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48th STFM Annual Spring Conference

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Transforming Opioid Prescribing in a Patient Centered Medical Home Residency Training Center

Becky Wilkins; William G Buoni, MD; Cari Brackett, PharmD


Opiate misuse in the United States is epidemic with the majority of diverted or misused medications originating from legitimate prescriptions generated by licensed prescribers. Consequent to our need to be part of the solution, our large, urban Family Medicine practice based in an academic patient-centered medical home has developed carefully-studied strategies for monitoring and controlling opiate prescribing. The resulting program has diminished both acute and chronic prescription of opiates. The program has functionally eliminated frustrating and dangerous patient behaviors toward staff, increased efficient referrals to pain management centers, implemented humane but highly-effective monitoring of patients who receive opioids, and measurably increased staff and physician job satisfaction. This seminar will provide a toolbox that includes rationale, metrics, and methods that can be implemented in attendees' own practices upon their return from the STFM meeting.

Upon completion of this session, participants should be able to:

  1. On completion of this session, participants should be able to assess threats to prescriber and public health and safety consequent to opiate prescribing in their own practices.
  2. We will spend 75% of the allotted time in interactive, slide-and-discussion-based presentation to and with the audience. This topic typically generates profound audience response, resonance, and sharing and attendees will participate in think-pair-share activities prior to beginning the presentation and again at its conclusion. 25% of the session will be reserved for questions and intellectual cross-fertilization between audience members and presenters.

PR01 FamPop 2015: Integrating Primary Care, Public Health, Family Medicine Education

Kirsten Rindfleisch, MD; Jacob Prunuske, MD, MSPH; Robin Lankton, MPH; Mina Silberberg, PhD; Konstantinos Deligiannidis, MD, MPH; Jennifer Edgoose, MD, MPH; Kwanza Devlin, MD; Jennifer Lochner, MD; Viviana Martinez-Bianchi, MD; Allen Perkins, MD, MPH; Janice Benson, MD; John Westfall, MD, MPH; Kim Griswold, MD, MPH; Nancy Pandhi, MD, PhD; Heather Bleacher, MD; Haley Ringwood, MPH, MD; Brian Arndt, MD; David Power, MD, MPH; Sally Bachofer, MD, MS; Montgomery Douglas, MD; Judith A. Furlong, MD; Katherine F Guthrie, MD; Kohar Jones, MD; Kjersti Elise Knox, MD; Linda Nicholson Meurer, MD, MPH; Julie P. Phillips, MD, MPH; Sallie Rixey, MD, MEd; Sarah-Anne Schumann, MD; Justine Strand de Oliveira, DrPH, PA-C; Elisabeth Wilson, MD, MPH; Mark W. Yeazel, MD, MPH

04/25/15 8:00 AM - 5:00 PM Asia 2

The Institute of Medicine has proposed a powerful approach to addressing population health challenges in the United States—integrating public health and primary care. While these two sectors have usually operated independently, there is increasing interest in collaboration. Family medicine educators are challenged with redesigning curricula to prepare learners for roles in a future, more integrated health system that is not yet fully defined. This preconference workshop will bring together educators engaged in curricular innovations to integrate public health and primary care and those considering new approaches at their home institutions. We will highlight current best practices, engage in group processes to develop and refine curricular ideas, and identify priority areas of focus for the STFM Group on Primary Care and Public Health Integration.

Upon completion of this session, participants should be able to:

  1. Describe current innovations in medical school and residency curricula in community and population health.
  2. Define future roles for family physicians in community and population health and the curricular changes needed to support this new practice model.
  3. Develop ideas for curricular innovation and implementation and strengthen those ideas through discussion and feedback from colleagues.

