EBCOE

1
E-BCOE

• Clerkship Feedback 2006-2007
• Jeanne du Manoir, M.Sc.
• Meds 2008

2
Agenda

• Data Collection Survey Format
• Data Review and Discussion
• Surgery
• Medicine
• Pediatrics
• OB/GYN
• Psychiatry
• Family Medicine
• Future BCOE Plans

3
Introduction

• Online survey (format initiated in 2005-2006)
• http//www.schulich.uwo.ca/survey/Login.asp
• Personalized e-mail with survey links for
  rotations just completed sent out every 6 weeks
• Reminder e-mail with survey links for all
  rotations sent out twice per year
• Draw for 50 to Chapters/Starbucks done twice per
  year

4
Survey Topics Questions

• Teaching
• Time spent in formal teaching sessions
  (modalities may include rounds, rotation
  packages, web-based tutorials etc) to cover major
  topics in the specialty over the course of the
  6-12 weeks.
• Time spent on informal clinical teaching
  surrounding patient encounters.
• 1 not enough time, 2 just right, 3 too much
  time
• Scheduling
• Did this rotation adhere to the on-call policy?
• Were you notified about the rotation placement,
  schedule and on-call responsibilities at least
  two weeks in advance.
• Comments requested if answered no to either
  question.
• Comments
• Nomination of faculty member.
• Negative feedback on rotation.
• Positive feedback on rotation.

5
Survey Topics Questions

• Core Questions
• The supervisors were well aware of the learning
  objectives and roles appropriate for a clerk
  within the rotation.
• As a clerk, I had an appropriate level of
  independence in seeing/treating patients.
• The methods of evaluation fairly assessed my
  knowledge and abilities in this rotation
• I received constructive feedback well before
  receiving my final evaluation.
• The rotation consisted of an excellent variety of
  patient problems.
• Teachers in this rotation model exemplary
  attitude towards gender and diversity issues.
• Teachers in this rotation model respect for other
  health professionals
• Overall, I would recommend this rotation to my
  friends
• Rotation-specific Questions
• OB/Gyn, Family Medicine, Medicine, Pediatrics
• 1 strongly disagree, 2 disagree, 3 disagree
  somewhat, 4 neutral, 5
  agree somewhat, 6 agree, 7 strongly agree

6
Surgery
7
BCOE 2006 Conclusions

• Strengths
• Formal teaching, Hands-on experience,
  Independence, and Teamwork
• Areas for Improvement
• Informal teaching in London
• ER in London
• Role of clerks on-call in Windsor
• Student Suggestions
• Implement resident evaluation form in general
  surgery as in CTU
• In Anesthesia, put students in rooms with high
  turnover and exposure to non-OR areas
• In London ER, try matching students schedules to
  one consultant or senior ER resident to decrease
  waiting time and increase continuity of learning

8
General Surgery Windsor
Average Rating
2006-2007 (n7) 2005-2006 (n9)
Question
Time spent in formal teaching sessions
2.1 2.2
Time spent on informal clinical teaching
2.1 2.1
5.6 5.7
Supervisors aware of objectives appropriate for
clerk
6.0 5.4
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
5.9 4.8
Feedback given throughout rotation
5.7 4.8
6.0 5.7
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
5.9 5.1
6.3 5.2
Teachers modeled respect for other health
professionals
6.3 6.0
I would recommend this rotation to friends
9
General Surgery London
Average Rating
2006-2007 (n14) 2005-2006 (n38)
Question
Time spent in formal teaching sessions
2.4 2.1
Time spent on informal clinical teaching
1.6 1.7
5.1 5.8
Supervisors aware of objectives appropriate for
clerk
5.6 6.2
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
4.7 4.8
Feedback given throughout rotation
4.6 4.5
5.4 5.9
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
5.1 5.3
5.5 5.3
Teachers modeled respect for other health
professionals
5.6 5.9
I would recommend this rotation to friends
10
Surgery Selectives Windsor
Average Rating
2006-2007 (n9) 2005-2006 (n12)
Question
Time spent in formal teaching sessions
1.8 2.2
Time spent on informal clinical teaching
2.0 2.1
5.3 5.1
Supervisors aware of objectives appropriate for
clerk
5.8 4.8
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
5.7 5.3
Feedback given throughout rotation
5.2 4.7
5.7 5.4
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
5.6 5.7
5.9 5.7
Teachers modeled respect for other health
professionals
6.0 5.4
I would recommend this rotation to friends
11
Surgery Selectives London
Average Rating
2006-2007 (n18) 2005-2006 (n61)
Question
Time spent in formal teaching sessions
2.1 1.9
Time spent on informal clinical teaching
1.9 1.9
5.3 5.6
Supervisors aware of objectives appropriate for
clerk
5.6 5.5
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
5.3 5.5
Feedback given throughout rotation
5.2 5.1
5.7 5.7
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
5.6 5.6
5.7 5.9
Teachers modeled respect for other health
professionals
5.8 5.9
I would recommend this rotation to friends
12
Anaesthesia Windsor
Average Rating
2006-2007 (n7) 2005-2006 (n6)
Question
Time spent in formal teaching sessions
2.1 2.0
Time spent on informal clinical teaching
2.4 2.2
6.1 6.2
Supervisors aware of objectives appropriate for
clerk
6.6 6.2
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
5.9 6.2
Feedback given throughout rotation
6.3 6.3
6.3 6.0
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
5.9 6.0
6.1 5.4
Teachers modeled respect for other health
professionals
6.7 6.3
I would recommend this rotation to friends
13
Anesthesia London
Average Rating
2006-2007 (n9) 2005-2006 (n25)
Question
Time spent in formal teaching sessions
1.9 1.9
Time spent on informal clinical teaching
2.1 2.1
5.2 5.5
Supervisors aware of objectives appropriate for
clerk
5.7 5.4
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
4.8 5.0
Feedback given throughout rotation
4.8 5.0
4.9 5.5
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
5.6 5.4
5.6 5.8
Teachers modeled respect for other health
professionals
5.2 5.6
I would recommend this rotation to friends
14
Emergency Dept Windsor
Average Rating
2006-2007 (n7) 2005-2006 (n8)
Question
Time spent in formal teaching sessions
2.1 2.0
Time spent on informal clinical teaching
2.3 2.1
5.7 5.3
Supervisors aware of objectives appropriate for
clerk
6.7 5.8
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
5.4 5.4
Feedback given throughout rotation
5.6 5.3
6.6 5.6
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
5.3 5.4
6.0 5.4
Teachers modeled respect for other health
professionals
6.3 5.6
I would recommend this rotation to friends
15
Emergency Dept London
Average Rating
2006-2007 (n11) 2005-2006 (n36)
Question
Time spent in formal teaching sessions
1.8 1.7
Time spent on informal clinical teaching
2.0 1.7
4.8 4.4
Supervisors aware of objectives appropriate for
clerk
5.8 5.4
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
5.7 4.5
Feedback given throughout rotation
5.9 4.0
6.0 5.8
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
5.4 5.0
5.5 5.3
Teachers modeled respect for other health
professionals
5.5 4.9
I would recommend this rotation to friends
16
Windsor Surgery Comments

