Future of Graduate Medical Education

Transcription

1 Future of Graduate Medical Education Laura Veach, Ph.D., LPC, LCAS, CCS, Professor WFSM-Surgery-Trauma; Director Specialized Intervention Services Olivia Currin, MA, LPCA, LCAS-A WFBMC Counselor/ Coordinator- Trauma and Trauma Survivor Network

2 Who are Millennials? This? Wake Forest Baptist Medical Center

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4 Who are Millennials? Or This? Wake Forest Baptist Medical Center

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6 First, Notice Values: connection, discoveries, & passion!! Next, deciding on who are millennials? Born between & Gen Z= (NY Times, 9/15) Or, Gen Y = born 80s or early 90s (echo boomers) (Business Dictionary, n.d.) Gen Y, & Gen Z, (urban dictionary) Wake Forest Baptist Medical Center 6

7 What does the future of graduate medical education look like? For millennials? Is it this? Wake Forest Baptist Medical Center

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12 Person-Centered Care To know and understand To feel known and understood Wake Forest Baptist Medical Center

13 Personalized Brief Intervention Personalized Brief Intervention (PBI) with Teachable Moment (TM) Robert Wood Johnson Foundation Study: PBI model of SBIRT reductions in alcohol usage from risky to not risky for 73% of TM participants at 6 month self-report follow-up; half quit or made major reductions in alcohol use. (O Brien, Reboussin, Veach & Miller, 2012) Table 2 BI Findings Quantity/ Frequency NIAAA BI Personalized Brief Intervention Sig. Baseline 6 months Change Baseline 6 months Change p value 1 Mean(SD) Mean(SD) Mean(SD) Mean(SD) Mean(SD) Mean(SD) Typical # 6.8 (4.9) 2.8 (3.4) 4.0 (5.1) 7.4 (5.2) 2.7 (2.9) 4.7 (5.9) drinks AUDIT 14.8 (7.8) 5.3 (6.8) 9.5 (8.6) 15.2 (8.5) 4.7 (5.8) 10.5 (10.7) Intervention Group Comparison of Six-Month Outcomes 1 Test of whether the change from baseline to 6 months is different between Q/F and Personalized Brief Intervention. 13

14 Interprofessional Communication Break down communication barriers Improved Communication= Cohesive Teams Cohesive teams limit adverse events, improve patient outcomes, decrease patient LOS, increase patient satisfaction 1 Another example, Epstein mentions about staff treating ICU psychosis is the importance of EMPATHY For example, in trauma care more empowerment tools are needed to flatten the so-called hierarchical pyramid and improve teamwork, itself a key aspect of trauma care 2 Wake Forest Baptist Medical Center 14

15 GME research examples Effective Methods for Teaching Bedside Manner ROLE MODELING SIMULATION EXERCISES SMALL GROUP DISCUSSIONS DIRECT FEEDBACK ON STUDENT PATIENT INTERACTIONS LECTURES Student's Opinion Faculty's Opinion Wake Forest Baptist Medical Center 15

16 Problems in Teaching Good Bedside Manner LACK OF FOCUS ON BEDSIDE MANNER TIME CONSTRAINTS PATIENT'S LIMITATIONS LACK OF EMPATHY Student's Opinion Faculty's Opinion Wake Forest Baptist Medical Center 16

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19 Interprofessional Collaboration Trauma simulations Trauma Survivor input to Interprofessional Team including learning healthcare professionals surgical residents and fellows Teaching and training clinicians 19

20 Wake Forest Baptist Medical Center 20

21 Why are Licensed Clinical Addiction Specialists and Professional Counselors core team members in a Department of Surgery? Wake Forest Baptist Medical Center 21

22 Effects of Alcohol in U.S. Almost 13,000 new first-time drinkers every day 4 #1 substance of abuse/risk/dependence out of 798 patients of the average daily census at our academic medical center have substance use complications Wake Forest Baptist Medical Center 22

