Welcome. This is a review of the required information for clinical teaching and assessment of UW School of Medicine and Public Health medical students. My name is Kathy Stewart and I'm the current Director of Phase 2 and Phase 3. If you're watching this video, thank you so much for what you do for our medical students.

 

What I'm going to review are some of the competencies and assessment processes that we have in place for the Phase 2 and Phase 3 students in our curriculum. The guiding principles of the ForWard curriculum include full integration of fundamental public health and clinical sciences across the spectrum of the curriculum. It's a competency-based curriculum with longitudinal sequencing, so what students do in Phase 2 and Phase 3 directly correlates to what they were taught in Phase 1. There's increased interprofessional and team-based educational opportunities built into the clinical years. There are longitudinal public health and systems-based practice opportunities also built into the curriculum. There's earlier entry into the clinical clerkships, so our students who enter Phase 2 have spent 18 months in Phase 1 in the basic science curriculum. There are advanced learning opportunities for internship preparation, and those are our Phase 3 required courses, Inpatient Acting Internship and the Ambulatory Acting Internship.

 

As clinical teachers, we ask you to facilitate the learning of medical students as part of your clinical care team. We would like for you to set situational expectations for your team, be it inpatient, outpatient operating room, whatever patient setting that you're in; encourage the active participation of our students; provide meaningful feedback in a timely fashion; and discuss any concerns that you have with the leadership, the faculty, and staff - such as the director of the course, the Integrated Block Leader, as well as site-based directors. Again, thank you so much for teaching our students.

 

Our curriculum is based on the core competencies as defined for clinical learning. Those are systems-based practice, professionalism, interpersonal and communications, practice-based learning and improvement, patient care, and medical knowledge. These six competencies are felt to be necessary for the practice of clinical medicine.

 

Our graduation competencies fall into those six domains. We refer to them as our Educational Program Objectives in LCME language - that's the Liaison Committee on Medical Education. They are reviewed and approved each year by our curriculum committee, and they map to all of our learning objectives and assessments. We're going to go over the six competencies now that we use for Educational Program Objectives.

 

The first competency we'll review is knowledge for practice. These competencies are written in expectation for student demonstration. So KP1, the student demonstrates mastery of clinical relevant scientific knowledge of the normal structure and function of the body, mechanisms of disease, therapeutic interventions, disease prevention, and health promotion. KP2, the student understands the clinical relevance of scientific inquiry and demonstrates the ability to critically evaluate and apply emerging knowledge. And KP3, the student demonstrates an understanding of the role of social and structural determinants of health on disease prevention, health promotion and health equity.

 

The second competency is patient care. PC1, the student acquires and synthesizes relevant patient information to formulate an appropriate differential diagnosis and patient-centered care plan. PC2, student counsels and educates patients and their families about health conditions, disease prevention and management, and available resources to meet health needs. PC3, the student uses this information and information technology to optimize patient care. And PC4, the student performs basic procedural skills related to the care of the patient.

 

The next competency is practice-based learning and improvement. PL1, student engages in evidence-based reasoning and problem-solving to address medical and public health questions. PL2, the student utilizes self-assessment and feedback from multiple sources to improve knowledge, skills, and attitudes. PL3, the student contributes to an environment of discovery and learning as a member of a professional community. Often that professional community refers to the patient care team.

 

The next competency, systems-based practice. SBP1, demonstrates a systems-based approach to health care delivery that optimizes quality and prioritizes patient safety measures. The student, in SBP2, draws upon community assets and resources, integrating individual and population-based strategies to improve the health of patients and populations. And for SBP3, the student navigates the healthcare system in a way that optimizes quality care for patients and populations, demonstrating best utilization of health and care resources.

 

The fifth competency is professionalism. For PR1, the student demonstrates respect for human dignity and diversity in accepting non-judgmental behaviors and providing compassionate care for all. For PR2, the student takes responsibility, behaves honestly and acts in a timely, organized, and dependable manner. For PR3, the student adheres to ethical principles in working with patients and populations. And for PR4, the student serves as an advocate and practices the key principles of community engagement to promote health of patients and populations.

 

The next competency is interpersonal communication skills. For IC1, the student demonstrates effective communication using oral, written and electronic formats to establish and maintain collaborative relationships with patients and families. For IC2, the student demonstrates effective communication and team skills to establish and maintain collaborative relationships with members of the interprofessional team. For IC3, the student effectively conveys evidence-based health practices, programs and policies to a variety of audiences. For IC4, the student addresses gaps in language, health literacy, and power to promote health equity and optimize health outcomes. And in IC5, the student effectively communicates patient information with peers and colleagues using oral, written and electronic formats. Those are our competencies that we base our curriculum on.

 

For Phase 2 learning and clinical sessions, all four blocks - so those are the four courses that we have: Acute Care, Chronic and Preventive Care, Special Care of Obstetrics and Gynecology and Pediatrics, and Surgical and Procedural Care. Orientation occurs on the first day of every 12-week block. The formal didactic schedule varies by block, with selected time when students will be pulled off the wards for their case-based learning sessions. Student work hours will not exceed 80 hours of clinical required sessions per week. Weekend rounding and call coverage will vary and students are aware that, depending on the rotation, their expectations for a call and weekend coverage will change. And then absences are tracked centrally, meaning by the Medical Education Office, and students are given no more than five days per 12 weeks off without requiring some type of makeup. The majority of time spent during these 12 weeks, students will be on the wards or in the clinics.

