Just In Time Medicine Developing and delivering content for the shared discovery curriculum Background & Technology Just In Time Medicine (or JIT) is a self-service content management system, enabling users to build customizable curricular content, assessment tools, and logging capabilities To access JIT: Teach Learn Med. 2008;20(1):44-52 Teach Learn Med. 2013;25(4):292-9 PeerJ Sep 17;1:e164. doi: /peerj.164

Just In Time Medicine JIT is cloud-based, and developed with a responsive web design, thus it functions effectively on tablets and laptop computers and on mobile devices. To access JIT: Teach Learn Med. 2008;20(1):44-52 Teach Learn Med. 2013;25(4):292-9 PeerJ Sep 17;1:e164. doi: /peerj.164Smartphone JIT has been a key resource for MED 608 for several years, and will be leveraged as the platform for the SDC new curriculum. JIT Home Page: Desktop iPad

Just In Time Medicine To access JIT: Teach Learn Med. 2008;20(1):44-52 Teach Learn Med. 2013;25(4):292-9 PeerJ Sep 17;1:e164. doi: /peerj.164 Content can be organized and displayed in flexible ways, including: Chief Complaints and Concerns (C3) Objectives specific for each C3 Discrete Objectives Tree structure can be organized by Chief Complaints and Concerns

Just In Time Medicine Teach Learn Med. 2008;20(1):44-52 Teach Learn Med. 2013;25(4):292-9 PeerJ Sep 17;1:e164. doi: /peerj.164 Content can be organized and displayed in flexible ways, including: Quick Reference Tables

Just In Time Medicine To access JIT: Teach Learn Med. 2008;20(1):44-52 Teach Learn Med. 2013;25(4):292-9 PeerJ Sep 17;1:e164. doi: /peerj.164Alphabetically Organization by objectives Diseases you should really know about

Just In Time Medicine Use To access JIT: Teach Learn Med. 2008;20(1):44-52 Teach Learn Med. 2013;25(4):292-9 PeerJ Sep 17;1:e164. doi: /peerj.164 Real time use data: Google Analytics JIT Use Data July – Sept Sessions111,562 Users71,332 Page views520,626 Pages / Session4.67 Average session duration3:56 % New Sessions63.68% Source: Google Analytics

Just In Time Medicine Authoring Content To access JIT: Teach Learn Med. 2008;20(1):44-52 Teach Learn Med. 2013;25(4):292-9 PeerJ Sep 17;1:e164. doi: /peerj.164 Several dozen faculty, residents and staff have created content Examples: Acute UGI bleeding (1,581 page views)Acute UGI bleeding Cirrhosis and ascites(1,945 page views)Cirrhosis and ascites Pneumothorax(1,641 page views)Pneumothorax

Just In Time Medicine To access JIT: Teach Learn Med. 2008;20(1):44-52 Teach Learn Med. 2013;25(4):292-9 PeerJ Sep 17;1:e164. doi: /peerj.164 Other enhancements: Supraventricular Tachycardia Tagging content Links to specific content within MSU library Pop ups Authoring made easier using templates CCC Template Disease template Medication template Laboratory study template CCC Documents

Just In Time Medicine Authoring Content To access JIT: Teach Learn Med. 2008;20(1):44-52 Teach Learn Med. 2013;25(4):292-9 PeerJ Sep 17;1:e164. doi: /peerj.164 Content creation facilitation: Application administrator (Nichole Frattaroli) hired to facilitate authoring Create tutorials “At-the-elbow” assistance Customer service

Just In Time Medicine Developing and delivering content for the shared discovery curriculum To access JIT: Teach Learn Med. 2008;20(1):44-52 Teach Learn Med. 2013;25(4):292-9 PeerJ Sep 17;1:e164. doi: /peerj.164 What you can do: We will need faculty to: C3 development groups Expert content reviewer Become a section editor (e.g. all of Pediatrics, or some piece of it) Become an author (e.g. Kawasaki disease) Contribute multimedia (images, videos, sound files, etc) Become a peer-reviewer of content As a contributor You will be contributing meaningfully to the SDC You will be identified on the page(s) you work on You will have access to data on page views/usage from google analytics

Just In Time Medicine Assessing Learners To access JIT: Teach Learn Med. 2008;20(1):44-52 Teach Learn Med. 2013;25(4):292-9 PeerJ Sep 17;1:e164. doi: /peerj.164 “Assessment of what trainees (or doctors) actually do in practice.”

