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Difficult to Assess Milestones. . . . An Open Collaboration In Teaching and Assessment. Saadia Akhtar , MD, FACEP Program Director Beth Israel Medical Center Albert Einstein College of Medicine
 Rodney Omron, MD, FACEP Assistant Program Director John Hopkins University

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an open collaboration in teaching and assessment

. . . An Open Collaboration In Teaching and Assessment

SaadiaAkhtar, MD, FACEP

Program Director

Beth Israel Medical Center

Albert Einstein College of Medicine


Rodney Omron, MD, FACEP

Assistant Program Director

John Hopkins University

Lynn Roppolo, MD, FACEP

Associate Program Director

University of Texas Southwestern

Parkland Health and Hospital System

slide3

Conflict of Interest

  • None to report
objectives
Objectives
  • Identify the challenges and obstacles to assessing these milestones
  • Create a more effective educational program to effectively teach these milestones
  • Develop assessment tools to appropriately evaluate residents in these milestones
  • Understand how to navigate the EM milestones wiki site
slide9
Most faculty are convinced that the RRC-EM Milestones are a solution for which there is no known problem. -anonymous
slide15

Developing a

roadmap . . .

slide16

Difficult Milestones Survey

  • 15-question survey, validated by 7 former PDs
  • Sent to CORDEM listserverin the Fall of 2013
  • 62% (99/160) of EM residency programs responded
  • IRB approved study
slide23
Sub-competency 20 (PBLI): Participates in performance improvement to optimize ED function, self-learning, and patient care.
slide24

EBM Practices and Expectations from EM Physician Educators

  • 98/157 CORD attendees surveyed
  • 71% do not use formal critical appraisal instrument
  • 75% do not have established EBM curriculum
  • 78% do not use any extramural sources (ACP, Best Evidence, EM Abstracts, or Annals of EM)

Carpenter CR . Incorporating evidence-based medicine into resident education: a CORD

survey of faculty and resident expectations. AcadEmerg Med 2010

learning basic ebm principles
Learning Basic EBM Principles
  • Journals: ACP Journal Club, EM Abstracts, Annals
  • Books
    • Emergency Medicine Decision Making by S. Weingart, 2006
    • User’s Guide to the Medical Literature by G Guyatt, 2008
    • Evidence-Based Diagnosis (Cambridge Medicine), TB Newman, 2009
    • EBM: How to Practice and Teach EBM, 4th Edition, SE Straus, 2010
    • Evidence-Based Physical Diagnosis: Expert Consult, S McGee, 2012
    • Evidence-Based Emergency Care: Diagnostic Testing and Clinical Decision Rules by JM Pines and CR Carpenter, 2013
learning basic ebm principles1
Learning Basic EBM Principles
  • Websites and podcasts
    • JAMAevidence: Using Evidence to Improve Care
    • http://www.dartmouth.edu/~library/biomed/guides/research/ebm-resources-materials.html
    • http://guides.mclibrary.duke.edu/ebm
    • https://www.med.emory.edu/EMAC/curriculum/diagnosis/maindiagnostic.html
    • http://www.annemergmed.com/content/ebemresources
    • http://adc.bmj.com/content/90/8/845.full.pdf
    • http://www.cebm.net/?o=1023
    • http://bestbets.org/teaching/current.php
    • http://ktclearinghouse.ca/
    • http://emjclub.com
critical appraisal worksheets http www cebm net index aspx o 1157
Critical Appraisal Worksheetshttp://www.cebm.net/index.aspx?o=1157
flipped classroom teaching and learning more efficiently
Flipped Classroom: Teaching and Learning More Efficiently
  • Need to be information managers, not encyclopedias of knowledge.
  • Need to be life long learners… to ask questions and go out and find answers for themselves.
  • Need to search and filter vast quantities of information on the internet - “Free Open Access MedEd”(FOAMed) by way of blogs, podcasts, and videos, apps and mobile websites
flipped classroom example
Flipped Classroom Example
  • One hour of ‘individualized learning’ at home
  • Provide a clinical scenario and 3-5 questions for residents to answer in advance
  • Provide some electronic resources
  • Interactive discussion in classroom
  • Evaluate residents by written submission of their findings or conference participation
fresno test
Fresno Test
  • 2 clinical scenarios with open ended questions
  • Must complete 4 key steps of EBM practice
  • 7 short answer questions, 2 mathematical calculations, and three fill-in-the-blank questions
  • The only validated, standardized, and objective measure of EBM competence currently available
  • 30 minute test
  • 13 page rubric
knowledge translation shift
Knowledge Translation Shift
  • Residents and an EBM faculty leader spend one shift per month in the ED answering EBM queries for all of the residents/faculty seeing patients.
sub competency 20 self assessment
Sub-competency 20: Self Assessment
  • 62% do a self-assessment tool or questionnaire
  • 61% discuss with residency leadership
  • 55% discuss with their advisor or mentor
  • 42% talk about it during clinical shifts
  • Most review semi-annually
sub competency 20 process improvement pi
Sub-competency 20: Process Improvement (PI)
  • 55% have PI project in the ED
  • 32% do a presentation at weekly conference
  • 28% have resident participate in a committee
  • 24% do not assess this
sub competency 21 sbp1 participates in performance improvement to optimize patient safety
Sub-competency 21 (SBP1): Participates in performance improvement to optimize patient SAFETY.
slide45
Sub-competency 21: Do you use any checklists or tools to assist with "Transitions of Care" such as the SBAR or Team Huddle?
slide50

After implementation of multiple medical team training programs:

    • Improved observed team behaviors.
    • Enhanced staff attitudes toward teamwork.
    • Reduced observedclinical errors.

Morey, JC, Simon, R, Jay GD, et al. Error reduction and performance improvement in the emergency department

through formal teamwork training: Evaluation results of the MedTeams project. Health Serv Res. 37:1553-1581, 2002

slide53

Sub-competency 22 (SBP2): Participates in strategies to improve healthcare delivery and flow. Demonstrates an awareness of and responsiveness to the larger context and system of health care.

slide63
emmilestones.pbworks.comORGoogle “EM Milestones Wiki”For assistance or to add to the wiki site: romron1@jhmi.edu
summary
Summary
  • EBM
  • Safety
  • Technology
  • Systems Based Management
  • Wiki site
    • How to navigate
    • How to access resources
    • How to contribute
questions
Questions
  • sakhtar@chpnet.org
  • romron1@jhmi.edu
  • lynn.roppolo@utsouthwestern.edu
references
References
  • Tews MC, Liu JM, Treat R. Situation-Background-Assessment-Recommendation (SBAR) and Emergency Medicine Residents' Learning of Case Presentation Skills. J Grad Med Educ. Sep 2012; 4(3): 370–373.
  • Morey, JC, Simon, R, Jay GD, et al. Error reduction and performance improvement in the emergency department through formal teamwork training: Evaluation results of the MedTeams project. Health Serv Res. 37:1553-1581, 2002
  • http://teamstepps.ahrq.gov
  • www.improvediagnosis.org