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TTUHSC IME Abstracts | AAMC 2008

Abstracts from the 2008 AAMC Innovations in Medical Education (IME) Exhibit

San Antonio, November 2-3, 2008

aamc posters 2008 aamc posters 2008

Walk in my shoes: A cross-cultural experience for preclinical students with the homeless

Patti J. Patterson, Betsy Jones, Erin Braddock, Marie Hall Institute for Rural and Community Health, Texas Tech University School of Medicine – Lubbock


Providing optimal health care for diverse populations involves understanding medical, social, economic and political influences on health, and the ability to communicate with people with different value systems, backgrounds and concepts of health and illness. 
While many first year medical students have extensive experiences living and working in other cultures, others do not. This project introduced students early in their education to a disenfranchised population. Students interviewed poor, primarily homeless persons in various community-based organizations. The goals were for students to better understand the potential root causes and long-term personal and societal impact of poverty and homelessness and to learn to more effectively communicate with persons of varying economic, social, cultural and educational backgrounds. This presentation outlines project goals, activities, teaching tools and evaluation results.


Corresponding Author: Patti J. Patterson, M.D. patti.patterson@ttuhsc.edu

Developing a Required Year 4 Geriatrics Rotation Based on the AAMC Geriatrics Competencies: Experiences from a Three-Campus Medical School


Andrew Dentino, Stephanie Leeper, Paul Casner, Lynn Bickley, Betsy Jones
Texas Tech University School of Medicine –Amarillo, El Paso, Lubbock


In July 2008, the Texas Tech University Health Sciences Center School of Medicine implemented a required two-week geriatrics rotation for fourth-year medical students. The result of many years of effort, as well as assistance from an Aging and Quality of Life grant from the D.W. Reynolds Foundation, this curricular initiative is especially noteworthy because it represents what may be one of the first efforts to adopt the new AAMC Geriatrics Competencies as learning objectives and basis for measurable outcomes. This Innovations in Medical Education poster will outline key features of the curriculum as it is implemented on three geographically separate campuses of a single medical school, all of which share rotation goals and objectives, but each of which takes advantage of resources unique to its campus and community:


Lubbock: Students receive training in geriatric medicine in a variety of settings, including assisted living facilities, long-term care facilities, home visits, hospice, and ambulatory sites. Students also take part in TTUHSC’s innovative geriatrics podcasting project, producing audio podcast episodes published to the Texas Tech MedCast Reynolds Geriatrics Series and available for download from the iTunes Music Store. Each podcast is developed for an audience of third-year medical students, based on a question from the USMLE Step 2CK Sample Exam that uses a vignette of a patient aged 60 and older. 


Amarillo: For an experience focusing on geriatrics, geriatric neuropsychiatry, and neurology, students see patients in a skilled nursing facility, geriatric wellness clinic, nursing home, and two senior assessment clinics. Students learn about the cultural aspects of aging through experiences at the Family Medicine Senior Assessment Clinic. They also participate in outreach activities such as the health fairs, where they have provided information on depression in the elderly and dementia and provide screening in these areas as well as blood sugars. Several groups of students lead community service projects that involve interviewing family caregivers, reviewing the literature on caregiver issues, and working with other seniors in the community. 


El Paso: Students receive training in a wide range of sites and experiences, including outpatient geriatric clinics, Hospice and Hospice home visits. They perform geriatric assessments at a senior day care center and receive additional experiences at a rehabilitation hospital.

Corresponding Author: Betsy G. Jones, Ed.D. betsy.jones@ttuhsc.edu

Using Podcasting to Teach Geriatrics to Third-Year Medical Students.

Betsy G. Jones, Lynn S. Bickley, Andrew Dentino, Fiona Prabhu, Charmaine Martin, Marichu Balmes, Robert Neilson, Steve Urban, Dinorah Nutis Texas Tech University School of Medicine –Amarillo, El Paso, Lubbock


Purpose of study: In its 2007 report, “Learn, Serve, Lead,” the AAMC recognized large-scale trends that will affect academic medicine in the coming years, including “technology-enhanced strategies” to help address “a rising burden of chronic disease and a mobile, diverse population.” This project evaluates one such strategy—podcasts—to promote medical student learning in geriatrics.


