Browsing by Subject "Clinical Competence"
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Item Assessing the Need for and Developing a Standardized Patient Handover Curriculum for Undergraduate Medical Education(2017-04-03) Gajera, Prakash; Reed, W. Gary; Greilich, Philip; Ambardekar, AditeeBACKGROUND: Improving patient handoff communication is a national patient safety goal; however, few medical schools have standardized handoff training curricula for their medical students. Studies show that a large number of medical students perform handoffs and observe handoff errors during their clerkships [1,2]. This lack of formalized training has a negative impact on medical student perceptions of handoffs [3]. This project assessed the need for handoff education at our institution and developed a curriculum aimed at medical students. IMPLEMENTATION: Clerkship directors were interviewed & preclinical medical students were surveyed for a stakeholder analysis. Prior to starting core clerkships, 200 total students participated in four 1-hour workshops consisting of a 20-minute lecture and three 10-minute handoff scenarios. Trained residents performed the scenarios and led group discussions. Pre- and post-course engagement surveys were used to evaluate the workshop. EVALUATION & OUTCOMES: Clerkship directors desired handoff training before clerkships; however, there was concern that the curriculum would be too advanced. Survey of pre-clinical students showed 71% had heard of standardized patient handoffs, but 94% had no training. 75% believed training should be done prior to core clerkships, and 64% believed handoff simulations were the best method for learning. Students scored 10.7% higher on the post-engagement quiz and 98% of students believed they better understood the elements of a good handoff after the workshop. IMPACT & LESSONS LEARNED: Standardized patient handoff curriculum designed for preclinical medical students improved confidence and knowledge about the handoff process. Concerns about creating handoff curriculum for medical students were addressed by focusing on general concepts rather than specific handoff tools and by creating simple handoff evaluation scenarios. Further work will focus on evaluating the impact of this workshop on the handoff experience during clerkships.Item Bedside ultrasonography in clinical medicine(2016-10-21) Badamosi, RazaqItem Development of the Liang Handover Assessment Tool for Simulation (L-HATS)(2020-05-01T05:00:00.000Z) Liang, Tyler; Greilich, Philip; Phelps, Eleanor; Reed, W. GaryINTRODUCTION: Clinical handovers are critical to patient safety and outcomes. Handover simulation prepares healthcare students for handoffs in the clinical setting upon graduation. UT Southwestern has developed a longitudinal handover educational curriculum in which student handovers will be assessed. Although valid and reliable tools exist for assessing clinical handovers, assessment tools adapted for the undergraduate simulation environment currently do not exist. Our objective was to develop a reliable and valid assessment tool that could be used by scholarly healthcare students to assess undergraduate simulated handovers throughout the longitudinal handover education curriculum. METHODS: A literature review was conducted to identify critical elements of high-quality, effective handovers. Following the tool's creation, we underwent several PDSA cycles to optimize the tool for medical student evaluation and ease of grading. Grader inclusion criteria were students who had completed the transition to clerkship (T2C) handover activity. A training curriculum was developed to train graders on proper use of the tool and to promote reliable grading with the tool. 62 pre-clinical student handovers were conducted in the simulation setting and recorded. The handovers were stratified into three levels (low, intermediate, and high quality), and 10 handovers were selected from each of the three levels for grading (30 handovers total). Each handover was scored by four clerkship medical students "graders". Two-way random effects intra-class correlation coefficients (ICC) were used to establish inter-rater reliability and inter-rater agreement among graders using the tool. Three external handover experts were used to establish the tool's validity using face validity. RESULTS: The product of this project is Liang Handover Assessment Tool for Simulation (L-HATS) which evaluated three domains: handover content, handover process, and language with a maximum score of 28. Two-way random effects ICC for agreement was 0.804, 95% CI [0.601, 0.906]. Two-way random effects ICC for reliability was 0.866, 95% CI [0.765, 0.930]. Three external handover experts have sufficiently validated the tool. CONCLUSIONS: The L-HATS had good to excellent inter-rater reliability and agreement. The L-HATS is the first reliable and valid handover assessment tool used for undergraduate simulation education. By using a two-way random effects model, the results suggest that the tool can be used in settings outside of the T2C handover simulation activity. Having good to excellent absolute agreement suggests that the tool is suitable for assigning grades. Future studies include comparing faculty vs student grading of handovers as well as evaluating the tool in the clinical setting.Item Development of Video and Simulation-Based Communication Skills Learning: Responding to Emotions(2021-05-01T05:00:00.000Z) Nguyen, Trung Tan; Siropaides, Caitlin; Sendelbach, Dorothy; Abraham, ReeniPROBLEM: Responding