The program designed for Yale residents is having a national impact
Since Yale School of Medicine’s Primary Care Residency established its Office-Based Medicine Curriculum about 20 years ago, there has been a push toward treating patients in outpatient settings instead of hospitals whenever possible. Meanwhile, primary care doctors have seen a constant stream of changes and refinements in the care of almost every malady they encounter.
All of this has created a hungry market for Yale’s curriculum, which was originally designed to teach Yale residents about common ambulatory problems, and it is now in use at 125 institutions, including some of the most prestigious medical centers in the country.
“This program represents a major accomplishment in training and teaching that’s having a national impact, and we’re proud of it—it’s something the entire university should be proud of,” said Patrick G. O’Connor, MD, MPH, professor of medicine and chief of general internal medicine, who frequently gets positive comments about the program in his travels to other academic centers.
Curriculum covers a wide span
At Yale, the online literature-based syllabus (print copies are available upon request) is designed to enhance clinical experience. Updates are provided when an important report is published, or when new developments occur in therapy or standards of care. Currently in its seventh edition, the curriculum includes two complementary syllabi:
- Housestaff guide, which can be read prior to clinic attendance, minimizing the amount of didactic information to be covered and enabling more in-depth discussion of the questions posed in different cases
- Faculty guide, which can be used for self-directed learning
Dr. O’Connor finds the curriculum valuable for both of these groups for four reasons: The curriculum covers “the bread and butter of internal medicine,” including how to diagnose and treat patients in a cost-effective way; it emphasizes topics that fall outside of the realm of traditional internal medicine; it covers broad behavioral and psychosocial topics and issues, such as addiction medicine and end-of-life care; and it utilizes a highly effective case-based approach that emphasizes the latest evidence from the medical literature. “It’s a broad set of training activities for real-world medicine that occurs outside of the hospital in the community,” he said.
The curriculum is written by Yale School of Medicine faculty and edited by Drs. Julie Rosenbaum, Seonaid Hay and Laura Whitman; and Mary Warner, PA-C, all of whom are part of the Section of General Internal Medicine. They update the curriculum every six months and add important information—such as a recent new guideline for the management of stable COPD—as necessary.
Serving on the curriculum’s advisory board along with Dr. O’Connor are Drs. Sally Haskell, Stephen Huot and Lisa Sanders.
“What we try to do is cover a range of the basic topics that you might encounter in terms of patient issues in the office,” said Dr. Rosenbaum, adding that they often add new topics, such as chapters on community-acquired methicillin-resistant staphylococcus aureus (MRSA) or practice issues such as open access scheduling.” Among the many topics listed in the index on the website are: outpatient management of atrial fibrillation, dermatologic malignancies, professionalism in clinic, hearing loss and fibromyalgia.
The cornerstones of the curriculum are the realistic, challenging cases and related questions prepared by Yale faculty, which emphasize practical aspects of diagnosis or management, Dr. Rosenbaum said. Exercises in the curriculum are designed to prompt not only information recall, but also higher order cognitive skills, such as solving problems, evaluating new information, and making judgments, she added.
Treating the ‘whole patient’
While many specialists might not feel they need some of the broad information, “It depends a little on what kind of specialist you are,” she said. “There are some specialists who still end up with a ‘whole patient’ orientation in their approach to patient care, and would be interested in such chapters as promoting patient adherence, promoting health literacy or psychosocial aspects of care.”
Dr. Rosenbaum expects the curriculum will continue to be increasingly important under the Affordable Care Act as it increases the number of insured patients and the burden on primary care providers. “We need to make sure that the care we provide in the doctor’s office is top quality and as outstanding as we can make it,” she said.
For a pediatrics version of the curriculum, visit the Yale Primary Care Pediatrics Curriculum website.