Patient Education Workshop

Dr. Shawna Faber and Dr. Ty Binfet

Please note: Use of this document is intended for those who attended this workshop to support and improve practice. Please do not replicate, distribute

nor use for other non-intended purposes.

Goals of Workshop

• To examine your current teaching practices

• To reflect on how educational theory and strategies can enhance your practice

• To leave with practical suggestions and strategies that can be directly implemented in your practice

Workshop Format

• Focus on:

– What you know (field experts)

– What we know (educational experts)

– Implications for practice

Brain Break

• On a piece of paper please write down the name of everyone at your table

• How many do you remember? (Not including

those you knew before today)

Effective CKD Education

Research and Our Observations…

What we are doing well Models of Care:

• Multidisciplinary Model (Dixon et al., 2011; Goldstein et al,

2004)

– Reduces risk of death by 50% (Ronskley & Hemmelgarn, 2012)

– Delays progression of CKD (Strand and Parker, 2012)

• Regular Care During Predialysis (Jungers et al., 2001).

– Phone contact or personal visits increase self-care (Strand & Parker,

2012)

– Proactive Care (Ronksley & Hemmelgarn, 2012)

• Caring Practitioners (Zubialde, Mold & Eubank, 2009)

What we are doing well

Educational Programming:

• Increases In Knowledge – Delayed progression of CKD linked to education and

supportive contact (Strand and Parker, 2012)

• Educational Components – One-on-one sessions (Gruman et al., 2010; Lingerfelt & Thorton, 2011)

– Classroom style presentations (Gruman et al., 2010)

– Patients talking to patients (Rygh, et al, 2012; Morton et al, 2006)

– Inclusion of family or social supports (Quinan, 2005, Richard 2005)

• Monitoring and Evaluating Educational Programming (MacGregor et al, 2006)

Areas for Improvement

• To achieve “best practice,” what are the areas that require improving?

• Working with the people in your discipline and using the chart paper provided to document your ideas, brainstorm a list of practices that could be improved upon.

Gallery Walk

• Post your chart paper on the wall

• Take some time to walk around to see what other groups have written

• When you get back together in your group, discuss if there are any changes/additions you would like to add to your list

• Mark your changes on your list

Implications

• The BC CKD educational program has many strengths

• Building on these strengths is vital

• Weaknesses can be found in any program, recognizing areas for improvement is important for creating a better program

• This workshop is the first step in this process

Modelling Note

What we did and why we did it:

• Started with an advance organizer (agenda)

• Brought in your prior knowledge

• Built on that knowledge

• Wrapped-up with summary and take-aways

• Included Brain Breaks

Expectations Activity

• On your pad of paper write down your expectations for this workshop

• Add a wild prediction of the best possible outcome should your expectations be met

– e.g., I’m expecting to learn how to handle difficult or challenging patients, and my wildest expectation is that if I knew how to do that, nobody would ever get under my skin again. Ever.

Expectations (Lea, Stephenson & Troy, 2003; Schommer, 1990; White, 1995)

• What was the point of this activity?

• Expectations are powerful –understanding them is key to the success of educational programming

• Understanding patients’ expectations helps us design education that is tailored to their needs and thus improves outcomes—participatory patient education

Educational Research

Overview:

Clear

Objectives

Health Literacy

Prevention and Health Promotion Quality

Teaching materials

Self-Regulation

Motivation

Clear Objectives

Good education always starts with clear goals and

well defined objectives

Objectives

• Good objectives focus on what patients will do/learn? Why?

• In education practice we often start objectives with SWBAT (Students Will Be Able To)

Health Literacy/Knowledge

• Increasing knowledge of CKD is important. (Strand and Parker, 2012)

• But…is knowledge enough?

Health Literacy

• Some research findings

– Medical knowledge does not necessarily lead to increased compliance and happiness (Katz et al., 2008).

– Compliers with dietary recommendations did not score higher on a CKD knowledge questionnaire (Katz et al., 2008).

– Awareness about CKD was NOT associated with improved outcomes (Tuot et al., 2011).

Knowledge

• Some knowledge is key, more is not necessarily better

• How do we decide what parts are key?

