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2018 Conference on Medical Student Education

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PR1 FMIG Faculty Advisor Summit

Ashley Bentley, MBA

02/1/18 10:00 AM - 5:00 PM

Family medicine interest group (FMIG) faculty advisors have both the opportunity and the calling to build and support medical student awareness, understanding, and commitment to family medicine at their institutions with the end goal of contributing to a more robust family medicine workforce. This goes far beyond simply helping a group of students reserve a conference room for a lunch lecture—it's about giving students the opportunity to follow their passion for primary care and spread it among their peers in a meaningful way, engaging students in reform, giving them crucial experiences that their curriculum leaves behind, and ultimately leading more of them to find their fit in family medicine. FMIG faculty and staff advisors from across the country come together in this biennial workshop to work together to share successful strategies and get reenergized for this vital work. At its foundation, the workshop provides dedicated space to explore with peers the role FMIGs play in developing the primary care workforce of the future and identify opportunities to make the programs, activities, and initiatives of FMIGs more effective and successful. The 2018 workshop will bring in current issues in new and emerging research on the role of FMIGs, models for FMIG engagement and management, and leadership skill development for faculty and staff.

Upon completion of this session, participants should be able to:

  1. Leverage new leadership skills to identify and harness shared goals with partners both within and outside of the institution to design new initiatives to increase student choice of family medicine.

  2. Develop a goal-oriented workplan for your FMIG that builds on best practices learned from peers, current research on student choice and FMIG impact, tools and resources provided by the AAFP and others, and unique opportunities at your institution or within your community, that connects the initiatives of your FMIG to larger medical school and primary care workforce goals.

  3. Activate a network of peers and stakeholders, including the FMIG Network and the AAFP Medical Education Division, to advise, problem-solve, and support your FMIG efforts.

PR2 Teaching in the Clinical Setting: Skills for Today’s Family Physician

Tomoko Sairenji, MD, MSc; Nehman Andry, MD; Laurie Belknap, DO, MS.MedL; Ronald Cook, DO, MBA; Joanna Drowos, DO, MPH, MBA; William Hay, MD; Matthew Holley, PhD; Kristen Hood Watson, MD; David Kelley, MD; Peter Koopman, MD; Peter Lewis, MD; Mary Lindholm, MD; Erika Schillinger, MD; Martha Seagrave, BSN, PA-C; Anne Walsh, PAC, MMSc; Srikala Yedavally-Yellayi, DO; Jana Zaudke, MD

02/1/18 1:00 PM - 5:00 PM

Family medicine physicians and other primary care health care professionals are critical to the success of teaching programs for medical trainees in both academic and community medical centers. Increasingly these teaching programs are implementing and emphasizing team-based care, interprofessional education (IPE), and longitudinal integrated clerkships (LICs). This preconference will focus on the related challenges that clinical teachers are likely to encounter, and prepare them for evolving trends, innovations, and requirements in medical education. Learners benefit from participating in patient care, but preceptors face challenges including limitations in preparation/faculty development, administrative/institutional support, and time. Additional challenges to the clinician-educator include providing appropriate patient selection and variation, meeting clinical and educational productivity and documentation expectations, and integration of a single learner or multiple learners (of varying levels, abilities, and/or professions) into the clinical encounter/environment. If these challenges are not constructively and repeatedly addressed then patient and learner satisfaction, as well as that of the preceptor, is likely to suffer.

Upon completion of this session, participants should be able to:

  1. Identify methods of teaching-including those pertaining to health systems that encourage medical trainees to participate in self-directed learning such as goal/educational-agenda setting.
  2. Utilize innovative documentation and information management tools (e.g. clinical decision support tools that may be accessed from the electronic health record-EHR-or point-of-care clinical references).
  3. Identify and incorporate successful methods and teaching strategies when working with learners and peer educators from diverse and complementary healthcare professions. Representative situations that combine clinical work and medical education include working with a single health profession student (e.g., medical student, PA student, NP student, Pharmacy student, nursing student, or other) and simultaneously precepting learners from different health professions-including learners within a given profession at different levels of training, and co-precepting (co-located or distant).

