What’s New in Human Medical Education?

Rebecca Henry PhDRebecca Henry, PhDOMERAD

College of Human MedicineCollege of Human MedicineMichigan State University

April 29, 2010p ,

To Borrow From PlatoTo Borrow From Plato....

Att ti th i htlAttention on the nightly news

IS the Mother of Invention

Powerful Forces At WorkPublicPublic

AccountabilityResident

Work HoursACGME Core C t i

Medical EducationGraphic?

Work HoursPolicy

O t

Competencies

+

“T E i

pOutcomes Project

“To Err is Human”

Patient Safety Initiatives

CQI: Systems Approach to Evaluation & InitiativesEvaluation & Assessment

CHM’s New Systems Approach for Education and Evaluation

Why?Why?yy

How?How?

What?What?

What?What?What?What?

CHM Competency Assessment Plan

So What?So What?

The Hybrid Model of Instruction: Blending the Best of TechnologyBlending the Best of Technology and Human Interface:

Moving from Teacher-CenteredCentered

toLearner-Centered

InstructionInstruction

Defining Face to Face, Fully Online and Blended/Hybrid InstructionBlended/Hybrid Instruction

Face to Face: An in-person class which meets the traditional amount of timeamount of time.

Fully Online: A course which meets wholly online utilizing no y y gclassroom time.

Blended/Hybrid: An in person class in which online tools andBlended/Hybrid: An in-person class in which online tools and activities replace some but not all scheduled class meeting time.

Today’s Learners:Students as Digital Nativesg

Students have changed radically. Today's students are no longer the people our

d ti l t d i d t t heducational system was designed to teach

Students from K thru College are "digital native speakers" and represent the first generations to grow with rapid dissemination of digital technologyof digital technology

Students have spent their entire lives surrounded by and using technology (computers, video games, mp3 players, video cams, cell phones and more), p )

They function best when networked

They live and move around their personal learning space (peer/instructor interaction, Podcasts Blogs Wikis Wikipedia etc )Podcasts, Blogs, Wikis, Wikipedia, etc.)

Source: Digital Natives, Digital Immigrants

Marc Prensky

2001

Face to Face Characteristics:In- person class

Lecture driven

Meets traditional amount of time

M / t t h lMay/may not use technology to enhance teaching and learning

Passive Learning

OnlineCharacteristics:Characteristics:

Meets wholly onlineNeither time nor place boundStudents work at own paceStudents need to pay close attention to course deadlines to stay on trackWeekly participation in class discussion is expectedAssignment and discussion delivery takes place in online software platform

Blended / Hybridy

++Characteristics:

In-person classIn person class

Online tools and activities replace some but not all scheduled class meeting time

Eff ti h b id d l bl d l d li th d lEffective hybrid models blends classroom and online methodology

Student-directed instruction with effective and timely teacher intervention

Peer-to-peer interaction is present both online and face to face

Benefits to Blended/Hybrid Teaching and LearningTeaching and Learning

Provides an opportunity for the learning process to become more engaging for students and for students to drive the learning processengaging for students and for students to drive the learning process more directly.

Effective way to increase students' learning autonomy and to increase/apply active learning strategies in the classincrease/apply active learning strategies in the class

Integrates effectively the use of Internet to deliver and to mediate the learning process

Combines face to face contact with others students and with theCombines face to face contact with others students and with the instructor

Provides a meaningful opportunity to bring together the best of both worlds (Face to Face and Online)worlds (Face to Face and Online)

Makes it possible to adjust the learning to different learning styles and learning requirements

Assessment Tool Delivered on Handheld Device

S fSystem-wide Implementation of a Medication Error Curriculum in a Community-based Family Medicine Clerkship

Prescription Writing Unit

Henry Berry, M.D. Project Director

HRSA Grant: D56HP05214 04 00HRSA Grant: D56HP05214-04-00

Medication errors: a significant cause of morbidity and mortalitymortality– To Err is Human: a significant component of the 44,000

deaths attributable to medical error

– Health Professions Education: A Bridge to Quality: Health professionals not adequately prepared to provide safest possible care

Locally, our students need additional training in preventing medication errors.– Fewer than half of students on recent OSCEs recognized a

medication error in one of the stations.

