List of Proposals for 2011 CORD with Ratings
"Zoom Zoom: Curricular Innovations to take your clerkship from a Honda to a Porche"
The Third Annual Curricular Innovations in Medical Student Education
Session Directors: Nicholas Kman and Laurie Thibodeau
and
Session Objectives:
1.Toexpose participants tothe new and innovative ways that Emergency Medicine is being taught to medical students of all years. The focus of CORD this year is technology which will also be represented in our session.
2. To give ideas and examples of how Emergency Physicians gain exposure to medical students early in the medical school experience while allowing participants an opportunity to discussthese methods
3. To highlight one or more exceptional IEME submissions in an oral format.
3. Compose a resource guide of “Innovations in Medical Student Curriculum Development” to make available to medical student educators.*
*This is not a peer-reviewed publication and is independent of CORD/SAEM.
Awarded CORD IEME Oral Presentations:
1. Adele Damlamian [:Video Review Enhances Feedback and Improves Medical Student Performance in Expert Consultations During Simulated Patient Encounters
2. Travis Eastin [: A Required 3rd Year Clerkship in Acute Care
Invited Innovations Session Presenters:
1.Teresa Y. Smith [: Medical Informatics Used to Create a “Virtual Campus” for Medical Education
2. KiranPandit [: Scenario-Based Learning BeyondSim Lab)
3. Douglas S Franzen/FS/VCU [: A Different Type of Shift Card
4. John Fox [: Ultrasound in Medical Student Education
5. Lynne Yancey [: Update on Resident Teaching Service
CORD IEME ORAL PRESENTATIONS:
Adele Damlamian: Videotape Debriefing Impacts Medical Student performance in Consultations during Simulation
Presenters: Adele Damlamian and Leigh Evans
Objectives: To determine if video debriefing impacts medical student performance in consultations during simulated patient encounters.
Methods: This was a prospective, randomized controlled study of 3rd year medical students participating in 24 simulated scenarios using a Laerdal SimMan 3G® mannequin during a 12 week clerkship. Each subject functioned 3 times as team leader (period 1= week 1-4, period 2= week 5-8 and period 3= week 9-12), responsible for communicating a faculty consultation request and care plan to the simulated patient. All sessions were recorded. During debriefing, subjects were randomized to one of three groups: the Intervention Group (IG) observed their recorded consultation, Control 1 their care plan, and Control 2 had no video review. All groups received verbal feedback. Two blinded independent raters viewed de-identified videos and completed checklists (scale 0-18) to rate subjects’ communication. The outcome variable for each model was the average of the raters’ assessment. A mixed effect model (PROC MIXED) with fixed effect of group and time and random effect of subject was used. The repeated statement was used to specify the covariance structure of the error term, with time as the repeated effect.
Results: There was excellent inter-rater reliability (ICC >0.85) for consultations. Consult communications improved over 12 weeks from a mean of 11.04 in period 1 to 12.99 in period 3 (mean difference -1.95, p<0.01, 95% CI: -2.95, -0.86). IG showed improvement as compared to Control 2 for period 1 vs 3 with a mean difference of -2.41(p=0.01, 95% CI:-4.27, -0.54). Control 1 showed no significant improvement in mean scores as compared to Control 2(p =0.46).
Conclusions: Video observation of the consultation improved communication skills as compared to students who received verbal feedback alone or observed their patient care plan. The inclusion of video feedback during simulations may be a powerful educational tool for medical education.
Travis Eastin: A Required 3rd Year Clerkship in Acute Care
Abstract: There currently is not a required Emergency Medicine (EM) clerkship for students at the University of Virginia School of Medicine. Students interested in a career in EM must wait until their fourth year to complete an EM elective; prior exposure to EM is through voluntary activities. To provide students with an earlier and more uniform exposure to EM, we designed a two-week “Perioperative and Acute Care Medicine” clerkship for third-year students, half of which is completed entirely within the Department of Emergency Medicine.
The clerkship was developed in conjunction with the Department of Anesthesiology. The EM week is comprised of group sessions and individual student rotations. Didactics include lectures on ECG Interpretation, Emergency Radiology, General Orthopedics and Disaster Management. Hands-on practice is gained via suturing and splinting workshops. All students complete AHA Healthcare Provider certification. Two simulation sessions focus on cardiac and trauma resuscitation with an emphasis on team training. Individual clinical rotations allow students the opportunity to apply principles learned during didactics and practice clinical and procedure skills as they rotate through various areas of the ED. Students are provided with a “Procedural and Student Skills Portfolio (PaSSPort)” in which to document successful completion of required procedures, and also choose a patient encounter which incites a clinical question for which the student does a literature search.
The clerkship was approved as a required rotation and was implemented at the beginning of the 2009-10 academic year. To facilitate the small-group nature of the learning activities, each group is limited to less than eight students. To date, evaluations have been outstanding.
To conclude, a required clerkship experience in the ED allows students earlier exposure to EM and provides a procedurally-rich, high-acuity environment for learning principles of acute care.
