Team-based Learning and Improvement
With a focus on Population Health, Quality Improvement & Health Equity
Population health is an important skill for any community-based family physician. Yet, physicians cannot hope to improve the health of communities or populations without having the tools to identify health inequities and implement change. Team time is designed to learn about these core topics in an interactive, participatory and collaborative way, while utilizing and building upon the strengths of your FMC teamlet. Upon completion of this experience you will be able to:
Describe basic QI tools (process map, run chart, root cause analysis, audit, PDSA)
Describe QI methodology (model for improvement, Lean)
Utilize at least 1 tool in a QI project
Examine health inequities in Cincinnati related to DM, HTN, and smoking using geospatial mapping tools (UDS mapper, HealthLandscape)
Create a registry of your patients and evaluate the state of their chronic conditions & preventive health for a1c, BP, and colonoscopy
Explore your leadership style
Drs Spata and Rich provide oversight for the experience. If you have questions about the experience or need to schedule a meeting to complete course requirements, you can email Dr Spata or email Dr Rich
Each teamlet will have at least one upper-level resident in the role of the FMC team leader as well as a faculty mentor.
Red Team: FMP R5’s and FM R3’s for team leaders, Dr Spata as faculty mentor
Blue Team: FM R3’s for team leaders, Dr Hartmann as faculty mentor
Yellow Team: FM R3’s for team leaders, Dr Lazaron as faculty mentor.
Teaching Logistics
During your designated Team Time, you will meet your teamlet in the Centering Room. Please arrive at 7:30a for a brief outpt teaching session.
Red Team: Monday mornings
Blue Team: Tuesday mornings
Yellow Team: Thursday mornings
Structure
The 4 hours of team time (8a until noon) follow roughly the same structure each time:
7:40 am: FMC teaching topic (led by faculty and senior residents)
8 am: Team building and wellness activities
9 am: FMC Lab — answering real time questions about your in-basket, outpatient phone calls and Epic.
10 am: independent study. Each year of training will follow a different schedule. Please download your schedule here:
FM R1’s (topics: QI, patient centered care and health equity)
FM R2’s (topics: population health, social determinants and patient safety)
FM R3’s (topics: leadership, advocacy and public health/policy)
11 am: Project time. this will be done individually, in pairs, and as a team. Please reference your schedule for guidance.
You can find an overview of the yearlong curriculum structure for FM residents here and for FMP residents here.
Checklists of assignments by year can be found at the links below.
Self study resources are located below, organized by year of training.
FM R1: Self Study Resources
Block 1
Week 1: IHI Open School QI module 101. These are the only modules that require a login. Please register for your free account.
Week 2: shadow someone in the office (MA, front office staff, CPC+ staff, SW, pharmacist) — your faculty mentor will help set this up
Block 2
Week 1: IHI Open school QI module 102
Week 2: shadow someone new in the office (MA, front office staff, CPC+ staff, SW, pharmacist) — your faculty mentor will help set this up
Block 3
Week 1: IHI Open school QI module 103
Week 2: shadow someone new in the office (MA, front office staff, CPC+ staff, SW, pharmacist) — your faculty mentor will help set this up
Block 4
Week 1: Interdisciplinary rounds (IDR)
Week 2: FMC data
Block 5
Week 1: IHI Open School QI module 104
Week 2: shadow someone new in the office (MA, front office staff, CPC+ staff, SW, pharmacist) — your faculty mentor will help set this up
Block 6:
Week 1: Catch up week
Week 2: Catch up week
Block 7:
Week 1: Interdisciplinary rounds (IDR)
Week 2: FMC data
Block 8:
Block 9
Week 1: Read Ch 18 from “Medical Management of Vulnerable and Underserved Patients” text and answer discussion questions
Week 2: Meet with your faculty mentor to discuss the questions at the end of Chapter 18 (reading from prior week)
Block 10
Week 1: Interdisciplinary rounds (IDR)
Week 2: FMC data
Block 11
Week 1: Ch. 3 from “Medical Management of Vulnerable and Underserved Patients” and
Week 2: answer the discussion questions and discuss with your faculty mentor
Block 12
Week 1: catch up week
Week 2: catch up week
Block 13
Week 1: Interdisciplinary rounds (IDR); patient handoffs when applicable
Week 2: FMC data
FMP R1: Self-Study Resources