 

In Phase 2, we document clinical experiences using two separate forms. The FaCET, which is the Forward Clinical Experience Tracker, is a form that has a list of required experiences that students are either asked to observe, assist or perform while on their clinical rotation. Students can ask for these certain required experiences, and they come to you and say, hey, I need to see or manage a patient with first trimester bleeding, can I come in with you to see this patient? Simulated activities are available if students don't see the required clinical experiences. There's also a direct observation form that students may hand you and say, could you please sign off on this, or they will say, hey, I'm going to use this experience to count as my direct observation. Students are required to be observed taking components of a history and performing components of a physical. These provide, the direct observation provides opportunity for formative feedback and helps you inform your clinical performance assessment of the student. Both the FaCET and direct observation forms, students are responsible for turning in at the end of their 12-week course as part of an assignment and checking with students on how they're completing the FaCET and the direct observation form is something that can happen during the interim feedback sessions.

 

Again, the FaCET experiences are tracked by students that either are asked to observe, meaning they shadow a skilled provider and witness how the skill task is performed. They either assist, the learner participates under the supervision of a skilled provider in some portion of the performance of a skill or task. I always think of that, in the operating room when I'm delivering a baby. And perform, the learner executes the skill task under the supervision of a skilled provider.

 

Phase 2 assessments are calculated at the end of the 12-week course. Students must pass all three components to pass the block or the course. The components are medical knowledge and that is assessed via the NBME shelf exams, patient care and interpersonal communication, which are assessed via the OSCE exam as well as clinical assessment rubrics, and then lifelong learning, which is accounted by attendance and assignments.

 

There are three types of items that you will see on the clinical performance assessment forms. There's a competency milestone assessment, and if you think back, we have those six core competency domains. Then there's the domain of competency assessment, and then the written comments.

 

So for example, if we're doing competency milestone assessment and we want to assess PC1: how the student acquires and synthesize relevant patient information to formulate an appropriate differential diagnosis and patient-centered care plan. This will map back to the competency PC1, and you will not see the unacceptable, you won't see the milestone language there, but these milestones are what generate the clinical assessment that you'll be asked.

 

So, to assess PC1, which of the following best describes the student's ability to generate a treatment plan? You're asked, not applicable, does not attempt, you can read through those, and you can see if you flip back to the previous slide how that will map back to the milestones. The milestone scale is shown with the different levels of observable skill listed so you can select the level that best describes the student performance.

 

Then there's the domain assessment. Looking at the domain assessment at the end of patient care or whatever competency you're on, there'll be a question. When considering the student’s level of training, their patient care skills, their communication skills, etc., and then you're asked to fill out the answers. Again, those directly mark back to the milestones that we have set for our competencies.

 

The third component of the clinical assessment are the narrative comments. These are directly included verbatim on the medical student performance evaluation or the MSPE which used to be called the Dean's letter. We ask that you describe observable behavior and do not make assumptions about student attitude. Not acceptable would be, “student didn't seem to care.” Another way to word that would be, “student was not observed to take advantage of clinical opportunities.” Be sure that the written comments and verbal feedback are compatible with the evaluation marks. An exceptional student: “excellent student, one of the best this year, advanced medical knowledge, well prepared for class.” Think about how you would go back and fill those milestone questions to reflect that verbal comment. Advanced student: “shows consistent effort, prepare good medical knowledge base.” That would look different on the assessment forms on the ratings that you would have provided.

 

So the assessments are used on the MSPE to calculate the Discipline Specific Comparative Performance as well as a Cumulative Comparative Performance. The DSCP is the NBME Shelf exams and clinical assessments and their discipline-based comparison of individual performance. If you think back to SCOGE which is Specialty Care of Obstetrics, Gynecology and Pediatrics, there still on the MSPE is an assessment of a student's performance in obstetrics, as well as a student's performance in pediatrics. So that's the DSCP. The CCP is a cumulative comparative performance. I always think of that as the class rank. The NBME Shelf exams, the clinical assessments, the OSCEs, and lifelong learning all tie into the CCP and it's the year-long based comparison of individual performance.

 

How this looks on the MSPE, all competency milestones and domain assessments from the clinical assessment forms mathematically contribute to the calculation. And then along with contributions of the Shelf, the OSCE, lifelong learning, they're graphically represented in a 20 percentile range. If you look at what's on the bar on the bottom of the slide, this is the overall cumulative comparative performance for a domain. You can see that the student performance is the blue bar, and this is a student who performs upper range of the class and lists the minimal cohort and the maximal cohort for the class. So you can see how that student performed in relationship to the other students in their class. Again, this is the graphic that is used on the MSPE or Dean's letter.

 

Again, Phase 2 student assessment, the supervising provider roles are in direct observation, clinical assessments, participation in the interim feedback form, and in daily feedback.

 

Some of the other things, supervision does not equal observation. Our students are asked on several course evaluations if they feel that they have adequate supervision on the clinical wards. Supervision is defined as the oversight of a medical student in clinical learning situations involving patient care in order to ensure patient and student safety, delegated level of responsibility being appropriate to the student's level of training, and that supervised activities are within the scope of practice of the supervising health professional. This does not mean that every student activity, taking an overnight history, etc., needs to be observed. And again, we are talking to our students about the difference between supervision.

 

Our work hour policy for students is the same as for residents - it’s not to exceed 80 hours per week averaged over four weeks. That includes patient care and required learning activities. It does not include reading, preparing, studying; and students are expected to have off one 24-hour period per week.

 

Phase 2 attendance policy, in regard to excused absences, students are allowed up to three excused absences total per 12 week block. They may be requested up to four weeks before the absence and are approved and tracked centrally. This is something that you are not expected to track with students.

