Articulate rationale for early assessment Describe process of assessment and feedback sessions List benefits of process based on:  Objective data Opinion of interns over past 2 year

Blackwelder, Reid

Fox, Beth Anne

Stockwell, Glenda

English

East Tennessee State University

East Tennessee State University Digital Commons @ East Tennessee State University ETSU Faculty Works Faculty Works 5-1-2010 Goal Directed Learning: Early Assessment And Individualized Education Plans for Family Medicine Interns Glenda Stockwell East Tennessee State University, stockwel@etsu.edu Beth Anne Fox East Tennessee State University, foxba@etsu.edu Reid Blackwelder East Tennessee State University, blackwel@etsu.edu Follow this and additional works at: https://dc.etsu.edu/etsu-works  Part of the Family Medicine Commons Citation Information Stockwell, Glenda; Fox, Beth Anne; and Blackwelder, Reid. 2010. Goal Directed Learning: Early Assessment And Individualized Education Plans for Family Medicine Interns. 43rd Annual Spring Conference Society of Teachers of Family Medicine, Vancouver, BC. This Presentation is brought to you for free and open access by the Faculty Works at Digital Commons @ East Tennessee State University. It has been accepted for inclusion in ETSU Faculty Works by an authorized administrator of Digital Commons @ East Tennessee State University. For more information, please contact digilib@etsu.edu. Goal Directed Learning: Early Assessment And Individualized Education Plans for Family Medicine Interns Copyright Statement Copyright The Authors. Document was originally published in the Society of Teachers of Family Medicine Resource Library. Creative Commons License This work is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 4.0 License. This presentation is available at Digital Commons @ East Tennessee State University: https://dc.etsu.edu/etsu-works/6928 Goal Directed Learning:Early Assessment and Individualized Education Plans for Family Medicine InternsGlenda F Stockwell, PhD,  Beth A Fox, MD,Reid Blackwelder, MDEast Tennessee State UniversityTime frame:• Welcome, background, objectives       (5 minutes)• Participants share experiences          (15 minutes)• Rationale, literature, our approach    (20 minutes)• Benefits and outcomes (10 minutes)• Small group discussion (20 minutes)• Large group debriefing (15 minutes)• Summary and conclusion (5 minutes)Objectives• Articulate rationale for early assessment• Describe process of assessment and feedback sessions• List benefits of process based on:• Objective data• Opinion of interns over past 2 yearsHandouts• Goal Directed Learning Goals & Objectives• Sample Schedule• Competency based self assessment form• Case presentation assessment checklist• Common Ground Assessment Instrument• Criteria for assessment in each category There is something You Don’t KnowR.D. Laing (adapted)There is something you don’t knowthat you are supposed to know.You don’t know what  it is you don’t know,and you feel you look stupidif you seem both not to know itand not know what it is you don’t know.Therefore, you pretend to know it.There is something…R.D. Laing (adapted)This is nerve-rackingsince you don’t know what you must pretend to know.Therefore you pretend to know everything.You feel I know what you’re supposed to knowbut I can’t tell you what it isbecause I don’t knowthat you don’t know what it is.There is something…R.D. Laing (adapted)I may know what you don’t know,But not that you don’t know it,And you can’t tell me.So I willhave to tell youeverything.Your experiences• How and when do you assess your interns’ competence• What works• What doesn’t Rationale • Statement of the Problem• Knowing what they know• Need to assess baseline skills• Varying levels of clinical skill and experience• Benefits of Early Assessment• Patient safety   Targeted teaching   Successful start• Identify problems early• ACGME Core CompetenciesBrief literature review• Professionalism in Emergency Medicine(Larkin, Binder, Houry, Adams, 2002)• Core Competencies in Integrative Medicine (Kligler, Maizes, Schachter, PSrk, Gaudet, Benn, Lee, Remen, 2004)• Direct Observation for Assessing Interpersonal Skills (Jouriles, Emerman, Cydulka, 2002)• Educational Interventions to Address Core Competencies in Surgery (Sachdeva, 2003)Brief literature review• Assessing the ACGME General Competencies (Swing 2002)• The ACGME Core Competencies:A National Survey of Family Medicine Program Directors (Delzell, Ringdahl, Kruse 2005)• A Counseling Practicum Curriculum to Teach and Assess ACGME Core Competencies (Dankoski, 2006)Brief look at literature• Considerations• What should be assessed• When should assessment take place• Who should assess resident performance • How should assessment be doneBrief look at literature• Methods for assessment• Ratings• Checklists• 360-assessment• Oral exams – structured case discussions• OSCEs• Simulations• Portfolios• Direct Observation Brief look at literature• Wide variation in design and implementation• Methods that include:• Focused assessment of residents performing• Clinical tasks• Instruments designed for the tasks• Task specific performance criteria• Training of evaluatorsProduce results with higher reliabilityOSCEs, SP exams (SP checklists) Brief look at literature• Survey of program