Session Number T148

Session Title Teaching Patient-Centered Care Principles

to Pre-Clinical Year PA Students

Kris Healy, MPH, PA-C Associate Director

Assistant Professor-Medical Education Northwestern University

Feinberg School of Medicine Physician Assistant Program

Chicago, Illinois

Teaching Patient-Centered Care Principles to

Pre-Clinical Year PA Students

Kris Healy, MPH, PA-C Physician Assistant Program

Department of Medical Education

Annual  Educa*onal  Forum    Physician  Assistant  Educa*on  Associa*on  Philadelphia,  PA    October  16,  2014  

Goals for this Spotlight Session §  Share Northwestern University Feinberg School of

Medicine PA Program approach to teaching patient centered care principles to pre-clinical year students

§  Describe patient-centered care constructs from PA education and professional organizations

§  Identify key elements of patient centered care that may be incorporated in preclinical year education.

§  Observe examples of educational methodologies and resources that are useful in teaching patient centered care

§  Compare/contrast your own pre-clinical year curricula with this and with others.

§  Allow you to adapt educational methodologies and resources shared during this session.

Patient Centered Care Defined Providing care that is

respectful of and responsive to individual patient

preferences, needs, and values, and ensuring that patient values guide all

clinical decisions. Institute of Medicine (IOM) 2001

https://www.iom.edu/~/media/Files/Report%20Files/2001/Crossing-the-Quality-Chasm/Quality%20Chasm%202001%20%20report%20brief.pdf

Since then…shift From

Patient-centered communications

To Comprehensive concept of

patient-centered care that requires

§  fostering healing relationships §  exchanging information §  responding to emotions §  managing uncertainty §  making joint decisions §  enabling patient self-management

Bertakis, KD and Azari, R. Determinants and outcomes of patient-centered care. Patient Educ Couns. 2011; 85:46–52.

Levinson, W, et al, Developing Physician Communication Skills For Patient-Centered Care. Health Affairs. 2010; 29(7):1310-1318.

Preparing Future PAs to be Patient Centered Clinicians

Overarching Principles ARC-PA standards (2010/2013)

§  B 1.06, 1.08, 2.05 §  … prepare students [for] …

patients from diverse populations §  … prepare students to work

collaboratively in inter-professional patient centered teams.

§  … patient evaluation, diagnosis and management … with treatment plans [that are] patient centered

http://www.arc-pa.org/documents/Standards4theditionwithclarifyingchanges9.2013%20FNL.pdf

PA Competencies (2012) §  NCCPA, AAPA, ARC-PA, PAEA

§  Many sections including §  Interpersonal &

Communications Skills §  Patient Care https://www.nccpa.net/Upload/PDFs/Definition

%20of%20PA%20Competencies.pdf

AAPA §  Guidelines for Ethical Conduct

for the Physician Assistant Profession (reaffirmed 2013) http://www.aapa.org/WorkArea/

DownloadAsset.aspx?id=815

Other Key ARC-PA Standards §  B2.06

§  The program curriculum must include instruction in the provision of clinical medical care across the life span. §  ANNOTATION: Preclinical instruction prepares PAs to provide preventive, emergent, acute,

chronic, rehabilitative, palliative and end-of-life care. It includes content relevant to prenatal, infant, children, adolescent, adult and elderly populations.

§  B2.08 §  The program curriculum must include instruction in the social and behavioral

sciences as well as normal and abnormal development across the life span. §  ANNOTATION: Social and behavioral sciences prepare students for primary care practice.

Instruction includes detection and treatment of substance abuse; human sexuality; issues of death, dying and loss; response to illness, injury and stress; principles of violence identification and prevention; and psychiatric/behavioral conditions.

§  B2.09 §  The program curriculum must include instruction in basic counseling and

patient education skills. §  ANNOTATION: Instruction in counseling and patient education skills is patient centered, culturally

sensitive and focused on helping patients cope with illness, injury and stress, adhere to prescribed treatment plans and modify their behaviors to more healthful patterns.

