IM Business Curriculum

Why a Business Curriculum?
ACGME Milestones
Triple Aim
Module Overview

Why a Business Curriculum?

In 2023-2024 and beyond, physicians need training and preparation before they sign a contract and enter their first practice location. Our internal surveys have identified a need in our graduates for training in the areas of healthcare reimbursement, population medicine, advanced communication with patients, EHR documentation and leading clinical teams. Our faculty has responded with the IM Business Curriculum, a modular approach to ongoing education in all these areas during resident learning months in the IMC.

Business-Oriented Practice Skills

The Accreditation Council for Graduate Medical Education (ACGME) has identified specific skills that graduates from current residencies need to practice in order to successfully transition to a healthcare position. These skills are wide ranging and include effective communication with patients and colleagues, working effectively as a leader in health teams, maintaining timely medical records (ACGME Common Program Requirements 2020, IV.B.e.(1), working effectively in various health care settings, advocating for quality care and optimal patient care systems, incorporating cost and understanding health care finances and its impact on individual patients' health decisions (ACGME 2020, IV.B1.f).(1).g) and respect and response to diverse patient populations (IV.B.1.a).(1).(e) The IM Business Curriculum creates a flexible structure in which to train for these skills.

The Triple and Quadruple Aim

The Institute for Healthcare Improvement Triple Aim is a framework that describes an approach to optimizing health system performance while advancing in three dimensions. Every health system organizes its own quality improvement efforts using these domains:
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  • Improving the patient experience of quality and care (including quality and satisfaction)
  • Improving the health of populations
  • Reducing the per capita cost of health care
The Quadruple Aim adds a fourth critical dimension that affects all the others: improving the work life of health workers. Health care workforce burnout is associated with lower patient satisfaction, reduced health outcomes and increased costs, imperiling the Triple Aim.

Since our graduates will join health care teams seeking to improve care in each of these areas, each of the IM Business Curriculum modules is designed to prepare residents within one or more of these dimensions.

This part of the IM Business Curriculum is about residents themselves. We want them to feel great about the care they are providing patients, day in and day out. Listening well to patients, solving quality issues in a health system and leading a clinical team that thrives all contribute to physician wellness and satisfaction. We want our graduates to thrive in the practices they join and to build on the skills they developed during residency. Physician wellness improves outcomes, starting with the physician.

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Course Overview: Modules

The IM Business Curriculum is organized by module. Each IMC month, residents are assigned to use one half day to master the material outlined by 2 modules based on their PGY year. Transitional Year and Preliminary residents generally receive Modules 1.0 and 2.0.

If there is Pre-Work to do for your module, you will receive a link with details about how to prepare for your learning experience.

Most modules include Pre-Work, a Face to Face Learning component and an Application Activity. Each module has a resource section on this page.
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  • Module 1.0      Healthcare Reimbursement ABC's
  • Module 2.0      Clinical Communication Skills: create a therapeutic relationship; shared decision making
  • Module 3.0      Population Health: Generating a Practice Report
  • Module 4.0      Leading Clinical Teams
  • Module 5.0      Health Equity and Bias

Module 1.0   Healthcare Reimbursement: ABC's

Rationale
Resident physicians need a basic working knowledge of healthcare reimbursement to understand how their actions and documentation affect resources available to their office and health system.

In this segment, residents review how health care is paid for in the US, including the rise in costs over time and the current reforms that are designed to reduce costs while maintaining quality.

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Key Concepts: Medicare, Medicaid, Medicare Parts A and B, ACO, ACA, PCMH, CMS, bundled payment, medicare advantage plan, Hierarchical Condition Categories (HCC)

ACGME Milestones addressed: SBP 3: Physician's role in health systems; SBP 6: Digital Health
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IHI Triple Aim Targets: Lower cost, improved outcomes, population health.
Resources
Healthcare ABCs Handout
Use the resource button to download the handout used for this module.
Pre-test
Pre Test
Before beginning the session, use this link to complete the Pre-Test required for this module.
Post-test
Post Test
To receive credit for the module, be sure to complete the Post Test.