Methodology: During the fall of 2007, during their 8-week family medicine (FM; n=67) or internal medicine (IM; n=50) clerkship, third-year medical students on TTUHSC’s three campuses were assigned to listen to four podcasts, covering topics in geriatric functional assessment, geriatric office visits, nutritional issues for the elderly, and preventive screening for the elderly. These podcasts are part of a multi-episode geriatric series of the Texas Tech MedCast. Afterward, students completed an evaluation instrument including a 15-item content quiz. 


Summary of Results: Using a 5-point Likert scale (5=strongly agree) to assess opinions about the podcasts, students generally agreed that they understand the podcasts’ content and that they had adequate opportunity to listen to the episodes. Students completing the FM clerkship were more likely to agree that podcasts offer a valuable teaching tool than did students completing the IM clerkship (means = 3.57 and 2.94 respectively; t (111) = 2.87, p = .005). On the other hand, IM clerks had slightly higher scores on the cognitive questions (90.85% vs. 90.5%, p<.86), reflecting IM’s use of those questions as part of the clerkship exam.

Conclusions: Students generally appreciate the availability of podcasts, but their enthusiasm for and use of this teaching tool varies according to their perceptions of the associated incentives, such as extra exam points or other “high yield” rewards.


AAMC. Learn, Serve, Lead: The Mission, Vision and Strategic Priorities of the AAMC. 2007.

Corresponding Author: Betsy G. Jones, Ed.D. betsy.jones@ttuhsc.edu

Does Early Exposure to Simulation Improve the Clinical Learning and Experience for Medical Students in an Anesthesiology Clerkship?


Suzanne Escudier, Department of Anesthesiology, Texas Tech University School of Medicine –Lubbock


Background: Medical students in anesthesiology clerkships learn by observing an anesthesiologist or an anesthesiology resident. The students participate in theoretical discussion during the administration of an anesthetic but usually do not participate in the formulation of an anesthetic plan. Using a screen based simulator, the student can experience the decision-making process first hand and, it is hypothesized, better understand what is observed and what is discussed afterwards.

Hypothesis: Early simulation experience improves overall knowledge acquisition during the clerkship and student satisfaction with the clerkship experience.


Study Design: Prospective, Randomized

Materials and Methods: Ten fourth year students who chose a four week anesthesiology clerkship performed two anesthetics using a screen based simulator as part of their training. The students were randomly divided into two groups. The first group completed one case simulation during the first week of clerkship and the second case during the fourth week. The second group completed both cases on the same day during the fourth week. First cases and second cases were the same for both groups. The same anesthesiologist provided all individual debriefing after each case. An assessment tool was used to evaluate the students’ selections including appropriateness and safety of their anesthetic plans. 
After completing the second simulated case all students were surveyed as to the quality of their clinical learning experience.


Results: (1) To determine if the simulation training at the start of the clerkship enhanced performance as compared to simulation training only at the end of the clerkship, the differences in the assessment scores of the first and second cases were compared between the two groups.
(2) To determine if early exposure to simulation training affected the students' assessment of their clinical learning experience, the student surveys of the two groups were compared.


Conclusions: Work in progress for academic year 2008 – 2009. 


Corresponding Author: Suzanne Escudier, M.D., suzanne.escudier@ttuhsc.edu

Promoting Self-Directed Learning Through Independent Study Aids and Peer Teaching in Anatomy Laboratory


Vaughan H. Lee, Anthony Allan Hewetson, and Branaslav Vidic: Department of Cell Biology and Biochemistry, Texas Tech University School of Medicine – Lubbock


