BOOT CAMP BEST PRACTICES: Designing a rotation to prepare 4 th year medical students for Pediatric internship J E N N I F E R B. W A L S H, M D, U T S O U T H W E S T E R N M E D I C A L S C H O O L, D A L L A S, T X K E N Y A M C N E A L - T R I C E, M D, U N C S C H O O L O F M E D I C I N E, C H A P E L H I L L, N C J U D I T H L. R O W E N, U T M E D I C A L B R A N C H, G A L V E S T O N, T X J E N N I F E R L. T R A I N O R, M D, N O R T H W E S T E R N U N I V E R S I T Y, F E I N B E R G S O M, C H I C A G O, I L
COMSEP SURVEY RESULTS 2012 REGARDING PREP FOR INTERNSHIP COURSES - 11 institutions are planning a course - Of the 23 institutions who currently have a course: Length Content/Format 10 8 6 4 2 0 20 15 10 5 0 Entirely peds Includes peds No peds
WORKSHOP OUTLINE Small groups #1: What knowledge & skills do pediatric interns need to have? How do these knowledge/skill areas map to the milestones? Best practices in boot camp design The initial planning process Evaluation and outcome measure Cost and partner collaboration Institution-wide initiatives Course descriptions and lessons learned Small groups #2: How could we measure competency-based outcomes, using milestones?
SMALL GROUPS
INITIAL PLANNING J E N N I F E R B. W A L S H, M D A S S O C I A T E P R O G R A M D I R E C T O R, P E D I A T R I C R E S I D E N C Y P R O G R A M U N I V O F T X S O U T H W E S T E R N M E D I C A L S C H O O L, D A L L A S, T X
IDENTIFY RESOURCES Who will be the core planning faculty? Planning committee? Gather early: planning can take up to 18 mos. What funds and resources are available? Educator time/effort Space & equipment Course materials Course logistics Length: 3 days - 4 weeks Timing: ideally close to graduation Student enrollment: #s, elective vs. required
DETERMINE COURSE CONTENT Define purpose of boot camp course Develop practical skills & knowledge needed for peds internship Focus on areas not uniformly covered in 3 rd /4 th year curriculum Develop a list of skills & knowledge to cover Review literature, ACGME milestones, COMSEP curriculum Review 3 rd and 4 th year pediatric MS curriculum & identify gaps Survey of 4 th years recently matched in Pediatrics What would you like to know? Survey of pediatric interns after month 1 & 2 What do you wish you had known? Brainstorming: How do we use our resources to best develop above skills and knowledge?
ASSEMBLING THE COURSE Outreach to potential educators to develop and lead sessions (faculty, fellows, residents, RNs, RDs, RTs, NPs, PharmDs) Build course schedule/calendar Get the word out Targeted e-mails Eager learners Gather/create take-home resources summary handouts, cheat sheets, pocket cards, useful websites and articles
UT SOUTHWESTERN BOOT CAMP 2012 MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY Week 1 Orientation & pre-test Communication workshop SIM CENTER: Case scenarios Endo cases IV / Central access SIM CENTER: Emergency Medicine Cases #2 Mock patient experience: H&P, orders, signout sheet GI Cases CHD 101 SIM CENTER: Emerg Medicine Cases #1 Signout / handoffs workshop Week 2 Gastrostomy/Ostomy workshop Nursing communication Laboratory Medicine Immersion Nutrition, Formula, and TPN 101 EBM EMR Dos and Don ts Mommy calls 101 ID Cases Motivational interviewing Dehydration/Fluids Cases PAGING EXERCISES: Please respond to all pages and document response/plan in EMR Week 3 Common Pediatric Symptoms / Intern Calls Pediatric EKGs Pharmacotherapy pearls SIM CENTER: Mock Codes / Procedures (ED fellows) Respiratory care workshop Mock patient experience: Debrief/feedback session SIM CENTER: Neonatal Resuscitation SIM CENTER: Umbilical line placement MATCH DAY Week 4 How to request a consult Continuity Clinic 101 When to call for help Physical Exam pearls Wrap up and post-test Lab Interpretation pearls EBM Neuro Cases Pearls from the chief residents ID Cases Signout / handoffs revisited ID Cases Simulation Experience Hands-on Workshop Case-based learning Mock Patient Experience
EVALUATION & OUTCOME MEASURE J E N N I F E R L. T R A I N O R, MD D I R E C T O R, S E N I O R S T U D E N T E D U C A T I O N I N P E D I A T R I C S F E I N B E R G S C H O O L O F M E D I C I N E, N O R T H W E S T E R N U N I V E R S I T Y, C H I C A G O, I L
PILOT PEDIATRIC BOOTCAMP 2012 Open to graduating Feinberg students going into Pediatrics, Medicine/Pediatrics, and Family Medicine Held the week before graduation (based on input from students via Doodle poll) Planned three days of small group interactive didactic instruction One day of individual assessment COMSEP grant
HOW TO MEASURE OUTCOMES? Remember feedback is not the same as outcomes Satisfaction is easy to measure, but not as rigorous Gold standard =? program director feedback sometime during internship v. other interns in program Problem: How do you know your outcomes are attributable to boot camp and not some other curricular component of medical school OR personal characteristic of student Measure specific competencies before & after boot camp Measure competencies in students who have & have not taken bootcamp (if elective) Correlation: Do students who have higher boot camp scores have higher evaluations during 1 st 6 mos internship?
