The American College of Osteopathic Family Physicians is accredited by the American Osteopathic Association Council to sponsor continuing medical education for osteopathic physicians.

The American College of Osteopathic Family Physicians designates the lectures and workshops for Category 1-A credits on an hour-for-hour basis, pending approval by the AOA CCME, ACOFP is not responsible for the content.

ACOFP / AOA’s 122nd Annual Osteopathic Medical Conference & Exposition

OCTOBER 7 - 10PHILADELPHIA, PENNSYLVANIA29.5 Category 1-A CME credits anticipated

OMED 17®

ACOFP Clinical Preceptor Series: An Achilles Heel: Preceptor Formative and

Summative Evaluation of Students

Katherine Fisher, DO

10/2/2017

1

An Achilles Heel:Preceptor Formative and

Summative Evaluations

of Students in 3 Parts

Katherine Fisher, DO

Director of Clinical Education

COMP-NW

Western University of Health Sciences

October 9, 2017

Disclosures

•Nothing financial or personal to disclose

10/2/2017

2

Learning Objectives

•Understand current and past issues of evaluating students on clinical rotations

•Understand the need to develop more useful and objective evaluation tools for preceptors

•Understand the importance of teaching preceptors how to do evaluations

A Talk in Three Parts (Thanks, TED)

• Past and present evaluation methods

• Creating the Adaptable Physician of the Future (as it relates to Evaluations)

•Teaching Preceptors to Evaluate Properly• What do you mean by “properly”?

10/2/2017

3

Why should you care?Who suffers for the weakness?

The school (credibility)

The preceptor (not engaged)

The student (but not their grade)

Ultimately, the patient (which could be any one of us)

Ghosts of preceptors past

Out of sight, out of mind

An afterthought

“As above”

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4

Part 1: The Past and The Present

Remote past

•Hmmm, does the past repeat itself?....

•“Those who do not study history are doomed to repeat it”…..

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5

100 years of {Not Much} Change…but ideas were brewing

•Physicians returning from European training

•Rise of mass public education and the modern university

•Philanthropy of wealthy industrialists

Present and Near Future(After another 100 years of not much change)

•Abraham Flexner’s legacy

•Evaluations based on 7 Competency Domains

•EPAs (Entrustable Professional Activities)

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6

You’ve Heard/Seen This Before

•Baby Boomers (‘46-’64) 18 year generation

•Gen X (‘65-’80) 15 year generation

•Gen Y (Millennials) (‘81-’01) 20 year generation

•Digital Natives (‘02 -?) ? Years

•Gen Y and Digital Native line blurred by socio-economics

Cross Cultural Psychology

•Hofstede’s Dimensions (Geert Hofstede, Dutch Psychologist 1960s-70s)• Individualism vs collectivism scale

• Cultural tolerance of ambiguity

• Power Distance Index (PDI)

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7

7 Core Competencies• Medical Knowledge

• Patient Care

• Interpersonal and Communication Skills

• Professionalism

• Practice based Learning and Improvement

• Systems based Practice

• Osteopathic Philosophy

Get Ready for Part 2

•Stretch and fidget

•Check messages

•Check FB

•Smart phones and functional cognitive dysfunction

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8

Part 2: Creating the Adaptable Physician

•Harvard Graduate School of Education: Making Caring Common Project (since 2014)• http://mcc.gse.harvard.edu/files/gse-mcc/files/parent_tips_.pdf?m=1448054400

Raising Caring, Respectful, Ethical Children Physicians

Part 2: Creating the Adaptable Physician(Harvard Guide)

• Work to develop caring, loving relationships with your kids

• Be a strong moral role model and mentor

• Make caring for others a priority and set high ethical expectations

• Provide opportunities for children students to practice caring and gratitude

• Expand your child’s circle of concern

• Promote children’s ability to be ethical thinkers and positive change-makers in their communities.

