All right, all right, okay, okay, thank you. All right, everybody, thank you so much for being here this afternoon. We're so thankful for you being here. And we're going to talk to you about wanting to be a preceptor. Also, our presentation is Precepting and Competency-Based Education. So Dr. Kral and I have no confidence of interest or financial disclosures. And our goals for today are to introduce educational concepts that are used to educate and evaluate residents on their path to becoming independent physicians, like everybody here in the room. Almost. I think we may have a resident here, too. Yeah, great. And we want to give you the tools to help you work with the residency program. Oh, okay, good. This gives me a chance to do it again. All right. All right, everybody, my name is Anna Nobis. Thank you for being here this afternoon. I'm very excited to have you. So we're going to talk today about how to be a preceptor. We have no financial disclosures or conflicts of interest. And our goals for today are to introduce educational concepts used to educate and evaluate residents on their path to becoming independent physicians and to give you tools to help you develop your own rotation that you can then offer to a residency program. So by the end of this session, you should be able to define competencies and milestones, formulate learning objectives for your rotation, describe other ways to become involved with residency programs, and then we're going to touch briefly on feedback and practicing some of those feedback skills. So just to let you know, I know many of you in the room, actually, but to let you know who's here speaking with you, my name is Anna Nobis, and I'm the Interim Assistant Medical Director at Vanderbilt in Nashville, Tennessee. How many of you have been to Nashville? Okay, great, great. So we're the home of hot chicken and honky tonks. So if you're ever in town, please reach out. We'd love to show you around. I'm not at work. I'm taking care of my three children, my 7-year-old daughter, Eva Rose, and my 4-year-old twins, Joanna and Juliet. So an interesting fact about me is I have twins, and I'm married to a twin. Hi, I'm Pam Kral. I'm the Residency Program Director at the Uniformed Services University in Bethesda. I live in Maryland, but not actually in Bethesda. I'm over in Annapolis. I've got one daughter who's, unbelievably to me, getting ready to head off to college here in the summer, so we did her big tour around from East Coast to West Coast over the summer, but she's all set. So that's me. Yeah, thank you. Thanks, Dr. Kral. All right, so just to get to the crux of why we're here, yes, some of you recognize this man. Probably many of you know him. The reason why Dr. Kral and I are here is to encourage you to become involved in residency education. And the reason I put a picture up of Dr. Peter Orris is because he has been one of my most influential teachers. And I want you to kind of think back over your own training and your career and reflect on those people who really made a difference, who made an inflection point on your life. And for me, Dr. Orris definitely did that by showing me not only how to be a physician within the clinic, interpersonal skills, but what it means to be a physician outside of the walls of your institution. So he taught me that to be an OEM physician is an opportunity to advocate for social justice. So I'm very thankful to Dr. Orris, and if you see him, tell him you saw his picture up in a presentation. So I would like for you guys to share, if you're willing, who has been influential in your life as a teacher. Dr. Orris as well. Yes. Great. Why did he make a difference for you? Oh, I mean, I think he was influential in a lot of ways. But he helped show me a lot of the work-life balance importance as well. And, you know, not everything. I guess in addition to what you mentioned, it would be about work-life balance and about continuing to be that example and leading by example, whether you're in the workplace or not. Thank you so much. Anybody else have someone they would like to share about who made a big influence in your life? Yes, sir. Dr. Harris from Chicago. Thank you. Anthony Harris. Another Peter, Peter Greeney, who's at the conference now. OCDOC out of California, but, you know, grew a pure health organization to over 700 employees. So huge impact in terms of how to scale your practice in such a way that you just make a bigger and bigger impact. Thank you so much. Two more people. Anybody else want to share about a very important teacher? Yes, sir. And tell us your name and where you're from, please. Hi. Cody Heiner from Boise, Idaho. I trained at the University of Iowa and had some great preceptors there. Fred Gerr was one that stands out in my mind. He was clinical and master's in public health preceptor and professor and really taught me to think critically and to analyze the data and always ask the question, like, how do we know what we think we know and do we truly know what we think we know? So that critical thinking piece has been very important for me. Great. Thank you so much. And I can echo that. Shout out, because I worked with him as a med student then. I'm going to