ann s. botash, md professor, pediatrics jason perez, ms, fnp graduate, college nursing patricia d....
TRANSCRIPT
A N N S . B O TA S H , M DP R O F E SS O R , P E D I AT R I C S
J A S O N P E R E Z , M S, F N PG R A D UAT E , C O L L E G E N U R S I N G
PAT R I C I A D. P O W E R S, D N P, M PA , R N, F N P- C , N P PC L I N I C A L A SS I S TA N T P R O F E SS O R , N U R S I N G
C A R O L R E C K E R - H U G H E S, P T, P H DA SS O C I AT E P R O F E SS O R , P H Y S I C A L T H E R A P Y
C A R R I E R O S E A M E L I A , M AFA M I LY M E D I C I N E
PA M E L A Y O U N G S - M A H E R , M . E D.C O O R D I N AT O R , O N L I N E L E A R N I N G
Distance Faculty Observation Using iPadsUpstate Medical University
Where We Work College of Medicine (Ann)
College of Nursing (Patty)
IT(Pam)
Physical Therapy (Carol)
Family Medicine (Carrie)
Background & Purpose
1. Clinical Education
2. Goals of Project
3. Literature Review
Percentage Clinical Education
%0
10
20
30
40
50
60
70
NP
PT
MD
NPPTMD
Education: From Classroom to Clinic
Academic Faculty Clinical Supervisors Clinical teachers in traditional & Practicing clinicians who supervise non-traditional classroom settings students in the clinic
Education: From Classroom to Clinic
Challenges of Clinical Teaching:Juggling Act
Variability teaching & learning
Lack of effective feedback skills
Time
Goals of the Project
Assess FaceTime as a mechanism to bridge time/distance barriers in observing students
Improve students’ clinical skills through use of formative feedback
Develop a shared observation tool across multiple disciplines to define core, observable clinical skills
Medicine
Physical Therapy
Nursing
• Fosters appreciation & understanding of other disciplines• Challenges norms & values of each discipline• Promotes student participation• Models strategies for future practice
Past to Future
An Interdisciplinary (Ad)Venture
COM
CON
CPT
Literature Review
Distance Technology:
1. Provides a mechanism for valuable feedback on performance and promote mastery of clinical skills (Bulik, Frye, Callaway, Romero, & Walters, 2002; Clever, Novack, Cohen, Levinson, 2003; Novack, Cohen, Peitzman, Beadenkopf, Gracely, & Morris, 2002).
2. May be used for long-distance communication assessment for a variety of learners (Bulik, Frye, Callaway, Romero, & Walters, 2002; Clever, Novack, Cohen, Levinson, 2003; Mattheos, Nattestad, & Attström, 2003; Novack, Cohen, Peitzman, Beadenkopf, Gracely, & Morris, 2002).
3. Can be distracting/problematic (Curran, Aziz, O'Young, Bessell, & Schulz, 2005; Clever, Novack, Cohen, Levinson, 2003).
Description of the Project
Timeline
• Planning & CommunicationAug/Sept/Oct:
•Recruitment & Training
Oct/Nov/Dec:
•Observations/FeedbackJan – May:
Planning
IRB Process Describe what we plan to do &
with whom Seek exempt status
Identify common ground across disciplines for patient examination Taking a patient history Create form with essential
elements
Define PI Roles
Communication
Communication with: The project team Academic Faculty Students Clinical sites
Tools Blackboard Google Drive Email
Research Methods
Develop Tools for Data Collection:• Student & Faculty Technology
Survey• Student Survey on Faculty Feedback• Create Focus Group Questions for
Faculty
Develop Protocols:• Patient Recruitment• Student & Faculty FaceTime
Encounters
Recruitment of Sites & Students
Recruitment Sites
HIPAA Wi-fi access Policies & Procedures Some sites could not participate
Students Expectations of participants Overview of the Project and iPad training Completing 2 Surveys online
Faculty Recruitment
Principal Investigators recruited faculty
iPad was an incentiveRequired commitment
3 hours of faculty development
1-2 hours/month January-May Complete survey and focus
groupMemorandum of
Understanding (MOU)
Faculty Development Workshop
Faculty Training
Set up and use of iPads 1 hour session (by department) Introduction to Face Time,
Apps, and Settings
Observation/Feedback Workshop 2 hour session Simulation in Clinical Skills
Center
Practice, Practice, Practice
Feedback Workshop Objectives
Following this workshop, faculty will:
• Differentiate between characteristics of effective versus ineffective feedback.
• Use open-ended questions to promote student reflection and decision making.
• Engage in a formative feedback session using Face Time.
• Assess challenges of technology in the delivery of feedback.
Effective Feedback
Promotes self-directed learning and professional development
Facilitates effective problem solving
Requires ability to:• question
appropriately• listen actively
I’m questioning
Feedback Should
Faculty Development Session
Setting up the iPad (Student)
Pediatric Observation of Student/Standardized Patient
Feedback: Nursing Feedback to Student
Data Collection & Results
Data Collection & Analysis
Data Collection and Analysis:1. Faculty Survey 2. Student Surveys
3. Faculty Focus Groups
Results: Technology Surveys
Did you experience difficulty connecting to FaceTime?Results
•Yes•No
Faculty•42%•58%
Students
•38%•63%
Results•Yes•No
Faculty•48%•52%
Students
•44%•56%
Did you experience difficulty staying connected to FaceTime?Faculty: It took multiple attempts before the call went through. Audio was choppy, the camera froze several times.
