This month, DPC is making some changes to the workflow that involves the review of clinical cases, referred to as the Peer To Peer process.
There is now an expectation that each provider will be involved in this process which will happen four times a year. Each provider is expected to submit at least four cases throughout the year, and everyone will be involved with the review of the cases that are submitted. Each DPC site will have a Peer Review Champion who will oversee this process. These individuals will be trained by Jayne Genier so that they are familiar with the computerized system used by Duke to confidentially analyze and review the cases.
Though I admit to my usual New Yorker skepticism pertaining to all things new and different, I actually think now that this process represents a valuable teaching opportunity for all involved. When asked to think about how to best
maximize learning in these settings, multiple individuals suggested that I interview Dr. Karl Bernat because he had created a number of effective Peers to Peer sessions in the past. So I have given him a new name, Coach KB, and I asked him what had worked for his groups in the past.
Coach KB first of all emphasized that he has had to be quite organized about the process, and he recalls sending out emails to his colleagues weeks in advance reminding them of the upcoming Peer to Peer session. He would encourage his providers to think of cases when they had learned from an omission, or an error, or a complication. When he would actually lead the session for 45 min, he found that it was too much to try to cover every case submitted. So he usually would focus on only a couple of cases that he thought would be most instructional to the group.
Additionally, Coach KB said that he found it quite helpful to project the cases onto a screen so that all could look collectively at the timelines, labs, etc. To enhance efficiency, he would designate someone to write down notes from the sessions and to even record those notes into the confidential program, so that the clinical opinions and judgments were submitted in a timely manner. He lastly emphasized that he tried really hard to not make anyone feel bad if they had made a mistake.
It turns out that collaborative learning theory is quite helpful when it comes to structuring these quarterly sessions. This method encourages working together and emphasizes that for many problems, there are different viewpoints and perspectives. With collaborative learning, we tend to learn from each other and no one has to be designated as a student or teacher. We also know that collaborative learning often pushes teams to achieve higher levels of thinking. As an example, think back to when two famous individuals worked together in a basic computer programming class in middle school- Bill Gates and Paul Allen obviously benefited from that collaboration and went on to create Microsoft.
So my take-home points here would emphasize the importance of being organized and realistic about what can be achieved. Be sure to involved everyone in your group. Create a positive learning atmosphere (maybe provide food ), and ask for feedback at the end of the session to see what works and what might be improved upon. I would also emphasize trying to focus on 2-4 main points, and not try to cover too much.
I would experiment with the process, and look at how your group goes about reviewing and discussing the cases. If you have some success in this area, please let me know so that I can share some best practices with everyone. And if you have any troubles or challenges, I am sure we can ask Coach KB what he thinks as well!
