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PATIENT, PHYSICIAN & SOCIETY IV

AND

M4 TEACHING SELECTIVE

JULY 2014 TO MAY 2015

NORTHWESTERN UNIVERSITY
FEINBERG SCHOOL OF MEDICINE
CLASS OF 2015

PATIENT, PHYSICIAN & SOCIETY IV:


ADVANCED PROFESSIONAL PERSPECTIVES

LEAD FACULTY
GREG BRISSON, MD
ELIZABETH RYAN, EDD

Overview of PPS IV
M4 is a time that medical students notoriously disperse, providing little cohesion or support for one
another as you continue to develop professionally. The college system remains a format for support and
interdisciplinary discussions on clinical medicine and your transition to postgraduate training.
As M4s you are in a unique position to examine various aspects of medical training and practice. Most of
you have completed your broad introduction to clinical medicine in the M3 clerkships; you have viewed
medicine from a more varied perspective than you will at any other time in your career. PPS IV looks back on
those experiences, as well as those you are currently having in the M4 rotations, and examines important
aspects of the practice of medicine: professional issues with which students often struggle, ethical issues
encountered routinely in clinical medicine, and teaching skills needed to succeed in residency.
Advanced Professional Perspectives Advanced Professional Perspectives explores the following topics:
social media and medicine, personal and professional balance, cultural issues, empathy in medicine, and
the relationship between physicians and pharma. Several of these topics have been addressed in PPS I-III,
though this unit expands on previous discussions by focusing on how your clinical experiences have
shaped and altered your views.
Ethics You studied clinical ethics in your first semester at Feinberg. At that time you learned principles
of ethical decision-making but lacked the clinical experience essential to fully understand the relevance of
the material. PPS IV offers an opportunity to review ethical issues commonly encountered in clinical
medicine and apply them to experiences from your clerkships.
Teaching Skills

As M4s you will teach less-experienced medical students, thereby benefiting both those

less experienced and yourselves. To make the most effective use of these experiences it is important to
improve your teaching skills and give and receive feedback on your performance. In PPS IV you will
explore methods of teaching and providing feedback to improve your skills.

Goals
This course aims to:
1.

Expand your knowledge of teaching techniques. (MKS-4b)

2.

Provide a supportive forum for you to self-assess and receive feedback on your teaching skills.
(CLQI-1)

3.

Address your personal perspectives on topics including social media and medicine, cultural
issues, community service, life balance, empathy, and the relationship between physicians and
pharma/device manufacturers. (PASC-1 & 2; CES-2 & 3)

4.

Review principles of ethical decision-making and improve your skill at applying these principles
in clinical medicine. (PBMR-1)

5.

Help you recognize that ethical decision-making is an evidence-based skill, which can be learned,
practiced, and improved upon. (PBMR-1).

Objectives
By the end of the unit, you will be able to:
1.

Write a blog exploring personal perspectives on topics such as cultural influences on patient care,
personal and professional balance, social media and medicine, and empathy in medicine. (PASC1&2; CES-2)

2.

Demonstrate effective techniques for giving feedback as a teacher. (CLQI-1)

3.

Demonstrate effective techniques for teaching small groups and for preparing and presenting
lectures. (MKS-4b)

4.

State criteria essential to determine a patients capacity to make medical decisions and
demonstrate your ability to apply it in clinical medicine (PBMR-1)

5.

State criteria essential to establishing informed consent and demonstrate your understanding of a
patients right to refuse treatment, even if you disagree with the patients decision. (PBMR-1)

6.

Identify principles of ethics and professionalism, which are challenged by the intersection of
social media and medicine. (PBMR-1&2)

7.

Verbalize guidelines on the use of social media in medicine to minimize the risk of harm to your
patients, yourself, or the medical profession. (PBMR-3 & 6; CLQI -2)

Learning Formats and Resources


Clinical Experiences Class discussions are based on your experiences during M3 and M4 clerkships
supplemented by selected readings and focused lectures. You are expected to critically examine your
clinical experiences and explore the experiences of your peers and your patients.
Small Group, College, and Full-Class Sessions On any given month PPS IV will begin either in colleges
or with the entire M4 class and then divide into colleges or small groups for the remaining time.
Presentation formats will vary with the topic being discussed.
Readings Readings are listed on the monthly summary sheets.
Monthly Blog Writing is a highly effective method to organize thoughts and make sense of complex
experiences. In preparation for each class, you will write a blog posting (250 words) on the monthly topic.
Think of yourself as a blogger with 10-12 subscribers: your small group, small group leader, mentor, and
unit director. Please create a title for your blog and place it, with your name, in the heading of your
posting.
The goal of blogging is for you to describe for your peers a pertinent issue or concern, relate your
personal values to the issue, and articulate new insight you have in considering the issue. Your blog
postings will contribute to the discussions in large and small groups and your insights will enable others
to learn from your experiences. You are expected to explore the monthly topic in a thoughtful posting.
Brief, undeveloped blogs will be returned for revision.
Creative or artistic blogs are welcome so long as the student can satisfactorily explain how the submission
relates to the topic.
Monthly blog postings are due 12 days before class sessions (due Monday morning 12 days
preceding a Friday class) and should be posted on your small groups blog on Blackboard. This deadline
allows everyone in the small group to read one anothers blogs and post comments before class. Only
your small group will have access to your blog postings.
For each class, every student is required to read the blogs of every member of his/her small
group. Additionally, each student is required to post a response or a comment to a minimum of three
(3) blogs written by members of his/her small group. Comments on your peers blogs are due five (5)
days before class (due Monday morning prior to the Friday class). Small group leaders will post
comments on each blog and, at times, your mentor or the course director will also post comments.
Please note that the content of your blog may be selected for discussion in small groups and
may also be used by your mentor in the large group setting. If your blog is selected for discussion it is
always because it contains an important observation or comment that will be helpful for others to hear.
However, if you prefer that your blog not be discussed in a group setting, do NOT post it on
Blackboardplease e-mail it to your college mentor and your small group leader AND post a notice to
the Blackboard site indicating you have submitted your posting privately. The latter action allows for
blog counts to determine eligibility for passing the course. Your small group leader and the course
coordinator will track blog postings, which will influence your evaluation.

