Transcript Diapositive 1

Formation médicale
axée sur l’acquisition de compétences
GTEA
Édition: [email protected]
Étude de cas
Édition: [email protected]
Dundee - Three Circle Model
The right person
doing it
Doing the thing right
Performance
of Tasks
Doing the right thing
Référence :
Harden, R.M. et al., An introduction to outcome-based education. Med Teacher 1999;21(1):7-14
Édition: [email protected]
What the doctor is able to do
Doing the right thing
Technical intelligences
1.
2.
3.
4.
5.
6.
7.
Clinical skills
Practical procedures
Patient investigation
Patient management
Health promotion and disease prevention
Communication skills
Information handling and retrieval
Référence :
HARDEN, R.M. et al. ,From competency to meta-competency: a model for the specification of learning outcomes,
AMEE Education Guide 14, Outcome-based Education, Center for Medical Education, University of Dundee, 1999
Édition: [email protected]
How the doctor approaches their practice
Doing the thing right
Intellectual intelligences
8.
Understanding of basic, clinical and social
sciences
Emotional intelligences
9.
Appropriate attitudes, ethical understanding and
legal responsibilities
Analytical and creative intelligences
10. Appropriate decision making , clinical reasoning
and judgment
Référence :
HARDEN, R.M. et al. ,From competency to meta-competency: a model for the specification of learning outcomes,
AMEE Education Guide 14, Outcome-based Education, Center for Medical Education, University of Dundee, 1999
Édition: [email protected]
The doctor as a professional
The right person doing it
Personal intelligences
11. Role of the doctor within the health service
12. Aptitude for personal development
Référence :
HARDEN, R.M. et al. ,From competency to meta-competency: a model for the specification of learning outcomes,
AMEE Education Guide 14, Outcome-based Education, Center for Medical Education, University of Dundee, 1999
Édition: [email protected]
Étude de cas
Édition: [email protected]
http://crmcc.medical.org/canmeds/bestpractices/index.php
Édition: [email protected]
Compétences
Expert médical
CanMEDS
Communicateur
2005
Collaborateur
Gestionnaire
Promoteur de la santé
Érudit
Professionnel
Frank, JR., Jabbour, M. et al. dir. Report of the CanMEDS Phase IV Working Groups.
Ottawa: Collège royal des médecins et chirurgiens du Canada. Mars 2005
Édition: [email protected]
Énoncés de compétences
Compétences
CRMCC
Collaborateur
Édition: [email protected]
Définition
Comme collaborateurs, les
médecins travaillent efficacement
dans une équipe de soins de santé
afin de prodiguer des soins
optimaux aux patients.
Énoncés de compétences
Compétences
CRMCC
Collaborateur
Édition: [email protected]
Compétences
attendues
Participer efficacement et
comme il se doit à l’activité
d’une équipe
interprofessionnelle de soins de
santé
Collaborer efficacement avec
d’autres professionnels de la
santé afin d’éviter des conflits
interprofessionnels, de les
négocier et de les résoudre.
Collaboration
Fellow
Et. 2ième
Externe
… est en mesure d’agir
comme
2ième année
un leader dans une équipe
… anime efficacement son
…
est
en
mesure
d’informer
multiprofessionnelle
groupe APP
efficacement les membres de
… reconnaît les rôles et
l’équipe multiprofessionnelle
compétences des autres
concernant la condition de
professionnels de la santé
R. senior
ses patients.
… est en mesure de déléguer
Et. 1ère
efficacement certains actes
Externe
… interagit avec respect avec
à d’autres professionnels
de
1ère année
les membres de son groupe
la santé
… est en mesure de situer son
rôle par rapport à celui des
R. junior
autres professionnels de la
Et. prép.
santé.
… utilise judicieusement
… partage ses connaissances
l’ensemble des ressources
avec ses pairs.
professionnelles pour adapter
les soins au patient
Édition: [email protected]
Étude de cas
Édition: [email protected]
Nine
Abilities
I.
II.
III.
IV.
V.
VI.
VII.
VIII.
IX.
