Table of Contents
- Welcome
- Clinical Skills
- Clinical Skills Segment 1
- Clinical Skills 1
- Segment 1 Proposed Actions
- Course 1 Overall Rating Improvements
- Clinical Skills 2
- Course Changes
- Segment 2 Proposed Actions
- Course 2 Overall Ratings
- Profile: Erin Miller, M.D.
- Profile: Christopher Guyer, M.D.
WELCOME
On behalf of Senthil Kumar Rajasekaran, M.D., MMHPE., Senior Associate Dean for Undergraduate Medical Education and Curricular Affairs, we would like to welcome you to the "You Said, We Did" (YSWD) Newsletter. As a Continuous Quality Improvement organization, Wayne State University School of Medicine has directly utilized feedback from many of our key stakeholder groups, primarily you the students, to make significant changes over the last several years. The purpose of the newsletter is to highlight these changes made during your tenure as a student and to show our appreciation for your involvement in these accomplishments. As you progress in the path of becoming a physician, we want to let you know that as you are progressing in the path of becoming a physician, you are nurturing the growth of the institution through your feedback. One of the goals of YSWD is to let students know that we value your input and are continually incorporating it into our ongoing and new initiatives.
Clinical Skills
This edition of You Said, We Did is based on student feedback from the end-of-the-year course reviews. The Clinical Skills Course directors wanted student feedback on the improvements in the course for Segment 1 and Segment 2.
Clinical Skills Segment 1
Clinical Skills Segment 1
During Clinical Skills 1, you navigated 10 simulated patient encounters, with increasing expectations and complexity. You attended nine debrief sessions designed to emphasize key learning points and build more advanced clinical reasoning and communications skills.
You learned to:
- Navigate an outpatient clinical encounter from introduction to closure
- Conduct yourself professionally in the clinical setting
- Build rapport with a variety of patients presenting different communication challenges
- Elicit a patient’s chief concern
- Collect a chronologic history of present illness
- Gather a patient’s medical, surgical, obstetrics and gynecologic, vaccine, family and social history
- Perform a medication reconciliation and assess patient allergies
- Use the iHELLP tool to evaluate a patient’s social determinants of health
- Employ motivational interviewing to collaborate with and coach patients to reach their health goals
- Gather a comprehensive review of systems
- Effectively express empathy by developing and practicing specific communication strategies
- Properly cleanse your hands during an encounter
- Drape to preserve patient modesty and comfort
- Assess a patient’s general appearance and orientation
- easure vital signs
- Perform a Core 30 physical exam, including exam maneuvers from the musculoskeletal; dermatologic; respiratory; cardiovascular; abdominal; head, ears, eyes, nose and throat; and neurologic systems
- Document a comprehensive patient note
- Deliver a comprehensive patient presentation
- Synthesize the information from a patient encounter in a summary statement
- Create a differential diagnosis and a problem list for a patient encounter
- Use semantic qualifiers to concisely convey pertinent patient information
- Identify the basic components of an illness script
Course Updates:
- The course changed to strict pass/fail, removing the pressure of obtaining Honors so that student focus remains on learning.
- Scheduling is now set in advance of each trimester and centralized in the Canvas calendar, allowing students to plan and organize time more effectively.
- In-person, hands-on learning for each session has resumed.
- LGBTQ+ content has been added to ensure students are trained to deliver more-inclusive care.
- Population, Patient, Physician and Professionalism, and Basic Science integration was updated to allow for more seamless reinforcement of content across courses.
- A centralized system to report grade concerns and standardized patient/M4 student inconsistencies was implemented, allowing the Clinical Skills team to track and address standardization concerns in real time.
