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					       North Dakota

 Distance Education in Pathology
Models for UME from CLS Success
      University of North Dakota
School of Medicine and Health Sciences
• Community based medical school founded 1905
• Small number of students: 62 positions,
  including 7 INMED (Indians into Medicine)
  – 2 or 3 INMED transfer to USD in 3rd year
• Program
  – Years 1,2: Grand Forks (NO hospital system at UND)
     • Integrated curriculum – “Patient Centered Learning”
  – Year 3:
     • Medical centers in 4 major cities of ND (Grand Forks,
       Bismarck, Minot, Fargo - or
     • ROME (7 months at approved rural FP; 4 months above)
  – Year 4: Rotations at same / alternate clinical campus
     Similarities and Contrasts
    Opportunities and Challenges
• Small department, school; No hospital
• Desire to role model for students
  – MD’s: Active, practicing pathologists in field
  – PhD’s: Active, funded researchers
• Heavy educational demands year 2, less year 1
• Desire expansion of Path in Years 3,4:
  – Students across state in 4 major, 8-10 minor sites
• Commitment to CLS, CT, HT education; other
  programs / schools for pathology education
   CLS/MT Some Similarities to UME
• Defined national curriculum and accreditation
• Defined national examinations, certifications,
  some state licensing
• Programs expensive - both faculty and space
  intensive in traditional model; few students
  – BS Degree in CLS / MT: Basic CLS coursework,
    “Student” labs; 8 – 9 month clinical with coursework

• Core study in Distance Education for CLS – now
  model for revisions in medical education delivery
 Evolution of Distance Learning
• LEND: Laboratory Education for/from North Dakota
  – Started early 1970’s as phone conferences
  – Meet state needs for MT / CP continuing education with
    distance and weather challenges
• “The Perfect Storm” – early 1990’s
  – Crisis in State Funding – mandatory budget cuts
  – Pathologists forced to hospital base rather than private
    practice in SOM
  – No full-time pathologists, closure HT program
  – Threatened closure of CLS, Cytotechnology
  – Faculty: 6 - 7; Students 4 -15; no clinical laboratory
• Distance /Collaborative CLS Program: SURVIVAL
    Model of CLS Education without a
            Base Laboratory
           3 yrs at University / CLS Prerequisites
        Concentrated                 Clinical practicum at
   coursework at UND (12               affiliated medical
          weeks)                     center. (28-30 weeks)

• Years 1, 2, 3: General education / electives; Distance
  CLS prerequisites
• Summer: 12 week intensive, on UND
   – Daily: Didactic (4 hours), laboratories (4 – 6) hours
• Year 4: Clinical sites (over 70 to date in 11 states):
   – Curriculum modules / NAACLS Accreditation: UND
   – Assessment: UND + Bench performance, log
   – Didactic: UND Distance
Morphing Model: Distance Delivery
             3 yrs at University / CLS Prerequisites
          Concentrated               Clinical practicum at
     coursework at UND (12             affiliated medical
            weeks)                   center. (28-30 weeks)

• Traditional Students on UND campus: Met all needs
• WCACLS: Partnerships with other Institutions
   – 4 year degree from home university (12 current; 4 pending)
   – Transfer from 2 year program to UND (10 formal)
• Distance Students: UND Degree, 12 wk on site
   – Developed with rural ND students / hospitals in mind
   – Specialized Partnerships: Pathways Into Health with Indian
     Health Service Initiative
Employer Model: Mayo Partnership
            3 yrs at University / CLS Prerequisites
        Concentrated                         Clinical practicum at
   coursework at UND (12                       affiliated medical
          weeks)                             center. (28-30 weeks)

    BS Degree in Related Field (no MT training)
     MLT Associate Degree / Bench Experience
    Prerequisite CLS Coursework – Online Delivery
 Online                Online                Online                Online





  CLS                   CLS                   CLS                   CLS
Courses               Courses               Courses               Courses

    Bench experience scheduled by Medical Center
                Categorical Training
      B.S. degree (must contain 20 hours of sciences)

  1 semester        1 semester        1 semester      1 semester
  Chemistry /      Immunology /       Hematology /    Microbiology
  Urinalysis     Immunohematology     Body Fluids
   (Online )         (Online)           (Online)        (Online)
  Intensive         Intensive          Intensive       Intensive
    Labs              Labs               Labs            Labs
    Bench        Bench Experience       Bench           Bench
  Experience                          Experience      Experience

Certificate (UND) / Qualification for National Certification Exam
Certificate / Degree in Histotechnology now on line
 Addressing Needs: “Student FTE”
                 (Over 400 students; 6000 credit hrs)





      base 95-96 96-97 97-98 98-99 99-00 00-01 01-02 02-03 03-04 04-05 05-06 06-07 07-08
       Success in Distance CLS
• High scores on National Certification
  – Over 95% first time pass; (84% nationally, ASCP)
  – 100% pass rate for Categorical and HT students
• Reviews
  – Excellent employer, clinical site reviews
  – National accreditation – commendations, max time
  – Students: Low drop rate, excellent reviews
• Financial: In 2005, program became totally self-
  sustaining, current positive tuition flow
• Relationships – strong in state and region
Distance Education: Delivery Lessons
• Didactic courses: Low tech vs. High tech
  – Web based, voice over powerpoint; some streaming
    media, CD/DVD’s can be sent on enrollment
  – 24 / 7 / 365 availability; all courses offered at all
    semesters. (65 credits undergrad; 38 graduate)
• Instructor and peer interaction important
  –   Email, (phone, person)
  –   Discussion boards / electronic group projects
  –   Case studies within small group – posted by students
  –   Controls / monitors pace, examinations
       Distance Delivery Lessons:
        Pre – Laboratory phase
• Video modules to practice
  lab techniques before
  attending concentrated
  laboratory creating better
  utilization of concentrated
  lab experience
• Planned expansion with
  virtual microscopy and
  other technologic
           Lessons for UME
• Define and target critical objectives
• Complementary roles in educational
  partnerships: University faculty and
  Community faculty
• Constantly monitor objective quality
  outcomes and modify as needed to exceed.
• Variety of formats available; small modules
  of information well received by students
• Don’t be afraid of low tech solutions
        Applications in Progress
• Grand Forks Campus, Year 1, 2
  – Lecture and Virtual Lab Integration
  – Pathology (with slides, clin lab) in all “PCL” cases
  – “CME” like case studies / autopsy value / death cert
• Role models in pathology
  – Active clinical practice of pathology illustrated in case
  – Distance modules allow participation by Pathologists at
    all regional campuses, alumni, others; students know
    local pathologists prior to 3, 4th years
  – Pathology leading areas of quality review, topics such as
    violence in medical practice, team building
  – Integration of researchers; highlight clinical translational
  Applications in Development
• Years 3, 4
  – “Core” curriculum lectures as supplement in
    Year 3 ?
  – “Grand Rounds” Statewide –Pathology and
    Basic Science Integration
• Other applications
  – Graduate medical education
  – Pathology in case studies of Integrated Health
           Summary Points
• Dynamic integration of pathology within
  medical education
• Integration of basic science research of
  pathology departments, clinical
  translational efforts into medical curriculum
• Distance education – modules to enhance
  curriculum and highlight off-site faculty
• Role models and thinking process of

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