Preparing Future PAs to be Patient Centered Clinicians

Selecting curriculum content Designing curriculum Assessing students

Assessing and improving curriculum

Role of PA Educators

Pre-clinical Year Courses

Pre-clinical Year  

Jun   Jul   Aug   Sept   Oct   Nov   Dec   Jan   Feb   Mar   Apr   May  

Patient Assessment I Patient Assessment II   Patient Assessment III  Behavioral/Preventive Medicine I   Behavioral/Preventive Medicine II   Behavioral/Preventive Medicine III  

Pharmacotherapeutics I Pharmacotherapeutics II   Pharmacotherapeutics III  

Basic Science I   Basic Science II   Basic Science III  Clinical Lab Medicine I Clinical Lab Medicine II Clinical Lab Medicine III

Clinical Medicine I  Problem–Based Learning

Clinical Medicine II  Problem–Based Learning

Clinical Medicine III Problem–Based Learning

Preparing Future PAs  Bioethics

Mastering Medical Information  Medical Spanish

Pre-Clinical Year Prep  

Clinical Year  

Rot

atio

n 1  

Rot

atio

n 2  

Rot

atio

n 3  

Rot

atio

n 4  

Rot

atio

n 5  

Rot

atio

n 6  

Rot

atio

n 7   Electives 1, 2, 3, 4

scheduled throughout clinical year  

Rotations Completed by Each PA Student  Internal Medicine, Family Medicine, Women’s Health, Pediatrics, Psychiatry, General Surgery, Emergency

Medicine  Elective Rotations:

Selections include possible tracks in Primary Care, Hospital Medicine, and Surgery

Evidence-Based Medicine Project (Master’s Degree Requirement)  

Trimester  1   Trimester  2   Trimester  3  

Hematology   GU/Renal   Neurology/Ophthalmology  

Pulmonary/ENT   Endocrine   Psychiatry  

Cardiology   Reproduc*ve   Dermatology  Infec*ous  Disease  

GI/Nutri*on   Musculoskeletal   Emergency  Med/Clinical    Skills  

Behavioral and Preventive Medicine § A three course series (BPM I, II, and III) § Trimester §  15-16 weeks in length

§ Class session §  2 hours §  1st hour – generally introductory presentation §  2nd hour – activities – large group, pairs, trios, small

group breakouts

§ Topics can be tied to specific organ systems and other core course content

BPM Course Goals Across All Three Trimesters

§  Knowledge §  Discuss the behavioral aspects of health care, wellness and disease from the

population and individual patient perspectives; §  Assess the contribution of behaviors, genetics, social, environmental, health

care systems to patient problems and conditions discussed during each organ systems in PBL cases;

§  Discuss prevention principles, levels of prevention, age and gender appropriate periodic screening;

§  List, describe, discuss and plan for the inclusion of members of the health care team, including the patient, as appropriate to the patient’s needs;

§  Utilizing evidence-based guidelines and given patient examples, select behavioral interventions as appropriate for patient problems related to PBL cases, and core conditions within organ systems covered in the trimester;

§  Utilizing evidence-based guidelines and given patient examples, select preventive interactions appropriate for patient problems related to PBL cases, and core conditions within organ systems covered in the trimester.

§  Skills §  Access evidence-based recommendations and guidelines for clinical practice

related to behavioral and preventive medicine topics; §  Demonstrate patient-centered communication skills in eliciting information from

patients using LEARN, BATHE, and other techniques; §  Perform behavioral assessments to determine individual patient’s readiness for

behavior change, using the Prochaska Stages of Change Model, the 5As, 5Rs, CAGE, CAGE-AID, and other similar tools;

§  Communicate with other members of the health care team, including the patient; §  Utilize patient education, counseling, and action-planning techniques appropriate

for the patients readiness for change and/or action; §  Accurately and appropriately document and report risk assessments gleaned

from model-patient encounters or DXR cases, orally or in writing.

