Background
Approach
Goal | EPAa links | Objectives | Learning sessions | Assessment |
---|---|---|---|---|
Goal 1: Recognize a patient requiring urgent or emergent care and demonstrate the ability to appropriately call for help and initiate basic life-saving maneuvers | – EPA 10 | – Demonstrate the ability to perform effective cardiopulmonary resuscitation, including basic airway management, and proper technique in performing jaw thrust, chin tilt, and bag-mask ventilation – Demonstrate how and when to activate rapid response, code blue, or emergency services for behavioral and medical crises, and describe which members of the interprofessional team are included in each of these groups – Recognize normal and unstable vital signs and variations that might be expected, based on patient and disease-specific factors – Recognize physical exam and laboratory findings indicative of clinical instability | – Large group, interactive session on identifying and responding to unstable vital signs – Small group, high-fidelity simulation: students rotate through 3 stations—adult patient with cardiac arrest; pediatric patient with fever, sepsis, and seizure; and an unstable psychiatric patient | – Inpatient/outpatient Observed Structured Clinical Examination (OSCE), using standardized rubricsb |
Goal 2: Communicate effectively and efficiently with patients, colleagues, and staff in both oral and written form | – EPAs 5, 6, 8 | – Demonstrate communication skills necessary to competent clinical care, including giving oral presentations, transition of care handoffs and describing how and when to call for consults – Use the electronic medical record to gather information on an assigned patient, and prepare and give an oral presentation – Demonstrate giving and receiving handoffs using closed-loop communication in various simulated transition settings | – Small group, high-fidelity activity: students are assigned a patient in the “practice” electronic medical record. They must access information for the patient and prepare and give an oral presentation and handoff on the patient. Facilitators and classmates provide feedback | – Inpatient/outpatient OSCE |
Goal 3: Demonstrate standard patient and personal protective equipment (PPE) safety measures appropriate to the healthcare environment | – EPA 12 | – Demonstrate proper scrubbing, gowning, gloving, sterile technique, and management of sharps and contaminated materials | – Small group, high-fidelity simulation: students rotate through 2 stations: infection control/PPE and scrubbing, gowning, gloving in a simulated operating theater | – Inpatient/outpatient OSCE |
Goal 4: Recognize gaps in knowledge, skills and attitudes, and identify and begin to utilize effective strategies for lifelong learning | – EPA 7 | – Recognize one’s own limitations and strengths – Describe several strategies to learn on your own and share knowledge with others, including searching primary literature to answer a clinical or science question about disease pathology, and generating questions to extend your knowledge of the foundational science related to clinical problems – Use information technology to find and apply knowledge-based information to healthcare for patients and populations – Explain components of formative assessments and clinical expectations during the clinical experiences | – Large group didactic session on generating and answering clinical questions. Overview of small group presentation expectations – Large group didactic session with a panel of clerkship directors – Small group activity: students deliver an evidence-based short presentation on a chosen clinical topic to faculty grader and staff | – Inpatient/outpatient OSCE – Small group oral presentations |
Goal 5: Understand the core professional, ethical, legal, and clinical expectations of students, regardless of healthcare environment or discipline | – EPAs 11, 13 | – Demonstrate a grasp of ethical and medicolegal topics, including informed consent, malpractice, and confidentiality | – Large group, high-fidelity simulated morbidity and mortality conference. Session involves analyzing a plane crash as well as case of medical neglect, with discussion on legal and ethical components, and root-cause analyses | – Inpatient/outpatient OSCE |
Goal 6: Understand and employ effective strategies to balance personal wellness alongside clinical duties | – None | – Discuss achieving and maintaining student wellness during rotations, and how and where you will seek help when you feel overwhelmed – Plan a strategy to work respectfully and effectively in the clinical environment | – Large group, interactive session run by university wellness leaders, focused on strategies to maintain wellness on rotations – Large group, interactive session run by an associate dean on student mistreatment – Individual activity: Reflection on personal wellness and strategies to maintain wellness on clinical rotations | – Not directly assessed |
Goal 7: Participate in an in-situ shadowing experience, and submit and share reflections in a small group | – EPA 9 | – Observe the dynamics of a clinical team during rounds – Plan strategies to work respectfully and effectively in the clinical environment | – Individual activity: students participate in a clinical ward shadowing experience to observe various roles on the interprofessional work team – Small group activity: students participate in a post shadowing debrief session, led by students and faculty | – Small group session with faculty and senior medical students |
Evaluation
Major themes | Sub-themes | Exemplar comments |
---|---|---|
Learning environment | Hands-on, active learning | – “I really found the active learning valuable. The whole range of active learning (from presenting/listening to peer presentations all the way to working with Sim Center models) were helpful” |
Pertinent skills for clinical practice | – “I really appreciated the training on unstable patients and the use of the simulation lab. Although I felt uncomfortable not knowing what was “next”, the unpredictability of the scenarios allowed me to better prepare for my time in the hospital and clinics” – “I particularly enjoyed the clinical sessions where we got to practice in the simulation lab. I really thought these were helpful in the pediatric case, because I really had no idea what I should be looking for in terms of emergencies with infants” – “It was super helpful to have practice with real-world situations. I appreciated the chance to learn and practice in a simulation” | |
Pertinent skills for the clinical environment | – “The strengths were the simulations and practical skills: scrubbing, PPE, oral presentations, etc” – “Scrubbing in, donning and doffing PPE, practicing handoffs and presentations were all extremely helpful!” | |
Course/session structure | – “I think having a week of practice scenarios followed by a week of testing was really helpful” – “I loved the way this course was structured and the different skills we were taught. I especially liked the unstable patient/CPR portion … the main thing that helped the most was the instructors having us do the scenarios over and over” – “I absolutely loved this course. It was how I envisioned much of medical school would be. Being thrust into an uncomfortable situation and asked to repeat a task over and over gave us a great opportunity to critique ourselves, improve, and become comfortable in a chaotic environment” | |
Faculty engagement | – “Really great teachers and passionate about what they were teaching” – “Everyone was respectful and gave really constructive feedback during the sessions that I think/hope will be valuable for clinicals!” | |
Collegiality | – “I also really appreciated working in small groups where I could get to know my new classmates better and the tasks (i.e., presentations, oral presentation/handoff practice) seemed a lot lower- risk” – “I liked the group sizes. I felt like I got to engage with my peers better” |