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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.

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Date
2022-01-27
Authors
Clay, Alison S
Leiman, Erin R
Theiling, Brent Jason
Song, Yao
Padilla, Blanca Blanca Iris
Hudak, Nicholas M
Hartman, Ann Michelle
Hoder, Jeffrey M
Waite, Kathleen A
Lee, Hui-Jie
Buckley, Edward G
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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 article
Subject
Direct observation
Entrustable professional activities
Feedback
Health professions education
Interprofessional collaboration
Learning climate
Undergraduate medical education
Permalink
https://hdl.handle.net/10161/24308
Published Version (Please cite this version)
10.1186/s12909-022-03133-z
Publication 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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Scholars@Duke

Buckley

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.
Clay

Alison Suzanne Clay

Adjunct Associate Professor of the Practice of Medical Education
Hartman

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,
Hoder

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
Hudak

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. 
Leiman

Erin Roxanne Leiman

Assistant Professor of Emergency Medicine
Theiling

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
Waite

Kathleen Ann Waite

Associate Professor of Medicine
Clinical Practice.
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