2012 AAMC
National
Convention
Update
Mindy Colgrove
Primary OSR Representative
Student-Raised Issues
 Wellness
 Diversity
 Reporting
mistreatment in medical
education
 Sharing standardized high-quality lectures
across campuses
 Increasing financial debt and how students
handle their financial debt
 OSR’s role in LCME accreditation for each
school
OSR Sessions
Thoughtful Points
 Many
students don’t understand that
Medicare helps fund residencies so cutting
the Medicare budget cuts the residency
budget as well.
 When you sign up for the role of a physician
you automatically sign up to be a role
model and a leader even if you don’t want
to be one.
 We are born patients and will die patients.
Look at things from the patient’s
perspective.
Important Issues
 Anonymous
reporting by staff and peers on
poor professionalism is important
 GRMC meetings: AAMC group which deals
with regional campus issues
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92 regional campuses in the US and 14 in
Canada
>50% of medical schools have a regional
campus
1st ever OSR liaison on the GRMC committee
currently; he takes student concerns about
regional campus issues to the AAMC directly
Breakout Session
 Social
media: If you don’t make your own
online presence, someone else will do it
for you and it may not be good. Put out
correct information about who you are
rather than having to change your
Facebook name during residency
application dates.
 Honor the Humanism In Medicine Award
nominees locally to guarantee they are
recognized for their achievements.
Methods At Other Schools
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Changes to curriculum grading:
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School surveys sent to recent grads/interns for their
opinions on grading because they interact with people
trained at other schools and have their skills tested
Mistreatment reporting:
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Committee reviews anonymous complaints
Hotline pager or answering machine
Discuss examples at student orientation (i.e. pimping to
the point of public humiliation)
Fine faculty like athletes based on the number/severity
of complaints
Is the aftermath/backlash a deterrent to student
reporting?
We all have a duty to report observed mistreatment
Poster Session
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Baylor College of Medicine – Baylor Community Service
Day: 5-6 hours of service in the community on the
Saturday of orientation for M1s
Cleveland Clinic Lerner College of Medicine of Case
Western Reserve University – Cleveland Clinic Lerner
College of Medicine's Capstone Experience: 2 weeks
around match day, ACLS accreditation over 2 days,
review of some important basic science and condition
management info necessary for intern year
Eastern Virginia Medical School – Anatomy Guy:
Engaging the World by Engaging Students and Faculty in
Vertically Integrated Medical Curriculum for the Web
Indiana University School of Medicine – Indiana University
Simulation Integration Rubric (IUSIR): interprofessional
simulation with nursing and medical students, 2 years on
the same team, learn each other’s role and how to
interact with each other on cases via simulation
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Texas A&M Health Sciences Center College of Medicine –
OSR Role During LCME Preparation and Site Visit: have the
faculty speak to the students about what they need the
students to know and do, have OSR organize PowerPoint
presentations and really inform the students, OSR should
serve as the point person between the faculty and the
students for explaining things to the students and organizing
the students to cooperate and help the school, avoid
sending tons of emails
University of Mississippi School of Medicine – Designing a
Medical School Capstone Course: a couple weeks during
the 4th year, transition to intern year with topics like 1) caring
for a critical patient, 2) fluid management, 3) managing
airways, and 4) common residency complaints, allow each
individual the opportunity to fail in a simulation setting rather
than with a real patient so they can learn from mistakes prior
to residency
University of Oklahoma College of Medicine – Capstone:
The Culmination and Highlight of Curriculum 2010: 9 weeks,
each one reviews one of the major science topics,
lectures/grand rounds/simulations/interactive sessions,
question of whether more appropriate for M2 rather than M4
NBME
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comprehensive basic and clinical science exams
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pretest questions are embedded in all exams
exams can be taken at Prometric centers
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assess prep for USMLE
away students can utilize
customized assessments for staff
clinical science mastery exams – new self
assessments for preparation for clerkship exams,
50 questions, started November 1st, $20, will try to
bundle within next year
plan to enhance feedback about student
pacing on exam
step 2 CK passing score changed over summer
and will be reviewing CS standards next month
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Step 2 CS changes:
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1) for each case patient will watch for specific behaviors to assess
communication skills, looking for 5 skills (foster relationship, support
emotions/empathy, gather info, provide info, help patient make decisions, and
soon will include 6th - enable patient behaviors/behaviorally council someone),
no longer effective to ask all the questions you can think of to get the checks
on a list, will assess these skills in more detail over next several years, you will be
expected to modify your behavior based on the case/symptoms
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Examinees demonstrate the ability to foster the relationship by listening attentively
and showing interest, care, concern, and respect.
Skills in gathering information are demonstrated by establishing a chronology of
the primary problem, including any additional concerns of the patient, and by
encouraging the patient to explain the situation in his/her own words, including
describing priorities, worries, and/or explanations of how the health issue has
affected the patient.
Skills in providing information are demonstrated by giving an explanation of what
is likely occurring, using clear and understandable statements; matching the
amount of information and content to a patient’s need and preference; and
encouraging and answering questions, while checking for patient understanding.
