title: Changing the Ambulatory Training Paradigm. Design and Implementation of an Outpatient Pulmonology Fellowship Curriculum.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  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.
authors: 1 Division of Pulmonary, Allergy & Critical Care, Perelman School of Medicine, and.
authors: Stacey M
authors: http://orcid.org/0000-0003-4125-2856
authors: SM
authors: Kassutto
authors: 1 Division of Pulmonary, Allergy & Critical Care, Perelman School of Medicine, and.|2 Leonard Davis Institute of Health Care Economics, University of Pennsylvania, Philadelphia, Pennsylvania; and.
authors: C Jessica
authors: CJ
authors: Dine
authors: 1 Division of Pulmonary, Allergy & Critical Care, Perelman School of Medicine, and.
authors: Maryl
authors: M
authors: Kreider
authors: 3 Division of Pulmonary, Critical Care, Allergy & Sleep Medicine, University of California-San Francisco, San Francisco, California.
authors: Rupal J
authors: RJ
authors: Shah
mesh_terms: D000068:Accreditation; D002983:Clinical Competence / Q000592:standards*; D003479:Curriculum / Q000592:standards*; D004503:Education, Medical, Graduate / Q000592:standards*; D019317:Evidence-Based Medicine; D005257:Fellowships and Scholarships / Q000592:standards*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D010045:Outpatients; D010414:Pennsylvania; D015272:Pulmonary Medicine / Q000193:education*; D011795:Surveys and Questionnaires
keywords: ambulatory care; fellowship training; graduate medical education; pulmonary medicine