Course Goals: BPM I, II, and III

Course Goals: BPM I, II, and III §  Attitudes

§  Recognize the influence patients’ and providers’ attitudes, biases (whether recognized or unrecognized) on health and health care;

§  Appreciate challenges and barriers to health and health care, from the individual, family, population or societal levels;

§  Accept the contributions of other members of the health care team, including the patient;

§  Develop empathy and consideration for perspectives other than one’s own; §  Be prepared for each session and demonstrate professional behaviors; §  Be ready and willing to accept and act upon feedback, correction, and

suggestions for improvement; §  Be committed to self-assessment and on-going self-directed improvement and

professional development; §  Demonstrate appropriate sensitivity to the boundaries of personal intimacy

and confidentiality; §  Treat all involved in the course with the same respect and courtesy as should

be accorded patients, preceptors and other health care team members in clinical settings.

Educational Methodologies § DocCom § Comprehensive web-based curriculum resource

for healthcare communication § Arts and Humanities § Films, literature, museum visit

§ Small group encounters with patients § Smoking cessation clients

§ Patient panels §  LBGTQ health issues § Persons with disabilities

Educational Methodologies § Experiential learning § medication adherence §  dietary/activity tracking §  role plays §  standardized patient (SP) interactions/observations §  on-line patient simulations §  visits to community self-help groups §  self-assessment activities

DocCom Web-based Curriculum Resource

http://doccom.aachonline.org/dnn/DocComContents.aspx

§  Innovative multi-media §  > 400 videos §  can use as trigger tapes

§  42 learning modules §  key principles §  behavior skills checklists §  evidence-based recommendations §  demonstrate interactional skills in encounters with SPs §  assessment questions §  fosters sensitivity to diverse communication styles

Cost: ~$45/student or institutional subscription

Free trial and some modules gratis

http://doccom.aachonline.org/dnn/Subscriptions.aspx

DocCom  Modules  

BPM  I   BPM  II   BPM  III  Module 15

Understanding Difference and Diversity in the Medical Encounter:

Communication Across Cultures

Module 24 Tobacco Intervention

Module 29 Alcoholism Diagnosis and Counseling

Module 3 Therapeutic Aspects of Medical

Encounters

Module 18 Asking about Sexuality

Module 30 Clinical Assessment of Substance Use

Disorders Module 14

It Goes Without Saying: Nonverbal Communication …

Module 25 Motivating Healthy Diet and

Physical Activity

Module 32  Advance Directives  

Module 19 Exploring Spirituality & Religious Beliefs

Module 28 Intimate Partner Violence

Module 34 Communication Near the End of Life

Module 16 Promoting Adherence and Health

Behavior Change

Module 33 Giving Bad News

Module 35 Discussing Medical Error

Module 13 Responding to Strong Emotions

Module 27 Communicating with Depressed Patients

Module 26 Anxiety/Panic Disorder

Module 23 Geriatric Interview

Module 20 Communication and Relationships with

Children and Parents Module 22

Adolescent Interview

Arts and Humanities § Cultural Aspects of Health Care § BPM I (ARC-PA B. 1.06, 2.05, 2.08)

§ “Book Club: Q and A” assignment §  When: Pre-matriculation and Week 1 §  Consider: NU PA Program Mission Statement §  Read: Anne Fadiman’s The Spirit Catches You and You

Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures (1998)

§  Prepare: set of questions and your responses to them for health care professionals book club discussion session

Arts and Humanities § BPM II (ARC-PA B. 1.06, 2.06, 2.08)

§ Visit to Mexican-American community § Share a traditional meal § Presentation about the ‘Day of Dead’

§  Cultural meaning of ‘dia de los muertos,’ common beliefs and rituals §  Opportunity to introduce students to Medical Spanish

course instructor for Spring trimester §  Connect to recent Ethics course content about death

and dying

§ National Museum of Mexican Arts §  Guided tour of annual ‘dia de los muertos’

exhibit

http://www.nationalmuseumofmexica

nart.org/

Arts and Humanities § BPM III

§ Neurology module (ARC-PA B. 1.06, 2.05, 2.06, 2.08)

§  Preparing to care for persons with disabilities §  Reading assignment: “The Diving Bell and the Butterfly”

§  Jean-Dominique Baudy (memoir) §  Class discussion – provide time for students to consider questions: §  Session led by Kristi Kirchner, MD (PMR Specialist) §  What were your take home lessons from “The Diving Bell and the

Butterfly”? §  What did you learn about yourself and your attitudes about

disability by reading “The Diving Bell and the Butterfly”? §  What elements/qualities/conditions you believe you need to have a

“good life?” What conditions/states lead you to question whether your life was “worth living?”

