BCOE Best Curriculum On Earth

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BCOE - Best Curriculum On Earth

• Results for 2008-2009 Clerkship
• Michael Zettler - Class of 2010

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Presentation Outline

• Goals and format of the surveys
• General feedback for all blocks
• Brief block-specific feedback for mandatory
  rotations
• Discussion of results
• Future goals of BCOE

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BCOE Surveys

• Online survey
• http//www.schulich.uwo.ca/survey/Login.asp
• Personalized e-mail with survey links for
  rotations just completed sent out every 6 weeks
• Reminder e-mail with survey links
• Draw for 50 to Chapters three times per year.

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BCOE Surveys

• Teaching
• Time spent in formal teaching sessions
  (modalities may include rounds, rotation
  packages, web-based tutorials etc) to cover major
  topics in the specialty over the course of the
  6-12 weeks.
• Time spent on informal clinical teaching
  surrounding patient encounters.
• 1 not enough time, 2 just right, 3 too much
  time
• Scheduling
• Did this rotation adhere to the on-call policy?
• Were you notified about the rotation placement,
  schedule and on-call responsibilities at least
  two weeks in advance.
• Comments requested if answered no to either
  question.
• Comments
• Nomination of faculty member.
• Negative feedback on rotation.
• Positive feedback on rotation.

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BCOE Surveys

• Core Questions
• The supervisors were well aware of the learning
  objectives and roles appropriate for a clerk
  within the rotation.
• As a clerk, I had an appropriate level of
  independence in seeing/treating patients.
• The methods of evaluation fairly assessed my
  knowledge and abilities in this rotation
• I received constructive feedback well before
  receiving my final evaluation.
• The rotation consisted of an excellent variety of
  patient problems.
• Teachers in this rotation model exemplary
  attitude towards gender and diversity issues.
• Teachers in this rotation model respect for other
  health professionals
• Overall, I would recommend this rotation to my
  friends
• Rotation-specific Questions
• OB/Gyn, Family Medicine, Medicine, Pediatrics
• 7-point Likert scale with anchors from Strongly
  Disagree (1) to Strongly Agree (7).

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Surveys Administered

• Family Medicine - 4 week, 2 week in Windsor or
  London
• Psychiatry - London, Windsor, and Rural
• Medicine - CTU (UH, VIC, ACE, Windsor), Elder
  Care, Oncology, Optho/ENT, Selective (all W L)

• Paediatrics - London, Windsor, Rural
• Ob/Gyn - Windsor, London (SJHC, VIC), Rural
• Surgery - General, Emergency, Anaesthesia,
  Selective (all W L)

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Detailed Results Available!

• Presentation will focus on results relevant to
  all rotations, as well as results specific for
  mandatory rotations.
• Please consult distributed document for results
  for selective rotations.
• Detailed numerical ratings and respondent
  comments available to rotation directors upon
  request.
• Contact Michael Zettler - mzettler2010_at_meds.uwo.c
  a or via your own student representatives.

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Results - Response Rate

• Results compiled with 5 of 8 blocks completed.
  Approximately 90 students finished each mandatory
  rotation.
• Response rate for mandatory rotations range from
  23 (Emergency Med) to 41 (Psychiatry). Most
  have approx. 33.
• Smaller number of responses and uncertain
  proportions for selective rotations.
• Difficulties busy clerk mentality, separate
  survey system not otherwise used, not mandatory

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Results - General Comments

• Strengths
• Medical students value a defined and practical
  role during their rotations
• Independence in assessing patients and making
  management plans is commonly cited in positive
  comments
• Organization and scheduling known well ahead of
  time relieves student anxiety.
• Providing opportunities to learn procedural
  skills is highly valued on rotations where this
  is possible.
• Well planned and carried-out formal teaching is
  extremely helpful. Consultants and residents who
  take the time to do informal teaching are
  well-liked.

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Results - General Comments

• Weaknesses
• Medical students do not value being a passive
  observer at this stage of their training.
• Formal teaching must be balanced between
  different sites, and evaluation methods in-line
  with the teaching.
• Disorganized scheduling on some rotations
  detracts from the learning experience.
• Though rare, having a consultant or resident that
  does not value teaching medical students makes
  for a poor experience.

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Results - Family Medicine

• Strengths
• Many positive comments about individual
  preceptors and their interaction with medical
  students.
• Variety of practice environments, skills
  performed, and patients seen is highly valued.
• Independence to assess patients and plan
  management is a strong positive attribute.
• Weaknesses
• Daytime and on-call scheduling not well
  communicated on some rural rotations this is
  likely preceptor-specific.
• Clinical cards and on-line cases not reviewed
  highly as learning tools.
• A small number of preceptors may not be aware of
  the role of the medical student and appropriate
  rotation objectives.

