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2012 AAMC National Convention Update

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2012 AAMC National Convention Update Mindy Colgrove Primary OSR Representative – PowerPoint PPT presentation

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Title: 2012 AAMC National Convention Update


1
2012 AAMC National Convention Update
  • Mindy Colgrove
  • Primary OSR Representative

2
Student-Raised Issues
  • Wellness
  • Diversity
  • Reporting mistreatment in medical education
  • Sharing standardized high-quality lectures across
    campuses
  • Increasing financial debt and how students handle
    their financial debt
  • OSRs role in LCME accreditation for each school

3
OSR Sessions
4
Thoughtful Points
  • Many students dont understand that Medicare
    helps fund residencies so cutting the Medicare
    budget cuts the residency budget as well.
  • When you sign up for the role of a physician you
    automatically sign up to be a role model and a
    leader even if you dont want to be one.
  • We are born patients and will die patients. Look
    at things from the patients perspective.

5
Important Issues
  • Anonymous reporting by staff and peers on poor
    professionalism is important
  • GRMC meetings AAMC group which deals with
    regional campus issues
  • 92 regional campuses in the US and 14 in Canada
  • gt50 of medical schools have a regional campus
  • 1st ever OSR liaison on the GRMC committee
    currently he takes student concerns about
    regional campus issues to the AAMC directly

6
Breakout Session
  • Social media If you dont make your own online
    presence, someone else will do it for you and it
    may not be good. Put out correct information
    about who you are rather than having to change
    your Facebook name during residency application
    dates.
  • Honor the Humanism In Medicine Award nominees
    locally to guarantee they are recognized for
    their achievements.

7
Methods At Other Schools
  • Changes to curriculum grading
  • School surveys sent to recent grads/interns for
    their opinions on grading because they interact
    with people trained at other schools and have
    their skills tested
  • Mistreatment reporting
  • Committee reviews anonymous complaints
  • Hotline pager or answering machine
  • Discuss examples at student orientation (i.e.
    pimping to the point of public humiliation)
  • Fine faculty like athletes based on the
    number/severity of complaints
  • Is the aftermath/backlash a deterrent to student
    reporting?
  • We all have a duty to report observed mistreatment

8
Poster Session
  • Baylor College of Medicine Baylor Community
    Service Day 5-6 hours of service in the
    community on the Saturday of orientation for M1s
  • Cleveland Clinic Lerner College of Medicine of
    Case Western Reserve University Cleveland
    Clinic Lerner College of Medicine's Capstone
    Experience 2 weeks around match day, ACLS
    accreditation over 2 days, review of some
    important basic science and condition management
    info necessary for intern year
  • Eastern Virginia Medical School Anatomy Guy
    Engaging the World by Engaging Students and
    Faculty in Vertically Integrated Medical
    Curriculum for the Web
  • Indiana University School of Medicine Indiana
    University Simulation Integration Rubric (IUSIR)
    interprofessional simulation with nursing and
    medical students, 2 years on the same team, learn
    each others role and how to interact with each
    other on cases via simulation

9
  • Texas AM Health Sciences Center College of
    Medicine OSR Role During LCME Preparation and
    Site Visit have the faculty speak to the
    students about what they need the students to
    know and do, have OSR organize PowerPoint
    presentations and really inform the students, OSR
    should serve as the point person between the
    faculty and the students for explaining things to
    the students and organizing the students to
    cooperate and help the school, avoid sending tons
    of emails
  • University of Mississippi School of Medicine
    Designing a Medical School Capstone Course a
    couple weeks during the 4th year, transition to
    intern year with topics like 1) caring for a
    critical patient, 2) fluid management, 3)
    managing airways, and 4) common residency
    complaints, allow each individual the opportunity
    to fail in a simulation setting rather than with
    a real patient so they can learn from mistakes
    prior to residency
  • University of Oklahoma College of Medicine
    Capstone The Culmination and Highlight of
    Curriculum 2010 9 weeks, each one reviews one of
    the major science topics, lectures/grand
    rounds/simulations/interactive sessions, question
    of whether more appropriate for M2 rather than M4

