The International Medical Graduate Institute

1. The International Medical Graduate Institute A Skills Assessment for International Medical Graduates Seeking Entry Into U. S. Family Medicine Residencies

2. Department of Family Medicine Quillen College of Medicine East Tennessee State University

3. The IMG Institute December 2009 Participants

4. Elements of the IMG InstituteA Three Day Program • Communication Skills • Human Patient Simulator Lab • “Morning Report” • OSCE • Competencies & Concepts in Family Medicine • Program Evaluation

5. Why the IMG Institute? • 55% of Family Medicine Residents at Quillen College of Medicine are IMGs [2009-2010] • IMGs have widely variable skill levels at entry • Quality of education at international medical schools highly variable

6. Why the IMG Institute? continued: • Language and cultural barriers impede successful completion of residency • Time and $$ invested is sizeable • Deficiencies in knowledge or skills can be remediated before beginning residency

7. How do we select our participants? > From inquiries to our Department about an Observorship > We do not offer an Observorship! > Via our website. > Word of mouth and other methods.

8. IMG Institute December 14 – 16, 2009 Welcome. Introduction. • Welcome by Dr. Franko and our Faculty • Participants diagrammed their family genogram • Each drew and then described his personal journey • Community and resident IMG physicians joined us for an international luncheon

9. Describe your life’s journey

10. Sharing International Cuisine

11. Human Patient Simulator Lab Human Patient Simulator Lab • Experiential learning tool • Teach essential clinical skills • Demonstrate basic competencies • Patient Care • Medical Knowledge • Interpersonal and Communication Skills • Professionalism • Requires team work to be successful • Performance critiqued by faculty and peers

12. HPS • Hx, Px by teams of two, make a prelim diagnosis • Patient suffers a critical event • ‘Nurse’ assists as Team resuscitates

13. HPS • Demonstrate clinical skills, medical knowledge • Debriefing: EKG, lab, x-ray • How did you interpret this? • Clinical outcomes reviewed • Teamwork essential

14. Communication Skills • Standardized patient • Group setting • Faculty observation, rating • Develop rapport with the standardized patient • Explicit “Positive Speak” • Explicit caring/ commitment • Avoid interruption • Avoid negative talk • Elicit full agenda • [continued]

15. Communication Skills • Information management • Open ended vs closed questions • Explore patient’s perspective on illness • Actively listen for clues • Assess patient’s ability to change • Explore patient’s feelings

16. Communication Skills • SPs, peers, • and Faculty • discuss • case • Patient’s Feelings • Facilitate patient’s expressions of concerns, thoughts, fears • Respond to clues patient gives • Negotiate to reach common ground • Avoid confrontational strategies • Develop a common ground plan • Recognize when agreement cannot be reached

17. SOAP Note concept Prioritized problem list Logical treatment plan Develop differential for a major problem Written and oral presentation Group process “Morning Report”

18. “Morning Report” • History/Physical exam/Lab data are given • Additional labs/EKG/x-ray must follow logically from assessment & plan • Further history can be a part of the plan

19. “Morning Report” • Write differential major Dx • Present treatment plan • Defend choices in plan • Participate in group process • Write-ups are graded

20. Objective Structured Clinical Exam • Standardized Patient Interview Station • Videotaped for later review • Focused Physical Exam Station • Discuss with Preceptor • Write up SOAP note with differential

21. Interview the standardized patient OSCE Trained to give up her information sparingly Standardized Patient presents consistent history and affect to each participant Videotape interview

22. Focused Physical Exam OSCE Participants used our Sim Lab model to complete the focused physical exam

23. OSCE Discuss with the Preceptor • Review specific moments of patient-interviewer interaction as recorded on CD • Participant discovers his strengths and weaknesses • Participant keeps his own CD

24. OSCE Write a differential diagnosis • They chose to do their write-ups collaboratively • Write-ups were graded • Evaluations were mailed to participants

25. Competencies & Concepts in Family Medicine Presents a selected topic current in Family Medicine • Chronic Care Model of Disease • Patient-centered Medical Home • Evidence Based Medicine • Information Mastery • Cultural Competence

26. Competencies & Concepts in Family Medicine • Evidence Based Medicine • Information Mastery • PICO questions • Participants learn to use EBM in patient care

27. Program Evaluation • 1 hour Focus Group • Conducted by faculty member not involved in the program • Questions provided by Co-directors • Evaluator “sampled” sessions as observer • ‘Embedded’ staff member • Knowledgeable Program Coordinator • Attended most sessions of Institute • A ‘note taker’ • Edited and shared notes • Solicited faculty feedback

28. Participant Evaluation • Performance Assessments • Communications skills • HPS Lab session • OSCE • ‘Morning Report’ • Faculty session leaders wrote assessment for each participant • ‘Morning Report’ chart notes graded • OSCE write-ups graded • Faculty’s assessments combined and sent to participants • Point of performance evaluations: communications

29. Major Findings and Recommendations • “Institute is a success. “ Faculty leaders, participants • Participants thought they got their money’s worth • Most activities were unique to them, not experienced in their medical school • Exceeded expectations in faculty contact, level of resident work • More demanded of them than they had anticipated

30. Major Findings and Recommendations • Participants want more practice/opportunities during the Institute to demonstrate competence • Expand length of each session, but not the overall time frame by more than a half day • Participants can prepare pre-Institute assignments, but cannot really ‘know’ what it is like • Participants risk takers; willing to “mix it up”

31. Major Findings and Recommendations • Participant evaluations by Faculty consistent. • Participants took criticism well…but did they understand? Can they apply it? • Some interesting observations – “we are praised in India for coming up with as many possibilities in our differential, no matter how unlikely.” • Built confidence, would recommend to others, worth more than it cost. • Not a guarantee to acceptance into residency program

32. Farewell