BCOE - Best Curriculum On Earth

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					BCOE - Best Curriculum On Earth

     Results for 2008-2009 Clerkship
            Michael Zettler - Class of 2010
     Presentation Outline
 Goals and format of the surveys
 General feedback for all blocks
 Brief block-specific feedback for
  mandatory rotations
 Discussion of results
 Future goals of BCOE
BCOE Surveys
 Online survey
 http://www.schulich.uwo.ca/survey/Login.as
  p
 Personalized e-mail with survey links for
  rotations just completed sent out every 6
  weeks
 Reminder e-mail with survey links
 Draw for $50 to Chapter’s three times per
  year.
BCOE Surveys
   Teaching
           Time spent in formal teaching sessions (modalities may include
            rounds, rotation packages, web-based tutorials etc) to cover major
            topics in the specialty over the course of the 6-12 weeks.
           Time spent on informal clinical teaching surrounding patient
            encounters.

           1 = not enough time, 2 = just right, 3 = too much time

   Scheduling
           Did this rotation adhere to the on-call policy?
           Were you notified about the rotation placement, schedule and on-
            call responsibilities at least two weeks in advance.
           Comments requested if answered ‘no’ to either question.

   Comments
           Nomination of faculty member.
           Negative feedback on rotation.
           Positive feedback on rotation.
BCOE Surveys
   Core Questions
           The supervisors were well aware of the learning objectives and roles
            appropriate for a clerk within the rotation.
           As a clerk, I had an appropriate level of independence in
            seeing/treating patients.
           The methods of evaluation fairly assessed my knowledge and abilities
            in this rotation
           I received constructive feedback well before receiving my final
            evaluation.
           The rotation consisted of an excellent variety of patient problems.
           Teachers in this rotation model exemplary attitude towards gender
            and diversity issues.
           Teachers in this rotation model respect for other health professionals
           Overall, I would recommend this rotation to my friends

   Rotation-specific Questions
           OB/Gyn, Family Medicine, Medicine, Pediatrics

