Tl1 clin experience orientation 2014
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Transcript of Tl1 clin experience orientation 2014
Marion Sills, MD, [email protected]
Orientation: the Clinical Experience
Orientation Overview
• Clinical Experience• Goals • Structure • Policies• Your experience
Orientation Overview
• Clinical Experience• Goals • Structure• Policies• Your experience
Clinical Experience: Goals
• Silos • training• research • practice
Clinical Experience: Goals
Clinical Experience: Goals
• What: bridge silos • When:
• now: during training• future: sustained during your research career
• Why: translational research -> progress in combating human disease
Translational Introduction
Orientation Overview
• Clinical Experience• Goals • Structure• Policies• Your experience
• Clinic schedule• Your role in clinic• Deliverables • Role of clinical mentor• Certification• Meetings• Evaluation
Orientation Overview
• Clinical Experience• Goals • Structure• Policies• Your experience
• Clinic schedule• Your role in clinic• Deliverables • Role of clinical mentor• Certification• Meetings• Evaluation
Clinical Experience: Structure
• Clinic schedule• ~ 1/month • frequency tailored to
• your desires/needs• the clinical situation (e.g., clinical continuity may require varied frequency of clinic attendance)
• Attendance required every day you arrange with your clinical mentor unless illness or emergency
Orientation Overview
• Clinical Experience• Goals • Structure• Policies• Your experience
• Clinic schedule• Your role in clinic• Deliverables • Role of clinical mentor• Certification• Meetings• Evaluation
Clinical Experience: Structure
• Your role in clinic• shadow the clinical mentor
• discuss dynamics of this with mentor a priori, e.g.:• how would you like me to introduce myself?• when would we discuss my questions?
• no clinical responsibilities including translation
• patient encounters will be the starting point for discussing real patients’ medical problems relevant to your research
Orientation Overview
• Clinical Experience• Goals • Structure• Policies• Your experience
• Clinic schedule• Your role in clinic• Deliverables • Role of clinical mentor• Certification• Meetings• Evaluation
Clinical Experience: Structure
• Deliverables related to each clinic attendance• Students • Clinical mentors
Clinical Experience: Structure
• Student deliverables related to each clinic attendance• A1-2 page report based on each clinic attendance (journal)
• Why:• stimulate discussion with clinical mentor• provide notes for writing the clinical chapter in your thesis
• helps you and us discuss and advocate for your learning in clinic
• What:• submit report to
• clinical and basic mentors • the Clinical Experience Committee
Clinical Experience: Structure
• Example of a journal entry • In my July clinic attendance, I saw JB (no PHI) with Dr. Wu.
• JB was being seen for [medical condition] and presented with [some features of the history and exam and testing].
• Problems JB faces related to [medical condition] include [problem(s) that engaged your research interest].
• In considering JB’s [problem(s)], one approach to improving JB’s outcomes might be [propose a translational project approach to improving outcomes for the problem(s), including relevant references].
• Example only—explore formats with your mentors
Clinical Experience: Structure
• Clinical mentor deliverables related to each clinic attendance• >1 relevant peer-reviewed clinical research paper • You and your clinical mentor discuss the paper in the context of patient(s) seen in clinic
• a relevant clinical research protocol for the student to review and critique• You and your clinical mentor discuss the clinical protocol outside of the clinic
• Basic science mentor(s) will be invited to these meetings
Orientation Overview
• Clinical Experience• Goals • Structure• Policies• Your experience
• Clinic schedule• Your role in clinic• Deliverables • Role of clinical mentor• Certification• Meetings• Evaluation
Clinical Experience: Structure
• Clinical mentor • On your thesis committee • Attends regular meetings with you• Is encouraged to meet with you and your basic research mentor • Clinical and basic science mentors will have the opportunity to interact on different aspects of a student’s project which may result in additional translational collaborations.
