native hawaiian standardized patient use of jabsom
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Native Hawaiian Standardized Patient Use of JABSOM
Martina L. Kamaka, MD
University of Hawaii
John A Burns School of Medicine
Department of Native Hawaiian Health
Photos courtesy of DNHH and JABSOM
Standardized Patients Development-US Overview
96% of LCME schools have at least one SP/OSCE75% have final comprehensive exam63% require passage for graduationUSMLE (US Medical Licensing Exam) now has required OSCE exams as part of USMLE 2 (10-12 cases)
46% will require passage of USMLE Step 2 CS (Clinical Skills) exam
Barzansky B, JAMA, 2004;292(9):1025-1031
JABSOM using Standardized patients for teaching and assessment since 1989 No Native Hawaiian cases with cultural issues exist
Photos courtesy of Center for Clinical Skills, JABSOM
SP Clinical Skills EvaluationsMD 1 2 3 4 MD 5 6 7 Clerkships
MD 4 Clinical Skills Exam
MD 7 Clinical Skills Exams
Comprehensive
Clinical Skills Exam
3rd YEAR Clinical RotationsFamily Medicine Internal MedicinePediatrics
4th YEARGeriatric Medicine
Department of Native Hawaiian Health• Piloted two Native Hawaiian OSLE cases with the Family
Practice residency• Family Practice residency
– 7 year history of using standardized patient cases (Micronesian and Filipino)
• DNHH C3 members acted as patients• Assessment:
– Other C3 members were evaluators– Patients also assessed residents– Resident self assessment– Based on AGME core competencies
• Issues:– Establishing trust, communication skills, greetings, etc.– Openness to the use of traditional medicines instead of western– Culturally based concepts around illness and healing including
role of family members
Circle descriptions that best reflect the residentÕs performance during your patient encounter, then give a final ÔscoreÕ for each category below
Below Expectations (1-2) Meets Expectations (3-4) Exceed Expectations (5) Num rating (1-5)
PATIENT CARE
Interviews and examines patients poorly; lacks technical proficiency
Misses key cues to examine patient problems more in-depth
Has poor judgment Disregards patient preference Ignores sensitive areas of history-taking
or physical exam DoesnÕt explain/give much warning before
conducting PE
Satisfactory skills in interviewing, PE
Attempts to examine at least one patient problem in-depth
Adequate judgment Usually respectful of patient
preferences Maintains patient modesty and
comfort Explains what s/he is going to do
before/during exam
Performs excellent patient interviews, exams, procedures
Able to examine at least two patient problems in-depth, according to highest priority
Uses sound judgment Is highly respectful of patient
preference ASKS PERMISSION and explains
what s/he is going to do before/during exam
MEDICAL KNOWLEDGE
Limited knowledge base Poor understanding of complex problems
Solid fund of knowledge Adequately understands complex
problems
Exceptional knowledge base Has comprehensive understanding of
complex problems
PRACTICE-BASED LEARNING AND IMPROVEMENT
Minimizes or ignores self-assessment Avoids new technology Ignores feedback
Intermittently uses new technology (i.e. PDA or web searches)
Intermittently seeks feedback
Uses new technology consistently (PDA at the bedside, web search during the patient encounter)
Eagerly accepts feedback
INTERPERSONAL AND COMMUNICATION SKILLS
Has poor relationships with patients/families
Negates or puts down patient concerns Misses all patient cues ÒTalks down to patientsÓ Does not listen to patients, answer their
questions or ask for patient understanding Interrupts patient often Avoid educating or counseling patients Speaks in medical jargon most of the
time, with little attempt to ensure the patient understands
Does NOT discuss options and plans for further management
Does NOT negotiate final plan with patient/family
Incomplete, illegible records Communicated in a way that did not instill
confidence or trustworthiness (LOTS of ÒoopsÓ, ÒsorryÓ or ÒI donÕt knowsÓ)
Maintains satisfactory relationships Acknowledges patient concerns
sometimes, picks up a few ÒcuesÓ Sometimes listens to patient,
sometime interrupts Asks questions of the patient to help
clarify understanding of the problem
Intermittently educates, counsels patients
Discusses options and plans for further management
Uses non-medical jargon sometimes
Fairly complete, legible records Communicated in a way that would
instill some confidence and trust
Establishes excellent relationships with patients/families
Acknowledges patientÕs concerns, picks up non-verbal or verbal cues
Interacts with patients at the same level, no Òtalking downÓ to patient
Listens carefully to patients and answers their questions, asks for confirmation of understanding
Hardly interrupts unless the patient is rambling
Educates and counsels patients, using language they understand
Discusses options and plans for further management
Negotiates final plan with patient/family Comprehensive, timely, legible medical
records Communicated in such a way that the
patient opened up, trusted and was confident in this physician
PROFESSIONALISM
Not respectful Not compassionate Dishonest Does not recognize limits of his/her
knowledge or skills Not considerate of others
Usually respectful Usually compassionate Recognizes limits of his/her
knowledge or skills Tries to be considerate of others
Consistently respectful Very compassionate Is honest and truthful in telling his/her
assessment of the problem(s) Recognizes limits of his/her knowledge
or skills and puts forth a plan to improve the deficiencies
Considers needs of others (patients, colleagues)
SYSTEM-BASED PRACTICE
No attempt to look for resources, drug formularies
No attempt to balance cost and resources with quality patient care
Makes no attempt to reduce errors No attempt to understand proper E/M
documentation and coding
Realizes need to look for resources, prescribe according to insurance formularies (or lowest cost medications)
Tries to understand proper E/M documentation and coding
Balances cost, resource allocation and quality patient care
Identifies and proposes to give patient resources at the end of the first visit
Prescribes medications according to insurance formularies
Properly documents and codes the patient visit
Form courtesy of G. Maskarinec, PhD
• Mahalo to:– Gregory
Maskarinec, PhD (Dept of Family Medicine)
– DNHH C3 Team– Mike Nagoshi, MD
• UH CCS (Center for Clinical Skills)
• http://www2.jabsom.hawaii.edu/ccs/
Photo courtesy of R. Kekuni Blaisdell, MD
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