To access your blog on Blackboard, select My Groups which is found on the left sidebar, and
click on your small group leaders last name. Post your writing on your small group blog, which is found
under the Group Tools heading.
Exception to confidentiality If your blog describes events or circumstances that pose a risk of
significant harm, your instructor's obligations to student and community safety may require him/her to
breach confidentiality. If this circumstance arises, you will be consulted before confidentiality is breached
and given the option of addressing the situation on your own or in partnership with a faculty member. In
every case, you will have the option of remaining involved with the handling of your concern.

Teaching You have two separate teaching requirements to complete in the M4 year:
A. Teaching Selective: This unit is described in the Teaching Selective course pack, found at the
end of the PPS IV course pack.
B. PPS IV Teaching Assignment: You are required to give a ten-minute mini-medical teaching
script presentation to your small group, which must be completed in either December or
March. A description of the assignment is below.

PPS IV Required Teaching Presentation


Assignment: Imagine you are a resident giving a talk during an impromptu afternoon teaching
session with your interns and students during a core rotation. Choose a competency and an objective
from one of the core clerkships, develop a 10-minute mini-medical scripted presentation on a topic that
addresses the chosen competency and objective.
Of note, in clinical medicine each of you have at times benefitted from these high-yield,
apparently spontaneous clinical presentations from interns, residents or attendings. Though these
presentations often feel off-the-cuff or back-of-the-napkin, they are often well-organized, scripted in advance and
frequently reprised for different groups of learners.
Format: Informal small group presentation. State the competency, clerkship objective that the
presentation addresses and use chalkboards, white boards, or simple (one page) handouts to strengthen
your presentation and enhance your learners recall. Computers cannot be used for this presentation.
Evaluation: Turn in a copy of your 10-minute mini-medical script to your small group leader.
Include your name, competency, and objective addressed. You will give your presentation to your small
groups and receive immediate feedback on your performance.

COMPLETION OF THE TEACHING PRESENTATION IS A REQUIREMENT TO PASS PPS


IV. Teaching presentations are scheduled to occur in December and March. You must decide when you
will present, based upon your schedule, and your decision is due to your small group leader by the
November class. If you are unable to make either session, you must arrange an alternate date with your
small group leader in advance.

Evaluation
Attendance and participation are mandatory for a grade of PASS in PPS IV. You are required to pass this
class to graduate from FSM. Failure is not an option. If you do not meet minimum requirements to pass
you are required to complete a remediation project developed by yourself and the course director. Your
evaluation will be shared with the Associate Dean for Student Programs and Career Development and
your college mentor.
Your small group leader is responsible for your evaluation, which will be based on the following
elements:
Attendance Please read the attendance policy closely:
You are required to attend every class unless you have an excused absence. You are expected to be on
time and to remain with your group until the day's agenda is complete. If you are ill or if other
circumstances prevent you from attending, you must notify the course coordinator, your mentor, and
your small group leader beforehand. Students with an unexcused absence may be subject to remediation.
Given the nature of the M4 year, we anticipate that you may not be able to attend every class
e.g., infeasibility of travel from an out-of-town rotation or sub-internship responsibility (though subinterns are expected to attend class as their ward duties permit). When you are unable to attend class
you are required to communicate the reason for your absence with the course coordinator, your
mentor, and your small group leader IN ADVANCE of class. If you do not communicate in advance,
your absence will be considered unexcused.
Please note that, when you miss class, even if you have an excused absence, you are still
required to submit your blog posting as usual. Additionally, for that class you are required to post
comments on the blogs of ALL of your peers in your small group. This way your thoughts on the topic
will be expressed and your contribution to discussion is assured. Students with an excused absence who
do not submit a blog or do not post comments on the blogs of all of their peers will be treated as if they
had an unexcused absence.
There are eleven classes in PPS IV. Each student is allowed three excused absences. Attendance at
eight classes is a minimum requirement for a passing grade in PPS IV. If you miss more than three

classes you must remediate those additional missed classes. To remediate those additional classes, you
must complete the requirements for an excused absence as described above (complete your blog and post
comments on all your peers blogs), and you must also submit a two page analysis and summary of the
experiences and comments of your small group. Your analysis is due two days before class and will be used
by your small group leader to offer a summary of the topic at the end of the small group discussion. This
process ensures that, even in your absence, you remain engaged with the experiences and thoughts of
your peers on the topics addressed in PPS IV.
Participation To pass this class, you are required to post your blog as well as post comments on peers
blogs each month, as described above. Additionally, your small group leader will determine if you have
satisfactorily participated in this class. You are expected to contribute to the content and learning in this
class through participation in all course activities, including small-group and full-college sessions. Your
participation will be assessed in two areas:
Attitudes: You are expected to demonstrate appropriate sensitivity to perspectives that differ from
your own. You are also expected to exhibit professional attitudes toward the patients you
discuss, including the attitudes you express in speaking about patients. A lack of sensitivity or
professionalism, as determined by your small group leader, may require remediation to pass the
course.
Skills: You must contribute to small group discussions to pass this class. Your small group leader
will assess your communication skills via your blogs as well as your performance in small group
discussions. Inadequate contributions to small group discussions or blog postings, as determined
by your small group leader, may require remediation to pass the course.

