SUPPORTING SAFE TRANSITION TO RESIDENCY THROUGH E-LEARNING AND SIMULATIONS

Thomas S. Riles, Lynn Buckvar-Keltz, Adina Kalet

NYU Langone Health

THE CHALLENGE CURRICULUM DEVELOPMENT

AAMC ENTRUSTABLE PROFESSIONAL ACTIVITIES INSTRUCTIONAL DESIGN STRUCTURE MODULES AVAILABLE
EPA 1: Gather a history and perform a EPA 8: Give or receive a patient Assuring that
Focus on common clinical symptoms that if 1. Introduction and review of
physical examination handover to transition care transitioning students common causes LOWER EXTREMITY

EPA 2: Prioritize a differential responsibility

mismanaged could have disastrous outcomes
PAIN & SWELLING

diagnosis following a clinical EPA 9: Collaborate as a member of

are prepared to safely
encounter an interprofessional team assume clinical Provide content as well as assessment components
EPA 3: Recommend and interpret EPA 10: Recognize a patient responsibilities in Make use of checklists
common diagnostic and screening requiring urgent or emergent care
tests and initiate evaluation and accordance with the 2. Case Presentation
Provide structured method for evaluation
EPA 4: Enter and discuss orders and management AAMCs EPAs
prescriptions EPA 11: Obtain informed consent o Information from nursing staff Video dramatization of the resident
EPA 5: Document a clinical encounter for tests and/or procedures and nurse assessing and managing
in the patient record EPA 12: Perform general o Review of the medical record the patient
EPA 6: Provide an oral presentation of procedures of a physician
a clinical encounter EPA 13: Identify system failures and o Listen to patients complaint
EPA 7: Form clinical questions and contribute to a culture of safety and 3. Practice Cases
improvement
o Physical examination
retrieve evidence to advance patient
care o Ordering appropriate laboratory tests Scripted cases with self assessment
questions
Recognize when to escalate to superiors
Emphasize professionalism and communication
THE PROBLEM Align content with summative assessment program 4. NightOnCall
Coming Soon
Unstructured approach to teaching clinical Provide applications that can be carried into clinical Live simulation allowing learners to Loss of Consciousness
practice and educators to measure all
reasoning practice EPAs for transitioning students.
Inadequate assessment of entrustability
prior to transitioning to residency

GRADUATING STUDENTS INCOMING RESIDENTS

IMPLEMENTATION IMPLEMENTATION
THE SOLUTION Modules assigned during
clinical years and
4-hour NightOnCall
summative simulation
Program directors
assign modules to
2-hour 1st NightOnCall
simulation assessment
matched residents during orientation
Develop a curriculum that addresses transition/capstone program assessment

clinical reasoning skills

CLINICAL CLINICAL
Design and implement an assessment RESPONSIBILITY RESPONSIBILITY
to assure students meet the EPA
standards at graduation March 17
MATCH DAY July 1
July 1
COMMENCE
COMMENCE
RESIDENCY
RESIDENCY

RESULTS RESULTS
Patient Note Mean Scores (0-3 pt.) May be Mean Standardized Patient Checklist Reporting an error Involving an attending
Escalating a situation
used to evaluate the following core EPAs: 2, Ratings. May be used to evaluate the

CONCLUSIONS 1.75
3, 5, 10, 12
90
80
following core EPAs: 1, 10, 11, 12

Before
70
WISE-OnCall modules are an effective means of teaching clinical reasoning 1.5 60

and preparing students for residency 50

1.25 40

WISE-OnCall modules map to the EPAs and reinforce the skill necessary to 30
1
achieve entrustability
20
After
10
0.75 0
Modules are used with graduating students and incoming residents to Reporting* Interpreting* Managing Overall* Communication* Physical Exam* History*

demonstrate a rational approach to common clinical presentations *p<0.01 Before WISEOnCall After WISEOnCall n = 111 transitioning students n = 141 incoming residents