ThefollowingslidescontainatemplatethatillustratesthegeneralformatusedforaY3orY4clerkshipreview.Inthe“notes”sectionofsomeslidestherearefurtherinstructionstoclarifywhatisneededforaparticularsectionofthereview.

Thecomponentsoftherevieware:1. revisitprioractionplanandinvestigateprogress2. assesscourseobjectivesincludingessentialskills/diagnoses3. evaluateplanned/unplannedredundancy4. assesspedagogy5. evaluateassessmentofcourseobjectives6. reviewmeasuresofquality(e.g.courseevaluations)

TheDeansoftheappropriateyear,ortheiragents,willserveastheteamleaderforeachcoursereview.Theresponsibilitiesoftheteamleaderare:

1. Assigntaskstothefacultyandstudentteammembersandconveydeadlinesforwhentheworkneedstobedone.

2. Recruitmembersforthereviewteamifnecessary(typicallyteammemberswillbeassignedbytheMEC).

3. Contacttheclerkshipdirectortoarrangeameetingwiththeteamtodiscusstheclerkship;informtheclerkshipdirectorofthedatethereviewwillbepresentedattheMECmeetingsotheycanputitontheircalendar/indicateavailability.

4. CollectalltheworkcompletedbytheteammembersandcollateintoonePowerPointpresentation;collecttheactionplanfromtheclerkshipdirectorandinsertitattheendoftheslides;sendtheslidestoRachel2weeksbeforetheMECmeeting.

5. PresentthefinalrecommendationsofthesubcommitteeattheMECmeeting(lastfewslides)

ReviewofYear3OB/GYNClerkship

• ClerkshipoccursinYear3• ClerkshipDirectors

– PaulHanissianandE.RebeccaPschirrer• ClerkshipAdministrator

– LoriAvery• ClerkshipLength– 6weeks,8cycles• Sitesused

– DH,CPMC,Concord,Nashua,Hartford,CT,SVMC,Keene,Peterborough• ClerkshipwaslastreviewedinFeb2014• ReviewDate/Team:4/29/16:Dr.OgeYoung(GAME),Dr.JohnDick(MEC/GAME);

BrendaGreen(BioMedLibraries-MEC);AaronBarnesMS4(MEC);AlisonRicker(OCE)

ActionPlanfromPriorReview• EssentialSkillsandConditions

– Provideclearalternativemeanstoaccomplish,whereappropriate• Done

– Changestudentresponsibility:frommanageto“managewithassist”• Done

– Drop“Papsmear”fromskillsandadd“CervicalCancerScreening”toconditions• NotDone

• LearningSessionsandActivities– Drop“Litigation&ClinicalPractice”

• Done– PlaceWellWomanCareobjectivesinIlios

• Done– Considerre-distributionendofclerkshipactivitiestostartofclerkship

• Whenpossible,wehavedonesoandwillcontinuetodoso– Increasecontinuitywithpreceptors

• Whenpossible,wehavedonesoandwillcontinuetodoso

CourseObjectivesGeiselCourseObjective HowStudentisAssessed LearningActivity

1 Applyappropriatereproductivemedicalscienceknowledgetopatientcare.

PerformanceEvaluationsShelfExamMentorSeries

Ward/Clinic/ORMentorSeries

2 Recognizeandincorporatecurrentclinicalandtranslationalsciencesintodeliveryofobstetricandgynecologicpatientcare.

PerformanceEvaluationsPowerPoint

Ward/Clinic/ORPowerpoint

3 Describecurrentknowledgeofdiseaseprevention,riskfactormodification,substanceabuse,painmanagementinclinicalproblemsinobstetricsandgynecology.

ShelfExam Ward/Clinic/ORReading

3a Describethecurrentknowledgeofendoflifeandpalliativecareinclinicalproblemsinobstetricsandgynecology

Performanceevaluations Ward,Reading

3b Describethecurrentknowledgeofmedicalethicsandmedicallegalissuesinobstetricsandgynecology

Throughparticipationinactiveworkshop

Workshop,Reading

CourseObjectivesCourse Objective Assessment LearningActivity

4 Communicateeffectivelywithpatientsofdifferentsocial,economicandculturalbackgroundsaroundindividualandgroupfactorsthatimpactreproductivehealth.

PerformanceEvaluations Ward/Clinic/OR

5 Establishcomfortableandmutuallyrespectfulstudent-patientandstudent-familyrelationshipswithdiversepatientsandfamiliesandestablishingarespectfulbasisforthedoctor-patientrelationship.

