Enhancing ED Bedside Teaching Resident Evaluation

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Enhancing ED Bedside Teaching & Resident Evaluation Stanford EM Faculty Development May 21 st , 2003

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Objectives Review late writing in regards to 'Bedside Teaching' and 'Occupant Evaluation' Discuss the ACGME Outcomes Project and related execution appraisal apparatuses Provide a gathering for staff exchange of issues identified with inhabitant instruction, with an objective of enhancing showing abilities Michael Gisondi, MD - Stanford Emergency Medicine

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Scope of the Problem EM Residents (when all is said in done) report low rates of bedside educating and aptitudes assessment Burdick WP and Schoffstall J. "Perception of crisis drug occupants at the bedside: how frequently does it happen?" 1995. Acad Emerg Med . 10(2): 909-13. Our EM occupants and 4 th - year therapeutic understudies keep on reporting an apparent insufficiency of bedside instructing (sum or quality?) Michael Gisondi, MD - Stanford Emergency Medicine

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What is Bedside Teaching? Happens at the bedside Encompasses an assortment of therapeutic aptitudes History-taking Physical Examination Procedures Demonstrative or observational Includes constant criticism or reflection Michael Gisondi, MD - Stanford Emergency Medicine

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Why trouble? Bedside educating permits the employee to good example practices that have been appeared to enhance the learners': Clinical aptitudes Ethical critical thinking Humanism & Professionalism Communication Skills Standardized examination scores (USMLE) Michael Gisondi, MD - Stanford Emergency Medicine

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Why don't we isn't that right? Most critical hindrances to bedside educating: Declining bedside showing aptitudes, particularly for junior employees The "emanation of bedside instructing": are the vital abilities basically impractical? Conviction that such educating is not esteemed Erosion of the showing ethic Ramani S et al. "Whither bedside educating? A center gathering investigation of clinical instructors." 2003. Acad Med. 78(4): 384-390. Michael Gisondi, MD - Stanford Emergency Medicine

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True or False? "EM Faculty don't have room schedule-wise for bedside instructing." Berger T et al. "Does the interest for clinical efficiency trade off educating in scholarly crisis divisions? Acad Emerg Med . 2003. 10(5): 473-5. Occupants and understudies were reviewed in regards to the nature of showing they got by the ED going to. Review results were contrasted with EM particular RVUs. No factual relationship between clinical efficiency and successful educating. Michael Gisondi, MD - Stanford Emergency Medicine

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How can one enhance their bedside instructing abilities? What decides quality bedside instructing? Requires readiness for centered experience The patient ought to consent to take an interest Learners ought to be arranged to the experience Requires questioning and criticism Michael Gisondi, MD - Stanford Emergency Medicine

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Some great articles to survey: Ramani S. "Twelve tips to enhance bedside instructing." 2003. Med Teach . 25(2): 112-115. (if) Reprint acquired and duplicate put in 701 gathering room library Attached to freebee Janicik RW, Fletcher KE. "Instructing at the bedside: another model." Med Teach . 2003. 25(2): 127-130. Talks about workforce advancement aptitudes workshop for junior staff Shayne P et al. "Secured clinical showing time and a bedside clinical evaulation instrument in a crisis pharmaceutical preparing program." Acad Emerg Med . 2002. 9(11): 1342-1349. Talks about "showing going to" position at Emory Univ. Michael Gisondi, MD - Stanford Emergency Medicine

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Some great articles to audit: Cydulka RK et al. "Assessment of inhabitant execution and escalated bedside educating amid direct perception." Acad Emerg Med. 1996. 3(4): 345-51. CWRU's program enhanced workforce work fulfillment! Thomas H. "Educating procedural abilities: past 'see one – do one'." Acad Emerg Med . 1994. 1(4): 398-401. Appended to freebee Hedges JR. "Pearls for the educating of procedural aptitudes at the bedside." Acad Emerg Med . 1994. 1(4): 401-404. Appended to freebee Michael Gisondi, MD - Stanford Emergency Medicine

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What makes for quality EM-particular bedside educating? Experiences arranged around regular elements Brief, coordinate learning destinations for every case Allow time for direct perception Provide quick " zones for development' and discover an opportunity to watch the inhabitant again A point for discourse and potential research! Michael Gisondi, MD - Stanford Emergency Medicine

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Outcome Measures Medical teachers truly concentrate on the wrong endpoints, concentrating more on process (learner fulfillment) than item (quality patient care, clinical result measures) How would you pick a result measure while assessing inhabitant instruction? Michael Gisondi, MD - Stanford Emergency Medicine

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The ACGME Outcome Project Focuses on achievements, not possibilities 2 Phases Phase 1: Implement 6 "General Competencies" Phase 2: RRC to command satisfactory appraisal of inhabitant capabilities by individual projects Go to: http://www.acgme.org/result/extend/OutIntro_fnl1.htm to see a slideshow on the history and objectives of the ACGME Outcome Project Michael Gisondi, MD - Stanford Emergency Medicine

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The 6 "General Competencies" Patient Care Medical Knowledge Practice-based learning and change Interpersonal relational abilities Professionalism Systems-based practice Full content portrayals of every competency at: http://www.acgme.org/result/comp/compFull.asp Michael Gisondi, MD - Stanford Emergency Medicine

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Assessment = Evaluations What is the best strategy for assessing every competency? One widespread evaluation instrument for every one of the six? All inclusive evaluation device for every forte? ACGME gives various cases of instructive appraisal devices at: http://www.acgme.org/Outcome/survey/Toolbox.pdf Michael Gisondi, MD - Stanford Emergency Medicine

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Making the Competencies EM-particular Competency evaluation apparatuses are a mainstream theme in EM training writing The Nov 2002 issue of Acad Emerg Med gives various articles in regards to novel techniques for inhabitant appraisal Article with great EM point of view: Strauss RW. "The calm upset in postgraduate preparing." Acad Emerg Med . 2002. 9(11): 1222-25. Michael Gisondi, MD - Stanford Emergency Medicine

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Other Stanford Resources Stanford Faculty Development Center Courses on bedside instructing (internist driven) http://www.stanford.edu/assemble/SFDP/ACEP Teaching Fellowship Wait rundown is well over a year long! Call now! http://www.acep.org/1,32536,0.html Michael Gisondi, MD - Stanford Emergency Medicine

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Points for Tonight's Discussion? Conceptualize thoughts for enhancing the showing abilities of our workforce Are we truly coming up short the occupants? How would we move forward? Workforce Teaching Retreat? Examine our present assessment process Are we truly tending to the points of interest of the ACGME Competencies? If not, how would we enhance the procedure? Michael Gisondi, MD - Stanford Emergency Medicine

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