Faculty Development, May, 2015
rd
TCMC’s 3 Year Redesign
Dr. Linda Berardi-Demo
Associate Dean of Student Affairs and Admissions
Brian Wilcox, MD, PhD.
Assistant Dean for Clinical Education
Disclosures
•
The speaker and planners of this event do
not have any relevant commercial relationships
to disclose.
• The content of this presentation is not based
on topics related to any commercial interests as
defined by the ACCME.
Outline
• Basics of the Redesign
– Schedule, Grading
– “What they know”
• LIC Component
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Schedule
Continuity Patients
Assessments
Logging
• Block Component
– Schedule
– Assessments
– Logging
• Learning Environment
3rd Year Revision
• Basic Design:
• Half of the students in a region will do an
uninterrupted LIC for the first half of the year.
• Half of the students in a region will do “block”
rotations for the first half of the year.
• The groups will switch in January.
Fall Semester (25 weeks)
Core Week (Scranton)
Orientation Week (Regional Sites)
3rd Year in
Review
23 weeks of LIC/Blocks
Holiday Recess (2 weeks)
Spring Semester (25 weeks)
Core Week
23 Weeks of LIC/Blocks
Core Week
3rd Year Revision
LIC Half:
• ½ day of Outpatient Internal Medicine
• ½ day of Outpatient Family Medicine
• ½ day of Outpatient Surgery
• ½ day of Outpatient Obstetrics and Gynecology
• ½ day of Outpatient Pediatrics
• ½ day of Outpatient Psychiatry
• 3 x ½ day of “White Space”
• ½ day of Clerkship Education (Fri. afternoon, CED)
• 80 hours of Emergency Medicine
3rd Year Revision
“Blocks”:
• 4 weeks of Inpatient Adult Medicine (IM or FM)
• 4 weeks of Inpatient Surgery
• 1 week of Anesthesia
• 3 weeks of Inpatient OB/GYN
• 3 weeks of Inpatient Psychiatry
• 2 weeks of Inpatient Pediatrics
• 4 weeks of “Elective”
• 2 weeks of “Selectives”
• Includes ½ day per week of CED
Clerkship Grading
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20% LIC Preceptor Evaluation*
20% Inpatient Block Evaluation*
20% Objective Clinical Exams (OSCEs)
30% NBME “Shelf ” exams
10% Clerkship Education Day Presentations/TBLs
So….What do they Know?
• Communication Skills (~18 hours)
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Learning through Listening (M1)
Responding to Emotions (M1)
Cultural Differences (M1)
Sexuality and Sexual issues (M1, M2)
Breaking Bad News (M2)
Working with interpreters (M2)
Adolescent Interviews (M2)
Depression (M2)
Elderly Interviews (M2)
So….What do they Know?
• Physical Exam Skills (18-25 hours)
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Vital signs (M1)
HEENT Exam (M1)
Chest/Abdomen Exam (M1)
Musculoskeletal Exam (M1)
Neuro Exam (M1, M2)
Newborn Exam (M2)
Female and Male Genital exam (M2)
Breast Exam (M2)
Clinical Skills (foley, suturing, IV, injections)
• Written Notes (M2)
MD3 Core Week
• Internal Medicine and Family Medicine:
– The IM/FM Experience
– Communication in IM/FM
– Respiratory Infections
– Assessment and Management of HTN
• Surgery:
– Educating the Millennial Surgeon
– Introduction to Surgery
– Suturing Workshop
MD3 Core Week
• Psychiatry:
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History Taking
Managing the Agitated Patient
Mental Status Exam
Practical Psychopharmacology
• Pediatrics:
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Fluids and Electrolytes
Interview/Exam of the Pediatric Patient
Acutely Ill pediatric Patient
Pediatric Emergencies
MD3 Core Week
• Obstetrics and Gynecology:
– Review of Labor & Fetal HR tracings
– Birthing Simulation
– OB/GYN History Taking
– OB/GYN Note-Writing and Oral presentations
LIC Component Details
• 23 Uninterrupted weeks
• Reduced from 37 weeks – all are required
• 5 Continuity patients/Discipline
• 3+ Separate encounters/patient
• Help them choose
• Assessments
• Early Warning : 4 weeks
• Formative: 8-12 weeks
• Summative: After 23 weeks
• Logging of Activities
LIC Component
• 23 Uninterrupted Weeks
– No unexcused absences
– Plan for extra sessions if necessary
– Notify the Region a.s.a.p. for issues
Continuity Patients
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Five (5) per discipline
Deliberate follow-up
At least 3 encounters/patient
Partner in management
Assessments
• Early Warning at 4 weeks
• Mid-LIC (Formative)at 8-12 weeks
• End-LIC (Summative) at 23 weeks
– Simplified:
• 8-9 questions
• Based on Entrustable Professional Activities
Assessments
• Early Warning
– After four (4) sessions
– Four (4) Questions
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Knowledge: Appropriate?
