I. Wise-On Call Modules

Assessment: End of Module Quiz

Abdominal Pain

Explain the differentiating characteristics of common causes of abdominal pain.

Describe typical presenting  signs and symptoms and make recommendations for assessment and diagnosis.

Acute Pain Management

Describe the common medications used to manage acute pain, comparing the relative strengths, modes of administration, side effects and contraindications.

Demonstrate how to safely manage acute pain.

Certifying a death

Examine the responsibilities in both pronouncing and certifying deaths.

Describe strategies for management of the emotions associated with the passing of a loved one.

Chest pain

Formulate a differential diagnosis of chest pain.

Understand the approach to early diagnosis and management.

Documentation for Patient Safety

Describe how to provide complete, professional entries into the medical record.

Dyspnea

Formulate a differential diagnosis of dyspnea.

Apply clinical skills to dyspnea cases of various etiologies.

Fever and Sepsis

Explain the framework to assess the febrile patient and to initiate management.

Discuss management of fever if the underlying cause is thought to be sepsis.

Hypertension

Explain when and how to treat the patient with urgent or emergent hypertension.

 

Hypotension

Explain the physiology of blood pressure control.

Describe guidelines to differentiating among the various types of shock and identifying the underlying cause.

Recognize the importance of early recognition and escalation to superiors. 

Loss of Consciousness

Describe the underlying causes, common diagnosis, and initial management of the patient who has experienced a sudden loss of consciousness. 

Lower Extremity pain

Formulate a differential diagnosis of lower extremity pain.

Understand the approach to early diagnosis and management including escalation of urgent cases.

Oliguria

Explain the pre renal, renal and post renal causes and the appropriate bedside and laboratory measures that can help determine the underlying cause.

Describe how a resident would assess and manage a typical patient with oliguria.

 

 

 

II.  Emotional Intelligence

Assessment: Self-Awareness Worksheet and Individual Energy Profile Worksheet

 

Define Emotional Intelligence and the impact on professional practice.

Explain Self-Awareness and Self-Management and their impacts on communication and patient care skills.

Discuss the impact of emotional intelligence skills on team-based care.

Explain Social Awareness and Social Skills and their impacts on communication and patient care skills.

Explore various resiliency strategies for wellness and burnout prevention as a physician.

Utilize emotional intelligence skills to enhance resilience skills.

 

 

III. Value-Based Care- Modules and Discussion

Assessment: Module completion and discussion session participation

 

MODULE 1: There’s A Better Way

Reflect on the causes of waste and inefficiencies in health care.

Define 'value' for patients.

Define and identify the major contributing components of healthcare waste.

Connect how the pursuit of high-value care for patients supports the professionalism of clinicians.

Introduce the concept of health care outcomes.

Examine a case that presents strategies and tools for increasing value in health care.

Explore data to gain understanding and appreciate the perspective of patients, individual clinicians, and health systems as it pertains to value-based health care.

MODULE 2: Measuring What Matters

Appreciate and reflect on outcomes that are meaningful to the patient.

Define the measurement of ‘patient outcomes’ as they relate to value-based health care.

Examine resources for choosing and measuring validated patient outcomes.

Apply a measures framework to evaluate the success of health care value programs from the perspective of patient outcomes.

Describe different types of measures and when they would be used.

Identify the reasons for collecting ‘patient-reported outcomes.’

Appreciate and reflect on how patient outcomes define physicians’ success.

 

MODULE 3: Understanding Costs In Health Care

Reflect on the impact of cost on patient care and the overall value of provided health care.

Define terms used in discussing health care costs.

Describe basic principles of health care delivery, organization, and financing.

Evaluate various financial methods used in health care.

Describe new methods for health care cost accounting and value-based payments.

Study methods to measure and evaluate the success of health care value programs.

Compare the application of traditional and value-based costing methods in the course of a patient’s treatment

 

MODULE 4: Coordinating Care For Patients

Reflect on the inefficiencies for patients and clinicians coordinating care in the current system.

Identify how inefficiencies contribute to harm to patients and clinicians.

Recognize the benefits of team-based care interactions organized around patient circumstances or conditions.

Define key components of patient-centered medical homes (PCMHs).

Evaluate the purpose of PCMHs.

Define integrated practice units (IPUs).

Evaluate the benefits and limitations of IPU models.

Demonstrate ability to design care models coordinated around the needs of patients.

