EBCOE

1
E-BCOE

• Clerkship Feedback 2005-2006
• Ilana Halperin and Noah Ivers
• Meds 2007

2
Agenda

• 1.0 Introduction 10 Min.
• 2.0 Data Review and Discussion
• 2.1 Surgery 30 Min.
• 2.2 Medicine 30 Min.
• 2.3 Break 10 Min.
• 2.4 Paediatrics 15 Min.
• 2.5 OB/GYN 20 Min.
• 2.6 Psychiatry 15 Min.
• 2.7 Family Medicine 15 Min.
• 3.0 Conclusions and Future Plans 15 Min.

3
Introduction

• Online survey
• http//www.schulich.uwo.ca/survey/Login.asp
• Email with survey links sent out every 6 weeks.
• Draw for 125 to chapters done every 12 weeks.
• Data kept on online software until transferred to
  excel then deleted.

4
Introduction

• New Format Online Surveys
• Pros
• Higher N than last year
• Better breakdown of data into specialties and
  locations
• Rotation-specific questions in Paeds, OB, FM,
  Medicine
• Will improve next year
• Cons
• Low N compared to BCOE in years 1 and 2
• Same students always fill out surveys
• We did make some errors, first time with online
  surveys.
• EXAMPLES Some people filled out multiple surveys
  (most likely forgot they filled it out the first
  time), Data tabulation was more onerous than
  anticipated

5
Surgery

• Previous BCOE Feedback
• General Strengths
• Formal teaching sessions
• Level of independence
• Variety of problems
• General Weaknesses
• Objectives and evaluation methods not clearly
  detailed from outset
• Inadequate opportunity for participation in OR
• Lack of firm post-call protocol
• Inadequate informal/resident teaching
• Problems related to St. Joes and Hospital
  Restructuring

6
General Surgery Windsor
Question
Average Rating, N9
Time spent in formal teaching sessions
2.2
Time spent on informal clinical teaching
2.1
5.7
Supervisors aware of objectives appropriate for
clerk
5.4
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
4.8
Feedback given throughout rotation
4.8
5.7
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
5.1
5.2
Teachers modeled respect for other health
professionals
6.0
I would recommend this rotation to friends
7
General Surgery London
Question
Average Rating, N38
Time spent in formal teaching sessions
2.1
Time spent on informal clinical teaching
1.7
5.8
Supervisors aware of objectives appropriate for
clerk
6.2
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
4.8
Feedback given throughout rotation
4.5
5.9
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
5.3
5.3
Teachers modeled respect for other health
professionals
5.9
I would recommend this rotation to friends
8
Surgery Selectives Windsor
Question
Average Rating, N12
Time spent in formal teaching sessions
2.2
Time spent on informal clinical teaching
2.1
5.1
Supervisors aware of objectives appropriate for
clerk
4.8
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
5.3
Feedback given throughout rotation
4.7
5.4
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
5.7
5.7
Teachers modeled respect for other health
professionals
5.4
I would recommend this rotation to friends
9
Surgery Selectives London
Question
Average Rating, N61
Time spent in formal teaching sessions
1.9
Time spent on informal clinical teaching
1.9
5.6
Supervisors aware of objectives appropriate for
clerk
5.5
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
5.5
Feedback given throughout rotation
5.1
5.7
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
5.6
5.9
Teachers modeled respect for other health
professionals
5.9
I would recommend this rotation to friends
10
Anasthesia Windsor
Question
Average Rating, N6
Time spent in formal teaching sessions
2
Time spent on informal clinical teaching
2.2
6.2
Supervisors aware of objectives appropriate for
clerk
6.2
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
6.2
Feedback given throughout rotation
6.3
6
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
6
5.4
Teachers modeled respect for other health
professionals
6.3
I would recommend this rotation to friends
11
Anasthesia London
Question
Average Rating, N25
Time spent in formal teaching sessions
1.9
Time spent on informal clinical teaching
2.1
5.5
Supervisors aware of objectives appropriate for
clerk
5.4
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
5
Feedback given throughout rotation
5
5.5
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
5.4
5.8
Teachers modeled respect for other health
professionals
5.6
I would recommend this rotation to friends
12
ER Windsor
Question
Average Rating, N8
Time spent in formal teaching sessions
2
Time spent on informal clinical teaching
2.1
5.3
Supervisors aware of objectives appropriate for
clerk
5.8
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
5.4
Feedback given throughout rotation
5.3
5.6
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
5.4
5.4
Teachers modeled respect for other health
professionals
5.6
I would recommend this rotation to friends
13
ER London
Question
Average Rating, N36
Time spent in formal teaching sessions
1.7
Time spent on informal clinical teaching
1.7
4.4
Supervisors aware of objectives appropriate for
clerk
5.4
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
4.5
Feedback given throughout rotation
4
5.8
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
5
5.3
Teachers modeled respect for other health
professionals
4.9
I would recommend this rotation to friends
14
Surgery Comments

