ThefollowingslidescontainatemplatethatillustratesthegeneralformatusedforaY3orY4clerkshipreview.Inthe“notes”sectionofsomeslidestherearefurtherinstructionstoclarifywhatisneededforaparticularsectionofthereview.

Thecomponentsoftherevieware:1. revisitprioractionplanandinvestigateprogress2. assesscourseobjectivesincludingessentialskills/diagnoses3. evaluateplanned/unplannedredundancy4. assesspedagogy5. evaluateassessmentofcourseobjectives6. reviewmeasuresofquality(e.g.courseevaluations)

TheDeansoftheappropriateyear,ortheiragents,willserveastheteamleaderforeachcoursereview.Theresponsibilitiesoftheteamleaderare:

1. Assigntaskstothefacultyandstudentteammembersandconveydeadlinesforwhentheworkneedstobedone.

2. Recruitmembersforthereviewteamifnecessary(typicallyteammemberswillbeassignedbytheMEC).

3. Contacttheclerkshipdirectortoarrangeameetingwiththeteamtodiscusstheclerkship;informtheclerkshipdirectorofthedatethereviewwillbepresentedattheMECmeetingsotheycanputitontheircalendar/indicateavailability.

4. CollectalltheworkcompletedbytheteammembersandcollateintoonePowerPointpresentation;collecttheactionplanfromtheclerkshipdirectorandinsertitattheendoftheslides;sendtheslidestoRachel2weeksbeforetheMECmeeting.

5. PresentthefinalrecommendationsofthesubcommitteeattheMECmeeting(lastfewslides)

ReviewofYear3MedicineClerkship

• ClerkshipoccursinYear3• ClerkshipDirector– HilaryRyder

– SiteDirectors– CampbellLevy,AmandaRatliff,KathleenVanier

• Sitesused– DH,VA,CPMC

• Clerkshipis8weekslong• ClerkshipwaslastreviewedinMay2014

ReviewTeam

• KellyKieffer,MD– ViceChairforEducation,Medicine• HarleyFriedman,MD– ResidencyProgramDirector,Medicine

• EugeneNattie,MD– GAMEmember• GregOgrinc,MD,MS– SADME,GAMEmember• JohnDick,MD– OCE,GAMEMember• AlisonRicker,OCE• LynnSymonds,MedicineStudent,MECmember

ActionPlanfromPriorReview• Altercourseobjectivestobetterrepresentconditionsstressedininpatient

medicine- Done• Alteressentialclinicalconditionsfortheclerkshiptobetterrepresentclinical

conditionsstressedininpatientmedicine– Done• Alteressentialclinicalskillstobetterrepresentclinicalskillsstressedininpatient

medicine- Done• CreateastructuredassessmentofAdmissionH&Ps– Done…Shouldthisbe

successfulwewillconsidercreatingasimilarassessmentofSOAPnotes.• Createdastructuredmini-CEXfocusingoncommunicationskillstofacilitatemore

helpfulfeedback– Done• Changegradingschemefortheclerkshiptomakethegrademoretransparent–

Done• Createanhour-longsmallgroupinteractivesessiononHighValueHealthCare.See

attachment“HVCCurriculumGeiselIM.”– Done• ChangeattendingschedulesatDHMCsothatstudentsonaveragewillspendtwo

weekswitheachattendingonthehospitalmedicineservice - Done

ActionPlanfromPriorReview• ReinforceresidentandfacultypreparationforstudentsatCPMC– Done.

– theresidentsandfacultyannuallyreceiveanoralpresentationdescribingthe14course-specificobjectives,theRIMEparadigmforgradingandthecomponentsofmedicalstudentgrades.AtCPMCthe14course-specificobjectivesanda“guidetoworkingwithmedicalstudents”aredistributedbyemailtofacultyandresidentseachtimetheyworkwithamedicalstudent.The“guidetoworkingwithmedicalstudents”goesthroughtheRIMEmodelandreiteratesexpectationsasdirectlyoutlinedinGeisel’seducationalobjectives.

