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MEC Review. Psychiatry Dec 17,2013. Recommendations. Update Objectives - done Update Essential skills/conditions language – done Essential skills/conditions – delirium. Learning Tools Learning Environment/Activities Residents as Teachers. Delirium. New Hampshire Hospital :

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MEC Review

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Mec review

MEC Review

Psychiatry

Dec 17,2013


Recommendations

Recommendations

  • Update Objectives - done

  • Update Essential skills/conditions language – done

  • Essential skills/conditions – delirium.

  • Learning Tools

  • Learning Environment/Activities

  • Residents as Teachers


Delirium

Delirium

  • New Hampshire Hospital:

    • The admissions process actively screens out patients with delirium.

    • NHH assigned students (max of 32 per year) do call at DHMC and may see this condition in this setting.

    • However, that is not reliable enough to have this as an essential condition.

    • Therefore, we would petition the MEC to reassign delirium to an alternative clinical service (eg medicine or surgery).


Learning assessment tools

Learning Assessment Tools

  • Recommendation

    • Consider Mini-CEX

  • Considering:

    • Oral Board model -

      • Last week of clerkship

      • 30 min interview

      • 5 min student prep

      • 10 min presentation

      • 10 min feedback

    • 4 trained evaluators

      • To standardize evaluation and feedback

    • Formative and Summative feedback (12.5 points)

      • Reporter skills (5 pts)

      • Interpreter (2.5 pts )

      • Manager

        • Early (2.5 pts)

        • Proficient (2.5 pts)


Learning environment activities

Learning Environment/Activities

  • Recommendation:

  • Outpatient: “enhance experience across sites.”

  • Current schedule:

    • DHMC – ½ day in the same clinic across 5 weeks.

    • NHH – ½ day at Heater Rd Primary Care.

    • VA – 1 full day at WCBH Claremont.

    • CPMC – ½ to 1 full day in child clinic.

  • Working toward:

  • DHMC – working with attendings and residents on more active student role.

  • NHH – adding an additional ½ day in another DHMC based integrated clinic (GIM or OB/GYN)

  • VA – re-new student involvement in PMHC walk-in clinic – which has received the 2005 American Psychiatric Association Gold Achievement Award and the 2007 VA Advance Clinical Access National Champion Award.

  • CPMC – actively working with Dr. Chung to expand this experience.

    • Site visit planned for March 2014


Learning environment activities1

Learning Environment/Activities

  • Recommendation:

  • Didactics: “more interactive”

  • Current schedule:

    • DHMC/NHH/VA – ½ day all together each Friday 1 -4pm.

    • Case centered discussion based is the goal.

    • But drifts back to power point format

    • CPMC – 2 students with Dr. Chung, very case based (no need to change)

  • Considering:

  • DHMC – 3 sessions will change to SBM-like live patient interview and discussion.

  • (students interview)

    • Mood disorders - Dr. Holtzheimer

    • Psychotic disorders - Dr. Noordsy

    • Substance use - Dr. Nordstrom

  • NBME review session

    • (as we are starting to see a downward trend in average test scores)


Learning environment activities2

Learning Environment/Activities

  • Recommendation:

  • Assignments: “checklist”


Learning environment activities3

Learning Environment/Activities

  • Recommendation:

  • Call hours: “more equitable .”

  • Current schedule:

  • Call is 5pm to MN

    • DHMC – 3 nights

    • NHH – 2 nights at DHMC

      • 2-3 admission nights at NHH – end before MN

    • VA – 2 nights at DHMC and phone call for VA

    • CPMC – 4 nights.

  • Changes already made:

  • NHH and VA – used to have a 12 - 24 hour weekend call.

  • Now is an 8 hour shift more on par with evening call.


Resident as teachers

Resident as Teachers

  • Recommendation:

  • “Assure distribution of policies and objectives”

  • Consider Survey Monkey to track and document.

  • Changes:

  • Chris Bolka is working with pediatrics coordinator to implement the same system.


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