fisher poster 042115 calibri - aamc · 2019-08-12 ·...
TRANSCRIPT
Development*of*a*Six0part*Pediatric*Case*Series*to*Parallel*Preclinical*Curriculum*HEALTH
PROFESSIONS EDUCATION
Neha*Joshi,*BS1,*Huiju*Carrie*Chen,*MD*MSEd1,2,*Michele*Long,*MD1,2*
1UCSF*School*of*Medicine,*San*Francisco*CA*2UCSF*Benioff*Children’s*Hospital,*San*Francisco*CA*
[Acknowledgements]***UCSF*Pathways*to*Discovery*in*Health*Professions*EducaOon*|*Daniel*West,*MD**UCSF*EPAC*’17*Students*|*The*study*authors*have*no*disclosures*to*report.!
!
A"Peek"into"EPAC"PedsCase"1:"Emergency"Medicine"• Parallels an Emergency Medicine case presented in the first year curriculum • Identifies differences in pediatric and adult physiology!*You*are*working*as*a*medical*student*in*the*Emergency*Department*at*San*Francisco*General*Hospital*when*your*team*is*called*for*a*912*trauma*acOvaOon.*Your*paOent,*Guadalupe,*is*a*7*year0old*female*is*arriving*with*EMS*aXer*a*motor*vehicle*accident.*How*should*you*introduce*yourself*to*Guadalupe?*What*sorts*of*reassurance*should*you*provide?*!
Pediatric"Model"Kit" Adult"Model"Kit"
What*are*reasons*why*a*child’s*airway*may*be*harder*to*keep*open*compared*to*an*adult?**Each!group!of!3-4!students!is!given!either!a!child!or!adult!airway!model!kit.!A=er!building!
their!model,!groups!are!asked!to!exchange!materials!with!a!group!with!a!differing!model!
type.!They!are!asked!to!compare!and!contrast!differences!in!airway,!and!then!collaborate!
with!the!larger!EPAC!PedsCase!group!to!discuss!their!findings.!Major!findings!in!children!
include!larger!head!in!proporHon!to!neck,!larger!tongue!in!proporHon!to!mouth,!smaller!
pharynx,!larger!and!floppier!epigloJs,!narrow!and!less!rigid!trachea.!
Airway"
A*child’s*rib*case*is*more*elasOc*than*an*adult’s.*How*does*this*affect*the*traumaOc*injuries*sustained*by*children?*
Breathing"Where*are*pulses*best*palpated*on*Guadalupe?*Are*certain*pulses*measured*be[er*on*children*compared*to*adults?**
Circula=on" Student"Reac=ons"“EPAC!PedCases!has!impressed!
me!with!its!well-organized,!
developed,!and!detailed!
supplement!to!our!med!school!
curriculum.!Besides!the!focus!
on!pediatrics,!EPAC!PedCases’!
emphasis!on!clinical!
presentaHons!and!real-life!
examples!has!proved!
extremely!useful!to!our!classes!
and!clinical!experiences.”!
“I!have!gained!a!beQer!understanding!of!how!
the!science!of!medicine!differs!in!children!
versus!adults,!and!how!to!structure!my!
communicaHons!to!address!the!enHre!family,!
not!just!the!paHent.”!!
!
“EPAC!PedCases!has!confirmed!my!interest!in!
pediatrics!and!made!me!very!excited!about!
pediatric!opportuniHes!yet!to!come!in!medical!
school.”!
!
“EPAC!PedCases!has!helped!introduce!
pediatrics!topics!into!a!very!adult-medicine!
focused!curriculum.”!!
!
“EPAC!PedCases!has!both!given!me!the!
opportunity!to!connect!with!dedicated!
pediatricians!and!helped!me!explore!pediatrics!
from!the!start!of!my!pre-clinical!years!at!
UCSF.”!
!
!
!