appropriately to patients’ emotions and concerns is vital for excellent patient care and outcomes. There is a lack of training in this area, with the need to educate healthcare providers about how to appropriately respond to emotions. While communication skills training programs exist for undergraduate medical education, medical students often feel unprepared in responding to patients’ emotions INTERVENTION: A 90-minute small group exercise was developed for second-year pre-clinical students at a large United States medical school in Texas. The exercise consisted of faculty-facilitated small group discussion of two video examples of a patient encounter, comparing clinician responses to patient emotions. The exercise utilized a framework for identifying skills and patient impact of verbal expressions of empathy to different patient emotions. CONTEXT: This curriculum sought to demonstrate examples of strong patient emotions for preclerkship students, and introduce a framework of concrete communication skills that can positively impact a clinical encounter. Data was collected by questionnaires delivered immediately pre-session and post-session, as well as 3 months post-session. Survey questions assessed student perception of effectiveness of the exercise, student-reported preparedness and feeling equipped to perform various communication skills during clinical visits. Paired t-tests were performed and data analyzed for qualitative responses. OUTCOMES: The process evaluation yielded a positive subjective learner response to the exercise which was sustained at 3-month follow-up. The students (N=161 paired for the immediate pre- and post-survey) reported significant increases in knowledge and preparedness to recognize and appropriately respond to different patients’ emotions (P= 0.001). Qualitative data were also captured in the surveys. LESSONS LEARNED: This video-based small group discussion of skills to express verbal empathy is perceived by pre-clinical medical students to be beneficial, and to improve their knowledge and preparedness for using empathic skills in the future. There is a need for further investigation whether this type of communication skills training results in behavior change and is sustained long-term.Item Donald W. Seldin, M.D., Research Symposium finalist presentations(2022-04-29) Almonte, Matthew; Duvalyan, Angela; McAdams, Meredith; Onyirioha, Kristeen; Saez-Calveras, Nil; Triana, TaylorThis edition of the UT Southwestern Internal Medicine Grand Rounds features presentations by the six Foster Fellows selected as finalists from the Seventh Annual Donald W. Seldin, M.D. Research Symposium, which was held on April 21, 2022. These Foster Fellows presented work that spanned the breadth and depth of scholarly activity across the department, and at the close of Grand Rounds, one will be selected as the 2022 Seldin Scholar, in honor of Dr. Donald W. Seldin. The Grand Rounds presentation includes additional award presentations recognizing Clinical Vignettes, as well as the Award for Research in Quality and Education at Parkland Hospital and the Social Impact Award.Item Improving cardiac care at Parkland: lessons learned from the quality improvement front line(2014-01-09) Das, Sandeep R.Item Improving Medical Student Performance on Clinical Skills Exams(2019-04-01) Thomas, Areon Scott; Wagner, James; Lysikowski, Jerzy; Reed, W. GaryBACKGROUND: Clinical Skills Exams were created in an effort to determine the readiness of medical students to enter into residency. These exams place students in a simulated patient encounter and grade them on their proficiency in handling that encounter. The National Board of Medical Examiners (NBME) instituted the United States Medical Licensing Exam: Step 2 Clinical Skills (CS), a Clinical Skills Exam, as part of the pathway to licensing physicians. LOCAL PROBLEM: UT Southwestern (UTSW) has noticed a rise in the number of students failing CS. The grading of CS is confidential; therefore, it has been difficult for UTSW to assess which students are at risk for failure. Through the initiation of the school administered clinical skills examination, The Objective Structured Clinical Exam (OSCE), UTSW was able to correlate poor performance on the exam with an increased likelihood of failure on the CS. This correlation has also been demonstrated in other studies. However, information on what factors lead to improved student performance on a clinical skills exam was lacking. METHODS: We reviewed 236 student records for the class of 2020 to ascertain what extracurricular clinical experiences students had taken in advance of the exam. We used bivariate and multivariate analysis to determine which of these experiences significantly impacted a student's OSCE exam score. The OSCE uses the same published grading criteria as the CS and is treated by the university as a proxy for the CS. The students are graded in three categories: Integrated Clinical Encounter (ICE), Spoken English-Language Proficiency (SEP) and Clinical Interpretation Skills (CIS). They are graded by their standardized patients and by faculty members overseeing the exam. The scores for each encounter are then averaged together to create a student's final score. We grouped the score into three categories for bivariate analysis: High Pass, Low Pass, and Fail. We then analyzed the number of students that fell in each category. We also used a separate computerized exam, the Clinical Data Interpretation (CDI) Exam, to ensure a representative sample. Box Plots, Chi Square, and