Module 2.0 Clinical Communication Skills

rationale
Residency education needs to specifically prepare residents to navigate complex patient interactions. Clinical communication approaches associated with building successful partnerships while respecting autonomy and reflecting empathy require training and practice to master.
Key Concepts:  therapeutic relationship, shared decision making, informed consent, de-escalating anger, establishing an agenda, setting self-management goals, using talking points for preventative health, identify emotional impact of disease, virtual visits

ACGME Milestones addressed: SBP 3: Physician’s role in health systems: Engages with patients in shared decision making, informed by each patient’s payment models 
ICS 1: Patient and Family Centered Communication:  Establishes and maintains therapeutic relationships using shared decision making, regardless of complexity; Mitigates communication barriers 
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IHI Triple Aim Targets: Patient experience, Improved Outcomes
Clinical Communication Slideset
Learning Objectives
  1. Understand the five processes that form a therapeutic relationship with patients
  2. Understand the steps required to conduct a shared decision making conversation with a patient to make a treatment decision
Secondary Objectives
  1.     1.  Respond with empathy to emotional clues using N-U-R-S-E elements
  2.     2.  Respond constructively to angry patients
  3.     3.  Set a shared agenda for busy appointments.
Resources
Pre Survey
Complete the Survey before beginning this module for module credit.
Five Processes Article
This study co-authored by Abraham Verghese found five processes that effective physician communicators use to connect with patients and build a therapeutic relationship.
Shared Decisions Article
This article by Braddock outlines the three steps you need to take to engage patients in simple informed consent decisions. For complex decisions there are seven steps. Using these steps will increase patient satisfaction and improve self care.

Module 3.0   
Generating a Practice Report

Rationale
Our EHR provides aggregate information about your continuity practice. As a clinical leader, physicians in training need to know how to create and run a practice report and prioritize a strategy to improve outcomes in their practice.
Key Concepts: practice report, continuity practice, population health

ACGME Milestones addressed: PBLI 2: Reflective Practice and Commitment to Personal Growth: Seeks performance data consistently with adaptability, and humility; Challenges one’s own assumptions and considers alternatives in narrowing the gap(s) between ideal and actual performance 
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IHI Triple Aim Targets: Population Health, Improved Outcomes
Learning Objectives
  • Learn to run a practice report and form a practical action plan to improve outcomes.
  • Use EPIC Splicer Dicer to run a continuity list of your patients.
  • Use Filter to examine two aspects of chronic disease management and take action to improve your practice (send a letter, or schedule patients behind in chronic disease management)
Pre and Post Survey
Submit the Pre-Test question before you begin the module. Submit the Post Test Question afterwards to obtain credit.
Brief Video Introduction: Slicer-Dicer
(Use password provided by Department of Medicine.) This brief video will give you an overview of how to use EPIC's population health tool, Slicer-Dicer. Residents have asked for a brief introduction so they can use the tool earlier as interns.
Slicer-Dicer Worksheet
Step by step instructions with example of how to use Slicer-Dicer to explore your own practice quality.
Module Slide Set
Slide set from face to face instruction session.

Module 4.0   Leading Clinical Teams

Rationale
National medical educational oversight bodies (CPAC, etc.) cite the need for resident training in leading small clinical teams, critical to patient care, QI, collaborative work groups and solving problems. 
Key Concepts: leadership styles, setting roles and expectations, solving conflicts, using patient outcomes to set team goals

ACGME Milestones addressed: ICS 2: Interprofessional and Team Communication: Facilitates conflict resolution between and amongst consultants when disagreement exists; Models flexible communication strategies that facilitate excellence in interprofessional teamwork 
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IHI Triple Aim Targets: Prepare clinical leaders for all aims
Learning Objectives
  • Learn basic principles of participating in, leading and optimizing patient outcomes using clinical teams
  • Assess your personal leadership style
  • Learn habits of highly effective clinical teams
Resources
Download a slide deck that walks you through three core skills in leading teams.
Leading Teams

Module 5.0 Health Equity and Bias

Rationale
The ACGME has identified resident learning about health equity as a priority because physician non-awareness contributes to reduced health care outcomes in treated populations.
Key concepts: Race and medical outcomes. race and medical education; unconscious bias; race as a social construct; structural, institutional, interpersonal and internalized racism; IOM Report: Unequal Treatment 1999 and 2018; microaggression, bias mitigation.