• Help children develop self-control and manage feelings effectively.

students

student’sstudent’s

student’s

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9

Making Caring Common Core Competencies

• Work to develop caring relationships with students

• Be strong moral role model and mentor

• Make caring for others priority and set high ethical expectations

• Provide opportunities to practice caring and gratitude

• Expand student’s circle of concern• Promote ability to be ethical

thinker & change-makers in their communities

• Help them develop self-control and manage feelings effectively

•Osteopathic philosophy & OMM•Patient Care• Interpersonal and

Communication Skills•Professionalism•Practice-based Learning

and Improvement• Systems-based Practice•Medical Knowledge

Making Caring Common Core Competencies

• Work to develop caring relationships with students

• Be strong moral role model and mentor

• Make caring for others priority and set high ethical expectations

• Provide opportunities to practice caring and gratitude

• Expand student’s circle of concern• Promote ability to be ethical

thinker & change-makers in their communities

• Help them develop self-control and manage feelings effectively

•Osteopathic philosophy & OMM•Patient Care• Interpersonal and

Communication Skills•Professionalism•Practice-based Learning

and Improvement• Systems-based Practice•Medical Knowledge

10/2/2017

10

Making Caring Common Core Competencies

• Work to develop caring relationships with students

• Be strong moral role model and mentor

• Make caring for others priority and set high ethical expectations

• Provide opportunities to practice caring and gratitude

• Expand student’s circle of concern• Promote ability to be ethical

thinker & change-makers in their communities

• Help them develop self-control and manage feelings effectively

•Osteopathic philosophy & OMM•Patient Care• Interpersonal and

Communication Skills•Professionalism•Practice-based Learning

and Improvement• Systems-based Practice•Medical Knowledge

Making Caring Common Core Competencies

• Work to develop caring relationships with students

• Be strong moral role model and mentor

• Make caring for others a priority and set high ethical expectations

• Provide opportunities to practice caring and gratitude

• Expand student’s circle of concern• Promote ability to be ethical

thinker & change-makers in their communities

• Help them develop self-control and manage feelings effectively

•Osteopathic philosophy & OMM•Patient Care• Interpersonal and

Communication Skills•Professionalism•Practice-based Learning

and Improvement• Systems-based Practice•Medical Knowledge

10/2/2017

11

Making Caring Common Core Competencies

• Work to develop caring relationships with students

• Be strong moral role model and mentor

• Make caring for others priority and set high ethical expectations

• Provide opportunities to practice caring and gratitude

• Expand student’s circle of concern• Promote ability to be ethical

thinker & change-makers in their communities

• Help them develop self-control and manage feelings effectively

•Osteopathic philosophy & OMM•Patient Care• Interpersonal and

Communication Skills•Professionalism•Practice-based Learning

and Improvement• Systems-based Practice•Medical Knowledge

Making Caring Common Core Competencies

• Work to develop caring relationships with students

• Be strong moral role model and mentor

• Make caring for others priority and set high ethical expectations

• Provide opportunities to practice caring and gratitude

• Expand student’s circle of concern• Promote ability to be ethical

thinker & change-makers in their communities

• Help them develop self-control and manage feelings effectively

•Osteopathic philosophy & OMM•Patient Care• Interpersonal and

Communication Skills•Professionalism•Practice-based Learning

and Improvement• Systems-based Practice•Medical Knowledge

10/2/2017

12

Making Caring Common Core Competencies

• Work to develop caring relationships with students

• Be strong moral role model and mentor

• Make caring for others priority and set high ethical expectations

• Provide opportunities to practice caring and gratitude

• Expand student’s circle of concern• Promote ability to be ethical

thinker & change-makers in their communities

• Help them develop self-control and manage feelings effectively

•Osteopathic philosophy & OMM•Patient Care• Interpersonal and

Communication Skills•Professionalism•Practice-based Learning

and Improvement• Systems-based Practice•Medical Knowledge

Making Caring Common Core Competencies

