Distance Faculty Observation Using iPads Upstate Medical University

1. Distance Faculty Observation Using iPadsUpstate Medical University Ann S. Botash, MD Professor, Pediatrics Jason Perez, MS, FNP Graduate, College Nursing Patricia D. Powers, DNP, MPA, RN, FNP-C, NPP Clinical Assistant Professor, Nursing Carol Recker-Hughes, PT, PhD Associate Professor, Physical Therapy Carrie Roseamelia, Ma family medicine Pamela Youngs-Maher, M. Ed. Coordinator, Online Learning

2. Where We Work College of Medicine (Ann) IT (Pam) Family Medicine (Carrie) Physical Therapy (Carol) College of Nursing (Patty)

3. Background & Purpose 1. Clinical Education 2. Goals of Project 3. Literature Review

4. Percentage Clinical Education

5. Education: From Classroom to Clinic Education: From Classroom to Clinic Academic Faculty Clinical Supervisors Clinical teachers in traditional & Practicing clinicians who supervise non-traditional classroom settings students in the clinic

6. Challenges of Clinical Teaching:Juggling Act Lack of effective feedback skills • Variability • teaching • & learning Time

7. Goals of the Project • Assess FaceTime as a mechanism to bridge time/distance barriers in observing students • Improve students’ clinical skills through use of formative feedback • Develop a shared observation tool across multiple disciplines to define core, observable clinical skills

8. An Interdisciplinary (Ad)Venture COM CPT Past to Future CON • Fosters appreciation & understanding of other disciplines • Challenges norms & values of each discipline • Promotes student participation • Models strategies for future practice

9. Literature Review Distance Technology: • Provides a mechanism for valuable feedback on performance and promote mastery of clinical skills (Bulik, Frye, Callaway, Romero, & Walters, 2002; Clever, Novack, Cohen, Levinson, 2003; Novack, Cohen, Peitzman, Beadenkopf, Gracely, & Morris, 2002). • May be used for long-distance communication assessment for a variety of learners (Bulik, Frye, Callaway, Romero, & Walters, 2002; Clever, Novack, Cohen, Levinson, 2003; Mattheos, Nattestad, & Attström, 2003; Novack, Cohen, Peitzman, Beadenkopf, Gracely, & Morris, 2002). • Can be distracting/problematic (Curran, Aziz, O'Young, Bessell, & Schulz, 2005; Clever, Novack, Cohen, Levinson, 2003).

10. Description of the Project

11. Timeline

12. Planning • IRB Process • Describe what we plan to do & with whom • Seek exempt status • Identify common ground across disciplines for patient examination • Taking a patient history • Create form with essential elements • Define PI Roles

13. Communication • Communication with: • The project team • Academic Faculty • Students • Clinical sites • Tools • Blackboard • Google Drive • Email

14. Research Methods • Develop Tools for Data Collection: • Student & Faculty Technology Survey • Student Survey on Faculty Feedback • Create Focus Group Questions for Faculty • Develop Protocols: • Patient Recruitment • Student & Faculty FaceTime Encounters

15. Recruitment of Sites & Students • Recruitment • Sites • HIPAA • Wi-fi access • Policies & Procedures • Some sites could not participate • Students • Expectations of participants • Overview of the Project and iPad training • Completing 2 Surveys online

16. Faculty Recruitment • Principal Investigators recruited faculty • iPad was an incentive • Required commitment • 3 hours of faculty development • 1-2 hours/month January-May • Complete survey and focus group • Memorandum of Understanding (MOU)

17. Faculty Development Workshop

18. Faculty Training • Set up and use of iPads • 1 hour session (by department) • Introduction to Face Time, Apps, and Settings • Observation/Feedback Workshop • 2 hour session • Simulation in Clinical Skills Center • Practice, Practice, Practice

19. Feedback Workshop Objectives • Following this workshop, faculty will: • Differentiate between characteristics of effective versus ineffective feedback. • Use open-ended questions to promote student reflection and decision making. • Engage in a formative feedback session using Face Time. • Assess challenges of technology in the delivery of feedback.

20. Effective Feedback • Promotes self-directed learning and professional development • Facilitates effective problem solving • Requires ability to: • question appropriately • listen actively I’m questioning

21. Feedback Should

22. Faculty Development Session

23. Setting up the iPad (Student)

24. Pediatric Observation of Student/Standardized Patient

25. Feedback: Nursing Feedback to Student

26. Transition SLIDE Data Collection & Results

27. Data Collection & Analysis • Data Collection and Analysis:1. Faculty Survey 2. Student Surveys 3. Faculty Focus Groups

28. Results: Technology Surveys Did you experience difficulty connecting to FaceTime? Student: Preceptor was unfamiliar with the technology. Did you experience difficulty staying connected to FaceTime? Faculty: It took multiple attempts before the call went through. Audio was choppy, the camera froze several times.