Introduc=on"• UCSF*is*parOcipaOng*in*an*AAMC*sponsored*pilot*70year*competency0
based*longitudinal*pediatrics*curriculum*0*EducaOon*in*Pediatrics*Across*the*ConOnuum*(EPAC)*
• To*expose*EPAC*students*early*to*pediatrics,*we*developed*six0case*series*(EPAC*PedsCases)*to*augment*the*exisOng*first0year*curriculum.*
• EPAC*PedsCases*are*designed*to*add*“pediatric*lens”*to*and*reinforce*core*curricular*concepts*by*introducing*pediatric*physiology*and*disease*processes,*and*pediatric0specific*communicaOon*skills.*
Methods"
IdenOficaOon*
• Student*and*faculty*team*idenOfied*concepts*from*the*first*year*curriculum*that*were*best*suited*for*adaptaOon*to*pediatrics.*
• Six*interacOve*cases*developed*and*implemented*in*pediatric*emergency*medicine,*cardiology,*pulmonology,*nephrology,*metabolism/nutriOon,*neurology/psychiatry.***
Design*
• Each*case:*• Discusses*approach*to*pediatric*paOent*• Addresses*differences*in*disease*presentaOon*in*children*vs.*adults*
• Explores*childhood*determinants*of*adult*diseases*• Reinforces*concepts*from*the*first0year*curriculum*by*including*hands0on*acOviOes*contrasOng*pediatric*and*adult*physiology**
EvaluaOon*
• EPAC*students*completed*evaluaOons*with*50point*Likert*raOng*scale*(1*=*not*at*all*effecOve,*5*=*extremely*effecOve)*and*free*response*items.*
• EPAC*and*control*students*completed*103*mulOple0choice*knowledge*quesOons.*
• Verbal*feedback*about*cases*obtained*from*subset*of*EPAC*students.*
Figure*1.*PDSA*Cycles*were*used*to*develop*EPAC*PedsCases.*
Results"
EPAC"PedsCase" N" Agree"1:*Emergency*Medicine* 17* 100%*2:*Congenital*Heart*Defects* 7* 100%*3:*CysOc*Fibrosis* 12* 83.3%*4:*Renal*Azotemia* 12* 91.7%*
I felt this session was interactive.
EPAC"PedsCase" N" Average" Standard"Devia=on"
1:*Emergency*Medicine* 17* 3.94* 0.429*2:*Congenital*Heart*Defects* 7* 4.00* 0.577*3:*CysOc*Fibrosis* 12* 4.58* 0.515*4:*Renal*Azotemia* 12* 4.00* 0.853*
How effective was this program in meeting the objectives of the session?
93.9* 81.8*92.4* 41.5*0*
20*
40*
60*
80*
100*
Interpersonal*and*CommunicaOon*Skills*
Medical*Knowledge*
EPAC*Non0EPAC*
Percen
tage"Answering"Co
rrectly
"" "
• It*is*possible*to*create*pediatric*focused*cases*that*can*reinforce*core*curricular*concepts*and*introduce*pediatrics*to*first*year*medical*students.*
• EPAC*PedCases*were*well0received*by*parOcipaOng*students,*and*support*EPAC’s*mission*of*early*introducOon*and*longitudinal*coverage*of*pediatrics*in*the*medical*school*curriculum.*
Conclusions"
Act* Plan*
Do*Study*
Using feedback from previous case, next EPAC PedsCase was developed.
Likert scale evaluations, multiple-choice questions, and free response questions were completed by EPAC students.
EPAC PedsCase developed to parallel
identified concepts in preclinical
curriculum.
Self-identified EPAC students in their first
year of medical school participated in 90 minute
interactive EPAC PedsCase.
Four EPAC PedsCases were presented so far, with last two cases scheduled for Spring 2014. Attendance was 18-37 students per case.!