Course Evaluation: All students must submit course evaluations, which will be available electronically.

Faculty & Staff


PPS IV Course Directors
Greg Brisson, MD

gbrisson@nmh.org

503-0430

Elizabeth Ryan, EdD

e-ryan@northwestern.edu

503-4326

s-tae@northwestern.edu

503-0430

Course Coordinator
Sue Anne Tae

Tschoe College / Thompson Society


Gordy Siegel, MD
Andrea Baumgartner, MD
Tim Caprio, MD
Adeboye Ogunseitan, MD
Mike Hughey, MD

g-siegel@northwestern.edu
acb976@northwestern.edu
tcaprio@nmh.org
aogunsei@nmh.org
obgyned@gmail.com

Collings College/ Lawless Society


John Glynn, MD
Jenny Lee, MD

lfglynn@yahoo.com
jklee@nmh.org

Cathy Cheng, MD

ccheng@nmh.org

Asim Hameeduddin, MD

asimh786@hotmail.com

Mazyck College / Rickets Society


Michael Raida, MD

m-raida@northwestern.edu

Ricardo Rosenkranz, MD

r-rosenkranz@northwestern.edu

Debi Mitra, MD

dmitra@nmh.org

John Stracks, MD

j-stracks@northwestern.edu

Brisson College / Cooper Society


Alex Lin, MD

alin@nmh.org

Jessica Montalvo, MD

jmontalv@northwestern.edu

Kellyn Marks, MD

kmarks@nmh.org

Gaurav Chaturvedi, MD

g-chaturvedi@northwestern.edu

Monthly Schedule
Classes meet from 3:30 - 5:00 pm

Date

Topic

July 11, 2014

Teaching skills

August 8, 2014

Social media and medicine

September 5, 2014

Everyday ethics

October 10, 2014

Medical Billing and Health System Reform

November 21, 2014

Personal and professional balance

December 5, 2014

TEACHING: Small group presentations

January 16, 2015

Physician-pharmaceutical relations

February 13, 2015

Cultural issues in medicine

March 13, 2015

TEACHING: Small group presentations

April 10, 2015

Empathy and detachment in medicine

May 8, 2015

College wrap-up session

July Teaching Skills


The entire class will meet in Williams Auditorium at 3:30 pm for this session. There will be no small groups.
There is no blog requirement for this session.

Optional Readings:
1. Kaufman DM. Applying educational theory in practice. BMJ 2003;316:213-216.
2. Bienstock JL et al. To the point: medical education reviews- providing feedback. Am J Obstet Gynecol
2007;196:508-513.
3. Rudolph JW et al. There's no such thing as "nonjudgmental" debriefing: a theory and method for
debriefing with good judgment. Simulation in Healthcare 2006;1:49-55.

**Looking ahead: Small Group Presentation Assignment (December or March)


Teaching presentations to your small groups will occur in December and March. Your decision about
when you will present is due to your small group leader by the November class session.
Assignment: Imagine you are a resident giving a talk during an impromptu afternoon teaching
session with your interns and students during a core rotation. Choose, a competency and an objective
from one of the core clerkships, develop a 10-minute mini-medical scripted presentation on a topic that
addresses the chosen competency and objective.
Of note, in clinical medicine each of you have at times benefitted from these high-yield,
apparently spontaneous clinical presentations from interns, residents or attendings. Though these
presentations often feel off-the-cuff or back-of-the-napkin, they are often well-organized, scripted in advance and
frequently reprised for different groups of learners.
Format: Informal small group presentation. State the competency, clerkship objective that the
presentation addresses and use chalkboards, white boards, or simple (one page) handouts to strengthen
your presentation and enhance your learners recall. Computers cannot be used for this presentation.
Evaluation: Turn in a copy of your 10-minute mini-medical script to your small group leader.
Include your name, competency, and objective addressed on the script document. You will give your
presentation to your small groups and receive immediate feedback on your performance.

August Social Media and Medicine


The entire class will meet in Williams Auditorium at 3:30 pm and then divide into small groups for the
second part of class.
Readings:
1.

Lamas, Daniela. Friend Request. New York Times, May 11, 2010.

2.

Strausburg M. How Facebook almost ended my career with a single click. Academic
Emergency Medicine. 2011; 18:1220

3.

Jain, SH. Practicing medicine in the age of Facebook. New England Journal of Medicine.
2009;361:649-651

4.

Mostaghimi A, Crotty BH. Professionalism in the digital age. Annals of Internal Medicine.
2011;154:560-2

5.

Kirschner KL, Brashler R, et al. Should health care professionals Google patients or
family members? PM&R. 2011;3:372-374

Blog topics (choose one):


1.

Do you believe that physicians, due to their membership in the profession, are held to a
higher standard than the general public regarding their online presence/behavior? If yes,
is this standard fair? Did you consider this issue prior to starting medical school? If no,
explain the reasons for your answer. Make reference to Mostaghimi and Crottys article
and the Strausbourg essay.

2.

Discuss how you manage your online presence. Do you edit your profile to maintain a
professionally appropriate presence? If yes, discuss the steps you use to curate your
online presence. If no, why not? Do you have concerns that your online presence could
have a negative impact on your career? Make reference to Mostaghimi and Crottys
article and the Strausbourg essay.

3.

Have you ever been friended by a patient? How did you handle it? Describe your
experience and comment on the experiences of Dr. Jain and/or Dr. Lamas in the readings.
If you have not been friended but would like to write on this topic, please address how you will
handle it.

