Transcript Navigating the CDHM Continuing Competency Program

NAVIGATING THE CDHM
CONTINUING COMPETENCY
PROGRAM
Joanna Asadoorian AAS(DH), BScD(DH), MSc
Associate Professor
School of Dental Hygiene, Faculty of Dentistry
University of Manitoba
Navigating the CDHM
Continuing Competency Program
2

The CDHM mandate is to protect the public by
ensuring safe, quality oral health care

What is quality…where does competence fit?

“degree to which health services for individuals and populations
increase the likelihood of desired health outcomes and are
consistent with current professional knowledge”
Blumenthal, 1996




Knowledge, skill and appropriateness of health care
Structure and process to ensure best outcomes
Competence and daily performance
Measurement and improvement of the entire profession
Asadoorian, J., CDHM Presentations Spring 2010 ©
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Diffusion of Innovations:
Problems & Recommendations
3
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A considerable lag time exists between new research
findings and general application into practice settings
Research shows almost a twenty year lapse between
dissemination and implementation
Significant time delays reflect a failure to implement
newer, more effective procedures and the
discontinuation of ineffective or harmful ones
Implies a delay of best practices available to patients
Known as the theory practice gap
“Education allowance systems” as in those based on CE
time requirements have been described as failures to the
profession…” (Grant, 2002)
“Conducting a needs assessment is essential
in directing
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the educational process.”
(Cantillon
andSpring
Jones,
1999)
Asadoorian, J., CDHM
Presentations
2010
©
Self-Assessment (SA):
Panacea or Part of the Problem
4
Rationale for Conducting
Self-Assessments



Provide direction to one’s
learning
Promotes increased
efficiency in learning
Generates motivation to
one’s learning and for
implementing change
(Asadoorian & Batty, 2005)
Problems with SelfAssessment


Incapability of self-assessing
accurately
SA used to protect one’s self
concept



Need to preserve confidence
and positive attitudes
Learning activities chosen
based on areas we excel
SA is an over and misused
term


Not intended to be an
individualistic activity
Multiple sources of external
feedback recommended
Asadoorian, J., CDHM Presentations Spring 2010 ©
(Eva & Regehr, 2007)
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1. Self-directed
Assessment
Self-directed Assessment Seeking
5

What is Self-directed Assessment Seeking?
 Collecting
data about one’s professional performance
through:
 honest
reflective introspection (internal)
 requesting unbiased feedback from others (external)
 Creating
an awareness of deficiencies, opportunities for
improvement and continuing competency needs
 specific
knowledge topics, skills, client problems and practice
issues
 Indicating
the continuing competency goals
that one should ideally address
Asadoorian, J., CDHM Presentations Spring 2010 ©
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1. Self-directed
Assessment
6
Self-directed Assessment Seeking
(SDAS)
How to accomplish a meaningful SDAS:
Internal


Internal evaluation should
be conducted in a
meaningful and structured
way
Use of tools for thinking
about one’s own practice
performance




1. Reflection-on-practice
2. Competencies & Practice
Standards
3. Evidence-based Practice
4. Self-assessment tests
External


External evaluation should
be intentional, ongoing
activity and increasingly
relied upon
Use multiple sources:


Include appraisal by
peers, experts, clients and
others to help expose
areas in need of
improvement
Tools available to carry
out
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Asadoorian, J., CDHM Presentations Spring 2010 ©
1. Self-directed
Assessment
7
Self-directed Assessment Seeking
Internal: 1. Reflection on Practice


Defined: “an important human activity in which people
recapture their experience, think about it, mull it over and
evaluate it” (Boud)
Reflect on and learn from:

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
Day-to-day practice problems
 client care including complex medical conditions, communication
challenges, procedural difficulties and poor treatment outcomes–
surprises!
Ongoing challenges from one’s practice environment
 Antiquated office policies, conflicting treatment philosophies and
structural inadequacies
Practice problems often generate emotional responses:

