C. Scott Smith

C. Scott Smith
United States Department of Veterans Affairs · Office of Academic Affiliations

MD, MACP

About

50
Publications
2,753
Reads
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622
Citations
Introduction
C. Scott Smith retired from the Office of Academic Affiliations, United States Department of Veterans Affairs in June 2018. Scott does research in Post-graduate Health Education and Internal Medicine (General Medicine). His current projects involve co-developing a peer grant-writing workgroup and use of serial Social Network Analysis (SNA) to assess cultural change due to large educational initiatives.
Additional affiliations
January 1990 - January 2015
University of Washington
Position
  • Residency Program Director
January 2015 - present
VA Centers of Excellence in Primary Care Education
Position
  • National Physician Consultant
Description
  • Consult in the design, implementation and evaluation of interprofessional training in patient-centered medical homes
April 1989 - present
University of Washington
Position
  • Professor (Full)
Education
July 1976 - June 1980
University of Washington
Field of study
  • Medicine
September 1972 - June 1976
Massachusetts Institute of Technology
Field of study
  • Mechanical Engineering

Publications

Publications (50)
Article
Full-text available
Small, isolated teaching centers have difficulty mentoring interprofessional junior faculty in research methods and grant writing. Peer mentoring programs for grant writing at larger institutions have been successful. In this short report, we describe our program that leveraged mentor experience using four framing seminars followed by project refin...
Article
Small, isolated teaching centers have difficulty mentoring interprofessional junior faculty in research methods and grant writing. Peer mentoring programs for grant writing at larger institutions have been successful. In this short report, we describe our program that leveraged mentor experience using four framing seminars followed by project refin...
Article
Full-text available
There is need for effective venues to allow teams to coordinate care for high-risk or high-need patients. In addition, health systems need to assess the impact of such approaches on outcomes related to chronic health conditions and patient utilization. We evaluate the clinical impact of a novel case conference involving colocated trainees and super...
Article
Full-text available
This paper describes the Centers of Excellence in Primary Care Education (CoEPCE), a seven-site collaborative project funded by the Office of Academic Affiliations (OAA) within the Veterans Health Administration of the United States Department of Veterans Affairs (VA). The CoEPCE was established to fulfill OAA’s vision of large-scale transformation...
Article
Introduction: Health professional education programs are currently focusing on interprofessional training. This can highlight differences between our professions in our learning theories and training assumptions. A standardized approach to picking a deliberate perspective from which to design specific interprofessional curricula may be useful. Dis...
Article
To better understand the effects of interprofessional training on clinical and systems outcomes, there is a need for cross-professional, competency-based assessment instruments that yield scores from which one can make valid inferences. Existing instruments have not been developed across medicine, nursing, pharmacy, and psychology for both pre- and...
Article
Background/Purpose As interprofessional education in clinical teaching settings continues to develop and workplace learning becomes more ubiquitous, early adopters will need to disseminate training innovations to diverse sites and programs. It is important for these sites to have a framework to understand and organize dissemination. Methods This s...
Article
Problem: As health care systems convert to team-based care, the need to improve interprofessional education is tremendous. In addition to formal instruction, trainees need authentic team-based workplace learning experiences. Approach: The authors designed the PACT-ICU (Patient-Aligned Care Team Interprofessional Care Update) conference to provid...
Article
In 2011, the US Department of Veterans Affairs established five Centers of Excellence to study training in the patient-centered medical home clinical microsystem. Early on, our center began a discourse analysis in order to better understand each profession's assumptions about roles, responsibilities, and the basis for "truth" in clinical care. We d...
Book
This book discusses the application of complex adaptive systems theory to the design and evaluation of patient-centered medical homes (PCMHs). The three defining goals of PCMHs are to spread patient-care roles among healthcare team members, focus on disease prevention and include the patient in the healthcare team. It explains why some PCMH pilots...
Chapter
The VA began nationwide conversion to a medical home system called Patient Aligned Care Teams (PACTs) in 2010. Primary care clinics were tasked with improving access, implementing team-based practice redesign, and improving clinical outcomes. For many clinics, these concepts represented a huge shift from their current practice culture. In addition,...
Chapter
