blockhead presentation fri pm - appd · clinical presentation ... simulation lab boards review...
TRANSCRIPT
APPD Annual Meeting – Miami, FLApril 2, 2011
UNIVERSITY OF WISCONSIN
Program DirectorJohn Frohna, MD
Associate Program Director
Melissa Cercone, MDChief Residents
Lindsay Geier, MDJeff Yaeger, MD
UNIVERSITY OF NEW MEXICO
Program DirectorBenjamin Hoffman MD
Associate Program Directors
Amy Staples MDWalter Dehority MD
Chief ResidentRebecca Rotello MD
Regularly scheduled didactic sessions
Departmental conferences, including regular morbidity and mortality conferences, seminars, teaching rounds, and other structured educational experiences must be conducted on a regular basis and with sufficient frequency to fulfill educational goals.
Reasonable requirements for resident attendance should be established for the various conferences; their attendance should be documented, and there must be appropriate faculty participation.
Press and release the "GO" button.While the light is flashing red and green, enter the 2 digit channel code: 41After the second digit is entered, Press and release the "GO" button. The light should flash green to confirm.Press and release the "1/A" button. The light should flash amber to confirm.
1 2 3 4 5 6
46%
16%
4%
8%
26%
0%
1. Program Director2. Associate Program
Director3. Coordinator4. Chief Resident5. Resident6. Other
1 2 3
23% 21%
57%1. 1‐102. 11‐203. 21+
1 2
2%
98%1. Yes2. No
1 2 3 4 5
4%
13%
0%
25%
58%1. <25%2. 25%3. 50%4. 75%5. 100%
1 2 3
81%
2%
17%
1. Frequently (daily)2. Infrequently3. Never
1 2 3 4
60%
2%4%
35%
1. Strongly agree2. Agree3. Disagree4. Strongly disagree
1 2
67%
33%
1. Yes2. No
Identify limitations inherent in a traditional noon conference structureDiscuss benefits of block curriculum designDescribe the process of block curriculum developmentDescribe evaluation opportunities for looking at block conferences.
To change or not to changeThe process of becoming a blockheadNow what do I do?Plan for evaluation
Limitations to your current lecture formatBenefits of a block curricular designBarriers to change
Content based on presenting signs/ symptomsBlock conferences every 2 weeksFriday afternoonsAll available residents attendProtected timeAttending/fellow coverage
Weekly meetingThursday afternoons1‐5 pmFollows noon Grand Rounds
4‐5 separate topics▪ Increased interaction as afternoon progresses▪ Integrates current schedule▪ Ensures no one misses single topics
All residents attend when not post‐call or awayProtected timeAttending coverage
Identify key stakeholders who need to be involvedIdentify content goals and initial motivationIdentify content sourcesEstablish overall designStructureTimingCoverageHandling absencesExpectations for residents and faculty
UW
RevolutionaryInvolvement of residents/facultyClinical presentation approachContent based on PREP topics
UNM
EvolutionaryMix of didactic, small group and interactive workABP content specs, PREP, reliable speakers
ParticipantsEinstein problemsTime Space
Individual session formatPreparation for presentersLearning objectivesFacilitating attendance
Design50 problem‐based sessions over 2 years
ParticipantsPL1‐3s
Scheduleq2 weeks on Fri afternoons, 1‐3:30pm
AbsencePost‐test +/‐ remediation
Pediatric Education and Active Resident Learning
Pre‐readingPre‐quiz (Turning Point)Didactic IntroductionMultidisciplinary & Active Learning▪ Resident Scholar▪ Cases, video, role play,
simulationPost‐quizResident feedback
Design18 month recurring curriculum2 months core content per year
ParticipantsPL 1‐3s
ScheduleThursday PM after grand rounds 1‐5 PM
Clinical coverageFaculty
AttendanceMonitored
Didactics carry over from Noon Conference
Need reliable speakersIncreasingly interactive
2‐3 hours lectureInteractive Sessions▪ Journal Club▪ QI curriculum▪ Simulation lab▪ Boards review▪ Housestaff meetings
Individual sessionsEfficacyQuality
Broader impactSatisfactionAttendanceDuty hoursClinical care
Session EvaluationResident pre/post knowledgeResident pre/post self‐efficacyResident and PD assessment of quality
General ImpactAttendanceResident and faculty perceptionsDuty hoursClinical care
Pre‐conversion surveyOld Noon Conference
6 month follow‐upResident school
Annual evaluations2006‐2010
ChallengesSmall numbersFaculty differentially involved
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
UNM Actual Attendance
UNM Potential Attendance
UW Actual Attendance
UW Potential Attendance
Noon Conf Block Conf
% Residen
t Class
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Inpatient Outpatient Inpatient Outpatient
UW Noon
UW Block
UNM Noon
UNM Block
Faculty Residents
% Respo
nden
ts Perce
iving Interferen
ce
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Inpatient Outpatient Inpatient Outpatient
UW Noon
UW Block
UNM Noon
UNM Block
Faculty Residents
% Respo
nden
ts Perce
iving Interferen
ce
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Happy with NoonConference
Unhappy withNoon Conferences
Happy withPEARLs
% Wanting toRevert to Noon
Conf.
Residents
Faculty
% Respo
nden
ts
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
% Happy withDaily Noon Conf.
% Unhappy withDaily Noon Conf.
Happy withResident School
% Wanting toRevert to DailyNoon Conf
Residents
Faculty
% Respo
nden
ts
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
PL‐1, 2 PL‐3
4.37 4.31
2006
2007
2008
2009
2010
Avg=3.38
Avg=3.45
QuestionPre‐Resident School (%)
Post‐Resident School (%)
Difference (95 % CI) p‐value
Satisfactionwith Resident Attendance
21.6 43.7 ‐22.1 (‐42.4 to ‐1.8) 0.0165
Difficult to Complywith Duty HourRequirements?
36.1 13.0 23.1 (4.9 to 41.3) 0.0068
Overall Happiness with Resident School
29.0 50.1 ‐21.1 (‐42.0 to ‐0.1) 0.0246
Question Noon (%) PEARL (%) p‐value
Satisfactionwith Resident Attendance
35.0 95.8 <0.0001
Difficult to Complywith Duty HourRequirements?
28.6 12.0 0.2012
Overall Happiness with
PEARL26.0 61.4 0.0096
QuestionPre‐Resident School (%)
Post‐Resident School (%)
Difference (95 % CI) p‐value
Satisfactionwith Quality of Presentations
65.3 88.3 ‐23.0 (‐43.9 to ‐1.8) 0.0168
Difficult to Complywith Duty HourRequirements?
41.7 2.9 38.8 (20.1 to 57.3) 0.0001
Overall Happiness with Resident School
84.6 100.0 ‐15.4 (‐28.0 to ‐2.7) 0.0088
Question Noon (%) PEARL (%) p‐value
Satisfactionwith Quality of Presentations
60.1 100.0 0.0012
Difficult to Complywith Duty HourRequirements?
21.4 0.0 0.0339
Overall Happiness with
PEARL64.3 100.0 0.0028
Careful planningStructureClinical coverageCurriculum
ImplementationEvaluation
It Can Be Doneand people will rejoice!