A N N S . B O TA S H , M DP R O F E SS O R , P E D I AT R I C S

J A S O N P E R E Z , M S, F N PG R A D UAT E , C O L L E G E N U R S I N G

PAT R I C I A D. P O W E R S, D N P, M PA , R N, F N P- C , N P PC L I N I C A L A SS I S TA N T P R O F E SS O R , N U R S I N G

C A R O L R E C K E R - H U G H E S, P T, P H DA SS O C I AT E P R O F E SS O R , P H Y S I C A L T H E R A P Y

C A R R I E R O S E A M E L I A , M AFA M I LY M E D I C I N E

PA M E L A Y O U N G S - M A H E R , M . E D.C O O R D I N AT O R , O N L I N E L E A R N I N G

Distance Faculty Observation Using iPadsUpstate Medical University

Where We Work College of Medicine (Ann)

College of Nursing (Patty)

IT(Pam)

Physical Therapy (Carol)

Family Medicine (Carrie)

Background & Purpose

1. Clinical Education

2. Goals of Project

3. Literature Review

Percentage Clinical Education

%0

10

20

30

40

50

60

70

NP

PT

MD

NPPTMD

Education: From Classroom to Clinic

Academic Faculty Clinical Supervisors Clinical teachers in traditional & Practicing clinicians who supervise non-traditional classroom settings students in the clinic

Education: From Classroom to Clinic

Challenges of Clinical Teaching:Juggling Act

Variability teaching & learning

Lack of effective feedback skills

Time

Goals of the Project

Assess FaceTime as a mechanism to bridge time/distance barriers in observing students

Improve students’ clinical skills through use of formative feedback

Develop a shared observation tool across multiple disciplines to define core, observable clinical skills

Medicine

Physical Therapy

Nursing

• Fosters appreciation & understanding of other disciplines• Challenges norms & values of each discipline• Promotes student participation• Models strategies for future practice

Past to Future

An Interdisciplinary (Ad)Venture

COM

CON

CPT

Literature Review

Distance Technology:

1. Provides a mechanism for valuable feedback on performance and promote mastery of clinical skills (Bulik, Frye, Callaway, Romero, & Walters, 2002; Clever, Novack, Cohen, Levinson, 2003; Novack, Cohen, Peitzman, Beadenkopf, Gracely, & Morris, 2002).

2. May be used for long-distance communication assessment for a variety of learners (Bulik, Frye, Callaway, Romero, & Walters, 2002; Clever, Novack, Cohen, Levinson, 2003; Mattheos, Nattestad, & Attström, 2003; Novack, Cohen, Peitzman, Beadenkopf, Gracely, & Morris, 2002).

3. Can be distracting/problematic (Curran, Aziz, O'Young, Bessell, & Schulz, 2005; Clever, Novack, Cohen, Levinson, 2003).

Description of the Project

Timeline

• Planning & CommunicationAug/Sept/Oct:

•Recruitment & Training

Oct/Nov/Dec:

•Observations/FeedbackJan – May:

Planning

IRB Process Describe what we plan to do &

with whom Seek exempt status

Identify common ground across disciplines for patient examination Taking a patient history Create form with essential

elements

Define PI Roles

Communication

Communication with: The project team Academic Faculty Students Clinical sites

Tools Blackboard Google Drive Email

Research Methods

Develop Tools for Data Collection:• Student & Faculty Technology

Survey• Student Survey on Faculty Feedback• Create Focus Group Questions for

Faculty

Develop Protocols:• Patient Recruitment• Student & Faculty FaceTime

Encounters

Recruitment of Sites & Students

Recruitment Sites

HIPAA Wi-fi access Policies & Procedures Some sites could not participate

Students Expectations of participants Overview of the Project and iPad training Completing 2 Surveys online

Faculty Recruitment

Principal Investigators recruited faculty

iPad was an incentiveRequired commitment

3 hours of faculty development

1-2 hours/month January-May Complete survey and focus

groupMemorandum of

Understanding (MOU)

Faculty Development Workshop

Faculty Training

Set up and use of iPads 1 hour session (by department) Introduction to Face Time,

Apps, and Settings

Observation/Feedback Workshop 2 hour session Simulation in Clinical Skills

Center

Practice, Practice, Practice

Feedback Workshop Objectives

Following this workshop, faculty will:

• Differentiate between characteristics of effective versus ineffective feedback.

• Use open-ended questions to promote student reflection and decision making.

• Engage in a formative feedback session using Face Time.

• Assess challenges of technology in the delivery of feedback.

Effective Feedback

Promotes self-directed learning and professional development

Facilitates effective problem solving

Requires ability to:• question

appropriately• listen actively

I’m questioning

Feedback Should

Faculty Development Session

Setting up the iPad (Student)

Pediatric Observation of Student/Standardized Patient

Feedback: Nursing Feedback to Student

Data Collection & Results

Data Collection & Analysis

Data Collection and Analysis:1. Faculty Survey 2. Student Surveys

3. Faculty Focus Groups

Results: Technology Surveys

Did you experience difficulty connecting to FaceTime?Results

•Yes•No

Faculty•42%•58%

Students

•38%•63%

Results•Yes•No

Faculty•48%•52%

Students

•44%•56%

Did you experience difficulty staying connected to FaceTime?Faculty: It took multiple attempts before the call went through. Audio was choppy, the camera froze several times.

