Welcome to the STFM Messenger Online
The STFM Messenger is the official news publication of the Society of Teachers of Family Medicine.
Each month, members with e-mail addresses on file with STFM will receive an e-mail with links to the Messenger's online stories. Members will be also be able to access the Messenger's current issue as well as its archives on the STFM Web site at www.stfm.org/Messenger.
We welcome your feedback on our member newsletter; send your ideas and comments to Traci Nolte, tnolte@stfm.org.
There's Still Time to Register for the Predoctoral Education Conference
The 2009 Predoctoral Education Conference will be held January 22–25 in Savannah, Ga. This year’s theme, “Celebrating Our Strengths: Masters of Complexity and Continuity,” will be highlighted by plenary speakers Beth Landon, MBA, MHA; John Rogers, MD, MPH, MEd; and Michael Parchman, MD.
This year’s conference will include special preconference opportunities for additional learning, including “Facing Down Our Demons: A 1-day Writing Workshop for Family Medicine Faculty” and “A Day for Students and Faculty to Celebrate and Strengthen Our National Network of Student-run Free Clinics.”
The complete conference brochure and registration information is available at www.stfm.org/PreDocConf/pd09/.
The conference hotel (Savannah Marriott Riverfront Hotel) is sold out. For assistance with hotel reservations, contact “A Room With A View” at 800-780-4343 for accommodations within walking distance of the conference hotel. This is a free service for all STFM conference attendees.
Attend the Predoctoral Directors Development Institute Just Prior to the Predoctoral Education Conference in Savannah
Consider recommending the 2009 Predoctoral Directors Development Institute (PDDI) if you know of someone who would benefit from this Institute. Following a second successful year, the PDDI Steering Committee is already planning and updating the curriculum for 2009 based on evaluations and comments from the 2008 fellows. The PDDI is a comprehensive educational program designed to give new and aspiring predoctoral directors the skills they need to be successful in the role of predoctoral director.
The 2009 Institute will include two preconference workshops, plus educational tracks at the conference and an individualized project for participants. The PDDI dates to mark for 2009 are:
• January 22, prior to the 2009 STFM Predoctoral Education Conference in Savannah, Ga
• April 29, prior to the 2009 STFM Annual Spring Conference in Denver
Register for PDDI 2009 at www.stfm.org/predocinstitute/index.htm. If you would like more information, contact PDDI Steering Committee Chair Katie Margo at kmargo@mindspring.com.
EDUCATIONAL EXCELLENCE WITHIN THE PATIENT-CENTERED MEDICAL HOME—PERSPECTIVES FROM THE STFM BOARD
Providing the Evidence Necessary to Fully Implement the Patient-centered Medical Home
The concept of the patient-centered medical home (PCMH) has been embraced by the major US primary care organizations and has now been endorsed by the American Medical Association. The PCMH model is seen as a promising path toward invigorating primary care, partly because of the intent to reform the reimbursement system. One of the major principles of the PCMH is that medical home providers should be paid not only for office visits but also for ongoing management of care for their patients, much of which requires work outside of office visits.
The PCMH model is also attracting the attention of payers and policy makers. For these groups, the PCMH is seen as a way to improve quality of care while managing health care costs. However, before policy makers fully embrace this model and payers broadly implement a new reimbursment system, they need evidence that the improved quality and cost savings from care coordination and chronic disease management will offset the increased expenditures required by this new model of care. While much of this evidence already exists in the primary care literature and health services research literature, there are still gaps in the evidence, and most of the existing evidence is not available in the summarized and easily translatable format that payers and policy makers need.
To help provide this evidence, STFM is working with the Society of General Internal Medicine (SGIM) and the Academic Pediatrics Association (APA) to organize a national invitational conference around the PCMH. This conference will convene national researchers, major primary care professional organizations, health care purchasers, payers, patient advocates, and policy makers. The objectives of the conference are (1) to inform and advance the state of the art and science and real-world experience about the PCMH, (2) to develop partnerships and build capacity to implement a practical evaluation model that can be used by health plans, government payers, and policy makers to assess components of the PCMH and alternative models, (3) to develop and recommend a research agenda to inform the development and broad implementation of the PCMH model, and (4) to disseminate the synthesis of the conference via the peer-reviewed literature, the Web, and presentations at relevant national health policy and professional association meetings.