§  Connect to past Ethics course sessions §  Advance directives, hospice, palliative care, etc.

Cinemeducation § Film Fridays

§  Once a trimester—Friday afternoon §  Group discussion immediately following §  Connecting films to patient-centered communications and

patient-centered care principles §  BPM I – within first month of program §  “The Doctor” (Drama) (Dir. R. Haines; William Hurt)

§  Surgeon facing own serious illness – what he learns/shares §  BPM II – during women’s health module §  “In the Family” (Documentary; Dir. Joanna Rudnick)

§  Personal exploration-risk for inherited breast/ovarian cancer §  BPM III – during psychiatry module §  “Gran Torino” (Drama) (Dir.: Clint Eastwood)

provides opportunity to re-visit aspects of cultural beliefs of Hmong immigrants; aging; serious illness; assessing suicide risk; community violence.

Panel Presentations followed by Student Directed Q and A

§ Knowledge Goals §  Discuss the behavioral aspects of health care,

wellness and disease from the population and individual patient perspectives …

§ Attitude Goals §  Recognize the influence patients’ and providers’

attitudes, biases (whether recognized or unrecognized) on health and health care

§  Appreciate challenges and barriers to health and health care, from the individual, family, population or societal levels …

BPM II: Urogenital and Renal System Module LGBTQ 101Presentation and Panel

ARC-PA B. 1.06, 2.05, and 2.08

Icebreaker (15 minutes) §  Define terms/phrases

commonly used in LGBTQ communities

Presentation (45 minutes) §  Define culture and cultural

competence §  Describe LGBT specific health

concerns §  Identify ways in which LGBTQ

clients experience heterosexism §  Identify ways to improve

interactions with LGBTQ clients §  Identify ways to improve your

LGBTQ cultural competence

Panel §  Invite: 3-4 individuals § Allow: 1-1.5 hr.

§ Panelists’ sample guidelines §  Please introduce yourself §  Have there been times when you have had

a negative experience because of your sexual orientation when trying to receive health care? Please explain.

§  What are some things healthcare providers have done to make you feel more comfortable and allowed you communicate openly about your needs?

§  Sum up your message for future PAs.

BPM  III:  Neurology  Module  Persons  with  Disabili*es  Panel  

ARC-PA B. 1.06, 2.05, 2.06, 2.08 Presentation (1 hr.) § Introduction to rehabilitation and PMR team § Are You Disability Aware?

§  Use person first language §  Offer assistance but wait until accepted. §  Know that a wheelchair is part of a

person’s personal space §  Identify yourself and introduce others

when speaking to someone who is blind or has low vision

§  Face people with hearing impairments when talking

§  Treat people the way you would like to be treated

Panel: 3-4 individuals § Allow: 1-1.5 hr. § Panelists’ sample guidelines

§  Please introduce yourself §  Have you experienced reactions from

healthcare professionals/staff that made you feel uncomfortable? If so, describe the effect on the quality of your care?

§  Have there been times when you have had a negative experience when trying to receive health care? Please explain.

§  What have healthcare providers done to make you feel more comfortable and allowed you communicate openly about your needs?

§  Sum up your message for future PAs.

