Teaching Residents About Continuity of Care

Queen’s University Health Sciences Education Rounds

November 15, 2007

Dr. Karen Schultz

Overview

Why teach this? Why change? Process to making changes What we did How we’re going to evaluate it

Why even teach this or What’s so important about continuity of care?

Increased patient satisfaction Improved patient outcomes Increased physician satisfaction

Why Change?

Continuity of care is good=the carrot

Because we were told we had to=the stick!

What we had been doing

4 months in first year 4 months in second year—often 2 x 2

What many other FM programs do ½ day back

Queen’s and the ½ day back

Evidence? Set up of the program

Queen’s Family Medicine Rotation Sites

Queen’s and the ½ day back

1=Evidence? 2=Set up of the program 3=Community rotations’ continuity of care 4=Residents’ reluctance

1+2+3+4=concern

Change. Oh so easy. Not!! “Things change only when people change” Buy in

– “Change is difficult but often essential to survival” “Change can be the rule but not the ruler”

– Informed– ++ consensus building (ideas, brainstorm difficulties, solutions from

within, not imposed…)• Working group• Rounds• Emails• Surveys

Pilotevaluationchangesprogram roll out Evaluate Feedback

What we are doing

Continuity of care clinics– ~10 patients/resident

• Deliberate selection of pts

– Clinic ~ every 2 months (minimum)• Deliberate timing

– 1-3 years

Evaluation

1. Impact:– Surveys of all involved– Patients, staff (receptionists, nurses, doctors),

residents

2. Is it achieving it’s educational objective? Did they get “IT”? How to measure “IT”?

RESEARCH!!

Literature review

Types of continuity of care– Longitudinal, informational, geographic,

multidisciplinary, interpersonal. Interpersonal continuity of care

– Patients—patient satisfaction surveys– Health care provider

Literature review IP C of C HCP=responsibility

Informal discussions

The Grand Plan

Objective: evaluate this change to our educational program

Step 1=gain an understanding of IP C of C from the doctors perspective

Step 2=take key concepts from 1, create a survey

Step 3=assess different ways of teaching about continuity of care

Step 4=save the world

Step 1: What are the components of IP C of C for the HC provider? Qualitative research What do I know of qualitative research?

The steps to step 1

Reading Conferences

– Workshops– Listening to others, looking at posters

Colleagues Networking

What I’ve learned

Different types of qualitative research– Focus groups

Bias issues– Triangulate data– Saturation– Member checking

Get a grant (or typing a transcript hurts!) Work with a colleague

Step 2: the Survey

Quantitative research What do I know of quantitative research?

With a little help from Gary Larson

What We Say To Dogs "Okay, Ginger! I've had it! You stay out of the garbage! Understand, Ginger? Stay out of the garbage, or else!"What They Hear"blah blah GINGER blah blah blah blah blah blah blah blah GINGER blah blah blah blah blah..."

My understanding of Quantitative research

What I’ve learned so far

Get a stats degree Collaborate

Discussion

Collaborating– Across disciplines

Getting grants in medical education ??