The conference is being planned for June of 2009, with a steering committee that includes representatives from the primary care organizations and other stakeholders. STFM members on the steering committee include James Gill, MD, MPH; Robert Phillips, MD, MSPH; Kevin Grumbach, MD; Michael Parchman, MD; Warren Newton, MD, MPH; and Allen Dobson, MD. In preparation for the conference, “white papers” are being commissioned and written around the major themes of the conference. These themes include (1) practice transformation, (2) measuring and operationalizing the PCMH, (3) payment reform, (4) financing the PCMH from the payer perspective, (5) clinical, satisfaction, and quality of care outcomes of the PCMH, (6) the value of a physician-led medical home, and (7) manpower issues and training requirements. The initial draft of these papers will form the basis for sessions at the conference, and the content of the discussions will be used to revise the papers before being submitted for publication and dissemination.
The steering group convened a meeting of evaluators of PCMH demonstration projects (including TransforMED) on December 2, 2008, in Philadelphia. The participants in this meeting will also be invited to participate in the main conference in June.
The conference is being funded by the Commonwealth Fund and the American Board of Internal Medicine Foundation, with pending funding from the Agency for Health Care Research and Quality.
Questions about this project can be directed to the co-leader from STFM, James Gill, MD, MPH (gillj@dvoresearch.com).
This section focuses on “Moments in STFM History,” gleaned from the collections of the Center for the History of Family Medicine. Housed at AAFP headquarters and administered by the AAFP Foundation, the Center serves as the principal resource center for the collection, conservation, exhibition, and study of materials relating to the history of family medicine in the United States. For more information on the Center, or if you have any questions, comments, or suggestions for this feature, contact Center staff at 800-274-2237 (ext. 4420 or 4422), fax: 913-906-6095, or chfm@aafp.org.
10 Years Ago
The December 1998 STFM Messenger announced that PEP2 (Preceptor Education Project, Second Edition) materials would become available in February 1999. A discount of 50% off the original PEP materials (published in 1992) was being offered.
20 Years Ago
At its January 29, 1989, meeting in St. Petersburg Beach, Fla, the STFM Board of Directors approved the compilation of a census of family practice faculty in departments and residency programs. The census was intended to help boost STFM membership by comparing the census results to STFM membership listings.
30 Years Ago
In January 1979, Family Medicine Teacher debuted. This publication was the successor to Family Medicine Times, STFM’s official publication from 1969–1978. Lynn Carmichael, MD, was named academic editor of Family Medicine Teacher, while Maureen Murphy continued as managing editor. (Alas, Family Medicine Teacher lasted only 2 years, when it was succeeded by the STFM Newsletter.)
If any STFM member happens to have an original copy of the January 1979 issue of Family Medicine Teacher, please consider donating it to the Center for the History of Family Medicine. The only existing copy in our collections is a photocopy.
40 Years Ago
The first newsletter of the Society, Family Medicine Times, reported in its first issue (published circa June 1969) on the approval of a board of family practice, with this headline: “Family Medicine Becomes Living, Viable Specialty.” The editor, Silas Grant, quoted Ward Darley on this occasion: “While it may appear we have come to the end of a long and tortuous road, it is really only the beginning. The philosophy and concepts of comprehensive health care must be turned into action. The hard work has just started.” Following this milestone, the development of family medicine residencies exploded.
| University of Miami 1968–1969 |
| University of Rochester 1969–1970 |
The photos depict two (University of Miami [top photo] and the University of Rochester [bottom photo]) of the first 15 residencies approved in the original application for a certifying board in family practice.
