1. A Multidisciplinary Transitions in Care Workshop for Medical Students
Melissa Morgan-Gouveia, MD
Lauren Block, MD, Danelle Cayea, MD, MS
Johns Hopkins University School of Medicine

2. Disclosures
The research reported during this presentation was supported by the Donald W. Reynolds Foundation and the Daniel and Jeannette Hendin Schapiro Geriatric Medical Education Center.
The investigators retained full independence in the conduct of this research.

3. Background AAMC core geriatric competencies include
The ability to “communicate the key components of a safe discharge plan (e.g., accurate medication list, plan for follow-up)”
Medical students perceive knowledge gaps related to the discharge process
Current medical student education in transitions of care is inconsistent
Leipzig RM, et al. Acad Med ; 84:
Drickamer MA, et al. J Gen Internal Med. 2006;21:

4. Needs Assessment National Local Few formal curricula, tend to be:
Lecture or large group
Focused on single topic, e.g. medication reconciliation
Not multidisciplinary or evidence based
Mostly informal / part of the “hidden” curriculum
Local
Existing curricula on hand offs and post-acute care
No formal curriculum about the discharge process
Buchanan IM, Besdine RW. Acad Med. 2011;86:

5. Objective
To develop, implement, and evaluate an evidence-based curriculum for medical students to acquire knowledge, attitudes, skills, and behaviors that facilitate patient safety during transitions of care

6. Curriculum
Developed and implemented 3 hour workshop for 3rd year medical students at midpoint of basic medicine clerkship
Interactive small-group sessions focused on case-based learning of key skills including:
Medication reconciliation
Identifying discharge barriers
Discharge instructions
Discharge summaries
Communication with outside providers
Multidisciplinary team collaboration

7. Educational Methods
Small group stations were facilitated by pharmacists, nurses, case managers, and internists
Case discussion
Role play
Discharge instructions
PMD phone call
Discharge summary review
Medication reconciliation exercise

8. Educational Methods
A large-group reflective exercise before and after the small groups was used to contextualize learning within students' clerkship experiences
Mini-CEX where physicians or nurses observe students giving a patient discharge instructions

9. Program Evaluation Approved by JHUSOM IRB Workshop evaluation
Pre/Post survey
Domains: Frequency, skills
Process: Peer review, student tested
Qualitative assessment of reflective exercise

10. Workshop Evaluation
103 out of 121 students completed the workshop evaluation (85%)
Students rated the session highly overall
Mean 3.70, std dev 0.51
Scale: 1 (poor) to 4 (excellent)

11. Results
84 out of 121 students completed both pre and post surveys (69%)
Students report being involved in the discharge process
Most common tasks:
Identifying barriers to discharge
Medication reconciliation
Educating patients at discharge

12. Student’s Self-Rated Level of Independence in Performing Discharge Tasks

13. Understanding of Roles of Multidisciplinary Providers
Poor Fair Good Very Good Excellent
Mean level of understanding

14. Communication with Multidisciplinary Providers
Number of Patients: None < ½ ½ > ½ All
Mean frequency of communication

15. Results Summary Students are involved in the discharge process
Increased understanding of the roles of nurses, case managers, and pharmacists in the discharge process
Increased communication with other health professionals
Increased self-rated independence in performing discharge tasks

16. Limitations Single academic center No control group Single time point
Can’t distinguish effect of curriculum vs. clerkship
Pre-survey ratings may have been falsely elevated given limited knowledge of topic
Single time point
Confidence may not correlate with competence

17. Conclusions
Skills in discharge planning and transitions of care are critical for medical students to learn
We have developed a curriculum that is:
Interactive, small group based
Multidisciplinary
Integrated with clinical experiences
Feasible within limited time constraints
Well received by students
Evaluation data suggests students are performing with improved skills and interdisciplinary communication

18. Next Steps Continue to improve curriculum based on student feedback
Disseminate curriculum and curricular materials

19. Melissa Morgan-Gouveia
Questions?
Melissa Morgan-Gouveia