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Innovative Initiatives in Intellectual &
Developmental Medicine
orCollaborative
Development of an “Orphan Curriculum”
My goals for today
The participant will be able to provide an overview of U.S. efforts to incorporate developmental disorders and intellectual disabilities into medical training.
The participant will be able to list details of the proposed curriculum content for medical residency training developed by the NCIDM.
The participant will be able to discuss strategies, mechanisms and incentives to pilot the proposed curriculum at select primary care residency programs.
An Orphan Curriculum?
The Society of Teachers of Family Medicine has approx. 48 “Groups on” – interest groups who promote a specific curriculum in FM training
Abortion Training
Addiction Medicine
Adolescent Health Care
Evidence Based Medicine
Genetics
Global Health
HIV/AIDS
Integrative Medicine
LGBT Health
Minority & Multicultural Health
Musculoskeletal/Sports Medicine
Nutrition Education
Oral Health
Pain and Palliative Medicine
Rural Health
Spirituality
Violence Education
What do these curricula have in common?
They have no specific “time” in the residency curriculum
They have no specific specialty organization that has stressed the importance of the curriculum time
Although most primary care educators would agree these topics are important – the requirements for teaching these topics are vague and weak
There are no large business or pharmaceutical organizations promoting CME around these topics – so no free lunches
The NCID Curriculum – and unlikely Partnering of Organizations-- not the usual suspects
American Academy of Developmental Medicine and Dentistry (AADMD)
Health Education Center (M-AHEC) Mini-fellowship in Adult Developmental Medicine
Family Medicine Educational Consortium (FMEC)
AADMD American Academy of Developmental Medicine and Dentistry
Founded 2002: “to improve the health of individuals with intellectual disabilities and nerurodevlopmental disorders (ID/ND) through patient care, teaching, research and and advocacy
--interdisciplinary network for clinicians
--advocacy for health care system change to create improved access and quality
--”disseminate specialized information to families”
Curricular Assessment of Needs CAN Project – AADMD 2005
1. Medical School graduates not competent to treat ID population (Deans 52%, Students 56%)
2. Residency graduates not competent - (Directors 32%)
3. Clinical training in ID not a high priority - (Deans, 58%)
4. Most students don’t receive any clinical experience - (Students, 81%)
5. Most residency programs are not providing clinical training - (Directors, 77%)
6. 80% of medical students and 90% of residents reported less than 1 hour of training in the care of patients with ID/DD.
CAN ReportThe good news
1. Students were interested in treating patients with ID as part of their career - (Students, 74%)
2. Deans said that students should receive significant clinical experience patients with ID - (Deans, 67%)
3. Programs are interested in implementing a curriculum regarding ID - (Deans 100%, Directors 90%)
Mountain Area Health Educational Center-- Mini-fellowship
1. 1st year - literature review, statewide surveys, focus groups, CME programs (Jurczyk)
2. 2nd year – Content development / no established model / many questions, no clear answers
3. 3rd year – initial cohort of 8 physicians
Mini – fellowship began in 2004 funded by North Carolina Council on Developmental Disabilities
MAHEC Mini - fellowship What we learned
1. Good people and innovative programs across the country devoted to this population
2. Strong desire for sense of community, shared vision, purpose, and training
3. Despite growing consensus in understanding the vast needs – no mandate to take action
4. Overarching recognition of need for educational models to train physicians
Family Medicine Educational Consortium
1. Affiliated with Northeast Region Society Teachers Family Medicine (STFM)
2. Mission: To build strategic relationships that transform medical education and health systems
3. 14 states / 130 Residency programs / 50 Departments FM / 350 faculty & residents/practice groups/FQHCs
4. Promote medical student interest, stimulate faculty recruitment / development, and leadership skills
FMEC Developmental Disabilities Collaborative Project -
1. Mission: Support availability and quality of medical care for people with DD
2. Collaborate with interested external organizations
3. Link to Future of Family Medicine Report – redesign care for patients with ID/DD into ‘medical homes’
4. Create relationships with community/service/ advocacy organizations
5. Explore curricular models to improve training
Medical Homes for People with Intellectual/Developmental Disabilities - FMEC
1. DD Collaborative pre-conference at the annual meeting since 2003 - funding from multiple sources – AHRQ, programs
Initially focused on issues in clinical care
2. Recurring themes: lack of information about I/DD medical issues, lack of training for physicians
3. Recognition of scattered “champions” for this population
National Curriculum Initiative in Developmental
Medicine
FMEC Pre-conferenceOctober 28, 2010
Acknowledgements – Support Provided by
The Walmart Foundation -
AADMD
The North Carolina Council
on Developmental Disabilities
Where Do We Go From Here?