Helping the patient make decisions is demonstrated by outlining what should
happen next, linked to a rationale, and by assessing a patient’s level of
agreement, willingness, and ability to carry out next steps.
Examinees demonstrate ability to support emotions when a clinical situation
warrants by seeking clarification or elaboration of the patient’s feelings and by
using statements of understanding and support.
2) patient note – will still have to report what was learned/found in history and
physical but now will have to only list 3 differential diagnoses (instead of 5) and
explain how the info you learned supports them, don’t leave blanks assuming it
carries over from what’s already written! (this is the biggest mistake students
have been making)
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Step 3 changes: in 2014 it will become 2 separate
days of exams rather than 1exam over 2 days, no
longer required to take on back-to-back days, will
enhance foundational science to assess similar
material as step 1 but in a clinical context, eventually
would like to have patient care exam and other
competency exam, will still be 1 score for now until
properly functions separately (about 1 year) then will
give 2 scores
DSMV scheduled to come out in May, all psychiatry
items on all exams will be reviewed, initially NBME will
only use questions that will not be affected with
changes
Will be getting rid of 2 digit scores on USMLE exams
within next year or so because the 3 digit score is used
for assessment more often
examples of exam literature interpretation questions
on website, this type of question is on step 2 and 3
currently
NRMP – Residency Match
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SOAP = supplemental offer and acceptance program
600 PGY1 positions were added in 2012 but the number
of applicants increased more, 95% of allopathic
students matched and 75% of osteopathic students
matched, 8:1 ratio of unmatched students to unfilled
positions (13:1 when considering students who didn’t
rank on the initial application)
US seniors increased by 1100, independent applicants
increased 20% (about 2000)
to participate in SOAP a student MUST be eligible to
participate in a residency by July 1
residencies can choose not to participate in SOAP but
most do
the open spots for SOAP are usually 1 year preliminary
programs in the areas of internal medicine and surgery
or family medicine positions
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round 1 of SOAP had 2 rounds and 260 spots of the
1246 open spots remained after those rounds (only
1131 participated), 106 spots remained after the
second day of matching, and 98 remained in the
end
seniors do better than those who take a year off
odds of matching through SOAP are NOT good,
you’d rather match the first time
this year the all-in policy is starting, all US allopathic
seniors must be offered positions through a match
and cannot withdraw themselves, programs must
place all or no positions in the match (must attempt
to fill all) except for accelerated programs/rural
programs/off-cycle residents starting before
February 1/dual ACGME and AOA programs/military
selection board applicants in a civilian program
nrmp.org
ERAS – Residency Application
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MyERAS 2013 dashboard – central page with
progress of each part (summary/review)
PDF version of user guide is the most exhaustive
resource and the power points hit the “high spots”
MyERAS worksheet simulates application
experience prior to registration opening
Twitter account launch in December
applicants have ERAS access for SOAP at noon on
Monday for 1 hour to do research on programs,
have from 1pm on Monday until 11:59 am on
Wednesday to use 30 applications and two
following rounds each with 10 applications to use
by Friday
Learner Mistreatment
Learner Mistreatment
 Most
common areas include: gender, sexual
orientation, physical harm, and public
humiliation
 On the 2012 Graduate Questionnaire (GQ) 16
% of students had experienced sexual
harassment and 34% had experienced public
humiliation
 Not everyone has the right to teach, and if
they can’t figure out how to teach without
mistreating learners after being warned they
should be removed from the teaching position
 Mistreatment should be considered under
professionalism
Learner Mistreatment
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Many people don’t recognize or report mistreatment
because they expect certain experiences in the
medical education culture
Faculty:
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Train faculty to give their peers feedback about what is
considered mistreatment rather than the administration
giving feedback
Use online modules for faculty training
Train entire department what is considered mistreatment
Do grand rounds with each department and show them
their own data (degree of mistreatment reports filed
against that department’s personnel) and give more
intervention to the departments with more violations
Learner Mistreatment
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Deliver the information about a
violation/accusation to the offender right away (90
second warning or coffee meeting) rather than
waiting until it’s too late to intervene or everyone
forgets the details about the event in question
We come into medical education as learners, and
before we know it we’ve become one of “them”
Our medical education culture is that of an
abusive family
Misuse of power vs. positive/constructive use
Gray zones in definition:
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a little “pimping” pushes learners to achieve/prepare
excessive pimping when the student clearly doesn’t
know the answers causes public humiliation
New Visions
Dr. Erik J. Topal
New Visions
 The
creative destruction of medicine –
medicine will never be the same
 Patient online health communities recently
created for patients (and their families) with
specific conditions to provide info and
support
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They’re publishing articles
Patients trust their online peers more than their
physicians in most cases
 Johns
Hopkins closed a medical school
library because it wasn’t being used (many
books are online now)
New Visions
 Zeo
EEG headband connects to phone or
radio and records brain waves during sleep
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Popular among athletes to improve
performance through sleep monitoring
Online competitions for best sleeper
 Phone
apps for monitoring BP, glucose, etc.