PerformanceEvaluationsObservedHandP

Ward/clinic/ORObservedHandP

6 Interviewpatientsskillfully,includingafocusedgynecologicandobstetrichistory.

PerformanceEvaluationsObservedHandP

Ward/Clinic/OR

7 Demonstratepelvicexamskillsandsuturingskills,withappropriateattentiontocommunication,skill,cleanliness,infectioncontrol,andpatientcomfortandprivacy.

PerformanceEvaluationsObservedSurgicalSkill

Ward/Clinic/ORSuturingWorkshopPelvicWorkshop

8 Defineandprioritizethepatientacuteandchronicproblemsastheyrelatetoobstetricsandgynecologyandgeneralhealth(needfulllanguageinIlios)

9 Performandexplaintheindications,complications,andlimitations,ofobstetricandgynecologicprocedures.

PerformanceEvalObservedSurgicalSkillShelfExam

Ward/Clinic/ORLecture,Reading

CourseObjectives10 Interpretcommonabnormalitiesandfindingson

commongynecologicandobstetricdiagnostictestsandstudies,suchasultrasound,Papsmears,cervicalcancerscreening andwet-preps.

PPMShelf

Ward/Clinic/ORReading

11 Communicateeffectivelywithpatientsandfamilies. PerformanceEval Ward/Clinic

12 Demonstrateabilitytoassistpatientsinunderstandingtheirtreatmentoptionsandmotivate them tomakehealthyreproductivehealthcarechoices.

Performanceevaluations Ward/Clinic/OR

13 Communicateeffectivelyandcollegiallywithphysiciancolleaguesandothermembersofthehealth-careteamverbally,inwritingandintheelectronicmedicalrecord.

PerformanceEvalPowerPointSkillsForm

Ward/Clinic/ORCommunicationvideoCommunicationlecture

14 Behaverespectfullyandresponsiblytowardspatients,families,colleagues,andallmembersofthehealth-careteamandempathizewith andberespectfulofeachpatient

PerformanceEvalObservedHandP

Ward/Clinic/OR

15 Performprofessionalresponsibilitiesfully inallareas. PerformanceEvalDMEDsObservedHandP

Ward/Clinic/OR

16 Adheretohighethicalandmoralstandards,acceptresponsibilityforpersonalactions,acceptconstructivecriticismandrespectpatientconfidentiality.

PerformanceEvalMentorSessions

Ward/Clinic/ORPowerPoint

CourseObjectives17 Takeresponsibilityforherorhis one’sownmedicaleducation,anddevelopthehabitsofmindfulnessandreflection.

PerformanceEvalMentorSessionsCorecasesPowerpoint

Ward/Clinic/ORPowerpointMentorSessions

18 Describebarrierstoaccesstobasicreproductivehealthservicesanditseffectonvulnerablepopulations.

Performanceevaluations Ward/Clinic/OR

19 Contributeconstructivefeedbackduringpeerreview. PowerPoint PowerPoint/OR

20 Identifyandcriticallyevaluaterelevantinformationaboutevidence-based,cost-consciousstrategiesinthecareofpatientsandpopulationsandtoapplythistopatientcareandtocontinuousupdatingofskills.

Evaluations StudentPowerpointexercise

21 Assessanddiscusstheeffectoftheenvironmentonclinicalcareandoutcomesandapplytheconceptsofimprovingqualityofcare,patientsafety,andvalueofcare.

22 Identifyandutilizeappropriateresourcestosupportpatientcareandcomparetherolesofandcollaboratewithallmembersofthenurse,nursepractioner,midwifeandphysicianinter-professionalteam.

PerformanceEval Ward/Clinic/OR

23 Discusshowhealthcareiscurrentlyorganized,financed,anddelivered,andthelargerenvironmentinwhichhealthcareoccursandtheimpactonfemalepatients.

