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Building Future Practices with the Medical Home Model: Educating Residents

This page outlines the various residency education programs that focus on the care of CSHCN and the medical home. This includes:

The AAP Community Pediatrics Training Initiative (CPTI)
Mission: To advance the field of community pediatrics through promotion and support of residency training activities that empower future pediatricians to become leaders in improving the health of all children in their communities.

Vision: All pediatric resident graduates should have the knowledge and skills to engage in interdisciplinary collaborations, community partnerships, and the practice of evidence-based community health care to advance child health in their communities.

At the request of the Dyson Foundation, the American Academy of Pediatrics began managing the CPTI in October 2004. The AAP was tasked with providing program and financial management for 10 Dyson-funded programs and strategizing ways to sustain and expand the excellent work of this initiative to all academic residency programs.

For additional information on the Initiative, and to learn how diverse programs around the country are educating residents about community pediatrics and fostering practical community experiences, go to: www.aap.org/commpeds/CPTI

Tools from CPTI

Community-based Resident Projects Toolkit
The Community-based Resident Projects Toolkit is a guide that will assist residents in project development, evidence-based public health, asset-based community development, working with community-based organizations, cultural competency, media awareness, legislative and social advocacy, evaluating resident projects and sustainability. To learn more click here.

Community Pediatrics Curriculum
The Community Pediatrics Curriculum is a resource for pediatric residents to learn about the eight core competencies in community pediatrics. These competencies are: delivery of culturally effective care; child advocacy; medical home; special populations; pediatrician as consultant, partner, and collaborative leader; educational and child care settings; community and public health, and research and scholarship. To learn more click here.

The AAP has also developed several programs to specifically facilitate and address resident interest in community pediatrics. The AAP Resident Portal provides related policy statements, power point presentations, information on the resident education and training special interest group, the AAP Resident Section and resident related CATCH initiatives.

Journal Supplement Examines Training and Practice in Community Pediatrics
The April 2005 Pediatrics supplement, Community Pediatrics: Making Child Health at the Community Level an Integral Part of Pediatric Training and Practice, contains a collection of articles about training and practice in community pediatrics that offer specific examples of clinical practice and research. The supplement's articles and commentaries discuss epidemiologic and historic perspectives on community pediatrics; examples of successful programs and training; and an agenda and next steps for research, program, and policy change.

Kaczorowski J (ed.). Community pediatrics: Making child health at the
community level an integral part of pediatric training and practice.
Pediatrics. 115(4, Suppl.):1119-1212.

Model Programs
A survey was recently sent out to the following residency programs to provide information on the size of these programs,funding/sustainability, evaluative components, and how the program is implemented. To obtain this information, click on the orange icon next to the program name.

Families and Residents Education Experience (FREE):
"The FREE program at the University of South Carolina School of Medicine is a collaborative effort between the Department of Pediatrics and Family Connection. The program teaches pediatric residents the knowledge and skills necessary to provide family-centered, community based care for children with special needs and their families. This program is unique in that families are the teachers and the community becomes the classroom." A Case Study

For more information contact: Kathy Taylor at Family Connection of South Carolina – 1-800-578-8750 or kathytaylor@familyconnectionsc.org. Or contact Betsy Wolff, Project Coordinator for the State Medical Home Team – 1-803-782-0238 or betsywolff@aol.com.

Families-As-Teachers
The Families-As-Teachers training program is a required component of residents' Developmental Pediatric rotation at Children's Hospital and Regional Medical Center. The program gives each resident the opportunity to visit with a family in their home for 3-6 hours. Twenty families currently participate in the Families as Teachers program.

Over the years, Families-As-Teachers has been rated very positively by the residents-frequently mentioned as one of the best components of the rotation. Residents appreciate the opportunity to meet with families outside the hospital, to hear their stories, to talk candidly about the issues families have, the challenges they face, to get some practical tips to enhance their effectiveness as physicians, and to witness these families' strengths and resilience. Evaluation findings support the success of the program.

The Families-As-Teachers model has been incorporated into other health professional education program at the University of Washington.

For more information go to: www.cshcn.org/projects/familiesasteachers.cfm

Parent Partners in Health Education Program: Developing Curriculum Models in Developmental Disabilities
The goals of the program are to:

  • Strengthen graduate and medical education curricula in developmental disabilities
  • Prepare primary care physicians and other physician groups to deliver high quality care to children with disabilities and their families
  • Improve health outcomes for children with disabilities
  • Enhance satisfaction with primary care services for children with disabilities and their families

Funded by the Illinois Council on Developmental Disabilities (ICDD), this guide describes components from successful pilot programs in three Illinois residencies that focused on joining residents and parents of CSHCN as partners in such activities as home visits, school meetings, medical appointments and therapies. This is correlated with small group discussion. The curriculum is accompanied by a CD of the forms, tools and other related materials and a video. For more information or to order a free copy of the curriculum, E-mail: jrouse@rampcil.org.

