Improving Value-Based Care Education in a Fellowship by Incorporating ACGME Competencies.
| Autor: | Zanotti K, Somasegar S, Hooper MW, Hopp E |
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| Jazyk: | angličtina |
| Zdroj: | Journal of graduate medical education [J Grad Med Educ] 2019 Dec; Vol. 11 (6), pp. 668-673. |
| DOI: | 10.4300/JGME-D-19-00311.1 |
| Abstrakt: | Background: Most value-based care educational interventions teach knowledge of cost but fail to recognize the interrelatedness of the Accreditation Council for Graduate Medical Education (ACGME) competencies of medical knowledge, patient care, practice-based learning and improvement, and systems-based practice. Objective: We analyzed the impact on clinical decision-making of an educational curriculum that incorporated the spectrum of ACGME competencies. Methods: Five didactic sessions for a gynecologic oncology fellowship were modified to incorporate cost- and value-based care considerations for each clinical topic addressed. After discussion, the group of fellows identified 1 high-value and 5 low-value practices to target for improvement. The fellows then undertook a chart audit of clinical decisions occurring for patients seen in the outpatient clinics. The frequency of low- and high-value practices was compared before and after the educational intervention. Results: A total of 126 patients with a cervical cancer diagnosis were seen by participants in the outpatient setting during the entire observation period. After the intervention, the occurrence of 3 identified low-value practices was reduced by 13% to 33%, demonstrating modest effect sizes (effect size ϕ = 0.2-0.3). One high-value practice (smoking cessation counseling) increased 100% after a fellow-initiated quality improvement project was undertaken. Two low-value practices, including routine surveillance imaging, remained unchanged. Conclusions: Overlaying value-based concepts in didactic conference teaching resulted in measurable changes in decision-making behavior. Engaging learners in a subsequent, focused quality practice review served as a vital part of their educational experience and allowed us to assess learner competency in its practical application. Competing Interests: Conflict of interest: The authors declare they have no competing interests. (Accreditation Council for Graduate Medical Education 2019.) |
| Databáze: | MEDLINE |
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