Performanceevaluation,shelfexam Lecture

24 Identifytherolesofthephysicianinaddressingthemedicalconsequencesofcommonsocialandpublichealthfactors,andtoadvocateforoptimalreproductivecareaspertainstoissuessuchasvaccinations,cervicalcancerscreening,breastcancerscreeningandothers.(notinIlios)

Shelfexam Lecture,wards,reading

CourseObjectives– Comments• Appropriatenumber,understandable• Coversover-archingGeiselcompetencies• UpdatesforIliosrequired• Minorlanguagechanges

FormatofCourse&SessionObjectives• Courseobjectivesarenotprovidedinthesyllabus– APGOobjectivelistedinstead

• Courseobjectivesarewritteninthecorrectformat• Sessionobjectivesaremostlyprovidedinthecoursematerials

andIlios– Several“Lectures”aremissingsessionobjectivesinCanvas– MedicalandSurgicalAbortionmissingobjectivesinIlios– Noinformationon“ChallengingEncounters/ReflectionRounds”

• Sessionobjectivesaremostlywritteninthecorrectformat– “Understand”shouldbechangedtoamoremeasurableverb.

HowdoY1/2coursesprepareforY3• Questionsaskedatendofclerkship– 1=poorand5=excellent

• Openended– Morepelvicexam– More“normal”obstetricsrequested

Results:Overall

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

FM MED OB PEDS PSYCH SURG GAM NEURO

13-14

14-15

15-16

Results:Communication

00.51

1.52

2.53

3.54

4.55

FM MED OB PSYCH SURG PEDS GAM NEURO

13-14

14-15

15-16

Results:PE

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

FM MED OB PED PSYCH SURG GAM NEURO

13-14

14-15

15-16

Results:MedicalKnowledge

00.51

1.52

2.53

3.54

4.55

FM MED OB PED PSYCH SURG GAM NEURO

13-14

14-15

15-16

IssuesofRedundancy• Aretheremajorissuesofredundancywithothercourses?– No

EssentialSkills

• Aretheseappropriateforthisclerkship?yes

• Wouldyouaddorsubtractany?No

• Aretheremajorissuesofredundancywithotherclerkships?No

BreastExam PerformwithSupervisionCesareansection PerformwithSupervisionContraceptionCounseling PerformwithSupervisionCounseling:BreastFeeding PerformwithSupervisionGestationalageassessment PerformwithSupervisionHPIrelevanttoclerkship PerformwithSupervisionOralpresentation,inptadmit PerformwithSupervisionOralpresentation,inptprogress PerformwithSupervisionPelvicExam PerformwithSupervisionPelvicsurgery PerformwithSupervisionUltrasoundabd/pelvis PerformwithSupervisionUltrasoundfetus PerformwithSupervisionVaginaldelivery PerformwithSupervisionVaginalsurgery PerformwithSupervisionWrittennote,inptadmit PerformwithSupervisionWrittennote,inptprogress PerformwithSupervision

EssentialProblems

• Aretheseappropriateforthisclerkship?Yes• Wouldyouaddorsubtractany?Considerthefollowing:Incontinence,dyspareunia;change

“Abortion”toDisordersofearlypregnancy/implantation• Aretheremajorissuesofredundancywithotherclerkships?No

AbnormalUterineBleeding ManagewithAssistanceAbortionDisordersofEarlyPregnancy/Implantation ManagewithAssistance

CancerScreening,Cervical ManagewithAssistance

Dysmenorrhea ManagewithAssistance

GynCancer ManagewithAssistance

Laboranddelivery,normal ManagewithAssistance

Laboranddelivery,complicated ManagewithAssistance

Menopause ManagewithAssistance

Pelvicpain ManagewithAssistance

Post-opCare Yes(SURG) ManagewithAssistance

Post-partumcare ManagewithAssistance

Prenatalcare ManagewithAssistance

Uterinedisease,benign ManagewithAssistance

Vaginitis ManagewithAssistance

Fertility add ManagewithAssistance

Urogynecologic Problems add ManagewithAssistance

ExplorationofEthicsandCulturalCompetencies

• Challengingencounters/ReflectionRounds– Facilitatedbymid-wifeandpsychologist– Non-graded– Nosettopics

CourseLearningOpportunities• Clinicalexperiences

– 5weeksatonesitewithmixofObstetrics,OutptClinic,Gynecology,NightFloatorCall

• Conferences– Orientation

• Pelvicexamcommunicationskills• Knot-tying;GTA,FetalMonitoring• Medical/SurgicalAbortion,NormalLandD,MedicalComplications

– DartmouthDay• Studentpresentations,ChallengingEncounters,UrinaryIncontinence,GynOncLectures

– WrapUp• GynAnatomy

CourseLearningOpportunities• Assignments– Onlinewoman’simagingcases(CORE)– Web-basedMicroscopyTest(PPMP)– MentorTeamTopics(4sessionscoveringcommonclinicalproblems/conditions– case-based)

