Basics Program for New Faculty Day 2: November 14, 2013 Dr. Steve Kahane, MD CCFP, FCFP, Assistant...

Basics Program for New FacultyDay 2: November 14, 2013

Dr. Steve Kahane, MD CCFP, FCFP, Assistant Professor, DFCMDr. David Palmer, MD CCFP, Assistant Professor, DFCM

INTEGRATING MEDICAL STUDENTS INTO THE OFFICE SETTING

Find this presentation online

This presentation can be downloaded from www.dfcmopen.com/item/basics-med-students-office.

http://www.dfcmopen.com/

About this presentation

This module is one of a series from the Department of Family and Community Medicine, University of Toronto. It is part of a three-day workshop that is provided to new family physician teachers, that is, faculty members in our Department

Presentation Overview

In this presentation and accompanying checklists, you will learn how to welcome and orient medical students into your practice. We describe how to prepare patients and staff for medical students, how to adjust your schedule for teaching and plans for what to do when you are behind. The checklists summarize and help you the the orientation process with your medical students.

Slides adapted from original iteration of The Basics Program

Dr. Merilee Brown, MD CCFPDr. Steve Kahane, MD CCFPUniversity of Toronto DFCM

INTEGRATING MEDICAL STUDENTS INTO THE OFFICE SETTING

FACULTY/PRESENTER DISCLOSURE

• Faculty: Steve Kahane and David Palmer

• Relationships with commercial interests:• Not Applicable

DISCLOSURE OF COMMERCIAL SUPPORT

• This program has received NO Commercial support

• This program has received NO in-kind support

• Potential for conflict(s) of interest:– Not Applicable

MITIGATING POTENTIAL BIAS

• Not Applicable

OBJECTIVES

• Describe how to welcome & orient students into your practice

• Describe how to prepare patients for medical students

• How to prepare staff for medical students• Describe how to adjust your schedule for teaching• Plans for what to do when you are behind• Provide checklists summarizing the orientation

process

WELCOME & ORIENTATION

• Student Orientation Checklist • Contact student prior to start date – email/phone • What should student bring? – stethoscope, tools,

dress code, ID badge• Plan student’s schedule, dates in office• Get student’s contact information, give your info• Any special needs?


Orientation Topics:General Learner work space, reference materials * Dress code: name tag, lab coat? * Hours/ days patient care provided, schedule Parking, phone system, email * Introduce staff, each one’s responsibilities * Unique learning opportunities (clinical activities, patient

population, provider interests)Orientation to community Community characteristics * Community resources, arranging visits to them * Where to buy groceries, do laundry *Overview of rotation Relate rotation to learner’s career plansIntroduction to learner Rotations completed * Experience and skills mastered Areas needing workExpectations of School or Residency Course objectives Criteria included in evaluation formLearner Objectives Specific knowledge, skills, and attitudes to develop Grade expectations Rotation objectives Requirements based on practice’s unique learning opportunities Specific knowledge, skills, attitudes you notice learner needs to

work on

* Topics that office staff might go over with learners

Preceptor Expectations:Daily routine Hours/ days learner in the office Learner’s level of responsibility and autonomy in providing patient

care Hospital rounds, night/weekend call Times preceptor is off; what to do Amount of reading expectedOffice policies Directions for writing chart notes, dictating, writing Rxs, referrals How pts selected for learner to see Length of time to spend with each pt Hospital policiesValues Show respect to pts & staff; how? Professionalism Get to know patientsPreceptor/learner interaction Format for case presentations Regular time & process for feedback Integrate teaching and learning styles Learner needs to explain needs Criteria to evaluate learner (“what it takes to get honors”) Learner self-evaluation before discussing preceptor’s evaluationIf a problem arises Absentee policy, how to notify office A contact for questions or problems How to reach preceptor in emergency

From http://www.mahec.net/pdp/e-Learning_Tools.asp

Student Orientation Checklist


Meet and Greet:•15-30 min before first clinic starts•Complete student information form•Review student’s experiences, rotations, career goals, interests, hobbies•Review course objectives•Review preceptor expectations •Student objectives – expectations, specific learning needs, goals•Review evaluation criteria•Review office policies, procedures


