VA Department of Veterans Affairs: Office of Academic Affiliation, 2016
A primer to curricular activities and strategies that can lead to the advancement of interprofess... more A primer to curricular activities and strategies that can lead to the advancement of interprofessional Veteran and person centered care in clinical workplace education programs
Journal of Interprofessional Education & Practice
Abstract Health professions trainees often provide one another with support and performance-relat... more Abstract Health professions trainees often provide one another with support and performance-related feedback, but seldom receive formal training on how to provide such support and feedback in an interprofessional setting. Peer coaching is a promising format of professional development and training that enhances non-competitive relationships among peers to provide support and improve task performance through goal-setting, direct observations, self-evaluation, and coach feedback. The Peer Coaching Curriculum was developed in an interprofessional academic primary care clinic and implemented among two cohorts of internal medicine residents and nurse practitioner trainees over the course of an academic year. Four learning objectives included: 1) practicing a collaborative communication style using motivational interviewing strategies, 2) performing direct observations of patient encounters by peer coaches, 3) applying collaborative communication elements to the delivery of feedback based on clinic observations, and 4) determining if participants’ self-reflection and insight were enhanced by engaging in this curriculum. The curriculum was delivered jointly by a health psychology postdoctoral fellow and a chief medical resident. Curricular interventions included brief didactic sessions and small group skills practice in a classroom setting followed by direct clinical observations and feedback in the primary care clinic. Participants were assessed using two questionnaires, the Self Reflection and Insight Scale and the Peer Coaching Inventory, and by behavioral counts of motivational interviewing strategies employed during a simulated skills demonstration. The majority of designated peer coaches successfully demonstrated the use of motivational interviewing strategies. Over the course of the sessions, participants demonstrated an increased understanding of peer coaching and an enhanced level of insight into the thought processes of themselves and others, suggesting that this curriculum inculcated important skills in an interprofessional learning environment. Descriptions of key curricular activities, a facilitator guide, and evaluation questionnaires are provided that may be adapted for other practice settings.
Teaching residents to practice independently is a core objective of graduate medical education (G... more Teaching residents to practice independently is a core objective of graduate medical education (GME). However, billing rules established by the Centers for Medicare and Medicaid Services (CMS) require that teaching physicians physically be present in the examination room for the care they bill, unless the training program qualifies for the Primary Care Exception Rule (PCER). Teaching physicians in programs that use this exception can bill for indirectly supervised ambulatory care once the resident who provides that care has completed six months of training. However, CMS does not mandate that programs assess or attest to residents’ clinical competence before using this rule. By requiring this six-month probationary period, the implication is that residents are adequately prepared for indirectly supervised practice by this time. As residents’ skill development varies, this may or may not be true. The PCER makes no attempt to delineate how residents’ competence should be assessed, nor ...
We created a tool to improve communication among health professional trainees in the ambulatory s... more We created a tool to improve communication among health professional trainees in the ambulatory setting. The tool was devised to both inform practice partner teams about high-risk patients and assign patient follow-up issues to team members. Team members were internal medicine residents and nurse practitioner fellows in the VA Connecticut Healthcare System Center of Excellence in Primary Care Education (CoEPCE), an interprofessional training model in primary care. We used a combination of Likert scale response questions and open ended questions to evaluate trainee attitudes before and after the implementation of the tool, as well as solicited feedback to improve the tool. After using the primary care sign out tool, trainees expressed greater confidence that they could identify high-risk patients that had been cared for by other trainees and that important patient care issues would be followed up by others when they were not in clinic. In terms of areas for improvement, respondents w...
Abstract The Institute of Medicine recommended the implementation of nurse practitioner transitio... more Abstract The Institute of Medicine recommended the implementation of nurse practitioner transition-to-practice programs, either called residency or fellowship, for new graduates. These programs are rapidly expanding on the national level in a variety of practice areas. However, there is a lack of literature on the effectiveness of these programs. The Veterans Affairs Centers of Excellence in Primary Care Education developed a competency-based assessment tool to measure program effectiveness, document the achievement of competency, and promote standardization. This article describes the development of the tool along with curricular examples to promote nurse practitioner transition to practice.
Academic medical centers are under increasing scrutiny to provide both timely, high-quality prima... more Academic medical centers are under increasing scrutiny to provide both timely, high-quality primary care (PC) and health professional education. The complexity of these issues will require innovative multipronged solutions aimed at academic ambulatory PC training programs. In this issue, Serrao and Orlander describe one model that may address some of these issues: the Ambulatory Diagnostic and Treatment Center (ADTC) in the Veterans Affairs Boston Healthcare System. The ADTC model offers primary care providers (PCPs) the opportunity to refer an especially complex patient to a team of PC faculty and trainees who are not familiar with the patient but who have more time and resources to dedicate to her or his care. The ADTC is one model that may mitigate some of the tension between patient care and education in PC settings. Another model is the West Haven Veterans Affairs Center of Excellence in Primary Care Education program, in which interprofessional teams of faculty and trainees ar...