L1A Lessons From an Unlikely Land: Clinical Care, Population Health, and Medical Education in Cuba (STU)

Rick Streiffer, MD

02/2/18 10:30 AM - 12:00 PM

The United States spends more on health care than any country, yet has far lower health measures than other rich countries. One reason is the lack of a robust primary care workforce optimally prepared as socially responsive leaders and clinicians who can address social determinants of health that impact patients and communities. Medical education, some argue, has persisted with "curricula rigidities, professional silos, static pedagogy, [and] insufficient adaptation to local contexts", failing to train physicians beyond the clinical focus and prepare them to address our "dysfunctional and inequitable health system". Since the revolution, Cuban health care has emerged from developing nation status to one built around an organized system and health measures that equal or exceed the United States. Their system is based on the family physician, neighborhood-centered care, clearly articulated principles (health care as a right, universal access, prevention first, integration of social services with medical care), a strong public health orientation and infrastructure, and preparation of a physician workforce that embraces "the central mandate of social accountability." This session will explore approaches of the Cuban medical education system—its unique emphasis on service-based learning, participatory action, prevention/public health, and intimate longitudinal linkages between medical education, their health system, and population health equity—that may apply in the United States.

Upon completion of this session, participants should be able to:

  1. Describe key features of the Cuban health care system
  2. Describe the Cuban approach to medical student education and how it integrates medical, public health and population health components into their model
  3. Relate aspects of the Cuban system to the priorities in the US, specifically preparation of practitioners for underserved communities where social determinants of health and prevention are paramount

L1B Value-Added Medical Education: Innovation in Quality Improvement, Population Health, and Telemedicine Training in Interprofessional Teams

Candice Kim, MS; Amelia Sattler, MD; Walter Domingo, PharmD; Benny Yau, PharmD; Daniel Polchinski, PharmD

02/2/18 10:30 AM - 12:00 PM

The Stanford Healthcare Innovations and Experiential Learning Directive (SHIELD) is an innovative early clinical immersion program that offers opportunities for preclinical medical students to contribute to patient care. One arm focuses on telemedicine and population health. Time constraints limit the ability of primary care physicians to provide the recommended preventive health services to patients.[1] SHIELD demonstrates that first-year medical students working with a faculty mentor can improve population health measures, foster early interprofessional interactions, inspire interest in primary care, and encourage quality improvement (QI) scholarship. As a medical student in SHIELD, I conducted a QI project with pharmacy residents and a primary care physician mentor to improve medication monitoring at the Stanford Family Medicine (SFM) clinic. The Healthcare Effectiveness Data and Information Set (HEDIS) recommends that patients on a diuretic, angiotensin-converting enzyme inhibitor (ACEI), or angiotensin-receptor blocker (ARB) annually monitor their serum potassium and creatinine. In Fall 2016, only 77% (477/622) of SFM patients on a diuretic and 79% (752/947) on an ACEI/ARB were compliant. We used the QI process to implement a multifaceted strategy, from personalized patient outreach to system-level changes, to reach the HEDIS goal of 87% compliance by summer 2017. These results suggest that programs like SHIELD would be a valuable addition to other institutions as well.

Upon completion of this session, participants should be able to:

  1. Describe the value of a structured, early immersion clinical experience in population health for medical students.
  2. Identify ways to engage interprofessional teams in quality improvement efforts in the context of innovative early medical education.
  3. Explain how personalized patient outreach can be used to improve population health, specifically for medication monitoring.

L2A Implementing a Student Elective in Primary Care-Based Addiction Medicine

Rebecca Cantone, MD; Rebekah Schiefer, LCSW; Nicholas Wolfgang; Chloe Ackerman

02/2/18 10:30 AM - 12:00 PM

Future physicians are continuing to seek ways to address the ongoing opioid epidemic, but few medical schools offer this training. New evidence found that a medication-assisted treatment (MAT) model in primary care is superior to abstinence only, and students are showing interest in gaining this experience. We have created an elective for medical students to explore this model and learn from physicians and nurse practitioners prescribing this medical treatment, nurses coordinating the population management, and behavioral health and addiction counselors focused on treating addiction. Through this 4-week elective, students gain exposure to opiate use disorder, team-based care, community resources for addictions and mental health, and follow patients throughout their course of treatment. This session will focus on how to incorporate students into this model of care to help recruit future family physicians and better address the shortage of care for this vulnerable population. It will give participants ideas on how to integrate students into addiction medicine, create a way for students to be involved in vulnerable and confidential populations, and provide strategies to compensate for the negative feelings of chronic pain in primary care. We will discuss barriers and ideas of how to sustain clinical experiences at more medical schools and help develop a foundation for considering this model in other institutions.

