A Multidisciplinary Transitions in Care Workshop for Medical Students Melissa Morgan-Gouveia, MD Lauren Block, MD, Danelle Cayea, MD, MS Johns Hopkins University School of Medicine

Disclosures The research reported during this presentation was supported by the Donald W. Reynolds Foundation and the Daniel and Jeannette Hendin Schapiro Geriatric Medical Education Center. The investigators retained full independence in the conduct of this research.

Background AAMC core geriatric competencies include The ability to “communicate the key components of a safe discharge plan (e.g., accurate medication list, plan for follow-up)” Medical students perceive knowledge gaps related to the discharge process Current medical student education in transitions of care is inconsistent Leipzig RM, et al. Acad Med. 2009; 84:604-10. Drickamer MA, et al. J Gen Internal Med. 2006;21:1230-1234.

Needs Assessment National Local Few formal curricula, tend to be: Lecture or large group Focused on single topic, e.g. medication reconciliation Not multidisciplinary or evidence based Mostly informal / part of the “hidden” curriculum Local Existing curricula on hand offs and post-acute care No formal curriculum about the discharge process Buchanan IM, Besdine RW. Acad Med. 2011;86:628-639.

Objective To develop, implement, and evaluate an evidence-based curriculum for medical students to acquire knowledge, attitudes, skills, and behaviors that facilitate patient safety during transitions of care

Curriculum Developed and implemented 3 hour workshop for 3rd year medical students at midpoint of basic medicine clerkship Interactive small-group sessions focused on case-based learning of key skills including: Medication reconciliation Identifying discharge barriers Discharge instructions Discharge summaries Communication with outside providers Multidisciplinary team collaboration

Educational Methods Small group stations were facilitated by pharmacists, nurses, case managers, and internists Case discussion Role play Discharge instructions PMD phone call Discharge summary review Medication reconciliation exercise

Educational Methods A large-group reflective exercise before and after the small groups was used to contextualize learning within students' clerkship experiences Mini-CEX where physicians or nurses observe students giving a patient discharge instructions

Program Evaluation Approved by JHUSOM IRB Workshop evaluation Pre/Post survey Domains: Frequency, skills Process: Peer review, student tested Qualitative assessment of reflective exercise

Workshop Evaluation 103 out of 121 students completed the workshop evaluation (85%) Students rated the session highly overall Mean 3.70, std dev 0.51 Scale: 1 (poor) to 4 (excellent)

Results 84 out of 121 students completed both pre and post surveys (69%) Students report being involved in the discharge process Most common tasks: Identifying barriers to discharge Medication reconciliation Educating patients at discharge

Student’s Self-Rated Level of Independence in Performing Discharge Tasks

Understanding of Roles of Multidisciplinary Providers Poor Fair Good Very Good Excellent Mean level of understanding

Communication with Multidisciplinary Providers Number of Patients: None < ½ ½ > ½ All Mean frequency of communication

Results Summary Students are involved in the discharge process Increased understanding of the roles of nurses, case managers, and pharmacists in the discharge process Increased communication with other health professionals Increased self-rated independence in performing discharge tasks

Limitations Single academic center No control group Single time point Can’t distinguish effect of curriculum vs. clerkship Pre-survey ratings may have been falsely elevated given limited knowledge of topic Single time point Confidence may not correlate with competence

Conclusions Skills in discharge planning and transitions of care are critical for medical students to learn We have developed a curriculum that is: Interactive, small group based Multidisciplinary Integrated with clinical experiences Feasible within limited time constraints Well received by students Evaluation data suggests students are performing with improved skills and interdisciplinary communication

Next Steps Continue to improve curriculum based on student feedback Disseminate curriculum and curricular materials

Melissa Morgan-Gouveia Questions? Melissa Morgan-Gouveia mmorgan@jhmi.edu