yankton model program
TRANSCRIPT
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Yankton Ambulatory Program
An Integrated Model
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50 students per year 4 MD/PhD
Year 1 and 2: Basic Sciences Year 3: Required clerkships
Sioux Falls Rapid City Yankton Ambulatory Program
Year 4: Electives and required clerkship
Sanford School of Medicine of the University of South Dakota
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Yankton County - 20,000 population Avera Sacred Heart Hospital
- 144 acute care beds- 75 physicians in community
Yankton Medical Clinic – private multispecialty clinic
- 42 physicians - 150,000 patient visits per year
No resident physicians
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1989 Planning began YMP Climate of Medicine/Education
Changes in Medical Practice GPEP Recommendations
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Students
10-14 per year Students self-select during year 2 200 graduates
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Core Faculty
Family Medicine – 8 Internal Medicine – 10 Surgery – 7 Pediatrics – 5 Obstetrics/Gynecology – 4 Psychiatry - 6
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Yankton Ambulatory Program
Ambulatory-based Integrated Student-centered Continuity care
experience Problem-based
learning
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Ambulatory - Based
Yankton Medical Clinic Affiliated clinics Assigned to Family Medicine, Internal Medicine, Pediatrics, OB/Gyn, Surgeryo Psychiatry – Human Services Center
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Goals
Provide broad based education Teach life-long learning skills Provide real-life experiences
“doctoring” Promote primary care
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Mission StatementThe mission of Sanford School of Medicine of the University of South Dakota is to provide the opportunity for South Dakota residents to receive a quality, broad-based medical education with an emphasis on family practice. The curriculum is to be established to encourage graduates to serve people living in the medically under served areas of South Dakota, and is to require excellence in the basic sciences and in all clinical disciplines.
Sanford School of Medicine of the University of South Dakota is to provide to its students and to the people of South Dakota excellence in education, research and service. To these ends, the School is to provide educational pathways to both the Doctor of Medicine and the Doctor of Philosophy Degrees; and
Quality health care for the people of South Dakota is addressed by undergraduate, graduate and continuing educational programs as well as by basic and applied medical research. Sanford School of Medicine should serve as a technical resource in the development of health care policy in the state and provide extension and research initiatives to improve the health care of the citizens of the state.
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Integrated
Students not “on” a specialty Primary care 12 months
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Student Centered
Faculty outlines objectives Student responsible for obtaining
knowledge Faculty provides resources and
opportunities
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Continuity Care
Patients followed in: Clinic Subspecialty clinic Hospital Surgery ER
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Week 1 Monday Tuesday Wednesday Thursday Friday
am Rounds FMF. M.
RoundsPsych
Rounds IMInt. Med.
ORSurg/OB/Gyn
Rounds Peds
noon
* *** * Chart Audit,J. Club, Pediatric Presentation, Psychiatric Presentation
pm ** Surgery Bedside Teaching1:30 –3:30
Week 2 Monday Tuesday Wednesday Thursday Friday
am Rounds F.M.
RoundsSurg/OR
Rounds IM
OROB/Gyn
Rounds Peds
noon * *** *Chart Audit,J. Club, Pediatric Presentation, Psychiatric Presentation
pm OB/Gyn**
Peds Psych Bedside Teaching1:30 –3:30
* Small Group – 11:30 – 1:00 ** Call – ER, OB/Surgery *** Requested lectures
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Problem-Based Learning
Six students per group two 1 ½ hour sessions/week Actual patient hx presented by student Serves as stimulus for learning issues Facilitators from Basic and Clinical Sciences
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Friday afternoon
Bedside teaching Chart audit Journal Club Pediatric case presentation Psychiatry case presentation
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Other opportunities
Grand rounds Local Videoconference
Requested lectures
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Coordinating Committee
Physician from each discipline Deans Student coordinators Meet 1-2x/month
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Student Evaluation
Triple Jump – 3x/year Departmental exams – 1x/year NBME Shelf Exams - 3x/year Database - monthly OSCE- end of year Observed H&P Pediatric & Psychiatry Case
Presentation
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Student Evaluation (cont.)
