Creating Innovations to Address the Palliative Care Workforce …€¦ · Describe an innovation in...
Transcript of Creating Innovations to Address the Palliative Care Workforce …€¦ · Describe an innovation in...
![Page 1: Creating Innovations to Address the Palliative Care Workforce …€¦ · Describe an innovation in HPM training ... Masters and Certificate Programs Other Possibilities. Barriers](https://reader034.fdocuments.net/reader034/viewer/2022042711/5f839dfda8bbee7b614f222b/html5/thumbnails/1.jpg)
Creating Innovations to
Address the Palliative Care
Workforce Shortage
Laura Dingfield, MD, MSEd
Director of Education, Penn Palliative Care Program
Program Director, Hospice and Palliative Medicine Fellowship
July 31, 2019
![Page 2: Creating Innovations to Address the Palliative Care Workforce …€¦ · Describe an innovation in HPM training ... Masters and Certificate Programs Other Possibilities. Barriers](https://reader034.fdocuments.net/reader034/viewer/2022042711/5f839dfda8bbee7b614f222b/html5/thumbnails/2.jpg)
2
![Page 3: Creating Innovations to Address the Palliative Care Workforce …€¦ · Describe an innovation in HPM training ... Masters and Certificate Programs Other Possibilities. Barriers](https://reader034.fdocuments.net/reader034/viewer/2022042711/5f839dfda8bbee7b614f222b/html5/thumbnails/3.jpg)
Join us for upcoming CAPC events
➔ Upcoming Webinars:
– BRIEFING: Key Findings on the Perceptions of Palliative Care
Thursday, August 8 at 2:00pm ET
– Latest Trends and Insights from the National Palliative Care Registry™
Tuesday, August 13 at 1:00pm ET
➔ Virtual Office Hours:
– Making the Case for Palliative Care: Demonstrating Value to Stakeholders
Tuesday, August 6 at 2:00pm ET
– Hospices Providing Palliative Care
Wednesday, August 7 at 12:30pm ET
Register at www.capc.org/events/ 3
![Page 4: Creating Innovations to Address the Palliative Care Workforce …€¦ · Describe an innovation in HPM training ... Masters and Certificate Programs Other Possibilities. Barriers](https://reader034.fdocuments.net/reader034/viewer/2022042711/5f839dfda8bbee7b614f222b/html5/thumbnails/4.jpg)
Creating Innovations to
Address the Palliative Care
Workforce Shortage
Laura Dingfield, MD, MSEd
Director of Education, Penn Palliative Care Program
Program Director, Hospice and Palliative Medicine Fellowship
July 31, 2019
![Page 5: Creating Innovations to Address the Palliative Care Workforce …€¦ · Describe an innovation in HPM training ... Masters and Certificate Programs Other Possibilities. Barriers](https://reader034.fdocuments.net/reader034/viewer/2022042711/5f839dfda8bbee7b614f222b/html5/thumbnails/5.jpg)
Disclosures
➔ Funded in part by the Josiah Macy Jr.
Foundation.
➔ No conflicts of interest.
5
![Page 6: Creating Innovations to Address the Palliative Care Workforce …€¦ · Describe an innovation in HPM training ... Masters and Certificate Programs Other Possibilities. Barriers](https://reader034.fdocuments.net/reader034/viewer/2022042711/5f839dfda8bbee7b614f222b/html5/thumbnails/6.jpg)
Objectives
➔ Characterize the Hospice and Palliative
Medicine (HPM) workforce
➔ Describe an innovation in HPM training
➔ Discuss strategies to implement innovations
6
![Page 7: Creating Innovations to Address the Palliative Care Workforce …€¦ · Describe an innovation in HPM training ... Masters and Certificate Programs Other Possibilities. Barriers](https://reader034.fdocuments.net/reader034/viewer/2022042711/5f839dfda8bbee7b614f222b/html5/thumbnails/7.jpg)
HPM Workforce
➔ 7,618 board-certified HPM physicians
➔ 115 HPM fellowship programs
➔ 325 annual HPM fellowship graduates
7
![Page 8: Creating Innovations to Address the Palliative Care Workforce …€¦ · Describe an innovation in HPM training ... Masters and Certificate Programs Other Possibilities. Barriers](https://reader034.fdocuments.net/reader034/viewer/2022042711/5f839dfda8bbee7b614f222b/html5/thumbnails/8.jpg)
US Demographic changes
8
Year % > 65 years % > 85
1960 9 % (17 million) 0.5 % (1 million)
2000 12% (35 million) 1.5% (4 million)
2030 22% (80 million) 2.5% (9 million)