Student Information Form

STUDENT NAME: ___________________________________________________________________________

MEDICAL SCHOOL: _________________________LEVEL OF TRAINING: ______________________________

DATES OF ROTATION: _______________________________________________________________________

CONTACT INFORMATION: PHONE:____________________________________________________________

PAGER:____________________________________________________________

EMAIL:_____________________________________________________________

WHAT I DID BEFORE MEDICAL SCHOOL: _______________________________________________________

ROTATIONS/ELECTIVES COMPLETED:_________________________________________________________

AREAS OF MEDICAL INTEREST: ______________________________________________________________

AREAS OF INTEREST OUTSIDE MEDICINE:______________________________________________________

AREAS THAT I FEEL CONFIDENT ABOUT MY SKILLS:_____________________________________________

AREAS OF DEFICIENCY/AREAS I WANT TO WORK ON:____________________________________________

WHAT I HOPE TO DO AFTER I COMPLETE MY TRAINING: __________________________________________

___________________________________________________________________________________________

OBJECTIVES FOR THIS ROTATION:_____________________________________________________________

___________________________________________________________________________________________

LANGUAGES SPOKEN:_______________________________________________________________________

IS THERE ANYTHING THAT YOU DO NOT EAT? __________________________________________________

DO YOU HAVE ANY SPECIAL NEEDS I NEED TO ACCOMMODATE (CHILD CARE SCHEDULES,

TIMES NEEDED OFF, ETC.)?___________________________________________________________________


Office Walk-Through:•Orient to office space, exam rooms, supplies, patient flow, bathroom, place for student’s stuff, desk space•Introductions – staff, MDs, Allied Health Care •Orient to charts – paper/EMR (?login and password)•Record keeping - Soap notes, format•Orient to requisitions, diagnostic imaging, labs•How to track student results, follow-up on tests? Mailbox?•Exam room set-up 1 or 2+ rooms? •Where will the student stand in rooms? Extra chair?•Video camera for taping student interviews•Access to Information: Internet, library, guidelines, handouts

PREPARE PATIENTS

• Avoid Surprises!• Signs – front desk, exam rooms• Reception to advise patients when booking• Reception to ask patients when arriving• Nurse to ask patients when going into exam rooms• Physician to ask patients before seeing them• Students to ask patients as they enter room• Patients can refuse – have a backup plan• Negotiate with patients – observe only, see student

first, see with preceptor, see on own

SAMPLE WALL SIGN

The University of Toronto has recognized this practice for training of family physicians.During your visits to the clinic, you may be cared for by a family practicephysician in training. These doctors work under the supervision of a faculty staff physician.Please speak with the staff if you have any questions.Thank you for your cooperation.

The Department of Family and Community MedicineUniversity of TorontoFaculty of Medicine500 University AvenueToronto, ON M5G 1V7

SAMPLE WALL SIGN

PREPARE PATIENTS

Introduce the student:• “Hello Mr. Jones. This is Kim Rogers; she is a 3rd

year medical student from U of T working with me today. Would you mind if she observes our visit today?”

Have student introduce themselves:• “Hello Mr. Jones, I am Dr. John Smith. I am a

Resident from U of T working with Dr. Palmer. He has asked me to see you first, and then he will come in to review after we are finished. Is this ok with you?”

PREPARING THE STAFF

• Tell your staff ahead of time!• Educate staff about student and teaching• Describe benefits of having student• Describe how the student will be involved –

observer, seeing from your list, or own list • Any need to change booking methods?• Give student’s schedule to staff• Give student’s contact information to staff

PREPARING THE STAFF

• Get feedback from staff on how to integrate trainees – they know your schedule best!

• Get feedback from staff on trainee for evaluations

• Tell other MDs about students and teaching• Ask other MDs or Allied health care team if

student can see interesting cases, procedures, spend time with them

• Staff attitudes toward teaching are critical

PATIENT SCHEDULING

Getting Organized:•Extra 15-30 min/half-day …•3 exam rooms ideal (2 for you, 1 for student)•Students take longer (20-30 min/patient)•Medical Students: 1-2 per hour•Residents: 2-5 per hour

Type of Schedule?•Separate student schedule or work from yours?•Leave empty space in schedule or book full?•Review schedule with your staff ahead of time•See examples of booking

PATIENT SCHEDULING

Selecting Patients:•Review your schedule with student before start of clinic•Preceptor selects cases for students - avoid certain patients•Student selects cases - based on needs, objectives

Seeing Patients:•Student shadows preceptor (often at beginning)•Student sees patients independently•Focus or prime student - take history, limited exam, task•Student sees patient with preceptor – have student perform a skill while you watch (BP, take history), be a fly on the wall•Set time limits, review tasks, plan when/how to review case•You see 1 or 2 patients, while student sees 1, then review

