Resources
Educator Resource #1: MedEdPortal
Jun 1st
We will be posting a series of emails/blog posts to highlight educational resources from the Education SIG throughout the year. Comments are welcome.
Dear Colleagues and Education SIG members
Now that we’ve gotten past the excitement of abstract submissions for next year’s Assembly in New Orleans, Lynn and I would like to engage you in sharing education resources with each other and our broader community. The goal is to promote increased scholarship for and dissemination of palliative care education initiatives. This email will be the first in a series to highlight a specific educator resource. All emails will also be posted on the AAHPM blog to engage a larger group of our colleagues. We encourage you to read about these resources, share your personal experiences with them, ask questions about them, pass them along to colleagues, and contribute to the conversation. Please also contact either of us directly if you would like to share a specific resource or have other ideas for pushing the shared vision of our Education SIG community forward.
Cheers, Everyone,
Laura Morrison, Chair lmorriso@bcm.edu
Lynn O’Neill, Chair-Elect lynn.oneill@duke.edu
Education Special Interest Group, AAHPM
Educator Resource #1: MedEdPortal www.mededportal.org
This major resource focuses on academic medical and dental education and is operated by the Association of American Medical Colleges (AAMC). Above all, MedEdPortal is a free, peer reviewed publication service. Because MedEdPortal publishes teaching and faculty development materials and assessment tools, it also serves as a place to find such things. In addition to medical and dental education materials, the website indicates they are now accepting interprofessional educational materials submissions that are relevant to medical or dental education. Those from non-medical disciplines can visit and submit materials.
The 3 main reasons to visit MedEdPortal:
1) Finding Education Materials and Resources for Your Program: One can easily search for curricular and assessment materials by numerous categories (medical specialty, ACGME competency, etc.) Searching under palliative care currently yields 27 items with some authors among our SIG community. You must create an account to log in and actually see the posted materials but summaries are accessible to anyone. Citations are also listed. Go see what resources you can find and avoid re-inventing the wheel.
2) Submitting Your Materials: A clear and rigorous submission and peer review process is described and diagramed on the website. This is much like a journal submission as far a formality, including a waiting period for review and feedback from editors with a decision (acceptance, rejection, and acceptance with revision). All materials accepted are published with a citation. Some institutions with clinician-educator pathways are giving these publications weight nearly equal to journal publications. Many aren’t but are still recognizing these as publications on a CV. As far as the timeline, MedEdPortal went through a major reorganization process last year to increase the efficiency of their system. It is new and improved. You should consider a submission, especially if your initiative will not be published in an article. Also, some materials published in articles are still eligible for publication here.
3) Peer Reviewing for Others: For those health professions educators interested in gaining peer review experience in this arena, MedEdPortal is accepting reviewer nominations. The website has very explicit detail about the review process and guidelines listed on the website. The listed contact is: peerreview@aamc.org
Questions:
Does anyone have experience with MedEdPortal? Have you found helpful materials or had success with a submission? Is anyone a peer reviewer?
Colleagues have indicated to me that the submission process requires attention and effort and that the review process is rigorous and highly repected. If one is successful with a publication, it’s a nice accomplishment and contribution. Comments?
I hope you’ll all consider a visit to the website www.mededportal.org and remember this terrific resource. Obviously, we need to encourage them to have a specific category for our subspecialty, and we need to grow the number of palliative care materials available in the repository.
Cheers, Laura
Common UNIPAC Questions Answered
May 18th
This is the last of three posts by UNIPAC series editor Porter Storey, MD FACP FAAHPM, in which he discusses the new UNIPAC series, including the amplifire™ online confidence-based learning modules, and addresses commonly asked questions.
1. I am mainly interested in coding for hospice services, is this covered?
a. While many hospice regulations are covered, the new AAHPM Hospice Medical Director Manual is the most comprehensive resource for this material.