Upon completion of this session, participants should be able to:

  1. Identify barriers in teaching addiction medicine to students
  2. Describe at least one model to practice medication assisted treatment in primary care with learner involvement
  3. Collaborate across disciplines to give better care to patients and better education to students

L2B Teaching Motivational Interviewing to Medical Students: Creating Curriculum, Training the Trainers, Building Capacity

Azadeh Moaveni; Kimberly Lazare; David Wheler; Peter Selby, MBBS, MHSc

02/2/18 10:30 AM - 12:00 PM

Medical Students at the University of Toronto identified a gap in their training in motivational interviewing (MI) in 2011. To remedy this gap, a curriculum in family medicine clerkship was created to teach MI in a 3-hour small group seminar session and launched in 2012. Faculty were trained over multiple iterations and paired with experienced faculty to deliver the seminar over a number of years. Capacity was built by offering refresher workshops prior to every medical student seminar. Evaluations of the seminar have been extremely positive with both faculty and staff reporting incorporation of MI interviewing skills into their practice. The Train the Trainer workshop for MI has now spread to teachers at the postgraduate level and community preceptors.

Upon completion of this session, participants should be able to:

  1. Strategize on how to build a motivational interviewing curriculum or seminar for their medical students
  2. Build on ideas to plan and organize a train the trainer workshop
  3. Learn how offerings in Faculty Development can engage community preceptors and teachers across undergraduate and postgraduate training

L3A Incorporating Interprofessional Standardized Patient Experiences Into OSCEs

Peggy Cyr, MD; Wayne Altman, MD; Victoria Hayes, MD; Corinn Martineau, PharmD; Julie Schirmer, LCSW, MSW

02/2/18 10:30 AM - 12:00 PM

Interprofessional education (IPE) is a critical and central aspect of training today’s physicians. Medical students who learn with, from, and about learners from other disciplines have been shown to develop skills and habits that create more effective and safe health care teams. It is often technically challenging to create IPE learning situations for students. We developed two interprofessional scenarios for our medical students’ third year Observed Structured Clinical Exams (OSCEs), using student "confederates" from other disciplines. Confederates are "individuals other than the patient who are scripted in a simulation to provide realism, additional challenges, or additional information for participants." Focusing cases on high stress, complex situations, helps to achieve the learning objectives where multiple disciplines are involved. Our cases involve the medical student meeting with: (1) a social work student, wife and adult child regarding end of life issues for their relative in the ICU, and (2) a pharmacy student and patient with complex chronic medical and pharmacy needs. Participating students complete a pre and post 9-item survey that assesses changes in attitudes: the Interprofessional Socialization and Valuing Scale (ISVS 9). Standardized patients and confederates guide their feedback, using an observational checklist that focuses on teamwork behaviors and skills: the Individual Teamwork Observation and Feedback tool (iTOFT).

Upon completion of this session, participants should be able to:

  1. List the rationale and requirements for incorporating interprofessional education into medical school curriculum.
  2. Apply resources provided to incorporate interprofessional standardized patient cases into the evaluation and training of their students.
  3. Identify evaluation tools that measure changes in interprofessional knowledge, attitudes and skills the Interprofessional Socialization and Valuing Scale (ISVS-9).

L3B TEAM Clinic: Transformation of Care Through Longitudinal Interprofessional Learning With Complex Patients

Keisa Fallin, MD, MPH; Maria Gabriela Castro, MD; William Elder, PhD; Lynn Hunter, LCSW; Carol Hustedde, PhD

02/2/18 10:30 AM - 12:00 PM

Dissatisfaction among physicians about increasing administrative practice burdens and widening gaps in health disparities for medically and socially complex patients has eroded our primary care work force and stunted its growth. Breaking the cycle involves transformation of care—rethinking goals of care and redesigning care delivery using interprofessional teams to deliver care that actually meets patient needs. We describe the implementation process, baseline learner measures, and lessons learned from a transformation of care curriculum in our TEAM clinic (Teach students, Empower patients, Assimilate interprofessional care, Meet health goals.) TEAM is a longitudinal experience for medical students, social work students, and a pharmacy resident, seeing established complex patients with a consistent attending. We completed a pilot in June 2017 and the full program began August 2017. This session addresses the challenges of putting into practice key transformation of care components including intentional interprofessional teamwork, meaningful integration of social determinants and enabling services that improve patient care and satisfaction. Baseline and periodic student attitudes toward family medicine, toward medically and socially complex patients, and self-assessment of burnout will be examined and compared with nonparticipant peers. In this session, we describe our progress and challenge participants to brainstorm and plan transformation of care curricula or clinical experiences within their own institutions.

