Medical Education Planning & Development Basics February 11, 2015
Family & Community Medicine Chaney Conference Room Workshop Agenda
Time Didactic Exercise Ref/Handouts 12:15-12:30
Introductions; Why do this; overall program; expectations, projects, etc
Discussion/Q & A Introduce project to work on through in workshop
Project Plan worksheet
12:30-12:40
Learner-centered ed; learner needs; Dreyfus level of learners—Novice—Master; Pathman Model
Discussion regarding residents as learners Table, pg 23
Kern Ch 2 Pathman Model
12:40-1:10
Developing Learning Objectives for learners and course/activity: learner, process and pt outcomes objectives
Write learning objective; share with peers; group feedback Table pg 78
Kern Ch 4 Learning Objectives Primer
1:10-1:40
Adult learning theory; competency based education; educational strategies; matching ed methods to objectives Promote Effective Presentation Skills March 11
Determine strategies for your activity; share w/ peers; feedback from group Follow up session: Effective Presentations Mar 18
Kern Ch 5 Ten Aspects of Learning for Effective Teaching (Viggiano)
1:40-2:00
BREAK
2:00-2:45
Learner assessment & Feedback: formative and summative; feedback strategies; summative assessment strategies
Practice with feedback strategies; Develop learner assessment strategies for activity Follow up sessions: EPAs & Milestones and Assessment & Feedback sessions June 5; Dealing with Difficult Learner Sept 9
Kern Ch 7 Preceptor pocket card
2:45-3:15
Implementation and Program evaluation; resources needed; timeline; overall program evaluation; stakeholders; methods for program evaluation; logic model
Develop implementation plan; identify needed resources; potential barriers & challenges; design overall program evaluation plan
Kern Ch 6/8 Logic model Data collection plan
3:15-3:35
Scholarly work: Making it Count Twice Recap from Viggiano presentation Jan 23.
Review examples of publications/posters/MedEdPortal publications Follow up session: Ed Scholarship Mar 11; Abstract Writing May 13
Kern Ch 9 MedEdPortal
3:35-4:00
Debrief: Key learning points; next steps Schedule on-site coaching
Each participant feedback key learnings; areas of uncertainty Flesh out activity plan template and review with table-mates
2/11/2015
1
Faculty Development
Medical Education Planning & Development
February 11,2015
Nancy Davis, PhDRuth Weber, MD, MSED
1
Workshop Outline
• Introductions/Overview of Fac Dev program
• Learner centered education
• Learning objectives
• Educational strategies for adult learners
• Learner assessment & feedback
• Implementation & program evaluation
• Scholarly work: make it count twice
• Debrief/next steps
2
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Your Needs‐‐Introductions
• What are your specific gaps?
• Your project
• Program timelines
• Interim activities
3
LEARNER CENTERED EDUCATION
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Learner Needs Assessment
• Perceived needs
– Individuals preferences
– Practice attributes
• Actual needs
– Practice/systems data
– Observation/feedback
– Regulation/mandates
5
Dreyfus Model: Novice Expert
Dreyfus and Dreyfus, 1982
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Developmental Stages of Learners
LevelTraining
LevelExample
Novice Beginning student
• Introductory lectures, web exercises
• Group work on case studies
Advanced Beginner
Advanced student
• Students apply concepts in a “project” at the academic health center
•Teacher is model and “coach”
Competent Post graduate training
• Apply concepts to his or her own panel of patients in interprofessional team
Proficient Early practice• Regularly review and improve care for patients
Expert Advanced practice
• Develop novel ways to understand and improve systems of care
Medical School Years 3&4
Residency
Medical School Years 1&2
Fellowship and Practice
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Methods for Stage of LearnerPathman/PRECEDE Examples
Stage/Method Awareness Agreement Adoption Adherence
Predisposing Lecture
Grand rounds
Enabling Champions
Clinical precepting
Problem‐based small group
Clinicalprecepting
Simulation
Reinforcing Role‐play
Feedback in practice
Reminders
Audit/Feedback
Davis DA, et al. The case for knowledge translation: shortening the journey from evidence to effect. BMJ 2003;327:33
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DEFINING COMPETENCE
Competency is defined as the observable behavior that combines knowledge, skills, values, and attitudes related to a specific activity
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Medical Knowledge
Patient Care
Interpersonal Communication
Professionalism
Systems‐based Practice
Practice‐based Learning and Improvement
ACGME Core Competencies
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Family Medicine Competencies
• Disease prevention and health promotion
• Critical thinking skills in patient care
• Patient safety
• Advocating for individual and community health
• Coordination of team based care
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EDUCATIONAL DEVELOPMENT
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Educational Development Cycle
1. Problem Identification
& Needs Assessment
1. Problem Identification
& Needs Assessment
2. Goals & Objectives2. Goals & Objectives
3. Educational Strategies
3. Educational Strategies
4. Implementation4. Implementation
5. Evaluation & Feedback5. Evaluation & Feedback
13
LEARNING OBJECTIVES
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Your Overarching Goals and Objectives
Program (activity) goal/aim
What do you hope to accomplish?
