GY2a Faculty HRSA Grant Training (2006-2007)  
   
   
This second installment of the faculty development component of OUCOM’s HRSA Grant on Evidence Based Medicine (EBM), Patient Safety (PS), and Cultural Competence (CC) is designed to help you work toward mastery in those areas and keep abreast of our students’ learning in those areas as well.

I have combined the first round of Grant Year 2 activities into a one-hour training packet with a one-page pre-test (2 min), followed by an activity in each area (30 min total) and finishing with a one-page post-test (10 min).

The OBJECTIVES for this training are:

Evidence Based Medicine (EBM)

  1. Review the central tasks of clinical work where clinical questions arise from.
  2. Describe the four elements of a good answerable clinical treatment question.
  3. Commit to what actions you will take as a result of this training.
  4. Increase your level of mastery of EBM by at least one-step on the scale of Novice, Advanced Beginner, Competent, Proficient, Expert, Master.

Cultural Competence (CC)

  1. Review or learn the LEARN model for cross cultural communication
  2. Discuss or teach the LEARN model to a colleague or student.
  3. Commit to what actions you will take as a result of this training.
  4. Increase your level of mastery of CC by at least one step on the scale of Novice, Advanced Beginner, Competent, Proficient, Expert, Master.

Patient Safety (PS)

  1. Review Patient Safety Statistics.
  2. Describe the five most common prescription writing errors and how to fix them.
  3. Commit to what actions you will take as a result of this training.
  4. Increase your level of mastery of PS by at least one step on the scale of Novice, Advanced Beginner, Competent, Proficient, Expert, Master.

Your role is to take the pretest before you view the materials, work through the packet and then take the posttest annotating what you learned and what actions you plan to take as a result. Please return the pre and post tests to me with your legible name so I can record your training completion and send you a memo for your records of the same.

Our grant requires 5 training events in EBM, CC, & PS and this is number two. Thank you for helping with our quest to move toward mastery of EBM, CC, and PS!

Regards, ssd
Stephen S. Davis, Ph.D.
Director, Faculty Development

  
   
   
   
   
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Pretest on Evidence Based Medicine (EBM), Cultural Competency (CC), and Patient Safety (PS) training
     
Evidence Based Medicine (EBM)    
     
Describe the four elements of a good answerable clinical treatment question.  
1.  
2.  
3.  
4.  
     
What do you think is your level of EBM?    
     
     
Cultural Competency (CC)    
     
Describe the LEARN model for cross cultural communication:  
L =  
E =  
A =  
R =  
N =  
     
Discuss/teach the LEARN model to at least one associate or student.

I certify I have fulfilled this requirement.      

     
What do you think is your level of CC?    
     
     
Patient Safety (PS)    
     
Report an estimate of how many medical errors occur and approximately how much they cost annually:    
     
Identify what’s wrong with each prescription abbreviation:  
.5  
1.0  
U or u  
 
QD or q.d.  
     
What do you think is your level of PS knowledge, skills, and attitude?    
     
     
     
     
Evidence Based Medicine

The first HRSA grant module taught/reviewed the five steps of EBM according to: Sackett, D. L., Straus, S. E., Richardson, W. S., Rosenberg, W., & Haynes, R. B. (2000). Evidence-based medicine: How to practice and teach EBM (2nd ed.). Edinburgh: Churchill Livingstone.

  1. CONVERT the need for information into answerable questions.
  2. TRACK DOWN the best evidence with which to answer the questions.
  3. CRITICALLY APPRAISE the evidence for its validity, impact, and applicability.
  4. INTEGRATE the critical appraisal with our clinical expertise and with our patient's unique biology, values, and circumstances.
  5. EVALUATE our effectiveness and efficiency in executing steps 1-4 and seek ways to improve them both for next time
    6.
     
This module focuses on #1. CONVERT the need for information into an answerable treatment question. Almost every time you see a patient you will need new information about some element of their diagnosis, prognosis or management. Conquering this skill avoids wasted time, frustration and clinical entropy.
     
Clinical questions arise from (Sacket, p. 26):
 
     

Well built clinical questions contain four elements:

Table 1.2 The four elements of well-built clinical questions, from Sackett, p. 27
     
Combine the tasks and elements to formulate good clinical questions.

Table 1.3, Examples of questions for each clinical task about a patient with heart failure, Sacket p. 29
     
Use the tables above to help formulate good clinical questions. Build your question in two steps, first specify the clinical task (Table 1.1) and then fill in all four elements of the questions (Table 1.2). You might even try dividing your paper into four columns, one for each element of the question, so that you can quickly enter each component without necessarily writing out the complete sentence as in Table 1.3. Try your hand at it in the box below.
 
