Paea 2012 aad course10.17.2012
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  • Figure 1.1 A Six Step Approach to Curriculum DevelopmentCurriculum development is a dynamic interactive processProgress was made on multiple steps simultaneouslyEach step has the potential to influence another. For example, in developing our pre- and post-test questions for our evaluation study, we continued to refine our learning objectives. EXAMPLE ON NEXT SLIDE
  • Clinic exposure varied from student to student; some were in clinic every day, some just a few times during the month. Number of half-days in clinic did NOT correlate with post-test scores (p 0.27). There is a trend showing that increased use of the website (i.e., completing more learning modules) is associated with higher post-test scores and greater delta from pre-test to post-test. The difference between the lowest quartile of website activity/usage and every other quartile is significant (p 0.001, 0.001, and 0.000), and the trend toward increasing scores with increasing website activity/usage is also statistically significant.-Year level of resident physicians had NO influence on post-test scores (p 0.55)-Post-test scores did NOT differ based on age, gender, or amount of time spent in dermatology clinic. (p values of 0.29, 0.09, and 0.27, respectively)This suggests that students are not only learning because they are seeing patients in clinic, but that the high use of the on-line curriculum leads to greater knowledge acquisition regardless of how much or how little clinic exposure residents had during their rotation.Note: p scores listed are for analysis of variance using the F test for multiple variables. Additional between group analysis was done for relevant groups but is not reported here.

Transcript

  • 1. Teaching Dermatology to PA Students with aPeer-reviewed Virtual Curriculum P. Eugene Jones, PhD, PA-C Patrick McCleskey, MD, FAAD
  • 2. 1. Problem Identification and General WHY? Needs Assessment 6. Evaluation WHO? 2. Targeted Needs andHOW WELL? WHAT? Assessment Feedback 3. Goals and5. Implementation WHAT? Objectives JUST DO IT HOW? WHEN? 4. Educational Strategies WHERE? 2
  • 3. Step 2: Targeted Needs Assessment Acne Seborrheic dermatitis Warts Rosacea Atopic dermatitis Superficial dermatophytoses McCleskey PE, Gilson RT, Devillez R. Medical student core curriculum in dermatology survey. J Am AcadDermatol2009;61(1):30-35. 3
  • 4. Goals and Objectives• The AAD working group through a modified Delphi process identified Goals and Objectives they felt all medical students should learn – Only 33 dermatology diagnoses covered, to avoid pitfall of “trying to teach too much” – All rated important or very important by primary care providers were included
  • 5. Implementation• Went live on AAD Website March 2012 – http://www.aad.org/education-and-quality- care/medical-student-core-curriculum – Free, publically available to everyone• Learners review at their own pace• Each Module can be given as a lecture or small group discussion
  • 6. UCSF Med Student Study• Students learned during rotation• Students liked the modules and preferred them to other learning methods• But question remains: did they learn because of the modules or because they were in a dermatology rotation? – Need to study a group that has internal controls – Variability of derm exposure among PA students and residents?
  • 7. Military Virtual Derm Study• Four-week dermatology rotations• Variables: – Age, gender, level of training – Number of half-days in clinic were highly variable – Website allowed tracking of activity – Pre-test, 33 learning modules, Post-test
  • 8. All Levels Benefit9080706050 Pre-Test Score40 Post-test Score3020100 PA Students* PGY1* PGY2* PGY3 *p-value <0.05
  • 9. Use of website correlates with higher post-test scores p 0.003 trend p 0.003 9
  • 10. Summary of Military Study• All types of learners have statistically significant improvement in knowledge – PA students using this curriculum perform as well at end-of-rotation as physicians• Increased website activity correlates with higher post-test scores – Proves the core curriculum is effective• High acceptance and preference of curriculum
  • 11. Summary of Core Curriculum• Standardized curriculum made publically available by the AAD• Goals & learning outcomes based on evidence, aligned with needs of PAs in practice• Online learning modules – Case-based – Builds through repetition• Peer-reviewed• Effective
  • 12. Intro to MSCC on AAD website
  • 13. UT Southwestern Justification for Implementation• Increasing difficulty scheduling dermatology clinicians due to clinical time demands and loss of income• Time and location inflexibility of traditional lecture- learner model• Quality of AAD content developed by academic dermatologists• Student desire for any time, any place learning• Opportunity to blend delivery to accommodate differing learning styles
  • 14. The UT Southwestern Decision• The AAD module content titles were compared to the PANCE disease list.• The two-week version of the AAD Core Curriculum was selected as it closely reflected previous dermatology lecture-learner contact hours.