• Positive Feedback
• Plenty of hands-on-experience and OR time
• Morning rounds with preceptor
• Opportunity to practice/master skills
  (catheters, sutures, ivs, intubations)
• Informal teaching was of excellent quality
• Negative Feedback
• Need more/better clinical teaching rounds and
  informal teaching
• More nights on call
• Poor integration b/w RNs and clerks
• Not feeling welcomed by MDs at Hotel Dieu (Emerg
  setting)

17
London Surgery Comments

• Positive Feedback
• Excellent integration into the team
• First call was a great experience, appropriate
  level of independence
• Lecture series was outstanding
• Opportunity to practice/master skills
  (catheters, sutures, ivs, intubations)
• Informal teaching in OR
• Variety of cases in Emerg
• Immediate feedback from physicians
• Negative Feedback
• Too many different preceptors in Emerg and
  Subspecialty rotations
• Lack of informal bedside teaching in Emerg
• Final evaluations done by physician not familiar
  with student
• Objectives unclear for rotations
• Exam not based on lecture series

18
Call/Scheduling Comments

• Windsor
• no formal call schedule, students expected to
  organize themselves
• call often discussed that morning for same day
  evening call
• schedules not available prior to start of
  rotation
• London
• advanced notification of ER shifts not always
  given
• changes to call schedules made on Gen Sx Team
  after start of rotation, and without clerk input
  (1 reported incident)
• Ortho does not observe post-call policy (home by
  noon)

19
Surgery Suggestions

• Windsor
• Site has become more accustomed to the roles of
  clerks on the Team
• independence, case variety, supervisors aware of
  objectives
• Formal teaching sessions continue to be an area
  for improvement
• Students have requested set call schedules
• London
• Informal teaching in General Surgery continues to
  be an area of weakness
• Get residents more involved in teaching in OR and
  on-call setting
• Objectives for individual rotations need
  clarification for both clerks and their
  preceptors
• ER rotations received better feedback compared to
  last year, but advanced notice of schedule still
  not available
• Limited case variety in Anesthesia
• Put students in ORs with higher turnover
• Have students spend a few days with anesthesia
  consultants not in OR (ex. chronic pain clinics,
  delivery room)

20
Medicine
21
BCOE 2006 Conclusions

• Strengths
• Formal teaching and independence in CTU, working
  with allied health, changes _at_ VIC
• Areas for Improvement
• Formal teaching in non-CTU blocks
• Informal teaching in CTU blocks
• Advance notice of on-call duties and general
  schedules in all blocks
• ENT and Optho blocks rated poorly overall
• Student Suggestions
• Session on equipment in patient rooms including
  02, IV machines, call buttons, etc
• Attempt to even out team size and distribute
  clerk call schedules evenly
• Consider 3 weeks on ACE and 3 weeks on CTU at VIC
• Allow students to go to all 12 weeks of medicine
  teaching sessions, i.e. during oncology, ENT,
  Optho
• Leave Geriatric psych for the 6-week psych block
  and focus on medical issues instead, or allow
  students to work on consult service.