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Emotional cues help identify competency challenges
Maintaining a practice log aids in recalling challenges for later reflection
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Asadoorian, J., CDHM Presentations Spring 2010 ©
1. Self-directed
Assessment
Self-directed Assessment Seeking:
Reflection on Practice
8
5 Good Reasons:
1. Links theory & practice
2. Uses our own (clinical) experiences
3. Helps make sense of real practice problems
“messy swamplands”
4. Encourages a different kind of learning
- deep rather than superficial
5. Generates a different kind of knowing
“transformative” knowing that motivates change
Asadoorian, J., CDHM Presentations Spring 2010 ©
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1. Self-directed
Assessment
Self-directed Assessment Seeking:
Reflection on Practice
9
Keys to Using Reflection in Practice:


Foundation is concrete experience; start with
meaningful experiences
Structure may help; use a model for a framework

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Many available: Kolb, Mezirow, Boud…
Use your feelings; trigger the need to reflect
Reflect regularly
Start with a Journal or practice log

Note your feelings and/or practice problems
Asadoorian, J., CDHM Presentations Spring 2010 ©
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A Suggested Model of Reflection
An integration of the literature…
10
Asadoorian, 2005
Develop a new Validate new
Perspective
Perspective
Develop an
Awareness
Trigger
Analyse the
Situation
Relate the
Experience
Describe the
Experience
Critical Reflectors
Reflectors
Non-reflectors
Asadoorian, J., CDHM Presentations Spring 7/30/10
2010 ©
A Suggested Model of Reflection
An integration of the literature…
Transformed
thinking results
and compels
change
11
Asadoorian, 2005
Take the
experience apart
and examine it
What was your
emotional response
Develop an
Awareness
Trigger
Analyse the
Situation
Develop a new Validate new
Perspective
Perspective
Relate the
Experience
Describe the
Experience
Give a descriptive
Non-reflectors
account of what
happened
Critical Reflectors
What was occurring
Reflectors
before and after;
what
other things were
influencing you
What knowledge
do you have that
relates to this; what
knowledge is
missing
Asadoorian, J., CDHM Presentations Spring 2010 ©
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Trying out new
thinking and
seeing how it
works in
practice
1. Self-directed
Assessment
12
Self-directed Assessment Seeking:
Internal: 2. Competencies &
Standards
What, why, how?
 Helpful for determining professional strengths and weaknesses
and directing one’s continuing competency goals
 Using these documents involves comparing one’s own practice
performance to the competency/standard outlined in the
document


To determine if one has competency in the specific item or if
additional development is required—


Look for new National Competencies document on CDHA website
(September)
often due to insufficient knowledge, skill and/or experience
The dental hygienist is cued in to develop a corresponding
continuing competency goal
Asadoorian, J., CDHM Presentations Spring 2010 ©
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1. Self-directed
Assessment
Self-directed Assessment Seeking:
Internal: Competencies & Standards
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ASSESSMENT (67 Competencies)
29
Assesses health status of dental implants
30
Assesses hard and soft deposits
31
Assesses intraoral hard tissues
√
Asadoorian, J., CDHM Presentations Spring 2010 ©7/30/10
1. Self-directed
Assessment
Self-directed Assessment Seeking
Internal: Evidence-Based Practice
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3. EBP: The rationale
 “the most cost-effective opportunity to improve patient outcomes
over the next quarter century will likely come not from discovering
new therapies but from discovering how to deliver therapies that
are known to be effective” (Berenholz & Pronovost, 2003)
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Even the most robust evidence supporting optimal clinical care
typically fails to be implemented
Failures in knowledge application results in gaps between best
practice and actual performance
In health care practice, practitioners may be unaware of what they
do not know
Dental hygienists may not realize that current research does not
support a specific routine procedure
Asadoorian, J., CDHM Presentations Spring 2010 ©
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1. Self-directed
Assessment
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Self-directed Assessment Seeking
Internal: Evidence Based Practice
Reading professional journals and
articles, attending professional
conferences and lectures, searching
databases, conducting research and
participating in journal clubs provide
valuable opportunities for exposure to
new research
Databases:
“PubMed” (Medline)
 Cochrane Collaboration- Reviews