2. Will the 4th Edition of the UNIPAC Series help me pass the Board Exam in October?
a. While AAHPM has no inside information about the content of the ABIM sponsored exam, we used the published list of topics covered on the exam to inform the development of this edition.
b. The ABIM exam is based on the best practices and current literature in our field, which is what we surveyed and referenced extensively.
c. One of the best ways to study for any exam is to focus on those areas in which your knowledge is weakest. The accompanying amplifire™ confidence-based learning modules will help you identify and focus on these areas.
Porter Storey MD FACP FAAHPM
Executive VP, AAHPM
Colorado Permanente Medical Group
Boulder, CO
UNIPAC 4th edition available for purchase.
More UNIPAC Questions Answered
May 11th
This is the second of three posts by UNIPAC series editor Porter Storey, MD FACP FAAHPM, in which he discusses the new UNIPAC series, including the amplifire™ online confidence-based learning modules, and addresses commonly asked questions.
At the AAHPM Annual Assembly, I was asked several good questions about the new UNIPAC Series 4th edition. Perhaps this information will help inform your purchasing decisions.
- Is there more information in the 4th edition than the 3rd?
a. Older, less-relevant material was replaced with new developments, and while an effort was made to keep them succinct, some books, like the Pediatric UNIPAC grew by nearly 50%.
b. Every effort was made to include systematic reviews and consensus statements to help the reader interpret the vast amount of new material being published in our field. - Has the 4th Edition really been updated? Is it evidence-based?
a. This edition includes 2551 references and over 600 of these are from 2010-2012.
b. You will find material from the NHPCO Facts and Figures 2011 edition and the new American College of Physicians Ethics Manual published in 2012, among many other new sources.
Porter Storey MD FACP FAAHPM
Executive VP, AAHPM
Colorado Permanente Medical Group
Boulder, CO
UNIPAC 4th edition available for purchase.
UNIPAC 4th edition Now Available
May 4th
This is the first of three posts by UNIPAC series editor Porter Storey, MD FACP FAAHPM, in which he discusses the new UNIPAC series, including the amplifire™ online confidence-based learning modules, and addresses commonly asked questions.
At the AAHPM Annual Assembly, I was asked several good questions about the new UNIPAC Series 4th edition. Perhaps this information will help inform your purchasing decisions.
1. Is the 4th Edition of the UNIPAC Series really any different that the 3rd edition?
a. Every UNIPAC was carefully revised and some (like Ethics and Pain) were completely re-written. New and extensively updated topics include:
i. the controversies around opioid contracts,
ii. the latest Catholic Ethical and Religious Directives,
iii. parental requests to withhold information from dying children,
iv. comprehensive assessment of fatigue and anorexia-cachexia,
v. management of co-infection of hepatitis C & HIV,
vi. the importance of legal decisions in the Barber, Saikewics, and Bouvia cases on withdrawing tube-feedings,
vii. treatment of agitation in dementia patients,
viii. the roles of opioids, pulmonary rehabilitation, and non-invasive ventilation in the treatment of dyspnea in patients with end-stage COPD,
ix. and many others.
b. Several of the UNIPACs have new authors who are leaders in our field (e.g. Russell Portenoy) and they were all reviewed by acknowledged experts (e.g. Timothy Quill).
Porter Storey MD FACP FAAHPM
Executive VP, AAHPM
Colorado Permanente Medical Group
Boulder, CO
UNIPAC 4th edition now available for purchase.
AAHPM Physician Compensation Survey Reveals Diversity in Pay, High Job Satisfaction
Jul 18th
Charles V. (Chuck) Wellman, MD FAAHPM, is Chief Medical Director of Hospice of the Western Reserve in Cleveland, OH, and chair of AAHPM’s Leadership and Workforce Strategic Coordinating Committee
It is with great pleasure that we can finally announce the availability of the AAHPM Physician Compensation and Benefits Survey Report. Two years ago a poll of AAHPM’s members indicated a strong interest in such a survey. Earlier surveys, while helpful, suffered from a low rate of participation and from a lack of depth and refinement in the data. Consequently, the Academy’s Board of Directors charged the Business Practice Task Force to select a vendor who could help to design and implement such a survey. As a co-chair of the Task Force at the time and as current chair of our Leadership and Workforce Strategic Coordinating Committee, I can attest to the many hours that Task Force members spent on this process and the challenges we faced in dealing with the complexity and variability in our field.