Effective Communication
Basic Clinical Skills
Using Basic Science in the Practice of Medicine
Diagnosis, Management, and Prevention
Lifelong Learning
Self-Awareness, Self-Care, and Personal Growth
The Social and Community Contexts of Health Care
Moral Reasoning and Clinical Ethics
Problem Solving
Référence :
SMITH, Stephen R. and R. Dollase, Planning, implementing and evaluating a competency-based curriculum, AMEE
Education Guide 14, Outcome-based Education, Center for Medical Education University of Dundee, 1999
Édition: [email protected]
Knowledge
Base
Basic science matrix
Molecular /
Single organ /
Whole person /
cellular
organ system
family
Community
Organization &
structure
Maintenance &
homeostasis
Defense against
disease & injury
Mechanisms of
and response to
disease & injury
Therapies &
interventions
Référence :
SMITH, Stephen R. and R. Dollase, Planning, implementing and evaluating a competency-based curriculum, AMEE
Education Guide 14, Outcome-based Education, Center for Medical Education University of Dundee, 1999
Édition: [email protected]
Knowledge
Base
Clinical medicine matrix - Clinical approaches to health & disease
Preventive /
developmental
Acute
Emergency
Chronic
Behavioral
family
Fetus / Neonates
Children
Adolescents
Adults
Elders
Référence :
SMITH, Stephen R. and R. Dollase, Planning, implementing and evaluating a competency-based curriculum, AMEE
Education Guide 14, Outcome-based Education, Center for Medical Education University of Dundee, 1999
Édition: [email protected]
Étude de cas
Édition: [email protected]
SCAL
Systematic Clinical Appraisal and Learning
Students independently
saw a patient and
were asked to make judgments
about the patient’s
potential diagnosis,
tests required,
management,
psychosocial needs,
preventive health requirements,
and any ethical problems.
These judgments were
then compared with those
of the clinical supervisor,
who saw the same patient
independently.
Source : RW Sanson-Fisher, IE Rolfe & N Williams, Competency based teaching: the
need for a new approach to teaching clinical skills in the undergraduate medical
education course, Medical Teacher 2005;27:29-36
Édition: [email protected]
1. Le médecin de famille est un clinicien
compétent et efficace.
2. La médecine familiale est « communautaire ».
3. Le médecin de famille est une ressource pour une
population définie de patients.
4. La relation médecin-patient constitue l’essence
du rôle du médecin de famille.
http://www.cfpc.ca/French
Édition: [email protected]
Nouveaux défis professionnels
pour le médecin des années 2000
« Que le Collège des médecins, de concert avec les
universités et les milieux d’enseignement, convienne d’un
plan directeur de façon que la formation médicale, dans
tout son continuum (formation prédoctorale, postdoctorale
et éducation médicale continue), permette aux médecins
d’aujourd’hui et de demain d’acquérir les compétences
nécessaires pour relever les défis de la médecine et des
problèmes de santé des années 2000. »
http://www.cmq.org
Édition: [email protected]
Nouveaux défis professionnels
pour le médecin des années 2000
Clinicien scientifique et efficace
Professionnel humaniste
Apprenant
Communicateur
Collaborateur capable de travailler en équipe
Gestionnaire
Leader pour sa communauté
Chercheur et enseignant
http://www.cmq.org
Édition: [email protected]
The New Doctor
Recommendations on General Clinical Training
Jan 2005
The Transitional Edition of The New Doctor
Good clinical care. Doctors must practise good standards of clinical care, practise within the limits of
their ability, and make sure that patients are not put at unnecessary risk.
Maintaining good medical practice. Doctors must keep up to date with developments in their field
and maintain their skills.
Relationships with patients. Doctors must be able to develop, encourage and maintain successful
relationships with their patients.
Working with colleagues. Doctors must work effectively with colleagues in medicine, other health-care
professions and allied health-care workers.
Teaching and training. Doctors have teaching responsibilities to colleagues, patients and their relatives.
They must develop the skills, attitudes and practices of a competent teacher.
Probity. Doctors must be honest.
Health. Doctors must not allow their own health or condition to put patients and others at risk. Doctors
must maintain their health. They must take the appropriate steps to make sure their own health does not
put patients, colleagues or the public at any risk.
http://www.gmc-uk.org/med_ed/default.htm
Édition: [email protected]
The residency program must require its residents to obtain competencies in the 6 areas below to the level
expected of a new practitioner. Toward this end, programs must define the specific knowledge, skills,
and attitudes required and provide educational experiences as needed in order for their residents to
demonstrate:
• Patient Care that is compassionate, appropriate, and effective for the treatment of health problems
and the promotion of health
• Medical Knowledge about established and evolving biomedical, clinical, and cognate (e.g.