January Is National Mentoring Month! Send Us Your Story for the “Future Family Docs” Project
STFM members have been busy working and teaching in 2008. We know many of you have stayed involved in working with students before medical school to help them find their way into family medicine. We need you to take a few moments at the beginning of this new year and jot down your latest inspiring story or a funny story about your work with young people to help them find their way into a career into family medicine. Maybe you just hosted a college student this past summer and learned how she or he is doing this year in their pre-med courses. Or perhaps your residency program sponsored a special "camp" for high school students to learn about health careers in your practice. Go ahead and write a paragraph on your mentoring story, or encourage one of those students to write their story about their experience, and send it in so we can post it on our www.FutureFamilyDocs.org Web site. (It will look great on those premedical school applications.)
Gear up in January 2009, which is National Mentoring Month! Check out the latest information on the national movement of mentoring by going directly to the Web site at www.nationalmentoring.org. This month is sponsored by the Corporation for National and Community Service, the Harvard School of Public Health, and MENTOR. You may find some of the materials useful for your work with schools and clubs. Send your residents to the site to do a little looking around. There are public service announcements, posters, bookmarks, and 10 ideas to get involved with mentoring that may be useful people links to your local activities.
Find out about President-elect Obama’s support for mentoring at their home Web site at www.Mentoring.org, where you can find more resources, such as a good literature base to guide your project design and evaluation or help you with that bibliography for a grant proposal. So, while you are thinking about it, start putting YOUR story down and send it to Janice Benson, MD, at Jben267@aol.com.
Role of Student-run Free Clinic Projects in Teaching Medical Students to Work With the Underserved
Premises
There is a line in America of people waiting for health care 47 million long and growing. According to the Surgeon General, for dental care, the line is 108 million people long.
Medical education should help students remain inspired to work with underserved communities and learn a humanistic empowerment transdisciplinary philosophy of health care. Effective teaching methods are needed for practice management, continuity of care, and teaching skills.
How Student-run Free Clinic Projects Can Address These Issues
Student-run free clinic projects exist all over the country, from the Sojourner Clinic in Kansas City to the HOME clinic in Hawaii, to La Casita del Salud in New York, and the long-standing Clinic Tepati in Davis, Calif. At the University of Southern California, San Diego (UCSD) Student-run Free Clinic Project,1 we started small, in one site, one night a week, in partnership with a community program. Now, 11 years later, we are in three sites, somewhere in the city each day of the week, and provide comprehensive outpatient health care to more than 1,000 medical patients, 85% of whom have chronic illnesses, and to an additional 1,000 patients who receive dental, acupuncture, legal, and/or social services. Our professional partnerships include pharmacy, acupuncture, dentistry, social work, and law and many outpatient specialty services. In our Fellowship in Underserved Health Care, of our first six fellows, five were former free clinic leaders who returned after family medicine residency to be our fellows. Our fellowship now includes dentistry, pharmacy, integrative medicine, and mental health.
What Are Some of the Successes?
Students learn not only a humanistic empowerment model but about health care management. Under supervision, they apply for medical waste-hauling waivers, organize county inspections, order lab tests, worry about the cost of diabetes test strips, and practice health promotion. They learn continuity of care, patient advocacy, how to practice in a transdisciplinary model, and that the community is their teacher. In a microcosm of a health care system, they measure outcomes, maintain a clinical database, create systems to minimize errors, and utilize patient assistance programs.
We pair third- and fourth-year students, who function as clinical coaches, with first- and second-year students. Our fourth-year clerkship in underserved medicine, in which students learn to be teachers and clinical coaches, has become very popular.
Learnings and Caveats
All care must be directly supervised by salaried or voluntary faculty. Our patients are those who do not qualify for government programs and cannot afford to purchase health care. Ethical issues about student-run free clinic projects have been raised, but, if patients would otherwise have no access to care, if continuous high-quality care is offered, if direct supervision is provided, and if community resources are utilized, these ethical issues can be addressed.
We recommend a curriculum students complete to work at the clinic project, in which they learn knowledge, skills, and philosophy and develop reflective practice. It is important to ensure effective transition from one group of students to the next; to maintain and update policies and procedures; to teach community, team building, and leadership; and to help the student see that the patient comes first.
