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SIU School of Medicine was one of the first medical schools in the nation to establish a department of medical humanities. SIU was the fifth pilot project to bring humanities into the clinical experience, according to Glen Davidson, PhD, founding chairman of the department. “SIU was the first to bring humanism integrated directly into clinical education,” says Dr. Davidson. “While other schools offered courses in medical humanities, no other medical school so carefully integrated them in students’ clinical experiences.” Working with the curriculum model brought by Dax Taylor, former associate dean for academic affairs, “we didn’t think in terms of courses but themes broken into modules like the rest of the SIU curriculum,” Dr. Davidson says. “Somebody from the medical humanities team participated in every clerkship, teaching with one of the clinicians.” Disciplines covered in medical humanities include: ethics, health policy, medical history, medical jurisprudence, psychosocial care, and religious studies. The department also is home for the MD/JD dual degree program, one of 24 US medical schools offering this combined degree.Medical Humanities
Family Practice Preceptorship
Preceptorships are what medical students dream of before they enter medical school: the opportunity to work alongside a practicing physician in a real office, helping real patients, making a real difference. SIU School of Medicine’s Department of Family and Community Medicine established the family practice preceptorship in 1981, making SIU “one of the earliest medical schools in the country to engage students in community-based education, placing students in ambulatory care settings with practicing physicians,” says Phillip Davis, PhD, who was among the faculty to get it under way. For five weeks in their third year, every student gets varied experience with one of 160 practicing family physician in downstate Illinois. That’s how it began, and it has stayed firmly in place. “We are interested in promoting primary care,” says Dr. Davis. “We’re still committed to that mission-based educational innovation today.” Since its beginning in 1981, nearly 2,000 students have participated in the program.Community Preceptor Program
Senior Clinical Competency Exam (SCCX)
The senior clinical competency exam (SCCX), developed by Reed Williams, PhD, Howard Barrows, MD, and others, has been used at SIU School of Medicine for more than 20 years. The school was the first among the US medical schools to develop this comprehensive, direct measurement of students’ clinical skills using standardized patients. What’s unique about this 14-station exam is that questions are administered randomly from any discipline of medicine. “This replicates what the student would see in practice,” notes Debra Klamen, MD, MHPE, senior associate dean for education and curriculum. Today, more than 90 percent of schools have some kind of clinical competency exam. The Step 2 Clinical Skills exam, which all students in the nation have to pass, now uses standardized patients in the testing process. (SIU’s own Reed Williams, PhD and Howard Barrows, MD, served on committees to get clinical skills included in the US Step 2 Exam.) In 2004, SIU developed the senior clinical competency exam remediation, a four-week course in which students are immersed full-time with clinical faculty to walk them through symptom presentations and differential diagnoses, giving students feedback all the way along.
“I think this is the most innovative technique since standardized patients,” notes Deb Klamen, MD, MHPE. SIU is one of only two medical schools in the nation who use nurse educators so extensively in their curriculums. Sometimes called “physician educator extenders,” the idea is simple: Experienced master’s-degree-educated nurses devote their days to educating students and ensuring they develop good clinical skills. Ten nurse educators have become embedded in the culture of SIU School of Medicine, working with nearly every department to ensure students in groups or individually receive guidance. The Department of Surgery is the only surgical program in the United States with two nurse educators. With nurses guiding them throughout their medical education, students develop positive attitudes toward nurses that carry over into their careers. SIU School of Medicine was lauded by the Liaison Committee for Medical Education for its success using nurse educators. SIU’s first nurse educator, Norma Wylie, MSN, RN, was hired in 1978. She was the first nurse to become a full professor with tenure at a US medical school.
Surgical Skills Center
Dr. Gary Dunnington, former professor and chair of the Department of Surgery and founding director of the SIU Surgical Skills Center, led efforts to open the Springfield, Illinois, based Surgical Skills Center in May 2000. At the time, it was one of only a handful of centers designed specifically for training surgical residents. Today, the Memorial Center for Learning and Innovation is home to our state-of-the-art facilities.
