Assessing the Principal Clinical Experience: A Progress Report

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´╗┐Assessing the Principal Clinical Experience: A Progress Report Ed Krupat, PhD Medical Education Grand Rounds May 18, 2007

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The PCE Pilots Cambridge Integrated Clerkship- - started July 2004 Brigham & Women's Hospital- - started July 2005 Beth Israel Deaconess Medical Center- - started July 2005 Massachusetts General Hospital- - started July 2006

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The Principles Longitudinality with workforce and house staff with patients of input of educational modules Mentoring Interdisciplinary points of view Integration of essential and clinical sciences Patient-focused approach Student-focused learning

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Plans & Methods Mentoring programs Planned educational modules Tutorials Students exhibit cases PCC (with doctors who admit to the doctor's facility) PD III at site Writing/reflection

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The Evaluation Plan Comprehensive Experiences Knowledge & information maintenance Skills Attitudes/recognitions Self-appraisal Multi-technique Quantitative Qualitative Scientifically thorough Tied specifically to experimental run program objectives

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The Design Comparison/control amass selected from understudies doing customary turns Pre-clerkship measures showed no distinctions on MCAT scores Step I scores PD II OSCE scores Career inclinations Attitudes toward patient care

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Characterizing the Experience

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"How well would you say the accompanying descriptors depict your clerkship encounter: Frustrating " (1= Not At All & 6= Perfectly) '05-'06 Clerkships

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"How well would you say the accompanying modifiers portray your clerkship encounter: Confidence-building " (1= Not At All & 6= Perfectly) '05-'06 Clerkships

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"How well would you say the accompanying modifiers depict your clerkship encounter: Humanizing " '05-'06 Clerkships

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"How fulfilled are you with: The general nature of your clerkship encounter " (1= Extremely Dissatisfied & 6= Extremely Satisfied) '05-'06 Clerkships

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Performance: Knowledge

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Shelf Scores: CIC versus Control Year 1 (2004-2005)

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Shelf Exam

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Shelf Exam

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Shelf Exam

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Shelf Exam

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Performance: Skills

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Comprehensive OSCE

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Comprehensive OSCE

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Comprehensive OSCE

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Comprehensive OSCE Skill Score History '05-'06 Clerkships

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Comprehensive OSCE Skill Score Physical Exam '05-'06 Clerkships

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Attitudes & Perceptions about the Year

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"To what degree have your encounters set you up: To have the learning base important to be a capable professional" (1= Very Poorly & 6= Very Well) '05-'06 Clerkships

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"To what degree have your encounters set you up: To incorporate fundamental sciences and clinical practice" (1= Very Poorly & 6= Very Well) '05-'06 Clerkships

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"To what degree have your encounters set you up: To practice confirm based drug " (1= Very Poorly & 6= Very Well) '05-'06 Clerkships

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"To what degree have your encounters set you up: To perceive how the social setting influences patients and their issues " (1= Very Poorly & 6= Very Well) '05-'06 Clerkships

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"To what degree have your encounters set you up: To relate well to a various patient populace " (1= Very Poorly & 6= Very Well) '05-'06 Clerkships

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"To what degree have your encounters set you up: To know your qualities and restrictions " (1= Very Poorly & 6= Very Well) '05-'06 Clerkships

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Attitudes & Perceptions about Patient Care and Life on the Wards

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Patient-Practitioner Orientation Scale (PPOS) '05-'06 Clerkships

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Patient-Practitioner Orientation Scale (PPOS) Pre Post Fall '05 Spring '06 Site 1 5.14 5.13 Site 2 4.89 4.83 Site 3 5.14 5.12 Control 4.90 4.57

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"Amid this past clerkship year, I watched occupants empowering patients' cooperation in their own care." (1= Never & 7= Always) '05-'06 Clerkships

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"Your group is adjusting on a patient in his healing facility room when one of the counseling administrations touches base for the patient. You're going to and the counseling going to continue to discuss the patient's case as though the patient weren't there." (1= Very Often & 5= Never) '05-'06 Clerkships

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"as a rule, when I endeavored to create compatibility with my patients, my educators _____ me." (1= Completely Discouraged & 7= Completely Encouraged) '05-'06 Clerkships

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"all in all, when I tried to become more acquainted with patients as exceptional people, my teachers _____ me." (1= Completely Discouraged & 7= Completely Encouraged) '05-'06 Clerkships

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Focus Group Findings Valued-included for the PCE understudies Continuity with personnel Access to listening to how workforce consider clinical issues Mentoring Peer aggregate bolster Sense of having a place with an option that is larger than self

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"Today I was in an open restroom at _____,and I saw how there was paper everywhere throughout the floor. For a minute I was sickened and I contemplated every one of the inhabitants and doctors who work so difficult to give first rate mind. I wouldn't need patients or their families to utilize the lavatory at ____ and feel this doctor's facility is filthy when healing facilities should be perfect! So I got all the junk. Right then and there, I understood that I had taken responsibility for doctor's facility."

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Value-Added for the Faculty Contact and important cross-teach discourse Ability to become more acquainted with understudies well Personally fulfilling Ability to recognize qualities and shortcomings Ability to give criticism and help with understudy development and advancement

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Remaining Challenges Paradox of the Pullout Longitudinal, interdiscipinary educational programs Attendings versus inhabitants?? More perception & better feedback

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Challenges (cont.) Patient contact pre-workup Longitudinal contact with patients Quality of the individual clerkships Consistency Across controls inside site, inside train crosswise over locales, and crosswise over PCEs

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