Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #112535

Amy Chesser, MAC¹, Tim Scanlan, MD¹, Linda M. Frazier, MD, MPH², Suzanne R. Hawley, PhD, MPH³, Melissa Armstrong, MAC³, Craig A. Molgaard, PhD, MPH³, and Ed Dismuke, MD, MSPH⁴. (1) Preventive Medicine and Public Health, University of Kansas School of Medicine, 1010 N. Kansas Avenue, Wichita, KS 67214, (316) 293-3541, achesser@kumc.edu, (2) Obstetrics and Gynecology and Preventive Medicine and Public Health, University of Kansas School of Medicine, 1010 N. Kansas, Wichita, KS 67214, (3) Department of Preventive Medicine and Public Health, University of Kansas School of Medicine-Wichita, 1010 N. Kansas, Wichita, KS 67214, (4) Dean's Office, Dean, KU School of Medicine-Wichita, 1010 N. Kansas, Wichita, KS 67214

There is widespread agreement that medical students should achieve competency in population-based medicine and selected public health skills in order to function effectively in their roles as modern physicians. The core public health competency domains established by the Council on Linkages have parallels in the training requirements by medical organizations such as the Accreditation Council for Graduate Medical Education (e.g. the ACGME competency for practice-based learning and improvement requires public health competencies in analytic/assessment, and leadership and systems thinking). Public health competencies were utilized in designing the learning objectives for a required four-week Health of the Public (HoP) clerkship. On the first day of the rotation, medical students (n= 60) used a five point Lickert scale to assess their skills in the seven public health competency domains. Didactic sessions and a population-health project were used to refresh skills learned in Years 1-3, as well as develop new skills. At the close of the rotation, students repeated the self-assessment. On average, medical students pre-test results rated “Attitudes” highest (3.38), “Basic Public Health Science Skills” somewhat lower (2.82) and “Dimensions of Practice Skills” the lowest (2.61). Post-test scores indicated higher self-assessments in all categories. Project reports verified attainment of the targeted population health competencies. These results suggest that core public health competencies can be useful in designing and assessing outcomes during physician training.

