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Evaluating the Principal Clinical Experience: A Progress Report. Ed Krupat, PhD Medical Education Grand Rounds May 18, 2007. The PCE Pilots. Cambridge Integrated Clerkship--begun July 2004 Brigham & Women’s Hospital--begun July 2005 Beth Israel Deaconess Medical Center--begun July 2005

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evaluating the principal clinical experience a progress report

Evaluating the Principal Clinical Experience: A Progress Report

Ed Krupat, PhD

Medical Education

Grand Rounds

May 18, 2007

the pce pilots
The PCE Pilots
  • Cambridge Integrated Clerkship--begun July 2004
  • Brigham & Women’s Hospital--begun July 2005
  • Beth Israel Deaconess Medical Center--begun July 2005
  • Massachusetts General Hospital--begun July 2006
the principles
The Principles
  • Longitudinality
    • with faculty and house staff
    • with patients
    • of feedback
    • of curriculum
  • Mentoring
  • Interdisciplinary perspectives
  • Integration of basic and clinical sciences
  • Patient-centered approach
  • Student-centered learning
plans methods
Plans & Methods
  • Mentoring programs
  • Planned curriculum
    • Tutorials
    • Students present cases
  • PCC (with physicians who admit to the hospital)
  • PD III at site
  • Writing/reflection
the evaluation plan
The Evaluation Plan
  • Comprehensive
    • Experiences
    • Knowledge & knowledge retention
    • Skills
    • Attitudes/perceptions
    • Self-assessment
  • Multi-method
    • Quantitative
    • Qualitative
  • Scientifically rigorous
  • Tied directly to pilot program goals
the design
The Design
  • Comparison/control group recruited from students doing traditional rotations
  • Pre-clerkship measures demonstrated no differences on
    • MCAT scores
    • Step I scores
    • PD II OSCE scores
    • Career preferences
    • Attitudes toward patient care
slide8
“How well would you say the following adjectives describe your clerkship experience:Frustrating”(1= Not At All & 6= Perfectly)

’05-’06 Clerkships

slide9
“How well would you say the following adjectives describe your clerkship experience:Confidence-building”(1= Not At All & 6= Perfectly)

’05-’06 Clerkships

how well would you say the following adjectives describe your clerkship experience humanizing
“How well would you say the following adjectives describe your clerkship experience:Humanizing”

’05-’06 Clerkships

slide11
“How satisfied are you with:The overall quality of your clerkship experience”(1= Extremely Dissatisfied & 6= Extremely Satisfied)

’05-’06 Clerkships

slide25

“To what extent have your experiences prepared you:To have the knowledge base necessary to be a competent practitioner”(1= Very Poorly & 6= Very Well)

’05-’06 Clerkships

slide26
“To what extent have your experiences prepared you:To integrate basic sciences and clinical practice”(1= Very Poorly & 6= Very Well)

’05-’06 Clerkships

slide27
“To what extent have your experiences prepared you:To practice evidence-based medicine”(1= Very Poorly & 6= Very Well)

’05-’06 Clerkships

slide28

“To what extent have your experiences prepared you:To see how the social context affects patients and their problems”(1= Very Poorly & 6= Very Well)

’05-’06 Clerkships

slide29
“To what extent have your experiences prepared you:To relate well to a diverse patient population”(1= Very Poorly & 6= Very Well)

’05-’06 Clerkships

slide30
“To what extent have your experiences prepared you:To know your strengths and limitations”(1= Very Poorly & 6= Very Well)

’05-’06 Clerkships

patient practitioner orientation scale ppos33
Patient-Practitioner Orientation Scale (PPOS)

Pre Post

Fall ’05 Spring ‘06

Site 1 5.14 5.13

Site 2 4.89 4.83

Site 3 5.14 5.12

Control 4.90 4.57

slide34
“During this past clerkship year, I observed residents encouraging patients’ participation in their own care.”(1= Never & 7= Always)

’05-’06 Clerkships

slide35

“Your team is rounding on a patient in his hospital room when one of the consulting services arrives for the patient. Your attending and the consulting attending proceed to talk about the patient’s case as if the patient weren’t there.”(1= Very Often & 5= Never)

’05-’06 Clerkships

slide36

“In general, when I made an effort to develop rapport with my patients, my instructors _____ me.”(1= Completely Discouraged & 7= Completely Encouraged)

’05-’06 Clerkships

slide37

“In general, when I made an effort to get to know patients as unique persons, my instructors _____ me.”(1= Completely Discouraged & 7= Completely Encouraged)

’05-’06 Clerkships

focus group findings
Focus Group Findings
  • Valued-added for the PCE students
    • Continuity with faculty
    • Access to hearing how faculty think about clinical issues
    • Mentoring
    • Peer group support
    • Sense of belonging to something

larger than self

slide39

“Today I was in a public restroom at _____,and I noticed how there was paper all over the floor. For a moment I was disgusted and I thought about all the residents and physicians who work so hard to give top notch care. I wouldn’t want patients or their families to use the bathroom at ____ and feel this hospital is dirty when hospitals are supposed to be clean! So I picked up all the trash. At that moment, I realized that I had taken ownership of this hospital.”

value added for the faculty
Value-Added for the Faculty
  • Contact and meaningful cross-discipline discussion
  • Ability to get to know students well
    • Personally satisfying
    • Ability to identify strengths and weaknesses
    • Ability to provide feedback and assist in student growth and development
remaining challenges
Remaining Challenges

Paradox of the Pullout

Longitudinal, interdiscipinary curriculum

Attendings vs residents?? More observation & better feedback

challenges cont
Challenges (cont.)
  • Patient contact pre-workup
  • Longitudinal contact with patients
  • Quality of the individual clerkships
  • Consistency
    • Across disciplines within site, within discipline across sites, and across PCEs