![Page 1: The following slides contain a template that illustrates ... one PowerPoint presentation; ... • Clarify Grading rubric given that 40% of grade given by ... consequences of common](https://reader031.vdocuments.us/reader031/viewer/2022030417/5aa32ba37f8b9a07758e03c7/html5/thumbnails/1.jpg)
ThefollowingslidescontainatemplatethatillustratesthegeneralformatusedforaY3orY4clerkshipreview.Inthe“notes”sectionofsomeslidestherearefurtherinstructionstoclarifywhatisneededforaparticularsectionofthereview.
Thecomponentsoftherevieware:1. revisitprioractionplanandinvestigateprogress2. assesscourseobjectivesincludingessentialskills/diagnoses3. evaluateplanned/unplannedredundancy4. assesspedagogy5. evaluateassessmentofcourseobjectives6. reviewmeasuresofquality(e.g.courseevaluations)
![Page 2: The following slides contain a template that illustrates ... one PowerPoint presentation; ... • Clarify Grading rubric given that 40% of grade given by ... consequences of common](https://reader031.vdocuments.us/reader031/viewer/2022030417/5aa32ba37f8b9a07758e03c7/html5/thumbnails/2.jpg)
TheDeansoftheappropriateyear,ortheiragents,willserveastheteamleaderforeachcoursereview.Theresponsibilitiesoftheteamleaderare:
1. Assigntaskstothefacultyandstudentteammembersandconveydeadlinesforwhentheworkneedstobedone.
2. Recruitmembersforthereviewteamifnecessary(typicallyteammemberswillbeassignedbytheMEC).
3. Contacttheclerkshipdirectortoarrangeameetingwiththeteamtodiscusstheclerkship;informtheclerkshipdirectorofthedatethereviewwillbepresentedattheMECmeetingsotheycanputitontheircalendar/indicateavailability.
4. CollectalltheworkcompletedbytheteammembersandcollateintoonePowerPointpresentation;collecttheactionplanfromtheclerkshipdirectorandinsertitattheendoftheslides;sendtheslidestoRachel2weeksbeforetheMECmeeting.
5. PresentthefinalrecommendationsofthesubcommitteeattheMECmeeting(lastfewslides)
![Page 3: The following slides contain a template that illustrates ... one PowerPoint presentation; ... • Clarify Grading rubric given that 40% of grade given by ... consequences of common](https://reader031.vdocuments.us/reader031/viewer/2022030417/5aa32ba37f8b9a07758e03c7/html5/thumbnails/3.jpg)
ReviewofYear4GAMClerkship
• ClerkshipoccursinYear4• ClerkshipDirectors
– RoshiniPinto-PowelandGinaFernandez• ClerkshipCoordinator
– HollyHarrison• ClerkshipLength– 4weeks,9cycles• Sitesused
– MultiplethroughoutNHandVT• ClerkshipwaslastreviewedinAug2014• ReviewDate/Team:5/9/16:Dr.Dick,Dr.Kieffer,LynnSymonsMS4(MEC),Alison
Ricker
![Page 4: The following slides contain a template that illustrates ... one PowerPoint presentation; ... • Clarify Grading rubric given that 40% of grade given by ... consequences of common](https://reader031.vdocuments.us/reader031/viewer/2022030417/5aa32ba37f8b9a07758e03c7/html5/thumbnails/4.jpg)
ActionPlanfromPriorReview• Addressstudentconcernsregardinghowtostudyforyournon-NBMEexam- Done• ClarifyGradingrubricgiventhat40%ofgradegivenbyclerkshipdirectorsbut
breakdownnotclearlydelineatedincoursematerial- Done• EssentialSkills/Conditions
– ChangeCHFto“CompensatedCHF”– MoveMedicationadjustmentfromConditiontoSkill– RemovechronicpainasalreadycoveredinFM– AddADLtoIADLsurveyforessentialskill– Thesedidn’tappeartogetchangedinOASISafterthelastreview
• Objectives– Droporincorporate“Contributeconstructivefeedbackduringpeerreview.”– Modifyobjective20tostate“Applytheconceptsofimprovingqualityofcare,patientsafety,and
valueofcareintheambulatorysetting.”– Modifyobjective23tostate“Identifytheroleofthephysicianinaddressingthemedical
consequencesofcommonpublicpolicyandpublichealthfactors…– Thisdidn’tappeartogetchangedinOASISafterthelastreview
![Page 5: The following slides contain a template that illustrates ... one PowerPoint presentation; ... • Clarify Grading rubric given that 40% of grade given by ... consequences of common](https://reader031.vdocuments.us/reader031/viewer/2022030417/5aa32ba37f8b9a07758e03c7/html5/thumbnails/5.jpg)
CourseObjectivesLearningObjective Assessment LearningActivity
1Applyevidencebasedknowledgetodiagnosisandtreatmentquestionsinambulatoryandgeriatricpatientcare.