(attach a device to the phone which takes the
measurement, and the app reads and tracks
the measurements)
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One glucose measuring device remains on the
body and takes measurements every minute to
help with food choices
New Visions
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AliveCor EKG for iPhone uses finger leads (place
left finger and right finger in specific spots) to
create an EKG image on the phone screen
In the future it will be possible to measure all vitals
with one app (already created but waiting for
approval)
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Will be able to monitor vitals remotely with the
patient in their own home
Heart attack ring tone goes off when it senses an MI
Skin Skan: take a picture of a mole, etc. with the
phone and an algorithm determines whether or
not the patient should seek medical attention for
a biopsy
New Visions
 An
eye refractor can be attached to the
phone to give a prescription, avoiding visits
to the eye doctor to update glasses
 The idea to measure labs (thyroid, liver,
electrolytes) using phones has been
discussed
 Chips can be put in pills to monitor
compliance when it is vital (i.e. TB drugs)
 A pocket-sized ultrasound device was given
to all Mount Sinai M1s; they are using these to
look at every patient’s heart like an
echocardiogram rather than just relying on
heart sounds via stethoscopes
New Visions
 An
app exists which shows all the variants in
your genome and their implications after it is
sequenced
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Mount Sinai M1 class had their entire genomes
sequenced
In an NPR survey 81% of participants said they
would have their genome sequenced if they
could afford it
 We’re
going to be using algorithms a lot
more in the future
 Virtual visits will become more important,
and hospitals will be reserved for critical
patients only
New Visions
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Only 1/3 of doctors communicate with patients
via email
A study showed that patients feel better after
reading the doctor’s notes, don’t take offense to
what’s written in the note, and adhere to their
meds better after reading the note
We’re not informing patients about how all the
scans we perform are going to affect them in the
long run (high levels of radiation exposure,
especially for the severely ill)
New medicine participates with the individual
and can be remarkably preventative
New Approaches
Sal Khan: hedge fund account manager  founder
of the Khan Academy
New Approaches
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The Khan Academy promotes a free world-class
education for everyone by providing online
videos for various subjects and education levels
(including medical school)
60 million users to date, 36 staff members, >6
million unique users per month
Google and Gates Foundation fund the
program
Lessons go through a logical progression as
concepts are mastered rather than receiving a
bad grade on a test and moving on to a more
advanced idea which requires mastery of the
concept you performed poorly on
New Approaches
 The
Khan Academy was created as a
supplement to existing schools, but it has
started replacing traditional lectures (do
videos on own time) so that classroom time
can be more interactive
 Analysis of the Khan Academy’s data shows
that students can go from the middle or
bottom of the class to the 2nd or 3rd student
in the class when they are allowed to work
at their own pace
 5th graders are doing trigonometry with the
program and think it’s 6th grade math…
New Approaches
 Kids
in other countries who have to work
instead of going to school can use the Khan
Academy
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Orphans in Mongolia recently started using the
program and making videos in their own
language
In the last year 24 employees reached 216
countries
 Wikipedia
has 1/10th the errors of Britannica,
etc.
 The Khan Academy isn’t a crowd source site
 consistent high quality, credible
background, comments made by reviewers
and errors fixed quickly
New Approaches
 Teachers
should not feel threatened because
the goal is not to replace teachers and
physical classrooms in med school; they
want to enhance the experience
 Dr. Rishi Desai is a resident helping to make
videos for medical education, including core
med school content; he’s the one to talk to
about collaboration in medicine
 MCAT prep course is something they want to
collaborate on
New Approaches
 There’s
no reason why there should be a
lecture when people get together, more
cases/conversations/questions can be done
in person
 Accelerate the 1st 2 years and spend more
time in the hospital
 The students are more likely to show up day
1 of class knowing the info  the future
MCAT could be step 1
 Medical school should focus more on
communication for assessments
New Approaches
 This
isn’t about replacing teachers; he wants
to make it a more humanizing experience
when we get together in class rather than a
teacher talking at the students
 The online lessons are a source of info like a
textbook so the teacher doesn’t have to
cover everything; textbooks are really
what’s in danger
 This method is really good for the factual
info that you really need to know and for
review (i.e. Anatomy, Microbiology,
Biochemistry, etc.)
New Approaches
A
great teacher should scale themselves up
and try to reach millions through online
lessons rather than feeling threatened in a
smaller classroom
 There’s a high level of scrutiny regarding
biases; a topic with multiple views can have
multiple videos put online (each depicting
one of the views)
 Sal Khan would like collaboration on ideas
for how to make this online material
interactive in class
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All OSR sessions
(even the ones
Mindy could not
attend) are
posted here with
PowerPoints:
https://aamc.exp
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map.sessResults&s
ponsor=Organizati
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Questions?
Contact your primary OSR
representative: Mindy Colgrove
mccolgrove@huskers.unl.edu