CourseObjectivesCourseObjective HowStudentisAssessed LearningActivity

1 Applyappropriate biomedicalscienceknowledgedevelopedfromrelevant,evidence-basedliteraturetothedeliveryofmedicalcare ofpatientswithacutemedicalconditions.

PerformanceEvaluationsShelfExamCaseDiscussionsWriteUpsStudentPresentationNBMEexam

WardsSIMPLEMorningReportCaseDiscussionsWriteUpsStudentPresentation

2 Describethepresentation,diagnosis andmanagementofcommonacutemedicalconditionswithparticularfocusonthe“essentialconditions”assignedtothemedicineclerkship.workupforandexplainthetreatmentforthemostcommoninpatientdiagnosesincluding chestpain,arrhythmia,CHF,COPD,PNA,PE/DVT,alteredmentalstatus,acutepaincrisis,electrolyteabnormalities,acutediabeticcomplications,GIbleeding,pancreatitis,AcuteKidneyInjury,cellulitis,SIRS/sepsis,UTI,cytopenias,commonmalignancies .

PerformanceEvaluationsWriteUpsCaseDiscussionsNBMEexam

WardsSIMPLEWriteUpsCaseDiscussionsInternReport

3 Interviewpatientsskillfully,includingacomprehensivehistory. PerformanceEvaluationsSkillsForm

WardsSIMPLE

4 Demonstratecompleteandfocusedphysicalexamineofpatients,withappropriateattentiontoskill,cleanliness,infectioncontrolandpatientcomfortandprivacy.

PerformanceEvaluationsSkillsForm

WardsPERounds

5 Defineandprioritizethepatient’sproblemsaccuratelyandgenerateanappropriatedifferentialdiagnosisforpatientswithcommonacutemedicaldiagnoses.

PerformanceEvalCaseDiscussionNBME

WardsCaseDiscussionMorningReportSIMPLEFormalOralpresentationtoTeachingResident(JuniorMedicineResident)withstructuredfeedback

6 Interpretwithoutassistancecommonabnormalitiesandurgentfindingsoncommon diagnostictestsandstudiesincludingchestx-rays,EKGs,completebloodcountsandchemistrypanels,gram-stain/cultureresults.

PerformanceEvaluationsCaseDiscussionsEKG/CXRtutorialNBMEexam

WardsCaseDiscussionsEKG/CXRtutorialsSIMPLE

CourseObjectives7 Communicateeffectivelywithpatientsand

families,establishmutuallyrespectfulrelationships,andshowabilitytohelppatientsunderstandtreatmentoptions.

PerformanceEvalsSkillsForm

WardsCaseDiscussionsProfessionalismSession

8 Communicateeffectivelywithpatientsandfamiliesofdifferent varioussocial,economicandculturalbackgroundsorwhenspecialneedsorbarrierstocommunicationexist,aroundindividualfactorsthatimpacthealth.

PerformanceEvals WardsProfessionalismsession

9 Communicateeffectivelyandcollegiallywithphysiciancolleaguesandothermembersofthehealth-careteamverbally,inwritingandintheelectronicmedicalrecord.

PerformanceEvalsStudentPresentationWriteUpsSkillsForm

WardsWriteUpsCaseDiscussionsOralpresentationtoFIREresident

10 Behaverespectfullyandresponsiblytowardspatients,families,colleagues,andallmembersofthehealth -careteam andempathizeandberespectfulofeachpatient.

PerformanceEvalsCasediscussions

WardsProfessionalismSession

CourseObjectives

11 Adheretohighethicalandmoralstandards,acceptresponsibilityforpersonalactions,acceptconstructivecriticismandrespectpatientconfidentiality.

PerformanceEvals,WriteUps

Wards

12 Identifyandcriticallyevaluaterelevantinformationaboutevidence-based,cost-consciousstrategiesinthecareofpatientsandpopulationsandapplythistopatientcareandtocontinuousupdatingofskills.

