Goals

Objectives

Exercises, tactics

q Computer / Operating system skills

Send questionnaire to incoming Rs ahead of time

Computer concepts

- Terminology

Know items in the survey questionnaire

References, books, parts of several lectures

- How a computer works

Understand CPU, memory, secondary storage, I/O devices, backup devices

Morning conference, Block 3

Know what happens when a program loads and runs

"Computer Boot Camp"

- Computer hardware

Be able to set up a personal computer system out of the shipping boxes.

Workshops for residents together

- How to use & care for your notebook

Physical security and passwords

- Distribute laptops, instruct in use

Battery care

Configuring your own system

- Practice tasks on network

- Basic computer survival

Using computers on a network

- Use Logician as example application

Logging in and out of network

Exercise for R1s in pairs

Opening applications

- Find own schedule in Logician

Privacy and security

- Find patient contact information

- Dealing with common problems

Technical support sources

Distribute quick-reference card

Using on-line help

Using undo, backing out of applications

Dealing with frozen application or system

(Using Cruisepads)

Taught individually as need arises

Goals

Objectives

Exercises, tactics

q Computer housekeeping

Working with files and directories

Morning conference, Block 3

Formatting diskettes

"Computer Boot Camp"

Installing & removing programs

Customizing your work environment

q General office applications

- Word processing

Know about reading level analysis

Skills session on Patient Education: CJZ
Session #2 first year.

Prepare a memo

Prepare a CV

Project during Practice Management rotation

Be able to prepare a case presentation for publication

Part of "scholarly activity" requirements

- Spreadsheets

Use and build a spreadsheet calculator

Diagnostic cases exercises in Block 3

- Presentation packages

Assemble and give a lecture using presentation software

Morning conference, Block 3

Prepare a handout for a lecture

"Use of PowerPoint in Medical Presentations"

- Calendars & scheduling

Review daily office schedules

Do morning conference schedule planning

- Personal databases

Document procedure/diagnosis experience

Database application to install on notebooks

Goals

Objectives

Exercises, tactics

q Communication technologies

- E-mail

Create messages

E-mail tutorial as part of introduction to Meditech and PHAMIS

Use E-mail manager

Use residency general E-mail system TBA

Use a directory to look up E-mail addresses

Use E-mail to deal with patient calls, refill requests

Use Logician EMR messaging system.

Use voice mail to store messages for patients

TBA

- Internet

Understand Internet basics & terminology

Morning conference, Block 3

Know equipment & software needs

"Using the Internet": DAN, GHB, CJZ

Use a browser

Use a search engine to locate medical information

Internet access through FPC & Hospital systems

q Troubleshooting

Be able to address and deal with technical

Taught individually as problems occur

q How to use technical support

problems as they arise

Goals

Objectives

Exercises, tactics

q Basing evaluation and treatment on evidence

Overview of evidence-based medicine

What is good evidence?

Morning conference: Block 1

- Usefulness equation:
usefulness = Validity x relevance / work

"Evidence-based medicine":

Truth as a probability statement

Dealing with uncertainty

Morning conference: Block 1

POEMs vs DOEs vs YUCKs

"Overview of Journal Club"

What EBM is not

Role of CME

Role of medical experts

Know wise use of experts in answering a clinical question

q Harmonizing evidence-based medicine with clinical experience

Realize that evidence and clinical experience both have important roles in patient care

Foster questions about evidence to be addressed in topics chosen for teaching conferences

Modifying evidence-based management to the individual patient

Encourage resident conferences to address both clinical cases and "best evidence".

Goals

Objectives

Exercises, tactics

q How do we acquire knowledge?