Program Objectives
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Goals/Objectives: SMART
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Interface of Learning Objectives and Teaching Strategiescase studies
projectsexercises
projects critiquesproblems simulations
case studies appraisalscreative exercises
problems develop plans EVALUATION
Teaching Strategies Related to Learning
Objectives
exercises constructs appraisecase studies simulations assess
exercises critical incidents choosepractice discussion SYNTHESIS estimate
demonstrations questions arrange evaluatequestions projects test collect judgediscussion sketches compose measure
review simulations ANALYSIS construct ratetest role play analyze create revise
assessment microteach calculate design scorereports compare formulate select
lecture learner APPLICATION contrast organize valuevisuals presentations apply criticize manage
video writing demonstrate debate planaudio dramatize diagram prepare
examples COMPREHENSION employ differentiate proposeillustrations describe illustrate distinguish set upanalogies discuss interpret experiment
Cognitive Processing Dimension
explain operate inspect→ KNOWLEDGE express practice inventory
define Identify perform question list recognize schedule relaterecord restate shop test
Learning Objectives
repeat translate sketchuse
Adapted from: Bloom, B.S. (Ed.), Engelhart, M.D., Furst, E.J., Hill, W.H., & Krathwohl, D.R. (1956). Taxonomy of educational objectives: The classification of educational goals. Handbook 1: Cognitive domain. New York: David McKay.
Ellen F. Goldman, EdD 11-1-2010
17
Learning Objectives ExamplesCognitive Level Action Verbs Behavioral Learning Objective Example Teaching Strategies Examples Assessment Strategies
Knowledge
Learners will
“know” something
new
Define
Describe
List
Record
Repeat
Learners will be able to list the five risk factors
of MI
Lecture
Video
Audio
Written exams
Oral exams
Pre/Post
Comprehension
Learner will be
able to “convey”
their new
knowledge.
Discuss
Explain
Express
Identify
Recognize
Restate
Translate
Learners will be able to explain the Krebs Cycle Question
Discussion
Learner presentations
Writing
Written exams
Oral exams
Pre/Post
Learner presentations
Writing critique
Analysis
Learners will be
able to “analyze
and interpret” new
information
Analyze
Calculate
Compare
Contrast
Criticize
Diagram
Differentiate
Distinguish
Experiment
Question
Learners will be able to analyze a fishbone
diagram for cause and effect of a problem
Problems
Exercises
Case Studies
Critical incident analysis
Discussion
Assessment of:
Problems
Exercises
Case Studies
Critical incident analysis
Root Cause Analysis
Evaluation
Learners will be
able to “evaluate”
situations or
concepts based on
what they’ve
learned
Appraise
Assess
Choose
Estimate
Evaluate
Measure
Revise
Score
Select
Value
Learners will be able to evaluate best treatment
plan based on efficacy and cost
Case Studies
Projects
Exercises
Critiques
Simulations
Appraisals
Assessment of:
Case Studies
Projects
Exercises
Critiques
Simulations
Appraisals
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1. Create a stem…
– After completing the lesson, the learner will be able to . . .
– After this unit, the learner will have . . .
– By completing the activities, the learner will . . .
– At the conclusion of the course/unit/study the learner will . .
2. Add an action verb
– Use verbs from Bloom’s taxonomy list
– Determine the actual product, process, or outcome.
Writing Educational Objectives
http://www.educationoasis.com/curriculum/LP/LP_resources/lesson_objectives.htm
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• Goal/Aim: 25% of all Family Medicine residents will complete a longitudinal QI project over the next academic year.