epidemiological and social-behavioral) sciences and the application of this knowledge to patient care
• Practice-Based Learning and Improvement that involves investigation and evaluation of their
own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care
• Interpersonal and Communication Skills that result in effective information exchange and
teaming with patients, their families, and other health professionals
• Professionalism, as manifested through a commitment to carrying out professional responsibilities,
adherence to ethical principles, and sensitivity to a diverse patient population
• Systems-Based Practice, as manifested by actions that demonstrate an awareness of and
responsiveness to the larger context and system of health care and the ability to effectively call on
system resources to provide care that is of optimal value
Approved by the ACGME, September 28, 1999
http://www.acgme.org/outcome/
Édition: [email protected]
http://www.acgme.org/outcome/
Édition: [email protected]
"...our mission is to collect worldwide information on requirements
and standards of undergraduate medical education and to develop
the global minimum essential requirements of medical education
that are necessary to equip all physicians, regardless of where
they are trained, with medical knowledge, skills, professional
attitudes and behavior of universal value..."
http://www.iime.org
Édition: [email protected]
Global Minimum Essential Requirements:
A Road Towards Competence-Oriented Medical
Education
(1) Professional Values, Attitudes, Behavior and Ethics
(2) Scientific Foundation of Medicine
(3) Clinical Skills
(4) Communication Skills
(5) Population Health and Health Systems
(6) Management of Information
(7) Critical Thinking and Research
Institute for International Medical Education
Copyright © 1999-2005
Édition: [email protected]
The LCME urges schools
to develop a system of evaluation
that fosters self-initiated learning by students
and disapproves of the use of frequent tests
which condition students
to memorize details
for short-term retention only.
Référence :
Liaison Committee on Medical Education, FUNCTIONS AND STRUCTURE OF A MEDICAL SCHOOL,
Standards for Accreditation of Medical Education Programs Leading to the M.D. Degree, June 2002.
Édition: [email protected]
Evaluation of student performance
should measure not only retention of factual knowledge,
but also development of
the skills, behaviors, and attitudes needed in
subsequent medical training and practice,
and the ability to use data appropriately
for solving problems commonly encountered
in medical practice.
Référence :
Liaison Committee on Medical Education, FUNCTIONS AND STRUCTURE OF A MEDICAL SCHOOL,
Standards for Accreditation of Medical Education Programs Leading to the M.D. Degree, June 2002.
Édition: [email protected]
Courses or clerkships
that are extremely short in duration
may not have sufficient time
to provide structured activities
for formative evaluation,
but should provide some alternate means
(such as self-testing or teacher consultation)
that will allow students to
measure their progress in learning.
Référence :
Liaison Committee on Medical Education, FUNCTIONS AND STRUCTURE OF A MEDICAL SCHOOL,
Standards for Accreditation of Medical Education Programs Leading to the M.D. Degree, June 2002.
Édition: [email protected]
Faculté de médecine
Formation médicale
Prédoctorale
Postdoctorale
Continue
Formation, certification, maintien
Programme
MD
Programmes
de résidence
Programmes
FMC
axée sur
l’acquisition de compétences
Édition: [email protected]
C
O
M
P
É
T
E
N
C
E
S
Convergence des rôles
IMC-IDC
Externat - MD CMQ - 2000
Pré-doctorale
CMFC - 2000
CanMEDS-2005
Post-doctorale et Formation professionnelle continue
Anamnèse
Examen
Interrogatoire
Examen physique
Gestes techniques
Prise en charge
Investigation
Traitement
Clinicien
scientifique
et efficace
Clinicien
compétent
et efficace
Expertise
médicale
Communication
Communiquer
Communicateur
Enseignant
Relation
médecin-patient
Communication
Contexte
Travailler en équipe
Collaborateur
Travailler équipe
Communautaire
Collaboration
Intégration
connaissances
Intégration
connaissances
Apprenant
Chercheur
Jugement critique
Gestionnaire
Maintien compétence
Éthique
Éducateur
Promotion santé
Leader pour sa
communauté
Notions éthiques
Professionnalisme
Professionnel
humaniste
Édition: [email protected]
Érudition
Ressource pour
population
définie
de patients
Gestion
Promotion
de la santé
Professionnalisme
Approche par
compétences
GTEA
Réformer le système d’évaluation des apprentissages :
un projet pour nous tous
Rapport du groupe de travail
sur
l’évaluation des apprentissages au programme MD
Comité du programme des études de premier cycle
13 novembre 2003
Entériné par le Comité du programme, 11 mars 2004
http://www.medbev.umontreal.ca/gtea
Édition: [email protected]
GTEA
Réforme du système d’évaluation
Innovations
• Modèle d’évaluation axé sur
la certification des compétences
• Tests périodiques de rendement
pour mesurer les progrès
• Profil cumulatif pour l’évaluation formative
• Mentors pour accompagner les étudiants
• Formation aux professeurs sur le feedback
Édition: [email protected]
GTEA
Les acteurs
Implantation du système
d’évaluation des apprentissages
Conseils
de compétences
Compétences
Plan directeur
Progrès
Profil individuel
Comités
d’épreuves
Épreuves
Réalisations
TRPs
Portfolio
Édition: [email protected]
Mentors
Accompagner
Guider
Évaluer
Étudiants
Pairs
Formatif
Task-Based Learning
The focus for learning is a set of tasks addressed by a doctor in
clinical practice. The learning is built round the tasks and learning
results as the student tries to understand not only the tasks
themselves but also the concepts and mechanisms underlying the
tasks. ( Harden 2000 )
1. The task is an important one facing a
doctor.
