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MEDICAL EDUCATOR
VOL 2, No 9, October 2000 Changes hone clerkship experienceIt's an experience that doesn't exist elsewhere in the undergraduate curriculum—the opportunity to practice medicine at one of 28 sites in rural South Carolina.Organizers of the Deans' Rural Primary Care Clerkship continue to hone that experience for students with additions to the rotation that emphasize self-directed learning, basic science and even more community involvement. Now loaded on the laptops students receive for use during the clerkship is ClinicSoft, a patient case simulator. Current third-year students are pilot testing the program. “The cases are designed to help broaden students' knowledge of the basic science and clinical issues,” said David Garr, M.D., associate dean of primary care and clerkship co-director. The software's ability to interpret natural language allows the user to phrase his or her own questions to the simulated patient like “What kind of a pain is it?” or “How long have you been having this?” As they work through the case, students can conduct a physical exam, order labs and write prescriptions. At the end, they're asked to commit to a diagnosis, follow-up and treatment plan. Faculty have the ability to check not only the students' diagnoses, but to track every click and entry each student makes as he or she progresses through the case. Cases are designed to meet the national internal medicine curriculum objectives for a third-year core clerkship. Initially, students were required to complete three cases. When that proved too time consuming, clerkship directors altered the requirement. “We continuously take student feedback into consideration as we're developing elements of the clerkship,” said Alec Chessman, M.D., associate professor of family medicine and clerkship co-director. As of October, students must complete one computer case and two written case reviews that evolve from his or her clinical experience. Students must write a short description of the patient they've seen, investigate a basic science issue related to the care of that patient, as well as identify resources and information that may be helpful to the patient. “One of our major themes is the incorporation of basic sciences into clinical training,” Chessman said. Clerkship directors have also added more time to the community component of the rotation, where students make home visits and design, implement and measure the outcome of a project that addresses a health need in the community. Many of the projects have focused on improving the care of people with diabetes. Last year the students spent 80 percent of their time in a primary care practice and the other 20 percent visiting patients at home and completing their projects. That ratio has now shifted to 70/30. “Students value being part of a community even though it's only for a short period of time,” said Donna Kern, M.D., assistant professor of family medicine and community-based education coordinator for the clerkship. “It's also a real eye-opener for the students seeing patients outside the office and in the context of their everyday lives.” To help guide students in the implementation of future health improvement projects, Chessman hopes to discover what areas of focus and changes have been most helpful to communities and in what ways. “If we know the approaches that work we can keep students from having to reinvent the wheel and speed change within the community,” Chessman said. In the future, Garr hopes to obtain funding to conduct outcome assessments to determine the impact the students have had on the lives of the people they treat at clerkship sites. “Over the past two and a half years we've seen pretty powerful changes at the community level as a result of the students' work,” Kern said. “Overall,” Garr said, “It's been very gratifying to see how well received
the students have been in the communities and how positive the students
have been about their educational experiences.”
CME initiative benefits prison medical staffPrison medical staff in rural Estill, S.C., can benefit from the expertise of MUSC faculty without leaving town through a new initiative of the Office of Continuing Medical Education (CME).With the help of MUSC Television Services and new telemedicine equipment installed at the Federal Correctional Institute in Estill, CME is conducting a series of 20 one-hour distance education programs on primary care medicine. Though separated by hundreds of miles, prison staff and MUSC faculty can interact just as if they were in the same room. “The prison's medical staff work under a lot of constraints and may not have flexibility to attend CME programs,” said Pam Benjamin, CME program coordinator. “This initiative allows prison medical staff to learn without traveling, and our faculty don't have to leave their patient and teaching obligations here,” Benjamin said. SpaWar Systems Center, who contracts with the Bureau of Prisons, contacted CME about the project in April. Benjamin coordinated the series, which began June 28 and ends Nov. 1. Programs were developed specifically based on the medical staff's background, knowledge base and the types of patients they treat most frequently. A needs assessment revealed several priority areas including diabetes, hypertension, infectious disease and psychiatric problems, as well as other areas of primary care. “All the programs have been well received,” said Benjamin. “For the prison medical staff, they provide real-time information and a chance to problem-solve and get quick responses from the experts.” CME hopes to initiate similar distance education programs with other federal correctional institutions. “It's anticipated that telemedicine equipment will be in place in other federal correction facilities by 2001, which would allow them to also receive distance education programming,” Benjamin said. MU Library to evaluate MEDLINEplusDuring the next year, students and preceptors in the Deans' Rural Primary Care Clerkship will help the National Library of Medicine (NLM) learn how MEDLINEplus can be used to address clinical problems in a rural setting.While MEDLINE serves as a web-based library for health professionals, MEDLINEplus goes a step further by providing access to journal citations and abstracts from biomedical literature, as well as medical dictionaries, lists of hospitals and physicians, links to other health information sites, and information on clinical trials. With a $46,000 grant from the NLM, the MUSC Library will analyze number of hits, type of search queries and number of transactions conducted on MEDLINEplus by students and preceptors. Library staff will also conduct focus group sessions at clerkship sites to gather additional information on usage habits. “We'll evaluate how well it worked or didn't work, and provide the National Library of Medicine with valuable feedback to improve the product,” said Elizabeth Connor, MUSC Library assistant director of public services and education. “The NLM selected MUSC because of their strong interest in underserved populations, particularly in the area of diabetes care,” Connor continued. “The rural clerkship was a perfect fit for their needs.” The NLM grant will also fund a telecommunications upgrade of the conference room used for the clerkship orientation and provide unequipped clerkship sites with the hardware they need for Internet access. Thirteen phones lines will be installed in the orientation classroom so students can be introduced to MEDLINEplus before they begin their clerkship. “Not only will the project help improve the product, it will promote
NLM's understanding the information needs of students and preceptors involved
in service-learning activities based in rural communities,” Connor said.