22
Medicine CTU Windsor
Average Rating
2006-2007 (n7) 2005-2006
Question
Time spent in formal teaching sessions
1.1 NA
Time spent on informal clinical teaching
1.6 NA
4.6 NA
Supervisors aware of objectives appropriate for
clerk
6.0 NA
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
4.9 NA
Feedback given throughout rotation
4.6 NA
5.9 NA
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
5.6 NA
5.7 NA
Teachers modeled respect for other health
professionals
5.1 NA
I would recommend this rotation to friends
23
Medicine CTU Windsor
Average Rating
2006-2007 (n7) 2005-2006
Question
Team structure was organized and collegial
4.6 NA
Role of the clerk within the team was well
defined
4.7 NA
5.4 NA
Attendings and residents were available for
advice
4.7 NA
Role of the allied health professional was
clearly delineated
Opportunity to observe/perform procedures
3.4 NA
24
Medicine CTU ACE
Average Rating
2006-2007 (n5) 2005-2006 (n10)
Question
Time spent in formal teaching sessions
1.6 1.9
Time spent on informal clinical teaching
1.4 1.6
4.0 5.4
Supervisors aware of objectives appropriate for
clerk
4.6 5.8
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
4.6 5.5
Feedback given throughout rotation
4.2 4.6
4.0 3.9
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
4.8 5.0
4.8 5.5
Teachers modeled respect for other health
professionals
4.6 5.0
I would recommend this rotation to friends
25
Medicine CTU ACE
Average Rating
2006-2007 (n5) 2005-2006 (n10)
Question
Team structure was organized and collegial
4.6 5.7
Role of the clerk within the team was well
defined
4.2 5.2
4.0 5.6
Attendings and residents were available for
advice
5.0 5.4
Role of the allied health professional was
clearly delineated
Opportunity to observe/perform procedures
3.8 3.4
26
Medicine CTU Vic
Average Rating
2006-2007 (n8) 2005-2006 (n11)
Question
Time spent in formal teaching sessions
2.0 2.0
Time spent on informal clinical teaching
1.6 1.4
5.4 4.9
Supervisors aware of objectives appropriate for
clerk
5.4 5.5
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
5.9 5.5
Feedback given throughout rotation
5.6 4.8
5.6 5.4
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
5.2 4.8
5.5 5.6
Teachers modeled respect for other health
professionals
5.8 5.0
I would recommend this rotation to friends
27
Medicine CTU Vic
Average Rating
2006-2007 (n8) 2005-2006 (n11)
Question
Team structure was organized and collegial
5.8 5.2
Role of the clerk within the team was well
defined
5.5 4.7
5.4 5.4
Attendings and residents were available for
advice
5.5 5.1
Role of the allied health professional was
clearly delineated
Opportunity to observe/perform procedures
4.5 3.4
28
Medicine CTU UH
Average Rating
2006-2007 (n7) 2005-2006 (n30)
Question
Time spent in formal teaching sessions
2.1 2.0
Time spent on informal clinical teaching
1.7 1.5
5.6 5.2
Supervisors aware of objectives appropriate for
clerk
5.9 5.6
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
5.0 5.2
Feedback given throughout rotation
5.3 4.5
5.9 5.5
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
5.4 5.1
6.0 5.8
Teachers modeled respect for other health
professionals
5.9 5.8
I would recommend this rotation to friends
29
Medicine CTU UH
Average Rating
2006-2007 (n7) 2005-2006 (n30)
Question
Team structure was organized and collegial
5.9 5.7
Role of the clerk within the team was well
defined
6.0 5.6
5.7 5.5
Attendings and residents were available for
advice
6.3 5.5
Role of the allied health professional was
clearly delineated
3.4 3.2
Opportunity to observe/perform procedures
30
Medicine Selectives Windsor
Average Rating
2006-2007 (n6) 2005-2006
Question
Time spent in formal teaching sessions
1.7 NA
Time spent on informal clinical teaching
2.0 NA
5.8 NA
Supervisors aware of objectives appropriate for
clerk
5.8 NA
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
5.3 NA
Feedback given throughout rotation
5.5 NA
5.7 NA
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
6.2 NA
6.2 NA
Teachers modeled respect for other health
professionals
6.2 NA
I would recommend this rotation to friends
31
Medicine Selectives Windsor
Average Rating
2006-2007 (n6) 2005-2006
Question
Team structure was organized and collegial
5.0 NA
Role of the clerk within the team was well
defined
4.5 NA
5.8 NA
Attendings and residents were available for
advice
5.0 NA
Role of the allied health professional was
clearly delineated
4.2 NA
Opportunity to observe/perform procedures
32
Medicine Selectives London
Average Rating
2006-2007 (n15) 2005-2006 (n44)
Question
Time spent in formal teaching sessions
2.1 1.7
Time spent on informal clinical teaching
2.1 2.0
5.7 5.2
Supervisors aware of objectives appropriate for
clerk
5.9 5.7
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
5.8 5.1
Feedback given throughout rotation
5.5 4.6
6.0 5.5
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
5.9 5.6
6.2 5.9
Teachers modeled respect for other health
professionals
6.2 5.7
I would recommend this rotation to friends
33
Medicine Selectives London
Average Rating
2006-2007 (n15) 2005-2006 (n44)
Question
Team structure was organized and collegial
5.8 5.5
Role of the clerk within the team was well
defined
5.5 4.9
5.8 5.5
Attendings and residents were available for
advice
5.6 5.3
Role of the allied health professional was
clearly delineated
5.3 3.5
Opportunity to observe/perform procedures
34
Windsor Medicine Comments