2Applycurrentclinicalandtranslationalsciencestodiagnosisandtreatmentquestioninambulatoryandgeriatricpatientcare.
3Applycurrentknowledgeofdiseaseprevention,riskfactormodification,end-of-lifecareandqualityimprovementtoclinicalproblemsinambulatoryandgeriatricpatientcare.
4Applyknowledgeabouttheimpactofsocial,economic,culturalandpersonalfactorsonhealthtoclinicalproblemsinambulatoryandgeriatricpatientcare.
5Establishcomfortableandmutuallyrespectfulstudent-patientandstudent-familyrelationshipswithadiversepopulationandtoestablishthebasisforafuturedoctor-patientrelationship.
6 Interviewpatientsskillfully,utilizingeitheracomprehensiveorafocusedhistoryrelativetothepresentingissuesinambulatorycare.
7Examineambulatorypatientsskillfullyandrespectfullyandrelativetoanypotentialsensoryorcognitivedeficitsespeciallyinthegeriatricpopulation.
![Page 6: The following slides contain a template that illustrates ... one PowerPoint presentation; ... • Clarify Grading rubric given that 40% of grade given by ... consequences of common](https://reader031.vdocuments.us/reader031/viewer/2022030417/5aa32ba37f8b9a07758e03c7/html5/thumbnails/6.jpg)
CourseObjectivesLearningObjective Assessment Learning
Activity
8 Identifyandprioritizeacuteand/orchronicproblemsinambulatorycarewithaccuracy,usingappropriatedifferentialdiagnoses.
9Correctlyidentifyabnormalitiesonroutinelaboratoryworkandradiographscommonlyutilizedinambulatorycare.
10Communicateeffectivelywithpatientsandfamilieswhenspecialbarrierstocommunicationexist,includingculture,language,educationandgeriatricsensoryandcognitivedeficits.
11Assistpatientsandtheirfamiliesinunderstandingtheirtreatmentoptionsandprognosis.
12Communicate,bywayofpatientpresentationstopreceptors,patientencounternotes,phonecallsand/oremails,effectivelyandrespectfullywithphysicianpreceptorsandothermembersofthehealthcareteam.
13Behaverespectfullyandresponsiblytowardspatients,families,colleaguesandothermembersofthehealthcareteamwhileacknowledgingindividualconcerns,opinionsandculturalperspectives.
14Meetprofessionalresponsibilitiescompletely.
![Page 7: The following slides contain a template that illustrates ... one PowerPoint presentation; ... • Clarify Grading rubric given that 40% of grade given by ... consequences of common](https://reader031.vdocuments.us/reader031/viewer/2022030417/5aa32ba37f8b9a07758e03c7/html5/thumbnails/7.jpg)
CourseObjectivesCourse Objectives Assessments Learning
Activities
15Adheretohighethicalandmoralstandards,acceptresponsibilityforpersonalactions,acceptconstructivefeedback,andrespectpatientconfidentiality.
16Takeresponsibilityforcontinuedmedicaleducationandtoidentifyandcritiqueevidencebasedliteraturethatguidesambulatorycarepractices.
17Describebarrierstoaccesstobasichealthservicesanditseffectonvulnerablepopulations.
18Contributeconstructivefeedbackduringpeerreview.
19 Identifyandcriticallyevaluaterelevantinformationaboutevidencebased,costconsciousstrategiesinthecareofpatientsintheambulatorysetting.
![Page 8: The following slides contain a template that illustrates ... one PowerPoint presentation; ... • Clarify Grading rubric given that 40% of grade given by ... consequences of common](https://reader031.vdocuments.us/reader031/viewer/2022030417/5aa32ba37f8b9a07758e03c7/html5/thumbnails/8.jpg)
CourseObjectivesCourse objectives Assessments Learning Activities
20Assesstheeffectofsocialenvironmentonclinicalcareandoutcomesandtoapplytheconceptsofimprovingqualityofcare,patientsafetyandthevalueofcareintheambulatorysetting.
21 Identifyappropriateresourcestosupportpatientcareandtocollaborateeffectivelywithallmembersofthehealthcareteamintheambulatorysetting.
22Describehowhealthcareiscurrentlyorganized,financedanddeliveredandthelargerenvironmentinwhichhealthcareoccursandtheimpactonambulatorypatientcare.
23Identifytheroleofthephysicianinaddressingthemedicalconsequencesofcommonsocialandpublichealthfactorsandtoadvocateforoptimalcareinambulatorysettings.
