Clinical Educator and Student Perceptions of a Weekly Observed Practice Activity Evaluation Tool.

BACKGROUND AND OBJECTIVES: Clinical teachers (or preceptors) have expressed uncertainties about medical student expectations and how to assess them. The Association of American Medical Colleges (AAMC) created a list of core skills that graduating medical students should be able to perform. Using this framework, this innovation was designed to provide medical students specific, progressive clinical skills training that could be observed. METHODS: We used the AAMC skills to develop observable events, called Observed Practice Activities (OPAs), that students could accomplish with their outpatient preceptors. Preceptors and students were trained to use the OPA cards and all students turned in the cards at the end of the rotation. RESULTS: Seventy-nine of 115 preceptors and 80 of 149 students completed evaluations on the OPA cards. Both students (60%) and preceptors (70%) indicated the OPA cards were helpful for knowing expectations for a third-year medical student, although preceptors found the cards to be of greater value than the students. CONCLUSIONS: The OPA cards enable outpatient preceptors to document student progress toward graduated skill acquisition. In addition, the OPA cards provide preceptors and students with specific tasks, expectations, and a template for directly observed, competency-based feedback. The majority of preceptors found the OPA cards easy to use and did not disrupt their clinical work. In addition, both students and preceptors found the cards to be helpful to understand expectations of a third-year medical student in our course. The OPA cards could be adapted by other schools to evaluate progressive skill development throughout the year.

Use of a structured approach and virtual simulation practice to improve diagnostic reasoning.

OBJECTIVES: In 2015, the National Academy of Medicine IOM estimated that 12 million patients were misdiagnosed annually. This suggests that despite prolonged training in medical school and residency there remains a need to improve diagnostic reasoning education. This study evaluates a new approach. METHODS: A total of 285 medical students were enrolled in this 8 center, IRB approved trial. Students were randomized to receive training in either abdominal pain (AP) or loss of consciousness (LOC). Baseline diagnostic accuracy of the two different symptoms was assessed by completing a multiple-choice question (MCQ) examination and virtual patient encounters. Following a structured educational intervention, including a lecture on the diagnostic approach to that symptom and three virtual patient practice cases, each student was re-assessed. RESULTS: The change in diagnostic accuracy on virtual patient encounters was compared between (1) baseline and post intervention and (2) post intervention students trained in the prescribed symptom vs. the alternate symptom (controls). The completeness of the student's differential diagnosis was also compared. Comparison of proportions were conducted using χ2-tests. Mixed-effects regressions were used to examine differences accounting for case and repeated measures. Compared with baseline, both the AP and LOC groups had marked post-intervention improvements in obtaining a correct final diagnosis; a 27% absolute improvement in the AP group (p<0.001) and a 32% absolute improvement in the LOC group (p<0.001). Compared with controls (the groups trained in the alternate symptoms), the rate of correct diagnoses increased by 13% but was not statistically significant (p=0.132). The completeness and efficiency of the differential diagnoses increased by 16% (ß=0.37, p<0.001) and 17% respectively (ß=0.45, p<0.001). CONCLUSIONS: The study showed that a virtual patient platform combined with a diagnostic reasoning framework could be used for education and diagnostic assessment and improved correct diagnosis compared with baseline performance in a simulated platform.

Students Adding Value: Improving Patient Care Measures While Learning Valuable Population Health Skills.

Medical students are potential resources for ambulatory primary care practices if learning goals can align with clinical needs. The authors introduced a quality improvement (QI) curriculum in the ambulatory clinical rotation that matched student learning expectations with practice needs. In 2016-2017, 128 students were assigned to academic, university affiliated, community health, and private practices. Student project measures were matched with appropriate outcome measures on monthly practice dashboards. Binomial mixed effects models were used to model QI measures. For university collaborative practices with student involvement, the estimated odds of a patient being screened for breast cancer in March 2017 was approximately 2 times greater than in 2016. This odds ratio was 36.2% greater than the comparable odds ratio for collaborative practices without student involvement (95% confidence interval = 22.7% to 51.2% greater). When student curriculum and assignments align with practice needs, practice metrics improve and students contribute to improvements in real-world settings.

Safe and practical: a guide for reducing the risks of opioids in the treatment of chronic pain.

Health care providers often face the challenge of deciding when and how to prescribe opioids for patients with chronic noncancer pain. In patients for whom opioid treatment is appropriate, the risks can be mitigated by an initial risk assessment, informed consent, regular monitoring, and treatment within a medical home.