For Blocks 3-5 and 9-13
Block 3
Week 1: shadow someone in the office (MA, front office staff, CPC+ staff, SW, pharmacist) — your faculty mentor will help set this up
Week 2: shadow someone new in the office (MA, front office staff, CPC+ staff, SW, pharmacist) — your faculty mentor will help set this up
Block 4
Week 1: Interdisciplinary rounds (IDR)
Week 2: FMC data
Block 5
Week 1: shadow someone new in the office (MA, front office staff, CPC+ staff, SW, pharmacist) — your faculty mentor will help set this up
Week 2: shadow someone new in the office (MA, front office staff, CPC+ staff, SW, pharmacist) — your faculty mentor will help set this up
Block 9
Week 1: Read Ch 18 from “Medical Management of Vulnerable and Underserved Patients” text and answer discussion questions
Week 2: Meet with your faculty mentor to discuss the questions at the end of Chapter 18 (reading from prior week)
Block 10:
Week 1: Interdisciplinary rounds (IDR)
Week 2: FMC data
Block 11
Week 1: Ch. 3 from “Medical Management of Vulnerable and Underserved Patients” and
Week 2: answer the discussion questions and discuss with your faculty mentor
Block 12:
Block 13
Week 1: Interdisciplinary rounds (IDR); patient handoffs when applicable
Week 2: FMC data
FM R2: Self Study Resources
Block 1
Week 1: creating a registry article
Week 2: empanelment article
Block 2
Week 1: Graham Center Population Health Module 1; chronic disease inventory
Week 2: Graham Center Population Health Case Study 1 with Dr Rich
Block 3
Week 1: Listen to the podcasts “ChenMed’s President on Breaking Health Care’s Rules,” and “From Real World Data to Real World Decisions”; review SDH screening tools looking for similarities & differencs
AAFP Project Everyone
CMS health related social needs screener
Week 2: article “A conceptual framework and path for integrating social determinants of health into primary care practice”; Try using a community resource tool in your practice over the next 3-4 weeks. Consider how useful it was, how successful you were, what could be improved. Be ready to share your experience with the team in block 6.
Block 4:
Week 1: Interdisciplinary rounds (IDR)
Week 2: FMC data
Block 5:
Week 1: Read Ch 9 from “Medical Management of Vulnerable and Underserved Patients” text and answer discussion questions
Week 2: select a chapter to read from the possibilities below
Care of the food insecure pt
Obesity as a clinical and social problem
Block 6:
Week 1: Catch up week
Week 2: Catch up week
Block 7:
Week 1: Interdisciplinary rounds (IDR)
Week 2: FMC data
Block 8
Week 1: IHI Open School Patient Safety (PS) module 101. These are the only modules that require a login. Please register for your free account.
Week 2: IHI Open School PS module 102
Block 9
Week 1: IHI Open School PS module 103
Week 2: IHI Open School PS module 104
Block 10
Week 1: Interdisciplinary rounds (IDR)
Week 2: FMC data
Block 11
Week 1: IHI Open School PS module 105
Week 2: IHI Open School Leadership module 101
Block 12
Week 1: catch up week
Week 2: catch up week
Block 13
Week 1: Interdisciplinary rounds (IDR); patient handoffs when applicable
Week 2: FMC data
FMP R2: Self Study Resources
Blocks 4-10
Week 4
Week 1: Interdisciplinary rounds (IDR)
Week 2: FMC data; review SDH screening tools looking for similarities & differencs
AAFP Project Everyone
CMS health related social needs screener
Block 5:
Week 1: Read article “A conceptual framework and path for integrating social determinants of health into primary care practice”; Try using a community resource tool in your practice over the next 3-4 weeks. Consider how useful it was, how successful you were, what could be improved. Be ready to share your experience with the team in block 6.
Week 2: IHI Open School QI module 101. These are the only modules that require a login. Please register for your free account.
Block 6
Week 1: IHI Open school QI module 102
Week 2: IHI Open school QI module 103
Block 7:
Week 1: Interdisciplinary rounds (IDR)
Week 2: FMC data
Block 8
Week 1: IHI Open school QI module 104
Week 2: IHI Open school QI module 105
Block 9
Week 1: Read Ch 9 from “Medical Management of Vulnerable and Underserved Patients” text and answer discussion questions
Week 2: Listen to the “All In” public health podcast, episode 14
Block 10
Week 1: Interdisciplinary rounds (IDR)
Week 2: FMC data
FM Team Leader (R3) Self Study Resources
Block 1
Week 1: IHI Open School Triple Aim (TA) module 101. These are the only modules that require a login. Please register for your free account.