• Structuredclinicalobservation(SCO)– Labor,Surgery,Outpt– 3requiredcurrently(downfrom4requiredlastyear)

Assessment• FinalGrade

– ClinicalPerformanceEvaluation - 40%• PleaseincludecopyonCANVAS

– *NBMEWrittenExam - 35%– DartmouthDay-OralPresentation 10%

• PeertoPeerFeedbackandFaculty

– MentorTeam/Chair’sTutorial 5%– Professionalism**ALLRequiredHomework 10%

• Midclerkshipfeedback– selfassess,reviewskills/conditions,assessfromfaculty

Measuresof

Quality–AAMCGQ

Geiselmean2011

Geiselmean2012

Geiselmean2013

Geiselmean2014

Geiselmean2015

Allschoolsmeans2015

CFM 3.2 3.1 2.9 3.2 3.5 3.3

MED 3.5 3.6 3.5 3.6 3.6 3.5

NEURO 3.1 3.4 2.7 3.1 3.1 3.1

OBGYN 3.1 3.0 3.0 3.1 3.2 3.2

PEDS 3.3 3.1 3.2 3.5 3.6 3.4

PSYCH 3.5 3.6 3.4 3.7 3.6 3.3

SURG 3.0 2.8 2.9 3.1 3.3 3.3

MeasuresofQuality– AAMCGQ“Ratethequalityofyoureducationalexperiencesinthefollowingclinicalclerkships.”[1=poor;2=fair;3=good;4=excellent]

Measuresof

Quality–AAMCGQ

OBGYNGeisel 2014 Geisel2015 AllSchools2015

Observedtakingrelevantportionsofpthistory? 90.5 79.5 78.9

Observed performingrelevantportionsofphysicalorMSE? 97.6 93.2 88.8

Provided withmidclerkshipfeedback? 94 95.9 92.3

MeasuresofQuality– AAMCGQ

PercentansweringYestoquestion(goalis100%)

Measuresof

Quality–AAMCGQ

OBGYNGeisel 2014 Geisel2015 AllSchools2015

Faculty providedeffectiveteaching 3.9 3.9 4.0

Residents providedeffectiveteaching 4.1 4.1 4.0

MeasuresofQuality– AAMCGQ

Scale:StronglyDisagree– 1– Neutral-3- StronglyAgree- 5

NBME“Shelf”ScorePercentiles

0

10

20

30

40

50

60

70

80

90

2010 2011 2012 2013 2014 2015 2016

MED

SURG

OBGYN

NEURO

PSYCH

FM

MeasuresofQuality– StepIICK

*valuesdepictedareSDabovetheUS/CanmeanforGeiselmeanscores

Measuresof

Quality–AAMCGQ

Clerkships OverallSatisfactionAY2014-2015

PEDS 4.5

MED 4.5

CFM 4.5

PSYCH 4.3

OBGYN 4.2

SURG 4.2

GAM 4.2

NEURO 4.0

MeasuresofQuality– CourseEvaluation

scale[1=poor;2=fair;3=good;4=verygood;5=excellent]

scale[1=poor;2=fair;3=good;4=verygood;5=excellent]

MeasuresofQuality– CourseEvaluationObstetrics

2013-14 2014-15 2015-16*

OverallExperience 4.16 4.17 3.96

Objectiveswelldefinedandclearly presented 4.39 4.46 4.39

Ability forY1and2topreparemeforthisclerkship

n/a 2.99 3.25

Expectationswelldefinedand clear 4.17 4.18 3.95

Volumeadequate forlearning 4.43 4.37 4.37

Varietyofdxadequateforlearning 4.22 4.17 4.23

Quality ofteachingbyattendings 4.2 4.36 4.32

Qualityofteaching byresidents 4.05 4.0 3.5

SiteDirectors responsivetoconcerns 4.61 4.56 4.45

Methodsusedto evalstudentperformancemadeclear 4.18 4.13 3.89

Qualityof mid-clerkshipfeedback 3.8 3.79 3.54

MeasuresofQuality– StudentComments

Strengths:• Clerkshipisverywellorganizedwithmanystudentsmentioningclerkship

coordinatorLoriAverybynameasasignificantstrength• Manystudentshighlightedthediversityinbothpathologyandpatient

populationsacrossthevarioussites.• Facultyandinstructorswhowereengagedandprioritizedmedicalstudent

involvementandeducationwereidentifiedacrossallsitelocations.• StudentsexpressedthattheyappreciatedreturningtoDHMConthree

separateoccasionsratherthanweeklyasisthecaseonotherclerkships.• Manystudentsidentifiedthe“ChallengingEncounters/ReflectiveRounds”

sessionasextremelyvaluableandappreciatedtheopportunitytoreflectontheirexperiences.

