Physician Assessment and Clinical Education (PACE) Program

Physician Assessment and Clinical Education (PACE) Program

DIRECTOR William A. Norcross, M.D. Clinical Professor of Family Medicine ASSOCIATE DIRECTOR Peter Boal Our Team Director OF EDUCATION Christine Moutier, M.D. Associate Clinical Professor of Psychiatry Assistant Dean for Student Affairs Contact Us UC SAN DIEGO Physician Assessment and Clinical Education (PACE) Program 1899 McKee Street, Suite 126 San Diego, California 92110.1976 Phone: 619.543.6770 Fax: 619.543.2353 Email: ucpace@ucsd.edu Web: paceprogram.ucsd.edu Director, Assessment Program Kate Seippel, M.P.H. Director, Physician Enhancement Program Nathaniel Floyd Senior Case ManagerS Kate Seippel, M.P.H. Nathaniel Floyd Patricia Reid, M.P.H. Coordinator, CONTINUING MEDICAL EDUCTAION Veronica Love PROGRAM DEVELOPER & MARKETING COORDINATOR Katie Borton information technology Chris Woodard To request periodic email updates about new and customized offerings, please send an email to: ucpace@ucsd.edu...with Add me to your email list in the subject line. 1

Quick Reference PROGRAM OFFERINGS DURATION COST CME* PAGE Physician Assessment Program Phase I 2 DAYS $8,500 - $9,500 N/A 4 Phase II 5 DAYS $4,000 - $10,000 40.00 5 Physician Assistant Assessment Program 5 DAYS $5,500 N/A 6 Fitness for Duty Evaluations (ComingSoon!) VARIES VARIES N/A 6 Physician Enhancement Program (PEP) - Monitoring ONGOING VARIES N/A 7 ContinuingMedical Education (CME) Offerings 8 Customized Programs VARIES VARIES VARIES 8 Anger Management For Healthcare Professionals 3 DAYS $2,800 29.50 9 Anger Management Intensive Follow Up Program VARIES $3,900 N/A 9 Clinician Patient Communication 1 DAY $500 6.00 10 Medical Record Keeping 2 DAYS $1,250 17.00 11 Physician Prescribing 3 DAYS $1,800 24.00 12 Pr o f e s s i o n a l Bo u n d a r i e s 3 DAYS $2,800 38.75 13 *The University of California, San Diego School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The University of California, San Diego School of Medicine designates this educational activity for a maximum of the above AMA PRA Category1 Credits. Physicians should only claim credit commensurate with the extent of their participation in the activity. 2

Introduction & History The University of California San Diego Physician Assessment and Clinical Education (PACE) Program is dedicated to the detection, evaluation, and remediation of deficiencies in the clinical performance of physicians and other healthcare professionals. In collaboration with physicians, state medical boards, hospitals and others, we work to promote public protection, patient safety, and the attainment of the highest possible quality of clinical care. Since 1996, the PACE Program has committed itself to promoting a culture of ongoing quality improvement and professional development in the medical field. It is our mission to better the quality of healthcare throughout the nation by offering assessment and remediation services to medical professionals. The largest assessment and remediation program for healthcare professionals in the country, the PACE Program has provided services to over 2,500 physicians and medical professionals, including podiatrists, physician assistants, and nurses. The PACE Program is a collaborating site for the Post Licensure Assessment System (PLAS), a joint program of the National Board of Medical Examiners TM (NBME TM ) and Federation of State Medical Boards (FSMB). The PLAS Program provides assessment tools to programs who conduct performance assessments and targeted remediation for practicing physicians in an effort to facilitate movement toward attainment of national standards for the field of physician assessment and remediation. The PACE Program is a nonprofit enterprise within the UCSD School of Medicine, administratively housed in the Department of Family and Preventive Medicine. Our outstanding faculty includes full-time faculty of the UCSD School of Medicine and represents over 30 specialties of medicine. 3

PACE Physician Competency Assessment: Phase I The UC San Diego PACE Comprehensive Physician Clinical Competency Assessment Program is divided into Phase I (2 days of multilevel clinical assessment and health evaluation) and Phase II (5 days of on-site, academic medical center- based formative and summative assessment with customized clinical education). Components of the Phase I (2 day) assessment program include: PULSE Survey 360 workplace assessment with individual feedback reports; Self-report history including practice demographic information, personal health behaviors, educational and training experiences, habits of continuing professional development, and medical practice history; Standardized post-licensure tests created by the National Board of Medical Examiners (NBME TM ); Observed history and physical on a mock patient, using standardized forms and procedures to evaluate communication skills, clinical ability in physical examination, and professionalism; Complete health history and physical examination performed on the visiting physician; Computerized neurocognitive screening test: Microcog, Pearson Education, Inc.; Computerized patient simulation/clinical management scenarios: Primum (NBME TM ); Structured oral review of the Primum scenario transactions to evaluate clinical thinking and judgment; Oral clinical exam in physician s specialty by PACE faculty member; Chart review of random sample of visiting physician s medical records using standardized procedures and instruments performed by PACE faculty in physician s specialty; Summary report emphasizing areas of achievement and areas needing improvement. 4

