Flexible Clinical Experiences (FCE) AY1314: Review Clinical Experiences (FCE) AY1314: Review Samir...

Flexible Clinical Experiences (FCE) AY1314: Review

Samir Malkani MD Colleen Burnham MBA October 20, 2014

• Program Overview – Course Description – Program Objectives

• Positive indicators • Challenges

• Feedback – Student Assessment (by faculty) – Faculty Evaluation (by student) – Course Evaluation (by student) – Program Evaluation (faculty development session)

• Advisory Group

Outline for Full Course Review

• Four, one-week electives, embedded in the third year Core Clinical Experiences curriculum

• Provides opportunity for individual exploration in a broad range of specialties related to healthcare

• Aims to provide exposure to areas not covered by the core curriculum.

• Student driven, to allow for career exploration and to discover ones interests

FCE Program Description

1. Career exploration and development 2. Exposure to evolving and cutting-edge branches

of medicine not covered in the core curriculum 3. Provide opportunity to work with recognized

experts in medicine and allied sciences 4. Exposure to novel concepts and systems of care

Specific Program Objectives

• Wide variety of pre-designed experiences across all disciplines of medicine − AY1213: 84 pre-designed & 84 student designed across 15 departments* − AY1314: 89 pre-designed & 116 student designed across 18 departments* − AY1415: 68 pre-designed & 95 student designed (so far) across 15 departments

• Careers in fields not traditionally related to medicine – Health Insurance Policy – Medical Technology & Engineering – Global Health Policy – Healthcare Management

*the EPC identifies 22 formal departments; Urology added AY1415

Objective 1: Career exploration and development


Hosting Department AY1213 AY1314 AY1415 Medicine 242 218 170 Surgery 111 93 39 Family Medicine & Community Health 89 112 34 Anesthesiology 74 75 55 Orthopedics & Physical Rehabilitation 68 103 24 Obstetrics & Gynecology 67 62 53 Pediatrics 58 105 76 Psychiatry 53 51 33 Emergency Medicine 49 46 12 Pathology 30 38 39 Radiation Oncology 28 7 7 Neurology 23 9 15 Radiology 22 22 21 Ophthalmology 9 8 11 Urology 2 11 9 Cancer Biology 1 0 0 Cell Biology 0 4 0 Program in Molecular Medicine 0 4 0 Otolaryngology 0 2 0 Quantitative Health Sciences 0 0 3 Biochemistry & Molecular Pharmacology 0 0 0 Microbiology & Physiology Systems 0 0 0 Neurobiology 0 0 0 TBD (student design) 0 0 34 926 970 635


FCE Slots Offered by Department 0 50 100 150 200 250

AnesthesiologyCancer Biology

Cell BiologyEmergency Medicine

Family Medicine & Community HealthMedicine

NeurologyObstetrics & Gynecology

OphthalmologyOrthopedics & Physical Rehabilitation

OtolaryngologyPathologyPediatrics

Program in Molecular MedicinePsychiatry

Quantitative Health SciencesRadiation Oncology

RadiologySurgeryUrology

AY1213 AY1314 AY1415

AY1213 Hosting Department Number slots OFFERED

Number slots ENROLLED

percent FILLED

Medicine 242 137 57% Family Medicine & Community Health 89 51 57% Pediatrics 58 51 88% Anesthesiology 74 44 59% Surgery 111 43 39% Obstetrics & Gynecology 67 35 52% Psychiatry 53 33 62% Orthopedics & Physical Rehabilitation 68 25 37% Emergency Medicine 49 21 43% Pathology 30 21 70% Radiology 22 18 82% Neurology 23 12 52% Radiation Oncology 28 6 21% Ophthalmology 9 3 33% Urology 2 2 100% Cancer Biology 1 1 100% TOTAL (includes 84 student designed: 17% of all enrollment)

926 503

AY 2012-2013


Number slots ENROLLED

percent FILLED

Medicine 218 135 62% Pediatrics 105 82 78% Family Medicine & Community Health 112 52 46% Surgery 93 44 47% Obstetrics & Gynecology 62 29 47% Orthopedics & Physical Rehabilitation 103 28 27% Psychiatry 51 28 55% Pathology 38 25 66% Anesthesiology 75 23 31% Emergency Medicine 46 15 33% Radiology 22 12 55% Urology 11 7 64% Ophthalmology 8 6 75% Cell Biology 4 4 100% Neurology 9 4 44% Program in Molecular Medicine 4 4 100% Radiation Oncology 7 3 43% Otolaryngology 2 2 100% TOTAL (includes 116 student designed: 23% of all enrollment)