4.

Have you ever Googled (or equivalent) a patient or a patients family member? Describe
the circumstances. In retrospect, was the online search appropriate? Is it ever appropriate
to Google a patient? Make reference to the essay by Kirschner, Brashler, et al.

Blogs are due Monday, July 28, 2014


Comments on blogs are due Monday, August 4, 2014

September Everyday Ethics


We will meet in colleges at 3:30 pm and will remain there for the entire session. This class will be team
taught by your mentor and a member of the FSM Department of Medical Humanities and Bioethics.

Readings:
Lo B. Resolving Ethical Dilemmas. Philidelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins,
2009. 4th ed.

Blog topics (choose one):


1.

Write about a clinical circumstance in which you and your team had to determine a
patients decision making capacity. How did the team handle it? Was a consultant
required to resolve the issue? In general, how confident are you in your ability to
determine a patients decision making capacity? Make reference to Los chapter (#10) on
determining decision making capacity.

2.

Write about a clinical circumstance in which you and your team had to obtain consent for
a procedure or treatment? Did you do it on your own? How confident are you in your
ability to obtain informed consent? In general, have you been involved in cases where
consent was obtained but you had concerns about whether the patient was truly
informed? Make reference to Los chapter (#3) on informed consent.

3.

Write about a clinical circumstance in which a patient refused a procedure or treatment


recommended by you and your team? Did you and the team challenge the patient? Did
you question his/her decision-making capacity? In general, how confident are you in your
ability to obtain informed refusal? To respect a decision by a patient with which you
strongly disagree? When would you obtain an ethics consult to assist? Make reference to
Los chapter (#11) on informed refusal.

Blogs are due Monday, August 25, 2014


Comments on blogs are due Tuesday, September 2, 2014

October Medical Billing and Health System Reform


We will meet in colleges at 3:30 pm then divide into small groups for the second part of class.

Readings:
1. Sample NMH hospital bill, 2006.
2. Gawande A. The Cost Conundrum: What a Texas town can teach us about health care. The New
Yorker, June 1, 2009.
3. Cooke M. Cost consciousness in patient carewhat is medical educations responsibility? N Engl J
Med. 2010;362:1253-1255.
4. Doherty RB. The certitudes and uncertainties of health care reform. Ann Intern Med. 2010;152:679682
5. Connors EE and Gostin LO. Health care reform- a historic moment in US social policy. JAMA
2010;303(24):2521-2522

Blog Topics (choose one):


1.

What surprises you about the sample hospital bill in the course pack? What costs more than you
expect? Is anything less expensive that you expect? What, if anything, is problematic about
different rates at which different insurers reimburse for medical services?

2.

List some of the drawbacks of the U.S. health care system in its current state and discuss how the
Affordable Care Act will address these issues. What problems with the current system are not
addressed in the ACA? Make reference to the articles by Doherty and Connors/Gostin.

3.

To what extent are physicians values and decisions responsible for the cost of health care, and
what responsibility do we have to control costs? In your clinical experience, how often do you
and your team members consider cost as part of your medical decision making? Make reference
to the articles by Gawande and Cooke.

Blogs are due Monday, September 29, 2014


Comments on blogs are due Monday, October 6, 2014

November Personal and Professional Balance


We will meet in colleges at 3:30 pm then divide into small groups for the second part of class.

Blog Topics (choose one):


1.

Imagine yourself in 10 years. Describe an ordinary weekday from your own (future) perspective.
Use the present tense.

2.

Write about concerns you have regarding the balance between your personal life and your
professional life in your careereither now, in residency or fellowship, or after you are finished
with training. What do you think is, or will be, the most difficult aspect of maintaining balance?
What mechanisms have you relied upon, or need to develop, in order to achieve and maintain
balance?

Blogs are due Monday, October 27, 2014


Comments on blogs are due Monday, November 3, 2014

**Looking ahead: Small Group Presentation Assignment (December or March)


Teaching presentations to your small groups will occur in December and March. Your decision
about when you will present is due to your small group leader by this session. \
Assignment: Imagine you are a resident giving a talk during an impromptu afternoon teaching
session with your interns and students during a core rotation. Choose a competency and an objective
from one of the core clerkships, develop a 10-minute mini-medical scripted presentation on a topic that
addresses the chosen competency and objective.
Of note, in clinical medicine each of you have at times benefitted from these high-yield,
apparently spontaneous clinical presentations from interns, residents or attendings. Though these
presentations often feel off-the-cuff or back-of-the-napkin, they are often well-organized, scripted in advance and
frequently reprised for different groups of learners.
Format: Informal small group presentation. State the competency, clerkship objective that the
presentation addresses and use chalkboards, white boards, or simple (one page) handouts to strengthen
your presentation and enhance your learners recall. Computers cannot be used for this presentation.
Evaluation: Turn in a copy of your 10-minute mini-medical script to your small group leader.
Include your name, competency, and objective addressed on the script document. You will give your
presentation to your small groups and receive immediate feedback on your performance.

December Teaching sessions


The entire session for this class will be spent in small groups.

