Integrating EM into All 4 Years of Medical School

Editor's Notes

• #3: CV
• #4: CV
• #5: NK What does the literature say? Folks have been publishing on this for years. Nick
• #6: A Case for Emergency Medicine in the Undergraduate Medical School Curriculum.” Russi & Hamilton,Acad EM, October 2005, 994-8 6 Reasons (…for the disconnect…): 1. EM education during all years not clearly endorsed. 2. Faculty resistance in already crowded curriculum. 3. Low EM representation on curriculum committees. 4. Lack of organized national core EM curriculum… CDEM Clerkship Primer, published 3rd, 4th, PEM curricula 5. Already overcrowded ED clinical environment. 6. Lack of creativity & innovation in med student ed.
• #9: CV State medical licensing boards, the National Board of Medical Examiners, the Liaison Committee on Medical Education (LCME), and medical school deans and faculties must ensure that every medical student has acquired the appropriate knowledge and skills to care for emergency patients. This education must be provided through educational experiences supervised by appropriately qualified emergency physicians. EPA= Entrustable Professional Activities “A patient’s chance of survival may be significantly reduced if he or she is managed by a physician without the ability to recognize sick or not sick, without the knowledge base of life-threatening disorders, and without the skill to capably intervene.” Russi 2005
• #10: CV Not just in the ED!
• #11: CV Adding students to an
• #12: CV
• #13: CV
• #14: CV
• #15: NK
• #16: NK Mention Day 1 IntraProfessional Session at OSU
• #17: NK
• #18: CV
• #19: CV
• #22: NK
• #30: NK
• #31: Chad
• #34: Method: After a literature review, the authors surveyed academic deans of all U.S. and Canadian medical schools and colleges (N = 124) to identify those that had implemented a learning community. Those with student learning communities (N = 18) answered a series of questions about the goals, structure, function, benefits, and challenges of their communities.  
• #35: 2006-2008 Data…
• #36: Schools adapt LC’s to their particular needs and while primary goals are common, structures vary substantially. This is evidence of the adaptability of this learning modality. Such curricular topics cannot be accomplished in a large lecture hall and may be addressed more effectively in a small, trusted group guided by a skillful mentor.
• #37: 151 = 134 in US + 17 in Canada
• #38: The reason this graph does not go to 66- not all colleges provided year of LC establishment. 4-6 additional schools with LC’s each year between 2005 and 2011 44% of all AAMC member schools had LC’s as of March 2012.
• #39: LC’s whose structure involved curricula generally had larger budgets that predominately social programs
• #41: Prospective evaluation of medical students perceptions of emerging LCs and their impact on medical student life at University of Iowa Lucille A Carver College of Medicine However, they did move into a brand-spankin new education building between surveys…
• #42: Medical schools in the US are facing critical job satisfaction issues among their faculty. Competing priorities of patient care, generation of clinical revenue, research, administration, and education have contributed to a culture where faculty struggle to find fulfillment. With a baseline of more than 45% of physicians in the United States at risk for burnout (Shanafelt et al. 2012), it is concerning that the pressures of academic medicine may compound this risk. In a recent study, 14% of academic faculty considered leaving their institution during the prior year while 21% considered leaving academic medicine altogether because of dissatisfaction (Pololi et al. 2012). Sources of dissatisfaction are varied but correlate with negative perceptions of the academic culture, such as feeling discon- nected with others and lacking collegial engagement (Bunton et al. 2012). A study of faculty at five medical schools highlighted the presence of a negative relational cultures in academic medical centers ‘‘that can affect faculty vitality, professionalism, and productivity and are linked to retention’’ (Pololi et al. 2009a).
• #44: In summary, the primary purpose for the establishment of LCs is to enhance the educational experience of our learners, rather than enhancing faculty job satisfaction. However, this study supports the importance of LCs for faculty learning and well being, as well. Involvement in an LC offers a faculty member the opportunity to collaborate with colleagues, establish positive and longitudinal relationships with learners, and develop a sense of connectedness with their academic institution. The authors believe that these are the main contributors to the satisfaction found in this study. Given this secondary benefit of LCs, these data could be used to make the financial argument that funding an LC could help with faculty retention (and, therefore, decrease the costs of turnover). Learning communities can address the serious issues that currently exist in the relational culture of academic medicine that have led to dissatisfaction and attrition (Pololi et al. 2009a, b, 2012). Further studies may show that LC’s provide a way forward to fortify the relational culture of academic medical centers and build a greater sense of connectedness among faculty members. Medical schools should consider establishing or enhancing existing LCs not only for the benefit of their students but also for recruitment and retention of talented and valuable medical educators.