970 503



Number slots ENROLLED percent FILLED

Anesthesiology 55 21 38% Obstetrics & Gynecology 53 28 53% Psychiatry 33 21 64% Orthopedics & Physical Rehabilitation 24 16 67% Surgery 39 26 67% Pathology 39 27 69% Medicine 170 124 73% Radiation Oncology 7 6 86% Neurology 15 13 87% Pediatrics 76 66 87% Urology 9 8 89% Radiology 21 19 90% Emergency Medicine 12 12 100% Family Medicine & Community Health 34 34 100% Ophthalmology 11 11 100% Quantitative Health Sciences 3 3 100% TBD (student design) 34 34 100% TOTAL (includes 98 student designed: 21% of all enrollment) 635 466

Anesthesiology, 5%

Biochemistry & Molecular

Pharmacology, 0%

Cancer Biology, 0%

Cell Biology, 1%

Emergency Medicine, 3%

Family Medicine & Community Health,

10%

Medicine, 27%

Microbiology & Physiology Systems, 0%

Neurobiology, 0%

Neurology, 1%

Obstetrics & Gynecology, 6%

Ophthalmology , 1% Orthopedics & Physical Rehabilitation, 6%

Otolaryngology, 0%

Pathology, 5%

Pediatrics, 16%

Program in Molecular Medicine, 1%

Psychiatry, 6%

Quantitative Health Sciences, 0%

Radiation Oncology, 1%

Radiology, 2%

Surgery, 9%

Urology, 1%

Percent AY1314 Enrollment by Department (includes student-designed)


Student Comments • Loved the experience! I am eager to see and learn more about hospital administration. …an

enlightening experience and may affect my career path. • …were approachable and encouraging. They shared some good advice. … Everyone was

friendly, welcoming, and very willing to discuss career options... (Introduction to Orthopedics)

• I got a great idea of what it would be like to be an ICU attending and it's a look into a career I may be interested in that I never would have seen just from a visit or two to the ICU on my peds rotation. (NICU)

• After this week I am strongly considering the field thanks to the hospitality I was shown by the doctors in the department and the residents in the programs. (Intensive Vascular Surgery)

• I thought I was interested in pedi ED as a career, and this experience has greatly strengthened that idea.

• Some chance networking also has occurred, which will definitely help develop my career as a physician. (student-design: Nutrition and Wilderness Medicine)

• This was a fantastic week spent with amazing physicians. It has helped me greatly in figuring out what future career to pursue. (student design: Pelvic & Reconstructive Surgery)

Objective 1: Positive Indicators



Residency Match

number of residency matches 97 one FCE match 34

two FCE matches 16

number of residency by FCE department matches 50

Over 50% of the AY2012-13 students matched to a residency specialty in which they had completed at least one FCE.


• Offered FCEs based on our understanding of student career goals – Student designs reoffered in subsequent years

• Limited access to local expertise in some specialized career choices – Students seek out experts where ever possible

• Our evaluation of adequate opportunities for career exploration is based on limited data (student comments and one year match data) – Plan to survey student preference in advance of CCE

year • offer medical education FCE to target survey across

class years

Objective 1: Challenges


Experience Examples • Introduction to Clinical Genetics • Physician Scientist in Cardiovascular Medicine - Bench to Bedside • Understanding Mindfulness • Occupational Medicine - Clinical & Administrative Aspects of • Path Week! Subspecialty Edition! • Infection Control • Journey Forward: Working with Patients Suffering Spinal Cord Injuries

(new approaches to) • Novel opiate detoxification program using non-traditional medicine such as

acupuncture and Reiki along with standard detox treatment in New Mexico.

Objective 2: Exposure to evolving and cutting-edge branches of medicine not covered in the core curriculum

Objective 2: Exposure to evolving and cutting-edge branches of medicine

Student Comments Exp. Knowledge Med Needs GLBT: This FCE provided a unique opportunity to gain knowledge not presented elsewhere in the medical education and I would highly recommend it to other students. Interventional Radiology: I really enjoyed this FCE and am seriously considering IR as a career choice as a result. …and many others



• FCEs perceived by leadership as novel or cutting-edge experiences often not picked by students (under-enrolled)

• Travel grants difficult to obtain



Experience Examples Interventional Cardiology Frederick St. Goar & Dr. Fogarty [of Fogarty catheter fame] Stanford University Medical Center MGH Trauma Surgery trauma surgery team of Dr. Marc DeMoya at Massachusetts General Hospital Adventures in Prison Medicine Janet Hale PhD RN FNP, UMass GSN Field Expansion for Homonymous Hemianopia using Prisms Eli Peli, at Schepens Eye Research Institute, HMS Type 1 Diabetes Management and Executive Cerebral Function in Pediatric Patients Ellen O’Donnell, MGH Inpatient Tobacco Consultation Shadowing Experience Greg Seward MSHCA, LADC-I CTTS-M, UMMS Department of Psychiatry Human Trafficking: Health Care Provider Perspectives Barbara Ingrassia, Librarian