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Results - Psychiatry

• Strengths
• On-Call shifts at Victoria ER and in Windsor were
  valued highly by students primary reasons cited
  were undifferentiated problems and teaching by
  residents.
• The opportunity to see a variety of patients and
  pathology was important to many students.
• Both formal and informal teaching by residents
  was appreciated by students.
• A few consultants were nominated for best
  teacher multiple times Drs. Robinson, Lefcoe,
  Velehorschi.
• Weaknesses
• Lack of on-call experience in rural rotations
• Discrepancy in level of independence granted to
  medical students more in Windsor and rural
  rotations, less in London.
• Child Psychiatry was felt to be inadequate,
  particularly in places where students only
  observed interviews.
• Windsor teaching sessions felt to be less
  organized and disjointed from London (on which
  the exam was based?).

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Results - Medicine CTU

• Strengths
• Medical students enjoyed the experience of
  working a member of a team.
• Level of independence to see consultations and
  care for patients was rated highly.
• Formal and informal teaching sessions were
  appreciated by students, with some exceptions
  (see below).
• Drs. Larocque, Rehman, and Saad received multiple
  nominations for best teacher.
• Weaknesses
• Students felt they did not get enough experience
  with procedures, either observing or actively
  involved.
• Seemingly, there are a small number of
  consultants who did very little teaching with
  their team, or had limited involvement generally.
• While most comments about residents were
  positive, there were a small number of very
  concerning complaints.

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Results - Paediatrics

• Strengths
• Drs. Killorn, McNeill, Awuku received multiple
  nominations for best teacher.
• Paediatric Emergency was the subject of many
  positive comments, particularly because of the
  variety of patients.
• Variety of patients was appreciated at all sites.
• Formal and informal teaching, especially by
  residents, was rated highly.
• Windsor morning teaching sessions were rated
  highly
• Weaknesses
• CLIPP cases were rated fairly evenly across the
  spectrum from very helpful to not at all helpful.
• Students felt there could have been more teaching
  sessions, especially in light of frequent
  cancellations.
• Students in London made several requests for a
  community paediatric placement.
• Students in Windsor felt that the
  videoconferenced teaching from London did not add
  to their own teaching sessions.

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Results - Obs Gyn

• Strengths
• Students spoke highly of the hands-on
  experience available at most sites, but
  particularly Windsor and rural rotations.
• Numerous positive comments about physicians at
  all sites.
• Variety of Ob/Gyn practice was a positive.
• Weaknesses
• Concerns raised about the St. Josephs site
  limited clinical experience with general
  gynaecology, limited hands-on experience due to
  large number of learners, not being involved for
  deliveries.
• Students commented that the teaching received did
  not fit well with the NBME exam evaluation.

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Results - General Surgery

• Strengths
• Medical students enjoyed the experience of
  working as member of a team.
• Level of independence to see consultations and
  care for patients was rated highly.
• Hands-on experience in the OR is highly valued
  by many students.
• Windsor students commented on the flexibility of
  their experience able to see a variety of
  problems with different consultants.
• Formal teaching sessions were rated highly.
• Weaknesses
• Some students commented on a paucity of informal
  teaching this seems to be resident and
  consultant-dependent.
• There were discrepancies between the formal
  teaching received in London and Windsor.
• Student commented on an expectation to stay well
  past noon, or for a full day, when post-call. One
  student said it was made to seem as though you
  were disinterested or uncommitted to learning if
  you didn't stay as long as possible.

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Results - Emergency Medicine

• Strengths
• Variety of patient encounters and problems dealt
  with was a big strength
• Amount of independence given to students in
  patient assessment
• Informal teaching from a number of consultants
  was highly rated.
• Weaknesses
• Scheduling shifts further in advance would be
  appreciated by many students
• There seems to be a small number of preceptors
  not interested in having students.
• Students question the validity of being evaluated
  each shift by a different preceptor.

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Results - Oncology

• Strengths
• Clinical experiences were valued by students
• Those able to see a variety of problems
  appreciated it.
• Weaknesses
• Students felt there was too much time for
  studying and presentation preparation, at the
  expense of clinical experience.
• Students questioned the value of the exam as an
  evaluation tool.

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Discussion of Results

• Well-rated rotations provide
• Independence to care for patients
• Role as a team member where possible
• Well organized, with schedules known in advance
• Opportunity for technical skills where possible
• Enthusiatic and appropriate formal informal
  teaching

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Discussion of Results

• Areas for Improvement
• Some rotations do not do a good job at providing
  an appropriate role for students.
• Formal teaching must be coordinated between
  different sites, and evaluation methods in-line
  with the teaching.
• Disorganized scheduling or lack of communication
  detracts from the learning experience.
• Educate consultants and residents regarding
  appropriate roles for clerks, how they can
  improve their experience.
• Need to identify rare instances of inappropriate
  conduct and redress situation.

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Future Directions for BCOE

• Curriculum evaluation done via Schulich
  administration.
• Duplication of some information between Admin.
  BCOE
• Importance of student-run feedback channel.
• Comments most important?
• Needs of students and rotation directors?