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Bismantara H, Ahern S, Teede HJ, Liew D. Academic health science centre models across the developing countries and lessons for implementation in Indonesia: a scoping review. BMJ Open 2022; 12:e051937. [PMID: 36691121 PMCID: PMC9453943 DOI: 10.1136/bmjopen-2021-051937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/10/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To describe models of academic health science centres (AHSCs) across developing countries, in order to inform AHSC development in Indonesia. DESIGN Scoping review with systematic methods. DATA SOURCES Ovid MEDLINE, ProQuest Central, Wiley online library, Scopus and Web of Sciences were searched for relevant publications from 1 January 2015 to 1 December 2020. 'Grey literature' was hand searched by targeted website searches, Google searches, as well as personal communication held with stakeholders in Indonesia specifically. Relevant articles regarding AHSCs in developing countries are included. The review would be synthesised to focus on the purpose, structure and core activities of AHSCs. Strategies for success were also considered. RESULTS Twenty-six recognised AHSCs in developing countries were identified, located in Asia (n=13), Europe (n=1), South America (n=7) and Africa (n=5). Innovation, health system improvement and enhancement in academic capacity were the common visions. Most centres are functionally integrated and university-led. Most AHSCs include community health services to complement primary stakeholders such as academic institutions and hospitals. Limited information was identified regarding patient and public involvement and workforce capacity building. Five AHSCs have been piloted in Indonesia since 2018, integrating universities, academic hospitals and provincial health offices. However, information regarding their core activities and successes is limited. CONCLUSIONS The review suggests that limited published data are available on AHSC models in developing countries, but they still provide important insight into AHSC development in Indonesia. Innovation and health systems strengthening are the common visions. Functional integration with university leadership is the most common model of governance. Other than universities and hospitals, community health centres, research centres and regional health offices are common partners. There is a little description of community engagement and workforce capacity building.
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Affiliation(s)
- Haryo Bismantara
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Health Policy and Management, Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Susannah Ahern
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Helena J Teede
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Monash Partners Academic Health Science Centre, Melbourne, Victoria, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
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Brunet F, Malas K, Pomey MP. Reconnecting health through innovation. Healthc Manage Forum 2022; 35:344-348. [PMID: 35960988 DOI: 10.1177/08404704221114249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Learning health systems identify appropriate data to improve their performance and population health. The pandemic has shown that a proper response depends on using data from patients' needs, scientific research, hospital capacity, digital innovations, and stakeholder knowledge. Academic health centres play a role in data collection, information synthesis, and decision making supported by digital innovations. The results obtained by an academic centre and network in Quebec have demonstrated the value of integrating these elements during the pandemic and beyond.
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Affiliation(s)
- Fabrice Brunet
- 25443Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.,HEC Montréal, Montreal, Quebec, Canada
| | - Kathy Malas
- 25443Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.,HEC Montréal, Montreal, Quebec, Canada
| | - Marie-Pascale Pomey
- 25443Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.,5622Université de Montréal, Montreal, Quebec, Canada
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Jacko JA, Sainfort F, Messa CA, Page TF, Vieweg J. Redesign of US Medical Schools: A Shift from Health Service to Population Health Management. Popul Health Manag 2021; 25:109-118. [PMID: 34227892 DOI: 10.1089/pop.2021.0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The integration of medical schools and clinical partners is effectively established through the formation of academic medical centers (AMCs). The tripartite mission of AMCs emphasizes the importance of providing critical clinical services, medical innovation through research, and the education of future health care leaders. Although AMCs represent only 5% of all hospitals, they contribute substantially to serving disadvantaged populations of patients, including an estimated 37% of all charity care and 26% of all Medicaid hospitalizations. Currently, most AMCs use a business model centered upon revenue generated from hospital services and/or practice plans. In the last decade, mounting financial demands have placed significant pressure on AMC finances because of the rising costs associated with complex clinical care and operating diverse graduate medical education programs. A shift toward population health-centric health care management strategies will profoundly influence the predominant forms of health care delivery in the United States in the foreseeable future. Health systems are increasingly pursuing new strategies to manage financial risk, such as forming Accountable Care Organizations and provider-sponsored plans to provide value-based care. Refocusing research and operational capacity toward population health management fosters collaboration and enables reintegration with hospital and clinical partners across care networks, and can potentially create new revenue streams for AMCs. Despite the benefits of population health integration, current literature lacks a blueprint to guide AMCs in the transformation toward sustainable population health management models. The purpose of this paper is to propose a modern conceptual framework that can be operationalized by AMCs in order to achieve a sustainable future.
