Translating a Multisource Feedback Program for Medical Students to a New Institution. M. Lai, N. Roberts, J. Martin Eastern Health Clinical School. Monash University and Deakin University

Background Different  ins*tu*ons  have  similar  aims  to  train  future  workforce  to  provide  pa*ent-­‐centred,  personalised  medicine  and  manage  chronic  illness  in  an  ageing  popula*on.  However,  due  to  ins*tu*ons’  different  educa*onal,  clinical  and  organisa*onal  contexts,  off-­‐the-­‐shelf  programs  may  not  transplant  effec*vely  to  new  environments.  We  describe  transfer  of  an  exis*ng  program  to  a  new  ins*tu*on  using  a  program  logic  framework  to  adapt  the  program  and  manage  its  implementa*on.    

The P3 PTA Program The  Pa*ent  Partner  Program  (P3)  recruits  pa*ent  volunteers  from  the  community  for  supervised  consult-­‐style  teaching.  P3  aims  to  equip  students  for  pa*ent-­‐centred  care,  development  and  integra*on  of  key  clinical  competencies.    P3  was  developed  in  2005  by  the  University  of  Tasmania  Launceston  Clinical  School  (1)  and  translated  to  the  first  clinical  year  at  Eastern  Health  Clinical  School  in  2013.  Key  features  of  P3  are  enthusias*c  pa*ent  teachers,  very  small  groups,  a  safe  environment,  adequate  *me,  and  immediate  mul*-­‐source  feedback  from  pa*ents,  peers  and  tutors.  Tutors  assess  students  using  a  structured  scale  (2)  and  provide  immediate  feedback  during  student-­‐led  consulta*on  prac*ces.  Students  also  receive  verbal  feedback  from  peers  and  pa*ents.  

The Evaluation Design

Formal  evalua*on  of  the  first  year  of  P3  PTA  implementa*on  was  undertaken  to  clarify  the  internal  structure  and  the  func*oning  of  the  translated  program.  Logis*c  and  educa*onal  challenges  of  implementa*on  were  explored  through  observa*on,  program  record  analysis  and    obtaining  pa*ent,  tutor  and  student  feedback.  The  resul*ng  program  logic  will  guide  further  implementa*on  to  maximize  the  desired  outcomes  of  the  program.    Educa*onal  research  exploring  the  development  of  the  students’  pa*ent  centred  consulta*on  skills  is  reported  elsewhere.  Ethics  approval  for  the  evalua*on  and  research  was  obtained  from  Monash  HREC.  

What Did We Learn? Successful  implementa*on  highlighted  the  value  of  a  clear  plan,  star*ng  small,  defined  expecta*ons  to  suit  our  learners,  experienced  mentors,  key  staff  with  necessary  skills,  suppor*ve  faculty  and  associates.  Learner  and  teacher  feedback  was  very  posi*ve,  favourably  contras*ng  the  new  learning  environment  to  the  tradi*onal  seXng.    

The P3 PTA Program Logic A  program  logic  to  guide  effec*ve  program  planning  and  implementa*on,  clearly  iden*fied  the  enablers  and  barriers  for  success.  This  approach  uncovered  the  implicit  assump*ons  and  understandings  of  P3,  focussed  the  team,  limited  unexpected  situa*ons  and  provided  the  basis  for  analysis  and  sharing  of  outcomes.  

Key success factors

Ø  Robust system for screening, informed consent, and support of patient recruits

Ø  Comprehensive database to manage patient, student, tutor data, session schedule and assessment process

Ø  Carefully developed pedagogy, and student assessment tool (Rating Instrument for Clinical Consultation Skills: RICS)

Ø  Mentoring and lifelong learning skills promoted: patients, tutors and students participate in a ‘community of educational practice’

Ø  Support of students, tutors and patients

Ø  Planned evaluation

Ø  Expect the unexpected!

References:  (1)  Barr  J,  Ogden  K,  Rooney  K  (2009).  Sustainable  involvement  of  real  pa*ents  in  medical  educa*on:  thanks  to  volunteerism  and  rela*onship  management.  Medical  Educa*on  43:  599-­‐600                                                                                                                                                                                      (2)  Ogden  K,  Barr  J,  Hill  A,  Summers  M,  Mulligan  B,  Rooney  K.  2012.  Valida*ng  a  tool  designed  to  assess  medical  student’s  pa*ent-­‐centred  capabili*es  and  integra*on  of  consulta*on  skills.  Poster  at  Oaawa  Conference,  Kuala  Lumpur.  Acknowledgements:  We  wish  to  express  gra*tude  for  the  generosity  of  Professor  Kim  Rooney,  Dr  Jennifer  Barr  and  Dr  Kathryn  Ogden  from  the  Launceston  Clinical  School  UTas    who  guided  us  in  this  transla*on.  Also,  to  our  wonderful  volunteer  pa*ents!  

