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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
          Intensive




                                Intensive




                                                      Intensive




                                                                            Review
            Labs




                                  Labs




                                                        Labs
  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”
175
                 (Over 400 students; 6000 credit hrs)

150
                           Categorical
                           WCACLS
125
                           Undergraduate
                           Graduate
100


75


50


25


 0
      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
             Education
• 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
  advances
           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
    studies
  – 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
    efforts
  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
    Course
           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
  pathology

				
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posted:3/14/2010
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