give him a shout out. Wow. That's awesome. Anyone else want to share about a teacher that made an impact in your life? Okay. Well, if at any point you want to, just please let us know. And, you know, again, the reason is we want you to get involved with education. As we know, satisfaction at work is informed by autonomy, mastery, and purpose. And I strongly feel that getting involved with teaching can really help you meet that purpose piece. So Dr. Craw, I'm going to hand it off to Dr. Craw. She's going to get a little bit more into the details here. All right. Well, this is just going to be a little bit of background for you. I think most everyone is familiar with the ACGME, so the accreditation body. Think of it as like the joint commission for education programs and ensuring the quality of the education that we provide to residents. You know, there's 12,000 residency and fellowship programs, 182 specialties. Our specialty, though, there's only 24 programs total. So just to kind of give an idea of where we are in the larger scope. But you should know that a lot of what happens specific to each specialty through ACGME is done by the residency review committee. And that committee is comprised of volunteer experts from within our own specialty. So the residency review committee for occupational medicine does include all three of the preventive medicine specialties. I would mention if you haven't heard about it, there is a current proposal that looks like it is likely to go through this summer. If you look currently in listings for occupational medicine through ARIS and things like that, you won't see it. You'll just see preventive medicine, and we're kind of tucked under the umbrella of preventive medicine. The change that's been proposed is to list each of the three preventive medicine specialties separately is the first part of it, so there would be more visibility and the ability to actually see the data specifically for occupational medicine. And it would change us from occupational medicine to occupational and environmental medicine, so OEM as opposed to OM. So what is a competency, right? I mean, you know, that's what we're kind of talking about. So let me first ask, we've got kind of a spread of folks. I think, let's see, who went through residency training in the era of competency-based education and is totally familiar with all this stuff? Because I didn't. Yeah, so we've got people who did, maybe some who haven't. So, you know, when did this change happen? I think it was, I don't know, a little while ago. Anyway, so it's an observable ability, right, of a health professional, and it has components of knowledge, skills, values, and attitudes. So what is observable? Okay, we've got a quiz. Who can find the heart in this picture? Can anybody find it? It's kind of tricky. Or you can shout out any other things that you see that are odd in there. I'll give you a hint. Look up toward the banana. Maybe it is a hot dog. I don't know. Anyway, the heart is right there. There's the heart. Kind of hard to see. So I think what we're trying to say is sometimes, you know, observing these things can be challenging, right? And so that's part of what preceptors do, is to try and make the observations that it takes and give the feedback that it takes to help people on their path to getting where they need to be. So the ACGME competencies, every specialty, so all of those 182 specialties all have the same six core competencies that are considered to be core to being a physician, and you can see those there. It's the subcompetencies that are actually what are specific to each specialty and work through with the RRC. So what are the milestones then? Because, you know, all this language can get very confusing, but the milestones are actually kind of markers of how someone is going down that path to get to where they can practice autonomously. What can they do? What can they be entrusted to do? So milestones are progressive over time, right? But there's not a prescribed speed at which a resident is expected to progress on each of them, and they won't progress evenly on each of them. You know, it all depends on what the experiences are that they're having through the course of their training. So this is kind of the summing it up in a picture, right? You know, you start here, you're brand new, you kind of work your way and you learn more. You get time, practice, and experience, and you work your way on up to being proficient and then being an expert. So they're not graduation requirements. There was a lot of confusion, I think, when milestones were first instituted a few years back, that this was going to be something that was required, and it's not. At the end of the day, it's a program director that says, yep, I think you're ready to go and do it. But I wanted to point out that is not done in a vacuum, right? So the clinical competency committees are key for every residency program, and it's definitely an opportunity if you want to get involved with residencies, and if you're precepting or doing other things with a residency program, you can become involved on their clinical competency committees. So they review twice a year all different aspects of what