• Negative
• In Windsor Gen Sx, students often not called to
  ward when on-call
• In London Gen Sx, most time spent with residents,
  but consultants fill out evaluation
• In London Gen Sx, 20 of students said the call
  policy was not adhered to schedules were not
  available in advance and post-call culture is
  still an issue
• In Windsor Plastic Sx had too much cosmetics
• In London Anasthesia sometimes offered few
  opportunities for intubation
• In London Selectives had poor communication of
  schedules and call expectations
• In ER, some consultants were not interested in
  teaching clerks
• In London ER, students felt they were a burden
  and it was difficult to find consultants to
  report to
• Overall, students not interested in surgery often
  were treated differently by the team

• Positive
• In Windsor Gen Sx, great opportunities for
  hands-on experience
• In London Gen Sx, great teamwork experience,
  well-defined role/responsibilities
• In London Gen Sx, call was regarded as a valuable
  learning experience
• Anasthesia offered excellent one-on-one teaching
• ER had good variety of patients and opportunities
  for procedures

15
Surgery 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 Anasthesia, 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
• Noteworthy Teachers
• Windsor Drs. Hartwell, Petrakos, GenSx Taylor,
  Alsaden, Anasthesia St. Amand, Nisbet, ER
  Yousif Ortho
• London Drs. Quan, Rajgopal, Colquhoun, Taylor,
  Vinden, GenSx Scott, Brock, Matic, Faber, Gan,
  Pautler, Malthaner, Luke, Nguyen, Ng,
  Selectives McCabe, Anasthesia Regan, Lewell
  ER

16
Medicine

• Previous BCOE Feedback
• No Recent Feedback for CTU
• General Strengths
• Elder care was viewed to be an excellent learning
  experience, with strengths in formal teaching and
  patient centered approach
• Oncology had an excellent student handbook
• General Weaknesses
• Elder care had inadequate patient variety and
  students did not appreciate having to travel b/w
  sites
• Oncology had significant blocks of free time
  mid-day

