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Clinical Skills Courses:  Review and Reflections about Content across Institutions

Clinical Skills Courses:  Review and Reflections about Content across Institutions. Toshi Uchida, MD Northwestern University Feinberg School of Medicine Nelia Afonso , MD Oakland University William Beaumont School of Medicine Pree Basaviah, MD Stanford University School of Medicine.

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Clinical Skills Courses:  Review and Reflections about Content across Institutions

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  1. Clinical Skills Courses:  Review and Reflections about Content across Institutions Toshi Uchida, MD Northwestern University Feinberg School of Medicine NeliaAfonso, MD Oakland University William Beaumont School of Medicine Pree Basaviah, MD Stanford University School of Medicine

  2. Objectives • Review the breadth of content of clinical skills courses • Original DOCS survey • Tally of pre-meeting survey • Brainstorm promising practices and challenges • Identify themes of inquiry to inform future DOCS surveys & workshops

  3. Seven Principles for Pre-Clerkship Education AAMC Task Force on Pre-Clerkship Clinical Skills Education

  4. 2011 Results: Curricular Deans Other: Palliative care, cultural competency, health systems, prevention, nutrition

  5. Results: Curricular Deans

  6. Course Organization • Curriculum organized by organ system (39%), Discipline based (31%) Other (30%) • Primary Format didactic (20%), PBL (4%), mix of PBL and didactic (58%), and other (18%) • Yearly longitudinal (73%), block module with defined # of weeks (15%), other (12%) • 89% stated PCCS course was integrated with basic science courses

  7. Results: Learning and Assessment • 87% have developed and use core competencies • 75% institutions use formal clinical skills curriculum in clinical years • 89% use OSCE’s in PCCS • 81% in Clerkships • 88% have clinical skills training lab • 83% use in PCCS • 65% use in Clerkships

  8. Additional topics taught in CS Courses

  9. Additional topics taught in CS Courses(contd.)

  10. Oversight of the Clinical Skills Curriculum

  11. Brainstorm: Major issues about breadth of content • Repository for content that does not belong elsewhere  delegated to other content experts  feels like hodgepodge (kitchen sink course) • MS 1, 2 have competing priorities and CS is a lower often than their science curriculum • Outcomes – as we integrate, assessing and recall for GQ survey is challenging. Need to educate student about roadmap, “emcee”

  12. Brainstorm (cont’d) • Loss of clinical skills during transition to clerkships 3rd year, hidden curriculum. Needs to be a formality in clerkship • Academic calendar with test dates for whole year in basic science  challenge with not concentrating on the cs skills right before exam • Silos exist and Course directors decide independently  challenge between centralization and autonomy

  13. Brainstorm • How do we meaningfully integrate CS with the sciences, reasoning? From central mgmt, need critical discussions • How do programs integrate pediatric content in preclerkship?

  14. Vote for your top 2 emerging topics for clinical skills courses to discuss in small groups: • Patient Safety/QI • Population Health (health disparities, prevention) • Systems Based Care • Heath Care Financing • Teamwork/Interprofessional Education • Other: Bootcamps, Disparities, • Pediatrics….

  15. Small Group Guiding Questions • What are the pros/cons of a focused vs an expanded course content? • Are expanded Clinical Skills courses becoming too big? • Who decides and how do we decide what content belongs in a clinical skills course? • Discuss your specific topic ( including resources ,assessment, faculty development) • Report out to group

  16. Report out – PreclerkshipBootcamps • Competes with Step 1, time allowed 1 d to 1 week to 1 month for these courses • Skills: simulation, clinical specialty specific, procedure-based skills. When do you do – clerkships vs during transitions course (ex. Pedi newborn exam, suturing) • Faculty intense if you push into clerkship but chance to standardize how you teach – ex. Neonatal exam. Receptive if formative rather than summative assessment.

  17. Report out: Social determinants of health, behavior change, MI • Taught within social history, in population health themes , health literacy should be part of the discussion • Formal discussion of social determinants, health literacy and then integrated into SP encounters • Get your wheels turning, keep in mind patient realities • Behavioral health, motiv interviewing implementation discussed and needs for faculty development

  18. Report out: Integration • Curricular models – how to avoid silos, how to move towards integrated approach as seen in newer schools and renewed curricula • Structure drives function and integration • There needs to be a planned governance / process • Ongoing, in-depth discussions weekly meeting with basic science and CS faculty • Need funded support to promote these interactions and efforts • Need for central calendar with shared approach on the content topics • Course directors having full reign over content can lead to challenges • Action item: to share specific curriculum interventions

  19. Next Steps • Topics for future DOCS surveys? • Topics for future DOCS workshops?

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