Learning Objectives: Overall Course Objectives

1. To learn how populations are defined. 2. To learn how to develop, implement and evaluate population based approaches to health care. 3. To understand how to recognize and address population-wide forces in health care that impact the doctor’s ability to care for individual patients. 4. To appreciate that physician leaders in all specialties increasingly gain professional benefit from addressing health needs of groups of patients, some of whom may not be under their direct care. Capstone Objectives
1. Students will understand the major expectations for their capstone project including the adoption and description of a patient population. 2. Students will be able to describe the demographic characteristics of their assigned population. 3. Students will work with their mentors to devise a project involving data collection (which may be qualitative) or an experimental intervention designed to better understand the population’s health or to influence it positively. LEARNING OBJECTIVE LECTURE TOPIC 112 Health of the Public
Capstone Dr. Scanlan, Amy Chesser The Capstone Project will be completed during the one-month course. Through this comprehensive population-based project, students will
1. apply the principles of epidemiology, quality improvement and community-oriented primary care to evaluate a specific health care need for a defined population. 2. critically appraise the efforts of a program to address the needs of a high-risk patient and the corresponding population. 3. develop critical appraisal skills in literature reviews. 4. create a fund of knowledge about a specific health care concern. 5. gain professional communication skills, both verbal and written. 6. become familiar with a public health project including the partnership between an academic hospital setting and a community-based organization. Poster Session The Capstone Project requires the student to develop a poster for display. Through the development of a poster presentation students will be able to
1. describe at least three characteristics of successful scientific posters. 2. create tables, graphs, and charts utilizing applicable software. 3. write a semi-structured abstract. Oral Presentation The Capstone Project requires the student to give an organized talk about a population they have studied, collected data about, and analyzed. LEARNING OBJECTIVE LECTURE TOPIC 114 History of Insurance & Current Issues in Managed Care Dr. Walling, Dr. Sumfest & M. Dauner 1. Students will be able to describe the historic role of rising costs in the changing financing of health insurance. 2. Students will be able to describe the traditional opposition to social insurance of the American Medical Profession. 3. Students will be able to explain at least two reasons why in the 1920s and 1930s insurance actuaries were opposed to offering health insurance to the public. 4. Students will be able to describe at least three basic health insurance structures in operation today. 5. Students will be able to discuss current trends in managed care. 6. Students will be able to define common managed care terms including
IPA, PPO, capitation, “point of service” managed care, withhold, and risk. 7. Students will be able to identify differences in the ability of different insurance structures to control costs. 8. Students will be able to describe the spectrum of managed care and the influence of managed care on physicians and patients’ decision. LEARNING OBJECTIVE LECTURE TOPIC 116 Practicing Medicine
The Barriers of Language and Culture Dr. Osio 1. Students will be able to reflect critically on potential conflicts between a physician’s personal values and professional obligations. 2. Students will be able to describe at least four cultural groups with unique health care beliefs and needs. 3. For at least one of these groups, students will be able to list at least three beliefs that may determine how members of that group receive health care in the “mainstream” American system. LEARNING OBJECTIVE LECTURE TOPIC 117 Medicare and Medicaid
An Overview Dr. Scanlan Medicare 1. Students will be able to understand benefits and gaps in typical Medicare coverage ("Medigap Insurance"). 2. Students will be able to discuss different Medicare options with a patient who has difficulty paying for services. Medicaid 1. Students will be able to explain how, at least in dollars spent, Medicaid is not primarily a program serving the poor. 2. Students will be able to list Medicaid eligibility requirements and Medicaid's federally mandated "menu" of specific services that states must offer. 3. Students will be able to discuss how escalating costs continue to pose a challenge to Medicaid funding. 4. Students will be able to explain how recent legislation has expanded Medicaid services to children. (CHIP) LEARNING OBJECTIVE LECTURE TOPIC 118 Current Topics in Medicine Student Presentations Dr. Scanlan For each vocabulary topic, students will be able to describe at least two primary characteristics relevant to the major topics of this week's HOP course
quality and accreditation. HEDIS, NCQA, and JCAHO – Stages of Change – Health Belief Model 1. Students will be able to illustrate at least two conditions in which behavior change based on theoretical models (Prochaska’s stages of change or the health belief model) is important to preventive health care. 2. Students will be able to describe the role of ‘case-mix adjustment’ in reports on quality of care(‘report cards’). 3. Students will be able to demonstrate an understanding of primary, secondary, and tertiary prevention. 4. Students will be able to describe the following behavioral models and the practical application for using these models