17
Medicine CTU - ACE
Question
Average Rating, N10
Time spent in formal teaching sessions
1.9
Time spent on informal clinical teaching
1.6
5.4
Supervisors aware of objectives appropriate for
clerk
5.8
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
5.5
Feedback given throughout rotation
4.6
3.9
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
5
5.5
Teachers modeled respect for other health
professionals
5
I would recommend this rotation to friends
18
Medicine CTU - ACE
Question
Average Rating, N10
5.7
The team was organized and collegial
Role of clerk well defined
5.2
Consultant and/or residents available for advice
5.6
Role of allied health care clearly delineated
5.4
3.4
Opportunity to observe/perform procedures
19
Medicine CTU - Vic
Question
Average Rating, N11
Time spent in formal teaching sessions
2
Time spent on informal clinical teaching
1.4
4.9
Supervisors aware of objectives appropriate for
clerk
5.5
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
5.5
Feedback given throughout rotation
4.8
5.4
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
4.8
5.6
Teachers modeled respect for other health
professionals
5
I would recommend this rotation to friends
20
Medicine CTU - Vic
Question
Average Rating, N10
5.2
The team was organized and collegial
Role of clerk well defined
4.7
Consultant and/or residents available for advice
5.4
Role of allied health care clearly delineated
5.1
3.4
Opportunity to observe/perform procedures
21
Medicine CTU - UH
Question
Average Rating, N30
Time spent in formal teaching sessions
2
Time spent on informal clinical teaching
1.5
5.2
Supervisors aware of objectives appropriate for
clerk
5.6
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
5.2
Feedback given throughout rotation
4.5
5.5
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
5.1
5.8
Teachers modeled respect for other health
professionals
5.8
I would recommend this rotation to friends
22
Medicine CTU - UH
Question
Average Rating, N10
5.7
The team was organized and collegial
Role of clerk well defined
5.6
Consultant and/or residents available for advice
5.5
Role of allied health care clearly delineated
5.5
3.2
Opportunity to observe/perform procedures
23
Medicine Selectives
Question
Average Rating, N44
Time spent in formal teaching sessions
1.7
Time spent on informal clinical teaching
2
5.2
Supervisors aware of objectives appropriate for
clerk
5.7
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
5.1
Feedback given throughout rotation
4.6
5.5
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
5.6
5.9
Teachers modeled respect for other health
professionals
5.7
I would recommend this rotation to friends
24
Medicine Selectives
Question
Average Rating, N10
5.5
The team was organized and collegial
Role of clerk well defined
4.9
Consultant and/or residents available for advice
5.5
Role of allied health care clearly delineated
5.3
3.5
Opportunity to observe/perform procedures
25
Oncology Windsor
Question
Average Rating, N4
Time spent in formal teaching sessions
1.5
Time spent on informal clinical teaching
1.8
5.5
Supervisors aware of objectives appropriate for
clerk
6
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
4.8
Feedback given throughout rotation
4.3
6
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
4.8
6
Teachers modeled respect for other health
professionals
6
I would recommend this rotation to friends
26
Oncology London
Question
Average Rating, N35
Time spent in formal teaching sessions
1.6
Time spent on informal clinical teaching
1.9
4.9
Supervisors aware of objectives appropriate for
clerk
4.9
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
4.5
Feedback given throughout rotation
3.8
5.4
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
5.1
5.4
Teachers modeled respect for other health
professionals
4.9
I would recommend this rotation to friends
27
Elder Care Windsor
Question
Average Rating, N4
Time spent in formal teaching sessions
1.8
Time spent on informal clinical teaching
1.8
4.8
Supervisors aware of objectives appropriate for
clerk
4.3
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
4
Feedback given throughout rotation
4.5
4
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
5
6
Teachers modeled respect for other health
professionals
4.8
I would recommend this rotation to friends
28
Elder Care London
Question
Average Rating, N22
Time spent in formal teaching sessions
2.3
Time spent on informal clinical teaching
1.9
5.6
Supervisors aware of objectives appropriate for
clerk
4.9
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
4.8
Feedback given throughout rotation
5.2
5.1
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
5.5
6.1
Teachers modeled respect for other health
professionals
5.1
I would recommend this rotation to friends
29
Ophtho, London
Question
Average Rating, N13
Time spent in formal teaching sessions
1.2
Time spent on informal clinical teaching
1.5
4.6
Supervisors aware of objectives appropriate for
clerk
3.7
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
3.2
Feedback given throughout rotation
2.8
4.1
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
4.5
5.2
Teachers modeled respect for other health
professionals
3.5
I would recommend this rotation to friends
30
ENT, London
Question
Average Rating, N14
Time spent in formal teaching sessions
1.4
Time spent on informal clinical teaching
1.9
4.8
Supervisors aware of objectives appropriate for
clerk
4
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
4.3
Feedback given throughout rotation
3.6
5.5
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
5.4
5.1
Teachers modeled respect for other health
professionals
4.6
I would recommend this rotation to friends
31
Medicine Comments

• Positive
• In Ophtho, opportunity to use slit lamp
• In ENT, good variety and learning of skills in
  clinic
• London Geriatrics was well-organized with good
  intro and opportunities to discuss cases
  throughout rotation.
• In London Oncology, good practice with hx, px,
  and dictations and lots of variety