• We have already started this—by looking at your top 5

Brain Break

• The Crab:

– Stand up and put your hands in the prayer position

– Bend your middle fingers so that your knuckles are touching

– Separate your:

• thumbs (return them)

• your pinky (return)

• your pointer (return)

• Your ring fingers

Overview:

Clear

Objectives Health Literacy

Prevention and Health Promotion

Prevention and Health Promotion

Review:

• What you are already doing well:

–Multidisciplinary model

–Pre-dialysis clinics

– Early modality training

–Patient-to-patient education

Prevention and Health Promotion

• Improving practice—some ideas:

– Increasing patient-centred education (LHIN, 2010)

• Enhancing opportunities for patient self-management – e.g., tools for patients to record and monitor their

own progress

• Increasing patient confidence

• Collaborating with patients to design care plans

Quality Teaching Materials

• What characterizes quality teaching material?

– Having quality objectives

– Strategic use of the materials

• when/how/where/how often – Providing small amounts of information gradually over

time (Campbell & Duddle, 2010).

– Environment for education is important

– Learner active participation is key

Quality Teaching Materials

Materials that meet the needs of learners

• Including a variety of pathways:

–Oral

–Written

–Models

• Address learners’ concerns

Topics of concern

What do you think CKD patients are concerned about?

– Discuss with the people at your table

CKD patients have concerns around: – life changes on dialysis

– coping

– health management

– preparing for the future (Clarkson, 2010)

Topics of Concern

Loss of control is also a major source of anxiety

– What we know:

• Education programs that focused on having choice and control over disease management were associated with more positive outcomes than programs that focused on emotional issues and knowledge gaps (Bass, 2012)

From Theory To Practice

• Looking at the diagram, how can you implement 3 things from this session into your practice?

• Discuss with the people around you what you could see yourself implementing in your practice.

Review:

Clear

Objectives

Health Literacy

Prevention and Health Promotion Quality

Teaching materials

Self-Regulation

Motivation

Self-Regulation/Motivation

What is Self-Regulation? Marshmallow test video:

• Discuss with the people around you what was needed for these children to wait for the second marshmallow.

• Given what you have just seen what do you think self-regulation involves?

Self-Regulation/Motivation

Self-Regulation is:

• Planning, acting, monitoring and evaluating behaviour in order to achieve goals

– Examples:

• Concentrating on instructions

• Evaluating progress

• Planning next steps

• Seeking assistance

– Assumes that people are participants in their own learning

– Is closely linked with motivation (Zimmerman & Schunk, 2001;

2008)

Self-Regulation/Motivation

Why is it important in CKD education?

Self-Regulation

Researchers have shown that successful CKD educational programs include:

• Support for self-regulated learning (Rawson, O’Neil, &

Dunlosky, 2011)

• Emphasis on self-management (Ronksley & Hemmelgarn,

2012; Thomas et al., 2008).

• Focus on improving patients’ self-monitoring (Ronksley, Hemmelgarn 2012).

Key Strategies

(Zimmerman & Schunk, 2001; 2008)

Having patients:

• reflect on what they already know, and generate questions about what they would like to know

• articulate ways to transfer the knowledge they just learned (e.g., how will they use this at home, or by doing a demonstration)

• set goals and monitor progress thereby increasing self efficacy and reinforcing persistence and motivation

Strategy Implementation

List 3 ways that you can structure your interactions so that patients are more actively involved in your sessions

Brain Break

Blink:

• Stand up

• Blink with your right eye and snap with your left hand

• Switch

• Switch again

Questioning Techniques

Understanding Questioning

• Quality of Questions

• Frequency of Questions

• Format of Questions

Quality of Questions (Egan, 2002; Thompson, 2003)

• Ask questions well-suited to targeting the information you’re after

• For example:

– Do you know why you’re here today?

Quality of Questions

Well constructed and delivered questions do not require as many follow-up probes as poorly constructed questions

• Poor:

– How are you feeling? (“good” “bad”)

• Better:

– Describe for me how you feel on a typical day.

Frequency of Questions (Beck, Daughtridge, & Sloane, 2002)

• There is a tendency to ask too many questions

• When too many questions are asked we can overwhelm and shutdown patients. This can decrease learning.

Participatory Dialogue (Latvala, 2002)

Review:

• What are the benefits of active learning for patients?