Continuity experience Oral Exams – Psychiatry Clinical skills – Attending Eval
3x/year Interpersonal skills Physician-related characteristics Peer Evaluation
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DatabaseComparison for July 2007-finalCUMULATIVE REPORT
Range Average
Total Encounters 1189-1478 1330
Clinic Visits 655-911 748
Patient seen 2 times 45-219 129
Patient seen 3-6 times 40-176 92
Patient seen > 7 times 4-59 26
ER visits 178-274 213
History and Physical (Audits) 30-41 32
Psychiatric Examination (Audits) 12-13 12
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Database
Range Average
Pap Smear/Pelvic 27-154 82
Vaginal Delivery 20-24 21
“Other” Delivery 5-14 8
Newborn Examination 14-34 24
Well Baby/Child Examination 5-160 38
Circumcision 1-8 3
Comparison for July 2007-finalCUMULATIVE REPORT
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DatabaseComparison for July 2007-finalCUMULATIVE REPORT
Range Average
Skin Surgery/Laceration repair 34-152 78
Abdominal Surgery 25-76 43
Hernia Repair 1-14 5
Laparoscopic Surgery 10-28 17
Chest Surgery 1-9 3
Breast Surgery 1-9 3
Orthopedic Surgery 2-46 12
OB/Gyn Surgery 20-56 43
Head/Neck Surgery 2-104 15
Endoscopy 2-34 15
Vascular, Carotid endart. 1-2 1
Vascular, venous access 3-12 6
Vascular 1-11 4
Total Surgeries 99-268 155
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Evaluation 50 Credit Hours
9 Clinical skills (H&P) 9 Clinical skills (Dx & Tx) 9 Problem solving skills 10 Knowledge base 10 Physician-related characteristics 1 Radiology 2 Clinical Colloquium
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Colloquium
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o Three times a yearo All studentso Professionalism, Ethics, Diversity, ACLS, Radiology, Nutrition, Residency Day
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Feedback
Coordinator for each student 3x/year minimum Database, attending evaluation, small group, and peer evaluation
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Program Evaluation
Students twice per year Medical Education Committee
Comparison of board scores OSCE
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Benefits to YMC
Recruiting Payment for teaching Education part of mission statement Students knowledgeable and skilled
at end of year
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Summary
Yankton Ambulatory Program - 16th year
Ambulatory based Integrated program Longitudinal – 1 year Continuity of care
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Yankton Ambulatory Program
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Obs NAME LOCATION LS MEAN STDERR 1. FIRST IM Rapid City 69 2.8042 2. LAST IM Rapid City 74.4444
2.29923 3. FIRST IM Sioux Falls 71.375
2.97431 4. LAST IM Sioux Falls 72.625
2.43871 5. FIRST IM Yankton 66.5714
1.83578 6. LAST IM Yankton 78.4286 1.5052
Shelf Board Score Comparison
• IM, Surgery, OB/GYN
• 3x year
• No statistical difference
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Evaluation Criteria
a. Clinical skills (H&P): Ability to perform a directed history and physical examination
Attending’s evaluation 80% Coordinator evaluation 10% Observed H&P none Final Psych oral 10%
b. Clinical skills (Dx & Tx): Ability to develop efficient diagnostic and educational plans and execute the plans
Attending’s evaluation 80% Coordinator evaluation 10% Psych oral 10%
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Evaluation Criteria (cont.)c. Problem solving skills
Small group facilitator evaluation 20% Triple Jump evaluation 40% Attending evaluation 40%
d. Objective Knowledge Base Performance on national board shelf exams
100%
e. Interpersonal skills and Physician-related Characteristics Clinic and Program Staff evaluation 10% Attending evaluation 50% Coordinator evaluation 30% Small group facilitator evaluation 10%
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Evaluation Criteria (cont.)
f. Radiology Evaluated on radiology material, lectures, and examcovered during clinical colloquium
g. Colloquium Meaningful participation 10% Professionalism paper 15% Cultural diversity experience 25% ACLS 25% Ethics 25%
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Outcomes
Student satisfaction Board scores (+ 12 vs 10 Step 1 → 2) 2005
(+ 11 vs 10 Step 1 → 2) 2006
OSCE Residency choice Shelf Board Exams
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Positive Student Commentso “I thought the clinical experience was excellent.”o “I enjoyed working with and learning from all the physicians I interacted with.”o “Small Group continues to be one of the strengths of the program. It allowed us to learn more effectively from each other.”o “Emergency Department duty was an important learning tool and provided excellent experience in physical exam, history taking, and diagnosing common problems.”o “The NBME Board Shelf exams are an exceptional way to monitor progress.”o “I enjoyed working with and learning from all the physicians I interacted with.”o “My experience with each of my attendings was very positive”
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Positive Student Commentso “I think our community project experience was one of the most important aspects contributing to our professional and personal development.”o “The immersion project was a wonderful and meaningful experience.”o “Bedside teaching was excellent and a very good learning tool.”o “I think Triple Jumps are a valuable component of the YMP. It is clear the process is about assessing the students approach to a case and their ability to reason and think things through than it is about coming up with the correct diagnosis.o “If I had to do it over again, I would enthusiastically choose the Yankton campus again.”
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Negative Student Comments
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Comparability of 3 clinical campuses Objectives the same Database Evaluations
Same requirements Oral Exams Department exams Shelf Board
Different evaluation
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YAP ExperienceLocal Barriers to Change
Department Chairs (loss of control)
Recruiting faculty Change in teaching style Comparability