• Negative
• In Ophtho, scheduling was poor, minimal
  role/responsibility for clerks and inadequate
  teaching
• In ENT, inadequate teaching
• In Windsor Geriatrics, not enough formal teaching
  and experience with family docs in nursing homes
  not of high utility
• In London Geriatrics, schedule not known in
  advance and limited independence in psych
• In London Oncology, schedule not provided ahead
  in advance and inadequate formal teaching with
  not enough patient contact

32
Medicine Comments

• Positive
• At UH, great team atmosphere, good resident
  teaching and independence
• At ACE, good resident teaching, team rapport and
  multidisciplinary approach
• At VIC, good independence, variety and teaching

• Negative
• At UH, more feedback requested throughout
  rotation.
• At UH, variable experiences and learning
  opportunities depending on team size
• At ACE, poor variety often more interesting and
  acute cases went to CTU diminishing learning
  opportunities.
• At VIC, many students had poor comments about ER
  Triage and floor call on mega-team.

33
Medicine Conclusions

• Strengths
• Formal teaching and independence in CTU, working
  with allied health, changes to 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 Ophtho 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 all12 weeks of medicine
  teaching sessions, ie during oncology
• Leave Geriatric psych for the 6-week psych block
  and focus on medical issues instead, or allow
  students to work on consult service.
• Noteworthy Teachers
• Drs. Sexton, Vandenburg, Hammond, Dingle,
  Vincent, Oncology Borrie, Diachun, Hurwitz, Van
  Bussel, Soong (Windsor), Geriatrics Franklin,
  Fung, ENT Rehman, Thompson, McManus, Johnson,
  Myers, Brymer, Gregor Medicine

34
Paediatrics

• Previous BCOE Feedback
• General Strengths
• Windsor ranked very highly
• Exam-style cases in student manual helpful
• Good exposure to procedures in PCCU
• General Weaknesses
• Inadequate formal teaching sessions especially
  during CTU and in NICU
• Inadequate bedside teaching
• Lack of independence/responsibility

35
Paediatrics Windsor
Question
Average Rating, N10
Time spent in formal teaching sessions
2.0
Time spent on informal clinical teaching
2.1
6.4
Supervisors aware of objectives appropriate for
clerk
6.3
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
6.2
Feedback given throughout rotation
5
6.3
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
6.5
6.5
Teachers modeled respect for other health
professionals
6.7
I would recommend this rotation to friends
36
Paediatrics Windsor
Question
Average Rating, N10
6.7
More comfortable communicating with
patients/family
More comfortable examining paeds patients
6.7
6.7
More confident with clinical reasoning skills for
paeds
CLIPP cases were helpful
5.5
5.8
More paeds in years 12 would have increased my
comfort
37
Paediatrics Rural
Question
Average Rating, N13
Time spent in formal teaching sessions
1.8
Time spent on informal clinical teaching
2.1
6.1
Supervisors aware of objectives appropriate for
clerk
6.2
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
5.8
Feedback given throughout rotation
5.2
5.6
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
5.6
5.8
Teachers modeled respect for other health
professionals
6.2
I would recommend this rotation to friends
38
Paediatrics Rural
Question
Average Rating, N10
6.2
More comfortable communicating with
patients/family
More comfortable examining paeds patients
6.3
More confident with clinical reasoning skills for
paeds
5.8
CLIPP cases were helpful
6.7
5.2
More paeds in years 12 would have increased my
comfort
39
Paediatrics London
Question
Average Rating, N39
Time spent in formal teaching sessions
1.8
Time spent on informal clinical teaching
1.6
5.4
Supervisors aware of objectives appropriate for
clerk
5.4
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
4.8
Feedback given throughout rotation
4.7
5.7
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
5.2
5.6
Teachers modeled respect for other health
professionals
5.3
I would recommend this rotation to friends
40
Paediatrics London
Question
Average Rating, N10
6.2
More comfortable communicating with
patients/family
More comfortable examining paeds patients
6.3
More confident with clinical reasoning skills for
paeds
5.8
CLIPP cases were helpful
6.1
6.2
More paeds in years 12 would have increased my
comfort
41
Paediatrics Comments