10
NBME
  • comprehensive basic and clinical science exams
  • assess prep for USMLE
  • pretest questions are embedded in all exams
  • exams can be taken at Prometric centers
  • away students can utilize
  • customized assessments for staff
  • clinical science mastery exams new self
    assessments for preparation for clerkship exams,
    50 questions, started November 1st, 20, will try
    to bundle within next year
  • plan to enhance feedback about student pacing on
    exam
  • step 2 CK passing score changed over summer and
    will be reviewing CS standards next month

11
  • Step 2 CS changes
  • 1) for each case patient will watch for specific
    behaviors to assess communication skills, looking
    for 5 skills (foster relationship, support
    emotions/empathy, gather info, provide info, help
    patient make decisions, and soon will include 6th
    - enable patient behaviors/behaviorally council
    someone), no longer effective to ask all the
    questions you can think of to get the checks on a
    list, will assess these skills in more detail
    over next several years, you will be expected to
    modify your behavior based on the case/symptoms
  • Examinees demonstrate the ability to foster the
    relationship by listening attentively and showing
    interest, care, concern, and respect.
  • Skills in gathering information are demonstrated
    by establishing a chronology of the primary
    problem, including any additional concerns of the
    patient, and by encouraging the patient to
    explain the situation in his/her own words,
    including describing priorities, worries, and/or
    explanations of how the health issue has affected
    the patient.
  • Skills in providing information are demonstrated
    by giving an explanation of what is likely
    occurring, using clear and understandable
    statements matching the amount of information
    and content to a patients need and preference
    and encouraging and answering questions, while
    checking for patient understanding.
  • Helping the patient make decisions is
    demonstrated by outlining what should happen
    next, linked to a rationale, and by assessing a
    patients level of agreement, willingness, and
    ability to carry out next steps.
  • Examinees demonstrate ability to support emotions
    when a clinical situation warrants by seeking
    clarification or elaboration of the patients
    feelings and by using statements of understanding
    and support.
  • 2) patient note will still have to report what
    was learned/found in history and physical but now
    will have to only list 3 differential diagnoses
    (instead of 5) and explain how the info you
    learned supports them, dont leave blanks
    assuming it carries over from whats already
    written! (this is the biggest mistake students
    have been making)

12
  • Step 3 changes in 2014 it will become 2 separate
    days of exams rather than 1exam over 2 days, no
    longer required to take on back-to-back days,
    will enhance foundational science to assess
    similar material as step 1 but in a clinical
    context, eventually would like to have patient
    care exam and other competency exam, will still
    be 1 score for now until properly functions
    separately (about 1 year) then will give 2 scores
  • DSMV scheduled to come out in May, all psychiatry
    items on all exams will be reviewed, initially
    NBME will only use questions that will not be
    affected with changes
  • Will be getting rid of 2 digit scores on USMLE
    exams within next year or so because the 3 digit
    score is used for assessment more often
  • examples of exam literature interpretation
    questions on website, this type of question is on
    step 2 and 3 currently

13
NRMP Residency Match
  • SOAP supplemental offer and acceptance program
  • 600 PGY1 positions were added in 2012 but the
    number of applicants increased more, 95 of
    allopathic students matched and 75 of
    osteopathic students matched, 81 ratio of
    unmatched students to unfilled positions (131
    when considering students who didnt rank on the
    initial application)
  • US seniors increased by 1100, independent
    applicants increased 20 (about 2000)
  • to participate in SOAP a student MUST be eligible
    to participate in a residency by July 1
  • residencies can choose not to participate in SOAP
    but most do
  • the open spots for SOAP are usually 1 year
    preliminary programs in the areas of internal
    medicine and surgery or family medicine positions

14
  • round 1 of SOAP had 2 rounds and 260 spots of the
    1246 open spots remained after those rounds (only
    1131 participated), 106 spots remained after the
    second day of matching, and 98 remained in the
    end
  • seniors do better than those who take a year off
  • odds of matching through SOAP are NOT good, youd
    rather match the first time
  • this year the all-in policy is starting, all US
    allopathic seniors must be offered positions
    through a match and cannot withdraw themselves,
    programs must place all or no positions in the
    match (must attempt to fill all) except for
    accelerated programs/rural programs/off-cycle
    residents starting before February 1/dual ACGME
    and AOA programs/military selection board
    applicants in a civilian program
  • nrmp.org