![Page 9: The following slides contain a template that illustrates ... one PowerPoint presentation; ... • Clarify Grading rubric given that 40% of grade given by ... consequences of common](https://reader031.vdocuments.us/reader031/viewer/2022030417/5aa32ba37f8b9a07758e03c7/html5/thumbnails/9.jpg)
CourseObjectives– Comments• Appropriatenumber,understandable• Coversover-archingGeiselcompetencies• UpdatesforIlios required
![Page 10: The following slides contain a template that illustrates ... one PowerPoint presentation; ... • Clarify Grading rubric given that 40% of grade given by ... consequences of common](https://reader031.vdocuments.us/reader031/viewer/2022030417/5aa32ba37f8b9a07758e03c7/html5/thumbnails/10.jpg)
FormatofCourse&SessionObjectives• Courseobjectivesarenotprovidedinthesyllabus• Courseobjectivesarewritteninthecorrectformat• Sessionobjectivesaremostlyprovidedinthecoursematerials
andareprovidedinIlios• Sessionobjectivesaremostlywritteninthecorrectformat
– Needverbchangestofocusonwhatskillthelearningobtainsratherthanwhatinformationisbeingdelivered• Example“Introduceasimple5stepmodelfordeliveringhighvaluecare”
![Page 11: The following slides contain a template that illustrates ... one PowerPoint presentation; ... • Clarify Grading rubric given that 40% of grade given by ... consequences of common](https://reader031.vdocuments.us/reader031/viewer/2022030417/5aa32ba37f8b9a07758e03c7/html5/thumbnails/11.jpg)
HowdoY1/2coursesprepareforY3• Questionsaskedatendofclerkship– 1=poorand5=excellent
![Page 12: The following slides contain a template that illustrates ... one PowerPoint presentation; ... • Clarify Grading rubric given that 40% of grade given by ... consequences of common](https://reader031.vdocuments.us/reader031/viewer/2022030417/5aa32ba37f8b9a07758e03c7/html5/thumbnails/12.jpg)
Results:Overall
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
FM MED OB PEDS PSYCH SURG GAM NEURO
13-14 14-15 15-16
![Page 13: The following slides contain a template that illustrates ... one PowerPoint presentation; ... • Clarify Grading rubric given that 40% of grade given by ... consequences of common](https://reader031.vdocuments.us/reader031/viewer/2022030417/5aa32ba37f8b9a07758e03c7/html5/thumbnails/13.jpg)
Results:Communication
00.51
1.52
2.53
3.54
4.55
FM MED OB PSYCH SURG PEDS GAM NEURO
13-14 14-15 15-16
![Page 14: The following slides contain a template that illustrates ... one PowerPoint presentation; ... • Clarify Grading rubric given that 40% of grade given by ... consequences of common](https://reader031.vdocuments.us/reader031/viewer/2022030417/5aa32ba37f8b9a07758e03c7/html5/thumbnails/14.jpg)
Results:PE
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
FM MED OB PED PSYCH SURG GAM NEURO
13-14 14-15 15-16
![Page 15: The following slides contain a template that illustrates ... one PowerPoint presentation; ... • Clarify Grading rubric given that 40% of grade given by ... consequences of common](https://reader031.vdocuments.us/reader031/viewer/2022030417/5aa32ba37f8b9a07758e03c7/html5/thumbnails/15.jpg)
Results:MedicalKnowledge
00.51
1.52
2.53
3.54
4.55
FM MED OB PED PSYCH SURG GAM NEURO
13-14 14-15 15-16
![Page 16: The following slides contain a template that illustrates ... one PowerPoint presentation; ... • Clarify Grading rubric given that 40% of grade given by ... consequences of common](https://reader031.vdocuments.us/reader031/viewer/2022030417/5aa32ba37f8b9a07758e03c7/html5/thumbnails/16.jpg)
IssuesofRedundancy• Aretheremajorissuesofredundancywithothercourses?– SomeoverlapwithFamilyMedicineintermsofpopulationseen,essentialconditions.
– SomestudentshavecommentedonFMandGAMseemingverysimilarintermsoftheclinicalexposure
– Givenwhatisstillarelativelyinpatientheavyclinicalcurriculum,subcommitteefeltthatrepetitionwasacceptable.
– CDsencouragedtofurtherclarifytostudentsatstartofclerkshipacknowledgmentofthisfact
![Page 17: The following slides contain a template that illustrates ... one PowerPoint presentation; ... • Clarify Grading rubric given that 40% of grade given by ... consequences of common](https://reader031.vdocuments.us/reader031/viewer/2022030417/5aa32ba37f8b9a07758e03c7/html5/thumbnails/17.jpg)
EssentialSkillsAbdominalExam Yes(MEDI) PerformwithSupervisionBackExam PerformwithSupervisionCardiacExam Yes(MEDI) PerformwithSupervisionCounseling:Diseaseissues Yes(MEDI) PerformwithSupervisionCounseling:Exercise Yes(CFM) PerformwithSupervisionCounseling:Medications Yes(MEDI) PerformwithSupervisionCounseling:ScreeningTests PerformwithSupervisionCounseling:Smokingcessation PerformwithSupervisionCounseling:WeightChange Yes(CFM) PerformwithSupervisionDermatologyExam PerformwithSupervisionFootExam PerformwithSupervisionHPIrelevanttoclerkship PerformwithSupervisionIADLsurvey(ADL) PerformwithSupervisionOralpresentation,ambulatory Yes(CFM) PerformwithSupervisionPulmonaryExam Yes(MEDI) PerformwithSupervisionSocialHistory PerformwithSupervision
• Aretheseappropriateforthisclerkship?Yes
• Wouldyouaddorsubtractany?Possibleadds- Counseling:advancedirectives,immunizations;Exam:kneeandshoulder;Other– cardiovascularriskassessment,fallriskassessment,substanceusescreening/riskassessment/counseling;consider“healthrelatedhabits”inadditionto/separatefromsocialhistory.Areteam-basedinterpersonalskillsandprofessionalbehaviorsincludedasskills?