Skill: Appropriate?
Attitude: Interested and eager to learn?
Behavior: Punctual, Professional?
Assessments (mid LIC, end LIC)
1. Appropriate History and Physical?
2. Appropriate Differential Diagnosis?
3. Recommend and Interpret Appropriate Tests?
4. Recommend Treatment Plans/Counseling?
5. Appropriate Oral Presentation of an Encounter?
6. Appropriate Documentation of an Encounter?
7. Professional, Punctual, Polite?
8. Eager, asks questions, seeks information?
Example Assessment Question
• Can the student gather a pertinent history and
perform an appropriate exam?
 N/A: I was unable to assess /evaluate this skill
 Incomplete or unfocused; forgets important history
components or fails to notice important exam findings
 Obtains most pertinent information and identifies most
common findings; forgets some commonly-missed details
or subtle exam findings
History and exam are always complete, precise, detailed,
focused and organized; elicits subtle findings
Example Assessment Question
• Can the student develop a prioritized differential
diagnosis and select a provisional diagnosis?
 N/A: I was unable to assess /evaluate this skill
 Frequently misinterprets data; diagnoses are frequently
incorrect or not well prioritized.
 Usually creates a reasonable differential diagnosis and correct
provisional diagnosis; makes common misinterpretations of
data or forgets some less-common diagnoses.
 Broad mastery of knowledge, understands complex issues and
includes major and minor problems; insightful prioritization.
Logging
• Continuity Patients:
– 5 per Discipline
• Skills:
– Two Times per 23 weeks
• Directly-Observed History-Taking
• Directly-Observed Physical Exam
• Directly-Observed Counseling
• Diagnoses Encountered:
Block Rotations
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4 weeks of Inpatient Adult Medicine (IM or FM)
4 weeks of Inpatient Surgery
1 week of Anesthesia
3 weeks of Inpatient OB/GYN
3 weeks of Inpatient Psychiatry
2 weeks of Inpatient Pediatrics
• 4 weeks of “Elective” (P/F)
• 2 weeks of “Selectives” (P/F)
• Includes ½ day per week of CED
Block “Selectives/Electives”
• “Selectives”: 2 weeks
– Radiology
– Pathology & Laboratory Medicine
– Neurology
• “Electives”: 2 or 4 weeks
– ANY discipline (includes Medicine Subspecialties)
– Must involve care of patients
Inpatient Blocks
• Learning Objectives have been revised.
– Syllabi will be distributed
• Continuity Patients – can be followed to the LIC,
or from the LIC
• Logging still required
• Assessments:
– Mid block (logged)
– End-of-Block
– Shift Cards
Assessments
1. Appropriate History and Physical?
2. Appropriate Differential Diagnosis?
3. Recommend and Interpret Appropriate Tests?
4. Recommend Treatment Plans/Counseling?
5. Appropriate Oral Presentation of an Encounter?
6. Appropriate Documentation of an Encounter?
7. Professional, Punctual, Polite?
8. Eager, asks questions, seeks information?
Learning Environment
Dr. Berardi-Demo
• Teacher Learner Compact
• Student Mistreatment and the clinical
environment
• Commendations and Celebrating the Positive
Learning Environment
• Support and Resources
Questions?
Estimate # of Students per Site
# of
Students
Comments
37
Includes 14 at
Pocono
South
27
Includes 8 at
Geisinger
West
14
…
Guthrie
17
…
Site
North
Example Schedules
North
(Main)
North
(Pocono)
South
(Main)
South
(Geising.)
West
Guthrie
TOTAL #
23
14
19
8
14
17
LIC
11-12
7
9-10
4
7
8-9
IM
2
1
2
1
1
2
Surgery
2
1
2
1
1
2
Psych
2
1
1
1
1
1
Peds
2
1
1
1
1
1
OB/GYN
2
1
1
-
1
1
Selective
1
1
1
1
1
Elective
1
1
2
1
1
-