• Positive
• In Windsor, excellent teaching physicians very
  good role models.
• In Windsor, great opportunities to follow
  patients from ER thru inpatient stay
• In Rural, great one-on-one teaching In Chatham,
  students supplied with excellent resource binder
• In London, ER highly rated for teaching and
  variety

• Negative
• In Windsor, very long hours and relatively more
  call, limiting time for independent study.
• In Windsor, organization could be improved
• For Rural, Tele/Video-Conferencing is not
  well-received and call expectations are not clear
  and experiences are varied
• In London, CTU teams were often too busy with
  minimal time for informal teaching
• In London, some students were unable to leave by
  noon post-call
• Lecture series not very well-received
• Lack of mid-rotation feedback at all centres

42
Paediatrics Conclusions

• Strengths
• Increased abilities and comfort with paeds, 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
• Noteworthy Teachers
• Drs. Tithecott, Lacroix, Awuku, Morgan, Lim,
  Frewen, Rieder

43
OB/GYN

• Previous BCOE Feedback
• General Strengths
• Family doctor teaching during block
• Significantly more hands-on experience in Windsor
• Teaching by clinicians
• General Weaknesses
• Difficulty getting experience and working with
  nurses in delivery room
• Unclear of responsibilities and expectations
• Pre-rounding thought to be redundant
• Uncertain scheduling of teaching sessions

44
OB/GYN Windsor
Question
Average Rating, N12
Time spent in formal teaching sessions
1.4
Time spent on informal clinical teaching
1.7
4.7
Supervisors aware of objectives appropriate for
clerk
5.5
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
5.2
Feedback given throughout rotation
4.5
4.6
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
5.4
6.1
Teachers modeled respect for other health
professionals
6.2
I would recommend this rotation to friends
45
OB/GYN Windsor
Question
Average Rating, N12
5.5
Best clinical teaching was on-call
4.1
Best clinical teaching was in D.R.
Best clinical teaching was in clinic
4.4
Comfortable providing well-woman physicals
5.9
6.5
Comfortable providing antepartum care for
low-risk OB
46
OB/GYN London St. Joes
Question
Average Rating, N20
Time spent in formal teaching sessions
1.6
Time spent on informal clinical teaching
1.6
4.3
Supervisors aware of objectives appropriate for
clerk
4.5
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
4.4
Feedback given throughout rotation
4.4
4.5
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
4.7
4.5
Teachers modeled respect for other health
professionals
3.5
I would recommend this rotation to friends
47
OB/GYN London St. Joes
Question
Average Rating, N20
4.3
Best clinical teaching was on-call
4.3
Best clinical teaching was in D.R.
Best clinical teaching was in clinic
4.9
Comfortable providing well-woman physicals
4.7
5.2
Comfortable providing antepartum care for
low-risk OB
48
OB/GYN London Vic
Question
Average Rating, N15
Time spent in formal teaching sessions
2
Time spent on informal clinical teaching
1.7
4.9
Supervisors aware of objectives appropriate for
clerk
5.1
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
5
Feedback given throughout rotation
4.1
4.8
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
5.3
5.4
Teachers modeled respect for other health
professionals
5.1
I would recommend this rotation to friends
49
OB/GYN London Vic
Question
Average Rating, N15
4.6
Best clinical teaching was on-call
3.4
Best clinical teaching was in D.R.
Best clinical teaching was in clinic
5.3
Comfortable providing well-woman physicals
5.7
6
Comfortable providing antepartum care for
low-risk OB
50
OB/GYN Comments

• Positive
• In Windsor, good variety and independence, lots
  of hands-on, especially deliveries
• In London-VIC, great clinician-teachers and some
  residents were very good teachers. Good
  opportunities for deliveries and good generalist
  focus.
• In London-St.Joes, good teaching from some
  clinicians and residents.
• Post-call policy followed