Skills Labs have since revolutionized surgical training. Using computer simulators and virtual reality technology as well as specially designed procedure models, surgical residents learn a wide array of surgical skills including but not limited to instrument tying, one/two-handed knot tying, Laparoscopic proficiencies, vascular anastomosis, chest tubes, central lines and splinting.
The SIU faculty and the SIU Surgical Skills Center staff assisted other surgical educators in developing a national curriculum in hopes that other residency programs would utilize the curriculum for their labs. The ACS/APDS National Surgical Skills Curriculum has developed three phases. Phase I includes basic surgical skills designed with first and second year residents in mind.
Resident Readiness Electives
Surgeon David Rogers, MD, developed the Resident Readiness Elective, a surgical elective that gives eager and anxious fourth-year students a peek into the skills they will need as surgery residents. The elective’s curriculum includes training in the Surgical Skills Center, simulations with nurse educators to introduce management of post-operative situations, and additional experiences in the dissection of human cadavers. It's one of the most popular electives at the School of Medicine. Similar versions have been developed for obstetrics, emergency medicine and internal medicine.
ePBLMs are considered the core of the problem-based curriculum at SIU School of Medicine. Beginning in 2003, the three-inch binders containing paper documents of the hundreds of PBL modules were transferred to the computer. By 2005, all the modules were converted, bringing problem-based learning into the 21st Century. Basic science researcher Amy Arai PhD, created the idea and developed these web-based modules whereby students work together in their tutor groups to address patient problems in a free-inquiry format using online resources to ask questions and receive answers. In 2005, standardized patients were added to the process. Students interview SPs, take a computerized test, and meet with a clinician who gives them immediate feedback on the oral presentation and physical exam. A regular problem-based learning case ensues.
Longitudinal Performance Assessment
This assessment tests students’ growth in clinical reasoning across their four years of medical school training. Students start each year of medical school by taking the test. Current questions include the ability of students to recognize a pattern of illness and clinical data interpretation. The results are mapped over time to measure students’ progress. SIU compares its results of the longitudinal performance assessment with five other schools so all the medical students will know how they’re doing in relation to their peers.
Health Information Technology Training
SIU School of Medicine is one of the few medical schools teaching second-year medical students how to effectively use electronic medical records (EMR). Nationally, most students learn to use them in the clinics during their third-year clerkships. The SIU Educational Policy Council’s subcommittee, eHIT (educational Health Information Technology), was established to facilitate students’ training with EMR, led by Educational Liaison Theresa Waters, RN, and Lauri Lopp, MD, associate professor of family and community medicine.
Third-year clerkship students at SIU began using EHR in 2008, initially in a read-only capacity. For the year two students, standardized patients step in to help teach with progressive tasks using the EMR system. Second-year students see an SP in the PBL lab, enter history and physical exam data into the electronic medical record while they are seeing the patient, close the database and re-open the EMR in the computer lab to document notes. Feedback follows. “The training also introduces students to the numerous efficiency and patient-safety aspects of an EMR that is necessary for great, quality care for patients,” says Dr. Lopp. “EMRs are increasingly an integral part of clinical practice, and so we need it to be an integral part of our curriculum and give our medical students the earliest possible exposure to them."
This exercise teaches second-year medical students how to handle “handoffs,” a critical point in patient care when shifts change and physicians transfer patient care to colleagues.
In this simulation, students see an SP with pancreatitis. The students then move to a simulated hospital unit, where they are given a written handoff from a resident who “went home sick.” While students document the patient data in a SOAP note, the computer lab is made as boisterous as possible to mirror a real-world situation: Nurses are on the phone, pizzas are being ordered, EKG alarms are going off, machines are beeping, people are loitering, a cacophony so intense it would irk the nerves of the most experienced attending. Amidst the clamor, the students receive two pieces of information: One note is not about their patient. How the students handle the last-minute information is key as they verbally handoff their patient to another resident. Feedback follows. First administered in 2009, faculty found that 50 percent of students made a medical error by including information in the handoff about the wrong patient. “It was an eye-opener to us and the students,” says Dr. Klamen. “They found out that it’s easier to make a mistake than they thought.”