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- The "Nuts and Bolts" of a Successful Student Experience in the Office
Ardis Olson, M.D., Dartmouth Medical School
Workshop presented at the COMSEP Annual Meeting, St. Petersburg Beach, Florida, March 1996
- New Clerkship Director's Workshop
Fred McCurdy, M.D., Ph.D., University of Nebraska
Susan Marshall, M.D., University of Washington
Bruce Morgenstern, M.D., Mayo Medical School
Workshop presented at the COMSEP Annual Meeting, St. Petersburg Beach, Florida, March 1996
Faculty development internet sites that provide
relevant information to Pediatric medical educators:

Models that Work:
The Nuts and Bolts of
Faculty Development
For
General Internal Medicine,
Family Medicine and
General Pediatrics
December 2 - 4, 1998
U.S. Department of Health and Human Services
Health Resources & Services Administration
and The Ambulatory Pediatric Association
This site provides extensive and relevant information for
faculty development activities. Many of the authors of these articles are
leaders in medical education and even a few COMSEP members. However, you will
need the Adobe Acrobat Reader to read the files.
The Asociation of Program directors in Internal Medicine
The Educational Clearinghouse for Internal Medicine
is a peer-reviewed compendium of articles, books, and locally produced
materials for education in Internal Medicine. The internal medicine clearinghouse contains excellent
material for faculty development.
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Center for Instructional Support
This site presents information and resources for helping
educators in all the health professions enhance their instructional,
leadership/management, and research skills, with additional resources that can
help them with career development.
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The Office of Medical Education Research and Development
The
Office of Medical Education Research and Development is a unit within the College of Human Medicine at Michigan State University. Its mission is to
improve medical education and related service programs through evaluation and
research, consultation, relevant instruction, and programs of faculty development.
Established in 1966, OMERAD is the oldest continuously operating office of
medical education in the United States.
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1. The "Nuts and Bolts" of a Successful Student Experience in the Office
Ardis Olson, M.D., Dartmouth Medical School
Workshop presented at the COMSEP Annual Meeting, St. Petersburg Beach, Florida, March 1996
Before the student comes to the office (1-2 weeks)
- clarify what is expected of you
- Determine what supports are available to you from the medical school
- Learn personal details of the student
- Review the "Student Profile and Skills" pages (below)
- Check you office schedule for surprises (days away from the office, trips, etc.)
- Look for scheduled patients, meetings, or events from which the student could benefit
- If planned routinely, arrange outside community experiences for students
The student's first day in the office
- Meet and establish ground
rules and expectations
- Orient student to office
staff, procedures, and routines
- Establish a plan to have:
- student work
progressively more independently during the time in the office
- student identify
ambulatory care areas of special interest
Setting the learning climate
What are we teaching
- Medical issues
- Role models of primary care
physicians and type of care given
- Interplay between
professional and personal lives
Who are the teachers
- The role of community
experiences options used by practitioners how to prepare the student
- Teaching by office staff:
nursing and office staff options
- The patients home visits, phone follow up, extended visits
How teaching is structured
- Number and type of patients students are involved in
- Focused teaching points
- Student's use of a learning list
- Options for reviewing patients seen
- How to relieve the daily teaching burden
- Student learning responsibilities
Checking in
- One week fine tuning
- Midway feedback, student self review
- Trouble shooting: typical student problems
Wrapping up the experience
- Review progress since midway
- Student feedback to preceptor
- Comments of parents and staff about the student
- Share written evaluation with the student
Practice reflection
- Review with colleagues and staff how would do different and jot down ideas in teaching file
- Write down personal goals that want to focus on next time
- Contact with Program Coordinator
- Solve logistic issues
- Feedback how students could be better prepared
- Opportunities for enhancing teaching skills
- National meetings
- Local workshops
- Seminars in the practice from the program
Name: __________________
Nickname (if any):__________________
Home telephone (other telephone if applicable):__________________
1. What other types of clinical/ambulatory care experiences have you had?
Medical Interests
1. What aspects of medicine do you find most interesting or appealing? Why?
2. What aspects of medicine do you find least interesting or appealing? Why?
3. What are your major career interests? (Primary Care? Subspecialty?
Undecided?)
Learning Style
Based on your experience and knowledge of appropriate teaching and learning
styles in clinical medicine, please answer the following:
1. Describe the qualities of an effective teacher.
2. What stifles or hinders your learning?
3. What are your responsibilities as a student?
Clinical Inventory Skills
This inventory is intended to help monitor development of your skills
essential to ambulatory pediatrics. Present this to your community preceptor on
your first day and discuss areas in which you would like or need more practice.
It is beneficial for you to also be aware of situations where you can either
learn a new skill or continue to develop competence in ones you have already
learned.