Upon completion of this session, participants should be able to:

  1. Identify pedagogical approaches to developing transformation of care competencies
  2. Describe a model for longitudinal IPE (Interprofessional Education)
  3. Explore ideas for similar IPE implementation across institutions.

L4A The Eyes Have It: Faculty Development Physical Exam Training Involving Simulated Partial Task Trainers

Victoria Hayes, MD; Peggy Cyr, MD

02/2/18 10:30 AM - 12:00 PM

Simulation task trainers are frequently used to teach and assess medical students’ basic physical exam skills, but only 15% of practicing family physicians have been involved in some type of simulation training. Orienting and training faculty have been identified as key barriers to recruiting and retaining community preceptors. In a survey we conducted to assess desired interventions to support continued teaching, our community preceptors rated faculty development highly (2nd). In order to address both the lack of exposure to simulation and promote preceptor retention, we created a faculty development simulation workshop. The skills section involved task trainer stations demonstrating physical exam findings accompanied by brief written clinical scenarios. Immediate Feedback Assessment Technique (IF-AT) cards assessed for correct responses. A small group review session utilizing a heart sounds simulator was included. A slide presentation included patient scenarios, representation of microscopic slides, and multiple choice questions focusing on potassium hydroxide (KOH), wet mount findings, and a brief review and discussion of the current recommendations by the US Preventive Services Taskforce (USPSTF) and other working groups on the value of the various components of the clinical exam and rationale for inclusion or exclusion from the annual wellness visit. Results of a postsession survey rated the hands-on portion as the most valued component of the session.

Upon completion of this session, participants should be able to:

  1. Describe the need for and value of faculty development in the use of simulated task trainers for physical exam skills training.
  2. Identify the benefits and challenges of utilizing task trainers for teaching basic physical exam skills.
  3. List several possible components of a faculty development workshop utilizing simulated partial task trainers.

L4B Teaching Choosing Wisely Through Family Medicine Clinical Simulations

Ryan Palmer, EdD; Rebecca Cantone, MD; Frances Biagioli, MD; Emily Thompson

02/2/18 10:30 AM - 12:00 PM

The Choosing Wisely campaign emphasizes utilizing evidence-based care paired with patient engagement in order to provide high quality, cost-conscious care and reduce unnecessary care. A health care system with a strong primary care foundation is critical in improving population health, increasing quality, and decreasing costs. To achieve the Triple Aim, there is a need to integrate teaching and measure stewardship as a professional competency. Students need to experience models of health care delivery that incorporate Choosing Wisely concepts so they can better implement these concepts in their practice. Family medicine provides an ideal learning environment to apply Choosing Wisely concepts and improve cost-conscious care as we train future physicians. This lecture discussion will describe how one family medicine clerkship at a US medical school incorporated Choosing Wisely training into its curriculum. Specifically, this program integrated Choosing Wisely concepts into its teaching Objective Structured Clinical Exam (OSCE) simulation activity. The teaching OSCE is a formative assessment that all students participate in during their 4-week required family medicine clerkship. Students progress in a serial fashion through a series of primary care clinical simulations with a standardized patient. Additionally, a faculty member is present who fills out a checklist and provides focused feedback in student performance after the encounter. One of these stations also is a telemedicine simulation, called the TeleOSCE. In 2014, our program received an education grant from the American Board of Internal Medicine (ABIM) to integrate Choosing Wisely concepts into existing teaching OSCE cases as well as create 3 additional TeleOSCE cases focused on the Choosing Wisely standards of care. This presentation will focus on how these important concepts were integrated into clinical simulations as well as share the impact of these simulations on medical student understanding of Choosing Wisely goals. Audience members will gain a better understanding of how they can incorporate these important standards into their own coursework in an experiential, hands-on learning approach.

Upon completion of this session, participants should be able to:

  1. List competencies and skills relevant to Family Medicine that can be introduced to learners through Choosing Wisely recommendations.
  2. Discuss how Choosing Wisely standards can be integrated into a Family Medicine clinical simulation or OSCE.
  3. Apply methods introduced in this presentation to their own institutional curricula.