The medical literature

Identifying "high yield" journals

Morning conference: Block 3

What and how to read

"Journal Club: Triaging Journals"

- Knowledge creation journals

Understand how to screen relevance - TOC

Understand how to screen validity - abstracts

Understand purpose of letters to editor

- Knowledge translation journals

Throw-away vs academic journals

Know difference between classic review and systematic review

On-Line Indexing

Know how to use MEDLINE

Individual R1 sessions with librarians at

- Know three ways to get search results

St. Luke's and Mercy

Dealing with uncertainty

Accept changes and limitations of medical knowledge

Morning conference: Block 3 "Dealing with Uncertainty": CJZ

Recognize limitations of personal clinical experience, amount of uncertainty in daily practice

Learn cognitive approaches to uncertainty

Be able to deal with uncertainty in patient encounters

"Murphy Hobson" clinical case simulation

- Understand emotional effects
Learn practical strategies

Goals

Objectives

Exercises, tactics

q Guidelines

Understand the guideline development process

Morning conference: Dr. Dobyns

How guidelines are written

possible Noon conference also

How to find guidelines

Evaluating guidelines

Implementing guidelines in clinical care systems

Lecture: "Implementing Guidelines":
Dr. Geerlofs or CJZ

Use guideline-based care templates & features of EMR

Evaluating usefulness/validity of medical literature and guidelines

Know differences among basic studies, meta-analyses, and guidelines

Understand statistics

Morning conference: Block 1

- Sensitivity, specificity

"introduction to diagnostic testing": CJZ

- Statistical significance

Morning conference: Block 3

- ROC curves & sensitivity analysis

"Diagnostic test exercises & cases":

Understand concept of clinical relevance

Goals

Objectives

Exercises, tactics

Evaluating diagnostic tests

- relevance to practice

- validity

Know role of a reference "gold" standard for comparison

Morning conference: Block 1
"Introduction to diagnostic testing": CJZ

Understand how and why the value of a test is affected by the nature of the target population

- importance

Understand concepts of sensitivity, specificity

Understand use of Bayes theorem to relate pre-test probability, post-test probability, and likelihood ratio

Morning conference: Block 3:
"Diagnostic test exercises & cases":

- practicality as applied to patient

Know role of availability, affordability, acceptability in test selection

Be able to gauge accuracy and precision in practice setting

Understand potential effects on patient management and outcomes

Be able to weigh benefits and risks

Goals

Objectives

Exercises, tactics

Evaluating information about therapies

- relevance to practice

Know how relevance is affected by prevalence of the problem, patient-oriented view of effects, potential to change current practices

Morning conference: Block 3:
"Evaluating therapy choices"

- validity

- determining importance of effect

Be able to compare relative risk reduction, absolute risk reduction, and number needed to treat as they apply to therapeutic interventions

Morning conference: Block 3:
"Choosing therapy: exercises & cases"

- application to patients

Understand the difference between potential benefit to individual patient and potential benefit to the population

Know how to relate choice of therapy to the patients values and preferences

q Evaluation based on local population-

- Screening principles

Applying statistics and Bayes theorem

Morning conference, Block 1

What makes a good screening test?

"Screening principles": CJZ

The USPHS screening task force guidelines

- The screening physical

Goals

Objectives

Exercises, tactics

QA activities

Search & query patient population records

TBA Use EMR capabilities

Modify approach to treatment based on population/ risk factors

Drug utilization

- Explaining evidence to patients

Teaching patients to evaluate information

(see Patient Education curriculum)

Dealing with patient expectations

Shared decision making

q Aids to evaluation and treatment

- Clinical decision support

Be aware of computerized tools to aid clinical decisions / diagnosis

Morning conference: Block 3 "Dealing with Uncertainty": CJZ

Understand problem-knowledge coupling

Skills session 2^nd year: "Computer-Assisted Diagnosis": DAN

Goals

Objectives

Exercises, tactics

q The nature of information

Morning conference: Block 3: "Introduction to medical databases": DAN

q Principles of documentation

Know why we keep medical records

Workshop for R1s (2 hrs) DAN

Understand what constitutes a medical record

Session on "Medical Records" during Practice Management rotation

Criteria for reliable documentation

Logician user training

q The Problem-oriented record

Know reasons for keeping POMR

Workshop for R1s "POMR" (2 hrs) DAN

Know what a problem list is

Logician user training

Know difference between POMR and SOAP note

q Classifications, coding

Be aware of coding resources

Workshop for R1s: Tashia + another faculty

- FlashCode

- Use example exercises

- CPT-4 and ICD-9 codebooks

Understand E&M coding of office & ER visits

Logician user training

q Appropriate but efficient documentation

How to focus on agenda

Workshop over lunch late in block

How to eliminate repetition, unnecessary words

- Give examples of long dictation and have

Flowcharts

residents revise them

Need to document every visit

q Privacy and security of health information

Morning conference: Block 3 "Protecting privacy and confidentiality in health care": DAN

