Informatics Competencies -- Developmental Milestones and Assessment Strategies

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1 Informatics Competencies -- Developmental Milestones and Assessment Strategies 1. Patient Care Informatics Competencies 1.1. Identify the types of information needed for appropriate documentation and document a clinical encounter Access and maintain patient medical information electronically using an electronic medical record (EMR/EHR) 1.3. Identify, evaluate and use appropriate Patient Education Materials at the point of care. Year 1 Year 2 Year 3 Year 4 medical school a student will be able to document under Subjective a PMH, Social Hx, Functional Hx,Family Hx, HPI, and under Objective document Vital Signs and an all-normal physical exam for an adult. Course: D1; Assessment Strategy: documentation assignment at CSSC or OSCE sessions. medical school a student will be able to open an EMR/EHR and identify the location of each section of the EMR such as the Problem List, Medications List, Allergies and Laboratory sections, and use a Health Maintenance spreadsheet and graphically represent Lab values Course: D1; Assessment Strategy: D1 small group and CSSC/OSCE sessions be able to identify three patient education sources/sites that are medical school a student will be able to document the SOAP sections of the chart for healthy and problem focused encounters for all age groups. (assessment and plan) Course: D2; Assessment Strategy: documentation assignment at each CSSC session or OSCE, and small groups in biomedical sciences courses. medical school a student will be able to add data to the appropriate sections of an EMR/EHR such as the encounters, patient summary data, labs, and vitals, and interpret trends generated, including Health Maintenance needs of the patient. Course: D2; Assessment Strategy: D2 small group faculty observation and CSSC and/or OSCE sessions be able to evaluate the quality and appropriateness of patient 1 By the end of the third year, students will be able to accurately and succinctly complete a problem oriented SOAP note on most encounters with an appropriate assessment and plan for each presenting problem. Course: D3 Chronic Care Course or any clerkship; Assessment Strategy: review of each student s progress notes by the Informatics Clerkship Director and/or OSCE. (?) By the end of the third year, students should be able to gather patient data from appropriate internal and external sources and document within the EHR in an organized manner Course: D3CCC; Assessment: Documentation review by clerkship faculty. Document a flow sheet of at least one chronic problem within D3CCC be able to use patient education resources clinically at a patient- During the 4 th year required clerkships, students will describe the elements of other types of encounter notes such as consult notes, admission and discharge notes, op notes Courses: required clerkships; Assessment Strategy: observations of supervising faculty. Elective Opportunity: Develop a clinical care template for a progress note to be used for patients presenting with a common problem, i.e. diabetes.. Elective Opportunity: Develop electronic templates/flow sheets for an EMR for common diseases/lab values/acute care Assessment: Reviewed by FSU faculty via the student portfolio Elective: Develop a unique educational set of materials for a chronic disease for the student portfolio including a cultural and

2 1.4. Locate and utilize clinical practice guidelines and decision support resources in the clinical decision making process. appropriate for patient education. education materials. Course: D1 Course: D2; M&B2, Pharm Assessment: D1 small group Assessment: Ad evaluation for participation, D1 exam questions Pharm. Pt Ed Handout assignment for M&B2. OSCE? Exam questions? be able to identify appropriate clinical practice guidelines and resources. Course: D1 Assessment: D1 CLC OSCE be able to evaluate a clinical guideline using strength of recommendation taxonomy (SORT) to a clinical problem. Course: D2 or HI Assessment: written or oral presentation, small group exercises 2 centered level (i.e. language, reading level.) Course: Family Medicine Clerkship (?) or D3 Small Group Assessment: Documentation in BB and portfolio as a reflective paper; be able to apply clinical practice guidelines at the point of care. Course: D3CCC Assessment: Develop a flowsheet on a chronic disease that is consistent with current high level clinical guidelines. Guideline assignment: with preceptor identify guideline appropriate to care of specific patient problem. Reviewed by FSU faculty via the student portfolio literacy assessment of original work. Assessment: Review educational resources by elective faculty 2. Medical Knowledge Year 1 Year 2 Year 3 Year Assess the reliability and validity of health information on the Web and other media. identify and apply unbiased criteria to online information resources to determine their value for clinical and research activities. Course: D101; Health Issues 1 Assessment: MCQ; Review several websites on a single topic and determine inter-rater reliability of reviews with peers and faculty. 2.2 Use the FSU Virtual Medical Library resources, i.e., journals, books, databases, demonstrate understanding of the differences among citation indexes and the most appropriate use of each. (Medline vs demonstrate the process of systematic gathering of information on a disease related topic and forming conclusions on the validity of the information. Course: Health Issues 2; Pharm Assessment: Produce an annotated bibliography that supports or refutes a position on a specific topic. Advertisement assessment. demonstrate understanding of the appropriate use of different virtual resource formats to address questions related to locate and validate web or mediabased resources to use for patient education. Evaluate web and media-based information resources being used by patients. Course: Clerkships or D3 Assessment: Prepare list of appropriate websites for patient education in the preceptor s practice. Elective Opportunity: Health Information Literacy Elective. Teach patients to assess the validity of the information they find on the web or other media and become smart information consumers. Course: Assessment:

3 2.3 Conduct appropriate literature searches and apply results to answer clinical and research questions. 2.4 Demonstrate the ability to critically review the medical literature applying levels of evidence to the decision making process. PsychLit ) Course: Health Issues. M1 foundational science courses. Assessment: Compare differing citation coverage in PubMed, Web of Science, and Google Scholar for 2 faculty and/or students (present or former). medical school, the students will identify various types of articles: abstract, primary research, review, clinical or randomized controlled trial, meta-analysis, case reports, practice guidelines, etc. and the characteristics that distinguish each. Course: Health Issues 1, M1 foundational sciences, D1 Assessment: Find citations for at least 3 types of articles on a specific topic. Compare several abstracts to their full-text articles and evaluate their congruence. clinical and research activities. Course: M2 foundational science courses, D2 Preceptorship Assessment: Select appropriate resources to answer coursespecific or patient-specific questions. OSCE. MCQ. medical school, the student will formulate an effective search strategy to research a clinical or basic science topic. Course: M2 foundational sciences, D2, Health Issues 2 Assessment: Define and research a course-specific or patientspecific question and document the knowledge acquired and sources used. Broaden or narrow the search strategy as needed based on the results. 3 medical school, the student will locate and evaluate appropriate resources to answer questions generated during clinical experiences. Course: Clerkships Assessment: Report to preceptor on knowledge acquired. describe the essential elements of select appropriate EBM resource, select appropriate resource and a research article/study, strengths and use the information in the apply to decision making process and weaknesses (controls, bias and methodology) of case reports, case control studies, cohort studies, randomized controlled trials, systematic reviews, and meta-analyses, and describe levels of evidence. decision making process related to a clinical question. Demonstrate understanding of levels of evidence. related to a clinical question. Demonstrate information management skills to assist in decision making process at POC. Course: Health Issues 1, Preceptorship, SCP Assessment: Describe the strengths and weaknesses (controls, bias and methodology) of case reports, case control studies, cohort Course: Health Issues 2, D2, Preceptorship Assessment: Formulate appropriate searchable questions based on clinical simulation or experiences. Compare Cochrane and BMJ systematic reviews on a specific topic and determine level of consistency. Assign levels of evidence to x Course: Clerkships Assessment: Discuss with preceptor the use of the evidence and/or information management strategies in making a clinical decision. Course: Assessment: Course: Assessment:

4 studies, randomized controlled trials, systematic reviews, and meta-analyses. Given a hypothetical clinical situation, formulate a clear, concise searchable question. studies related to a specific topic. Assess limitation issues related to a specific set of articles in an EBM exercise. 2. Practice Based Learning and Improvement 3.1 Demonstrate knowledge of learning styles, preferences and strategies to facilitate lifelong learning 3.2 Identify effective and efficient strategies for staying current, including identifying information resources useful to keep up-to-date Use highly-referenced, decision support tools at point of care (POC) and other settings (i.e. disease and drug references, treatment guidelines, diagnostic tools, and prevention resources that may be available as Year 1 Year 2 Year 3 Year 4 be familiar with different learning styles including an understanding of the learning style that is best for them Course: all courses Assessment: advisor evaluation in conjunction with student evaluation and careers in medicine tools and a reflection of which learning styles they use. describe some of the most commonly used disease and drug reference, treatment guidelines and prevention resources be able to identify different lifelong learning strategies expected of them in the professional medicine Course: all courses Assessment: advisor evaluation in conjunction with student evaluation, E portfolio exercise, multiple-choice questions have an understanding of the scope of the problem of the amount of information needed to stay current as well as being able to identify techniques to assist them in staying current Course:. All first-year courses Assessment: multiple choice questions, small group exercises, literature reviews, PDA exercises be able to demonstrate the appropriate use of decision support tools in the care of a patient. 4 participate in self-directed forms of lifelong learning activities Course: all clinical courses Assessment: participation in a continuing medical education program with a reflective statement specifically directed at the concepts of lifelong learning No different than third-year No different than third-year recognize the rapid changes in medical information and how this might affect patient care Course: any clinical course Assessment: preceptor discussion with student, small group session, clerkship director meetings and evaluations regularly use decision support tools in their care of patients at POC and as reference information in decision making. No different than third-year

