ICC: 7001 Transition to Clinical Core

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ICC 7001Transition to Clinical Core

• Nuts Bolts
• Lisa Schilling

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ICC 7001

• Pass Fail
• Required attendance
• Limited assignments
• Time to get ready for Clinical Core not tightly
  scheduled
• On-line evaluations 4 weeks into your first block
  required

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ICC - 7001

• Education and Administration

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ICC - 7001- Monday

• Course Session Medical Errors Medical Students
• Goal/Rationale
• To advance medical student familiarity with the
  occurrence and personal impact of medical errors
  as well as a systems approach to error reduction
  and student role in patient safety.

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ICC - 7001- Monday

• Course Session Mentored Scholarly Activity Lunch
  Breakout Sessions
• Goal/Rationale by thematic area
• Review MSA Expectations and Benchmarks
• Review MSA rubrics
• Review Phase III plans for students and how they
  translate into Phase IV

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ICC - 7001- Monday

• Session LCME Survey, Pagers
• The student LCME medical education needs you!
• Bring your lap top
• USA Mobility - student pagers

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ICC - 7001- Tues, Wed, Thursday

• 4 main Groups 1-4
• 1.1-1.4,
• 2.1- 2.4
• 3.1 -3.3

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ICC - 7001- Tues, Wed, Thursday

• Course Session Shadowing
• Goal/Rationale
• Decrease anxiety
• Increase familiarity with block/team/specialty

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ICC - 7001- Shadowing

• You only go 1 morning - see the roster
• Your 1st or 2nd inpatient block
• Call the contact on the roster the afternoon
  before you are scheduled to shadow
• Confirm and clarify the arrangements
• MUST WEAR WHITE COAT AND BADGE
• Dress how?

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ICC - 7001- Tues, Wed, Thursday

• Course Session IV Placement Surgical Scrub
• Goal/Rationale New skills
• Surgical scrub and gown and glove must have!
• (OR Nurses)
• IV placement and phlebotomy (Anesthesia)

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ICC - 7001- Tues, Wed, Thursday

• Course Session Clinical Pearls
• Goal/Rationale Get tips from MS4s
• What books to buy and carry
• Useful PDA programs
• Study tips
• Unwritten rules
• No faculty will be present during these sessions!

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ICC - 7001- Tues, Wed, Thursday

• Session Learning Logs Session
• (Listed as IT on Group Schedule)
• Goal/Rationale
• Learn to use the new logging system
• Bring your PDA!!

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ICC - 7001- Tues, Wed, Thursday

• VA paperwork, fingerprinting, badging, HIPPA
• Goal/Rationale
• Authorization for electronic record access takes
  at least 48hr after fingerprinting.
• Dont delay, if possible

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ICC - 7001- Tues, Wed, Thursday

• CAPE Oral Presentation Session
• Goal/Rationale
• Improve your clinical reasoning oral
  presentation skills
• Practice a focused clinical exam.
• Use the information you gather to prepare for and
  deliver a 5-minute new patient oral presentation.
• 1st Tuesday group begins at 1230 pm
• BRING YOUR DIAGNOSTIC KITS!!
• ARRIVE EARLY!!

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ICC - 7001- Thursday

• MD- MBA Student Interest Lunch

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ICC - 7001- Friday

• Course Session Legal Obligations to Patients,
  Erin Egan, JD
• Goal/Rationale
• Understand your legal obligations to patients
• Understand the legal ramifications of
  documentation

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ICC - 7001- Friday

• Course Session Professionalism Case Discussions-
  small group sessions
• Goal/Rationale Improve your skills at managing
  ethically complex situations
• Please see the 7001 website
• Assigned reading in preparation

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ICC - 7001- Friday

• Course Session Gold Professionalism Ceremony,
• Guest Speaker Cliff Zwillich, MD
• Goal/Rationale
• Be inspired at professionalism ceremony
• CU Honor code presentation - the Honor Code
  Committee

Student professionalism committee and Student
Affairs organized
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ICC - 7001- Friday

• USMLE Exit Survey
• Ice Cream (EDR)
• Mini-Graduate Questionnaire (GQ)
• Class Meeting

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ICC 7001 Contact information

• Christy Linsenmaier
• 303-724-7732

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Oral Presentation
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Oral Presentation

• Method of communication to allow collaborative
  conduct of patient care
• Opportunity for teaching and evaluation of
  clinical competence
• Negotiation of professional relationships
• Representation of professional values

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Model of Communication

• Purpose- What is the reason for the
  communication? What outcome do I desire?
• Audience- Who is my audience and what is their
  role?
• Setting/Circumstance- What are the circumstances
  that must influence my presentation?
• Message/Content -What is the necessary content?
  How do the above influence the content?

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Oral Presentation

• A story
• An argument

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Purpose

• Contribute to patient care by organizing
  information in a manner that benefits the
  decision-maker
• Present a well-constructed argument that sustains
  iterative clinical reasoning
• Melding of a story and an argument
• Show case your knowledge and analytic skills

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Audience

• Your attending
• Your team
• Consultants
• What do you want from each of them?
• What do they need from you?