The complexity is and will continue to be a challenge. HPM practitioners come from many different backgrounds. We work fulltime and part-time. We work for hospices, hospitals, the Veterans Administration, or as independent practitioners. Some of us are on salary while others have productivity-based compensation. We measure productivity in different ways. Some of us are in academic settings, and many of us have administrative, research, and teaching responsibilities. We have great variability in titles with no consistent agreement on chief medical officer, medical director, associate medical director, and team physician. As you might imagine, each iteration of the survey resulted in further discussion, and we realized a constant tension between designing a thorough, comprehensive survey versus a survey that might be too complex or time-consuming. In the end we find ourselves very pleased and grateful that nearly 800 of us were willing to complete this survey.
One will find that there is a wealth of data in this survey. It tells us a lot about who we are in this relatively young field. It will help to establish ranges of benefits and compensation, which will be increasingly important as we strive to attract residents and mid-career physicians to our field. The survey will give us greater flexibility in negotiating work hours, time off, productivity expectations, and CME benefits. There were also questions about job satisfaction, and it is exciting and gratifying to know 96% of us are satisfied or very satisfied with our profession and 93% of us are likely or very likely to recommend a career in HPM.
The survey will continue to be a work in progress. As we review the current survey results, it is expected that additional questions will arise, and there will be recommendations on how to further refine the survey questions. The unique and evolving arrangements in our field will challenge our future revisions, but we invite your feedback and encourage dialogue on how we can make future surveys more helpful and accurate. Comments can also be sent to the Academy at info@aahpm.org, (Subject: Comp Survey Feedback.) It is an exciting start.
NHPCO Management & Leadership Conference through Tweeter Eyes
Apr 15th
I attended the NHPCO Conference and this year it was different. I’m a committed member of the tweeting subculture inspired by my twitter buddies after reading live commentary from sessions at the recent AAHPM conference in Canada.
I had not planned it before going to the conference but fell into it as I listened to the first session. My initial thoughts…..take notes in the form of tweets that I can review later. But with time and the growing joy in it, I embraced the mission to benefit to the bigger audience and resolved to tweet notes that others could follow, giving credit to the presenters & bringing the message to more people. I felt like a reporter bringing tales from the edge. I reveled at bringing the results of the Moran report to the twitter community, giving insight into the issues affecting the multigenerational hospice workforce, CMS’s recommendations about the Face to Face Visit regulations or bringing eAdvocacy strategies. It changed my conference experience completely. People around me asked what I was doing punching madly on my blackberry and became starry eyed at the thought of stardom in Twitterwood!
A highlight was meeting fellow tweeters. No introductions needed, we already know each other on a different level. I laugh as I approached them in hallways and at the bookstore “Hi!—– EOLnavigator. Great to finally meet you IRL (in real life). My real name —–Niamh!”
So what’s the point of tweeting live from a conference? Our collective mission is to get everybody passionate about end of life care with something to say about it online bringing their expertise to the masses and bringing the conference experience to non-attendees. I won’t miss another AAHPM conference & you can expect tweets on the road, not literally speaking! Read our tweets for the conference at www.tweetchat.com and enter #mlc11 hashtag or follow the #hpm hashtag to meet your online hospice and palliative care brothers and sisters.
JPSM Call for QI Papers Closes April 15
Apr 12th
The Journal of Pain and Symptom Management is pleased to announce a call for papers that report the results of Quality Improvement initiatives in palliative care.
This publication of brief reports is a joint project of the American Academy of Hospice and Palliative Medicine and the National Hospice and Palliative Care Organization. Papers focusing on hospice and palliative care settings are encouraged.
The Journal offers this professional forum to encourage dialogue, peer review, and dissemination in response to a growing international concern about quality care, patient safety, and the role of evidence-based medicine. Submissions should describe specific Quality Improvement projects, such as efforts to increase pain screening, encourage goals discussions, promote palliative care consults, encourage earlier hospice referrals, or support staff well-being. Submissions must describe the impact of the intervention, either in terms of change over time or relative to a comparator.
