Paea 2012 aad course10.17.2012
-
Upload
eugene-jones -
Category
Health & Medicine
-
view
100 -
download
1
Transcript of Paea 2012 aad course10.17.2012
Teaching Dermatology to PA Students with a
Peer-reviewed Virtual Curriculum
P. Eugene Jones, PhD, PA-C
Patrick McCleskey, MD, FAAD
6. Evaluation and Feedback
1. Problem Identification and General Needs Assessment
2. Targeted Needs Assessment
3. Goals and Objectives
4. Educational Strategies
2
5. Implementation
WHY?
WHO?WHAT?
WHAT?
HOW? WHEN?WHERE?
HOW WELL?
JUST DO IT
Step 2: Targeted Needs Assessment
Acne
Seborrheic dermatitis
Warts
Rosacea
Atopic dermatitis
Superficial dermatophytoses
3
McCleskey PE, Gilson RT, Devillez R. Medical student core curriculum in dermatology survey. J Am AcadDermatol2009;61(1):30-35.
Goals and Objectives
• The AAD working group through a modified Delphi process identified Goals and Objectives they felt all medical students should learn
– Only 33 dermatology diagnoses covered, to avoid pitfall of “trying to teach too much”
– All rated important or very important by primary care providers were included
Implementation
• Went live on AAD Website March 2012
– http://www.aad.org/education-and-quality-care/medical-student-core-curriculum
– Free, publically available to everyone
• Learners review at their own pace
• Each Module can be given as a lecture or small group discussion
UCSF Med Student Study
• Students learned during rotation
• Students liked the modules and preferred them to other learning methods
• But question remains: did they learn because of the modules or because they were in a dermatology rotation?– Need to study a group that has internal controls
– Variability of derm exposure among PA students and residents?
Military Virtual Derm Study
• Four-week dermatology rotations
• Variables:
– Age, gender, level of training
– Number of half-days in clinic were highly variable
– Website allowed tracking of activity
– Pre-test, 33 learning modules, Post-test
All Levels Benefit
0
10
20
30
40
50
60
70
80
90
PA Students* PGY1* PGY2* PGY3
Pre-Test Score
Post-test Score
*p-value <0.05
Use of website correlates with higher post-test scores
p 0.003 trend p 0.003
9
Summary of Military Study
• All types of learners have statistically significant improvement in knowledge
– PA students using this curriculum perform as well at end-of-rotation as physicians
• Increased website activity correlates with higher post-test scores
– Proves the core curriculum is effective
• High acceptance and preference of curriculum
Summary of Core Curriculum
• Standardized curriculum made publically available by the AAD
• Goals & learning outcomes based on evidence, aligned with needs of PAs in practice
• Online learning modules– Case-based
– Builds through repetition
• Peer-reviewed
• Effective
Intro to MSCC on AAD website
UT Southwestern Justification for Implementation
• Increasing difficulty scheduling dermatology clinicians due to clinical time demands and loss of income
• Time and location inflexibility of traditional lecture-learner model
• Quality of AAD content developed by academic dermatologists
• Student desire for any time, any place learning
• Opportunity to blend delivery to accommodate differing learning styles
The UT Southwestern Decision
• The AAD module content titles were compared to the PANCE disease list.
• The two-week version of the AAD Core Curriculum was selected as it closely reflected previous dermatology lecture-learner contact hours.