• Attends your thesis defense• Is expected to model principles related to
• ethical conduct of research• privacy issues in research
Orientation Overview
• Clinical Experience• Goals • Structure• Policies• Your experience
• Clinic schedule• Your role in clinic• Deliverables • Role of clinical mentor• Certification• Meetings• Evaluation
Clinical Experience: Structure
• Certification• Online training in human subjects research and privacy
• http://www.ucdenver.edu/academics/research/AboutUs/comirb/Submissions-and-Training-Portal/investigator%20responsabilities/Pages/Completing-CITI-Education-and-Acessing-InfoEd.aspx#refresh_education• Scroll to “New Investigators and Research Coordinators” and follow instructions
Orientation Overview
• Clinical Experience• Goals • Structure• Policies• Your experience
• Clinic schedule• Your role in clinic• Deliverables • Role of clinical mentor• Certification• Meetings• Evaluation
Clinical Experience: Structure
• Meetings• National meeting of CTSA pre-doctoral trainees (TL1s) in St. Louis. This is an opportunity to • present research-in-progress posters• share experiences • develop networks of clinical translational researchers
• On campus: • professional development seminars, workshops, and Research-in-Progress meetings
• relevant clinical-translational seminars, such as • Grand Rounds• Dean’s Distinguished Speakers Seminar• Meetings and seminars at your clinical site
Orientation Overview
• Clinical Experience• Goals • Structure• Policies• Your experience
• Clinic schedule• Your role in clinic• Deliverables • Role of clinical mentor• Certification• Meetings• Evaluation
Clinical Experience: Structure
• Evaluation• Clinical mentors and students complete written evaluations on the clinical experience for CCTSI PhD trainees
• Annual CCTSI Clinical Experience Committee meeting with mentors to review each students’ goals, experiences and achievements
Orientation Overview
• Clinical Experience• Goals • Structure• Policies• Your experience
Clinical Experience: Policies
• Policies • Clinical core policy• Clinical dress code• Honor code*• Professionalism
• Settings vary• Badge access• Regulation• Dress code
*if non-MSTP seeGraduate Student Handbook
Clinical Experience: Policies
Clinical Experience: Policies
• It is about respecting the patient – not fashion• Always display ID badge; white coat optional• Clothes must cover shoulders to knees• Dresses, suits, collared shirts, skirts and tailored
trousers; scrubs if appropriate • No T-shirts, shorts and jeans• No slogans• Piercing jewelry limited to the ears• Cover tattoos• No open toed shoes • Heels <2”• Wear socks or hosiery • No strong perfume
Clinical Experience: Policies
Clinical Experience: Policies
Clinical Experience: Policies
Clinical Experience: Policies
Clinical Experience: Policies
• Clinical context varies• Four major hospitals: CHCO, UCH, DHMC, VA
• Others – AHEC, PSL, Rose, etc.
• All sites vary• policies, paper work and rules• EMR systems• organizational culture• other requirements: PPD, BLS
Orientation Overview
• Clinical Experience• Goals • Structure• Policies• Your experience
• It’s different in clinic• Communication• Self-knowledge
Your Clinical Experience
• It’s different in clinic• Patients entrust clinicians with
confidential and private matters• their nakedness• their pain• their stories• their struggles• their shame
• This trust is • an enormous privilege• a powerful opportunity to help• a terrifying responsibility• a source of many feelings• an inspiration• sometimes itself healing for the patient
Your Clinical Experience
• It’s different in clinic• Physician-patient privilege is easily and too often
violated• 30% of state medical boards have fielded complaints of online
breaches of confidentiality• Pitfalls
• social media
• partners, BFFs
• public space in clinical setting
• online platform for discussing cases
Your Clinical Experience
• It’s different in clinic• Learning opportunities are
opportunistic and unpredictable
• At times, your needs come second• your time is not always your own
• you may have to rearrange basic things like meals, bathroom breaks, checking in with family/friends
Your Clinical Experience
• Communication• Mentor:
• ask questions
• ask for feedback about your own communication
• Patient: • introduce yourself—learn how best do do this
• study how your clinical mentor communicates with and about patients
• Clinical staff: • introduce yourself
• an opportunity for learning about patients and about the system of patient care
• Other students: share experiences
Your Clinical Experience
• Self-knowledge• Clinical realm is a chance to learn about being
• patient-focused• team-player in a multi-disciplinary team• self-directed, independent• flexible• an active listener• a researcher collaborator on a clinical team• building relationships with colleagues
• It also can teach you about• your own limits• what works best for you to stay centered and balanced• other professional self-care skills key to professional longevity
• Ask for help, guidance, advice