Clinical Skills Segment 1: PROPOSED ACTIONS FOR NEXT ACADEMIC YEAR, 2021-2022
Based on feedback from Student End of the Year evaluations, Dr. Miller provided the following feedback, “As with everything else, COVID certainly threw us for a loop. The Clinical Skills Center team was able to respond, however, and many of the student narrative comments indicate they still feel the course taught them valuable skills despite the constraints of the pandemic. Of note, the course received the highest overall rating by students for Segment 1 of the curriculum. The students’ overall rating of the course also improved from the 2019-2020 year, which was itself an improvement from the 2018-2019 course.”
Overall Rating Improvements
“Comparing the course’s progress from previous years on a more granular level, there were a few domains where our overall favorable score did drop (organization, high-quality work, active participation and feedback). These areas will be closely examined. It is worth noting, however, that in all these domains, the number of students who gave an overall unfavorable score dropped from the previous year. I do believe that the transition to strict pass/fail and removal of Honors helped improve student engagement with course material for the sake of learning and translated to a more positive experience. Going forward, the Skills Center as a whole is working to improve standardized patient and M4 student standardization, and improve meaningful feedback, an area consistently requiring improvement. I also look to continue pushing forward with fostering skills that students will use in practice by adding nutrition counseling and integrating more seamlessly with Population, Patient, Physician and Professionalism; Service Learning; and Basic Science. Finally, I hope to bolster the course’s commitment to social justice and equity by improving teaching relating to the LGBTQ+ population and minority stress.”
Key Areas of Improvement:
- Continued improvement in feedback standardization and alignment with other M1 courses
- Social justice improvements
- Nutritional education
- Additional blood pressure training
Clinical Skills Segment 2
Clinical Skills Segment 2
During Clinical Skills Segment 2 you navigated 8 simulated patient encounters exploring core clerkships. You attended 8 clinical decision-making sessions where you received robust feedback on oral presentations, practiced clinical procedures and participated in 24 small-group cases.
Course changes
- Return to in-person learning for all sessions
- Clinical Skills sessions all moved out of the summative examination weeks
- Change to pass/fail, competency-based course model with no high-stakes exams
- Dedicated learning coaches working one-on-one to facilitate Deliberate Practice
- Advanced scheduling – schedules set in advance of each semester to allow for planning of life events
- Central scheduling in Canvas
- 360-degree feedback process introduced for getting feedback from every standardized patient and M4 student during every encounter and providing feedback to standardized patients and M4 students
What you learned
- Eight standardized patient encounters
- 24 small-group cases
- Eight National Board of Medical Examiners-style quizzes
- History taking, note writing and oral presentation in core clerkships – Pediatrics, Surgery, Internal Medicine, Family Medicine, Obstetrics and Gynecology, Emergency Medicine, Neurology and Psychiatry
- How to navigate an electronic medical record
- Assessing the needs of patients with food insecurity, substance abuse, alcohol use disorder, and working with veterans and homeless patients
- How to write and use illness scripts
- The Emergency Medical Treatment and Labor Act
- How to identify dangerous patients
- Physical exams – pediatric; musculoskeletal; dermatological; cardiopulmonary; abdominal; male genitourinary; female genitourinary; breast; head, ears, eyes, nose and throat; neurological, Montreal Cognitive Assessment, National Institutes of Health stroke scale
Procedures:
- How to use a growth chart
- Using the Ages and Stages Questionnaire to assess milestone development
- Hand washing, universal precautions and aseptic technique
- Performing a wound culture
- How to use interpreter services
- Echocardiography and abdominal ultrasound
- Performing an ECG
- Foley catheter placement
- Urethral swab test
- Papanicolaou smear and potassium hydroxide preparation
- Nasopharyngeal swab and throat swab
- Intramuscular and subcutaneous injections
- Using clinical calculators and clinical decision rules
Interpretation:
- Immunization records
- Limb x-rays, chest x-rays and abdominal x-rays
- Lab tests electrolyte panel, renal function tests, calcium, phosphorous, urinalysis, complete blood count and differential, clotting function tests, cardiac enzymes, urine drug screen
- ECG
- Diagnostic imaging tests – ultrasound, CT, MRI
Patient counseling:
- Providing anticipatory guidance to a parent
- Performing motivational interviewing for tobacco use, alcohol use disorder, substance abuse
- Obtaining a clean catch urine specimen
Clinical Skills Segment 2: Proposed Actions for Next Academic Year, 2021-2022
Consistent note-writing feedback and deliberate practice activities have been enhanced for academic year 2021-2022 through the use of a larger group of M4 preceptors.
