Transcript Profile of The Class of 2002

Welcome to the Third Year!
Warren Newton, MD, MPH
Vice Dean for Education
UNC School of Medicine
June 25, 2012
Objectives
• Review UNC SOM Outcomes for
clinical years.
• Describe educational rationale for
year III, with the core competencies
we expect
• Describe what will be new this year,
with points of emphasis
• Give rules for living for third year;
start planning for the fourth year
Step 2—UNC vs National
Match is Becoming More
Competitive
Match Post-Mortem
• 98% Match Rate (national average 95%)
» 3 unmatched students
• 1 each in general surgery, orthopedics, & pediatrics
MSIII—Educational
Rationale
UNC Curriculum 2011
Educational Rationale—Year III
• General Clinician
• Active Learning
» Get involved in care
» Read on individual patients
• Breadth of Experience
» Varieties Patients/Specialties
» AHEC—different systems,
different patient mix
Grading
•
•
•
•
See Clerkship SWebsites
Clinical Evaluations
Shelf Exams—20% of grades
OSCEs, either formative or
summative
• End of Year (CPX, NBME II
MK/CS)
Core Competencies
• Practicing medicine requires more than
medical knowledge
• In late 90’s, organized medicine committed to
explicit training in six domains of competence
in residencies
• All US residencies (and CME) focus training
in medical knowledge, communication,
clinical skills, professionalism, problem based
learning, systems based practice
UNC Approach
• ACGME core competencies plus one
other, improving the health of
populations
• We have specified defined the
conditions all UNC students should
see, inpatient and outpatient (the UNC
96)
• We have defined the procedures all
students should learn—eg BLS, ACLS,
venipuncture and placing IVs
Medical Knowledge
• Tests of knowledge are
foundation of our current
system
• You will take tests for the rest
of your life.
• Assessment: Clinical
Evaluations, shelf exams
Clinical Skills
• History/Physical
• Differential Diagnosis,
Management Plan,
Procedures
• Assessment: Clinical
Evaluation, OSCE, CPX
Communication Skills
• Your reputation, patient satisfaction,
pay and liability risk depend on
communication skills
• Not just patients and residents/
attendings, but also staff
• Oral and Written; including cultural
sensitivity
• Specialty and situation dependent
• Assessment: Clerkship evaluations,
OSCE’s, CPX
Systems Based Practice—
How you take care of patients
•
•
•
•
•
•
•
WebCIS
CPOE
Care Management
Speech Therapy, etc
Referrals
Discharge Planning
Time-outs before
procedures
• Assessments: Ward
Evaluations,
OSCE/CPX
Systems Based Practice
Being Aware of Systems
Problem Based Learning
“Life Long Learners”
• Case by case learning
• Critical appraisal of literature
and application to cases
• Assessment: Clinical
evaluations, special
assignments
Improving the Health of
Populations
• Focus on populations (and not just the whole
population)
• Managing costs, quality and access
• Both primary and subspecialty care
» Diabetes, Asthma, CHF in priamry care
» Center of Excellence for Bariatric Surgery
» ACOs and Bundled Payments for common
major procedures
• Assessment: Projects, Family Medicine
Clerkship and others being piloted
Improving the health of
populations
Professionalism
Why all the fuss?
• Social Contract: trade off of
autonomy, privilege and financial
security for self regulation
• Increasing public concern that
doctors and hospital systems
have their own financial interests
foremost…
Professionalism in Third Year
•
•
•
•
•
•
•
Honesty/Integrity
Confidentiality
Being on Time
Respect for patients, peers and staff
Learning from feedback…
Assessment: Clinical Evaluations
Remember, some professionalism issues are
one strike you’re out…
What’s new this year…
Curriculum
• New curriculum: ongoing tinkering + critical
incidents in several clerkships + population
health project in family medicine
• Spread of teaching practices in outpatient
rotations—FM, OPM and Community
Pediatrics
• Grading: Shelf exams will count 20% across
all clerkships, normed to quarter
• Developing a feed-forward system
• Consistent processes: direct observation of
clinical skills in all clerkships; all grades within
six weeks; Honors set at about 40%. Regular
review of duty hours, timeliness and
distribution or grades across clerkships/sites
Common Assessment Form
UNC 96
• Conditions all UNC students need to learn
about in both inpatient and outpatient settings
• Each attributed to a clerkship and in One45;
ongoing improvements in user friendliness
• You need to see/learn about them all, and we
need to make sure that experiences are
comparable across the state
• At mid clerkship, you and your clerkship site
leader will see/review what you’ve seen, and
develop a plan if necessary
• Be assertive; take responsibility for your
education.
Clinical Log
Procedures
• Essential to learn hands on skills and
also about procedures...