Please rate your mastery of the following skills/procedures using the scale
below. (Circle one)
0 = no previous experience, skill, or
competence
1 = some experience but still require supervision
2 = much experience, require little or no supervision
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Procedure
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No experience
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Some experience
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Much experience
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1. Growth charts(charting/analyzing)
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0
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1
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2
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2. Hematocrit
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0
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1
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2
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3. Stool test-blood
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0
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1
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2
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4. Throat culture
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0
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1
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2
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5. Urinalysis
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0
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1
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2
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6. Vision/hearing screening tympanometry
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0
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1
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2
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7. X-ray - extremity
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0
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1
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2
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8. DDST
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0
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1
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2
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9. Finger/heel stick
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0
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1
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2
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10. Immunizations
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0
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1
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2
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Are there other procedures with which you feel you need specific instructions? What are they?
Please rate your mastery of the following examinations in the same was as above.
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Examination
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No experience
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Some experience
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Much experience
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1. Newborn
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0
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1
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2
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2. Infant/toddler
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0
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1
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2
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3. Preschool
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0
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1
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2
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4. School
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0
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1
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2
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5. Adolescent
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0
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1
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2
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6. Illness or acute problem
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0
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1
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2
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7. Assessment of minor trauma
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0
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1
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2
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8. Ear exam with oreumatic otoscopy
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0
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1
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2
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This section may be helpful to the preceptor in organizing time and
responsibilities for staff and student.
1. A Good Start
Read through the student profile and clinical skills inventory to become
acquainted with the student
Review the patient log with student and identify particular outpatient
readings or clinical experiences at your site (Outpatient Reading Binder) which
may be helpful to the student.
Review the ambulatory curriculum, noting seasonal variations.
2. Establishing Ground Rules
Introducing the student to office staff and providing a tour are essential
first day experiences in making a student feel welcome . Giving students
written guidelines and discussing these at the beginning of the rotation is
important for both of you. It establishes your expectations of the student and
eliminates confusions which waste time for everyone. These guidelines should
include
- Days and hours the student is expected to be in the office, including evening clinics
- Who else in the office will the student be responsible and how often
- What role do students have in the hospital and can they write in hospital charts? What about admissions and newborns?
- Student on-call responsibilities
- Preceptor's days off and who the student should report to on those days.
- Specific expectations - such as presentations, specific readings, etc.
- Discuss when feedback and evaluation will occur.
- Community activities of the preceptor in which the student will participate in.
- Other office policies and procedures of which the student should be aware
- Other logistical information which the student needs to know, i.e., parking at site and hospital, telephone numbers, pager systems, etc.
3. Orientation
The student should have an understanding of how the office works, as well as
any particular information for the hospital.
- Establish ground rules (see above)
- Office staff and responsibilities
- Standard office procedures (appointments, chart information, etc.)
- Individual practitioner's interests
- Office lab procedures
- Hospital logistics including chart information, paging systems, location of specialty areas (x-ray, nursery, etc.)
(Based on a two week rotation)
First Week
- Review the above and orient the student to the practice.
- Set specific feedback sessions for each day and a wrap up for the week.
- Integrate student interests with your plans for him/her.
- Have the student watch as you see patients until he/she is familiar with the routine and flow.
- Have the student see patients.
- See patient alone
- Present to you after seeing patient
- Have the student observe or participate while you examine the child
- discuss observations after the patient has left
- For selected patients, have the student write the SOAP notes - if these are good perhaps the student can write the assessment and plans, as well.
Second Week
- Have the student see patients collecting history and exam data.
- have the student discuss present findings to you
- See the patient together allowing the student to demonstrate specific clinical skills.
- Include teaching of procedures by you or your staff.
- Help the student clarify why patient problems are not the same in this setting as what would be seen on other services/tertiary care center. Help student understand how continuity in patient care changes treatment.
- Help the student develop problem solving skills.
- Set up specific feedback times for each day and a wrap up evaluation session at the end of the week.
For sites having students longer than two weeks, continue to expand on
the above ideas.
2. New Clerkship Director's Workshop
Fred McCurdy, M.D., Ph.D., University of Nebraska
Susan Marshall, M.D., University of Washington
Bruce Morgenstern, M.D., Mayo Medical School
Workshop presented at the COMSEP Annual Meeting, St. Petersburg Beach,
Florida, March 1996
I. How do you fit? What is your departmental and institutional
clerkship governance? Are you the capo di tutti capi or is there a more
diffuse committe structure?
II. What do you want? What is your personal
philosophy/goal/vision/mission for the clerkship? Where do you want the
students to be after they complete the rotation?
III. How can you implement your vision?
A. (see I above). If you are really in charge, you have a head start.
If you are but a cog in a slow-moving wheel, you have to get allies. Seek them
out. Proselytize.
B. Get a feel for where your clerkship is now (notice, you are taking
ownership, it is yours!!). Devise a plan to get from point a (here) to point b
(perfection). Break the plan down into pieces. Act on several small pieces at a
time. Don't pick on the same people to assist, unless their enthusiasm is
infectious
IV. So, you've got a vision: Don't labor under the illusion that your
vision is unique. Others, in your school, or in the pediatric clerkship
directors' community may share your vision and have been along this path
before. Network. Learn from your peers. Learn how your vision fits into
the structure of your particular setting.