As mentioned previously, we began building our interprofessional medical home training clinics without much structure or a road map. Since then, we have discovered how complex adaptive systems theory can help to clarify the difficulties involved and how the SHED sub-theories can bracket a portion of the clinic system for more detailed analysis. In...
Chapter
As part of the Department of Veterans Affairs (VA) system-wide redesign to improve primary care, the Boise VAMC undertook an effort to integrate psychology, medicine, pharmacy, and nurse practitioner postgraduate training programs. Despite a shared goal in supporting interprofessional education (IPE), initial efforts to focus on curriculum developm...
Chapter
The concepts of simple, complicated, and complex adaptive systems helped us to understand some difficulties that our team was experiencing. However, for some problems, this perspective seemed too broad, and a more fine-grained approach was desirable.
Chapter
When you are trying something completely new, like an interprofessional medical home training clinic, how do you know if it works? This question has different answers depending on whether the report is for the funder, considering return on investment; the institution, considering whether to continue the program after the grant expires; the trainees...
Chapter
The patient-centered medical home (PCMH) represents, quite simply, good primary care that has been systematized to be shared among highly functional teams. This seems at odds with classic views of primary care, in which one provider shouldered the responsibilities for a panel of patients, with specific tasks delegated to ancillary staff. PCMH allow...
Chapter
Our local training clinic began the transformation to interprofessional education and the patient-centered medical home (PCMH) model of care without much of a road map. This twofold cultural shift was exhilarating—and often times very difficult. We generally made progress but did have problems along the way that required concerted efforts to genera...
Chapter
Many of the struggles our site has experienced have to do with organizational process, regulatory policies, and research structures at the institutional level and above. While most of these entities espouse the need for interprofessional education and team-based care, the institutional rules, processes, and structures lag behind and often do not su...
Article
Full-text available
We aimed to study linguistic and non-linguistic elements of diagnostic reasoning across the continuum of medical education. We performed semi-structured interviews of premedical students, first year medical students, third year medical students, second year internal medicine residents, and experienced faculty (ten each) as they diagnosed three comm...
Article
The very nature of the Patient-Centered Medical Home (PCMH) necessitates new instructional models that prepare learners for the roles they will have to assume in these transformed primary care practices. In this manuscript we describe a new instructional framework that seeks to blend the goals of patient-centered care and inter-professional educati...
Article
Full-text available
Background: The Accreditation Council for Graduate Medical Education (ACGME) requires that training programs integrate system-based practice (SBP) and practice-based learning and improvement (PBLI) into internal medicine residency curricula. CONTEXT AND SETTING: We instituted a seminar series and year-long-mentored curriculum designed to engage in...
Article
Purpose: The Accreditation Council for Graduate Medical Education's (ACGME's) six-competency framework has not been validated across multiple stakeholders and sites. The objective of this study was to perform a multisite validation with five stakeholder groups. Method: This was a cross-sectional, observational study carried out from October to D...
Article
Full-text available
The very nature of the Patient-Centered Medical Home (PCMH) necessitates new instructional models that prepare learners for the roles they will have to assume in these transformed primary care practices. In this manuscript we describe a new instructional framework that seeks to blend the goals of patient-centered care and inter-professional educati...
Article
Full-text available
A national task force identified domains and developmental milestones from the national competencies for resident training. Cultural Consensus Analysis (CCA) is a standard anthropological technique that can identify value conflicts. We created a CCA based on the internal medicine milestones (M-CCA) in 3 steps: converted the 38 domains into active s...
Article
Little is known about the factors during internal medicine residency that influence career choice. To determine if rural training experiences were associated with primary care career choice. We conducted a retrospective cohort study at a single, large, internal medicine residency program. We reviewed self-reported career plan at the time of graduat...
Article
Night float rotations are being increasingly used in the era of resident physician work-hour regulations, but their impact on resident education is not clear. Our objective was to clarify resident perceptions of the educational aspects of night float rotations. An anonymous survey of internal medicine residents at a university-based residency progr...
Article
Full-text available