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Affiliation(s)
- Julie A Jacko
- Dr. Kiran C. Patel College of Allopathic Medicine, Department of Population Health Science, Nova Southeastern University, Fort Lauderdale, Florida, USA.,H. Wayne Huizenga College of Business and Entrepreneurship, Department of Management, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - François Sainfort
- Dr. Kiran C. Patel College of Allopathic Medicine, Department of Population Health Science, Nova Southeastern University, Fort Lauderdale, Florida, USA.,H. Wayne Huizenga College of Business and Entrepreneurship, Department of Management, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Charles A Messa
- H. Wayne Huizenga College of Business and Entrepreneurship, Department of Management, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Timothy F Page
- H. Wayne Huizenga College of Business and Entrepreneurship, Department of Management, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Johannes Vieweg
- Dr. Kiran C. Patel College of Allopathic Medicine, Department of Population Health Science, Nova Southeastern University, Fort Lauderdale, Florida, USA
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Yang S, Chaudhary Z, Mylopoulos M, Hashmi R, Kwok Y, Colman S, Yogaparan T, Sockalingam S. Using simulation to explore medical students' understanding of integrated care within geriatrics. BMC MEDICAL EDUCATION 2019; 19:322. [PMID: 31455354 PMCID: PMC6712598 DOI: 10.1186/s12909-019-1758-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 08/19/2019] [Indexed: 05/09/2023]
Abstract
BACKGROUND Given the increasing evidence and expansion of integrated care (IC) in healthcare, new IC curricula introduced early in undergraduate medical education (UME) are needed. Building on a pilot IC simulation called "Getting to Know Patients' System of Care" (GPS-Care), we aimed to explore students' understanding of patients' complex physical and mental health needs, and to increase our understanding of how students learned in this simulation. METHODS 177 of 259 first-year medical students participated in GPS-Care at the University of Toronto. Students role-played an elderly patient or caregiver within 5 simulated healthcare professional appointments. Students completed written reflections and 7 students participated in one-on-one interviews. A thematic analysis of the reflections and transcripts was conducted and descriptive data was generated for questionnaires. RESULTS Data saturation was reached at 43 reflections and 7 transcripts and the following themes emerged: a) students reflected on patients' complex care experiences, b) students reflected on of the healthcare system needs care, c) students increased understanding of IC, and d) students desire to improve the care of IC patients within the healthcare system. CONCLUSIONS In addition to confirming previous pilot study themes, the results from this study identified the role of productive struggle to provide students with a deeper understanding of patients' IC care needs. Moreover, GPS-Care resulted in a transformative learning experience resulting in new insights into the importance of IC early in UME training.
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Affiliation(s)
- Samantha Yang
- MD Program, University of Toronto, 27 King’s College Cir, Toronto, ON M5S 3H7 Canada
| | - Zarah Chaudhary
- The Wilson Centre for Research in Education, Faculty of Medicine, University of Toronto, University Health Network, 200 Elizabeth Street, 1ES-565, Toronto, ON M5G 2C4 Canada
| | - Maria Mylopoulos
- The Wilson Centre for Research in Education, Faculty of Medicine, University of Toronto, University Health Network, 200 Elizabeth Street, 1ES-565, Toronto, ON M5G 2C4 Canada
| | - Rida Hashmi
- Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, ON M5T 1R8 Canada
| | - Yvonne Kwok
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, 5th floor, Toronto, ON M5G 1V7 Canada
| | - Sarah Colman
- Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, ON M5T 1R8 Canada
- Centre for Addiction and Mental Health, 33 Russell Street, Suite 2065, Toronto, ON M5S 2S1 Canada
| | - Thirumagal Yogaparan
- Baycrest Centre for Geriatric Health Care, University of Toronto, 3560 Bathurst Street, Toronto, ON M6H 4A6 Canada
| | - Sanjeev Sockalingam
- Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, ON M5T 1R8 Canada
- Centre for Addiction and Mental Health, 33 Russell Street, Suite 2065, Toronto, ON M5S 2S1 Canada
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Lemaire JB, Miller EN, Polachek AJ, Wong H. Stakeholder Groups' Unique Perspectives About the Attending Physician Preceptor Role: A Qualitative Study. J Gen Intern Med 2019; 34:1158-1166. [PMID: 30937665 PMCID: PMC6614296 DOI: 10.1007/s11606-019-04950-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Attending physician preceptors are accountable to many stakeholder groups, yet stakeholders' views about what the preceptor role entails have not been sufficiently considered. OBJECTIVE To explore stakeholder groups' unique perspectives of the preceptor role. DESIGN Qualitative study with a constructivist orientation. PARTICIPANTS Semi-structured interviews were conducted with 73 participants from two university teaching hospitals between October 2012 and March 2014. Participants included representatives from seven stakeholder groups: patients and their families, allied healthcare providers, bedside nurses, nurse managers, medical students, internal medicine residents, and preceptors. APPROACH An inductive thematic analysis was conducted where researchers coded transcripts, abstracted codes into themes, and then mapped themes onto six focus areas: role dimensions, role performance, stressors and rewards, mastery, fulfillment, and impact on others. Two authors then identified "recurrent themes" (emerging in two or more focus areas) and compared them across groups to identify "unique themes" (emerging from a maximum of two stakeholder groups). "Unique thematic emphases" (unique themes that would not have emerged if a stakeholder group was not interviewed) are described. KEY RESULTS Patients and their families emphasized preceptors' ultimate authority. Allied healthcare providers described preceptors as engaged collaborators involved in discharge planning and requiring a sense of humor. Bedside nurses highlighted the need for role standardization. Nurse managers stressed preceptors' need for humanism. Medical students highlighted preceptors' emotional labor and their influence on learners' emotional well-being. Residents emphasized preceptors' responsibilities to multiple stakeholders. Preceptors described lifelong learning and exercising control over one's environment. CONCLUSIONS Various stakeholder groups hold unique and nuanced views of the attending physician preceptor role. These views could broaden formal role guidance for medical education and patient care. This study generated real-world, practical examples of what stakeholders feel are important preceptor skills. These skills should be practiced, taught, and role modeled in this clinical setting.
