1. Meeting the ED-2 Standard: Gaining Consensus, Building for the Future
University of Missouri-Columbia
School of Medicine
Elizabeth Garrett, MD, MSPH
Kimberly Hoffman, PhD
Caroline Kerber, MD

2. ED-2
Quantified criteria for the types of patients (real or simulated) must be defined:
The level of student responsibility/extent of student interaction
The appropriate clinical settings/venues
Numbers and kinds of patients that must be seen
Major disease states and conditions
Central oversight must occur
Gaps must be remedied

3. MU’s Response: Selecting the Opportunity (Round One)
2005- committee appointed
Met three times
Not successful……why???

4. Reflecting on Failure Technology Barrier No liaison to IT
No urgent deadline
Who was driving this process?
Team never “melded”
Resources? ($$$)
Overwhelmed by all the technology issues. PDA alone, only web-based, both, is there already something out there we can buy?
No liaison to IT….needed a translator/reality checker. (Dr. Hoffman)
Who was going to pay for this to happen?
Who was driving this process? LCME (yes), us? The faculty? The CCSC? All of us?

5. Selecting the Opportunity (Round Two)
Late fall 2005-birth of web based Patient LOG
Subcommittee formed (ED-2/PLOG)
(Clinical Curriculum Steering Committee)
Chair of subcommittee named (Family Medicine CD)
Members of PLOG
Chair of CCSC (Internal Medicine CD)
Computer guru
Child Health, Surgery and Family Medicine CDs
Dean for Evaluation
Staff support
Naming the chair was critical…..leadership critical
Evaluation Dean was able to provide human resources…..programmers and support staff in her office.

6. Selecting the Opportunity (Round Two)
Empowered
Needs/Wants
Options

7. Reflecting on Success Right mix of humans
Technology decision made EARLY
Resources identified and prioritized
Regular meetings

8. Reflecting on Success Behind the scenes work (other products/vendors?)
CQI approach
Real deadlines
New AY June 2006
LCME 2008
IT programming resources reserved (use it or lose it !)
KH. We looked at several vendors. Invited them to do a demo and had our IT people in the room to see the demo. We debrief after each presentation so the programmers had a good idea of what we wanted going into the project. From a programming point, it was important NOT to make major changes for the first six months. In this way we could devote the resources where we needed.

9. Other Keys to Success Communication
To CCSC/stakeholders
To programmers via one person
Feedback encouraged
Flexibility of PLOG to majority of needs
Diagnoses
Signs/symptoms
Skills/procedures
Buy-in from all CDs

10. Other Keys to Success Transparency of data: sharing
Aim for an extensive list
Can turn items on and off (“grayed out”)
Committee problem-solved well
Effective support staff

11. PLOG- Going Beyond ED-2 Overall goals
Meet the ED-2 standard
Must work for all clerkships
Document the review and feedback of student progress
Identify needs for mid-course corrections
Students must meet clerkship objectives
Students take more responsibility for their own learning

12. More goals Use to compare students’ experiences to curricular goals
Explore potential to track students’ experiences across the curriculum
Potential use in scheduling/placement decisions

13. More goals Added value for all Need for useful data summary reports
CDs/coordinators
Education leaders/deans
Faculty
User Friendly

14. Examples from Family Medicine Clerkship
Use the Family Medicine PLOG site as our model
Screen shots to walk through the process students and clerkship directors use to use and review PLOG

15. Where students start to enter an encounter- Enter basic demographic and site data and level of participation. May do maximum of 3 entries per patient in any of 3 domains- dx/sx; skill; special domain.

16. This is part of the diagnosis/symptom domain
This is part of the diagnosis/symptom domain. The list is the same for every clerkship- what varies is what is in bold or “live”. These are the diagnoses and symptoms Family Medicine has decided are important to be able to track.

17. This is a sample of the skill domain
This is a sample of the skill domain. We chose not to be heavily procedurally oriented but instead focus on administrative/documentation skills, behavior change and education and prevention counseling. Other clerkships use the procedure options of this domain more heavily.

18. The special domain has had the most range of use with pediatrics and ob-gyn having the most requirements in this area. This allowed very rotation specific goals. Family medicine has only a few requirements in this domain related to cultural and well adult and well child exams.