29. Results: Technology Surveys FaceTime is an effective mechanism for delivering student feedback I would recommend the use of FaceTime technology on a regular basis Faculty: Promising but doesn't have it's sea-legs yet.

30. Results: Student Reflections The faculty member provided meaningful feedback about…

31. Results: Student Reflections The faculty member provided….. “tricks of the trade” advice or helpful tips Students Results • Agree • Disagree • Unsure • 76% • 14% • 10%

32. Themes: Faculty Focus Groups • What Worked? • Assessing Students • Providing Feedback • Communication with the • Onsite Faculty • What Did Not Work? • Imposition & Scheduling • Connectivity • Viewing Patients & Students • Student Initiative & Accountability

33. Themes: Faculty Focus Groups • Suggestions • Expand Use of iPad Observations • Earlier & more frequently • History and physical examination • Connect with clinical faculty • Use for Site Visits • Teaching Tools • iPad • Apps • Additional Faculty Development

34. Lessons Learned

35. Students • Recruitment • Sample of convenience • “Carrot or Stick”=Participation • Training • Memorandum of understanding • Practice, practice, practice! • In the Clinic • Variable support of instructors • Informed consent process • Survey Completion

36. A Student’s Experience

37. Faculty • Recruitment • Training • Commitment • PI Support

38. Pilot Study…..Next Steps? • Expand use across colleges • Implement “carrot or stick” policies • Consider cross discipline observations • Use, and validate, forms across disciplines • Guidelines for delivery of feedback • Observation tool • Observe history AND physical examination

39. Next Steps for Faculty Use? • Communication skills workshops • For new and current faculty • Inter professional • Professional development • iPad use • Apps • Use of the iPad for “site” visits • Rural and remote settings

40. Observation/Feedback Forms…. Observation Form: • https://docs.google.com/file/d/0B7a8mExE0x3HdnpSUFM1WFpjYW8/edit?usp=sharing Feedback Checklist: • https://docs.google.com/file/d/0B7a8mExE0x3HT1MwVTNUZ045cEU/edit?usp=sharing

41. References • Bulik, R., Frye, A. , Callaway, M., Romero, C., & Walters, D. (2002). Clinical Performance Assessment and Interactive Video Teleconferencing: An Iterative Exploration. Teaching and Learning in Medicine, 14 (2), 124-132. • Clever, S., Novack, D., Cohen, D., Levinson, W. (2003). Evaluating surgeons' informed decision making skills: Pilot test using a videoconferenced standardized patient. Medical Education, 37 (12), 1094-1099. • Curran, V., Aziz, K., O'Young, S., Bessell, C., & Schulz, H. (2005). A comparison of face-to-face versus remote assessment of neonatal resuscitation skills. Journal of Telemedicine and Telecare, 11 (2), 97-102. • Glavaz, G., Parish, T., Byous, R., Chambers, D., Gerdom, L., Leffert, J., & Wright T. (2012). The use of videoconferencing for clinical site evaluations. Journal Physician Assistant Education,23(2), 50-55. • Lentz, L.M., & Fincher, R.M. (1999). Using telemedicine and standardized patients to evaluate off-campus students' skills. Journal of the Association of American Medical Colleges, 74 (5), 598-599. • Mattheos, N., Nattestad, A., & Attström, R. (2003). Feasibility of and satisfaction with the use of low-bandwidth videoconferencing for examination of undergraduate students. Journal of Telemedicine and Telecare, 9(5), 278-281. • Novack, D., Cohen, D., Peitzman, S., Beadenkopf, S., Gracely, E., & Morris, J. (2002). A pilot test of WebOSCE: A system for assessing trainees' clinical skills via teleconference. Medical Teacher, 24 (5), 483-487. • Robinson, S. (2011). Promote active learning with iPads. Radiologic Technology, 83(2), 204-207. • Smith, C. , & Skandalakis, J. (2005). Remote presence proctoring by using a wireless remote-control videoconferencing system. Surgical Innovations, 12(2), 139-143.

42. Upstate Medical University Any “burning” questions??

43. What we are doing…. CNY Central: • http://www.cnycentral.com/news/story.aspx?id=878617#.UVnRcjnWaf8 What's Up at Upstate: • http://whatsupatupstate.wordpress.com/2013/04/01/professors-use-ipad-facetime-feature-in-teaching-medical-students/ Student interview: • http://www.youtube.com/watch?v=p7KDIYU3Ngc&list=UUIC6B4ULFCqa8bXKVc1sjYA&index=1