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Affiliation(s)
- Jane B Lemaire
- Division of General Internal Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada. .,W21C Research and Innovation Center, Cumming School of Medicine, University of Calgary, Calgary, Canada.
| | - Erin Nicole Miller
- Division of Endocrinology and Metabolism, University of Ottawa, Ottawa, Canada
| | - Alicia J Polachek
- W21C Research and Innovation Center, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Holly Wong
- W21C Research and Innovation Center, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Wagoner H, Seltz B. Attending Physicians' Perspectives of Resident Academic Half Day. TEACHING AND LEARNING IN MEDICINE 2019; 31:270-278. [PMID: 30706738 DOI: 10.1080/10401334.2018.1551140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Phenomenon: Academic health centers face significant challenges trying to improve medical education while meeting patient care needs. In response to problems with traditional forms of didactic education, many residency programs have transitioned to Academic Half Day (AHD), a curricular model in which learning is condensed into half-day blocks. In this model, trainees have protected educational time free from clinical responsibilities. However, an understanding of the impact on attending physicians and patient care when residents depart clinical sites for learning activities has not been well described. We sought to explore attending physicians' perspectives when residents depart clinical sites to attend AHD. Approach: We performed a qualitative study with a grounded theory approach using individual semistructured interviews (December 2016-April 2017) of attending physicians who worked at inpatient and emergency department clinical sites from which residents departed to attend AHD. We used the constant comparative method, generating codes using an iterative approach and continuing sampling until saturation was reached. Major themes were identified and disagreements were resolved by consensus. Findings: Fifteen attending physicians from 6 clinical services were interviewed. Data analysis yielded 5 themes: emotional strain of workload, technology and systems challenges, patient safety and care concerns, disrupted resident learning, and the challenge to optimize resident education. Attending physicians, already working on busy services, felt frustrated and perceived having an increased workload when residents departed for AHD. They were concerned about safely entering orders in the electronic health record, impeded patient workflow, and further disruption of resident schedules already disrupted by duty hour restrictions and continuity clinic. Attending physicians described the importance of experiential learning from caring for patients and from structured didactic learning; however, the optimal balance was uncertain. Insights: We found that attending physicians experienced significant emotional strain, faced technological challenges, and were concerned about impeded workflow and patient safety when residents departed clinical sites for AHD. This is likely to be true whenever residents are pulled out of the clinical setting for any reason. Educators need to partner with hospital administrators to provide appropriate support for attending physicians when residents leave clinical sites, evaluate the effectiveness of different educational models, and determine how structured learning activities fit into the overall curriculum.
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Affiliation(s)
- Holly Wagoner
- a Department of Pediatrics , Children's Hospital Colorado and University of Colorado School of Medicine , Aurora , Colorado , USA
| | - Barry Seltz
- a Department of Pediatrics , Children's Hospital Colorado and University of Colorado School of Medicine , Aurora , Colorado , USA
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Smitherman HC, Baker RS, Wilson MR. Socially Accountable Academic Health Centers: Pursuing a Quadripartite Mission. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:176-181. [PMID: 30303815 DOI: 10.1097/acm.0000000000002486] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Academic health centers (AHCs) in the United States have had a leading role in educating the medical workforce, generating new biomedical knowledge, and providing tertiary and quaternary clinical care. Yet the health status of the U.S. population lags behind almost every other developed world economy. One reason is that the health care system is not organized optimally to address the major driver of health status, the social determinants of health (SDOH). The United States' overall poor health status is a reflection of dramatic disparities in health that exist between communities and population groups, and these are associated with variations in the underlying SDOH. Improving health status in the United States thus requires a fundamental reengineering of the health delivery system to address SDOH more explicitly and systematically. AHCs' tripartite mission, which has served so well in the past, is no longer sufficient to position AHCs to lead and resolve the intractable drivers of poor health status, such as unfair and unjust health disparities, health inequities, or differences in a population's SDOH.AHCs enjoy broad public support and have an opportunity-and an obligation-to lead in improving the nation's health. This Perspective proposes a new framework for AHCs to expand on their traditional tripartite mission of education, research, and clinical care to include explicitly a fourth mission of social accountability. Through this fourth mission, comprehensive community engagement can be undertaken, addressing SDOH and measuring the health impact of interventions by using a deliberate structure and process, yielding defined outcomes.
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Affiliation(s)
- Herbert C Smitherman
- H.C. Smitherman Jr is vice dean of diversity and community affairs, Wayne State University School of Medicine, Detroit, Michigan. R.S. Baker is vice dean of medical education, Wayne State University School of Medicine, Detroit, Michigan. M.R. Wilson is president, Wayne State University, Detroit, Michigan
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Martin PJ, Skill NJ, Koniaris LG. Obligation for transparency regarding treating physician credentials at academic health centres. JOURNAL OF MEDICAL ETHICS 2018; 44:782-786. [PMID: 29483234 DOI: 10.1136/medethics-2016-103937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 10/16/2017] [Accepted: 02/06/2018] [Indexed: 06/08/2023]
Abstract
Academic health centres have historically treated patients with the most complex of diseases, served as training grounds to teach the next generations of physicians and fostered an innovative environment for research and discovery. The physicians who hold faculty positions at these institutions have long understood how these key academic goals are critical to serve their patient community effectively. Recent healthcare reforms, however, have led many academic health centres to recruit physicians without these same academic expectations and to partner with non-faculty physicians at other health systems. There has been limited transparency in regard to the expertise among the physicians and the academic faculty within these larger entities. Such lack of transparency may lead to confusion among patients regarding the qualifications of who is actually treating them. This could threaten the ethical principles of patient autonomy, benevolence and non-maleficence as patients risk making uninformed decisions that might lead to poorer outcomes. Furthermore, this lack of transparency unjustly devalues the achievements of physician faculty members as well as potentially the university they represent. In this paper, it is suggested that academic health centres have an obligation to foster total transparency regarding what if any role a physician has at a university or medical school when university or other academic monikers are used at a hospital.
