Addiction, Pain & Palliative Care 2011 Block Summary

1. Addiction, Pain & Palliative Care 2011 Block Summary CPCSC July 11, 2011 Steve Clay, DO, Doug Mann, PhD, Tracy Marx, DO

2. APPC Block Overview • This two-week course will introduce students to topics related to addiction, pain and palliative care. Addictiontopics include the abuse of and dependence on alcohol, prescription drugs, illicit drugs and other addictions. Pain and palliative care topics will address chronic pain, palliative care and hospice. You will be presented with a holistic approach to comprehensive pain and symptom management and given tools to help care for patients from a primary care approach. • A solid foundation in the management of addiction, pain and end of life care will be a crucial component of medicine that you will find very helpful in your personal and professional lives.

3. Teaching Methods • Interactive lectures • drugs of abuse, addiction assess/tx, chronic pain, symptom mgmt, goals of care, dying process, grief, spirituality • Panels • Addiction in Professionals – removed d/t poor attendance • Physician/Student Stress • Problem sets • Addiction Clinical Scenarios • Equianalgesic Dosing Problem Sets • Ethical Concepts & Cases

4. Innovative Teaching Methods • Multimedia experiences • HBO Clips on addiction • “Wit” Film • “Confessions of a Reluctant Caregiver” Play • “A Lion in the House” • Synthesis & Integration • Real patients

5. End of Block Exam 131 point exam – 116 matching/multiple choice, 3 short answer/essays ( 5 pts each) • Addiction – 59 points - multiple choice/matching questions • Pain – 13 points – multiple choice questions • Palliative care – 59 points - 44 multiple choice AND 3 short essays worth 5 points each • S&I – 5% , attendance only

6. End of Block Exam • Key Concepts given at beginning of block • Addiction: Assessment, Special Populations, Drugs of Abuse, Treatment • Pain:General, Assessment/Treatment, Equianalgesic Dosing • Palliative Care/Hospice: Patient Mgmt, Ethics/Decision Making, Grief, Spirituality • Exam questions directly linked to key concepts • Clinical Context: about 80%

7. Exam Results • 116 MC +15 Essay = 131 Total Points • Mean score 103.51 (79.8%) • Median score 104.00 (80.0%) • Scored from 84-122 (64.6% - 93.8%) • 1 MC questions thrown out • 7MC questions – accepted 2 answers

9. Feedback: Medical Knowledge • MK areas rated highest at 4.6-4.8 • Learning topics helped direct my learning, sequencing of learning activities, enhanced learning, lectures (overview/focused), and problem sets (statements 1, 2, 3, 4, 5, 6 & 8) • MK area rated lowest by students at 3.9-4.0 • Self assessment quiz, written block exam measuring master of learning topics, (statements 7, 10, & 11) MK Calculated Average – 4.5 (stable, but down 0.3 from summer placement) Overall, I rate this block as excellent – 4.2 (down 0.2)

10. Focus Group on Learning Activities • 0 groups attended

11. EOB Comments • I thought the questions on the exam were too ambiguous or subjective. The distribution ratio would have been nice to know in advanced. The essays were unnecessary. No offense to theinstructors, but this block was once again a waste of time from board studying. • The exam was extremely difficult even though I attended all the lectures and activities. I felt the many of the addiction exam questions did not reflect information discussed in lectures. • Block exam seemed quite difficult for the amount of time and lectures we had this block. Seemed to have blindsided a lot of the students. If it’s going to be this challenging I recommend moving the whole block to early in the quarter. • I thought this block was by far the worst block in the past two years. The first week of the block (and most of the second) were either covered in psych block or should have been. It is importantto learn to deal with death and palliative care but I do not think it should take an entire week. Ithink a single lecture would be sufficient. Watching TV, movies, and a play is not a good use of time when we are trying to maximize our board studying. I feel like activities were put in just to take up time rather than let us study for boards.

12. EOB Comments • I really liked the play and the movie as well as the problem set. I thought it was very helpful to have the patient come in for S&I, and I know that it was taken out due to low attendance, but I think that if you send an email out to remind people, it would be great to have a panel of physicians and professionals that have struggled with addiction in the past. • "Wit" and "Confessions of a Reluctant Caregiver" should probably have been mandatory sessions or at least had more emphasis on the exam. Many classmates who seem to lack empathyand other related skills were not there and I feel like the message didn't get across. • I wished in the future there was a way to move this block to a better time to accommodate our schedule better. I've heard from lots of students that they wished they were able to attend more for this block but the boards were just more important… simply poor timing • This was an excellent block and I am thankful to OUCOM for giving us the opportunity to learn more about AP&P, as we will be seeing it often in our patients throughout our careers.

13. Revisions for 2012 • Issues with block location? • Request from students to place before Geriatrics • Stress need to study for the exam, not to “blow it off” in favor of studying for boards • Revise and write new exam questions