Changing the Ambulatory Training Paradigm. Design and Implementation of an Outpatient Pulmonology Fellowship Curriculum

Abstract

Rationale: The Accreditation Council for Graduate Medical Education has mandated that pulmonary fellows practice evidence-based medicine "across multiple care settings." Currently, most clinical fellowship training is inpatient based, suggesting that more robust fellowship training in outpatient pulmonology is needed. No standardized ambulatory pulmonary curriculum is currently available.

Objectives: To design, implement and test the feasibility of a standardized, case-based outpatient curriculum implemented for pulmonary fellows at the Perelman School of Medicine at the University of Pennsylvania.

Methods: A list of 20 topics in ambulatory pulmonology was generated and was used to create a series of literature-based teaching scripts, which served as the foundation for twice-monthly small group teaching sessions. Before implementation, the fellows were asked to complete a survey regarding their impressions of their existing outpatient training and their competency in ambulatory patient care. Participants were surveyed again at 6 and 12 months thereafter.

Measurements and main results: Fellow survey respondents reported that the curriculum improved the overall ambulatory educational experience. Before implementation, only 6 of 12 fellows (50%) agreed that their current instruction on relevant outpatient pulmonary topics was adequate, compared with 100% after the curriculum (P = 0.01, n = 10). In addition, only five fellows (42%) initially agreed or strongly agreed that their current outpatient educational experience had prepared them well for independent pulmonary practice, compared with 90% on the 12-month survey (P = 0.02).

Conclusions: We created a standardized outpatient pulmonary curriculum and demonstrated its feasibility in positively influencing fellows' perceived competency in ambulatory pulmonology. Additional assessment of knowledge, performance outcomes, and applicability at other institutions is needed.

Keywords: ambulatory care; fellowship training; graduate medical education; pulmonary medicine.