PATIENT SCHEDULING

Other things to consider:•Book specific types of patients for student day•Pull learner in for interesting cases•Continuity of care - get student to see patients in follow-up, rebook with student •How will the student follow-up on cases, results? (ie. add student’s name to lab requisition, put results aside, mailbox, EMR)•Consider other office activities – spend time with Office Manager, Reception, Nursing, Dietitian, etc•Teach them basics of billing, diagnostic codes•FHG, FHO, FHT, etc.•Scheduling and work-life balance

PATIENT SCHEDULING

Sample Schedule: No change, student shadowing

9:00 am HTN (Student + Preceptor)9:10 am DM (Student + Preceptor)9:20 am Cholesterol (Student + Preceptor) 9:30 am Well Baby (Student + Preceptor)9:40 am Sprain (Student + Preceptor)9:50 am Flu (Student + Preceptor)10:00 am Depression (Student + Preceptor)

Dr. David Palmer - Integrating Medical Students into the Office Setting

PATIENT SCHEDULING

Sample Schedule: No change, but select patients for student

9:00 am HTN (Student + Preceptor)9:10 am DM (Student)9:20 am Cholesterol (Preceptor) 9:30 am Well Baby (Student + Preceptor)9:40 am Sprain (Student + Preceptor)9:50 am Flu (Student)10:00 am Depression (Preceptor)


PATIENT SCHEDULING

Sample Schedule: Leave empty space

9:00 am HTN (Student)9:10 am DM (Preceptor)9:20 am Cholesterol (Preceptor) 9:30 am9:40 am Well Baby (Student)9:50 am Sprain (Preceptor)10:00 am Flu (Preceptor)10:10 am 10:20 am Depression (Student)


PATIENT SCHEDULING

Sample Schedule: Separate rooms (“Double Book, Book, Review”)

Room 1 (Student)Room 2 (Preceptor)

9:00 am URI HTN

9:10 amDM

9:20 am Review9:30 am Cholesterol

Sprain 9:40 am

Flu9:50 am Review10:00 am Well Baby

Depression


ENSURING PATIENT FLOW

• Trainee doesn’t have to see every patient• Student sees case, then break to read around it• Avoid difficult or problem patients• Focus / limit your teaching (One Minute Preceptor)• Basic principles vs. detailed medical knowledge • Teach at breaks / between patients• Review cases at end of day, take home points,

reading• Non-teaching time for student

WHEN BEHIND

• Ask learner to chart /read / look up question• Set strict time limits for slower trainees• Go and rescue student• Have student shadow you for a few cases• Have the trainee work with your staff• Choose simpler patients if appropriate• Save it for later – write it down, and discuss after clinic• Just stop teaching, and have student take a break

ATTITUDE IS EVERYTHING

• Role Model• Positive Attitude• Professionalism• Work-Life Balance

SUMMARY

• Welcome and orient the student• Prepare your patients• Prepare your staff and colleagues• Adjust your schedule• Maintain flow, and find time to teach• Have a positive attitude• Use the Checklist for help

STUDENT INTEGRATION CHECKLIST

WELCOME AND ORIENTATION:

Orientation Checklist Contact student prior to start date – email/phone What should student bring? – stethoscope, tools, dress

code, ID badge Plan student’s schedule, dates in office Get student’s contact information, give your info Any special needs?

Meet and Greet 15-30 min before first clinic starts Complete Student Information Form Review student’s experiences, rotations, career goals,

interests, hobbies Review course objectives Review preceptor expectations Student objectives – expectations, specific learning needs,

goals Review evaluation criteria Review office policies, procedures

Office Walk-Through Orient to office space, exam rooms, supplies, patient flow,

bathroom, place for student’s stuff, desk space Introductions – staff, MDs, Allied Health Care Orient to charts – paper/EMR (?login and password) Record keeping - Soap notes, format Orient to requisitions, diagnostic imaging, labs How to track student results, follow-up on tests? Mailbox? Exam room set-up 1 or 2+ rooms? Where will the student stand in rooms? Extra chair? Video camera for taping student interviews Access to Information: Internet, library, guidelines, handouts

�

PREPARE PATIENTS:

Avoid Surprises! Signs – front desk, exam rooms Reception to advise patients when booking Reception to ask patients when arriving Nurse to ask patients when going into exam rooms Physician to ask patients before seeing them Students to ask patients as they enter room Patients can refuse – have a backup plan Negotiate with patients – observe only, see student first, see with

preceptor, see on own

PREPARE STAFF:

