endoscopy training in a family medicine residency
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Endoscopy Training in a Family Medicine Residency. American Association of Primary Care Endoscopy San Francisco November 2, 2012. Endoscopy Training in Texas A&M Family Medicine Residency. David A. McClellan, md Texas a&M Family medicine residency bryan /college station. - PowerPoint PPT PresentationTRANSCRIPT
Endoscopy Training in a Family Medicine
Residency
American Association of
Primary Care Endoscopy
San Francisco
November 2, 2012
DAVID A. MCCLELLAN, MD
TEXAS A&M FAMILY MEDICINE RESIDENCY
BRYAN/COLLEGE STATION
Endoscopy Training in Texas A&M Family Medicine
Residency
TAMFMR - Mission Statement
Our mission is to conduct comprehensive family medicine training that prepares physicians for rural practice; to provide compassionate, high quality healthcare; and to foster scholarly activity.
TAMFMR Endoscopy – History
The Early Faculty Pioneers – Brazos Family Medicine Residency• John Frederick, MD - 2000 Hospital Endoscopy Privileges• Dennis LaRavia, MD – 2001 Hospital Endoscopy Privileges
The New Faculty Trainees: Endoscopy in the FMC Endo Suite with donation of 2 Colonoscopes and 2 Gastroscopes by Fujinon 2003• Robert Pope, MD• David McClellan, MD• Stuart Quartemont, MD
Residency Transitioned to TAMHSC Sponsorship 2008• Ryan Loyd, MD• Joshua Loyd, MD
Trained in our Program: • John Simmons, MD - 2009
New Faculty:• John Rodney, MD – 2012
Faculty
Robert Pope, MD John Rodney, MD
A Visionary
Christine Pinones, RN
Searching for $ Funds $
Cancer Prevention Research Institute of Texas• Approved by taxpayers of Texas 2007• $3 billion in bonds authorized by a constitutional
amendment• Funds cancer research, prevention programs, and
services in TexasGrant application #1 - CPRIT 2010 - not funded
• Equipment now ~ 6 years oldNew Facility with New Endoscopy Procedure Suite - 2011
• Equipment now 7 years old
Texas A&M PhysiciansFamily Medicine Center
Second Try – Funded!
Grant application #2 - CPRIT 2011 – Funded• $2.7 million over 3 years. • Split between TAM FMR and School of Rural Public
Health Screening procedures, pathology Personnel Equipment: Endoscopes, Jet washer, Scope Washer
(plumbing) Simulator
CSTEP• Colorectal Screening Training & Education Program
Public Health Partners
Jane Bolin, RN, JD, PhD
Marsha Ory, PhD, MPH
Procedure Suite – New Scopes
GI Mentor Simulator
TRANSLATING RESEARCH INTO PRACTICE
CO-PRINCIPAL INVESTIGATORSDR. DAVID MCCLELLAN, MD - COLLEGE OF MEDICINE
DR. JANE N. BOLIN, RN, JD, PHD - SCHOOL OF RURAL PUBLIC HEALTH
Enhanced Colorectal Cancer Screening in a Family Medicine
Residency ProgramServing Low-Income & Underserved
GOALS
C-STEP Project
C-STEP Goal #1
Increase the number of low-income underserved Texans
>50 years of age, and those at risk, who receive colorectal
cancer screenings at the TAMHSC Family Medicine
Residency Program.American Cancer Society, 2011
C-STEP Goal #2
Improve access to cancer screenings, follow-up care and treatment in the Brazos Valley for poor, rural and/or minority
populations through community outreach and culturally-relevant
case management, from Promotoras/Community Health
Workers.
C-STEP Goal #3
Increase the number of family medicine physicians (FMPs) trained in colorectal cancer screening in Texas by 8 to 10 physicians each
year, with 43 new FMPs trained over three years of funding.
FM Resident Training
C-STEP Goal #4
Increase the pool of trained providers to conduct colorectal cancer screenings by providing
interested practicing family medicine physicians who have
prior training in flexible sigmoidoscopy with advanced
training in colonoscopy screening.
C-STEP Goal #5
Sustain colorectal cancer screening and colonoscopy
training at the Texas A&M Health Science Center (TAMHSC) Family Medicine Residency program by continued training of all family
medicine residents andby partnering with aftercare
providers.
Sources of Referrals
Community Events
Health Fiesta
Health Fairs
Community Outreach (churches, community centers, senior centers)
Tracking and evaluating through patient navigation
Tracking and evaluating through patient navigation
Promotoras and community health workers will:
Receive referrals
Work planned community outreach events to register individuals for colorectal cancer screenings
Collect relevant data
Serve as a “bridge” or patient advocate between clinical staff and patient services
Help patients navigate the complex health care system
Cancer Training Innovation
Implementation of a culturally appropriate evidence-based colonoscopy screening training.
