Clinical Teaching Post Graduate Medicine

1. Clinical TeachingPost Graduate Medicine A Workshop Drs. Henry Averns and Lewis Tomalty

2. Post Graduate Medicine Structure • Personnel • Administrative Assistant for each program • Program Director: faculty member responsible for administering the overall conduct of the residency program • Program Directors form an overall Program Committee that meets monthly

3. Post Graduate ProgramObjectives • Objectives are approved by Program Committee • Based on the national objectives as approved by the Royal College (specialties) or the College of Family Physicians • http://www.royalcollege.ca/public/credentials/specialty_information • http://www.cfpc.ca/Home/ • Clinical objectives and non clinical objectives (eg professionalism, scholar, manager etc)

4. Internal Medicine Program Overview

5. 3 year program • Primarily hospital based • Graded responsibility

7. Clinical teaching units • Fundamentals of acute emergency management and in patient care of undifferentiated medical conditions • Acute and chronic medical conditions

8. Formal Education Activities • Morning Report (sign in rounds) • Conference where CTU teams present and discuss recent admissions • Academic Half Days • Weekly academic rounds where core general internal medicine topics discussed • Core Medicine Rounds • Twice weekly. Case conferences, patient safety rounds, case of the month, rotating subspecialty presentations • Departmental Conferences • Grand rounds and weekly morbidity and mortality conferences

9. Formal Education Activities • Journal Club • Critical appraisal skills – review of EBM • Simulation Lab • Simulation teaching and procedural training

10. Evaluation • Twice yearly meetings with Program Director • Mid Rotation and end of rotation in-training Evaluation Reports • American Board Internal Medicine exam annually • Multi-Source Feedback (Peer-Peer and Nurse-Resident) feedback • Annual practice OSCE • First year residents take a national OSCE exam • E-portfolio system recently implemented

11. Evaluation • Mini-CEX • Used to assess learners in real life settings • Can be used for formative or summative assessment • Process: real life clinical encounter with a patient (15 minutes) • Teacher observes • Debrief the encounter immediately to discuss areas for improvement and to provide positive feedback – most important part of process (10 minutes) • Formally assessed either on paper or on line

12. FAMILY MEDICINE

13. Curriculum • 2 year program • Triple C Curriculum • Comprehensive Learning • Continuity of Patient Care, supervision and curriculum • Family medicine CENTERED

14. Comprehensive learning • Learning objectives structured around Domains of clinical care • Maternity and Newborn Care • Care of Children and Adolescents • Care of the Elderly • Palliative Care • Care of Adults • Global Health (Care of vulnerable and underserviced populations) • All training through the lens of family medicine (eg FM preceptors in obstetrics, long term care etc)

15. Development of Physician Characteristics • Communication • Professionalism • Ethics • Patient Centered Approach • Practice Management

16. Continuity of Learning • Continuity of Patient Care • Responsible for own defined group of patients by sharing preceptor’s patients • Build relationships with patients over the two year program

17. Continuity of Learning • Continuity of Supervision • Academic advisor that meets regularly with each resident • Same core family medicine preceptors for extended periods

18. Continuity of Learning • Continuity of Curriculum • Build on each learning experience- topics revisited with a different perspective or level of complexity. Eg pediatrics in first and second year

19. Centered in Family Medicine • Learning is always through the lens of a Family Physician • Majority of time working in Family Medicine clinics • Work with Family Physicians who are hospitalists, care for obstetrical patients, practice palliative medicine, do minor surgery etc

20. Evaluation • Competency based • Portfolio • Objective: observed clinical encounters and summative evaluation forms (Mini-CEX) • Reflective: Self evaluation, reflective exercises, feedback • Majority of assessment happens in clinic • Interim and final evaluation forms • National testing: OSCE and written exams

21. Faculty Development • Ongoing • Compulsory versus voluntary • Issues particularly for Post Graduate Training • Time, money, importance • Competencies (national plan) • Student assessment and faculty evaluation • Communication skills • Scholarship • Leader • Information and Communication technologies • Teacher/Educator

22. Faculty Development in Post Graduate Medicine Priorities • Assessment • Teacher as a facilitator of learning • Providing Feedback • Teaching clinical skills • Professionalism in the clinical setting • Communication skills for both teacher and learner • EBM (using I.T. appropriately and effectively) • Others? Do you agree with this list?