Objective 3: Provide opportunity to work with recognized experts in medicine and allied sciences




Student Comments I think that many times physicians may be in a position to be a source of help for victims of human trafficking, but we have never been given the means or knowledge to relate to these patients and understand what their point of view is. I was strongly recommend that this be incorporated into the curriculum as an interstitial experience or during 1st or 2nd year during DCS groups when we learn to take a history. I think learning to take a history from someone who has been abused sexually or in a relationship of that sort would be extremely helpful and beneficial to my medical education. Make this experience and ones like it an integral part of medical education. Very well done and incredibly useful. Ryan does a fantastic job and every physician in the hospital has something to learn from him. Seriously, all 1st year med students should be required to spend a day with him at one time or another over the course of training... (Smoking Cessation)

• Unable to identify and recruit high numbers of experts

• Experts unaware of avenue to mentor and teach students

• Last minute cancellations and rescheduling head-aches (experts travel)



Experience Examples Accupuncture Podiatry DynaMed Publishing A Week in Alternative Medicine and Acupuncture Working with adult with intellectual disabilities Addiction Medicine (adults, adolescents) Inpatient Palliative Care and Geriatrics (home-based) An In-Depth Look at Lactation Support Physical Medicine and Rehabilitation: Focus on Cancer Rehabilitation Learning more about the Good Samaritan Hospital

Objective 4: Exposure to novel concepts and systems of care


Student Comments • She offered such a rich experience that has been unmatched in other electives. I was

able to pick a topic that I thought would be meaningful to me and was able to explore that topic.

• It was great that I got to sit in on the different fellowships of EM and get a sense of what each one is about. For me, I was also looking to explore the pace and feel of the ED. I think that that is something that many students considering ED also look for.

• This was a fantastic opportunity to experience a subspecialty that I have not otherwise had the chance to explore. I feel very lucky to have taken this FCE!

• I definitely recommend this FCE and look forward to a fourth year rotation to explore this specialty further.

• I sat in on several board meetings where hospital finances and growth projections were discussed. It was fascinating to see the administrative and executive side of medicine as well as the decision making process that lies behind new initiatives.

• Loved the experience! I am eager to see and learn more about hospital administration. It was an enlightening experience and may affect my career path.



• Faculty retention for unpopular courses (low enrollment)



• Difficult to maintain consistent rigor • Difficult to ensure FCE time is independent curricular piece

(spirit of FCE) – not used to achieve other course objectives – Eg, Capstone project enhancement and not project assignment

completion • Difficult to confirm appropriate time and purpose • Student development of own curriculum may represent lack of

vision – Corrective action: possible “training” in FOM2 year

• Program evaluation data inherently longitudinal • Enrollment flexibility allows for high number of last minute

student change requests – [can’t predict all enrollment]

Curricular Challenges

Process – Learning management system (LMS): EPiServer

(no BBL presence) – Allotment (EVOS)

• Enrollment (hand) • Schedule/roster & frequent updates (hand)

– Evaluation (e*Value) – Credit (500 individual credits sent by hand)

Administrative Challenges

FCE Student Performance Evaluation*

Attendance 32%

Effort 31%

Participation 30%

Other 7%

Evaluation Type

Clinical Skills 33%

Case Presentation

20%

Journal 4%

Project Report

6%

Research Paper 2%

Oral Presentation

15%

Other 20%

Evaluation Criteria

*Time Period: 06/01/2012 to 10/14/2014 n = variable

FCE Faculty Evaluation*

*Time Period: 09/2012 to 10/14/2014 N =817 Scale: 0 – strongly disagree; 4 – strongly agree

3.76

3.8

3.73

3.59

3.85

3.8

My faculty sponsor was appropriately available…

My faculty sponsor was a professional role model…

My faculty sponsor addressed my specific…

I was offered constructive feedback

I was treated with respect as a student

I would recommend this faculty sponsor to other…

FCE Course Evaluation*

FCE Course Evaluation

Time Period: 06/14/2013 to 10/14/2014 n ≈ 700 Scale: 0 – strongly disagree; 4 – strongly agree

3.78

3.68

3.56

3.6

3.57

3.6

3.65

3.44

increase your understanding of the topic

stimulate your interest in the topic

FCE objectives were clearly defined

FCE objectives were attainable

Organization of the FCE was adequate

FCE helped me integrate knowledge, ideas, and…

I would recommend this FCE to other students

help you make an informed decision regarding…

To what extent did this experience...

