Integrating the core competencies: proceedings from the 2005 Academic Assembly consortium

Developing Medical Student Competencies, Clinical Skills, and Self-Efficacy With an Emergency Medical Responder Certification Course

Introduction

Previous studies have claimed gap year clinical experiences before medical school matriculation increase student self-efficacy and clinical confidence. At the University of Central Florida College of Medicine, 41 first-year medical students participated in a new certification course to become emergency medical responders before beginning their coursework. This study describes the results of a follow-up study that aims to investigate the impact the course had on student competency, self-efficacy, and clinical efficacy and if the course would prepare students similarly to previous clinical experience.

Methods

First-year medical students completed a 30-question survey consisting of a Likert scale and free-response questions. Questions were based on the Accreditation Council for Graduate Medical Education core competencies: medical knowledge, practice-based learning and improvement, systems-based practice, patient care, professionalism, and interpersonal and communication skills. Questions on the perceived benefit of the emergency medical responder course and previous clinical experiences were also included. Responses were separated based on participation in the emergency medical responder course and prior clinical experience. Two-tail Welch’s t-tests were performed on the data to determine significance.

Results

Of 98 responses: 20.4% (20/98) of participants of the emergency medical responder course had previous clinical experience, 21.5% (21/98) of participants of the course had no clinical experience, 26.5% (26/98) did not participate in the course but had previous clinical experience, and 31.6% (31/98) did not participate in the course nor had previous clinical experience. Students with previous clinical experience reported the emergency medical responder course improved both their patient care skills and performance in courses that emphasized patient interviewing and physical exams. Students with clinical experience had significantly higher medical knowledge (p < 0.1) and professionalism (p < 0.1) Likert scores. Eighty-seven percent of students agreed the course had a positive impact on their patient care skills.

Conclusion

Larger sample size is needed to make stronger conclusions; however, the responses show the emergency medical responder course had a positive subjective impact on students with previous medical experience. Previous clinical experience leads to the most positive subjective reporting of competencies such as medical knowledge and professionalism. Early clinical exposure, such as an emergency medical responder certification course, may improve self-efficacy and patient care skills for medical students with no previous clinical experience.

Not Another Boring Resident Didactic Conference

BACKGROUND

The Accreditation Council for Graduate Medical Education (ACGME) requires that residency programs in emergency medicine plan at least 5 hours of didactic experiences per week. Instructional methods should include small-group techniques, problem-based learning, or computer-based instruction. Despite recommendations from the ACGME, many programs' conference didactics continue to include primarily lecture-based instruction.

METHODS

The authors describe instructional methods that promote active learning and may be superior to traditional lecture-based education.

RESULTS

These methods include varying instructional methods, case-based learning, team-based learning and the flipped classroom, audience response systems, simulation, "wars," oral boards, escape rooms and scavenger hunts, expert panel discussions, debates, clinical pathologic cases, and leaderboards. The authors discuss how these methods can be implemented to make emergency medicine didactic conferences more varied and interactive for learners.

CONCLUSIONS

While there is minimal research on the efficacy of these methods in graduate medical education, many have shown to improvement engagement of learners and to be effective in undergraduate medical education. Further research will be needed to determine if long-term learning outcomes can be improved with these strategies.

National Survey of Pediatric Care Providers: Assessing Time and Impact of Coding and Documentation in Physician Practice

BACKGROUND

Documentation and billing/coding are essential to medical practice. Physicians spend significant time documenting to meet coding and medicolegal requirements, potentially reducing time for patient care and learning. We sought to assess time spent charting in pediatric practice and provider understanding and comfort level regarding billing/coding.

METHODS

An anonymous web-based survey was emailed to members of American Academy of Pediatrics Section of Pediatric Trainees practicing in the United States.

RESULTS

A total of 601 trainees responded to the survey. Thirty-seven percent of trainees spent more than half of patient encounter time documenting in outpatient settings while 62% ( P < .01) in inpatient settings. There was a positive correlation between trainees' apprehension about documentation and reporting increased stress due to documentation ( r = 0.32, P < 0.001). Sixty-two percent respondents had no prior training of billing/coding, and >70% feel necessity of including billing/coding in the medical curriculum ( P < 0.0001).

CONCLUSIONS

Our study highlights increasing burden of documentation in practice. Majority of pediatric trainees feel the need to including billing/coding skills as a part of medical curriculum.