Planning Tip § If you have limited resources for patient

panels § Videotape them §  Use in future should it not be possible to host in-class

panels §  If have resources, edit for later use as trigger tapes for

discussions

Experiential Learning § Examples

§ medication adherence §  dietary/activity tracking §  role plays §  standardized patient (SP) interactions/observations §  on-line patient simulations §  visits to community self-help groups §  self-assessment activities

Image : SIMmersion

Experiential Learning BPM  I   BPM  II   BPM  III  

Medication Adherence Hospital Pharmacy Interns

Prescription Medication Regimen 1 week

Must Track Doses/When Taken in a Log Write Reflection Essay

Connect to The Spirit Catches You and You Fall Down: A Hmong Child, Her

American Doctors, and the Collision of Two Cultures

Tobacco Intervention Small Group Meetings with

Smoking Cessation Program Clients

Assessment of Substance Use: ETOH SIMmersion

Alcohol Screening and Brief Intervention Virtual Reality Simulation Practice and Feedback on

Two Cases: Low Risk and High Risk Drinking

5As/5Rs Tobacco Assessment

Assessing Readiness for Change In Class Role Plays

Use Trigger Tapes or Prepared Cases for Students

Students in Pairs/Switch Roles

Dietary and Physical Activity Tracking MyFitness Pal

Role Plays in Class Using Collected Data Assessing Readiness for Change

Counseling for Change Collaborative Action Planning

HIV Testing Pre-test and Post-test Counseling Standardized Patients (MATEC)

Small Groups Random Assignment of Interaction Type

Test Results: HIV neg or HIV pos Counseling for Harm Reduction

MATEC Instructor and Patient Feedback

Assessing Adherence to Regimens Responding to Patients’ Stories using

BATHE*:

Sexual Practices Risk Assessment/Harm Reduction

Counseling Standardized Patients (MATEC)

Small Groups MATEC Instructor and Patient Feedback

*Stuart, M, Lieberman, J. The BATHE Method: Incorporating Counseling and Psychotherapy Into the Everyday Management of Patients. Prim Care Companion J Clin Psychiatry. 1999 April; 1(2): 35–38

**SIMmersion: see http://simmersion.com/Solutions.aspx#Healthcare **MATEC = Midwest AIDS Training and Education Center

Communication Models Disease Centered Model

§  Provider knows best §  Hierarchical (top down) §  Decision based on

clinical experience §  Patient compliance may

not be optimal

Patient Centered Model §  Participatory §  Patient autonomy §  Individual needs and

preferences the focus §  Improved patient

adherence

BPM I: Patient Centered Communication CV/GI Systems Modules

§  CC: “I came in today for my blood pressure check up and a refill of my medications for blood pressure and high cholesterol.”

§  … My wife came last week [because] her eyes were yellow. … after the CT scan, one of the doctors took her into an office and told her it is pancreatic cancer.

§  CC: CC: “I came in today to talk about my pressure. I think it is very high.”

§  I take hydrochlorothiazide 25 mg. for it. You have told me in past visits it was working well. … but I am very worried about gang activity in our neighborhood . One of my son’s friends was killed during a drive-by gang fight last week….

§  CC: “I got my tests last week. You wanted to talk with me about my sugar and cholesterol. ”

§  At my last visit you increased all my medications but I will be out work and my apartment at the end of the month…soon I will not be able

to buy them. Last week I started to stretch them out.

Patient Centered Model BATHE* § Background

§  Ask the patient to describe the situation in a few sentences. § Affect

§  How does the situation make the patient feel? §  Help them name an emotion (sad, angry, etc.) if necessary

§ Troubles §  What troubles the patient the most about the situation? This is the real reason behind the emotion.

It is often not what you expect - that's why you have to ask.

§ Handling §  How is the patient handling it? How has the patient handled similar (or equally bad) circumstances

in the past? Are there options that the patient has not yet considered? Help the patient identify at least one positive step they can take to respond to the situation.

§ Empathy §  Instill hope by expressing your understanding of what the patient is going through. §  Reinforce the patient's plan to deal with the problem. *Stuart, M, Lieberman, J. The BATHE Method: Incorporating Counseling and Psychotherapy Into the

Everyday Management of Patients. Prim Care Companion J Clin Psychiatry. 1999 April; 1(2): 35–38

Stuart MR, Lieberman JA. The Fifteen Minute Hour: Applied Psychotherapy for the Primary Care Physician. 2nd ed. Westport, Conn: Praeger. 1993 .

