Troubleshooting Your Clerkship 104:
Teaching Challenges
Alan P. Ladd, MD
aladd@iupui.edu
Disclosures
• Published evidence provided where possible
• Personal Commentary (*)
• Comments do not necessarily reflect the views
of the Indiana University School of Medicine
Disclosures—why me?
•
•
•
•
•
Clerkship Director for 7 years
340+ students
Central Campus (6 hospitals)
8 statewide, regional sites
I know JOE
General Surgery at the
Academic Health Center
“The Mecca”
General Surgery at AHC
• Medical Center or Traditional University Hospital
– Specialized and Sub-specialized services
• Typical Services
– “Whipple-a-day” service
– “Only Breast and Thyroid” service
General Surgery Clerkship
• Training models for MS3 clerks
– Inherent to the Medical Center (traditional)
– Curricular models slow to change
– Lack of opportunities to change
Novel Clerkship Models
• Completely Distributed System
– Multiple regional campuses
– Student Apprentice Model
– Regional oversight for instruction
– Central oversight for Curriculum, Resources,
Outcomes
EL Bradley et al. JSR 177 (2012) 14-20
TCW Yu et al. JSR 168 (2011) e17-e23
Novel Clerkship Models
• Non-Academic Clerkship Model
– Use of Community hospitals
– With or without Academic structure of
residency
M Williams, et al. JST 116 (2004) 11-13.
Novel Clerkship Models
• Surgical Subspecialty Model
– Use of Subspecialty surgery rotations
– High Ambulatory patient population for
instruction
MK Sandquist et al. JSR 153 (2009) 152-5.
Poenaru et al. Amer J Surg 175 (1998) 515-517
Novel Clerkship Models
• Common Themes
– Centralized Curriculum Oversight
– Identical Educational Objectives/Resources
– Faculty Development/Instruction
– Monitoring of Outcomes
The Solutions to
General Surgery at AHC *
• Mindset Change (for CD/Chair/Department)
• Education not about the Emersion
• Universal, Reproducible Surgery Curriculum
• Faculty Development
Clerkship is not Emersion
• Service and/or Hospital becomes Context
• Not Team dependent
• Team can be redefined
Universal Curriculum
• Identical Objectives
• Standard Teaching Material & Resources
• Standard Assessments
• Pedagogical Options
Faculty Development
•
•
•
•
Shared Educational Goals
Common Understanding of Objectives
Awareness of Resources
Updated Versions
Surgery Core Curriculum
• Successfully Navigating the First year of
Surgical Residency: Essentials for Medical
Students and PGY-1 Residents
• ( National Curriculum)
• Guidebook for Clerkship Directors, 4th
Edition
Developing Core INSTRUCTION
• Didactics
• Experiential Opportunities
• Skill Instruction
• Always remember equivalency (LCME)
The IUSM Example
•
•
•
•
•
•
Core topic Small Group Discussions
Lectures—Surgical Nutrition, Ventilators
Clinics—Breast Oncology; Colorectal
Calls—Acute Care Surgery/Trauma
Skills—Venipuncture; Suturing; Foley
Patient Assessment—Simulation
General Surgery at AHC
• Curriculum, Objectives, and Instruction that
Compile to make a General Surgery
experience
General Surgery for the
“Non-surgical” Students
“Non-surgical” Students
• Who are our learners?
• 90+ % of students are not surgeons
• What should be our Educational Mindset?
The Generalist Education
• Clinical Encounters
MJ Curet et al. Am J Surg 178 (1999) 78-84
MJ Curet et al. Am J Surg 178 (1999) 78-84
The Generalist Education
• Clinical Encounters/Diagnoses
– Higher interest in topics of subspecialty surgery
– Orthopedics
– Otolaryngology
– Ophthalmology
• Not trauma, vascular problems, CAD, PE
MJ Curet et al. Am J Surg 178 (1999) 78-84
The Generalist Education
• Skill Proficiency
MJ Curet et al. Am J Surg 178 (1999) 78-84
MJ Curet et al. Am J Surg 178 (1999) 78-84
The Generalist Education
• Skill Proficiency
– Shared importance of Documentation
– Highly rated “office procedures”
– Wound Management, Epistaxis, Abscess
MJ Curet et al. Am J Surg 178 (1999) 78-84
The Generalist Surgical Education*
• Not always reflective of AHC healthcare
• Higher Subspecialty emphasis
• Office-based procedural elements
The IUSM Example
• Core Discipline didactics
• Skills—Casting/Splinting; Vascular Exam
• TBD
The Generalist Surgical Education*
Resources
• WISE-MD
• Lawrence Text: Essentials of General Surgery
Headline Here
No More Than 2 Lines
•
•
•
•
Body text here. Never center bulleted text.
Line 2
Line 3
Line 4 – no more!
Headline Here
No More Than 2 Lines
•
•
•
•
Body text here. Never center bulleted text.
Line 2
Line 3
Line 4 – no more!
• Bullet text here. Never center bulleted text.
• Item 2 might be a single line of text.
• Line 3 might be a bit longer, and could wrap to
a second line.
• Line 4 should be the last bullet on your slide!
Major Title Slide
Limit to 2 Lines
Major Title Slide
With a subhead
Headline Here
•
•
•
•
Body text here. Never center bulleted text.
Line 2
Line 3
Line 4 – no more!