Transcript The Need for Professional Educational Competences in Diabetes Management by Prof. Morsi Arab Causes of Failure of Patients Education 1- unqualified educators 2- pour resourses 3- patient uncompliance.

The Need for
Professional Educational
Competences in Diabetes
Management
by
Prof. Morsi Arab
1
Causes of Failure of Patients
Education
1- unqualified educators
2- pour resourses
3- patient uncompliance
The Education Triangle
Objectives
Evaluation
( Test )
Strategy
( Methods of
teaching )
Teaching and Education
* Teaching competence :an “art “
or a “ science” ?
* Only by an inborn talent,
or a science with rules to be
learned and skills to be
acquired…….?.
Adjusting the Education to the Community
Needs : Steps……
1. The needs of the community for
certain jobs.
2. job description ,by defining the tasks needed .
3. Set objectives
( acquiring certain knowledge, skills
and attitudes)
4. Design curriculum
5. Evaluate achievement of objectives.
Task Analysis
* Each task requires
(i) Specific knowledge
(ii) Specific skills.
(iii) Specific attitudes
Example of task selection needed for the
job of : “Podologist “
1- Examine feet:
2- Diagnose problems
3- Manage
4- Educate patients
Task analysis:
Knowledge
- Anatomy
- Factors foot vulner.
- Mechanics of
walking
- Circulation
- Pain sensation…etc
requirements for Podologist)
Skills
(viz how to learn)
- Cutting nails:
technique,
instruments.
- Debridement..etc
Attitudes
(viz how to learn)
- Show respect
- Accuracy
- Showing care &
sympathy…etc.
Objectives
Objective Domains :
1- Cognitive ( knowledge)
2- Skills
- psychomotor
- communication
- cognition
3- Attitudes
The selection of objectives depends on what the
learner needs and is going to do (tasks) during
the job , and at which level of competence
In an Education Course :
N.B.: You can not teach everything,… So stick to
“selected” priorities :
1- obligatory to learn
2- useful to learn
3- if possible to learn
Objectives
General Considerations
1- Set clear-cut objectives.
2- in behavioral terms( i.e. describing what the learner
ultimately can do) e.g.:
1- If cognitive e.g. describe,
enumerate
2- In skills e.g. inject , do blood testing
etc.
3- In attitudes e.g. demonstrate punctuality ,
sympathy , etc….
-
Objectives ( cont.):
3- The education Faculty: (team work) …
( to avoid contradictions )
4- Different objectives to different learners
5- Different teaching methods to suit different
objectives.
Objectives ( cont.):
6- Different objectives at different stages
of the disease.
7- Overloading leads to confusion ,
depression and hopelessness.
8- Only achievable objectives .
Some variables that define different
patient objectives:
1- Their existing Knowledge about DM.
2- Their general educational competence
(eg. if illiterate?).
3- Their belief, perception of their illness,
mis-conceptions., etc.
4- Psychological stage and readiness to learn
5- State of illness: controlled ? complicated, ?
handicapped.?,etc.
5- Socioeconomics: cost feasibility , etc.
STRATEGY
To prepare for an educational
presentation :
1- identify the need of the learners for the set
objectives.
2- identify their background (what they already
know). Repetition (as revision) may be
useful as enforcement.
3- select the content : never “tell all” (only the
useful and appropriate)
4- focus objectives to the outcome: (what they
can do, think , believe and know, at the end of
the lecture, which they could not do before ).
The Big Group Presentation
The Beginning ( Introduction) :
- gain attention and interest : e.g.by
a question , a story ,problem, case
presentation, etc….. (or)
- provide a skeleton of the contents to
be covered
The Flow of the presentation:
I- To keep capturing attention :
1- repeat significant points.
2- check perception of the main points.
3- have reasonable sense of humor .
4- face audience and distribute eye contact.
5- keep logical sequence: chronological, cause and
effect, less complex to more complex , problem and
solution, etc.
The flow of the presentation ( cont.)
6- change your methods.
7- avoid : jargon , stereotyped phrases, unclear
expressions , sophisticated words above learner’s
level of comprehension; long complicated
sentences.
8- avoid : monotony , mannerism.
9- ensure that everybody sees and hears well.
The flow of the presentation ( cont.)
10- Use properly selected A.V. aids e.g.charts, slides
(minimal, readable material) ,models, specimens
etc.
11- Be aware of the time allowed .
12- Prepare for the unexpected mishaps (projector
lamps , power failure , chart slipping, etc.
The Audience :
Respect and get feed back from the Audience :
1- show respect and interest:( punctuality , dress?)
2- be concerned with negative responses: ,
yawns , expressions of perplexion , whispering questions,
looks of unbelief or disapproval, etc. …Don’t ignore !!
3- do not be angered or intimidated by negative
responses but react by re-shaping the presentation.
4- get final feedback e.g. by distributing & collecting
handouts……… (later)
The End :
1- Draw conclusions , …or invite independent conclusions.
2- Make end flows naturally from introduction
(e.g. answering the questions , solve the problem …).
3- Simple summary…. (pin point important aspects.)
4- Tie up loose points, to make the whole presentation as
a unit ..
5- Suggest ways for application and benefits.
6- suggest ways for continued learning.
Small Group Education
- Select suitable size of the group ?
- Educate, not teach (active participation).
- Monitor Group behavior dynamics at
different stages.
- Control individual dynamics:
*positive behaviours…(encourage)
* negative behaviours..(checked )
The One-to-One Education
1- Listen.
2- Motivate.
3- Individualize (quality) according to
* stage of disease.
* educational level…etc.