 

Student Managed Absence days are a little bit different. There are no more than two Student Managed Absence days allowed to be taken for 12 week block and students may take these for mental health reasons, just as a pop off while to attend maybe a wedding, etc. Students may submit an SMA notification at any time during the rotation up to one business day prior to the requested date. To submit the SMA, the students will need to email the department education coordinator and the block coordinator, and they are responsible to directly communicate with the faculty and residents on the team. “Hey, I'm taking an SMA day tomorrow, I will not be there for rounds.” Students will receive an email receipt from the block coordinator and department coordinator that this is being tracked and we know that they're taking it.

 

It's a little bit different for Phase 3 because there are different types of courses in Phase 3. Phase 3 have required courses, the IAI, the AAI, the Inpatient Acting Internship, the Ambulatory Acting Internship, public health requirements, basic science requirements, and then their free electives. The start of Phase 3 is the completion of Step 1 and the end date is graduation. Students are allowed 22 SMAs throughout the entire Phase 3, so that's 18 months. The number permitted missed is based on the length of the course. So for four week course, students can have four days, three-week course, three days, two-week course, two days. The Ambulatory Acting Internship and the Inpatient Acting Internship have the same SMA absence policy as for the Phase 2 courses. Notification time is a minimum of one business day prior to the desired SMA day. Students will receive an email from the course coordinator documenting receipt of the notification. Student will email the team or the provider that they're working with, and notification will be reviewed for approval. Submission is sufficient. For the basic science, public health selective, clinical electives, and non-clinical elective, because those courses often run two weeks in length and sometimes only have one or two students in them, notification time is a minimum of 72 hours prior to the start of the course. So that's important. Students will receive an email from the course coordinator, similar to the IAI and AAI policies. They will email the provider or the professor involved in that course and notification will not be reviewed for approval; submission is sufficient.

 

Mobile device guidelines. We ask students to turn their phone to vibrate, or refrain from using during patient care activities. HIPAA is a requirement to be followed. Oftentimes, ask permission: “Hey, I need to look up this drug. I'm not going onto Facebook, if I look on my phone,” and follow any institutional policies. We know that the policies vary from site to site.

 

The learning environment is important. The UW School of Medicine Public Health defines mistreatment in eight general domains: public belittlement or humiliation; threats of physical harm or actual physical punishment; requirements to perform, personal services such as shopping; being subjected to unwanted sexual advances; being asked for sexual favors in exchange for grades; being denied opportunities for training because of gender, race, ethnicity or sexual orientation; being subjected to offensive remarks/name based on gender, race, ethnicity or sexual orientation; and receiving lower grades or evaluation based on gender, race, ethnicity or sexual orientation. These are reported in real time online to Student Services and then Phase 2 leadership. The link on the slide will take you to the mistreatment policy as well as where students can report. Any of the policies that we've discussed, also the links that in the slides will take you directly to the USMPH Guidelines.

 

And remember, you matter. The required clinical experiences really impact students’ specialty choice. As an OB-GYN, I focus on the OB literature and there was a study that came from 2010 from Magee: post clerkship interest in obstetrics and gynecology was associated with perceptions that the residents behave professionally. Students were treated as part of the team and having clear expectations for their participation on labor and delivery. It did not correlate with specific hands-on opportunities or experience. So just your attitude and your welcoming environment in which you encourage students to participate make a huge difference on how they perceive your field.

 

So for the remainder of the presentation, the first part of this video is relevant and required for all disciplines and teachers of the UWSMPH medical students. The next portion is divided into six parts and review the specific learning objectives and teaching modalities requirements for each block: Acute Care, Chronic and Preventive Care, Special Care of Obstetrics and Gynecology and Pediatrics, and Surgical and Procedural Care, Inpatient Acting Internship, and the Ambulatory Acting Internship. So fast forward to the sections that apply to your clinical education role, and you are only required to watch the portion that applies to your clinical education.

 

The tracking of training is important for LCME compliance. On each student clinical assessment form, there is an attestation that you will see that is associated with a link to this video. This attestation must be answered for compliance with the LCME, dated, and all medical student assessors need to document that they are familiar with the learning objectives of the course and prepared for their roles as clinical educators in assessment as well as in teaching. The attestation reads, “In 2025, I reviewed the required information and I'm aware of expectations related to teaching and assessing UW School of Medicine and Public Health, medical students and required clinical rotations.”

 

Other resources, my email address; all policies that impact the students, this is a functional link; our educational site; feel free to reach out to the residency director as well as the Department of Medical Education team.

 

And I really like this quote by Albert Einstein: “I never teach my pupils. I only attempt to provide the conditions in which they can learn.” And that's what clinical teaching is all about. We provide students the learning environment in which to develop their clinical and professional skills. Thank you very much.

 

Hello, and welcome to Acute Care. I'm Laura Zakowski, the Acute Care Black leader. And I'll talk to you a bit about other aspects of Acute Care beyond what you heard from Kathy Stewart in the earlier part of this video. So Acute Care is located in Phase 2 here. I'm showing you the W to show you where it is located. Students may take it at any time during Phase 2. It may be the first thing they do in January, it may be the last thing they do that they start in September. Acute Care is made up of five integrated specialties. These are all focused primarily on inpatient care. And starting from the left here with the little images, we're made up of hospital medicine, radiology, psychiatry, emergency medicine, and neurology.

 

And four of our clinical experiences are in a block format, something like this. Medicine is a total of six weeks - and students may have four weeks of medicine and then another two weeks of medicine later, but that'll add up to six weeks. They'll have two weeks of each of the other specialties, emergency medicine, neurology, and psychiatry.