The Pediatric Medical Home Project at UCLA
The David Geffen School of Medicine at UCLA and the Mattel Children’s Hospital, Los Angeles, CA
The Pediatric Medical Home Project at UCLA will implement a four-pronged initiative comprising care coordination, Resident medical education, prospective pediatric health services research and community awareness and involvement for children with special health care needs. The goal of the project is to provide a medical home for children with special health care needs in West Los Angeles now while training pediatricians to provide medical homes to their patients in the future. For more information on this project click here.

Funding is made possible through the Healthy Tomorrows Partnership for Children Grant 2003-2008.For more information on the Healthy Tomorrows Grant Program click here.For more information on this HTPCP project, please e-mail your name, address, telephone, and fax numbers with your specific request to healthyt@aap.org.

Medical Home Model Thrives at UCLA. Pediatric News. September 2004.
Access to Pediatric News Online is free, but requires registration.

Project DOCC
www.uhfnyc.org/pubs-stories3220/pubs-stories_list.htm?attrib_id=7687
Project DOCC (Delivery of Chronic Care) improves the quality of care for severely chronically ill children by educating pediatricians-in-training about their special needs from a parent's perspective.

Mission
Project DOCC's mission is to promote an understanding of the issues involved in caring for a family living with special health care needs regardless of age, diagnosis, or prognosis; to put the family at the center of the health care system.

How Project DOCC Works
Medical centers and family members form teams to implement Project DOCC. The curriculum is integrated into an existing rotation (e.g., general pediatrics or internal medicine) and is required for all residents and/or medical students during their training. Teaching videos, manuals, and slides are free. Each team must complete a two-day training workshop. Project DOCC encourages each hospital to pay a stipend to every family member who participates in teaching.

Pediatric Program
The Project DOCC curriculum is taught by parent teachers and made up of three components:

  • Grand rounds panel presentation (one hour)
  • Home visit (two hours)
  • Parent interview using the Chronic Illness History (two hours)

Project DOCC in the News
Moms, Doctors Address Communication Gap - Mothers of Chronically Ill Children Work With Doctors to Bridge Communication Gap in New York
By FRANK ELTMAN
The Associated Press
Feb. 4, 2005

For more information or to learn how to participate in Project DOCC, contact Maggie Hoffman at mhoffman@uhfnyc.org.

Resident Education Series
This four part lecture series on caring for CSHCN was developed for pediatric resident education. The lectures are case based and designed to allow time for small group discussion of each case. Each lecture incorporates communication skills, family resources, state referral agencies, preventive care, and issues of transition. Lectures can be modified for region or state specific resources. An introduction session is followed by sessions on Down Syndrome, Spina Bifida, and Cerebral Palsy.

Lectures
I. Approach to Children with Special Health Care Needs
II. Down Syndrome
III. Spina Bifida
IV. Cerebral Palsy

For more information contact Tressia Shaw, M.D., info@swifamilies.org

TEAM (Together Everyone Achieves More)
TEAM experiences take place in the setting of home and community. This program is a collaborative effort between healthcare providers and families and underscores the need to forge alliances in order to improve care, quality of life and outcomes for CSHCN. Family teachers volunteer to invite the residents into their homes and their child’s school, to share their challenges, rewards, needs, beliefs, hopes, and perspectives so that you may have a glimpse into their reality. In addition residents will visit and learn about various public, private and community resources that help to meet the needs of these children and families. Project TEAM is part of the children with Special Health Care Needs Section of the Behavioral Pediatrics rotation for Third Year Pediatric Residents at Children’s Hospital of Wisconsin and the Medical College of Wisconsin.