directors (2005)• Believe patient care most important competency• Time major barrier to implementation• Need for faculty development• PDs didn’t correctly identify evaluation tools they were already using • 99.6% using ITE• 53.3% identified it as a method they were usingIneBrief look at literature• Survey of program directors (2005)• Active precepting                   76.0%• Record review                        72.8%• Procedure logs                       63.8%• Simulations                            11.1%• Audit of computer utilization   10.5%• OSCEs                                     9.1%Brief look at literature• All competencies are not created equal• More familiar with assessing some• I & CS taught through role modeling• Assessment subjective• Adult education principles• Experiential learning• Reflection and analysis of one’s thinking• Feedback• Detailed,  specific,  timelyBrief look at literature• Direct Observation (Emergency Medicine)• Faculty shadows resident for 4 hours in ED• History taking • Physical exam • Generation of differential diagnosis • Resource utilization • Interpretation of data • Procedural skills • Charting • Communication skills • Patient care efficiency• Faculty completes a “Direct Observation” formBrief look at literature• Counseling Practicum Curriculum (Family Medicine)• Communication and interpersonal skills• Counsel own patient – 1 hour• Live supervision by faculty and peers• Pre-mid-post session for feedback, direction, debriefing• Benefits• Experiential learning process• Immediate teaching moments• Real time assessment Our Approach to the Problem• How do we teach our students• COL• OSCE• POM• Communication Skills• Presentation SkillsOur approach…• What has worked in the past • OSCE• ECG • Video recording and review• Self evaluation• Faculty evaluationOur approach…• What methods do we have available• ACGME competencies• Practicing medicine cases• Recorded communication sessions/review• Self assessments based on competencies• Human Patient Simulation • Faculty expertiseBefore they arrive…• They receive a packet with• Communication CD• Rapport• Agenda setting• Information Management• Active listening• Addressing feelings• Reaching common groundBefore they arrive…• They also receive• Detailed PE handout• PowerPoint on ECG• PowerPoint on differential diagnosisGoal Directed Learning Structure• 2 weeks 3 interns• 4 weeks in July• FMS• FPC• ClinicGDL Content – half day sessions• Residency Expectations• PGY 1 Peer Group meeting• Clinic• Communication Skills and OSCE • ITE• Competency-based Self AssessmentGDL Content• Human Patient Simulator• Chart review & coding• PE - SP checklist & direct observation by faculty• Procedures• ECG packet• Practice medicine cases After completing GDL• Intern meets with Program Director, Faculty Advisor and Psychologist • Go over results• Discuss strengths• Discuss growth opportunities• Develop specific goals and strategies for improvement• Competency based summary letterOutcomes• Introduction to our education style• Confidence-building• Identification of “Partners in Difficulty”• Resident-specific educational and catch-up plan• Improved medical knowledge• Better prepared to care for patientsIntern 1 190 370 450Intern 2       206 240 330Intern 3 243 340 440Intern 4 193 200 360Intern 5 189 220 380Intern 6 226 370 NAStep 2 GDL ITE ABFM ITEExam ScoresBenefits• Identification of personal strengths• Identification of growth opportunities• Introduction to ACGME competencies• Communication problems (ESL)• Verbal, written, and comprehension• Immersion in clinic with closer faculty guidance• Introspection and self assessment• Bonding and “safe place”What was helpful about GDL• Learned to be ‘independent’ in clinic• Oriented IMGs to US medical system • Decreased anxiety• Learned how to write notes • Introduced to coding • Building relationships “meeting every week in July was great”What was helpful about GDL• Weekly PGY 1 meetings normalize the “Oh my gosh, what have I gotten myself into?” feeling.• ITE was useful – not pleasant – but useful• “Some of my friends in other programs still don’t know the names of the other interns” April 2010• ECG – “didn’t know at all before GDL”What should we add to GDL• More orientation to hospital:• Portal• Morning report• Rounds• Go over chart• How to dictate – how to press the button• What to include in dictationWhat should we add to GDL• Shadow a resident (hospital)• Discuss case managers role • More procedural “stuff”• Review chest x-ray• Review CT Scan• Write prescriptions• More time with ICD 9 & Flash CoderAnd… f i n a l l y …please tell us• GDL• ITE• OSCE• FMS• FMC• PD• COL• SPs• STFM• EKG• ECG• TLA• POM• PID• BFFSmall Group discussionAdditional ways to improve the processLarge Group sharingDebriefing and collaborationAFTER GOAL DIRECTED LEARNINGR.D. Laing (adapted)You know what you don’t know,And I know that you don’t know it.So we will make a plan to help you learn it. And then you will know. 

Goal Directed Learning: Early Assessment And Individualized Education Plans for Family Medicine Interns

https://dc.etsu.edu/cgi/viewcontent.cgi?article=8180&amp;context=etsu-works

Goal Directed Learning: Early Assessment And Individualized Education Plans for Family Medicine Interns

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