“We hope this will serve as a model for understanding the benefits and
limitations of the products and services developed by the NLM.”
Small-group learning comes to third yearFoundations in Clinical Medicine, a small-group learning experience for third-year students, becomes part of the undergraduate curriculum in July 2001.The course was approved by the Undergraduate Curriculum Committee at its Sept. 14 meeting. Every Wednesday, third-year students will leave their clinical rotations to meet in small groups for a two-hour discussion of patient cases. For the first three weeks of each rotation month, students will study cases related to a theme—like heart disease, different forms of cancer, trauma or cerebrovascular disease. The fourth week will be reserved for discussions about challenging doctor-patient communication issues. Student groups will rotate to a different theme at the end of each month. Clinicians with expertise in each area will serve as group facilitators. “The cases, written by clinical and basic science faculty, will draw out and reinforce basic science principles that the students learned in their first two years,” said Jerry Ondo, Ph.D., professor of physiology and neuroscience. Course coordinators Ondo and Elisha Brownfield, M.D., assistant professor of medicine, modeled Foundations in Clinical Medicine after the problem-based style of the Parallel Curriculum. As the Parallel Curriculum is phased out during the next two years, the Foundations in Clinical Medicine course will be one way this style of learning lives on. Ondo and Brownfield also relied upon input from current students in designing the course. “We found that students like the surgery core where they worked through short problem-based learning cases,” Ondo said. “They liked being able to get opinions directly from the experts and learning how they actually handled cases.” Though the course takes a portion of time away from students' clinical experiences, it serves an important purpose. “The problem with the third year was that there was no way to revisit the basic sciences in the context of clinical medicine,” Brownfield said. “This will allow students to have overlap between basic and clinical sciences during their clinical rotations.” “In fact,” Brownfield continued, “the majority of the disciplines were already taking students off the wards at certain times to think about patient problems. This course is just a different avenue that also allows for the integration of basic sciences.” At the beginning of each month, students will receive case material, study questions and objectives. They will be expected to present material related to the study questions during group discussion sessions. During the monthly discussion devoted to doctor-patient communication, students will address issues related to the patients they are caring for such as end-of-life care, or dealing with an angry, depressed or manipulative patient. “There are few places in medical school where doctors in training can talk about how they are affected by what they are experiencing,” said David Garr, M.D., associate dean for primary care. “These discussions will help them learn about themselves and how their reactions can affect their ability to effectively care for patients.” The course will be graded on a pass-fail basis. Evaluation will consist of computer-based exams and preceptor and peer evaluations. Students participating in rotations at sites off-campus will not be
required to participate in small group discussions, but will receive case
materials and be responsible for the content reflected in the study questions
and objectives.
Don't miss thisNov. 84 - 7 p.m. Improving Presentation Skills Franklin Medio, Ph.D. and George Tempel, Ph.D. Gazes Auditorium Topics covered will include:
For more information or to register, call 792-2081. Nov. 21
For more information or to register, call 792-2081. Dec. 1
Proposal submission materials for “Teaching, Learning and Knowing in 2001: An Odyssey for Outcomes” are now available. Workshops, presentations, poster and small-group discussion sessions are welcomed. The meeting will be held March 22 - 24, 2001, in Little Rock, Ark. For submission information, call Dr. Amy Blue at 792-3409.
For information, call Dr. Amy Blue at 792-3409.
November24 - 6 p.m. Developing a Personal Financial Plan 2 West Amphitheater 3
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30
To register, call Angela Ybarra, 792-0761, or Ginger Blanchard,
792-9304.
Continuing Medical EducationThe following conferences are sponsored by MUSC. All conferences are to be held in Charleston, S.C., unless noted otherwise.November
18
December
2001
Call the Office of Continuing Medical Education at 876-1925 for more information.
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