Objective: At Windsor University School of Medicine, we have adopted pieces of our COVID-19 learning design and resources to create a long-term hybrid rotation model with the goal of achieving positive student outcomes through alignment of instruction and assessment. Like many others during COVID-19, we explored ways of engaging students virtually, including using APGO educational resources in our year 3, six (6) week Ob/Gyn clerkship. As the pandemic continued and rotations resumed in person, the challenge of limited clinical experiences--both due to lack of patient volume and a reduced number of clinical sites--remained for our students. We decided to keep components of our virtual experience and create a long-term hybrid rotation to ensure students met the goals and objectives of the required clinical experiences in a structured way, leveraging the instructional design work and curriculum created at the start of COVID-19.
As we refined our approach, we found success in carefully linking our learning objectives to APGO objectives, ACGME level 1 milestones and various assessments methods. Our focus was also to meaningfully engage students in a variety of active learning strategies for online active learning in preparation for face-to-face skills sessions. By implementing this approach, we saw NBME shelf exam and OSCE scores improve, and student confidence rise. In addition due to alignment of our objectives and assessment methods with APGO objectives and ACGME level 1 milestones, we believe we are working towards better UME/GME transition during core clerkship experience rather than working on a separate boot camp or fourth year elective.
The objectives of the workshop session is to:
• Outline the structure of our hybrid clerkship curriculum.
• Describe our experience including successes, challenges and student satisfaction
• Brainstorm to identify best practice curricular components and assessment methods.
• Brainstorm and identify significance of UME-GME continuum through mapping of APGO objectives, level 1 milestones and assessment methods.
Methods: We implemented a hybrid curriculum that involved traditional teaching methods that incorporated student learning at clinical teaching sites and a new online weekly core curriculum that engaged learners both synchronously and asynchronously. The online weekly curriculum structure was implemented in conjunction with in-person rotations. For example, for our 6-week OB/GYN clerkship, while students are engaged in their face-to-face rotation experience, students completed 4 weeks of virtual instruction. Initial 2 weeks topics for obstetrics and later 2 weeks for gynecology, weeks 3 and 6 are assessment weeks.The key feature of the virtual section of our hybrid learning program was using once a week per rotation synchronous active learning instructional session like team-based learning (TBL) and review of pre-assigned APGO objective based topics and Basic Clinical Skills curriculum topics. For the weekly synchronous session TBL session, the iRAT (individual readiness assessment) quiz was based on the asynchronous assignments. Students were continually assessed using team application exercises, which utilized APGO topic based teaching cases. By combining discussion and assessment, we were able to engage students and ensure that all topics assigned asynchronously were reviewed during synchronous sessions. Cases were discussed by the dedicated clerkship specific instructors (one each from clinical and pre-clinical phase). key feature for assessments like OSCE, was the utilization of four cases that are part APGO`s case based curriculum for milestone 1, the common clinical skills in each rotation--which were commonly assessed as individual tasks during end rotation OSCE--were made part of each week’s clinical skills training. For example, as one of the milestone 1 OSCE cases dealt with labor and delivery, this particular task was addressed and taught during the OBG week 2 simulation session utilizing APGO`s basic clinical skills teaching module and other resources identified by our faculty. Students were anonymously surveyed pre- and post-intervention to assess the impact of the curriculum.
Results: The students have expressed that the hybrid clerkship experience has made them more comfortable and confident in participating in patient care, performing supervised procedural skills, or even doing routine clinical examinations during their actual face-to-face interactions at the clinical teaching sites. They have also expressed that their weekly involvement and following the structured curriculum was a benefit, providing an appropriate foundation and knowledge base to do well in their clerkship. This was corroborated by noticing an improved performance of students in NBME shelf and end of rotation OSCE examinations. We are also confident in preparing the students for their residency training, as students towards the end of each clerkship rotations have shown proficiency in level 1 ACGME milestones and achieving required EPA`s. The feedback from faculty has also been very encouraging, several of the faculty found this structured approach helpful in terms of gauging students’ knowledge. During actual bedside teaching sessions, faculty feel more able to focus on teaching patient management issues. One challenge we faced is that since not all clinical preceptors participate in the weekly instructional sessions, there was a gap in preceptors being aware of what are the weekly topics assigned to students. Relevant department chairs and clerkship directors are working on filling this gap. Another challenge is the increased workload on the dedicated instructors, which was heaviest initially when they worked on creation of various instructional and assessment instruments derived from various APGO resources.
Conclusion/ Discussion: This hybrid approach, with closer alignment of objectives between instruction and assessment, ensures a better foundation from which students do better during their face-to-face clerkship rotations. We have utilized several resources, but we did not have to go far as most of the resources are available through APGO membership. Other schools can definitely benefit from the usage of readymade educator resources available on APGO. Certain innovative tweaking of the APGO tools--like usage of cases as a base for creating standardized patient OSCE and including a TBL session utilizing teaching cases during synchronous sessions -- aids in closer compliance of students completing the assigned APGO topics.
Related APGO Publications/Modules: APGO objective based topics and teaching cases, Basic Clinical Skills curriculum topics, APGO`s case based curriculum for milestone 1,
Topics: Faculty Development Seminar, 2022, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Patient Care, Medical Knowledge, Professionalism, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, UME, Assessment, Virtual Patient, Simulation, Independent Study, Problem-Based Learning, Standardized Patient, Team-Based Learning,