Health Belief Model and the Trans theoretical Model. Case Study in Quality Measurement 1. Students will be able to describe a difference between case management and disease management 2. Students will be able to describe the difference between post acute and long-term care. 3. Students will be able to describe current topics related to bio terrorism. Informed Consent 1. For each level, students will be able to illustrate at least two elements of informed decision-making that should be present in the clinical encounter. 2. Students should be able to identify at three least important informed consent issues that arise in common primary care ambulatory scenarios. Health Care Policy 1. Students will be able to describe current trends in costs and utilization of health services and the impact of current efforts to curb costs and utilization. 2. Students will be able to describe the effect of different types of insurance (or lack thereof) on access to and utilization of health care. 3. Students will be able to describe mechanisms by which care is provided to the poor and underserved. 4. Students will be able to describe the new medicare improvements. LEARNING OBJECTIVE LECTURE TOPIC 120 Professionalism, Population health and the Association of American Medical Colleges Dean Dismuke 1. Students will be able to describe at least two characteristics of medical professionalism relevant to clinical practice. 2. Students will be able to understand the history of the “Health of the Public Movement” in American Medical Education and at KUMC-W. LEARNING OBJECTIVE LECTURE TOPIC 121 Quality
Variation and Quality; Measuring and Improving Care Dr. Scanlan, Dr. Ekengren 1. Students will be able to describe small area variation in the use of medical services. 2. Students will be able to discuss at least two reasons why small area variation is important. 3. Students will be able to discuss how quality can be defined in multiple ways
most simply as “doing the right thing the right way”. 4. Students will be able to explain how quality can be measured by assessing “structure”, “Process”, or “outcome”. 5. Students will be able to list six common threats to achieving maximal quality in clinical practice. 6. Students will be able to describe how quality assurance looks retrospectively for outliers and attempts to modify these. 7. Students will be able to discuss how Quality improvement looks for prospective improvement by modifying and optimizing processes. 8. Students will be able to describe accreditation as a process of quality assessment and certification. 9. Students will be able to list major accrediting agencies including at least JCAHO, NCQA, and AMAP. For each agency, be able to describe the health care process they most commonly accredit. 10. Students will be able to list at least two different types of clinical practice guidelines. 11. Students will be able to describe the Leapfrog Initiative. LEARNING OBJECTIVE LECTURE TOPIC 121 Capstone Journal Article Discussion Session and Assignment Dr. Scanlan, Various Preventive Medicine Faculty Overall Goal
Clinical excellence requires the physician to weigh medical evidence to determine best management for a given patient. Data from research studies play a crucial role in this process. The capstone journal article discussion session is designed to provide an opportunity for students to critique an article related to the topical area of their capstone project. Learning goals
1. To understand common biostatistical terminology used in the medical literature. 2. To be able to apply critical appraisal skills to the review of a scientific article. LEARNING OBJECTIVE LECTURE TOPIC 123 Disclosing Medical Mistakes Walburg 1. Students will learn to use the basic skills of ethical analysis in making choices about a physician’s duties with respect to patient care. 2. Students will recognize ethical issues in everyday clinical decisions. 3. Students will recognize ethical issues outside the context of a clinical visit. 4. Students will be able to describe the responsibilities of physicians in ensuring that abnormal laboratory results are communicated to patients. 5. Students will be able to list at least three ways in which systems can be put in place to help insure that abnormal results do not fall through the cracks. 6. Students will be able to describe what ethical responsibility doctors have to their patients when they believe they may have made an error in care. LEARNING OBJECTIVE LECTURE TOPIC 124 Biostatistics and the Capstone Dr. Hawley Overall goal
The Biostatistics for the Capstone session is designed to help students understand data management issues related to conducting analyses of population-based data. Although students are not expected to become programmers, a behind-the-scenes look at data management enhances the understanding of how health outcomes in populations are analyzed. Learning goals
1. Students will be able to describe at least two statistical representations or tests that can be used to display, analyze, or test for significance data from Capstone projects. For each of these, students should be able to illustrate the necessary SPSS menu commands. 2. To demonstrate how data are managed in commonly used software packages such as Excel and SPSS. 3. To demonstrate methods of performing univariate statistical analyses to compare categorical (yes-no) variables and continuous variables (means/medians). 4. Students will be able to describe three ways in which spreadsheets may be used to record and analyze data derived from clinical practice. LEARNING OBJECTIVE LECTURE TOPIC 126 Public Health Practice