Week 2: IHI Open School TA module 102
Block 2
Week 1: Take leadership inventory and write reflection
Week 2: finish reflection and share with your faculty mentor
Block 3
Week 1: Read Ch 6 from “Medical Management of Vulnerable and Underserved Patients” text
Week2: answer discussion questions and discuss with faculty mentor
Block 4:
Week 1: Interdisciplinary rounds (IDR)
Week 2: FMC data
Block 5
Week 1: Review the Practical Playbook slides
Week 2: Listen to the “All In” public health podcast, episode 14
Block 6:
Week 1: Catch up week
Week 2: Catch up week
Block 7:
Week 1: Interdisciplinary rounds (IDR)
Week 2: FMC data
Block 8
Week 1: Start the public policy activity
Week 2: Complete the public policy activity
Block 9
Week 1: start the STFM Advocacy modules
Week 2: Finish the STFM Advocacy modules
Block 10
Week 1: Interdisciplinary rounds (IDR)
Week 2: FMC data
Block 11:
Week 1: finish any outstanding STFM advocacy modules; Using what you learned through the modules and activity, participate in one activism act - write a letter/email or make a phone call to a person you identified in previous activities. This may be at a local, state or national level. Send Dr Rich an email and tell her how it went. Have trouble getting started? Send Dr Rich a text or ask your faculty mentor.
Week 2: get coffee with Dr Rich and discuss the behaviors of the health advocate and how to incorporate them into your future career
Block 12
Week 1: catch up week
Week 2: catch up week
Block 13
Week 1: Interdisciplinary rounds (IDR); patient handoffs when applicable
Week 2: FMC data
FMP R3: Self Study Resources
Block 1-4 & 9-13
Block 1
Week 1: creating a registry article
Week 2: empanelment article
Block 2
Week 1: Graham Center Population Health Module 1; chronic disease inventory
Week 2: Graham Center Population Health Case Study 1 with Dr Rich
Block 3
Week 1: Listen to the podcasts “ChenMed’s President on Breaking Health Care’s Rules,” and “From Real World Data to Real World Decisions”
Week 2: Review the Practical Playbook slides
Block 4:
Week 1: Interdisciplinary rounds (IDR)
Week 2: FMC data
Block 9
Week 1: IHI Open School Patient Safety (PS) module 101. These are the only modules that require a login. Please register for your free account.
Week 2: IHI Open School PS module 102
Block 10
Week 1: Interdisciplinary rounds (IDR)
Week 2: FMC data
Block 11
Week 1: IHI Open School PS module 103
Week 2: IHI Open School PS module 104
Block 12
Week 1: IHI Open School PS module 105
Week 2: IHI Open School Leadership module 101
Block 13
Week 1: Interdisciplinary rounds (IDR); patient handoffs when applicable
Week 2: FMC data
FMP Team Leader (R5): Self Study Resources
Block 1-4 & 9-13
Block 1
Week 1: IHI Open School Triple Aim (TA) module 101. These are the only modules that require a login. Please register for your free account.
Week 2: IHI Open School TA module 102
Block 2
Week 1: Take leadership inventory and write reflection
Week 2: finish reflection and share with your faculty mentor
Block 3
Week 1: Read Ch 6 from “Medical Management of Vulnerable and Underserved Patients” text
Week2: answer discussion questions and discuss with faculty mentor
Block 4:
Week 1: Interdisciplinary rounds (IDR)
Week 2: FMC data
Block 9
Week 1: start the STFM Advocacy modules
Week 2: Finish the STFM Advocacy modules
Block 10
Week 1: Interdisciplinary rounds (IDR)
Week 2: FMC data
Block 11
Week 1: finish any outstanding STFM advocacy modules; Using what you learned through the modules and activity, participate in one activism act - write a letter/email or make a phone call to a person you identified in previous activities. This may be at a local, state or national level. Send Dr Rich an email and tell her how it went. Have trouble getting started? Send Dr Rich a text or ask your faculty mentor.
Week 2: get coffee with Dr Rich and discuss the behaviors of the health advocate and how to incorporate them into your future career
Block 12
Week 1: Start the public policy activity
Week 2: Complete the public policy activity
Block 13
Week 1: Interdisciplinary rounds (IDR); patient handoffs when applicable
Week 2: FMC data
Materials
Modules:
The only module that requires a login is IHI Open School. Please register for your free account.
For the STFM Advocacy Modules, you must “purchase” them (they cost nothing but you must go through the check out process). If you have problems with this, please contact Dr Rich.
See above to links for the other modules
Readings
All book chapters are scanned in for easy access
All articles have links attached
Podcasts & webinars
All are free with links provided.
Other assignments and materials
Most assignments will be turned in via online submission (using wufoo). They will go directly to Dr Rich or Dr Spata who will then email you any feedback.
If a link is broken or you are unsure how/where to turn in an assignment, please contact Dr Rich for instructions.
Experiential learning
For all meetings and observation experiences, please ask your faculty mentor at the beginning of the team time session