HOW TO STUDY WHILE YOU IMPLEMENT IRB in advance, consent to use data for research up front Planned data collection: Survey pre and post for students who enrolled in boot camp Survey pre and post for students going into same fields but not enrolled in boot camp Pilot assessment instruments for communication (history taking & hand-off ), lumbar puncture skill, and informed consent Daily feedback from the students on effectiveness of individual modules
THINGS THAT WORKED WELL All modules began with short (<15 minute didactic on topic) different leaders for each Followed by small group interactive instruction Facilitators (faculty & fellows) led groups of 4 learners, but peers taught as well Composed groups of both high and low level performers (mixed peds, med/peds, FM) Focused all tasks around patient cases Individual feedback to learners during their assessment on Day #4
THINGS THAT WORKED WELL Created videos demonstrating both good and poor communication between: Intern and nurse Intern and parent Used videos as springboard for discussion Students loved the hands-on skills: Infant lumbar puncture Bag mask ventilation First 5 minutes of an arrest: BLS When & how to defibrillate Students specifically requested more simulation-based cases in Year 2 (adding an extra day this year)
COST AND COLLABORATION K E N Y A M C N E A L - T R I C E, MD D I R E C T O R O F M E D I C A L S T U D E N T E D U C A T I O N U N C S C H O O L O F M E D I C I N E, C H A P E L H I L L, N C
TRANSITION TO PEDIATRIC INTERNSHIP COURSE 4-week course designed to: Develop skills essential to becoming a successful pediatric intern Practice clinical and procedural skills Explore attitudes on doctoring, mentoring, and professionalism Develop skills to become an effective teacher and communicator Explore expectations for chosen career paths Implemented in 2009
CURRICULUM High-yield clinical exposures Peds Anesthesia PICU/NICU Peds Plastic Surgery ENT Conscious Sedation Team Workshops Professionalism Handoffs Residents as Teachers Quality Improvement Evidence Based Medicine Skills and Procedure Workshops IM/Subcutaneous injections Lumbar Puncture Splinting Suturing and Wound Management Standardized Patients Communication Challenges Trained Actors Didactic Sessions Airway Management Tracheostomy/Gastrostomy Pediatric Nutrition/TPN Pediatric Pharmacology Pediatric Emergencies Health Care Reform Discussion Groups Child with Chronic Illness Death of a Child Interprofessional Simulation School of Nursing School of Pharmacy Neonatal Resuscitation Program Pediatric Advanced Life Support
Monday Tuesday Wednesday Thursday Friday Orientation Pediatric Emergencies Handoff Workshop Things You Just Have to Know Clinical Sites Procedural Skills Workshops Clinical Sites Carolina Outdoor Education Center Ropes Course Monday Tuesday Wednesday Thursday Friday Teaching Workshop WORKSHOPS/ DIDACTICS SIMULATION/S KILLS LAB CLINICAL SITES SPECIAL ACTIVITIES PALS PALS Clinical Sites Clinical Sites U.S. Healthcare Reform Professionalism Evidence Based Medicine Quality Improvement Monday Tuesday Wednesday Thursday Friday Airway Management Tracheostomy Gastrostomy Pediatric Formulas and TPN NRP Clinical Sites NRP MATCH DAY! Pharmacology Monday Tuesday Wednesday Thursday Friday Standardized Patients Conclusion/Debrief Child with Chronic Illness Death of a Child Interprofessional Simulation Interprofessional Simulation Success in Residency Chair, Program Directors, Chief Residents, Interns
BUDGET & COSTS Anticipated Costs to Consider Learning Materials Materials for skills labs Costs for certifications (PALS, NRP) Simulation Center use Standardized Patients Training of faculty and staff Compensation for faculty, staff, or volunteers Team building exercises Faculty time Faculty time Faculty time
BUDGET & COSTS
THINGS THAT WORKED WELL Course Funding 2009: Professorship and personal funds 2010: Philanthropic donation ($4500) 2011: UNC Jr. Faculty Development Grant ($7500) 2012: Dept. of Pediatrics funds ($2000) & philanthropic donation ($1500) 2013: Dept. of Pediatrics funds ($2000) and Early Career Faculty Grant ($5400) Faculty Development Leadership Academy Faculty training for development of program design, management, and resource allocation Develop plan for sustained institutional support of resources from the School of Medicine and Healthcare System
THINGS THAT WORKED WELL Demonstration of course success facilitated vested support from the Dept. of Pediatrics and School of Medicine More national models Dissemination of this curriculum to other departments in School of Medicine lays foundation for institutional support and funding Collaboration with other Departments and Professional Schools Interprofessional Education and Collaboration
INSTITUTION-WIDE INITIATIVES J U D I T H L. R O W E N, M. D. A S S O C I A T E D E A N F O R E D U C A T I O N A L A F F A I R S U N I V E R S I T Y O F T E X A S M E D I C A L B R A N C H
UNIQUE FEATURES ILP individualized learning plan Requested by email 2 months before course Assess student experience before the elective Clinical assignments in new areas Helps determine course content Have student assess strengths and weaknesses Allows them to assess their progress Begins PBLI
MOVING TOWARD A REQUIRED COURSE Friends in high places (it helps to be a Dean) Allies in the trenches Surgery course Align carefully with allies Buzz in many venues clerkships, residencies, Grand Rounds, Curriculum Committee, student groups Starting on voluntary basis next Spring, eye to required the following year
PRESUMED STRUCTURE One week of shared activities over Match Week required Examples handoffs, admission orders Competency assessment Can test out of activities Bracketed by discipline specific activities optional, garners elective credit
NEXT STEPS Committee to draft core competencies Incentive for adding discipline-specific opportunities Big question drop another requirement or add this one on? Eventual goal longitudinal curriculum with capstone and final assessment
SMALL GROUPS