• Positive Feedback
• Great deal of independence and responsibility
• Negative Feedback
• Not enough formal and informal teaching by
  preceptors
• Lack of predictable/protected lecture time
• Confusion about duties of clinical clerks on
  ward
• Minimal exposure to procedures
• Call Policy/Schedules
• Often not sent home by noon post-call

35
London Medicine Comments

• Positive Feedback
• Great deal of independence and responsibility
• Plenty of teaching (morning and noon rounds)
• Excellent team environment and interaction with
  residents
• Negative Feedback
• Minimal interaction with staff consultant
• Patient load too large (particularly at Vic)
• Not enough bedside teaching
• Lack of opportunity to do procedures
• Too many long-term care patients limited
  exposure to new cases
• Call Policy/Schedules
• Inconsistent call duties between clerks on same
  team and between teams

36
Medicine Suggestions

• Windsor
• Formal teaching series and informal teaching
  opportunities are insufficient
• Appoint residents to have teaching sessions (am,
  noon)
• Set schedule for teaching sessions as done in
  London
• Clerk involvement in doing procedures is lacking
• Have a lecture on common procedures in Medicine
• London
• Set limit to of patients clerks can have
  awaiting placement
• Clerk involvement in doing procedures is lacking
• Ensure call duties are similar for clerks (within
  teams, between teams)
• Initiate mandatory meeting 3 weeks into rotation
  w/ consultant or senior resident to give feedback

37
Oncology Windsor
Average Rating
2006-2007 (n7) 2005-2006 (n?)
Question
Time spent in formal teaching sessions
1.7 1.5
Time spent on informal clinical teaching
2.0 1.8
4.9 5.5
Supervisors aware of objectives appropriate for
clerk
5.1 6.0
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
4.3 4.8
Feedback given throughout rotation
4.4 4.3
4.1 6.0
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
6.0 4.8
5.9 6.0
Teachers modeled respect for other health
professionals
5.0 6.0
I would recommend this rotation to friends
38
Oncology London
Average Rating
2006-2007 (n13) 2005-2006 (n35)
Question
Time spent in formal teaching sessions
1.9 1.6
Time spent on informal clinical teaching
1.9 1.9
4.7 4.9
Supervisors aware of objectives appropriate for
clerk
4.8 4.9
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
4.5 4.5
Feedback given throughout rotation
4.2 3.8
5.3 5.4
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
5.3 5.1
5.5 5.4
Teachers modeled respect for other health
professionals
4.8 4.9
I would recommend this rotation to friends
39
Oncology Comments

• Positive Feedback
• Good variety of different common tumour types
• Exposure to breaking bad news
• Reasonable balance between radiation and medical
  oncology, and flexibility to see things clerks
  were interested in (London)
• Teaching sessions were good (breast examination,
  chemotherapy ward)
• Negative Feedback
• Too much dictation
• No feedback (hand evaluation to preceptor at the
  end of every half day, but do not get the
  opportunity to view results or get verbal
  feedback)
• Working with too many consultants
• Insufficient teaching
• Library session (pubmed talk) not helpful
• Final exam did not test important take-home
  points from rotation

40
Elder Care Windsor
Average Rating
2006-2007 (n7) 2005-2006 (n4)
Question
Time spent in formal teaching sessions
1.4 1.8
Time spent on informal clinical teaching
1.9 1.8
5.1 4.8
Supervisors aware of objectives appropriate for
clerk
4.7 4.3
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
5.6 4.0
Feedback given throughout rotation
5.6 4.5
4.1 4.0
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
5.7 5.0
6.1 6.0
Teachers modeled respect for other health
professionals
4.4 4.8
I would recommend this rotation to friends
41
Elder Care London
Average Rating
2006-2007 (n7) 2005-2006 (n22)
Question
Time spent in formal teaching sessions
1.9 2.3
Time spent on informal clinical teaching
1.7 1.9
5.4 5.6
Supervisors aware of objectives appropriate for
clerk
5.3 4.9
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
5.1 4.8
Feedback given throughout rotation
5.0 5.2
5.0 5.1
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
5.0 5.5
5.9 6.1
Teachers modeled respect for other health
professionals
5.1 5.1
I would recommend this rotation to friends
42
Elder Care Comments

• Positive Feedback
• Multiple environments (Nursing home, rehab,
  geriatric assessment program)
• Good feedback given to students
• Negative Feedback
• Not enough informal or formal teaching
• Too much emphasis on geriatric psychiatry
• Too much rotation between supervisors
• Patient load too small, poor patient variety
• Geriatrics excess if on ACE and Elder Care
  during Medicine, while no exposure to Geriatrics
  if on CTU and ENT/Optho