Family Medicine Education in the Care of Patients with
Intellectual Disabilities in the U.S. -
Caryl J Heaton, D.O.New Jersey Medical School – UMDNJ
IASSID Bethesda, MD May 25, 2011
What has worked before?
• Stealth Curriculum
• Fellowships? • Geriatrics, Sports
Medicine, Adolescent Medicine
• Infiltrate leadership of organizations
• National curriculum vetted by all• Easily accessible
tools
• Free or cheap CME for practicing physicians
• Mandated requirements
Lessons Learned From International Initiatives
Clinical Support Networks Before curriculum
Tools Before curriculum
Program Status from Colleges (Academies)
Teaching through experience with patients is key
Trans-disciplinary training is ideal
So where is the innovation?
Three Tiers of a Curriculum for People with Intellectual
Disabilities
How would a tiered curriculum work?
Core Tier Should be basic and so straightforward that any
reasonable residency director would say – of course we should do that
More likely they will say “of course we already do that” – but wonder if they really do?
Advanced Tier Should be an expected goal for each residency and
residency graduate
Exemplary Tier Should be a level that suggests a graduate could be
prepared to take responsibility for a large number complicated patients
Should be recognized as a center of excellence
Immediate goal wouldfor every residency to teach and support core competencies….
Breakfast of
CHAMPIONS!
We need champions at each level:
Click icon to add picture
Student
Resident
Faculty
Residency
University and
StudentResident/Residency
DepartmentalUniversity
AssociationState
Federal level
Family Medicine Education in the Care of Patients with Intellectual Disabilities in the U.S.
Phase 1
Recognize the excellent work that has been done internationally and incorporate it to….
Create an excellent curriculum document Create tools, methodology and evaluation to
support the curriculum – match to objectives Must have face validity Establish curriculum “tiers”
Create a repository of all curricular materials Don’t reinvent the curriculum wheel
Residency Faculty as the unit of intervention
Three Tiers of a Curriculu
m for People with
Intellectual
Disabilities
Family Medicine Education in the Care of Patients with Intellectual Disabilities in the U.S.
Phase 2
Create a support network – Family Medicine Education Consortium National network “partners” – NC, FL and CA Connect with university department champions
Recognize “Advanced” and “Exemplary” residencies
Recognize Residency faculty champions Connect residency faculty in some meaningful way
Move the curriculum through organized family medicine
Family Medicine Education in the Care of Patients with Intellectual Disabilities in the U.S.
Phase 3
Create advocacy support for residency and residency faculty champions network Link patient self-advocates to network and
individual residencies
Develop policy and funding initiatives HRSA priority for patients with ID/DD Search out other funding partners
Accountable Care Organizations – Virtual ACO
FMEC Champions Project – NCIDPreconference Oct. 20, 2011 Danvers MA
• Skills Building• OSCE (Objective Structured Clinical
Evaluation) Development• Evaluation of Video-tape Reviews
• Clinical Success Stories• Integrating NCID Curriculum into the
Residency• Cultivating Curriculum Champions• Funding Curricular Initiatives – building
partners in the Community
FMEC Champions Project – NCIDProject Goals Oct. 20, 2011 Danvers MA
• Recruit first members of “Project”• Residencies, Practice Groups, FQHC• …….One Champion
• Recruit Mentors from AADMD, MAHEC, FMEC and STFM “group on”
• Establish communication system and “learning community”• Clinical information support • Teaching support
FMEC Champions Project – NCIDProject Goals Oct. 20, 2011 Danvers MA
• Basic training in community advocacy• How do you get support in you institution
• Basic training in “institutional advocacy”• How do you get support in your institution
• Dissemination and implementation of curriculum tools – for basic skills residency • Evaluation and improvement
Continued
FMEC Champions Project – NCIDChallenges and Opportunities
• Piecing together the funding• Consider HRSA training application for
Faculty Development• Create a PBRN – pilot data, research
questions
• What if you build it and nobody comes?• Faculty or residents or both?
• Question of Fellowship or Certificate of Added Qualification Continued
Final Thoughts
• Who are the other partners for these orphans curriculum?• Medicine • Pediatrics• “organized medicine”
• How can we find more intra-discipinary partners?
• How do we sustain this effort?
Thank youCaryl J. Heaton, D.O.
Associate Professor of Family Medicine New Jersey Medical School
