secondary data analysis

Competency Oriented Residency Education (CORE): Transition From A Topic-Based to Clinical Presentations-Based Academic

Curriculum

Nipa Shah, MD

Mark Potter, MD

Karen Connell, MS

University of Illinois at ChicagoDepartment of Family Medicine

April 2006

Participants will be able to:

• Transition from a topic-based to a clinical presentation-based academic curriculum

• Utilize Univ. of IL at Chicago Dept. of Family Medicine CORE Session list as a prototype for developing/enhancing their own department’s academic curriculum

• Organize and teach a clinical presentations-based residency education session

What is the Challenge?

• Vast array of material • 3 years of training time• Usually one ½ day/wk, or 1 hour 3x/week• Resident work duty hours• Differing levels of teaching expertise,

availability and clinical foci of faculty• Differing levels of knowledge among

residents

Comparison

• Pros of Topic Based– Easy to organize

• Availability• Teaching Expertise• Clinical experience

– Immediate need learning

• Cons of Topic Based– Gaps in curricular areas– Not comprehensive– Problem solving and

transfer of learning not usually emphasized

• Pros of Clinical-Based– Comprehensive– Shorter list, so can repeat

(120 per Mandin)– Long-term learning– Promotes problem-solving

and transfer of learning (applicability to variations on a clinical problem)

• Cons of Clinical-Based– Hesitation from faculty– Initial training required

RRC Program Requirements

• Well organized, effective• Academic (supplemental to Clinical)• Variety of teaching methods• Each curricular area addressed• Each curricular area to include a defined

experience with measurable outcomes• Help from the AAFP

– Recommended Curriculum Guidelines for Family Medicine Residents

Resources for transitioning

• Strategy– Define the need– Survey the residents– Create a focus group

• Curriculum committee

– Expert (Henry Mandin) did a “clinical presentation concept” workshop for faculty

– Modified the clinical presentations concept for family medicine residency training---A FIRST!

CORE Series

CORE-Competency-Oriented Residency Education– 18 month curriculum– Sessions videotaped, reviewed– 4 sessions/month for 1-3 hour sessions– Multimedia– Small group learning– Actual patient cases (often modified)

CORE Session Format Characteristics

• This format has been “stable” when applied to sessions addressing patient issues (complaints or problems) as various as: – Leg Pain – Concerns about heritable disease (genetics) – Hematuria – Consideration for blood product transfusion

CORE Presentation Format Characteristics

• Emphasizes learning a diagnostic approach (algorithm) to presenting issue rather than long lists of facts about particular disease entities.

• Allows learning a larger area of medicine in a defined session, e.g., (give example)


• Presentation based format mirrors what physicians actually do in patient diagnosis

• Focusing on learning algorithms may create knowledge that can be generalized more readily from one case to the next

Sample Algorithm on Leg Pain

HipD eg en era tive

F ra ctu reA v ascu la r n ec ro s is

KneeD eg en era tive

C rys ta l a rth ro p a thyS e ptic, P a te lla r

Ankle/Foot/toesG o ut

in fe c tion

Articular(see jo in t p a in )

M uscular/TendonsE xerc ise /T rau m a

T e nd in i t is , B u rs i t isF a sc i i t is , C ys ts

VascularT hro m bo -p h le b it is

A r te r ia l in su ff.V ar icose v e ins

NeurologicL u m b ar d isc/S p in a l s te no s is

N e uro va scu la r en tra p .

Non-articular(see p er i-a rticu la r p a in )

PAINLOWER EXTREM ITY


• Highly interactive. 20 minutes maximum of “lecture”

• Learners apply learned material to cases in small groups of 1-3. This tests and consolidates knowledge

• Case interpretations by groups are reviewed with the whole group to fine tune knowledge and interpretation

CORE Presentation Format Suggested Outline

Before session: Readings are sent in advance. Usually E-mail of links to on-line articles.

At session:

1) Review of session goals

2) Session outline

CORE Session FormatGoals

• The same 3 goals are adapted for each session. Residents will:a) Incorporate an orderly approach to patients presenting with_______ (e.g. leg pain)b) Have enough knowledge of (lower extremity) disease categories, H+P and diagnostic tests to accurately evaluate patients with (leg pain)

c) Correctly identify emergent and “red flag” conditions in patients presenting with (leg pain)


3) Brief discussion of relevance of this patient presentation: “Have any of you managed any patients presenting with _______?”

4) Reading during session (10-20 minutes)– Focus on algorithms and tables in articles– More advanced readings provided for those

who have “mastered” articles sent before session


5) Review of Emergent and Red flag conditions presenting with _______. Residents offer their ideas. These are discussed. List of emergencies and red flags made by session leader is then reviewed.


• 6) Review of key facts or concepts This can be a more “lecture like” segment, with

overheads or power point.

Residents encouraged to frequently to ask questions regarding significance of points and discuss. May include key points on definitions, epidemiology, risk factors, relevant H+P, differential diagnosis, diagnostic testing, management, prognosis and follow-up. Continued until the second resident looks sleepy (usually 15-20 minutes).


7) Case discussion:– Resident in groups of 2-3– Cases provided in segments The resident group

works to answer specific questions that drive learners to study algorithms provided. Usually 5-10 minutes per case segment

Sample Case

Page One

A 65 Y.O. man presents to you with pain in his Right leg on and off for 2 months.

Questions:

1) What are your best 10 history questions?

2) What are your best 5 physical exam items?


8) Whole group review of case questions.

Small groups present their answers. Large group discussion of why answers were selected leads to correct synthesis of data and application of algorithms

The cycle of small group case segment review and then whole group discussion may be repeated 2-4 times during the session

CORE Presentation FormatBenefits

• Including “emergencies and red flags” in every session: – may support safer care, and– May help meet RRC requirements for

Emergency Care didactics within this same series

CORE Presentation FormatBenefits

• Recurring format builds resident participation from session to session: – Reading, in advance, and during session– team interaction – case investigation – interpretation of findings and evidence .

CORE Sessions, Evaluation

• Anonymous resident evaluation form, summary rating:“How Likely was this session to change your practice?” Date VAS ScoreN– 8/24/2005 9.18 11– 9/7/2005 9.04 13– 10/5/2005 9.12 15– 11/2/2005 9.03 12– 12/28/20059.60 5– 1/18/2006 8.58 7– 3/8/2006 8.78 12

– Ave. Score 9.05 11– VAS=Visual Analog Scale

• Other sessions offered during the same time period had an average VAS score of 7.0

To contact us for a consultation, workshop for faculty development:

• Nipa Shah, MD [email protected]• Mark Potter, MD [email protected]• Karen Connell, MS [email protected]

University of Illinois at ChicagoDepartment of Family Medicine

1919 W. Taylor St., M/C 663Chicago, IL 60612

312-996-1103

secondary data analysis

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