Teaching Presentations:
Some of you will make a 10-minute presentation on a medical topic to your PPS IV small group today.
The remainder of you will do your teaching presentation in March, 2013.
Assignment: Imagine you are a resident giving a talk during an impromptu afternoon teaching
session with your interns and students during a core rotation. Choose a competency and an objective
from one of the core clerkships, develop a 10-minute mini-medical scripted presentation on a topic that
addresses the chosen competency and objective.
Of note, in clinical medicine each of you have at times benefitted from these high-yield,
apparently spontaneous clinical presentations from interns, residents or attendings. Though these
presentations often feel off-the-cuff or back-of-the-napkin, they are often well-organized, scripted in advance and
frequently reprised for different groups of learners.
Format: Informal small group presentation. State the competency, clerkship objective that the
presentation addresses and use chalkboards, white boards, or simple (one page) handouts to strengthen
your presentation and enhance your learners recall. Computers cannot be used for this presentation.
Evaluation: Turn in a copy of your 10-minute mini-medical script to your small group leader.
Include your name, competency, and objective addressed on the script document. You will give your
presentation to your small groups and receive immediate feedback on your performance.

*Please start your teaching presentation with a brief (1 minute) summary of your blog and the teaching
qualities you strive to emulate.

January Physician-Pharma Relations


The full class will meet in Williams Auditorium at 3:30 pm. We will then divide into colleges for the
second part of class.

Readings:
1.

Elliott C, The drug pushers. The Atlantic Monthly, April 2006, 1-13.

2.

Steinbrook R. Controlling conflict of interestproposals from the Institute of Medicine. N Engl J


Med 2009;360:2160-2163

3.

Redig A. Finding the line: physicians, pharma, and drug development. Acad Med 2009; 84:228229.

Blog topics: Pick the topic that most closely aligns with your personal opinion.

1.

Write a blog posting which asserts that there should be no relationship between medicine and
pharma/device manufacturers. Explain why zero tolerance is the only reasonable policy. Is
complete independence possible? Suggest reasonable alternatives to the financial/in kind support
routinely provided by pharma/device manufacturers, such as medical education, new drug
awareness, free drug samples, research grants, etc. Support your writing with references from the
readings and, if needed, outside sources.

2.

Write a blog posting which asserts that the relationship between medicine and pharma/device
manufacturers can be productive and mutually beneficial if regulated and monitored closely.
What does that relationship look like? What should be restricted? Does your choice of specialty
affect your opinion? For instance, if you are going into orthopedic surgery, are you required to
interact with the hardware reps? Support your writing with references from the readings and, if
needed, from outside sources.

3.

Physicians are, in general, ethical professionals who can effectively manage conflicts of interest.
Write a blog posting which asserts that the relationship between medicine and pharma/device
manufacturers does not require additional oversight, aside from self-regulation.

Blogs are due Monday, January 5, 2015


Comments on blogs are due Monday, January 12, 2015

February Cultural Issues


We will meet in colleges at 3:30 pm then divide into small groups for the second part of class.

Blog topics (choose one):


1.

Describe a patient under your care whose cultural beliefs put his or her medical care at odds with
the recommendations of the medical team. How did it impact care? How did you or your team
address this issue with the patient, if at all? In your experience, how often does this circumstance
occur in clinical medicine?

2.

Describe your own ethnic background. What values do members of your ethnicity hold, if any,
that influence their health and health care? Do you or your family adhere to these values? Has it
had an impact on the health of you or your family? Have you ever tried to persuade them to
change their views?

Blogs are due Monday, February 2, 2015


Comments on blogs are due Monday, February 9, 2015

March Teaching sessions


The entire session for this class will be spent in small groups.

Teaching Presentations:
Some of you will make a 10-minute presentation on a medical topic to your PPS IV small group today.
The remainder of you will do your teaching presentation in March, 2013.
Assignment: Imagine you are a resident giving a talk during an impromptu afternoon teaching
session with your interns and students during a core rotation. Choose a competency and an objective
from one of the core clerkships, develop a 10-minute mini-medical scripted presentation on a topic that
addresses the chosen competency and objective.
Of note, in clinical medicine each of you have at times benefitted from these high-yield,
apparently spontaneous clinical presentations from interns, residents or attendings. Though these
presentations often feel off-the-cuff or back-of-the-napkin, they are often well-organized, scripted in advance and
frequently reprised for different groups of learners.
Format: Informal small group presentation. State the competency, clerkship objective that the
presentation addresses and use chalkboards, white boards, or simple (one page) handouts to strengthen
your presentation and enhance your learners recall. Computers cannot be used for this presentation.
Evaluation: Turn in a copy of your 10-minute mini-medical script to your small group leader.
Include your name, competency, and objective addressed on the script document. You will give your
presentation to your small groups and receive immediate feedback on your performance.

*Please start your teaching presentation with a brief (1 minute) summary of your blog and the teaching
qualities you strive to emulate.

April Empathy and Detachment in Medicine


We will meet in colleges at 3:30 pm then divide into small groups for the second part of class.

Blog topic:
Write about the challenges you faceas well as factors that help youin maintaining empathy
while practicing medicine. Give examples of patients or circumstances where you have found it
particularly easy or difficult to maintain empathy. What are the barriers to empathy in clinical
medicine? In general, have you observed physicians to be more empathic or more detached?
Does it vary by specialty?

Blogs are due Monday, March 30, 2015


Comments on blogs are due Monday, April 6, 2015

May Final college session; end of PPS curriculum.


We will meet in colleges at 3:30 pm.

Blog topics (choose one):


1.

What is your best memory or high point of medical school? What was the low point?

2.

What is your most memorable college moment or activity?