INVITED INNOVATIONS SUBMISSIONS:
1. Teresa Y. Smith, MD:Medical informatics used to create a “virtual campus” for medical education (ALEX)
Presenters: Teresa Y. Smith, MD1 and Srikala Shenbagamurthi, MD 2
1Emergency Medicine Resident, Department of EmergencyMedicineNYUSchool of Medicine/ Bellevue HospitalNY, NY
2Assistant Residency Director, Department of EmergencyMedicineNYUSchool of Medicine/ Bellevue HospitalNY, NY
Objectives
As advances in technology improve healthcare, medical informatics has also allowed medical education to expand outside of the classroom creating a “virtual campus.” Our academic medical center has provided a web-based program to allow for expansion of these modalities in inventive ways. In our efforts to expand the availability of our robust academic calendar, we created a mobile curriculum, which is geared towards teaching high yield emergency medicine topics to medical students and residents. Topics include ultrasound, ECG tutorial, evidence based medicine discussions, ophthalmology web tools, and radiology image bank. There are also two on-going initiatives: Case of the Month Series and Morning Report Podcasting. Morning Report Podcasting, one aspect of the mobile curriculum, is a weekly recording of our morning report lecture series. One case presentation per week is podcast and made accessible by download from a secure intra-hospital website to all rotating emergency medicine medical students and residents to review. The purpose of this proposal is to present the mobile curriculum, along with the novel podcasting feature, which allows for the creation of a “virtual” expansion of our didactics.
Methods
The Morning Report lecture series occurs every weekday as a senior emergency medicine resident presents a detailed case of a patient seen in the emergency department. The format of the case presentation is an interactive evidence based workshop lead by a senior resident. The discussants include faculty from adult EM, pediatric EM, and toxicologist, clinical pharmacists, EM residents, and rotating medical and pharmacy students. The audio from the session is recorded and translated into a podcast. This podcast is then available through our institution’s secure web site. The podcast is later accessible to all students and residents by download to their personal multimedia players. There will be a pdf file accompanying the audio podcast that is a screen capture of the notes transcribed by the presenter from an electronic whiteboard. In order to assess the utility of this new technology based tool, multiple choice questions written by the resident presenter are asked of the listener to ensure that the main teaching points have been conveyed and in time provide credit for online distance learning.
Discussion
We seek to assess whether this dynamic model of education is useful as a means to teach medical students and residents as an alternate to lectures in the static classroom setting. We theorize that through our “virtual campus” we will be able to teach and evaluate our time restricted, technology driven students and residents. This new teaching model will serve as a pilot for future web-based teaching tools.
ALEX Emergency Medicine
Curriculum Proposal 2010-2011
Objective: ALEX is the name of our university’s learning management website that provides a platform for online medical education and computer based learning activities.The purpose of the ALEX Emergency Medicine Curriculum is to create a dynamic and mobile learning environment for Emergency Medicine residents and students. In the changing environment of our department and hospitals, it has become very difficult to maintain our high standards of teaching during clinical time. ALEX is a means to teach and evaluate our time restricted, technology driven residents and students through a “virtual campus” as an alternate to lectures in the static classroom setting.
ALEX EM Curriculum: we have re-structured ALEX to allow teaching of high-yield curricula that are essential for an emergency medicine resident and student. The focused curricula for the academic year 2010-2011 are the following:
1. Monday Morning Report Podcasting and Evaluation
2. Ultrasound
3. ECG
4. Radiology
5. EBM
6. Ophthalmology
7. Case of the Month series
The theme of each section is to create self-learning, web-based tools that the residents may reference as an adjunct to clinical training and scheduled academic lectures.
- Monday Morning Report:
We will podcast each Monday Morning report presented by the 4th year resident. Through ALEX the residents (and faculty) will be able to download the audio file along with a PDF capture of the white board notations. In addition, there will be a 2-question quiz (via the icon Monday Morning Report), which each resident is required to complete. This process of mobile learning will provide an additional hour of education in an offsite manner. Resident participation will be tracked and proper conference credit will be given upon completion of questions.
- Ultrasound: Directed access to web based teaching tools (which have already been developed and freely available on the web)
Our goal is to create a central location, in which the residents can find these web-based tools to assist them in learning how to perform and read high quality ultrasound.This section of ALEX will also display the ultrasound policy, data collection sheet, and minimal images requirements for ACEP resident certification.
- ECG: Online curriculum based on case presentations and an ECG collection bank
This structured curriculum will allow the resident and student to learn to read ECGs based on the clinical presentation of the patient.
- Radiology: Access to the content of the radiology lecture series in 2009-2010 done by Dr. Partridge (4th year Resident) during Intern Report
Additionally, assimilation of a radiology bank through the Case of month presentations.
- EBM (Evidence based medicine): This section will give the resident and student access to an updated Litbank, the monthly Up for Debate questions and answers, and outsidejournal club articles. The Up for Debate series is a new initiative of the residency which brings evidence based medicine into the clinical shifts. There are questions posted in the clinical areas each month addressing management and treatment strategies of specific clinical presentations. The answers are emailed out to the residency at the end of the month along with a brief literature review and associated articles. The journal series will be accessible via ALEX thereby creating a mobile journal club environment. In addition, the journal articles discussed during the off-site journal club sessions will also be visible through ALEX.