– Improved retention

– Feelings of ownership

– Greater self-management

– Higher self-efficacy

– Better self-regulatory skills

– Increased compliance

Participatory Dialogue (Latvala, 2002)

• How we ask questions can increase or decrease patients’ participation

– Example: “Any questions?” is one of the worst ways to increase active participation in the dialogue

Format of Questions (Ford, Fallowfield, & Lewis, 1996; Roter & Hall, 1997)

Closed versus Open questions

Format of Questions (Ford, Fallowfield, & Lewis, 1996; Roter & Hall, 1997)

Closed questions:

• run the risk of eliciting little information

• often require 1-word responses

• can be effective in accessing basic information

• “Did you take your medication today?” “Yes”

Format of Questions (Ford, Fallowfield, & Lewis, 1996; Roter & Hall, 1997)

Open-ended questions:

• encourage more elaborate (richer) descriptions

• “Can you explain how you manage all of the medications that are prescribed for you?”

Scenario—Ling

Ling is 37 year old woman with newly diagnosed glomerulonephritis (specific kidney disease diagnosed on biopsy). She reports feeling well, has minimal swelling, high protein in her urine, however her kidney function is pretty good at eGFR 45. She has just been referred to a clinic by her Nephrologist so this will be her first visit. She needs to start therapy with immunosuppressants and get blood work once a month.

Constructing Good Questions

• Step 1: Working with the people at your table, design a question for Ling that will increase active learning and a question that might decrease active learning – Write each question on a separate piece of paper

Scenario:

Ling is 37 year old woman with newly diagnosed glomerulonephritis (specific kidney disease diagnosed on biopsy). She reports feeling well, has minimal swelling, high protein in her urine, however her kidney function is pretty good at eGFR 45. She has just been referred to a clinic by her Nephrologist so this will be her first visit. She needs to start therapy with immunosuppressants and get blood work once a month.

Constructing Good Questions

• Step 1: Working with the people at your table, design a question for Ling that will increase active learning and a question that might decrease active learning – Write each question on a separate piece of paper

• Step 2: Pass your papers to the table beside you. As a group, read the questions and rewrite the question aimed at decreasing participation

• Step 3: Pass all questions back and have a look at how your questions have been changed

• Step 4: Discuss

Timing of Questions

• We often wait until the end of a session to check for comprehension (and then ask the

dreaded “any questions”)

• Waiting until the end runs the risk of missing out on opportunities to provide richer participatory dialogue and may lead to misunderstandings in the level of patient comprehension

Formative versus Summative Questions (Noble, Kubacki, Martin, & Lloyd, 2007)

• Formative Assessment involves regularly checking comprehension throughout the session

• Summative Assessment focuses on verifying comprehension at the end of a session.

• Both are important!

Summative Assessment

• It is important to verify what patients have gotten out of a session by asking them questions before they leave:

• e.g.,

– what they understand to be important

– what behavioural changes they’re prepared to make

– if they require clarification

Writing Summative Questions

• Come up with a question to help verify if patients are leaving your session with what you think they are leaving with.

• Who would like to share their question?

PowerPoint

• What makes for a good PowerPoint slide?

Effective Slides (Bartsch & Cobern, 2003a,b; Blokzijl & Naeff , 2004; Earnest, 2003; Earnest, Szabo & Hastings, 2000;

Levasseur & Sawyer 2006)

• Clearly fit the objectives of the teaching

• Have a small amount of text on the screen

• Font size is large and easy to read

• Includes visuals

• Shows one point at a time

• Enhances what you are saying (doesn’t distract)

• Know your audience!

Some examples of good slides:

PowerPoint

What are some of the ways that you have seen that PowerPoint distracts rather than adds?

– Too much text

– All text put up at the same time

PowerPoint

What are some of the ways that you have seen that PowerPoint distracts rather than adds?

– Too much text – All text put up at the same time – Have information you don’t discuss – Text too small you can’t read – Too much happening on the slide (motion,

pictures popping up, etc.) – Busy background that distracts – Information not in order (having to jump back

and forth)

PowerPoint

How you use slides is also important

– Practice and know what you will be teaching

– Not great for one-on-one

– Where you stand (face the audience not the screen)

– Use a wireless mouse

PowerPoint Tricks

• You can make the screen go black by hitting “b” (or white with “w”)

• You can skip slides by going to insert tab and then clicking on action

• Demo:

Visual Support

• PowerPoint is not the only visual supports that can/should be used

• Also effective are: – Hands-on activities

– Use of Manipulatives (e.g., PD belly)

