The Perelman School of Medicine at the University of Pennsylvania
Philadelphia, PA
Program Director: Maryl Kreider, MD
Program Type: Pulmonary and Critical Care Medicine
Abstract Authors: SM Kassutto, MD, CJ Dine, MD, M Kreider, MD, RJ Shah, MD
RATIONALE
The Accreditation Council for Graduate Medical Education has set forth core competencies and curricular milestones for trainees in pulmonary medicine. These milestones require that fellows work, communicate and transition care effectively “across multiple health care settings,” assimilate evidence from the literature into clinical practice, and demonstrate competence in the diagnosis, care, and treatment of patients with over sixty different clinical conditions in various disease stages.
The medical knowledge and patient care competencies outline many topics and disease states that are primarily seen in the outpatient clinic. However, most clinical training currently occurs in the inpatient setting. To the best of our knowledge, no standardized outpatient pulmonary curriculum is currently available for pulmonary fellowship training. We hypothesized that a structured case and evidence-based outpatient curriculum will provide a more robust and educational outpatient experience for the pulmonary fellow as assessed by a survey of trainees following the curriculum’s implementation.
EDUCATIONAL STRATEGY
The outpatient fellows’ curriculum consists of thirty minute case-based conferences held bi-weekly before clinic. The pulmonary faculty of the Perelman School of Medicine at the University of Pennsylvania authored and facilitated the conferences. Faculty followed a teaching script format based on the previously published “Yale Office-Based Medicine Curriculum.” The conferences were open to all fellows, regardless of training cohort.
A list of twenty core topics was generated based on fellow feedback and current expected pulmonary fellowship trainee competencies (see Table I). The teaching scripts with answers to case-based questions and citations to key references in the literature were provided at the end of each conference.
IMPLEMENTATION AND EVALUATION
Prior to the curriculum’s implementation, study participants were asked to complete an electronic survey regarding impressions of the existing outpatient pulmonary fellowship curriculum and provide a self-assessment of individual competence as outpatient pulmonologists. Participants were surveyed at six month intervals thereafter. Conference attendance was also tracked and correlated with participant survey responses.
Twelve (71%; 4 female, 8 male) out of seventeen eligible fellows agreed to participate. Five (42%) of the participants were first year fellows and seven were from upper year cohorts. When asked on the pre-implementation survey about likelihood to attend a pre-clinic conference dedicated to outpatient pulmonary medicine topics, 92% (n=11) of fellows agreed or strongly agreed that they were likely to attend and 10 (82%) fellows felt that outpatient pulmonary clinic is crucial to overall pulmonary fellowship education. However, only 6 fellows (50%) agreed that the current instruction and teaching on clinically relevant outpatient pulmonary topics was adequate and only 5 (42%) fellows indicated that their current outpatient educational experience had prepared them well for independent pulmonary practice. Attendance among all fellows at the first six conferences was 55%. Among first year fellows, attendance was 92%. Assessment of the curriculum is ongoing. However, the pre-implementation survey results and conference attendance suggests that the curriculum’s content and structure satisfies an otherwise unmet educational need.
CONCLUSIONS
There is a need to provide more robust training in outpatient pulmonology for the fellowship trainee. Case-based conferences are a feasible method for introducing a structured curriculum to address this educational need.
Table 1. Topics Included in Outpatient Pulmonary Fellows Curriculum
