“BOOT CAMP” BEST PRACTICES: Designing a rotation to prepare 4th 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:

0

5

10

15

20

Entirely

peds

Includes

peds

No peds 0

2

4

6

8

10

Length Content/Format

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 3rd/4th year curriculum

• Develop a list of skills & knowledge to cover • Review literature, ACGME milestones, COMSEP curriculum

• Review 3rd and 4th year pediatric MS curriculum & identify gaps

• Survey of 4th 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

SIM CENTER:

Emergency Medicine

Cases #2 IV / Central access

Mock patient experience:

H&P, orders, signout sheet

GI Cases

SIM CENTER:

Emerg Medicine Cases #1

Signout / handoffs

workshop

CHD 101

Week 2 Gastrostomy/Ostomy

workshop

Laboratory Medicine

Immersion

EBM Motivational

interviewing

Dehydration/Fluids

Cases EMR Dos and Don’ts

Mommy calls 101

Nursing communication Nutrition, Formula, and

TPN 101

ID Cases

PAGING EXERCISES: Please respond to all pages and document response/plan in EMR

Week 3 Common Pediatric

Symptoms / Intern Calls

Pediatric EKGs SIM CENTER:

Mock Codes / Procedures

(ED fellows)

Respiratory care

workshop

MATCH DAY

Pharmacotherapy pearls

Mock patient experience:

Debrief/feedback session

SIM CENTER: Neonatal

Resuscitation

SIM CENTER:

Umbilical line placement

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 “Mock Patient” Experience Case-based learning

EVALUATION & OUTCOME MEASURE

J E N N I F E R L . T R A I N O R , M D

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 1st 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 , M D

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

WORKSHOPS/

DIDACTICS

SIMULATION/S

KILLS LAB

CLINICAL

SITES

SPECIAL

ACTIVITIES

Monday Tuesday Wednesday Thursday Friday

Orientation

Clinical Sites

Procedural

Skills

Workshops

Clinical Sites

Carolina Outdoor

Education Center

Ropes Course

Pediatric Emergencies

Handoff Workshop

Things You Just Have to Know

Monday Tuesday Wednesday Thursday Friday

PALS

PALS

Clinical Sites

Clinical Sites

Teaching Workshop

U.S. Healthcare Reform

Professionalism

Evidence Based Medicine

Quality Improvement

Monday Tuesday Wednesday Thursday Friday

Airway Management

NRP

Clinical Sites

NRP

MATCH

DAY!

Tracheostomy

Gastrostomy

Pediatric Formulas and TPN

Pharmacology

Monday Tuesday Wednesday Thursday Friday

Standardized Patients

Interprofessional

Simulation

Interprofessional

Simulation

Conclusion/Debrief

Success in Residency Chair, Program Directors, Chief Residents, Interns

Child with Chronic Illness

Death of a Child

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