– Pictures

– Handouts

– Guest Speakers (CKD Patients)

Environment

• The environment in which learning takes place is important – Sends a message about importance of the

learning

• What can you do to enhance your teaching environment? – Lobby for better space – Enhance the space you have

• Visuals on walls (e.g., salt with pictures and packages)

• Manage the layout

Brain Break

Stretching your brain:

• Read the following words out-loud (ignoring the actual color of the word)

Brain Break

Stretching your brain:

• Now, try saying the color no matter what the word says

Research suggests that, in general, people retain:

• 10% of what they HEAR

• 20% of what they READ

• 30% of what they SEE

• 70% of what they SAY

• 90% of what they SAY AND DEMONSTRATE (Stice, 1987)

Participation

• Enhancing patient participation is key.

• What are some ways to do this? – The start of your session sets the tone—start

well!

– Make sure patients feel as relaxed and comfortable as possible (environment can enhance or detract from this)

– Be sure patients know your name • Name activity

• Improving name tags

Participation

• Don’t just talk, design activities for participation

• Demonstrations

– Model how and then get them to demonstrate

– We learn best when teaching

Participation

Information

– More is not always better—keep the amount of information manageable

– Work at the level of the patient

• Assess that level using questioning techniques (from session 3)

• Watch your use of medical terminology that may “shut-down” the patient

• Make sure that activities get the point across (sometimes they remember the activity and not the point)

Participation Review:

• Start with open-ended questions • Start by asking what they know and what they want to

know

• Answer to their questions is what they will remember most—so try to illicit good questions from them

• End with a recapping question: • What did you learn today?

• What are the three things you learned that you can do to keep yourself healthy?

• What are your key take-aways from this session?

Brain Break

• Strength test:

– I need a volunteer to help me demonstrate

– Did you notice any difference between time 1 and 2?

– What?

– Now with a partner, give it a try.

Positive Psychology (Seligman & Csikszentmihalyi, 2000; Seligman, Steen, Park, Peterson, 2005))

• Focuses on positive emotions, positive character traits and supportive institutions.

• The intent is to have a more complete and balanced understanding of the human experience—the peaks and the valleys.

Positive Psychology

• What does this mean in your educational practice? – Find the strengths in every patient

– Focus on the positives in your interactions (what patients already know and what they are doing well)

– Help patients to see that they are the experts on their lives and you are there to help

– Build relationships

– More satisfaction for the patient and for you

Summary Activity

Summary Activity

• How does this video relate to you as CKD educators?

• List some of the things that we did today that modelled what we taught – e.g., PowerPoint slides points came up one at

a time

Patient Education Workshop

Day Two

Quick Review Contest

• Work together with the people at your table

• Quickly write down 10 different things that you remember from yesterday that can be applied to your practice.

• The first group who comes up with 10 different strategies wins a prize.

• Stand up when you think you are done!

Program Standardization

Why might it be important to have a standardized CKD educational program in BC?

– So patients get equal programming no matter where they are

– So we can test the effectiveness of the program

– Continuous quality improvement

– Staff turnover does not affect education quality

Why we need standardization

• Key Research Findings:

– Successful programs include the coordination of care within multiple disciplines. (Ronksley &Hemmelgarn, 2012)

– A high percentage of patients exposed to a structured Pre-Dialysis Education Programme start with a self-care modality (Goovaerts et al., 2005)

– Monitoring an education program once it has been developed is important.

Challenges

• What are the patient-related challenges specific to CKD?

– Cognitive Impairment (Campbell & Duddle, 2010 ; Gelb, et al., 2007)

– Anxiety (Vilaplana, et al., 2009)

– Depression (Gençöz & Astan, 2008)

Brain Break

Finger aerobics

• Sit opposite a partner and both place one hand flat on the desk.

• Take turns create patterns (lifts, taps, stretches) that your partner must copy.

• Start with 2-3 moves and see how many you can get up to.

Activity

• Elastics & Cups

What we know about cognitive impairment (Wookfolk, 2010)

• Cognitive impairment can affect:

–Acquiring

–Remembering

–And using knowledge.