5 web sites, PDA applications, computer software, etc.) 3.4 Perform each of the steps of the EBM process a. Formulate a clinical question, identify the type of question, b. identify the type of research that would answer that type of question, then c. search the primary literature for evidence-based information using evidence-based search filters, d. search EBM databases such as Clinical Evidence, DynaMed or Essential Evidence Plus for digested forms of relevant evidence, e. evaluate the usefulness and applicability of the information found to the particular circumstance, f. communicate the evidence to the patient. Course: any first-year courses Assessment: multiple-choice questions, small group exercises be able to describe steps a-f. Course:D1 Assessment: MCQ test Course: Doctoring, microbiology, pharmacology Assessment: small group exercises, PDA exercises, OSCE station(s) be able to demonstrate steps a-f in controlled/simulated environment Course: D2 Assessment: OSCEs, MCQ, course homework (Educational prescriptions) Course: all clinical courses Assessment: preceptor evaluation, self-evaluation, patient evaluation, OSCE station be able to demonstrate steps a-f at least twice in each rotation for actual patient encounters Course: Each clinical clerkship except Community Medicine Assessment: Clerkship faculty feedback By the end of the fourth year of be able to demonstrate steps a-f at least twice in EM and Geriatrics clerkships for actual patient encounters Course: EM, Geriatrics Assessment: Clerkship faculty feedback g. 3.5 Interpret the level of evidence of information resources based on CEBM, SORT, and other criteria. 3.6 Demonstrate skill and the use of information technology to identify online resources which contain medical statistical data sets. be able to describe varied levels of evidence and their meaning Course: D1 &/or Health Issues Assessment: MCQ test be able to list sources of medical data sets be able to describe appropriate uses of levels of evidence in a simulated case Course: D2 Assessment: Small group work and feedback, homework be able to demonstrate access to medical data sets 5 be able to discuss implications of levels of evidence in clinical decision making with actual patient cases Course: Every clinical clerkship Assessment: Clerkship director feedback specific to level of evidence be able to demonstrate access to appropriate online resources for By the end of the fourth year of be able to discuss implications of levels of evidence in clinical decision making with actual patient cases Course: EM and Geriatrics Assessment: Clerkship directors feedback No new milestones

6 3.7 Identify the role of informatics in practice-based quality improvement. 4 Interpersonal & Communication Skills 4.1 Demonstrate professional presentation skills Course: Health Issues Assessment: MCQ tests, assignment(s) be able to define and describe components of the patient care record and how this may be used for practice based-quality improvement. Course: Health Issues & Doctoring Assessment: MCQ tests, assignments Course: D2 Assessment: Small Group faculty feedback be able to use informatics simulations to identify opportunities for practice-based QI Course: D2 Assessment: Small group faculty feedback, MCQ tests, chart review exercise information on community health issues and needs. Course: Community Med Assessment: Dean feedback from D3 sessions and student presentations be able to create and demonstrate an informatics-based QI plan. Course:D3 chronic care curriculum Assessment: Course homework, presentation to faculty Elective Opportunity: Utilize technology to support research to include data collection, data analysis, and reporting, including creation of charts and graphs for analyzing one s practice data for quality improvement. Year 1 Year 2 Year 3 Year 4 medical school, when giving a presentation, students will demonstrate the following professional presentation skills: introduce topic and each presenter, motivate audience, dress professionally, maintain eye contact with audience, appear correctly. Students will be practiced and at ease, enunciate, prepared to discuss their topic use professional language, and and answer audience questions. use time allotted effectively, Course: Any course that requires Course: Any course that requires a presentation. faculty or Video of presentation skills in portfolio. develop a professional presentation whose content is at an appropriate level for audience, accurate and current, organized and sequenced logically, with appropriate references and cited a presentation. faculty, or Video of presentation skills in portfolio. By the end of the third year, students, when giving a presentation, will adapt the language and content to the audience when the audience is a group of patients. For example, a present to members of a rural community, nursing home, etc. Course: Students will present to a patient group. Community medicine? faculty observing or video of presentation in portfolio reviewed by appropriate faculty. By the end of the fourth year, when giving a presentation, students will adapt presentation language and content to the multidisciplinary professional audience such as members of an agency or staff in hospital or clinic. Course: During required clerkship or elective, students will present to a multidisciplinary group. faculty observing or video of presentation in portfolio reviewed by appropriate faculty. 6