 

Our radiology curriculum is located within the Acute Care case-based learning topics. Students cover a different topic each week of the block over the course of 12 weeks and within each of those subjects is radiology as a discipline. These weekly topics are taught on Wednesday afternoon in Madison, but may be taught on different days of the week at other sites. For the case-based learning activities, students will participate in preceptor groups where they will discuss cases that help to focus on medical decision making; they'll learn more about radiology, as I said; and then they'll either participate in simulation or specialty sessions, the first where they practice managing patients in the SIM centers and the latter, the specialty session also focuses on cases within that discipline for the week. Students will have assignments that they need to complete prior to their small group learning activities, so they may be working on those when they're on service with you.

 

We have a number of goals and objectives on Acute Care and I'm going to talk about the six major categories and then show you the objectives. The major goals include first interpersonal and communication skills. Secondly, knowledge for practice. Third, patient care. Fourth is practice-based learning and improvement. For an example, beneath this would be for students to learn to use feedback to improve their skills. Professionalism being the fifth and the sixth being systems-based practice, for example, utilizing quality and safety in patient care. These competencies or goals are very much like what ACGME has for residents and fellows.

 

Within each of these six competency areas, I have listed here individual course objectives that you can look at in more detail if you wish to learn more about what students will be focusing on while they're working with you. Primarily, their patient care and interpersonal and communication skills are the things you will likely see most often. But also, you can pay attention to the practice-based learning and improvement, professionalism, and systems-based practice.

 

Sharing with you here the experience requirements for Acute Care, the FaCET is the Forward Activity and Clinical Experience Tracker. And we expect students under supervision to evaluate patients with each one of these conditions. Since our block is 12 weeks long, students will most likely see all of these conditions. However, if they do not have the opportunity to see these conditions, we do have specific cases set aside for them that they can study and learn more. However, if you're looking at these particular topics and thinking about what you might want to spend some time teaching your students, here are some high yield areas for them. So thank you. We appreciate you taking the time to care for the patients while you are challenging our learners to grow and supporting them in this process to become physicians.

 

Hello. My name is Carrie Rees, I'm the Integrated Block Leader for Chronic and Preventive Care. In terms of schedules, it'll be a variety of outpatient experiences in family medicine, usually 4-6 weeks; internal medicine, usually at least two weeks; geriatrics; neurology, which is usually two weeks; some students will have experiences in physical medicine and rehabilitation; and then two weeks of psychiatry.

 

In addition to clinical experiences, students have a variety of videos, articles, and interactive cases that they're asked to review asynchronously each week. You can see here in the table the list of the different topics for each week. Additionally, there are CBL or case-based learning sessions, and those are a variety of both in-person and virtual activities. They mostly correspond to the weekly ELO topics. There'll be 10 total sessions, two of which include interactions with standardized patients to practice clinical skills. One of the sessions is co-taught by our pharmacists. And then at the end of the experience, the facilitators will complete a performance assessment.

 

Unique to CPC are the Community Health Engagement Projects. Students participate in a variety of different activities that they complete with a community partner organization. In addition to the actual activities they're completing, students have check-in meetings where there'll be a discussion about assigned articles. And then at the end of the rotation, students complete an individual reflection, a group presentation, and a handoff document for the next group of students.

 

In terms of course objectives for CPC, I’ll give you a moment to read through the full list here.

 

Now to review required experiences, students will have a list of activities and clinical experiences they need to complete. They will log these in the Forward Activities and Clinical Experience Tracker, the FaCET in Acuity. I'll allow you all to read through this. Thank you all for taking the time to teach our students in CPC. Thank you.

 

Hi, I'm Dr. Kirstin Nackers. I'm the Course Director for one of the required Phase 2 integrated blocks known as SCOPE, which stands for Specialized Care of Obstetric, Gynecologic and Pediatric Patients. Let me start by taking a moment to thank you. Our students’ interactions with their clinical supervisors are so important, as is how you help shape their learning experiences. Additionally, your observations of our students are so helpful for clinical assessments. For the resident supervisors in particular, students often view you as near peer role models who can be incredibly influential in their education, as well as in their career decisions. So thank you for the important role that you play with our students. As you've heard, our school's three-phase curriculum is a bit different than a traditional medical school curriculum. If you went to a medical school with a more traditional curriculum, think of these Phase 2 blocks as similar to the required M3 clerkships. Hopefully, you've already watched the preceding video which gave a broader overview of Phase 2 and many of the school's policies and practices. This video focuses on a few specific details for students and supervisors in SCOPE.

 

So I want to start by briefly showing you the course's overarching goals. If you were to pause the screen, you'd see that many of these are general objectives that can be completed in a variety of clinical settings, whether that's on the pediatric side or the OB-GYN side. These are really about helping the students apply some of those foundational patient care skills that they've learned in Phase 1 to our patient populations.

 

The medical students from UW complete their required core clinical experiences in both pediatrics and OB-GYN on this block, SCOPE. At some sites, family medicine is also contributing to the learning opportunities on the block related to the care of women and children. Students will participate in pediatric care in a variety of settings, including ambulatory primary care clinics, inpatient wards or ICUs, and some students may have the opportunity to participate with pediatric subspecialties in ambulatory or inpatient or consultative settings. For OB-GYN, students will be participating in obstetric care in clinics, antepartum units, and labor and delivery units. Surgical gynecology experiences will also occur in ambulatory surgical and inpatient settings. This is all to say that you will encounter students across your department.

 

The students are required to complete a number of experiences over the course of this rotation. Some of these are specific to the care of children or to women's health, but others could be completed in multiple settings. For example, postpartum depression screening at a newborn well visit or in the postpartum clinic; sexually transmitted infection screening in the care of an adolescent pediatric patient or in women's health. It is the student’s responsibility to make sure that they have participated in each of these experience requirements, though they may ask your help for identifying patients to help them be able to complete these requirements. If a student is unable to complete an item in a clinical setting, makeup opportunities are available and are listed in the course website. The course administrator can also assist the students in finding these activities if needed.

