S.O.S. Introducing the new CDIM Subinternship Curriculum to Enable Learners to Ask for Help

Transcription

1 S.O.S. Introducing the new CDIM Subinternship Curriculum to Enable Learners to Ask for Help Jonathan Appelbaum, MD Allison H. Ferris, MD Brian Kwan, MD Michelle Sweet, MD The Subinternship Curriculum Subinternship: dates back to World War II Experiential learning Intense ( acting intern ) No specific curriculum Curriculum version 1.0: developed between Based on a needs assessment of PDs Included skills as well as clinical cases/problems to use

2 But Duty Hours EMRs Handoffs More to do, less time to do it = Burnout Curriculum revision Curriculum version 2.0: based on needs assessment of PDs (2010 APDIM survey) 4 main skills Time Management Communication Sick vs Non sick Asking for help CACTI recommendations on using 4th year as overall prep for internship AAMC 13 Core EPAs Developing landscape on burnout and wellness

3 4 Core Skills Time Management Organizing the day effectively, prioritizing tasks Communicating Effectively Within Healthcare Teams Written (electronic) Notes, Oral Presentations, Handoffs, Discharges Recognizing Sick vs Non Sick Patients Uses 10 common scenarios/problems to help trainees identify sick vs non sick Knowing When to Ask for Assistance Requires self awareness, self critique, and acknowledgement of shortcomings How does Wellness fit into the puzzle? Stay tuned!

4 Drowning in the world of clinical medicine Subinterns will inevitably encounter situations which exceed their confidence or skill to handle alone Trainees decisions regarding whether to seek clinical support Clinical How urgent is the clinical situation? How important are the implications of the clinical decision to be made? Does the clinical question fall within the scope of practice expected at the level of training? Supervisor Is the supervisor available and approachable? Trainee Can a trainee recognize when they are overwhelmed and need support? Does the trainee desire greater independence and responsibility? Is the trainee concerned about potentially negative evaluations from supervisors if they ask for help?

5 Metacognition thinking about one s own thinking processes enables learners to recognize an absence of knowledge in a given context. complex skill based upon selfawareness, memory, attention to task, and individual expectations. 1 Megacognitics Techniques Techniques to enhance metacognitive skills: Reflection Graphic organizers Feedback Think aloud Cognitive de biasing Predicting outcomes Questioning Self questioning Five Whys

6 Slide 10 1 animation style bullet points Michelle Sweet, 1/17/2018

7 2 Set Specific Limits and Expectations Clinical situations in which subinterns must contact their supervisor include: Discharge or patient disposition decision making Escalation in level of care (i.e., recognizing clinical deterioration) Non procedural medical error Other potential scenarios which also warrant direct supervision include: Interpretation of significant physical exam findings and/or diagnostic test results Assistance with standard medical procedures Difficult conversations with patient and/or family members Divergence from previously established plan Medical Student Wellness

8 Slide 11 2 Timed- answer when click in animation form Michelle Sweet, 1/17/2018

9 Roadmap Review of Data on Burnout Brief Literature Review Some of our Recommendations Invite Comments/Reactions and Other Ideas Why Address Medical Student Wellness? 40 76% experience burnout May vary year by year Must learn to manage own well being Ability to counter burnout with resilience and vitality Medical Student wellness evaluation Medical Student Well Being Index Maslach Burnout Inventory

10 Medical Student Well Being Index (MSWBI) Yes No 1. Do you feel burned out from medical school? 2. Do you worry that medical school is hardening you emotionally? 3. During the past month have you often been bothered by feeling down, depressed, or hopeless? 4. In the past month, have you fallen asleep while stopped in traffic or driving? 5. During the past month, have you felt that all the things you had to do were piling up so high that you could not overcome them? 6. During the past month, have you been bothered by emotional problems (such as feeling anxious, depressed, or irritable)? 7. During the past month, has your physical health interfered with your ability to do your daily work at home and/or away from home? Total Score Dyrbye LN, Schwartz A, Downing SM, Szydlo DW, Sloan JA, Shanafelt TD. Efficacy of a brief screening tool to identify medical students in distress. Acad Med 2011;86: Dwivedi A, Purohit BM, Bhambal A. Is Dentistry TUrning into Weary Profession? Dimensionality of Experienced Professional Burnout among Dentists in Central India. J Dent Oro Surg (5): 122.

11 What Does the Literature Say? St Louis experience Relaxation and self hypnosis CBT Reflective writing Behavioral change plan Effective in preclinical years only Behavioral Change Plan (BCP) Kushner RF, Kessler S, McGaghie WC. Using behavior change plans to improve medical student selfcare. Acad Med 2011; 86(7):

12 Body Mind Soul Framework AAIM CHARM Group Large Group Discussion What is your institutional experience with medical student/resident burnout? What has your institution done to address this issue? Has your institution incorporated any type of formal or selfassessment?

13 Small Group Activity What are some educational activities you would like to begin at your institution to prevent burnout? To encourage asking for help/self awareness? **bonus points for small group: Is this something to assess? And how? Please take 30 minutes in your group to discuss these points. At the end of this time, each group will report out to the larger group key portions from your discussion. Concluding Thoughts Subinternship Curriculum 2.0 coming soon Interested in Piloting Curriculum? Contact Us!

14 Contact Information Jonathan Appelbaum, MD Florida State University College of Medicine, Allison H. Ferris, MD Florida Atlantic University, Brian Kwan, MD University of California, San Diego, Michelle Sweet, MD Rush University Medical College, References/Where to find everything CHARM Annotated Bibliography on Evidence based Wellness Interventions Teaching Metacognitive Skills: Helping Your Physician Trainees in the Quest to Know What They Don t Know Preserving Professional Credibility: Grounded Theory Study of Medical Trainee s Requests for Clinical Support