113 clinical tasks
as the focus
for learning
Édition: [email protected]
2. The task is likely to be encountered by
students during their clinical
attachments and usually in more than
one attachment.
3. The task can serve as an appropriate
focus for learning clinical medicine, for
reviewing the basic medical sciences
and for the development of the generic
competences expected of a doctor.
Task-Based Learning
Clinical attachments
1 General medicine
2 Specialized medicine
3 Ageing and health
dermatology
4 Surgery
5 Orthopaedics
Accident and emergency
6 ENT/Ophthalmology
7 General practice
8 Obstetrics & gynaecology
9 Child health
10 Psychiatry
Pain
Pain in the leg on walking
Acute abdominal pain
Loin pain and dysuria
Joint pain
Back and neck pain
Indigestion
Headache
Cancer pain
Earache
Source : RM Harden, J Crosby, MH Davis, PW Howie & AD Struthers,
Task-based learning: the answer to integration and problem based learning in the clinical
years, Medical Education 2000;34:391-397
Édition: [email protected]
Nutrition/weight
Thirsty and losing weight
Difficulty swallowing
Weight loss
Seriously overweight
Des courants majeurs
issus des milieux anglo-saxons
Outcome-Based Education
Competency-Based Assessment
Édition: [email protected]
Outcome-Based Education
It is an approach to education in which decisions about
the curriculum are driven by outcomes the students
should display by the end of the course ( Harden 1999 )
A way of designing, developing, delivering and
documenting instruction in terms of its intended goals
and outcomes ( Spady 1988 )
You develop the curriculum from the outcomes you want
students to demonstrate, rather than writing objectives
for the curriculum you already have ( Spady 1988 )
Édition: [email protected]
Compétence
Un savoir agir complexe prenant appui sur la mobilisation
et l’utilisation efficaces d’une variété de ressources (
Tardif 2003 )
La compétence est la possibilité pour un individu, de
mobiliser de manière intériorisée un ensemble intégré de
ressources en vue de résoudre une famille de situationsproblèmes( Roegiers 2000 )
Aptitude à mettre en œuvre un ensemble organisé de savoirs,
de savoir-faire et d’attitudes permettant d’accomplir un
certain nombre de tâches ( MERF 1997, 2000 )
Édition: [email protected]
Competency-Based Assessment
Démonstration
Compétences
Intégration
Connaissances
Habiletés
Attitudes
Apprentissages
Référence :
National Postsecondary Education Cooperative Competency-Based Initiatives Working Group
U.S. Department of Education - 2001
Édition: [email protected]
Certifier
des niveaux de compétences
Intermédiaire
Novice
Édition: [email protected]
Expert
Évaluation des compétences
Authentique
Assessment that looks at performance and practical application of
theory. Direct observation is thus a critical component
Critériée
Outcome of observation should be an assessment of whether the
trainee has met the predetermined criteria.
Formative
Importance of ongoing input to the learner about performance.
Formative feedback becomes a necessary component.
Multimodale
A variety of assessment tools to measure the breadth of
performance
Source : Carraccio, C. and R. Englander, Evaluating Competence using a Portfolio: A Liiterature Review and Web-Based
Application to the ACGME Competencies, Teaching and Learning in Medicine, 2004.
Édition: [email protected]
Approche par
compétences
Pour en savoir plus …
www.medbev.umontreal.ca/docimo
Diaporama
Rubrique: Dossier compétences
Bibliographie
[email protected]