Society of Teachers of Family Medicine (STFM)
American Journal of Preventive Medicine
Contributed Best Practices
Community Experiences Yrs 1-2 (RVU-COM)
Contact Person: Joseph Stasio, DO firstname.lastname@example.org
Students at RVUCOM are required to complete at least 16 documented hours of a Medical Shadowing or Community Service experience each academic year as part of their Principles of Clinical Medicine Courses. Medical shadowing experience can include a wide variety of experiences including but not limited to office and hospital based experiences, emergency room, operating room and other medical care venues. Community service experiences include health fairs, children’s hospital visits, homeless shelters, domestic violence shelters, school physicals and international medical missions to name a few.
Shelf Exam for Rotations
Contact Person: Kay Kalousek, DO email@example.com
Online Clinical Remediation Experiences
Contact Person: R. Taylor Scott firstname.lastname@example.org
OSCE-Clinical Performance Exam End of Yr 2
Contact Person: Dat Trinh, DO email@example.com
The knowledge and skills at the end of the year to determine the student’s readiness for OMS III clinical rotations. This examination requires students to achieve a score not less than 70% on five patient encounters in the Clinical Skills Laboratory. The timing and format of the examination is modeled after the NBOME’s COMLEX II PE examination and is scaled to the proficiency level of a student entering clinical training. The examination is the final physical examination skills assessment for the two-year Essentials of Clinical Medicine course (ECM). Students unable to pass the examination receive an incomplete for the ECM IV course and may be delayed in starting rotations until they have undergone successful remediation.
Medicine in Society-Covers all Core Competencies (GA-PCOM)
Rotation Didactic Weeks
Contact Person: Stephanie White, DO firstname.lastname@example.org
Following each 12-week block of rotations, OMS III students are required to return to campus for the Didactic Week activities. During the Didactic Week, students participate in case-based facilitated discussions to summarize the rotations they just completed as well as participate in preview sessions to become familiar with cases that they will be expected to see during the next 12 weeks of rotations. Students also must pass discipline-specific OSCEs and shelf exams related to the prior 12 weeks of rotations. A student’s final core rotation grade is based upon the evaluation from the clinical site, the OSCE, the shelf examination, and the student’s participation in the case-based discussions.
Simulation Center for Yr 1-2
Contact Person: Penny Patton, BFA email@example.com
Throughout a student’s career at PCOM, the Clinical Learning and Assessment Center provides a variety of settings and opportunities for hands-on practice in a standardized and professional environment through the use of live patients, robotics, and models.
- The center sets a tone for the larger context of professionalism, high standards, and continuous learning that DOs will in inhabit in their continuing career
- During the first two years, through a series of encounters with Standardize Patients (SPs), students practice and hone physical exam and history taking skills to align with classroom learning. SPs portray cases, assess skills and provide verbal feedback directly to the student after each encounter. As a result, students hear first-hand about the impact of their own behaviors as they learn to demonstrate empathy and build rapport.
- From the very “first meeting” with a live patient, students are guided to improve their ability communicate and develop techniques to create more patient-centric interactions.
- SP encounters are video-taped, allowing faculty to integrate learning systems and create tools for assessment. Students can evaluate their progress by accessing their own videos.
- The same technology will be used to provide a record of a student’s progress in the context of specific competencies that can be tracked during their time here at PCOM.
Standardized Patient Program - Throughout the entire undergraduate medical curriculum
Contact Person: Loretta Graham-Freesm, PhD firstname.lastname@example.org
The Standardized Patient Program at Rocky Vista University COM is housed in a clinical skills laboratory which is made up of 20 Standardized Patient Rooms with one-way glass to enhance faculty viewing of students as they work with patients, a Harvey simulator class room, a large monitoring room and two other classrooms plus offices for its staff. Currently the program has a Director and 2 part-time trainers. In the past almost 3 years we have hired 60 SPs from the community as well as from the University of Colorado Program and spent hundreds of hours training them.
Ensuring that all patients portraying a case are standardized is the goal of this program. Each SP receives 6 hours of training for each SP project, two of which is training using the Arizona Clinical Interview Rating Scale. Reliability using this instrument on exams has ranged between .83 and .92 which is exceptional.
The Educational Management System (EMS) Arcadia software, which is a total clinical skills application, runs on a computer that runs our program. EMS allows patients to complete both checklists and ACIR scales on the computer and the students to write SOAP notes and answer Post Encounter Questions related to the case they just encountered. The system times the exam, provides overhead announcements directing the students as to the beginning and ending of sessions as well as a warning letting students know the end of a given time segment is nearing. All encounters are digitally recorded and both students and faculty have opportunity to review them after the exam is over. The assessment portion of this software produces reports of all types of psychometric data which is most useful in evaluation of both students and patients.
The training method used at RVU involves use of a patient’s episodic memory (scripts that tell a story), tactile memory (teaching of physical exams are done on each person to enable them to remember where (s) he were touched), and drill and practice (a question and answer study sheet) which SPs fill out together to ensure that their answers to open-ended questions are identical). In addition a 2 hour session on the ACIR is conducted to allow patients to see how stringently the other patients are grading students and to enhance inter-rater reliability. The final 2 hours of training is a dress rehearsal at which time the trainers play the part of a student physician and conduct both a focused interview and a focused physical exam.
The final step in our procedure is to keep records of individual patient performance as well as group performance and statistically analyze the data to spot weaknesses and to remediate deficiencies.
Students in years I and II are introduced to a hands-on approach to learning to communicate with people of differing ages, genders, ethnicities, and educational levels through a variety of cases developed by faculty. In this setting they have opportunity to practice their history taking, communication and physical exam skills and receive feedback from Standardized Patients as well as faculty. It is in this setting that our goal is for them to learn to think like physicians on their feet and not rely on a memorized rote list of questions and physical exam maneuvers. One of the most important skills they must learn is to listen and truly hear the message and anything that might be lurking behind the message.
As students move on to the third year they are faced with the COMLEX II PE. This certifying exam utilizes Standardized Patients and each student must interview 12 individual patients, document his or her findings and finally write up a plan for the patient. This is a must pass exam. At Rocky Vista University College of Osteopathic Medicine, a concerted effort is put forth to ensure the students that they have the skills, knowledge, and thought processes that will guarantee success on this exam. Currently each third year student will be taking three different practice exams consisting of three patients each. The first two will offer them feedback as to how they can improve and the last one will be the “final” at which time the student will know if he or she is ready to take the NBOME exam.