PerformanceEvalsCaseDiscussionsWriteUps

WardsCaseDiscussionsWriteUps

13 Takeresponsibilityforhisorherownmedicaleducation,developthehabitsofmindfulnessandreflection.

PerformanceEvalStudentStudentPresentationCaseDiscussionsEKG/CXRsessionsSIMPLE

WardsSIMPLECaseDiscussionsEKG/CXRsessions

14 Identifyandutilizeappropriateresourcestosupportpatientcareandcomparethe rolesofandcollaborate withallmembersoftheinter-professionalteam.

PerformanceEvals

Wards

FormatofCourse&SessionObjectives• Courseobjectivesareprovidedinthesyllabus• Courseobjectivesarewritteninthecorrectformat[mentionanythatarenotincorrectformat]

• Sessionobjectivesaremostlynotprovidedinthecoursematerials

• Sessionobjectivesarewritteninthecorrectformat

HowdoY1/2coursesprepareforY3• Questionsaskedatendofclerkship– 1=poorand5=excellent

• Openended– Codestatus,palliativecare– DDx formostcommondiagnoses– DailyRounding,Oralpresentationsrelatedto– MorepracticeofPEonabnormals

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

14-15

15-16

Results:Communication

00.51

1.52

2.53

3.54

4.55

FM MED OB PSYCH SURG PEDS GAM NEURO

14-15

15-16

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

14-15

15-16

Results:MedicalKnowledge

00.51

1.52

2.53

3.54

4.55

FM MED OB PED PSYCH SURG GAM NEURO

14-15

15-16

IssuesofRepetition/Redundancy• Aretheremajorissuesofredundancywithothercourses?– No

• Repetition– Breakingbadnews(MED,ICE,SURG)– MedicalError(HSP,NewYear1course)- focusesonapplicationratherthantheory

– HVHC– focusesonapplicationratherthantheory

• Conditions/Skills– AcutePain(Surgery)

IssuesofRepetition/Redundancy• ECG/EKGinstructionacrossthe4years– CVandResp Phys(PHSL110):lectures– SBM-CV:EPlectures,Seminar– CFM/MED/PED/SURG:assessandinterpretEKG

• Thisprogressionfromunderstandingwhereelectricalimpulsecomesfromtoconnectingtopatho-phys tousinginpracticeisappropriateandstudentsfindthishelpful

EssentialSkills

• Aretheseappropriateforthisclerkship?-NotHEENT(moreoutpatientbasedandalreadycoveredinCFM)-AddAbdominalExamasveryrelevanttoinpt medicine-Rewordcounseloncodestatus– thisistoohighlevelforMS3

Skill Overlap LevelExpectedCallConsult PerformwithSupervisionCardiacExam Yes(CFM) PerformwithSupervisionComplete ComprehensiveInitialExam PerformwithSupervisionCoordinated/cwithd/cplannerandpatient PerformwithSupervisionCounseling:Diseaseissues CounselPatient/FamilyonDiseasespecificissue Yes(GAM) PerformwithSupervisionCounseling:DNRstatus Inquireaboutcodestatusandadvanceddirectives PerformwithSupervisionCounseling:Medications Yes(GAM),(NEURO) PerformwithSupervisionEKG(interpret) PerformwithSupervisionExtremityExam PerformwithSupervisionFluidmanagement PerformwithSupervisionAbdominal Exam Yes (SURG) PerformwithSupervisionHEENTexam Yes(CFM) PerformwithSupervisionHPI(relevanttoclerkship) PerformwithSupervisionOralpresentation:inptadmit PerformwithSupervisionOralpresentation:inptprogress PerformwithSupervisionPulmonaryExam Yes(GAM) PerformwithSupervisionWrittenNote:inptadmit PerformwithSupervisionWrittenNote:inptprogress PerformwithSupervisionX-raychestinterpretation PerformwithSupervision

EssentialDiagnoses

• Aretheseappropriateforthisclerkship?• Wouldyouaddorsubtractany?• Aretheremajorissuesofredundancywithotherclerkships?