 

Throughout the course of the block, students participate in some classroom learning as well. All students complete these six integrated case-based learning sessions facilitated by faculty and resident preceptors. Additionally, they participate in additional learning activities offered at the site, and those vary a little bit from one site to the next by design to help round out the student's overall learning experience. So that is the 50,000 foot view of SCOPE. Thank you again for your contributions to our student learning, and please don't hesitate to reach out if you have any questions.

 

Hi, I'm Courtney Morgan. I'm the IBL for the Surgical Procedural Care block. So I'm going to tell you a little bit about our block and all of the relevant information.

 

General overview of this block is a combination of both clinical experiences and case-based learning. Clinical experiences is 4-6 weeks of general surgery, depending on the site; two weeks of anesthesia ;and then 2-4 weeks of subspecialty surgeries. For case-based learning, we have both clinical CBLs based in general surgery, anesthesiology, subspecialties with some radiology tie-in as well, and then some integrated CBLs that we really feel span skills that go across probably all of the blocks but are particularly relevant during SPC, and so this is how we address them.

 

The learning objectives for SPC, I'm going to go over these. For both the knowledge for practice and patient care learning objectives, these include: to relate anatomy and physiology of core clinical conditions and applying these to anatomic relationships; exploring the role of social determinants of health on patient outcomes; demonstrating a comprehensive approach to the care of adult and pediatric patients; discussing important findings, management, treatment and prevention options with patients and families; demonstrate effective use of health information technology; and participate in providing care to adult and pediatric patients who require common procedures as part of their medical care.

 

For the practice-based learning and systems-based practice learning objectives on our block, this includes: access, analyze and evaluate scientific and medical literature to address learning needs and apply current evidence to patient care.; identify and use skills necessary to improve quality of medical care and patient safety; identify appropriate ways to provide patient care in a resource limited setting.

 

Then finally for professionalism and communication, these learning objectives include: communicate effectively with assigned patients and their families; identify and use skills that promote interprofessional and team-based care; identify the role of personal biases and morals in influencing patient care; model accurate, clear and concise oral and written presentations; seek out feedback from teammates and supervisors and use it to engage in ongoing self-assessment; demonstrate honesty and dependability and team based work; and demonstrate legal and ethical principles and patients, especially as it pertains to the informed consent process.

 

The way that we teach all of these things during the SPC block, these are a list of all of our didactic curriculums or CBLs. This includes a variety of delivering lectures, case-based discussions, as well as simulation sessions.

 

The clinical rotations are 4-6 weeks of general surgery, this is inpatient and ambulatory and does include one trauma experience; two weeks of anesthesia, and there are a variety of skills opportunities in addition to taking care of patients on their anesthesia clinical rotation; and then we have a variety of subspecialty rotations. Those who have four weeks of general surgery have two 2-week blocks of subspecialties. Those with six weeks of general surgery have one 2-week block of subspecialties.

 

The role of a medical student on SPC is to gather and complete focus history and physicals; to accurately present and report information; develop skills making assessments and plans; develop skills with simple procedures such as wound care, suturing and airway procedures; and directly participate in the care of patients in the emergency department, clinic, wards, and the OR.

 

Students have required experiences that we want them to have on their SPC rotation so these fall under the FaCET category and are tracked throughout their rotation. The first category of these that we have are to participate in the care of a patient with some of the following surgical problems. We want all of our students to participate in the care of a patient with abdominal pain, colorectal or anal disease, hepatobiliary disease, and trauma. Then we also require four experiences of the following, and this is a very long list of other surgical problems. The reason we have some variability here is we know that students will have different experiences based on their either general surgery or subspecialty rotations.

 

Another aspect of the FaCET experiences for students on SPC is performing some technical skills, and these do fall under that perform category. The technical skills that we require are airway management, gowning and gloving, IV placement, NG tube management, and suture and knot tying. We also have some additional FaCET experiences in radiology, requiring them to read an x-ray for device placement. And observing an informed consent process and observing a multi-disciplinary conference.

 

Additional required clinical experiences include a trauma call, an evening handoff, and a leadership discussion. These are different based on the sites that the students are at, but each site does have at least some component of each of these experiences.

 

Required formative feedback, so we have two different types of formative feedback that we have for our students. Form-based includes our direct observation forms. There's four of these per student block that really help to guide the students to make sure that they are being observed performing some of the physical exam and history-taking skills. Then we have interim feedback forms and there's two of these per block per student, one in their ambulatory setting or their continuity clinic and one during their inpatient general surgery rotation. It's also important that students receive in real time feedback on technical skills. This is often verbal feedback in the OR with residents and faculty as well as opportunities in skills lab, and then verbal and written communication feedback on rounds.

 

To dive in a little bit more on those two types of feedback, the interim feedback, these are the two forms that are required, one on the general surgery and patient rotation and one in their ambulatory experience. This is student initiated. It is preferred this be faculty supervisors, but a senior resident or APP is okay if that seems most appropriate. It does need to be done between weeks 2-8 and this is to make sure we're allowing the student to make changes based on the feedback, and it has to be signed and dated by both the student and the evaluator.

 

And then direct observation forms. There are four of these per student per block on the right-hand side of the screen is the general surgery, an example of what that looks like. It really includes a variety of different skills, both history taking and physical exam skills that we want to make sure that the students are observed performing and get some feedback on. Then on the left-hand side of the screen, this is an index card size form that students will print out with them and bring around to their anesthesiology rotation. These do not need to be signed off on by the assessor, but they are really used for the student to be able to initiate the observation and they are required to attest that they have completed the skills and upload them.