The obligation of any student-run free clinic project is to provide the best high-quality care possible within the limits of the system for those who don’t qualify for other programs. Implicit within the term underserved is a right to health care. In a city without a county hospital, our greatest need at the UCSD Project is when a patient needs a nonemergent, yet important, inpatient treatment or surgery.
What Is Our Role as Faculty in Family Medicine?
Core institutional funding is essential to the effective implementation and growth of these programs. A faculty director funded to ensure legal, safe, and supervised practice; implement the curricular components; liaise with the institution; ensure risk management, affiliation agreements, and liability structures; and provide continuity is essential to the long-term success of student-run free clinic projects. Medical schools benefit from the visibility of the program as a powerful aid in recruitment.
Vision for the Future
Much has been written about the pre-professional school pipeline. We must pay equal attention to the pipeline after entering health professional training to create a workforce committed to care for the underserved. Student-run free clinics, residency training programs focusing on care of the underserved such as the Scripps Chula Vista Family Medicine Residency near the border with Mexico, post-residency long-term fellowships in underserved health care, and faculty development programs such as ours, Addressing the Health Needs of the Underserved,2 must provide the skills, knowledge, and the support of like-minded colleagues to create role models and leaders in underserved health care.
Family physicians are uniquely positioned to be leaders in underserved health care. In these times, the need for these programs is increasing, at the same time that funding is drying up. Policy efforts must include addressing HRSA’s recent decision to not have a 2009 health professions new grant cycle. We must ensure that clinical underserved settings, such as community health centers, support both the uninsured patient and the family physician. Legislation for coverage to physicians providing free care, as in Georgia and Florida, must be established. Of course, many of us dream of an effective humanistic single payor health care system, but in the meantime, student-run free clinic projects provide meaningful venues in which students learn to take ownership and pride in the provision of high-quality health care to persons on the 47-million people waiting list.
Next Steps and Upcoming Meetings
• A student free clinic organization, organized by students across the country, is starting to share communication and best practices among projects nationally.
• January 22, 2009. Preconference Day on Student-run Free Clinic Projects prior to the STFM Predoctoral Education Conference, Savannah, Ga.
• March 27–29, 2009. Conference on Student-run Free Clinic Projects, organized by students and faculty of the UNMC-SHARING clinic, Omaha, Neb.
References
1. Beck E. The UCSD Student-run Free Clinic Project: transdisciplinary health professional education. J Health Care Poor Underserved 2005;16(2):207-19.
2. Beck E, Wingard D, Zúñiga ML, Heifetz R, Gilbreath S. Addressing the health needs of the underserved: a national faculty development program. Acad Med 2008;83(11):1094-102.
Make Plans Now to Attend the 2009 Annual Spring Conference
The STFM Program and Communications departments are working on the production of the advance brochure for the 42nd Annual Spring Conference, which will be held April 29–May 3 in mile-high Denver!
Plenary speakers for the 2009 conference are Jeannette South-Paul, MD; Frank deGruy, MD; Sandra Burge, PhD; and John Wennberg, MD, MPH.
The conference will also offer a variety of preconference activities on Wednesday, April 29.
For more complete details about these and other presentations, or to register and make hotel reservations, visit www.stfm.org/AnnualConf/an09/. Brochures will be mailed to all STFM members in late January.
Do You Have an Open Position to Fill? Consider STFM’s Positions and Opportunities Book
STFM will publish its annual Positions and Opportunities Book for distribution with conference materials at the Annual Spring Conference April 29–May 3, 2009, in Denver. This publication will be a valuable, organized reference to current opportunities in family medicine education.
Programs and institutions with positions available should submit copy to Family Medicine Classifieds, c/o Russell Johns Associates, PO Box 1510, Clearwater, FL 33757-1510. E-mail: familymedicine@medical-admart.com. 800-237-7027. Fax: 727-445-9380. When you send in your ad, be sure to note that the ad is being submitted for the STFM Positions and Opportunities Book.