Teaching Resource §  Maldonado, A; Landel, G,

A Picture Is Worth a Thousand Words — Experiential Teaching of the Patient-Centered Care Approach ─ Workshop* Presented at PAEA Annual Education Forum 2011 (New Orleans) (Session 1099) • http://www.paeaonline.org/index.php?ht=a/GetDocumentAction/i/131108 (To open link, if needed, please copy and paste in your browser.)

*Ana Maldonado, MPH, PA-C, Associate Professor, and Grace Landel, MEd, PA-C, Joint MSPAS/MPH Program Director, Truro University-California

§  Student workshop §  Use case vignettes and

communication skills evaluation form

§  Three BATHE cases §  Students in trios

§  Role rotations §  Patient §  PA (provider) §  Observer/Critiquer

(recommender of improvements)

§  Apply content from lectures with brief role plays §  Provide scenarios

§  Students in pairs or trios (if trios: one serves as observer) §  Students switch/rotate roles

§  Some options to consider §  Intimate Partner Violence/Abuse §  Elicit the patient’s history §  Provide information and plan follow-up

§  Child Abuse and Neglect §  Explain to child’s parent/guardian your suspicion of neglect or abuse §  Describe your professional obligations and what it means for he/she/

them §  Driving discussion with older patient whose family is ‘worried’

§  Reproductive decision-making §  Many other options

Role Plays

Focus on asking for, hearing and responding to each patient’s story

Community Observations § BPM I (first time—September 2014) § Bus trip (with all M1s) § Visit to 1 of 5 communities §  Led by community organizations’ leaders §  Five communities visited by small groups of students

§ Communities diverse but each affected variety of health and health care disparities

§ Designed BATHE case exercises (described earlier) with patient descriptions based on communities visited

Community Observations § BPM I (first time—September 2014) § Bus trip (with all M1s) § Visit to 1 of 5 communities §  Led by community organizations’ leaders §  Five communities visited §  Community leaders emphasized assets as well as

struggles § Communities diverse but each experiencing a

variety of health and health care disparities § Designed BATHE exercises with patient

descriptions based on communities visited

Community Observations § BPM II (ARC-PA B. 1.06, 1.08, 2.05, 2.08, 2.09)

§ Two required ‘community observational experiences’ §  Goals include but not limited to: §  Observing other health professionals interacting with patients/clients who

are involved with or contemplating behavioral change §  Observing and interacting with health professional students who are

embarking on community engagement projects §  Attending patient education or patient/peer support sessions §  Observing service activities with community organizations.

§  Total Time: 3-6 hours §  Students provided with examples and lists of some sites §  Students responsible for contacting organizations/group leaders

§  Maximum of 2 students per session or as desired/required §  by organization

Student Self-Assessment § Each student reviews 3 videotaped of SP exams

§  Required to observe, document and comment on patient centered interviewing, responses to patient’s concerns, and goals for improvement

§ Course reflection essay – at end of each BPM course “Imagine it is time for an ARC-PA site visit … visitors reviewed the

BPM curriculum, MCQ tests administered, student performance (knowledge achieved) on these tests. The site visitors ask you to describe your personal learning outcomes in the domains of skills and attitudes. You will accomplish this by writing a reflective essay that demonstrates your self-assessment relating to acquisition of the skills and attitudes related to certain ARC-PA Standards. …”

Methods for Assessing Students § SP Encounters § Checklist includes patient

centered care items § Medication Adherence §  Logs of doses and timing § Reflection on experience § Connecting personal experience

with patient and family experiences reported in “The Spirit Catches You and You Fall Down”

Assessing Students § Assessment tools for each DocCom Module § MCQs § Discussion questions

§ SIMmersion § Scores and certificate of completion

§ Community observations narrative report §  Who/what did you observe? §  Did you attend with other classmates? If so, with whom? §  Why did you select this activity? §  What did you like most about your observational experience? §  What did you like least about your observational experience? §  Will this observational experience influence your practice as a future PA? If yes,

how? If no, why not? §  Would you recommend this observational experience to future PA students? If yes, why? If no, why not?