• Studentsfoundthepelvicexaminstructional/practicesessiontobevaluableandimportant.

MeasuresofQuality– StudentComments

Weaknesses/AreasforImprovement:• Numerousstudentsidentifiedamountofrequiredpaperworktobe

burdensome.• Studentsacrossseveralsitessuggestedthatschedulesattempttobe

arrangedtoallowforlongerstretchesworkingwiththesamegroupofresidentsorattendingssoastoallowformoreconsistencyandbetterfeedback.

• AtCPMC,severalstudentsidentifiedthelargenumberofattendingsandsuggestedthatalistofthestellareducatorsandmentorsbeprovidedsoastoimprovetheoverallexperience.

• SeveralstudentsidentifiedaneedforEMRorientationatNashuasitesoastoallowforgreaterstudentinvolvementinpatientcare.

• OnestudentreportedoverhearingracistcommentsmadebynursesatHartfordsiteinadditiontopatientsreceivingverydifferentcarebaseduponinsurancestatus.

MeasuresofQuality– StudentComments

• Attempttodecreasetheamountofrequiredpaperworkordigitizesomeoftheevaluations

• Worktoarrangestudentschedulesinawaythatallowforgreaterconsistency

• ConsideradditionbriefEMRorientationatNashuasite

• Addressconcernregardingnursingbehavior/commentswithHartfordsitedirector

Recommendations• Objectives– Minormodificationstolanguageasindicated:

• 5– change“establishing”to“establish”• 10– change“PapSmear”to“cervicalcancerscreening”• 12– change“motivating”themto“motivate”them• 14– “respectful”isredundant,considerremovinglastportionofthephrase.

• 15– add“inallareas”• 17– removegenderspecificpronouns– “one’sownmedicaleducation”

• 8&24– endofstatementsarecutoffinIlios.

– AddMECapprovedLearningObjectivestoCANVASsite

Recommendations• EssentialSkills/Conditions– Change“Abortion”to“Disordersofearlypregnancy/implantation”tomorebroadlycoverthetopic

– Consideraddingthefollowing:• Fertility,Urogynecologicproblems- likeincontinence.

• ContinuetoworkwithDirectoratCPMCtofindwaystoincreasetimespentwithmorevaluededucators

• AddressEMRissueinNashuaandRNconcerninHartford• Continuetofindwaystoincreaseteam/preceptor– student

continuitywhileemphasizingtostudentsthatOBGYNisdifferentfromotherclerkshipsgiventhemultipleservicestheyareoninashort5weeks

ActionPlan

• Courseobjectives:seecorrectionsinred.• IliosCourseAdministrator- adddeletedportionsofobjectives

8and24.• MECapprovedGoalsofClerkshiphavebeenaddedtoCANVAS

(tobeeditedpendingapprovaltonight)

ActionPlan• EssentialSkills/Conditions

ü Change“Abortion”to“Disordersofearlypregnancy/implantation”tomorebroadlycoverthetopic

ü Addthefollowing:Fertility,Urogynecologicproblems.ü ContinuetoworkwithDirectoratCPMCtofindwaystoincreasetime

spentwithmorevaluededucatorsü AddressedEMRissueinNashuaü AddressedRNconcerninHartfordonexitinterviewday.ü Continuetofindwaystoincreaseteam/preceptor– studentcontinuity:

MentorTeam(s),LocalClerkshipDirector,Callschedulewithconsistentattendingorresident.Smallersitesdonothavethisissue.

ü EmphasizedtostudentsthatOBGYNisdifferentfromotherclerkshipsgiventhemultipleservicestheyareoninashort5weeks

ActionPlan

• SessionobjectivesinthecoursematerialsandIlios– MedicalandSurgicalAbortionmissingobjectivesinIlios

• WillupdatelectureinIliosandCANVAStoincludeobjectives

– Noinformationon“ChallengingEncounters/ReflectionRounds”– (Discussion/workshop)• Facilitatoraskedforemailtobesentoneweekpriortosession.

• Courseobjectivesarenotprovidedinthesyllabus– APGOobjectivelistedinstead

• OBCourseObjectivesareadded.