Helping Medical Students Develop an Osteopathic Professional Identity: The ACOM Curriculum E. Hengstebeck, D.O.
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Disclosures • None
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Objectives 1. Describe curricular methods that can be used to promote the development of emotional intelligence in first and second year medical students. 2. Illustrate methods that can be used to incorporate self-assessment and peer feedback into a first and second year medical school curriculum. 3. Discuss ideas that provide first and second year medical students opportunities to practice crucial communication skills. 4
The Total Osteopathic Lesion: A Holistic Approach to Patient Care
Parsons Jon, Marcer Nicholas. Osteopathy: Models for Diagnosis, Treatment and Practice, 2005. 5
The ACOM Curriculum: Integrating an Osteopathic Identity Throughout the Undergraduate Years
• OMS I and II – Primary Clinical Skills • Aka the doctoring course
– Other courses • Osteopathic Principles and Practices • Foundations of Modern Health Care • Systems courses
• OMS III and IV – Clerkship rotations 6
Developing a Holistic Approach to the PatientPhysician Interaction: Patient-Centeredness •
Patient-centered communication – Teaching students to encourage the patient to tell their story (elicit internal and external influences) •
Core resources – –
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Key Elements – – – –
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DocCom Smith’s Patient-Centered Interviewing: An Evidence-Based Method Setting the stage and establishing rapport Agenda setting Active listening skills » SOFTEN Empathy, respect, support and partnership statements » PEARLS, BATHE
Preparing students to engage in difficult conversations – Motivational interviewing – Giving bad news – End of life communication
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Opportunities for Practice – Formative • •
Small group FOSCE’s
– Summative •
OSCE’s 7
Developing a Holistic Approach to the Patient-Physician Interaction: Integrating Osteopathic Manual Medicine
• OMS I and II Osteopathic Principles and Practices course – Clinical scenarios
• Simulation – Standardized patient clinical scenarios • Osteopathic structural screening exam during every FOSCE and OSCE
– End of Year Capstone OSCE • Osteopathic manipulative treatment in the context of a clinical presentation
– May encourage the use of empathic touch 8
Self-assessment and Peer Assessment: Laying the Foundation for Lifelong Learning •
Promotes the development of emotional intelligence – Critical self-reflection – Giving and receiving critical feedback
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Teaching self-assessment and peer assessment/feedback – Formal •
Didactic and small group sessions – –
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DocCom Mindfulness and Reflection in Clinical Training and Practice LEaP (Learning from your Experiences as a Professional) SOAP notes available at MEDedPortal
FOSCE’s
– Informal • • •
During feedback sessions with clinical faculty and clinical skills educators Students working in pairs during FOSCE’s Oral case presentations – –
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360 feedback Peer to peer
2nd year TA’s provide feedback
– Provides opportunities for deliberate practice – Promotes self-regulated learners
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ACGME milestones – Emphasis on self and peer assessment in FM residency milestones assessment system
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Helping Students Define a New Professional Identity as an Osteopathic Physician • Simulation experiences – Standardized patient encounters • Staging – Timeliness – Professional appearance and attire – Preparedness
• HIPAA compliance required in all “patient care areas” • OSCE grading rubric – Appearance, attire, and timeliness – Attitude and demeanor with standardized patient – Behavior and conduct with staff 10
Making It Clinically Relevant: OMS II Capstone Small Group Project • OSCEr video competition – Opportunity to showcase the knowledge and skills acquired in their professional development – Focus is on difficult conversations i.e. end of life • Assigned two specific objectives
– Create a role 6-8 minute role play and record in a simulated clinical environment • Every student in the group is an active participant either in front of the camera or behind the scenes • Reflective journaling
– Video premiere • Students and faculty view videos together – Faculty grade and rank the videos according to assigned objectives, professionalism, and educational value – Students provide peer feedback through anonymous surveys at the end of each video
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2014-2015 Winning Video Assigned objectives 1. Demonstrate the ability to suggest interventions and limits that are consistent with your patient’s goals at the end of life in an outpatient setting. 2. Describe palliative care and hospice services to patients and families and assist them in deciding to accept referrals in an outpatient setting.
The scenario A 28-year-old female with end stage breast cancer presents with her husband to her PCP for a follow-up appointment to discuss her options after multiple unsuccessful treatments with chemotherapy and radiation 12
The Video • Insert clip
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Integration of the Osteopathic Philosophy Throughout the ACOM Undergraduate Curriculum •
Foundations of Modern Health Care – – – – –
Balance and self-care Cultural competency Spirituality in medicine Interprofessional collaboration/teamwork Professionalism •
Six didactic hours on professionalism
– Medical ethics and end of life challenges
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Systems courses – Didactic session emphasizing osteopathic principles and practice •
Example: The Renal System –
“OPP Considerations in the Renal Field”
– Team-based learning and peer assessment
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3rd and 4th Year Clerkship Rotations – Preceptor evaluations • •
“the ability to accurately self-reflect” Direct observation of students performing patient-centered interviews
– Monthly OMM videoconferences – Hospice rotation
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References • Aronson L, Kruidering M, Niehaus B, O'Sullivan P. UCSF LEaP (Learning from your Experiences as a Professional): Guidelines for Critical Reflection. MedEdPORTAL Publications; 2012. (Available from: https://www.mededportal.org/publication/9073) • Epstein, Ronald M., DocCom: Mindfulness and Reflection in Clinical Training and Practice. American Academy on Communication in Healthcare AACH and the Drexel University College of Medicine. • Parsons, Jon. Marcer, Nicholas. Osteopathy Models for Diagnosis, Treatment and Practice. 2005. 15