• Negative
• In Windsor, learning opportunities were missed,
  especially on call. Friday morning formal
  teaching was not well-prepared.
• In Windsor, not enough emphasis on gyne
• In Chatham, both formal and informal teaching was
  lacking
• In London-VIC, the nurses in the DR were not
  conducive to clerk learning
• In London-St.Joes, there was too much
  subspecialty work, not enough exposure to routine
  physical exam skills.
• In London-St.Joes some consultants who were not
  interested in teaching clerks or providing
  feedback.
• In London-St.Joes, the attendance card was felt
  to discourage responsible adult learning.
• In London-St.Joes, pre-rounding was redundant
• In London-St.Joes, the 2nd clerk on-call had no
  work many clerks had 5/6 weekends on-call

51
OB/GYN Conclusions

• Strengths
• Increased comfort w 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.
• Noteworthy Teachers
• Drs. Patel, Pattinson, Jasey, Maruncic, Usher,
  Crumley, MacMillan, Fellows, Penava

52
Psychiatry

• Previous BCOE Feedback
• General Strengths
• Very high rating for rural experiences
• Good teaching from clinicians
• General Weaknesses
• More outpatient experience requested
• Too much paperwork
• Child Psych groups too large

53
Psychiatry Windsor
Question
Average Rating, N8
Time spent in formal teaching sessions
2.1
Time spent on informal clinical teaching
1.9
5.9
Supervisors aware of objectives appropriate for
clerk
6.5
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
5.4
Feedback given throughout rotation
5.4
6
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
5.9
6.4
Teachers modeled respect for other health
professionals
6
I would recommend this rotation to friends
54
Psychiatry Rural
Question
Average Rating, N18
Time spent in formal teaching sessions
2
Time spent on informal clinical teaching
1.9
6
Supervisors aware of objectives appropriate for
clerk
5.8
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
5.6
Feedback given throughout rotation
5.8
5.9
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
6
6.3
Teachers modeled respect for other health
professionals
6.5
I would recommend this rotation to friends
55
Psychiatry London
Question
Average Rating, N26
Time spent in formal teaching sessions
2
Time spent on informal clinical teaching
1.6
4.8
Supervisors aware of objectives appropriate for
clerk
5.2
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
4.4
Feedback given throughout rotation
4.1
4.4
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
5
5.5
Teachers modeled respect for other health
professionals
4.5
I would recommend this rotation to friends
56
Psychiatry Comments

• Positive
• In Windsor, great preceptors, and especially good
  outpatient exposure
• In Rural, good independence, teaching and variety
• In London, good opportunity to become more
  comfortable with psych patients and mental
  illness, good exposure to acute and chronic
  problems

• Negative
• In Windsor, some preceptors see fewer patients
• In London, learning during call was minimal,
  students often not involved in treatment plan
• In London, RMHC ward patients are very chronic
  with no active issues and minimal learning points
  for clerks
• In London, the on-call experience is not ideal
  for learning. There are too many learners/nurses
  there before midnight and too few after. Often
  when students do stay or are called in after
  midnight, the post-call policy is not enforced.
• Wednesday morning lectures are not well-received
• Child psych often involves no patient interaction
• Exam was not reflective of rotation

57
Psychiatry 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).
• Noteworthy Teachers
• Drs. Velehorschi, Chandrasena, Cleto, Lefcoe

58
Family Medicine

• Previous BCOE Feedback
• General Strengths
• Excellent variety, independence and informal
  teaching on community (4 week) rotation
• Excellent example of patient-centered approach
  and good variety in academic rotation
• General Weaknesses
• Inadequate formal teaching, unclear objectives
  and minimal contact with block coordinator during
  community (4 week) rotation
• Low patient-load and minimal formal teaching
  during academic rotation