Course Reflection Essays as an Assessment Tool

§ LGBTQ Panel – excerpts from 2 students §  “…I learned how important it is to ask questions when unsure about

what something means, and to be sensitive to the type of language we use. [This session] highlighted the importance of being open and approachable so it is easy to develop a relationship with all patients in general, but specifically with LGBTQ patients who may have experienced insensitive providers in the past. …”

§  “…To be able to understand language used by our patients is vitally important… This idea was reinforced when one of the gay panelists shared that he would not be opposed to seeing a straight doctor as long as he felt supported, understood, and non-judged. I want to be able to be that “straight doctor.” …”

Persons with Disabilities Panel – 2 Excerpts §  “…One of my favorite sessions was on Disability Awareness. We had

an excellent presentation on disability and rehabilitation, followed by a panel of guests with patients with disabilities. Each shared their personal story with us and then invited questions. I cannot think of a better way to learn about working with disabilities. You can read about this or hear from someone else, but it was so much better hearing the information first hand from someone who is living with a disability. I feel much more confident interacting with people with disabilities. Also, I am more aware of the barriers individuals with disabilities must face (ramps or elevators for wheelchairs and providing doors that are wide enough and providing interpreters) and how I can overcome these barriers [in the future]. ….”

§  “…The patients came from various backgrounds and presented their experiences of being blind, deaf, or with immobility limitations. The ability to ask questions and gain a better understanding from the panel allowed their stories to ‘hit home’ more so than just information in a lecture format would. …”

Community Observation – 2 Excerpts §  “… We attended an AA Straight and Sober meeting but had not considered the reasons for why

I was drawn to it--it was nearby, it was open, and its time convenient. It made perfect sense to attend, but it was only when reflecting on my past experiences for this paper that it became clearer that there are deeper, personal issues that influenced my decision to attend. … I found the experience to be somewhat intimidating at times, yet very fulfilling. While the meeting was beginning, the group heartily invited us to introduce ourselves. I wondered if they thought we too were alcoholics, so we both told them that we were students who were here for a class assignment. Rather than make us feel like outsiders at that point, as I thought they might, they welcomed us even more warmly, telling us they were ecstatic that we wanted to learn about the group, what it does, and why it is so important in their lives. …”

§  “…Unlike others who selected this type of experience, I had quite a personal reason for attending the AA meeting. When I was a young child, my dad had a significant problem with alcohol. He successfully quit drinking through the support of AA and has remained sober for over 25 years. I was old enough to know that there were problems and that my dad went to a lot of meetings, but still too young to really understand what he did and how they were helpful. For me, this experience was an opportunity to revisit some confusing times of my childhood, and place the understanding that can be applied with a mature vantage. It allowed me the opportunity to appreciate the bravery, and commitment my father had to his family to make such a drastic change in his life. While I realize that this may have been quite selfish motivation, it was really quite therapeutic for me to experience it.

One Reflection After a SP Patient Encounter §  In our HIV unit, individuals from MATEC came to teach us how to give the

diagnosis of HIV and how to communicate about the disease, the treatment plan, and how this would affect the patient’s life. … I got to practice counseling, talking to a patient about the disease. I got a realistic reaction from the patient, instead of just reading about how a patient might act in certain situations. This helped me to see where I fell short in communicating about HIV, showed me my comfort level in delivering the news, and I realized how it really takes practice to learn how to explain a disease process in a clear and non-overwhelming, not-too-technical way. It was difficult for me to not use medical jargons; I didn’t know how much information was too much. I also had a hard time figuring out how much the patient wanted to know, especially right at the moment when they found out about their diagnosis. After my classmate and I took turns interacting with the patient, the MATEC instructor advised us on better ways to the explain things that we fumbled. It was so great to learn from an individual who had been doing this for a very long time, and knew how to clearly explain things in way that is easy for the patient to understand. The little techniques and methods

the instructor taught us helped immensely. …”

Course Evaluations--Anonymous § Session by session

feedback elicited for each trimester

§ Suggestions gleaned, shared with others, and, some implemented

§ Good numbers and comments from students

Course Evaluations by Students BPM III (AY 2013-4) n=26 students/N=29 students

5 is the highest or best rating; 1 is the lowest or poorest rating Ave. Rating

How much have you learned in this course? 4.04

I feel I have become more competent in this area due to this course. 3.96

Do you feel the course objectives were accomplished? 4.15

Do you feel you improved your ability to solve real problems in this field? 4.08

I feel the course gave me skills and techniques directly applicable to my career. 4.12

