University of Virginia School of
Minutes – 01/16/14
Pediatric Conference Room, 4:00 p.m.
Present (underlined) were: Gretchen Arnold, Stephen Borowitz, Elizabeth Bradley, Megan Bray, Donna Chen, Peter Ham, Donald Innes (Chair), Sean Jackson, Keith Littlewood, Nancy McDaniel, Bart Nathan, Sabrina Nunez, Theresa Schlager, Neeral Shah, Amita Sudhir, Linda Waggoner-Fountain, Casey White, Bill Wilson, Mary Kate Worden, Derrick Thiel (alternate Mary Grace Baker), Lee Eschenroeder, Brian Wakefield, Debra Reed (secretary)
HeART of Medicine Program. Presented by Pranay Sinha and Chelsea Becker
What we believe:
1. We believe that every human being deserves a peaceful and comfortable dying process consistent with his or her beliefs and wishes. 2. We believe that healthcare providers who are uncomfortable with the science, art, and logistics related to end-of-life (EOL) care often pass on their discomfort to their patients. 3. We believe that quality of all care, particularly care at the end of life, suffers when doctors, nurses, and other health professionals don't talk to each other.
What we hope to accomplish:
1. The HeART of Medicine program is designed to help participating medical and nursing students attain the following learning objectives: 2. The student will be able to better describe policies for hospice referral and expand their knowledge regarding palliative care topics. 3. The student should be better able to engage in shared decision making and inter-professional collaboration in end-of-life discussions to improve patient care. 4. The student should be able to describe and demonstrate techniques in bereavement counseling and personal coping strategies.
How we hope to accomplish it:
1. The HeART of Medicine Program macro-pilot was held in Fall 2013 and consisted of 3 workshops that focused on "art" as a means of sparking conversation about values associated with death and dying. Once the students were engaged and convinced of the complexity and importance of end-of-life care, they were provided practical and scientific details about palliative care and hospice. The program culminated in a difficult conversations workshop that brought together all the threads hitherto explored in the program. Students, in interdisciplinary teams of "doctors" and "nurses," interviewed standardized patients portraying difficult palliative care and end-of-life care scenarios and received personalized feedback from the standardized patients. 2. The participants were asked to fill out pre- and post-workshops surveys that we are currently analyzing in order to improve inter-professional communication and end-of-life education and awareness. 3. We are currently planning workshops for Transition Week 2014 for the entire third year medical and nursing school classes. Workshops will be Monday, February 24 and Wednesday, February 26th from 2:30-5:30pm. Students will begin with a large group didactic presentation outlining end of life care and management strategies. Then, students will break out into pre-assigned inter-professional small groups where they will actively participate in end-of-life focused activities and discussion. Some groups will be at the Fralin Museum of Fine Art examining pieces dealing with death, dying or bereavement; others will be using poetry as a springboard for discussing their attitudes towards the end of life and related issues. Finally, the students will reconvene in the learning studio for a large group debriefing and discussion of their experiences with a meal provided.
Powerpoint Presentation Synopsis
2013 Pediatric Clerkship Review. Gretchen Arnold and Amita Sudhir
· Excellent faculty and housestaff who enjoy teaching and being role models, and who have won many teaching awards · Education is a priority in the Department of Pediatrics and this is enunciated clearly as a department expectation · CLIPP cases help to standardize the education received across different sites and times of year (since some illnesses are seasonal) · Attending does student rounds with students on night float (new addition to clerkship this year) after each night and these dedicated student rounds are a much appreciated feature of the pediatrics clerkship · Mark Mendelsohn is the new associate clerkship director (See 2012 recommendations.) · Mid clerkship assessment has been instituted with a clerkship director evaluation of the student’s CLIPP case progression. An email informs the students if their evaluations are satisfactory or not to date.
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The Committee reviewed the grade distribution for the Pediatric clerkship. Although some students thought they were graded harder at off sites than students at UVA the statistics do not support such a claim. It is noted that 66% of the class has received an “A” grade (A+, A, or A-) and 33% a “B” grade (B+, B, or B-).
· Losing 2 weeks was a significant challenge for the clerkship this year, resulting in decreased continuity of exposure to attending physicians · Faculty find that assessment of students has become more difficult due to less continuity in the six-week clerkship.
· Restructure the outpatient portion of the clerkship (Mark Mendelsohn) to increase continuity of exposure to attending physicians (perhaps decrease student movement between clinics and increase time with one attending physician). Strongly consider decreasing the time in the Intermediate Care Nursery (ICN) and New Born Nursery (NBN) by merger or other means, and increasing the outpatient time in clinics to two weeks or more. Consider one week of mornings in the NBN and afternoons in the clinics. In other weeks consider full days in a single clinic, allowing students to gain confidence and receive feedback. · Rewrite the learning objectives for more precision and clarity and perhaps organize the LOs around chief complaints rather than disease processes. · Communicate clear expectations for the resident and attending physicians at Bon Secours, INOVA and UVA, e.g. the expectation to teach - take a minute for a didactic moment, let the student take a history and examine the patient, listen to the student’s presentation and provide constructive feedback. · Feedback should be immediate or at least sufficiently early to allow for practice and improvement. · Standardize topics covered in didactic material - lectures - at all three sites. · Provide a structure or expectations for the night float - for the student and for the attending/resident physicians. · Pursue the development of a Pediatric OSCE - perhaps a phone triage. · Move the Phone Triage and Ear Examination workshops currently in the Pediatric clerkship to the Transition course. The curriculum committee requests that the Transition Course leadership revisit the phone triage and ear exam workshops in the Transition course since these are relevant to other clerkships (repeat suggestion from last year). · To further enhance the foundational importance of Basic Science topics in clinical medicine we recommend that all clerkships develop “pocket” guides for resident and attending physicians to steer basic science topics into rounds and other teaching venues.
Consistency across the three clerkship sites is adequate but should be regularly monitored by the clerkship leaders. Review of an analysis of the numerical grades and NBME Subject examination scores for Pediatrics show no difference between sites. Interviews with pediatric students at the away sites indicated that their experiences although different were comparable to what their colleagues were receiving at UVa. Review of the student written comments indicates a need for clarity of expectations for the resident and attending physicians at all sites - Bon Secours, INOVA and UVA.
Both the analytic data and the student comments indicate that most of the Pediatric clerkship faculty and resident physicians at all sites are interested and enthusiastic about teaching. However a worrisome number of students report that their attending and resident physicians are not interested or do not have the time to teach, e.g. listen to the student present or include them in rounds. Additional adjustments to the Pediatric clerkship appear to be needed due to the change in the length of the clerkship from eight weeks to six weeks. The increase in class size (Class of 2016 = 156+ returning MSTPs; Class of 2017 = 162+ returning MSTPs) and the increased number of students at the UVa site may have led to some unanticipated issues as well. Placing more students at INOVA and Bon Secours may help, recognizing that the communication of expectations to all resident and attending physicians involved in teaching may be made more difficult.
In summary, the Pediatric clerkship does a good job of preparing our students for the medical degree, but has several challenges in the coming 2014 - 2015 clerkship year that need to be addressed for the Class of 2016. A plan addressing the recommendations above should be presented to the Curriculum Committee at the February 6 meeting.
Competencies Required of the Contemporary Physician. The Committee discussed amendments to the “UVA Competencies Required of the Contemporary Physician” to make them actionable and measurable for assessment. The Committee approved a number of changes that will be incorporated in a new revision. This will be circulated to the Committee for proofing.
Donald J. Innes, Jr., M.D.Debra Reed