Nosocomial Infection Dr. Goodpasture 1. Students will be able to list three organisms that pose major problems of bacterial resistance in hospitals. 2. Students will be able to describe two mechanisms for the acquisition of resistance in microorganisms. 3. Students will be able to list three ways in which hospital infection surveillance can work to improve the health of patients in the hospital and the community. LEARNING OBJECTIVE LECTURE TOPIC 127 Office Systems to Improve the Delivery of Health Care Dr. Early 1. Students will be able to list two ways in which spreadsheets and relational databases differ. 2. Students will be able to list three ways in which automated medical record systems can enhance the quality of medical care. 3. Students will be able to contrast a small practice customized medical records system with the enterprise-wide system in use at the VA. LEARNING OBJECTIVE STUDY GUIDE TUTORIAL TOPIC 129 Occupational Medicine Basics Dr. Surprenant Introduction to Occupational Medicine At the completion of this discussion students will be able to
• Describe occupational and environmental health and the training components.
• List major occupational and environmental specialty associations and postgraduate training organizations. Introduction to Environmental Medicine
• Discuss the practice of industrial hygiene and will be familiar with the process of recognition, evaluation, and control of occupational health hazards. Industrial hygiene is the science of anticipating, recognizing, evaluating, and controlling workplace conditions that may cause workers’ injury or illness. Industrial hygienists use environmental monitoring and analytical methods to detect worker exposure and employ engineering, administrative practices, and other methods to control potential health hazards.
• Discuss the major categories of occupational health hazards; chemical, physical, biologic, noise induced, and ergonomic.
• Describe the hierarchy of controlling workplace hazards
  a. engineering (engineer out the hazard by reducing or removing the hazard at the source or isolating the worker from the hazard) b. administrative practices (follow proper procedures, shift rotation, maintain equipment, good housekeeping, etc.) c. personal protective equipment (ppe is last in the hierarchy due to problems with non-compliance and potential ppe malfunction).
  • List and describe governmental agencies and professional associations in occupational and environmental health. Understand the difference between OSHA and NIOSH.
  • List the major routes of chemical exposures in the environment and occupational setting. 1. Describe the evolution of an OSHA standard including the definitions. 2. Recognize the components of a MSDS (Material Data Safety Sheet). 3. Describe the Hazard Communication Standard. 4. Identify the major EPA acts, which safeguard our environment. Occupational and Environmental Resources for Physicians
  • Describe the important occupational/environmental and governmental resources for primary care specialists treating occupational and environmental illness/injuries. Importance of an Occupational/Environmental Medicine Exposure History
  • Discuss the importance of a brief exposure history.
  • Discuss when to take a more detailed history.
  • Describe the detailed history components for assessing dose including
    *concentration *duration of exposure *frequency of exposure *ppe compliance 4. Describe the two categories of SHE (O)’s [Sentinel Health Events-Occupational] and the utility of SHE (O)’s. 5. Assess the potential for an occupational/environmental exposure in the role of causation in the development of cancer. Management of the Injured Worker
    • Describe the SPICE Treatment Model for managing injured workers.
    • Discuss how typical patient complaints can be better understood by acquainting oneself with the patients work environment or by performing a work site visit.
    • Discuss the role of work conditioning and work hardening in the rehabilitation of an injured worker and the difference between the two.
    • Determine how work capacity/readiness is evaluated and the purpose of a FCE (Functional Capacity Evaluation).
    • Describe the role of the Vocational Rehabilitation Specialist. Disability Systems & Impairment
    • describe the basic components of the Workers’ Compensation System including
      ¨ employee responsibility ¨ what injuries and illnesses are compensable ¨ importance of documenting work-relatedness ¨ confidentiality issues ¨ the components of wage and medical benefits
      • discuss the reasons IME’s are requested and who may request them.
      • recognize the difference between impairment and disability, and exacerbation and aggravation.
      • describe the role of the American Medical Association Guides to the Evaluation of Permanent Impairment.
      • identify the parts of an Independent Medical Examination.
      • determine a settlement award by using the “AMA Guides” through use of a case study.
      • describe the main components of the Family Medical Leave Act, Pregnancy Discrimination Act and American’s with Disabilities Act Case Studies in Occupational Medicine
      • discuss the etiology., prevention, and management of
        a. carpal tunnel syndrome b. cubital tunnel syndrome c. radial nerve syndrome d. common upper extremity tendonitis
        • demonstrate competency performing the basic hand exam.

        Keywords: Curricula, Physicians

        Presenting author's disclosure statement:
        

        I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

        Workforce Issues in Public Health - Posters

        The 133rd Annual Meeting & Exposition (December 10-14, 2005) of APHA