Background: UCF COM enrolled its charter class in August 2009

1. A Novel First-Year Medical Student Course in Psychiatry: Development, Delivery, & Lessons Learned M Verduin MD, N Malik MD, V Bagley MS, A Berry MPA, M Feldman PhD, R Moroose MD University of Central Florida College of Medicine, Orlando, Florida Course Evaluation • Background: • UCF COM enrolled its charter class in August 2009 • Teaching faculty charged with developing an integrated, interactive, non-lecture based educational program • Included in the first year curriculum is an 11 week (33 contact hour) course, “Psychosocial Issues in Healthcare” Sample AFE on Professional Boundaries: Dr. Carlson finds herself becoming increasingly attracted to one of her patients, Joe, who she has been seeing more frequently for diabetic care. She has always taken an extra interest in her diabetic patients, as she appreciates their struggle, having observed her brother battle brittle diabetes for years. Dr. Carlson enjoys Joe’s flattering remarks about her appearance and intelligence. Joe has asked her out for a cup of coffee and she has politely declined his offer, explaining that she feels it would be unethical. Dr. Carlson was recently divorced and has occupied herself with long hours of work to distract herself from feelings of loneliness. Dr. Carlson looks forward to Joe’s visits and at times regrets turning down his offer as he seems like a nice guy. She recommends that Joe schedule his appointments at the end of the day. This allows her to allot more time to him than her usual follow-up visits. On one occasion, she returned his phone call regarding a medical question in the evening, which turned into a lengthy off-topic conversation. Dr. Carlson also makes sure to freshen her makeup prior to entering the exam room where Joe is waiting. Having maintained the highest professional standards her whole career, she finds herself feeling very vulnerable and confused right now. Which of the following statements best summarizes the above scenario AND the most appropriate intervention? A normal relationship which has not breached any physician-patient boundaries and does not require an intervention. An unethical relationship which should result in transfer of the patient to another physician. An inappropriate boundary violation which should be presented before an ethics committee. An inappropriate relationship which can be overlooked due to extenuating circumstances. A potentially problematic relationship which would benefit from counseling from a trusted colleague. In general, I am satisfied with this course • Approach to Development: • Multidisciplinary team led by course director (psychiatrist) to ensure relevance and broad-based applicability to all specialties • Primary goal: prepare the undifferentiated medical student for psychosocial issues encountered in all fields of medicine • Pedagogy: Team-Based Learning (TBL) to encourage student engagement and application of course material • Course concepts integrated horizontally and vertically across curriculum (e.g., covering human sexuality when learning about sexually transmitted infections and taking a sexual history in other courses) • Course concepts reinforced with small group discussions in which students present real-life examples of relevant psychosocial issues from their preceptorship experiences • To our knowledge, this is the only course in a US medical school to be taught entirely by TBL Course workload was appropriate Teaching methods used were effective Percent Responding • Student Comments: • Strengths - • “Great method of learning!” • “My favorite module hands down.” • “TBL was very effective and should be included as a teaching method in other modules.” • “It was interactive and gave a chance for students to practice their teamwork and discussion skills. Beyond the material that was learned, I grew personally from the class because of the format.” • “I loved this module!! I feel like I really learned and retained the information.” • “Thoroughly and creatively thought-out curriculum; well-selected reading materials; great relevance to medical practice and board exams.” • Weaknesses - • “Very frustrating to get the hang of [TBL]” • “Reading assignments were lengthy and low-yield.” • Course Structure: • Reading assignments based on weekly objectives given prior to class (from Behavior & Medicine by Wedding & Stuber, and articles from primary literature) • Monday afternoon: Individual Readiness Assurance Tests (IRATs) and Group Readiness Assurance Tests (GRATs), followed by discussion and appeals (1 hour); essentially a 10 question quiz taken individually and then again as a group • Thursday morning: Application Focused Exercises (AFEs), followed by discussion and appeals (2 hours); essentially a series of challenging clinical vignettes • Course Grade: 65% TBL (Grade weights for TBL component set by the class: 20% IRAT, 40% GRAT, 20% AFE, 20% Peer Feedback), 30% Exams, 5% NBME Customized Exam NBME Customized Exam • Lessons Learned: • Students needed time to adjust to TBL format, especially the intended ambiguity of AFE answers for generating in-class discussion • Overall, the course was very well-received (“best-received” course of first year) • Students mastered and retained course material extremely well, as indicated by high scores on NBME exam • Plans for the future: • Emphasize the nature of TBL to students early and often • Pursue more targeted readings • Develop weekly overviews summarizing key concepts to deliver at the end of AFEs • Include option to provide credit in “real time” for alternative AFE answers that are well-argued and substantiated in class • Weekly Course Topics: • Human Development & Learning Theory • Death, Dying, & Giving Bad News • Coping Styles, Stress & Illness, & Personality • Patient Education, Compliance, & Change • Human Sexuality • Alcohol Use & Misuse • Abuse, Neglect, & Partner Violence • Cultural Issues in Healthcare • Difficult Patients, Transference/Countertransference, & Professional Boundaries 90% The authors have no financial relationships that relate to the topic of this presentation. 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