28/47 PANCE Disease List in
AAD MSCC• Dermatitis• Dyshidrosis• Lichen simplex chronicus• Drug eruptions• Lichen planus• Psoriasis• Pityriasisrosea• Erythemamultiforme• Stevens-Johnson
syndrome• Toxic epidermal
necrolysis• Bullouspemphigoid• Acne vulgaris• Rosacea• Actinic keratosis• Seborrheickeratosis• Lice
• Scabies• Spider bites• Basal cell carcinoma• Kaposi sarcoma• Melanoma• Squamous cell
carcinoma• Alopecia• Onychomycosis• Paronychia• Condylomaacuminatum• Exanthems• Herpes simplex• Molluscumcontagiosum• Varicella zoster• Verruca• Cellulitis• Erysipelas
• Impetigo• Candidiasis• Dermatophytes• Acanthosisnigricans• Burns• Hidradenitissuppurativa• Lipomas/EICs• Melasma• Pilonidal disease• Pressure ulcers• Urticaria• Vitiligo
15
Supplemental Instruction
• PowerPoint® podcasts were recorded and posted for Alopecia, Onychomycoses, Paronychia, and Genodermatoses
• Two 2-hour supplemental Q&A sessions were provided by local Dermatology PAs
• A one-hour hands-on liquid nitrogen cryosurgery lab was provided
Course Examination Outcomes
• Class of 2013
– N=36 students
– Mean exam score 92.3
– Range 81-98
• Class of 2014
– N=38 students
– Mean exam score 91.05
– Range 80-97
Course Feedback: Effort Required
0%
10%
20%
30%
40%
50%
60%
70%
great deal more
somewhat more
about the same somewhat less a lot less
Course Feedback: Module Number
0%
10%
20%
30%
40%
50%
60%
much too many somewhat too many
right amount somewhat too few
Much too few
Course Feedback: Satisfaction
very satisfied somewhat satisfied
neutral somewhat dissatisfied
very dissatisfied
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Course Feedback: Intellectual Challenge
0%
10%
20%
30%
40%
50%
60%
very easy easy average difficult very difficult
Course Feedback: Derm PA Value
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
extremely helpful
somewhat helpful
undecided somewhat unhelpful
extremely unhelpful
Course Feedback: Online Effectiveness
0%
10%
20%
30%
40%
50%
60%
extremely effective
somewhat effective
neutral somewhat ineffective
extremely ineffective
Course Feedback: Knowledge Increase
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
strongly agree agree neutral disagree strongly disagree
Course Feedback: Would Recommendto Other PA Students
0%
10%
20%
30%
40%
50%
60%
70%
definitely recommend
probably recommend
uncertain probably not recommend
definitely not recommend
UT Southwestern Course Summary
• Well-received
• Minimal faculty oversight or time requirements
• Consistent, high-quality instruction
• Knowledge acquisition (as measured by post-test) equivalent to face-to-face instruction
Medical Student Core Curriculum
• Ideal for PA students or early practice PAs
• Agree that name might be off-putting for PA students and PAs in practice
– influenced by AAD politics
• Designed to teach up to level of primary care providers
27
How to Use the Curriculum
• Know what’s on the MSCC website
• Suggestions in the Educator’s Guide and handout for this session
• Direct the learner’s study based on their level
28
Be a Coach: follow-through
• Need to have follow-up to make sure the learning process is complete
• Examples for tineaversicolor:
– PA Student: differential diagnosis of light rashes, or performing KOH exam
– New PA-C: bring back a paper prescription for treatment of tineaversicolor
29
Take-Home Points
• Instead of teaching in clinic, direct the students what to learn on their own
• Visit the AAD website:
– http://www.aad.org/education-and-quality-care/medical-student-core-curriculum
• Use the website to do the teaching for you, to save time in clinic
• Follow-up to close the learning loop
30
Incorporating the Core Curriculum into PA instruction
Discussion about how you might use this curriculum in your program or office
31
Use of Curriculum: Clinic
• Designed to be used as independent modules for review at home by learners
• Self-paced
• Interactive with questions throughout and after each module
32
Use of Curriculum: Small Groups
• Each module can be used in group setting
– “Lecture” with questions interspersed
– Group discussion for each case
• With discussion, each module is perfect length for 40-60 minute session
33
Use of Curriculum: Other Specialties
• These lectures can be given on other rotations• Pediatrics
– Atopic dermatitis, molluscum, pediatric fungal
• Internal medicine– Bacterial and fungal infections, vasculitis, drug
eruptions
• Surgery– Ulcers, the red leg
• Pathology– Skin cancers, biopsy techniques, path requests
34
Flow of Dermatology Learning
PA-C IN PRACTICE
GENERAL*: CME/PANRE DERM*: DLI
MSCC LEARNING MODULES AS TEST PREP / DERM PRIMER
PACKRAT* PANCE*
PA SCHOOL
LECTURES* DERM ELECTIVE*
* POSSIBLE USES OF AAD CORE CURRICULUM
Open Discussion and Questions
36
Discussion
• How can this be used as an adjunct to current curriculum at your program?
• How might you use this to orient new PAscoming into your practice?
• Could you now convince local dermatologists to take on PA students?
37
Thank You
Members of the American Academy of Dermatology Medical Student Core Curriculum Workgroup
Tim Berger, Sarah Cipriano (UCSF)
PAEA leadership and membership
38