Creating a win-win for the health system and health Profession's education: a direct observation clinical experience with feedback iN real-time (DOCENT) for low acuity patients in the emergency department.
Abstract
<h4>Background</h4>Clinical education across the professions is challenged by a lack
of recognition for faculty and pressure for patient throughput and revenue generation.
These pressures may reduce direct observation of patient care provided by students,
a requirement for both billing student-involved services and assessing competence.
These same pressures may also limit opportunities for interprofessional education
and collaboration.<h4>Methods</h4>An interprofessional group of faculty collaborated
in a sequential quality improvement project to identify the best patients and physical
location for a student teaching clinic. Patient chief complaint, use of resources,
length of stay, estimated severity of illness and student participation and evaluation
of the clinic was tracked.<h4>Results</h4>Clinic Optimization and Patient Care: Five
hundred and thirty-two emergency department (ED) patients were seen in the first 19 months
of the clinic. A clinic located near the ED allowed for patients with higher emergency
severity index and greater utilization of imaging. Patients had similar or lower lengths
of stay and higher satisfaction than patients who remained in the ED (p < 0.0001).
In the second clinic location, from October 2016-June 2019, 644 patients were seen
with a total of 667 concerns; the most common concern was musculoskeletal (50.1%).
Student Interprofessional Experience: A total of 991 students participated in the
clinic: 68.3% (n = 677) medical students, 10.1% (n = 100) physician assistant students,
9.7% (n = 96) undergraduate nursing students, 9.1% (n = 90) physical therapy students,
and 2.8% (n = 28) nurse practitioner students. The majority (74.5%, n = 738) of student
participants worked with students from other professions. More than 90% of students
reported that faculty set a positive learning environment respectful of students.
However, 20% of students reported that faculty could improve provision of constructive
feedback. Direct Observation: Direct observation of core entrustable professional
activities for medical students was possible. Senior medical students were more likely
to be observed generating a differential diagnosis or management plan than first year
medical students.<h4>Conclusions</h4>Creation of a DOCENT clinic in the emergency
department provided opportunities for interprofessional education and observation
of student clinical skills, enriching student experience without compromising patient
care.
Type
Journal articleSubject
Direct observationEntrustable professional activities
Feedback
Health professions education
Interprofessional collaboration
Learning climate
Undergraduate medical education
Permalink
https://hdl.handle.net/10161/24308Published Version (Please cite this version)
10.1186/s12909-022-03133-zPublication Info
Clay, Alison S; Leiman, Erin R; Theiling, Brent Jason; Song, Yao; Padilla, Blanca
Blanca Iris; Hudak, Nicholas M; ... Buckley, Edward G (2022). Creating a win-win for the health system and health Profession's education: a direct
observation clinical experience with feedback iN real-time (DOCENT) for low acuity
patients in the emergency department. BMC medical education, 22(1). pp. 66. 10.1186/s12909-022-03133-z. Retrieved from https://hdl.handle.net/10161/24308.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Edward George Buckley
James Pitzer Gills, III, M.D. and Joy Gills Distinguished Professor of Ophthalmology
in the School of Medicine
Dr. Buckley is a native of Cincinnati, Ohio. He graduated from Duke University in
1972 with a BSE in Electrical Engineering. He received his MD degree from Duke in
1977 followed by a residency in ophthalmology. He then completed two fellowships,
one in pediatric ophthalmology and the other in neuro-ophthalmology, both at the University
of Miami Bascom Palmer Eye Institute returning to the faculty at Duke in 1983. He
is currently the Chairman of the Department of Ophthalmology and the James P.
Alison Suzanne Clay
Adjunct Associate Professor of the Practice of Medical Education
Ann Michelle Hartman
Assistant Clinical Professor in the School of Nursing
Dr. Ann "Michelle" Hartman came to DUSON from Jefferson College of Health Sciences
in Roanoke, Virginia. She earned her BSN and MSN at Virginia Commonwealth University.
She worked as a pediatric nurse practitioner at level 2 NICU in Georgia and as a Clinical
Nurse Specialist at a multidisciplinary children’s hospital in Virginia. She then
transitioned to a faculty role while completing her DNP at Case Western University.
As an Assistant Professor at Jefferson College of Health Sciences,
Jeffrey M. Hoder
Associate Professor in Orthopaedic Surgery
Dr. Hoder is a clinician, an educator and mentor in the DPT program. His specific
area of expertise is in adult neurological rehabilitation. Dr. Hoder brings his expertise
to Neurological Patient Management I in the second year of the DPT curriculum, to
the gait assessment component of Movement Science in the first year of the DPT curriculum
and throughout the curriculum for content areas related to the examination and management
of Adults with Neurological deficits. His teaching philosophy i
Nicholas Mark Hudak
Associate Professor in Family Medicine and Community Health
Nicholas Hudak is an Associate Professor in the Department of Family Medicine and
Community Health in the Duke University School of Medicine. He is faculty clinical
coordinator with the Duke Physician Assistant (PA) Program, practicing PA in the Department
of Neurology, and an Assistant Director in the Duke Center for Interprofessional Education
and Care.
Erin Roxanne Leiman
Assistant Professor of Emergency Medicine
Brent Jason Theiling
Associate Professor of Emergency Medicine
Dr. Theiling is a board-certified emergency medicine physician with expertise in Emergency
Department and hospital operations. He is currently the vice chair of operations for
Duke University's Department of Emergency Medicine, as well as CSU Medical Director
of the Emergency Services Clinical Service Unit for Duke University Hospital. This
unit encompasses Duke's Emergency Department, Life Flight Critical Care transport
teams, the Duke Trauma Center, Patient Transport and Emer
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