43
Optho London
Average Rating
2006-2007 (n6) 2005-2006 (n13)
Question
Time spent in formal teaching sessions
1.7 1.2
Time spent on informal clinical teaching
1.7 1.5
4.0 4.6
Supervisors aware of objectives appropriate for
clerk
3.7 3.7
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
3.2 3.2
Feedback given throughout rotation
3.7 2.8
4.7 4.1
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
4.7 4.5
4.5 5.2
Teachers modeled respect for other health
professionals
4.2 3.5
I would recommend this rotation to friends
44
ENT London
Average Rating
2006-2007 (n7) 2005-2006 (n14)
Question
Time spent in formal teaching sessions
1.7 1.4
Time spent on informal clinical teaching
1.9 1.9
4.1 4.8
Supervisors aware of objectives appropriate for
clerk
3.9 4.0
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
3.6 4.3
Feedback given throughout rotation
3.0 3.6
6.0 5.5
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
4.9 5.4
5.3 5.1
Teachers modeled respect for other health
professionals
5.0 4.6
I would recommend this rotation to friends
45
Optho/ENT Comments

• OPTHO
• Positive Feedback
• Good consolidation of skills (eye drop
  instillation, examination of fundus)
• Broad overview of specialty (OR, Clinics,
  Emergency clinic)
• Negative Feedback
• Minimal interaction with faculty (Emerg clinic)
• Rotation schedule given on the first morning
• Too much variability in students experiences
• Exam at end did not match student objectives
• Too little time scheduled in clinics
• ENT
• Positive Feedback
• Broad overview of specialty (OR, clinics) and
  common clinical problems
• Good resident teaching re HN examination
• Negative Feedback
• Changing clinics every half-day didnt allow for
  any consistency

46
Pediatrics
47
BCOE 2006 Conclusions

• Strengths
• Increased abilities and comfort with children,
  CLIPP cases, ER, Windsor
• Areas for Improvement
• Formal teaching sessions
• Informal teaching in London (relative to
  Rural/Windsor)
• Mid-rotation feedback
• Student Suggestions
• Lectures should be related to objectives and exam
  topics
• Attempt to organize a schedule for resident
  teaching to clerks during CTU
• Put Dr. Tithecotts Resource Manual online
• In Rural centres, allow students to see patients
  in ER that are not admitted

48
Pediatrics Windsor
Average Rating
2006-2007 (n7) 2005-2006 (n10)
Question
Time spent in formal teaching sessions
2.2 2.0
Time spent on informal clinical teaching
2.0 2.1
6.2 6.4
Supervisors aware of objectives appropriate for
clerk
6.3 6.3
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
6.3 6.2
Feedback given throughout rotation
5.8 5.0
6.2 6.3
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
5.8 6.5
6.0 6.5
Teachers modeled respect for other health
professionals
6.8 6.7
I would recommend this rotation to friends
49
Pediatrics Windsor
Average Rating
2006-2007 (n6) 2005-2006 (n14)
Question
More comfortable communicating with
family/patients
6.7 6.7
7.0 6.7
More comfortable examining pediatric patients
6.7 6.7
More confident with clinical reasoning skills for
peds
3.5 5.5
Clipp Cases were helpful
5.0 5.8
More peds exposure in years 1 2 would have
increased my comfort
50
Pediatrics Rural
Insufficient data reported to report (n2) No
obvious concerns identified
51
Pediatrics London
Average Rating
2006-2007 (n14) 2005-2006 (n39)
Question
Time spent in formal teaching sessions
1.9 1.8
Time spent on informal clinical teaching
1.6 1.6
5.0 5.4
Supervisors aware of objectives appropriate for
clerk
4.8 5.4
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
5.4 4.8
Feedback given throughout rotation
5.1 4.7
5.6 5.7
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
5.0 5.2
5.5 5.6
Teachers modeled respect for other health
professionals
5.2 5.3
I would recommend this rotation to friends
52
Pediatrics London
Average Rating
Question
2006-2007 (n7) 2005-2006 (n39)
More comfortable communicating with
family/patients
6.2 6.2
6.2 6.3
More comfortable examining pediatric patients
6.0 5.8
More confident with clinical reasoning skills for
peds
6.1 6.1
Clipp Cases were helpful
5.9 6.2
More peds exposure in years 1 2 would have
increased my comfort
53
Pediatrics Comments

• Positive Feedback
• Great opportunity for independent learning
• Much more comfortable working with children now
• Excellent teaching in Windsor
• Lots of exposure to a variety of ages and
  presentations in ER and on call
• ability to select own cases to meet objectives
  in ER setting
• Negative Feedback
• Subspecialty was highly variable in quality and
  patient exposure
• Teleconferencing of London lectures to Windsor
  was not helpful, as students felt that their own
  teaching sessions were of excellent quality
• Inefficient use of time and limited learning
  opportunities on CTU rounds in London
• Consultants/Residents too busy on Peds CTU to
  teach informally
• No exposure to community pediatrics if in London
• Call Policy
• Occasionally not sent home by noon when
  post-call (very resident-dependent)
• Clerks commonly worked 4/6 week-ends during Peds
  rotation (CTU call ER shifts)

