Communication

One Minute Preceptor

The “microskills” paper discusses the One Minute Preceptor (OMP) strategy, which is intended to make the teaching/learning process both efficient and interactive. We want to try to avoid “mini-lectures” in the DCs. Instead, we want to teach by asking questions and thereby get students actively engaged in the learning process. The 5 microskills of the OMP are a handy tool to do that.

• 5 Microskills (Required article)

Clinical Reasoning

Judy Bowen’s NEJM paper on teaching clinical reasoning does a very good job of explaining the importance of the CASE REPRESENTATION/PRESENTATION – something we want to try to emphasize when we interact with our DC groups.  We will be expecting our groups to present their case each time they meet with us.  We will then work around the circle and ask clinic members to also summarize {a} their thinking on the case (DfDx, etc), {b} their developing diagnostic plan, and {c} their planned interaction with their client. Let’s get them ready for 4^th year and their external rotations!

• Clinical Reasoning (Required article)

RACE CE

We continue to offer RACE CE credits – see link above for more details. You will need to register for these credits before DCs. If you are planning to receive RACE CE credit, an have not set up an account for RACEtrack, please do so, before the end of DCs (it makes this process easier).

• Teaching & Learning (5 Credits) – This is what you will already be doing during the DCs – guiding students through the simulation.
• Clinical (3 Credits) – As a facilitator you are required to do a majority of the following tasks: prepare your case, know your disease so you can facilitate student learning, and complete a “Notes for Next Time” document with your co-facilitator. This document describes what went well and what could be approved for your case so that in 3 years the next facilitator can implement those things into the case. The ONLY addition to receive the credit is to write at least a 1-page reflection on your experience. The other requirements are things you will already do.

Quick refresher about DCs. Since this is your first DCs as a facilitator, we often like to pair you with an experienced person to help show you the ropes of being a DC Facilitator. The DC has typically about 5 different cases running simultaneously, where four “clinic teams” (students) are assigned to each case. Clients are paired with Facilitators, and each pair has two clinics. Therefore, each case has two facilitator/client pairs and 4 clinic teams.

You should have access to a separate team called “Student – CVM Diagnostic Challenge 1 or 2” and your 2 clinics.  This is ONLY accessible by you and your clinics (clients cannot see this folder).  I have attached the instruction I gave the students to navigate these folders for your reference. Please let me know if you have not seen an invite or do not have access. 

You will receive emails from “transportation” – the systems sends multiple emails, one for each day. This step is fairly NEW, so please read and be prepared BEFORE getting to campus!!! Similar to what we did in the past for DCs for those that were here.

WSU has moved away from using a paper version of the parking passes in our windows and is now all electronic. You will need to register your vehicle’s license plate for each day you are going to be parking on campus.  We no longer have the options of either use the Green 1 or 3 lots – I had to make the decision on which lot specifically for which day.  Again, we always encourage carpooling as much as possible, as these passes are $9.20/pass. We are only charged for the pass claimed/used.

You should have already received an email from transportation@wsu.edu – THIS is not a SPAM email (be sure to check your junk mail if you are not seeing emails from them) I sent everyone on this email an invite for you to log into the parking services and claim a parking pass for each day.  Again, you only need to claim the passes you are going to use – and can be done the night before. 

It is a very simple process, and I have attached a handout that has some visuals to explain. 

1. Click on the link provided in the email
2. Fill out your information
3. Add a vehicle
4. Enter a correct licenses plate
5. Hit the “Complete guest permit” button
6. Find the next email and Repeat for each day you need a pass

***Note – for those with rental cars, you will just need to wait until you get your car before claiming your parking passes.

With DC’s next week, things are starting to gear up.  Below is more details about the upcoming week. There is a lot of information – PLEASE READ.

• Professional Attire: As this event is a simulated learning environment for our students once they enter their 4^th year and out into practice, we would like to ask everyone to dress in business professional during the week. Holding both the students and facilitators at the same level of professionalism.    

• A quick reminder the look through the Facilitator Folder on Microsoft Teams – Especially the “Facilitator Handbook” (for DC1 found in the PULLMAN Facilitator” folder) everyone should have access, please let me know soon if you do not.

• Clinic Folders (Digital Student folders)  – Everyone should have access to a 2^nd Microsoft Team called  “Student – CVM Diagnostic Challenge 1 or 2” and see their 2 clinics.

• Communicate with your Client During our meeting on Monday, you will need to determine the best way to communicate with your client (Microsoft teams, text, and/or email) – as long as you are consistent, do what works for the client and you. 

• Brief itinerary: (also in teams) This itinerary is only for times and subject to change (any major changes will be made Monday afternoon). 