- Ophthalmology:
On-line tool structured to teach the residents ophthalmology as it relates to emergency medicine. Direct link to the website created by Dr. Cooper (4th Year Resident).
- Case of the Month Series: Each month there will be a case on ALEX presented by one ofthe above ALEX Curriculum teams (i.e. Ultrasound, ECG, Radiology, EBM).
The case will be presented in full with history, diagnosis, management and treatment, as well as discussion with reference articles. The residents and students will be able to blog about the case during the month to provide suggestions on case management and added commentary.
2. Kiran Pandit: Scenario-Based Learning: Beyond Sim Lab (Disasters…)
Presenters:Kiran Pandit MD MPH, Christopher Tedeschi MD MA
Kiran Pandit, MD MPH, Assistant Professor, ColumbiaUniversity Emergency Medicine
This presentation discusses the advantages of scenario-based learning methods ranging from small-group exercises to large drills involving hundreds of people, far beyond the limits of the SimLab. Scenario-based learning emphasizes learning not only book content, but understanding people's roles and how to interact with others, communication and leadership and organization of personnel, the use of physical space, resource allocation, and the pressure of time. Students and residents learn best by immersion in situations in which they have to figure out what to do and how to do it, regardless of level of training. The best results are achieved when students play the role they would in real life. For example, teaching Internal Medicine residents how to respond to a "code" would be much more effective if they participated in a scenario in a real patient room in the hospital, with their real colleagues and real nurses and real equipment. We have all seen how these codes actually play out, and the reason is lack of scenario-based learning.
An additional way to really maximize the utility of scenario-based learning is to videotape the scenario and play it back (or parts of it) immediately for viewing and discussion immediately after the exercise -- as is commonly referred to in disaster medicine as a "hotwash."
We have used scenario-based learning not only for the typical "mock-resuscitation" in SimLabs, but also for the following teaching activities:
1. teaching students on the first day of medical school how to be first-responders to an unexpected medical emergency in a nonclinical setting
2. teaching students and residents via case-based conferences
3. teaching students how to interview patients
4. backcountry trips for wilderness medicine scenarios (e.g. a backpacker breaks a leg or gets altitude sickness or gets stung by a bee)
5. disaster drills both in NYC and abroad in India and Sri Lanka, including both large-scale table-top drills and full-scale real-time disaster exercises with hundreds of victims having to be transported to multiple hospitals.
The basic idea of the talk is that we need to think bigger and broader than the SimLab when we think of the utility of simulating real-life -- we need to think about how we can incorporate it into every medical teaching exercise.
Doug Frazen: End of shift evaluation (See Attachment A)
This presentation offers one approach to student evaluations that goes beyond simple “good, excellent, honors…”. It takes into account what the student is actually doing, and seeks to reflect the student’s competency in a variety of areas.
To develop this shift card we reviewed our experience:
95% of evaluations returned (525/550)
The missing evaluations were mostly from the first 3: 143 out of possible 165 (87%)
out of the final 7 evaluations, I got 382 out of possible 385 (99%)
I also looked at the response rate by section (I sometimes get evaluations thatwere onlypartially filled out, incorrectly filled out,or sometimes an evaluator would choose not to evaluate a student in a particular area.)
For this, of 4400 possible individual scoring opportunities (8 sections * 10 evals * 55 students), I had 4059 responses (92%)
J Christian Fox, MD, RDMS, FAIUM[: Ultrasound in Medical Student Education
Associate Professor of Clinical Emergency Medicine
Director of Emergency Ultrasound Fellowship
University of California, IrvineSchool of Medicine
This session will describe a novel approach to ultrasound throughout all four years of medical school, allowing for access to students at a much earlier time than is customary.
7. Lynne Yancey: Teaching Resident Track
Every EM3 spends 8 weeks as the “teaching resident.” They are part of a “teaching team” consisting of all rotating students, including those on the core EM clerkship, and a teaching attending. The service was developed specifically to incorporate more structured and bedside teaching into their clinical experience, while allowing the team to still be clinically productive in the eyes of administration. The students get lots of teaching from residents and attendings, and the residents get lots of teaching too, but some is specifically focused on how to teach. Obviously the residents also get lots of practice at bedside teaching, lecturing, and small group sessions.
Scheduling and clinical productivity challenges, the specific teaching curriculum, and also the impressive improvement in student evaluations of the clerkship after implementation will be discussed. As a result of its success, we have been able to implement a teaching service for the core EM clerkship at all three of our clinical sites (including one out of town private hospital) where core EM clerkship students rotate.
Attachments:
A. End of Shift Feedback Card
Attending / PGY 3 (please print): ______Attending / PGY3 Signature:______
Number of cases on which this evaluation is based: ______Number of: Chest Pain / Dyspnea ______Abdominal Pain ______