54
Pediatrics Suggestions

• Informal teaching
• Designated teaching time slots on CTU
• Daily resident teaching at morning rounds
• More bedside teaching needed
• Limited Community Peds exposure
• Introduce community peds as 2 week elective
  option
• Discontinue teleconferencing of teaching sessions
  to Windsor
• Some subspecialties in peds need revision
• Minimal patient contact, excessive self-directed
  learning time
• Many students not matched to electives of
  interest
• No objectives for individual electives

55
OB/Gyn
56
BCOE 2006 Conclusions

• Strengths
• Increased comfort with antepartum, well-woman
  care, hands-on experience, clinics in London
• Areas for Improvement
• Formal teaching sessions
• Informal teaching
• Clerk experience at St. Joes, especially on-call
  schedule
• Student Suggestions
• In Windsor instead of 2 weeks DR, spend 4 weeks
  with a preceptor and go to their deliveries
• Eliminate 2nd clerk on call or consider full home
  call, especially on w/e
• Inform clerks ahead of time regarding time
  requirement for gyne-onc
• Involve nurses in learning in DR maybe one nurse
  per shift who will take clerks
• Ensure generalist exposure in clinic scheduling
  for clerks at St. Joes.

57
OB/Gyn Windsor
Average Rating
2006-2007 (n6) 2005-2006 (n12)
Question
Time spent in formal teaching sessions
1.2 1.4
Time spent on informal clinical teaching
1.5 1.7
4.3 4.7
Supervisors aware of objectives appropriate for
clerk
5.3 5.5
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
5.5 5.2
Feedback given throughout rotation
3.3 4.5
5.3 4.6
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
5.5 5.4
6.0 6.1
Teachers modeled respect for other health
professionals
5.7 6.2
I would recommend this rotation to friends
58
OB/Gyn Windsor
Average Rating
Question
2006-2007 (n6) 2005-2006 (n12)
Best clinical teaching was on call
6.3 5.5
Best clinical teaching was in delivery room
4.3 4.1
5.0 4.4
Best clinical teaching was in clinic
5.8 5.9
Comfortable providing well-woman physicals
Comfortable providing antepartum care for
low-risk OB
6.0 6.5
59
OB/Gyn St Joes
Average Rating
2006-2007 (n9) 2005-2006 (n20)
Question
Time spent in formal teaching sessions
1.7 1.6
Time spent on informal clinical teaching
1.4 1.6
3.5 4.3
Supervisors aware of objectives appropriate for
clerk
4.2 4.5
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
4.6 4.4
Feedback given throughout rotation
4.0 4.4
5.0 4.5
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
4.5 4.7
4.7 4.5
Teachers modeled respect for other health
professionals
3.5 3.5
I would recommend this rotation to friends
60
OB/Gyn St Joes
Average Rating
Question
2006-2007 (n9) 2005-2006 (n20)
Best clinical teaching was on call
4.8 4.3
Best clinical teaching was in delivery room
4.5 4.3
4.8 4.9
Best clinical teaching was in clinic
4.2 4.7
Comfortable providing well-woman physicals
Comfortable providing antepartum care for
low-risk OB
4.6 5.2
61
OB/Gyn Vic
Average Rating
2006-2007 (n8) 2005-2006 (n15)
Question
Time spent in formal teaching sessions
1.9 2.0
Time spent on informal clinical teaching
1.6 1.7
5.0 4.9
Supervisors aware of objectives appropriate for
clerk
4.8 5.1
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
4.6 5.0
Feedback given throughout rotation
4.1 4.1
4.9 4.8
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
5.4 5.3
5.1 5.4
Teachers modeled respect for other health
professionals
4.6 5.1
I would recommend this rotation to friends
62
OB/Gyn Vic
Average Rating
Question
2006-2007 (n8) 2005-2006 (n15)
Best clinical teaching was on call
5.0 4.6
Best clinical teaching was in delivery room
3.1 3.4
5.2 5.3
Best clinical teaching was in clinic
5.5 5.7
Comfortable providing well-woman physicals
Comfortable providing antepartum care for
low-risk OB
5.8 6.0
63
OB/Gyn Comments

• Positive Feedback
• Great hands on experience in DR but this was
  not consistent
• Residents spent a great deal of time with the
  clerks (rounds, OR)
• Teaching sessions with GPs were outstanding
• Negative Feedback
• Informal teaching was limited clinics were
  overbooked and residents were too busy on call to
  teach
• Limited opportunities to do pap smears/cervical
  checks
• Role of clerk in DR was repetitive and clerks
  were not involved in management decisions
• Had to be pushy to get a good experience,
  intimidation by some preceptors/RNs/residents
• Experiences at Vic and St Joes were entirely
  different (urogyne at St Joes w/o exposure to
  common gyne presentations, 2 week DR rotation at
  Vic)
• Clinic cancellations at St. Joes and of
  elective students limited clerk opportunities
• Repeated no-show lecturers
• Many sessions not videoconferenced to rural
  sites
• Call Policy
• Some delays in posting of call schedules
• No post-call policy observed if gyne clerks
  called in from home-call