Student: Preceptor was
unfamiliar with the
technology.
Results: Technology Surveys
Results•Agree•Disagree•Unsure
Faculty•73%•12%•15 %
Students
•81%•6%•13%
Results•Agree•Disagree•Unsure
Faculty•55%•18%•27 %
Students•69%•16%•16%
FaceTime is an effective mechanism for delivering student feedback
I would recommend the use of FaceTime technology on a regular basis
Faculty: Promising but doesn't have it's sea-legs yet.
Results: Student Reflections
The faculty member provided meaningful feedback about…
My Strengths
•Agree 86%•Disagree 10%•Unsure 3%
Areas for Improvement
•83%•10%• 7%
Might do Differently
•79%• 7%•14%
Results: Student Reflections
The faculty member provided….. “tricks of the trade” advice or helpful tips
Students
• Agree• Disagree• Unsure
Results
• 76%• 14%• 10%
Themes: Faculty Focus Groups
What Worked?• Assessing Students• Providing Feedback• Communication with the Onsite Faculty
What Did Not Work?• Imposition & Scheduling• Connectivity • Viewing Patients & Students• Student Initiative &
Accountability
Themes: Faculty Focus Groups
Suggestions Expand Use of iPad
Observations Earlier & more frequently History and physical
examination Connect with clinical faculty
Use for Site Visits
Teaching Tools iPad Apps
Additional Faculty Development
Lessons Learned
Students
Recruitment Sample of convenience “Carrot or Stick”=Participation
Training Memorandum of understanding Practice, practice, practice!
In the Clinic Variable support of instructors Informed consent process
Survey Completion
A Student’s Experience
Faculty
• Recruitment
• Training
• Commitment
• PI Support
Pilot Study…..Next Steps?
• Expand use across colleges
• Implement “carrot or stick” policies • Consider cross discipline observations
• Use, and validate, forms across disciplines• Guidelines for delivery of feedback• Observation tool
• Observe history AND physical examination
Next Steps for Faculty Use?
Communication skills workshops For new and current faculty Inter professional
Professional development iPad use Apps
Use of the iPad for “site” visits Rural and remote settings
Observation/Feedback Forms….
Observation Form: https://docs.google.com/file/d/0B7a8mExE0x3HdnpSUFM1W
FpjYW8/edit?usp=sharing
Feedback Checklist: https://docs.google.com/file/d/0B7a8mExE0x3HT1MwVTNUZ
045cEU/edit?usp=sharing
References
Bulik, R., Frye, A. , Callaway, M., Romero, C., & Walters, D. (2002). Clinical Performance Assessment and Interactive Video Teleconferencing: An Iterative Exploration. Teaching and Learning in Medicine, 14 (2), 124-132.
Clever, S., Novack, D., Cohen, D., Levinson, W. (2003). Evaluating surgeons' informed decision making skills: Pilot test using a videoconferenced standardized patient. Medical Education, 37 (12), 1094-1099.
Curran, V., Aziz, K., O'Young, S., Bessell, C., & Schulz, H. (2005). A comparison of face-to-face versus remote assessment of neonatal resuscitation skills. Journal of Telemedicine and Telecare, 11 (2), 97-102.
Glavaz, G., Parish, T., Byous, R., Chambers, D., Gerdom, L., Leffert, J., & Wright T. (2012). The use of videoconferencing for clinical site evaluations. Journal Physician Assistant Education,23(2), 50-55.
Lentz, L.M., & Fincher, R.M. (1999). Using telemedicine and standardized patients to evaluate off-campus students' skills. Journal of the Association of American Medical Colleges, 74 (5), 598-599.
Mattheos, N., Nattestad, A., & Attström, R. (2003). Feasibility of and satisfaction with the use of low-bandwidth videoconferencing for examination of undergraduate students. Journal of Telemedicine and Telecare, 9(5), 278-281.
Novack, D., Cohen, D., Peitzman, S., Beadenkopf, S., Gracely, E., & Morris, J. (2002). A pilot test of WebOSCE: A system for assessing trainees' clinical skills via teleconference. Medical Teacher, 24 (5), 483-487.
Robinson, S. (2011). Promote active learning with iPads. Radiologic Technology, 83(2), 204-207.
Smith, C. , & Skandalakis, J. (2005). Remote presence proctoring by using a wireless remote-control videoconferencing system. Surgical Innovations, 12(2), 139-143.
Upstate Medical University
Any “burning” questions??
What we are doing….
CNY Central: http://www.cnycentral.com/news/story.aspx?id=878617#.UVnR
cjnWaf8
What's Up at Upstate: http://whatsupatupstate.wordpress.com/2013/04/01/professors-
use-ipad-facetime-feature-in-teaching-medical-students/
Student interview: http://www.youtube.com/watch?v=p7KDIYU3Ngc&list=UUIC6
B4ULFCqa8bXKVc1sjYA&index=1