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ICC: 7001 Transition to Clinical Core

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Title: ICC: 7001 Transition to Clinical Core


1
ICC 7001Transition to Clinical Core
  • Nuts Bolts
  • Lisa Schilling

2
ICC 7001
  • Pass Fail
  • Required attendance
  • Limited assignments
  • Time to get ready for Clinical Core not tightly
    scheduled
  • On-line evaluations 4 weeks into your first block
    required

3
ICC - 7001
  • Education and Administration

4
ICC - 7001- Monday
  • Course Session Medical Errors Medical Students
  • Goal/Rationale
  • To advance medical student familiarity with the
    occurrence and personal impact of medical errors
    as well as a systems approach to error reduction
    and student role in patient safety.

5
ICC - 7001- Monday
  • Course Session Mentored Scholarly Activity Lunch
    Breakout Sessions
  • Goal/Rationale by thematic area
  • Review MSA Expectations and Benchmarks
  • Review MSA rubrics
  • Review Phase III plans for students and how they
    translate into Phase IV

6
ICC - 7001- Monday
  • Session LCME Survey, Pagers
  • The student LCME medical education needs you!
  • Bring your lap top
  • USA Mobility - student pagers

7
ICC - 7001- Tues, Wed, Thursday
  • 4 main Groups 1-4
  • 1.1-1.4,
  • 2.1- 2.4
  • 3.1 -3.3

8
ICC - 7001- Tues, Wed, Thursday
  • Course Session Shadowing
  • Goal/Rationale
  • Decrease anxiety
  • Increase familiarity with block/team/specialty

9
ICC - 7001- Shadowing
  • You only go 1 morning - see the roster
  • Your 1st or 2nd inpatient block
  • Call the contact on the roster the afternoon
    before you are scheduled to shadow
  • Confirm and clarify the arrangements
  • MUST WEAR WHITE COAT AND BADGE
  • Dress how?

10
ICC - 7001- Tues, Wed, Thursday
  • Course Session IV Placement Surgical Scrub
  • Goal/Rationale New skills
  • Surgical scrub and gown and glove must have!
  • (OR Nurses)
  • IV placement and phlebotomy (Anesthesia)

11
ICC - 7001- Tues, Wed, Thursday
  • Course Session Clinical Pearls
  • Goal/Rationale Get tips from MS4s
  • What books to buy and carry
  • Useful PDA programs
  • Study tips
  • Unwritten rules
  • No faculty will be present during these sessions!

12
ICC - 7001- Tues, Wed, Thursday
  • Session Learning Logs Session
  • (Listed as IT on Group Schedule)
  • Goal/Rationale
  • Learn to use the new logging system
  • Bring your PDA!!

13
ICC - 7001- Tues, Wed, Thursday
  • VA paperwork, fingerprinting, badging, HIPPA
  • Goal/Rationale
  • Authorization for electronic record access takes
    at least 48hr after fingerprinting.
  • Dont delay, if possible

14
ICC - 7001- Tues, Wed, Thursday
  • CAPE Oral Presentation Session
  • Goal/Rationale
  • Improve your clinical reasoning oral
    presentation skills
  • Practice a focused clinical exam.
  • Use the information you gather to prepare for and
    deliver a 5-minute new patient oral presentation.
  • 1st Tuesday group begins at 1230 pm
  • BRING YOUR DIAGNOSTIC KITS!!
  • ARRIVE EARLY!!

15
ICC - 7001- Thursday
  • MD- MBA Student Interest Lunch

16
ICC - 7001- Friday
  • Course Session Legal Obligations to Patients,
    Erin Egan, JD
  • Goal/Rationale
  • Understand your legal obligations to patients
  • Understand the legal ramifications of
    documentation

17
ICC - 7001- Friday
  • Course Session Professionalism Case Discussions-
    small group sessions
  • Goal/Rationale Improve your skills at managing
    ethically complex situations
  • Please see the 7001 website
  • Assigned reading in preparation

18
ICC - 7001- Friday
  • Course Session Gold Professionalism Ceremony,
  • Guest Speaker Cliff Zwillich, MD
  • Goal/Rationale
  • Be inspired at professionalism ceremony
  • CU Honor code presentation - the Honor Code
    Committee

Student professionalism committee and Student
Affairs organized
19
ICC - 7001- Friday
  • USMLE Exit Survey
  • Ice Cream (EDR)
  • Mini-Graduate Questionnaire (GQ)
  • Class Meeting

20
ICC 7001 Contact information
  • Christy Linsenmaier
  • 303-724-7732

21
Oral Presentation
22
Oral Presentation
  • Method of communication to allow collaborative
    conduct of patient care
  • Opportunity for teaching and evaluation of
    clinical competence
  • Negotiation of professional relationships
  • Representation of professional values

23
Model of Communication
  • Purpose- What is the reason for the
    communication? What outcome do I desire?
  • Audience- Who is my audience and what is their
    role?
  • Setting/Circumstance- What are the circumstances
    that must influence my presentation?
  • Message/Content -What is the necessary content?
    How do the above influence the content?

24
Oral Presentation
  • A story
  • An argument

25
Purpose
  • Contribute to patient care by organizing
    information in a manner that benefits the
    decision-maker
  • Present a well-constructed argument that sustains
    iterative clinical reasoning
  • Melding of a story and an argument
  • Show case your knowledge and analytic skills

26
Audience
  • Your attending
  • Your team
  • Consultants
  • What do you want from each of them?
  • What do they need from you?