L5A Our Recipe to Attract and Retain Family Medicine-Bound Students

Carolyn Peel, MD; Judy Gary, M Ed; Sydney Davis

02/2/18 10:30 AM - 12:00 PM

The Department of Family Medicine and Population Health at Virginia Commonwealth University embarked on the Family Medicine Scholars Training and Admissions Track (fmSTAT) in 2011. fmSTAT is designed to select and retain 8-10 family medicine-bound students each academic year. First, we identify medical school applicants with high interest and likelihood of pursuing careers in family medicine during the admissions process and work with the admissions office to (1) DUALLY ADMIT them to VCU and our program. The other five components of fmSTAT include: (2) SUPPORT—peer support spanning all 4 years, a structured 1:1 mentorship with a family physician focused on the mentees’ personal and professional growth from the start, and social/network opportunities; (3) CONTENT—advanced family medicine curriculum delivered (two retreats and two seminars per year); (4) EXPERIENCES—intentional family medicine clinical placements, additional electives, a scholarly project); (5) PROFESSIONAL DEVELOPMENT—deliberately involving fmScholars in leadership and scholarship at local and national levels; and (6) FINANCIAL SUPPORT—long term goal to raise enough scholarship support and structure disbursement to attract and retain enrollees, and defray their tuition costs. Even in the absence of monetary support, we have a 64% rate of fmSTAT matriculants matching into family medicine residencies, and a 78% rate matching into primary care in our two graduating cohorts.

Upon completion of this session, participants should be able to:

  1. On completion of this session, the participants should be able to describe the 6 potential ingredients in a dual admission family medicine scholars track.
  2. On completion of this session, the participants should be able to identify the combination of desired components for your particular school environment.
  3. On completion of this session, the participants should be able to assess the anticipated challenges associated with importing program components.

L5B Rolling With the Punches: Maintaining Strong FMIG Collaboration With Residency Programs in a New Curriculum (STU)

Tomoko Sairenji, MD, MSc; Jeanne Cawse, MD; Michelle Nemetz

02/2/18 10:30 AM - 12:00 PM

While participation in a Family Medicine Interest Group (FMIG) has been described as one of the only extracurricular activities that predicts matching in family medicine, it can be challenging for FMIGs to successfully present events and workshops for a variety of reasons. Challenges include difficulty securing teaching faculty and residents, asking students to participate in workshops outside class time, and concerns that FMIG events often appeal only to students who are already interested in FM. It is common for students to participate in skills workshops provided by FMIG, but only for skills. Retention into FM is challenging, as students don’t learn what family medicine is about during these sessions. By designing a for-credit FMIG workshop course for MS1-2s in collaboration with local residencies, our FMIG at the University of Washington has developed a creative and win-win approach to address the above challenges, as well as helping bridge the gap between students and residents, which helps students learn more about the process of selecting and applying to residencies. In this session we will discuss various methods that participants have used to collaborate with local residency programs. This session will describe the history of relationship building with nearby family medicine residencies, the process undertaken to improve student participation in FMIG workshops, and the feedback thus far from students and faculty who participated in the workshops.

Upon completion of this session, participants should be able to:

  1. Participants will be able to describe a variety of methods through which a FMIG can collaborate with residency programs
  2. Participants will be able to discuss methods of engaging and retaining new students in FMIG events and membership.
  3. Participants will be able to initiate planning one new event at the FMIGs at their home institutions.

L6A Dean’s Letter Update: How the AAMC 2016 Recommendation for the Revised MSPE Will Impact the Application Process for Students and Faculty (STU)

Kathryn Trayes, MD; Andrea Manyon, MD; Kathryn Horn, MD; David Henderson, MD

02/2/18 10:30 AM - 12:00 PM

The Medical Student Performance Evaluation (MSPE), Dean’s letter, serves as an objective evaluation of a student’s performance. The MSPE is composed on behalf of the medical school faculty and is critical in the residency selection process. Through this evaluation, students are compared to their peers, in their success in achieving the educational objectives of the medical curriculum. The MSPE is one component of the Electronic Residency Application Service (ERAS) and includes an assessment of both the student’s academic performance and professional attributes. Family medicine educators from different medical schools serving as student affairs deans will describe the MSPE components and the various processes in preparing it, as well the changes they have implemented based on the recommendations for revising the MSPE released by the AAMC in 2016. This presentation will inspire family medicine educators to appreciate and contribute to the process in a meaningful fashion through authentic evaluation, and in preparing genuine letters of recommendation.