• #45: Split to 2 slides?
• #47: Learning Portfolios Each of you will develop a learning portfolio through your participation in the Societies Program. The purpose of the portfolio is to: Provide a repository for your written work (patient write-ups, reflective exercises, etc.) Allow you and your Society Mentor to track your progress Maintain a record of your Society evaluations   Your portfolio will help you assess your personal and professional growth. Your Mentor will periodically review your portfolio with you to help you identify your learning needs. You have access to your portfolio at any time.
• #50: NK
• #51: Logistics Noon Lunch 100 Attendees Supported by Dean’s office Students only at University Hospital CPC Like Format Current M4 on EM rotation Picks a suitable case Interactive H & P with audience M1 from designated Learning Community “Anatomy” “Physiology” M2 from designated Learning Community “Pathophysiology” Interdisciplinary Student “Pharmacology” M3 from designated Learning Community Gives the Diagnosis Hospital Course
• #53: Some experience from Ohio State.
• #54: Clinical Assessment and Problem Solving (CAPS) What is CAPS? CAPS is a new longitudinal course for medical students that integrates some components of the Physician Development (PD) and the Patient-Centered Medicine (PCM) courses. It will span all four years of medical school and focus on student performance of clinical competencies. The new course is also integrated with the basic science curriculum and reinforces and enhances basic science learning. What are the course objectives? We have used the College of Medicine’s institutional objectives to help guide us in the development of objectives for the new course. The CAPS course objectives are: • Interpersonal and Communication Skills: Demonstrate effective interpersonal communication skills while working with patients, families, colleagues and members of the academic and healthcare teams • Professionalism: Understand and demonstrate the tenets of professionalism and ethics in one’s personal and professional life, demonstrating sensitivity and responsiveness to all people • Medical Knowledge/Technical Skills: Acquire and apply medical knowledge and technical skills to the clinical care setting • Clinical Reasoning/ Patient Care: Synthesize and analyze information from the clinical encounter to effectively and appropriately diagnose and treat patients • Self Awareness and Reflection: Develop skills and attitudes needed to engage in self-awareness, reflection and life-long learning • Health Systems Awareness: Demonstrate understanding of the health care and medical education systems to become an effective learner, colleague, teacher and physician How is the course taught? While a small amount of content is delivered in large group settings through lecture or panel discussion, the majority of the course is taught in small groups of 12 students led by a physician facilitator. In this more personal setting, content is delivered using various models. Teaching methods include working through standardized patient and written cases, self-reflection, video discussion, problem-based learning, playing simulated games, and group processing. Who teaches the course? A group of physicians from various specialties (Family Medicine, Internal Medicine, Pediatrics, PM&R, OB/GYN, Emergency Medicine, Pathology) participate as small group facilitators. The course is directed by Dr. Doug Post. What are the components of the course? Med 1 During the first 14 weeks of school, students participate in CAPS: FOUNDATIONS OF CLINICAL CARE. This introductory course includes: • BASIC information on the physical examination (how to take vital signs, the use of PE instruments, where to place the stethoscope to listen to heart sounds, how to palpate and percuss, etc.). Students at this level do not have enough medical knowledge to interpret findings, but begin to understand the basics of the physical assessment while learning gross anatomy. Students practice physical examination skills on one another during small group sessions (and receive feedback on their skills by instructors), and also practice skills on 4th year medical students serving as patient instructors to receive formative feedback on skills. • An introduction to the patient-centered interview and practice interviewing patients using this style. Students practice the essential elements of patient-centered interviewing that are appropriate to their developmental stage: open the discussion, gather information, understand the patient’s perspective, share information, and provide closure. Students demonstrate and practice interviewing skills on one another and on trained standardized patients in the Clinical Skills Education and Assessment Center. Facilitators provide feedback on skills in person, and through digital recording review of student interactions. • An introduction to professionalism as a foundational skill for all physicians • An introduction to careers in medicine through a Medical Careers Fair. • An OSCE (Objective Structured Clinical Examination). At the end of the FOUNDATIONS