Workshop as part of Joint Training Day

UEMS-CAP-ESCAP-EFPT June 2021

L3 – Lifelong Learning

Thorsten SchumannHead of Child and Adolescent Psychiatry Department Southern

Jutland / Denmark

Associate Professor in Medical Education,

University of Southern Denmark

Declaration of conflicts of interest

• Working in public child and adolescent psychiatry hospital

• Working in Medical Education at university

• Contact person for Læger uden Sponsor (No Free Lunch)

• Member of different regional, national and international

bodies in C&A + Med

• No ties to medical or medicotechnical companies for 12 yrs

All you need is…

• Smartphone with internet connection

• Worksheet from padlet – or blank sheet of

paper (A4 or A3)

• 3 colours of pens / pencils

(red, blue, green if possible)

What we will do…

Postgraduate training in CAP is to prepare trainees for a life as

specialists. In an ever-changing world that means adapting to

new contexts and demands and opportunities. That requires a

commitment and a mindset – but also tools that should be

developed in postgraduate training. The workshop will give an

overview of relevant learning theories and a model to support

trainees in assessing their own learning preferences,

prioritizing and designing learning initiatives in line with

organizational needs and evaluate learning outcomes in an

iterative process. We will discuss and test feedback on these

skills.

Lifelong learning is about commitment ?

-> ressources

-> know-how

-> technology

-> skills

-> work

Lifelong learning is about certificates ?

National

requirements…

-> adequacy

-> alignment

Lifelong learning is about quantity + prestige ?

The ”more” the merrier

The ”categorical comparative”

The Union tale

-> effect on daily practice

-> is it you

Experience:

Learning moment

Exercise 1

• Partner work in Break-out Room

• Mentimeter (go to: menti.com – code: 90544393)

• Short phrases – max 3 words

• 1 min self-reflection

• 1 min presentation one to the other

• 1 min extraction (-> upload what was core to making it possible)

• 1 min presentation the other to the one

• 1 min extraction (-> upload what was core to making it possible)

• Back to plenum after 7 minutes

Catch up with a moment of learning you have

experienced in the last two weeks.

How did it play out and how come that worked for you?

Having a look at Mentimeter

Reflections

• Change / transformation / transfer

• Self-reflection ( learning diary ?)

• Narrative / dialogue

• Expand by looking at different learning situations

(knowledge/skill/attitude – simple/complex - individual/team)

• Not academic and comprehensive - but personal and

contextual

• Learning patternS

Implications for learning design

(personal and organizational)

Forethoughtto backcast

Backdrop - Megatrends

• Older and multimorbid populations in OECD-countries

deflect focus & ressources from C&A

• Shortage – financial + workforce + increased demands

• The new health care consumer (focus on shared decision

making)

• Wearables + artificial intelligence taking over in screening,

diagnosis, treatment planning, psychoeducation, treatment

(feel free to add…)

As a specialist…

• You should have developped ”skills to assess own learning

needs, plan and implement learning initiatives and evaluate

learning outcomes as a lifelong learner” (from the draft of

the revised UEMS-CAP Curriculum Framework)

• So how do we learn that and how do we support that

learning and how do we evaluate that learning ?

Development of learningthroughout a medical career

Graduate

education

Postgraduate

medical training

Continuous

professionel

development

Regulated by

external

prescriptions

Self-regulated

learning

MacDougall et al. Continuing professional development: Putting the learner back at the centre. Arch Dis Child Educ

Pract Ed 2017;102:249-253 (adapted from Knowles andrological assumptions / Pappas)

• Considering the context of compulsion, accountability, tick-box-culture,

”mandatory reflection” + appraisal by professional bodies / national

authorities

• Considering the continuum of fixed and growth mindset (Carol Dweck)

Self-regulated learning 1

Zimmerman`s social-

cognitive model of

self-regulation

Similar to PDSA-

cycle of Quality

improvement /

Patient Safety /

Learning

Organizations

Self-regulated learning 2

Context - Denmark

• Competency-based postgraduate training based on

CanMEDS roles – Workplace-Based Assessment (no

exams, no recertification)

• 10 days of CME every year (to achieve CPD) as part of

collective agreement (doctors´ union…)

• Formalized dialogue with leadership once a year (MUS) to

agree competency development plan (KUP)

The CPD-cycle - Forethought

Focus on cognitive components + alignment

1. Assess needs - experiences / preferences (from self-

reflection) + organizational agenda / external demands (from

dialogue to include QI + PS) - by Mindmap (CanMED-roles)

2. Identify gaps between ”is” / ”want + should” + formulate

”Research question(s)” / learning objective(s)

3. Select + prioritize short/longterm-projects

4. Choose methodology / technology of learning design

5. Define outcome measurement (gap closed - change in own

practice – dissemination of new better practice)

Go on to implement (activity + measurement)

STEP 1

Assess

• Needs - experiences - preferences (from self-reflection)

• Organizational agenda / external demands (from dialogue

to include QI + PS)

by Mindmap (CanMED-roles)

Mindmap:https://www.mindmeister.com/1907742422/my-personal-learning-wishes-

preferences-in-red-learning-opportunities-in-my-context-in-blue

Exercise 2

• Individual exercise

• Mindmap on CANMEDS model

• Status on own preferences + ideas on external demands

• 8 minutes

• A3 or A4 + Pens (3 colors)

– Red own learning wishes / preferences

– Blue learning opportunities in my context / external demands

– Green perspectives (as growing points for initiatives)

Feedback

Feedback and assessment

• Summative (within competency-based framework): When is

it good enough - dialogue in supervisor group to calibrate

expectations as to proficiency level ”specialist”

• Formative: Focus on adaptive changes (to SRL strategies)

Leggett et al. Twelve tips on how to provide self-regulated learning enhanced feedback on clinical performance. Med

Teach 2019 Feb; 41(2):147-151

Feedback and assessment

• Learners can be trained to improve their SRL.Durning et al. Perspective: viewing "strugglers" through a different lens: how a self-regulated learning perspective

can help medical educators with assessment and remediation. Acad Med 2011 Apr;86(4):488-95.