ACGME Milestones addressed: SBP-2 System Navigation for Patient-Centered Care: Demonstrates knowledge of population and community health needs and disparities; Identifies specific population and community health needs and inequities for the local population

IHI Triple Aim Targets: Population Health, Improved Outcomes
Learning Objectives
  • Understand impact of unconscious bias on healthcare in a race-conscious society
  • Understand the historical challenges of medical education in the Unites States with regard to race
  • Understand and apply mitigation approaches to bias when expressed in clinical settings
Resources
View a slide presentation focused on the impact of race bias on medcial education.and clinical outcomes. 
Health Equity and Clinical outcomes
View a slide presentation that addresses successful bias mitigation approaches you can use with patiebnts and staff. This training includes a series of applied examples.
Mitigating Bias in Clinical Settings

Talking Points

As clinicians, we must engage our patients in many complex discussions about their health. When we use an evidence-based, people sensitive approach, patients become more fully engaged in obtaining vaccinations, completing screening tests and working together with us on their care.

Our library of Talking Points was developed using national guidelines and language recommended by clinical experts in each field. When we use these approaches, patient autonomy is respected, they are part of the decision process and the orders are filed in a way that updates your Health Maintenance record. Please review these often until these approaches are second nature.

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Colorectal Health screening
Colon health
human trafficking
trafficking
chest pain protocol
chest pain
smoking cessation
tobacco use
asthma screening talking points
asthma
well woman exam
well woman
TDAP and Pneumovax talking points
TDAP/PMVX
HIV and Hep c screening
HIV/HEP C
Health literacy techniques
Health literacy
uninsured patient talking points
uninsured
serious illness converstaions
serious illness
falls risk talking points
Falls
bone health
bone health

Setting Goals for Patients with Chronic Disease

Click the IMC photo to watch a short video by Vonod Krishnappa, to learn why and how we are setting goals for patients in the IMC.
Why Set a Goal?
When you set a goal with a patient as described here, you engage the patient in their own self care in a fundamentally different way than when handing them patient instructions.

If you set and record a goal together, you will learn the context in which the patient is trying to self care and solve a barrier to make them successful.

Goal setting is associated with improved clinical outcomes and patient satisfaction scores.

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How to set a Goal

To set a Goal, ask the patient what they would like to work on. This may be taking their medications, or improving their diet, or exercising more. Start with a general category and then refine it together so it is a SMART Goal:

Specific (exact steps to take)
Measurable (How to know you did it)
Achievable (A reach but possible)
Realistic (Adjust to be doable)
Time-related (short term: 2-6 week)
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Ask, "How confident are you that you will complete this goal?" On a 1-10 scale, anything less than a 7 will fail.

Ask, "What barrier would keep them from completing this goal?

"How can we adjust the goals so the barrier addressed?"


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How to Add a Goal in EPIC and Print it in the AVS

Select the Wrapping Up view from the far left navigation menu.
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Find the Patient Goal section in the center column and select Add to see the pop up window.

Select a broad goal category from items marked MH CC. Click Accept.

In the smart text, use F2 to record the needed elements for an effective goal.

Close the Patient Goals and select Plan. In the Patient Instructions section, add the dot-phrase .GOAL

Now the Goal will print to the upper left section of the first page of the AVS.

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about SUmma HEALTH

Summa Health System is located in Northeast Ohio. It's multiple campuses serve as an academic community teaching resource for the Northeast Ohio Medical University and hosts 11 residencies and 7 fellowship programs.

useful links
Summa Health SystemWellness Resources: GMECHealthcare Equity Resources
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