Overall, how would you rate this experience? 3.69

• Why faculty participate – introduce students to specialties – recruitment of UMMS students

• What felt successful – personal fulfillment – Interdisciplinary and interprofessional

• Contribution to medical education – allow students to craft their own learning experiences – early exposure to specialty

• Challenges – generating a week-long “curriculum” for one – Scheduling can be difficult

End of Year Faculty Feedback


• Advice to new FCE faculty – third years know very little – teach the basics – identify reliable administrative support and back up

• Advice to FCE leadership

– concern on students doing humanities electives when core content has been cut.

– difficult to give formative feedback after a week with more than one preceptor

• Most surprising

– significant administrative support necessary – long-term relationships formed during a short rotation


• Provide formative evaluation of the program based on evaluations

• Final decision on students not awarded a passing grade and student appeals

• Approval of self-designed experiences that don’t meet standard criteria

• Recruitment of faculty, and provide ideas for new experiences

• Advocacy for FCE faculty

FCE Advisory

FCE Advisory: Committee Role

Contact FCE Program [email protected]

FCE Program website

http://umassmed.edu/oume/fce

mailto:[email protected]

http://umassmed.edu/oume/fce

• Faculty feedback comments • Advisory committee meeting notes

APPENDIX

• Opportunity to introduce students to the breadth of our specialty

• …never had a similar opportunity... • Exposure for medical students in our specialty • Great way to get medical students interested • …had a unique experience to offer • Improve interest and recruitment of UMMS

students • Enjoy teaching/working with students


Faculty Feedback: Why faculty participate

• Allowing students to learn from interprofessional team

• Generating interest in specialty • Exposure to various aspects of EM not normally

available to medical students • Perspective not offered in core rotation • Multi-discipline exposure • it felt fulfilling • Students were engaged and enthusiastic


Faculty Feedback: What felt successful

• Generating a week-long “curriculum” for one • Five days sometimes not enough time • Scheduling can be difficult • FCE term schedule “feels random” • “I’m no longer on campus” • Process can be confusing • Planning for/around pre-requisites (eg, surgical

training) • Enrollment communication


Faculty Feedback: Challenges

• All they need is the enthusiasm to teach. • Involve multiple professions for richer experience • It is enjoyable and rewarding • Keep it fun for the students. • Provide valuable training and experience • Remember that third years know very little … teaching about the basics

is welcomed • Spend as much time with them as possible so that you can evaluate them

properly, though it is very difficult to evaluate someone after only one week with them.

• Students sometimes won't "just ask" • Try one student before you accept many. • Identify reliable admin support and back up. • Understand the time commitment and potential needs of the student(s).


Faculty Feedback: Advice to new FCE faculty

• Focus on an extremely important health issue that is not formally fit into the core curriculum

• Early exposure to the fascinating world of hematology and Immunology

• Opportunity to learn about something that is not generally part of the curriculum

• Having set up a visit for a UMass student to Seattle for their FCE with a colleague of mine…my colleague enjoyed her UMass visiting FCE student so much that she has asked U of Washington to consider including a similar experience in their new school curriculum…

• Opportunities for students to craft some of their own learning experiences

• Students can be self-directed and enthusiastic • …allows more breadth of exposure…


Faculty Feedback: Contribution

• E value very easy to use [but] no place to give “incomplete” for students who are late with required assignment

• have a way to designate the faculty member who will have the most contact with the student and route the evaluation to them electronically.*

• It is difficult to give really formative feedback after a week, in particular, when each day may be with a different attending/preceptor.

• …more information, more time heads up, more updates…^ • Some faculty are angry that students are doing humanities electives

when core content has been cut. Need to collect documentation that program has value to convince the non believers.

• The process went well, no suggestions • No change. It works well as it is.


Faculty Feedback: Advice to FCE leadership

* e*Value process changed as a result of this comment (ie, WDYWW) ^ added more consistent and regular reminders as a result of this comment

• How much administrative support necessary • …surprised by the flexibility and lack of red tape • how rewarding and fulfilling the experience was

for me • …not that difficult. • Sometimes I missed the student after the end of the

FE term... • The level of student enthusiasm • We have formed great relationships with the

students even though the rotation is ultra short. End of Year Faculty Feedback

Faculty Feedback: Mostly Pleasant Surprises

FCE Advisory

FCE Advisory: Meeting Discussion Example

Flexible Clinical Experiences (FCE) AY1314: Review Clinical Experiences (FCE) AY1314: Review Samir...

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