Figure 2: Percentage of students correctly answering knowledge questions within two tested competencies after EPAC PedsCase 1: Emergency Medicine. (EPAC, N = 33; Non-EPAC, N = 118)
The PedsCases Legacy Project: An example of a longitudinal, collabora>ve curriculum in medical educa>on
Herrick Fisher, Mphil1, Michele Long, MD1,2 1UCSF School of Medicine, 2UCSF Benioff Children’s Hospital, San Francisco CA
Through compleDon of a Health Profession EducaDon legacy project, MS4 learners: • Demonstrate skills of curriculum development, delivery and disseminaDon • CollaboraDvely develop a novel longitudinal pediatric curriculum for MS1 and MS2s
• The PedsCases Legacy Project serves as an individualized, longitudinal curriculum in medical educaDon for three MS4 learners, allowing refinement of medical educaDon skills and creaDon of two novel pediatrics programs for junior learners
• Future steps include formal evaluaDon of the legacy project component of the HPE pathway
• ApplicaDon of this work could include encouraging a collaboraDve, longitudinal model of legacy projects for future UCSF learners or introducDon of a medical educaDon legacy project at other insDtuDons
• The UCSF Health Profession EducaDon (HPE) Pathway is an opDonal medical educaDon curriculum for MS4s, residents and fellows that includes a year-‐long legacy project
• For their legacy projects, three MS4s in two academic years have developed the PedsCases ElecDve -‐ a series of nine clinical pediatrics cases for MS1s and MS2s that integrate into the EducaDon in Pediatrics Across the ConDnuum (EPAC) AAMC pilot project
• This collaboraDve longitudinal legacy work is an example of what can be accomplished in a medical educaDon curriculum
Background
Methods
Demonstra>on of Educa>onal Skills & Curriculum Development
Development*of*a*Six0part*Pediatric*Case*Series*to*Parallel*Preclinical*Curriculum*HEALTH
PROFESSIONS EDUCATION
Neha*Joshi,*BS1,*Huiju*Carrie*Chen,*MD*MSEd1,2,*Michele*Long,*MD1,2*
1UCSF*School*of*Medicine,*San*Francisco*CA*2UCSF*Benioff*Children’s*Hospital,*San*Francisco*CA*
[Acknowledgements]***UCSF*Pathways*to*Discovery*in*Health*Professions*EducaOon*|*Daniel*West,*MD**UCSF*EPAC*’17*Students*|*The*study*authors*have*no*disclosures*to*report.!
!
A"Peek"into"EPAC"PedsCase"1:"Emergency"Medicine"• Parallels an Emergency Medicine case presented in the first year curriculum • Identifies differences in pediatric and adult physiology!*You*are*working*as*a*medical*student*in*the*Emergency*Department*at*San*Francisco*General*Hospital*when*your*team*is*called*for*a*912*trauma*acOvaOon.*Your*paOent,*Guadalupe,*is*a*7*year0old*female*is*arriving*with*EMS*aXer*a*motor*vehicle*accident.*How*should*you*introduce*yourself*to*Guadalupe?*What*sorts*of*reassurance*should*you*provide?*!
Pediatric"Model"Kit" Adult"Model"Kit"
What*are*reasons*why*a*child’s*airway*may*be*harder*to*keep*open*compared*to*an*adult?**Each!group!of!3-4!students!is!given!either!a!child!or!adult!airway!model!kit.!A=er!building!
their!model,!groups!are!asked!to!exchange!materials!with!a!group!with!a!differing!model!
type.!They!are!asked!to!compare!and!contrast!differences!in!airway,!and!then!collaborate!
with!the!larger!EPAC!PedsCase!group!to!discuss!their!findings.!Major!findings!in!children!
include!larger!head!in!proporHon!to!neck,!larger!tongue!in!proporHon!to!mouth,!smaller!
pharynx,!larger!and!floppier!epigloJs,!narrow!and!less!rigid!trachea.!