AVOID CHOOSE• Vague verbs
“Know how to …” Explain, describe, discuss
• General terms Be as specific as possible
Example of Program/Activity Objective
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Examples of Learner ObjectiveNot so good:
The resident will understand quality improvement methodology and the relevance to their future careers in medicine.
BETTER:
After completing the year‐long curriculum, each resident will be able to:
• Define steps of a PDSA cycle (knowledge)
• Explain the importance of quality improvement in medicine (comprehension)
• Perform a RCA (application)
• Diagram a process map (analysis)
• Design a QI project (synthesize)
• Evaluate performance data (evaluation)
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Another Good Example
After completion of this course the learner will be able to:
define Root Cause Analysis (RCA);
recognize which clinical situations require RCA;
explain why RCA is important;
demonstrate mutual respect on interprofessional teams;
and have performed an interprofessional mock RCA.
What is the highest level of cognitive processing this faculty expects her learners to achieve?
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Your Project
Develop SMART Objectives for:
Your activity
Your learners
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EDUCATIONAL STRATEGIES
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Interface of Learning Objectives and Teaching Strategiescase studies
projectsexercises
projects critiquesproblems simulations
case studies appraisalscreative exercises
problems develop plans EVALUATION
Teaching Strategies Related to Learning
Objectives
exercises constructs appraisecase studies simulations assess
exercises critical incidents choosepractice discussion SYNTHESIS estimate
demonstrations questions arrange evaluatequestions projects test collect judgediscussion sketches compose measure
review simulations ANALYSIS construct ratetest role play analyze create revise
assessment microteach calculate design scorereports compare formulate select
lecture learner APPLICATION contrast organize valuevisuals presentations apply criticize manage
video writing demonstrate debate planaudio dramatize diagram prepare
examples COMPREHENSION employ differentiate proposeillustrations describe illustrate distinguish set upanalogies discuss interpret experiment
Cognitive Processing Dimension
explain operate inspect→ KNOWLEDGE express practice inventory
define Identify perform question list recognize schedule relaterecord restate shop test
Learning Objectives
repeat translate sketchuse
Adapted from: Bloom, B.S. (Ed.), Engelhart, M.D., Furst, E.J., Hill, W.H., & Krathwohl, D.R. (1956). Taxonomy of educational objectives: The classification of educational goals. Handbook 1: Cognitive domain. New York: David McKay.
Ellen F. Goldman, EdD 11-1-2010
25
Educational Strategies
• Content ‐‐‐Flows from learning objectives
– Schedule of events
– Written material
– Resources for additional learning
• Educational Methods
– Cognitive, affective, psychomotor
– Use multiple educational methods
– Feasible with available resources
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Cognitive Objectives
• Readings
• Lecture
• Discussion
• Technology based materials
• Problem based learning
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Affective Objectives
• Targeted Reading
• Exposure
• Facilitation of openness, introspection and reflection
• Role models
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Psychomotor Objectives
• Supervised clinical experience
• Simulations
• Role‐plays
29
Learner Centeredness
• Formal/informal assessment of learner needs
• Tailoring of content/methods to meet learners’ needs
– Modify /add to curriculum
– What objectives are critical, desirable but not critical, feasible
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Special considerationsPractice‐Based Learning and Improvement
• Locates, appraises and assimilates evidence from scientific studies related to patients health problems
• Demonstrates self‐directed learning
• Improves systems in which the physician provides care
Methods:
Independent learning projects
Individual learning plans
Self assessment/chart audits
31
Special considerationsSystems‐Based Practice and Teamwork
• Provides cost‐conscious medical care
• Emphasizes patient safety
• Advocates for individual and community health
• Coordinates team based care
Methods:
• inclusive health care teams
• feedback on cost of care
• work in disease management programs
• participate in QI and safety teams
32
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Special considerationsProfessionalism
• Demonstrates professional conduct and accountability
• Demonstrates humanism and cultural proficiency
Methods:
• Role modeling
• Facilitated reflection/discussion of experiences embodying professionalism
• Peer evaluations
• Honor Council
33
Your project…..
Look at your objectives…..
What educational methods will be most effective and feasible?
What resources are available?
What time is involved?
Will your curriculum involve PBLI, SBP and/or professionalism?