The morbidity and mortality conference: a unique opportunity for teaching empathic communication

BACKGROUND

The morbidity and mortality conference is an educational tradition in American medicine that dates to the early 20th century. Traditionally, this conference has focused entirely on issues of diagnosis and treatment, in the context of a disappointing clinical outcome.

INTERVENTION

We report on a new method for teaching empathic doctor-patient communication skills at an obstetrics and gynecology morbidity and mortality conference. For each case presented, we identified the communications challenges and allowed faculty and residents to "practice" the discussion they would have with the patient and the patient's family in that situation. In some sessions, actors assumed the role of the patient. Following the discussion of the case, we offered didactic presentations on how we communicate with patients and their families. These focused on techniques for being patient centered and included the use of body language, open-ended questioning, reflective listening before offering to explain, and the importance of naming and validating emotions.

RESULTS

The majority of participants felt the sessions to be helpful, and after one month many were able to identify a positive change in their interactions with patients.

CONCLUSIONS

We believe that this unique teaching format allows learners to refine their communication skills in the context of situations that they know to be both realistic and important.

The business of emergency medicine: a nonclinical curriculum proposal for emergency medicine residency programs

Over the course of their postgraduate medical education, physicians are expected not only to acquire an extensive knowledge of clinical medicine and sound procedural skills, but also to develop competence in their other professional roles as communicator, collaborator, mediator, manager, teacher, and patient advocate. Although the need for physicians to develop stronger service delivery skills is well recognized, residency programs may underemphasize formal training in nonclinical proficiencies. As a result, graduates can begin their professional careers with an incomplete understanding of the operation of health care systems and how to utilize system resources in the manner best suited to their patients' needs. This article proposes the content, educational strategy, and needs assessment for an academic program entitled The Business of Emergency Medicine (BOEM). Developed as an adjunct to the (predominantly) clinical content of traditional emergency medicine (EM) training programs, BOEM is designed to enhance the existing academic curricula with additional learning opportunities by which EM residents can acquire a fundamental understanding of the nonclinical skills of their specialty.

RVU ready? Preparing emergency medicine resident physicians in documentation for an incentive-based work environment

OBJECTIVES

The emergency medicine (EM) job market is increasingly focused on incentive-based reimbursement, which is largely based on relative value units (RVUs) and is directly related to documentation of patient care. Previous studies have shown a need to improve resident education in documentation. The authors created a focused educational intervention on billing and documentation practices to meet this identified need. The hypothesis of this study was that this educational intervention would result in an increase in RVUs generated by EM resident physicians and the average amount billed per patient.

METHODS

The authors used a quasi-experimental study design. An educational intervention included a 1-hour lecture on documentation and billing, biweekly newsletters, and case-specific feedback from the billing department for EM resident physicians. RVUs and charges generated per patient were recorded for all second- and third-year resident physicians for a 3-month period prior to the educational intervention and for a 3-month period following the intervention. Pre- and postintervention data were compared using Student's t-test and repeated-measures analysis of variance, as appropriate.

RESULTS

The evaluation and management (E/M) chart levels billed during each phase of the study were significantly different (p < 0.0001). The total number of RVUs generated per hour increased from 3.17 in the first phase to 3.71 in the second phase (p = 0.0001). During the initial 3-month phase, the average amount billed per patient seen by a second- or third-year resident was 282.82 USD, which increased to 301.94 USD in the second phase (p = 0.0004).

CONCLUSIONS

The educational intervention positively affected resident documentation resulting in greater RVUs/hour and greater billing performance in the study emergency department (ED).

Direct observation of residents in the emergency department: a structured educational program

OBJECTIVES

The objective was to describe the implementation of a program of structured direct observation of emergency medicine (EM) residents during clinical shifts in the emergency department (ED).

METHODS

The authors developed a program in which an observer spent 4 to 5 hours with each resident, without intervening in the clinical encounters. A structured data form was developed to document the resident's performance in a number of defined clinical areas relevant to patient care and mastery of the core competencies. Individual strengths and weaknesses were noted, and the observer provided directed feedback at the end of the session.

RESULTS

Over an 18-month period, 32 EM residents were observed during their ED shifts. The sessions not only provided specific information on individual residents' performances, but also identified areas where the residency program curriculum could be enhanced and provided a means of assessing mastery of the core competencies. In addition, the program provided an opportunity to give detailed and timely directed feedback to residents. Both residents and attending staff found the sessions acceptable and useful.

CONCLUSIONS

Implementation of a structured direct observation program was feasible and well received and provided insight into the strengths and weaknesses of residents both individually and as a group.