SCOAR: from theory to practice

PD Dr. med E. Van Gessel Geneva

Education?

 Education is described as one of the « three legs » of academic medicine along with research and clinical work!

 As research is necessary for the creation of new knowledge,

effective education is essential to generate new doctors

Competence?

  Being a good Anesthesiologist requires more than strong scientific knowledge and excellent clinical and technical skills Key qualities also required are:     communicate effectively with patients and colleagues, act in a professional manner, cultivate an awareness of one's own values and prejudices, provide care with an understanding of the cultural and spiritual dimensions of patients' lives.

Carr SJ PMJ 2003

Going beyond the “see one, do one, teach one”

 Not only a good “knower” but an accountable one  Less theory and more practice-based knowledge  Maintain standards and quality of care  Assessment: Progress defined by competencies achieved and NOT by underlying educational process or knowledge only

Greaves JD BJA 1997; Leung WC BMJ 2002

Assessment drives the curriculum

   To ensure that trainees are competent to practice medicine we should include:    Consistent guidance Measurement of performance Systemic and structured feed-back Assessment should take place during residency and not afterwards only (using exams) The ultimate intended goal is the impact on patient safety!

Rodriguez-Paz JM PMJ 2009

The DAILY MAIL

‘Killing season' on NHS wards: Patients at risk when junior doctors start new jobs, says health boss ’

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7,000 medical students start foundation year in August

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Hospital death rates rise 8% during the period

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NHS chief Sir Bruce Keogh vows to end 'killing season' scandal

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From 2013 it'll be compulsory for all juniors to shadow senior doctors

By Jenny Hope http://www.dailymail.co.uk/news/article-2163382/NHS-wards-Patients-risk-junior doctors-start-new-jobs-says-health-boss-Sir-Bruce-Keogh.html

The question?

How to make competencies concrete… so that they can be clearly assessed?

The SGAR competence-based curriculum or SCOAR

 Document defines:  Roles  Domains of competence  Competences as well as Level to be achieved     A B

Has knowledge of, describes… Performs, manages, demonstrates under supervision

C

Performs, manages, demonstrates independently

D

Teaches or supervises others in performing, demonstrating managing,

 Learning objectives (& syllabus for more precision)

Knowledge / Technical skills / Clinical and Case-management skills / Drills / Specific attitudes

(including professionalism, specialist practice and patient consideration)

       CanMeds framework and the SGAR

Updated 2005

Medical Expert: Knowledge/clinical and procedural skills/professional attitudes that are practice-based and contextual: Collaborator: Team work/consultants Communicator: Doctor/patient relationship Manager: Healthcare organization, resources; sustainable practices Scholar: International patient-safety movement; learning from errors; life-long learning Professional: attitudes and values (integrity, respect, responsibility…) Health advocate: health promotion, communities and population

Example of our roles: Professional

Domains of Competence

The competences

Levels of achievement

The learning objectives

Another example: Obstetrics

Another example: Obstetrics

The matrix (EPAs)

tenCate et al. AcadMed 2007

Masters the anesthetic management of cesarean section and other operative deliveries under regional or general anesthesia (level D) Manages the high -risk obstetric situations (level C)…

Knowledge of the possible indications for C-sections and their level of emergency X X Knowledge of the potential complications of regional analgesia for labor and C section (unsatisfactory analgesia or anesthesia, neurological complications, postdural puncture headaches, toxicity of local anesthetics, high block)… Rapid sequence induction with specific consideration for difficult airway in the pregnant patient X X X

Teaching, learning, assessing…

Context Teacher Learner Assessment

Consistent Guidance Performance Measurement Feed-back

Wong A Can J Anaesth 2011

It is impossible!

WORK TRAINING

The pluses of Anesthesiology

  Majority of learning occurs in clinical settings Assessment:       OR: one to one allows formative interactions  Guidance and Motivation  Accurate feed-back (prescriptive, relevant, focused)  Visible technical skills Different settings (OR, consultation, labour, emergency, etc…) More “linear” training => Duration of time of training can be varied Use of simulation tools Possibilities of focusing only on certain competencies, interactions…(e.g, team-working) Questions on thought process and decision-making Kathirgamanathan-Woods. BJA-Cont Educ in Anaesth, Crit care & Pain 2011

The minuses of Anesthesiology

        OR: uncomfortable experience for the novice Non-verbal communication Patient safety is an issue, patient as primary focus Learners may have a more passive role in challenging cases Maintaining efficiency of the OR list Large number of different clinical teachers => variety in practice is confusing!

Rapid OR case turnover = no time for questions and discussion Identifying “teachable moments” Bould et al. Can J Anaesth 2011

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Where we are

New curriculum since 2008 = new training paradigm!

The cultural change is a difficult one:     Collaborative process between teacher and learner No prescription on how the teacher must teach or the resident must learn…

Agreement upon the assessment of competence and progressive independence of the trainee (certification)

Supervision of juniors should never occur without adequate formative assessment and feed-back 

Major influence on the European curriculum

European Curriculum

     The differences are small! Switzerland has pioneered the EBA curriculum ROLES: major difference? Only 4 Concept of Leadership, comprises Manager Communicator-Collaborator (and Health advocate) Other roles: Medical Expert, Professional, Scholar

European Curriculum

  Domains of competence: near identical Political issues of Emergency, ICM

European Curriculum

 For each domain, the competences were discussed twice and rewritten

European Curriculum

European Curriculum

   Many different writers from different cultures, backgrounds, trainings… Confusion between competences and activities/learning objectives Political issues to be discussed

Some good news: 25% countries endorsed the new curriculum; 25% will do it over the next year; 50% are thinking about it!

SCOAR

 A tool… Context Teacher Learner Assessment

Consistent Guidance Performance Measurement Feed-back

SCOAR: what will it help you to do?

Assessment of competence (Outcome) Progressive independence of the trainee (certification)

What we will have to discuss

      Working VS Training?

Change in our culture Change in our tradition of training Train tutors Help training centres Money…

THANK YOU