 

Hello. My name is Sarah Ahrens. I am the Director of the Inpatient Acting Internship and this brief video is here to help you understand the role of the Inpatient Acting Internship within the overall curriculum, and in particular, your role in precepting or being the attending for IAI student.

 

Acting internships are a key and required portion of the Phase 3 or last portion of the curriculum at SMPH. They are designed to increase student autonomy. I am the director of the Inpatient Acting Internship and my colleague Dr. Hunter is the director of the Ambulatory Acting Internship. The Inpatient Acting Internship or IAI is four weeks of intense clinical experience. We try to minimize the amount of classroom time or other project time so that patients can really be immersed in the clinical setting and in this case, the title implies, the inpatient setting. Grading is, as with all other courses at SMPH, Pass/Fail or Satisfactory/Unsatisfactory, which is what shows up on the transcript. This replaces the traditional “SubI” for some students and students can take one Inpatient Acting Internship during their medical school career and they can take it in medicine, OB-GYN, Peds or surgery. The clinical settings for the IAI are as you would probably expect from a standard SubI, they are usually inpatient ward services. This can include subspecialty services such as pediatric Heme/Onc or neurosurgery. Medicine IAIs are available on our statewide campus sites, that includes Green Bay, LaCrosse, Marshfield, and Milwaukee. Again, students can only choose one.

 

One of the most important things and the reason you're probably watching this video is because you are assessing a student on your IAI. Remember that our best assessments of students come from direct observation. That means you working with the student, watching the student. To get this done on a lot of our services requires a little extra time and a little extra planning. I suggest that you think about this at the beginning of your time working with the student and think, when would be my best time to do this and try to set aside the time to do that? Even if you have to block it on your calendar and tell the student, I'm working with you at this time. Now sometimes that's the most effective way to do it rather than thinking it'll just come up and the opportunity will present itself. Because reality is in the clinical setting, something else will probably interfere with that. The other thing that's helpful is, tell the residents on your service, especially if the residents really run the service that you need time with the student and what things you want to see the student do. Take notes immediately after working with the student - I always say we shouldn't really trust our memories, we should trust what we write down - and work on describing behaviors that you saw that student doing well or things they could build upon or improve upon. This is very helpful because you're going to need to fill out a formal evaluation of the student.

 

At SMPH, evaluations are called clinical performance evaluations. These currently happen in the Oasis system, but we'll move to the Acuity system. Just a change in software, much of the evaluation is staying the same. So there's the grading portion of this, so it's always online, it's at the end of the rotation, or at least at the end of your time working with that student, and again, pass/fail and this is a summative rather than formative as you go along, assessment. The impact of your evaluation, which is something I think faculty members often want to know, is to know that the multiple-choice ranking system that you have there can affect their class rank, but I want you to fill it out as honestly as you can. Don't think that you're hurting them or helping by giving them an inaccurate assessment. Then there are two main boxes at the bottom of the form for comments. The top box, also known as above the line, those are comments about the students that will go directly to the Dean's letter. By directly, I mean verbatim. So your punctuation errors or strange grammar can also make its way into the Dean's letter. Sometimes we edit that out if it's egregious, but just keep in mind, this is what goes into the Dean's letter. This is where you say things. This is where you tend to praise the student and say positive things. At the same time, if you need to say something in terms of this student needs growth in a particular area and you think that would be helpful for someone reading it in the future, you can put it in there. So the bottom box or below the line is where the comments for students development really go. And if you have any concerns about a student, that's where those comments go. This is a particularly important thing to remember if you are going to mark a student low on any of those above rankings - let's say they are not good at doing oral presentations and you're rating that, you should you rank them low on that saying they need to improve, you should say why they need to improve and what they need to improve and be as specific as possible. Those comments go to various faculty members, LTCs who coach them and can help give that feedback.. Within the IAI, students have a minimal amount of required work. They have to do a mid-rotation feedback form. They have a clinical skills checklist. They have to log patient encounters as an attempt to make sure that students are seeing similar numbers of patients on their rotation. Students are responsible for these. Faculty input is needed for the first two of these.

 

The mid-rotation feedback form is a standard process in all clinical clerkships, and it helps students understand where they are and skills they can build, and it's an opportunity for direct formative feedback, does not contribute to the grade.

 

Clinical skills checklist, preceptors sign off on skills that they observe students doing. This needs to occur throughout the IAI, not on the last day of the IAI. Again, students are responsible for this.

 

There is also in the an IAI first day session. I hesitate to call it orientation because this is more about a skills building session. It occurs on the first afternoon of the rotation so students go to their rotation, find their team, hopefully get assigned a few patients, learn where the bathroom is, other key things, and then they come to the session in the afternoon. It's entirely online so that our statewide campus can also participate. It is required for all students with very few exceptions, and those exceptions have to go through me as the course director. The curriculum for this is something designed to apply no matter where you're rotating. We go through how to call consult effectively, how to do hand-offs and sign out more effectively, and how to start having code status discussions.

 

That is what I have about the IAI. Hopefully, you found this helpful in terms of understanding where the IAI sits in the overall curriculum and some of the details of the IAI. If you have any questions about the IAI or if you are concerned about a student on your rotation, please contact me. Email is a great way to get a hold of me. You can find me through the paging operator. You can even use secure chat if I'm not available. That's what I have. Thank you very much.