PR04 Evolutionary Teaching

Julie Schirmer, MSW; Jeffrey Ring, PhD; Jennifer Ayres, PhD; Emilee Delbridge, PhD; Daniel Felix, PhD; Jonathan Moulder, MD; Jeffrey Morzinski, PhD, MSW; Andrea Pfeifle, EdD

04/25/15 8:00 AM - 12:00 PM Asia 1

This preconference workshop applies evolutionary learning theory and teaching principles to provide the essential knowledge, attitude, and skills needed for experienced and new faculty to transform their teaching practice. The clinical care and patient visits provided by family physicians 30 years ago is very different from what is provided today, given advancements in medical knowledge, payment mechanisms, and information sharing. Our teaching strategies must demonstrate a similar pattern of growth to meet the needs of today’s adult learners and facilitate efficient and effective information sharing. Participants will leave this workshop with enhanced capacity to teach with creativity and effectiveness, grounded in theory and the latest in brain-science research, and delivered in the context of a nurturing teacher-learner relationship.

Upon completion of this session, participants should be able to:

  1. Integrate and apply basic evolution theory, teaching theory, curriculum development, brain-science research, and evidence-based practice in family medicine education.
  2. Describe clinical teaching skills to help medical learners acquire, apply, and become proficient with essential competencies in interprofessional communication, professionalism, and mental health assessment in the inpatient and outpatient settings.
  3. Describe and apply the elements commonly represented in effective presentations, to include gold standard tips, tricks, and resources to improve presentation delivery.

    Describe and apply the key developmental concepts, principles and evaluation methods to curriculum design.

PR02 Student Interest and the Future of Family Medicine

Stanley Kozakowski, MD; Ashley Bentley, MBA; Jay Fetter Jr, MSA

04/25/15 10:00 AM - 5:00 PM Asia 4

Though medical student interest in family medicine careers has seen a slight uptick in recent years, the decades-old issue of recruiting the quantity and quality of students needed to fill the family physician pipeline still offers new and unsolved challenges. A burgeoning demand for a primary care physician workforce that can meet the needs of the US has led to much introspection on what can be done to increase the number of primary care physicians in the US, including the development of the AAFP Student Interest Portfolio, CAFM’s Four Pillars for Primary Physician Workforce Reform, and important elements of the Family Medicine for America’s Health initiative. Medical school and family medicine residency faculty are important stakeholders in the workforce pipeline that hold both the influence and responsibility to contribute to improving student interest in and pursuit of family medicine careers. Join your colleagues from both the UME and GME communities for an interactive, collaborative, solution-seeking workshop meant to give you updates on the current status and resources, ideas, and best practices and connections to help us all make a difference.

Upon completion of this session, participants should be able to:

  1. Understand the direction of the specialty of family medicine and the implications for students' interest in and likelihood of pursuing family medicine careers, as informed by the Family Medicine for America's Health project and current literature.
  2. Be up-to-date on recent literature and the latest findings related to student interest in family medicine and primary care, as well as workforce needs and projections.
  3. Be up-to-date on the current models of primary care physician workforce reform and medical student interest in family medicine and understand how to apply them to institutional initiatives.

PR03 Teaching Palliative Care to Family Medicine Residents: A Developmental and Narrative Approach

Lucille Marchand, MD, BSN

04/25/15 1:00 PM - 5:00 PM Oceanic 2

Palliative care (PC) competencies for resident training are essential in delivering patient-centered care for those with serious, advanced chronic illnesses. In a new Institute of Medicine report called Dying in America, universal improvements are called for in the training of all health professionals in all aspects of palliative care including communication and advance care planning, pain and symptom control, safe use of opioids, and plans of care that reflect the values and goals of patients and families across all transitions of care including end of life care. This is called primary palliative care. It minimizes ineffective, expensive care especially at end of life and improves quality of life. This session will explore strategies in teaching essential palliative care competencies effectively to residents using a narrative and developmental approach.

Upon completion of this session, participants should be able to:

  1. Integrate a developmental, narrative-based model of palliative care training into family medicine residency training.
  2. Identify the core palliative care competencies established for residents.
  3. Practice using innovative, narrative-based, and experiential methods to teach these competencies.

