IMPROVING AND TEACHING
POPULATION HEALTH
Taking a look at teaching methods
and materials
July 1 2014 webinar
AAMC / CDC / Duke collaboration
Mina Silberberg, Ph.D.
Associate Professor
Vice-Chief for Research and Evaluation
Division of Community Health
J. Lloyd Michener, MD
Professor and Chair
Department of Community and Family Medicine
Director, Duke Center for Community Research
Gwen Murphy, RD, MS, PhD
Assistant Consulting Professor
Division of Community Health
Department of Community and Family Medicine
Population Health: the health outcomes of a
group of individuals, including the distribution of
such outcomes within the group.
Source: Kindig D, Stoddart G. What is Population Health?
Am J of Public Health. 2003; 93(3): 380-383.
The Goal: “from Health Care to Health”
How do we teach clinicians to
collaborate in population health
improvement?
• not training clinicians to be public health
professionals, but to collaborate with public
health and other sectors from their unique
vantage point and strengths
• sometimes clinicians will take the lead, but
not always
Focus today: Sample training materials
and methods
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Population Health Competency Map
Practical Playbook
iCollaborative Population Health Collection
Duke Family Medicine PHIT curriculum
The Population Health Competency Map
Kaprielian VS et al. A Competency Map Approach to Education for Population Health.
Academic Medicine 2013 8(5): 628-637. PMID: 23524919.
The Population Health Competency Map
Training Levels:
1. Foundational — Basic awareness of the principles and
appreciation for their impact and importance in community health.
2. Applied — An intermediate level of learning, enabling skilled
participation in community-engaged population health activities.
3. Proficient — Advanced learners who achieve competence for
independent practice or leadership of the design and
implementation of community-engaged health improvement activities.
Competencies
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Public Health
Community Engagement
Critical Thinking
Team Skills
Population Health Curriculum, sample competency:
Training levels
Basic
Intermediate
Advanced
Learner types
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Primary care
residents
CFM faculty
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Identify appropriate
preventive strategies
for a population,
based upon
literature, data
assessment and
stakeholder input

All students &
residents
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Competency
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Discuss potential
population-based
interventions to
improve health
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Population health
fellows & faculty
CH faculty
Develop and
implement
population-based
prevention
strategies in
collaboration with
community
partners
The Practical Playbook for the
Integration of Public Health and
Primary Care
www.practicalplaybook.org
What is integration?
The Institute of Medicine defines integration as ‘the linkage of
programs and activities to promote overall efficiency and effectiveness
and to achieve gains in population health.’

Principles of Integration:
 Shared goal of population health
 Aligned leadership
 Community engagement
 Sustainability
 Collaborative use of data
What is the Practical Playbook?
Practical guidance to support the application of
integration principles to practice
Practical Playbook Overview
3. Share
The AAMC MedEdPORTAL
iCollaborative
https://www.mededportal.org/icollaborative/
https://www.mededportal.org/icollaborative/about/initiatives/populationhealth/
Population Health Improvement Teamwork
(PHIT)
An evolving curriculum of Duke Family Medicine
For residents (4/year)
And faculty
Domain
Population HealthNon-Specific, i.e.,
covers multiple
domains
PHIT Year 1 (PGY1)
Introduction to Pop.
Health. Lead:
Michener
PHIT Year 2 (PGY2)
Population Health Core Course (2nd, 4th,
and 5th Tuesdays). Lead: Silberberg.
Pop. Health
Workshop. Lead:
Martinez-Bianchi
PHIT Year 3 (PGY3)
Advanced Population Health (12
sessions (1/month)). Lead: Murphy
Facilitation of one core course
discussion session. Lead:
Silberberg
A Real-Life QI
Experience. Lead: Hull
All three years:
Population Health Workshop with Residency Applicants. Lead: Martinez-Bianchi.
Population Health Management Rotation (includes community health rotation with informatics
component). Lead: Shahsahebi
Attend Partnership for a Healthy Durham meetings. Lead: Martinez-Bianchi
Balint Group. Lead: Kingsolver.
Population Health Projects. Leads: Silberberg and Shahsahebi
Presentation: The Durham Community Health Needs Assessment (Erika Samoff). Lead: Silberberg
Domain
PHIT Year 1
(PGY1)
Population
Public Health
Health Domain I: Essential
Public Health
Function webbased modules
with one followup discussion.
Lead: Murphy
PHIT Year 2 (PGY2)
Population
Health Domain
II:
Community
Engagement
Community health assessment Rotation in community
and presentation. Lead: Tran. clinic. Lead: MartinezBianchi
Leading a community health
education session. Lead: Tran
Site visits (e.g.,
CAARE, Lincoln,
Public Health
Dept.). Lead:
Tran
PHIT Year 3 (PGY3)
Attending a PAC meeting.
Lead: Ragsdale
Rotation in community clinic.
Lead: Martinez-Bianchi
All three years: Community Health Engagement Day. Lead: Martinez-Bianchi
Sometime over the three years: Involvement with community health education
training. Lead: Martinez-Bianchi
Domain
Population
Health Domain
III: Critical
Thinking
PHIT Year 1
(PGY1)
(See RCD below)
PHIT Year 2 (PGY2)
PHIT Year 3 (PGY3)
I-3 Quality Thread Webinar.
Lead: Ramer
I-3 Quality Thread Webinar.
Lead: Ramer
All three years:
Journal club. Lead: Ostbye
Population
Health Domain
IV:
Leadership/Team
Skills (Lead:
Ragsdale)
Resident as
Clinical Director I
-- quality
improvement and
informatics,
assessment of
leadership
skills/training
plan, time
management,
professionalism.
Lead: Ragsdale
Resident as Clinic Director II -team development /group
facilitation, organizational
behavior and culture,
collaboration in large systems,
health policy. Lead: Ragsdale.
Resident as Clinic Director
III -- assessment of
remaining leadership
training needs and
corresponding plan,
business of medicine.
Lead: Ragsdale
All three years: Workshops on leadership, communications, and conflict
management. Lead: Kingsolver
Resident Population Health Project
Requirements
During the course of the three years, the resident must:
1. Play a lead role in at least one effort that involves two or
more rapid CQI
2. Design an evaluation plan, collect data, analyze data, or
write up evaluation results.
3. Collaborate with non-clinical entities on a community
health initiative.
Additional requirements
1. Document and disseminate
2. Use appropriate tools
3. Formal mentor
4. Approved workplan
Population Health Curriculum
evaluation methods
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Discussion participation
Project completion
Final assessment – just alpha-tested
Post-graduation activity
Real test – health improvement in home communities
Recent/ongoing developments
• PHIT, not PHIL
• Inclusion of population health management rotation
• Changes to project to enhance community engagement,
alignment with ongoing work of clinic
• Testing and revising of final assessment
• Development of alumnae survey questions’
• Increased integration among PHIT components and
between PHIT, larger curriculum, and clinical practice
Milestones webinar schedule
repeated
June 3rd Tuesday 2:30pm EST
June 19th Thursday 3:30pm EST
repeated
July 1st Tuesday 10am EST
July 15th Tuesday 9am EST
repeated
August 5th Tuesday 9am EST
August 12th Tuesday 9am EST
repeated
September 9th Tuesday 10am EST
September 16th Tuesday 3pm EST
repeated
October 8th Wednesday 3pm EST
October 14th Tuesday 9am EST
Next Steps
• Anybody willing to volunteer today to make an
institutional presentation?
• Sharing of alumnae survey questions and
other evaluation tools…