• Parking Permits:  See earlier email for parking details – reminder: You need a new one for each day.  They are a bit pricey so we try to be careful with these and we encourage carpooling when possible.  **note parking passes for green lot #1 – next to the vet school & #3 – next to the Owen’s concourse – there is a difference and you have to park in the appropriate lots** 

• Travel Reimbursement: 
  • If you or your client have travel expenses, please make sure they keep their receipts and that they make contact with me to sign all the required paper work. 
    • If you are driving, we can reimburse fuel costs, but we have to have fuel receipts – please save your receipts.
  • All claims have to be filed within 60 days of expense, or they will be applied to your income and reflected on your taxes. 

• Monday meeting #1 –
  • 3:45 PM – Group Picture, meet in ADBF Lobby
  • 4 PM:  This FACILITATOR meeting will be held in ABDF 2018 (next to the elevator on the 2^nd floor).  As one of our goals is to get everyone out earlier.  The main focus of this meeting is to make sure everyone is on the same page this week and to cover facilitator ONLY issues. I will have parking permits.
• Monday meeting #2
  • 5:30 pm: The communication course will be finishing up, and we will not able to get into the rooms ahead of time.  After our meeting in Bustad we will walk over to the Owen’s Concourse to set up and meet our clients.  We will have a brief meeting cover logistics and then you will have the opportunity to discuss the case with your client.  We would also like to make sure everyone can log onto the CVM network from your workspace and that you can print to the local printers.  

• Appointments & Room Assignments:  Our first appointments start at 8:10 AM on Tuesday. 
  • Lobby Protocols –  Throughout the week – students will be asked not to congregate in the lobby as we have done in the past – we will ask them to not come into the lobby until 5 minutes prior to their scheduled appointment, unless their facilitator has requested them to arrive earlier. They are welcome to arrive at the Owen’s Library or museum across the hall, but just not in the small space we have.

• Food: During the DC, we will provide coffee, tea, and snacks in the back room of the communication center.  You can also get coffee and espresso at no charge from the Starbucks – starting Tuesday.  Just ask for details. Briefly, though, all you need to do is tell the barista that you are with the Diagnostic Challenge and give them your name.  There is a Campus Cart is in the Digital Classroom Buildings (Sparks Building) behind the Owen’s Library.  Please note also that there are WSU students operating the cart and there are sometimes problems with getting this all straight.  So be patient and let me and Jeff know if there are any problems. We will also have drip coffee/tea and snack in our backroom throughout the week (including lunches). 

To Do Before Tomorrow’s First Interview

• Meet with your client and partner facilitator to FINALIZE Day 1 of your case!
  • Make sure you AND your client(s) are ready for tomorrow AM!
    • Including what time you want them to arrive Tuesday AM
  • Any final touches for the case? 
  • Client name (It is best to change at least the last name so as to NOT use their real name). 
  • Animal name
• Set up your computer for the week. Get help as needed.
  • Logon to your Microsoft Teams folders! Make sure you have access to everything you need.
  • Can you log on to ALL of the teams folders you need?
    • Students Clinic Folders
    • Facilitator Folder
• Needed Websites:
  • The DC Facilitator home page: DC facilitator web page
  • Bookmark these 2 tabs: DC Student Page & DC Communication
    
• Make sure you have your clinic’s Teams Folder – Prepare case scenario AND appointment Post in Teams
  • Have it ready to email to BOTH clinics – late tonight or early Tuesday AM
• Prepare case materials, including printing off initial Physical Exam findings if needed – be complete
• Check radiology & consulting needs for your case and fill any gaps
• Check the lab data carefully and make sure it is in a format that is easy to use – ideally ready to email to your groups. “Compare the results to normal values and make sure there are no mistakes!”
• Review first meeting AGENDA for tomorrow morning.  
  • You will go through this itinerary with each clinic before they meet their client.
• Review the Facilitator Training Modules, especially the 5 microskills & Case Presentation: Review the example of a Case Presentation: from Sys Path earlier this semester (dog – “Duke”)
• Get any final questions answered !!

The One Minute Preceptor (5 Microskills)

1. Get a commitment
2. Probe for supporting evidence 
   (Why do you think that? Why do you say that?)
3. * Reinforce what was done right/well
4. * Correct mistakes
5. * Teach general rules / concepts

* order of these last 3 steps is not important

Try to teach by asking questions – NOT giving mini-lectures

Students need and really want feedback!

NOTE: We make it very clear to students that the Academic SOAP format is NOT the medical records format they will be using routinely in practice. It is designed to foster learning, critical thinking, and (when needed) an analytical approach.