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LEARNER ASSESSMENT & FEEDBACK
35
Feedback
• Individual Learner– Formative
• Improve performance
– Summative• Grades/promotion
• Curriculum/Program– Formative
• Improve effectiveness
– Summative• Resources, External requirements, Promotion, Publication
36
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One Minute PreceptorMicroskill Strategies
1 Assess prior knowledge Assess learner knowledge/experienceEstablish goals for encounter
2 Get a commitment “What” questions: what is going on? What would you like to do?
3 Probe for evidence Encourage learner to think out loudWhy do you think that’s so?
4 Give positive feedback Reinforce what was done rightUse specific, behavioral examples
5 Identify and correct mistakes Specific and focused: “That drug is often a good choice, but not with renal failure.”
6 Teach the general rule Chose a rule at learner’s levelConsider competencies other than “knowledge” eg, communication, professionalism
7 Encourage reflection and promote self directed learning
“What do you feel you did well?”“What do you need to study?”
Irby DM. The One‐Minute Preceptor. First presented at the annual Society of Teachers of Family Medicine Predoctoral meeting. Orlando FL Feb 1997
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Standardized Students
• Break into dyads
• One person is student, one is faculty member
• Five minutes to roll play
• Group discussion about how it went….
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Your project
• What will be evaluated?
– Think of your objectives…..
– Measurable
• What forms/implements will you use?
• What resources will you need?
• Who will do the evaluation?
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IMPLEMENTATION PROGRAM EVALUATION
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Logic model and common types of evaluation
Needs/asset assessment: What are the characteristics, needs, priorities of target population?
What are potential barriers/facilitators?
What is most appropriate to do?
Process evaluation:How is program implemented?
Are activities delivered as intended? Fidelity of implementation?
Are participants being reached as intended?
What are participant reactions?
Outcome evaluation: To what extent are desired changes occurring? Goals met?
Who is benefiting/not benefiting? How?
What seems to work? Not work?
What are unintended outcomes?
Impact evaluation: To what extent can changes be attributed to the program?
What are the net effects?
What are final consequences?
Is program worth resources it costs?
41
Start with the end in mind
Learner Outcomes
Educational Strategies• Content• Formats
Resources needed
Input
Output
Outcome
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Evaluation Data Collection Plan
Questions Indicators Data collection
Sources Methods Sample Timing
Needs Target learner needs met?
Process Target reachedProgram run well?Satisfied?
Outcomes
Impact
Goals met?Desired changes?
Changes attributable to program?ROI?
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Logic Model and Reporting
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SCHOLARLY WORK: MAKE IT COUNT TWICE
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Dissemination Considerations
• Who else is interested in what you’re doing?
• What are your career goals?
• What do you enjoy? Play to your passions
• Where do you excel?
• Who are your professional peers?
• How do they like to learn about new innovations?
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Dissemination Opportunities Presentations
• Clinical– UKSM‐W DFMC
– KAFP: posters and lectures
• Practice Improvement
• Educational– STFM: workshop, seminar, poster
– RPS
– NCFMR
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Dissemination Opportunities
Publications– Med Ed journals and sites
• STFM
• Academic Medicine
• Medical Teacher
• Teaching & Learning in Medicine
– General medical journals and sites• ABFM
– Specialty journals
– Quality journals
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Dissemination Time/Effort• Get help!
• Collaborate
• Create realistic timeline
• Peer review
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Project work
Coaching
Next session:Effective Presentation SkillsMarch 18
53
Interface of Learning Objectives and Teaching Strategiescase studies
projectsexercises
projects critiquesproblems simulations
case studies appraisalscreative exercises
problems develop plans EVALUATION
Teaching Strategies Related to Learning
Objectives
exercises constructs appraisecase studies simulations assess
exercises critical incidents choosepractice discussion SYNTHESIS estimate
demonstrations questions arrange evaluatequestions projects test collect judgediscussion sketches compose measure
review simulations ANALYSIS construct ratetest role play analyze create revise
assessment microteach calculate design scorereports compare formulate select
lecture learner APPLICATION contrast organize valuevisuals presentations apply criticize manage
video writing demonstrate debate planaudio dramatize diagram prepare
examples COMPREHENSION employ differentiate proposeillustrations describe illustrate distinguish set upanalogies discuss interpret experiment
Cognitive Processing Dimension
explain operate inspect→ KNOWLEDGE express practice inventory
define Identify perform question list recognize schedule relaterecord restate shop test
Learning Objectives
repeat translate sketchuse
Adapted from: Bloom, B.S. (Ed.), Engelhart, M.D., Furst, E.J., Hill, W.H., & Krathwohl, D.R. (1956). Taxonomy of educational objectives: The classification of educational goals. Handbook 1: Cognitive domain. New York: David McKay.