M4 TEACHING SELECTIVE

LEAD FACULTY
ELIZABETH RYAN, EDD
LEAD COURSE ADMINISTRATOR
CLARE PETRIE

Rationale:
A core function of a physicians role, regardless of specialty choice, is an expectation to teach
and provide feedback to your patients, medical students, peers and team members during your
residency and beyond. Another role that a physician in training will experience is that of being
a life long learner. In this role one would be expected to possess the necessary skills to create
self-directed improvement plans. Feinberg School of Medicine (FSM) highlights the
importance of professionalism, learning how to teach, provide feedback through and create selfdirected improvement plans through their core competencies listed below:
Professional Behavior and Moral Reasoning Standards 3 & 5
Our graduates will demonstrate a commitment to professional responsibilities and behavior as well as the
ability to understand, reflect upon, and integrate ethical and moral dimensions of healthcare. FSM
graduates will:
3. Behave with honesty, integrity, respect, and compassion towards all patients,
families, students, faculty, and members if the healthcare team.
5. Behave with accountability and dependability.

Professional
Behavior
Accountability

Medical Knowledge and Scholarship - Standard 4b


Our graduates will demonstrate knowledge of the scientific basis of medicine, the ability to apply
knowledge to patient care and contribute to scholarship in medicine though research or teaching. FSM
grates will:
4. Contribute to medical knowledge through research and the practice of
evidence-based teaching and learning, including:
b. Evidence-based teaching and learning by imparting knowledge to

Teaching

others as well as by participating in activities to improve the teaching


and learning of others.
Continuous Learning and Quality Improvement Standards 1 & 2
Our graduates will demonstrate the ability to accurately assess and improve classroom and clinical
performance, as well as to acquire, appraise and apply scientific evidence to classroom activities and
patient care. FSM graduates will:
1. Demonstrate competence in the art of receiving and providing meaningful
assessments and feedback in the service of their peers, their own education
and their school.
2. Create a well-articulated plan for improvement.

Feedback and
Self-Assessment

The aim of the Teaching Selective is to provide a clinical teaching experience that allows M4
students to build the necessary stills in evidence-based teaching, feedback and self-assessment
aiding them in the transition to the residency of their choice. Additionally, we would like to
differentiate FSM graduates from other institutions because the majority of FSM students
report that they want to include teaching in their career plan and FSM is one of the few
institutions that requires a Teaching Selective unit in their curriculum.
Goals:
This unit aims to:
1. Provide a supportive opportunity for learners to apply their knowledge of teaching
techniques in medicine.
2. Provide a supportive forum for learners to self-assess and receive feedback on their teaching
skills.
3. Provide a supportive forum for learners to reflect and debrief one another on their
experiences in clinical medicine focusing on teaching experience and individual
improvement plan.
Objectives:
1. Demonstrate effective techniques for teaching small groups or for preparing and presenting
lectures. (MKS 4b)
2. Demonstrate effective techniques for giving feedback as a clinical teacher. (CLQI 1)
3. Demonstrate the ability to personally assess and improve performance through the creation
of an individual teaching improvement plan. (CLQI 2)

FACULTY AND STAFF

M4 Teaching Selective Unit Director:


Elizabeth Ryan, EdD
e-ryan@northwestern.edu

503-4326

Unit Coordinator:
Clare Petrie

503-0654

c-petrie@northwestern.edu

TEACHING OPPORTUNITIES:
*Please let Clare Petrie c-petrie@northwestern.edu know by email what unit you would like
to teach by July 3, 2014.
Please note: The new M1/M2 curriculum is organized into organ system-based modules. The
Clinical Skills curriculum in Phase 1a (M1) and Phase 1b (M2) is a combination of the content
previously taught in M1 PEX and M2 Clinical Skills. Teaching Options include:
Phase 1a Clinical Skills (M1s) Mon - Thurs, 1:00pm - 3:00pm
This course teaches first year students communication, history and physical exam skills. The organ
systems covered in Phase 1a are: Foundations (Clinical Skills focuses on communication skills), CV,
Pulmonary, Renal, Musculoskeletal, and Derm. Choose a clinical skill or an organ system that interests
you. In the Clinical Education Center students will work with small groups of M1s and their faculty
Preceptor as they begin to develop their clinical skills. M4s will receive feedback on your teaching from
faculty/teaching resident.
Phase 1b Clinical Skills (M2s) Mon - Thurs, 3:00pm - 5:00pm
This course continues teaching second year students the history and physical exam, and also includes
write-ups, oral presentations and clinical reasoning. The organ systems covered in Phase 1b are: GI,
Head and Neck, Neuro, Psych, Endocrine, Repro/GU and Heme/Onc. This is a wonderful opportunity to
use your knowledge and interest in your chosen specialty to shape the clinical perspective of the M2s as
they prepare for their clerkships! M4 Students will have a chance to receive feedback on your teaching
from faculty/teaching resident.
ECMH (Education Centered Medical Home):
In this course, students will care for medically complex patients in an outpatient primary care clinic,
which will be expected to attend about every two weeks. Students will pair with an M1 or M2 student to
see patients; giving feedback on basic clinical skills and then modeling more advanced diagnostic and
management skills. M4s will be supervised and receive feedback from an attending faculty member.
Participating in ECMH will meet most of the Teaching Selective teaching credit. Students are still
required to teach one two-hour session in the CEC and complete the videotape and selfimprovement plan requirement and meet with a resident for formative feedback.
PROBLEM-BASED LEARNING (PBL):
PBL is a vehicle for medical students to use authentic clinical cases to:
1.
Acquire, synthesize and apply basic science knowledge in a clinical context.
2.
Engage in analysis, critical thinking and problem solving.
3.
Develop the ability to evaluate learning/gaps in knowledge and collaborate with peers.
4.
Effectively utilize information technology and identify the most appropriate resources for
knowledge acquisition and hypothesis testing.
5.
Contextualize and communicate knowledge to others.
6.
Ask for, provide and incorporate feedback.

