Meeting the ED-2 Standard Gaining Consensus Building for

Meeting the ED-2 Standard: Gaining Consensus, Building for the Future University of Missouri-Columbia School of Medicine Elizabeth Garrett, MD, MSPH Kimberly Hoffman, Ph. D Caroline Kerber, MD

ED-2 Quantified criteria for the types of patients (real or simulated) must be defined: – The level of student responsibility/extent of student interaction – The appropriate clinical settings/venues – Numbers and kinds of patients that must be seen – Major disease states and conditions – Central oversight must occur – Gaps must be remedied

MU’s Response: Selecting the Opportunity (Round One) 2005 - committee appointed Met three times Not successful……why? ? ?

Reflecting on Failure Technology Barrier No liaison to IT No urgent deadline Who was driving this process? Team never “melded” Resources? ($$$)

Selecting the Opportunity (Round Two) Late fall 2005 -birth of web based Patient LOG – Subcommittee formed (ED-2/PLOG) (Clinical Curriculum Steering Committee) – Chair of subcommittee named (Family Medicine CD) Members of PLOG – – – Chair of CCSC (Internal Medicine CD) Computer guru Child Health, Surgery and Family Medicine CDs Dean for Evaluation Staff support

Selecting the Opportunity (Round Two) Empowered Needs/Wants Options

Reflecting on Success Right mix of humans Technology decision made EARLY Resources identified and prioritized Regular meetings

Reflecting on Success Behind the scenes work (other products/vendors? ) CQI approach Real deadlines – – – New AY June 2006 LCME 2008 IT programming resources reserved (use it or lose it !)

Other Keys to Success Communication – To CCSC/stakeholders – To programmers via one person – Feedback encouraged Flexibility of PLOG to majority of needs – Diagnoses – Signs/symptoms – Skills/procedures Buy-in from all CDs

Other Keys to Success Transparency of data: sharing Aim for an extensive list – Can turn items on and off (“grayed out”) Committee problem-solved well Effective support staff

PLOG- Going Beyond ED-2 Overall goals Meet the ED-2 standard Must work for all clerkships Document the review and feedback of student progress Identify needs for mid-course corrections Students must meet clerkship objectives Students take more responsibility for their own learning

More goals Use to compare students’ experiences to curricular goals Explore potential to track students’ experiences across the curriculum Potential use in scheduling/placement decisions

More goals Added value for all Need for useful data summary reports – – – CDs/coordinators Education leaders/deans Faculty User Friendly

Examples from Family Medicine Clerkship Use the Family Medicine PLOG site as our model Screen shots to walk through the process students and clerkship directors use to use and review PLOG

Program Requirements

2006 -07 PLOG Total Number of Reviews Entered by Clerkship (Blocks 9 -11) Professionalism/Timeliness Student Progress and Documentation of Clerkship Requirements Student is demonstrating professionalis m by entering data in a timely and thoughtful manner. Student is not demonstrating professionalism by not entering data in a timely and thoughtful manner. Student is making appropriate progress and is on target to meet clerkship requirements. No problems are anticipated. Student has made some progress but needs to increase participation and/or documentation in order to meet clerkship requirements. Student has not demonstrated adequate progress and is at risk of not meeting clerkship requirements. Child Health 41 2 39 2 2 Family Med 124 3 122 3 2 Internal Med 52 3 52 2 1 Neurology Ob/Gyn 1 1 Psychiatry Surgery 69 66 3 Grand Total 287 9 280 11 5 Clerkship

2006 -07 PLOG Summary of Unprofessional Reviews by Clerkship Directors (Blocks 9 -11) Slide 2 of 2 Professionalism/Timeliness Student Progress and Documentation of Clerkship Requirements Student is demonstrating professionalism by entering data in a timely and thoughtful manner. Student is not demonstrating professionalism by not entering data in a timely and thoughtful manner. Student is making appropriate progress and is on target to meet clerkship requirements. No problems are anticipated. Student has made some progress but needs to increase participation and/or documentation in order to meet clerkship requirements. Student has not demonstrated adequate progress and is at risk of not meeting clerkship requirements. Student ID Clerkship 799017 Child Health ü ü Surgery ü ü 944461 Child Health ü Family Med ü Surgery ü ü ü 772070 Family Med ü ü Internal Med ü ü 942034 Surgery ü ü ü 941997 Child Health ü ü ü Family Med ü ü 725225 Family Med ü ü Internal Med ü ü 944458 Child Health ü ü Family Med ü ü ü

What did we learn? – Improved understanding of clinical exposure Each clerkship Across clerkships – Improved individual plans of study – Bringing the clerkship objectives into “focus” – Improved ability to see patterns in student performance across clerkships – Reasonable time commitment- most faculty and students spent one hour or less on PLOG each week. – High degree of user satisfaction

What did we learn? – Improved monitoring of off site educational experiences – Improved monitoring of on site educational experiences – Students and clerkship director conversations stimulated by PLOG. – Clerkship director/preceptor conversations – Insight into student professionalism

Establishing & Developing the Team Right Mix – Skills, knowledge, experience Clear paths for communication Prioritize among competing “opportunities” Process for design Align resources – – 0. 3 FTE “translator” x 6 months 1. 5 FTE programmers x 4 months 0. 3 FTE staff support x 6 months Faculty time

To Date Review 6 month data PLOG retreat Requirement adjustments Documenting mid point corrections for Psychology and Neurology Reflection on changes in LCME requirements

Next Steps Review full year data Survey students PLOG data to inform: – Educational objectives of clerkships – Total experience of third year student from student view – End of third year competencies – Develop process to address students with recurring professionalism concerns

MU PLOG Demo Site Pleased to offer a demo site E-mail Laurie Lough: – loughl@health. missouri. edu to get a time-limited user name and password Real data with names changed and some of student comments edited/dropped Can visit and enter patients, play with tool 2 -week user but can request multiple temporary IDs and passwords. Would appreciate your feedback and suggestions.