27
Setting/Circumstances
  • To emergency medicine attending during the
    arrival of several trauma victims
  • To Dr. Deterding during a bronchoscopy of an
    18-mo old child
  • To your internal medicine attending where you are
    presenting a stable but ill patient who is
    diagnostically challenging

28
Content
  • You must decide what content is most appropriate
    for the given purpose, audience,and setting,
  • Most of us learn by trial error,
  • Thinking about purpose, audience, setting and
    content will help you

29
Oral Presentation
  • Method of communication to allow collaborative
    conduct of patient care
  • Opportunity for teaching and evaluation of
    clinical competence
  • Negotiation of professional relationships
  • Representation of professional values

30
Teacher-Student Miscommunication
  • Be brief ----- Talk faster
  • Students make interpret feedback out of context,
    and consider it a rule.
  • No social history, please
  • Teacher may not explicitly ground feedback in the
    appropriate context

31
An Argument
  • Constructing the case into a diagnostic
    therapeutic plan
  • Content Relevance-
  • Information that assists with clinical reasoning
  • Clinical reasoning improves as knowledge and
    experience grow

32
Relevance
  • The majority of feedback students receive is to
    provide relevant or pertinent information
  • Relevance - not only about content, but audience,
    setting, and purpose

33
SNAPPS
  • Summarize the patients problem in 2-3 sentences.
  • Narrow the differential to at least 2-3
    possibilities/diagnoses
  • Analyze by comparing and contrasting
  • Probe the teacher with smart questions
  • Plan
  • Select what you will learn

34
Novice Clinical Reasoning
  • Extensive biomedical knowledge
  • Limited clinical experience
  • Dont recognize the clues Key Features
  • Dont see the patterns from case to case

35
Expert Clinical Reasoning
  • Extensive biomedical knowledge
  • Extensive clinical experience
  • Recognize clues Key Features
  • Recognize Patterns - by combination of biomedical
    knowledge and clinical experience

36
From Novice to Expert
  • SNAPPS guides you - practice
  • Summarize the key information
  • Use descriptive medical language
  • Choosing the key information is a skill

37
Language Matters
  • What would the medical words be?
  • he had an elevated temperature
  • he wasnt making sense or being appropriate
  • he couldnt move the left side of his body
  • when she lays down she gets short of breath

38
Language Matter
  • Use special qualifying words to help compare
    and contrast diagnoses or describe them.
  • Use qualifiers that have implied or explicit
    opposites (bipolar)
  • acute / chronic
  • low fever / high fever
  • Left-sided abd. pain/ right-sided abd. pain
  • Sharp pain/ dull pain

39
Other examples of qualifiers
  • Increased Decreased
  • Tense Soft
  • Abnormal Normal
  • Sudden Slow
  • Rapid Slow
  • Non-focal Focal
  • Irritable Happy
  • Lethargic Awake

40
Summarize
  • Use descriptive language and terms
  • Choose key components that contribute to the
    listeners ability to make medical decisions (or
    to do what ever else you need of them)

41
Narrow - Analyze Differential
  • Present information that allows you to compare
    and contrast, support or refute likely diagnoses
  • Improves clinical knowledge clinical reasoning
  • Youll likely need to read up on your patient to
    do this

42
Plan
  • Present a diagnostic and/or therapeutic plan
  • Put yourself in the position of the
    decision-maker
  • What more do you need to know to formulate a
    plan?

43
Probe
  • Ask smart questions
  • Frame them in a decision

44
Select for Self-directed Learning
  • What are your knowledge gaps- general or specific
  • What is the evidence?
  • Challenge everything? Not out loud!
  • Use new resources

45
You have to deliberately practice!
  • You cant be passive to improve
  • Give examples of those that deliberately practice

46
Examples of Deliberate practice
  • Solitary activities to study and analyze
    published games of the best players
  • What are your knowledge gaps? What should you
    study?
  • Mentally play the game to understand Chess
    masters moves
  • Find and incorporate the knowledge you need to
    become a master!


Kasparov
47
What is deliberate practice?
  • Effortful activities associated with constant
    improvement
  • Focus on primary goal of improvement of a
    specific task
  • Obtain detailed immediate feedback
  • Perform the same or similar tasks repeatedly

ERICSSON, Acad Med, 2004
48
CAPE-Oral Presentation Session
  • Youll see 1 stnd pt
  • Youll perform a focused, history and exam in 30
    minutes have 15-minutes to jot notes
  • Youll receive diagnostic results before you
    leave CAPE
  • Youll use your information to prepare a 5-minute
    new patient oral presentation
  • For your new patient presentation you can assume
    that the setting is for inpatient attending
    rounds.

49
Oral Presentation Session
  • Youll be in a group of 7-8 students, half of
    whom will have seen the same patient you.
  • Youll have the opportunity to present and listen
  • In addition to the new patient oral presentation,
    youll have the opportunity to present in other
    contexts
  • This is safe, friendly environment!

50
Oral Presentation Session
  • Dont read your presentation!
  • Dont memorize your presentation!
  • Learn about the probable diagnoses and use the
    presentation to construct the story/argument you
    need to tell the attending needs to hear!
  • This is safe, friendly environment!

51
Best wishes
  • Focus on the patient and you wont go wrong!

52
ICC 7001 Schedules
  • In your packet
  • Posted on Black Board
  • Shadowing time and place posted at Orientation
    Black Board
  • Professionalism small groups posted
  • Other?
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