Papers will be considered Brief Reports and must include the following:
1) A structured abstract of <150 words with five headings: Background, Measures, Intervention, Outcomes, Conclusions/Lessons Learned.
2) Five sections—Background, Measures, Intervention, Outcomes, Conclusions/Lessons learned—requiring no more than 1,250 words
3) No more than 10 references and two graphs or tables. (References/tables/ graphs are not included in the word count.)
4) A cover letter specifying that the Brief Report is being submitted in response to this Call for Papers.
Papers that fulfill the length and formatting requirements will undergo preliminary review by the Editors, and some will undergo external peer review. Acceptance for publication will depend on evaluation of the problem addressed, innovation, quality of the description, and clinical relevance of the intervention and outcomes.
Manuscripts submitted in response to this announcement should be submitted online to the Journal of Pain and Symptom Management (http://ees.elsevier.com/jps/) by April 15, 2011.
For questions regarding format or content of potential manuscripts, please contact Dr. David Casarett (Casarett@mail.med.upenn.edu).
MedPAC meeting in Washington on Palliative Care
Mar 31st
I have always yearned for a Medicare Benefit for palliative care services, so it was with some excitement that I read an e-mail from MedPAC inviting me to a meeting in Washington March 23, to discuss palliative care.
The Medicare Payment Advisory Commission (MedPAC) is an independent Congressional agency established by the Balanced Budget Act of 1997 to advise the U.S. Congress on issues affecting the Medicare program. The Commission’s statutory mandate is quite broad: In addition to advising the Congress on payments to private health plans participating in Medicare and providers in Medicare’s traditional fee-for-service program, MedPAC is also tasked with analyzing access to care, quality of care, and other issues affecting Medicare.
The Commission staff invited a diverse group of palliative care specialists to come to Washington to discuss general issues such as the definitions and scope of non-hospice palliative care, the strength of the evidence that palliative care improves quality, outcomes, and service use, and factors that enable or hinder the delivery of palliative care.
The conference was attended by MedPAC staff, a moderator from the Lewin Group, and Janet Bull (Four Seasons, NC), Lyn Ceronsky(Fairview Services, Minneapolis), Timothy Keay (U Md Ca Center, Baltimore), Randall Krakauer (Aetna, NJ), James Lee (Everett Clinic, Washington), Diane Meier (CAPC , NY), Susan Mitchell (Harvard Aging Research, Boston), Michael Nisco (UC & Hospice, Fresno), Russell Portenoy (Beth Israel, NY), Greg Sachs (U of Indiana Aging Research, Indianapolis), Linda Todd (Hospice and PACE of Siouxland, Indiana), and myself.
It soon became clear that a new benefit for palliative care services is not on anyone’s drawing board, but the inclusion of palliative care services in new initiatives like Accountable Care Organizations, Community Health Teams to Support the Patient-Centered Medical Home, Hospital Value Based Purchasing, or Center for Medicare and Medicaid Innovation at the Center for Medicare Services is a possibility.
It was an energized discussion of wide-ranging aspects of our field, and we all hope the MedPAC staff can use what they learned from us to help Medicare beneficiaries with serious illnesses get the best possible care.
Porter Storey MD
Executive VP, AAHPM
Colorado Permanente Medical Group
Boulder, CO
Happy 100th Anniversary, PC-FACS
Dec 2nd
The 100th issue of PC-FACS, an AAHPM signature service, represents a milestone. Celebrating this century issue, Editor-in-Chief Amy Abernethy commented on trends in palliative care since the digest’s inception. Read the 100th issue of PC-FACS.
(1) Increasing acceptance of palliative care as a discipline. The palliative care philosophy now extends into diverse settings including mainstream medicine. Once identified with end-of-life care, palliative care now defines care delivered appropriately throughout complex life-threatening illnesses.
(2) Systematic development of an evidence base, and iterative refinement of a toolbox, for palliative care practice. Research now includes rigorous randomized controlled trials and systematic reviews as well as observational studies, and addresses a wide spectrum of clinical issues and outcomes ranging from quality of life to health service utilization.