Increase your ad exposure and take advantage of our special combination pricing. For more information on placing your ad, contact Susan Deakins, Russell Johns Associates, at 800-237-7027. Overnight delivery: 1001 S. Myrtle Avenue, Suite 7, Clearwater, FL 33756-3930.
Click here to see full pricing information for the Spring 2009 Positions and Opportunities Book.
Conference on Practice Improvement 2009 Call for Submissions
The 2009 Conference on Practice Improvement, “Constructing the Medical Home,” will be held November 5–8 in Kansas City, Mo. You can submit online at www.stfm.org/stfmpresenter/submission/start.cfm?confid=162. The deadline for submissions is March 9, 2009.
STFM Conference Calendar
Predoctoral Education Conference—January 22–25, 2009, Savannah, Ga
Predoctoral Directors Development Institute—January 22, 2009, at the Predoctoral Education Conference and April 29, 2009, at the Annual Spring Conference in Denver
Annual Spring Conference—April 29–May 3, 2009, Denver
In Memoriam
STFM sadly reports the death of longtime STFM member Thomas P. Owens, MD, Universidad de Panamá (FM-UP), Panama City, Panama. He started a professorship in Anatomical Sciences at FM-UP and his general practice at the Policlínica Presidente Remón, Caja de Seguro Social (CSS) until his retirement in 2005. He also held his own private practice Clínica Owens, in the inner city, where he practiced until his untimely passing.
Dr Owens was appointed chief of the General Practice Service of the republic of Panama in 1969 and remained in that position until 1989. He successfully negotiated the formation of the Department of Family Medicine at FM-UP. He created the academic basis of the discipline in his native Panama and through his kinship with the world luminaries of the specialty, pushed forward an agenda of excellence in primary care throughout the world. He was a founding member and third president of the International Center for Family Medicine and an active participant in the AAFP, STFM, and Wonca through 4 decades. In 2005, he was declared the Father of Family Medicine in Panama by the national schools of medicine.
Known as a man of honor and unquestionable integrity, Tommy was a great man by any measure, yet humble and kind, moving with ease between high-level meetings and the care of the least privileged, who truly adored him and deeply respected him. For those who knew him, he will never be forgotten: the affable smile, the loyal friendship, the beautiful mind. There was no greater friend of family medicine.
Dr Owens´ widow, Cris, and family can be reached at owensaad@pa.inter.net and by mail at Dra. Criseida Saad de Owens, Apartado 0816- 00893, Panama, República de PANAMA.
New Members
| California Nathan Carlson, MD Romeo Castillo, MD Kerri Frank, MD Gabriel Lopez, MD |
New Jersey Elizabeth Koorie Justin Wright, MD |
| Colorado Jeff Powell, MD, MPH |
New Mexico Douglas Zang, MD |
| Connecticut Kelly Hookstadt Jessica Johnson Kathleen Nurena, MD |
New York Irina Erlikh, MD |
| District of Columbia Iman Xierali, PhD |
Ohio Amardeep Athwal, MD Lisa Casey, DO |
| Georgia Michael Fite, MD |
Oregon Scott Sallay, MD |
| Hawaii Jerry Allison, MD Kay Eagar, LCSW, MSW |
Pennsylvania James McGeary, MD Jeannine Weimar-Fitzpatrick, MD |
| Illinois Marcia Hugen, MD Roxanne Smith |
Rhode Island Kimberly Zeller, MD |
| Indiana Taihung Duong, PhD |
South Carolina Joseph Benich III, MD |
| Maine Tyler Raymond |
Texas David Wright, MD |
| Massachusetts Carlos Cappas Karen Kelly, MD |
Virginia Russell Hendershot, DO, MS |
| Michigan John Coumbe-Lilley, PhD Ewa Matuszewski |
West Virginia Kathleen Bors, MD |
| Missouri Henry Pelto |
Wisconsin Casey Gallimore |
| Nevada Scott Wiltz, MD, MPH |
Canada Frances Kilbertus, MD |
| New Hampshire Leslie Fall, MD Phenton Travis Harker, MD, MPH |