The Clinical Transaction Program
The Clinical Transactions Project is a clinical curriculum organized around 25 presenting problems that are taught by Master Clinical Teachers. With a specific and defined curriculum an objective assessment of learner outcomes is possible. CORE is collaborating with selected Master Clinical Teachers to investigate a variety of assessment methods. These include standardized patient-based assessments, computer-based cases, oral examinations and abstractions from the medical students' actual patient records. We envision a system where medical students will know the assessment targets they need to reach, have a list of resources to meet those targets and be able to schedule "on demand" assessments to determine their level of performance. Such a system 1) will support habits of life long learning and 2) allow more efficient use of instructor time. These 25 presenting problems address two major criteria from the LCME. CORE collaborated on a manuscript that is currently under editorial review.
Moral Distress I, II and III
Investigation of situations causing moral distress to students and residents has been a long-standing desire of Dr. Bonnie Miller, associate dean for undergraduate medical education. Funded by the Medical Scholars program at Vanderbilt, two medical students have worked with Dr. Miller to develop a program of research. In Moral Distress I, a survey was developed with incidents that might cause a learner moral angst. The respondent indicates the frequency with which they have witnessed these situations and the degree of distress each caused them. This was administered to 4th year medical students in the winter of 2007. Later in the summer, the population of respondents was expanded to 3rd year medical students and residents at Vanderbilt (Moral Distress II). This spring (2008) in Moral Distress III, the original survey will have additional items regarding coping strategies and burnout. Results from Moral Distress I indicate that "systems issues" are both most frequent and most disturbing. Interestingly, we found a large range of student sensitivity to and distress from these situations despite the assumption that most students are witness to or participant in all of the situations in an approximately equal number. CORE collaborated on survey development, data analysis and interpretation, and preparation of a manuscript and a peer-reviewed presentation. The manuscript is under editorial review.
Sensitivity to Patient Concerns
Interpersonal Skill and Communication is a theme of the new curriculum with a team responsible for students' development of these skills throughout the curriculum. A particular learning and assessment event occurred during one of our third-year Intersessions. Dr. Lynn Webb and his team created cases portrayed by standardized patients who would interject concerns about their medical condition. Students had two encounters, receiving feedback after the first. Responding to casually spoken patient concerns is a more subtle and advanced form of communication skills, but one which learners can master with sufficient practice and feedback. Collaborating from the Center for Experiential Learning and Assessment (CELA) was Lisa Rawn and Dr. Jim Bills. CORE has been involved in design of the activity, creation of data collection sheets, data analysis and interpretation. We are now leading the project team in writing this for publication.
Research concerning the Electronic Medical Record
Funded through the National Library of Medicine, Dr. Trent Rosenbloom and a team of researchers will systematically study features of an electronic medical record and providers' responses to those features in a simulated patient care environment. Several studies will use the new Center for Experiential Learning and Assessment (link to CELA) that opened in October 2007. CORE has collaborated in forming study designs and preparing the grant application and will continue to play a role in the analysis and interpretation of data. Vanderbilt has received national recognition over the last 15 years for our electronic medical records. We see this as an important laboratory for more efficient and thorough studies of electronic medical records prior to installation is actual patient care. Total funding is $500,000 for the next 3 years.
Conversations around Medical Education Research
"Conversations" is new in the spring of 2008. Hosted by CORE, this monthly forum is an opportunity for students, residents and faculty to air research ideas for advice, where data can be shared for interpretation and where manuscripts can be critiqued prior to submitting for publication. Focused topics will be presented from time to time on aspects of quantitative and qualitative research in medical education. The goal is to elevate the quantity and quality of scholarship in medical education at Vanderbilt University School of Medicine and create an international identity as a place where quality scholarship happens. Faculty, staff and students may register to attend, submit a request for focus, and/or suggest a topic for discussion by clicking on the following link: CORE Conversations RSVP. Bring your ideas and your lunch, beverages will be provided.
