msk practice support program train the trainer 2 faculty development
TRANSCRIPT
“Tell me and I forget, teach me and I may remember, involve me and I learn.” Benjamin Franklin
“What is a teacher? I'll tell you: it isn't someone who teaches something, but someone who inspires the student to give of her best in order to discover what she already knows.” Paulo Coelho, The Witch of Portobello
“The best teacher is not the one who knows most but the one who is most capable of reducing knowledge to that simple compound of the obvious and wonderful.” H.L. Mencken
Objectives for Today
1. Able to facilitate small and large group physician learning through adult learning principles.
2. Able to demonstrate the use of clinical tools within the targeted patient population
Where’s the Gap ?
Low Back Pain In a recent study, the one-year incidence of low back
pain was 19% with 40% of this population reporting persistent symptoms and 14% experiencing an
aggravation of their symptoms. Canadian medical expenditures with respect to low back pain are
estimated between $6 and $12 billion annually Source: Back Care Canada and American College of Physicians, National
Institute for Health and Clinical Excellence.
Facilitating High Yield Learning
• Physicians learn best when the learning is in the context of patient care, answers their questions about patient care issues, is directly applicable to their work and does not take up too much of their time.
• Physicians learn in response to clinical problems. Once a problem has been identified, decide to act on it by learning the things they need to know to solve the problem. They then apply this knowledge to the problem. (Slotnick)
• Physician learning is unique in that there is a high inclination towards autonomy and self-directed learning. (Knowles)
Unskilled and Unaware
• Unskilled and Unaware of It: How Difficulties in Recognizing One's Own Incompetence Lead to Inflated Self-Assessments, Kruger J, Dunning D.,J Pers Soc Psychol. 1999 Dec;77(6):1121-34.
Physician Self Assessment• In many studies, poor correlation between physician
self-assessment and standardized external assessment.
Got the right answer, I must have knowledge
Accuracy of Physician Self-assessment Compared With Observed Measures of Competence:A Systematic Review, JAMA, Sept. 2006, vol 96(9)
Motivating the Adult Learner
Social relationships External Expectations Social Welfare Personal Advancement Need Stimulation/Diversity Inquisitive Interest
.
Adult LearnersR- Relevance
E- Experienced Contributor
S- Self-directed
P- Practical
E- Equality
C- Connections
T - Timely Goals
Reflective Practitioner
• SURPRISE
• a brief emotional state experienced as the result of an unexpected significant event
Reflection on Action
Gap: Guidelines to Practice Time and Logistics
Solutions Synthesize Disseminate Implement●
Clinical Competence Excellent knowledge / skills
Effective communication
Sound clinical reasoning
Teaching Skills Aware of role
Explicit about model
Respect for learner needs
Provides feedback
Encourages reflection
Personal Qualities Compassionate
Enthusiastic for practice
Effective interpersonal skills
Commitment to excellence
Demonstrates humour
The Importance of Role Models
Teaching and learning in ambulatory care settings: a thematic review of the literature.(PMID:7575922) Irby DM – Academic Medicine : Journal of the Association of American Medical Colleges [1995, 70(10):898-931]
A thematic review was conducted of the 1980-1994 research literature on teaching and learning in ambulatory care settings for both undergraduate and graduate medical education. Included in the review were 101 data-based research articles, along with other articles containing helpful recommendations for improving ambulatory education. The studies suggest that education in ambulatory care clinics is characterized by variability, unpredictability, immediacy, and lack of continuity. Learners often see a narrow range of patient problems in a single clinic and experience limited continuity of care. Few cases are discussed with attending physicians and even fewer are examined by them. Case discussions are short in duration, involve little teaching, and provide virtually no feedback. Excellent teachers are described as physician role models, effective supervisors, dynamic teachers, and supportive persons.
Strategies for Role Modeling
Teaching and learning in ambulatory care settings: a thematic review of the literature.(PMID:7575922) Irby DM – Academic Medicine : Journal of the Association of American Medical Colleges [1995, 70(10):898-931]
Longitudinal teaching programs
Focus on: Interviewing, physical examination, and management of psychosocial issues.
Encouraging collaborative and self-directed learningFaculty developmentStrengthening assessment and feedback procedures. .
Top 5 Valued Learning Qualities
Motivated to seek new information Set Realistic Goals Ability to reflect on new information Critical Thinker Confident to take risk
● ....not necessarily the highest marks !
Top 5 Valued Teaching Qualities
Able to provide Interactive Setting Creative thinker Flexible in methodology Commitment and passion Supportive of learner needs
● .....Not Necessarily the Expert !
Teaching with Video1. Patient and doctor relationship
Apply to new and related scenarios How would the physicians response change if the
patient said …. How would the patient’s response change if the
physician said…..
Teaching with Video
2. Real Model Evaluation Seek realistic teaching examples
What worked and was well done … What could have clearer or improved…
Teaching with Video
3. Translate into Principles Link with guideline evidence Link with clinical decision making
What principles would you want your resident to understand …
What key messages are you trying to give to your patient….
Case Builder Process
Case Histories Curriculum Key Messages Learner Competency Outcomes Scripted Standardized Patients Training Taping and Editing
Video Vignettes-Osteoarthritis
Ms. Irene Genou is a 58 year old retired elementary school teacher who has come to your office for her annual health evaluation and complains of increasing right knee pain and intermittent swelling.
Patient History - Inflammatory Screening History /PHQ9/ Pain and Function Follow-up
Physical Examination//Investigations /Indication for Surgical Referral / Pain and Function Follow-up
Treatment and Management Options / Medication /Patient Self Management
Selection Criteria
Relevant to Primary CareDiagnosisClinical Decision MakingManagement
Realistic in GP timePatient visitsDocumentation
Checklist
Explain Principle Concepts Relevance to Primary Care Demonstrate – Video Reflection Practice Feedback
Can we translate to teaching?
Role Modeling
Case based Application
Reflection on Practice
SIMPLIFY the SPINE