Secondary Data Analysis


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  • Secondary Data Analysis

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