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Secondary Data Analysis

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  • 1. Competency Oriented Residency Education (CORE): Transition From A Topic-Based to Clinical Presentations-Based Academic Curriculum Nipa Shah, MD Mark Potter, MD Karen Connell, MS University of Illinois at Chicago Department of Family Medicine April 2006
  • 2. Participants will be able to:
    • Transition from a topic-based to a clinical presentation-based academic curriculum
    • Utilize Univ. of IL at Chicago Dept. of Family Medicine CORE Session list as a prototype for developing/enhancing their own department’s academic curriculum
    • Organize and teach a clinical presentations-based residency education session
  • 3. What is the Challenge?
    • Vast array of material
    • 3 years of training time
    • Usually one ½ day/wk, or 1 hour 3x/week
    • Resident work duty hours
    • Differing levels of teaching expertise, availability and clinical foci of faculty
    • Differing levels of knowledge among residents
  • 4. Comparison
    • Pros of Topic Based
      • Easy to organize
        • Availability
        • Teaching Expertise
        • Clinical experience
      • Immediate need learning
    • Cons of Topic Based
      • Gaps in curricular areas
      • Not comprehensive
      • Problem solving and transfer of learning not usually emphasized
    • Pros of Clinical-Based
      • Comprehensive
      • Shorter list, so can repeat (120 per Mandin)
      • Long-term learning
      • Promotes problem-solving and transfer of learning (applicability to variations on a clinical problem)
    • Cons of Clinical-Based
      • Hesitation from faculty
      • Initial training required
  • 5. RRC Program Requirements
    • Well organized, effective
    • Academic (supplemental to Clinical)
    • Variety of teaching methods
    • Each curricular area addressed
    • Each curricular area to include a defined experience with measurable outcomes
    • Help from the AAFP
      • Recommended Curriculum Guidelines for Family Medicine Residents
  • 6. Resources for transitioning
    • Strategy
      • Define the need
      • Survey the residents
      • Create a focus group
        • Curriculum committee
      • Expert (Henry Mandin) did a “clinical presentation concept” workshop for faculty
      • Modified the clinical presentations concept for family medicine residency training---A FIRST!
  • 7. CORE Series
    • CORE-Competency-Oriented Residency Education
      • 18 month curriculum
      • Sessions videotaped, reviewed
      • 4 sessions/month for 1-3 hour sessions
      • Multimedia
      • Small group learning
      • Actual patient cases (often modified)
  • 8. CORE Session Format Characteristics
    • This format has been “stable” when applied to sessions addressing patient issues (complaints or problems) as various as:
      • Leg Pain
      • Concerns about heritable disease (genetics)
      • Hematuria
      • Consideration for blood product transfusion
  • 9. CORE Presentation Format Characteristics
    • Emphasizes learning a diagnostic approach (algorithm) to presenting issue rather than long lists of facts about particular disease entities.
    • Allows learning a larger area of medicine in a defined session, e.g., (give example)
  • 10. CORE Presentation Format Characteristics
    • Presentation based format mirrors what physicians actually do in patient diagnosis
    • Focusing on learning algorithms may create knowledge that can be generalized more readily from one case to the next
  • 11. Sample Algorithm on Leg Pain
  • 12. CORE Presentation Format Characteristics
    • Highly interactive. 20 minutes maximum of “lecture”
    • Learners apply learned material to cases in small groups of 1-3. This tests and consolidates knowledge
    • Case interpretations by groups are reviewed with the whole group to fine tune knowledge and interpretation
  • 13. CORE Presentation Format Suggested Outline
    • Before session: Readings are sent in advance. Usually E-mail of links to on-line articles.
    • At session:
    • Review of session goals
    • Session outline
  • 14. CORE Session Format Goals
    • The same 3 goals are adapted for each session. Residents will:
    • a) Incorporate an orderly approach to patients presenting with_______ (e.g. leg pain)
    • b) Have enough knowledge of (lower extremity) disease categories, H+P and diagnostic tests to accurately evaluate patients with (leg pain)
    • c) Correctly identify emergent and “red flag” conditions in patients presenting with (leg pain)
  • 15. CORE Presentation Format Suggested Outline
    • 3) Brief discussion of relevance of this patient presentation: “Have any of you managed any patients presenting with _______?”
    • 4) Reading during session (10-20 minutes)
      • Focus on algorithms and tables in articles
      • More advanced readings provided for those who have “mastered” articles sent before session
  • 16. CORE Presentation Format Suggested Outline
    • 5) Review of Emergent and Red flag conditions presenting with _______. Residents offer their ideas. These are discussed. List of emergencies and red flags made by session leader is then reviewed.
  • 17. CORE Presentation Format Suggested Outline
    • 6) Review of key facts or concepts
    • This can be a more “lecture like” segment, with overheads or power point.
    • Residents encouraged to frequently to ask questions regarding significance of points and discuss. May include key points on definitions, epidemiology, risk factors, relevant H+P, differential diagnosis, diagnostic testing, management, prognosis and follow-up. Continued until the second resident looks sleepy (usually 15-20 minutes).
  • 18. CORE Presentation Format Suggested Outline
    • 7) Case discussion:
      • Resident in groups of 2-3
      • Cases provided in segments The resident group works to answer specific questions that drive learners to study algorithms provided. Usually 5-10 minutes per case segment
  • 19. Sample Case
    • Page One
    • A 65 Y.O. man presents to you with pain in his Right leg on and off for 2 months.
    • Questions:
    • 1) What are your best 10 history questions?
    • 2)  What are your best 5 physical exam items?
  • 20. CORE Presentation Format Suggested Outline
    • 8) Whole group review of case questions.
    • Small groups present their answers. Large group discussion of why answers were selected leads to correct synthesis of data and application of algorithms
    • The cycle of small group case segment review and then whole group discussion may be repeated 2-4 times during the session
  • 21. CORE Presentation Format Benefits
    • Including “emergencies and red flags” in every session:
      • may support safer care, and
      • May help meet RRC requirements for Emergency Care didactics within this same series
  • 22. CORE Presentation Format Benefits
    • Recurring format builds resident participation from session to session:
      • Reading, in advance, and during session
      • team interaction
      • case investigation
      • interpretation of findings and evidence .
  • 23. CORE Sessions, Evaluation
    • Anonymous resident evaluation form, summary rating:
      • “ How Likely was this session to change your practice?”
      • Date VAS Score N
      • 8/24/2005 9.18 11
      • 9/7/2005 9.04 13
      • 10/5/2005 9.12 15
      • 11/2/2005 9.03 12
      • 12/28/2005 9.60 5
      • 1/18/2006 8.58 7
      • 3/8/2006 8.78 12
      • Ave. Score 9.05 11
      • VAS=Visual Analog Scale
    • Other sessions offered during the same time period had an average VAS score of 7.0
  • 24. To contact us for a consultation, workshop for faculty development:
    • Nipa Shah, MD nshah1@ uic . edu
    • Mark Potter, MD mcpotter @ uic . edu
    • Karen Connell, MS kconnell @ uic . edu
    • University of Illinois at Chicago
    • Department of Family Medicine
    • 1919 W. Taylor St., M/C 663
    • Chicago, IL 60612
    • 312-996-1103