Residency Review and Residency Review and Redesign in Pediatrics (RRedesign in Pediatrics (R33P) P)

ProjectProject

Durham, NCDurham, NC

August 1-3, 2007August 1-3, 2007

1978

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Future of Pediatric Education Future of Pediatric Education (FOPE I) - 1978(FOPE I) - 1978

Minimum duration of residency should be 36 monthsMinimum duration of residency should be 36 months

Need for increased educational experience in: Need for increased educational experience in: – Biosocial and developmental pediatricsBiosocial and developmental pediatrics– Adolescent medicineAdolescent medicine– Clinical pharmacology and toxicologyClinical pharmacology and toxicology– Community pediatricsCommunity pediatrics– Handicapping conditions and chronic illnessHandicapping conditions and chronic illness– Medical ethicsMedical ethics– Musculoskeletal, skin, and dental disordersMusculoskeletal, skin, and dental disorders– NutritionNutrition

Elective experience in areas of special interestElective experience in areas of special interest

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Will History Repeat Itself?Will History Repeat Itself?

“The Task Force’s ten sponsoring organizations and the readers of this report must assume responsibility for continuing the process of reevaluation, incorporating into educational programs as many of the Task Force’s recommendations as continue to seem appropriate, and devising new recommendations to meet emerging needs.”

Forward, The Future of Pediatric Education, 1978

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Future of Pediatric Education IIFuture of Pediatric Education II(FOPE II) - 2000(FOPE II) - 2000

Enhancement of the science of pediatric medical Enhancement of the science of pediatric medical education education Flexible 3-year residency to train pediatricians for Flexible 3-year residency to train pediatricians for varied professional rolesvaried professional rolesDevelopment, ongoing revision and evaluation of Development, ongoing revision and evaluation of core competencies and core curriculumcore competencies and core curriculumAdjustments to residency training as the product of Adjustments to residency training as the product of ongoing attention by all pediatric organizationsongoing attention by all pediatric organizationsImportance of career counseling and mentorshipImportance of career counseling and mentorshipIndividualized professional education plan for 3Individualized professional education plan for 3rdrd year year residents incorporating anticipated needs for future residents incorporating anticipated needs for future practicepractice

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Where We BeganWhere We Began

Review current training in light of:Review current training in light of:– thematic aspects of the future of health care thematic aspects of the future of health care

for children and adolescentsfor children and adolescents– knowledge, skills and attitudes needed for knowledge, skills and attitudes needed for

that futurethat future– current understanding of medical educationcurrent understanding of medical education

Make recommendations for changes in Make recommendations for changes in pediatric graduate medical educationpediatric graduate medical education

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Emergent OpportunitiesEmergent Opportunities

To use flexibility within the current residency (9-To use flexibility within the current residency (9-16 of 33 months) to explore innovations that 16 of 33 months) to explore innovations that serve patients through better resident educationserve patients through better resident educationTo come to terms with the implications of the To come to terms with the implications of the “continuum of medical education”:“continuum of medical education”:– Residency is not an island, entire of itself.Residency is not an island, entire of itself.– Residency is not the time or place for all learning.Residency is not the time or place for all learning.

To facilitate ongoing, post-RTo facilitate ongoing, post-R33P innovation, P innovation, evaluation and improvementevaluation and improvement– Beyond a “better present”Beyond a “better present”– A complicated administrative undertakingA complicated administrative undertaking

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[Complex] Systems do not accept direction, only provocation.…They leave us with no choice but to become interested experimenters, sending pulses into the system to see what it notices.

Wheatley & Kellner-Rogers, a simpler way, 1998, pp. 97-98

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Where We Are NowWhere We Are Now

Discussion of a QI approach to innovation in Discussion of a QI approach to innovation in Pediatric GMEPediatric GME– Prescribes specific, measurable outcomes, not Prescribes specific, measurable outcomes, not

processprocess– ““Offers a path forward”Offers a path forward”– Takes advantage of situation-specific opportunities, Takes advantage of situation-specific opportunities,

strengths, imagination, energystrengths, imagination, energy

Early positive responses to the concept from Early positive responses to the concept from AAP Resident Section, APPD, AMSPDC, ABP AAP Resident Section, APPD, AMSPDC, ABP committees, RRC for Pediatrics, PAScommittees, RRC for Pediatrics, PAS

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The “Competencies”The “Competencies”A Conceptual Sea ChangeA Conceptual Sea Change

Outcomes as CompetenciesOutcomes as Competencies– Medical knowledgeMedical knowledge– Patient carePatient care– ProfessionalismProfessionalism– Interpersonal and communication skillsInterpersonal and communication skills– Systems-based practiceSystems-based practice– Practice-based learning and improvementPractice-based learning and improvement

Configures the conversation, sets the agenda: a Configures the conversation, sets the agenda: a profound culture shiftprofound culture shiftSets the stage for an outcomes-driven QI Sets the stage for an outcomes-driven QI approach to Pediatric GMEapproach to Pediatric GME

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Synchrony with ACGME Outcome Synchrony with ACGME Outcome ProjectProject

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An Itemized List of ChallengesAn Itemized List of Challenges

1.1. How to permit innovation:How to permit innovation: regulatory aspects; make regulatory aspects; make sure PD’s know they have permission to innovatesure PD’s know they have permission to innovate

2.2. How to facilitate and sustain innovation:How to facilitate and sustain innovation: consider consider innovation as a professional obligation; imagine it; innovation as a professional obligation; imagine it; identify the barriers; identify mechanisms to facilitate; identify the barriers; identify mechanisms to facilitate; understand what is practical, what works, what doesn’t understand what is practical, what works, what doesn’t

3.3. How to oversee innovation:How to oversee innovation: RRC, ABP, APPD and RRC, ABP, APPD and more broadly the entire pediatric communitymore broadly the entire pediatric community

4.4. How to disseminate innovation:How to disseminate innovation: collaboratives; collaboratives; narratives describing successes and failures; narratives describing successes and failures; seminars/colloquiaseminars/colloquia

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Goals for Colloquium IIIGoals for Colloquium III

Develop and prioritize goals for innovation in Develop and prioritize goals for innovation in residency [“goals for an outcomes-based residency [“goals for an outcomes-based innovation process”]innovation process”]– Create examples of innovative models to achieve the Create examples of innovative models to achieve the

innovation goalsinnovation goals

Consider differences in pediatric practiceConsider differences in pediatric practice– Determine whether differences in pediatric practice Determine whether differences in pediatric practice

justify some variation in pediatric trainingjustify some variation in pediatric training

Determine the direction for R3P and the future Determine the direction for R3P and the future for R3P initiativesfor R3P initiatives