US Census Bureau, The Older Population 2010
![Page 9: Creating Innovations to Address the Palliative Care Workforce …€¦ · Describe an innovation in HPM training ... Masters and Certificate Programs Other Possibilities. Barriers](https://reader034.fdocuments.net/reader034/viewer/2022042711/5f839dfda8bbee7b614f222b/html5/thumbnails/9.jpg)
Geographic Variation
9
Journal of Pain and Symptom Management 2018 55, 1216-1223DOI: (10.1016/j.jpainsymman.2018.01.011)
Copyright © 2018 American Academy of Hospice and Palliative Medicine Terms and Conditions
![Page 10: Creating Innovations to Address the Palliative Care Workforce …€¦ · Describe an innovation in HPM training ... Masters and Certificate Programs Other Possibilities. Barriers](https://reader034.fdocuments.net/reader034/viewer/2022042711/5f839dfda8bbee7b614f222b/html5/thumbnails/10.jpg)
Supply vs. Demand
10
Journal of Pain and Symptom Management 2018 55, 1216-1223DOI: (10.1016/j.jpainsymman.2018.01.011)
Copyright © 2018 American Academy of Hospice and Palliative Medicine Terms and Conditions
![Page 11: Creating Innovations to Address the Palliative Care Workforce …€¦ · Describe an innovation in HPM training ... Masters and Certificate Programs Other Possibilities. Barriers](https://reader034.fdocuments.net/reader034/viewer/2022042711/5f839dfda8bbee7b614f222b/html5/thumbnails/11.jpg)
Future Projections
➔Workforce numbers declining
➔ Burnout increases likelihood of early exit
➔ New fellowship graduates do not replace workforce
attrition
11
Kamal et. al., Health Affairs 2019 38 (https://doi.org/10.1377/hlthaff.2019.00018)
![Page 12: Creating Innovations to Address the Palliative Care Workforce …€¦ · Describe an innovation in HPM training ... Masters and Certificate Programs Other Possibilities. Barriers](https://reader034.fdocuments.net/reader034/viewer/2022042711/5f839dfda8bbee7b614f222b/html5/thumbnails/12.jpg)
Future Projections
12
Kamal et. al., Health Affairs 2019 38 (https://doi.org/10.1377/hlthaff.2019.00018)
![Page 13: Creating Innovations to Address the Palliative Care Workforce …€¦ · Describe an innovation in HPM training ... Masters and Certificate Programs Other Possibilities. Barriers](https://reader034.fdocuments.net/reader034/viewer/2022042711/5f839dfda8bbee7b614f222b/html5/thumbnails/13.jpg)
More HPM Graduates Needed
13
![Page 14: Creating Innovations to Address the Palliative Care Workforce …€¦ · Describe an innovation in HPM training ... Masters and Certificate Programs Other Possibilities. Barriers](https://reader034.fdocuments.net/reader034/viewer/2022042711/5f839dfda8bbee7b614f222b/html5/thumbnails/14.jpg)
Existing Training Models
➔One-year HPM fellowship
➔Part-time/shared position exception
➔Masters and Certificate Programs
➔Other Possibilities
![Page 15: Creating Innovations to Address the Palliative Care Workforce …€¦ · Describe an innovation in HPM training ... Masters and Certificate Programs Other Possibilities. Barriers](https://reader034.fdocuments.net/reader034/viewer/2022042711/5f839dfda8bbee7b614f222b/html5/thumbnails/15.jpg)
Barriers to Workforce Growth
➔ Recruiting residents
➔ CMS residency cap
➔ Funding for fellowship positions
➔ Educational capacity
15
![Page 16: Creating Innovations to Address the Palliative Care Workforce …€¦ · Describe an innovation in HPM training ... Masters and Certificate Programs Other Possibilities. Barriers](https://reader034.fdocuments.net/reader034/viewer/2022042711/5f839dfda8bbee7b614f222b/html5/thumbnails/16.jpg)
Thinking Outside the Box…
16
![Page 17: Creating Innovations to Address the Palliative Care Workforce …€¦ · Describe an innovation in HPM training ... Masters and Certificate Programs Other Possibilities. Barriers](https://reader034.fdocuments.net/reader034/viewer/2022042711/5f839dfda8bbee7b614f222b/html5/thumbnails/17.jpg)
Mid-Career Physicians
➔ Potential source of workforce growth
➔ Train in place
➔ Expand to under-represented specialties
➔ Lead education, research, QI
17
