An Expert Educator Teaching Shift Used as a Method to Assess Milestones in Students

Nicholas Kman, Cindy Leung, David Hartnett, Sarah Greenberger, Daniel

Bachmann, David Way, SorabhKhandelwal, Daniel Martin

No Disclosures

Nicholas Kman

Cindy Leung

David Hartnett

Sarah Greenberger

Daniel Bachmann

David Way

Sorabh Khandelwal

Daniel Martin

2

Background

24 competency-based milestones for fourth-year medical students completing their emergency medicine (EM) clerkships were recently published.

3 Santen, et al. “Medical Student Milestones in Emergency Medicine”.

Background

Our institution implemented a competency-based curriculum in 2011 called the Lead.Serve.Inspire (LSI).

In response to both low numbers of evaluations of direct observation of competence requirement & development of milestones, our clerkship implemented an expert educator shift.

4

Educational Objectives

To use an expert educator teaching shift as a way to improve direct observation of competence and assessment of the milestones in EM.

Curricular Design

An expert educator (3 total) completed two 4 hour teaching shifts per month with two to four 4th year medical students.

For the first three hours, the group focused on clinical care of ED patients during which students were encouraged to pick up new patients and present them to the teaching attending physician, similar to a conventional shift.

6

Curricular Design

Each student was directly observed and assessed by faculty during the patient encounter on a predetermined set of objectives corresponding with 10 medical student milestones in EM (Table 1).

Remaining hour for direct individual feedback & informal didactic session (addition to core medical student lecture series).

7

Table 1 List of medical student milestones assessed during an

expert educator shift.

8

Milestone Description

Recognizes abnormal vital signs.

Recognizes when a patient is unstable requiring immediate intervention.

Performs and communicates a reliable, comprehensive history and physical exam.

Performs and communicates a focused H&P which effectively addresses the chief complaint and urgent patient issues. Constructs a list of potential diagnoses based on chief complaint and initial assessment.

Formulates basic diagnostic and therapeutic plans based on a differential diagnosis.

Establishes rapport with and demonstrates empathy toward patients and their families.

Demonstrates behavior that conveys caring, honesty, patient confidentiality, genuine interest and tolerance when interacting with a diverse population of patients and families.

Demonstrates basic professional responsibilities such as timely reporting for duty, appropriate dress, conference attendance, and timely completion of clerkship documents.

Effectively listens and communicates with patients and their families.

Preliminary Results

Compared program evaluation results between graduates of 2014 and the current class on 6 measures related to direct observation and satisfaction:

Key: Strongly Disagree.....Strongly Agree

Q1. A faculty member personally observed me taking a history

Q2. A faculty member personally observed me performing a physical examination

Q3. Faculty members provided me with sufficient feedback on my performance

9

Preliminary Results

Compared program evaluation results between graduates of 2014 and the current class on 6 measures related to direct observation and satisfaction:

Key: Not Important.....Very Important

Q4. Rate the importance of the Expert Educator Shift

Q5. Rate the importance of Direct Observation

Key: Poor.....Excellent

Q6. Rate the quality of your overall educational experience

10

Results

11

Impact/Effectiveness

Improvement in student perception of direct observation of competence exercise and have demonstrated that an expert educator shift can be utilized to directly assess 10 of the recently published medical student milestones for EM.

An expert educator shift with direct observation of competence can be further utilized to assess additional competency based milestones in undergraduate medical education.

12

Future Directions: Advanced Clinical Track

Develop an advanced clinical track to teach residency level 1 and level 2 residency milestones prior to graduation

Supplement to the medical student milestones evaluated in the clerkship

Prepare medical students for success in EM residency

13

Questions?

14