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Search, by topic

Oral health
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Asadoorian, J., CDHM Presentations Spring 2010 ©
1. Self-directed
Assessment
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Self-directed Assessment Seeking
Internal: 4. Self-Assessment Tests
Read article and then take SA test immediately
Take SA test first to determine if reading article is
necessary
Take SA test later for retention and application
Asadoorian, J., CDHM Presentations Spring 2010 ©
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1. Self-directed
Assessment
Self-directed Assessment Seeking
External: Questions, Discussion and Feedback
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
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Increasingly rely on external sources for feedback about performance
Highlights topics or issues that one has limited knowledge about or
contradicts one’s current beliefs

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It is human nature to dismiss or rationalize negative feedback or conflicting
philosophies
Opportunities may occur spontaneously (i.e. client questions,
employer/colleague comment and discussions), but more often individuals
must solicit others for feedback

Questions, discussions, and feedback from peers, employers and
clients provide excellent resources for identifying deficiencies and
opportunities
for improvement: Continuing competency
goals
Asadoorian, J., CDHM Presentations Spring 2010
©
7/30/10
1. Self-directed
Assessment
Self-directed Assessment Seeking
External: Questions, Discussion and Feedback
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It is important to ask for others to be specific and limit feedback:
DENTAL HYGIENIST SELF-DIRECTED FEEDBACK FORM
Name:
Date:
Please return feedback by:
Thank you for agreeing to provide your valuable feedback to me regarding my
dental hygiene practice. Your feedback will assist me in addressing my learning
needs.
On the following sheet(s) please make written comments about the area(s) indicated
below.
When you are providing the feedback please be specific, clear and descriptive.
Please include examples where possible.
I would also appreciate meeting briefly with you to discuss your feedback. Perhaps
we can schedule some time to meet after you have returned the written feedback.
1.__________________________________________________________________
2.__________________________________________________________________
3.__________________________________________________________________
Asadoorian, J., CDHM Presentations Spring 2010 ©
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1.
Strengths I have noticed:
A
B
C
Enhancements that could be made:
A
B
C
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Date Written:
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Date
Reviewed:
Self-directed
Assessment
Self Directed Assessment: CCR
20
FILLING OUT THE FORM! Step One:
How did you determine that you had a professional
need or deficiency? (See pages 10 & 11 in Section 2 of
the CCP Package)
Practice problems & reflection
Using the CDHM Competencies/Standards/Code of Ethics
Questions, discussions or external feedback
Evidence-based practice
Other: (Specify) ________________________________________
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Asadoorian, J., CDHM Presentations Spring 2010 ©
Navigating the CDHM
Continuing Competency Program
21
Professional Development Component: CCR
3. Activity
Implementation
& Evaluation
2. Goals
Development &
Activity Planning
1. Self-directed
Assessment
Asadoorian, J., CDHM Presentations Spring 2010 ©
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2. Goal
Development &
Planning Activity
Goal Development &
Planning Activity
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Self-directed assessment seeking strategies assist in detecting deficiencies and
opportunities for improvement
Step two involves developing continuing competency goals and associated
plans to address identified deficiencies
Two typical types of goals:


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knowledge attainment goals
action oriented goals
 action oriented goals often require change to practice and may require activities to
support the behavior change from the clinician or other practice members
Practice deficiencies must be prioritized to determine if which require
immediate attention and those that should be deferred
Planned activities should address some aspect of achieving one’s goal and
chosen based on resources and preference


one to several activities will be needed to support achievement of goals
use traditional methods and new online and digital resources
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Asadoorian, J., CDHM Presentations Spring 2010 ©
2. Goal
Development &
Planning Activity
Goal Development
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Developing the goal