PACE Physician Competency Assessment: Phase II Phase II is a formative and summative assessment of the participant s clinical skills, knowledge and judgment. During the 5-day Phase II clinical assessment and education program, the participant s clinical skills and knowledge are further evaluated while being integrated into the educational activities of the host specialty residency or fellowship program at the UCSD Medical Center. The participant learns new knowledge, skills and techniques from faculty of the UCSD School of Medicine, acquiring methods of fostering and maintaining lifelong learning. PACE participating physicians do not have direct responsibilities for patient care, but are otherwise incorporated into the full spectrum of specialty-specific educational opportunities offered daily in a busy academic health center teaching service. The teaching environment is supportive, uplifting and enjoyable. Phase II takes place at the inpatient and outpatient facilities of the UCSD Medical Center Hillcrest; UCSD Medical Center Thornton Hospital; VA Medical Center, La Jolla; and other teaching venues of the UCSD School of Medicine. Typical teaching opportunities include: outpatient clinics, inpatient ward rounds, Grand Rounds and other conferences, and observation of procedures. To the extent possible, Phase II is tailored to: the results of the Phase I Assessment, the reasons the visiting physician is referred to PACE, and the personal wishes of the visiting physician or referring organization. Each visiting physician is assigned a faculty mentor to ensure that the objectives of Phase II are met. Highlights include: Addressing individual needs and requirements of the physician; Creation of an evidence of learning and achievement portfolio; Evidence-based medicine project; Medical informatics exercise; Commitment to Change contract; Summary report including final grade; At the conclusion of Phase II, a multidisciplinary review group evaluates the performance of the visiting physician in a timely manner, and when appropriate, makes recommendations regarding further training. For CME credit information, please refer to our website (paceprogram.ucsd.edu). 5

PACE Physician Assistant Competency Assessment The Physician Assistant Assessment Program is a 5-day comprehensive program incorporating a variety of evaluation methods to provide an overall picture of the Physician Assistant s skills, knowledge, and physical health. The P.A. Assessment Program includes the following components: Review of Practice Profile Chart Review Oral Clinical Examination Written Exams: Participants will take two written multiple-choice question exams created by the National Board of Medical Examiners TM (NBME TM ). History and Physical Skills Exam: Participants are evaluated performing an H&P exam on a mock patient. Standardized Patient Encounters: Participants complete 4 encounters on patients who have been trained to represent various clinical entities. History taking, physical examination, development of an assessment & plan, physician-patient interaction and communication, and information sharing will be assessed. Comprehensive Physical and Mental Health Screening 3 Days of Clinical Observation Evidence-Based Medicine Project At the conclusion of the assessment week, a multidisciplinary staff meeting is held to determine if the P.A. has completed the program, or if more Clinical Education or other remediation is necessary. PACE Physician Fitness For Duty Evaluation PACE is in the process of developing a Fitness for Duty Evaluation designed specifically for physicians. The purpose of the program is to determine the extent to which the referred physician may be physically, mentally, or chemically impaired from performing the duties of his or her job. The PACE Fitness for Duty Evaluation will draw upon expert clinicians and state-of-the-art resources of the renowned UC San Diego Health System. Please visit paceprogram.ucsd.edu often for updates on this exciting new offering. 6