goes on in the development of a resident. And I show this because it's not just, you know, oh, your in-service exam scores were good, great, check, moving on. No, it is far more than that these days. So, you know, I would say in our program, we use everything on here except for case logs. So this is just a generic sort of example of what can go into evaluations. But definitely all of these are a part of it. Some things that you may not have heard of, the OSCE, it's like an objective structured clinical evaluation. I mean, for us, we have a wonderful resource at our institution to be able to put on these OSCEs for our new residents. And then after a year of training, we use standardized patients, and we have standardized cases, and they're observed and get to provide feedback. And then our senior residents then watch the incoming residents and provide them with feedback as well. So they get a chance to sit on both sides of the equation there and practice. We also get peer evaluations. We get rotation evaluations from preceptors. We have them self-evaluate where they think they are. So all of this goes together. It's kind of a big deal, although twice a year when we do the clinical competency committees, to go through this for all of our residents. So the six general core competencies you can see there are around the outside. When the milestones first came out, all of the underlined ones here were all identical between occupational medicine and public health and general preventive medicine. In the newest version, version 2.0 of the milestones, there is more of a difference between the two specialties. Occupational medicine's new 2.0 milestones came out last summer in July, and preventive medicines are coming out this July. So I got a chance to look at those and kind of compare, and there's definitely more differences than last time. Definitely the 2.0 version I think is more user-friendly than the first version. I see some other residency PD folks. I don't know. I think they're a little bit easier than the last one, certainly. So just to kind of lay it out and maybe try and make it make more sense all of what I was saying about competency and sub-competency and milestone for those who aren't familiar, this is what it actually looks like in the document. This patient care there is the general competency, and patient care one is the sub-competency, which happens to be history and physical examination. And then the developmental levels, so that progress along the way, levels one through five, and then the specific milestones are here for each level. So when we have to rate them out, like for the clinical competency committee, if they meet one of these milestones and not the other, then you end up kind of in between the two levels is basically how it goes. So you can get the idea that it's a pretty involved process when we're going through and trying to rate these milestones out. And so, you know, that's just to give you an idea of how many of these there are. So there's six for patient care, three for medical knowledge, four for systems-based practice, two for practice-based learning and improvement, one for professionalism, and three for interpersonal and communication skills. So if you want to refer to them at the back end of this presentation or handout that you have, they're all there in detail for you. So the other thing that can sometimes get confusing is that ACOM also publishes core competencies, right? So when you look in the ACGME program requirements for our specialty, it actually calls out that our rotations should address the ACOM core competencies. So there's ten areas of the ACOM core competencies that you can see there. They're much more, to me, granular and specific and maybe somewhat easier to apply to a specific rotation. I think they're great when working with preceptors and putting together objectives for a rotation. It's easier to kind of put into context. So just to give an example, this is just to show how they're broken down. The core knowledge and skills kind of expected of anyone who's practicing within the field. And then there's additional knowledge and skills, which some people may have and some may not. So it's not necessarily something that would be required for everyone. But it can give you an idea of how you can frame out rotation objectives depending on what you happen to do. Not everyone practices differently in occupational medicine, depending where you are or what you do. And having a wide breadth of preceptors gives a chance to give the residents all of the different opportunities that they need so they can move all of these milestones. You know, if you just stayed in one place, you'd get really good at that one area, but you wouldn't get all of the breadth of the different milestones that are out there. I think the ACOM core competencies are great for that. So I just have one bit more to give you regarding ACGME-type things. The ACGME is also interested in making sure that not just what the residents learn, but the environment that they're learning it in, recognizing that the system in which you're practicing and the culture that you're around all impacts your development as a physician. So the clinical