I gained skills during this course to help me learn independently. 3.92

Rate the instructor's knowledge of the subject. 4.62

The instructor seemed well-prepared for classes. 4.62

The instructor treated you with respect. 4.54

The instructor fostered a sense of collegiality and cooperation between students. 4.62

The instructor promoted an atmosphere conducive to work and learning. 4.46

How well did the examination questions reflect the content and emphasis of the course?

3.38

The Values and Value of Patient-Centered Care

“…patients are known as persons in context of their own social worlds, listened to, informed, respected, and involved in their care—and their wishes are honored (but not mindlessly enacted) during their health care journey. There have been concerns that patient-centered care, with its focus on individual needs, might be at odds with an evidence-based approach, which tends to focus on populations. Fortunately, that debate has been laid to rest; proponents of evidence-based medicine now accept that a good outcome must be defined in terms of what is meaningful and valuable to the individual patient. Patient-centered care, as does evidence-based medicine, considers both the art of generalizations and the science of particulars….”

Epstein, RM and SL Street, Jr. The Values and Value of Patient-Centered Care. Ann Fam Med. Mar 2011; 9(2): 100–103. doi: 10.1370/afm.1239. PMC3056855.

Questions and Discussion

Image:  hRp://hcca-­‐act.blogspot.com/2011/07/reflec*ons-­‐on-­‐pa*ent-­‐centred-­‐care.html  

Patient Centered Care Word Cloud

References §  Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Washington (DC):

National Academies Press. 2001. http://www.iom.edu/~/media/Files/Report%20Files/2001/Crossing-the-Quality-Chasm/Quality%20Chasm%202001%20%20report%20brief.pdf. Accessed September 28, 2014.

§  Institute of Medicine. Unequal Treatment: What Healthcare Providers Need to Know About Racial and Ethnic Disparities in Health Care. Washington (DC): National Academies Press. 2002. http://www.iom.edu/~/media/Files/Report%20Files/2003/Unequal-Treatment-Confronting-Racial-and-Ethnic-Disparities-in-Health-Care/Disparitieshcproviders8pgFINAL.pdf. Accessed September 28, 2014.

§  Levinson, W, et al, Developing Physician Communication Skills For Patient-Centered Care. Health Affairs. 2010; 29(7):1310-1318.

§  Bertakis, KD and Azari, R. Determinants and outcomes of patient-centered care. Patient Educ Couns. 2011; 85:46–52.

§  Epstein, RM and SL Street, Jr. The Values and Value of Patient-Centered Care. Ann Fam Med. Mar 2011; 9(2): 100–103.

§  The Accreditation Review Commission on Education for the Physician Assistant. Accreditation Standards for Physician Assistant Education. Fourth edition. First Published March 2010. Effective September 1, 2010. Clarifications 7/2010, 10/2011, 9/2012, 12/2012, 9/2013. http://www.arc-pa.org/documents/Standards4theditionwithclarifyingchanges9.2013%20FNL.pdf. Accessed September 28, 2014.

§  NCCPA, ARC-PA, AAPA, PAEA, PA Competencies (revised 2012) https://www.nccpa.net/Upload/PDFs/Definition%20of%20PA%20Competencies.pdf. Accessed September 28, 2014.

§  Guidelines for Ethical Conduct for the Physician Assistant Profession (reaffirmed 2013) §  http://www.aapa.org/WorkArea/DownloadAsset.aspx?id=815 Accessed September 28, 2014

Contact Information Kris Healy, MPH, PA-C Associate Program Director

Assistant Professor, Medical Education k-healy@northwestern.edu

312-503-3157

Northwestern University Feinberg School of Medicine Department of Medical Education/Center for Medical Education

Physician Assistant Program McGaw Pavilion Suite 1-200

240 East Huron Street Chicago, Illinois 60611