(3) Basic science exploration. Complementing clinical studies, basic science can provide insights into, and a biological underpinning for, clinical observations. Bidirectional conversation between basic scientists and clinicians will help develop, evaluate, and refine the next generation of interventions, and continuously improve quality and outcomes.
(4) Examination of quality. Efforts to define quality will allow us to benchmark clinical practice, advance/improve standards, identify effective approaches, and disseminate best practices.
Palliative Care Grand Rounds 2.9
Sep 1st
Welcome to the monthly edition of Palliative Care Grand Rounds the monthly review of the best of hospice and palliative care content from blogs. We started in February of 2009 and are almost done with our second full year. To see previous editions of Palliative Care Grand Rounds go the http://palliativecaregr.blogspot.com/.
Marten Creek Photo by Joan Robinson RN CHPN Seattle WA
This summer has been a exciting month for palliative care and hospice advocates. At the beginning of the month we were still taking in all the attention form Atul Gawande’s article in the New Yorker titled ‘Letting Go.‘ And then in the middle of August we had the ground breaking research published in the NEJM demonstrating early palliative care improves QOL, reduces depression and potentially can improve survival.
So I thought we could start with blog posts relating to those two big tent poles.
The Gawande Article
People were reflecting on the writing of Atul Gawande and I think there is a lot to learn from how he tells his stories. It may help in how you give a presentation or write articles or blog posts of your own. My favorite was a blog called ‘Not Exactly Rocket Science’, where blogger Ed Yong writes on ‘Deconstructing Gawande – why structure and narrative are important.’ Also check out Bob Wachter’s blog piece on Atul Gawande and the Art of Medical Writing. He writes:
In this month’s piece, Gawande continues to tackle the most important healthcare issues of our day. By doing this with such clarity and beauty, he makes us all a little smarter, wiser, and more sensitive. His writing is a gift.
Debra Bradley Ruder from the GrowthHouse blogs Goodbyes writes on the Gawande article as well.
The NEJM Study
Both Geripal (Alex Smith) and Pallimed (Lyle Fettig) jumped on the NEJM research quickly and provided really helpful insights into the research that you wouldn’t get just reading the New York Times or other media sources. Between these two posts there are currently over 35 comments! Several days later Drew Rosielle let the results marinate with him a bit and the result is a tasty dessert highlighting the implications for our field in his Pallimed post ‘You had me at improves HRQOL.’
Diane Meier jumped into blogging and wrote a good piece at the John Hartford Foundation blog, that was picked up my the (general medicine) Grand Rounds and got 2nd billing. Many other key blogs covered this as well including:
- Center for Practical Bioethics
- Hospice Foundation of America
- AAHPM blog
- Palliative Care Success (good one on applying the results of this study)
- db’s Medical Rants
- Science Codex
- Freeforall – A health policy discussion
- Right Truth – Palliative Care Improves Survival?
- American Cancer Society – Dr. Len’s blog
Other great bits
- Joanne Kenen has done a number of stories on palliative care issues and got a lot of feedback on her piece in Slate magazine about palliative care issues in the emergency room. She had a great follow-up piece with on her blog at The New Health Dialogue about the challenges to why these conversations don’t necessarily happen in a primary care setting.
- You may have heard of a new breed of patients: the e-patient. One of the vanguards in the e-patient movement is Dave deBronkart who recently wrote a book Laugh, Eat and Sing Like a Pig. He published an excerpt on KevinMD that is a must read and made me go buy the book too.
- You don’t see many CEO’s of hospitals blogging and no one does it better than Paul Levy. He had a great post about visitng patients in his hospital and the role of hope that I think many of us could identify with. An excerpt:
Each person faces cancer in his or her own way. There is nothing right or wrong about the different approaches people take. Denial or acceptance is not a statement about someone’s character. Having hope or not does not always come from an explicit decision to be hopeful; it often just happens one way or the other. Likewise, the spectrum from stoicism and strength to dependence and, yes, even weakness, are reactions that are unpredictable until you are actually faced with the disease. Too, how one feels can change over time — whether minute to minute, day to day, or year to year. So, one thing I have learned is not to be judgmental about how a person responds to cancer.