![Page 18: Creating Innovations to Address the Palliative Care Workforce …€¦ · Describe an innovation in HPM training ... Masters and Certificate Programs Other Possibilities. Barriers](https://reader034.fdocuments.net/reader034/viewer/2022042711/5f839dfda8bbee7b614f222b/html5/thumbnails/18.jpg)
Barriers for Mid-Career
Physicians
➔ Professional responsibilities
➔ Personal considerations
➔ Transition back to trainee role
18
![Page 19: Creating Innovations to Address the Palliative Care Workforce …€¦ · Describe an innovation in HPM training ... Masters and Certificate Programs Other Possibilities. Barriers](https://reader034.fdocuments.net/reader034/viewer/2022042711/5f839dfda8bbee7b614f222b/html5/thumbnails/19.jpg)
Competency vs. Time-Based
Training
19
Fellow 1 Fellow 2 Fellow 3TIME
Minimum
acceptable
competenceMA
ST
ER
Y
![Page 20: Creating Innovations to Address the Palliative Care Workforce …€¦ · Describe an innovation in HPM training ... Masters and Certificate Programs Other Possibilities. Barriers](https://reader034.fdocuments.net/reader034/viewer/2022042711/5f839dfda8bbee7b614f222b/html5/thumbnails/20.jpg)
Foundations of CBME in HPM
20
➔ HPM competencies (2009)
➔ HPM assessment toolkit (2010)
➔ Entrustable professional activities (2015)
➔ Curricular milestones (2018)
➔ ACGME HPM Reporting Milestones (2019)
![Page 21: Creating Innovations to Address the Palliative Care Workforce …€¦ · Describe an innovation in HPM training ... Masters and Certificate Programs Other Possibilities. Barriers](https://reader034.fdocuments.net/reader034/viewer/2022042711/5f839dfda8bbee7b614f222b/html5/thumbnails/21.jpg)
Competency vs. Time-Based
Training
21
Time-Based Competency-Based
Curriculum Standardized Individualized, iterative
Assessment Indirect, often summative,
variable frequency
Direct, frequent, embedded in
program, multimodal
Feedback Structured feedback at
least twice per year
Frequent, individualized
feedback
Graduation Occurs after specified time
frame
Occurs when competencies
are mastered
![Page 22: Creating Innovations to Address the Palliative Care Workforce …€¦ · Describe an innovation in HPM training ... Masters and Certificate Programs Other Possibilities. Barriers](https://reader034.fdocuments.net/reader034/viewer/2022042711/5f839dfda8bbee7b614f222b/html5/thumbnails/22.jpg)
Prior CBME Innovations
22
![Page 23: Creating Innovations to Address the Palliative Care Workforce …€¦ · Describe an innovation in HPM training ... Masters and Certificate Programs Other Possibilities. Barriers](https://reader034.fdocuments.net/reader034/viewer/2022042711/5f839dfda8bbee7b614f222b/html5/thumbnails/23.jpg)
Penn Program Creation
23
![Page 24: Creating Innovations to Address the Palliative Care Workforce …€¦ · Describe an innovation in HPM training ... Masters and Certificate Programs Other Possibilities. Barriers](https://reader034.fdocuments.net/reader034/viewer/2022042711/5f839dfda8bbee7b614f222b/html5/thumbnails/24.jpg)
Building Blocks
➔ Faculty interest
➔ Institutional support
➔ ACGME
– Advancing Innovation in Residency Education
➔ ABIM review and approval
24
![Page 25: Creating Innovations to Address the Palliative Care Workforce …€¦ · Describe an innovation in HPM training ... Masters and Certificate Programs Other Possibilities. Barriers](https://reader034.fdocuments.net/reader034/viewer/2022042711/5f839dfda8bbee7b614f222b/html5/thumbnails/25.jpg)
Features of Penn Program
➔ Competency-based advancement
➔ Part-time, interrupted schedule
➔ Continue faculty responsibilities & Maintain Salary
➔ Integrated Practice Rotation
➔ Asynchronous education
![Page 26: Creating Innovations to Address the Palliative Care Workforce …€¦ · Describe an innovation in HPM training ... Masters and Certificate Programs Other Possibilities. Barriers](https://reader034.fdocuments.net/reader034/viewer/2022042711/5f839dfda8bbee7b614f222b/html5/thumbnails/26.jpg)
First Steps
➔ Identify mid-career candidates
➔ Identify core faculty
➔ Identify assessment tools and plan
➔Create evaluation program
26