The objectives of these projects were to promote self-directed learning with 1) study aids for cross-sectional and medical images and 2) peer teaching exercises during laboratory dissection sessions. These projects were developed for first year medical students in their first block which is Clinically Oriented Anatomy. Consistently labeled cross-sectional and medical images were developed and distributed as hard-copy keys and Web-based images for independent study. A peer teaching system called Students Teaching Students (STS) was developed to help instruct dissection during Anatomy laboratory sessions by utilizing a group of the students as teaching assistants. In our approach to this method, the student teaching assistants (STAs) are provided with special pre-laboratory instruction on the material for the upcoming dissection. It is then up to the STA to prepare, guide and direct their small groups (4-5 students) during that laboratory dissection. The STS system was expanded to its current form where approximately one half of laboratory sessions were STS, while the others were classically presented. Both of these projects help the students develop self-directed skills necessary to become life-long learners, and begin to prepare them for the type of questioning they will experience during clinical rotations. The effectiveness of these study aids has been evaluated by measuring examination performance and by soliciting information from the students for the last five years. There was no difference in academic success associated with these new methods. Web-based materials were preferred for independent study and hard-copy guides for small group learning in the gross laboratory. In conclusion, these teaching methods have enhanced active self-directed and small group learning experiences and reduced the need for passive, faculty-guided sessions. Supported by TTUSOM Awards in Educational Innovation and Scholarship and the Dept. of Cell Biology and Biochemistry. 


Corresponding Author: 
Vaughan H. Lee, Ph.D.
, TTUHSC/CBB Room 5B103
3601 4th Street 
Lubbock, TX 79430, 
806-743-2714
, vaughan.lee@ttuhsc.edu

Spirituality – Religiousness Curriculum in a Psychiatry Residency Program:
Enhance Conversation

Thomas F. McGovern, Terry McMahon, Kumud Joshi, and Jules Molina, Department of Psychiatry, Texas Tech University School of Medicine – Lubbock


An enhanced focus on the place of spirituality/religiousness in our Psychiatry Residency Program has been in place for the past three years. A grant from the Office of the Dean, followed by a three year grant (now in its third year) from the George Washington Institute for Spirituality and Health (GWish), John Templeton Foundation have facilitated the development of an interactive, resident driven curriculum. This curriculum explores the relevance of spirituality/religiousness in the personal and professional lives of the residents as healers but, more importantly, in addressing the holistic care of patients/families.


The didactic component of the curriculum addresses, over a three year cycle, the following topics: religiousness/spirituality in psychiatric practice, major religions in their relationship with mental health, the assessment of spirituality and religiousness in clinical work. These areas are covered in years One and Two. “Spirituality dinners” on a monthly basis, introduce the residents, in the context of open animated table talk, to the insights of major religions as presented by representatives of various faith communities. The dinners have promoted dialogue, conversation and have enriched a sense of community among the residents, who themselves represent the major religions in the richness of many cultures. Other topics, addressed in the third and fourth year, deal with the spiritual dimensions of suffering, grief, addiction, guilt and forgiveness. The focus of these sessions is highly interactive and reflective, with a distinct psychotherapeutic direction. 
A Spirituality Awareness in Residents Psychiatric Practice (SARPP) instrument is being used to measure change across several domains including definitions, clinical competency, attitudes, and evaluations. Strongly endorsed items indicate that residents, at the beginning of their training lack both comfort and ability in dealing with spiritual issues. This improves over time. A Residents Portfolio also evaluates resident response to the enhanced curriculum. This aspect of the evaluative process is currently being examined. It remains to be seen how resident awareness and competency in spiritual/religious matters translates into more holistic patient care. Overall, the enhanced conversation of the past three years has been challenging and rewarding and, above all, a community builder.


Corresponding Author: Thomas F. McGovern, Ed.D., Professor Thomas.McGovern@ttuhsc.edu

The Use of Simulated Patients to Evaluate and Teach Communication and Interpersonal Skills in Surgical Residency: One Program Directors Experience.

Ari Halldorsson, Department of Surgery, Texas Tech University School of Medicine –Lubbock

Introduction: Good communication and interpersonal skills are essential for any physician in clinical practice. 
Although the surgical profession has long accepted that surgeons need to be “talkers” as well as “doers” teaching, evaluating and setting standards for these skills are still being debated. These have traditionally been taught by role modeling and global 360O evaluations used to assess the learner’s proficiency. The drawbacks to using ward rounds and other clinical settings solely to teach and assess interpersonal and communication skills include; lack of uniform experience, the subjectivity of the teacher’s evaluation and lack of timely feedback. 