Problem specific checklists as displayed on internet enabled mobile devices …. Just In Time Medicine Assessing Learners

Just In Time Medicine Assessing Learners Problem specific checklists as displayed on internet enabled mobile devices ….

Just In Time Medicine Assessing Learners Problem specific checklists as displayed on internet enabled mobile devices ….

A web-based permanent record of observed skills Qualitative comments from evaluator StudentCompetency assessedQuantitative and algorithm generated grade Just In Time Medicine Assessing Learners

A web-based permanent record of observed skills Detailed list of specific competencies performed (or not) by learner Just In Time Medicine Assessing Learners

Individual Achievement Dashboard Competencies Sub-competencies Individual assessments green = “well done” yellow = “needs improvement” dark = “yet to be assessed” Example of individual learner dashboard Using metatags for assessment reports

Just In Time Medicine Assess a Learner 1.Interviewing a patient with chest pain in the ED 2.Their capacity to articulate the pros and cons of discussing advanced directives in this patient 3.Their understanding of the differential effects of norepinephrine and epinephrine on the CV system On any 1 – 2 year old internet enabled device go to: test.justintimemedicine.com You will be asked to assess a learner on 3 domains Note the browsers on older devices may not support JIT

Go to: test.justintimemedicine.com Just In Time Medicine Assess a Learner On any internet enabled device Log on: Upper right corner Enter: address: Password: test Click > Select an Assessment Under Assessment Tree click ►Chest Pain Ignore anything under “Incomplete Assessments” Go to: test.justintimemedicine.com Log on: Upper right corner Enter: address: Password: test Click > Select an Assessment Under Assessment Tree click ►Chest Pain Ignore anything under “Incomplete Assessments” IGNORE

Just In Time Medicine Assess a Learner Click > CP: History Taking, then click > History Taking

Just In Time Medicine Assess a Learner Post-Assessment Questions

Assessment Simulation Use this checklist to view and rate the student who is interviewing a man with chest pain For orientation, this list displays the identical items as on the device

Assessment Simulation When done Click at the bottom right of the page Continue You will see Social Context of Clinical Decisions And Basic Science Correlate

Assessment Simulation After completing the history the student is asked to reflect on a social science correlate (e.g. the pros and cons of discussing the patients code status at this initial encounter); and a basic science correlate (e.g. list 3 effects that norepinephrine has on the CV system Their answer for the social science correlate is: “In evaluating a patient with an acute symptom that could potentially be life-threatening, discussing their preferences in the event of a cardiac or respiratory arrest could have the potential to cause the patient added anxiety (e.g. “Why is the doctor asking me this now, am I really that sick?”); However failing to enquire about the patients wishes risks violating the patients autonomy in decision making, and risks that we may do a procedure that the patient may have already decided they do not want.” Their answer for the basic science correlate is: “I believe that norepi has the effect of 1) raises the patients blood pressure 2) increasing conduction through the His-Purkinje system and 3) decreasing myocardial wall tension. I’m not sure about the effects of epi.”

Reviewing the students report

Just In Time Medicine Developing and delivering content for the shared discovery curriculum To access JIT: Teach Learn Med. 2008;20(1):44-52 Teach Learn Med. 2013;25(4):292-9 PeerJ Sep 17;1:e164. doi: /peerj.164 What you can do: We will need faculty, students, residents to: Become a section editor (e.g. all of Pediatrics, or some piece of it) Become an author (e.g. Kawasaki disease) Contribute multimedia (images, videos, sound files, etc) Become a peer-reviewer of content As a contributor You will be contributing meaningfully to the SDC You will be identified on the page(s) you work on You will have access to data on page views/usage from google analytics