Document

Report
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
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
•
•

The New Faculty Trainees: Endoscopy in the FMC Endo Suite with donation of 2
Colonoscopes and 2 Gastroscopes by Fujinon 2003
•
•
•

•
Ryan Loyd, MD
Joshua Loyd, MD
Trained in our Program:
•

Robert Pope, MD
David McClellan, MD
Stuart Quartemont, MD
Residency Transitioned to TAMHSC Sponsorship 2008
•

John Frederick, MD - 2000 Hospital Endoscopy Privileges
Dennis LaRavia, MD – 2001 Hospital Endoscopy Privileges
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
•
•
•
Approved by taxpayers of Texas 2007
$3 billion in bonds authorized by a constitutional amendment
Funds cancer research, prevention programs, and services in
Texas
 Grant
•
application #1 - CPRIT 2010 - not funded
Equipment now ~ 6 years old
 New
2011
•
Prevention Research Institute of Texas
Facility with New Endoscopy Procedure Suite -
Equipment now 7 years old
Texas A&M Physicians
Family 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
Enhanced Colorectal Cancer Screening in
a Family Medicine Residency Program
Serving Low-Income & Underserved
TRANSLATING RESEARCH INTO PRACTICE
CO-PRINCIPAL INVESTIGATORS
DR. DAVID MCCLELLAN, MD - COLLEGE OF MEDICINE
DR. JANE N. BOLIN, RN, JD, PHD - SCHOOL OF RURAL
PUBLIC HEALTH
C-STEP Project
GOALS
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 and
by partnering with aftercare
providers.
Sources of Referrals
Community
Events
Self Referral
Family
Medicine
Physician
Residency
Referrals
Clinic
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
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.
Patient
Screening
Algorithm
Moderate Risk: ≥
age 40 w/ family
Hx CRC, polyps,
or positive FOBT
Average Risk: ≥
age 50 with no
family Hx CRC
•Follow USPS Task Force
Screening Guidelines
•Annual FOBT
•Colonoscopy once
every ten years
High Risk: Personal
Hx CRC, IBD, or
genetic syndrome
Begin colonoscopy at
age 40 or 10 yrs younger
than age of family
member with colon ca.
NORMAL?
•Routine clinical
f/u
•Patient education
•CHW/Promotores
•Navi4Health
Begin colonoscopy at age 40 or
10 yrs younger than age of
family member with colon ca.
ABNORMAL
•Adenomatous Polyps
Polypectomy enter surveillance at
TAMFMC;
•Colorectal CancerAfter Care
Referral, CHW/Promotores, Navi4Health, Surgeon Consultation,
Oncology Consultation
Link to Clinical
Trials (e.g., TLSF
CTNet ) for
Evaluation of
cancer clinical
trials options.
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
[email protected]
Questions?
THANKS!
JANE BOLIN, RN, JD, PHD
CHRISTINE PINONES, RN
SONJA WELCH, RN
JANET HELDUSER, MPH
MARSHA ORY, PHD, MPH
PHILIP NASH, BSC
PATRICIA DUNBAR
CHELSEY HOLLAS
CHINEDUM OJINNAKA
NICHOLAS EDWARDSON
ELISABETH ALMANZA, LVN
SABRINA WASHINGTON, CHW
CPRIT
AND MANY OTHERS

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