Hello. I'm Dr. Paul Hunter. I'm a family physician at the University of Wisconsin School of Medicine and Public Health, and the course director for the Ambulatory Acting Internship. I want to welcome you preceptors, community physicians, and other physicians who are teaching in the Ambulatory Acting Internship and preparing our advanced medical students here for the outpatient time that they're going to be spending during their residency. The academic goals and administrative logistics of this course are fairly straightforward. We're trying to get students ready for the autonomy level that they need on day 1 of their outpatient residency clinic. And in order to do this, we need them to practice developing and implementing outpatient clinical management plans that are designed to improve the health and coordinate the medical care of patients. In addition, we'll have them reflect, especially in the last day on teamwork, physician wellness, and how inequities in medical resources affect patients. This course is taught all over the state of Wisconsin and a couple of places nearby. So we have policies in this course to keep tabs on students that relate to the deadlines that are there and how we communicate with students. It is a four week long required course that all UWSMPH medical students take before they graduate. It's taught by about 60 preceptors and about 40 different communities, and the grading is pass, fail. The grade is really the preceptor's grade. You'll be entering a grade online, which is satisfactory or unsatisfactory pass, fail, and you'll be judging their clinical skills and professional behavior and incorporating observations and input from other clinicians that they spend time with when they're with you for the four weeks. I have as course director, 5% of the grade, which really won't affect the pass, fail part of things, but that is very important and could go on their permanent record. We mainly use it to inform the students about their timeliness of response to administrative messages, turning in forms and assignments on time, and occasionally some behaviors with patients, clinical staff, and physicians that you point out to me. The grading form is called the clinical performance evaluation, and it's online. You will get a link sent to you automatically at the end of the rotation. I believe it's usually about 7:00 AM on the last Thursday. And again, it's pass, fail or satisfactory, unsatisfactory. There's three main parts to the clinical performance evaluation. There's the ratings, a bunch of boxes at the top, which are multiple choice items, and that can affect the students class rank, which is important to students as they're applying to residencies, especially those students who are in the third year portion of their Phase 3 in March through June and then July, August of their fourth year, so early on. Also, even more important than the ratings that affect class rank or the above the line top box comments that go straight copied and pasted, grammar and spelling errors included onto the Dean's letter or medical student performance evaluation letter. And that goes to the residencies when the students send their applications to the residencies in September of their fourth year. There's also below the line or bottom box comments that are meant to help the students improve their education and performance throughout the rest of their medical school training, and that you can say things like work on expanding your differentials there. This is a list of the AI assessments and required activities that the students need to do. There's a pre rotation quiz on the course, policies, and a video they need to watch so that we know that they've been oriented to the course when they get to you, the administrative parts of the course. You still have to orient them to your site and the policies of your health system. There's a check-in webinar in the first week, the first Wednesday from noon to 1:00, which the students can miss if needed to attend a once in the month clinical opportunity. I just need to know that they're okay because if they don't show up to required activities and don't let me know what happened, I worry literally that they're in the ICU having hit a deer and bleeding to death or on a ventilator and COVID. I really do worry about that. So if the student has a wonderful experience to attend during that time, have them email me right away, and there are backup activities that I will contact them about. There's four forms here, the professional activity rubric A, mid rotation feedback form, professional activity rubric B, and the skills checklist, which are weekly, usually paper forms that the student drives the process on this and as you as the preceptor complete the feedback to them. The feedback on these forms is not incorporated into determining the grade, so that is pure feedback, but you can use these forms whatever way you want to to give the student the feedback they need to improve during the time they're with you. I'll go over those forms in more detail on future slides. The symposium webinar, the last afternoon is what I was referring to earlier when the students are reflecting on wellness, health inequities, and other issues of high level that they had some experience with during the four weeks with you. Getting into a little bit more specifics about some of the weekly forms that are feedback forms. The professional activities rubric A and B are meant to get the students up to speed with performing some activities that they just need to have to get through their day in any specialty. This includes recommending and interpreting common diagnostic and screening tests, and entering and discussing orders and prescriptions. Really, this is about you observing the students' ability to give you a good reason for their medical decisions for what tests they chose and what orders and prescriptions they're looking at, incorporating into the clinical management plan. You should discuss that the merits and deficiencies of the students plan as you're staffing the patients with them. It's also about you observing the communication with patients about how they talked about the test results and the orders and prescriptions and answer the patient's questions about that. The next type of form is the mid-rotation feedback form. This you may be familiar with from other students in any health professions in the middle of a course where the students assess themselves in a first column and then you rate them in the second column. So it's a standard assessment and it uses a broader range of topics like history, physical, professionalism, and jargon that's different than the rubrics A and B. As I said, the students rate themselves in the first column and you rate them in the second column. The thing to keep in mind in this, if you see a student that's rating themselves higher than you are rating them, then the student will need more direct feedback as you're staffing the patients with them and as you're giving them feedback through the rubric B the week after this. The the AAI skills checklist. This is a form that the students carries around with them in clinic, and we'll have you sign off on observing them do certain important behaviors as they happen. Even though this is due on the last day, you should see this off and on throughout the four weeks. Some of them are very simple behaviors to observe. Present a patient to your preceptor. That should happen probably the first day or two that you're working with them. However, there are some other behaviors that are a little more complicated to observe. You may need to go in and watch the student delivering the plan to the patient in order to experience seeing them incorporate patients' preferences into a clinical decision. There are also things that may just not come up in the four weeks, and you'll see on the form itself that you can put not applicable there. Moving on to policies, more administrative policies, the students can have up to four days off during a four week course in Phase 3. That's the last portion of the third year and all of fourth year. So any clinical course during that time, including the Ambulatory Acting Internship, can have up to four days off. It's not your job to give permission for time off. It's actually not even mainly my job to do that. There are certain cases where I do need to approve things, but most of the time it's the student informing us through a form