Once “cued in”, describe
in detail the perceived
practice
deficiency/opportunity for
improvement
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In one sentence, define a
goal that captures the
need you have identified
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May be just a hunch at this
point
Include:

Defining the goal

Include a subject, action,
timeline and measurable
outcome
Example:

“Within 6 months, I will
ensure that the dental
implant care I
provide/recommend is
based on the most current
evidence
available
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What led to this observation?
What do you already know?
Is it possible this knowledge
could be updated?
Is it possible that practice is not
currently based
on evidence?
Asadoorian,
J., CDHM Presentations Spring 2010 ©
”
2. Goal
Development &
Planning Activity
Goal Development
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Developing the goal

I have been out of school for several years and have not
really ever incorporated ultrasonic scaling into my clinical
practice; I practice with a new graduate dental hygienist and
she uses the ultrasonic scaler along with hand scaling with
virtually every client. She explains to her clients that
ultrasonics is the latest technology and that it has several
therapeutic benefits over and above hand scaling. This
makes me feel uncomfortable for several reasons. First, I
am not sure how accurate the information she is sharing is,
but I feel a little out of date on my knowledge surrounding
power scalers and therefore not well-equipped to have a
discussion about it. Second, I would prefer that we practice
in a more standardized way based on the most recent
evidence. Lastly, I am wondering if my clients feel shortchanged that they are not receiving ultrasonic debridement
7/30/10her clients.
because they may over hear what she is telling
Asadoorian, J., CDHM Presentations Spring 2010 ©
2. Goal
Development &
Planning Activity
Goal Development
25
Defining the goal
I
will use the ultrasonics/power scalers in my
dental hygiene practice in accordance with the
most recent research/evidence within 6 months.
 Be
specific
 Be realistic
 Include only one goal
 Will you be able to measure your success?
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Asadoorian, J., CDHM Presentations Spring
2010 ©
2. Goal
Development &
Planning Activity
Planning Activity
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Once the goal is developed and
defined, determine some objectives
(mini-goals) to meet the goal
Think about the learning component
AND what will be needed to ensure
implementation of the goal into
practice: be realistic and detailed
Consider what resources will be
available and what you prefer to
use for achieving goals



This may require some research
Try to incorporate new methods (i.e.
internet searches, online learning
programs)
This is a plan, and may require some
modifications later

Objectives/mini-goals:

What do I need to achieve and learn?


i.e. latest ultrasonics information/research
How am I going to do it? (potential
ideas)

Do PubMed/Cochrane search


See if any courses/workships coming up
on topic


MDHA, CDHA, industry
Call an expert


Download relevant articles
Educator, researcher, colleagues
Then what?


Implement!!
Read, attend, consult, buy…Make
Changes To Practice!
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Asadoorian, J., CDHM Presentations Spring 2010 ©
Goal
Development &
Activity
Planning
Goal Development &
Activity Planning: CCR
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FILLING OUT THE FORM! Step Two:
Please describe the professional need or deficiency perceived:
(see pages 10 & 11 in Section 2 of the CCP Package)
________________________________________________________________
_____________________________________________________________
_____________________________________________________ ...
CONTINUING COMPETENCY GOAL # 1: (see pages 12 & 13 in Section
2 of the CCP Package)
I will use the ultrasonics/power scalers in my dental hygiene practice
in accordance with the most recent research/evidence within 6
months.
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Asadoorian, J., CDHM Presentations Spring 2010 ©
Navigating the CDHM
Continuing Competency Program
28
Professional Development Component: CCR
3. Activity
Implementation
& Evaluation
2. Goals
Development &
Activity Planning
1. Self-directed
Assessment
Asadoorian, J., CDHM Presentations Spring
2010 ©
7/30/10
3. Activity
Implementation
& Evaluation
Changing Practice: Activity
Implementation & Evaluation
29

Knowledge Awareness ≠ Knowledge Application


People, including dental hygienists, resist change
Dental hygienists have been shown to embrace traditional behaviours and
maintain the status quo ~ even in the face of strong evidence