• Both psychomotor and interpersonal
• You have to go to internship with
competence in some of these
(venipuncture, IVs, injections, throat
swabs, paps) and exposure to others
(lumbar punctures, etc)
• Be assertive…
Mid-rotation Review
• With clerkship or site director
• Review
» How is it going?
» Performance so far…
» Exposure to conditions and
procedures—any adjustments
necessary?
AHEC Infrastructure
Improvements
• Orientation
• Student
Health
• Counseling
Services
• Needlestick
Protocols
• Housing
Campus Directors
Patricia White, MD
Charlotte
Robyn
Latessa, MD
Asheville
Mark Darrow, MD
Wilmington
Bert Fields, MD
Greensboro
John Perry, MD
Wake
Improving the
Learning Environment
What is mistreatment?
• Not being asked questions or to
do things for patients
• Rarely nurse vs. student
• Rare physical violence,
inappropriate sexual advances, or
ethnic/racial slurs.
Disrespect for
Patients or Students
• “There are patients that residents and
attendings make fun of… there is judgment
about whether they have had too many kids,
shouldn't have kids, about their social situation,
about whether they can afford kids, and most
often that they are large.”
• Another student, seeing that the patient was
being placed on the wrong side in the OR,
made the resident aware of this and the
resident said, “YOU’RE A MEDICAL
STUDENT, YOU DON’T SPEAK! I DON’T
EVEN WANT YOU TO THINK!!!!”
What is mistreatment?
Specialty Bashing/Bigotry
• “I was interested in ------- until my third year
rotations. EVERY single specialty talked
trash about --- physicians stating how
frustrating and incompetent most of them
were.”
• “Because the residents knew that I did not
plan to go into ---, they did not give me the
opportunity to do many things in the OR
despite my attempts to show enthusiasm and
motivation.”
Ongoing work…
Ombudsmen
David Carl
Charlotte
John Perry, MD
Wake
Gary Gala, MD
UNC Chapel Hill
Michelle Kane, PsychD
Greensboro
David Gittleman, DO
Wake
Dale Fell, MD
Asheville
Joe Kertesz, MA
Wilmington
Rev. Barbara Bullock
Charlotte
• Promoting positive learning
environment, with emphasis
on respect, engagement in
patient care, and student
participation in care (pagers,
Webcis, POE)
• Zero-tolerance approach,
with close to real time
monitoring through clerkship
evaluations, clerkship
directors, chairs, and
ombudsmen
• Ensure safety of process for
students, continue
separation of grading from
evaluation
Next Steps—What you can do?
• Get involved in patient care and your teams
• If you have questions or concerns, let us
know: contact your site or clerkship director,
the chair, the local or Chapel Hill
ombudsmen, Ms. Stone, Dr. Dent or me.
• Grades handed in before we review; we will
respond to every case, and report your name
only with your permission
Surviving and Thriving as
an MSIII
Rules for Living
• Keep in touch: Advisors, Dean Dent,
Student Affairs Staff; day backs
• Laptops—OIS walk-in, or email Jake
Achey
• Student Health – remember the
waiver; take off for care
• Any Difficulties--Communicate With
Course Directors
• Excuses through local staff, tracked by
student affairs office
Academic Difficulty
• 5-10% of Students
• Differential Diagnosis
» Test Taking
» Clinical Skills
» Professionalism Issues
• Get In Touch With Us!
Natural History of Specialty Choice
• 50% in July of third year (1/2 will
later change)
• 75% by April Next Year
• 5-10% will apply in 2 or more
specialties
• 5% will change after internship
• National: increasing students for
fixed number residency slots
Specialty Choice Timeline
• January 13 Specialty Information
Sessions
• Specialty Career Advisors mandatory
• 2013 Summer/Fall MS IV
» CPX, NBME Part II MK/CS
» Audition Electives
• Dean’s Letter Deadline—10/1/13
• ***Identify writers of recommendations
this year
Year IV
Year IV Educational Rationale
Getting Ready for Residency
• Specialty Choice/Applications
• Advanced Skills (AI, Critical Care,
Specialty specific areas)
• Schedule Flexibility/Choice
» For Boards and Interviewing
» Student Choice: Advanced Practice
Selective, Medicine and Science
• You will never be as free again: Keep in
mind special interests
Extending medical school…
# Students
% Students
MD/MPH
41
24.8
MD/PhD
9
5.5
MD/JD
1
0.6
MD/MTS
1
0.6
21
12.7
Other
2
1.2
Total
75
45.5
Research Year
Timelines
• Remember the longitudinal course
Introduction to Acute Care; includes ACLS
and other procedures in specific clerkships
• Take CPX at end of Junior year or beginning
of senior year; must pass to graduate.
• Take NBME II CK that summer, and take II
CS as early as possible
• MSPE (Dean’s letters) due earlier—October
1, which means interviews for letters will
need to be earlier
GOOD LUCK!