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Affiliation(s)
- Paul J Martin
- Department of Surgery, Indiana University Purdue University at Indianapolis, Indianapolis, Indiana, USA
| | - N James Skill
- Department of Surgery, Indiana University Purdue University at Indianapolis, Indianapolis, Indiana, USA
| | - Leonidas G Koniaris
- Department of Surgery, Indiana University Purdue University at Indianapolis, Indianapolis, Indiana, USA
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Chen AS, Revere L, Ratanatawan A, Beck CL, Allo JA. A Comparative Analysis of Academic and Nonacademic Hospitals on Outcome Measures and Patient Satisfaction. Am J Med Qual 2018; 34:367-375. [PMID: 30246541 DOI: 10.1177/1062860618800586] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Academic hospitals contribute to health care through patient care, research, and teaching; however, their outcomes may not be equivalent to nonacademic hospitals. Multivariate analysis of variance is used to compare publicly reported data on patient satisfaction, readmission rates, mortality rates, and hospital-acquired injury scores between 1906 academic and nonacademic hospitals, while controlling for hospital-level covariates. Results show that academic hospitals have higher levels of patient satisfaction on 7 of the 11 measures and are equivalent to nonacademic hospitals on the remaining 4 measures. Academic hospitals have lower pneumonia mortality rates than nonacademic hospitals, with no difference for other mortality or disease-specific readmissions. However, academic hospitals have a slightly higher overall readmission rate. Infection rates were equivalent between academic and nonacademic hospitals for central line-associated bloodstream infections, pressure ulcers, and wound dehiscence for abdominal and pelvic injuries, but academic hospitals have higher catheter-associated urinary tract infection rates.
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Affiliation(s)
- Alissa S Chen
- 1 The University of Texas Health Science Center at Houston, TX
| | - Lee Revere
- 1 The University of Texas Health Science Center at Houston, TX
| | | | | | - Julio A Allo
- 3 The University of Texas MD Anderson Cancer Center, Houston, TX
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Edelman A, Taylor J, Ovseiko PV, Topp SM. The role of academic health centres in improving health equity: a systematic review. J Health Organ Manag 2018; 32:279-297. [PMID: 29624138 DOI: 10.1108/jhom-09-2017-0255] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose Academic health centres (AHCs) are organisations that pursue a "tripartite" mission to deliver high-quality care to patients, undertake clinical and laboratory research, and train future health professionals. The last decade has seen a global spread of AHC models and a growing interest in the role of AHCs in addressing health system equity. The purpose of this paper is to synthesise and critically appraise the evidence on the role of AHCs in improving health equity. Design/methodology/approach Peer-reviewed and grey literature published in English between 2000 and 2016 were searched. Articles that identified AHCs as the primary unit of analysis and that also addressed health equity concepts in relation to the AHC's activity or role were included. Findings In total, 103 publications met the inclusion criteria of which 80 per cent were expert opinion. Eight descriptive themes were identified through which health equity concepts in relation to AHCs were characterised, described and operationalised: population health, addressing health disparities, social determinants of health, community engagement, global health, health system reform, value-based and accountable financing models, and role clarification/recalibration. There was consensus that AHCs can and should address health disparities, but there is a lack of empirical evidence to show that AHCs have a capacity to contribute to health equity goals or are demonstrating this contribution. Originality/value This review highlights the relevance of health equity concepts in discussions about the role and missions of AHCs. Future research should improve the quality of the evidence base by empirically examining health equity strategies and interventions of AHCs in multiple countries and contexts.
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Affiliation(s)
- Alexandra Edelman
- College of Public Health, Medical and Veterinary Sciences, Division of Tropical Health and Medicine, James Cook University , Townsville, Australia
| | - Judy Taylor
- College of Medicine and Dentistry, Division of Tropical Health and Medicine, James Cook University , Townsville, Australia
| | - Pavel V Ovseiko
- Radcliffe Department of Medicine, Medical Sciences Division, John Radcliffe Hospital, University of Oxford , Oxford, UK
| | - Stephanie M Topp
- College of Public Health, Medical and Veterinary Sciences, Division of Tropical Health and Medicine, James Cook University , Townsville, Australia
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Chari R, O'Hanlon C, Chen P, Leuschner K, Nelson C. Governing Academic Medical Center Systems: Evaluating and Choosing Among Alternative Governance Approaches. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:192-198. [PMID: 28906263 DOI: 10.1097/acm.0000000000001903] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The ability of academic medical centers (AMCs) to fulfill their triple mission of patient care, medical education, and research is increasingly being threatened by rising financial pressures and resource constraints. Many AMCs are, therefore, looking to expand into academic medical systems, increasing their scale through consolidation or affiliation with other health care systems. As clinical operations grow, though, the need for effective governance becomes even more critical to ensure that the business of patient care does not compromise the rest of the triple mission. Multi-AMC systems, a model in which multiple AMCs are governed by a single body, pose a particular challenge in balancing unity with the needs of component AMCs, and therefore offer lessons for designing AMC governance approaches. This article describes the development and application of a set of criteria to evaluate governance options for one multi-AMC system-the University of California (UC) and its five AMCs. Based on a literature review and key informant interviews, the authors identified criteria for evaluating governance approaches (structures and processes), assessed current governance approaches using the criteria, identified alternative governance options, and assessed each option using the identified criteria. The assessment aided UC in streamlining governance operations to enhance their ability to respond efficiently to change and to act collectively. Although designed for UC and a multi-AMC model, the criteria may provide a systematic way for any AMC to assess the strengths and weaknesses of its governance approaches.