- In another post Paul Levy also discusses the case of the ER staff who took pictures of a dying patient and posted them to Facebook. Obviously this was a dumb thing to do, but people still did it so it begs the question, is this an issue of social media is bad or lack of professionalism? Read ‘Blocking Facebook won’t stop stupidity’ to find out.
- Eric Widera at Geripal noted the findings of the NEJM study may impact how we look at palliative care in nursing homes as well with his analysis of a recent study in the Journal of the American Geriatrics Society. How can geriatricians and palliaticians ( I just made that up) work closer together?
- AAHPM Board member and PC-FACS editor Amy Abernethy (with Donald Taylor) blogs at Health Affairs on End of Life Savings: The Fools’ Gold of Reform. An excerpt:
It is doubtful that a focus on reducing EOL spending per se will result in as much savings as is often assumed, for one simple reason: The concept of the last year of life is inherently retrospective. You do not know when the last year of someone’s life started until it ends. The stylized fact that leads to the assumption of wasteful EOL spending., i.e., 1 in 4 dollars spent on care in the last year of life, is based on an inherently retrospective concept that does not translate easily into the prospective decision-making that would be needed to reduce wasteful, futile or harmful spending in the last year of life.
- The anonymous blogger Hospice Doctor writes about going to funerals and the impact it has on our lives ina ddition to what it means to families. An excerpt:
And then I understood. I wasn’t crying for him. I was crying for me.
I cried because I couldn’t imagine a memorial service for me looking anything like the one for Rob. I cried because I couldn’t imagine that twenty people, let alone two hundred, would give up an evening to say nice things about me. I cried because I couldn’t imagine that my life, already a lot longer than Rob’s, would ever have that kind of meaning and impact. I understood then that my patient’s short life was telling me to live the rest of my own life better — to be warmer, and more open-hearted, and more loving.
- Frances Shani Parker from the Hospice and Nursing Homes Blog found a great video on YouTube from the EPEC-O series featuring Charles Von Gunten on burnout and wrote a post about a recent study from the Mayo Clinic on physician burnout.
- Richard Smith blogs over at BMJ about Contemplating my deathbed and discusses the various regrets people may have and hot make sure you don’t have so many regrets yourself! An excerpt:
people—actually mainly men—wished that they hadn’t worked so hard. They “deeply regretted spending so much of their lives on the treadmill of a work existence.” My wife would say that I work all the time, but I live a life where work and play are not easily distinguished. Is writing this work? It doesn’t feel like it to me. Tomorrow I’m off to give a talk at a science festival in the Austrian Alps. Is that work? The truth is that even in the most serious jobs I’ve always let the appealing (and often frivolous) come before the serious.
Some humor
- Alex Smith from Geripal created this very funny animation about trying to use your great communication skills honed in palliative medicine at home when your spouse asks you to ‘take out the trash.’ My favorite line: “I wish the trash were taken out but unfortunately it has not been”
- Brian Vartabedian of the very excellent blog 33 charts found an old ad for senna that you may want to bring to your next IDT.
- No one likes to say the words death or dying, but we know it is important to be able to convey these messages with honesty and in an individualized manner. Schott’s Vocab at the New York Times asked readers for different ways you could euphemize ‘dying’. I will warn you some are coarse, some poignant but check out some of the 845 comments and counting for ways to say ‘Kick the bucket.’
- And finally we have heard that Oscar the nursing home cat that can predict the impending death of patients has a movie deal based on the book. Let’s hope they get an advisor on the movie who is knowledgeable about hospice.
Oscar the Cat - Photo by Stew Milne of AP.
So as you can see there are many people talking about the difficult things people don’t want to talk about. We are not alone in wanting to provide good quality care for patients and families facing with life-threatening illness. Sometimes with a little humor is a tough time, sometimes with fantastic insights into what it means to be alive. Go read and support the things that impact you with a comment, Facebook ‘like’ or email to a colleague.
Check out next month’s host the SWHPN blog called palliative-sw. They have a new look!
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