Prepare, Prepare, Prepare!
1. What are the shared interests?
2. What are the options that we can explore?
3. To what standards can we refer?
4. What are the alternatives? What is our BATNA?
5. What do we have to offer? How much leverage?
1. What are the shared interests of all parties?
The team members interviewed a variety of people across the medical school and teaching hospital, then met in two weeks to compare notes:
a. Dr. Anderson, the Ob-Gyn residency program director, discovered that her department’s clerkship director was submitting a grant for interdisciplinary women’s health education to the Association of Professors of Gynecology and Obstetrics (APGO). She had already secured the approval of the medical school curriculum committee and the participation of four other clerkship directors and two second-year instructors. The tools they were developing for assessment of student performance and program evaluation could be adapted for use by residency programs. The clerkship directors thought their grant application would be much stronger if they could show support of the residency programs.
b. Dr. Jacobs discussed the program informally with the Chair of the Graduate Medical Education Committee. She discovered that the Chair of Surgery was interested in a cross-residency program in team-building. The GMEC chair thought the women’s health curriculum and the team-building concept would be ideal platforms for the ACGME competency in systems-based practice.
c. Dr. Jacobs took the idea to the surgery program director, who agreed to support the women’s health program if it fostered the development of team learning skills. He was not enthusiastic about a women’s health program that included the surgery department only for its breast care services.
d. In searching for grant opportunities, Dr. Jacobs discovered several federally funded programs centered on women’s health education and research. She contacted the grants officer and learned that she was ideally suited to be a Principal Investigator for one of these programs if she could build her program as a community-based research and education program.
e. After the high school soccer game, the pharmacy educator spoke to the chair of the hospital board of trustees about the program. She expressed interest in having the Board learn more about the program and its impact on the community.
2. What options can we explore “to make the deal”?
a. Align the program with the medical student curriculum and develop teaching teams for students and residents together using the on-line Women’s Health Competencies.
b. Develop workshops in team-building based on woman-centered health care teams and conduct these as part of the annual GME core curriculum; this would serve as a showcase for the program’s impact on improving health care in general.
c. Use the 10% funding from the Dept. of Ob-Gyn to request matching funds from the hospital to develop a community-based research plan.
d. Definitely follow up with the invitation to inform the Hospital Board. Dr. Jacobs will ask a few patients and residents who have benefited from the program to write in support of its expansion.
3. To what standards can we refer?
|Type of Standard||Use in negotiating expanded women’s health care education programs|
|Market value||AAMC salary survey to estimate costs of faculty teaching time|
Other interdisciplinary services
|Scientific judgment||Evidence-based outcomes|
|Professional requirements||LCME LCME Accreditation Standards requirements
ACGME Outcomes project
APGO Women’s Health Care Education Competency Project
|Efficiency and cost||
Single presentation to multiple services (rather than faculty in all services developing similar lessons)
Time savings through single teaching team of complex subject
|Reciprocity||Educational services have been provided to services not previously funding the effort; CME, undergraduate education, and residency education may use similar tools for teaching and assessment|
4. What are the alternatives if we are not able to negotiate expansion? What is our best alternative, or BATNA?
a. We could give up our time for the project, but continue to be preceptors for students and residents without a core curriculum and without a cross-disciplinary experience.
b. We could resign our positions and move to a medical center that is supportive of women’s health practice and interdisciplinary education.
c. We could “buy out” of a percentage of salary in return for time to develop the educational program.
d. Our BATNA is continuing the experience for residents, at least with the participation of the clinicians willing to volunteer their medical practice and teaching time, then to align the learning objectives with the medical student curriculum. This approach would strengthen the residency program and make it more difficult for administration to withdraw support if the clerkship directors receive their grant.
5. What do we have to offer? How much leverage? How can we build leverage?
a. We can describe our patient population for the interdisciplinary women’s health clinic. The patient base is now well-established and growing, with approximately 30% Medicare, 20% self-pay and 50% third party payer mix. Our departments and finance managers need to be informed of this growing revenue source.
b. The medical school curriculum committee is supportive, but we need to secure the support of the deans.
c. Support of board of trustees.
d. Combine small funds for education and research to build a program strong enough to apply for federal funding.
e. Present abstracts at national meetings; publish papers in recognized journals to demonstrate potential scholarship in the endeavor.
f. Be sure to send letters of appreciation to sponsors in the medical school and hospital leadership; copy all chairs and division chiefs of staff participating in national conferences.
g. Make an appointment with the public relations department of the health care center to get media attention for the project.
Remember: Work to increase and demonstrate value to our institution, our students, and our patients. Collaborate and support each other as a team!