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Affiliation(s)
- Ramya Chari
- R. Chari is policy researcher, RAND Corporation, Arlington, Virginia; ORCID: http://orcid.org/0000-0002-6805-0974. C. O'Hanlon is assistant policy researcher, RAND Corporation, and a doctoral candidate, Pardee RAND Graduate School, Santa Monica, California; ORCID: http://orcid.org/0000-0001-6398-5845. P. Chen is physician policy researcher, RAND Corporation, Santa Monica, California. K. Leuschner is research communications analyst, RAND Corporation, Santa Monica, California. C. Nelson is senior political scientist, RAND Corporation, and professor of policy analysis, Pardee RAND Graduate School, Santa Monica, California
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McDaniel PA, Malone RE. Health Care Organizations and Policy Leadership: Perspectives on Nonsmoker-Only Hiring Policies. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:299-305. [PMID: 29068824 PMCID: PMC5788708 DOI: 10.1097/acm.0000000000001956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE To explore employers' decisions to base hiring policies on tobacco or nicotine use and community perspectives on such policies, and analyze the implications for organizational identity, community engagement, and health promotion. METHOD From 2013 to 2016, 11 executives from six health care organizations and one non-health-care organization with nonsmoker-only hiring policies were interviewed about why and how their policies were created and implemented, concerns about the policies, and perceptions of employee and public reactions. Focus groups were conducted with community members (n = 51) who lived in or near cities where participating employers were based, exploring participants' opinions about why an employer would stop hiring smokers and their support (or not) for such a policy. RESULTS Most employers excluded from employment those using all forms of nicotine. Several explained their adoption of the policy as a natural extension of a smoke-free campus and as consistent with their identity as health care organizations. They regarded the policy as promoting health. No employer mentioned engaging in a community dialogue before adopting the policy or reported efforts to track the policy's impact on rejected applicants. Community members understood the cost-saving appeal of such policies, but most opposed them. They made few exceptions for health care organizations. CONCLUSIONS Policy decisions undertaken by health care organizations have influence beyond their immediate setting and may establish precedents that others follow. Nonsmoker-only hiring policies may fit with a health care organization's institutional identity but may not be congruent with community values or promote public health.
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Affiliation(s)
- Patricia A McDaniel
- P.A. McDaniel is associate professor, Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, California. R.E. Malone is professor, Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, California
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Wilkins KM, Fenick AM, Goldenberg MN, Ellis PJ, Barkil-Oteo A, Rohrbaugh RM. Integration of Primary Care and Psychiatry: A New Paradigm for Medical Student Clerkships. J Gen Intern Med 2018; 33:120-124. [PMID: 28849354 PMCID: PMC5756162 DOI: 10.1007/s11606-017-4169-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 06/16/2017] [Accepted: 08/16/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Public health crises in primary care and psychiatry have prompted development of innovative, integrated care models, yet undergraduate medical education is not currently designed to prepare future physicians to work within such systems. AIM To implement an integrated primary care-psychiatry clerkship for third-year medical students. SETTING Undergraduate medical education, amid institutional curriculum reform. PARTICIPANTS Two hundred thirty-seven medical students participated in the clerkship in academic years 2015-2017. PROGRAM DESCRIPTION Educators in psychiatry, internal medicine, and pediatrics developed a 12-week integrated Biopsychosocial Approach to Health (BAH)/Primary Care-Psychiatry Clerkship. The clerkship provides students clinical experience in primary care, psychiatry, and integrated care settings, and a longitudinal, integrated didactic series covering key areas of interface between the two disciplines. PROGRAM EVALUATION Students reported satisfaction with the clerkship overall, rating it 3.9-4.3 on a 1-5 Likert scale, but many found its clinical curriculum and administrative organization disorienting. Students appreciated the conceptual rationale integrating primary care and psychiatry more in the classroom setting than in the clinical setting. CONCLUSIONS While preliminary clerkship outcomes are promising, further optimization and evaluation of clinical and classroom curricula are ongoing. This novel educational paradigm is one model for preparing students for the integrated healthcare system of the twenty-first century.
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Affiliation(s)
- Kirsten M Wilkins
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
| | - Ada M Fenick
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Matthew N Goldenberg
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Peter J Ellis
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Andres Barkil-Oteo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Robert M Rohrbaugh
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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Towards a practical model for community engagement: Advancing the art and science in academic health centers. J Clin Transl Sci 2017; 1:310-315. [PMID: 29707251 PMCID: PMC5915810 DOI: 10.1017/cts.2017.304] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 09/13/2017] [Accepted: 10/19/2017] [Indexed: 12/14/2022] Open
Abstract
Introduction Community engagement (CE) has become more prevalent among academic health centers (AHCs), with significant diversity in practices and language. The array of approaches to CE contributes to confusion among practitioners. Methods We have reviewed multiple models of CE utilized by AHCs, Clinical and Translational Science Awards, and higher education institutions overall. Taking these models into consideration, we propose a comprehensive model of CE that encompasses a broader spectrum of activities and programs. Results The CE Components Practical Model includes 5 components: Community Outreach and Service, Education, Clinical Care, Research, and Policy and Advocacy. The components are supported by the foundational elements within administrative functions and infrastructure. Conclusions This model will accomplish the following: (1) reduce confusion about CE; (2) provide a broader understanding of CE; and (3) increase the ability of CE practitioners to interact with each other through this common reference and engage in advancing CE scholarship.
