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Engaging Medical Students in OB/Gyn in the New Curriculum

Explore the new curriculum in OB/Gyn and how it engages medical students. Discover the importance of adult learning principles and the impact of cognitive neuroscience. Learn about active learning strategies and the unique characteristics of today's medical students.

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Engaging Medical Students in OB/Gyn in the New Curriculum

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  1. Engaging Medical Students inOB/Gyn in the New CurriculumCharles Hunter OrationAGOS Annual MeetingSeptember 15, 2017 Deborah L Conway, MD Professor and Chair (Interim) Dept of Obstetrics & Gynecology Associate Dean for Curriculum/Office of UME Joe R and Teresa Lozano Long SOM UT Health San Antonio

  2. “It is rare that I have had the opportunity to officially extend my gratitude to an organization… for offering me the substance to further a life-time goal – that of being able to infuence, in a positive way, the education in our specialty. No other senior medical society has been so well endowed with all the ingredients necessary for accomplishing this goal – the goal of learning...” Charles A. Hunter, Jr., MD Presidential Address – “The goal of learning – to be enlightened” 86th Annual Meeting of the AAOG September, 1975

  3. Session Objectives • What is the “new curriculum”? • Why is there a new curriculum? • Who are our learners and what do they need? • What do we in OB/Gyn have to offer them? “To read or listen without planned goals is similar to starting a cross-country trip without a map.” “Enlightenment is achieved only when, in addition to knowing what a (wo)man says, you understand what (s)he means and why (s)he says it.” Dr. Charles Hunter

  4. UME is not standing still… LCME Annual Medical School Questionnaire Part II, 2012-2013

  5. LCME Annual Medical School Questionnaire Part II, 2012-2013

  6. What is driving the recent energy in UME curriculum renewal?

  7. Andragogy Cognitive Neuroscience Modern UME Curriculum Reform Publication of “Educating Physicians” Increased LCME Scrutiny

  8. Adult learners… • Are independent and self-directed • Bring a variety of motivations and expectations about learning goals based on prior experience • Prefer to learn through experience/application • Are internally incentivized • Value feedback over tests and evaluations MS Knowles, The Modern Practice of Adult Education: From Pedagogy to Andragogy, 1988

  9. Where is adult learning “located”? Hagen and Park, 2016

  10. “A Call for Reform…” • “The new Flexner report” • 2010 • Identified weaknesses and threats in the way we train: • Inpatient >> Outpatient • Impact of clinical pressures on faculty teaching • Inflexible, not learner-centered • 14 institutions

  11. “Toward a vision for the future of medical education” Four goals: • Standardization of learning outcomes and individualization of the learning process • Integration of formal knowledge and clinical experience • Development of habits of inquiry and innovation • Focus on professional identity formation Cooke, Irby, O’Brien 2010

  12. LCME Annual Medical School Questionnaire Part II, 2012-2013

  13. “If one of the major goals to be achieved at the end of medical school is to produce a graduate with a basic biomedical background for a lifetime of learning, then we should design our curriculum to enable him to do so… Why are most of our evaluations relying on recall-type of testing? Why have we not clearly defined the end goals and the methods for achieving these goals for the learner at the beginning of his training?”Dr. Charles Hunter

  14. Full Circle: Science and Theory Applied Hagen and Park, 2016

  15. Active and Applied Learning in UME • Team-based learning • Case-based learning • Audience response technology • Virtual anatomy • Standardized patients

  16. Emphasis on Teamwork Foundational Sciences Clinical Integration Active Learning Professional Identity Formation Early Patient Encounters

  17. Who are the medical students of today? Median age at matriculation: 23 (IQR 22-24) aamc.org Late adolescent Millenials in an increasingly competitive pipeline nrmp.org pewresearch.org

  18. (MORE) Cognitive/developmental neuroscience

  19. The “adolescent” brain • Impulsivity • Risk taking • Emotional reactivity • Prefrontal cortex • Subcortical regions: • Accumbens • Amygdala npr.org

  20. Prefrontal cortex: • Executive function: attention, motivation, sequencing, planning, delayed responding, problem-solving • Linear development with age • Amygdala • Emotional significance of cues in the environment • Fear/anxiety • Nucleus accumbens • Prediction of reward outcomes Strengthening and pruning the connections between the PFC and the subcortical regions continues into the MID TO LATE 20s AND BEYOND!! npr.org

  21. Who are the Millenials? • ~1980-2000, ¼ of the US population, biggest • Relevant period and cohort effects: • Massive technology growth, instant access, data integration • Collaborative and team-oriented • Motivation: meaning > money • Raised and educated with a “seat at the table” • Comfort with diversity

  22. What do they face? • Increased pressure on existing residency spots • Increased perception of scarce residency spots • Grades • USMLE exams

  23. NRMP 2017 Main Residency Match

  24. The application “arms race” Overall: OBG: 54% Data from ERAS, aamc.org

  25. OB/GYN and Today’s Medical Student

  26. We aren’t their favorite… Quality of education experience = “Good” or “Excellent” AAMC Graduation Questionnaire

  27. Reasons Cited in Clerkship Evaluations • Long work hours, overnight shifts • Less autonomy/hands on • Limited faculty interaction • Ineffective teaching by residents/fellows • Mistreatment Pradhan et al, AJOG 2016

  28. What do we have to offer? • Unique: The mix • Deliveries, surgeries, colposcopy, ultrasound, oncology, intensive care, preventive care, office procedures, urology, fertility, adolescent health… • Universal: Perspective of women as patients • Foundational: Doctoring skills • Gathering relevant clinical data • Accurate clinical reasoning • Sound prescribing practices • Creation of an evidence- and value-based treatment plan • Effective patient communication in various situations

  29. Gather a history and perform a physical examination • Prioritize a differential diagnosis following a clinical encounter • Recommend and interpret common diagnostic and screening tests • Enter and discuss orders and prescriptions • Document a clinical encounter in the patient record • Provide an oral presentation of a clinical encounter • Form clinical questions and retrieve evidence to advance patient care • Give or receive a patient handover to transition care responsibility • Collaborate as a member of an interprofessional team • Recognize a patient requiring urgent or emergent care and initiate evaluation and management • Obtain informed consent for test and/or procedures • Perform general procedures of a physician • Identify system failures and contribute to a culture of safety and improvement

  30. “All too often, following formal training, we physicians tend to relinquish our intellectual drive. I ask each of you to pause in your busy life and ponder your role in developing and guiding our pursuit of learning. Will you be a part of this pursuit? Are you willing to help? I sincerely hope so.”Dr. Charles Hunter

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