A. What are you students expected to know by the time they get to your
clerkship? What's in the Medical School curriculum? How much pediatric contact
will they have had?
B. Where can you put your students? How many sites for ambulatory care do
you have? How much in-patient time? What about newborn care? What about care of
the indigent? The disabled?
C. Who's going to care for your students when they're not under your
watchful eye? You will need helpers in the "remote" sites. They may
need to be physicians, or may need to be secretaries, this depends upon your
circumstances. Remember, people need time, and time equals $$!
V. Budget: How much yak got? How much ya need? Who controls the purse
strings? Realize there is a study in the literature (Academic Medicine
1991;66:348-353) which demonstrates a 30-40% decrease in productivity (read:
patient through-put) and a consequent $25,000 loss in revenue when students are
taught in an ambulatory setting. Be careful what you ask for, and whom you ask!
VI. Your needs: Pediatricians tend to be a self-deprecating lot.
Remember to protect yourself. This requires: 1) adequate FTE allotment for you
to do the job, 2) appropriate secretarial resources, 3) a computer - you've got
to be in cyberspace to do this job well, 4) administrative assistance
(especially with class sizes in excess of 60-70 students at the least). You
will also need to learn the language of education - basic terms are
essential, esoteric stuff sounds good. Become familiar with the educator's
portfolio - you're going to work hard and deserve credit for your work.
VII. Your target audiences (AKA the students and your colleagues)
Check them out. Find out from the admissions office a little about the class.
They'll have some basic data to give you a little overview. Assume that they
are adults, and they will usually act accordingly, but don't count on it.
A. How do adults like to learn? This goes back to your needs (VI above). Go
to some faculty development workshops. Learn what adult learning about. See how
you can implement these things at your school. Remember IV above. As you
network, you will find others who have tried to implement adult-oriented
teaching and learning processes (maybe even your predecessor). Many wheels have
been created, you may just need to add the hubcap specific to your school.
That's a lot easier than starting from scratch. See appendix for some resources
VIII. A little more structure
A. Orientation: You will need one or two (at the least) orientation sessions
with your colleagues on the faculty. They won't be able to give you what you
want or need unless you let them know. Written communications can be iffy, they
may not be read, they may not be understood. The students will also need to be
oriented at the beginning of their clerkship. They need to hear what is
expected of them and what they can expect. They need an overview of the
clerkship, the way they are to be evaluated and the complaint process (i.e.,
who do they call if there's a problem during the rotation - what if one of them
is the victim of harassment?). If the students are to be spread out over
multiple sites during the clerkship, consideration should be given to a joint
orientation prior to the dispersion. If this is impossible, you will need to
assign an official orienter at the other sites and make certain the message is
consistent. If you are relying on the residents as educators (and who
doesn't?), you cannot forget to include them in your orientation process. They
need to understand what the students are expected to do, what they are to so
with the students, etc.
B. Evaluations: Everyone ought to be evaluating everyone else, but there is
a limit, or you'll be inundated in paper. The students can evaluate the faculty
(those critiques can be sent to the school, thence to the chair, with you
copied). The students can evaluate the residents, with the critiques going to
the residency program director. The residents and faculty will evaluate the
students, of course, but you need to be sure these evaluations are useful. This
is easier said than done. Find out what the dean considers to be helpful in an
evaluation (for school progress or for the Dean's letter) and try to get input
along these lines. Try to get objective information whenever possible. Do not
be afraid to point out a student's weakness, just have data to back it up.
Learn more about evaluation processes and keep refining what you want. If you
can create a simple form, so much the better.
C. Assessments: What will you use for student assessment? How will you
weight the different aspects? Will you use standardized tests? OSCEs? Locally
developed tools? Students like to know this before the course. It will also
make your life easier as you do the students' final evaluations.
D. Plan for failure: Yours and the students. If you try something, put into
place a tool to monitor it, so if it works you'll know why, and if it doesn't
you'll know that too, before it's too late. When a student is doing poorly, you
will need to have a mechanism in place so that you are made aware of the fact
as soon as possible, and that the student also gets this feedback. There's
nothing worse (for you or a student) than being told after the fact that you've
done badly. Have a plan for remediation. Decide if the student would need to
repeat the course if he or she does not improve. The mediocre student will be
your most difficult challenge.
IX. Basic teaching strategies (a primer only)
- Lectures: enough said, although, having the student lecture can be effective at times.
- Case-based conferences: interactive, the student gets to participate
- Problem based learning
- Observation and shadowing
- OSCEs as teaching tools can be much like a case-based conference
- Hands on patient care: it's where everything is immediately relevant. All context-based. The real world, but there has to be some teaching to accompany the learning, or the learning can be wrong (e.g. bad habits, poor technique)
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