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Bzowyckyj AS, Dow A, Knab MS. Evaluating the Impact of Educational Interventions on Patients and Communities: A Conceptual Framework. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:1531-1535. [PMID: 28471778 DOI: 10.1097/acm.0000000000001718] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Health professions education programs can have direct effects on patients and communities as well as on learners. However, few studies have examined the patient and community outcomes of educational interventions. To better integrate education and health care delivery, educators and researchers would benefit from a unifying framework to guide the planning of educational interventions and evaluation of their impact on patients.The authors of this Perspective mirrored approaches from Miller's pyramid of educational assessment and Moore and colleagues' framework for evaluating continuing professional development to propose a conceptual framework for evaluating the impact of educational interventions on patients and communities. This proposed framework, which complements these existing frameworks for evaluating the impact of educational interventions on learners, includes four levels: (1) interaction; (2) acceptability; (3) individual outcomes (i.e., knowledge, skills, activation, behaviors, and individual health indicators); and (4) population outcomes (i.e., community health indicators, capacity, and disparities). The authors describe measures and outcomes at each level and provide an example of the application of their new conceptual framework.The authors encourage educators and researchers to use this conceptual framework to evaluate the impact of educational interventions on patients and to more clearly identify and define which educational interventions strengthen communities and enhance overall health outcomes.
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Affiliation(s)
- Andrew S Bzowyckyj
- A.S. Bzowyckyj is clinical assistant professor, Division of Pharmacy Practice and Administration, University of Missouri-Kansas City School of Pharmacy, Kansas City, Missouri; ORCID: http://orcid.org/0000-0002-9007-5852. A. Dow is assistant vice president of health sciences for interprofessional education and collaborative care and professor, Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia; ORCID: http://orcid.org/0000-0002-9004-7528. M.S. Knab is associate professor and director of IMPACT Practice, Center for Interprofessional Studies and Innovation, MGH Institute of Health Professions, Boston, Massachusetts
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Tseng J, Samagh S, Fraser D, Landman AB. Catalyzing healthcare transformation with digital health: Performance indicators and lessons learned from a Digital Health Innovation Group. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2017; 6:150-155. [PMID: 28958850 DOI: 10.1016/j.hjdsi.2017.09.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 08/06/2017] [Accepted: 09/10/2017] [Indexed: 11/26/2022]
Abstract
Despite considerable investment in digital health (DH) companies and a growing DH ecosystem, there are multiple challenges to testing and implementing innovative solutions. Health systems have recognized the potential of DH and have formed DH innovation centers. However, limited information is available on DH innovation center processes, best practices, or outcomes. This case report describes a DH innovation center process that can be replicated across health systems and defines and benchmarks process indicators to assess DH innovation center performance. The Brigham and Women's Hospital's Digital Health Innovation Group (DHIG) accelerates DH innovations from idea to pilot safely and efficiently using a structured process. Fifty-four DH innovations were accelerated by the DHIG process between July 2014 and December 2016. In order to measure effectiveness of the DHIG process, key process indicators were defined as 1) number of solutions that completed each DHIG phase and 2) length of time to complete each phase. Twenty-three DH innovations progressed to pilot stage and 13 innovations were terminated after barriers to pilot implementation were identified by the DHIG process. For 4 DH solutions that executed a pilot, the average time for innovations to proceed from DHIG intake to pilot initiation was 9 months. Overall, the DHIG is a reproducible process that addresses key roadblocks in DH innovation within health systems. To our knowledge, this is the first report to describe DH innovation process indicators and results within an academic health system. Therefore, there is no published data to compare our results with the results of other DH innovation centers. Standardized data collection and indicator reporting could allow benchmark comparisons across institutions. Additional opportunities exist for the validation of DH solution effectiveness and for translational support from pilot to implementation. These are critical steps to advance DH technologies and effectively leverage the DH ecosystem to transform healthcare.
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Affiliation(s)
- Jocelyn Tseng
- Kaiser Permanente, San Francisco, CA, USA; University of California, San Francisco, CA, USA
| | - Sonia Samagh
- Kaiser Permanente, San Francisco, CA, USA; University of California, San Francisco, CA, USA
| | - Donna Fraser
- Information Systems, Partners HealthCare, Somerville, MA, USA
| | - Adam B Landman
- Information Systems, Partners HealthCare, Somerville, MA, USA; Department of Emergency Medicine, Brigham & Women's Hospital, 75 Francis Street, Hospital Administration, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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18
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Bacchus M, Ward DR, de Grood J, Lemaire JB. How evidence from observing attending physicians links to a competency-based framework. MEDICAL EDUCATION 2017; 51:633-644. [PMID: 28370354 DOI: 10.1111/medu.13265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 09/22/2016] [Accepted: 12/15/2016] [Indexed: 06/07/2023]
Abstract
CONTEXT Competency-based medical education frameworks are often founded on a combination of existing research, educational principles and expert consensus. Our objective was to examine how components of the attending physician role, as determined by observing preceptors during their real-world work, link to the CanMEDS Physician Competency Framework. METHODS This is a sub-study of a broader study exploring the role of the attending physician by observing these doctors during their working day. The parent study revealed three overarching elements of the role that emerged from 14 themes and 123 sub-themes: (i) Competence, defined as the execution of traditional physician competencies; (ii) Context, defined as the environment in which the role is carried out, and (iii) Conduct, defined as the manner of acting, or behaviours and attitudes in the role that helped to negotiate the complex environment. In this sub-study, each sub-theme, or 'role-related component', was mapped to the competencies described in the CanMEDS 2005 and 2015 frameworks. RESULTS Many role-related components from the Competence element were represented in the 2015 CanMEDS framework. No role-related components from the Context element were represented. Some role-related components from the Conduct element were represented. These Conduct role-related components were better represented in the 2015 CanMEDS framework than in the 2005 framework. CONCLUSIONS This study shows how the real-world work of attending physicians links to the CanMEDS framework and provides empirical data identifying disconnects between espoused and observed behaviours. There is a conceptual gap where the contextual influences of physicians' work and the competencies required to adjust to these influences are missing from the framework. These concepts should be incorporated into learning both broadly, such as through an emphasis on context within curriculum development for the workplace (e.g. entrustable professional activities), and explicitly, through the introduction of novel competencies (e.g. the Conduct role-related components described in this study).