Diagnoses Overlap LevelAcuteCHFHeartFailure ManagewithAssistanceAlteredmentalstatus ManagewithAssistanceAnemia yes(GAM) ManagewithAssistanceArrhythmia yes(GAM) ManagewithAssistanceBacteremiaorsepsis ManagewithAssistanceAcuteComplication ofCancer ManagewithAssistanceChestPain ManagewithAssistanceCOPD yes(CFM) ManagewithAssistanceDMTypeIorIIAcuteComplications ManagewithAssistanceDKA ManagewithAssistanceFever(sourceunknown) ManagewithAssistanceFluid/ElectrolyteAbnormality ManagewithAssistanceGIbleeding ManagewithAssistanceLiverFailure/Cirrhosis ManagewithAssistancePain,acute yes(SURG) ManagewithAssistancePancreatitis ManagewithAssistancePneumonia ManagewithAssistanceAcuteKidneyInjury ManagewithAssistanceChronicKidneyDisease Yes(GAM) ManagewithAssistanceShortnessofBreath ManagewithAssistanceSyncope,pre-syncope ManagewithAssistance

ExplorationofEthicsandCulturalCompetencies

• Professionalismsession• EndofLifeCaresession

CourseLearningOpportunitiesClinicalexperiences• Wardrounding/care:– CPMCoffers7weeksofgeneralmedicinewards– VA/DHMCeither7weeksgenmedorhalfgenmed,halfspecialtywards(cardsorheme/onc)

– OneovernightcallatVA,otherwisenoovernights– Admissionsorhandoffsdaily

CourseLearningOpportunitiesLecture• Orientationlectures– EKGtutorial,cultureofsafety,endoflifecare;assignedpre-readings

• Didactics2hours1x/weekatDHMC,2x/weekatVAandCPMC

CourseLearningOpportunitiesDHMCConferences(“M2conferenceschedule”)• Mandatory

– Chiefresidentrounds1x/week– Chairrounds1/block– EndofrotationconferencesonDeath&Dying,andonProfessionalism– Endofrotationdebriefingonpatientsafetyandpreventing

errors/adverseevents

• Optional– Noonconferences,Internreport,MM&I,Autopsyrounds– AMreportencouraged2x/week,butnotpossibleonM1(istherea

casediscussionforumthatoffsetsthis?)

CourseLearningOpportunitiesVAConferences• Mandatory:

– AMreport(required2x/week,offered3x/week)– Chiefresidentrounds1x/week– M&M1x/week– Grandrounds1x/week– EndofrotationconferencesonDeath&Dying,andonProfessionalism– Debriefingonpatientsafetyandpreventingerrors/adverseevents

• Optional:– noonconferences,journalclub,Internreport

CourseLearningOpportunitiesCPMCConferences• Mandatory

– Clerkshipdirectorrounds(patientpresentations,bedsiderounds,ECGreading);90minutes,weekly

– WildCardrounds(image-based,quizshow,CXRteachingwithradiologist);60minutes,weekly

– ?EndofrotationconferencesonDeath&DyingandProfessionalism– ?Debriefingonpatientsafetyandpreventingerrors/adverseevents

• Optional– Morningreport(recommended);60minutes4x/week– Grandrounds,internreport?

CourseLearningOpportunitiesOther(ie simulation)• Endoflifecarediscussionwithstandardizedpatientsduring

orientation,followedbydebriefingandreflectivesession• SIMPLEcases(minimumof6,studentchoosesfromselected

options)• Studentpowerpoint presentation• FiveH&P’s,orfourH&P’sandapatientsafetyanalysis(thisis

anassignment,butifthereisfeedbackgivenitisalsoalearningopportunity)

CourseLearningOpportunitiesCommentsaboutpedagogy…• Incorporatescurriculaonseveralimportanttopicsin

competencyareasthatcanbeachallengetoteach:highvaluehealthcare,medicalerror,deathanddying

• SIMPLEcasesprovidetheopportunityforstudentstocovercoreclinicaltopicstheydonotseeonthewards

• Arethereopportunitiesforexplicitteachingaboutteam-basedcareandtherolesofnon-physicianprofessionals?

• Shouldtherebeasim centercurriculumforanyprocedures?

• Therearesomepotentialsourcesofvariationinclinicalcontentacrosssites,anddifferencesinconferences.Dotheseresultinasubstantivelydifferentexperienceforstudents?

