DISCLOSURE: No conflicts of

interest to report

February 28, 2015

@PracPlaybook

SES129 When the population is “the patient”: Developing Population Health Milestones to teachessential skills for tomorrow’s clinicians

Lloyd Michener, MD lloyd.michener@duke.edu

Denise Koo, MD MPH dkoo@cdc.gov

Kathy Andolsek, MD MPH kathryn.andolsek@duke.edu

Accreditation Council for Graduate Medical Education Conference | San Diego,

CA

Who are you?

• Geography: NE (5) SE (4) SW (1) Mid-Atlantic (1)

Midwest (3) outside US (1) n/a (1)

• Specialty: IM (2) Peds (2) FM (6)

Psych (1) Plastic Surgery (1)

• Profession: MD (10) DO (1) MPH (2) PhD (1) Masters

Education (3) MA (1) Bachelors (1)

• Role: DIO (1) PD (3) Core faculty (6) RAC (1)

Div chief (1)

Who are you?

• How long in GME

– 1-2 year 1

– 3-5 years 3

– 6-10 years 1

– 11-15 years 2

– > 16 years 9

• Population Health Curriculum?

– Institution Yes (5) No (8) don’t know (2) n/a (1)

– Program Yes (3) No (11) don’t know (2)

Please seat yourself at a table based on the milestone placard you are most interested in.

Placard 1: Applies principles of public health to improve

the health of populations (BLUE)

Placard 2: Applies principles of community engagement

to improving the health of populations (RED)

Placard 3: Utilizes critical thinking to improve the health

of populations (GREEN)

Placard 4: Utilizes team and leadership skills to

improve the health of populations (PURPLE)

Goals and Objectives

• Prioritize milestones in population health

• Identify gaps in available curricular materials

• Recognize solutions to common challenges

What is population health?

Definition of population health

“The health outcomes of a group ofindividuals, including, the distributionof such outcomes within a group”

David Kindig and Greg

Stoddart

Why does population health matter?

Why does population health

matter?

Why does population health

matter?

Why does population health

matter?

Why does population health

matter?

SIM Awardees

Medical education:

Flexner’s principles • The training, quality, and quantity of physicians

should meet the health needs of the public

• Collaborations between the academic medicine and public health communities… benefits both

Why does population health

matter?

http://macyfoundation.org/docs/macy_pubs/JMF_GME_Conference2_Monograph%282%29.pdf

Conclusions and Recommendations

Conclusion 1 GME must meet the needs of – and be accountable to – the public.

Why does population health

matter?

http://www.iom.edu/~/media/Files/Report%20Files/2014/GME/GME-RB.pdf

GME links with population

health• Graduate outcomes

• CLER

• Milestones

Graduate performance

• Historically: board pass rates

• Today: ?

% fulfilling US healthcare needs?

GME links with Population

Health

GME links with population

health:CLER

• Patient Safety

• Health Care Quality

Disparities

• Care Transitions

• Supervision

• Fatigue Mitigation/Duty Hours

• Professionalism

GME links with population

health:CLER

HQ Pathway 5: Resident/fellow, faculty education on

reducing health care disparities.

Focus

• Extent to which individuals receive education on clinical

site’s priorities/ goals for addressing health care disparities in

its patient population.

• Extent to which individuals receive training in cultural

competency relevant to patient population served.

• Proportion aware of clinical site’s progress in

meeting its goals/priorities.

How does this connect with

GME?CLER Pathways

https://www.aamc.org/download/419276/data/dec2014communityhealth.pdf

How does this connect with

GME?Milestones

Our vision is to:

• Collaborate

• Align with what we’re already doing

• Identify/Develop Relevant Population Health

Milestones

• Match to available curricular, assessment, and

evaluation tools

What are you doing well?

What is your biggest challenge?

Let’s tackle one or two together.

Q-Sort “Game”

We asked “your help” prioritizing some potential population milestones

Where did we find them?

• Extracted from existing specialty milestones

• Identified from literature review

• Editorial license . . .

What is Q-Sort?

Q-Sort Findings

Competency Domains PH 1-4

• Applies principles of public health

• Applies principles of community engagement

• Utilizes critical thinking to address

population health

• Demonstrates team and leadership

skills for population health

Competency Domains–What’s

missing?

• Applies principles of public health

• Applies principles of community engagement

• Utilizes critical thinking to address

population health

• Demonstrates team and leadership

skills for population health

Please seat yourself at a table based on the milestone placard you are most interested in.

Placard 1: Applies principles of public health to improve

the health of populations (BLUE)

Placard 2: Applies principles of community engagement

to improving the health of populations (RED)

Placard 3: Utilizes critical thinking to improve the health

of populations (GREEN)

Placard 4: Utilizes team and leadership skills to

improve the health of populations (PURPLE)

Small Group Task

• You are seated within small

groups at your table by

“milestone”

• Introduce yourself

• Analyze/Edit your milestone

(use worksheet)

Small Group Task

Analyze/Edit your milestone (use worksheet)

• Is it relevant at some level for all/most resident specialties?

• Can you make it more so?

• Are levels appropriately progressive?

• Are levels sufficiently robust? Too hard? Too easy?

Is 5 “a stretch”; is 3-4 where “most residents might be at

program completion”?

• How might this be best “assessed”?

Debrief

“We cannot solve our problems with the same thinking we used when we created them”

— Albert Einstein

Resources

http://www.cdc.gov/policy/ohsc/desiredstate.html

Resources Used

• AAMC MedEd Portal - 3

• iCollaborative - 1

• American Teachers of

Preventive Med - 1

• CDC - 7

• Practical Playbook - 0

• Local and Duke - 1

Practical Playbook

http://practicalplaybook.org/

CDC Population Health

http://www.cdc.gov/

Invest in Your Community: 4 Considerations to Improve Health & Well-Being for

All

Examples of Teaching in the Community

http://www.mededportal.org/icollaborative/resource/2364

APTR

http://www.aptrweb.org/

Association of Schools & Programs of Public

Health

http://www.aspph.org/educate/models/population-health-across-all-professions/

Choosing Wisely

http://www.choosingwisely.org/doctor-patient-lists/

American Academy of Family Practices

http://www.aafp.org/dam/AAFP/documents/about_us/initiatives/choosing-wisely-fifteen-questions.pdf

Example of Assessment Resource

https://www.mededportal.org/about/initiatives/dream

Example of Evaluation Resource

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4266696/pdf/nihms615280.pdf

The Vision:

The Vision:

For more information, connect with us on social media.

https://practicalplaybook.org/

Follow us: @PracPlaybook

Like our page: Practical Playbook

Follow us: Practical Playbook

Follow us: Practical Playbook