MODULE 5: Bringing It All Together: Value Based Health Care Delivery

Analyze the features of a high-functioning value-based health care delivery system

Recognize the benefits of team-based care interactions organized around patient medical needs and

conditions

Reflect on the importance of measurement focused on patient health outcomes

Recognize the benefits of measuring and capturing actual costs of providing patient care

Reflect on the causes and impacts of waste in health care

Explore methods to curb overuse in health care

Describe reimbursement mechanisms that support value of care provided across a full care cycle for medical conditions

Explore examples of how health information technology can be leveraged to help restructure care delivery and accurately measure results

Describe key structures of a delivery system focused on moving from volume to value

Review key components of value-based health care

 

MODULE 6: ENHANCING AFFORDABILITY FOR PATIENTS THROUGH HIGH-VALUE Prescribing

Reflect on the impacts of high medication costs on patients

Recognize the harms of cost-related medication non-adherence

Define high-value prescribing

Explore the principles of conservative prescribing

Articulate how to identify patients who are having difficulty paying for their medications

Describe strategies to reduce out-of-pocket drug costs for patients

Reflect on how Kaiser Permanente has achieved better outcomes for patients through high rates of generic prescribing and affordable medications

Practice methods for decreasing the costs of necessary medications for a patient

 

MODULE 7: Introduction To High-Value Communication

Describe how miscommunications can occur between the patient and clinician

Identify the challenges to addressing misconceptions at the point-of-care

Suggest strategies for promoting high-value, shared decisions

Develop an approach to discussing optimal use of resources with colleagues, consultants, and supervisors

Discuss opportunities to improve interprofessional communication to limit less helpful tests and treatments and promote patient-centered, team-based care

Use tools that help patients actively engage in their health

Reflect on the key principles of the communication program developed at Cleveland Clinic

Apply high-value communication techniques during a patient encounter

 

MODULE 8: Creating A High-Value Care Culture

Describe the ways ingrained institutional cultures contributes to low-value care

Identify how organizational culture influences the value of health care delivery

Define how culture can be measured and analyzed

Analyze the key domains that contribute to a high-value care culture

Characterize change management strategies

Describe conditions that support culture change related to overuse

Define ‘nudge’ strategies

Describe how nudge strategies can used to minimize waste in health care

Recognize personal responsibility in promoting cultural change

Apply nudge theories to advance behavior change toward high-value care

Reflect upon your local organizational culture in order to make a commitment to create change

 

MODULE 9: Shifting Payments From Volume To Value

Characterize the ways in which low-value care is incentivized

Apply your knowledge of reimbursement mechanisms

Describe the current predominant fee-for-service payment model

Describe the drawbacks of the pay-for-performance reimbursement model

Recognize the pros and cons of bundled payment models

Explore the value of combining elements of different reimbursement models

Define value-based insurance design

Summarize the current evidence supporting the VBID strategy

Discuss the CMS application of the bundled payment model

Compare systems and policies for clinical care reimbursement that maximize value and reduce costs

 

MODULE 10: LEADING VALUE IMPROVEMENT PROGRAMS ON THE FRONTLINES

Articulate the ways in which issues can often have complex, system-ingrained causes

Describe common improvement methodologies

Build an actionable foundation for change implementation

Identify tools that can help grow understanding of an issue

Evaluate the “COST” framework for value improvement efforts

Utilize tools for change measurement and tracking

Identify methods to measure and evaluate the success of health care value programs

Evaluate examples of successful value improvement projects and systems

Compare a lean health care system approach to a problem in your local organization

Apply the concepts of change implementation and/or change analysis in authentic situations

 

IV. Pain and Opioid Lecture

Assessment: Quiz

 

Explain the rationale for the development of the 2016 CDC Guidelines for the Management of Chronic Pain​

Summarize the role of a clinical guideline​

Summarize the 12 key points of the CDC guidelines​

Utilizing the CDC Guidelines for the Management of Chronic Pain, outline an appropriate strategy to mitigate risk to patients if initiating opioids ​

Define “morphine milligram equivalents” (MME) and calculate given an opioid dose​

Summarize best practices for opioid tapering and discontinuation.​

Describe the role of a prescription drug monitoring database​

Explain how urine drug testing can help in risk assessment and decision making when prescribing opioids

 

V. EOL OSCE

The EOL OSCE has objectives which the students are provided in advance:

1.      Assess a patient in pain

-          Obtain a thorough history

-          Demonstrate knowledge of key principles of pain management with nonopiods and opiods, including equianalgesic dosing and common side effects

-          Develop a management plan for a patient’s pain

2.      Communicate serious news to a patient

-          Apply the key steps in delivering serious news

-          Demonstrate patient-centered communication skills and strategies when giving serious news

3.      Discuss advance directives with a patient

-          Define advance directive

-          Describe a durable power of attorney for healthcare

4.      Discuss hospice with a patient

-          Demonstrate knowledge of the philosophy of hospice

-          Define hospice

-          Demonstrate knowledge of the services provided by a hospice program

-          Explore patient understanding of illness, concerns, goals, and values that inform the plan of care

-          Demonstrate basic approaches to handling emotion in patients facing serious illness