course, students demonstrate competency in basic patient-centered interviewing style and physical examination in order to complete the Foundations course. Those not demonstrating competency are remediated until skills meet the minimum desired level. During the rest of the Med 1 year, students participate in CAPS 1. This course includes: • Small group sessions are primarily based around the undifferentiated patient. The sessions center on clinical skills and behavioral science topics, and are well-integrated with the basic science curriculum. Within the small group, activities may include interviewing standardized patients, using “paper” cases, group discussions, “take home” readings, “games” to illustrate points, team learning activities, reflective exercises, etc.. An examples of a small group sessions follows: o While the IP students are studying host defense and the ISP students are studying respiratory physiology, students in small groups interview a patient who is having an asthma flare due to a respiratory infection. During the physical assessment, students learn about adventitious breath sounds and wheezing as part of physical diagnosis. In addition, they find that the asthma sufferer is a smoker, and in the behavioral component of the small group sessions, they learn stages of change theory and how to apply them to this patient scenario. They also learn about community resources for smoking cessation and the importance of utilizing these resources to increase the likelihood of cessation. • Longitudinal preceptorship: Once a month from January of the Med 1 year through December of the Med 2 year, students work with a community preceptor to see patients in the outpatient setting. This experience centers around the focused history and physical examination and its longitudinal nature allows the preceptor to help the student develop these skills over time. • Community Project: Students participate in a service-learning project that includes a minimum of 12 hours of service to an agency of their choice and completion of a series of reflective-oriented assignments, including an end-of-year presentation to their peers on the nature of their service work. • Senior Partners: Each student is paired with a geriatric “patient” during this portion of the course. Activities and assignments for the seniors will integrate with the basic science and CAPS curriculum. Course facilitators may run small group discussions or reflection exercises for this portion of the course during small group sessions. For example: o During the pharmacology module, students may obtain a medication list from their senior partner. They may review the list for drug interactions, then contact pharmacies to develop an understanding of the costs of these medications with and without insurance coverage. Med 2 During the Med 2 year, students will participate in CAPS 2. This course includes: • Continued small group sessions centered around the undifferentiated patient, as in the CAPS 1 course, but with increased emphasis on clinical decision-making and skills development • Continued participation in the longitudinal preceptorship through December • Continued participation in the Senior Partners program • Clinical Reasoning: students will participate in problem-based learning exercises and learn clinical reasoning and differential diagnosis skills. • A Hospital-Based Preceptorship during which students will spend time on a service at a local hospital to practice complete histories and physicals on hospitalized patients, and start to participate in formulating patient management plans. • A CAPS 2 OSCE: At the end of the Med 2 year, students will need to demonstrate complete history and physical examination skills through an OSCE. Those who demonstrate competency will progress to the third year, those who do not pass will need to remediate before starting their first clerkship. During the Med 3 and Med 4 years, the components of the course are yet to be determined, but conceptually will include demonstrating competency in advanced communication techniques, generally through standardized patient encounters. For example, this would include: o Demonstration of obtaining informed consent o Demonstration of leading a family meeting o Demonstration of describing a treatment plan to a patient What is the time commitment for a small group facilitator? Small groups meet on either Mondays or Wednesdays for Med 1 groups, or Tuesday or Thursday for Med 2 groups. All sessions take place from 1:30 – 4:30 pm. During the weeks when students do not have small group sessions planned, facilitators will participate in FACULTY DEVELOPMENT sessions. What happens during the faculty development sessions? Facilitators discuss and learn about group process and classroom management, review group activities and plans for upcoming sessions, and discuss specific challenges that are occurring in their groups. These sessions are held approximately once/month from 1:30 – 4:30 pm.
• #56: How many of you have a physician development course?
• #61: Point out Emergency Medicine
• #65: Not to be confused with IPA’s.