20. Students and clerkship directors can at a glance see what patients have been entered thus far, and sort by age or date. I can go in and see the full details of each patient entered including extra notes students may have written for their own benefit.

21. This has been a great feature- In a glance we can see the progress students are making towards each requirement- green means the minimum number have been met, yellow means that requirement is underway, and red means no entries have been made for that topic yet.

22. Program Requirements
This is another way for students to be able to see what is included as options under each category.

23. One of our goals was to be able to go in at any time and evaluate the student’s progress with PLOG- we chose 2 areas as you can see. This has been more helpful to us as faculty than we could have imagined.

24. Another great feature of PLOG is the ability to generate reports with a couple of key strokes.

25. All clerkships agreed that students are required to have all PLOG entries done by 0700 Monday of each week.

26. This is based on the data from the first three blocks
This is based on the data from the first three blocks. (Family Medicine requires all patients entered for the first 6 of the 8 weeks of the clerkship.

29. Students continue entering patients and diagnoses/symptoms even after their minimum requirements are met.

30. 2006-07 PLOG Total Number of Reviews Entered by Clerkship (Blocks 9-11)
Professionalism/Timeliness
Student Progress and Documentation of Clerkship Requirements
Clerkship
Student is demonstrating professionalism by entering data in a timely and thoughtful manner.
Student is not demonstrating professionalism by not entering data in a timely and thoughtful manner.
Student is making appropriate progress and is on target to meet clerkship requirements. No problems are anticipated.
Student has made some progress but needs to increase participation and/or documentation in order to meet clerkship requirements.
Student has not demonstrated adequate progress and is at risk of not meeting clerkship requirements.
Child Health 41 2 39
Family Med
124 3
122
Internal Med 52 1
Neurology
Ob/Gyn
Psychiatry
Surgery 69 66
Grand Total
287 9
280 11 5
This feature has been quite useful.

31. 2006-07 PLOG Summary of Unprofessional Reviews by Clerkship Directors (Blocks 9-11) Slide 2 of 2
Professionalism/Timeliness
Student Progress and Documentation of Clerkship Requirements
Student ID
Clerkship
Student is demonstrating professionalism by entering data in a timely and thoughtful manner.
Student is not demonstrating professionalism by not entering data in a timely and thoughtful manner.
Student is making appropriate progress and is on target to meet clerkship requirements. No problems are anticipated.
Student has made some progress but needs to increase participation and/or documentation in order to meet clerkship requirements.
Student has not demonstrated adequate progress and is at risk of not meeting clerkship requirements.
799017
Child Health ü
Surgery
944461
Family Med
772070
Internal Med
942034
941997
725225
944458
It is helpful to be able to check and see if a student who seems to not be fulfilling the PLOG requirements on your clerkship had similar problems on other clerkships (e.g. student above)

32. What did we learn? Improved understanding of clinical exposure
Each clerkship
Across clerkships
Improved individual plans of study
Bringing the clerkship objectives into “focus”
Improved ability to see patterns in student performance across clerkships
Reasonable time commitment- most faculty and students spent one hour or less on PLOG each week.
High degree of user satisfaction

33. What did we learn?
Improved monitoring of off site educational experiences
Improved monitoring of on site educational experiences
Students and clerkship director conversations stimulated by PLOG.
Clerkship director/preceptor conversations
Insight into student professionalism

34. Establishing & Developing the Team
Right Mix
Skills, knowledge, experience
Clear paths for communication
Prioritize among competing “opportunities”
Process for design
Align resources
0.3 FTE “translator” x 6 months
1.5 FTE programmers x 4 months
0.3 FTE staff support x 6 months
Faculty time

35. To Date Review 6 month data PLOG retreat Requirement adjustments
Documenting mid point corrections for Psychology and Neurology
Reflection on changes in LCME requirements

36. Next Steps Review full year data Survey students PLOG data to inform:
Educational objectives of clerkships
Total experience of third year student from student view
End of third year competencies
Develop process to address students with recurring professionalism concerns

37. MU PLOG Demo Site Pleased to offer a demo site E-mail Laurie Lough:
to get a time-limited user name and password
Real data with names changed and some of student comments edited/dropped
Can visit and enter patients, play with tool
2-week user but can request multiple temporary IDs and passwords.
Would appreciate your feedback and suggestions.