Upon completion of this session, participants should be able to:

  1. Goals: 1: To present the components of and variations in the process of compiling the Medical Student Performance Evaluation (MSPE). Objectives: 1.1: To present the formal and structured content of the MSPE.
  2. 1.2: To describe the processes from different medical schools in compiling the MSPE. 1.3: To outline how the 2016 recommendations have changes the process
  3. 1.4: To illustrate the opportunities to contribute to the MSPE by family medicine educators in authentic evaluations.

L6B Decoding the Dean’s Letter: Hints for Interpreting the MSPE

Richard Holloway, PhD

02/2/18 10:30 AM - 12:00 PM

The MATCH is typically a time of high anxiety for both faculty and medical students. Both program faculty and students hope to portray themselves in an optimal light, while the other party attempts to discern the "real" story. A subject of frequent discussion is the record of students as it is portrayed by medical school officials. There are a major number of misunderstandings, myths, and rumors regarding the "Medical Student Performance Evaluation (MSPE)", or "Dean’s Letter". Every year, student affairs deans generate MSPE’s in the hope of representing their students for residency training. Interpretations of these letters by program directors and residency faculty are critical to effectively finding qualified matches for their residency programs. The purpose of this lecture will be to shed some light on common misunderstandings, frequent practices of deans in crafting letters, and to foster discussion among participants regarding the use of deans’ letters. Current surveys of program directors suggest that MSPEs are used extensively for selection for interview as well as selection for rank order list (ROL). However, there are persistent misperceptions and erroneous assumptions about the utility of the MSPE. Discussion will hope to focus on the meaning of frequently used language, process of selection of comments written by faculty in evaluations to be included, and overall recommendation categories used by a number of schools.

Upon completion of this session, participants should be able to:

  1. Participants will list elements and requirements, including the intent of the Dean’s letter (MSPE) from the schools’ and students' perspectives;
  2. Participants will voice their concerns/understandings/perspectives and issues with Dean’s letters (MSPE);
  3. Participants will display common verbiage, misconceptions, myths and practices used among schools.

L7A Cultivating Family Physicians With Innovative Longitudinal Clinic Curriculum

John Hayes, DO; Mark Loafman, MD, MPH; Andrew Cudmore; Suvai Gunasekaran

02/2/18 10:30 AM - 12:00 PM

Efforts to address the shortage of family physicians through innovations in medical student education have shown some success with longitudinal rather than "one and done" block rotations. We also know that students' perception of family medicine can be enhanced by exposure to the full scope of family medicine including maternity care, inpatient rounds, home visits, etc. The opportunity for students to build significant ongoing relationships with patients and family physicians in all of these settings is challenged by both traditional curricular design and a lack of willing and able physician mentors. We will present two longitudinal family medicine curricular models that appear to be both effective and sustainable. AT Still University School of Osteopathic Medicine in Arizona has significantly disrupted the traditional medical school structure. Their innovative model embeds students in community health centers starting in their MS-2 year, and then with family medicine hospitalists and obstetricians in their MS-3 and MS-4 years. Northwestern University's Feinberg School of Medicine has created a longitudinal primary care experience based on the Patient Centered Medical Home model, called the Education Centered Medical Home. Cohorts of students see patients together in the same primary care clinic during all 4 years of their training. Upper level students gradually become more involved in clinic leadership through teaching, quality improvement, and care coordination.

Upon completion of this session, participants should be able to:

  1. Describe the structure of two successful longitudinal medical student clinic experiences.
  2. Describe the longitudinal clinic experience from both the perspective of a Family Medicine Attending and a Senior Medical Student.
  3. Discuss implementing intensive longitudinal clinical experiences at their home institution.