Objectives: This pilot study was designed to compare the performance of 'relationship-based' statements from a cultural consensus analysis, a standard anthropological technique for measuring value differences, with 'gold standard' patient and nursing satisfaction surveys often used in 360° evaluation of the systems-based practice competency. Method...
Article
Teaching clinic managers struggle to convert performance data into meaningful behavioral change in their trainees, and quality improvement measures in medicine have had modest results. This may be due to several factors including clinical performance being based more on team function than individual action, models of best practice that are over-sim...
Article
Full-text available
In the past two decades there has been tremendous worldwide interest in assessing the clinical competence of learners in medical education. This interest marks a philosophical shift toward greater objectivity, accountability, and predictive power in the evaluation of trainees. One of the core competencies in medical education is clinical reasoning....
Article
Full-text available
The general framework for approaching residents in difficulty that we present here includes (1) explicit criteria that separate suggestions for improvement from formal remedial action, (2) categorization of the problem into three areas with different approaches (competence, laws and professional standards, and performance and disability), and (3) a...
Article
Recurrent problems in medical teaching clinic are common and difficult to address because of complex interpersonal dynamics. To minimize this difficulty, we developed a conceptual model that simplifies problems and identifies the root cause of tension between groups in clinic. We used recursive analysis and modeling of the data from a larger multi-...
Article
Recurrent operational problems in teaching clinics may be caused by the different medical preferences of patients, residents, faculty, and administrators. These preference differences can be identified by cultural consensus analysis (CCA), a standard anthropologic tool. This study tests the exportability of a unique CCA tool to identify site-specif...
Article
BACKGROUND: Recurrent operational problems in teaching clinics may be caused by the different medical preferences of patients, residents, faculty, and administrators. These preference differences can be identified by cultural consensus analysis (CCA), a standard anthropologic tool. OBJECTIVE: This study tests the exportability of a unique CCA tool...
Article
Some problems in clinic function recur because of unexpected value differences between patients, faculty, and residents. Cultural consensus analysis (CCA) is a method used by anthropologists to identify groups with shared values. After conducting an ethnographic study and using focus groups, we developed and validated a CCA tool for use in clinics....
Article
Qualitative analysis of a large ethnographic database from observations of a resident teaching clinic revealed three important findings. The first finding was that breakdown, a situation where an 'actor' (such as a person or the group) is not achieving expected effectiveness, was the most important category because of its frequency and explanatory...
Article
The authors conducted a pilot test of the organizational culture model in a health care setting. The study was based on a questionnaire with mixed quantitative and qualitative analysis. Quantitative analysis confirmed the expected distribution of responses among the subcultures for all three questions, with significant differences in two of the thr...
Article
When a patient comes to the clinic with a new complaint, the often wide array of possible causes creates uncertainty about the optimal evaluation and treatment. Selecting an approach to evaluation involves values that range from ruling out all disease processes (all zebras) regardless of cost to limiting cost by looking only for those processes tha...
Article
Ask faculty if they provide feedback and they will likely reply "Sure, it's important, I do it all the time". Ask medical students if they receive feedback and they may say, "We hardly ever get it". Ask most residents if they receive feedback and you get "Rarely, but it's not that helpful anyway". How is it that these perceptions are so strikingly...
Article
While ambulatory care education typically does not provide much direct instruction, supervision, or feedback, experiential learning occurs. Using experiential learning theory, the authors describe how this process of learning works. the process is characterized by a cycle of having a concrete experience (e.g., an encounter with a patient), reflecti...
Article
Background: Residents have an important role as teachers of medical students.Purpose: This study addressed assessment of the impact of written learner feedback on resident teaching.Methods: Senior residents (N = 30) were randomized into either an experimental group receiving feedback or a control group receiving no feedback. Team members were inter...
Article
The author assessed the effects on quality and continuity of care at a Veterans Affairs hospital as a result of its conversion to an interdisciplinary firm system. Before the firm system was implemented, ambulatory care at the hospital was provided in two medicine clinic areas and in one unscheduled "walk-in" clinic. Care for intercurrent illnesses...

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