7 4.2 Demonstrate the use of software to support professional presentations such as PowerPoint 4.3 Demonstrate the ability to produce appropriate handouts for professional presentations using a variety of applications 4.4 Demonstrate knowledge of the uses of telecommunications in medicine (including telemedicine). By the end of the second year, students, when creating a professional presentation using presentation software, will use background/design, text, images and animation appropriately for visibility. Course: Presentation from any course/clerkship that has students developing presentations. Assessment: Evaluation of presentation by faculty in attendance or faculty advisor from presentation in portfolio. prepare a handout (electronic or paper) appropriate to the audience. Course: M&B2 (at same time as patient ed.) Assessment: MCQ, as a part of an assignment or reflection. define telemedicine and describe benefits and barriers to its use in rural and other settings; and list barriers and benefits to the use of video conferencing in medical practice. Course:Health Issues? Assessment: MCQ describe and/or prepare appropriate handouts to accompany a talk to a community of patients that will help them understand a condition and take home the message in the talk. Course: Community medicine, or clerkship (seek out opportunity) Assessment: evaluation by regional dean or advisor of handout in portfolio. Identify opportunities for use of telemedicine in rural and other settings. Course: Any clerkship or rural experience Assessment: reflection in portfolio Elective possibility: Work with clinician who provides telemedicine consultations. Assessment: write up project in portfolio, evaluated by advisor. 7

8 medical school, students will Identify how the technology can interfere with communication with patients in the patient care setting, and recognize when an arrangement of a technology in an exam room might interfere with communication between the doctor and patient. Course: Doctoring Assessment: reflection in portfolio, written assignment during Preceptorship. utilize technology in the exam effectively utilize an EMR in the room with simulated patients patient care setting in such a way effectively and support the as to support, not hinder, doctor/patient relationship. doctor/patient communications. Example: announce to preceptor Specifically, when using an EMR or standardized patient intent for with a patient, when possible the use of computer or mobile student will construct a triad device; i.e. to look up patient s with the patient and computer, lab values or do an interaction Introduce the computer into the check, prior to consulting the encounter, device/computer. adjust screen so patient can see it, Course: Doctoring in CLC or share EMR information on screen others with patient, and alert patient Assessment: CLC either during verbally when turning to EMR normal session demonstrating Course: Any clerkship. competence or OSCE. Assessment: OSCE or direct faculty observation in a clerkship. 5. Professionalism Year 1 Year 2 Year 3 Year Demonstrate the characteristics of deliberate practice in the appropriate use of information for acquisition of medical knowledge, lifelong learning and adaptation to changes in the professional environment (medical system). Assessment: Course directors Assessment: Course directors monitoring student s ability monitoring student s ability to self-monitor their learning to self-monitor their learning needs and performance and needs and performance and make corrections as needed. make corrections as needed. Assessment: Clerkship directors, Education directors and RC Deans monitoring student s ability to selfmonitor their learning needs and performance and make corrections as needed. Assessment: Clerkship directors, Education directors and RC Deans monitoring student s ability to self-monitor their learning needs and performance and make corrections as needed. 5.2 Systematically document, store and retrieve all evidence of professional development and lifelong learning. Assessment: Monitoring of eportfolio by advisor and course directors. Assessment: Monitoring of eportfolio by advisor and course directors. Assessment: Monitoring of eportfolio by RC Dean, education directors and clerkship directors Assessment: Monitoring of eportfolio by RC Dean, education directors and clerkship directors 5.3 Appropriately cite copyrighted materials used in papers, presentations, posters, etc. including web sites, images, and videos in addition to journal articles and books. Assessment: by course directors and evaluators of products. Assessment: by course directors Assessment: by education and evaluators of products. directors, clerkship directors and other evaluators of products. Assessment: by education directors, clerkship directors and other evaluators of products. 8

