Learner Model Abnormal Finding Reporting Policy

Definitions

For the purpose of this policy and set of procedures:

• A Learner Model (LM) is any person (student, housestaff, faculty, volunteer, etc.) participating as a model for a physical examination skill or ultrasound skill.
• Examiner will encompass any person (student, housestaff, faculty, etc.) performing a physical examination skill or ultrasound skill.
• Skill will encompass a physical examination skill or ultrasound skill
• Instructors will encompass any faculty, housestaff, staff or learner instructing in a skill session
• Observers will encompass other learners observing the skills being performed by others
• Staff are SOM personnel
• Licensed healthcare provider will encompass those credentialled to assess the LM for an abnormal finding

Purpose

This policy serves as a SOM guideline for how to report any abnormal findings of the LM in a consistent manner.

LMs Rights and Responsibilities

• Participation as an LM is voluntary, and individuals can withdraw at any time.
• Instructors should remind LMs that they can decline to be examined if they are uncomfortable or no longer desire to participate.
• LMs shall always be treated with respect by the examiners, instructors, staff, and observers.
• Prior to the examination, examiners shall explain to the LM what they intend to do and why.
• Parts of the body that may be examined include the chest (excluding breasts) and abdomen, head and neck, extremities, and transabdominal pelvis. Prior to the exam, the LM will be informed about which parts of the body will be examined.
  • No genitourinary examinations allowed except in special situations with trained LMs.
  • If the LM is uncomfortable with the parts of the body being examined, they should not volunteer and have the right to stop the procedure at any time if unexpected discomfort arises.
• If an examiner does not comply with these guidelines, LMs should stop the examination and immediately notify the course instructor or staff.
• Examiners shall maintain respect of the LM's pain limits. If the examiner is pushing too hard the LM should tell the examiner and any necessary accommodations should be made or the LM may tell the examiner to stop the examination.
• LMs should not be placed in an uncomfortable physical position for an extended period of time.
• For ultrasound examination LM may be asked to lie supine, prone, or lateral. Multiple examiners may scan the LM at different times. The LM will experience varying amount of pressure. Ultrasound gel will be used.
• If a LM is not feeling well, they should not attend the session.
• If a LM has any medical conditions that might affect their ability to participate, they may decline to be examined.
• LMs should tell the course director or staff if there is any chance that they may be pregnant; in this case a licensed healthcare provider is required to give permission to participate.
• LM information is kept confidential.
• LMs will be made aware that the scanning is educational and does not substitute for a medical examination.
• At no time will a LM's name or other identifying information be placed on ultrasound images.
• Incidental findings are handled discretely according to the process described below.
• It is important to remember that this is not a true medical examination, and while the LM will be informed of incidental findings, it is the responsibility of the LMs to consult a healthcare provider for workup and treatment.

Process for managing abnormal findings

Purpose: To respond in a consistent manner when examiners or instructors discover a potential abnormal finding on a LM.

• Most students will not recognize abnormal findings when they see them for the first time. Whether in the presence of the course director or faculty instructor or not, the potential abnormal finding should be confirmed by the responsible faculty or another licensed healthcare provider.
• If the abnormal finding is confirmed, that according to the supervising physician requires follow-up, this information will be forwarded to the Associate Dean for Student Affairs, Clinical Services. Following this notification, the Associate Dean for Student Affairs, Clinical Services will discuss with the LM and notify them using a templated correspondence (appendix) noting the abnormal finding, discussion, and suggested next steps. This letter will be transmitted electronically with return receipt by the Associate Dean for Student Affairs, Clinical Services. A copy of the letter will be saved by the Associate Dean for Student Affairs, Clinical Services and the Emory School of Medicine Office of Medical Education and Student Affairs.
• All unexpected abnormal findings should be mentioned privately to the LM, not in front of other individuals.
• If an examiner or instructor suspects an unexpected abnormal finding, they should stop examining that structure and they should privately inform the LM.
• If an examiner inadvertently mentions the possibility of an abnormal finding with the group, the instructor should wait until the session is over before addressing the issue unless believed to be a medical emergency.

Appendix: Correspondence Template

LM name and address

Date

Dear _______,

Thank you for attending the (event name) on (date) and serving as a simulated patient. As you are aware, (abnormal finding) was discovered. I understand that this information was conveyed to you verbally by the instructor and/or a (licensed healthcare provider), an (specialty) faculty member. Although the information was conveyed to you verbally, I wanted to make sure you had a written copy of the information.

This was an educational activity, and it was not intended to be diagnostic. Thus, no physician-patient relationship has been established between you and the providers present during the training, nor by virtue of this letter. We want to encourage you to use the information above to seek care with your (specialist) care provider. Please feel free to pass along this information to your care provider.

Sincerely,

Signature

Title