PR05 Building a Business Case for Academic Activity

James Campbell, MD, MS; Feraz Ghazal, MD; Rita Horwitz; Amy Zack; David Wank

04/25/15 1:00 PM - 5:00 PM Asia 3

Providing key financial decision makers with context, knowledge, and tools to improve their effectiveness greatly increases the chance of attaining funding for academic activity (ie, quality improvement, research, faculty development, or a grant). A solid business case will preserve academics despite clinical productivity demands. A comprehensive business case should not narrowly focus on revenue but also take into account the total value to be gained by participating in an academic activity. The overall goal of this workshop is for health care professionals to walk away with a new paradigm for understanding economic evaluation techniques by building and proposing a business case. Participants will be mentored through the development of their own business cases and will be provided with a forum for feedback from clinical and non-clinical presenters as well as from other participants. Participants should come prepared with ideas concerning these questions: What is the essence of my academic activity? Who will benefit from the my academic activity? How much does my academic activity cost? Why would my institution support my academic activity?
* Participants are encouraged but not required to bring their own laptop computer.

Upon completion of this session, participants should be able to:

  1. Identify and apply the key elements of a business case for faculty academic activity.
  2. Prepare a stakeholder analysis and differentiate between true “value” and revenue.
  3. Compose and present a compelling business case “story” for academic activity as opposed to just presenting data.

PR06 Learning Faculty Development Skills in Mentorship, Coaching, Scholarly Activity, and Interprofessional Teamwork: A Toolkit For New Faculty in Family Medicine

Michelle Roett, MD, MPH; Rahmat Na'Allah, MD, MPH, FAAFP; Cheryl K. Seymour, MD; Manjula Julka, MD; Angela Kuznia

04/25/15 1:00 PM - 5:00 PM Australia 3

New faculty in family medicine face unique challenges navigating medical student education, residency education, and research realms. Family medicine departments often struggle to provide a comprehensive orientation for new faculty with a sustainable model for continuing faculty development. The Group on New Faculty will welcome new faculty to academic family medicine, providing guidance on faculty development, mentorship, coaching, and interprofessional teamwork opportunities. Presenters will facilitate small-group discussions around common challenges, fundamental resources, performance feedback, and ongoing development needs, including toolkit resources developed after feedback from annual sessions presented 2011-2014. A panel of new and veteran faculty members will present mentorship and coaching styles for seeking adequate support, take questions and offer advice, including guidance on establishing an educator portfolio. Distinguishing coaching styles and mentorship opportunities is a crucial component of faculty development, particularly with pressing need for collaborative work, project completion, and scholarly activity products. Attendees will be oriented to a toolkit to share with home institutions for other new faculty.

Upon completion of this session, participants should be able to:

  1. Describe the most common personal, clinical, administrative, and academic challenges identified by new faculty in family medicine and identify resources for overcoming barriers.
  2. Identify effective mentoring and coaching concepts and styles, identify accessible opportunities for inter-professional collaborative teamwork, and seek appropriate academic resources for building mentoring and coaching relationships.
  3. Be introduced to tools to implement faculty development programs and identify existing local, regional, and national resources to support faculty development for new faculty in family medicine.

PR07 Empowering Family Medicine Faculty and Residents to Address Prescription Opioid Abuse With Office-Based Buprenorphine Treatment

Kenneth Saffier, MD; Jeffrey Baxter, MD

04/25/15 1:00 PM - 5:00 PM Oceanic 1

Objectives: Participants will complete 4.25 of 8 approved CME hours required to obtain a DEA waiver to prescribe buprenorphine in your offices for patients with opioid dependence. Rationale: Abuse of prescription opioids is epidemic. Office-prescribed buprenorphine treatment is safe and effective, but few family physicians and residents are trained to prescribe it. Content: This face to face session will review essentials of delivering office-based buprenorphine treatment in family medicine residency settings and qualify participants for waiver certification. Outline: Buprenorphine treatment strategies will be taught using case-based presentations and small-group case discussions. At the conclusion, participants will be eligible to complete the remainder of training online to obtain prescribing waivers.

Upon completion of this session, participants should be able to:

  1. Complete 4.25 hours of approved education toward the 8 hours required to obtain the buprenorphine DEA waiver needed to prescribe this medically assisted treatment for opioid addiction (for physicians only) .
  2. Explain how buprenorphine is an effective medication for the management of opioid dependence in a variety of populations including youth, pregnancy, and patients with co-occurring disorders such as chronic pain after appropriately selecting patients for induction, detoxification, or maintenance.
  3. Discuss strategies for implementing buprenorphine treatment into residency clinical practices, including strategies for effective education, documentation, practice sharing, and precepting of family medicine trainees, addressing issues of safety and diversion.

