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Pre-Clerkship Clinical Skills Courses in the US, 2010: Results of a National Survey

Pre-Clerkship Clinical Skills Courses in the US, 2010: Results of a National Survey. Matthew Mintz, MD, FACP Associate Professor of Medicine The George Washington University School of Medicine. Pre-Clerkship Clinical Skills Courses in the US, 2010: Results of a National Survey.

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Pre-Clerkship Clinical Skills Courses in the US, 2010: Results of a National Survey

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  1. Pre-Clerkship Clinical Skills Courses in the US, 2010: Results of a National Survey Matthew Mintz, MD, FACP Associate Professor of Medicine The George Washington University School of Medicine

  2. Pre-Clerkship Clinical Skills Courses in the US, 2010: Results of a National Survey Julie Taylor, MD, Alpert Medical School at Brown University Alex Mechaber, MD, University of Miami Miller School of Medicine Ronald Silvestri, MD, Harvard Medical School Preetha Basaviah, MD, Stanford University School of Medicine Steven Durning, MD, Uniformed Services University of the Health Sciences F. Stanford Massie, MD, University of Alabama School of Medicine Sara Tariq, MD, University of Arkansas for Medical Sciences Wendy Madigosky, MD, MSPH, University of Colorado School of Medicine Andrea Flory, MD The George Washington University School of Medicine Felise Milan, MD, Albert Einstein College of Medicine Jeffrey La Rochelle, MD Uniformed Services University of the Health Sciences

  3. State of the Union

  4. Mid 90’s to Early 2000’s:Interest Groups and Task Forces Form • AAMC Lewis, J., Antonelli, M., Brown, D. D., Haist, S., Hasbrouck, C., McArthur, J., et al. (1993). Report of the introduction to clinical medicine task force. Sponsored by AAMC Group on Educational Affairs • Council on Medical Student Education in Pediatrics (COMSEP) • Society of Teachers of Family Medicine (STFM) • Clerkship Directors of Internal Medicine (CDIM)

  5. Mary Ann Antonelli, MD FACP Department of Veterans Affairs Pacific Islands Health Care System, Honolulu, HI

  6. Earlier Surveys Deloney Linda A. A Comprehensive Overview of Introduction to Clinical Medicine Courses and Course Directors, Chapter IV, November 2003 Two survey questionnaires were e-mailed to identified curriculum contacts in 126 accredited United States MD-granting medical schools and 16 accredited Canadian medical schools in the spring of 2003. 48% response rate

  7. AAMC Task Force on Clinical Skills Education met in 2003, Recommendations published in 2005

  8. AJM Perspective in 2005 Introduction to clinical medicine: A time for consensus and integration-Association of Professors of Medicine Perspective, American Journal of Medicine 2005 Discussed results of CDIM 2003 survey which identified status of ICM course from Clerkship Directors (only some of which were ICM directors)

  9. Letter to Editor re: AJM Perspective Mechaber, Bernstein, Dyrbe, Harper, Massie 2003 CDIM survey “was a good starting point to begin this dialogue, but a more comprehensive survey of ICM directors is likely warranted.” “More important, though, a national forum through an organization with a broad constituency such as the Association of American Medical Colleges is essential to provide more formal recommendations.”

  10. AAMC Task Force On the Preclerkship Clinical Skills Education of Medical Students 2005 Eugene C. Corbett, Jr., M.D. (Chair) Roger L. Berkow, M.D. Lisa B. Bernstein, M.D. Liselotte N. Dyrbye, M.D. Scott A. Fields, M.D. Maryellen E. Gusic, M.D. William R. Harper, M.D. Starla G. Martinez, M.D. F. Stanford Massie, Jr., M.D. Alex J. Mechaber, M.D. John C. Rogers, M.D., M.P.H, M Ed Matthew R. Thomas, M.D

  11. Recommendations For Clinical Skills Curricula For Undergraduate Medical Education 2008 AAMC Task Force On the Preclerkship Clinical Skills Education of Medical Students

  12. Recommendations For Clinical Skills Curricula For Undergraduate Medical Education 2008 Adhere to an explicit set of principles to guide the design and implementation of the preclerkship clinical skills curriculum. Implement a clinical curriculum that reflects the developmental nature of skills learning, including the designation of expected levels of skill performance. Adopt explicit competency goals which, in turn, determine the specific skill objectives in the preclerkship curriculum.

  13. Recommendations For Clinical Skills Curricula For Undergraduate Medical Education 2008 Provide sufficient learning opportunities, using a variety of healthcare settings, that enable students to achieve specified preclerkship objectives. Design and implement strategies to assess students’ achievement of expected clinical skills outcomes. Provide the program elements critical to the success of the preclerkship clinical skills curriculum: leadership, programmatic infrastructure, and the resources required for continuous curricular enhancement.