Airway"
A*child’s*rib*case*is*more*elasOc*than*an*adult’s.*How*does*this*affect*the*traumaOc*injuries*sustained*by*children?*
Breathing"Where*are*pulses*best*palpated*on*Guadalupe?*Are*certain*pulses*measured*be[er*on*children*compared*to*adults?**
Circula=on" Student"Reac=ons"“EPAC!PedCases!has!impressed!
me!with!its!well-organized,!
developed,!and!detailed!
supplement!to!our!med!school!
curriculum.!Besides!the!focus!
on!pediatrics,!EPAC!PedCases’!
emphasis!on!clinical!
presentaHons!and!real-life!
examples!has!proved!
extremely!useful!to!our!classes!
and!clinical!experiences.”!
“I!have!gained!a!beQer!understanding!of!how!
the!science!of!medicine!differs!in!children!
versus!adults,!and!how!to!structure!my!
communicaHons!to!address!the!enHre!family,!
not!just!the!paHent.”!!
!
“EPAC!PedCases!has!confirmed!my!interest!in!
pediatrics!and!made!me!very!excited!about!
pediatric!opportuniHes!yet!to!come!in!medical!
school.”!
!
“EPAC!PedCases!has!helped!introduce!
pediatrics!topics!into!a!very!adult-medicine!
focused!curriculum.”!!
!
“EPAC!PedCases!has!both!given!me!the!
opportunity!to!connect!with!dedicated!
pediatricians!and!helped!me!explore!pediatrics!
from!the!start!of!my!pre-clinical!years!at!
UCSF.”!
!
!
!
Introduc=on"• UCSF*is*parOcipaOng*in*an*AAMC*sponsored*pilot*70year*competency0
based*longitudinal*pediatrics*curriculum*0*EducaOon*in*Pediatrics*Across*the*ConOnuum*(EPAC)*
• To*expose*EPAC*students*early*to*pediatrics,*we*developed*six0case*series*(EPAC*PedsCases)*to*augment*the*exisOng*first0year*curriculum.*
• EPAC*PedsCases*are*designed*to*add*“pediatric*lens”*to*and*reinforce*core*curricular*concepts*by*introducing*pediatric*physiology*and*disease*processes,*and*pediatric0specific*communicaOon*skills.*
Methods"
IdenOficaOon*
• Student*and*faculty*team*idenOfied*concepts*from*the*first*year*curriculum*that*were*best*suited*for*adaptaOon*to*pediatrics.*
• Six*interacOve*cases*developed*and*implemented*in*pediatric*emergency*medicine,*cardiology,*pulmonology,*nephrology,*metabolism/nutriOon,*neurology/psychiatry.***
Design*
• Each*case:*• Discusses*approach*to*pediatric*paOent*• Addresses*differences*in*disease*presentaOon*in*children*vs.*adults*
• Explores*childhood*determinants*of*adult*diseases*• Reinforces*concepts*from*the*first0year*curriculum*by*including*hands0on*acOviOes*contrasOng*pediatric*and*adult*physiology**
EvaluaOon*
• EPAC*students*completed*evaluaOons*with*50point*Likert*raOng*scale*(1*=*not*at*all*effecOve,*5*=*extremely*effecOve)*and*free*response*items.*
• EPAC*and*control*students*completed*103*mulOple0choice*knowledge*quesOons.*
• Verbal*feedback*about*cases*obtained*from*subset*of*EPAC*students.*
Figure*1.*PDSA*Cycles*were*used*to*develop*EPAC*PedsCases.*
Results"
EPAC"PedsCase" N" Agree"1:*Emergency*Medicine* 17* 100%*2:*Congenital*Heart*Defects* 7* 100%*3:*CysOc*Fibrosis* 12* 83.3%*4:*Renal*Azotemia* 12* 91.7%*
I felt this session was interactive.