learning environment reviews are something that was started about five years ago. And they're mainly looking at six areas, patient safety, health care quality, the care transitions, supervision, well-being, and professionalism. So in terms of setting up rotations with preceptors, we try to make sure that they're aware of ACGME duty hour rules, that it's usually an issue for our residents, but certainly something to be aware of. There's requirements for appropriate physical spaces. And then being attuned to the resident's wellness is key as well. And then last, supervision. So just a word on supervision. Direct supervision, you're right there with the resident when they're seeing a patient. Certainly that's required for all interns, PGY-1 residents. Usually we only have folks come in at PGY-2. We do usually suggest some direct supervision until you get to know someone, and then you can move to indirect where you're right there. And then oversight is just providing review after care is provided. So supervision is fine to move through those levels. It's just basically you have to do it deliberately in terms of where the resident is and are they able to move forward that way. And now I'll hand it off to Dr. Novick. Thank you, Dr. Krull. So hopefully that gave you an idea about competencies and milestones, kind of introducing the language that you would be seeing if you were to host a resident at your clinic or hospital. So we're just going to touch briefly on feedback. So feedback can make some people uncomfortable, right? But it shouldn't. It should be seen as a tool to help residents, OK? We don't want them to continue making a mistake, going down the wrong path, and then carry that on into their professional career. This is the time to try to correct any bad habits or deficits. So it's very important when you're hosting a resident, you want to set a roadmap. You want to know, what are they working toward? What do they themselves feel that they need to work on? And how can you guys work towards that together, using maybe the SMART goals? Specific, measurable, attainable, relevant, and achievable within the time that you're going to be together. So when you do have to have some slightly uncomfortable conversations, you want to make sure you're kind of in a private environment, taking time to gather your thoughts, and then spend some time listening to the resident, get their thoughts on how they feel they're doing, and see if it matches up with your own impression. And make sure, if you are addressing some deficits, that you've got some specific examples. And don't go by hearsay. And again, you want to develop a plan and also understand how you're going to measure improvement or progress. So as Dr. Kral was saying, resident evaluations, they're part of the whole clinical CCC committees that meet twice a year. And it's very important to be honest, not only in your feedback to the resident while they're with you, but also when you're documenting it for the program director. So it's very problematic when what you're saying to the resident, or not saying to the resident, doesn't match up with what you're reporting to the program director. So it's also very helpful to provide feedback halfway through the rotation, as well as at the end. Again, to give people time to improve. So at the end of the day, though, remember, feedback is a gift. They have to decide what to do with it. So you've got to give it your best shot, but then it's up to them. And just a word about the struggling medical learner. So if you do have a resident that is not meeting expectations, please take the time to try to figure out what's going on, either by talking with the resident, if you feel comfortable, or elevating the concern to the program director. As we know, life is complicated, and there's all kinds of things going on. And there's a lot of demands on residents. So if anything kind of falls apart in terms of relationships, or as we know, sometimes mental well-being can be a time when problems arise. Please, again, make sure to elevate those concerns, and don't just let things go unchecked. So at this point, we're going to ask you to pair up and practice providing feedback for scenario one, and then switch roles and provide feedback for scenario two. So you guys want to pair up for just a moment? Don't be shy. Don't be shy. We're all in here together? Make it, everybody. Make it. Hi. Hi. Hi. There you are. We'll take about 10 minutes. So five minutes per scenario, please. I have a question. I have a question. Please. Yes. I'm Dr. Perez. Yes. Nice to meet you. Is he here already? I don't know, because I'm trying. OK. And you are? Yes. Nice to meet you. I think I can participate in this one here. Are you Miss Pan or Pan? Pamela? Yeah, yeah. Pamela? Yeah. Hello, Dr. Perez. Hi. How are you? What do you prefer? That's the only question I have. Or feedback. No more. OK. Thank you. Thank you. What time is this going to cut out? Let's see. It's 10 o'clock. It's OK. It's maybe like 1.20. OK. Not good. Yeah. Yeah. Yeah. Because then you can, you can get a little too excited. Yeah. Because we have a session now. We're learning objectives now. So we'll have time for that. Yeah. But at this time, we do have a session. OK. I'm going to go around and come back. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. OK. So anybody want to share what that was like? Was it uncomfortable? And how did you phrase it? Anybody want to volunteer? I'm going to call on someone like they do in the classrooms. Yes, sir. Well, it's not that great. And tell us where you're from. Neil Haas. I am from Augusta, Maine, right now. Well, actually, I'm not sure. But that's where I work, where I'm from. But one of the things that I approached was just starting with commentary about the general approach. And I had to assume an interaction of what the resident had done with the patient, and tried to give some positive commentary about the thoroughness of the evaluation, or the examination, and asked him about how he felt about his interaction with the patient. And of course, my resident had read the scenario. So he admitted that he felt like his interpersonal style wasn't as good. And I asked him to offer things about that. That's about as far as we got. I take my time with patients, too. That's good. All right, anybody else? Anybody else? Was the recipient defensive at all, or was everybody thankful for the feedback? Anybody try to? Dr. Harris? No, this is good. I played the role of the resident. And it's historically the opposite of how I have been as a resident. So it was good to embody that perspective of being apprehensive to communicate, or apprehensive to seemingly engage. And the role play was very eye-opening in terms of how I interact with residents now at UIC in regards to giving them the feedback. Because I am reluctant, on the other side, to give critical feedback at times, realizing that, is it really worth it? Is it going to benefit them the way I want? But this allowed me to feel comfortable in that exchange. Thanks, Dr. Harris. And as I was talking with our Montreal colleagues, we have colleagues here from Montreal, it takes practice. And as people know, I do not like confrontation at all. And I try to avoid it. But if you can develop a good relationship with your residents, then they know that that feedback is coming from a place of encouragement, and not necessarily negative criticism. So all right, wonderful. So again, it just takes some practice. Let's see, did we? Oh, yes, OK. So if you want to become a preceptor, how many of you here are community practitioners? Not necessarily affiliated. OK, all right. And the rest of you guys are with a university or academic medical center? OK. We already are preceptors. Yeah, you guys are already preceptors, so that's OK. Future or past. Future or past. Yeah, either. Or present. What are you doing these days? Me? Preceptor, probably. A preceptor, probably. Probably I am a preceptor. I don't know. You can tell me, please. What I am now? A preceptor? I don't think so. OK, we'll go back to the first slide. Preceptor just means that you are hosting residents and helping to train them. So let's see if this link, let's see, how can we get to the link? If you want to find a residency program, I don't know if it's going to work on here, unfortunately. But you have access to these slides, and this will give you a full list of the different OEM programs around the country. And that's one way of reaching out to program directors. We're also willing, from the academic section, to serve as liaisons. So once you decide to become a preceptor, you do have to approach the program director with some learning objectives. What is the program, what is the resident going to gain from spending time with you? And also, it is important to acknowledge, having trainees does take time, right? It's an investment that you're making. But it's, again, very fulfilling and rewarding. So some of the documents that you may need to complete are Memorandum of Understanding or Program Letters of Agreement. So how many of you have practice writing learning objectives? OK, good, good. So for those of you who don't, we're just going to go over some basic building blocks. So you want to start with the phrase, at the conclusion of this activity, the participant should be able to do something. And you want to use specific action verbs. You want to avoid vague words such as know or understand, which are very hard to measure. So this is a list of measurable verbs, which if you are doing any of these verbs, then it indicates that there's some critical thinking going on, OK? So this would be a very good list to refer to. These are words and phrases, on the other hand, that you want to avoid, just because they're so general. And again, they're just too hard to measure and pinpoint. So we're going to do one more exercise, and then I promise we'll stop with that. But once again, if you want to pair up, but maybe this time with someone different. And I want you guys to practice writing three learning objectives, three things that a resident would gain from coming to work with you. So I will put this list up. All right, one more time to just get up and pair up. Yeah, I mean, because if you're just sitting here, you're sleepy, I guess. Yeah? Right after lunch. Oh, I know. Did you have lunch? I did. Yes. I went to Austin Street. I was