Troubleshooting Your Clerkship 104: Teaching Challenges Alan P Troubleshooting Your Clerkship 104: Teaching Challenges Alan P. Ladd, MD aladd@iupui.edu

Disclosures Published evidence provided where possible Personal Commentary (*) Comments do not necessarily reflect the views of the Indiana University School of Medicine

Disclosures—why me? Clerkship Director for 7 years 340+ students Central Campus (6 hospitals) 8 statewide, regional sites I know JOE

General Surgery at the Academic Health Center “The Mecca”

General Surgery at AHC Medical Center or Traditional University Hospital Specialized and Sub-specialized services Typical Services “Whipple-a-day” service “Only Breast and Thyroid” service

General Surgery Clerkship Training models for MS3 clerks Inherent to the Medical Center (traditional) Curricular models slow to change Lack of opportunities to change

Novel Clerkship Models Completely Distributed System Multiple regional campuses Student Apprentice Model Regional oversight for instruction Central oversight for Curriculum, Resources, Outcomes EL Bradley et al. JSR 177 (2012) 14-20 TCW Yu et al. JSR 168 (2011) e17-e23

Novel Clerkship Models Non-Academic Clerkship Model Use of Community hospitals With or without Academic structure of residency M Williams, et al. JST 116 (2004) 11-13.

Novel Clerkship Models Surgical Subspecialty Model Use of Subspecialty surgery rotations High Ambulatory patient population for instruction MK Sandquist et al. JSR 153 (2009) 152-5. Poenaru et al. Amer J Surg 175 (1998) 515-517

Novel Clerkship Models Common Themes Centralized Curriculum Oversight Identical Educational Objectives/Resources Faculty Development/Instruction Monitoring of Outcomes

The Solutions to General Surgery at AHC * Mindset Change (for CD/Chair/Department) Education not about the Emersion Universal, Reproducible Surgery Curriculum Faculty Development

Clerkship is not Emersion Service and/or Hospital becomes Context Not Team dependent Team can be redefined

Universal Curriculum Identical Objectives Standard Teaching Material & Resources Standard Assessments Pedagogical Options

Faculty Development Shared Educational Goals Common Understanding of Objectives Awareness of Resources Updated Versions

Surgery Core Curriculum Successfully Navigating the First year of Surgical Residency: Essentials for Medical Students and PGY-1 Residents ( National Curriculum) Guidebook for Clerkship Directors, 4th Edition

Developing Core INSTRUCTION Didactics Experiential Opportunities Skill Instruction Always remember equivalency (LCME)

The IUSM Example Core topic Small Group Discussions Lectures—Surgical Nutrition, Ventilators Clinics—Breast Oncology; Colorectal Calls—Acute Care Surgery/Trauma Skills—Venipuncture; Suturing; Foley Patient Assessment—Simulation

General Surgery at AHC Curriculum, Objectives, and Instruction that Compile to make a General Surgery experience

General Surgery for the “Non-surgical” Students

“Non-surgical” Students Who are our learners? 90+ % of students are not surgeons What should be our Educational Mindset?

The Generalist Education Clinical Encounters MJ Curet et al. Am J Surg 178 (1999) 78-84

MJ Curet et al. Am J Surg 178 (1999) 78-84

The Generalist Education Clinical Encounters/Diagnoses Higher interest in topics of subspecialty surgery Orthopedics Otolaryngology Ophthalmology Not trauma, vascular problems, CAD, PE MJ Curet et al. Am J Surg 178 (1999) 78-84

The Generalist Education Skill Proficiency MJ Curet et al. Am J Surg 178 (1999) 78-84

MJ Curet et al. Am J Surg 178 (1999) 78-84

The Generalist Education Skill Proficiency Shared importance of Documentation Highly rated “office procedures” Wound Management, Epistaxis, Abscess MJ Curet et al. Am J Surg 178 (1999) 78-84

The Generalist Surgical Education* Not always reflective of AHC healthcare Higher Subspecialty emphasis Office-based procedural elements

The IUSM Example Core Discipline didactics Skills—Casting/Splinting; Vascular Exam TBD

The Generalist Surgical Education* Resources WISE-MD Lawrence Text: Essentials of General Surgery

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