the international medical graduate institute
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7/27/2010
The International Medical Graduate Institute
A Skills Assessment for International Medical Graduates Seeking Entry Into U. S. Family Medicine Residencies
7/27/2010
Department of Family Medicine
Quillen College of MedicineEast Tennessee State University
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The IMG Institute December 2009 Participants
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Elements of the IMG InstituteA Three Day Program
Communication Skills Human Patient Simulator Lab “Morning Report” OSCE Competencies & Concepts in Family Medicine Program Evaluation
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Why the IMG Institute?
55% of Family Medicine Residents at Quillen College of Medicine are IMGs [2009-2010]
IMGs have widely variable skill levels at entry
Quality of education at international medical schools highly variable
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Why the IMG Institute? continued:
Language and cultural barriers impede successful completion of residency
Time and $$ invested is sizeable
Deficiencies in knowledge or skills can be remediated before beginning residency
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> From inquiries to our Department about an Observorship
> We do not offer an Observorship!> Via our website. > Word of mouth and other methods.
How do we select our participants?
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Welcome. Introduction.
IMG Institute December 14 – 16, 2009
Welcome by Dr. Franko and our Faculty Participants diagrammed their family genogram Each drew and then described his personal journey Community and resident IMG physicians joined us
for an international luncheon
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Describe your life’s journey
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Sharing International Cuisine
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Human Patient Simulator Lab
• Experiential learning tool • Teach essential clinical skills• Demonstrate basic competencies
–Patient Care–Medical Knowledge– Interpersonal and Communication Skills–Professionalism
• Requires team work to be successful• Performance critiqued by faculty and peers
Human Patient Simulator Lab
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Hx, Px by teams of two, make a prelim diagnosisPatient suffers a critical event‘Nurse’ assists as Team resuscitates
HPS
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Demonstrate clinical skills, medical knowledge
Debriefing: EKG, lab, x-ray
How did you interpret this?
Clinical outcomes reviewed Teamwork essential
HPS
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• Standardized patient
• Group setting
• Faculty observation, rating
• Develop rapport with the standardized patient
– Explicit “Positive Speak”– Explicit caring/ commitment– Avoid interruption– Avoid negative talk
• Elicit full agenda
• [continued]
Communication Skills
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Information management Open ended vs closed questions
Explore patient’s perspective on illness Actively listen for clues Assess patient’s ability to change
Explore patient’s feelings
Communication Skills
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Patient’s Feelings Facilitate patient’s expressions of concerns, thoughts, fears Respond to clues patient gives
Negotiate to reach common ground Avoid confrontational strategies Develop a common ground plan Recognize when agreement cannot be reached
SPs, peers,and Facultydiscusscase
Communication Skills
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SOAP Note conceptPrioritized problem listLogical treatment plan
Develop differential for a major problemWritten and oral presentation
Group process
“Morning Report”
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History/Physical exam/Lab data are givenAdditional labs/EKG/x-ray must follow logically from assessment & planFurther history can be a part of the plan
“Morning Report”
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•Write differential major Dx •Present treatment plan•Defend choices in plan•Participate in group process•Write-ups are graded
“Morning Report”
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Objective Structured Clinical Exam Standardized Patient Interview Station Videotaped for later review Focused Physical Exam Station Discuss with Preceptor Write up SOAP note with differential
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Interview the standardized patient
Standardized Patient presents consistent history and affect to each participant
OSCE
Trained to give up her information sparingly
Videotape interview
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Focused Physical Exam
Participants used our Sim Lab model to complete the focused physical exam
OSCE
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Discuss with the PreceptorReview specific moments of patient-interviewer interaction as recorded on CDParticipant discovers his strengths and weaknessesParticipant keeps his own CD
OSCE
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Write a differential diagnosis
They chose to do their write-ups collaboratively
Write-ups were graded Evaluations were mailed
to participants
OSCE
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Competencies & Concepts in Family Medicine
Chronic Care Model of DiseasePatient-centered Medical Home Evidence Based MedicineInformation MasteryCultural Competence
Presents a selected topic current in Family Medicine
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Competencies & Concepts in Family Medicine
Evidence Based MedicineInformation MasteryPICO questionsParticipants learn to use EBM in patient care
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Program Evaluation
1 hour Focus Group o Conducted by faculty member not involved in the programo Questions provided by Co-directorso Evaluator “sampled” sessions as observer
‘Embedded’ staff membero Knowledgeable Program Coordinatoro Attended most sessions of Instituteo A ‘note taker’o Edited and shared notes
Solicited faculty feedback
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Participant Evaluation Performance Assessments
o Communications skillso HPS Lab sessiono OSCEo ‘Morning Report’
Faculty session leaders wrote assessment for each participant
o ‘Morning Report’ chart notes gradedo OSCE write-ups graded o Faculty’s assessments combined and sent to participants
Point of performance evaluations: communications
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Major Findings and Recommendations
“Institute is a success. “ Faculty leaders, participants
Participants thought they got their money’s worth
Most activities were unique to them, not experienced in their medical school
Exceeded expectations in faculty contact, level of resident work
More demanded of them than they had anticipated
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Major Findings and Recommendations
Participants want more practice/opportunities during the Institute to demonstrate competence
Expand length of each session, but not the overall time frame by more than a half day
Participants can prepare pre-Institute assignments, but cannot really ‘know’ what it is like
Participants risk takers; willing to “mix it up”
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Major Findings and Recommendations
Participant evaluations by Faculty consistent.
Participants took criticism well…but did they understand? Can they apply it?
Some interesting observations – “we are praised in India for coming up with as many possibilities in our differential, no matter how unlikely.”
Built confidence, would recommend to others, worth more than it cost.
Not a guarantee to acceptance into residency program
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Farewell
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