like, oh, dude, I love Austin Street. Oh, my god. I didn't even want that lunch. I just had something. I know. I went to the little, the brasserie here, but I just got some oatmeal and a croissant, because. I just wanted something small. Yeah. Yeah. And now it's $32. Yeah. Because I was at the Hollywood Buffet, and I was like, I don't want to go anywhere. It's a Sunday brunch, and it was delicious, but it was not. I had breakfast. Yeah. Are you staying at the Little America? Yeah. OK. I'm staying at the Little America. Yeah, this is still happening. I know. And now I'm sad, because I wish we could access the links, but. Right. Right. But I don't know. I guess it's a good thing. Yeah. So it's $1.23. We'll give them maybe until $1.30. OK. And then, yeah, because we're not. We don't have that much left. Yeah. Yes. That's a good idea. Oh, it's a hot dog. Thank you. Yeah. Yeah. Yeah. Yeah. It's just very good. It is gorgeous. And did you see that? Yeah. It's really good. Really good. I think this is the middle of the competition. Mm-hmm. Leadership Seminar was yesterday. I think it was. Yeah. Oh. Yeah. Yeah, you're right. Yeah. A few more minutes. Mm-hmm. Oh, gosh. I mean, I prefer this. I think so. Yeah. I mean, I thought about that because, like, you know, it's people. I mean, so we don't have a resume. But we have a resume. I don't think so. I don't think so. I think we're in a good position. I think we're in a good position. A lot of them are NPs. But I'm going to see if I can put in a reach. But helping them might be, because they might be sticking to them. Might be saying, yeah. Yeah. Yeah. Yeah. Yeah. Yeah. can we have a few volunteers who feels like they have a winner of a learning objective. Yes sir. If you could say your name and tell us where you are coming from. My name is George Moore. I'm from the University of Connecticut Health Center and I think the number one, well for our rotation medical, we receive medical residents and one of the main objectives is to complete an occupational and environmental history by the end of the rotation. Thank you. Who else would like to share a really good learning objective? Let's see. Perfect. All right. Coming over to you. At the conclusion of this rotation, at the conclusion of this rotation, residents should be able to assess for military exposures and illness. One more. Anybody have one more? One more example? Yes sir. I'm coming back over to you from Maine maybe, right? We think? Okay. Maine question mark. We assumed, I work in a community or hospital-based occupational medicine clinic and we assumed an environment with a new occupational medicine resident who's coming with us for the first time and who's mainly been in an academic environment and the one of the issues that I find is a misunderstanding of how the workers' compensation system works. So the goal would be for the resident to understand the difference in the way that we approach a patient who presents for a workers' compensation claim versus evaluation of a chief complaint in a primary care environment. Differentiate. Okay. Got it. Right. Yeah. That's excellent. Right. Feedback. That was constructive feedback. Thank you. Thank you. Wonderful. All right. So let's see here what else we have. All right. Also I want to note that we, the academic section, are proposing something called the virtual lecture access point and library called Polly for short. So if you do have residents rotating with you that could be a resource. Essentially it's going to be a website supported by ACOM where different residency programs can post live lecture links. So for example if I were part of the residency program in at Meharry in Nashville and I have a great speaker coming up next week I would post that link and then my colleagues in OEM programs around the country could tune in live. They will be recorded and then filed into a library so that you could access it later. So just keep that in mind. That's kind of on the horizon and that could be an educational tool. So any questions about any of this? It's just, yes sir. Yeah they should be. Yeah we turned them in on time and everything so. If you don't see them for any reason you know where to find me. Yes sir. I think that anyone who's dealt with ACOM for a while knows that a substantial portion of our membership is not formally trained in occupational medicine. Most of us are physicians or board certified in occupational medicine but a substantial minority or board certified in other things like family medicine and internal medicine. The other the other prelude to to my question is that most of us have probably worked in environments where we have a lot of associate clinicians working and most of the time none of those people receive formal training in occupational medicine. So how would you approach a person who is not a resident but still needs to be precepted versus a resident? Okay good question. So are you talking you're talking about like a nurse practitioner, physician assistant? Okay okay yeah. You know I think some of the basics are gonna apply whether it's for a resident or for you know a fellow physician. You know in terms of coming from a place of respect and trying to connect and then you know