PACE Physician Enhancement Program (PEP) The PACE Physician Enhancement Program (PEP) is both: an on-site, in-practice monitoring program designed to ensure the participating physician is practicing safely; and a mentoring program designed to assist the practicing physician in attaining the highest standards of professional growth and clinical excellence. PEP was created to aid state medical boards provide high quality monitoring services to physicians. Our goal is to use independent and well qualified practice monitors who can provide objective oversight and assessment of the participating physicians while simultaneously helping them improve their practices. To achieve our goal of selecting well qualified independent monitors, we carefully vet each potential new monitor. If selected, our monitors will receive a detailed orientation and training process prior to starting. Where possible, we employ faculty of the UCSD School of Medicine, who are experienced clinicians, assessors, and educators. PEP highlights: Initial and Semi-annual on-site Practice Review using standardized instruments and procedures. The practice site visit is performed by a physician member of the PACE faculty; PULSE Survey 360 workplace assessment with individual feedback reports; Interval Review of Professional Growth & Education to identify strengths and/or deficits contributing to the physician s overall clinical practice and medical knowledge; Creation of an individualized Personal and Practice Development Plan (PPDP) including the development and conduct of quality improvement and practice-based research projects to enhance clinical performance and behavior; Monthly Chart Audits using standardized instruments and procedures; Monthly phone conversations with PACE faculty reviewing chart audits, Practice Review Results and progress on PPDP; Summary reports provided to the referring agency on a quarterly basis. The Medical Board of California recognizes PEP as an official alternative to having a practice monitor. 7

PACE Continuing Medical Education (CME) Continuing Medical Education (CME) is the mechanism for the life-long learning requirement for every healthcare professional. PACE offers CME that is inherent to good medical practice but is unique in content. Our objective is CME that matters. Our offerings are focused and interactive, in line with effective adult learning principles that lead to behavior change. All courses use Pre and Post tests to measure the acquisition of knowledge. We continuously evaluate participant feedback and course content to ensure our courses remain relevant and of the highest quality. The PACE Program offers regularly scheduled CME courses (ranging in size from 8 to 60 people) in the topic areas of anger management, professional boundaries, clinician-patient communication, medical record keeping and prescribing. (See pages 9-13) CUSTOMIZED PROGRAMS Occasionally, a physician or organization will require a program or course of study that cannot be found after a search of customary CME venues. PACE faculty and staff will work to create a customized program that suits the needs of the physician and/or referring organization. We can also provide customized on-site educational programs to referring organizations. Frequently requested customized courses: Wrong-Site Surgery Utilization Management Supervising Physician Assistants Obtaining Informed Consent Billing and Coding Other Examples of Topics Available for Customized Programs: Chronic Disease Critical Thinking Cultural and Linguistic Competency Enhancing Team Communication Disruptive Physician/ Practitioner Programs Ethics & Communication Interpersonal & Leadership Skills Session Interpersonal Relationship Enhancement Judicial Legal Medicine Pain Management Patient Safety and Risk Management Primary Care Education for the Physician Assistant Review of Primary Care Topics Specific Clinical Topic by Request Please call 619-543-6770 for inquiries or visit our website, paceprogram.ucsd.edu, for updated offerings, accreditation information, and the current schedule of classes. 8

ANGER MANAGEMENT FOR HEALTHCARE PROFESSIONALS Conflict, stress and disruption in the hospital and clinic setting create low morale, heightened rates of staff turnover, and patient safety concerns. This course is designed to help those physicians and healthcare providers who have contributed to a disruptive working environment by way of inappropriate expression of anger. Course highlights: PACE Continuing Medical Education (CME) (cont.) Small (maximum of 12), intensive, three-day program led by an experienced clinical psychologist; Practice in cognitive and behavioral strategies as well as action methods relevant to managing anger and stress in the healthcare environment including: communication techniques for conflict de-escalation & the role of mindfulness and self-care in emotional intelligence; Discussions include: the contribution of medical education and the medical environment to stress and conflict, cognitive and behavioral strategies of anger management; Development of an action plan for improved functioning in the workplace; ANGER MANAGEMENT INTENSIVE FOLLOW UP PROGRAM Behavioral change takes time and reinforcement of learned skills to become habit. A follow-up coaching/ mentoring program is available to increase the likelihood of sustained success in behavioral change for the participant. The program consists of seven 50 minute coaching sessions over 3 months, which are done via telephone or video conferencing over the internet (e.g. Skype TM ). At the end of the three months a progress evaluation will be provided. Additional sessions are available in three month intervals until the participant meets behavioral goals that are consistent with acceptable professional conduct. Source information on achievement of goals includes feedback from: the participant, the referring organization, and results of 360 degree workplace survey (beginning and end of the program). The creation of a behavioral contract may also be necessary. This would be addressed on an individual basis determined by the needs of the referring organization. In addition, recommendations for local therapeutic behavioral treatment will be made on an as needed basis with the participant referred to a provider near his/ her location. The coaching/mentoring program is not to be a substitute for a therapeutic relationship. 9