Assessment• ClinicalPerformanceEvaluations– Tiedtocourseobjectives– Outstandinganchorsseemhardtoreachformanydomains

• FinalExam– NBME

• Other– WriteUps,Participation,ProfessionalismPoints,PowerPointpresentation

Measuresof

Quality–AAMCGQ

Geiselmean2011

Geiselmean2012

Geiselmean2013

Geiselmean2014

Geiselmean2015

Allschoolsmeans2015

CFM 3.2 3.1 2.9 3.2 3.5 3.3

MED 3.5 3.6 3.5 3.6 3.6 3.5

NEURO 3.1 3.4 2.7 3.1 3.1 3.1

OBGYN 3.1 3.0 3.0 3.1 3.1 3.1

PEDS 3.3 3.1 3.2 3.5 3.6 3.4

PSYCH 3.5 3.6 3.4 3.7 3.6 3.3

SURG 3.0 2.8 2.9 3.1 3.3 3.3

MeasuresofQuality– AAMCGQ“Ratethequalityofyoureducationalexperiencesinthefollowingclinicalclerkships.”[1=poor;2=fair;3=good;4=excellent]

Measuresof

Quality–AAMCGQ

MEDIGeisel 2014 Geisel2015 AllSchools2015

Observedtakingrelevantportionsofpthistory? 96.4 97.3 91.5

Observed performingrelevantportionsofphysicalorMSE? 91.7 97.3 92.9

Provided withmidclerkshipfeedback? 100 100 97.2

MeasuresofQuality– AAMCGQ

PercentansweringYestoquestion(goalis100%)

Measuresof

Quality–AAMCGQ

MEDIGeisel 2014 Geisel2015 AllSchools2015

Faculty providedeffectiveteaching 4.5 4.4 4.5

Residents providedeffectiveteaching 4.6 4.5 4.6

MeasuresofQuality– AAMCGQ

Scale:StronglyDisagree– 1toStronglyAgree- 5

MeasuresofQuality– StepIICK

*valuesdepictedareSDabovetheUS/CanmeanforGeiselmeanscores

MeasuresofQualityNBMESubjectMatterExamScores

Year Geisel Mean PercentileRank

NationalMean

9-10 78.6 67th 75.8

10-11 79.9 67th 77.1

11-12 81.1 70th 77.6

12-13 78.4 56th 78.1

13-14 80.5 63rd 78.5

14-15 81.9/ 76.3* 63rd 76.5/73.3*

*NBMEmovedtoEquatedPercentCorrectScorewhichisdifferentfromtheprior2digitscaledscore.

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]

scale[1=poor;2=fair;3=good;4=verygood;5=excellent]

MeasuresofQuality– CourseEvaluationMedicine

2012-13 2013-14 2014-15

OverallExperience 4.28 4.14 4.48

Objectiveswelldefinedandclearly presented 4.49 4.34 4.46

Ability forY1and2topreparemeforthisclerkship n/a n/a 3.99

Expectationswelldefinedand clear 4.34 4.17 4.42

Volumeadequate forlearning 4.2 4.21 4.45

Varietyofdxadequateforlearning 4.17 4.07 4.37

Quality ofteachingbyattendings 4.28 4.15 4.37

Qualityofteaching byresidents 4.26 4.36 4.56

Directors responsivetoconcerns 4.7 4.62 4.73

Methodsusedto eval studentperformancemadeclear 4.06 3.99 4.21

Qualityof mid-clerkshipfeedback n/a 3.87 4.09

CardiologyExperience 4.18 4.18 4.24

Heme Experience 3.71 3.95 4.62

MeasuresofQuality– StudentComments

Strengths:• Manystudentsfeltvaluedbytheirteams:

– “Overall,myteammademefeelthatIwasavaluedmember,thatmyworkwasappreciated,anddemonstratedstrongvaluesofprofessionalismandpatient-centeredclinicalcare”

• StudentsappreciatedhavingautonomyattheVA:– “EspeciallyattheVAstudentsfelttheyhadlotsofautonomy:Abilitytoreallytake

ownershipofpatientsinallaspectsofcare”• Didacticsweremeaningfulandworthwhile:

