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>>KOPELOW: I'm Murray Kopelow the CEO of the Accreditation Council for Continuing
Medical Education.
>>CURRAN: I'm Debra Curran, I'm Associate Director for Continuing Professional
Development at HealthPartners Institute for Medical Education in Minneapolis, MN.
>>KOPELOW: Tell me about HealthPartners.
>>CURRAN: Well, we're a large health care system in Minnesota, a non-profit and we have
about 600 physicians in the medical group, two hosp, three hospitals. We just acquired
a third hospital, all sorts of ancillary services.
And, um, I think we're close to a million members now. So it's a large health care organization.
>>KOPELOW: And you do continuing medical education entirely for those physicians that
are in this network or the physicians of Minnesota?
>>CURRAN: Physicians of Minnesota and actually physicians in the five state area.
>>KOPELOW: So, we're here today to talk about an educational activity
>>CURRAN: Right.
>>KOPELOW: that you have done both locally and regionally.
>>CURRAN: Right.
>>KOPELOW: You are evaluating and measuring for physicians that are beyond their
network.
>>CURRAN: That's right.
>>KOPELOW: So, Let's talk about that.
>>CURRAN: OK.
>>KOPELOW: Because those challenges that you described are very real and all of the
people that are listening to this are living and experiencing the same kind of thing.
>>CURRAN: Right. Right.
>>KOPELOW: So, what's the name of your educational intervention?
>>CURRAN: It's called Joining Forces.
>>KOPELOW: Joining Forces. And where did the idea for Joining Forces come from?
>>CURRAN: Well, at HealthPartners we had what they call a lunch and learn and they invite
the employees to come up for lunch to talk from time to time and we knew of one that
addressed the issues of the returning troops from Iraq and Afghanistan. There were 3,000
troops scheduled to come back. And this chaplain said that there was a misperception in
terms of the health care system that all of these troops would be cared for by the VA
system. And that actually a lot of these people would be going to their own primary care
physician. And that primary care physician may or may not even know that they even
served in the military.
>>KOPELOW: So, from my, the competency perspective this is like a systems based
practice issue. Where the system and the challenges of the system were going to present
challenges to the individual participant, the individual patient
>>CURRAN: Right.
>>KOPELOW: And you recognized that this person who was speaking to you
>>KOPELOW: recognized it. So, how did that craft professional practice gaps, if you turned
it around, because this was obviously a very patient centered presentation and you were
clearly moved by the
>>CURRAN: We were.
>>KOPELOW: By what this person was saying and from a patient centered way if you turn
it over to the physician centered what implications for their practice, practice gaps, was
this person speaking about or did you think about as they talked about these returning
veterans?
>>CURRAN: Well we thought if the physicians don't know that these people are in the
military how can they know how to treat them? And in fact, they don't know how to treat
them. There's so many issues that the average primary care provider is not aware in terms
of these people that have gone through military, have gone through combat.
>>KOPELOW: So that was two very quick professional practice gaps.
>>CURRAN: Right.
>>KOPELOW: that you just talked about. One was not recognizing that they were veterans,
>>CURRAN: Right.
>>KOPELOW: not knowing that they were veterans and then the second was perhaps not
having an understanding of how to care for the special
>>CURRAN: Exactly.
>>KOPELOW: issues of veterans.
>>CURRAN: Exactly.
>>KOPELOW: And that's how you started.
>>CURRAN: Yes. And in addition to that, this chaplain spoke of a lack of empathy for the
returning troops and what they had been through. I think that he thought that many people
see that, well, they're back, they're happy, they're no longer serving, so they must be
doing just fine. And in fact, there were so many issues that are not being addressed.
And so we saw that as a huge opportunity for us
to do something about that.
>>KOPELOW: You used the word empathy, probably quite a range of words: sensitivity,
understanding, awareness. Empathy implies it sort of has a negative connotation of the
ability to understand it would be all of these things in the competency world would be the
management of care, in professionalism
>>CURRAN: Right.
>>KOPELOW: in intercommunication, inter-professional or inter-patient communication.
>>CURRAN: Right.
>>KOPELOW: So, you're talking about an educational activity that would have a lot of
targets.
>>CURRAN: Right.
>>KOPELOW: Lot of scope and a lot of purpose and objective. Describe for me some of the
changes in the docs that you thought you wanted to try and accomplish through this
activity. You've already spoken about just finding out if people are veterans, but there's
other changes about other skills.
