Center of Excellence Pathway

The Center of Excellence is a training pathway with the outpatient rotations primarily based at the Louis Stokes Cleveland VA Medical Center. This program began in 2011 when the Louis Stokes Cleveland VA Medical Center received a $5 million federal grant to offer physicians and nurse practitioner learners a novel and visionary approach to health care in the 21st century. It has several curricular components: training in the six sigma and other performance improvement tools-leadership in quality improvement care; interdisciplinary team-based care; proactive care; real-time patient feedback; humanities in health care and virtual health care.

Length of training: three years
Setting: University Hospitals Cleveland Medical Center and Louis Stokes Cleveland Veteran Affairs Medical Center

Description and Defining Characteristics

The Center of Excellence (COE) residents participate in an innovative program primarily based at the VA called Transforming Out-Patient Care (TOPC).

In January 2011, the Louis Stokes Cleveland VA Medical Center received a $5 million federal grant to offer physician and nurse practitioner learners a novel and visionary approach to health care in the 21st century. In collaboration with the Frances Payne Bolton School of Nursing and supported by the VA Office of Academic Affiliations, this Center of Excellence will prepare residents and nurse practitioner students to work in new models of care that demand teamwork and patient-centered care. Students will be offered novel educational opportunities to build on current strengths in the curriculum as well as acquire new skill sets.

Clinical Experience

The outpatient clinical experience at the Louis Stokes Cleveland VA Medical Center serves a diverse patient population of varying age and medical complexity with oversight by dedicated faculty who are selected on academic merit and proven commitment to clinical education. In this environment, trainees manage patients in collaboration with pharmacists, psychologists and registered nurses.

Emphasis on chronic disease management is provided via traditional office visits, shared medical appointments, telehealth communication and through utilization of locally-developed diabetes, chronic kidney disease and heart failure disease registries. The Louis Stokes Cleveland VA Medical Center will have fully implemented the PACT (Patient-Aligned Care Team) model (synonymous with patient-centered medical home) which provides dedicated interdisciplinary team members to enhance patient care and provider and patient satisfaction.

Robust Curricular Components

Training in Six Sigma and Other Performance Improvement Tools: The Center of Excellence is excited to partner with faculty from the Case Weatherhead School of Management to provide trainees with the skills and tools necessary to implement performance improvement into the everyday care of patients. Learners will have the opportunity to receive training in management skills such as Six Sigma taught by Weatherhead faculty.

Leadership in Quality Care Improvement: Learners will become competent in leading and incorporating quality measures and performance improvement into the delivery of health care. Specific to the Center of Excellence, residents and nurse practitioner students will have access to chronic disease registries and will be provided various opportunities to learn how to use these tools effectively for panel and population management and improve safety and quality at the system level.

Interdisciplinary Team-Based Care: Learners in the program will engage in a team-based model for health care delivery. As members of a PACT team, residents and nurse practitioners will work collaboratively with RNs, LPNs, social workers, pharm-Ds, health psychologists, as well as dedicated administrative support for a specified panel of patients. The goal of this model is to provide comprehensive patient care while enhancing provider and nursing staff satisfaction.

Humanities in Health Care: Learners will engage in a narrative health care course, which will include predesignated reading assignments of relevant popular press and movies as well as discussion of these readings/videos at regular meetings led by members of the Department of Bioethics and Case Western Reserve University. Additionally, the Lois Stokes Cleveland VA Medical Center has partnered with the Cleveland Museum of Art to develop an Art in Health Care curriculum as well as with the Allen Memorial Library to provide a historical perspective to the practice of medicine and nursing.

Virtual Health Care: Learners will partake in a robust curriculum, which will emphasize the role of emerging technologies in non-face-to-face care of the patient. This will include different perspectives on maximizing telephone management opportunities, utilization of telehealth resources already available through the VA system (home monitoring systems) as well as secure messaging via e-mail.

Example Schedule

PGY1

  • 3 months of COE
  • 1 month of vacation
  • 1 month of elective (0.5 months during COE time, 0.5 months during wards time)
  • 1 month of Geriatrics
  • 0.5 months of primary care
  • 0.5 months of Professional Development Block (PDB)
  • 0.5 - 1 months of night float
  • 0 - 0.5 months of Jeopardy
  • 0 - 0.5 months of urgent care at the VA
  • 1 month of ICU
  • 4 - 4.5 months of wards

PGY2

  • 6 months of COE
  • 1 month of vacation (0.5 months during COE time, 0.5 months during wards time)
  • 2 months of elective (1 month during COE time, 1 month during wards time)
  • 0.5 - 1 month of night float
  • 1.5 - 2 months of ICU
  • 2 - 3 months of wards

PGY3

  • 3 months of COE
  • 1 month of vacation
  • 3 months of elective (1 month during COE time, 2 months during wards time)
  • 1 month of DACR (Day Acting Chief Resident)
  • 0 - 0.5 months of VACR (VA Acting Chief Resident)
  • 1 - 1.5 months of ICU
  • 0 - 0.5 months of urgent care at the VA
  • 3 - 4 months of wards

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