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Bridge over Troubled Water Linking UME and GME. Monica L. Lypson, MD Assistant Dean, Graduate Medical Education University of Michigan Jeff Fabri, MD Rita M. Patel, MD . Education Across the Continuum Standardization of Assessment Student Portfolios to Baseline Assessment.

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Bridge over troubled water linking ume and gme l.jpg

Bridge over Troubled WaterLinking UME and GME

Monica L. Lypson, MD Assistant Dean, Graduate Medical EducationUniversity of Michigan

Jeff Fabri, MD

Rita M. Patel, MD


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Education Across the Continuum Standardization of AssessmentStudent Portfolios to Baseline Assessment

Monica L. Lypson, MD Assistant Dean, Graduate Medical EducationUniversity of Michigan

Associate Chief of Staff, VA Ann Arbor Health Care System


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Developed by the Graduate Medical Education Committee (GMEC) at the University of Michigan

It is our initial step in training our residents

It was established to determine residents’ baseline proficiency in particular aspects of the ACGME’s six general competencies

Institutional OSCE – Post-Graduate Orientation Assessment (POA)

Lypson ML. et.al. Academic Medicine. 79(6):564-70, 2004 Jun.


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Knowledge and skills needed during the first six to eighteen weeks of residency/internship

Emphasizes clinical situations that are often encountered without formal supervision

9 Assessment & Educational Stations

POA CONTENT


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Results of the POA determine the basis for individualized “learning agendas”

Remediation is provided after the completion of each station

Residents received educational materials that provide the “answers” to the information assessed during the POA

Standardized Patient feedback is provided to the program director within 24 hours if the resident performs exceptionally well or poorly during the POA

The POA as Formative Assessment


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Administered over 4 days of Paid hospital orientation “learning agendas”

Provided to approximately 150 PGY-1 residents in over 15 specialties

Cost Approximately $250 per resident for the assessment - $500 if you add in salary

There are some discipline specific scenarios – e.g. Pediatric cases and examples

Scores are provided to the resident and program director within 7-10 days of the POA

Implementation


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Dentistry “learning agendas”

Emergency Medicine

Family Medicine

General Surgery

Preliminary Residents

Internal Medicine

Preliminary Residents

Internal Medicine – Pediatrics

Neurosurgery

Obstetrics & Gynecology

Otolaryngology

Orthopedics

Pathology

Pediatrics

Plastic Surgery

Psychiatry

Urology

PGY-2s

(Residents that did not complete their Internships at UMHS)

Physical Medicine & Rehabilitation

Dermatology

Neurology

Subspecialty Programs


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Critical Values / Multiple Choice “learning agendas”

Computer Based assessment

Review and diagnose 17 short patient scenarios

Multiple Choice Format similar to United States medical Licensing Exam (USMLE) Step 3

Competencies:

Patient Care

Medical Knowledge

Socio-Cultural Communication

Standardized patient assessment

Assesses the understanding of disease and treatment recommendations in the context of the patient’s health beliefs and socio-economic setting

Competencies:

Interpersonal and Communication Skills

Professionalism

Patient Care

Practice-Based Learning and Improvement

Station Content


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Evidence-Based Medicine (EBM) “learning agendas”

Computer-based Assessment

Generate a clinical question

Residents reviewed abstracts & identify the appropriate treatment

Competencies:

Practice-based Learning and Improvement

Medical Knowledge

Images (X-Rays)

Computer-based Assessment

Review & diagnose 18 images

Many of the common films reviewed in the middle of the night while “on call”

Competencies:

Patient Care

Medical Knowledge

Station Content


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Informed Consent “learning agendas”

Standardized patient Assessment

Obtain informed consent from a patient for a procedure

Hospital & JCAHO standards and policies

Competencies:

Interpersonal and Communication Skills

Professionalism

Patient Care

Patient Safety

Pen & Paper Assessment

Order Writing Station

Legibility

Signature, Date, Time

Respiratory Distress

Treatment of the acute Asthmatic

Competencies:

Systems-Based Practice

Professionalism

Patient Care

Medical Knowledge

Station Content


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Aseptic Technique “learning agendas”

Checklist Evaluation by Expert Nursing Staff and Standardized Patients

Create & maintain a sterile field while performing a “mock” I&D

Universal Protocol & “Time-out” procedures covered

Assessment/Remediation materials include a review of JCAHO requirements

Improved nursing and house officer interactions

Competencies:

Patient Care

Medical Knowledge

Systems-Based Practice

Station Content


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System Compliance / Fire Safety Station “learning agendas”

Surgical Fire Safety (20/20)

Housestaff involvement with a Patient fire

Questions covering use of safety equipment & review of JCAHO requirements

Video & Computer Based Assessment

Competencies:

Patient Care

Systems-Based Practice

Pain Assessment

Pain Assessment Tools

Educates on the appropriate medications to use for pain

Explains hospital and JCAHO Pain assessment mandates

PowerPoint & Computer Based Assessment

Competencies:

Patient Care

Medical Knowledge

Station Content


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Resident Satisfaction with the POA “learning agendas”-Survey Response Rate 93%2002-2004


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The POA was based on the following… “learning agendas”

The University of Michigan

Comprehensive Clinical Assessment

(CCA)


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A high-stakes examination for University of Michigan Medical Students

Fourth Year students must pass the CCA in order to Graduate

10-15 stations over ~4-5 hours

~150 M4 students per year

Summative Evaluation

Standards have been set for Pass/Fail

Remediation for failures

Comprehensive Clinical Assessment 1991-Present

Rochester AB. et.al.. Academic Radiology. 5(3):169-72, 1998


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POA- GME Students

Formative

Informed Consent & Policy

Pain Assessment

Socio-Cultural Communication

Evidence Based Medicine

Images

CCA-UGME

Summative

History & Physical Diagnosis

Geriatrics

Socio-Cultural Communication

Evidence Based Medicine

Images

Summary of Station Comparison:CCA & POA


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Training the Faculty in the Teaching Skills of competency assessment

Medical School Objectives Project (MSOP)

Accreditation Council of Graduate Medical Education

Reimbursement of faculty time and effort

Payment for both assessments – Medical School vs. Hospital

Is the medical school or the hospital responsible for ‘educational cost’?

Trainee awareness of “competency gap” between the expectations of medical School and residency

Institutional Implications for GME & UGME



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Joint Hire faculty member with the Department of Medical Education

Centralized OSCE – Post-Graduate Orientation Assessment (POA)

This is based on the system already in place for Undergraduate Medical Education at UMHS.

The University of Michigan Health System Plan for Competency Based Resident Education


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One of ~5 departments of medical education at LCME accredited medical schools

The department had focused on CME and UGME in the past with assessment and research expertise

The office of Graduate Medical Education and the Department of Medical Education

Joint Hire

Job Description

50% appointment GME office, 50% appointment Dept. of Med. Ed.

Aid Residency programs with curriculum development, core competency assessment

Use this work as a vehicle of scholarly pursuit

The department has a long history of UGME – now will develop its expertise in GME

The Department of Medical EducationChairman: Larry Gruppen, PhD