Program Curriculum

Physician/APP Preceptor Responsibilities

1. Effectively communicate to the observer, their role, and responsibilities in the program.
2. Ensure the observer adheres to the requirements of the program.
3. Introduce the observer to patients and obtain their verbal consent to allow observation of the clinical interaction.
4. Obtain prior approval from appropriate authority for the observation of any procedures.
5. Debrief clinical interaction with the observer after leaving the patient’s bedside and provide clinical teaching.
6. Provide feedback and complete an evaluation for the observer.

Observer Responsibilities

1. Follow the instructions of the physician preceptor and don’t spend time in a clinical setting unless scheduled and approved by the preceptor.
   1. An observer may not behave or speak in any manner that would lead a patient to believe that they are a practicing physician, on staff, at JHBMC.
   2. Observers must always be accompanied by a JHBMC attending physician when observing patient care activities.
   3. Should a patient request an observer to leave at any point during an encounter, the observer must leave at once.
2. Do not conduct physical examinations, treatments, or diagnoses of any patient. Observers cannot be involved in obtaining patient consent for any encounter or procedure (clinical or research).
3. Accept no compensation.
4. Follow the rules and regulations of the hospital, and the university always.
5. Adhere to Health Insurance Portability and Accountability Act (HIPAA) regulations.
6. Participate in any prerequisite training (e.g., HIPAA) at the hospital.
7. Pay for actual costs of administrative or prerequisite items.
8. Participate in activities (clinical tutorials, ward rounds, teaching conferences), and observe procedures and operations under the supervision of the preceptor.
9. Observe the use of electronic medical information systems, health records, laboratory, and radiology reports, etc., if available.
10. Research the general structure and organization of the U.S. health care system, as well as private sector and government payers.
11. Review clinical articles, posters, and publications per the discretion of their preceptor.
12. Arrange their own transportation, meals, and lodging.
13. Record Observership hours and confirm their schedule and responsibilities with the physician preceptor regularly.
14. Be professional (per JHHS/JHM Code of Conduct, HR905, dated 7/1/2022).
15. Uphold the integrity, mission, vision, and values of the organization.
16. Do not discuss any patient privileged information with anyone at any time, except for with the preceptor. This applies to both in and out of the hospital, and to the use of any oral, or written communication (including but not limited to social media).
17. Observers must be clearly identified to all patients and staff, and permission must be obtained from each patient (or proxy) for Observer to be present during any encounter.
18. Observers cannot publish any works that imply a formal affiliation with JHBMC.
19. Observers cannot obligate JHBMC financially or suggest or imply that they are acting with the authority of JHBMC.

Note: An observership does not include participation in direct or indirect patient care or management, nor constitute medical training. An observership is NOT a clerkship/subinternship, nor an experience that should confer academic credit.

Division/Program Leadership Responsibilities

1. Ensure and monitor compliance with all applicable JHU/SOM/hospital policies.
2. Ensure and monitor completion of required training such as HIPAA.
3. Meet weekly with the learner to ensure learning goals and objectives are being met and to discuss any issues e.g., any alleged misconduct or mistreatment, physical and mental wellness, etc.
4. Refer the learner to appropriate health providers in the case of any mental or physical health issues.
5. Report misconduct to relevant University and/or School of Medicine officials, including (in the case of Title IX matters), the office of Institutional Equity.
6. Documentation and collection of documents regarding immunizations, health screens, health insurance coverage, criminal background checks, OSHA training.

Assignments

Before starting the program, observers will:

1. Complete all mandatory HR orientation online modules assigned through myLearning.
2. Complete the assigned online e-modules.

During the program, observers will:

1. Maintain weekly log of self-identified goals in a SMART format (Specific, Measurable, Actionable, Relevant and Time-bound).
2. Write weekly reflections on their learning process.
3. Present chalk-talks during daily bedside rounds.
4. Present an interactive case report with literature review on an approved topic in their last week of the program. This conference will be attended by division faculty.
   Note: Failure to submit assignments in a timely manner will result in early termination of the program.
5. Meet biweekly with the division’s R.I.S.E (Resilience in Stressful Events) counsellor.
6. Meet with the program director mid-rotation and at the end of the rotation.
7. Attend divisional conferences, house staff morning reports and noon conferences, and hospital medicine and department grand rounds.

At the conclusion of the program, observers will:

1. Fill out the confidential rotation feedback and evaluation form (for programmatic and faculty assessment).
2. Comply by the organizational rules and policies to conclude their program (e.g., returning any badges, borrowed materials from the division etc.).
3. Not contact other members of division (Except the program director or the coordinator) for any communication. If the observer wishes to maintain communication with any division preceptor that they observed during the program, an explicit written permission from the program director must be obtained in advance.

Recommended Text and Other Materials

• Osler Residency guide
• Pocket Medicine: The Massachusetts General Hospital Handbook of Internal Medicine
• Clinical Problem Solvers Podcast
• UpToDate: electronic clinical resource tool
• Global Morning Report (Human Diagnosis Project)

Evaluation and Grading

Formative

1. Observers are encouraged to reflect daily on their progress and prioritize their learning goals, which should be communicated to the program director at the beginning of the observership. This can enhance the specificity and quality of feedback and will promote lifelong learning skills.
2. The program director is expected to provide frequent, informal feedback. The questions below can help guide this informal feedback:
   • What did the learner notice? (about communication, observations of patient, patient’s room, physical findings, etc.). Develop thoughtful observation skills.
   • What are the most important things we do not know the answer to yet?
   • How does learner do with targeting questions, rather than posing general question about a diagnosis
   • Learner can voice their diagnostic reasoning
   • What was the interpretation of an exam finding done in the room?
   • Does the learner embrace humanistic, patient-centered approach to care?
   • Does the learner demonstrate self-directed learning?
3. Mid-rotation written feedback: A copy of the midpoint feedback form will be filled out by the observer to document their self-reflection on progress relative to program objectives. Another copy of the same form will be filled out by the program director who will solicit feedback from supervising attendings, based on the observations of the observer’s progress and performance. The program director and the observer will then meet and engage in feedback. The goal of this exercise is to provide a safe space for the observer to celebrate success, acknowledge gaps in skills and to formulate an action plan for improvement. Note: While the information documented on the Mid-Rotation Feedback Form will not be used in determining the successful completion of the program, the observer must submit the completed Feedback Forms to the program director to receive a certificate of completion.  Failure to comply will result in early termination of the program.

Summative

1. The program director will, using input from supervising attendings, complete the “Observer Performance Assessment Form”. The ratings and comments on the assessment forms will be compiled by the program director and provided to the observer to support their career growth.
2. The observer will give a case-based presentation at the end of their Observership and attendees will complete a short evaluation form.
3. The observers will read through one of three optional cases (e.g., chest pain, shortness of breath, or syncope) and write a SOAP note focusing on the assessment and plan.  The observers' note will be assessed with a pre-designed scoring rubric.

Grading

The program director and the education committee will review the summative assessment and determine if the observer has successfully completed the course.