64
OB/Gyn Suggestions

• Promote informal on call teaching by consultants
  to clerks
• Provide clerks with clinic schedules for each
  week so students are aware of cancellations, can
  plan alternatives
• Videoconference all lectures to rural sites
• Identify areas of limited exposure at each
  teaching site and have lectures on this material
• St. Joes Abnormal bleeding, pregnancy
  prevention, Gyne Onc
• Vic UroGyne, High risk pregnancy

65
Psychiatry
66
BCOE 2006 Conclusions

• Strengths
• Increased comfort with psychiatric illness, Rural
  and Windsor centres
• Areas for Improvement
• Formal teaching sessions
• Informal teaching in London
• On-Call experience in London
• Student Suggestions
• In Windsor try to rotate b/w preceptors to even
  out patient numbers per clerk
• Eliminate 2nd clerk on call or consider
  scheduling one clerk until midnight and the 2nd
  after midnight as the residents have done.
• Alternate Child Psych times throughout the week
  to allow for smaller groups of learners
• Increase outpatient exposure in London
• Formal teaching sessions should be better
  organized in themes and should be more
  interactive/discussions or case-based (as in
  Surgery).

67
Psychiatry Windsor
Average Rating
2006-2007 (n4) 2005-2006 (n8)
Question
Time spent in formal teaching sessions
2.5 2.1
Time spent on informal clinical teaching
1.5 1.9
5.6 5.9
Supervisors aware of objectives appropriate for
clerk
6.2 6.5
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
4.8 5.4
Feedback given throughout rotation
5.8 5.4
5.8 6.0
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
6.2 5.9
6.5 6.4
Teachers modeled respect for other health
professionals
5.3 6.0
I would recommend this rotation to friends
68
Psychiatry Rural
Average Rating
2006-2007 (n6) 2005-2006 (n18)
Question
Time spent in formal teaching sessions
1.8 2.0
Time spent on informal clinical teaching
1.8 1.9
5.5 6.0
Supervisors aware of objectives appropriate for
clerk
5.0 5.8
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
5.2 5.6
Feedback given throughout rotation
6.2 5.8
5.5 5.9
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
5.5 6.0
5.8 6.3
Teachers modeled respect for other health
professionals
5.8 6.5
I would recommend this rotation to friends
69
Psychiatry London
Average Rating
2006-2007 (n12) 2005-2006 (n26)
Question
Time spent in formal teaching sessions
2.0 2.0
Time spent on informal clinical teaching
1.8 1.6
5.4 4.8
Supervisors aware of objectives appropriate for
clerk
6.0 5.2
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
5.1 4,4
Feedback given throughout rotation
5.1 4.1
5.6 4.4
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
5.6 5.0
5.7 5.5
Teachers modeled respect for other health
professionals
5.3 4.5
I would recommend this rotation to friends
70
Psychiatry Comments

• Positive Feedback
• On call and inpatient duties were viewed as best
  learning experiences
• Urgent care clinic has excellent exposure to
  diverse psychiatric illnesses
• One-on-one time with preceptors and residents
• Reasonable amount of autonomy with patients
• Clerical Staff/Nurses were welcoming of clerks
• Negative Feedback
• Too much paperwork (dictation summaries) took
  away from time for patient interaction
• Formal teaching too much repetition from 2nd
  year lectures, multiple no-show lecturers
• Inconsistency between preceptors, lack of
  knowledge of teaching objectives and level of
  independence
• Final examination was too difficult for our
  level of training, bad format (i.e. overheads)
• Call Policy
• Policy to send clerks home post-call by noon was
  not always observed
• Windsor clerks were not notified in advance of
  their call shifts

71
Psychiatry Suggestions

• Ensure each clerk has outpatient inpatient
  exposure
• Too many hands on deck on call
• 2 clerks 1-2 CEPS nurses 2 residents
• Perhaps have 1st and 2nd call (2nd clerk only
  called in if busy)
• Group teaching sessions by themes
• Introduce case presentations by clerks or
  informal case discussions with consultants
• Change exam format (on-line or paper format)
• Improve feedback (limited with One45 system)

72
Family Medicine
73
BCOE 2006 Conclusions

• Strengths
• Informal teaching, good focus on
  cost-effectiveness, preventative medicine, and
  communication skills, good clinician-teachers
• Areas for Improvement
• Formal teaching sessions
• Evaluation
• Mid-rotation feedback in Windsor
• Student Suggestions
• Implement morning teaching rounds with residents
  (like CTU) involve residents in more
  student-teaching
• Develop online case-based formal teaching (like
  CLIPP)
• Offer exposure to variety of clinics including
  teen-health, urgent-care, sport-medicine,
  palliative, etc.
• Provide preceptor and clerk schedule/expectations
  ahead of time