   7-point Likert scale with anchors from “Strongly Disagree”
    (1) to “Strongly Agree” (7).
Surveys Administered
 Family Medicine - 4  Paediatrics -
  week, 2 week in         London, Windsor,
  Windsor or London       Rural
 Psychiatry - London,
                         Ob/Gyn - Windsor,
  Windsor, and Rural
                          London (SJHC,
 Medicine - CTU
                          VIC), Rural
  (UH, VIC, ACE,
  Windsor), Elder        Surgery - General,
  Care, Oncology,         Emergency,
  Optho/ENT,              Anaesthesia,
  Selective (all W & L)   Selective (all W & L)
Detailed Results Available!
 Presentation will focus on results relevant to
  all rotations, as well as results specific for
  mandatory rotations.
 Please consult distributed document for
  results for selective rotations.
 Detailed numerical ratings and respondent
  comments available to rotation directors
  upon request.
 Contact: Michael Zettler -
  mzettler2010@meds.uwo.ca or via your own
  student representatives.
Results - Response Rate
 Results compiled with 5 of 8 blocks
  completed. Approximately 90 students
  finished each mandatory rotation.
 Response rate for mandatory rotations range
  from 23% (Emergency Med) to 41%
  (Psychiatry). Most have approx. 33%.
 Smaller number of responses and uncertain
  proportions for selective rotations.
 Difficulties: “busy clerk” mentality, separate
  survey system not otherwise used, not
  mandatory
Results - General Comments
   Strengths
    –   Medical students value a defined and practical
        role during their rotations
    –   Independence in assessing patients and making
        management plans is commonly cited in positive
        comments
    –   Organization and scheduling known well ahead of
        time relieves student anxiety.
    –   Providing opportunities to learn procedural skills
        is highly valued on rotations where this is
        possible.
    –   Well planned and carried-out formal teaching is
        extremely helpful. Consultants and residents who
        take the time to do informal teaching are well-
        liked.
Results - General Comments
   Weaknesses
    – Medical students do not value being a passive
      observer at this stage of their training.
    – Formal teaching must be balanced between
      different sites, and evaluation methods in-line
      with the teaching.
    – Disorganized scheduling on some rotations
      detracts from the learning experience.
    – Though rare, having a consultant or resident that
      does not value teaching medical students makes
      for a poor experience.
Results - Family Medicine
   Strengths
          Many positive comments about individual preceptors
           and their interaction with medical students.
          Variety of practice environments, skills performed, and
           patients seen is highly valued.
          Independence to assess patients and plan management
           is a strong positive attribute.
   Weaknesses
          Daytime and on-call scheduling not well communicated
           on some rural rotations; this is likely preceptor-specific.
          Clinical cards and on-line cases not reviewed highly as
           learning tools.
          A small number of preceptors may not be aware of the
           role of the medical student and appropriate rotation
           objectives.
Results - Psychiatry
   Strengths
        On-Call shifts at Victoria ER and in Windsor were valued highly by
         students; primary reasons cited were undifferentiated problems and
         teaching by residents.
        The opportunity to see a variety of patients and pathology was
         important to many students.
        Both formal and informal teaching by residents was appreciated by
         students.
        A few consultants were nominated for ‘best teacher’ multiple times:
         Drs. Robinson, Lefcoe, Velehorschi.
   Weaknesses
        Lack of on-call experience in rural rotations
        Discrepancy in level of independence granted to medical students;
         more in Windsor and rural rotations, less in London.
        Child Psychiatry was felt to be inadequate, particularly in places where
         students only observed interviews.
        Windsor teaching sessions felt to be less organized and disjointed from
         London (on which the exam was based?).
Results - Medicine CTU
   Strengths
        Medical students enjoyed the experience of working a member of a
         team.
        Level of independence to see consultations and care for patients was
         rated highly.
        Formal and informal teaching sessions were appreciated by students,
         with some exceptions (see below).
        Drs. Larocque, Rehman, and Saad received multiple nominations for
         ‘best teacher’.
   Weaknesses
        Students felt they did not get enough experience with procedures,
         either observing or actively involved.
        Seemingly, there are a small number of consultants who did very little
         teaching with their team, or had limited involvement generally.
        While most comments about residents were positive, there were a
         small number of very concerning complaints.
Results - Paediatrics
   Strengths
          Drs. Killorn, McNeill, Awuku received multiple nominations for ‘best
           teacher’.
          Paediatric Emergency was the subject of many positive comments,
           particularly because of the variety of patients.
          Variety of patients was appreciated at all sites.
          Formal and informal teaching, especially by residents, was rated highly.
          Windsor morning teaching sessions were rated highly
   Weaknesses
        CLIPP cases were rated fairly evenly across the spectrum from very
         helpful to not at all helpful.
        Students felt there could have been more teaching sessions, especially
         in light of frequent cancellations.
        Students in London made several requests for a community paediatric
         placement.
        Students in Windsor felt that the videoconferenced teaching from
         London did not add to their own teaching sessions.
Results - Obs & Gyn
   Strengths
          Students spoke highly of the “hands-on” experience
           available at most sites, but particularly Windsor and
           rural rotations.
          Numerous positive comments about physicians at all
           sites.
          Variety of Ob/Gyn practice was a positive.
   Weaknesses
          Concerns raised about the St. Joseph’s site: limited
           clinical experience with general gynaecology, limited
           “hands-on” experience due to large number of learners,
           not being involved for deliveries.
          Students commented that the teaching received did not
           fit well with the NBME exam evaluation.
Results - General Surgery
   Strengths
          Medical students enjoyed the experience of working as member of a
           team.
          Level of independence to see consultations and care for patients was
           rated highly.
          “Hands-on” experience in the OR is highly valued by many students.
          Windsor students commented on the flexibility of their experience;
           able to see a variety of problems with different consultants.
          Formal teaching sessions were rated highly.
   Weaknesses
        Some students commented on a paucity of informal teaching; this
         seems to be resident and consultant-dependent.
        There were discrepancies between the formal teaching received in
         London and Windsor.
        Student commented on an expectation to stay well past noon, or for a
         full day, when post-call. One student said “it was made to seem as
         though you were disinterested or uncommitted to learning if you didn't
         stay as long as possible.”
Results - Emergency
Medicine
   Strengths
          Variety of patient encounters and problems dealt with
           was a big strength
          Amount of independence given to students in patient
           assessment
          Informal teaching from a number of consultants was
           highly rated.
   Weaknesses
          Scheduling shifts further in advance would be
           appreciated by many students
          There seems to be a small number of preceptors not
           interested in having students.
          Students question the validity of being evaluated each
           shift by a different preceptor.
Results - Oncology
   Strengths
          Clinical experiences were valued by students
          Those able to see a variety of problems appreciated it.


   Weaknesses
          Students felt there was too much time for studying and
           presentation preparation, at the expense of clinical
           experience.
          Students questioned the value of the exam as an
           evaluation tool.
Discussion of Results
   Well-rated rotations provide:
    –   Independence to care for patients
    –   Role as a team member where possible
    –   Well organized, with schedules known in
        advance
    –   Opportunity for technical skills where
        possible
    –   Enthusiatic and appropriate formal &
        informal teaching
Discussion of Results
   Areas for Improvement
    – Some rotations do not do a good job at providing
      an appropriate role for students.
    – Formal teaching must be coordinated between
      different sites, and evaluation methods in-line
      with the teaching.
    – Disorganized scheduling or lack of
      communication detracts from the learning
      experience.
    – Educate consultants and residents regarding
      appropriate roles for clerks, how they can improve
      their experience.
    – Need to identify rare instances of inappropriate
      conduct and redress situation.
Future Directions for BCOE
 Curriculum evaluation done via
  Schulich administration.
 Duplication of some information
  between Admin. & BCOE
 Importance of student-run feedback
  channel.
 Comments most important?
 Needs of students and rotation
  directors?