4- Not too much (quantity).
5- Reward, more than blame.
Teaching of Skills
Types of Skills
1- Psychomotor skills
2- Communication skills
3- Cognitive skills , like taking decisions
to which action to take .
How to Teach Skills ( 3 steps) :
( Describe- Demonstrate- Exercise)
Step 1- Describe : show importance, indications,
steps of performance , preparations,
precautions…etc.
Teaching of Skills
Step 2Demonstrations:
a) every one should be able to see the
demonstration.
b) may have to be repeated
c) describe what you are doing during the
performance ( to explain)
d) support by AV aids
Teaching of Skills
Step 3 :Exercising ( Training)
a) everybody exercises.
b) Feed back ,to correct mistakes and
advice for better performance.
c) use helping methods: play role ,
simulation equipment , etc.
d) give sufficient time for the training.
e) initiate training in groups or projects
Teaching Attitudes
Attitude = Tendency to behave
in specific way.?
* Could they be acquired by
educational methods?
Ways to teach, develop and encourage
behaviours
1- Provide relevant information: e.g. dangers of
smoking (to stop smoking), or bad effects of
hyperglycemia ,(to encourage compliance).
2- Give example of model (good) behaviour , to inspire.
3- Acquiring a (good ) behaviour from long observation of
the results of a negative (bad) behaviours .
4- From close contact e.g. working or living with individuals
with positive or negative attitude (camps..)
5- Give chance to discuss (good & bad behaviours ) :
in small groups; every one must share in the
discussion and should be free to express.
Evaluation
Evaluation by judgment :
A- Expert judgment by trained observers:
* the expert observer determines “ how well” ,
without having to define further the concept of
“well”.
Evaluation by judgment : ( cont.)
B- By the use of tests and scales :
- The concept “well” has to be
defined beforehand .
- Standardization ensures objectivity .
Evaluation
General Considerations :
- There is no one ideal method for evaluation .
- The choice of one method depends on :
1- is it reliable?
2- is it valid?
3- Time consumed?
4- availability of its tools .
5- Gives good FB (feed-back) to the learning
process
6- Not only testing knowledge but also skills
and attitude.
How to ensure” reliability” of the
test
By using objective methods
e.g. MCQ s, check lists, rating scales
and similar methods ,( to help the
examiners to unify their judgment
under all conditions ).
To ensure “validity”, be sure that
evaluation is testing for the exact
requirements of the job: e.g.
1- Discard Qs on sophisticated Kn which is beyond
the learner’s needs for performing the required
tasks in the job.
2- Concentrate on the skills and attitudes needed
( as was defined by task analysis and job
description.)
Long Essay Questions :
Have minimal advantages e.g
1- Very easy to prepare ( for the examiner).
2- Tests ability of student to construct an article.
Conclusion:
- Better not to use it.
- If necessary try to improve .
Multiple Short Essay Questions
Advantages:
1- covers a large part of the curriculum
2- less unreliable
3- answered in shorter time ( by students).and
also marked in shorter time ( by examiner).
Disadvantages:
Still tests simple knowledge and no skills or application of the
knowledge in solving problems ( taking decisions).
The MCQ
Type 1: Short stem + a number of choices
Example: During a hypoglycemic episode :
(a) there may be excessive sweating √
(b) palpitations
√
(c ) there is hypotension
√
(d) very dry mouth
√
(e)……………………………………….. √
N.B. Here all choices should be taken
×
×
×
×
×
Multiple Choice Questions (MCQ)
Type 2:one stem +4-6 (usually 5) choices
- Example : After describing some clinical features
…………..what is the most probable diagnosis ?
(To answer select only one )
( a )…………………………
Answer: e.g. (c)
( b )…………………………
( c )………………………….
( d )………………………….
( e )……………………………
Advantages of MCQ Test
- scored in a short time and precisely.
- if numerous , covers widely the syllabus.
- can be used for self assessment.
- high reliability.
Disadvantages :
- difficult and need long time and experience
to prepare good MCQs.
- usually test only knowledge
(rarely skills e.g. in decision making ).
Oral Examination
- Advantages (few): vivid, can probe increasing depth of
knowledge (escalate).
- Disadvantages:
- induces anxiety to students (stress not existing in
practical life).
- consumes long time.
- unreliable
- can not test skills (v. rarely).
- does not give good FB to the education process.
Conclusion : better avoided
Evaluation by Check Lists
- very useful for testing skills
- Example: during a particular performance, the learner’s
actions are observed by the examiner to score for
each appropriately performed step.
1-……………………………………………… √
2-……………………………………………… √
3-……………………………………………… √
4-……………………………………………… √
5-……………………………………………… √
6-……………………………………………… √
7-……………………………………………… √
8-……………………………………………… √
9-……………………………………………… √ etc.
- Has high reliability
- Gives good feed-back to teachers . (e.g. , if all the learners
miss a particular step or do it with bad performance
reconsider the training course.)
Check List / Rating scale, for measuring attitudes
(behaviours) e.g. of a person during his training or
working (job)
0
1
2
3
4
1- shows interest
2- accepts instructions
3- cares for patients
4- shows desire to learn
5- keeps on time
6…………………..
5
×
×
×
×
×
0: strongly lacking…………5: strongly agree/ evident
The Follow-up Record of Proper
Performance
* The Record contains a number of tasks enlisted.
* Each individual should fulfill the performance of all tasks.
* A satisfactory achievement of each task ( separately )
is noted.
* Unsatisfactory performance indicates repeat training
(This method is very helpful to the learning process )
Alexandrie – Palais du Montazah
Thank You