The use of herbal products has been studied in the general population, but few studies have focus... more The use of herbal products has been studied in the general population, but few studies have focused on the prevalence of herbal therapy use for treatment of symptoms or disease among female internal medicine patients or on predictors for delaying obtaining conventional care while using herbal therapy. Cross-sectional 34-item self-report surveys were mailed to female patients in two private practice internal medicine sites and interviewer administered to patients in a resident ambulatory clinic. The survey included sociodemographics, medical problems, use of herbal therapies, and whether conventional care was delayed while using herbal therapy. Of 354 patients, 220 (62%) participated. Their mean age was 51 years, and most were Caucasian (77%) and had more than a high school education (60%). Of these, 81 (37%) women used herbal therapies for treatment of symptoms or disease, and use did not differ by study site. Twenty-six (32%) delayed obtaining conventional care while waiting for an...
Background Education in health policy and advocacy is recognized as an important component of hea... more Background Education in health policy and advocacy is recognized as an important component of health professional training. To date, curricula have only been assessed at the medical school level. Objective We sought to address the gap in these curricula for residents and other health professionals in primary care. Innovation We created a health policy and advocacy curriculum for the VA Connecticut Healthcare System, Center of Excellence in Primary Care Education, an interprofessional, ambulatory-based, training program that includes internal medicine residents, nurse practitioner fellows, health psychology fellows, and pharmacy residents. The policy module focuses on health care finance and delivery, and the advocacy module emphasizes negotiation skills and opinion-based writing. Trainee attitudes were surveyed before and after the course, and using the Wilcoxon signed rank test, relative change was determined. Knowledge acquisition was evaluated with precourse and postcourse examin...
VA Department of Veterans Affairs: Office of Academic Affiliation, 2016
A primer to curricular activities and strategies that can lead to the advancement of interprofess... more A primer to curricular activities and strategies that can lead to the advancement of interprofessional Veteran and person centered care in clinical workplace education programs
Journal of Interprofessional Education & Practice
Abstract Health professions trainees often provide one another with support and performance-relat... more Abstract Health professions trainees often provide one another with support and performance-related feedback, but seldom receive formal training on how to provide such support and feedback in an interprofessional setting. Peer coaching is a promising format of professional development and training that enhances non-competitive relationships among peers to provide support and improve task performance through goal-setting, direct observations, self-evaluation, and coach feedback. The Peer Coaching Curriculum was developed in an interprofessional academic primary care clinic and implemented among two cohorts of internal medicine residents and nurse practitioner trainees over the course of an academic year. Four learning objectives included: 1) practicing a collaborative communication style using motivational interviewing strategies, 2) performing direct observations of patient encounters by peer coaches, 3) applying collaborative communication elements to the delivery of feedback based on clinic observations, and 4) determining if participants’ self-reflection and insight were enhanced by engaging in this curriculum. The curriculum was delivered jointly by a health psychology postdoctoral fellow and a chief medical resident. Curricular interventions included brief didactic sessions and small group skills practice in a classroom setting followed by direct clinical observations and feedback in the primary care clinic. Participants were assessed using two questionnaires, the Self Reflection and Insight Scale and the Peer Coaching Inventory, and by behavioral counts of motivational interviewing strategies employed during a simulated skills demonstration. The majority of designated peer coaches successfully demonstrated the use of motivational interviewing strategies. Over the course of the sessions, participants demonstrated an increased understanding of peer coaching and an enhanced level of insight into the thought processes of themselves and others, suggesting that this curriculum inculcated important skills in an interprofessional learning environment. Descriptions of key curricular activities, a facilitator guide, and evaluation questionnaires are provided that may be adapted for other practice settings.
Teaching residents to practice independently is a core objective of graduate medical education (G... more Teaching residents to practice independently is a core objective of graduate medical education (GME). However, billing rules established by the Centers for Medicare and Medicaid Services (CMS) require that teaching physicians physically be present in the examination room for the care they bill, unless the training program qualifies for the Primary Care Exception Rule (PCER). Teaching physicians in programs that use this exception can bill for indirectly supervised ambulatory care once the resident who provides that care has completed six months of training. However, CMS does not mandate that programs assess or attest to residents’ clinical competence before using this rule. By requiring this six-month probationary period, the implication is that residents are adequately prepared for indirectly supervised practice by this time. As residents’ skill development varies, this may or may not be true. The PCER makes no attempt to delineate how residents’ competence should be assessed, nor ...