74
Family Medicine Windsor, 2/52
Average Rating
2006-2007 (n4) 2005-2006 (n7)
Question
Time spent in formal teaching sessions
1.2 1.6
Time spent on informal clinical teaching
1.8 2.0
4.8 5.4
Supervisors aware of objectives appropriate for
clerk
5.5 6.3
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
4.5 5.9
Feedback given throughout rotation
4.0 4.6
5.4 5.9
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
6.0 6.3
6.5 6.3
Teachers modeled respect for other health
professionals
5.5 5.6
I would recommend this rotation to friends
75
Family Medicine Windsor, 2/52
Average Rating
2006-2007 (n4) 2005-2006 (n7)
Question
Emphasized effective patient and family
communication
5.3 6.1
Fostered cost-effective approach
4.8 6.1
5.5 6.0
Preventative medicine encouraged
6.0 5.4
Encouraged to involve patients in clinical
decisions
Teachers demonstrated empathy, respect,
compassion, and were non-judgmental towards
patients
6.5 6.1
2.5 NA
I used to on-line cases.
The on-line cases assisted my learning in this
rotation
3.0 NA
1.5 NA
I used the clinical cards regularly as a
learning resource
2.0 NA
The clinical cards assisted my learning in this
rotation
76
Family Medicine London, 2/52
Average Rating
2006-2007 (n16) 2005-2006 (n37)
Question
Time spent in formal teaching sessions
1.8 1.7
Time spent on informal clinical teaching
1.8 2.0
5.5 5.8
Supervisors aware of objectives appropriate for
clerk
5.6 5.9
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
5.4 5.5
Feedback given throughout rotation
5.1 5.5
5.1 5.3
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
5.4 5.7
5.8 6.1
Teachers modeled respect for other health
professionals
5.4 5.7
I would recommend this rotation to friends
77
Family Medicine London, 2/52
Average Rating
2006-2007 (n4) 2005-2006 (n37)
Question
Emphasized effective patient and family
communication
5.6 6.0
Fostered cost-effective approach
5.3 5.7
5.6 6.0
Preventative medicine encouraged
5.4 5.9
Encouraged to involve patients in clinical
decisions
Teachers demonstrated empathy, respect,
compassion, and were non-judgmental towards
patients
5.8 6.2
3.3 NA
I used to on-line cases.
The on-line cases assisted my learning in this
rotation
3.4 NA
2.3 NA
I used the clinical cards regularly as a
learning resource
2.4 NA
The clinical cards assisted my learning in this
rotation
78
Family Medicine 4/52
Average Rating
2006-2007 (n20) 2005-2006 (n38)
Question
Time spent in formal teaching sessions
1.7 1.8
Time spent on informal clinical teaching
2.2 2.0
5.6 5.5
Supervisors aware of objectives appropriate for
clerk
6.3 6.2
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
5.9 5.6
Feedback given throughout rotation
5.8 5.6
6.2 6.3
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
5.8 5.8
6.9 6.3
Teachers modeled respect for other health
professionals
6.2 6.2
I would recommend this rotation to friends
79
Family Medicine 4/52
Average Rating
2006-2007 (n20) 2005-2006 (n38)
Question
Emphasized effective patient and family
communication
6.2 6.8
Fostered cost-effective approach
6.0 6.1
6.2 6.1
Preventative medicine encouraged
6.0 6.0
Encouraged to involve patients in clinical
decisions
Teachers demonstrated empathy, respect,
compassion, and were non-judgmental towards
patients
6.1 6.0
3.0 NA
I used to on-line cases.
The on-line cases assisted my learning in this
rotation
3.5 NA
1.9 NA
I used the clinical cards regularly as a
learning resource
2.2 NA
The clinical cards assisted my learning in this
rotation
80
Family Medicine Comments

• Positive Feedback
• Preceptors/Residents/Support staff knew the
  roles of clerks
• Immediate feedback from preceptors often
  provided
• Quantity of informal teaching was outstanding
• Excellent variety of cases settings on 4-week
  (rural) rotations
• Opportunity to do office procedures
• Negative Feedback
• Little value in afternoon at London-Middlesex
  Health Unit
• ROMP was very disorganized in notifying clerks
  of rotations, selecting preceptors, etc.
• Preceptors in rural locations werent aware of
  students level of training/expectations

81
Family Medicine Suggestions

• On-line cases and clinical cards not well
  utilized
• Formal teaching in Windsor identified as
  insufficient
• Involve residents in clerk teaching in
  Windsor/London
• Ensure mandatory mid-rotation feedback
• Rural Rotation planning
• Notify students that information regarding rural
  rotations may not be available until last minute
• Inform ROMP, NOMEC, SWOMEN of this student
  concern

82
The Future of E-BCOE

• Poor response rate from 2006-2007 year
• Excessive on-line surveys with One45 system
• Residents, consultants, lecturers, fellow clerks
• Increased time demand of T-Res
• Bribery initiated only a slight increase in
  response rate
• CEC BCOE meeting now held earlier in year
• Greater opportunity to initiate changes for
  2007-2008 year
• Less responses accumulated by time of meeting
• Final report at end of year required?
• Academic half-days
• Currently no opportunity for student feedback
• Surveys initiated next year?

83
Acknowledgements

• Meds 2007
• Ilana Halperin
• Noah Ivers
• Computer Information Services
• Sergio Rodriguez
• Erin Pearson