Clinical Boot Camp: It’s More Than Needle drivers and IV Fluids

Tanya Fernandez, MS, PA-C Janice Baker, MHR

Karen Vogel, MS, PA-C

Disclosures None to report

GoalsAt the end of this session, the participant will be able to: Identify the three main areas in which learners struggle when

transitioning from didactic to clinical learning environments Describe the components of a transition course that prepares

students for workplace learning Illustrate how a transition course can reduce professionalism lapses,

improve onboarding procedures, increase efficiency for the Clinical Team, teach early skills for self-directed learning and overcome logistical struggles in PA students

Summarize professional practice, clinical skills, communication, health disparity and ethical topics to consider including in a transition course and how they align with ARC-PA standards

A little bit about our program 3-year program

» 2 years of didactics with early clinical integration» 1 year of clinical rotations

Colorado Curriculum innovation

Colorado Curriculum Launched in Summer 2018 No longer have silo courses Integrated curriculum with basic science, clinical medicine and

professional practice 7 body system blocks 4 clinical threads 70 clinical presentations Learner-centered Longitudinal and spiraling Largely case-based

Why did we design Clinical Boot Camp? Increasing student struggles with transition from

classroom to clinic» Roles, Responsibilities and Expectations» Adjusting to different clinical cultures and setting

Bridge gap Professionalism issues Early identity formation Lost time for learning in clinic for orientation

A little bit about our Boot Camp Semester-long course

» 4-hour classes (afternoons dedicated to trainings, assignments) 2, 2-hour sessions (30 sessions in the semester)

» Incorporated softer clinical skills» Tuesdays (which correspond to when our students will be in clinical

experiences)» White coat

Areas where students struggle when transitioning to clinical learning environments

Lack preparation to participate in authentic tasks and activities*» Oral presentations, writing notes, basic procedures

Unfamiliar with relationships in clinical settings*» How to work with and the roles of attendings, residents, nurses

Unfamiliar with work practices*» Introduction to routines, rules, logistics and culture

*O’Brien BC, Poncelet AN. Transition to Clerkship Courses: Preparing Students to Enter the Workplace. Academic Medicine. 2010. 85(12):1862-1869.

Components of a transition course that prepares students for workplace learning

Components of our course that focused on Authentic tasks/activities Home visits with families

with children with disabilities Working with Interpreters workshop Transgender Healthcare Health Literacy Art of Observation Resiliency practices (HeartMath) Medical Improv BLS for Healthcare Providers

Components of a transition course that prepares students for workplace learning

Components of our course that focused on relationships in the workplace A Day in the Life Giving and receiving feedback Introduction to implicit bias

and stigmas Introduction to cultural

sensitivity and health care disparities

Guided observation in a clinical environment

Components of a transition course that prepares students for workplace learning

Components of our course that focused on routines, rules, norms, and culture of the workplace Student-Educator agreement CV writing Professionalism Social media and professionalism

Benefits of this course for the Clinical Team Reduced professionalism lapses

» No missed assignments/clinical requirements» Dedicated time to accomplish onboarding paperwork, drug

screens, immunizations and badging for sites» 20% professionalism lapses in year prior

Increased efficiency» Less time from Clinical Team to track these items down» Bulk downloads of applications, immunizations

Overcame logistical struggles» Used our learning management system for providing

instructions and assignments, so reduced individual emails to and from students

Benefits of this course for the Clinical Team Introduced self-directed learning

» Allowed for student-directed time management» Student-led responsibility for assignments» Will carry forward from modules to 3rd Year ILPs» Will incorporate into 3rd Year rotation preparation

and pre-readings/preparation for rotation sites

Benefits of this course for preceptors “I was impressed with how ready these students were to hit the ground running and how

little time was lost teaching them some of the basics.” --Preceptor at Children’s Hospital Colorado

“This student is one of the best 1st year students that we have had. She is so passionate about her own learning. She communicates well with people and wants to make sure that they understand her at their level.” --Naomi Miyazawa, PA-C, CHA/PA preceptor for more than 25 years

“She did an excellent job of preparing for weekly rotation time, and was self-directed in setting personal goals and taking steps to accomplish her goals.” --Peggy Walsh, PA-C, Preceptor and Past-President of Colorado Academy of PAs

“Great cultural competency, medical knowledge base was strong, willing to continue learning, positive attitude, adaptable, respectful and courteous to our patients from varying backgrounds. This rotation is mostly observational, but she stayed engaged and interested, which is sometimes difficult in this type of rotation.” -–Preceptor at a local refugee clinic

What did students think was valuable? Communication

Using empathy when communicating with patients (Medical Improv)

Health literacy principles Collaborating with interpreters

Professionalism Digital Professionalism in practice Identifying implicit bias

Feedback - Receiving and Welcoming from preceptors

Self-Resiliency Strategies

Lessons learned? Don’t make assumptions about what the students will find

valuable in the moment or after reflection Continuous quality improvement with student input is

valuable, even when it is tough to hear Prioritize and focus on professionalism, professional

identity formation, communication and giving and receiving feedback, as these will carry forward throughout the student’s career

Integration really does work

Topics to consider & alignment with ARC-PA standardsCorresponding ARC-PA Standard TopicB1.03 (B1.01d) The curriculum must be of sufficient breadth and depth to prepare the students for the practice of medicine.

Course as a whole, in conjunction with other curricular components

B1.05 (B2.19) The curriculum must include instruction in intellectual honesty and appropriate academic and professional conduct.

Professionalism, DigitalProfessionalism, Student-Educator Agreement

B1.06 (B2.06a-f) The curriculum must provide instruction to prepare students to provide medical care to patients from diverse populations.

Collaborating with patients and families from different cultural backgrounds, Health stigma, Refugee and immigrant health

Topics to consider & alignment with ARC-PA standardsCorresponding ARC-PA Standard TopicB1.07 (B2.05) The curriculum must include instruction related to the development of clinical reasoning and problem-solving abilities

Guided Observation in the Clinical Setting

B2.04 (B2.04) The curriculum must includeinstruction in interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families and other health professionals.

Medical Improv, Health Literacy, Cultural Sensitivity, Implicit Bias, Using Interpreters

ActivityIn small groups, take a few minutes to discuss the aspects of an ideal preparatory course that you might design, if time was not a factor and clinical/procedural skills were covered elsewhere in your curriculum. What areas do your learners struggle with when

transitioning to clinical work environments? What would you include to address these struggles?

Discussion How many of you have a transition course? How robust is the course? Who runs that course (didactic or clinical educator)? Does your course include any “soft skills” or just

procedural skills? Does your course include student well-being? What processes do you have in place to take care of

clinical rotation logistics/onboarding?

Speaker Contact InfoJanice Baker, MHR

Janice.S.Baker@CUAnschutz.edu

Tanya Fernandez, MS, PA-CTanya.Fernandez@CUAnschutz.edu

Karen Vogel, MS, PA-CKaren.Vogel@CUAnschutz.edu