Transcript Sample Talk - AHME | Association for Hospital Medical Education

Bridge over Troubled Water
Linking UME and GME
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Monica L. Lypson, MD
Assistant Dean, Graduate Medical Education
University of Michigan
Jeff Fabri, MD
Rita M. Patel, MD
Education Across the Continuum
Standardization of Assessment
Student Portfolios to Baseline Assessment
•
Monica L. Lypson, MD
Assistant Dean, Graduate Medical Education
University of Michigan
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Associate Chief of Staff, VA Ann Arbor Health Care System
Institutional OSCE – Post-Graduate
Orientation Assessment (POA)
Developed by the Graduate Medical Education
Committee (GMEC) at the University of
Michigan
It is our initial step in training our residents
It was established to determine residents’
baseline proficiency in particular aspects of the
ACGME’s six general competencies
Lypson ML. et.al. Academic Medicine. 79(6):564-70, 2004 Jun.
POA CONTENT
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Knowledge and skills needed during the first
six to eighteen weeks of residency/internship
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Emphasizes clinical situations that are often
encountered without formal supervision
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9 Assessment & Educational Stations
The POA as Formative Assessment
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Results of the POA determine the basis for
individualized “learning agendas”
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Remediation is provided after the completion of
each station
 Residents received educational materials that provide the
“answers” to the information assessed during the POA
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Standardized Patient feedback is provided to the
program director within 24 hours if the resident
performs exceptionally well or poorly during the
POA
Implementation
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Administered over 4 days of Paid hospital
orientation
Provided to approximately 150 PGY-1
residents in over 15 specialties
Cost Approximately $250 per resident for the
assessment - $500 if you add in salary
There are some discipline specific scenarios –
e.g. Pediatric cases and examples
Scores are provided to the resident and
program director within 7-10 days of the POA
Subspecialty Programs
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Dentistry
Emergency Medicine
Family Medicine
General Surgery
– Preliminary Residents
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Internal Medicine
– Preliminary Residents
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Otolaryngology
Orthopedics
Pathology
Pediatrics
Plastic Surgery
Psychiatry
Urology
PGY-2s
Internal Medicine –
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Pediatrics
(Residents that did not complete their Internships at UMHS)
– Physical Medicine & Rehabilitation
Neurosurgery
– Dermatology
– Neurology
Obstetrics & Gynecology
Station Content
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Critical Values /
Multiple Choice
– Computer Based assessment
– Review and diagnose 17 short
patient scenarios
– Multiple Choice Format
similar to United States
medical Licensing Exam
(USMLE) Step 3
– Competencies:
• Patient Care
• Medical Knowledge
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Socio-Cultural
Communication
– Standardized patient assessment
– Assesses the understanding of
disease and treatment
recommendations in the context
of the patient’s health beliefs and
socio-economic setting
– Competencies:
• Interpersonal and
Communication Skills
• Professionalism
• Patient Care
• Practice-Based Learning and
Improvement
Station Content
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Evidence-Based
Medicine (EBM)
– Computer-based
Assessment
– Generate a clinical
question
– Residents reviewed
abstracts & identify the
appropriate treatment
– Competencies:
• Practice-based
Learning and
Improvement
• Medical Knowledge
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Images
(X-Rays)
– Computer-based
Assessment
– Review & diagnose 18
images
– Many of the common
films reviewed in the
middle of the night while
“on call”
– Competencies:
• Patient Care
• Medical Knowledge
Station Content
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Informed Consent
– Standardized patient
Assessment
– Obtain informed consent from a
patient for a procedure
– Hospital & JCAHO standards
and policies
– Competencies:
• Interpersonal and
Communication Skills
• Professionalism
• Patient Care
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Patient Safety
– Pen & Paper Assessment
– Order Writing Station
• Legibility
• Signature, Date, Time
– Respiratory Distress
• Treatment of the acute
Asthmatic
– Competencies:
• Systems-Based Practice
• Professionalism
• Patient Care
• Medical Knowledge
Station Content
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Aseptic Technique