Ellen F. Goldman, EdD 11-1-2010
54
Educational Project Plan Sample
Name:___________________________________________________________________________ Activity Goal/Aim: To teach PGY1 residents appropriate techniques counseling patients regarding tobacco cessation.
Educational Design Learning Objective Educational format/strategy Learner Assessment strategy Resources needed
1. Take accurate tobacco history
Lecture/pre-reading Pre/post test Content experts
2. Identify patients who are receptive to counseling
Case-based session Pre/post test
3. Develop process for systematic approach to counselling.
Group exercise to create evidence-based process for our clinic
Observation; critique plan Examples of approaches
4. Refer patients to resources, eg Quit Line;
Assignment to research available resources, eg on-line, clinic, local agencies
Critique plan Internet search; local agency resources
5. Appropriately prescribe medications for tobacco cessation
Lecture/discussion/cases Observation; case evaluations
Program Evaluation Plan: Brief description. Design and attach logic model.
Implementation Timeline Milestone Date
Due Develop learning objectives 3/1 Create cases 4/1 Consult with Dr X, content expert 4/15 Meet with Nancy/Ruth 4/30 Consult with behavioral health professional 5/1 Create tobacco cessation resource tool 6/1 Develop pre/post tests 6/15 Meet with Nancy/Ruth 6/30 Evaluation plan (logic model) completed 7/1
Educational Project Plan
Name:___________________________________________________________________________ Activity Goal/Aim: Educational Design Learning Objective Educational format/strategy Learner Assessment strategy Resources needed 1.
2.
3.
4.
5.
Program Evaluation Plan: Brief description. Design and attach logic model.
Educational Project Plan
Name_________________________________________________________Date___________________
1. Goal/Aim: What is the gap or problem you want to address through your activity?
2. Objectives: What are the learning objectives? Use the term “Performance expectations” to guide you. What do you want learners to do after the activity? Think SMART: specific, measureable, actionable, relevant and time bound.
3. Educational design: What learning methods/formats will you use? Devleop 2-3 bullet points to outline your educational idea, project or innovation and what content you want to include.
4. Learner Assessment: How will you assess your learners? What methods will you use to assess what your learners have accomplished?
5. Program evaluation: How will you evaluate your activity? How will you know its impact and how it might be improved?
6. Implementation: How will you implement? Who will be your partners? What resources will you need? From whom will you need buy-in?
Timeline: Project your planning, implementation and evaluation timeline.
Questions Indicators Data collection
Sources Methods Sample Timing
Needs Target learner needs met?
Process Target reached
Program run well?
Satisfied?
Outcomes
Impact
Goals met?
Desired changes?
Changes attributable to program?
ROI?
Educational Evaluation Data Collection Plan
Medical Education Planning & Development Basics February 11 Workshop Outline
Time Didactic Exercise Who Ref/Handouts 12:15-12:30
Introductions; Why do this; overall program; expectations, projects, etc
Discussion/Q & A Introduce project to work on through in workshop
ND
12:30-12:40
Learner-centered ed; learner needs; Dreyfus level of learners—Novice—Master; Pathman Model
Discussion regarding residents as learners Table, pg 23—Consider this when developing obj
ND Kern Ch 2
12:40-1:10
Developing Learning Objectives for learners and course/activity: learner, process and pt outcomes objectives
Write learning objective; share with peers; group feedback Table pg 78
ND/RW Kern Ch 4
1:10-1:40
Adult learning theory; competency based education; educational strategies; matching ed methods to objectives Promote Effective Presentation Skills March 11
Determine strategies for your activity; share w/ peers; feedback from group
RW Kern Ch 5 Ten Aspects of Learning for Effective Teaching (Viggiano)
1:40-2:00
BREAK
2:00-2:45
Learner assessment & Feedback: formative and summative; feedback strategies; summative assessment strategies Promote EPAs & Milestones and Assessment & Feedback sessions June 5 & Dealing with Difficult Learner Sept 9
Practice with feedback strategies; Develop learner assessment strategies for activity
RW Kern Ch 7
2:45-3:15
Implementation and Program evaluation; resources needed; timeline; overall program evaluation; stakeholders; methods for program evaluation; logic model
Develop implementation plan; identify needed resources; potential barriers & challenges; design overall program evaluation plan
ND Kern Ch 6/8
3:15-3:35
Scholarly work: Making it Count Twice Recap from Viggiano presentation Jan 23. Promote Abstract Writing session on May 13
Review examples of publications/posters/MedEdPortal publications
RW/ND Kern Ch 9 MedEdPortal
3:35-4:00
Debrief: Key learning points; next steps Each participant feedback key learnings; areas of uncertainty Flesh out activity plan template and review with table-mates
ND/RW
*Refer to Kern Example Curriculum: Primary Care GYN for Internal Medicine Residents *Promote relevant upcoming Fac Dev sessions