• Aretheremajorissuesofredundancywithotherclerkships?No
![Page 18: The following slides contain a template that illustrates ... one PowerPoint presentation; ... • Clarify Grading rubric given that 40% of grade given by ... consequences of common](https://reader031.vdocuments.us/reader031/viewer/2022030417/5aa32ba37f8b9a07758e03c7/html5/thumbnails/18.jpg)
EssentialProblemsAnemia yes (MEDI) ManagewithAssistanceArrhythmia yes(MEDI) ManagewithAssistanceBalanceProblems ManagewithAssistanceChestPain yes (MEDI) ManagewithAssistanceCHF(Compensated) ManagewithAssistanceChronicPain yes(CFM) ManagewithAssistanceDementia yes(NEURO) ManagewithAssistanceDizziness ManagewithAssistanceDMTypeII yes(CFM) ManagewithAssistanceFatigue ManagewithAssistanceFrailty ManagewithAssistanceHyperlipidemia yes(CFM) ManagewithAssistanceHypertension yes(CFM) ManagewithAssistanceIschemicHeartDisease ManagewithAssistanceJointPain yes(CFM) ManagewithAssistanceMedicationAdjustment ManagewithAssistanceObesity yes(CFM) ManagewithAssistanceGERD ManagewithAssistanceChronicKidneyDisease Yes(MEDI) ManagewithAssistanceSkinLesionorRash yes(CFM) ManagewithAssistanceUrinaryIncontinence/frequency ManagewithAssistance
• Aretheseappropriateforthisclerkship?Yes
• Wouldyouaddorsubtractany?PerhapsArrhythmiashouldbemorespecificallyatrialfibrillation;possiblyadd:diarrheaand/orconstipation(especiallythelatterincontextofgeriatrics);acuteinfections– UTI,pharyngitis/URI;somatization;depression;(low)backpain
• Aretheremajorissuesofredundancywithotherclerkships?No(thoughI’msurprisedthatmoreofthesedon’toverlapwithMEDI)
![Page 19: The following slides contain a template that illustrates ... one PowerPoint presentation; ... • Clarify Grading rubric given that 40% of grade given by ... consequences of common](https://reader031.vdocuments.us/reader031/viewer/2022030417/5aa32ba37f8b9a07758e03c7/html5/thumbnails/19.jpg)
ExplorationofEthicsandCulturalCompetencies
• FOSS(FromtheothersideoftheStethoscope)– Ethicalissuessometimesarisebuttheseareorganicdiscussionsandcannotbeensured
• HighValueCareSessionandMedicare/Medicaidsessions– Discussresourceallocation
![Page 20: The following slides contain a template that illustrates ... one PowerPoint presentation; ... • Clarify Grading rubric given that 40% of grade given by ... consequences of common](https://reader031.vdocuments.us/reader031/viewer/2022030417/5aa32ba37f8b9a07758e03c7/html5/thumbnails/20.jpg)
CourseLearningOpportunities• Clinicalexperiences
– 4weeksatoutpt clinic
• Conferences– ElderFOSS(reflectonelderpt encounter/eldermentorsreflectontheirexperiences)
• Assignments– CasePresentation– Powerpoint presentation(fromGAMcorelist)ORJournalClubArticle
– DischargeSummaryCritique
• OASISclinicallogs– 2pt encountersperhalfdayclinic
![Page 21: The following slides contain a template that illustrates ... one PowerPoint presentation; ... • Clarify Grading rubric given that 40% of grade given by ... consequences of common](https://reader031.vdocuments.us/reader031/viewer/2022030417/5aa32ba37f8b9a07758e03c7/html5/thumbnails/21.jpg)
CourseLearningOpportunities• SmallGroup– QIsessionatorientation– Journalclub101– Medicare/Medicaid101– HighValueCostConscienceCare
![Page 22: The following slides contain a template that illustrates ... one PowerPoint presentation; ... • Clarify Grading rubric given that 40% of grade given by ... consequences of common](https://reader031.vdocuments.us/reader031/viewer/2022030417/5aa32ba37f8b9a07758e03c7/html5/thumbnails/22.jpg)
Assessment
• Midclerkshipfeedback– selfassess,reviewskills/conditions• Studentperformanceevaluationform(Filledoutbypreceptors)• Skillsform
• Grading– PreceptorEval – 60%ofGrade– CDeval – 40%ofGrade
