Patient-Centered Learning University of North Dakota School of Medicine & Health Sciences

1. Patient-Centered LearningUniversity of North Dakota School of Medicine & Health Sciences Kurt Borg, Ph.D. Director of Assessment Office of Medical Education

2. Medical Education in U.S. - 2004 Active Learning by Students Didactic Lectures and Labs (30%) Clinical Correlations (32%) Small Group Cases (23%) PBL Hybrid PBL (15%) % of 123 Medical Schools Ref. Scott Kinkade, MD University of Missouri, Columbia 2004

3. Orientation Week Offices of Medical Education and Student Affairs Student Orientation Logistics PCL Case Processing Skills Case Wrap-Up / Patient White-Coat Ceremony

4. 62 Students / Year (Year 4) (Years 1-4) (Years 3-4) (Years 3-4)

5. Patient Centered Learning PBL Hybrid Concept Began Year One 1998 Began Year Two 1999

6. Patient Centered Learning PBL Hybrid Concept Block Design Teams Basic Scientists + Clinicians Volunteer Clinical Faculty

7. Year 1: Normal Structure & Function

9. Year 2: Pathobiology Ambulatory Care Experience (ACE)

10. Interprofessional Healthcare Course The Interprofessional Health Care (IPHC) course uses patient-centered cases to focus on the process involved in team building. Emphasis is placed on effective teamwork, the unique contributions of different professions, and patient or family-centered approach in health care delivery. Blocks III, IV, V, VI (15-16 medical students/Block)

11. Student Participants Nine professions: Physical Therapy (required), Medicine (required), Nursing (required), Communication Sciences and Disorders, (elective), Nutrition and Dietetics (elective), Social Work (elective), Occupational Therapy*, Clinical Lab Sciences*, and Physician Assistants* Student level of education varies from Senior Undergraduate to first or second year Graduate level *Students will participate when on-line course available

12. IPHC Objectives Apply knowledge and perspectives of health professions in team discussions about patient/client care situations Apply group skills in case management approaches throughout the course Demonstrate patient/client-centered approach in healthcare decision-making as an interdisciplinary team Demonstrate ability to reflect about team experiences and feedback Identify sources of potential error and consequences to health care delivery

13. PCL Patient

14. PCL Case Process

15. PCL Learning Issue Presentation

16. Physician / Patient Wrap-Up

17. Physician / Patient Wrap-Up

18. Assessment Week * Basic and Clinical Science Knowledge and Skills * Students must pass each component at 75%

19. Additional Assessment Facilitator Assessment during PCL Sessions for Eight Weeks (Formative Feedback – Midblock) Three Domains: 1. Acquisition and Integration of Knowledge 2. Peer Teaching and Communication Skills 3. Professionalism

20. SPIRAL “Sequenced Progress Inventory & Reflective Assessment of Learning” Olson, L.M., A.D. Schieve, K. G. Ruit, and R.C.Vari. Measuring inter rater reliability of a sequenced performance inventory and reflective assessment of learning (SPIRAL). Academic Medicine 78 (8): 844-850, 2003. 1. Facilitator assessment on scale / narrative regarding observations in PCL 2. Formative feedback at Week 4 3. Students conduct self-assessment (Week 4) 4. Summative feedback at Week 8 (S/U Grade)

24. Faculty Feedback • Meet with Block Director (Weekly QB Meeting) • Electronic Lecture Form • E-mail Notification • Electronic Facilitator Form (End-Block) * Constructive Professional Process

25. USMLE Step 1Performance of Examinees Taking Step 1 for the First Time Mean Scores for 1997-2007 Graduating Classes PCL

26. USMLE STEP 1 High PerformersNumber of Step 1 Scores at or above 240for 1997-2007 Graduating Classes PCL

27. Year 3/4 Medical Curriculum • Redesigned in 1998 • Year 3 : Traditional Rotations (8 weeks each) • Surgery, OB/GYN, Psychiatry, Family Medicine, Internal Medicine, Pediatrics • Rural Opportunities In Medical Education: ROME • 7 months at Rural site • Self selection with Committee approval • Year 4: • Acting Internships in Internal Medicine and Surgery (4 weeks each) • Electives (4 weeks each) • Research Project • Senior Colloquium

28. Rural Opportunities in Medical Education (ROME) Began 1998-1999 One or two students at rural site for 7 Months Parent Campus: • 8 Weeks of Psychiatry • 4 Weeks each Pediatrics, OB/GYN, Internal Medicine Surgery & Family Medicine at ROME site Clinical Skills Lab prior to ROME • Chest tubes • Catheterizations

29. Community Populations ROME Williston (12,400) ROME Devils Lake (7,000) ROME Jamestown (14,800) ROME Hettinger (1,307)

30. PCL

31. Office of Medical Education Dir. Of OME, PCL Director, Tom Hill, Ph.D. Program Development (BORDERS, Norway . Exchange) Linda Olson, Ed.D Assessment Director, Basic Sciences Director Year 02 Kurt Borg, Ph.D. Basic Sciences Director Year 01 Patrick Carr, Ph.D. Clinical Sciences (IPC) Co-Director Year 02, Jon Allen, M.D. Clinical Skills (CSA), Assistant Dean – Northeast Campus Clinical Sciences Co-Director Year 02 Ralph Levitt, M.D. IPHC Course Director Sue Offutt, Ph.D. Statistics / Research Clint Hosford, Ph.D. Pharmacology Content Rick Clarens, Pharm.D. Clinical Sciences (IPC) Co-Director Year 01 Charles Christianson, M.D. Rosanne McBride, Ph.D ROME, Case Development Roger Schauer, M.D.

32. Office of Medical Education Standardized Patients, (IPC) Dawn Drake, M.A. PCL Coordinator Kathy Williams, B.A. IPC Coordinator Janelle Studney, M.Ed. PCL Cases & Accounting Roxanne Korynta Grand Forks Campus Phyllis Tweton, B.A. Administrative Support Faye Aker, B.A.