![Page 27: Creating Innovations to Address the Palliative Care Workforce …€¦ · Describe an innovation in HPM training ... Masters and Certificate Programs Other Possibilities. Barriers](https://reader034.fdocuments.net/reader034/viewer/2022042711/5f839dfda8bbee7b614f222b/html5/thumbnails/27.jpg)
Baseline Assessment
Creation of Individualized
Learning Plan (ILP)
Implementation of ILPFormative
Assessment
Fellow Triggered
Re-Assessment
Revision of ILP or
Graduation
Overview
![Page 28: Creating Innovations to Address the Palliative Care Workforce …€¦ · Describe an innovation in HPM training ... Masters and Certificate Programs Other Possibilities. Barriers](https://reader034.fdocuments.net/reader034/viewer/2022042711/5f839dfda8bbee7b614f222b/html5/thumbnails/28.jpg)
Programmatic Assessment
➔ Direct observation
➔ OSCE
➔ Multiple choice exam
➔ Evidence-based case log
➔ Chart-stimulated recall
➔ Multisource evaluation
➔ Narrative self-reflection
![Page 29: Creating Innovations to Address the Palliative Care Workforce …€¦ · Describe an innovation in HPM training ... Masters and Certificate Programs Other Possibilities. Barriers](https://reader034.fdocuments.net/reader034/viewer/2022042711/5f839dfda8bbee7b614f222b/html5/thumbnails/29.jpg)
Data Collection
➔ Number of patients
➔ Time on rotations
➔ Assessments
➔ Costs
29
![Page 30: Creating Innovations to Address the Palliative Care Workforce …€¦ · Describe an innovation in HPM training ... Masters and Certificate Programs Other Possibilities. Barriers](https://reader034.fdocuments.net/reader034/viewer/2022042711/5f839dfda8bbee7b614f222b/html5/thumbnails/30.jpg)
Challenges and Opportunities
➔ Faculty time to participate
➔ Resource intensive
➔ Faculty development in assessment
➔ Unknown impact on faculty, interdisciplinary
team, existing programs
![Page 31: Creating Innovations to Address the Palliative Care Workforce …€¦ · Describe an innovation in HPM training ... Masters and Certificate Programs Other Possibilities. Barriers](https://reader034.fdocuments.net/reader034/viewer/2022042711/5f839dfda8bbee7b614f222b/html5/thumbnails/31.jpg)
Next Steps
➔ Develop partnerships at expansion sites
➔ Ensure availability at all programs with
accredited fellowships
➔ Pilot program with other disciplines
31
![Page 32: Creating Innovations to Address the Palliative Care Workforce …€¦ · Describe an innovation in HPM training ... Masters and Certificate Programs Other Possibilities. Barriers](https://reader034.fdocuments.net/reader034/viewer/2022042711/5f839dfda8bbee7b614f222b/html5/thumbnails/32.jpg)
Can I do this too?
➔ Yes!
➔ Submit a proposal to ACGME
➔ Consider serving as an expansion site for
the Mid-Career Fellowship!
32
![Page 33: Creating Innovations to Address the Palliative Care Workforce …€¦ · Describe an innovation in HPM training ... Masters and Certificate Programs Other Possibilities. Barriers](https://reader034.fdocuments.net/reader034/viewer/2022042711/5f839dfda8bbee7b614f222b/html5/thumbnails/33.jpg)
33
![Page 34: Creating Innovations to Address the Palliative Care Workforce …€¦ · Describe an innovation in HPM training ... Masters and Certificate Programs Other Possibilities. Barriers](https://reader034.fdocuments.net/reader034/viewer/2022042711/5f839dfda8bbee7b614f222b/html5/thumbnails/34.jpg)
Conclusions
➔ There is a need to develop innovative
solutions to expand the HPM workforce.
➔ Competency-based education for mid-career
physicians and other interprofessional team
members could grow the workforce.
34
![Page 35: Creating Innovations to Address the Palliative Care Workforce …€¦ · Describe an innovation in HPM training ... Masters and Certificate Programs Other Possibilities. Barriers](https://reader034.fdocuments.net/reader034/viewer/2022042711/5f839dfda8bbee7b614f222b/html5/thumbnails/35.jpg)
Questions?
Please type your question into the questions pane on your
WebEx control panel.
![Page 36: Creating Innovations to Address the Palliative Care Workforce …€¦ · Describe an innovation in HPM training ... Masters and Certificate Programs Other Possibilities. Barriers](https://reader034.fdocuments.net/reader034/viewer/2022042711/5f839dfda8bbee7b614f222b/html5/thumbnails/36.jpg)