Transforming Clerkships into an Integrated Longitudinal Learning Module: Model Madres: Maternal, Child and Family Health Adriana Padilla, MD Susan Hughes, MS UCSF Fresno Medical Education Program

Background Clinical education reform is needed (1) National concern that the current clinical training model is poorly aligned with society’s present and future health care needs (2) New models of clinical education need to address a lack of connection or continuity among different learning experiences (2) Two current models of integrated clinical education; Longitudinal integrated clerkship model (LIC) and Hybrid models (integration and longitudinal patient care within traditional clerkships) 1. Irby DM. Educational continuity in clinical clerkships. N Engl J Med. Feb 22 2007;356(8):856-857. 2. Hirsh DA, Ogur B, Thibault GE, Cox M. "Continuity" as an organizing principle for clinical education reform. N Engl J Med. Feb 22 2007;356(8):858-866.

Objectives Design and implement a new 3rd year clinical educational model that integrates a thematic approach to learning clinical medicine in maternal, child and family health at UCSF Fresno. Incorporate continuity as the overarching theme of our new curriculum (continuity of site, continuity of peer cohort, continuity of care, continuity of mentoring) Test the effectiveness of this innovation via a core competency plan, pre/post survey and attitudinal assessments from focus groups. Evaluate the impact on programmatic resources

Design 7 student participants 6 month model Pre-program ramp up for orientation Longitudinal training Integrated learning Community based education Structured mentoring

Methods Pre-Program Ramp Up Transitional clerkship time (2 days) for introductions and orientation Hospital systems orientation Community orientation via a “treasure hunt” Review each discipline’s objectives and competency cards Review patient’s options for financing of health care

Methods Longitudinal Training Continuity practice with pediatric, obstetric and family medicine patients Individual student schedules Detailed orientation for promoting patient care follow-up/continuity

Methods Integrated Learning 2 half-days for interdisciplinary education each week in a small group format Curriculum coordinator

Methods Community based education 4 learning opportunities with community based organizations to enhance care of the underserved (Poverty Medicine, Hmong Health, Indigenous Health, and Elder Care) Reflection exercises

Methods Structured Mentoring Mentors from each discipline (ob-gyn, pediatrics and family medicine Faculty Development for mentoring 3 mentors for each student, representing each discipline Formal mentoring meetings 3x over program Mentor prep meetings

Other Benefits Medical Spanish tutorials Travel Stipend Planned vacation schedule Study sessions for final examinations in each discipline

Evaluation Plan Core competency based Pre/Post Survey Attitudinal assessments from focus groups Impact on Programmatic Resources

Core Competency Based Plan Shelf Exam X E*Value Structured Clinical Observation Patient Satisfaction Clinical Practice Exam Chart Audit Community Project Learner Portfolio

Preliminary Results Students met continuity patient care goals Students met core learning goals Patient satisfaction high CPX scores within one SD of entire class Pre/Post Survey results show improvement in SOAP note writing Use of translators Focus group results are mixed

Discussion Educational goals were met Optimum integration of the participating clerkships was not met Challenges were many Logistics space needs programmatic resources educator preparation and buy in

Conclusion Hybrid models, like Model Madres, are innovative and integrative and meet core learning objectives Hybrid models can face multiple challenges Ongoing educational research of the outcomes from the educational design of the clinical core either by LIC or Hybrid models is needed

Acknowledgments Academy of Medical Educators innovations award, 2007-2008. UCSF Fresno leadership in supporting and encouraging collaborative training and innovation.