UTAS P3 EHCS P3 PTA

•  Senior students – Year 4&5

•  2 year program

•  Progressive skill development and complexity

•  Range of consult styles/settings

•  GP tutors

•  Patient volunteers from GP practices

•  Multisource feedback

•  Video to support feedback and reflection

•  Junior clinical students – Year 3

•  One semester (current)

•  Focus on patient centred consultation skills

•  GP style consult

•  Tutors mainly hospital staff

•  Patient volunteers from patient support groups and advertising

•  Multisource feedback

•  No video

 “It  made  me  more  confident  talking  about  my  condi*on”    “I  probably  get  as  much  out  of  it  as  the  students”    “Volunteering  helps  me  to  feel  useful,  and  I’m  excited  to  see  these  students  in  their  medical  training.  I  like  being  part  of  their  future.”     “It’s  a  great  thing  for  our  community”  

         

 

!Context!!

Increased!

burden!of!

chronic!disease!

!

!

!

!

!

!

!Changing!

consumer!and!

societal!

expectations!of!

doctors!

!

!

!

!

!

Patients!

increasingly!

informed!and!!

willing!to!be!

actively!engaged!

in!own!

healthcare!and!

medical!

education!

!Changing!learning!

environment!in!

health!services!

! ! ! !

Develop!competence!in;!

=!Consultation!and!communication!skills!=!Patient=centred!care!!=!Chronic!disease!management!

Intended!outcomes!Effective!and!efficient!learning!methods!to!

complement!acute!environment!Safe!and!paced!learning!environment!

!

Better!tools!for!learning,!teaching,!

assessment!and!feedback!

Inputs!Learning!theory!based!education!approach!

People!

• Patient!volunteers!(PTAs)!

• Clinical!tutors!

• Educators!

• Students!

• Program!manager!

• Coordinator!

• Administrative!support!staff!

• Steering!group!

Logistics:!

Community!resources!

• PTA!volunteers!

Eastern!Health!Clinical!School!

• Administrative!Staff!

• Equipment!

• Consumables!!

• Funding!

• PTA!and!tutor!recruitment!!

Medicare!Local!

• Venue!

• Facilities!and!equipment!

• Consumables!

• PTA!and!tutor!recruitment!!

Launceston!Clinical!School!

• Database!support!

• P3!intellectual!property!

• Mentoring!and!resources!!

Monash!University!&!Deakin!University!

• Faculty!support!

• Research!funding!

• Research!support!!

External!funding!resources!

Activities!!

PTA!

• Recruitment!

• Training!

• Management!!

• Feedback!

• Support!

• Database!

Tutor!

• Recruitment!

• Training!

• Management!!

• Support!

Administration!

!Session!

• Structure!

• Management!

!Program!

• Development!

• Management,!logistics!

• Promotion!

!Education!

• Objectives!

• Design!

• Monitoring!

!Collaboration!

• Internal!

• External!

Research!

Short!term!Student!experience!and!learning!

• Diversity!of!cases!

• Skill!development!

o Consulting!tasks!

o Patient!management!

o Communication!skills!

• Knowledge!development!

o Clinical!content!

o Health!care!system!

o Patient!journey!

o Psycho=social!

o Demographic!diversity!

• Attribute!development!

o Clinical!reasoning!

o Patient=centred!care!

o Professional!identity!!

o Empathy!

o Cultural!competency!

o Reflective!practice!

o Team!work!

Tutors!

o Skill!development!

o Build!capacity!

o Modelling!professionalism!

PTAs!

o Satisfaction!with!experience!

o Development!of!teaching!role!and!

skills!

o Development!of!communication!skills!

o Motivation!

Program!

o Issue!management!

o Viability!

Medium!term!

!

!

!

!

!

!Student!

• Increased!self=efficacy!

• Retained!knowledge!and!

skills!

• Sustained!reflective!

practice!

• Enhanced!OSCE!

performance!

!

PTAs!

o Diversity!of!cases!

o Identification!with!

team!and!program!

o !

Team!member!role!

development!!

!

Research!achievements!and!

opportunities!

!

Long!term!

!

!

!

!

!

!Graduate!

• Practice!behaviours!

• Reflective!practice!

Workforce!implications!

Community!engagement!

Program!development!!

o Branding!

o Transferability!to!

other!medical!

education!setting!

Program!sustainability!

o Funding!

o Clinical!School!and!

Faculty!support!

o Demonstrated!

effectiveness!and!

efficiency!

Changing!

teaching!culture!

in!medical!

profession!

! ! ! ! ! Measurement!Program!delivery!parameters!

• Scheduled!sessions,!reach,!costing!and!resource!use!• Unplanned/adverse!events!

!

Feedback!

o PTAs!

o Students!

o Tutors!

The translation Students

Patients

                                                         s                                    “even  more  enjoyable  than  I  expected”        “a  great  opportunity  to  comment  and  help  improve  student  performance  there  and  then    “much  easier  than  teaching  in  General  Prac*ce  where  I  am  more  focused  on  pa*ent  diagnosis  and  management”     “obviously  enjoyable  and  sa*sfying  for  pa*ents”    

 

                  “much  more  helpful  to  me  than  I  expected”    “excellent  environment,  everything  we  needed  was  there”    “ability  to  prac*ce  history  and  examina*on  in  an  unhurried,  controlled  seXng”                          “the  feedback  was  great  ,much  beaer  than                                                                                  I  expected”  

   

 

Tutors

Relative importance of program features in narrative descriptions Introduction One year

The Research

Measurable  improvement  in  pa*ent-­‐centredness  afer  5  sessions.  Posi*ve  benefit  of  wriaen  pa*ent  feedback