B001 The Development of Skill Assessment Tools for Family Medicine Residents Providing Maternity Care

Komal Bhatt, MD; Rhina Acevedo, MD; Elizabeth Clark, MD, MPH; Terri Nordin, MD

04/26/15 7:15 AM - 8:15 AM Pacific Hall B

Maternity care is an essential component of family medicine training. As faculty, we strive to produce competent and confident future maternity care providers. The new Accreditation Council for Graduate Medical Education (ACGME) requirements emphasize an assessment of competence instead of the number of procedures performed. We will discuss our approach to assessing the maternity care skills of our family medicine residents and how we accommodate the new ACGME requirements. We will invite discussion about the approaches taken by other family medicine programs.

Upon completion of this session, participants should be able to:

  1. List at least two changes in ACGME requirements for family medicine resident maternity care training,
  2. Identify three barriers faced by family medicine faculty in assessing maternity care proficiency in their learners.
  3. Discuss two tools that document the competency of family medicine residents’ maternity care skills; tools will assess prenatal care and labor and delivery competencies.

B002 Cannabis as Medicine: Practical Considerations

Lucas Hill, PharmD; Gregory Castelli, PharmD; Brittany Sphar, MD

04/26/15 7:15 AM - 8:15 AM Pacific Hall B

Junior and senior clinicians from all professions will benefit from this facilitated discussion of cannabis as a medicine. Planned topics will include cannabis use in chronic pain and its impact on opioid contracts, passive acceptance versus active recommendation in severe disease, legal and logistical limitations to use, and experience with pharmaceutical analogs. Handouts detailing basic pharmacologic and legal information with additional resources will be provided. Active participants will be able to address patient queries confidently and serve as a resource to fellow providers regarding cannabis use.

Upon completion of this session, participants should be able to:

  1. Recall approved indications for synthetic cannabinoids and comparative efficacy/safety of inhaled cannabis.
  2. Formulate patient-specific recommendations for cannabis use or avoidance based on legal and clinical factors.

B003 Best Practices in Medical Humanities Education

Jose E. Rodriguez, MD; Jo Marie Reilly, MD; Hugh J. Silk, MPH, MD

04/26/15 7:15 AM - 8:15 AM Pacific Hall B

As family physicians and educators, we recognize the role that narrative medicine and the humanities play in the formation of new providers. We understand that humanities allow us new ways to connect to each other and our patients, and form meaningful bridges between us. However, there are multiple ways in which humanities and narrative medicine are taught and much to be shared and learned between educators. This seminar will present three programs, each distinct in the manners in which humanities are successfully taught to their residents and medical students. The presenters and participants will work together to identify, share and formalize best practices in medical humanities education medicine.

Upon completion of this session, participants should be able to:

  1. Upon completion of this seminar, learners will be able to: 1. Identify “best practices” in humanities education
  2. 1. Introduction of the presenters: (5 minutes) 2. Presentation of the three humanities programs (20 minutes) 3. Small group discussion of best practices in humanities (10 minutes) 4. Summarization of all practices identifies (10 minutes) 5. Presentation of literature based best practices (5 minutes) 6. Questions and identification of next steps (10 minutes)

B006 How to Improve Billing and Coding Teaching Strategies in Family Medicine Education: Thoughts From Our Residency Programs

David Banas, MD, FAAFP; Heather Joseph-Chupp, CPC; David Oram, FAAFP, MD

04/26/15 7:15 AM - 8:15 AM Pacific Hall B

With continued changes to the health care system, it is becoming increasingly important that graduates from primary care residency programs know how to accurately bill and code in an efficient and effective manner. Unfortunately, billing and coding is not a very exciting topic, and it is not a topic commonly encountered at academic conferences. Further, there seems to be great variety in how billing and coding is taught across residency programs. This seminar is designed to bring together family medicine educators from different programs to share ideas about teaching billing and coding and to discuss how to make teaching more effective for trainees. It is our hope that attendees will leave our seminar with fresh ideas about this topic.