Unique to a Family Medicine Residency Program in Texas
Enhancing colonoscopy screening training will increase colon cancer screenings in the Brazos Valley and throughout Texas, and create a model for translating colon cancer screening and prevention services into the family practice setting utilizing CHW/Promotoras.
Unique partnership between SRPH & COM.
Employment of three (3) SRPH Faculty, two (2) staff, and two (2) graduate assistants over three years.
Patient Flow
Data Flow
Average Risk: ≥ age 50 with no family Hx CRC
Moderate Risk: ≥ age 40 w/ family Hx CRC, polyps,
or positive FOBT
High Risk: Personal Hx CRC, IBD, or
genetic syndrome
CRC Screening Algorithm: Staff and CHW/Promotores review & update patient history, including family history for colon cancer. Assess for symptoms such as rectal bleeding,
anemia or inflammatory bowel disease.
•Follow USPS Task Force Screening Guidelines•Annual FOBT•Colonoscopy once every ten years
Begin colonoscopy at age 40 or 10 yrs younger than age of family member with colon ca.
Begin colonoscopy at age 40 or 10 yrs younger than age of family member with colon ca.
NORMAL? ABNORMAL
•Adenomatous Polyps Polypectomy enter surveillance at TAMFMC; •Colorectal CancerAfter Care Referral, CHW/Promotores, Navi-4Health, Surgeon Consultation, Oncology Consultation
•Routine clinical f/u
•Patient education•CHW/Promotores•Navi4Health
Link to Clinical Trials (e.g., TLSF CTNet ) forEvaluation of cancer clinical trials options.
Patient
Screenin
g
Algorithm
Partners
When should preventative screening occur?
The Need for Colorectal Cancer Screening in TAMHSC’s Service Area
Colorectal cancer is the second leading cause of cancer deaths in Texas.
Incidence of colon cancer and associated mortality is higher in rural regions than in metropolitan areas.
The Need for Colorectal Cancer Screening in TAMHSC’s Service Area
The Brazos Valley (BV) region of Texas has a significant need for improved colon cancer screening• 5 rural counties show colon cancer
rates higher than the state average.
Texas Colorectal Cancer Incidence
Colon Cancer Incidence in the Brazos Valley
CHWs in Action
The SuperColonTM
The SuperColonTM
Texas C-STEP
Results: Clinical Services
Colorectal Cancer Screenings(First year: 9/1/2011 – 8/31/2012)
401 Received CRC Screening
132 Abnormal CRC Screening Results
107 Adenomas Detected (27%)
4 Local stage cancers detected (0.998%)
Results: Clinical Services
Colorectal Cancer Screenings(9/1/2011 – 10/10/2012)
Cecum Attained – 96.54%
Average Procedure Time – 0:48
Average Withdrawal Time – 0:16
Withdrawal Rate > 0:06 minutes – 94%
Results: Professional Education
Professional Development(First year: 9/1/2011 – 8/31/2012)
30,114 Professionals Reached by Indirect Contact
(professional meetings & publications)
437 Professionals Educated by Direct Contact
(training, referral network, & provider meetings)
Results: Community Outreach
Community Outreach(First year: 9/1/2011 – 8/31/2012)
30,870 People Received by Indirect Contact
(brochures, patient education materials)
1,617 People Reached by Direct Contact
(educational programs, physician referrals/consults)
Bibliography
1) Sarfaty, Mona. How to Increase Colorectal Cancer Screening Rates in Practice: A Primary Care Clinician's Evidence-Based Toolbox and Guide 2008. Eds. Karen Peterson and Richard Wender. Atlanta: The American Cancer Society, the National Colorectal Cancer Roundtable, and Thomas Jefferson University 2006, Revised 2008.
*Take Home Points*
Be persistent Partner with anyone willing in your community Partner with nearby School of Public Health
• MPH Candidates need a “Practicum” experience• 12 weeks working in a clinical or public health setting• Assistance with Grant writing, Clinical Data
Management, Creation of an Endoscopy Patient Registry for your practice, Community Outreach, etc……….
CDC has a colon cancer screening program in some states. CDC a possible opportunity.
Contact Information
Texas A&M Physicians Family Medicine Center - Family Medicine Residency Program
David A. McClellan, MD(979) 436-0485
THANKS!JANE BOLIN, RN, JD, PHDCHRISTINE PINONES, RN
SONJA WELCH, RNJANET HELDUSER, MPH
MARSHA ORY, PHD, MPHPHILIP NASH, BSCPATRICIA DUNBARCHELSEY HOLLAS
CHINEDUM OJINNAKA NICHOLAS EDWARDSON
ELISABETH ALMANZA, LVNSABRINA WASHINGTON, CHW
CPRITAND MANY OTHERS
Questions?