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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

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. - PowerPoint PPT Presentation

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Page 1: Native Hawaiian Standardized Patient Use of JABSOM

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

Page 2: Native Hawaiian Standardized Patient Use of 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

Page 3: Native Hawaiian Standardized Patient Use of JABSOM

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

Page 4: Native Hawaiian Standardized Patient Use of 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

Page 5: Native Hawaiian Standardized Patient Use of JABSOM

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

Page 6: Native Hawaiian Standardized Patient Use of JABSOM

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

Page 7: Native Hawaiian Standardized Patient Use of JABSOM

• 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