  14. Methods • Several of us (AM, SM, SD, JLR, MM) from CDIM decide to do a national survey (two actually) • PCCS Course Directors • Curricular Deans • CDIM also agrees to add two questions (name and contact info) to it’s annual survey in 2010

  15. Methods • Dr. Julie Taylor used direct methods to determine PCCS Course Director names/contact information • Handed out contact information sheets at the 2010 NEGEA • Called US and Canadian medical and osteopathic schools. • By 5/7/2010, this database had contact information from 158 programs, of which there were 229 names and emails available for the 133 AAMC US medical schools.

  16. Methods Dr. Jim Blatt makes connection CDIM group and Dr. Taylor combine forces

  17. Methods • Study was approved by the GWUMC IRB • Emails were sent to curricular deans and PCCS course directors with link to an online survey • Instructions given in the email and survey to forward to appropriate individual if recipient incorrect • Reminder email sent to non-respondents • Remaining non-responding schools were contacted directly by research group via phone and/or email

  18. Methods • Two surveys were sent to 133 AAMC member US medical schools. • First survey was sent to curricular deans • Initially, from CurMITT (6/2010) 130/133 names and emails • Direct contact of 3 missing institutions • Direct contact of 8 “bounce backs” from first sent on 10/11 • Contact of correct contact from 1 respondent who was not the correct contact.

  19. Methods • Second survey sent on 10/14 to PCCS course directors identified from: • Dr. Taylor’s data base (229 names/emails) • CurMITT database (77 additional emails from 94/133) • CDIM annual member survey: 82 (75%) responders generated 26 new names and emails (updated five emails addresses already in the database) • 332 total • Curricular Dean Survey- 20 new names/emails • Attempted to contact initial non-responding institutions.

  20. As an aside……

  21. Initial response remarkable!! Survey to PCCS course directors sent 10/14/2010 Direct emails to Dr. Mintz suggested overwhelming support Impromptu meeting at November 2010 AAMC meeting in Washington, DC sets stage for today’s event.

  22. Now, back to the study

  23. Branched Logic • For Course Directors survey, in order to include all directors and co-directors as well as not duplicate results for the same course, branched logic was used • Baseline demographics and opinion questions were to be completed by all • Organization and Administration questions completed only by • Overall director • Year 1 and Year 2 director where no overall director existed.

  24. Results: Curricular Deans • 80 of the 133 curricular deans responded (60% response rate) • All schools reported having a PCCS course or content • 64% PCCS courses managed centrally • 76% reported that curricular time devoted to PCCS courses in the first two years ranged from 11% to 30% • Though content varied considerably, 90% responded that their school’s PCCS course teaches other curricular elements such as professionalism, ethics, and clinical reasoning.

  25. Results: Curricular Deans

  26. Results: Curricular Deans

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

  28. Results: Curricular Deans

  29. Results: Curricular Deans

  30. Results: PCCS Course Directors 138 PCCS course directors from 92/133 medical schools responded (69% response rate). • 138 completed baseline demographics • 106 completed organization and administration questions • 119 completed opinion questions

  31. Baseline Data or Demographics from PCCS Course Directors

  32. Results: Course Name

  33. Bedside Diagnosis Essentials of Clinical Medicine Physical Diagnosis and Clinical Integration (Introduction to) Clinical Skills (Essentials of) Clinical Reasoning On Doctoring Foundations of Patient Care/Clinical Practice Competency Based Apprenticeship in Primary Care Patient Physician Society Introduction to the Patient/ to Patient Care Clinical Continuum Doctoring Skills

  34. Results: PCCS Course Directors • 91% PCCS course directors are physicians (37% general internal medicine, 24% family medicine, 21% subspecialty, and 9% pediatrics). • Wide range of years in current position and variety of academic ranks • Many have other educational roles • 36% in other PCCS course • 38% in Clerkship • 38% in Residency Program

  35. Results: PCCS Course Directors

  36. Years in Current Position

  37. Academic Rank

  38. Course Organization from PCCS Course Directors

  39. 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

  40. 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

  41. Communication with Clerkship Directors

  42. Course Administration from PCCS Course Directors

  43. Results: PCCS Course Directors 2/3 PCCS Courses run by 1-3 faculty

  44. Results: PCCS Course Directors ~2/3 PCCS Courses need over 50 faculty to run

  45. Results: Number of Non-Faculty Administrators (FTE) Three quarters have only 1-3 administrators • 1 (24%) • 2 (31%) • 3(19%) • 4(10%) • 5(5%) • more than 5 (11%)

  46. Results: Percent Full Time Faculty

  47. PCCS Course Directors Opinions on a National Organization

  48. Results: PCCS Course Directors • 87% of PCCS course directors felt that a national organization or resource for PCCS course directors was needed as a way of communicating, sharing, and collaborating. • Majority believe AAMC national meeting would be a good venue for a live meeting

  49. Results: PCCS Course Directors A national organization for PCCS course directors is needed

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