15
ERAS Residency Application
  • MyERAS 2013 dashboard central page with
    progress of each part (summary/review)
  • PDF version of user guide is the most exhaustive
    resource and the power points hit the high
    spots
  • MyERAS worksheet simulates application experience
    prior to registration opening
  • Twitter account launch in December
  • applicants have ERAS access for SOAP at noon on
    Monday for 1 hour to do research on programs,
    have from 1pm on Monday until 1159 am on
    Wednesday to use 30 applications and two
    following rounds each with 10 applications to use
    by Friday

16
Learner Mistreatment
17
Learner Mistreatment
  • Most common areas include gender, sexual
    orientation, physical harm, and public
    humiliation
  • On the 2012 Graduate Questionnaire (GQ) 16 of
    students had experienced sexual harassment and
    34 had experienced public humiliation
  • Not everyone has the right to teach, and if they
    cant figure out how to teach without mistreating
    learners after being warned they should be
    removed from the teaching position
  • Mistreatment should be considered under
    professionalism

18
Learner Mistreatment
  • Many people dont recognize or report
    mistreatment because they expect certain
    experiences in the medical education culture
  • Faculty
  • Train faculty to give their peers feedback about
    what is considered mistreatment rather than the
    administration giving feedback
  • Use online modules for faculty training
  • Train entire department what is considered
    mistreatment
  • Do grand rounds with each department and show
    them their own data (degree of mistreatment
    reports filed against that departments
    personnel) and give more intervention to the
    departments with more violations

19
Learner Mistreatment
  • Deliver the information about a
    violation/accusation to the offender right away
    (90 second warning or coffee meeting) rather than
    waiting until its too late to intervene or
    everyone forgets the details about the event in
    question
  • We come into medical education as learners, and
    before we know it weve become one of them
  • Our medical education culture is that of an
    abusive family
  • Misuse of power vs. positive/constructive use
  • Gray zones in definition
  • a little pimping pushes learners to
    achieve/prepare
  • excessive pimping when the student clearly
    doesnt know the answers causes public humiliation

20
New Visions
  • Dr. Erik J. Topal

21
New Visions
  • The creative destruction of medicine medicine
    will never be the same
  • Patient online health communities recently
    created for patients (and their families) with
    specific conditions to provide info and support
  • Theyre publishing articles
  • Patients trust their online peers more than their
    physicians in most cases
  • Johns Hopkins closed a medical school library
    because it wasnt being used (many books are
    online now)

22
New Visions
  • Zeo EEG headband connects to phone or radio and
    records brain waves during sleep
  • Popular among athletes to improve performance
    through sleep monitoring
  • Online competitions for best sleeper
  • Phone apps for monitoring BP, glucose, etc.
    (attach a device to the phone which takes the
    measurement, and the app reads and tracks the
    measurements)
  • One glucose measuring device remains on the body
    and takes measurements every minute to help with
    food choices

23
New Visions
  • AliveCor EKG for iPhone uses finger leads (place
    left finger and right finger in specific spots)
    to create an EKG image on the phone screen
  • In the future it will be possible to measure all
    vitals with one app (already created but waiting
    for approval)
  • Will be able to monitor vitals remotely with the
    patient in their own home
  • Heart attack ring tone goes off when it senses an
    MI
  • Skin Skan take a picture of a mole, etc. with
    the phone and an algorithm determines whether or
    not the patient should seek medical attention for
    a biopsy

24
New Visions
  • An eye refractor can be attached to the phone to
    give a prescription, avoiding visits to the eye
    doctor to update glasses
  • The idea to measure labs (thyroid, liver,
    electrolytes) using phones has been discussed
  • Chips can be put in pills to monitor compliance
    when it is vital (i.e. TB drugs)
  • A pocket-sized ultrasound device was given to all
    Mount Sinai M1s they are using these to look at
    every patients heart like an echocardiogram
    rather than just relying on heart sounds via
    stethoscopes