>>CURRAN: Right.
>>KOPELOW: So, tell me about some of the changes you were trying to focus on.
>>CURRAN: Well, I think the behavioral health issues were number one. The state of
Minnesota, in fact, had declared a emergency, because there were so many troops that
were expected to arrive on our doorstep or back home and they knew based on their
history that these people do have these behavioral issues. So, that was one. The
depression, the post-traumatic stress disorder, which you know can show up right away
or within months. This particular chaplain gave examples of many times these individuals
are hypersensitive. They can be in a home improvement store and some noise or some
light will trigger something within them. And that trigger can cause huge amounts of
anxiety and fear. They also tend to not know what to do with that adrenaline high that
they are so used to being on. They are now back in their homes they are expected to take
care of their children change the diapers and it's such a change for them that people
just don't think about that. The other things we
knew after we started talking to our partners, the people we partnered with on this, are
the mild traumatic brain injury. The major brain
injuries are treated, of course, but the mild traumatic brain injuries symptoms can
manifest much later, weeks, months, sometimes later.
>>KOPELOW: What you've talked about so far actually is two parts of the ACCME
requirements. One is that your need and your professional practice gap had been defined
by others outside of you.
>>CURRAN: Yes.
>>KOPELOW: That you've used other sources, you used this chaplain speaker, you used
some government sources to define a professional practice gap
>>KOPELOW: to define issues physicians need to know about in a specialty kind of way.
>>CURRAN: that's right. And we knew that we weren't in a position to do that.
>>KOPELOW: Right.
>>CURRAN: We knew that we could facilitate all those people that knew those specific
needs
>>KOPELOW: Right.
>>CURRAN: to come together, but we ourselves didn't know that.
>>KOPELOW: Right.
>>CURRAN: But, we knew we could make it happen based on our resources.
>>KOPELOW: So, your starting point was this after this sort of moment
>>CURRAN: Right.
>>KOPELOW: of, there must have been some sort of process that you went through a few of
you went to this event.
>>CURRAN: We did.
>>KOPELOW: You were moved, you were informed, you were challenged. You talked
about it on the way back, but what did you do as a collective group both internally to
your unit and in maybe other ways to bring some form to this concept?
>>CURRAN: Yeah.
>>KOPELOW: As an educational activity?
>>CURRAN: Well, we were moved and there were several of us that went to this. We went
back we sat down, actually with our executive director, Dr Patow, who used to serve in
the military. So, he was very much inspired by this and also said, we need to do
something. But, what is that? We have been looking at all the formats not always
jumping to that "conference" idea, but in this case we felt that we needed something
live and that would reach the biggest, the largest
number of people.
>>KOPELOW: So, choosing the live was in order to get to the audience because
>>CURRAN: Right.
>>KOPELOW: because this is correct me this is multi-media, multiple format kind of thing?
>>CURRAN: Right. Right.
>>KOPELOW: Isn't just that lecture?
>>CURRAN: No. It started out with a conference.
>>KOPELOW: It started off with a conference.
>>CURRAN: It started off with a conference. And we didn't know where it would take us.
>>KOPELOW: Alright.
>>CURRAN: We thought well we'll see. Perhaps that will be it. We'll do our measurement
and we'll know that we made a difference. But, we really had no idea of the type of
reaction we would get.
>>KOPELOW: So, what were you trying to accomplish in the conference. What would you
say was the change that the conference was trying to initiate?
>>CURRAN: Number one we wanted them to be aware of the problems. That there were
these military folks coming back soon; that they could be in your office and you may not
even know it. And you need to ask. You need to find out if they were in combat. Did they
have any injuries related to that?
>>KOPELOW: So, these we would characterize as competencies
>>CURRAN: Right.
>>KOPELOW: This is about giving the docs strategies. People have heard me talking about
not knowing you don't know and knowing you don't know.
>>CURRAN: Ya.
>>KOPELOW: And that's sort of what you're talking about.
>>CURRAN: Yah. These physicians didn't know that they didn't know.
>>KOPELOW: Right. And now
>>CURRAN: Now, they know and not only do they have to remember to ask, but what's
next.
>>KOPELOW: OK. So, tell me about what's next with this educational activity. Which
again, multi-media not just one event
>>CURRAN: Right.
>>KOPELOW: What did you do, what else did you do in this project?