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Setting/Circumstances

• To emergency medicine attending during the
  arrival of several trauma victims
• To Dr. Deterding during a bronchoscopy of an
  18-mo old child
• To your internal medicine attending where you are
  presenting a stable but ill patient who is
  diagnostically challenging

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Content

• You must decide what content is most appropriate
  for the given purpose, audience,and setting,
• Most of us learn by trial error,
• Thinking about purpose, audience, setting and
  content will help you

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Oral Presentation

• Method of communication to allow collaborative
  conduct of patient care
• Opportunity for teaching and evaluation of
  clinical competence
• Negotiation of professional relationships
• Representation of professional values

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Teacher-Student Miscommunication

• Be brief ----- Talk faster
• Students make interpret feedback out of context,
  and consider it a rule.
• No social history, please
• Teacher may not explicitly ground feedback in the
  appropriate context

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An Argument

• Constructing the case into a diagnostic
  therapeutic plan
• Content Relevance-
• Information that assists with clinical reasoning
• Clinical reasoning improves as knowledge and
  experience grow

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Relevance

• The majority of feedback students receive is to
  provide relevant or pertinent information
• Relevance - not only about content, but audience,
  setting, and purpose

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SNAPPS

• Summarize the patients problem in 2-3 sentences.
• Narrow the differential to at least 2-3
  possibilities/diagnoses
• Analyze by comparing and contrasting
• Probe the teacher with smart questions
• Plan
• Select what you will learn

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Novice Clinical Reasoning

• Extensive biomedical knowledge
• Limited clinical experience
• Dont recognize the clues Key Features
• Dont see the patterns from case to case

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Expert Clinical Reasoning

• Extensive biomedical knowledge
• Extensive clinical experience
• Recognize clues Key Features
• Recognize Patterns - by combination of biomedical
  knowledge and clinical experience

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From Novice to Expert

• SNAPPS guides you - practice
• Summarize the key information
• Use descriptive medical language
• Choosing the key information is a skill

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Language Matters

• What would the medical words be?
• he had an elevated temperature
• he wasnt making sense or being appropriate
• he couldnt move the left side of his body
• when she lays down she gets short of breath

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Language Matter

• Use special qualifying words to help compare
  and contrast diagnoses or describe them.
• Use qualifiers that have implied or explicit
  opposites (bipolar)
• acute / chronic
• low fever / high fever
• Left-sided abd. pain/ right-sided abd. pain
• Sharp pain/ dull pain

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Other examples of qualifiers

• Increased Decreased
• Tense Soft
• Abnormal Normal
• Sudden Slow
• Rapid Slow
• Non-focal Focal
• Irritable Happy
• Lethargic Awake

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Summarize

• Use descriptive language and terms
• Choose key components that contribute to the
  listeners ability to make medical decisions (or
  to do what ever else you need of them)

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Narrow - Analyze Differential

• Present information that allows you to compare
  and contrast, support or refute likely diagnoses
• Improves clinical knowledge clinical reasoning
• Youll likely need to read up on your patient to
  do this

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Plan

• Present a diagnostic and/or therapeutic plan
• Put yourself in the position of the
  decision-maker
• What more do you need to know to formulate a
  plan?

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Probe

• Ask smart questions
• Frame them in a decision

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Select for Self-directed Learning

• What are your knowledge gaps- general or specific
• What is the evidence?
• Challenge everything? Not out loud!
• Use new resources

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You have to deliberately practice!

• You cant be passive to improve
• Give examples of those that deliberately practice

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Examples of Deliberate practice

• Solitary activities to study and analyze
  published games of the best players
• What are your knowledge gaps? What should you
  study?
• Mentally play the game to understand Chess
  masters moves
• Find and incorporate the knowledge you need to
  become a master!

Kasparov
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What is deliberate practice?

• Effortful activities associated with constant
  improvement
• Focus on primary goal of improvement of a
  specific task
• Obtain detailed immediate feedback
• Perform the same or similar tasks repeatedly

ERICSSON, Acad Med, 2004
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CAPE-Oral Presentation Session

• Youll see 1 stnd pt
• Youll perform a focused, history and exam in 30
  minutes have 15-minutes to jot notes
• Youll receive diagnostic results before you
  leave CAPE
• Youll use your information to prepare a 5-minute
  new patient oral presentation
• For your new patient presentation you can assume
  that the setting is for inpatient attending
  rounds.

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Oral Presentation Session

• Youll be in a group of 7-8 students, half of
  whom will have seen the same patient you.
• Youll have the opportunity to present and listen
• In addition to the new patient oral presentation,
  youll have the opportunity to present in other
  contexts
• This is safe, friendly environment!

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Oral Presentation Session

• Dont read your presentation!
• Dont memorize your presentation!
• Learn about the probable diagnoses and use the
  presentation to construct the story/argument you
  need to tell the attending needs to hear!
• This is safe, friendly environment!

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Best wishes

• Focus on the patient and you wont go wrong!

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ICC 7001 Schedules

• In your packet
• Posted on Black Board
• Shadowing time and place posted at Orientation
  Black Board
• Professionalism small groups posted
• Other?