Student: Preceptor was

unfamiliar with the

technology.

Results: Technology Surveys

Results•Agree•Disagree•Unsure

Faculty•73%•12%•15 %

Students

•81%•6%•13%

Results•Agree•Disagree•Unsure

Faculty•55%•18%•27 %

Students•69%•16%•16%

FaceTime is an effective mechanism for delivering student feedback

I would recommend the use of FaceTime technology on a regular basis

Faculty: Promising but doesn't have it's sea-legs yet.

Results: Student Reflections

The faculty member provided meaningful feedback about…

My Strengths

•Agree 86%•Disagree 10%•Unsure 3%

Areas for Improvement

•83%•10%• 7%

Might do Differently

•79%• 7%•14%

Results: Student Reflections

The faculty member provided….. “tricks of the trade” advice or helpful tips

Students

• Agree• Disagree• Unsure

Results

• 76%• 14%• 10%

Themes: Faculty Focus Groups

What Worked?• Assessing Students• Providing Feedback• Communication with the Onsite Faculty

What Did Not Work?• Imposition & Scheduling• Connectivity • Viewing Patients & Students• Student Initiative &

Accountability

Themes: Faculty Focus Groups

Suggestions Expand Use of iPad

Observations Earlier & more frequently History and physical

examination Connect with clinical faculty

Use for Site Visits

Teaching Tools iPad Apps

Additional Faculty Development

Lessons Learned

Students

Recruitment Sample of convenience “Carrot or Stick”=Participation

Training Memorandum of understanding Practice, practice, practice!

In the Clinic Variable support of instructors Informed consent process

Survey Completion

A Student’s Experience

Faculty

• Recruitment

• Training

• Commitment

• PI Support

Pilot Study…..Next Steps?

• Expand use across colleges

• Implement “carrot or stick” policies • Consider cross discipline observations

• Use, and validate, forms across disciplines• Guidelines for delivery of feedback• Observation tool

• Observe history AND physical examination

Next Steps for Faculty Use?

Communication skills workshops For new and current faculty Inter professional

Professional development iPad use Apps

Use of the iPad for “site” visits Rural and remote settings

Observation/Feedback Forms….

Observation Form: https://docs.google.com/file/d/0B7a8mExE0x3HdnpSUFM1W

FpjYW8/edit?usp=sharing

Feedback Checklist: https://docs.google.com/file/d/0B7a8mExE0x3HT1MwVTNUZ

045cEU/edit?usp=sharing

 

References

Bulik, R., Frye, A. , Callaway, M., Romero, C., & Walters, D. (2002). Clinical Performance Assessment and Interactive Video Teleconferencing: An Iterative Exploration. Teaching and Learning in Medicine, 14 (2), 124-132.

Clever, S., Novack, D., Cohen, D., Levinson, W. (2003). Evaluating surgeons' informed decision making skills: Pilot test using a videoconferenced standardized patient. Medical Education, 37 (12), 1094-1099.

Curran, V., Aziz, K., O'Young, S., Bessell, C., & Schulz, H. (2005). A comparison of face-to-face versus remote assessment of neonatal resuscitation skills. Journal of Telemedicine and Telecare, 11 (2), 97-102.

Glavaz, G., Parish, T., Byous, R., Chambers, D., Gerdom, L., Leffert, J., & Wright T. (2012). The use of videoconferencing for clinical site evaluations. Journal Physician Assistant Education,23(2), 50-55.

Lentz, L.M., & Fincher, R.M. (1999). Using telemedicine and standardized patients to evaluate off-campus students' skills. Journal of the Association of American Medical Colleges, 74 (5), 598-599.

Mattheos, N., Nattestad, A., & Attström, R. (2003). Feasibility of and satisfaction with the use of low-bandwidth videoconferencing for examination of undergraduate students. Journal of Telemedicine and Telecare, 9(5), 278-281.

Novack, D., Cohen, D., Peitzman, S., Beadenkopf, S., Gracely, E., & Morris, J. (2002). A pilot test of WebOSCE: A system for assessing trainees' clinical skills via teleconference. Medical Teacher, 24 (5), 483-487.

Robinson, S. (2011). Promote active learning with iPads. Radiologic Technology, 83(2), 204-207.

Smith, C. , & Skandalakis, J. (2005). Remote presence proctoring by using a wireless remote-control videoconferencing system. Surgical Innovations, 12(2), 139-143.

Upstate Medical University

Any “burning” questions??

What we are doing….

CNY Central: http://www.cnycentral.com/news/story.aspx?id=878617#.UVnR

cjnWaf8

What's Up at Upstate: http://whatsupatupstate.wordpress.com/2013/04/01/professors-

use-ipad-facetime-feature-in-teaching-medical-students/

Student interview: http://www.youtube.com/watch?v=p7KDIYU3Ngc&list=UUIC6

B4ULFCqa8bXKVc1sjYA&index=1