offer something with you know specific observations and constructive. I think at the end of the day that feedback is still a gift that they can choose to accept or not. I really appreciated that part that Anna added in there. You know I I think that it yeah I understand it can be a little more you know daunting perhaps to offer that but I think you know hopefully if everyone goes through the same process and everyone has learned some of these core competencies and has some amount of reflection they should appreciate someone taking the time to offer their experience and and hopefully to learn from it because I you know if you're changing fields you know you'd hope that that you would recognize that someone has been doing it for a while is gonna have something to potentially offer. One of the things that I usually do is to ask the new person a lot of questions to see where their understanding and training level is. You're talking about assessing where they are at this outset as opposed to yeah. Yeah I mean I think what you point out is a great point though. It's good to get to know whoever it is at the beginning when you first meet them regardless of who they are, whether they're a resident. It's kind of part of that setting those goals kind of figuring out where they are and kind of setting out a plan you know to move forward. Yeah does anybody else have other thoughts on this? I was just gonna add to that I think that's great and I think we even even for those who are trained in occupational medicine for those of us who are in a very specialized area of OCMED like I were medical center occupational health it's a very specific environment. Residents may or may not have a lot of training in that throughout through their residency so even board certified or you know residency trained occupational medicine physicians may need additional precepting and help in whatever environment they're in so I think to his point it's just kind of figuring out where you're starting from so you know a residency trained individual might have some of the more of the basics down but may still need that you know stepwise help whereas somebody who wasn't residency trained may just need to back it up just a little bit farther. Different question how would you change or tailor this when you're working primarily with medical students instead of residents? That's a great question Pam I don't know if you what I mean so it's a good question I don't know if I have the complete answer yeah we have started well we have some medical students occasionally Laurie is my boss everybody so so just tell her how great I did okay after this you know so we have some medical students occasionally and I guess the way I approach it differently is I just started a more basic level and I have a PowerPoint that says you know what is occupational medicine and it talks about the history of occupational medicine and so I provide that but let me see if other people have something they want to add might have more experience with this difference than I do. This is just a plug okay Kathy Fagan I'm a semi-retired I'm in Cleveland but I'm gonna put in a plug I'm with the environmental health section and we have a session tomorrow at 11 called Ramazzini and Hamilton go to medical school so and we have a bunch of people who are doing stuff with med students and it's gonna be really a fun we'll have a lot of discussion too so come. That was developed by Dr. Marion Claren from University of Maryland so she has developed a whole OEM curriculum for medical students that her meds her undergrad is instituting yeah. So I have a little bit different of a question but so you've you've set up the resident rotation of the medical student rotation what do you all find as being successful to get students or residents into the rotation because it's going to be elective they have to want to do it or at least decide to put it down instead of something else like neurology whatever there's a ton of other specialties so. Thank you again anybody have experience with this that's met with some success yes Dr. Myers and then I can add my thoughts. Hi I'm Sonia Myers from Kaiser and San Jose I actually trained at UIC for med school and residency and we actually have a med as a selective within family medicine and it's a one-week rotation it's not very long but we it's it's actually short it's not it's it's a short short rotation but we get to learn a few things and it's like people talk it up and it's word-of-mouth throughout the medical school you and you see it in the rotation rotation feedback so and I was just gonna say real quick have you heard of ACOM ambassadors okay that is a new program they have a whole slide set developed for and they're looking for ambassadors to go to medical schools and present to different med student groups about what ACOMED is and you know I would say that now if it was due we have a preg med student peers group so our residents get involved too and they interact with the med students and try to get them to learn more about it and then hopefully after the first part you get them interested and then hopefully you give them a good enough experience that yeah the word is spread so yeah first