L7B The Longitudinal Alliance Project: A 4-Year Patient-Student Relationship

Robin Maier, MD, MA

02/2/18 10:30 AM - 12:00 PM

Charged by our Dean Arthur Levine, over the past four years the University of Pittsburgh School of Medicine has developed an ambitious project to connect each medical student with an individual patient throughout their medical education: The Longitudinal Alliance Project. During this Lecture/ Discussion, we will present our Longitudinal Alliance program, logistics, curriculum and outcomes as observed throughout the initial four years of this longitudinal four-year co-curricular experience. In the fall of 2013, we started with a small pilot group of ten students, and in the successive three years, we have expanded to groups of 20-40 students per year, divided into small groups of approximately eight. At the end of Academic Year 2016-17, the Longitudinal Alliance included a total of approximately 100 students across the entire medical school. Our ultimate goal is to transform this experience into a universally required project throughout the University of Pittsburgh medical education. As students develop closer relationships with their patients and accompany them to medical visits, the goal is to have them advocate for their patients and better navigate the complex medical system. In the fall of 2013, the first cohort of students were paired with medically complex patients recruited from a variety of fields: two were pregnant mothers, one young and frightened, another experienced and medically complex, two were children with cancer, the others had diabetes, hypertension, heart disease, breast cancer, dementia, peripheral vascular disease, or atrial fibrillation. Each patient was individual, with unique frustrations, hopes, difficulties and goals. The students initiated relationships with their patients, interacting inside and outside the medical setting (in patient appointments, coffee shops, etc). Students met with faculty and other students in the program to debrief every few months, each time focusing on a different theme: listening to patient stories, the influence of family and culture, or the basic science of each patient's disease. While the general theme of the first year experience was a focus on the patients themselves, in the 2nd year students focused on the health care team's role in the patient's care. During their debriefing meetings in the second year, students reflected on how other health professionals could or were helping their patients. They met with a nurse case manager, speech language pathologist, physical therapist, nurse administrator, and dentists. During the third year, students reflected on how various physicians interact in their patient's experience. As they rotate through required clerkships, students noticed how emergency physicians, hospitalists, and PCP's interact. They saw how generalists relate to specialists, and how radiologists and pathologists contribute as well. They reflected in writing on these issues, and their meetings focused on the interactions among physician specialties, and their patients' challenges in working with all of their various physicians. During the fourth year of the Longitudinal Alliance Project, students took the time to reflect on how the health care system as a whole looked from their patient's perspective. Throughout the past 3 years, the students had built up their patient relationship and their understanding of their patient's challenges. This was a year in which there were opportunities for quiet reflection on how well it is all working as a whole for their patient: how well the insurance works, how well the transportation works, how well the food delivery system works, how well the opportunities for exercise work, how well the patient is able to thrive within the setting of the community and the health care system. Students got a chance to question systems and policies, preparing them to join the ranks of resident physicians with a powerful and unique perspective on what good health care means. Finally, graduating students invited their patients to graduation to celebrate together the completion of this stage of their medical education.

Upon completion of this session, participants should be able to:

  1. Describe the Longitudinal Alliance Project as it has developed over the past four years at the University of Pittsburgh.
  2. Outline benefits of these longitudinal relationships to students, patients and the healthcare system.
  3. Describe challenges to supporting the development of stable patient-student relationships over the course of four years.

PA1 Teaching Preclerkship Medical Students to Take a Sexual History: Lessons From a Transgender Standardized Patient Case (STU)

Sarah Stumbar, MD, MPH; Elizabeth Gray; Samantha Syms, MS; Maria Ortega; Nicholas Romano

02/2/18 10:30 AM - 12:00 PM

With high rates of suicide, substance abuse, and sexual health concerns, as well as poor access to health screenings, transgender people experience health disparities unrivaled by other communities in the United States. These disparities are propagated by inadequate training and exposure to transgender health concerns during all stages of medical training. For example, 30% of North American medical schools report no required curriculum regarding LGBT health and less than 40% report teaching content specific to transgender health. At Herbert Wertheim College of Medicine, students have been clamoring for increased exposure to sexual health, including LGBT health. In response to student requests and a need identified during a formal review of our school’s sexual and reproductive health curriculum, we designed and executed our first standardized patient (SP) case involving a gender-questioning patient during the 2016-2017 academic year. This case, in which small groups of students interviewed the SP during a faculty-led session, was part of a half-day session in the second-year clinical skills course. Feedback from this SP experience was overwhelmingly positive; after completing the case, students reported high levels of confidence regarding their ability to address various sexual complaints, including questions regarding gender. This presentation will outline the process of developing and implementing this case; as well as the received student feedback.

Upon completion of this session, participants should be able to:

  1. explain three reasons why increasing medical school curricular exposure to LGBT (lesbian, gay, bisexual, transgender) health issues is important for both students and patients.
  2. describe the process involved in designing a curriculum that teaches to students to appropriately gather data relevant to a sexual history, including history pertinent to the LGBTQ community.
  3. list the steps required to develop a high-quality patient-centered OSCE experience related to a gender-questioning patient scenario.