We created a tool to improve communication among health professional trainees in the ambulatory s... more We created a tool to improve communication among health professional trainees in the ambulatory setting. The tool was devised to both inform practice partner teams about high-risk patients and assign patient follow-up issues to team members. Team members were internal medicine residents and nurse practitioner fellows in the VA Connecticut Healthcare System Center of Excellence in Primary Care Education (CoEPCE), an interprofessional training model in primary care. We used a combination of Likert scale response questions and open ended questions to evaluate trainee attitudes before and after the implementation of the tool, as well as solicited feedback to improve the tool. After using the primary care sign out tool, trainees expressed greater confidence that they could identify high-risk patients that had been cared for by other trainees and that important patient care issues would be followed up by others when they were not in clinic. In terms of areas for improvement, respondents w...
Abstract The Institute of Medicine recommended the implementation of nurse practitioner transitio... more Abstract The Institute of Medicine recommended the implementation of nurse practitioner transition-to-practice programs, either called residency or fellowship, for new graduates. These programs are rapidly expanding on the national level in a variety of practice areas. However, there is a lack of literature on the effectiveness of these programs. The Veterans Affairs Centers of Excellence in Primary Care Education developed a competency-based assessment tool to measure program effectiveness, document the achievement of competency, and promote standardization. This article describes the development of the tool along with curricular examples to promote nurse practitioner transition to practice.
Academic medical centers are under increasing scrutiny to provide both timely, high-quality prima... more Academic medical centers are under increasing scrutiny to provide both timely, high-quality primary care (PC) and health professional education. The complexity of these issues will require innovative multipronged solutions aimed at academic ambulatory PC training programs. In this issue, Serrao and Orlander describe one model that may address some of these issues: the Ambulatory Diagnostic and Treatment Center (ADTC) in the Veterans Affairs Boston Healthcare System. The ADTC model offers primary care providers (PCPs) the opportunity to refer an especially complex patient to a team of PC faculty and trainees who are not familiar with the patient but who have more time and resources to dedicate to her or his care. The ADTC is one model that may mitigate some of the tension between patient care and education in PC settings. Another model is the West Haven Veterans Affairs Center of Excellence in Primary Care Education program, in which interprofessional teams of faculty and trainees ar...
The use of herbal products has been studied in the general population, but few studies have focus... more The use of herbal products has been studied in the general population, but few studies have focused on the prevalence of herbal therapy use for treatment of symptoms or disease among female internal medicine patients or on predictors for delaying obtaining conventional care while using herbal therapy. Cross-sectional 34-item self-report surveys were mailed to female patients in two private practice internal medicine sites and interviewer administered to patients in a resident ambulatory clinic. The survey included sociodemographics, medical problems, use of herbal therapies, and whether conventional care was delayed while using herbal therapy. Of 354 patients, 220 (62%) participated. Their mean age was 51 years, and most were Caucasian (77%) and had more than a high school education (60%). Of these, 81 (37%) women used herbal therapies for treatment of symptoms or disease, and use did not differ by study site. Twenty-six (32%) delayed obtaining conventional care while waiting for an...
Background Education in health policy and advocacy is recognized as an important component of hea... more Background Education in health policy and advocacy is recognized as an important component of health professional training. To date, curricula have only been assessed at the medical school level. Objective We sought to address the gap in these curricula for residents and other health professionals in primary care. Innovation We created a health policy and advocacy curriculum for the VA Connecticut Healthcare System, Center of Excellence in Primary Care Education, an interprofessional, ambulatory-based, training program that includes internal medicine residents, nurse practitioner fellows, health psychology fellows, and pharmacy residents. The policy module focuses on health care finance and delivery, and the advocacy module emphasizes negotiation skills and opinion-based writing. Trainee attitudes were surveyed before and after the course, and using the Wilcoxon signed rank test, relative change was determined. Knowledge acquisition was evaluated with precourse and postcourse examin...
To integrate health care professional learners into patient-centered primary care delivery models... more To integrate health care professional learners into patient-centered primary care delivery models, the Department of Veterans Affairs has funded five Centers of Excellence in Primary Care Education (CoEPCEs). The main goal of the CoEPCEs is to develop and test innovative structural and curricular models that foster transformation of health care training from profession-specific "silos" to interprofessional, team-based educational and care delivery models in patient-centered primary care settings. CoEPCE implementation emphasizes four core curricular domains: shared decision making, sustained relationships, interprofessional collaboration, and performance improvement. The structural models allow interprofessional learners to have longitudinal learning experiences and sustained and continuous relationships with patients, faculty mentors, and peer learners. This article presents an overview of the innovative curricular models developed at each site, focusing on nurse practitioner (NP) education. Insights on transforming NP education in the practice setting and its impact on traditional NP educational models are offered. Preliminary outcomes and sustainment examples are also provided.
Uploads
Books by Rebecca Brienza
Papers by Rebecca Brienza