Transforming Clerkships into an Integrated Longitudinal Learning Module

Transforming Clerkships into an Integrated Longitudinal Learning Module: Model Madres: Maternal, Child and Family Health Adriana Padilla, MD Susan Hughes, MS UCSF Fresno Medical Education Program

Background o Clinical education reform is needed (1) o National concern that the current clinical training model is poorly aligned with society’s present and future health care needs (2) o New models of clinical education need to address a lack of connection or continuity among different learning experiences (2) o Two current models of integrated clinical education; Longitudinal integrated clerkship model (LIC) and Hybrid models (integration and longitudinal patient care within traditional clerkships) 1. Irby DM. Educational continuity in clinical clerkships. N Engl J Med. Feb 22 2007; 356(8): 856 -857. 2. Hirsh DA, Ogur B, Thibault GE, Cox M. "Continuity" as an organizing principle for clinical education reform. N Engl J Med. Feb 22 2007; 356(8): 858 -866.

Objectives o Design and implement a new 3 rd year clinical educational model that integrates a thematic approach to learning clinical medicine in maternal, child and family health at UCSF Fresno. o Incorporate continuity as the overarching theme of our new curriculum (continuity of site, continuity of peer cohort, continuity of care, continuity of mentoring) o Test the effectiveness of this innovation via a core competency plan, pre/post survey and attitudinal assessments from focus groups. o Evaluate the impact on programmatic resources

Design o 7 student participants o 6 month model o Pre-program ramp up for orientation o Longitudinal training o Integrated learning o Community based education o Structured mentoring

Methods Pre-Program Ramp Up o Transitional clerkship time (2 days) for introductions and orientation o Hospital systems orientation o Community orientation via a “treasure hunt” o Review each discipline’s objectives and competency cards o Review patient’s options for financing of health care

Methods Longitudinal Training o Continuity practice with pediatric, obstetric and family medicine patients o Individual student schedules o Detailed orientation for promoting patient care follow-up/continuity

Methods Integrated Learning o 2 half-days for interdisciplinary education each week in a small group format o Curriculum coordinator

Methods Community based education o 4 learning opportunities with community based organizations to enhance care of the underserved (Poverty Medicine, Hmong Health, Indigenous Health, and Elder Care) o Reflection exercises

Methods Structured Mentoring o Mentors from each discipline (ob-gyn, pediatrics and family medicine o Faculty Development for mentoring o 3 mentors for each student, representing each discipline o Formal mentoring meetings 3 x over program o Mentor prep meetings

Other Benefits o Medical Spanish tutorials o Travel Stipend o Planned vacation schedule o Study sessions for final examinations in each discipline

Evaluation Plan o Core competency based o Pre/Post Survey o Attitudinal assessments from focus groups o Impact on Programmatic Resources

Core Competency Based Plan Shelf Exam X E*Value X X Structured Clinical Observation X X X X Patient Satisfaction X Clinical Practice Exam X X Chart Audit X Community Project Learner Portfolio X X X X X

Preliminary Results o Students met continuity patient care goals o Students met core learning goals o Patient satisfaction high o CPX scores within one SD of entire class o Pre/Post Survey results show improvement in n n SOAP note writing Use of translators o Focus group results are mixed

Discussion o Educational goals were met o Optimum integration of the participating clerkships was not met o Challenges were many n n Logistics space needs programmatic resources educator preparation and buy in

Conclusion o Hybrid models, like Model Madres, are innovative and integrative and meet core learning objectives o Hybrid models can face multiple challenges o Ongoing educational research of the outcomes from the educational design of the clinical core either by LIC or Hybrid models is needed

Acknowledgments o Academy of Medical Educators innovations award, 2007 -2008. o UCSF Fresno leadership in supporting and encouraging collaborative training and innovation.