59
Family 2 Weeks Windsor
Question
Average Rating, N7
Time spent in formal teaching sessions
1.6
Time spent on informal clinical teaching
2
5.4
Supervisors aware of objectives appropriate for
clerk
6.3
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
5.9
Feedback given throughout rotation
4.6
5.9
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
6.3
6.3
Teachers modeled respect for other health
professionals
5.6
I would recommend this rotation to friends
60
Family 2 Weeks Windsor
Question
Average Rating, N7
6.1
Emphasized effective patient and family
communication
6.1
Fostered cost-effective approach
Preventative medicine encouraged
6
Encouraged to involve patients in clinical
decisions
5.4
6.1
Teachers demonstrated empathy, respect,
compassion and were non-judgemental towards
patients
61
Family 2 Weeks London
Question
Average Rating, N37
Time spent in formal teaching sessions
1.7
Time spent on informal clinical teaching
2
5.8
Supervisors aware of objectives appropriate for
clerk
5.9
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
5.5
Feedback given throughout rotation
5.5
5.3
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
5.7
6.1
Teachers modeled respect for other health
professionals
5.7
I would recommend this rotation to friends
62
Family 2 Weeks London
Question
Average Rating, N37
6
Emphasized effective patient and family
communication
5.7
Fostered cost-effective approach
Preventative medicine encouraged
6
Encouraged to involve patients in clinical
decisions
5.9
6.2
Teachers demonstrated empathy, respect,
compassion and were non-judgemental towards
patients
63
Family Medicine 4 Weeks
Question
Average Rating, N38
Time spent in formal teaching sessions
1.8
Time spent on informal clinical teaching
2
5.5
Supervisors aware of objectives appropriate for
clerk
6.2
Appropriate level of independence
Evaluation fairly assessed my knowledge and
abilities
5.6
Feedback given throughout rotation
5.6
6.3
Variety of patient problems
Teachers modeled positive gender/diversity
attitudes
5.8
6.3
Teachers modeled respect for other health
professionals
6.2
I would recommend this rotation to friends
64
Family 4 Weeks
Question
Average Rating, N38
6.3
Emphasized effective patient and family
communication
6.1
Fostered cost-effective approach
Preventative medicine encouraged
6.1
Encouraged to involve patients in clinical
decisions
6
6
Teachers demonstrated empathy, respect,
compassion and were non-judgemental towards
patients
65
Family Medicine Comments

• Positive
• In Windsor, very good patient exposure,
  easy-going preceptors, used to having students
  (as compared to rural)
• In London academic block, some students felt
  clinicians were very dedicated to ensuring a
  broad and comprehensive exposure to family
  medicine

• Negative
• In London academic block, too few patients
• In London academic block, students complained
  about being evaluated on physical exam skills
  without being observed
• Few formal lectures
• Learning objectives daunting

66
Family Medicine 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
• Noteworthy Teachers
• Drs. Yanchula, Schumacher, Parr, Sangster, Wong,
  Lyons, Schmidt, Hammond, Lent

67
Conclusions Systemic Issues

• ISSUES
• Advance notice of schedules. Call policy document
  dictates at least 2 weeks notice.
• Informal teaching is sacrificed on busy wards.
• Windsor call experience does not capitalize on
  learning opportunities.

• SUGGESTIONS
• Admin staff must circulate schedules earlier,
  make use of email and websites for communication.
• Decrease variability of team sizes. Ensure
  protected resident to clerk teaching time, allow
  clerks to evaluate residents teaching.
• Continue educating nurses and faculty re clerk
  role on call.

68
Conclusions Systemic Issues

• ISSUES
• ER in London has limited capacity for teaching
  clerks.
• Only half of the class gets any elder care
  teaching.
• ENT/OPHTHO ranked poorly and half the class is
  assigned there.

• SUGGESTION
• After elder care study complete consider
• Move ER to the medicine block and make the
  rotation a one week experience with the same
  preceptor throughout. The second week would be a
  single week of geriatric medicine. While
  geriatric psychiatry is integrated into the
  psychiatry block.
• Return ENT and OPHTHO to the surgery block as two
  week individual selectives. This should permit
  students to attend surgery teaching and still get
  adequate exposure to that selective.

69
Discussion

• What is the Future of BCOE in Clerkship?
• Redundancy with one45
• vs.
• Potential for improvement and importance of
  student buy-in