Tell your staff ahead of time! Educate staff about student and teaching Describe benefits of having student Describe how the student will be involved – observer, seeing from

your list, or own list Any need to change booking methods? Give student’s schedule to staff Give student’s contact information to staff Get feedback from staff on how to integrate trainees – they know your

schedule best! Get feedback from staff on trainee for evaluations Tell other MDs about students and teaching Ask other MDs or Allied health care team if student can see

interesting cases, procedures, spend time with them Staff attitudes toward teaching are critical


SCHEDULING:

�Getting Organized Extra 15-30 min/half-day … 3 exam rooms ideal (2 for you, 1 for student) Students take longer (20-30 min/patient) Medical Students: 1-2 per hour Residents: 2-5 per hour

Type of Schedule? Separate student schedule or work from yours? Leave empty space in schedule or book full? Review schedule with your staff ahead of time See examples of booking

Selecting Patients Review your schedule with student before start of clinic Preceptor selects cases for students - avoid certain patients Student selects cases - based on needs, objectives

Seeing Patients

Student shadows preceptor (often at beginning) Student sees patients independently Focus or prime student - take history, limited exam, task Student sees patient with preceptor – have student perform

a skill while you watch (BP, take history), be a fly on the wall Set time limits, review tasks, plan when/how to review case You see 1 or 2 patients, while student sees 1, then review

� Other things to consider Book specific types of patients for student day Pull learner in for interesting cases Continuity of care - get student to see patients in follow-up,

rebook with student How will the student follow-up on cases, results? (ie. add

student’s name to lab requisition, put results aside, mailbox, EMR)

Consider other office activities – spend time with Office Manager, Reception, Nursing, Dietitian, etc

Teach them basics of billing, diagnostic codes FHG, FHO, FIT, etc. Scheduling and work-life balance

ENSURE PATIENT FLOW: �Trainee doesn’t have to see every patient Student sees case, then break to read around it Avoid difficult or problem patients Focus / limit your teaching (One Minute Preceptor) Basic principles vs. detailed medical knowledge Teach at breaks / between patients Review cases at end of day, take home points, reading Non-teaching time for student

WHEN BEHIND: Ask learner to chart /read / look up question Set strict time limits for slower trainees Go and rescue student Have student shadow you for a few cases Have the trainee work with your staff Choose simpler patients if appropriate Save it for later – write it down, and discuss after clinic Just stop teaching, and have student take a break


Sample Schedule: No change, Student shadowing

9:00 am HTN (Student + Preceptor)9:10 am DM (Student + Preceptor)9:20 am Cholesterol (Student + Preceptor) 9:30 am Well Baby (Student + Preceptor)9:40 am Sprain (Student + Preceptor)9:50 am Flu (Student + Preceptor)10:00 am Depression (Student + Preceptor)

Sample Schedule: No change, but select pts for student

9:00 am HTN (Student + Preceptor)

9:10 am DM (Student)

9:20 am Cholesterol(Preceptor)

9:30 am Well Baby (Student + Preceptor)

9:40 am Sprain (Student + Preceptor)

9:50 am Flu (Student)

10:00 am Depression(Preceptor)

Sample Schedule: Leave empty space

9:00 am HTN (Student)9:10 am DM (Preceptor)9:20 am Cholesterol (Preceptor) 9:30 am9:40 am Well Baby (Student)9:50 am Sprain (Preceptor)10:00 am Flu (Preceptor)10:10 am 10:20 am Depression (Student)

Sample Schedule: Separate rooms (“Double Book,

Book, Review”)

Room 1(Student)Room 2 (Preceptor)9:00 am URI

HTN 9:10 am

DM 9:20 am Review9:30 am Cholesterol Sprain 9:40 am

Flu9:50 am Review10:00 am Well Baby Depression


REFERENCES

• Brown, Merilee and Kahane, Steve. Original Presentation from The Basics Program, Integration of Students into the Office Setting, 2006.

• Palmer, David. Integrating Medical Students into the Office Setting. Presentation for Orientation of New Faculty, Family Medicine Longitudinal Experience, 2011.

• Rubenstein, W. & Talbot, Y. Medical Teaching in Ambulatory Care, Second Edition . Springer (2003)

• Mountain Area Health Education Center (MAHEC) Department of Continuing Medication Education: Integrating the Learner into the Busy Practice. (http://www.mahec.net/pdp/e-Learning_Tools.asp)

• Sheet, KJ, Harris DL. Questions asked by family physicians who want to serve as preceptors. J. Fam Pract 1996;42:503-11.

• Langlois JP. Support of Community Preceptors: what do they need? Fam Med 1995; 27(10)641-5.

• Freeman, Risa. Teaching 101. Power Point Presentation. Updated 2005

http://www.mahec.net/pdp/e-Learning_Tools.asp

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