Faculty Development, May, 2015 TCMC’s 3 rd Year Redesign

1. Faculty Development, May, 2015TCMC’s 3rd Year Redesign Dr. Linda Berardi-Demo Associate Dean of Student Affairs and Admissions Brian Wilcox, MD, PhD. Assistant Dean for Clinical Education

2. Disclosures •      The speaker and planners of this event do not have any relevant commercial relationships to disclose. •     The content of this presentation is not based on topics related to any commercial interests as defined by the ACCME.

3. Outline • Basics of the Redesign • Schedule, Grading • “What they know” • LIC Component • Schedule • Continuity Patients • Assessments • Logging • Block Component • Schedule • Assessments • Logging • Learning Environment

4. 3rd Year Revision • Basic Design: • Half of the students in a region will do an uninterrupted LIC for the first half of the year. • Half of the students in a region will do “block” rotations for the first half of the year. • The groups will switch in January.

5. 3rd Year in Review

6. 3rd Year Revision LIC Half: • ½ day of Outpatient Internal Medicine • ½ day of Outpatient Family Medicine • ½ day of Outpatient Surgery • ½ day of Outpatient Obstetrics and Gynecology • ½ day of Outpatient Pediatrics • ½ day of Outpatient Psychiatry • 3 x ½ day of “White Space” • ½ day of Clerkship Education (Fri. afternoon, CED) • 80 hours of Emergency Medicine

7. 3rd Year Revision “Blocks”: • 4 weeks of Inpatient Adult Medicine (IM or FM) • 4 weeks of Inpatient Surgery • 1 week of Anesthesia • 3 weeks of Inpatient OB/GYN • 3 weeks of Inpatient Psychiatry • 2 weeks of Inpatient Pediatrics • 4 weeks of “Elective” • 2 weeks of “Selectives” • Includes ½ day per week of CED

8. Clerkship Grading • 20% LIC Preceptor Evaluation* • 20% Inpatient Block Evaluation* • 20% Objective Clinical Exams (OSCEs) • 30% NBME “Shelf” exams • 10% Clerkship Education Day Presentations/TBLs

9. So….What do they Know? • Communication Skills (~18 hours) • Learning through Listening (M1) • Responding to Emotions (M1) • Cultural Differences (M1) • Sexuality and Sexual issues (M1, M2) • Breaking Bad News (M2) • Working with interpreters (M2) • Adolescent Interviews (M2) • Depression (M2) • Elderly Interviews (M2)

10. So….What do they Know? • Physical Exam Skills (18-25 hours) • Vital signs (M1) • HEENT Exam (M1) • Chest/Abdomen Exam (M1) • Musculoskeletal Exam (M1) • Neuro Exam (M1, M2) • Newborn Exam (M2) • Female and Male Genital exam (M2) • Breast Exam (M2) • Clinical Skills (foley, suturing, IV, injections) • Written Notes (M2)

11. MD3 Core Week • Internal Medicine and Family Medicine: • The IM/FM Experience • Communication in IM/FM • Respiratory Infections • Assessment and Management of HTN • Surgery: • Educating the Millennial Surgeon • Introduction to Surgery • Suturing Workshop

12. MD3 Core Week • Psychiatry: • History Taking • Managing the Agitated Patient • Mental Status Exam • Practical Psychopharmacology • Pediatrics: • Fluids and Electrolytes • Interview/Exam of the Pediatric Patient • Acutely Ill pediatric Patient • Pediatric Emergencies

13. MD3 Core Week • Obstetrics and Gynecology: • Review of Labor & Fetal HR tracings • Birthing Simulation • OB/GYN History Taking • OB/GYN Note-Writing and Oral presentations

14. LIC Component Details • 23 Uninterrupted weeks • Reduced from 37 weeks – all are required • 5 Continuity patients/Discipline • 3+ Separate encounters/patient • Help them choose • Assessments • Early Warning : 4 weeks • Formative: 8-12 weeks • Summative: After 23 weeks • Logging of Activities

