Proactive Advising In The Medical School Setting. November 5, 2012

Transcription

1 Proactive Advising In The Medical School Setting November 5, 2012

2 Panel Tom Koenig, M.D. Johns Hopkins University School of Medicine Amy Fleming, M.D. Vanderbilt School of Medicine Emily Frosch, MD Johns Hopkins University School of Medicine Mercedes Rivero for James Hill, Ph.D. New Jersey Medical School Norma S. Saks, Ed.D. Robert Wood Johnson School of Medicine

3 SESSION Goals Proactive Advising Why use it in a medical school setting? How can this approach be utilized to counter the culture of silence that exists among our students? Illustrate how this approach is utilized in different medical school advising programs. What are the pros and cons of utilizing this approach?

4 Let s Start With A Story: The Power of Silence Do you recognize any of this?

5 Setting: Outstanding University of Clinical Health Known as O.U.C.H. Has multiple health professions schools including nursing, dental, allied health professions, and medicine Medical school utilizes a traditional four year curriculum

6 Dean of Students of OUCH Medical School Dr. Goodheart 57 year old pediatrician Member of OUCH faculty since completing residency Beloved teacher and faculty mentor Asked to become Dean of Students because of how well she works with students

7 Dr. Goodheart s Students First Day

8 Two Weeks Later A Little Stunned

9 First Exam: What the

10 Second exam: This is not good

11 Winter: Three and half years to go

12 I must be the only one

13 Survival Strategy: Keep Quiet!!!

14 Join The Culture of Silence

15 What do you do about this?

16 What is Dr. Goodheart supposed to do? She has all of these silent students She encounters many students with problems who often don t let her know until it is too late She sometimes feels as though she wants to ask more early on but is unsure of when and how to do this

17 Attends AAMC meetings To help her learn about how to manage in her role and get ideas about what to do she attends AAMC meetings She hears many good things and goes back to OUCH and starts Wellness activities A study skills program

18 Advice for Dr. Goodheart How have our panelists used proactive advising to address the culture of silence in their programs?

19 Johns Hopkins University School of Medicine Colleges Advisory Program Emily Frosch, MD Associate Director Colleges Advisory Program

20 Colleges: Basic Structure Advisory Molecule S Career Advising Clinical Skills: CFM S F S Relationships: Students, Faculty, Peer Advisors S S Nathans Thomas Taussig Sabin

21 Learning Community: Group sharing common values & beliefs, actively engaged in learning together & from each other Four essential elements: Membership Influence Fulfillment of individual needs Shared events, connections McMillan & Chavis, 1986

22 Year 1: Advising Touch Points Colleges Inductions Meet Peer Advisor Advisor Mtgs begin Winter Holiday Celebration White Coat Ceremony Anatomy CFM Retreat Meet Advisor & Molecule Olympics! End of Year 1!

23 Advising meeting topics Academic issues study habits/outcomes Physical Health issues new/old/wellness/illness Mental Health issues new/old/wellness/illness Social issues friends/relationships Financial issues loans/expenses/supports Family issues expectations/responsibilities Future issues models/connections Extracurricular issues creative/service/other

24 New Jersey Medical School (NJMS) Proactive Advising Program Mercedes Rivero for James Hill, Ph.D. Associate Dean for Student Affairs

25 Components of Proactive Advising at NJMS Early assessment Required periodic advising meetings Early alert systems tied to grades and other performance measures Use of peer faculty and peer mentors as part of our learning community system

26 Early Assessment Every student is asked to complete an intake form during first year orientation We emphasize that this is voluntary and the information is kept confidential Meet with one of four staff members for minutes Referrals made if necessary Information used in tracking process

27 What We Assess This has evolved over the past four years to include: Educational / Academic History Family History Language History Psychological History History of Reading Difficulties Financial History Coping History Motivation

28 Tracking Students are seen: If they fail any exam If there is a significant change in their exam performance

29 Preparing for step 1 Recognizing the stress and meaning attached to this exam we meet with each student individually to assess their approach to preparing and current state.

30 Career advising Each student is met with multiple times throughout their time in medical school regarding this issue and significant time is spent assessing motivation.

31 Proactive Academic Support at Robert Wood Johnson Medical School (RWJMS) Norma S. Saks, Ed.D. Assistant Dean for Educational Programs & Director, Cognitive Skills Program

32 Academic Support at RWJMS Philosophy of promoting self-directed lifelong learning Cognitive Skills Program 2.5 faculty trained in educational/cognitive psychology consult individually about study & test taking strategies, time management, USMLE preparation PASS Reviews Course content small group sessions with M2 peer teachers Peer Tutoring

33 Student Outreach Prior to Matriculation Survey to accepted students: What are you looking forward to in medical school? What are your concerns about medical school? Information from survey is shared during orientation program to advertise academic support services

34 Prematriculation Outreach to Students Potentially At Risk for Academic Difficulty: Letter sent to students with admission number(s)* 2 or more standard deviations below the mean *MCAT scores; GPA Science; GPA Total Advises of student eligibility to attend M1 content review sessions. Students encouraged to schedule appointment with a CSP faculty member to discuss study strategies for medical school. (Not mandatory.)

