Mission: to patch up holes at SVMD

PPG:

• anxiety about new time schedule, 15/30
• inconsistent Rx practices
• patient experience
  • uncertainty about billing
  • lack of access
  •  communication with care team
• inadequate HTN and DM scores
• epidemiologic / new eyes on what's out there

learning objectives TBD, likely multidisciplinary

format

• 1 on 1
• live/lecture/Zoom
• hands-on (skin Bx, I&D, suturing, nails, bedside US)

DPA: pt care, informatics, MD QOL, 

 SCS: we're not getting commercial support, need a means of collecting FRs, not all topics are clinical.

Evaluation based on performance and outcomes

Comm Criteria - involve students, PAs MAs community, CME research, creativity, achieves outcomes, public health

Modernizing the Armenian Healthcare System

The Wigmore Experience

Updated August 18, 2024

 Armenia still has 1 foot in the Soviet system Which arguably limits progress and development in several areas. Examples of the paternalistic system include continued addressing of colleagues by (your father's name)-ich and the inclusion of father's name when a patient is identified in their healthcare Billing program.  The Soviet thinking that got us to this point is not the thinking that will carry us through the coming century.

The educational system currently in place as fostered a pedagogical approach, where students listen and record what is taught, but do not question or discuss. The medical school system is based on a moneymaking model where students supply funding through tuition (and possibly bribes?) But are not provided clinical practice, cadaver labs, proper equipment. In short, the current healthcare system ought to be replaced.  Much effort has been expended in specialty clinics through Diaspora efforts, but it is recognized that a solid primary care/family practice/general medicine structure makes the most sense at this time.

This project aims to increase Western influence in Armenia's healthcare system by increasing ties and relationships to Western institutions. An example of the success is the formal relationship between American University of Armenia and the University of California system.We need to increase the core number of people who understand that a new way of thinking is needed.

What are examples of this new thinking? The notion that the patient could should come first or that students should question their teacher is revolutionary.

The Wigmore clinic in Yerevan has been led by physicians who had opportunity to train in the West. However these positions, now 30 years later, Are nearing retirement in a new generation must be cultivated. The clinic has established formal ties with institutions in the US creating the possibility of student, resident and possibly postgraduate exchange programs. Current relationships are in place with:

1. Valley Children's Hospital In California
2. San Francisco General Hospital and Operation Rainbow
3. Bassett clinic in New York State

While Wigmore aims to change a medicine is applied in Armenia, some of the efforts have been viewed as outsiders upsetting the apple cart.

 Proper medical and nursing Education is sorely needed. (CME institutions in the US are recognizing the need for interdisciplinary education, planned and delivered by interdisciplinary teams). Wigmore has instituted a training program by which sponsored pre-needs are sent from Armenia to the US.  The only 2 requirements are that they speak English and to do not smoke.

Editor's note:  Wigmore has associations with UCSF and with Valley Children's Hospital (which is in turn affiliated with Stanford University school of medicine). Whether Sutter health is a viable partner remains to be seen. Meanwhile we have colleagues affiliated with universities throughout the US. And once we have a working model that could be replicated abroad, we have colleagues affiliated with universities worldwide.

https://accme.org/rules/criteria/

In addition to the above Educational Planning and Evaluation criteria, there are requirements for the overall CME program, which include:

• a Mission Statement, a statement of what we want to do.  It should include our expected results, expressed in terms of physician competence, physician performance or patient outcomes.
• Program Analysis, a formal discussion of whether we actually met the Mission Statement
• Program Improvements, a description of changes we implemented in order to meet the Mission Statement (sometimes it includes changing to Zoom calls during pandemics).

 https://accme.org/wp-content/uploads/2024/05/626_20211221_Accreditation_Requirements.pdf

The old rules for CME involved criteria which were numbered.  The CME program was responsible for criteria 1 through 13,  and each learning activity was constructed according to criteria 2-11.

ACCME now uses the criteria above, and sometimes you see comments like, "Designed to Change (formerly Criterion 3), or  "Analyzes Change (formerly Criterion 11)"

1. Mission Statement:  We need to start with a mission statement, and follow it.
2. Address practice gaps:  figure out where you need to improve.  Have some rationale for determining practice gaps.  "It's interesting" doesn't cut it.
3. Create learning objectives designed to increase physician competence, physician performance, patient outcomes, or some combination of these.  Learning objectives should not simply increase knowledge.  This is a common mistake.
4. Choosing the target audience is no longer required.  But we keep it as part of the planning process.  
5. We should choose the appropriate teaching format, venue.  Lecture isn't always the best way to change how physicians practice.  Another common mistake.
6. Address "Desirable Physician Attributes".  Not everything is about patient care.  Sometimes it's about professionalism, sometimes just learning informatics.  Rarely a reason to fail an audit, it's usually where we spot the inexperienced CME providers.
7. Get financial disclosures from everybody in control of course content and resolve potential conflicts of interest before the educational activity.  Disclose to learners whether or not there was a relevant financial relationship.  Document that you did it.  This is a VERY common reason to fail an audit.
8. Follow our honorarium policy, and if you have commercial support, there's some rules to follow.
9. If you have commercial support, there are some rules to follow.
10. Make sure you are teaching medicine and not advertising a product.
11. Evaluate whether your teaching activities were successful.  Lotsa ways to do this.  Periodically review whether these learning activities are helping you meet your Mission Statement.
12. Periodically review whether your CME program is going the way you intended.  You can do this at midnight the weekend before your reapplication is due, or you can do it ahead of time.
13. Figure out how to adapt the CME program based on the lessons learned in step 12. 

•  The accreditation is for 4 years.  With "commendation criteria" it can be increased to 6 years.  Commendation criteria (criteria 23-39) are pretty straightforward, but need conscious planning.
• Cultural and Linguistic Competency (CLC) is a requirement for all CME accreditation originating in California.  The idea is to address disparities in health care related to culture and language.
• soon we will have the requirement to address "implicit bias".  Worthwhile, but not clear how we will do that.
• There is specific wording that should be followed when offering CME credit.  Best to have the phrase,   El Camino Hospital is accredited by the California Medical Association (CMA) to provide continuing medical education for physicians.  El Camino Hospital designates this live internet activity for a maximum of 1 AMA PRA Category 1 credit TM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Quitting Smoking

Cold Turkey

set a quit date

Tobacco-free Earth has a helpful page at this link

Medication-assisted

Buproprion (Wellbutrin,