1. Academy of Educators Quarterly Meeting Tuesday, September 24, 2013 5:30-6:45pm Bondurant G030

2. Agenda
Welcome by Julie Byerley, MD, MPH, Vice Dean for Medical Education
Introduction of AOE and proposed By-law changes - Beat Steiner, MD
Overview of upcoming events and workshops - Todd Zakrajsek, PhD
Service and Education updates - Cheryl McNeil, MD & Michael Meyers, MD
EPIC talk - Ryan Madanick, MD
Scholarship talk - Kevin Biese, MD

3. AOE Welcome by Julie Byerley, MD, MPH Vice Dean for Medical Education

4. Draft Bylaw Changes Beat Steiner, MD
Change #1: Different Term Length and Structure for AOE faculty leaders.
3 year term (President Elect, President, Past President)
Funding for President Elect and President
Immediate Past President is on AOE Executive Committee
Rationale:
Presence of Executive Director and full time staff person
New title differentiates elected faculty leaders from executive directors
Create more leadership opportunities within AOE
Ensure ongoing creativity and innovation within AOE

5. Draft Bylaw Changes Beat Steiner, MD
Change #2: Membership Requirements
Each member will be required to participate in 8 AOE events over the course of 2 years
Assure appropriate and accessible offerings for AHEC and other faculty who have a hard time coming to AOE seminars
Reminder for AOE members who fall behind on completion of requirements
Rationale:
Make AOE membership meaningful
Ensure an active and engaged membership that contributes to the educational mission of the school

6. New in the AOE Todd Zakrajsek, PhD
Foundational Workshop Sessions
Advanced Workshop Sessions
Visiting Professors
Residency Discussions
AOE Banquet
Others???

7. AOE-UNC School of Medicine
Mike Meyers, M.D.
Cheryl McNeil, M.D.
09/24/13

8. Background
Balance between service and education can be challenging for trainees
Impact on education
Accreditation issue for programs
NEJM ;368:6.

9. Background
Institutions have commonly relied on residents for tasks not requiring a physician
Ancillary services have improved this
Problems remain
Increased documentation needs significant issue now
Inpatient and outpatient

10. Background Activity % of Time Direct Patient Care 12
Indirect Patient Care 64
Educational Activities 15
Misc 9
Computer Use
40%
J Gen Int Med ;28:1042.

11. UNC House Staff Survey
Distributed to all house staff (n=~730) in March 2013
Goal to generate list of things residents identify as areas for institutional attention/improvement
~25 things identified by residents as potential issues
5 point Likert scale (How significantly does each of the following impact our work as a resident at UNC)

12. Results 362 responded Top Problems Identified
Having to personally obtain outside records instead of a having a system
Medication reconciliation
Waiting for pages to be returned (instead of moving toward txt system and/or personal phones)
Waiting for nurse to come to phone instead of pages being made to personal phones nurses carry
Inefficiency of ordering in CPOE
Night-time pages for non-urgent issues (medication reviews, etc) that could wait until day shift

13. Next Steps
AOE endorsement for addressing this issue with the hospital administration?
Separate AOE committee?
Interested in Participating?
Mike, I can

14. What about Medical Students?

15. Students are unable to contribute to the team’s main burden of work
Residents spend the majority of their time documenting in the EMR
Students are unable to document in the EMR
Students are passive instead of active in team work. Residents interact with students less.
Students spend increasing percentage of clinical time away from patient care
More and more didactic and simulation time needs to be set aside to make up for lack of practical experience
Students are not getting enough real experience to become competent

16. What if Students Could Document?
At least in theory, students should be able to legally directly populate the following sections of any encounter: Medications, Allergies, Past Med Hx, Soc Hx, Fam Hx, and Review of Systems.
This would increase their usefulness to the team while unburdening the residents/ faculty, creating more opportunity for them to be included meaningfully in the work of the team.

17. Next Steps to Getting Students Access to Meaningful Use
Ryan Madanick is our AOE liaison to the EPIC team. He is actively working on this issue and Deb Bynum is also researching how this was legally implemented through EPIC at other campuses.
Besides working with EPIC, what are other ways to get the students more meaningfully involved in patients care?
Discuss…..

18. EPIC: Medical Student Training Presented by Ryan Madanick, MD
8-hour class: 4 Ambulatory, 4 Inpatient

19. EPIC: Medical Student Training
8-hour class: 4 Ambulatory, 4 Inpatient
MS4 (c/o ‘14): Only if needed

20. EPIC: Medical Student Training
8-hour class: 4 Ambulatory, 4 Inpatient
MS4 (c/o ‘14): Only if needed
MS3: Training for all between 2/17 & 3/31/14
Schedule not final
PMs & some weekend training
Release students from clinical responsibilities

21. EPIC: Medical Student Training
8-hour class: 4 Ambulatory, 4 Inpatient
MS4 (c/o ‘14): Only if needed
MS3: Training for all between 2/17 & 3/31/14
MS2: Training for all between 4/14 & 6/28/14

22. EPIC: Medical Student Training
8-hour class: 4 Ambulatory, 4 Inpatient
MS4 (c/o ‘14): Only if needed
MS3: Training for all between 2/17 & 3/31/14
MS2: Training for all between 4/14 & 6/28/14
MS1: View only access, still in discussion

23. EPIC: Medical Student Training
8-hour class: 4 Ambulatory, 4 Inpatient
MS4 (c/o ‘14): Only if needed
MS3: Training for all between 2/17 & 3/31/14
MS2: Training for all between 4/14 & 6/28/14
MS1: View only access, still in discussion
Stork (OB):
Likely modified training
Timing?

24. EPIC: Medical Student Notes
Will be part of Epic record, not legal record
Viewable once signed
Routing for review, not co-signature
No use of macros
“Type” of note
Recommended changing type from “Medical Student” to specific type (e.g., H&P)

25. EPIC: Medical Student Orders
Students able to enter orders
Orders to be “pended” & routed for signature

26. EPIC: Medical Students as SuperUsers
Dr. Dent working to create a course
Will require signed agreement from student

27. Scholarship in the AOE Kevin Biese, MD
Basics of Scholarship Workshop Series
IRB, Basic Survey Construction, Qualitative Analysis, Basic Quantitative Analysis
Half-day writing seminar
Botanical Gardens(?), food
Expanded AOE Banquet
Team-based scholarship projects
Data Analyst Support

28. Thank you for your continuous support of the AOE