• Feedback should be given on self, task, process and SRL.

• Feedback should be given “within a challenging, yet

supportive relationship, between the learner and the

educator”Telio S, Ajjawi R, Regehr G. 2015. The “educational alliance” as a framework for reconceptualizing feedback in

medical education. Acad Med. 90:609–614.

• Use microanalysis (”think aloud protocols”) on the different

phases of the SRL-cycle

• Here on Forethought in the CPD-cycle

(goal setting: clear&specific + strategic planning: goal-

directed&explicit)

Reflective Performance Feedback R2C2

1) Building rapport and Relationship

2) Explore Reactions to and perceptions of the data/report

3) Explore physician understanding of the Content of the data/report

4) Coach for performance change (SMART goals)

Sargeant et al. Facilitated reflective performance feedback: developing an evidence- and theory-based model that

builds relationship, explores reactions and content, and coaches for performance change (R2C2). Acad Med 2015;

90: 1698-706.

Coaching compared to other dialogical techniques

Power of the expert Powerless non-expert

RELATION

TOOL

Answer

Question

Instruction

Counselling

Guidance

Mentoring

SupervisionCoaching

Mediation -

facilitation

Adapted from Holmgren et al: Coaching - læring og udvikling 2021

Venn diagram

CoachingThe goal of coaching as applied in medical education is to

support a developmental process whereby an individual learner

meets regularly over time with a faculty coach to create goals,

identify strategies to manage existing and potential challenges,

improve academic performance, and further professional

identity development toward reaching the learner’s highest

potential

• Helping the learners gain insights into their own

assumptions,

• Clarifying meaning about relevant outcomes and

• Helping identify specific actions needed to achieve a desired

result

By asking reflective questions to help learners identify and

develop personal values, preferences and unique perspectives.Cummings TG, Worley CG. Coaching and mentoring (in) Organizational development and change.

Mason, OH: South-Western Cengage Learning; 2009.

Karl Tomm – question types

Tomm. Interventive Interviewing Part III. Intending to Ask Lineal, Circular,

Strategic, or Reflexive Questions, Family Process 1988 Mar;27(1):1-15.

Family Medicine PGME-curriculum in DK• Demonstrate understanding of the necessity for lifelong learning and personal

development in order to function as general practitioner. This includes

understanding of the influence of personal feelings. behaviour and ethics as

significant factors for a good balance between work and private life.

• Demonstrate understanding of the necessity to allocate time and resources for

personal and professional development and how this is a prerequisite for medical

proficiency and prevents burnout.

• Be able to plan own CME activities.

In this planning, be able to employ elements like:

– Audit

– Self-reflection

– Adverse events

– Own strengths and weaknesses

– Own proficiency level

– Learning strategies and style

– Necessary resources (personal, time, money)

• Be able to register own educational activities.

Role: Scholar

Assessment by Global assessment of reflective ability (GAR)

Assessment byGlobal assessment of reflective ability (GAR)Tool for formative and summative assessment of the ability to reflect

– in two parts

Preparation:

• The trainee produces a mind map or similar written presentation

in a concept formation process addressing a concrete, complex

competency. The trainee is given 1-2 weeks for the preparation

and uses the description of the competency in the curriculum and

possible portfolio notes as inspiration.

Structured discussion:

• This begins with the trainee presenting his/her mind map/written

presentation which then is the basis for a structured discussion

between trainer and trainee that includes references to the

concrete experience that the trainee has had in the field.

Assessment byGlobal assessment of reflective ability (GAR)

1. Does the trainee show ability to reflect on the

problem/competency and on his/her own role as a GP

according to the matter?

2. Does the trainee demonstrate relevant analytical skills

concerning the problem/competency?

3. Is the trainee able to participate open-minded in a dialogue

and demonstrate relevant flexibility?

The focus of the discussion is on formative aspects leading to

a plan for further learning, but it also includes a summative

assessment of whether the competency is successfully

achieved.

Lillevang et al. How to assess and encourage reflection in specialist training. A mixed methods validation study of a

new instrument for Global Assessment of Reflection Ability. BMC Med Educ 2020 Oct 8;20(1):352.

Exercise 3(we could do it in threes but we do not have the time –

you could add an observer and refine your work…)

• Partner work in Break-out Room

• Based on A3 or A4-mindmap

• Elaborating further together / providing feedback

• (Observer feedback on useful strategies)

• 2 x 12 minutes

• Your A3 or A4 + Pens (3 colors)

– Red own learning wishes / preferences

– Blue learning opportunities in my context / external demands

– Green perspectives (as growing points for initiatives)

Feedforward

Feedforward

• Individual reflection

• Mentimeter (go to: menti.com – code: 74737711 )

• What was useful (thoughts ´n tools) ?

• How would you like to use that in your own practice ?

• Short phrases – max 3 words

THANK YOU

FOR YOUR

COLLABORATION