

A Model of Clinical Emergency Medicine Advisory Panel created draft of Model

containing Acuity Elements for list of most common diagnoses

Task Force reviewed draft Sent to all sponsoring organizations for

approval

A Model of Clinical Emergency Medicine3) National Survey Random sampling of 1084 certified emergency

physicians Specific questions and Comments requested

regarding content and concepts Overwhelmingly positive response that both

Model was true representation of EM practice Narrative comments reviewed and presented to

the Task Force for consideration

A Model of Clinical Emergency Medicine4) Preparation of EM Model

Task Force revised Model based on survey and wrote descriptive preamble and recommendations for future:

a) Future Task Forces should have some of old Task Force for continuity

b) A one-year review should occur

A Model of Clinical Emergency Medicine

Recommendations for future:

c) Model reviewed every 2 yrs

d) New practice analysis every 5 yrs

A Model of Clinical Emergency Medicine – What is it?3 dimensional model

List of conditions and components linked to a matrix composed of

Physician Tasks Patient acuity frames

www.abem.org

Model Patient Acuity Critical

Life threat if immediate intervention not initiated immediately

Emergent May progress in severity to high probability for

morbidity if treatment not initiated soon

Lower Acuity Low probability of progression to serious disease

Model List of Conditions

3.3 Cardiovascular Disorders

Critical Emergent Lower acuity

3.1 Cardiopulmonary Arrest

X

3.3 Arterial Thromboembolism

X

Model Physician TasksDiagnosis Develop a differential

diagnosis; establish the most likely diagnoses in light of the history, physical, interventions, and test results.

Model Physician TasksTherapeutic

interventions

Perform procedures and nonpharmacologic therapies, and counseling.

Model Physician TasksPrevention and education Apply epidemiologic

information to patients at risk; conduct patient education; select appropriate disease and injury prevention techniques.

Finally… Now possible to create a Curriculum based

upon same common-model as Test and Program Requirements

Weighting has been standardized Content will not change unless all

organizations agree

Curriculum modification2003 – 2004 Two major academic societies are

collaborating to modify existing Model Curriculum to be consistent with the Model of Clinical Practice

Web-published

Existing Curriculum www.saem.org/model/intro.htm

Based upon Pre-1997 List 23 Condition and Skill categories VERY long

Existing Curriculum Weighted according to importance of

knowledge or skill to the practice of EM Mastery Proficiency Familiarity