1. Experiences Implementing a 4 th Year Distance-Learning Elective Society of Teachers of Family Medicine January 31, 2014 Nashville, TN

2. Suzanne Leonard Harrison, MD, FAAFP Director of Family Medicine Education suzanne.harrison@med.fsu.edu Tana Jean Welch, PhD Visiting Assistant Professor tana.welch@med.fsu.edu Heather Staples, MD Pediatrics Resident, Palmetto Health FSU College of Medicine Class of 2013 heatherstaples19@gmail.com

3. Janine Edwards, PhD, for her inspiration and direction in creating this elective Dan Van Durme, MD, for allowing time in our busy schedules to create and implement a non-traditional elective NO FINANCIAL DISCLOSURES

4. Increased flexibility in schedule during interview season Designed as a distance-elective that can provide meaningful content and development without daily patient contact Modules designed to foster empathy and uncover bias ACGME competencies: Communication Skills and Professionalism

5. Consider point of view of several characters Make personal connection to text Contemplate differences in generation, gender, sex, class, race, ethnicity, culture, family structure Encourage participants to ponder characters as patients and how they might present for medical care Provide a safe environment to address personal biases

6. Team approach to teaching Students choose 2 or 4 week option Theme and/or reading list Orientation prior to start of elective Weekly reading assignments approximately 300 pages Weekly written reflection approximately 1500 words with written feedback Weekly videoconference to discuss readings and application to clinical medicine

7. Written reflection Feedback and probing questions based on student reflection Discussion Questions Videoconference discussion Close reading and interpretation Ethics discussion – actions and motives Physician-Patient relationship with character as patient

8. What is the social context (religion, ethnicity, gender, class, family) in which each character lives his or her life? How does this context relate to and define motives and actions? What are some of the psychosocial issues faced by the central character? How do these issues affect their health and decisions made regarding their health?

9. Death & Dying Violence/Abuse Global Health HIV/AIDs care Gender-Specific Health Topics PTSD/Mental Health Special Populations Cross-Cultural Medicine LGBT Issues in Medicine Life & Work Balance

10. Invaluable resource for creating reading lists Links to annotated entries for literature, film and art related to chosen theme Summary of text and suggestions for medical connections and other learning points Over 100 key words / themes http://litmed.med.nyu.edu/

11. Appreciative Chose own topics Opportunity to consider other perspectives Increased insight into some patient groups Improved ability to communicate about unfamiliar topics “Break” from medical reading Diversity of student participants Consider online forums More frequent discussions Prefer longer texts Technical issues Holiday conflicts Volume of reading Constructive

12. Pressures of 4 th year are at peak during interview season. Introspective reading and discussion found to be cathartic by many students. Flexibility is key Allows travel during interview season Reading done at convenient times Meetings scheduled around interviews

13. Scheduling! Coordinating differing themes Video technology Volume of reading for busy faculty Serious and valuable course

14. Applicable to any medical school Flexibility enables 4 th year students to participate in meaningful curriculum during interview season Finding the right faculty members is challenging but offers opportunity for collaboration Possible future directions: Expand to include students in pre-clerkship years Consider students from other health professions

15. “…given me a better understanding of how to approach difficult conversations with patients…” “It raised a lot of questions that I will have to address if I end up pursuing my goal of medical missions.” “…contributed to the maturation of my thought process in that I as able to view situations and choices from a variety of perspectives.” “…forced me to think in a different manner…related to patient care…” “I learned how to better examine my own biases while practicing medicine.”

16. Distance-learning elective that allows for ongoing enrollment during interviews. Content and discussion designed to foster empathy and consider personal bias. Challenges in scheduling and videoconferencing Overall, we consider this a HUGE success just 18 months after implementation Increasing student enrollment Rapid response and change based on student feedback