Barriers exist that contribute to making change difficult– but enhancers exist too!
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Facilitating the change process:
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Recognize the relevance of a change

Possess transformed thinking (from reflection on practice)
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Use more active strategies for learning
Problems carrying out change:
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
Change is not automatic; humans do not behave completely rationally
Human change process is complex

based on individual and structural influences
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Asadoorian, J., CDHM Presentations Spring 2010 ©
3. Activity
Implementation
& Evaluation
Changing Practice: Activity
Implementation & Evaluation
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Activity Implementation:
 Matching activities to practice
deficiencies ensures the most efficient
use of one’s time—




rather than spending numerous hours on
activities that are irrelevant to one’s practice
Using a detailed and realistic activity
plan, it is relatively straightforward to
carry out
Activities can be conducted over a
period of time to achieve continuing
competency goals
Despite the most carefully developed
activity plans, some obstacles may be
encountered

Evaluation:
 One of the most important continuing
competency tasks is the evaluation of
goals
In these cases it will be necessary to
implement a contingency plan and adjust
one’s timeline accordingly


Three possible outcomes to the
evaluation are possible:




Without evaluation it is impossible to know
how to proceed
goal is met
goal is unmet
goal is in process
Based on the outcome, think about
what will need to occur next

Goals are fully met: focus on new
continuing competency activity or goal

Unmet or in process goals: more learning or
supplementary activities may be necessary;
a need to revise the goal may also become
apparent
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Asadoorian, J., CDHM Presentations Spring 2010 ©
Activity
Implementation
& Evaluation
Activity Implementation &
Evaluation: CCR
31
FILLING OUT THE FORM! Step Three:
CONTINUING COMPETENCY ACTIVITIES: What type of activities did you participate in
to support the achievement of this goal? Check all that apply (see pages 14 & 15 in
Section 2 of the CCP Package)
 Educational Courses/Seminars
__________
 Online Courses
__________
 Advanced Formal Education
___
 Professional Journals/ Articles
 Journal Clubs
 Videos or DVDs
 Other: (Specify) _______
Date of Course: _______ Name of Course/Presenter:
Date of Course: _______ Name of Course/Presenter:
Institution: ___________ Name of Course/Program of Study:
Date Read: __________ Journal/Article Reviewed: (may attach)
Date(s) Met: _________ Journal and/ or Topic Reviewed: _____
Date Viewed: _______ Title of Video/DVD/Producer: ________
Please describe: ______________________________________
What was the approximate time spent participating in the
activities? __________
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Asadoorian, J., CDHM Presentations Spring 2010 ©
FILLING OUT THE FORM! Step Three (cont...):
Did these activities assist you in meeting your Continuing Competency Goal?
 Met  Not Met  Partially Met
Please Explain: ________________________________________________...
Please describe the information/skills gained from these activities:
_____________________________________________________________...
What changes do you intend to make in your area of dental hygiene practice
as a result of these activities?
(please include the timeframe you hope to accomplish this in - i.e. immediately,
within 1 year): __________________________________________________...
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Asadoorian, J., CDHM Presentations Spring 2010 ©
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FILLING OUT THE FORM! Step Three (cont...):
Did you implement these changes into your dental hygiene practice?
 Yes  No  In-Process
Briefly Describe:
___________________________________________________________ …
If a change was made, did it help to improve your dental hygiene practice?
 Yes  No  In-Process
Briefly Describe: __________________________________________________________
…
Were there any constraints you encountered in implementing this change?
 Yes  No
Briefly Describe:
__________________________________________________________ …
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Asadoorian, J., CDHM Presentations Spring 20107/30/10
©
Navigating the CDHM CCP:
In Summary
34
Self directed
assessment
Goals
development &
activity planning
Activity
implementation
& evaluation
7/30/10
Asadoorian, J., CDHM Presentations Spring 2010 ©