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Affiliation(s)
- Maria Bacchus
- Health Sciences Centre, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - David R Ward
- Health Sciences Centre, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jill de Grood
- W21C Research and Innovation Centre, University of Calgary, Calgary, Alberta, Canada
| | - Jane B Lemaire
- Health Sciences Centre, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- W21C Research and Innovation Centre, University of Calgary, Calgary, Alberta, Canada
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Lieff SJ, Yammarino FJ. How to Lead the Way Through Complexity, Constraint, and Uncertainty in Academic Health Science Centers. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:614-621. [PMID: 28441672 DOI: 10.1097/acm.0000000000001475] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Academic medicine is in an era of unprecedented and constant change due to fluctuating economies, globalization, emerging technologies, research, and professional and educational mandates. Consequently, academic health science centers (AHSCs) are facing new levels of complexity, constraint, and uncertainty. Currently, AHSC leaders work with competing academic and health service demands and are required to work with and are accountable to a diversity of stakeholders. Given the new challenges and emerging needs, the authors believe the leadership methods and approaches AHSCs have used in the past that led to successes will be insufficient. In this Article, the authors propose that AHSCs will require a unique combination of old and new leadership approaches specifically oriented to the unique complexity of the AHSC context. They initially describe the designer (or hierarchical) and heroic (military and transformational) approaches to leadership and how they have been applied in AHSCs. While these well-researched and traditional approaches have their strengths in certain contexts, the leadership field has recognized that they can also limit leaders' abilities to enable their organizations to be engaged, adaptable, and responsive. Consequently, some new approaches have emerged that are taking hold in academic work and professional practice. The authors highlight and explore some of these new approaches-the authentic, self, shared, and network approaches to leadership-with attention to their application in and utility for the AHSC context.
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Affiliation(s)
- Susan J Lieff
- S.J. Lieff is director of academic leadership development, Centre for Faculty Development, University of Toronto Faculty of Medicine and St. Michael's Hospital, and professor and vice chair of education, Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.F.J. Yammarino is director, Centre for Leadership Studies, and SUNY Distinguished Professor of Management, School of Management, Binghamton University, Binghamton, New York
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DeVoe JE, Likumahuwa-Ackman S, Shannon J, Steiner Hayward E. Creating 21st-Century Laboratories and Classrooms for Improving Population Health: A Call to Action for Academic Medical Centers. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:475-482. [PMID: 27655058 DOI: 10.1097/acm.0000000000001385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Academic medical centers (AMCs) in the United States built world-class infrastructure to successfully combat disease in the 20th century, which is inadequate for the complexity of sustaining and improving population health. AMCs must now build first-rate 21st-century infrastructure to connect combating disease and promoting health. This infrastructure must acknowledge the bio-psycho-social-environmental factors impacting health and will need to reach far beyond the AMC walls to foster community "laboratories" that support the "science of health," complementary to those supporting the "science of medicine"; cultivate community "classrooms" to stimulate learning and discovery in the places where people live, work, and play; and strengthen bridges between academic centers and these community laboratories and classrooms to facilitate bidirectional teaching, learning, innovation, and discovery.Private and public entities made deep financial investments that contributed to the AMC disease-centered approach to clinical care, education, and research in the 20th century. Many of these same funders now recognize the need to transform U.S. health care into a system that is accountable for population health and the need for a medical workforce equipped with the skills to measure and improve health. Innovative ideas about communities as centers of learning, the importance of social factors as major determinants of health, and the need for multidisciplinary perspectives to solve complex problems are not new; many are 20th-century ideas still waiting to be fully implemented. The window of opportunity is now. The authors articulate how AMCs must take bigger and bolder steps to become leaders in population health.
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Affiliation(s)
- Jennifer E DeVoe
- J.E. DeVoe is professor and chair, Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, and senior research advisor, OCHIN, Inc., Portland, Oregon. S. Likumahuwa-Ackman is research program manager, Department of Family Medicine, Oregon Health & Science University, Portland, Oregon. J. Shannon is associate professor, School of Public Health, director, Knight Community Engaged Research Program, Knight Cancer Institute, and associate director, Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland, Oregon. E. Steiner Hayward is adjunct associate professor, Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, and senator, Oregon State Legislature, Salem, Oregon
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George DR, Rovniak LS, Dillon J, Snyder G. The Role of Nutrition-related Initiatives in Addressing Community Health Needs Assessments. AMERICAN JOURNAL OF HEALTH EDUCATION 2016. [DOI: 10.1080/19325037.2016.1250019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Gooding HC, McCarty C, Millson R, Jiang H, Armstrong E, Leichtner AM. The Boston Children's Hospital Academy: Development and Initial Assessment of a Hospital-Based Teaching Academy. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2016; 91:1651-1654. [PMID: 26760057 DOI: 10.1097/acm.0000000000001095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PROBLEM Medical education academies play an important role in the recognition and career advancement of educators. However, hospital-based clinical faculty have unique professional development needs that may not be met by medical-school-based academies. APPROACH The Boston Children's Hospital Academy was founded in 2008 to serve the needs of its clinician-educators. It was open to junior faculty scholars and to senior faculty scholars and mentors, including interprofessional educators. To maintain membership, individuals must propose and work toward an education project or serve as a project mentor. In 2012, a survey was sent to all members, and annual project reports were reviewed to assess the academy's impact. OUTCOMES Sixty-five members completed the survey. The majority agreed that the academy created a community of educators, provided opportunities for networking and scholarship, contributed to their personal identity as an educator, and led to recognition by their chief. Projects addressed curriculum development, faculty development, learner assessment, program assessment, and resource development. They largely focused on graduate medical education and on patient safety and quality. During their tenure in the academy (mean length of membership = 2.4 years), members produced an average of 4.4 education presentations and 1.9 education publications, and 11 members were promoted. NEXT STEPS A hospital-based academy provides opportunities for interprofessional faculty development. Next steps include increasing interprofessional membership, wider dissemination of members' successes, better integration with the hospital's mission, specifically regarding graduate medical education and patient safety, and additional evaluation of the academy's impact on project completion and members' accomplishments.