23 Interprofessional Teamwork: Outcomes and Cost Effectiveness CASA Columbia found that every $1 spent for hospital-based SBIRT yields $3.81 in health care cost reductions 5 In Arizona, the mandate to provide SBIRT in trauma centers resulted in a 44% reduction in readmission rates 6 Wake Forest Baptist Medical Center 23

24 What about Interprofessional Education? Licensed Clinical Addiction Specialists (LCAS) embedded in medical setting (inpatient hospital daily surgery rounds) 1 LCAS, CCS; 3 LCASA LCAS at the table - our professional voice LCAS informing Medical Team: ETOH withdrawal, other drug use with medical concerns, compassion For example: All injured moped riders are not under the influence. Wake Forest Baptist Medical Center 24

25 Trauma-Informed Screening & Brief Intervention As part of the screening process for appropriateness for a peer visit and to provide TSN resources, the Coordinator/Counselor meets with many of patients on the service. Sometimes patients express concerns or desires that call for alcohol/substance use or Acute Stress Disorder (ASD)/PTSD risk assessment and brief intervention. Wake Forest Baptist Medical Center 25

26 Trauma-Informed Peer Support Inpatient: TSN OASIS: Outreach and Supportive Information Sharing A weekly meeting to help meet the needs and address the concerns of those who care for and about the patient during hospitalization. Peer Visitation Program Peer visitation offers patients the opportunity to talk with a trained volunteer who has experienced the aftermath of a serious injury. They answer questions and address concerns from the perspective of someone who has been there. Wake Forest Baptist Medical Center 26

27 Trauma Survivors Network at our Trauma Center The TSN program was developed in collaboration with consumers, scientists and clinician experts in trauma care Lower Extremity Assessment Project (LEAP) (MacKenzie & Bosse, 2006) showed psychosocial issues were more important factor than amputation or salvage in functional outcome of patients with lower limb injuries at seven-year follow-up. Trauma Collaborative Care Study (TCCS), a national multi-year evaluation of the TSN program with orthopedic trauma patients, began at our site in 2012 Our Surgery department determined TSN valuable and funded Initial funding for national TSN/TCCS was provided by the Major Extremity Trauma Research Consortium (METRC) which is funded by the Department of Defense SURVIVE. CONNECT. REBUILD. 27

28 Program Director Expert Clinician Educator Educate Leaders in EBP Clinical Addiction Specialists Center for Research on Substance Use & Addiction Center for Neurobiology of Addiction Treatment Integrative Education Neuroscience Expertise & Emphasis Maya Angelou Center for Health Equity Translational Research Rigorous Course of Study 28

29 3 rd Annual Trauma Survivor Reunion 29

30 Thank you!! Comments? Questions? Contact: Wake Forest Baptist Medical Center 30

31 We do not have relevant financial relationships with commercial interests that pertain to the content of our presentation.

32 References 1. Epstein NE. Multidisciplinary in-hospital teams improve patient outcomes: A review. Surgical Neurology International. 2014;5(Suppl 7):S295-S303. doi: / Pucher, P.H., Aggarwal, R., Twaij, A. et al. World J Surg. 2013; 37: Farooq Z, Mustaf T, Akram A, et al. Bedside manners: do we care? Journal of Ayub Medical College, Abbottabad : JAMC. 2013;25: Substance Abuse and Mental Health Services Administration(SAMHSA). Treatment Improvement Protocol (TIP) Series 57: Trauma-Informed care in behavioral health services. HHS Publication No. (SMA). 2014; The National Center on Addiction and Substance Abuse at Columbia University. Addiction medicine: Closing the gap between science and practice Hinde, J. M., Bray, J. W., Aldridge, A., & Zarkin, G. A..The impact of a mandated trauma center alcohol intervention on readmission and cost per readmission in Arizona. Medical Care. 2015; 53(7), Wake Forest Baptist Medical Center