Troubleshooting Your Clerkship 104: Teaching Challenges Alan P. Ladd, MD aladd@iupui

1. Troubleshooting Your Clerkship 104:Teaching ChallengesAlan P. Ladd, MDaladd@iupui.edu

2. Disclosures • Published evidence provided where possible • Personal Commentary (*) • Comments do not necessarily reflect the views of the Indiana University School of Medicine

3. Disclosures—why me? • Clerkship Director for 7 years • 340+ students • Central Campus (6 hospitals) • 8 statewide, regional sites • I know JOE

4. General Surgery at the Academic Health Center “The Mecca”

5. General Surgery at AHC • Medical Center or Traditional University Hospital • Specialized and Sub-specialized services • Typical Services • “Whipple-a-day” service • “Only Breast and Thyroid” service

6. General Surgery Clerkship • Training models for MS3 clerks • Inherent to the Medical Center (traditional) • Curricular models slow to change • Lack of opportunities to change

7. Novel Clerkship Models • Completely Distributed System • Multiple regional campuses • Student Apprentice Model • Regional oversight for instruction • Central oversight for Curriculum, Resources, Outcomes EL Bradley et al. JSR 177 (2012) 14-20 TCW Yu et al. JSR 168 (2011) e17-e23

8. Novel Clerkship Models • Non-Academic Clerkship Model • Use of Community hospitals • With or without Academic structure of residency M Williams, et al. JST 116 (2004) 11-13.

9. Novel Clerkship Models • Surgical Subspecialty Model • Use of Subspecialty surgery rotations • High Ambulatory patient population for instruction MK Sandquist et al. JSR 153 (2009) 152-5. Poenaru et al. Amer J Surg 175 (1998) 515-517

10. Novel Clerkship Models • Common Themes • Centralized Curriculum Oversight • Identical Educational Objectives/Resources • Faculty Development/Instruction • Monitoring of Outcomes

11. The Solutions toGeneral Surgery at AHC * • Mindset Change (for CD/Chair/Department) • Education not about the Emersion • Universal, Reproducible Surgery Curriculum • Faculty Development

12. Clerkship is not Emersion • Service and/or Hospital becomes Context • Not Team dependent • Team can be redefined

13. Universal Curriculum • Identical Objectives • Standard Teaching Material & Resources • Standard Assessments • Pedagogical Options

14. Faculty Development • Shared Educational Goals • Common Understanding of Objectives • Awareness of Resources • Updated Versions

15. Surgery Core Curriculum • Successfully Navigating the First year of Surgical Residency: Essentials for Medical Students and PGY-1 Residents • ( National Curriculum) • Guidebook for Clerkship Directors, 4th Edition

16. Developing Core INSTRUCTION • Didactics • Experiential Opportunities • Skill Instruction • Always remember equivalency (LCME)

17. The IUSM Example • Core topic Small Group Discussions • Lectures—Surgical Nutrition, Ventilators • Clinics—Breast Oncology; Colorectal • Calls—Acute Care Surgery/Trauma • Skills—Venipuncture; Suturing; Foley • Patient Assessment—Simulation

18. General Surgery at AHC • Curriculum, Objectives, and Instruction that Compile to make a General Surgery experience

19. General Surgery for the “Non-surgical” Students

20. “Non-surgical” Students • Who are our learners? • 90+ % of students are not surgeons • What should be our Educational Mindset?

21. The Generalist Education • Clinical Encounters MJ Curet et al. Am J Surg 178 (1999) 78-84

22. MJ Curet et al. Am J Surg 178 (1999) 78-84

23. The Generalist Education • Clinical Encounters/Diagnoses • Higher interest in topics of subspecialty surgery • Orthopedics • Otolaryngology • Ophthalmology • Not trauma, vascular problems, CAD, PE MJ Curet et al. Am J Surg 178 (1999) 78-84

24. The Generalist Education • Skill Proficiency MJ Curet et al. Am J Surg 178 (1999) 78-84

25. MJ Curet et al. Am J Surg 178 (1999) 78-84

26. The Generalist Education • Skill Proficiency • Shared importance of Documentation • Highly rated “office procedures” • Wound Management, Epistaxis, Abscess MJ Curet et al. Am J Surg 178 (1999) 78-84

27. The Generalist Surgical Education* • Not always reflective of AHC healthcare • Higher Subspecialty emphasis • Office-based procedural elements

28. The IUSM Example • Core Discipline didactics • Skills—Casting/Splinting; Vascular Exam • TBD

29. The Generalist Surgical Education*Resources • WISE-MD • Lawrence Text: Essentials of General Surgery

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