multivariate analysis were used to analyze our data. We chose to use Box plots to examine the distribution of the data, and give us a starting point for analysis. From there chi-square analysis provided us with information on which intervention had the most significant effect on OSCE Scores. Finally multivariate analysis was performed to search for interaction between the interventions, and to check for a linear relationship between MOSCE and OSCE scores. INTERVENTIONS: Mock OSCE (MOSCE), Student-Run Free Clinic (SRFC) Volunteering, and Thee Longitudinal Outpatient Orientation Clerkship (LOOC) RESULTS: As SEP scores were well above 90% for all students and no significant findings were discovered in our initial box plots, it was dropped from further analyses. Our box plots suggested a positive association of OSCE CIS and ICE subcomponent scores taking the MOSCE. This association proved to be statistically significant by linear regression, multivariable regression, and multivariable analyses. There was insignificant association of OSCE exam with participation in an SRFC by Chi Square analysis. These results may have been insignificant due to insufficient study power. CONCLUSION: Based on these results, it appears that taking the Mock OSCE examination is associated with improved student performance in both the CIS and the ICE subcomponents of the OSCE. In light of these findings, we suggested making the Mock OSCE more widely available to all UTSW students for the 2018 administration of the exam.Item Lies, damned lies, and evaluations: the quest for "high value" feedback(2022-01-21) Scielzo, Shannon; Kazi, SalahuddinItem Looking Back on Creating a COVID Telemedicine(2022-05-01T05:00:00.000Z) Murtuza, Mohammad Imran; Reed, W. Gary; Croft, Carol; Phelps, EleanorBACKGROUND: In March 2020, the Dallas Fort Worth (DFW) Metroplex experienced a surge in acute COVID-19 infections. At that time, no consistent protocols existed for follow-up of discharged patients with COVID-19 from the William P. Clements Jr. University Hospital at the University of Texas Southwestern Medical Center (UTSW). Simultaneously, medical students were suspended from in-person clinical activities to limit viral spread. In response to these events, a telemedicine elective was created to provide timely and high-quality telehealth follow-up for recently discharged COVID-19 patients from April of 2020 to July of 2020. METHODS: The pilot team, consisting of several second- through fourth-year medical students, developed a call script that included warning signs and symptoms, CDC guidelines for isolation, and primary care physician referral information. COVID-19 patients discharged from the Emergency Department and inpatient services were identified and assigned to student callers. All patients were discussed with an attending physician, who was available if an acute issue arose. The elective also included education on the SBAR handover technique, telehealth education, updated COVID-19 literature, and CDC guidelines. RESULTS: Improvement was noted in students' ability to identify patients who required escalation of care, as seen by over 60% of patients who were advised to return to ED required hospital admission. Statistically significant improvement was observed in the students' degree of feeling informed about the current state of COVID-19 and their degree of comfort with interviewing patients over the phone. DISCUSSION: This elective provided quality virtual healthcare to COVID-19 patients while allowing medical students to progress in their medical education and participate in patient care. This elective was an example of an early adopter of telemedicine in COVID-19 follow up. Now two years into the COVID-19 pandemic, the CDC, NIH, and health systems all around the United States have made virtual visits commonplace when treating patients with COVID-19 and beyond.Item Responding to requests for futile or potentially inappropriate treatment(2017-03-14) White, Douglas B.Managing requests for potentially inappropriate treatment is deceptively complex and exposes unanswered questions about the boundaries of good medical practice in patients with advanced illness. This talk will summarize the recent guidelines from five major United States and European critical care societies on how to respond to such requests and how to proceed in the face of intractable conflict.Item Structural competency: new frameworks to understand and respond to inequities in health(2023-04-11) Holmes, Seth M.Research on disparities in health and in medical care demonstrates that social, economic, and political inequities are key drivers of poor health outcomes. The influence of such inequities on health has long been noted by clinicians and public health practitioners, but such content has been incorporated unevenly into clinical training and clinical ethics. Recently proposed by clinicians, ethicists, and medical social scientists, the framework of "structural competency" offers a paradigm for training health professionals to recognize and respond to the impact of upstream, structural factors on patient health and health care. This lecture will cover key terms and primary domains of structural competency to allow medical practitioners, ethicists, and researchers to perceive and respond to social inequities in health in new ways.Item The teaching and evaluation of clinical competence: an undergraduate medical education perspective(2015-01-30) Wagner, James M.Item [UT News](1985-12-01) Lyon, PamelaItem Why?(2023-01-06) Butler, Javed