1. 7/27/2010 The International Medical Graduate Institute A Skills Assessment for International Medical Graduates Seeking Entry Into U. S. Family Medicine Residencies

2. 7/27/2010 Department of Family Medicine Quillen College of Medicine East Tennessee State University

3. 7/27/2010 The IMG Institute December 2009 Participants

4. 7/27/2010 Elements of the IMG Institute A Three Day Program  Communication Skills  Human Patient Simulator Lab  “Morning Report”  OSCE  Competencies & Concepts in Family Medicine  Program Evaluation

5. 7/27/2010 Why the IMG Institute?  55% of Family Medicine Residents at Quillen College of Medicine are IMGs [2009-2010]  IMGs have widely variable skill levels at entry  Quality of education at international medical schools highly variable

6. 7/27/2010 Why the IMG Institute? continued:  Language and cultural barriers impede successful completion of residency  Time and $$ invested is sizeable  Deficiencies in knowledge or skills can be remediated before beginning residency

7. 7/27/2010 > From inquiries to our Department about an Observorship > We do not offer an Observorship! > Via our website. > Word of mouth and other methods. How do we select our participants?

8. 7/27/2010 Welcome. Introduction. IMG Institute December 14 – 16, 2009  Welcome by Dr. Franko and our Faculty  Participants diagrammed their family genogram  Each drew and then described his personal journey  Community and resident IMG physicians joined us for an international luncheon

9. 7/27/2010 Describe your life’s journey

10. 7/27/2010 Sharing International Cuisine

11. 7/27/2010 Human Patient Simulator Lab Experiential learning tool Teach essential clinical skills Demonstrate basic competencies – Patient Care – Medical Knowledge – Interpersonal and Communication Skills – Professionalism Requires team work to be successful Performance critiqued by faculty and peers Human Patient Simulator Lab

12. 7/27/2010  Hx, Px by teams of two, make a prelim diagnosis  Patient suffers a critical event  ‘Nurse’ assists as Team resuscitates HP S

13. 7/27/2010  Demonstrate clinical skills, medical knowledge  Debriefing: EKG, lab, x-ray  How did you interpret this?  Clinical outcomes reviewed  Teamwork essential HPS

14. 7/27/2010 Standardized patient Group setting Faculty observation, rating Develop rapport with the standardized patient – Explicit “Positive Speak” – Explicit caring/ commitment – Avoid interruption – Avoid negative talk Elicit full agenda [continued] Communication Skills

15. 7/27/2010  Information management  Open ended vs closed questions  Explore patient’s perspective on illness  Actively listen for clues  Assess patient’s ability to change  Explore patient’s feelings Communication Skills

16. 7/27/2010  Patient’s Feelings  Facilitate patient’s expressions of concerns, thoughts, fears  Respond to clues patient gives  Negotiate to reach common ground  Avoid confrontational strategies  Develop a common ground plan  Recognize when agreement cannot be reached  SPs, peers, and Faculty discuss case Communication Skills

17. 7/27/2010  SOAP Note concept  Prioritized problem list  Logical treatment plan  Develop differential for a major problem  Written and oral presentation  Group process “Morning Report”

18. 7/27/2010  History/Physical exam/Lab data are given  Additional labs/EKG/x-ray must follow logically from assessment & plan  Further history can be a part of the plan “Morning Report”

19. 7/27/2010 Write differential major Dx Present treatment plan Defend choices in plan Participate in group process Write-ups are grade d “Morning Report”

20. 7/27/2010 Objective Structured Clinical Exam  Standardized Patient Interview Station  Videotaped for later review  Focused Physical Exam Station  Discuss with Preceptor  Write up SOAP note with differential

21. 7/27/2010 Interview the standardized patient Standardized Patient presents consistent history and affect to each participant OSCE Trained to give up her information sparingly Videotape interview

22. 7/27/2010 Focused Physical Exam Participants used our Sim Lab model to complete the focused physical exam OSCE

23. 7/27/2010 Discuss with the Preceptor  Review specific moments of patient-interviewer interaction as recorded on CD  Participant discovers his strengths and weaknesses  Participant keeps his own CD OSCE

24. 7/27/2010 Write a differential diagnosis  They chose to do their write-ups collaboratively  Write-ups were graded  Evaluations were mailed to participants OSCE

25. 7/27/2010 Competencies & Concepts in Family Medicine  Chronic Care Model of Disease  Patient-centered Medical Home  Evidence Based Medicine  Information Mastery  Cultural Competence Presents a selected topic current in Family Medicine

26. 7/27/2010 Competencies & Concepts in Family Medicine  Evidence Based Medicine  Information Mastery  PICO questions  Participants learn to use EBM in patient care

27. 7/27/2010 Program Evaluation  1 hour Focus Group o Conducted by faculty member not involved in the program o Questions provided by Co-directors o Evaluator “sampled” sessions as observer  ‘Embedded’ staff member o Knowledgeable Program Coordinator o Attended most sessions of Institute o A ‘note taker’ o Edited and shared notes  Solicited faculty feedback

28. 7/27/2010 Participant Evaluation  Performance Assessments o Communications skills o HPS Lab session o OSCE o ‘Morning Report’  Faculty session leaders wrote assessment for each participant o ‘Morning Report’ chart notes graded o OSCE write-ups graded o Faculty’s assessments combined and sent to participants  Point of performance evaluations: communications

29. 7/27/2010 Major Findings and Recommendations  “Institute is a success. “ Faculty leaders, participants  Participants thought they got their money’s worth  Most activities were unique to them, not experienced in their medical school  Exceeded expectations in faculty contact, level of resident work  More demanded of them than they had anticipated

30. 7/27/2010 Major Findings and Recommendations  Participants want more practice/opportunities during the Institute to demonstrate competence  Expand length of each session, but not the overall time frame by more than a half day  Participants can prepare pre-Institute assignments, but cannot really ‘know’ what it is like  Participants risk takers; willing to “mix it up”

31. 7/27/2010 Major Findings and Recommendations  Participant evaluations by Faculty consistent.  Participants took criticism well…but did they understand? Can they apply it?  Some interesting observations – “we are praised in India for coming up with as many possibilities in our differential, no matter how unlikely.”  Built confidence, would recommend to others, worth more than it cost.  Not a guarantee to acceptance into residency program

32. 7/27/2010 Farewell