– Checklist Evaluation by Expert Nursing Staff and Standardized
Patients
– Create & maintain a sterile field while performing a “mock” I&D
– Universal Protocol & “Time-out” procedures covered
– Assessment/Remediation materials include a review of JCAHO
requirements
– Improved nursing and house officer interactions
– Competencies:
• Patient Care
• Medical Knowledge
• Systems-Based Practice
Station Content
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System Compliance /
Fire Safety Station
– Surgical Fire Safety (20/20)
– Housestaff involvement with a
Patient fire
– Questions covering use of
safety equipment & review of
JCAHO requirements
– Video & Computer Based
Assessment
– Competencies:
• Patient Care
• Systems-Based Practice
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Pain Assessment
– Pain Assessment Tools
– Educates on the appropriate
medications to use for pain
– Explains hospital and JCAHO
Pain assessment mandates
– PowerPoint & Computer Based
Assessment
– Competencies:
• Patient Care
• Medical Knowledge
Resident Satisfaction with the POA
-Survey Response Rate 93%
2002-2004
Question
YES
Have you learned any new clinical
skills during this assessment?
70.6%
Do you think this was a useful way to 83.4%
spend part of orientation?
Do you feel better prepared for some 80.6%
aspects of internship after this
assessment?
Do you expect to refer back to the
teaching materials handed to you
today?
84.7%
Would you recommend that we
continue the POA next year?
84.7%
The POA was based on the
following…
The University of Michigan
Comprehensive Clinical Assessment
(CCA)
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Comprehensive Clinical Assessment
1991-Present
A high-stakes examination for University of
Michigan Medical Students
Fourth Year students must pass the CCA in
order to Graduate
10-15 stations over ~4-5 hours
~150 M4 students per year
Summative Evaluation
Standards have been set for Pass/Fail
Remediation for failures
Rochester AB. et.al.. Academic Radiology. 5(3):169-72, 1998
Summary of Station Comparison:
CCA & POA
POA- GME
CCA-UGME
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Formative
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Summative
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Informed Consent &
Policy
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History & Physical
Diagnosis
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Pain Assessment
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Geriatrics
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Socio-Cultural
Communication
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Socio-Cultural
Communication
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Evidence Based
Medicine
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Evidence Based
Medicine
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Images
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Images
Institutional Implications for
GME & UGME
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Training the Faculty in the Teaching Skills of
competency assessment
– Medical School Objectives Project (MSOP)
– Accreditation Council of Graduate Medical Education
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Reimbursement of faculty time and effort
• Payment for both assessments – Medical
School vs. Hospital
– Is the medical school or the hospital responsible for ‘educational
cost’?
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Trainee awareness of “competency gap”
between the expectations of medical School
and residency
POA Demographics 2002-2004
Gender
Male
54%
Race
White / Non-Hispanic
Underrepresented Minorities
Other
70.1%
6.5%
23.4%
Medical Schools
Public
62%
International
United States Medical Licensing
Examination (USMLE)
1.5%
Step 1
Step 2
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The University of Michigan Health System Plan
for Competency Based Resident Education
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Joint Hire faculty member with the Department
of Medical Education
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Centralized OSCE – Post-Graduate Orientation
Assessment (POA)
This is based on the system already in place for
Undergraduate Medical Education at UMHS.
The Department of Medical Education
Chairman: Larry Gruppen, PhD
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One of ~5 departments of medical education at
LCME accredited medical schools
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The department had focused on CME and UGME in
the past with assessment and research expertise
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The office of Graduate Medical Education and the
Department of Medical Education
– Joint Hire
– Job Description
• 50% appointment GME office, 50% appointment Dept. of Med. Ed.
• Aid Residency programs with curriculum development, core competency
assessment
• Use this work as a vehicle of scholarly pursuit
– The department has a long history of UGME – now will develop its expertise in
GME