PA2 Inclusion of Education on Unplanned Pregnancy and Abortion as Part of the Third-Year Family Medicine Clerkship Rotation (STU)

Shenary Cotter, MD, BSN; Sydney Sarantos

02/2/18 10:30 AM - 12:00 PM

For the past 6 years, the University of Florida College of Medicine (UFCOM) has included a novel content in its curriculum: third-year didactic education on unplanned pregnancy and abortion. The need was recognized when students, having gone through the third year, reported questions based on the observation of varying techniques of addressing unplanned pregnancies in various clinical situations without any apparent standardized approach or teaching having been given. The students also gave feedback that formal instruction including unbiased evidence-based information on abortion was absent from the curriculum. This curriculum was introduced into the family medicine clerkship in 2011, and includes education on unplanned pregnancy, contraception including emergency contraception, and abortion (medical and surgical). It includes applicable and up-to-date laws governing physicians’ professional behavior surrounding and involvement in abortion or the process of a woman’s decision to obtain elective abortion. We instruct the students to discuss in an unbiased manner, urging them to remain professionally detached when dealing with these subjects with their patients. This presentation will examine the evaluations of 6 years of medical student feedback on the course and its content.

Upon completion of this session, participants should be able to:

  1. appreciate the value of education on unplanned pregnancy and abortion in third year medical school curriculum.
  2. discuss the relevance of inclusion of unplanned pregnancy and abortion education based on the prevalence in our population of patients experiencing these health conditions.
  3. confidently design a curriculum for third year medical students at their own institutions that will uniquely address their students’ educational needs regarding the subjects of unplanned pregnancy and abortion

PA3 Opioid Overdose Prevention in Medical Education: CERA Clerkship Director Survey Results

Laura Gano; Scott Renshaw, MD; Ruben Hernandez Mondragon, MD; Peter Cronholm, MD, MSCE

02/2/18 10:30 AM - 12:00 PM

The purpose of this study is to examine how clerkships educate learners on opioid overdose prevention and the use of naloxone. Barriers to implementing education on this curriculum are also described. Given the increased rates of opioid abuse, overdoses, and deaths on a national level, it is imperative to understand how opioid overdose prevention is being addressed in medical education.

Upon completion of this session, participants should be able to:

  1. Describe the extent of the national crisis related to opioid abuse, overdose and fatalities
  2. Discuss opioid abuse, overdose and fatality prevention efforts in clerkships, including barriers to implementation
  3. Evaluate the need to train medical students in the recognition and prevention of opioid abuse, overdose and death

PA4 Student Perspectives on the National Resident Matching Process (NRMP) (STU)

Kari Nilsen, PhD; Anne Walling, MB, ChB; Jill Grothusen; Cassie Scripter, MD

02/2/18 10:30 AM - 12:00 PM

The National Resident Matching process dominates the senior year and is a significant concern of students throughout medical school. Studies have provided information about the cost, time, and disruption of securing a residency position. Surveys conducted in our institution in 2015-2017 provided extensive information about the cost, time, and other factors involved in the NRMP process. Also illustrated was the stress and disruption to fourth-year studies imposed by participating in the NRMP. This qualitative study complemented the surveys and achieved deeper understanding of the burden the NRMP imposes. Focus groups were conducted within weeks of announcement of NRMP results. The 24 participants (33% primary care) reported that they were most anxious at the beginning, helpful information was provided by others who had been through the NRMP, and they appreciated dedicated time off for interviews. A key theme was receiving complete information from residency programs, including after interviews. Participants provided feedback for residency directors, medical school faculty and administrators, and future applicants. The study findings will be provided to residencies, student affairs departments, and curricular planners to assist in improving services to students, and in enhancing the overall fourth-year experience. Nationally, as the first qualitative study concerning residency transition, this study contributes to the growing literature on issues and possible reforms of NRMP.

Upon completion of this session, participants should be able to:

  1. Summarize the major themes in student experiences in the National Resident Matching Program (NRMP) process.
  2. Describe differences in perspectives and experiences of the NRMP process between students applying to primary care programs and their classmates applying to other specialties.
  3. Discuss how the study findings add to the literature on 1) the student experience of NRMP, and 2) proposals for changes in the current system.

Copyright 2017 by Society of Teachers of Family Medicine