PACE Continuing Medical Education (CME) (cont.) CLINICIAN-PATIENT COMMUNICATION COURSE The Physician Patient Communication workshop is a fast-paced, one day program for 6-30 participants, designed to improve the healthcare communication skills of the physician. This highly interactive workshop employs the Institute for Healthcare Communication material, exercises, and workbook. The materials have been successfully taught and employed throughout the country. Course Highlights: Examining the relationship between communication skills and important patient outcomes including: Improved diagnostic accuracy; Greater involvement of the patient in decision making; Increased likelihood of adherence to therapeutic regimens; Better patient satisfaction; A reduced likelihood of malpractice litigation; Active participation analyzing videotaped re-enactments of actual cases identifying effective and non-effective interactions; Practice demonstrating communication skills and techniques individually and in teams; Team development of constructive approaches to current patients in physician s own practice; Immediate implementation of one or two techniques into participant s practice. 10

PACE Continuing Medical Education (CME) (cont.) MEDICAL RECORD KEEPING COURSE The Medical Record Keeping Course is an intensive two-day program designed in response to numerous requests from state medical boards, risk management groups and hospitals to teach proper medical charting methodology and billing practices. Feedback is gathered from expert chart reviews and prior activity. The topics of billing & coding, legal requirements and technical and electronic advancements in medical record keeping will be addressed. In addition to physicians, office personnel who wish to ensure that they maintain appropriate billing codes are encouraged to attend. Course Objectives: To improve the quality of charting behavior and documentation of medical records by physicians To increase physician knowledge about the laws pertaining to medical documentation To improve physician knowledge regarding documentation and coding for correct billing procedures To provide information on current technological innovations to improve medical documentation and information retrieval Topics Include: The Law and the Medical Record; Avoidance of Deficiencies in the Medical Record that Lead to Malpractice Suits or Disciplinary Action; HCFA Guidelines, Coding and Documentation of Services; Medical Informatics and the Medical Record; Health Insurance Portability and Accountability Act (HIPAA); The Electronic Health Record; Chart Review Workshop: Individual Personalized Review and Critique of Medical and Billing Records. 11

PACE Continuing Medical Education (CME) (cont.) PHYSICIAN PRESCRIBING COURSE The Physician Prescribing Course is a two and one-half day small group continuing professional development program designed to improve the participant s prescribing behavior by providing education on the legal, biomedical, pharmacologic and clinical aspects of prescribing drugs, especially controlled substances. Physician-patient interaction including dealing with the manipulative patient is discussed. Course Objectives: To address common pitfalls in physicians prescribing practices To highlight critical, clinically relevant pharmacological principles To improve the recognition of manipulative patient behaviors To develop effective strategies for managing difficult drug-seeking behaviors To appraise the clinical utility of a scientific article using evidence based guidelines. Topics in this course include: State Laws and Medical Board Guidelines for the Prescription of Controlled Drugs; Pharmacokinetics and Drug Metabolism; Pharmacology of Sedatives, Narcotics, and Amphetamines; Drug Interactions; Patient Compliance; Charting Drug Prescriptions; Managing the Difficult Patient; Critical Review of the Medical Literature; Management of Chronic Pain; Special Issues in Chronic Pain: Headache, Back Pain and Fibromyalgia. 12

PACE Continuing Medical Education (CME) (cont.) PROFESSIONAL BOUNDARIES PROGRAM The Professional Boundaries Program is a dynamic, interactive three-day educational training program facilitated by a minimum of two physicians board-certified in psychiatry. The program objective is to assist professionals in addressing the issues that contribute to their misconduct in the workplace. Additional goals and objectives include: 13 Developing a greater understanding of the multiple issues and factors that lead to sexual harassment and sexual misconduct in the workplace; Increasing knowledge and understanding of the impact of sexual harassment and sexual misconduct on victims and the work environment; Increasing insight into personal attitudes and paradigms about work, power, self-esteem, gender and cultural factors, and issues of sexuality; Values and boundary clarification; Improving coping skills; Providing tools for appropriate workplace behaviors. PACE has developed this program to meet the needs of the professional who: Had had a complaint or grievance filed against him/her for sexual harassment and/or misconduct in the work place; Is at risk of losing his job, practice, privileges, or license due to allegations of sexual misconduct or creating a hostile work environment; Is on probation or suspension while under investigation; Needs to meet court, state board, or employer recommendations for sexual harassment/misconduct prevention training. PACE provides an intensive training program that offers professionals an opportunity to obtain educational information and personalized assessment in a highly sensitive, supportive and confidential environment away from the workplace. Post course follow-up occurs at 3 months, six months and one year to help ensure behavioral changes are maintained.

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1899 McKee Street, Ste. 126 San Diego, CA 92110 P: 619.543.6770 F: 619.543.2353 E: ucpace@ucsd.edu paceprogram.ucsd.edu