kazakhstan health technology transfer and institutional reform project clinical teaching post...

Kazakhstan Health Technology Transfer and Institutional Reform Project

Clinical TeachingPost Graduate Medicine

A WorkshopDrs. Henry Averns and Lewis Tomalty


Post Graduate Medicine Structure

•Personnel•Administrative Assistant for each program•Program Director: faculty member responsible for administering the overall conduct of the residency program•Program Directors form an overall Program Committee that meets monthly


Post Graduate ProgramObjectives

• Objectives are approved by Program Committee• Based on the national objectives as approved by

the Royal College (specialties) or the College of Family Physicians

• http://www.royalcollege.ca/public/credentials/specialty_information

• http://www.cfpc.ca/Home/• Clinical objectives and non clinical objectives (eg

professionalism, scholar, manager etc)


Internal Medicine Program Overview


• 3 year program• Primarily hospital based• Graded responsibility


Year 1 Year 2 Year 3

Clinical teaching unit Allergy Elective

Palliative care Infectious diseases Clinical teaching unit

Clinical teaching unit Elective Gastroenterology

Cardiology Intensive care unit Elective

Elective Intensive care unit Hematology

Clinical teaching unit Rheumatology Clinical teaching unit

Specialty elective Clinical teaching unit Nephrology

Community medicine Respirology Consults and clinics

Emergency medicine Clinical teaching unit Cardiology

Clinical teaching unit Oncology Clinical teaching unit

Elective Night float Endocrinology

Clinical teaching unit Elective Clinical teaching unit

Intensive care unit Clinical teaching unit neurology


Clinical teaching units• Fundamentals of acute emergency

management and in patient care of undifferentiated medical conditions

• Acute and chronic medical conditions


Formal Education Activities• Morning Report (sign in rounds)

– Conference where CTU teams present and discuss recent admissions

• Academic Half Days– Weekly academic rounds where core general internal medicine

topics discussed• Core Medicine Rounds

– Twice weekly. Case conferences, patient safety rounds, case of the month, rotating subspecialty presentations

• Departmental Conferences– Grand rounds and weekly morbidity and mortality conferences


Formal Education Activities• Journal Club– Critical appraisal skills – review of EBM

• Simulation Lab– Simulation teaching and procedural training


Evaluation• Twice yearly meetings with Program Director• Mid Rotation and end of rotation in-training

Evaluation Reports • American Board Internal Medicine exam annually• Multi-Source Feedback (Peer-Peer and Nurse-

Resident) feedback• Annual practice OSCE• First year residents take a national OSCE exam• E-portfolio system recently implemented


Evaluation• Mini-CEX• Used to assess learners in real life settings• Can be used for formative or summative assessment• Process: real life clinical encounter with a patient (15

minutes)• Teacher observes• Debrief the encounter immediately to discuss areas for

improvement and to provide positive feedback – most important part of process (10 minutes)

• Formally assessed either on paper or on line


• FAMILY MEDICINE


Curriculum• 2 year program• Triple C Curriculum

• Comprehensive Learning• Continuity of Patient Care, supervision and

curriculum• Family medicine CENTERED


Comprehensive learning• Learning objectives structured around Domains of clinical

care– Maternity and Newborn Care– Care of Children and Adolescents– Care of the Elderly– Palliative Care– Care of Adults– Global Health (Care of vulnerable and underserviced

populations)

– All training through the lens of family medicine (eg FM preceptors in obstetrics, long term care etc)


Development of Physician Characteristics

• Communication• Professionalism• Ethics• Patient Centered Approach• Practice Management


Continuity of Learning

• Continuity of Patient Care

– Responsible for own defined group of patients by sharing preceptor’s patients

– Build relationships with patients over the two year program



• Continuity of Supervision

– Academic advisor that meets regularly with each resident

– Same core family medicine preceptors for extended periods



• Continuity of Curriculum– Build on each learning experience- topics revisited

with a different perspective or level of complexity. Eg pediatrics in first and second year


Centered in Family Medicine• Learning is always through the lens of a Family

Physician• Majority of time working in Family Medicine

clinics• Work with Family Physicians who are

hospitalists, care for obstetrical patients, practice palliative medicine, do minor surgery etc


Evaluation• Competency based• Portfolio• Objective: observed clinical encounters and

summative evaluation forms (Mini-CEX)• Reflective: Self evaluation, reflective exercises,

feedback• Majority of assessment happens in clinic• Interim and final evaluation forms• National testing: OSCE and written exams


Faculty Development• Ongoing• Compulsory versus voluntary• Issues particularly for Post Graduate Training

– Time, money, importance• Competencies (national plan)

– Student assessment and faculty evaluation– Communication skills– Scholarship– Leader– Information and Communication technologies– Teacher/Educator


Faculty Development in Post Graduate Medicine Priorities• Assessment

• Teacher as a facilitator of learning• Providing Feedback• Teaching clinical skills• Professionalism in the clinical setting• Communication skills for both teacher and

learner• EBM (using I.T. appropriately and effectively)• Others? Do you agree with this list?

kazakhstan health technology transfer and institutional reform project clinical teaching post...

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