35 M1 Proactive Academic Support Orientation presentation with skits by M2 students about learning & test taking challenges in medical school. Seminars for M1 students on study & test taking strategies & time management (3 during first month). Handouts regarding effective & efficient study strategies & for studying course specific material are distributed.

36 Vanderbilt University School of Medicine The Colleges Vanderbilt Careers in Medicine Vanderbilt Wellness Amy Fleming, MD College Mentor

37 Learning Community Structure

38 Early Introduction to Support and Advising Support: academic, wellness, professional Community: peers, college mentors, course directors, faculty, office of student affairs Weekly: colloquium, office hours Events: College cup, service Family events Self Assessment and Reflection Colloquium Wellness retreats Personalized learning plans

39 Personalized Learning Plans An approach to advising, education, career planning that takes into consideration a student s strengths, weakness, and goals Improving self-assessment and identifying areas for improvement Mentor Student meetings every 6 months Self assessment + outside assessment Career exploration Learning objectives

40 Personalized Learning Plans Students comfort discussing concerns with their college mentor in PLP meeting

41 Key ideas Continuous relationship with mentor Creating a Community Self assessment/ identification of areas for improvement Communication

42 Case Examples: What would you do to help?

43 Monica: Aspires to be Dr. Goodheart Grew up wanting to change the world Had a wonderful pediatrician who helped her cope with childhood asthma and decided that she wanted to be just like her doctor a caregiver who can make a difference

44 Has a Lot of Ideas Very interested in community health and healthcare policy Has been thinking about also pursuing an MPH because she wants to understand healthcare systems better

45 Develops a Student Service Project Has an interest in promoting healthy nutrition in the local community and starts Project BITE to educate local children about healthy eating She asks Dr. Goodheart to become the faculty advisor for this student group

46 Medical School Has Ups And Downs Highly thought of student because of her service interests Passes her courses in first year but fails at least one exam in each course - does not reach out for help

47 Crisis Point Fails pathology course in second year Is required to see Dr. Goodheart

48 What would you want to know?

49 What Dr. Goodheart Learns In addition to being very active in school service work Monica has been dealing with some significant family and personal stressors Her mother has been unemployed since Monica was a college senior Monica has also been working 20+ hours per week as a MCAT tutor to help her mother out

50 Questions For Our Panel Would your proactive programs have identified Monica s problems earlier? What would you recommend that Dr. Goodheart do differently to detect and address problems that students might be having in their lives outside of school before these issues impact performance?

51 Jose: The American Dream Born in a small Latin American town and immigrated to the US at the age of 19 Acclimated well and completed college with a bachelor s in biomedical engineering Is interested in returning to his country of origin one day to help the medically underserved

52 Adjustment To Medical School Early on he passed most course exams but had trouble on shelf exams and this always brought down his grade Developed anxiety that was manifest in testing situations but since he was passing he didn t say anything

53 Crisis Point Became increasingly more anxious about his ability to perform as a physician when he reached third year. This became evident to residents and attendings working with him and they suggested he see Dr. Goodheart.

54 What would you want to know?

55 What Dr. Goodheart Learns Jose reports that although he has passed his previous courses he hasn t felt as capable as his peers. He began feeling this way in first year because of his problems with shelf exams. He has dealt with this by trying to avoid thinking about it but finds that he is now doubting his ability to be a physician.

56 Questions For Our Panel Would your proactive programs have identified Jose s problems earlier? What would you recommend that Dr. Goodheart do differently to detect and address mental health issues that develop during medical school that might impact performance?

57 Rachel: Why am I here? Rachel has done very well since beginning medical school honoring all of her basic sciences courses Her father, an alum of OUCH, is a cardiologist and is very proud that Rachel, the oldest child in the family, is following in his footsteps

58 Mixed Emotions Rachel does well on each exam without having to try much. She keeps this quiet because she knows how hard her peers work. She is generally pleased that she is doing well because she knows how happy it makes her father who calls everyday to offer encouragement.

59 Crisis Point Shortly after beginning third year clerkships Rachel was noted to be repeatedly late and acting as if she was not taking her work seriously. She was required to see Dr. Goodheart.

60 What would you want to know?

61 What Dr. Goodheart Learns Rachel admitted to feeling as though she couldn t take on the responsibility of caring for patients and never really wanted to do this She had always dreamed of being a chef but did not want to disappoint her father who felt that being a chef was unacceptable and would not be living up to the family tradition (seven members of the family had been physicians) Dr. Goodheart got a bit emotional (angry) when hearing about the father s expectations

62 Questions For Our Panel Would your proactive programs have identified Rachel s problems earlier? What would you recommend that Dr. Goodheart do differently to detect and address issues related to motivation earlier?

63 Some Final Advice for Dr. Goodheart

64 The Benefits of Proactive Advising: Helps Change the Culture

65 The Challenges of Being Proactive Must balance concerns over confidentiality carefully with value in detecting issues early. The proactive approach requires a huge investment in staff hours.

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