1. Acting CME Chair Dr. G. David McCoy announced that Thursday, March 20, the Match begins at noon in the BRB Lobby. Congratulations to all students and faculty who participated in Doc Opera that took place March 8.
2. Update on the PDA (Personal Digital Assistant) Project
Dr. Jason Chao, co-director of the Family Medicine clerkship, presented an update on Student Use of Handheld Computers in Ambulatory Clerkships. This project was funded by a HRSA (Health Resources and Services Administration) grant. PDA’s (using the Palm Operating System) were loaned to all third year students for the 8-week period comprised of 4 weeks of Family Medicine and 3 weeks of Ambulatory Internal Medicine followed by 1 week of Psychiatry. Dr. Chao acknowledged the contributions of Dr. Patricia Moore, CWRU Family Medicine Clerkship Director; Mr. Pete Spanos, Family Medicine Web site Coordinator; and Ms. Judy Parsons, Family Medicine Coordinator.
Reasons for implementing the use of handheld computers include 1) the enhancements they offer in medical education, 2) the growing number of physicians using them in clinical practice, 3) the need to be familiar with new high efficiency-producing technologies, and 4) their utility in collecting data on patient care and monitoring in an increasingly decentralized ambulatory clerkship network. Dr. Chao recalled the deficiencies of the paper and pencil system that had been used for the last 15 years by medical students to track information for each patient. Spotty compliance by students in filling out the forms resulted in slow turnaround time and prevented timely feedback. Cases that students had seen could not be determined until after clerkships had been completed.
PDA’s were loaned to students during their 8-week combined Family Medicine and Ambulatory Internal Medicine Clerkship. Students received a PDA orientation session at the beginning of the clerkship. There is an option for a one-on-one tutorial session if needed or requested. The log is a program that recorded all programs that were accessed. Only aggregate data on PDA use by students were collected. Students were required to record all patient information on the PDA. Data were downloaded to a central PC by hot synching during weekly didactic clerkship sessions.
Dr. Chao described the programming of PDA’s for use in the clerkships. Pharmacological Databases include 1) ePocrates, the most commonly used program, 2) Tarascon, which was only available for the first three months and is no longer free, and 3) Herbal Zone helpful for Complementary and Alternative Medicine. Dr. Chao indicated the number of times each of the three programs was accessed, the total number of minutes of usage for each program, and the average number of minutes per single use. Dr. Chao also presented the same breakdown for Textbook usage of the 5 Minute Clinical Consult and the Merck Manual. Dr. Chao again presented the same breakdown for Infectious Disease Reference usage comprised of the Hopkins Antibiotic Guide and qID, which was only available for the first three months and is no longer free. Only one program could be open at a time.
Dr. Chao provided Student Demographics on the 72 students who for the first 6 months of the 2002-2003 academic year have received PDA’s: 62% male, mean age 26.7 years, and breakdown of prior PDA experience ranging from none to PDA programmers. Approximately 50% of students had prior use of PDA’s in clinical settings. In general, there was good compliance by the students, even though there were some losses of data due to system crashes.
Program Usage was indicated by a total number of times that each program was used. This figure was further broken down into number of times and equivalent percent that each program was used. The log program measured how often programs were accessed and for how long. The “utilities” category is comprised of the address book and calendar used for scheduling purposes. Contact information for key clerkship faculty is also provided.
PDA logs indicate the number of patients and diagnoses. Log Program Use revealed 75 patient encounters per student and 119 total diagnoses per student. Due to his involvement in both the Family Medicine Clerkship and the Primary Care Track, Dr. Chao is in a position to compare the longitudinal PCT experience whereby a third year student spends one day per week in a physician’s office with the block experience in the Family Medicine/Ambulatory Internal Medicine clerkship. Data in the Primary Care Track longitudinal experience does not rely on handheld computers but is electronically collected.
Dr. Chao highlighted some conclusions from the PDA project. Use of the handheld computer varied among students, ranging from none to more than one hour per day. In general PDA’s were well received by the students. PDA use has begun to be incorporated into didactic sessions. Examples include a PDA program for Dr. Georgia Wiesner’s genetic risks for breast cancer, and a program for determining lipid level goals with Adult Treatment Panel III Cholesterol Management Guidelines to target LDL for each patient.
Dr. Chao concluded his presentation by summarizing suggested Future Directions. He recommended issuing a PDA to all students by the time they begin their first clerkship. If the School of Medicine decides not to provide PDA’s, there still need to be guidelines for standardized PDA use. The clerkships are not standardized. At University Hospitals, the majority of faculty use Palm Operating System based units. If a decision is made to move to a Windows Operating System, faculty would have to switch over.
PDA’s are being used to alter the student’s experience so that he/she encounters diversity in patient experiences. When students are halfway through their combined 8-week clerkship, they are encouraged to review their cumulative log of patients/diagnoses and number of each different disease that they have seen firsthand. At the very least, they can read about what they have not encountered during their rotation. Currently, procedures are not logged by the student on the PDA, although residents have to keep logs of their procedures.
Because of patient confidentiality and the HIPPA (Health Insurance Portability and Accountability Act) rules, neither patient names nor patient ID numbers were recorded.
The PDA’s were purchased more than a year ago. The retail price was approximately $300 per unit then. The School of Medicine’s bulk purchase of a batch of 30 PDA’s averaged between $240-250 per unit. The retail price has come down since the date of purchase.
Important issues for the School of Medicine were cited: 1) whether to go wireless, and 2) whether to adopt a Palm OS or Windows operating system. Dr. Chao would like to see standardized usage of PDA’s.
3. Report from the Patient-Based Program
Dr. Jay Wish, Patient-Based Program Coordinator, announced that on March 11, he attended a meeting of the Cleveland Clinic Medical Student Education Council. This group is composed of clerkship directors active during the Clinic’s Ohio State University affiliation and other key members of the clinical curriculum leadership. The Clinic has ongoing electives for fourth year students at its Florida facilities, and Dr. Wish has invited a Clinic representative to present this opportunity to the CWRU third year medical students at their next class meeting on April 11. All CCF clerkship directors have been invited to attend the April 9, 4:30 p.m. Clerkship Directors meeting at the School of Medicine.
4. Report from Faculty Development
Dr. Terry Wolpaw announced that all the faculty student teams from the Scholars Collaboration in Teaching and Learning will have posters represented at Research Showcase 2003, Friday, April 4. If sufficient funding is obtained, the Scholars Collaboration in Teaching and Learning project will continue next year. Preliminary plans for next year include expanding the program to include residents.
5. Report from the CRDC
Dr. Chris Brandt, Clinical Rotation Development Council Chair, mentioned that this Wednesday, another “think-tank” meeting will take place focusing on new core clinical options for faculty of both the CCF “college” and the CWRU “university.” This is an opportunity to take a fresh look at clinical education.
6. Vertical Themes
Dr. Mireille Boutry announced that the Nutrition team will have its poster displayed on Research Day.
7. Clinical Skills Examination Update
Plans to prepare our students for the CSE are underway. Dr. Lindsey Henson will present a summary of the plans of the working group for the USMLE Clinical Skills Examination at the March 27 CME meeting. For questions about the ECFMG’s use of the clinical skills exam, Dr. Wile suggested referring to the Educational Commission for Foreign Medical Graduates Web site, URL: http://ecfmg.org/csa/com/descrip.html
See Curriculum Revision Update section.