called the student managed absence form that they are abiding by the policies, and they're giving us advanced notice of their time off and we're recording it that they're not taking too much time off during a required course. So your job is to thank the student for the advanced notice so that you're not worried about them being in the ICU, like I talked about, and to ask the student, did they fill out the form and send it to us here in Madison? Another administrative issue is keeping track of making sure the student has enough time in clinic to get the academic goals of this course achieved. So we want at least 40 hours per week of clinical time, and at least half of that has to be in outpatient clinics, where they're working up to the level of an intern. This can include overnight and weekends. It doesn't have to be Monday through Friday 9:00-5:00. Ideally, and this happens in a few sites, but this is the ideal is about 60% or maybe three days a week is with one main preceptor, and about 40% or two days a week with one or two other physicians. In practice, the number of preceptors varies widely between sites. Usually, with the lower number of preceptors, there's more student autonomy, which is really great. However, there are certain situations where there's a lot of preceptors where, for example, at family medicine residencies where we have a few sites where the diversity of the cases can be very educational for the student, and sometimes there can be the level of autonomy that's really good too there. That autonomy is so important to help the student increase in their responsibility for patients because they're going to not just need to do physical exam and history, but they're going to need to communicate with not just the patients, but their colleagues, the team members that work with you, and even consultants. You're going to need to be looking at their notes to see that they reflect the essential information from the clinic visits because we really want them to practice writing notes and to be efficient when they're in residency. You should also ask your students to go do reading and consultation and research in order to formulate questions about the patients they saw and learn how to research appropriate literature and be able to apply that to individual patients. So that can help you get through the day faster by having them teach you and asking them to do some research while you go off and see the patients. By the end of this rotation, the students need to be putting all the pieces together to demonstrate the comprehensive approach to care of patients and outpatient settings, and to be able to do that in a level of an intern. So you're not necessarily as an intern having the physician go in with you throughout the whole visit. You're definitely not shadowing as a new intern. And shadowing should not be significant portion of what's done in this course. The coordination of care of the assigned patients after the office visits may require you forwarding the student some test results since they might not have an in basket of their own. There's also opportunities to be creative in the scheduling so that the student experiences transitions of care. For example, spending some time in the hospital with the inpatient team, following a patient to the emergency room, or for a urgent radiologic test at the hospital. Maybe rounding at skilled nursing facilities to see how the outpatient and nursing facility interaction occurs. So don't be afraid to be creative, and even on the fly create some experiences that might be very educational for your students. Students are looking at you as role models for how to practice in the real world, they may like how you do things and use that in the future. They may say, I don't want to do it quite that way and modify things too. So be who you are and they will model their career based on their experience with you. You're able to see them one on one in an apprenticeship like relationship, and that's super important to us in the medical school because you will be the quality control at the end of the line of production of a new physician. So your job is to find that widget that's coming down the assembly line and identify a problem that might need to be fixed before that student gets out into residency and before they become practicing physician. You don't necessarily have to fix that problem at your site during the four weeks. Sometimes there's things that can't be fixed. That is something I need to be working on and with the resources at the School of Medicine and Public Health. But please let me know, don't wait for any forms. If you say something major that needs to be fixed, let me know right away. Don't wait for any forms. This course should be very challenging to the students as far as things they need to be challenged with to be a doctor. The autonomy to make decisions is very nerve racking for students, the challenging cases that might be very hard for them to not feel like they know what's going on. That's okay. Professional dilemma is about what is the right thing to do ethically with this? That's also fine for you to let them twist in the wind a little bit and sweat a little bit about those things because they need to deal with those. There's things that they shouldn't have discomfort about because that's nothing they can do about and that's just not the right thing. One thing you might not think about as much is the medical specialty. It's really a high anxiety thing for certain medical students. At any time of the year, even after they put in their rank order list of did I choose the right specialty? So I'm encouraging preceptors to not ask their students what medical specialty they're in so I can arrange your schedule for these four weeks. But rather say, what experiences do you need during these four weeks to be the best resident and doctor you can be. So make that non-specific about specialties. And a lot of times the students will volunteer, but the students that would be upsetting to them can choose not to volunteer if you phrase it that way. I'm assuming that you are well trained in your health systems policies about talking about gender identity, sexual orientation, partisan politics, race, ethnicity, socioeconomic status, and spirituality. So I don't see that an issue with preceptors. What happens sometimes though is that patients might bring those issues up with a student, and it may or may not apply to that student. But even if it doesn't apply to that student, that may be upsetting to the student because they know that other students in their class who it does apply to are coming through and they may feel bad about the fact that that might happen and they may report that to us and I encourage them to do that. So I want you to know that some of that might happen and that if it happens in front of you, if you could get your experience up of how to remind your patients that that's not appropriate behavior and is most likely your health system has policy-oriented that you can just remind the patients of that. Rarely that I've seen students overhear things that are confusing to them at workstations and you may have them come to you and say, this was confusing to me and I'm struggling with how to incorporate what I heard at the workstation by staff about this particular issue, and sometimes that'll make them a little uncomfortable. So if you can process that with them, if you'd rather me deal with that, you can bring that issue up with me. I do want to let you know there is anonymous reporting process for what's called student mistreatment. That is a very important process for us dealing with what I call bad discomfort, and it doesn't necessarily mean that anybody mistreated the student in the way you might think of it, but it is a situation that could be uncomfortable for future students, for example, as I described before. Thank you so much for everything you do for teaching the students. And I wanted to let you know on this last slide that we have Corie Leifker and I are very open to your questions and very responsive and we really need your input. Generally, we go doctor to doctor and administrator to administrator. So you can start with me first, and then I may refer you to Corie. But if I don't respond quickly, please don't be afraid to contact Corie directly. Thank you so much for teaching in the Ambulatory Acting Internship.

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