• Casepresentation10%(BreakdownGiven)• PP/JC10%(BreakdownGiven)• Professionalism10%• Exam10%(50questions)- ComefromCoretopicslist
![Page 23: The following slides contain a template that illustrates ... one PowerPoint presentation; ... • Clarify Grading rubric given that 40% of grade given by ... consequences of common](https://reader031.vdocuments.us/reader031/viewer/2022030417/5aa32ba37f8b9a07758e03c7/html5/thumbnails/23.jpg)
MeasuresofQuality– StepIICK
*valuesdepictedareSDabovetheUS/CanmeanforGeiselmeanscores
![Page 24: The following slides contain a template that illustrates ... one PowerPoint presentation; ... • Clarify Grading rubric given that 40% of grade given by ... consequences of common](https://reader031.vdocuments.us/reader031/viewer/2022030417/5aa32ba37f8b9a07758e03c7/html5/thumbnails/24.jpg)
Measuresof
Quality–AAMCGQ
Clerkships OverallSatisfactionAY2014-2015
PEDS 4.5
MED 4.5
CFM 4.5
PSYCH 4.3
SURG 4.2
GAM 4.2
OBGYN 4.2
NEURO 4.0
MeasuresofQuality– CourseEvaluation
scale[1=poor;2=fair;3=good;4=verygood;5=excellent]
![Page 25: The following slides contain a template that illustrates ... one PowerPoint presentation; ... • Clarify Grading rubric given that 40% of grade given by ... consequences of common](https://reader031.vdocuments.us/reader031/viewer/2022030417/5aa32ba37f8b9a07758e03c7/html5/thumbnails/25.jpg)
scale[1=poor;2=fair;3=good;4=verygood;5=excellent]
MeasuresofQuality– CourseEvaluationGAM
2014-15 2015-16*
OverallExperience 4.18 4.13
Objectiveswelldefinedandclearly presented 4.47 4.6
Ability forY1and2topreparemeforthisclerkship
4 4.19
Expectationswelldefinedand clear 4.46 4.6
Volumeadequate forlearning 4.36 4.35
Varietyofdxadequateforlearning 4.07 4.13
Quality ofteachingbyattendings 4.23 4.36
SiteDirectors responsivetoconcerns 4.64 4.7
Methodsusedto eval studentperformancemadeclear 4.3 4.49
Qualityof mid-clerkshipfeedback 4 4.03
![Page 26: The following slides contain a template that illustrates ... one PowerPoint presentation; ... • Clarify Grading rubric given that 40% of grade given by ... consequences of common](https://reader031.vdocuments.us/reader031/viewer/2022030417/5aa32ba37f8b9a07758e03c7/html5/thumbnails/26.jpg)
MeasuresofQuality– StudentComments
Strengths:• Manystudentsfoundthedidacticssessionsuseful
– “Usefuldidacticsthatwereparticularlyrelevanttopracticingmedicineintherealworld”– “OfalltheclerkshipsI'vedonesofar,Ienjoyedtheformatofthisclerkship'sdidactic
sessionsthebest.Theywerefun,interesting,andvaried--andIlearnedalotfrommyclassmates.”
– “Thedidacticsessionswereengagingandcoveredusefultopicssuchasmedicare/medicaid,introductiontobilling,studentpresentations."
• Minimalbusywork/reasonableworkload– “Ialsoappreciatedthatalotofthe"busywork"thatclutterssomeoftheother
clerkshipswasnotpresentonthisclerkship”– “Reasonablework-loadintermsofclinicdays&clerkshipassignments.”– “Ilikednothavingtoomanyadditionalclerkshipassignments(i.e.writeups,reports,etc)
otherthanthe2presentations.Feltlikeitallowedmetoconcentratemoreontheclinicalexperienceaspectandgetmoreoutofitratherthanhavingtoworry.”
• Manystudentsappreciatedhavemoreautonomy– “Independenceintheoutpatientareaofmedicine- treatedmorelikeaninternthanI
havebeeninallmyY3clerkships”
![Page 27: The following slides contain a template that illustrates ... one PowerPoint presentation; ... • Clarify Grading rubric given that 40% of grade given by ... consequences of common](https://reader031.vdocuments.us/reader031/viewer/2022030417/5aa32ba37f8b9a07758e03c7/html5/thumbnails/27.jpg)
MeasuresofQuality– StudentComments
Strengths:• Manystudentsfeltitwasauseful/relevantculminatingexperience
– “Greatexposuretoambulatorymedicineinthe4thyear,nowthatwearemoreabletomanagepatientsindependently.Inaway,itfeelslike'comingfullcircle'andtakingallwehavelearnedthusfarandapplyingitholistically."
