Challenging Patients Curriculum

This database is no longer actively maintained and is here for archival purposes only

Organization Type: 
Educational Institution
Program Type: 
Education Level: 
Postgraduate (e.g., residency, fellowship)
Educational Elements: 
Independent Study
Experiential not including services to patients
Other Element(s): 
Standardized patient examinations
Program Description: 

The University of Virginia School of Medicine offers a Challenging Patients Curriculum designed to better prepare family medicine residents to meet the needs of elderly patients with multiple chronic illnesses, refugees and immigrants, and patients with chronic pain.The Challenging Patients Program is a three-year progressive curriculum developed through a Residency Training in Primary Care Grant funded by the Department of Health and Human Services, Health Resources and Services Administration (HRSA).  It is built upon the concept of the patient-centered clinical method, and uses a variety of teaching methods to help residents achieve the overall goal of helping physicians reach common ground with patients (i.e., shared, mutually understood goals, and plans of care).  The groups of patients targeted in this program comprise a growing proportion of the U.S. population, require a disproportionate share of healthcare resources, and have specifically been identified as “challenging” by residents in the program.

Curriculum modules and assessment materials for each patient population (elderly with multiple chronic illnesses, refugees and immigrants, patients with chronic pain) have been developed for residents in each of the three post-graduate years of training. These modules also reflect increasing complexity across the three years in order to parallel the developing skills of residents as they move through their training program. Curricula are structured through proposed two-hour workshop formats. Assessments are structured via the use of standardized patients. Curriculum and assessment modules for each patient population (by post graduate year) include the following: 1) a step-by-step guide for instructors to enable them to teach the relevant workshop; 2) all associated handouts, references for reading material, and teaching materials associated with the workshop; and 3) all needed case materials to implement the associated standardized patient case, including standardized patient training materials, case materials for the actual assessment, and associated post-encounter checklists.

The curriculum explores the evaluation and management of the unique medical conditions posed by older patients with multiple co-morbidities, patients with chronic pain, and refugee and immigrant patients, as well as commonly associated psychological co-morbidities, relevant family dynamics and socio-cultural factors. 

The program is grounded in the patient-centered clinical method. The centerpiece of this method is use of patient-centered interviewing methods and an empathic interviewing style to reach common ground with the patient – mutually understood problems and goals of care. The curriculum for each group of challenging patients is taught in a series of workshops that feature a variety of teaching methods, including lectures, role-playing, case discussions, and learning games.

Each year of the curriculum has a standardized patient evaluation that complements the curriculum. The curriculum is provided over three years of residency, with each year’s curriculum building on the residents’ growing competence and sophistication to deal with more complex issues of management in these patients.  For example, in the older patients with multiple co-morbidities curriculum, the first year focuses on aging-disease interactions, using diabetes as a prototypical chronic illness; the second year emphasize practical interdisciplinary geriatric assessment in the context of caring for patients with functional decline; and the third year focuses on finding common ground with patients through a deep understanding of the patient’s and family’s preferences, and the patient’s functional status, medical problems and resources. Each module includes instructors' guides, presentations, handouts and readings, and standardized patient scenarios.


Program Results: 

The curriculum has been evaluated using pre and post-surveys of participants, and pre and post-testing of knowledge of participants.   Evaluations have shown that participants find the program helpful, and that it has helped increase their self-reported level of comfort in caring for the groups of challenging patients.

Targeted Professions
Family Medicine
Internal Medicine
Nurse Practitioners
Ambulatory Care
Physician Assistants
Self-Reported Competencies
PCPCC’s Education and Training Task Force identified 16 interprofessional training competencies critical for preparing health professionals for practicing in team-based, coordinated care models such as patient-centered medical homes. Listed below are the self-reported competencies that this program has achieved, which have been organized by the five core features of a medical home as defined by the Agency for Healthcare Research and Quality
Patient-Centered Care Competencies: 
Advocacy for patient-centered integrated care
Cultural sensitivity and competence in culturally appropriate practice
Development of effective, caring relationships with patients
Patient-centered care planning, including collaborative decision-making and patient self-management
Comprehensive Care Competencies: 
Assessment of biopsychosocial needs across the lifespan
Risk identification
Last updated November 15, 2013

* Please note: Information contained in this database is self-reported by representatives from each program. It does not represent an exhaustive list of education and training programs and inclusion does not constitute an endorsement from the PCPCC.


Go to top