  • 15. 28/47 PANCE Disease List in AAD MSCC• Dermatitis • Scabies • Impetigo• Dyshidrosis • Spider bites • Candidiasis• Lichen simplex chronicus • Basal cell carcinoma • Dermatophytes• Drug eruptions • Kaposi sarcoma • Acanthosisnigricans• Lichen planus • Melanoma • Burns• Psoriasis • Squamous cell • Hidradenitissuppurativa• Pityriasisrosea carcinoma • Lipomas/EICs• Erythemamultiforme • Alopecia • Melasma• Stevens-Johnson • Onychomycosis • Pilonidal disease syndrome • Paronychia • Pressure ulcers• Toxic epidermal • Condylomaacuminatum • Urticaria necrolysis • Exanthems • Vitiligo• Bullouspemphigoid • Herpes simplex• Acne vulgaris • Molluscumcontagiosum• Rosacea • Varicella zoster• Actinic keratosis • Verruca• Seborrheickeratosis • Cellulitis• Lice • Erysipelas 15
  • 16. Supplemental Instruction• PowerPoint® podcasts were recorded and posted for Alopecia, Onychomycoses, Paronychia, and Genodermatoses• Two 2-hour supplemental Q&A sessions were provided by local Dermatology PAs• A one-hour hands-on liquid nitrogen cryosurgery lab was provided
  • 17. Course Examination Outcomes• Class of 2013 • Class of 2014 – N=36 students – N=38 students – Mean exam score 92.3 – Mean exam score 91.05 – Range 81-98 – Range 80-97
  • 18. Course Feedback: Effort Required70%60%50%40%30%20%10%0% great deal somewhat about the same somewhat less a lot less more more
  • 19. Course Feedback: Module Number60%50%40%30%20%10%0% much too many somewhat too right amount somewhat too Much too few many few
  • 20. Course Feedback: Satisfaction50%45%40%35%30%25%20%15%10% 5% 0% very satisfied somewhat neutral somewhat very satisfied dissatisfied dissatisfied
  • 21. Course Feedback: Intellectual Challenge60%50%40%30%20%10% 0% very easy easy average difficult very difficult
  • 22. Course Feedback: Derm PA Value50%45%40%35%30%25%20%15%10% 5% 0% extremely somewhat undecided somewhat extremely helpful helpful unhelpful unhelpful
  • 23. Course Feedback: Online Effectiveness60%50%40%30%20%10%0% extremely somewhat neutral somewhat extremely effective effective ineffective ineffective
  • 24. Course Feedback: Knowledge Increase90%80%70%60%50%40%30%20%10%0% strongly agree agree neutral disagree strongly disagree
  • 25. Course Feedback: Would Recommend to Other PA Students70%60%50%40%30%20%10%0% definitely probably uncertain probably not definitely not recommend recommend recommend recommend
  • 26. UT Southwestern Course Summary• Well-received• Minimal faculty oversight or time requirements• Consistent, high-quality instruction• Knowledge acquisition (as measured by post- test) equivalent to face-to-face instruction
  • 27. Medical Student Core Curriculum• Ideal for PA students or early practice PAs• Agree that name might be off-putting for PA students and PAs in practice – influenced by AAD politics• Designed to teach up to level of primary care providers 27
  • 28. How to Use the Curriculum• Know what’s on the MSCC website• Suggestions in the Educator’s Guide and handout for this session• Direct the learner’s study based on their level 28
  • 29. Be a Coach: follow-through• Need to have follow-up to make sure the learning process is complete• Examples for tineaversicolor: – PA Student: differential diagnosis of light rashes, or performing KOH exam – New PA-C: bring back a paper prescription for treatment of tineaversicolor 29
  • 30. Take-Home Points• Instead of teaching in clinic, direct the students what to learn on their own• Visit the AAD website: – http://www.aad.org/education-and-quality- care/medical-student-core-curriculum• Use the website to do the teaching for you, to save time in clinic• Follow-up to close the learning loop 30
  • 31. Incorporating the CoreCurriculum into PA instructionDiscussion about how you might use this curriculum in your program or office 31
  • 32. Use of Curriculum: Clinic• Designed to be used as independent modules for review at home by learners• Self-paced• Interactive with questions throughout and after each module 32
  • 33. Use of Curriculum: Small Groups• Each module can be used in group setting – “Lecture” with questions interspersed – Group discussion for each case• With discussion, each module is perfect length for 40-60 minute session 33
  • 34. Use of Curriculum: Other Specialties • These lectures can be given on other rotations • Pediatrics – Atopic dermatitis, molluscum, pediatric fungal • Internal medicine – Bacterial and fungal infections, vasculitis, drug eruptions • Surgery – Ulcers, the red leg • Pathology – Skin cancers, biopsy techniques, path requests 34
  • 35. Flow of Dermatology Learning PA SCHOOL LECTURES* DERM ELECTIVE* MSCC LEARNING MODULES AS TEST PREP / DERM PRIMER PACKRAT* PANCE* PA-C IN PRACTICEGENERAL*: CME/PANRE DERM*: DLI * POSSIBLE USES OF AAD CORE CURRICULUM
  • 36. Open Discussion and Questions 36
  • 37. Discussion• How can this be used as an adjunct to current curriculum at your program?• How might you use this to orient new PAs coming into your practice?• Could you now convince local dermatologists to take on PA students? 37
  • 38. Thank You Members of the American Academy of Dermatology Medical Student Core Curriculum Workgroup Tim Berger, Sarah Cipriano (UCSF) PAEA leadership and membership 38
  • 39. Please visit www.aad.org formore information on the core curriculum 39