Upon completion of this session, participants should be able to:

1. Identify billing and coding teaching strategies within his or her residency program that are effective and areas that need improvement
2. Implement specific techniques to teach effective and efficient billing and coding while precepting family medicine residents
3. Design effective strategies to teach billing and coding in his or her residency program.

B007 A Workshop on Precepting Patients With Chronic Nonmalignant Pain

Martha Rumschlag, MD; Jill Schneiderhan, MD

04/26/15 7:15 AM - 8:15 AM Pacific Hall B

Patients with chronic nonmalignant pain are challenging to precept. They often have ambiguity regarding diagnosis, psychological comorbidities, and psychosocial factors and often do not respond to standard medical therapy leading to challenging encounters for the residents. We will introduce an approach for precepting residents using a stepwise format. The first step is to help the resident determine the pathophysiology of the pain. Second is setting a functional goal with the use of relationship building and the development of an understanding of the impact of the pain. Last is determining an appropriate evidence-based treatment strategy. By helping residents use these steps, it is possible to work through the challenging aspects while helping the residents gain confidence in their ability to treat these difficult patients.

Upon completion of this session, participants should be able to:

  1. Apply a stepwise approach to patients with chronic nonmalignant pain.
  2. Feel comfortable using this approach to guide residents in precepting patients with chronic pain.
  3. Apply current evidence to the development of a patient-specific treatment plan for chronic nonmalignant pain.

B008 The Tale of Three Universities: Incorporating Family Medicine Colposcopy Into Academic Practices

Matthew Meunier, MD; Maria Syl de la Cruz, MD; Ebony Parker-Featherstone, MD

04/26/15 7:15 AM - 8:15 AM Pacific Hall B

Family physicians are uniquely qualified to provide comprehensive medical care to women, and colposcopy remains an important diagnostic procedure for family medicine residency training. In this Lecture-Discussion presentation, we will describe three unique models for incorporating colposcopy into academic family medicine departments and also into the residency gynecology curricula at these institutions. An audience discussion will follow on the barriers and potential solutions to creating or refining an existing gynecology curriculum, including a review of methods for colposcopy competency assessment.

Upon completion of this session, participants should be able to:

  1. Describe different models of incorporating colposcopy into a family medicine residency training program for use in their home institutions.
  2. Identify barriers and strategies to create or refine an existing gynecologic or colposcopy-based curriculum.
  3. Describe various methods for assessing residency competency in colposcopy.

B009 Involving the Entire Clinic in the QI Process

Gerald Liu, MD; Ehab Molokhia, MD; Allen Perkins, MD, MPH

04/26/15 7:15 AM - 8:15 AM Pacific Hall B

Achieving the Triple Aim in the primary care setting has proved elusive. The science of quality improvement (QI) dictates that all parties should be engaged to optimize the care being delivered. The best method to accomplish change and optimize QI efforts has not been determined. Although team-based care is a tenant of the patient-centered medical home, the use of the totality of the staff—providers, nursing staff, front office staff, and referral clerks—is unusual. This session will provide information, including barriers, successes, failures, and lessons learned about how to include everyone who works in the clinic in QI teams using the Plan-Do-Study-Act cycle to implement QI projects in a residency practice setting.

Upon completion of this session, participants should be able to:

  1. List the benefits of including everyone who works in the clinic in QI teams.
  2. Identify barriers to implementing an inclusive QI process in their clinic and approaches to overcome those barriers.
  3. Apply and implement a similar inclusive quality improvement environment in their own clinic.

B010 Value-Added Medical Education: Engaging Future Doctors to Transform Health Care Delivery Today

Steven Lin, MD; Erika Schillinger, MD

04/26/15 7:15 AM - 8:15 AM Pacific Hall B

Value-added medical education describes real world learning experiences that leverage the talents and commitments of early medical students to add value to the care of patients. Programs that merge robust experiential learning with the delivery of high-quality patient-centered primary care is not only desirable to produce 21st century physicians able to achieve better health outcomes for the American people but necessary as an immediate solution to address the growing imbalance between population demands for medical care and our capacity to provide care. In this roundtable, participants will share their experiences with value-added education models at their own institutions as we make a collective call for national engagement of our 80,000 medical students to transform medical education.

