Pediatric Educational Excellence Across the Continuum (PEEAC) Conference Sept 2009

Goals Bring ideas from PEEAC conference Reasons to add new tools. –Time, Efficiency, short attention span of learner Present some tools for medical student and resident teaching –Strategies –Resources – handouts from PEEAC –Share Web-based resources and bibliography for further reading.

Medical students Orientation!! “The Wave” Priming –before student goes in the room. Exam room presenting Structured modeling Limited observation – of particular portion of visit Life-long learning journal Learning with support staff

Efficiency: Creative Scheduling The “Wave” 9AM-9:20AM: Student sees pt #1, preceptor sees pt #2 9:20AM-9:40AM: Pt #1 seen by both 9:40AM-10:00AM: Student charts pt #1, preceptor sees pt #3 10:00Am-10:20AM: Student sees pt #4, preceptor sees pt #5 and so on

Priming Review pt’s medical background Tell trainee what complaint to focus on Set guidelines for physical exam + Set time limit for encounter Alert student to sensitive issues

Exam room presentation Present at the bedside – while med student is presenting, MD can be examining child at the same time

Medical students Orientation!! ‘The wave’ Priming – read up/discuss before student goes in the room. Exam room presentation Structured modeling Limited observation – of particular portion of exam Life-long learning journal Learning with support staff

Dr. Louis First’s Take-Home Lessons 1.Never underestimate the power of “day one” 2.Always let the student enter first. 3.Feedback after every patient encounter and remember feedback is not = to evaluation!

Resident/medical student One minute preceptor Aunt Minnie Two minute observation/drop in visit. Exam room presentations Narrative Medicine Spanish language lunches

The next 6 slides are courtesy of Dr. Louis R First

Does the One-Minute Preceptor Work? 29/36 faculty resurveyed 4 years after wkshp-- 90% still use it, 58% find it extremely helpful as clinical teachers (Neher et al. Clin Teach 1992; 5: ) 57 residents randomized to use it at UCSF--87% of 28 residents found it useful; Students rated OMP residents vs controls higher in all skills except “teaching general rules”and “overall effectiveness”--also found to be more motivated to read (Furney et al. J Gen Intern Med 2001; 16:620-24) »L. First MD

More on OMP Effectiveness (Aagaard E et al. Acad Med (1): 42-49) 116 preceptors at 7 universities watched videos of both OMP and traditional models using two cases With OMP model, preceptors better able to correctly diagnose pt’s condition, rated student ability higher on hx taking/PE skills, presentations, clinical reasoning, and FOK, and rated themselves more confident in rating students abilities OMP rated more effective and efficient than traditional model in teaching students »L. First MD

Resident/medical student One minute preceptor Aunt Minnie Two minute observation/drop in visit. Exam room presentations Narrative Medicine Spanish language lunches

Aunt Minnie (For developing rapid pattern recognition) Learner sees patient, takes hx, does PE Learner presents –Main complaint and presumptive dx (30 sec) While learner writes up note, teacher sees pt, dx’s problem and creates plan (5 min) Discuss care w/ learner – 1-5 min reviews and signs chart 1-2 min

Resident/medical student One minute preceptor Aunt Minnie Two minute observation/drop in visit. Exam room presentations Narrative Medicine Spanish language lunches

Exam room presentation - Resident Especially useful for interns If resident is wrong, you can say “you raise an interesting point – I want to look something up – will you excuse us for a moment.” Then leave and resident comes back. Never contradict resident in the room.

Exam room presentations No change in parent satisfaction – incl. parents seeing resident as their doctor Attendings preferred – able to assess resident skills, model advice, and demonstrate PE Residents – /less comfortable discussing sensitive topics; embarrassed when asked a question they didn’t know the ans to. Better observation and feedback. No change in visit duration Baker et al. Ambulatory Pediatrics 2007 Promotes family centered care

Seeing residents’ patients Study – teachers assigned rating to residents’ evaluations and the perceived severity of the care both immediately after resident presentation and again directly after seeing the patient. After seeing the patients, teachers rated residents evaluations less well and the patients as more severely ill Seeing patients took longer. –Gennis and Gennis; What do you do?

Also Activated Demonstration – watch how I counsel this mother on how assess potty training readiness.

Evidence-based Physical exam Make the exercise evidence based –Rational Clinical Examination series - JAMA Ex. Does this child have appendicitis? Bundy DG, et. al Systematic review –Why is this important? –LR and summary LR ratios for physical findings –Rebound tenderness LR=3.0

Resources Technology resources: 2 handouts from Drs Lopreiato and White Bibliography of best articles on teaching Web resource list

site_index_by_topic.htmlhttp://library.med.utah.edu/pedineurologicexam/html/ site_index_by_topic.html ar.htm ar.htm - wonderful for medical students. Not specific to peds great demonstration of cover uncover test (also afferent papillary defect) es.htm Easy access to summary asthma guidelines – for medical students and residents. Also print easy to read brochures for patients – in multiple languages. es.htm – nice educational module for medical students. Can complement videos distributed by Steve Caddle.

List of YouTube videos from Steve. HnXeYSwhttp:// HnXeYSw FwRLLB0 FwRLLB0 List distributed