– “IalsoreallyenjoyedthedidacticsessionswithCXRsandEKGs,asIthinkthesewerewellorganizedandimprovedmyconfidencewiththesebasicskills”

• Manystudentsappreciatedthevarietyandbreadthofdiagnosestheysawonthewards:– “Complicatedpatientswithinterestingdiagnoses”

• Lotsoflearningopportunities(didactics,conferencesetc)andexcellentteachingbyinterns,residents,fellows,andattendings:– “Theteachingneverstops,whetherit'swiththeteamorindidactics”– “Iexperiencedthebestclinicalteachingofmyentirethirdyearofmedicalschoolonthis

clerkship"

MeasuresofQuality– StudentComments• Thegradingschemewasuncleartosomestudentscomparedtootherclerkships:

– “gradingneedstobemuchmoretransparentforthisclerkship.Wearegivenbreakdownofhoweachcomponentfactorsintoagrade,butthereisnobreakdownofwhatscoreisneededtoachieveaP/HP/H.This,alongwiththelackoftransparencyabouthowevaluationsareconvertedintoagrade,makesitacompletemysteryandapparentlysubjecttoclerkshipdirectorwhimsabouthowmanypeopletoassignacertaingradeto”

• Theclerkshipisverytimeintensiveanditcanoftenbedifficultforstudentstofindstudytime:– “Thebalanceisdelicatebetweengivingthemedstudentthefullexperiencecomplete

withweekenddaysandcallnightsandgivingthemenoughtimetomeetthenon-clinicaldemandsoftheclerkship(write-ups,didacticprep,qbank,etc.)”

– “ThewaythescheduleworksIwasconsistentlyhitting80hourseveryweek(plusawrite-uptodoonmyonedayoff)andfeltitwascounterproductivetomylearningtobesodeeplyexhausted”

• Somestudentsworked>80hrs/week:– “Thehourswerelong,>80hrs insomeweeksinwaysthatIdidn'tfeelIcouldcontrol”

MeasuresofQuality– StudentComments

SuggestionsforImprovement:• Somestudentsfelttheyhadalotof“scut work”:

– Lessscut workformedicalstudents,please.Ithinkthatitisimportanttoknowhowtomakefollowupappointments,consults,andcallOSHforyourpatientsandtooccasionallyhelpoutwiththeteam'sotherpatients,butwhenitmeansthatyoumissalmostallmorningreportsandothereducationalopportunitiestolearn,itbecomesuselesstous.”

• Somestudentswisheddidacticscoveredmoretopicsand/orinvolvedacase:– Iwouldappreciatedidacticscoveringbreadandbuttermedicinetopics.Didacticsessions

wouldbeniceiftherewasacaseinvolved.• Write-upsweremoretimeconsumingthenintended,strictlygraded,andnumerous:

– Ipersonallyspentatleast8-10hoursoneachofmywrite-ups,andIwasveryfrustratedwiththeresults”

– “wishtherewereonly4writeupsasweonlyhaveonedayoffperweekandthatdayisspentworkingonthewriteupwhichusuallytake>5htowritethemwell”

– “WhileIunderstandtheintentofthewriteups,Idobelievethat5alongwithapresentationistoomanywhenyouonlyhave1dayoffperweekandstudyingtokeepupwith”

SummaryregardingMeasuresofQuality• Summary:

– Themajorityofstudentshadverypositiveexperiencesonthisclerkshipandfeltlikevaluedteammembers

– Excellentteachingfromallmembersoftheteamandmanylearningopportunitiesthroughdidactics,morningreport,conferencesetc

– Manystudentsfeltthewrite-upswereuseful,butgivenhowtimeintensivetheclerkshipiswouldhaveappreciatedeitherfewerassignmentsorapass-failgradingschemeonwrite-ups

– Studentswantedmoretransparencyabouthowfinalgradeswerecalculated– Manystudentsappreciatedthatdidacticssolidifiedimportantskills(reading

EKGs),whileotherswishedtheyhadcoveredabroaderrangeoftopicsand/orincludedacase

– Multiplestudentsmentionedworkingclosetoorgreaterthan80hoursandfounditdifficulttoadequatelypreparefortheshelf