– “Revisitingoutpatientclinicalmedicineafterathirdyearandsub-Icompletelyfocusedonainpatientmedicinewasrefreshingandremindedmeofthechallengeofcreatinganassessmentandplanwithinafiniteperiodoftime."
• ThemajorityofstudentsenjoyedElderFOSS– “Ilearnedalotabouthigh-valuecareandgeriatric-specificissueslikeagingina
community,performingIADLsandcare-takers.IalsolikedthatthissessionwasinthemiddleoftherotationbecauseIusedwhatIlearnedformylasttwoweeksinclinic.”
– “Providedavaluableplatformforopendiscussiononissuesrangingfromchangesinthemedicalsystemtoassistedlivingvs.nursinghomecare,tosuggestionsforhowwemightbettercarefortheelderlyinourcareers."
![Page 28: The following slides contain a template that illustrates ... one PowerPoint presentation; ... • Clarify Grading rubric given that 40% of grade given by ... consequences of common](https://reader031.vdocuments.us/reader031/viewer/2022030417/5aa32ba37f8b9a07758e03c7/html5/thumbnails/28.jpg)
MeasuresofQuality– StudentComments
SuggestionsforImprovement:• Mostsuggestionsforimprovementwereminorandverysitespecific• Whilestudentsfelttheclerkshipfunctionedwell,somequestioneditsutilityinthebroader
curriculumorfeltitmightbemoreusefulifincorporatedintoIM– “Theutilityofasecondaryoutpatientmedicineclerkship,inthesettingofalready
dedicating5weekstofamilymedicine,and4weekstooutpatientpediatrics,seemsexcessive.”
– “Therearemanyaspectsofthisrotationthatoverlapwithfamilymedicineand,althoughIfeelthatmyexperienceonGAMwasimportant,itfeltsomewhatredundantasapost-matchfourthyear.”
– “In3rdyeartheIMshelfis50%outpatientyetwehavenooutpatientIMexposureduringthatrotation.GAMshouldbeincorporatedintothe3rdyearclerkship,notasastandalonecourseduringthe4thyear."
• SomestudentsfoundcommutingforFridaysessionstobedifficult– “SuggestFridaylecturestoberemotesopeopledon'thavetocommuteasmuch”
![Page 29: The following slides contain a template that illustrates ... one PowerPoint presentation; ... • Clarify Grading rubric given that 40% of grade given by ... consequences of common](https://reader031.vdocuments.us/reader031/viewer/2022030417/5aa32ba37f8b9a07758e03c7/html5/thumbnails/29.jpg)
SummaryregardingMeasuresofQuality
• Summary:– Commentswerelargelypositiveandstudentslikedhavinggreaterautonomy,
feltdidacticsessionswerewellrunandinformative,enjoyedtheFOSSsession,andappreciatedthereasonableworkload
– Studentsfeltliketheclerkshipfunctionedwellandwasaniceculminatingexperiencethatchallengedthemtothinkabouthowtheywillbefunctioningaspartofthehealthcaresystem
– Themajoritysuggestionsforimprovementwereverysitespecific– Inthe“bigpicture”ofcurriculumredesign,anumberofstudentsquestioned
whetherthecontentofthisclerkshipwasredundantorwhetheritshouldbeincorporatedintootherclerkships(familymedicine,IMetc)
![Page 30: The following slides contain a template that illustrates ... one PowerPoint presentation; ... • Clarify Grading rubric given that 40% of grade given by ... consequences of common](https://reader031.vdocuments.us/reader031/viewer/2022030417/5aa32ba37f8b9a07758e03c7/html5/thumbnails/30.jpg)
Recommendations• Objectives
– AssurethecourseandsessionobjectivesareprovidedinCANVAS– RevisechartshowingAssessmentandLearningActivitiesforeachObj.– Obj 20:Dropphrase“Assesstheeffectofsocialenvironmenton
clinicalcareandoutcomes”fromthefollowing:Assesstheeffectofsocialenvironmentonclinicalcareandoutcomesandtoapplytheconceptsofimprovingqualityofcare,patientsafetyandthevalueofcareintheambulatorysetting.• Thisisnotuniformlycoveredorassessedinthisclerkship
– Obj 23:Remove“social”fromthefollowing:Identifytheroleofthephysicianinaddressingthemedicalconsequencesofcommonsocialandpublichealthfactorsandtoadvocateforoptimalcareinambulatorysettings.• Coursefocusedmoreonpublichealthfactorsthansocialfactors
![Page 31: The following slides contain a template that illustrates ... one PowerPoint presentation; ... • Clarify Grading rubric given that 40% of grade given by ... consequences of common](https://reader031.vdocuments.us/reader031/viewer/2022030417/5aa32ba37f8b9a07758e03c7/html5/thumbnails/31.jpg)
Recommendations• SessionObjectives