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Affiliation(s)
- Holly C Gooding
- H.C. Gooding is assistant professor of pediatrics and medicine, Harvard Medical School, and Boston Children's Hospital, Boston, Massachusetts. C. McCarty is clinical research associate, Massachusetts General Hospital Cancer Center, Boston, Massachusetts. R. Millson is senior administrative associate, Boston Children's Hospital, Boston, Massachusetts. H. Jiang is principal biostatistician, Boston Children's Hospital Clinical Research Center, Boston, Massachusetts. E. Armstrong is clinical professor of pediatrics, Harvard Medical School, Boston, Massachusetts. A.M. Leichtner is associate professor of pediatrics, Harvard Medical School, and Boston Children's Hospital, Boston, Massachusetts
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Petrie D, Chopra A, Chochinov A, Artz JD, Schull M, Tallon J, Jones G, MacPhee S, Ackerman M, Stiell IG, Christenson J. CAEP 2015 Academic Symposium: Recommendations for University Governance and Administration for Emergency Medicine. CAN J EMERG MED 2016; 18:1-8. [PMID: 27046286 DOI: 10.1017/cem.2016.22] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE 1) To identify the strengths and challenges of governance structures in academic emergency medicine (EM), and 2) to make recommendations on principles and approaches that may guide improvements. METHODS Over the course of 9 months, eight established EM leaders met by teleconference, reviewed the literature, and discussed their findings and experiences to arrive at recommendations on governance in academic units of EM. The results and recommendations were presented at the annual Canadian Association of Emergency Physicians (CAEP) Academic Symposium, where attendees provided feedback. The updated recommendations were subsequently distributed to the CAEP Academic Section for further input, and the final recommendations were decided by consensus. RESULTS The panel identified four governance areas of interest: 1) the elements of governance; 2) the relationships between emergency physicians and academic units of EM, and between the academic units of EM and faculty of medicine; 3) current status of governance in Canadian academic units of EM; and 4) essential elements of good governance. Six recommendations were developed around three themes, including 1) the importance of good governance; 2) the purposes of an academic unit of EM; and 3) essential elements for better governance for academic units of EM. Recommendations included identifying the importance of good governance, recognizing the need to adapt to the different models depending on the local environment; seeking full departmental status, provided it is mutually beneficial to EM and the faculty of medicine (and health authority); using a consultation service to learn from the experience of other academic units of EM; and establishing an annual forum for EM leaders. CONCLUSION Although governance of academic EM is complex, there are ways to iteratively improve the mission of academic units of EM: providing exceptional patient care through research and education. Although there is no one-size-fits-all guide, there are practical recommended steps for academic units of EM to consider.
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Affiliation(s)
- David Petrie
- *Department of Emergency Medicine,Dalhousie University/Queen Elizabeth II Health Sciences Centre,Halifax,NS
| | - Anil Chopra
- †Division of Emergency Medicine,University Health Network,Toronto,ON
| | - Alecs Chochinov
- ‡Department of Emergency Medicine,St. Boniface Hospital,Winnipeg,MB
| | | | | | - John Tallon
- *Department of Emergency Medicine,Dalhousie University/Queen Elizabeth II Health Sciences Centre,Halifax,NS
| | - Gordon Jones
- ‡‡Department of Emergency Medicine,Kingston General Hospital and Hotel Dieu Hospital,Kingston,ON
| | - Shannon MacPhee
- §§Department of Emergency Medicine,IWK Health Centre,Halifax,NS
| | | | - Ian G Stiell
- ***Department of Emergency Medicine,The Ottawa Hospital Research Institute,Ottawa,ON
| | - Jim Christenson
- ††Department of Emergency Medicine,University of British Columbia,Vancouver,BC
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Abstract
STUDY DESIGN Descriptive, cross-sectional observational study. BACKGROUND In the physical therapist profession, the outcomes of specialty practice analyses are used to determine content areas for specialty board examinations and for American Physical Therapy Association (APTA)-accredited residency curricula. To maintain currency for specialty practices, the American Board of Physical Therapy Specialties (ABPTS) requires any approved specialty area to revalidate its Description of Specialty Practice (DSP) a minimum of every 10 years. OBJECTIVES The purpose of this article was to describe the most recent practice analysis process and to report revisions to the DSP for orthopaedic physical therapists. METHODS A survey instrument was developed by a group of subject matter experts, following guidelines established by the ABPTS. The survey was sent electronically to a random sample of 800 orthopaedic certified specialists (OCSs). The survey contained 5 sections: (1) knowledge areas (eg, human anatomy and physiology); (2) professional roles, responsibilities, and values (eg, consultation); (3) patient/client management model (eg, examination); (4) percentage of body regions treated; and (5) demographic information. RESULTS A total of 224 completed surveys and 43 partially completed surveys were submitted, for a response rate of 33.4%. Based on a priori decision rules regarding survey data, consensus of the group of subject matter experts, and ABPTS suggestions, the DSP for orthopaedic physical therapy was revised. CONCLUSION The revised DSP will be used to reconstruct the blueprint for future OCS examinations, APTA-accredited orthopaedic residency program curricula, as well as professional development activities related to recertification in orthopaedic physical therapy.
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