Curricular frameworks developed: – MSOP Report X: Education In Safe and Effective

Prescribing Practices; July 2008– Worked with content experts, curriculum design experts,

li i i d l k hi di tclinicians, and clerkship directors

Grant funding for a medication error curriculum obtained 2008.Curriculum developed, pilot tested and refined 2008-2009.Implemented system-wide 2009-2010 academic year in 7 campuses

Curriculum developmentp

Needs assessment– Baseline state of curriculum

Brief orientation to patient safety during prematriculationP ti t f t i i di l PBLPatient safety overview in cardiology PBLOrientation to writing ordersNo systematic approach to writing prescriptionsNo formal medication safety content

Design and development– Systematic approach: goals, objectives, content,

instructional and learner evaluations strategies.

Curriculum

Two curricular units:– Unit 1 goal: “At the end of this unit, the student will follow a

systematic approach to writing prescriptions.”

Content: prescription writing process and product checklistContent: prescription writing process and product checklist

– Unit 2 goal: “At the end of this unit, the student will identify appropriate responses when medical errors are identified.”

How errors are identified

Apology

E l ti d ti fEvaluation and prevention of errors

Curriculum

Instructional strategies: Unit 1– Teaching session (two hours)

– *Job aids: 1. Checklist for writing prescriptions

2. Elements of medication orders or prescriptions

3. Look Alike, Sound Alike medications to be aware of (“LASA”3. Look Alike, Sound Alike medications to be aware of ( LASA meds) for outpatient and inpatient use

4. “Do not use” list of abbreviations

Curriculum—job aidsjChecklist for writing a prescription1. Does the patient need the drug?

2 Contraindications

5. Safety• Correct patient2. Contraindications

• Allergies and intolerances

• Special circumstances*Age (children, elderly)

Gender (childbearing/contraception)

p

• Medication reconciliation

• Look-alike, sound alike (see LASA)

• Abbreviations (see JCAHO list)

• Drug interactions (e.g. ePocrates)*( g )

Pregnancy/breast feeding

3. Does the dose need modifying?• Elderly, children

• Renal insufficiency

g ( g )

6. Communication*• What (name, purpose)

• How (route, frequency, duration)

• What to expect (benefits/side effects)• Hepatic insufficiency

• Other drugs (e.g. warfarin/phenytoin/digoxin)

4. Use of the medication• Formulary

• What to expect (benefits/side effects)

• When to call and follow-up

• Verify understanding

*For these and for patients on complex regimensFormulary

• Cost*

• Simplicity*

*For these and for patients on complex regimens, use a team (pharmacist, nurse, health educator, etc.) to assist you and to negotiate final regimen

Curriculum—job aidsj

Elements of medication order or prescription

5. The dosage form

6 The amo nt to be dispensedprescription**The following elements should always

be included

1 Patient’s full name (use two

6. The amount to be dispensed—package units (e.g. bottle, tube, ampule) should not be used

7. Directions for use, route of 1. Patient s full name (use two identifiers)

2. Patient-specific data (allergies, age, DOB, weight)

administration, and frequency (ambiguous orders should be avoided like “take as directed”)—Orders should be specific (e.g. “take i th i ”)

3. Generic/Brand name of drug (both should be stated. If only one is used, the generic is preferred; if generic is like a “sound alike” then use brand

in the evening”)

8. Purpose of medication (e.g. heart diagnosis, lung diagnosis, skin disorder)

name to decrease confusion)

4. Drug strength in metric units by weight such as mg, meq, mmol

)

9. Number of authorized refills

10. Dated signature

Curriculum

Instructional strategies: Unit 1 (continued)– Practice writing Rx using job aids during initial teaching session

– Integration Rx writing into Common Problems teaching sessions Basic curricular framework for much of clerkship content

Example: Common Problems Session #2: headache otitis back painExample: Common Problems Session #2: headache, otitis, back pain, dementia (with some depression), sinusitis/allergic rhinitis/URI

– *Application in outpatient setting with at least four patients

S Wh t’ N ?So What’s New?Systems Approaches to support

decisions and enhance accountability

“Blended” learning to promote efficient g pand effective learning