– Needverbchangestofocusonwhatskillthelearningobtainsratherthanwhatinformationisbeingdelivered• Example“Introduceasimple5stepmodelfordeliveringhighvaluecare”
• EssentialConditions– ChangeCHFtocompensatedCHF– ChangeArrhythmiatoAtrialFibrillation– AddConstipationandUrinaryTractInfection– RemoveAnemia(coveredinIM)– MoveMedicationAdjustmentfromconditiontoskill
![Page 32: The following slides contain a template that illustrates ... one PowerPoint presentation; ... • Clarify Grading rubric given that 40% of grade given by ... consequences of common](https://reader031.vdocuments.us/reader031/viewer/2022030417/5aa32ba37f8b9a07758e03c7/html5/thumbnails/32.jpg)
Recommendations• EssentialSkills
– ConsideraddingAssessforAdvancedDirectives– ConsideraddingCVriskassessment– ConsideraddingFallRiskassessment– ConsideraddingScreenforsubstanceabuse(screeninghasnototherwise
beencovered,managementisinPsych)• Pedagogy
– Removerequirementtolog2patientsperhalfdayintoOASIS(otherclerkshipsnotdoingthis);simplysticktohavingstudentslogthosethatmeetessentialconditions/skills
– FurtherdiscussandcontemplatehowGAMisdifferentfromFM• Sincein4th year,shouldthisbebrandedasan“advancedambulatoryexperience”with
emphasisplacedonefficiencyinclinic,increasedautonomy• ConsidernamingparadigmgiventhatmanyclinicalsiteswillnotbeGeriatricsfocused,yet
curriculumis
![Page 33: The following slides contain a template that illustrates ... one PowerPoint presentation; ... • Clarify Grading rubric given that 40% of grade given by ... consequences of common](https://reader031.vdocuments.us/reader031/viewer/2022030417/5aa32ba37f8b9a07758e03c7/html5/thumbnails/33.jpg)
ActionPlan• CourseObjectives20and23weremodifiedassuggested.AddedHealthandValuesobjectives
• SessionObjectiveswererewritten(slideattached)• Course/SessionobjectivesandAssessmentsposted• EssentialConditionsmodified(slideattached)• EssentialSkillsmodified(slideattached)• Pedagogy:changedtosinglelogofconditionsandskills
• ContinuetoreinforcedifferencesbetweenFMinYear3andGAMinYear4,highlightingpositiveaspectsofbothdisciplines
![Page 34: The following slides contain a template that illustrates ... one PowerPoint presentation; ... • Clarify Grading rubric given that 40% of grade given by ... consequences of common](https://reader031.vdocuments.us/reader031/viewer/2022030417/5aa32ba37f8b9a07758e03c7/html5/thumbnails/34.jpg)
SessionObjectives• SessionName:ClerkshipDirectorSessions1,2and3;2hr casebased
andcriticalthinkingdidactics• Analyzeambulatorypatientcasesusingcriticalreasoningandpresent
evidencebasedinformationforaspecificteachingpointhighlightedbythecases.
• Synthesizeacurrent,evidencebasedanalysis,onaspecifictopicingeriatricandambulatorymedicinechosenfromalistofcoretopicsinthesyllabus,inaPowerPointformat.
• AppraiseacurrentorsentineljournalarticlerelevanttogeriatricandambulatorycareusingpreceptsofEBM,inaPowerPointformat
• SessionName:Orientation: QualityImprovementwithMr.PotatoHead• DescribethehistoryandreviewconceptsofQualityImprovement
includingthePDSAcycle,wasteandmedicalerror.• ApplytheconceptofaPDSAcycleaninteractivegame
![Page 35: The following slides contain a template that illustrates ... one PowerPoint presentation; ... • Clarify Grading rubric given that 40% of grade given by ... consequences of common](https://reader031.vdocuments.us/reader031/viewer/2022030417/5aa32ba37f8b9a07758e03c7/html5/thumbnails/35.jpg)
SessionObjectives• SessionName:ClerkshipDirectorSession2;HighValueHealthCareandChoosing
WiselyCampaign• AnalyzeambulatorypatientcasesfromtheAAIMusingcriticalreasoningand
evidencebasedinformationtovalidatetheprinciplesofHVHC• ExamineandinterprettheChoosingWiselyrecommendationsofeachstudent’s
individualspecialtychoice.• Identifytheethicalimperativetoreducewasteinhealth-care.
• SessionName:AgingCenter: ElderFOSS• Engageinaninteractivedialoguewithcommunityelders(mentors)toreflecton
andsharehealthcareexperiencesandtheirimpactonpatients,familiesandcaregivers.
• Discoverthespectrumofhealth,cognitiveabilitiesandhealthcaredesiresamongstthegeriatricpopulation.
