Clinical Skills Courses: Review and Reflections about Content across

Institutions

Toshi Uchida, MDNorthwestern University Feinberg School of Medicine

Nelia Afonso, MDOakland University William Beaumont School of Medicine

Pree Basaviah, MDStanford University School of Medicine

Objectives• Review the breadth of content of clinical skills

courses– Original DOCS survey– Tally of pre-meeting survey

• Brainstorm promising practices and challenges• Identify themes of inquiry to inform future

DOCS surveys & workshops

Seven Principles for Pre-Clerkship EducationLearning to Improve Patient Outcomes

Patient-Centered Care Strategies

Interactive, Experiential and Learner-Centered

Encourage self-directed learning

Developmental

Coordination of Assessment

Continuous Quality Improvement

AAMC Task Force on Pre-Clerkship Clinical Skills Education

2011 Results: Curricular Deans

Other:

Palliative care, cultural competency, health systems, prevention, nutrition

Results: Curricular Deans

Course Organization• Curriculum organized by organ system (39%),

Discipline based (31%) Other (30%)• Primary Format didactic (20%), PBL (4%), mix

of PBL and didactic (58%), and other (18%)• Yearly longitudinal (73%), block module with

defined # of weeks (15%), other (12%)• 89% stated PCCS course was integrated with

basic science courses

Results: Learning and Assessment

• 87% have developed and use core competencies• 75% institutions use formal clinical skills

curriculum in clinical years• 89% use OSCE’s in PCCS – 81% in Clerkships

• 88% have clinical skills training lab– 83% use in PCCS– 65% use in Clerkships

Additional topics taught in CS Courses

Additional topics taught in CS Courses(contd.)

Oversight of the Clinical Skills Curriculum

Brainstorm: Major issues about breadth of content

• Repository for content that does not belong elsewhere delegated to other content experts feels like hodge podge (kitchen sink course)

• MS 1, 2 have competing priorities and CS is a lower often than their science curriculum

• Outcomes – as we integrate, assessing and recall for GQ survey is challenging. Need to educate student about roadmap, “emcee”

Brainstorm (cont’d)

• Loss of clinical skills during transition to clerkships 3rd year, hidden curriculum. Needs to be a formality in clerkship

• Academic calendar with test dates for whole year in basic science challenge with not concentrating on the cs skills right before exam

• Silos exist and Course directors decide independently challenge between centralization and autonomy

Brainstorm

• How do we meaningfully integrate CS with the sciences, reasoning? From central mgmt, need critical discussions

• How do programs integrate pediatric content in preclerkship?

Vote for your top 2 emerging topics for clinical skills courses to discuss in small groups:

• Patient Safety/QI• Population Health (health disparities, prevention)• Systems Based Care• Heath Care Financing• Teamwork/Interprofessional Education• Other: Bootcamps, Disparities,

• Pediatrics….

Small Group Guiding Questions

• What are the pros/cons of a focused vs an expanded course content?

• Are expanded Clinical Skills courses becoming too big?

• Who decides and how do we decide what content belongs in a clinical skills course?

• Discuss your specific topic ( including resources ,assessment, faculty development)• Report out to group

Report out – Preclerkship Bootcamps

• Competes with Step 1, time allowed 1 d to 1 week to 1 month for these courses

• Skills: simulation, clinical specialty specific, procedure-based skills. When do you do – clerkships vs during transitions course (ex. Pedi newborn exam, suturing)

• Faculty intense if you push into clerkship but chance to standardize how you teach – ex. Neonatal exam. Receptive if formative rather than summative assessment.

Report out: Social determinants of health, behavior change, MI

• Taught within social history, in population health themes , health literacy should be part of the discussion

• Formal discussion of social determinants, health literacy and then integrated into SP encounters

• Get your wheels turning, keep in mind patient realities• Behavioral health, motiv interviewing implementation

discussed and needs for faculty development

Report out: Integration • Curricular models – how to avoid silos, how to move towards

integrated approach as seen in newer schools and renewed curricula• Structure drives function and integration• There needs to be a planned governance / process• Ongoing, in-depth discussions weekly meeting with basic science

and CS faculty• Need funded support to promote these interactions and efforts• Need for central calendar with shared approach on the content

topics • Course directors having full reign over content can lead to challenges• Action item: to share specific curriculum interventions

Next Steps

• Topics for future DOCS surveys?• Topics for future DOCS workshops?