25
New Visions
  • An app exists which shows all the variants in
    your genome and their implications after it is
    sequenced
  • Mount Sinai M1 class had their entire genomes
    sequenced
  • In an NPR survey 81 of participants said they
    would have their genome sequenced if they could
    afford it
  • Were going to be using algorithms a lot more in
    the future
  • Virtual visits will become more important, and
    hospitals will be reserved for critical patients
    only

26
New Visions
  • Only 1/3 of doctors communicate with patients via
    email
  • A study showed that patients feel better after
    reading the doctors notes, dont take offense to
    whats written in the note, and adhere to their
    meds better after reading the note
  • Were not informing patients about how all the
    scans we perform are going to affect them in the
    long run (high levels of radiation exposure,
    especially for the severely ill)
  • New medicine participates with the individual and
    can be remarkably preventative

27
New Approaches
  • Sal Khan hedge fund account manager ? founder of
    the Khan Academy

28
New Approaches
  • The Khan Academy promotes a free world-class
    education for everyone by providing online videos
    for various subjects and education levels
    (including medical school)
  • 60 million users to date, 36 staff members, gt6
    million unique users per month
  • Google and Gates Foundation fund the program
  • Lessons go through a logical progression as
    concepts are mastered rather than receiving a bad
    grade on a test and moving on to a more advanced
    idea which requires mastery of the concept you
    performed poorly on

29
New Approaches
  • The Khan Academy was created as a supplement to
    existing schools, but it has started replacing
    traditional lectures (do videos on own time) so
    that classroom time can be more interactive
  • Analysis of the Khan Academys data shows that
    students can go from the middle or bottom of the
    class to the 2nd or 3rd student in the class when
    they are allowed to work at their own pace
  • 5th graders are doing trigonometry with the
    program and think its 6th grade math

30
New Approaches
  • Kids in other countries who have to work instead
    of going to school can use the Khan Academy
  • Orphans in Mongolia recently started using the
    program and making videos in their own language
  • In the last year 24 employees reached 216
    countries
  • Wikipedia has 1/10th the errors of Britannica,
    etc.
  • The Khan Academy isnt a crowd source site ?
    consistent high quality, credible background,
    comments made by reviewers and errors fixed
    quickly

31
New Approaches
  • Teachers should not feel threatened because the
    goal is not to replace teachers and physical
    classrooms in med school they want to enhance
    the experience
  • Dr. Rishi Desai is a resident helping to make
    videos for medical education, including core med
    school content hes the one to talk to about
    collaboration in medicine
  • MCAT prep course is something they want to
    collaborate on

32
New Approaches
  • Theres no reason why there should be a lecture
    when people get together, more cases/conversations
    /questions can be done in person
  • Accelerate the 1st 2 years and spend more time in
    the hospital
  • The students are more likely to show up day 1 of
    class knowing the info ? the future MCAT could be
    step 1
  • Medical school should focus more on communication
    for assessments

33
New Approaches
  • This isnt about replacing teachers he wants to
    make it a more humanizing experience when we get
    together in class rather than a teacher talking
    at the students
  • The online lessons are a source of info like a
    textbook so the teacher doesnt have to cover
    everything textbooks are really whats in danger
  • This method is really good for the factual info
    that you really need to know and for review (i.e.
    Anatomy, Microbiology, Biochemistry, etc.)

34
New Approaches
  • A great teacher should scale themselves up and
    try to reach millions through online lessons
    rather than feeling threatened in a smaller
    classroom
  • Theres a high level of scrutiny regarding
    biases a topic with multiple views can have
    multiple videos put online (each depicting one of
    the views)
  • Sal Khan would like collaboration on ideas for
    how to make this online material interactive in
    class

35
Questions?
  • All OSR sessions (even the ones Mindy could not
    attend) are posted here with PowerPoints
    https//aamc.expoplanner.com/index.cfm?doexpomap.
    sessResultssponsorOrganization20of20Student20
    Representatives2028OSR29search_typesponsorev
    ent_id2
  • Contact your primary OSR representative Mindy
    Colgrove
  • mccolgrove_at_huskers.unl.edu
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