Enhanced standardized patient training, certification and education are underway, supported by the addition of an education specialist as part of the Clinical Skills team.
Office hours are consistently available to students. Standardized patients and guest specialty faculty provide consistent and unique feedback to students on their physical exam performance. Opportunities for Deliberate Practice are available to all students in the course.
Overall Rating Improvements
• 2018-2019 - Course Did not Exist
Key Areas of improvement:
- Standardized patients and guest specialty faculty training
- Enhanced standardized patient teaching assistant training, certification and education
Profiles
Erin Miller, M.D.
Erin Miller, M.D., graduated from the Wayne State University School of Medicine in 2013. She remained in Detroit for residency, training at the Detroit Medical Center in the combined Internal Medicine/Pediatrics program. She stayed on for an additional year as chief resident. Dr. Miller is an assistant professor of Pediatrics at the Wayne State University School of Medicine.
As director of the Segment 1 Clinical Skills Course, she teaches medical students the importance of communication, reasoning and physical exam skills. Dr. Miller is a practicing primary care physician at Central City Integrated Health, a Federally Qualified Health Center in Detroit.
Board-certified in both Internal Medicine and Pediatrics, she works with medical students and residents to provide high-quality primary care to underserved patients, many of whom face significant behavioral health challenges. She also volunteers as a preceptor at the Robert R. Frank Student Run Free Clinic, and in 2019 received the Gold Humanism Honor Society’s Leonard Tow Humanism in Medicine Faculty Award.
Christopher Guyer, M.D.
Dr. Guyer graduated from the Wayne State University School of Medicine in 2006. He completed a residency in Emergency Medicine at Detroit Receiving Hospital/Wayne State University in 2009 and completed a fellowship in Sports Medicine at Henry Ford Hospital in 2010.
Dr. Guyer serves as the director of the Clinical Skills Segment 2 Course, teaching medical students specialty-specific communication skills, advanced physical exam maneuvers, clinical procedures and clinical reasoning. He came to us from Henry Ford Health System as a senior staff physician, practicing in the Division of Emergency Medicine and Division of Orthopedics.
He is an assistant professor at the Wayne State University School of Medicine and an adjunct physician Instructor for the University of Michigan School of Medicine. Dr. Guyer is pursuing a master's degree in Health Professions Education at the University of Illinois, Chicago. His research interests include assessment methodology in undergraduate and graduate medical education, and using simulation for medical education. He is a visiting team medical liaison for the Detroit Lions, and a team physician with U.S. Ski and Snowboard.
Visit the Clinical Skills page at: programs.med.wayne.edu/kado
We want to hear from you
If you have any topics you would like to know about or have suggestions to how we can improve as a medical school, connect via the Warrior Med Suggestion Program.
The purpose of the Warrior Med Suggestions Program is to ensure each stakeholder of the School of Medicine has the opportunity to provide suggestions and feedback that may improve the organization’s mission. This program will serve as the mechanism that will drive the culture of Continuous Quality Improvement within the School of Medicine. These opportunities for improvement will drive cultural change and allow leaders to make a positive impact on a pathway to organizational excellence.
If you have any additional questions or concerns, feel free to reach us at oaacqi@med.wayne.edu. Thank you.
Kanye L. Gardner - Director of Continuous Quality Improvement
Volume 2 catalog of issues available here: Volume 2 - #1 - October 4, 2021 | Volume 2 - #2 - October 15, 2021| Volume 2 - #3 - October 29, 2021
Credits:
Medical Communications