One Minute PreceptorMicroskill Strategies
1 Assess prior knowledge Assess learner knowledge/experienceEstablish goals for encounter
2 Get a commitment “What” questions: what is going on? What would you like to do?
3 Probe for evidence Encourage learner to think out loudWhy do you think that’s so?
4 Give positive feedback Reinforce what was done rightUse specific, behavioral examples
5 Identify and correct mistakes Specific and focused: “That drug is often a good choice, but not with renal failure.”
6 Teach the general rule Chose a rule at learner’s levelConsider competencies other than “knowledge” eg, communication, professionalism
7 Encourage reflection and promote self directed learning
“What do you feel you did well?”“What do you need to study?”
Irby DM. The One‐Minute Preceptor. First presented at the annual Society of Teachers of Family Medicine Predoctoral meeting. Orlando FL Feb 1997
Stage/Method Awareness Agreement Adoption Adherence
Predisposing Lecture
Grand rounds
Enabling Champions
Clinical precepting
Problem-based small group
Clinical precepting
Simulation
Reinforcing Role-play
Feedback in practice
Reminders
Audit/Feedback
Pathman/PRECEDE Model: Effective Methods for Different Learner Stages
Davis DA, et al. The case for knowledge translation: shortening the journey from evidence to effect. BMJ 2003;327:33
My Te4Q Educational Project Plan Name:____________________ Date: _________________________ Email: ____________________ Please complete Sections 1-3 (via participant application) prior to workshop 1. GOAL/AIM: What is the gap or problem you want to address through your educational program? What are the Quality Improvement/Patient Safety competencies you want your learners to exemplify at the completion of your educational program? 2. OBJECTIVES: What are the learning objectives? Use the term ‘performance expectation’ to guide you here. What do you want learners to do after the activity? Think SMART: specific, measurable, actionable, relevant and time bound
2. EDUCATIONAL DESIGN: What learning methods/formats will you use? Develop 2-3 bullet points to outline your educational idea, project or innovation and what QI/PS content you want to include. 3. LEARNER ASSESSMENT: How will you assess your learners? What methods will you use to assess what your learners have accomplished? 4. PROGRAM EVALUATION: How will you evaluate your initiative? How will you know its impact and how it might be improved? 5. IMPLEMENTATION: How will you implement? Who will be your partners? What resources will you need? From whom will you need ‘buy-in”?
How many learners will participate?
Timeframe: Estimated Implementation Date: Confidence Level: How confident are you that you will be able to complete your
Association of American Medical Colleges
project? VERY Moderately Unlikely What barriers to you anticipate?
Additional Activity(ies): What educational QI activities aside from this project will you implement?
© 2014 AAMC. May not be reproduced without permission.
1
Wesley Family Medicine Residency Name: Academic Year: Date: Goals: can be broad, sweeping, philosophical, lofty ideas. For example, “feel more confident doing skin excisions” Objectives: must be narrow, specific, concrete. Try to specify how much of what by when. Eg “Schedule extra 2 slots for Friday Colonoscopy Sessions by XXXX, 20XX” You may have multiple objectives to achieve one goal. Forces For: what are the things that will work in your favor to help you achieve your goals: a supportive partner, time coming up an a rotation Forces Against: what factors in your life may conspire against you to make it difficult to attain your goals” lifelong pattern, family responsibilities...
GOALS OBJECTIVES Forces FOR Forces AGAINST
Clnical: Skills/Procedures
Medical Knowledge
GOALS OBJECTIVES Forces FOR Forces AGAINST
Leadership/Scholarly Work
Personal: Self-Care, Relationships, Self-Expression
Professional Development: Professionalism, Life-long learning, managing Information, Licensing, Certifications, Conference
Other Domain:_______________________
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