Simulated patient program: Few years ago we began using simulated patients to evaluate interpersonal and communication skills of surgery residents. The scenarios cover such topics as obtaining an informed consent, interaction with religious and ethnic minorities, understanding and respecting the patient’s autonomy and delivering bad news. Each resident is tested once per year.

Program evaluation: Before participating the residents almost uniformly felt that this would not be a good method to assess their patient encounter skills. After taking the simulated encounters they had a much more favorable opinion and thought that this was a useful educational tool and a good proxy to clinical encounters. Most admitted that their own performance needed more improvement than they expected. The Attendings commented on the importance of observing the residents performance in a controlled environment. The importance of being able to give and receive timely feedback was frequently mentioned as a major positive to this method. 
Lessons learned: 


1. The simulated case needs to be concise and simple with clearly defined assignments and detailed performance expectations.


2. Delineated attending evaluation form with a check list and evaluation of each component of the assignment, not just over all performance.


3. Detailed and compartmentalized evaluation form for the standardized patient.


4. Immediate constructive feedback on each component of the scenario making sure the resident understands deficiencies and accepts recommendations for improvement.


Conclusion: We have found that using simulated patient scenarios in a constructive, organized manner was well accepted by the residents and Attendings and this method has become a valuable tool in teaching and evaluating interpersonal and communication skills in our program. 


Corresponding Author: Ari Halldorsson, M.D.
Program Director General Surgery, Professor and Vice Chair, Department of Surgery, 
Texas Tech University Health Sciences Center, 
3601 4th St., MS 8312, Suite 3A159
, Lubbock, Texas 79430-8312
, Phone: (806) 743-2460
, Fax: (806) 743-2113, 
E-mail: ari.halldorsson@ttuhsc.edu

The Laura W. Bush Institute for Women’s Health Women’s Health Fellowship Program
: A Multidisciplinary Educational Program in Gender-Differences and Women’s Health


Marjorie Jenkins, Department of Internal Medicine - Texas Tech University School of Medicine – Amarillo


In 2007 Texas Tech University Health Sciences Center (TTUHSC) established the Laura W. Bush Institute for Women’s Health with the First Lady’s 
permission. The Institute is located across the TTUHSC campuses of Amarillo, El Paso, Lubbock and the Permian Basin and in the future, Abilene and Dallas. Currently the impact area is 140,000 geographical miles The mission of the Laura W. Bush Institute for Women’s Health (LWBIWH) is dedicated to the cultivation and advancement of multi-disciplinary science in women’s health and to promote the well-being of women through research, education and community outreach.


The expansion of the LWBIWH brought together the strengths of TTUHSC’s Schools of Medicine, Pharmacy, Nursing, Allied Health Sciences, F. Marie Hall Institute for Rural and Community Health and the Garrison Institute on Aging. 


The LWBIWH has an established Women’s Health Fellowship (WHF) program on the TTUHSC Amarillo campus. In addition the TTUHSC El Paso Foster School of Medicine will launch a WHF/MPH program in July 2009. These two training programs constitute 2 of 23 such programs as listed in the annual Journal of Women’s Health Fellowship Directory.


The LWBIWH WHF training programs are multidisciplinary programs geared toward training leaders in gender-specific medicine. Through involvement of Internal Medicine, Family Medicine, and Obstetrics and Gynecology faculty our fellows are prepared to bridge the gap between gynecology and primary care and take bench research to the bedside. 
The LWBIWH will set the standard for multidisciplinary educational programs in gender-differences and women’s health. 


Corresponding Author and Creator of the LWBIWH Fellowship: Dr. Marjorie Jenkins


Contact Person: Marjorie Jenkins,  LWBIWH, 1400 Wallace Blvd. Amarillo, Tx, 79106, 806.356.4617, marjorie.jenkins@ttuhsc.edu.

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