15. LIC Component • 23 Uninterrupted Weeks • No unexcused absences • Plan for extra sessions if necessary • Notify the Region a.s.a.p. for issues

16. Continuity Patients • Five (5) per discipline • Deliberate follow-up • At least 3 encounters/patient • Partner in management

17. Assessments • Early Warning at 4 weeks • Mid-LIC (Formative)at 8-12 weeks • End-LIC (Summative) at 23 weeks • Simplified: • 8-9 questions • Based on Entrustable Professional Activities

18. Assessments • Early Warning • After four (4) sessions • Four (4) Questions • Knowledge: Appropriate? • Skill: Appropriate? • Attitude: Interested and eager to learn? • Behavior: Punctual, Professional?

19. Assessments (mid LIC, end LIC) 1. Appropriate History and Physical? 2. Appropriate Differential Diagnosis? 3. Recommend and Interpret Appropriate Tests? 4. Recommend Treatment Plans/Counseling? 5. Appropriate Oral Presentation of an Encounter? 6. Appropriate Documentation of an Encounter? 7. Professional, Punctual, Polite? 8. Eager, asks questions, seeks information?

20. Example Assessment Question • Can the student gather a pertinent history and perform an appropriate exam? • N/A: I was unable to assess /evaluate this skill • Incomplete or unfocused; forgets important history components or fails to notice important exam findings • Obtains most pertinent information and identifies most common findings; forgets some commonly-missed details or subtle exam findings • History and exam are always complete, precise, detailed, focused and organized; elicits subtle findings

21. Example Assessment Question • Can the student develop a prioritized differential diagnosis and select a provisional diagnosis? • N/A: I was unable to assess /evaluate this skill • Frequently misinterprets data; diagnoses are frequently incorrect or not well prioritized. • Usually creates a reasonable differential diagnosis and correct provisional diagnosis; makes common misinterpretations of data or forgets some less-common diagnoses. • Broad mastery of knowledge, understands complex issues and includes major and minor problems; insightful prioritization.

22. Logging • Continuity Patients: • 5 per Discipline • Skills: • Two Times per 23 weeks • Directly-Observed History-Taking • Directly-Observed Physical Exam • Directly-Observed Counseling • Diagnoses Encountered:

23. Block Rotations • 4 weeks of Inpatient Adult Medicine (IM or FM) • 4 weeks of Inpatient Surgery • 1 week of Anesthesia • 3 weeks of Inpatient OB/GYN • 3 weeks of Inpatient Psychiatry • 2 weeks of Inpatient Pediatrics • 4 weeks of “Elective” (P/F) • 2 weeks of “Selectives” (P/F) • Includes ½ day per week of CED

24. Block “Selectives/Electives” • “Selectives”: 2 weeks • Radiology • Pathology & Laboratory Medicine • Neurology • “Electives”: 2 or 4 weeks • ANY discipline (includes Medicine Subspecialties) • Must involve care of patients

25. Inpatient Blocks • Learning Objectives have been revised. • Syllabi will be distributed • Continuity Patients – can be followed to the LIC, or from the LIC • Logging still required • Assessments: • Mid block (logged) • End-of-Block • Shift Cards

26. Assessments 1. Appropriate History and Physical? 2. Appropriate Differential Diagnosis? 3. Recommend and Interpret Appropriate Tests? 4. Recommend Treatment Plans/Counseling? 5. Appropriate Oral Presentation of an Encounter? 6. Appropriate Documentation of an Encounter? 7. Professional, Punctual, Polite? 8. Eager, asks questions, seeks information?

27. Learning EnvironmentDr. Berardi-Demo • Teacher Learner Compact • Student Mistreatment and the clinical environment • Commendations and Celebrating the Positive Learning Environment • Support and Resources

28. Questions?

32. Estimate # of Students per Site

33. Example Schedules