Conclusions The purpose of medical education is to improve the - - PDF document

4/3/16 1

Follow the Leaders: What Medical Education Can Learn from High Quality Primary Care

4/3/16

Catherine R Lucey MD, Professor of Medicine Vice Dean for Education

Conclusions

§The purpose of medical education is to improve the health and wellbeing of our patients and our communities. §Achieving this goal in the 21st century requires a transformation of the professional identity of physicians. §Primary Care Physicians already embrace this identity and can lead this essential transformation.

4/3/16 2

4/3/16 2

20th Century Science: Physics

3

20th Century Medicine: Linear Correlation between Causation, Disease, Treatment

4

Exposure Disease Diagnosis Treatment Un-disease

“Mono-causal, Reductionist, Biomedical

Pauli HG. Medical Education, Research, And Scientific Thinking in the 21st

• Century. Education for Health, Vol. 13, No. 1, 2000, 15–25

4/3/16 3

20th Century Medical Education:

The Teaching Paradigm

5

20th Century Physician Role: Omnipotent Manager

6

4/3/16 4

Success!

7

Nable E, Braunwald E. NEJM 2012

Success!

8

4/3/16 5

And Challenges

9

21st Century Science: Systems Biology

10

4/3/16 6

21st Century Medicine: Complexity

11

http://www.nature.com/clpt/journal/v93/n1/images/clpt2012199f1.gif

21st Century Medical Education:

The Learning Paradigm

12

4/3/16 7

21st Century Physician Role: Collaborative Complexity Leader

13

Core elements of Complexity Leadership

§Focuses on Purpose §Uncovers communal vision & contrasts with reality §Catalyzes knowledge sharing, experimentation and innovation §Adapts to changing contexts and forces §Facilitates emergent leadership & relationships §Harnesses structure and incentives to support innovation

Uhl-Bien M et al. Complexity Leadership Theory. The Leadership Quarterly 18:4 (August 2007), pp. 298-318

14

4/3/16 8

Primary Care Physicians Are Natural Complexity Leaders

15

Purpose Driven Vision and Values

§Patient Centered Care

§ Respectful, Comprehensive, Coordinated, High Quality, Safe, Dignified

§Patient Centered Outcomes

§ Compatible with Patient Goals § Focus on Function, Quality of Life, and Relief of Suffering

§Patients Supported by Interprofessional Teams

16

JAGS 53:S245–S256, 2005

4/3/16 9

Leadership Strategies and Values

§Advance and Disseminate Knowledge §Mobilize Expertise from Entire Interprofessional Team §Synthesize Shared Knowledge to Innovate §Work in & continuously improve systems §Adapt to individual patients as well as changing environment

17

The Success of Complexity Leadership in Primary Care Practice

§Innovating in Care Delivery §Posing new questions about medical decisions §Challenging dominant paradigms of disease and disability §Developing others §Broadening educational venues §Re-conceptualizing Wellness to Include Healthy Aging

18

4/3/16 10

A Continued Challenge

Encouraging physicians to pursue Primary Care as a career.

19

LEADERS ASK BIGGER QUESTIONS

20

4/3/16 11

LEADERS CLARIFY THE VISION

21 22

That Vision Must Be..

Authentic Patient Centered Care…

4/3/16 12

23

….Across the Human Lifespan.....

Develop Mature and Reproduce A Age

24

…..Provided by Collaboratively Expert Physicians and Teams

4/3/16 13

LEADERS CONTRAST CURRENT REALITY WITH ASPIRATIONAL GOAL

25

20th Century Physician Competencies

Biomedical and Behavioral Sciences Clinical Skills

4/3/16 14

• Foundational

knowledge to understand and advance disease and therapeutics

• Foundational

knowledge to

• ptimize care

delivery

• Diagnosing, treating

and supporting patients

• Dedication, empathy

, commitment

• Understanding and

improving patient experience, population health and clinical systems

Systems Improvement Skills Direct Patient Care Skills Biomedical and Behavioral Sciences Implementation Sciences

21st Century Physician Competencies

ENDURING EMERGING

LEADERS BUILD A GUIDING COALITION AROUND COMMON PURPOSE

28

4/3/16 15

29

Common Purpose: Healthy People

Primary Care Physicians Clinician Educators Physician Experts in Population and Public Health Physician Scientists

• Precision Medicine

LEADERS ALIGN EDUCATIONAL STRATEGIES WITH VALUES

30

4/3/16 16

Core Values

§Patient Centeredness §Interprofessional teamwork §Continuous monitoring and improvement of systems of care §Synthesizing Information into new knowledge §Eliminating Inequities and Achieving Social Justice

31

SO WHAT DOES THIS MEAN TO THOSE OF YOU WHO ARE HELPING TO EDUCATE THE NEXT GENERATION?

32

4/3/16 17

33

Change in Sequence & Priorities of Med Ed

Understanding Patient Goals

Transactional Conversations

Working in Interprofessional Teams

Mono- professional work

Systems Membership and Accountability

Career Exploration

Critical Problem Solving

Mastery of Facts

Enduring Emerging

Wenger, Etienne (1998) ‘Communities of Practice. Learning as a social system’, Systems Thinker,

Patients

Focus on Authentic Work in Communities of Practice

Learner à ExperiencedàExperts

4/3/16 18

35

Prioritize Relationships

36

Emphasize Deep Thinking Rather than Fact Finding

4/3/16 19

37

Help us work to Make Medicine more Diverse and Inclusive

Conclusions

§The purpose of medical education is to improve the health and wellbeing of our patients and our communities. §Achieving this goal in the 21st century requires a transformation of the professional identity of physicians. §Primary Care Physicians already embrace this identity and can lead this essential transformation.

38

4/3/16 20

UCSF is driven by the idea that great breakthroughs are achieved when the best research, the best education and the best patient care converge.