9 5.4 Systematically and reliably document all patient encounters. Assessment: On preceptorship and SCP, monitoring by course director Assessment: Preceptorship monitoring by course director Assessment: monitoring by clerkship and education directors on all required clerkships. Assessment: monitoring by clerkship and education directors on all required clerkships. 5.5 Demonstrate knowledge of and respect Assessment: MCQs with for patient privacy and confidentiality as clinical scenarios, HIPAA articulated in the Health Insurance certification, and evaluation Portability and Accountability Act by preceptors and CLC (HIPAA), and maintain security of clinical supervisors data. preceptors and CLC supervisors; D2 OSCE. clerkship faculty; D3 CCC documentation reviewed by ICDs. clerkship faculty 5.6 Protect one s professional reputation and be respectful when communicating with colleagues, patients and others when using electronic communications. ( , social media, discussion lists, etc.) During the first year of medical school, students will identify appropriate and inappropriate uses of social media and other electronic communication for medical students and professionals. Course: Orientation Assessment: Monitored by course director in use of Yammer for SCP. identify adverse consequences of inappropriate use of social media on one s future career, such as application to residency programs, hospital privileges, and medical licensure. Course: D2 Assessment: Case review Course: Any clerkship using social media. D3. Assessment: student selected case review Activity: M4 Teach Back. Assign each 4 th year to mentor 1 st year student in uses of social media in medicine: associated risks, benefits, and professional reputation issues. Assessment by M1 student and RC Dean. 6. Systems Based Practice Year 1 Year 2 Year 3 Year Demonstrate knowledge of the current uses of information/communications technology including clinical information systems in health care which impact patient outcomes and patient safety, positively or negatively..identify uses of technology in the clinical setting. Courses: D2 preceptorship and SCP. Assessment: Reflection on use of technology in clinical settings and impact on patient care. Identify elements of a clinical information system, such as the EMR, billing system, CPOE, eprescription writers, describing their effect on patient outcomes and safety. List or identify systems that might improve patient outcomes and safety. Course: Health Issues Assessment: Case analysis of system failure, or MCQs. 9 identify methods of incorporating social media into practice that might benefit patients, like posting/tweeting the time for flu shots. Course: Any clerkship Assessment: reflection in portfolio medical school, students wil utilize the elements of a clinical information system, such as the EMR, CPOE, eprescription By graduation, students will incorporate the use of technology in the care of patients targeted towards improving patient outcomes or safety. Identify opportunities in point of care settings to use technology to improve patient safety and outcomes. clerkship faculty. Reflection paper or project.

10 6.2 Demonstrate knowledge of current local, regional and national initiatives in healthcare IT to promote patient safety, coordinate care, improve medical research and reduce of healthcare costs. (Examples (2012) include local health information exchanges (HIEs), regional health information organizations (RHIOs), nationally the HealthIT and ARRO Acts (healthit.gov) created to reward physicians and hospitals for adoption of EHRs that meet Meaningful Use criteria, establishing the Office of the Coordinator of HIT to oversee.) By the end of the second year, students will identify current local and national initiatives in Healthcare IT that promote patient safety Course: Health Issues or D2. Activity: Interactive formative group discussions Assessment: formative quizzes writers, and identify how these improve patient outcomes and safety, in their clerkship settings. Course: D3CCC Assessment: Systems Project By the end of the third year, students will identify the impact of current initiatives in Healthcare IT on the practices in which they are training. Course: D3 discussion Assessment: Reflection Activity: M4 Teach Back. Assign each 4 th year to mentor 1 st year student in the impact of current local, regional and national initiatives in Healthcare IT on patient outcomes and safety as well as systems of care. Assessment by M1 student and RC Dean. 10

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