SummaryregardingMeasuresofQuality

• Overall,themedicineclerkshipisratedhighlybyourstudents– AAMCGQdataremainstrongandabovethenationalmean

– Endofclerkshipratingishigh

• GeiselstudentsperformverywellonshelfexamandonUSMLEstep2

• Mid-clerkshipfeedbackandhematologylearningappearstobebetterthanpastfewyears

Recommendations• CourseObjectives

– Changewordingofcourseobjectivesasindicatedinslides7-9.• SessionObjectives

– IncorporateobjectivesintoCANVASsitesomorevisibletostudentsandplacedwithsessionmaterials/assignments

• EssentialSkills/Conditions– Makechangesasindicatedonslide18and19

• Pedagogy– ConsiderdecreasingCXRsessionsandaddingsessiononclinicaldecisionmaking/morningreport

styleforstudents– UpdateCANVASsiteforlearningsessionsatVA– MakeCPMCconferencescheduleavailableonCANVAS– ConsiderusingfacultytofillinforChairRoundsorChiefResidentRoundsifneededinordertokeep

continuityofscheduleforstudents– ConsiderdevelopinganddeployingwardattendingbasedrubricforSOAPnotereview

• Assessment– Clarifycontribution/useofwardperformanceevaluationsforstudentgrades– Considermaking“gradegrid”availabletostudentsorshowexampleatorientation– Postspecificrulesforfailureforprofessionalismcomponent– Moreclearlydefine/enforcepage/timelimitonclinicalwriteups

ActionPlan• CourseObjectives

– Changewordingofcourseobjectivesasindicatedinslides7-9.Completed.• SessionObjectives

– IncorporateobjectivesintoCANVASsitesomorevisibletostudentsandplacedwithsessionmaterials/assignments.Wehave(1)AddedsessionobjectivestoourCANVASsite,(2)includedsessionobjectiveswithintheclerkshipsyllabus,and(3)askedeachinstructortopublicizeandreinforcesessionobjectivesatthebeginningofeachsession.

• EssentialSkills/Conditions– Makechangesasindicatedonslide18and19Completed

• Pedagogy– ConsiderdecreasingCXRsessionsandaddingsessiononclinicaldecisionmaking/morningreport

styleforstudents.WehavedecreasedthenumberofCXRinstructionanddoubledourclinicaldecisionmakingtime.

– UpdateCANVASsiteforlearningsessionsatVA.WehaveupdatedtheGuidelinesandScheduletoreflectcurrentpracticesandalsoaddedaSiteDescription.

– MakeCPMCconferencescheduleavailableonCANVASSupportstaffatCPMCisbeingtrainedtoupdatetheconferencescheduleonCANVAS.

– ConsiderusingfacultytofillinforChairRoundsorChiefResidentRoundsifneededinordertokeepcontinuityofscheduleforstudents.ChairofMedicineabsencesoccurredprimarilyinAY14-15andChairRoundshavebeenconsistentandwellattendedinAY15-16.OurapproachwillbetoasktheViceChairforMedicalEducationtostepinforfutureabsences.ChiefResidentRoundswillbestaffedbytheResidentEducatorincaseofCMRabsence.

– ConsiderdevelopinganddeployingwardattendingbasedrubricforSOAPnotereviewWeareawaitinginformationfromDr.Dickastohowtoaccomplishthis.

ActionPlan• Assessment

– Clarifycontribution/useofwardperformanceevaluationsforstudentgradesWehaveclarifiedthisonCANVASunder‘GradingandEvaluation’.

– Considermaking“gradegrid”availabletostudentsorshowexampleatorientationWenowprovideablankgradegridonCANVAS.

– PostspecificrulesforfailureforprofessionalismcomponentWehaveupdatedour‘GradingandEvaluation’toincludethis.

– Moreclearlydefine/enforcepage/timelimitonclinicalwriteups Wehaveaddedthislanguageto‘NewPatientWriteUps’documentonCANVASandalsowillreinforceitinsmallgroups.