>>CURRAN: Well, our partners, the Minnesota Army National Guard, and the Minneapolis
VA, and the state of Minnesota, those were our main partners for the event. And we
decided to do some macro simulations of what it would be like to be in the military. We
didn't just want people to come and sit down and do the morning announcements as
usual. So, we actually had one of the military dressed in full gear and stand up and started
talking to us like we were on a mission briefing. We were actually going to be leading a
convoy through unregulated roads and through dangerous territory, So, instead of the
usual conference lingo it was 0800 you will be doing this and it was so intense. It really
made you realize what a different world these people lived in
>>KOPELOW: You describe this as a macro-simulation
>>CURRAN: Right.
>>KOPELOW: So, you're talking about having people come they're live and your teachers
and educators are not just a lecturer
>>CURRAN: Right.
>>KOPELOW: But, they're talking about people dressed like this to establish the
environment and what you're trying to accomplish. You used tents to register people,
>>CURRAN: We did.
>>KOPELOW: Right, tell me about that.
>>CURRAN: Yah, yah. We had a tent and had all of our registration materials out and
people had to come in and resister under the tent. Some of us, well, we weren't in
military uniform, but the military were there. We also had Humvees stationed outside so
during the break and over lunch people could actually go out and put on these field packs
these heavy field packs that the troops have to wear every single day. And get an idea
of what it was like to carry that around on your
back for eight hours, to wear a helmet, to sit
in the Humvee, and those Humvees they look huge but they would cram eight people into
those Humvees. And we tried to emphasize the amount of stress that would be to be
sitting in that Humvee for eight hours going over rough roads in a cramped environment.
And just how that can relate to medical issues.
>>KOPELOW: So, it's putting the physician in the context of the learner?
>>CURRAN: Exactly.
>>KOPELOW: making this sort of a learner-centered event, a patient-centered event. Sounds
like you thought that would be critical to getting the health care provider to understand
how to be a better health care provider.
>>CURRAN: Right. Right. I think we wanted them to see this is not just your average
patient walking through your doors. This is somebody with very unique needs who
perhaps is not sharing those needs with you.
>>KOPELOW: So, what did you do next in this event where they sat in the Humvee and
signed up in the tent and wore a pack? How did you transmit some of this content? Did
you do it through lecture? Did you do it through small groups? Did you
>>CURRAN: We did it primarily through lecture, but something we did that was different is
we asked the participants, we gave them a pad of sticky notes and said, As you listen
to this today think about those key takeaways.
What are those insights, what are those aha moments?
>>KOPELOW: Yes.
>>CURRAN: What will you do differently? And write that down and put it on the back wall.
So, we had a whole wall covered with yellow sticky notes of things that people thought
of. And it really helped us through our evaluation process. Because it helped us see that
they were starting to understand. Or they were then asking the next question. And that
they were starting to understand, yes there is a gap here and I need to do something about
it.
>>KOPELOW: So, in a qualitative way they were describing for you the change that they
were going through
>>CURRAN: Exactly.
>>KOPELOW: And that I think that's important in educational assessment and evaluation
that it doesn't have to be a percentage change
>>CURRAN: No.
>>KOPELOW: It doesn't have to be a score, I was 33 percent then I was 85 percent.
>>CURRAN: No.
>>KOPELOW: this was a qualitative kind of research where they're giving you kind of
a descriptive information about what they think,
about what they feel, they're getting to express as part of the educational activity,
but then you were repurposing it for the evaluation. Because we have this Criteria
11 where you have to evaluate an activity and
understand the change
>>CURRAN: Right.
>>KOPELOW: that people are going through. And you used those stickies as part of your
strategy.
>>CURRAN: We did. Yah.
>>KOPELOW: Again what kind of some of the things did you find out about the physicians
abilities and what the physicians were going to do or their attitudes from those things.
Just two or three things? Do you remember?
>>CURRAN: They said, I remember, some of the notes said, I didn't realize how much this
impacted the family.
>>KOPELOW: Good. OK.
>>CURRAN: Because we did have one of the people who had returned from Iraq stood up
and told his story of what it was like to come back and to be so happy one minute to
see my family, but the next day I just really
didn't know what to do, I didn't know, there was
nobody telling me what to do. I was so used to having a schedule and an officer telling
me what me every move was and now life is just totally different. So, that was a key
thing people took away: is how these people were warriors one day and now they're
expected to be back in our states as a civilian, be totally autonomous and independent
with their thinking and how that must be really tough for them. So, that was a huge
takeaway for them.