What s New in Human Medical Education? OMERAD. Michigan State University April 29, 2010

Transcription

1 What s New in Human Medical Education? Rebecca Henry, PhD OMERAD College of Human Medicine Michigan State University April 29, 2010

2 To Borrow From Plato... Attention ti on the nightly news IS the Mother of Invention

3 Powerful Forces At Work ACGME Core Competencies + Outcomes Project Public Accountability Medical Education Graphic? Resident Work Hours Policy CQI: Systems Approach to Evaluation & Assessment To Err is Human Patient Safety Initiatives

4 CHM s New Systems Approach for Education and Evaluation

5 Why?

6 How?

7 What?

8 What?

9 CHM Competency Assessment Plan

10 So What?

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12 The Hybrid Model of Instruction: Blending the Best of Technology and Human Interface: Moving from Teacher- Centered to Learner-Centered Instruction

13 Defining Face to Face, Fully Online and Blended/Hybrid Instruction Face to Face: An in-person class which meets the traditional amount of time. Fully Online: A course which meets wholly online utilizing no classroom time. Blended/Hybrid: An in person class in which online tools and Blended/Hybrid: An in-person class in which online tools and activities replace some but not all scheduled class meeting time.

14 Today s Learners: Students as Digital Natives Students have changed radically. Today's students are no longer the people our educational system was designed d to teach Students from K thru College are "digital native speakers" and represent the first generations to grow with rapid dissemination of digital technology Students have spent their entire lives surrounded by and using technology (computers, video games, mp3 players, video cams, cell phones and more) They function best when networked They live and move around their personal learning space (peer/instructor interaction, Podcasts, Blogs, Wikis, Wikipedia, etc.) Source: Digital Natives, Digital Immigrants Marc Prensky 2001

15 Face to Face Characteristics: In- person class Lecture driven Meets traditional amount of time May/may not use technology to enhance teaching and learning Passive Learning

16 Online Characteristics: Meets wholly online Neither time nor place bound Students work at own pace Students need to pay close attention to course deadlines to stay on track Weekly participation in class discussion is expected Assignment and discussion delivery takes place in online software platform

17 Blended / Hybrid + Characteristics: In-person class Online tools and activities replace some but not all scheduled class meeting time Effective hybrid models blends classroom and online methodology Student-directed instruction with effective and timely teacher intervention Peer-to-peer interaction is present both online and face to face

18 Benefits to Blended/Hybrid Teaching and Learning Provides an opportunity for the learning process to become more engaging for students and for students to drive the learning process more directly. Effective way to increase students' learning autonomy and to increase/apply active learning strategies in the class Integrates effectively the use of Internet to deliver and to mediate the learning process Combines face to face contact with others students and with the instructor Provides a meaningful opportunity to bring together the best of both worlds (Face to Face and Online) Makes it possible to adjust the learning to different learning styles and learning requirements

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24 Assessment Tool Delivered on Handheld Device

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27 System-wide Implementation of a Medication Error Curriculum in a Community-based Family Medicine Clerkship Prescription Writing Unit Henry Berry, M.D. Project Director HRSA Grant: D56HP

28 Medication errors: a significant cause of morbidity and mortality To Err is Human: a significant component of the 44,000 deaths attributable to medical error Health Professions Education: A Bridge to Quality: Health professionals not adequately prepared to provide safest possible care Locally, our students need additional training in preventing medication errors. Fewer than half of students on recent OSCEs recognized a medication error in one of the stations.

29 Curricular frameworks developed: MSOP Report X: Education In Safe and Effective Prescribing Practices; July 2008 Worked with content experts, curriculum design experts, clinicians, i i and clerkship directors Grant funding for a medication error curriculum obtained Curriculum developed, pilot tested and refined Implemented system-wide academic year in 7 campuses

30 Curriculum development Needs assessment Baseline state of curriculum Brief orientation to patient safety during prematriculation Patient t safety overview in cardiology PBL Orientation to writing orders No systematic approach to writing prescriptions No formal medication safety content Design and development Systematic approach: goals, objectives, content, instructional and learner evaluations strategies.

31 Curriculum Two curricular units: Unit 1 goal: At the end of this unit, the student will follow a systematic approach to writing prescriptions. Content: prescription writing process and product checklist Unit 2 goal: At the end of this unit, the student will identify appropriate responses when medical errors are identified. How errors are identified Apology Evaluation and prevention of errors

32 Curriculum Instructional strategies: Unit 1 Teaching session (two hours) *Job aids: 1. Checklist for writing prescriptions 2. Elements of medication orders or prescriptions 3. Look Alike, Sound Alike medications to be aware of ( LASA meds) for outpatient and inpatient use 4. Do not use list of abbreviations

33 Curriculum job aids Checklist for writing a prescription 1. Does the patient need the drug? 2. Contraindications Allergies and intolerances Special circumstances* Age (children, elderly) Gender (childbearing/contraception) Pregnancy/breast feeding 3. Does the dose need modifying? Elderly, children Renal insufficiency Hepatic insufficiency Other drugs (e.g. warfarin/phenytoin/digoxin) 4. Use of the medication Formulary Cost* Simplicity* 5. Safety Correct patient Medication reconciliation Look-alike, sound alike (see LASA) Abbreviations (see JCAHO list) Drug interactions (e.g. epocrates)* 6. Communication* What (name, purpose) How (route, frequency, duration) What to expect (benefits/side effects) When to call and follow-up Verify understanding *For these and for patients on complex regimens, use a team (pharmacist, nurse, health educator, etc.) to assist you and to negotiate final regimen

34 Curriculum job aids Elements of medication order or prescription **The following elements should always be included 1. Patient s full name (use two identifiers) 2. Patient-specific data (allergies, age, DOB, weight) 3. Generic/Brand name of drug (both should be stated. If only one is used, the generic is preferred; if generic is like a sound alike then use brand name to decrease confusion) 4. Drug strength in metric units by weight such as mg, meq, mmol 5. The dosage form 6. The amount to be dispensed package units (e.g. bottle, tube, ampule) should not be used 7. Directions for use, route of administration, and frequency (ambiguous orders should be avoided like take as directed ) Orders should be specific (e.g. take in the evening ) 8. Purpose of medication (e.g. heart diagnosis, lung diagnosis, skin disorder) 9. Number of authorized refills 10. Dated signature

35 Curriculum Instructional strategies: Unit 1 (continued) Practice writing Rx using job aids during initial teaching session Integration Rx writing into Common Problems teaching sessions Basic curricular framework for much of clerkship content Example: Common Problems Session #2: headache, otitis, back pain, dementia (with some depression), sinusitis/allergic rhinitis/uri *Application in outpatient setting with at least four patients

36 So What s New? Systems Approaches to support decisions and enhance accountability Blended learning to promote efficient and effective learning