Cognition and CKD (Kurella et al., 2004; Murray, 2008)

• Level of kidney function – Lower function is related to higher cognitive

impairment

• Age – Higher rates of cognitive impairment at older

ages (Marrón et al., 2008)

• Medications – Some medications (or combination of

medications) can reduce cognition

Impacts of Cognitive Impairment

• Learning abilities

• Compliance levels (Elias et al., 2009)

• Ability to make decisions (e.g., modality choices) (Gelb et al., 2007)

• Can increase anxiety and depression (these

are inter-related)

Anxiety

CKD Stressors (Harwood et al., 2009; Logan et al., 2009)

People with CKD report being worried about:

• Job and family

• Health

• Daily life restrictions

• Physical appearance

• Decline in social ability

• Fatigue, sleep problems, fluid restrictions

Anxiety

• Did you know?

– Around 53% of patients have some degree of anxiety (28% experience severe anxiety) (Feroze

et al., 2012)

– Those younger than 65 have higher stress (Harwood et al., 2010)

– Symptoms of depression and anxiety are often unrecognized in CKD patients (Preljevic et al.,

2012)

Did you know?

• Reduction of stress during modality choice leads to increased selection of home dialysis (Harwood et. al., 2012)

• Higher anxiety often leads to “avoidance coping” which reduces compliance (Kohli et al.,

2009)

• Anxiety affects attention, learning, and recall abilities (Inott & Kennedy, 2011; Lee & Boyde, 2012)

Anxious Patients (Inott & Kennedy, 2011; Lee & Boyde, 2012)

Divide their time between

New Material

Preoccupation with how nervous they’re feeling

Anxious Patients (Inott & Kennedy, 2011; Lee & Boyde, 2012)

• Are more easily distracted by irrelevant or incidental aspects of tasks

• See things that are unimportant as important

Reducing Anxiety—What Works

• Early education (Golper, 2001)

• Education where the:

• learning context does not threaten self-concept

• learning activities are well planned and include immediate feedback (Ammon-Gaberson,

1987)

• Social support (Ye et al., 2008)

Reducing Anxiety—What Works

• Fostering optimism (Harwood et al., 2009)

• Relaxation techniques (Geier, 2011; Tsai, 2004)

– e.g., deep breathing, exercise, muscle relaxation, guided imagery, meditation

• Peer-to-peer communication (especially with cultures where oral traditions are emphasized) (Perry et al., 2005)

Brain Break

• Just having brain breaks can reduce anxiety

• This one in particular can help:

– Rolling your head in circles, slowly one way, then slowly the other way.

– Then practice deep breathing - count in and out slowly for ten breaths.

Depression

Depression (Beck et al., 1961; Kessler et al., 2003)

There is great variability in depression

Mild – to Moderate – to Severe

Depression

• Increases medical costs in chronic disease by 50% (Katon, 2003)

• Reduces compliance and self-management (Katon, 2003)

• Reduces communication and disclosure (Swartz et al., 2008)

• Impacts concentration and decision-making (Block, 2001)

• Increases feelings of being overwhelmed even by small things (Penland et al., 2000)

What we know . . .

• Patients often present with profiles characteristic of all three of these challenges

• Thus many strategies will overlap

• What educational strategies that we have already discussed might help with depression?

Strategies to Consider . . .

• Establish a positive affective climate

• Provide a rationale at the start of each session (this provides a framework, supports learning,

and decreases anxiety)

• Set mini-goals for each session

• Consider “Chunking” each session into sections (makes information easier to digest)

• Use repetition, use repetition, use repetition

Strategies to Consider . . .

• Use social support networks to support learning

• Teach goal setting as a strategy

• Patient-to-patient education

Recapping Our Session

• We’ve covered a lot of information in this session.

• Reflect for a brief moment, what is the one key take-away for you from this session?

• Share with your group.

• Consensus??

Activity—Solution-Seeker

• Write a problem/concern you have about patient self-management (or teaching for self-management).

• Pass your sheet to the right. • Read the problem on the sheet and write

down the first thought/s that come to mind for addressing that problem.

• You will only have 30 seconds to respond to that problem—so it really is your first idea.

• We will rotate every 30 seconds until each person gets his or her own sheet back.

Self-management

• What do you know?

– What is it?

– Why is it important?

– How do we increase self-management?

Self-Management

• What we know

– Who tends to self-manage well?

• Those who are employed

• Higher educated

• Have high self efficacy (Yu et al, 2012)

• Have a coping style that matches treatment demands (Christensen & Ehlers, 2002)

Self-Management (Health council of Canada, 2012)

• Who needs extra support?