You must complete at least 5 sessions signing up for at least one full block of PBL (information
listed below) and supplement (if needed) with hours spent substituting in sessions for other
tutors (on an as-needed basis), or signing up for multiple blocks of PBL. The commitment spans
the entirety of the PBL block(s) you must be able to make all of the sessions. Additionally,
M4s will be expected to attend the Beginning and End of Block Tutor meetings (~30-45 minutes
each).
M4s will have their own PBL group. The student facilitator will provide feedback to the
students throughout the block(s), with at least one instance of written feedback via email
(copying course coordinator), in addition to completing formal assessments at the end of the
block. After the completion of the PBL block(s), the M4 will receive the student feedback and
formulate a self-improvement plan. Then, the M4 will meet with one of the PBL course codirectors to go over the self-improvement plan, the written feedback that the M4 emailed to the
students, and the student evaluations and receive an assessment of their performance as a PBL
tutor.
Blocks: PBL will convene in most of the organ-base modules:
M1 Modules: M1 PBL groups meet Mon/Wed @ 1-3pm OR Tues/Thurs @ 10am-12pm
Phase 1A (M1) PBL OPTIONS
Block

Module(s)

Block 1

Foundations 1
Foundations 2

Block 2

Foundations 3

Block 3

Module Dates

Cardiovascular-Blood

Block 4

Pulmonary
Renal

Block 5

Musculoskeletal
Dermatology

Approx. # of
PBL Sessions

August 18 September 26, 2014


September 29 October 31, 2014
November 3 November 26, 2013
December 8 19, 2014 & January 5
30, 2015
February 2 February 27, 2015
March 2 March 27, 2015
April 13 May 8, 2015
May 11 May 22, 2015

7
5
6
10
4

M2 Modules: M2 PBL groups meet Mon/Wed @ 3-5pm OR Tues/Thurs @ 3-5pm


Phase 1B (M2) PBL OPTIONS
Block

Module(s)

Block 6

Gastrointestinal

Block 7

Head & Neck

Block 8

Neurology
Psychology

Block 9

Endocrine

Block 10
Block 11

Reproductive-GU
Heme-Oncology

Module Dates

July 28 August 22, 2014


August 25 September 19, 2014
September 22 October2 4, 2014
October 27 November 7, 2014
November 17 December 12, 2014
December 15 19, 2014 & January 5
30, 2015
February 2 March 6, 2015

Approx. # of
PBL Sessions
4
3-4
9
6
6
4-8

Please note that the dates listed are the start/end dates for the Modules, not the specific PBL
session start/end dates, which are as of yet undetermined. PBL blocks within the organ-based
modules can consist of 3-8 sessions, depending on the content and schedule of the block in
question.
If you have any questions about PBL, please contact Jessica Voth (j-voth@northwestern.edu /
312.503.2165).

In addition to:
You will be paired up with a M2 over the course of the year to review and provide feedback on
three of their H&Ps.
Teaching Selective Requirements:
The Teaching Selective is a unit requirement in the PPS IV curriculum, allowing you the
opportunity to develop your teaching/feedback skills. You are provided an opportunity to
teach in the M1/M2 curriculum (listed below) under the guidance of FSM faculty.
Successful completion of the Teaching Selective includes teaching in either Phase 1a or Phase 1b
Clinical Skills, ECMH, PBL and completing M2 Inpatient H&Ps (requirements described
below):
Phase 1a or 1b Clinical Skills: teach 10 hours (5 sessions), you will be taped for one session
and provided formative feedback from a resident.
ECMH: M4s teach in their home plus teach one session in the CEC. This session will be
videotaped and you will receive formative feedback. (Drs. Evans & Ryan recommend that
you complete this earlier in the year to use the feedback while teaching in your home)
PBL: M4s must complete at least 5 sessions or a combination of a complete block(s). The
PBL Director will provide students formative feedback during a one-one meeting.
M2 Inpatient H&Ps: In addition to teaching in Clinical Skills, ECMH, or PBL, you will each
be paired up with an M2 from October through March to review their H&Ps. Also, your M2
may ask you to help find patients to complete their H&P. The M2s are required to complete
3 H&Ps over the course of the M2 year, each H&P has an assigned due date. Once they
complete these they will send them to you for you to review, you will provide feedback, and
complete an evaluation for their portfolio. Clare Petrie will be sending you an email with
the M2 that you are paired with along with evaluation information and due dates.
You will complete and submit an independent learning plan regardless of the setting.
IMPORTANT TO NOTE:
As you are considering the various areas in which you will teach, please keep in mind the
following:
Students CANNOT teach during required Core/required clinical/educational responsibilities.

Important suggestion: Based on previous student feedback and the Directors


recommendation for planning your teaching think about continuity with sessions and/or
groups. For example: teaching all oral presentation sessions vs. oral presentations plus
cardiac exam, etc. We do not sign student times to teach, we offer options and allow
students to report their interests for scheduling. In hindsight, M4 students have reported
that they wished that they had continuity with the learners or continuity with the content
taught. Both offer valuable lessons.
Please schedule time to complete your teaching selective hours during your flex or down
time.
Any Previous teaching experiences will NOT fulfill this requirement.
You need to review each teaching opportunity and reply to Clare Petrie with your preference
and dates you are available by Wednesday, July 3rd.
Video Tape & Formative Feedback Assignment: (except from M4s teaching in PBL)
1.
Students will be videotaped teaching during one session.
2.
Students must watch their video and complete a self-assessment checklist (See attached
Appendix A - paper copy).
3.
Students must meet for formal feedback with a designated reviewer to create a teaching
improvement plan for future teaching experiences (see the attached Appendix B improvement plan form).
4.
You will need to complete the videotape requirement/teaching improvement plan by May
1st 2015
Creation of an Individual Teaching Improvement Plan:
Students will submit their improvement plans (Attachment B) to Clare Petrie via email cpetrie@northwestern.edu
Assessment the M2 students inpatient H&P write-up:
Attachment C is a paper copy of the form that the M4 will use o assess the M2s Inpaitient H&P
Write-up performance.
Teaching Opportunities Concept Map:
Attachment D provides a visual overview of teaching opportunities, assignments and
devliverables for PPS IV and the Teaching Selective unit.
EVALUATION:
All students must submit course evaluations, which will be available electronically. All teaching
selective requirements must be finished by May 1, 2015, when your grade for the M4 Teaching
Selective will be recorded as Complete or Not Complete. This information will be shared
with the Senior Associate Dean for Student Programs and your College Mentor. Students who
fail the course will receive a remediation plan, and the Student Promotions Committee will be
notified and asked to review the students academic status. Completing the M4 Teaching
Selective is a graduation requirement.

