Faculty Development, May, 2015 TCMC’s 3 rd 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 – 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.

3 rd Year in Review Fall Semester (25 weeks) Core Week (Scranton) Orientation Week (Regional Sites) 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

3 rd 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 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) – 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) – 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: – History Taking – Managing the Agitated Patient – Mental Status Exam – Practical Psychopharmacology Pediatrics: – 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 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 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 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 Site # of Students Comments North37 Includes 14 at Pocono South27 Includes 8 at Geisinger West14 … Guthrie17 …

Example Schedules North (Main) North (Pocono) South (Main) South (Geising.) WestGuthrie TOTAL # LIC IM Surgery Psych Peds OB/GYN Selective11111 Elective112-11