Upon completion of this session, participants should be able to:

  1. Describe the principles of value-added medical education.
  2. Identify opportunities to form value-added medical education programs at their own institutions.

B011 Six Steps to Promote Faculty Scholarship

Stoney Abercrombie, FAAFP, MD; Amanda Davis, MD

04/26/15 7:15 AM - 8:15 AM Pacific Hall B

Our community unopposed 32-resident family medicine residency has progressed from scant scholarly activity a few years ago to each faculty member being actively involved in scholarly pursuits. We will duscuss six steps used to change our culture to produce quality faculty scholarship. After defining our six steps and discussing pitfalls, we will engage the audience on other ideas to improve faculty scholarship.

Upon completion of this session, participants should be able to:

  1. Develop a plan to promote faculty scholarship.
  2. Outline a six-step approach to enhance faculty scholarship.
  3. Address cultural changes necessary for quality faculty scholarship.

B012 The Clinical Competency Committee: Best Practices

Maili Dalla Tor, MD; Maria Christina Tolentino, DO

04/26/15 7:15 AM - 8:15 AM Pacific Hall B

Data from the milestones beta testing demonstrated that resident milestone assessment would be time consuming. Residency programs are searching for ways to make the process more efficient. The Clinical Competency Committee members of the Pomona Valley Hospital Family Medicine Residency Program struggled with the time constraints and developed a simplified approach to the milestone assessments. As the novel ACGME requirements for the Clinical Competency Committee and the assessment of milestones reaches its first year anniversary, programs should come together to share and explore processes and to develop ideas on how their Clinical Competency Committees can streamline the assessment of resident milestones at their institutions.

Upon completion of this session, participants should be able to:

  1. Access tools that will simplify the milestone assessment for their residents.
  2. Evaluate their milestone assessment processes in comparison to other residency programs.

B013 The Characteristics of Scholarship That Are of Educational Value to Residents

Dean Seehusen, MD, MPH; Christy Ledford, PhD

04/26/15 7:15 AM - 8:15 AM Pacific Hall B

The family medicine requirements for resident participation in scholarly activity have increased. It is critical that scholarly products are not the ultimate goal of this increase. Rather, it is to train physicians who are better equipped to systematically analyze their own practices, critically interpret the medical literature, and efficiently provide evidence-based care. Scholarship that is of educational value to residents must train them to produce scholarship while simultaneously enhancing these essential skills. Scholarship that meets these goals shares five characteristics: (1) It begins with a scholarly question (2) It includes a systematic search for existing knowledge, (3) appropriate data are gathered, (4) The data is analyzed and synthesized in a way that answers the question, (5) The findings are presented to an appropriate audience.

Upon completion of this session, participants should be able to:

  1. Explain what the goals of requiring residents to participate in scholarship are, and connect these goals to the ultimate residency objective of creating outstanding family physicians.
  2. List and define both Boyer’s four types of scholarship.
  3. List the five features of scholarship that are of educational value to residents and describe how various types of scholarly projects possess these features.

B014 Institute of Medicine Report on Governance and Financing of GME: Is Family Medicine Already There?

Joshua Raymond, MD, MPH; Geronima Alday, MD; Maria Ciminelli, MD; Kelly Dallavalle, MBA; Lisa Mellor, MD

04/26/15 7:15 AM - 8:15 AM Pacific Hall B

With the implementation of the Affordable Care Act and Triple Aim, the importance of primary care is continued to be reinforced. Despite the recognition of the importance of a robust primary care health force there is no centralized agency to ensure the proper percentage of specialists and primary care physicians. In the summer of 2014, the Institute of Medicine released the Report on Governance and Financing of Graduate Medical Education that may place pressure on institutions to increase the training of primary care physicians influencing the percentage of primary care providers. This seminar will review basic tenets of primary care training that are already in place that support the recommendations of the Institute of Medicine.

Upon completion of this session, participants should be able to:

  1. List at least three best practices that family medicine residencies are using that are consistent with the Modernized Medicare payment methodology.
  2. List at least three best practices that family medicine residencies are using to develop strategic plans and ensure coordination of care.
  3. List at least three best practices that family medicine residencies are using to increase the number of active, full-time practicing primary care physicians in the United States.

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