Student Name:

Appendix A.

Photo

Observer Name:
Person Completing the Checklist (Student or Observer)
Teaching setting (session/unit taught):
Date:

Teaching Selective: Feedback Checklist

Demonstrated

Yes
1. Setting Expectations:
Clearly explained the process for the learning session
Clearly explained expectations of the learner
Clearly explained the relevance - "why" it is important
Took into consideration learners current knowledge and needs

2. Communicated Effectively:
Body Language is natural
Gestures are not distracting
Spoke clearly and spoke loudly enough for the setting
Spoke at an appropriate pace and incorporated pauses to highlight key learning points
Engaged learners - probed their understanding, asked them questions, invited their
participation/interpretation of the case
Actively listened to learners, adapted to their needs and solicited level of understanding

3. Feedback:
Asked learner for a self assessment (pros and areas for improvement)
Probed for the learners rationale or reasons why they think they performed a certain way
Was specific
Identified positives and area(s) for improvement
Provided an example to the learner on how they could improve
Provided a take home message
Negotiated goals with the student and agreed upon next accomplishment

4. Knowledge Application and Integration:


Highlighted basic science material in a clinical context
Related M2 coursework to an aspect of the case

Overall:

No

Feedback
comments

Appendix B.

M4 Teaching Selective Self-Improvement Plan


Student Name:
College:
Small Group Leader:
Teaching Placement:
Unit/Session Taught:
Name of Feedback Provider:

__________________________________
__________________________________
__________________________________
__________________________________
________________________________ _
__________________________________

Directions: Answer the questions below after watching your teaching videotape and after you
have met for individual feedback. Submit the completed Self-Improvement Plan via blackboard
and give your PPS IV small group faculty tutor a copy of your plan (either in December 2010 or
March 2011).
1. Identify and describe below area(s) of strength identified and discuss in your feedback
session.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
________________________________________
_________
2. Identify and describe below area(s) for improvement identified and discuss in your
feedback session.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
____________________________________________
_____
3. Personal Goal and Objective (what do you want to change?)
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Appendix B.

4. How are you going to achieve your goal? (What resources and strategies are you going
to use)
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
_________________________________________________
5. How are you going to know that you learned it? (What evidence)
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
____________________________________
_____________

(Self-Improvement Plan is based on the learning contract model created by: Knowles, Malcolm;
Holton, E. F., III; Swanson, R. A. (2005). The adult learner: The definitive classic in adult
education and human resource development (6th ed.). Burlington, MA: Elsevier)

Appendix C.

Feinberg School of Medicine M2 Inpatient Written H&P Assessment Form


Course
Unit
Assessment

Date
Evaluator Name
Student Name

Clinical Medicine
M4 Review of Written H&P

INSTRUCTIONS:
Please complete one form per student in regard to their Written H&P.
Note that if you assign a rating of 7, 8, or 9, the system will require you to provide an explanation with a minimum length of 140
characters.

PATIENT-CENTERED MEDICAL CARE


PCMC-5 Deliver oral presentations and write chart entries that are accurate, organized, well-reasoned, and appropriately
thorough.
1

Write-up is incomplete
and disorganized.

Write-up is not entirely


well-organized, or is
incomplete or poorly
reasoned.

Write-up is accurate,
organized, wellreasoned and
appropriately thorough

N/A

N/A

PCMC-3 Formulate assessments and plans with attention to acuity of illness, risk benefit estimations, and patient preferences.
1

Problem list,
assessment and
differential diagnosis
are incomplete or show
poor knowledge
application.

Problem list,
assessment and
differential diagnosis
are mostly complete
and prioritized and
show good knowledge
application

Problem list,
assessment and
differential diagnosis
are complete and
prioritized and show
good knowledge
application for complex
patients.

N/A

N/A

MEDICAL KNOWLEDGE AND SCHOLARSHIP


Efficiently identify knowledge gaps, utilize appropriate information sources and critically evaluate information and data,
including:
MKS-2a Progressive skills for disciplined, continuous learning in order to stay current with evolving medical knowledge.
1

Write-up contains no
evidence of additional
reading

Write-up contains
evidence of additional
reading but knowledge
is not applied to
specific patient case

Write-up contains
evidence of additional
reading appropriately
applied to specific
patient case

Write-up contains
evidence of additional
reading of complex
information from varied
sources applied to
specific patient case

N/A

PROFESSIONAL BEHAVIOR AND MORAL REASONING


PBMR-5

Behave with accountability and dependability.


1

N/A

Failed to turn in write-up


on time

POSITIVE OBSERVATIONS:

SUGGESTIONS FOR IMPROVEMENT:

Turned in write-up on time

N/A

N/A

Appendix D.