The CARE assignment:
This assignment helps student move beyond disease specific guidelines when caring for patients with complex chronic comorbidities. Students will apply the principles of minimally disruptive medicine, explore social determinants of health, incorporate motivational interviewing, and integrate population management to achieve the following SOM milestones:
• Patient Care and Clinical Skills: Succinctly list cost effective assessment strategies and management plan for core patient types.
• Interpersonal and Communication Skills: Improve oral communication skills with patients
• Medical Knowledge: Develop more sophisticated understanding of social, cultural, and behavioral factors that influence the health of patients
• Population Health: Describe and apply principles of population health improvement for specific populations with attention to access, cost and clinical outcomes including quality of care, morbidity and mortality, functional status and quality of life. Identify factors that place populations at risk for disease or injury, and select appropriate strategies for risk reduction.
• Professionalism: Develop strategies to deal with difficult situations through self-reflection and peer feedback
This assignment will use team based learning and narrative writing to teach these principles.
The final product of the assignment will be a written consultation for the preceptor that provides specific suggestions on how to improve the care for a selected patient using interventions that can be implemented during the one on one encounter with the patient and interventions that require systems changes in the practice or the community. The individual components of the CARE assignment and how the CARE assignment is evaluated are described in further detail below.
Individual Components of the CARE assignment:
1) The assignment will be introduced during the orientation session of the clerkship. This introductory session will use TBL format and thus will require student preparation. Preparatory material will be sent to the students 1 week prior to the clerkship. At the end of the session students will be able to:
• describe principles of minimally disruptive medicine
• describe important social determinants of health and relationship to the biopsychosocial approach.
• demonstrate techniques of motivational interviewing and patient centered goal setting.
2) Each student will select a patient with a complex chronic health challenges (multiple chronic illnesses, concurrent mental health illness, complicated psychosocial context). The preceptor should be enlisted to help select an appropriate patient. The student will interview the physician who has been taking care of patient and identify the challenges and or questions the preceptor has had managing this patient. At the same time, the student will identify all relevant evidence based guidelines that apply to patient and prioritize recommendations that would be most beneficial to patient (finding the balance strongest evidence from studies and the patient’s own goals).
The student will then interview the patient to explore the patient’s understanding of their chronic illnesses and the patient’s psychosocial context and works with patient to set realistic goals to improve their health. Interviews can take place in the office, the patient’s home, or the patient’s workplace. The interview should be recorded (with patient consent).
In preparation for the didactic session, each student should reflect on strength of available guidelines, the interview with the preceptor and the patient and the review of the Flip recording video. Based on these reflections, the student should develop management plan that answers preceptor’s questions, integrates most beneficial interventions and responds to patient’s context and goals. Students will also read assigned material in preparation for TBL component of the “day back”.
3) During the didactics, student will discuss and prioritize chronic illness guidelines relevant to their patients. Students will review each other’s video recordings, reflecting on the cultural and behavioral factors that influence the health of patients and refining skills of motivational interviewing. The TBL component of the “day back” will introduce students to population management concepts and techniques using a practice registry. At the end of the session, students will be able to:
• define core terms used in population health management
• demonstrate ability define populations within the practice and describe characteristics of those populations
• describe community resources available to practices to help in care for populations of patients in the
• describe systems interventions at the level of the practice to improve quality of care, cost, and patient satisfaction for defined populations of patients.