• Work to develop caring relationships with students

• Be strong moral role model and mentor

• Make caring for others priority and set high ethical expectations

• Provide opportunities to practice caring and gratitude

• Expand student’s circle of concern• Promote ability to be ethical

thinker & change-makers in their communities

• Help them develop self-control and manage feelings effectively

•Osteopathic philosophy & OMM•Patient Care• Interpersonal and

Communication Skills•Professionalism•Practice-based Learning

and Improvement• Systems-based Practice•Medical Knowledge

10/2/2017

13

Making Caring Common Core Competencies

• Work to develop caring relationships with students

• Be strong moral role model and mentor

• Make caring for others priority and set high ethical expectations

• Provide opportunities to practice caring and gratitude

• Expand student’s circle of concern• Promote ability to be ethical

thinker & change-makers in their communities

• Help them develop self-control and manage feelings effectively

•Osteopathic philosophy & OMM•Patient Care• Interpersonal and

Communication Skills•Professionalism•Practice-based Learning

and Improvement• Systems-based Practice•Medical Knowledge

Get Ready for Part 3

•Thinking about your smart phone?

•Stretch and fidget

•Check messages

•Send messages

•Watch YouTube

10/2/2017

14

Getting Preceptors To Go Along With The Plan

https://youtu.be/S7UWeKbTSx8

10/2/2017

15

Part 3: Herding Cats

Oops. I Mean

Turning Preceptors Into Teachers

No, I Mean Teaching Physicians To Be Preceptors Who Are Mentors

Part 3: Teaching Preceptors to Evaluate What Needs To Be Evaluated

•The form

•The person completing the form

•Make the information on the form useful to others

•Make it easy to complete the form

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16

10/2/2017

17

University of Washington, Neuro elective

(UofW continued)

10/2/2017

18

10/2/2017

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From Family Medicine, March 2006

The RIME Developmental Process

The RIME Developmental Process

Educator

Manager

Interpreter

Reporter

Observer

MS-I MS-2 MS-3 MS-4 PGY-I PGY-2 PGY-3

Time

Modified from "The Learning Vector" by Stritter and colleagues. n

MS—medical student PG Y—postgraduatc year

Average

Above Average Learner

Below

Average

Learner

10/2/2017

20

Teaching Preceptors to Evaluate What Needs To Be Evaluated (cont.)

•The form

•The person completing the form (that’s you)

•Make the information on the form useful to others (the school and you)

•Make it easy to complete the form (the school)

Observation CardsCompetency or Skill: Rarely or

not at all

Done Occasiona

lly

Most of

the time

Consistently

Excellent

NotObserve

d

Medical Knowledge: knows basic science and disease mechanisms and applies to clinical setting

Physical exam skills: accurate and appropriate to the setting, interprets abnormal findings correctly

Documentation: accurately records information in organized manner

Clinical Problem Solving: formulates problem list, differential dx, and treatment plan

Interpersonal and Communication Skills: with patient and healthcare team, empathy, pt education

Osteopathic Philosophy: whole person approach, considers self-healing and self-regulatory capabilities

Practice Based Learning: identifies gaps in learning and seeks solutions; self-directed learner

Professionalism, Ethics: Punctual, honest, professional demeanor, respectful of pt and team

Comments on student’s performance (Will appear on MSPE e.g. Deans Letter)

10/2/2017

21

Books and Articles Of Influence

• Essential Skills For A Medical Teacher, Ronald M. Harden and Jennifer M. Laidlaw

• Cultures and Organizations: Software of the Mind, Revised and Expanded 3rd Edition. Geert Hofstede, Gert Jan Hofstede, Michael Minkov, 2010

• Outliers, The Story of Success, Malcolm Gladwell

• History of US medical education: http://www.encyclopedia.com/history/united-states-and-canada/us-history/medical-education

• TED Talks, Chris Anderson 2016

• The Question of Competence, Brian Hodges, editor

• Raising Caring Children, https://mcc.gse.harvard.edu/parenting-resources-raising-caring-ethical-children/raising-caring-children

• EPAs (Entrustable Professional Activities): https://www.aacom.org/docs/default-source/med-ed-presentations/core-epas.pdf?sfvrsn=20

• 7 Core Competencies of Osteopathic Profession: http://www.acoi.org/CoreComp.pdf

• Teaching In Your Office and Teaching In The Hospital, the ACP Teaching Medicine series

Questions?

Strengthen your

Achilles Heel.

Thank you,

kfisher@westernu.edu