Transcript MSK Practice Support Program

MSK Practice
Support Program
Train the Trainer 2
Faculty Development
“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.
2.
Able to facilitate small and large group
physician learning through adult learning
principles.
Able to demonstrate the use of clinical
tools within the targeted patient
population
Where’s the Gap ?
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Low Back Pain
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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.
Helping Physicians
Learn
Facilitating High Yield Learning
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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.
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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)
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Physician learning is unique in that there is a high inclination
towards autonomy and self-directed learning. (Knowles)
Know what I Know
Know what I Don't Know
Don't know what I Know
Don't Know what I Don't Know
Unskilled and Unaware
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Unskilled and Unaware of It: How Difficulties in
Recognizing One's Own Incompetence Lead to
Physician Self Assessment
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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)
Strategy
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2.
3.
Adult Learners
Reflective Practice
Role Modeling
Motivating the Adult Learner
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Social relationships
External Expectations
Social Welfare
Personal Advancement
Need Stimulation/Diversity
Inquisitive Interest
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Describe your learning experience
Adult Learners
R- Relevance
E- Experienced Contributor
S- Self-directed
P- Practical
E- Equality
C- Connections
T - Timely Goals
Strategy
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2.
3.
Adult Learners
Reflective Practice
Role Modeling
Reflective Practitioner
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Reflective Practitioner
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SURPRISE
a brief emotional
state experienced
as the result of an
unexpected
significant event
Clinical Responses
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Aware
Acknowledge
Investigate
Analyze
Integrate
Reflection
Reflection on Action
Gap:
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Guidelines to Practice
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Time and Logistics
Solutions
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Synthesize
Disseminate
Implement
How do improve hand washing ?
Strategy
1.
2.
3.
Adult Learners
Reflective Practice
Role Modeling
Clinical Competence
Excellent knowledge / skills
Effective communication
Sound clinical reasoning
Teaching Skills
Personal Qualities
Aware of role
Explicit about model
Respect for learner needs
Provides feedback
Encourages reflection
Compassionate
Enthusiastic for practice
Effective interpersonal skills
Commitment to excellence
Demonstrates humour
The Importance of Role Models
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.
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]
Strategies for Role Modeling
Longitudinal teaching programs
Focus on:
Interviewing, physical examination, and
management of psychosocial issues.
Encouraging collaborative and self-directed
learning
Faculty development
Strengthening assessment and feedback
procedures. .
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]
Top 5 Valued Learning Qualities
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Motivated to seek new information
Set Realistic Goals
Ability to reflect on new information
Critical Thinker
Confident to take risk
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....not necessarily the highest marks !
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Top 5 Valued Teaching Qualities
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Able to provide Interactive Setting
Creative thinker
Flexible in methodology
Commitment and passion
Supportive of learner needs
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.....Not Necessarily the Expert !
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Teaching with Video
Teaching with Video
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Patient and doctor relationship
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Apply to new and related scenarios
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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
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Seek realistic teaching examples
What worked and was well done …
 What could have clearer or improved…
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Teaching with Video
3. Translate into Principles
 Link with guideline evidence
 Link with clinical decision making
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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
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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.
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Patient History - Inflammatory Screening History /PHQ9/ Pain and
Function Follow-up
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Physical Examination//Investigations /Indication for Surgical
Referral / Pain and Function Follow-up
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Treatment and Management Options / Medication /Patient Self
Management
Teaching with
Clinical Tools
Selection Criteria
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Relevant to Primary Care
 Diagnosis
 Clinical
Decision Making
 Management
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Realistic in GP time
 Patient
visits
 Documentation
Integration into Clinical Process
Language, Behaviour, Clinical Decisions
Checklist
Explain Principle Concepts
 Relevance to Primary Care
 Demonstrate – Video
 Reflection
 Practice
 Feedback
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Can we translate to teaching?
Role Modeling
Case based Application
Reflection on Practice
SIMPLIFY the SPINE