Faculty Development, May, 2015

TCMC’s 3rd Year Redesign Dr. Linda Berardi-DemoAssociate Dean of Student Affairs and

Admissions

Brian Wilcox, MD, PhD. Assistant Dean for Clinical Education

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.

 

Outline• Basics of the Redesign

– Schedule, Grading– “What they know”

• LIC Component– Schedule– Continuity Patients– Assessments– Logging

• Block Component– Schedule– Assessments– Logging

• Learning Environment

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.

3rd Year in

Review

Fall Semester (25 weeks)Core Week (Scranton)

Orientation Week (Regional Sites)

23 weeks of LIC/Blocks

Holiday Recess (2 weeks)

Spring Semester (25 weeks)Core Week

23 Weeks of LIC/Blocks

Core Week

3rd Year RevisionLIC 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

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

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

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)

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)

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

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

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

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

LIC Component

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

Continuity Patients

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

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

Assessments

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

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?

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

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.

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:

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

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

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

Assessments1. 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?

Learning EnvironmentDr. Berardi-Demo

• Teacher Learner Compact• Student Mistreatment and the

clinical environment• Commendations and Celebrating the

Positive Learning Environment• Support and Resources

Questions?

Estimate # of Students per Site

Site# of

StudentsComment

s

North 37 Includes 14 at Pocono

South 27 Includes 8 at Geisinger

West 14 …

Guthrie 17 …

Example SchedulesNorth (Main)

North (Pocono

)

South (Main)

South (Geising

.)West Guthrie

TOTAL #

23 14 19 8 14 17

LIC 11-12 7 9-10 4 7 8-9

IM 2 1 2 1 1 2

Surgery

2 1 2 1 1 2

Psych 2 1 1 1 1 1

Peds 2 1 1 1 1 1

OB/GYN

2 1 1 - 1 1

Selective

1 1 1 1 1

Elective

1 1 2 - 1 1