This program is coordinated and funded by Children's Hospital of Wisconsin, the Medical College of Wisconsin and a MCH Title V Services Block Grant, through the Maternal Child Health Bureau of the Health Resources and Services Administration, Department of Health and Human Services. For more information contact Anne Juhlmann (414-266-3196) or e-mail: ajuhlmann@chw.org

You can also learn more about the program by viewing the following presentations from the CATCH and Medical Home National Conference - July 16, 2004

Wisconsin Medical Home Special Needs Rotation Presentation
Children's Hospital of Wisconsin (CHW) Special Needs Program: A Primary Care/ Tertiary Care Medical Home Partnership - Holly Colby, RN, MS

  • Evolution of the Special Needs Program
  • Care coordination at Children’s Hospital of Wisconsin
  • Reimbursement strategies
  • Issues/Challenges

Together Everyone Achieves More: A Children with Special Health Care Needs Rotation for Third Year (PL-3) Residents at CHW - Anne K. Juhlmann RN, BSN

  • Focus of the Rotation
  • Assessing Resident Learning
  • Family Views

Residency Education in Community-based Pediatrics and Medical Home
Presentation CATCH & Medical Home National Conference. July 16-17, 2004.

  • Diane D. Behl, MEd
    Senior Researcher
    Early Intervention Research Institute
  • Dana Hargunani Moore, MD*+
    Chief Resident, Pediatrics
    Oregon Health and Science University
  • Donna Gore Olsen, BA
    Executive Director
    Indiana Parent Information Network
  • Julie O'Keefe, MD, FAAP* Assistant Professor of Pediatrics and Faculty Advisor for Child Advocacy
    Oregon Health and Science University
  • Lisa Samson-Fang, MD, FAAP+ Assistant Professor of Pediatrics
    Department of Pediatrics, University of Utah School of Medicine
  • Sarah Stelzner, MD Assistant Clinical Professor of Pediatrics
    Indiana University School of Medicine
  • Nancy Swigonski, MD, MPH, FAAP
    Associate Professor of Pediatrics
    Indiana University School of Medicine

Medical Home as Continuity Care Clinics
CPTI Symposium, Philadelphia. March 25, 2005

This session discussed how to teach residents to effectively care for children and families, including those with special needs by focusing on providing medical homes to children in the context of a continuity clinic.
Medical Home in the Resident Continuity Clinic Presentation
-Alan Kohrt, MD
Medical Home Competencies Presentation | Handout
-Beth Rezet, MD
Continuity Clinics as Medical Home Presentation
-Louise Iwaishi, MD
Medical Home in Continuity Clinics – The Indiana Experience Presentation
-Nancy Swigonski, MD

ACGME Program Requirements for Residency Education in Pediatrics
www.acgme.org/acWebsite/home/home.asp
The American College of Graduate Medical Education states in its Requirements for Pediatric Residency Program that “there must be structured educational experiences that prepare residents for the role of advocate for the health of children within the community. These should include both didactic and experiential components that may be integrated into other parts of the curriculum, e.g., continuity, adolescent behavior/development, or they may be designed as distinct longitudinal or block rotations.” The ACGME refers to this as a “Community Experience” requirement. Here you will learn more about the guidelines that shape residency programs.

The ACGME endorsed general competencies for residents to the level expected of a new practitioner. Note the relationship of the medical home into these outcome competencies in pediatric residency training.

  • Patient Care
    Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.
    –Accessible, Family-Centered, Compassionate
    –Comprehensive, Continuous,
    –Coordinated
    –Informed decisions
    –Develop, carry out care  plans
    –Counsel and educate families
    –Work with health care professionals to provide patient-centered care

  • Medical Knowledge
    Residents must demonstrate knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care.
    –Demonstrate Knowledge and apply to Comprehensive Care

  • Practice-based learning and improvement
    Residents must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices.
    - Comprehensive,
    - Coordinated
    -     Investigate, evaluate patient care
    – Use systematic methodology to improve patient care
    – Use information technology to improve care

  • Interpersonal & communication skills
    Residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their patients families, and professional associates.
    - Family-Centered Care
    - Coordinated Care
    – Demonstrate effective communication and teaming with patients, families, other health professionals
    – Create ethically sound and therapeutic relationships with patients
    – Use effective listening, nonverbal, questioning, explanatory and writing skills

  • Professionalism
    Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.
    - Culturally Effective Care
    –Altruism, Compassion, Respect, Honor, Sense of duty, Integrity, Advocacy, Sensitivity to diversity

  • Systems-based practice
    Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value.
    – Accessible
    – Coordinated Care
    – Be aware and responsive to the larger health care system
    – Utilize community resources appropriately
    – Be aware of differences between health care delivery systems, including costs and resource utilization
    – Practice cost-effective care while also mindful of  the quality of care
    – Advocate and assist patients in receiving quality care
    – Partner with health care managers to provide and improve care 

Last Updated August 15, 2006

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