Goals

Objectives

Exercises, tactics

q Database principles

Morning conference: Block 3: "Introduction to medical databases": DAN

q Principles of search & query

Know how to formulate valid & relevant questions

Ongoing- day-to-day clinical questions, "Educational prescriptions"

q Use of computerized patient information

Know how to access Logician

Included in basic skills workshop

Know how to access Meditech system

Session with Mercy IS staff (2 hrs)

- login, retrieve patient lists

- retrieve patient lab, X-ray, dictations, etc.

Know how to access PHAMIS

Session with St. Lukes IS staff (2 hrs)

- login, retrieve patient lists

- retrieve patient lab, X-ray, dictations, etc.

q Structure of the patient record

Included in EMR training

q Automated data collection

Structured data entry

Use of visit templates, part of Logician

Patient generated information

Instant Medical History?

q Retrieval in multiple formats

Flow sheets

Progress notes

Goals

Objectives

Exercises, tactics

q Automated reminders

Part of EMR training and use

q Integration of data sources (lab, X-ray, ER)

Using Logician reminders, flags

q Collection/retrieval without walls

q Retrieval of valid medical literature and guidelines

Know basics of how to use Patient Ed

Workshop IFM (2 hrs): CJZ, TAM

- Start up program and log in

- Exercises in information finding

- Find a given template, adjust a prescription

- R1s work in pairs

- Print results

q Just in time information

Be able to access the FPC CD resources
- AFP online

4^th Wednesday exercise on "Just in time" information

- Flash Code

- Drug Facts and Comparisons

- MAXX

- STAT!-Ref

- The Cochrane Library

- United Way Services Directory

Goals

Objectives

Exercises, tactics

q Communication and learning principles

Know seven adult learning principles

Morning conference: Block 1
"Adult learning principles": CJZ and RHB

q Communication to patients

Know how to notify FPC patients of lab results

Incorporated into tour of FPC

Know principles of phone triage

Luncheon meeting with chief residents

Appreciate timeliness in handling patient messages

Individual R1s spend time as message nurse

q Personalized patient education

Recognize and understand that patients have differing belief systems and cultural backgrounds

Morning conference during Patient Education topic block

q Integrating behavioral science with communication tools

Know principles of communication as they relate to technology

Morning conference: Block 3

"Patient Education: the physician-patient-computer relationship": CJZ

q The physician-patient-computer relationship

Understand effects of information technology on the physician-patient relationship

- review research, feelings, ways to adapt

Be reassured that computers need not harm ones relationship with patients

Know how to use the computer to improve the physician-patient relationship

Goals

Objectives

Exercises, tactics

q Design of medical care systems

- Quality improvement

Understand process control

Morning conference: Block 3

Understand error trapping

"Errors in medicine": CJZ

Know mechanisms for preventing errors

- Chaotic systems

Be able to describe / define chaos theory

Morning conference: Block 3

Recognize chaotic systems

"Dealing with Uncertainty": CJZ

Know how principles of chaos theory apply to medical decisions and interventions

- Outcome measures

Know how to measure patient satisfaction

Resident involvement in Quality Workgroups

Know how to use patient satisfaction data

Other activities TBA

- Efficiency

Be able to recognize and solve system problems to improve efficiency

q Communication with third parties

- Consultants

Know how to formulate and express specific questions

Resident consultant letters reviewed by faculty (CJZ) with specific feedback

Foster collegial relationships

Residents formulate specific questions for lecturers in planning morning conference topics and schedule

Be able to use POMR principles to communicate

Workshop for R1s "POMR" (2 hrs) DAN

. Automated referral letters

To be implemented in EMR

- Nurses

TBA

- Administrative staff

- Hospital - Payers

Goals

Objectives

Exercises, tactics

q How to buy a computer

q Programming and programming languages

q Designing information resources

q Knowledge bases, Artificial intelligence

q Controversies in informatics

q Research in informatics