#KeyLIMEPodcast 98: #MedEd + Chronic Disease

Let me join the long list of health care apocalyptic hand-wavers… the grey tsunami is coming.  Yep. Heard that one, right?  Yet, how has the #MedEd community thoughtfully anticipated this significant patient demographic change?  With the exception of our fixation on erectile dysfunction, I have not seen targeted education interventions that address the influence of an aging population.

Enter the Key Literature in Medical Education podcast for this week.  It summarizes a systematic review of education interventions relevant to the management of sentinel chronic care conditions.  For all of the analysis, check out the podcast here.  (This was a live recording at ICRE2015 featuring special guest Eric Holmboe @boedudley).  If you want to skim the highlights, check out the abstract below.

– Jonathan (@sherbino)

KeyLIME Session 98 – Article under review:

Fri post_KeyLIME

Listen to the podcast

View/download the abstract here.

Bogetz JF, Rassbach CE, Bereknyei S, Mendoza FS, Sanders LM, Braddock CH III. Training Health Care Professionals for 21st-Century Practice: A Systematic Review of Educational Interventions on Chronic Care. Academic Medicine. 2015 Jun [ePub ahead of print]:1-12

Reviewer: Eric Holmboe

Chronic disease affects large numbers of individuals worldwide, and the burden is expected to increase with the aging of populations in many countries. Multiple studies show the quality of care these patients receive is often inadequate. Preparing future physicians to care for patients with chronic disease, especially patients with multiple chronic conditions, is critical to the future health of populations and healthcare systems.

The purpose of this study was to systematically review the evidence regarding educational interventions to train health care professionals effective approaches to chronic disease care.

Type of Paper
Systematic Review

Key Points on the Method

  1. The literature search appears to have been robust and used reasonable search terms. What may have been missed by the search strategy were studies targeting effective quality improvement interventions that may have also targeted teaching and curriculum about chronic disease care.
  2. The authors nicely used a series of frameworks to guide their review: the Wagner Chronic Disease Model (CDM) and the Miller competence “pyramid.’
  3. The authors used a validated instrument to judge study quality (MERSQI).
  4. They did not check conference proceedings from internal medicine or family medicine, two disciplines actively engaged in chronic disease care so this review may have missed some studies.
  5. The study excluded qualitative studies that could have provided insights into how to implement the CDM.

Key Conclusions
The authors conclude that few high quality studies exist on implementing educational interventions for chronic disease care, and most of these were performed with undergraduate students.

However, a few important lessons include:

  • Include learners in redesigned health care delivery that fosters team-based care
  • Incorporate training in patient self-management (important communication skill)
  • Involve learners in quality improvement initiatives

Much more work in needed to build out effective educational experiences in CDM with special attention to using patient level quality data as an outcome measure for the educational intervention (i.e. quality performance indicators for chronic disease).

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