you gotta get them to at least look and then you gotta give them what excuse me so I just yeah I just wanted to give a actually a success story so we have in the University of Connecticut Health Center we have a one-month elective rotation and we receive the medical residents and last year we had a resident that after the first week of the rotation she said I'm gonna apply for ACOMED she she said she was looking for something like that and as soon as she learned about it she and when she started she knew nothing about ACOMED and so she she was second year then she applied and she got into Yale and she's here presenting a poster in during this rotation success story that's that's wonderful and I'm just gonna say real quick what I've done at Vanderbilt is I've gotten in touch with like our Dean of Medical Students Dean of Student Affairs and I've let them know like hey you know I'm in this field and if there's anybody that either expresses an outright interest or it maybe doesn't know they just know they don't want to do inpatient medicine or something like that send them my way and we do we have someone like that and she's gonna go into preventive medicine hi everybody my name is Linda force from University of Illinois Chicago and these guys were residents they're attending one thing that we just did was we developed a MD MPH for that can be done within four years and one of the core courses that those students have to take is called environment toxicology and disease so it's the occupational health that that core course and so there there's quite a lot of interest in the program and then they'll get you know that that really is you know the occupational disease course is really the only sort of clinically relevant course in public health that's specifically clinical so all right yes yes ma'am can you tell us where you're from my name is Martin by a show I am from University of Montreal so I've been developing undergraduate medical education occupational medicine for the past 15 years and we've had we've have a lot of different things but what I would like to say is the the students in Montreal and or in Quebec they really get on hold an occupational medicine when you link occupational medicine to environment because they're very environmentally anxious and when you get that link it really you know brings them up and also the social justice part of occupational medicine also that makes really a big difference also with the clinical part because when you're teaching medical students you know you have to most of them are going to go into clinics so we're trying to help them you know approach a patient the worker as patient and and all that but social justice and linking with the environment I find those are things that really work what time is it dr. crawl do you know okay I just want to say one more thing linking it to social justice when the residents are with you they're in your care and one thing that we've been discussing at our institution is what to do when a resident is when a patient or maybe another staff member makes a racist comment okay either intentional or unintentional we call those microaggressions so you may if you're somewhere where you think that might happen you may want to sit down with the resident beforehand and say hey here's how I plan to handle that if it happens or get their thoughts because some studies have shown some residents prefer you know immediate interventions some residents prefer kind of to let it happen and then step outside of the patient room and have kind of a debrief and not necessarily involve that patient but it's just something to be aware of you know no one should have to feel disrespected in their workplace we'll take two more comments real quick and then we'll wrap up good afternoon everyone I'm Carmen just Carmen you want to know more I'm very happy to be here I just have a quick question for Amelia and Dr. Nogler. Would you like a medical student with you, a rotation in this group? It's up to you. I am not in your group. But I have to hear one of you. And I would say, oh my goodness, my question is interacting with him because I asked my question to him. Okay? And his equation did not. So, keep him there. Bye. Okay, thank you. I appreciate it. Advocating. Thank you. Thank you. Do you want to ask your question or you're good? You're good. Okay. Thank you everybody so much. Please feel free to reach out to Dr. Kralerai in the academic section. Okay. Oh, you are so kind. Oh, thank you. I think you came to visit our institution at UIC back in 2013 or 14. Oh, really? There was somebody from you since you showed up. I don't think it was me though. It wasn't you? You work with John Downs, right? I do, yeah. But I don't think it was me. Okay. Well, you have a good memory. I was like, oh. I just want to talk about the four pieces of bystander intervention. Okay. And it's a distract, distract, distract, delineate, and delegate. You get that every year in our section. Yeah, I'm just now starting to learn about it. Yeah.

precepting

competency-based education

feedback

residents

competencies

milestones

learning objectives

supportive learning environment

preceptors

occupational medicine rotations