Resident-led Curriculum Reform Letting Residents help you improve your Curriculum

Presenters  University of Missouri-Kansas City Department of Community and Family Medicine  Rose Zwerenz, MD  Family Medicine Clerkship Director  Predoctoral Director  Drew Glover, MD  Chief Resident  Medical Student Education Committee Resident Chair

Objectives  By the end of the session attendees will have:  Learned about our experience with resident-led curriculum reform  Reflected on their own experiences as medical students and residents and how those experiences shaped them as educators  Gained the tools to get residents to buy-in to medical student education  Collaborated with other attendees to discuss ways in which they might implement resident-led curriculum reform within their clerkships

History of the UMKC School of Medicine Clerkship  6 Year Medical School with combined MD/MBA Program  98% of first year medical students are 18 year old new high school graduates  All students have one half day of “continuity clinic” per week during the final four years at the University Hospital  All students are assigned to a Docent unit with an internal medicine physician acting as a Docent for the final four years of medical School

History of the UMKC School of Medicine Clerkship  All Students have 2 months of inpatient internal medicine in each of the last three years at the university hospital (6 months total)  Students have little or no contact with Family Physicians during the first three years of medical school

History of the UMKC School of Medicine Clerkship  Two non-consecutive one month Family Medicine courses are required in the curriculum  The Year 4 (of 6) Family Medicine I required Clerkship  Offered in the University affiliated community hospital 20 miles from the university based medical school  Prior to curriculum reform the clinical experience was a combination of inpatient and outpatient assignments, mirroring those of residency  There was little continuity of contact with learners and teachers  The FM I clerkship ranked in the lower 1/3 f all required clinical rotations

History of the UMKC School of Medicine Clerkship  The Year 5 Family Medicine II required rural preceptorship  Offered in underserved areas in the state of Missouri  Private physicians mentor the students in established community practices and offer one on one supervision and education in a family medicine setting  This Clerkship is consistently ranked #1 or #2 of all required clinical rotations in the School or Medicine

Involving Family Medicine Residents in Clerkship Curriculum Reform: “Why, How and Who”  Why:  Student Evaluations of the FM I clerkship  Mid-Month Evaluations  The Student Schedule  Student Evaluations of Residents  FM Resident feedback  Spiraling downward trend over the past years in the number of UMKC graduates choosing FM as a career

Involving Family Medicine Residents in Clerkship Curriculum Reform: “Why, How and Who”  How:  Initiatives to shape the clerkship experience to be a reflection of Family Medicine as a specialty rather than as a mirror image of the residency curriculum  A Full day retreat focusing on the Family Medicine I Clerkship  Development of a subsection of the Family Medicine resident curriculum on teaching residents how to teach medical students

Involving Family Medicine Residents in Clerkship Curriculum Reform: “Why, How and Who”  Who:  A second year resident and graduate of the UMKC school of medicine with a interest in reforming the medical student experience  The Family Medicine I Clerkship Coordinator  The Family Medicine Residency Coordinator  Faculty Members of the student Education Committee

The Strategic Plan  Goal:  To continually improve the impact of family medicine experiences in order to better introduce medical students to the concepts and philosophy of our specialty  Aim:  To Expose students to a relevant and vibrant curriculum in urban and rural settings using Board Certified Family Medicine physicians as mentors  Purpose:  To introduce and reinforce the realistic health care needs of more than 56 million uninsured Americans  Target:  To enhance Family Medicine student interest, reinforce Family Medicine practices and policies, address medical school debt and ultimately, to see 18-20% of UMKC school of medicine graduates enter the specialty of family medicine within the next five years

Why this Resident got involved  I had been there...just a moment ago  It was time to pay it forward  I was a poor teacher...and I wasn’t alone  I wanted to change the perception of family medicine within my school of medicine  I wanted my school of medicine to improve its output of family physicians

Getting Resident Buy-In: “The Holy Grail”  The state of medical student-resident affairs upon arrival...bring a helmet  Students perceived as a “time-suck”  Students often disengaged and many residents preferred it that way...but still complained about it  Heard most often during resident discussions about medical students “they slow me down!”

Improving resident perception and MS engagement from the ground: seriously, where’s the helmet  Walking the Walk  Talking the Talk  Peer-level feedback...and sometimes taking the wheel  The Closed-resident meeting; just the perfect spot for an ambush  Setting peer-level expectations  Recruiting for tomorrow

Resident curriculum Changes to Facilitate Clerkship Improvement  Orientation of residents to changes in the Clerkship and why it’s important to them  Giving Residents tools for success as teachers  Residents as Teachers sessions  Residents receive evaluation feedback from students  Where and Who are the resources for Residents as Teachers? YOU can be that resource!

A Win-Win-Win Situation  Benefits for the Students:  More realistic view of primary care and family medicine in particular  1:1 time with residents who know how to incorporate students into a busy clinical practice  Timely feedback from residents  Meaningful interactions with residents  Serve as a MEMBER of the healthcare team with specific responsibilities  Few assignments outside the hospital and a more focused experience in family medicine  More objective clinical evaluations that include behaviorally anchored assessments

Benefits for the Clerkship  Opportunity to demonstrate the benefits of our specialty and mentor our learners in a more organized approach (increased satisfaction among residents and faculty)  Improved consensus and overall reputation of the course  Improved evaluations for course content  Improved evaluation for resident teaching  Improved student interest and desire to consider FM as a career  Improved student awareness of FM and concepts of health care delivery  Improved satisfaction scores for overall evaluation of course content, faculty and resident teaching  Improved ranking compared to other required clinical rotations

Benefits for the Resident  Improvement of teaching skills  Greater understanding of how to effectively engage and mentor a student  Improved interactions with medical students on a daily basis (equals greater satisfaction for resident)  Greater understanding for why my staff does some of the things they do and act the way they act!  Better outlook on medical student involvement  Better understanding of structuring education and a clerkship

Break-Out Groups  Question 1: What was your experience as a medical student interacting with residents?

Break-Out Groups  Question 2: What would you have wanted your medical student experience with residents to be?

Break-Out Groups  Question 3: What barriers do you have to getting resident involvement with your clerkship?

Break-Out Groups  Set a goal for the next 3 months for implementing resident input into your clerkship.

Question and Answer  Thank You for your time!