Write a good clinical question based upon your last seen case using the criteria above.
Patient/Problem Intervention Comparison Outcome
       
 
The book is available in the OU-COM LRC and the OU Health Sciences Library. The book's website is the Center for Evidence-Based Medicine at the University of Toronto.
More information on your FD Web Site: http://www.oucom.ohiou.edu/fd/evidence_based_medicine_resources.htm
     
     
Cultural Competency (CC)

By the year 2000, almost 50 million people in the U.S. will be ethnically diverse. Immigration contributes to the growing diversity of the U.S. In 1940, 70% of immigrants were from Europe. By 1992, the pool of immigrants had changed so that 15% came from Europe, 37% came from Asia and 44% came from Latin America and the Caribbean. The U.S. attracts two thirds of the world's immigration and 85% of American immigrants come from Central and South America. Generalist physicians can expect more than 40% of their patients to be from minority cultures. (http://www.amsa.org/programs/gpit/cultural.cfm)

     
The LEARN model for cross-cultural healthcare (see table 2) is commonly taught to medical students and residents. It is an excellent model because it implies that cross-cultural communication is always a work in progress.
     

Table 2. The LEARN model for cross-cultural healthcare
L isten to the patient and family's concepts of the illness, reactions to biomedical approaches, and desires for therapy
E xplain your biomedical assessment, using drawings, videotapes, and test results
A cknowledge differences and similarities between Hmong and biomedical perspectives; emphasize common ground
R ecommend your diagnostic and therapeutic approaches, and listen to their responses
N egotiate all areas of care, accommodating the patient and family's cultural beliefs and practices

Adapted from Berlin EA, Fowkes WC Jr. A teaching framework for cross-cultural health care: application in family practice. West J Med 1983;139(6):934-8

     
As Dr Joseph R. Betancourt concluded in a recent issue of the New England Journal of Medicine, "Cultural competence is not a panacea that will single-handedly improve health outcomes and eliminate disparities, but a necessary set of skills for physicians who wish to deliver high-quality care to all patients. If we accept this premise, we will see cultural competence as a movement that is not marginal, but mainstream".

The changing demographics of the United States and the increasing diversity of patient needs require us to educate ourselves so that we can respond accordingly to best serve our patients, ourselves, and the credibility of the profession we love. (http://www.postgradmed.com/issues/2004/12_04/comm_cole.htm).
     
     
Patient Safety (PS)    
     
To Err is Human (1999)
  • Between 44,000 to 98,000 people die each year (nationwide) as a result of avoidable hospital errors.
  • More people die each year from medical mistakes than from motor vehicle accidents, breast cancer, or AIDS.
  • More than 7,000 deaths from medication errors occur each year.
  • The financial cost of preventable medical errors is between $17 billion and $29 billion a year.
  • Medical errors’ costs include frustration, mistrust and low morale among hospital employees and patients alike.
  • Most medical errors are systems problems rather than the result of individual negligence or misconduct.
 
Investigating Medical Errors
  • Focus tends to concentrate on front line staff where patient/caregiver interaction occurs.
  • People believe that errors must result from lack of attention, incompetence and a lack of caring.
  • The typical response to errors is blame, retraining, censure and other forms of discipline.
  • Yet, the key contributing factors are most frequently rooted in organizational policies, procedures and resource allocation decisions.
  • Medication errors are usually system problems, rather than the result of the acts of omissions of the people in the system.
  • The elimination of medication errors requires changing the system, not changing the people.
    Harvard Medical Practice Study found that preventable adverse drug events caused one out of five injuries or deaths in hospitalized patients.
  • Estimated that 56% of preventable adverse events occur during the stage of medication ordering.
  • Order-related errors can stems from the use of abbreviations.
www.ohioansfirst.org
 
     
     
     
     

Posttest on Evidence Based Medicine (EBM), Cultural Competency (CC), and Patient Safety (PS) training
     
     
Evidence Based Medicine (EBM)    
     
Describe the four elements of a good answerable clinical treatment question.  
1.  
2.  
3.  
4.  
     
What actions do you plan to take as a result of this learning activity?    
     
What do you think is your level of EBM?    
     
     
Cultural Competency (CC)    
     
Describe the LEARN model for cross cultural communication:  
L =  
E =  
A =  
R =  
N =  
     
What actions do you plan to take as a result of this learning activity? (Suggestions: teach it to someone, use it to evaluate your CC), discuss with a colleague…)    
     
What do you think is your level of CC?    
     
     
Patient Safety (PS)    
     
Report an estimate of how many medical errors occur and approximately how much they cost annually:    
     
Identify what’s wrong with each prescription abbreviation:  
.5  
1.0  
U or u  
 
QD or q.d.  
     
What actions do you plan to take as a result of this learning activity?    
     
What do you think is your level of PS knowledge, skills, and attitude?    

   
   
EDUCATION RESEARCH COMMUNITY DIVERSITY HOME
   
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Last updated: 11/15/2007