• Identifytheeffectofsocial,culturalandeconomicfactorsonaging.
![Page 36: The following slides contain a template that illustrates ... one PowerPoint presentation; ... • Clarify Grading rubric given that 40% of grade given by ... consequences of common](https://reader031.vdocuments.us/reader031/viewer/2022030417/5aa32ba37f8b9a07758e03c7/html5/thumbnails/36.jpg)
SessionObjectives• SessionName:ClerkshipDirectorSession3; MedicalInsuranceBasics
• ExplainthemedicalInsurancecoveragesystemsincludingMedicare,MedicaidandPrivateInsurance
• Debatetheimpactofsocial,economicandculturalfactorsonhealthcareforalladults,especiallytheelderly
![Page 37: The following slides contain a template that illustrates ... one PowerPoint presentation; ... • Clarify Grading rubric given that 40% of grade given by ... consequences of common](https://reader031.vdocuments.us/reader031/viewer/2022030417/5aa32ba37f8b9a07758e03c7/html5/thumbnails/37.jpg)
AmbulatoryClinicExperience• Choosepersonallearninggoalsforthemonthonthefirstdayandreviewthese
withtheclinicpreceptor• Establisharespectfulstudent-patientrelationshippayingattentiontocultural,
socioeconomicandotherfactors• Interviewandexaminepatientsskillfullyandrespectfully• Collectandprioritizethepatient’sproblems• Formulateanappropriatedifferentialdiagnosisandbeabletoretrieveandapply
evidencebasedknowledgetopatientcare• Listenandcommunicateeffectivelywithpatients,families,colleaguesand
consultantsbothinpersonandthemedicalrecord• Exhibitprofessionalbehaviorintermsofinitiative,interest,punctuality,
appropriatedress,patientconfidentialityandexpectedduties• Demonstrateawarenessofclinicandcommunityresourcesandcostawarenessas
partoftheassessmentandplan
![Page 38: The following slides contain a template that illustrates ... one PowerPoint presentation; ... • Clarify Grading rubric given that 40% of grade given by ... consequences of common](https://reader031.vdocuments.us/reader031/viewer/2022030417/5aa32ba37f8b9a07758e03c7/html5/thumbnails/38.jpg)
SessionObjectives• Learnandapplyknowledgeintheareasofdiseaseprevention,riskfactor
modification,polypharmacy,specificgeriatriccoretopicsandendoflifedecisionmakingcare.
• Advocateforoptimalcareforeachpatient• Receivemidclerkshipfeedbackfromtheclinicpreceptorattheendofweek2
usingaformthatbeginswithself- reflection• Receivesummativeevaluationandfeedbackfromtheclinicpreceptorattheend
ofweek4
• CommunityExperience:ElderFOSS,HomeBasedPrimaryCare/Homevisits,NursingHome/Skillednursingfacilityvisits
• SessionObjectives:• Interactwithpatientsinavarietyofsettingsoutsideofaclinicsettingtobetter
understandsocialandculturaldeterminantsofhealthcare.
![Page 39: The following slides contain a template that illustrates ... one PowerPoint presentation; ... • Clarify Grading rubric given that 40% of grade given by ... consequences of common](https://reader031.vdocuments.us/reader031/viewer/2022030417/5aa32ba37f8b9a07758e03c7/html5/thumbnails/39.jpg)
EssentialConditions• AtrialFibrillation• BalanceProblems/Falls• CompensatedCHF• Constipation• ChronicDiarrhea/IBS• Chestpain(typical/atypical)• Dementia• DepressioninChronicDisease• Dizziness• DMTypeII• Fatigue• Frailty• Hypertension• Hyperlipidemia• IschemicHeartDisease• JointPain– unspecified• Obesity• RenalInjury/Insufficiency• SkinLesions(NOS/composite)• UrinaryIncontinence• UTI
![Page 40: The following slides contain a template that illustrates ... one PowerPoint presentation; ... • Clarify Grading rubric given that 40% of grade given by ... consequences of common](https://reader031.vdocuments.us/reader031/viewer/2022030417/5aa32ba37f8b9a07758e03c7/html5/thumbnails/40.jpg)
EssentialSkills• HPIrelevanttoclerkship• SocialHistory• PhysicalExamskills:
– Cardiacexam– Pulmonaryexam– Abdominalexam– Backexam– Extremity/Footexam– Dermatology/Skinexam
• GeriatricAssessments– FunctionalStatus(ADL/IADL)– AdvanceCarePlanning/Advancedirectives– FallRiskScreening
• ScreeningTestsCounseling• DiseaseIssuesCounseling(e.g.DM,HTN)• WeightManagement,Diet,ExerciseCounseling• MedicationReconciliation/Counseling• SubstanceUseScreening/RiskAssessment/Counseling• SmokingCessationCounseling• InterprofessionalCareCollaboration(Workingwithmembersofthecareteam)