At the end of each day: Please review the high yield problem and the students’ plan for SOAPing their problems.

High yield versus low yield problems: A high yield problem is a problem that has high diagnostic significance and is worthy of further consideration and/or diagnostic investigation. For the purposes of DC, a high yield may also be a problem in which writing a SOAP is likely to lead to significant learning. “High yield” does NOT necessarily mean there are a limited number of potential causes.

Jeff Abbott’s best practice:  Go through the SOAPs in real time with the students during a face-to-face session (client not present).  Students much appreciate this and it will likely save you time and effort.

Ideally, no student should be SOAPING more than  about 2-3 problems each night.  Of course some problems are pretty simple and quick, and they’ve SOAPed some problems before (like anemia, stress leukogram, increased liver enzyme) so these shouldn’t take too long.

It’s often good, especially if the number of active problems is small, to have multiple (even all) students SOAP central problems in the case (e.g. nasal discharge in an animal with possible fungal rhinitis or cancer).  One potential strategy in a case like this is to have them focus on different sets of DfDx – e.g. infectious versus neoplastic.

Expect written summary SOAP at end of each day’s SOAP – Be clear what are expectations are.

Ask your students to present their case at EVERY meeting

You should ask your students to deliver “rounds style” case presentations each time you meet with them this week – as we’ve been practicing this semester.   

In general, it works best if one member of the clinic does the case presentation, but 2 members can also share it. 

• Signalment, complaint, findings – delivered succinctly and efficiently 
• Problem List and Key Observations in case 
• DfDx – with rationale for each and explanations for DfDx ruled out 
• Dx Plan 
• Other Plan – notably treatment, client communications 

 THEN:  Probe for supporting evidence 

The debriefing session is Thursday afternoon (Day 3), where the discussion is an culmination of all the work everyone has done over the course of the week.  The students are excited to get feedback, which they will often use in their grand rounds presentations on Friday.

• PLEASE limit each debriefing session to no more than 45-60 minutes.  After about 50 minutes, not much more is heard.  More importantly perhaps, there is often another group or the other facilitators waiting.
• Use the Debriefing Agenda:  It’s best for the facilitator and client to go through the agenda BEFORE the session so that everyone knows the itinerary/plan.  A pre-debrief discussion is also a great time to preview and discuss what feedback you want to give, and ask questions.
• Use the appointment schedules to set both of your 2 groups. Communicate those times to both the students and client. The goal is to be completed by 4 pm.
• If you’ve not previously led a debriefing or just want to see how other experienced facilitators run their meeting, block off the 1:15 timeslot and WATCH ONE FIRST.  You are welcome to observe and then start your own session at 2:00 or 2:15.  We don’t all do debriefings the same but we should strive for some consistency.  The agenda helps a lot with this.
• Before you provide feedback, REMIND your students that what you are about to say is just ONE PERSON’S opinion, but you are trying to give honest feedback that you think will be helpful.  Of course, most of what we have to say is VERY positive.  Vet students don’t often get a lot of positive feedback, especially on a personal level.
• Make a plan to meet with your client on Friday to lead them to the correct grand round’s room
• Facilitator’s meeting in the lobby of the Communications Center at 4 PM.  Others are welcome to attend, especially the DVM’s who were clients.  We are interested in your impressions and feedback!

DC Grand Rounds will be held in on Friday (DC1 – 2 session – AM & PM; DC2 – 5 sessions ALL in AM). The presentations will go in the order listed for each room/session.  Each group will have 15 minutes for their presentation and 4 to 5 minutes for questions. 

We need to stick fairly close to this schedule in order to get through all of the presentations. For that reason, someone will be to in charge of the timer in each room. 

Your clinic teams will be assigned to separate rooms. Start in the room with the earliest scheduled time for your clinic, then move to the next room for the next session. Please bring your client with you, as they may not be familiar with the college layout, and remember to sit in the back of the room.

Questions – Please allow the students clinics to ask their questions first. If you start asking questions right away, it can make the students hesitant to speak up afterward.

We’re almost done, but there are still a number of tasks that need attention to bring the exercise to a close and make sure the case you facilitated is left in good condition for the next time it is used.

• Complete all required evaluations and feedback
• DC Case – update and organize – The goal is to leave the record so that it looks and works like you would like to receive it if you were facilitating the case NEXT TIME.
  • Facilitator Comments – “Notes for Next Time“: This is VERY Important!
  • Update and organize your case to be used again in Teams
• Complete CE Credit Requirements
• Complete needed paperwork and submit receipts for travel reimbursement and honorarium