– patients with lower incomes

– less education

– more complex disease

– or who are unable (for a variety of reasons) to join a group program

Self-Management

What influences Self-Management abilities?

– Depression and anxiety (Cukor et al., 2006)

– Perceived competence (Christensen et al., 1996)

– Health literacy

– Confidence in health care practitioners (Christensen et al., 1996)

– Support network

– Support for caregivers (Hawley et al., 2008)

Improving Self Management

Higher self-efficacy is linked with higher compliance overall (Braun et al. 2008; Tataki & Yano, 2012)

Attending pre-dialysis clinics improves self-efficacy (Jansen et al., 2010)

Those with higher self-efficacy tend to disclose (Walker, James & Burns, 2011)

Disclosing illness increases self-management (James & Burns

2012)

Positive Self-Management Practices

• Work on building confidence (self-efficacy)

• Provide necessary knowledge base

• Directly teach self-management skills

–Active goal setting

–Behavioural change strategies

Positive Self-Management Practices

• Focus on shared decision-making and collaboration

–Collaboratively :

• Define problems

• Develop realistic goals

• Determine a personalized action plan

• Encourage the development of problem-solving skills

What we know… and what we do…

Example protocol

1. Assess a patient’s level of self-care and together determine a care issue relevant to his/her life

2. Assist patient to set a behavioural goal to address the care issue and design a simple plan to help work towards that goal

3. Plan follow-up with patient to ensure continued success.

Brain Break

Back to Back:

• Working in pairs

• You have 20 seconds to “study” your partner

• Turn back-to-back and change 3 things about yourself

• Turn back around and see if you can identify what was changed

REVIEWING

Did you know: (Rozakis, 2003)

The average adult can’t remember 50% of what s/he has just read.

The next day, s/he can only recall 20 – 30%.

The Role of Reviewing in Memorization (www.brainweb.us-com)

After this # of days

Recall with NO REVIEW

Recall WITH REVIEW

7

33% 83%

63

14%

70%

More About Review (Bahrick & Phelphs, 1987)

• Spanish Vocabulary test after 8 years

– Two practice sessions separated by:

• 720 hours (30 days)

• 48 hours

• 24 hours

• Zero hours

– After 8 years recall was significantly better the greater the distribution of practice

Application to Practice

• How can we apply what we have just learned about review to our own educational practice?

Memory Activity

Would it have helped to see….

A B C

D E F

G H I

Memory Strategies: – Most people use the most

inefficient/ineffective memory strategy:

• Rehearsal

–Why?

–What are some better strategies?

• Organization

• Elaboration (e.g., keyword/imagery, mnemonics)

– Meaning making is key!

Content knowledge

The ability to remember new information is highly related to the amount of knowledge already acquired

– Novice vs. expert paradigm

Key: The more you know, the easier it is to learn and remember.

CKD Education and Memory

• What strategies could you use to help patients remember important content?

Final Activity

You will have about 20 seconds to look at

the following numbers:

7 4 2

Your assignment is to forget these

numbers.

Activity—Forgetting

• Write down the numbers you were told to forget

• Did you remember?

• Why?

• What does this have to do with patient education?

Types of Knowledge

Activity

Putting on a coat:

• Write out the steps to putting on a coat

• Please be as clear as you can

• Be prepared: you may be asked to read your directions out loud

Basic processes of memory (Anderson, 2004)

• Attention: concentrating and focusing mental resources on a task

• Selective attention: ability to focus on important aspects while blocking out other stimuli

• How can we get patients attention?

• How do we maintain that attention?

Wrap-up Activity—take away

• What can you change to help patients improve their retention of information?

• How can you insure that what patients learn isn’t just basic knowledge?

• Brainstorm with the people around you to come up with 3-4 ideas to share

Brain Break

With a partner: – Shake right hands

– Shake left hands

– Right hand fist bump

– Left hand fist bump

– Right hand hammer tap

– Left hand hammer tap

– Crossing high Ten

– Both fist pump

– High ten

Advisory Committee

• What we know is that multidisciplinary approaches work

• We want to take a multidisciplinary approach to creating a standardized CKD educational program

• You have very important knowledge to share • If you are interested in being a part of a

Community of Practice (Advisory Committee) to design this new program, please sign-up at the front before you leave or send an e-mail to: shawna.faber@ubc.ca