EPAC"PedsCase" N" Average" Standard"Devia=on"
1:*Emergency*Medicine* 17* 3.94* 0.429*2:*Congenital*Heart*Defects* 7* 4.00* 0.577*3:*CysOc*Fibrosis* 12* 4.58* 0.515*4:*Renal*Azotemia* 12* 4.00* 0.853*
How effective was this program in meeting the objectives of the session?
93.9* 81.8*92.4* 41.5*0*
20*
40*
60*
80*
100*
Interpersonal*and*CommunicaOon*Skills*
Medical*Knowledge*
EPAC*Non0EPAC*
Percen
tage"Answering"Co
rrectly
"" "
• It*is*possible*to*create*pediatric*focused*cases*that*can*reinforce*core*curricular*concepts*and*introduce*pediatrics*to*first*year*medical*students.*
• EPAC*PedCases*were*well0received*by*parOcipaOng*students,*and*support*EPAC’s*mission*of*early*introducOon*and*longitudinal*coverage*of*pediatrics*in*the*medical*school*curriculum.*
Conclusions"
Act* Plan*
Do*Study*
Using feedback from previous case, next EPAC PedsCase was developed.
Likert scale evaluations, multiple-choice questions, and free response questions were completed by EPAC students.
EPAC PedsCase developed to parallel
identified concepts in preclinical
curriculum.
Self-identified EPAC students in their first
year of medical school participated in 90 minute
interactive EPAC PedsCase.
Four EPAC PedsCases were presented so far, with last two cases scheduled for Spring 2014. Attendance was 18-37 students per case.!
Figure 2: Percentage of students correctly answering knowledge questions within two tested competencies after EPAC PedsCase 1: Emergency Medicine. (EPAC, N = 33; Non-EPAC, N = 118)
Objec>ves
HPE Learner 1 2013-‐2014
• Develop MS1 PedsCases curriculum
• IniDate MS1 saDsfacDon-‐based program evaluaDon
HPE Learner 2, 2014-‐2015 • Revise MS1 PedsCases curriculum • Develop MS2 peer-‐teacher component • Expand MS1 program evaluaDon to include knowledge and communicaDon skills assessment with comparison group
HPE Learner 3, 2014-‐2015 • Develop MS2 PedsCases curriculum • ConDnue MS2 saDsfacDon-‐based program evaluaDon
Faculty guidance
PDSA
CollaboraDve DisseminaDon
(other insDtuDons, specialDes)
Discussion
PDSA
Not at all 0%
Slightly 0% Somewhat
33%
Very 48%
Extremely 19%
How well did the MS1 PedsCases reinforce principles from the core
curriculum?
Crea>ng Learner Assessments Conduc>ng Program Evalua>on
Sample Curriculum Products
1. Pediatric Emergency Medicine 2. Congenital Heart Disease 3. CysDc Fibrosis 4. Pediatric Kidney Disease and Lab Workup 5. Infant NutriDon and CommunicaDng
about Chronic Diseases 6. Child and Adolescent Depression 7. Neonatal HepaDDs C Exposure 8. InfanDle Anemia and Clinical Reasoning 9. Toddler Development and Problem Lists
Needs Assessment to Iden>fy Topics
• Two novel curricula • 2014 UCSF Dean’s Prize for
HPE Legacy Project • Three posters in local and
regional educaDonal conferences
• Nine abstracts accepted in peer-‐reviewed contexts
• Planned disseminaDon through MedEdPORTAL
Dissemina>ng Scholarship
Educa>onal Strategies
• Readings • Lectures • Audiovisual materials • Discussion • ReflecDon • Small group learning • Problem-‐based learning • Role models • Role plays • SimulaDon
29% 33%
29%
5% 5% 0% 5%
10% 15% 20% 25% 30% 35%
Knowledge
Comprehension
ApplicaDon
Analysis
Synthesis
Distribu>on of Ques>ons by Bloom's Taxonomy Level (n=21)
Acknowledgements: Neha Joshi MD | Julia Shalen BS | Carrie Chen MD