www.pspbc.ca

MSK Practice Support Program

Train the Trainer 2Faculty Development

2

3

4

“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

5

1. Able to facilitate small and large group physician learning through adult learning principles.

2. Able to demonstrate the use of clinical tools within the targeted patient population

Objectives for Today

6

Low Back Pain› 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.

Where’s the Gap ?

www.pspbc.ca

Helping Physicians Learn

8

• 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.

• 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)

• Physician learning is unique in that there is a high inclination towards autonomy and self-directed learning. (Knowles)

Facilitating High Yield Learning

9

Know what I Know

10

Know what I Don't Know

11

Don't know what I Know

12

Don't Know what I Don't Know

13

• Unskilled and Unaware of It: How Difficulties in Recognizing One's Own Incompetence Lead to Inflated Self-Assessments, Kruger J, Dunning D.,J Pers Soc Psychol. 1999 Dec;77(6):1121-34.

•

Unskilled and Unaware

14

• 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 ofCompetence:A Systematic Review, JAMA, Sept. 2006, vol 96(9)

Physician Self Assessment

15

1. Adult Learners2. Reflective Practice3. Role Modeling

Strategy

16

Social relationships External Expectations Social Welfare Personal Advancement Need Stimulation/Diversity Inquisitive Interest

Motivating the Adult Learner

17

Describe your learning experience

18

R- Relevance E- Experienced ContributorS- Self-directedP- Practical E- Equality C- Connections T - Timely Goals

Adult Learners

19

1. Adult Learners2. Reflective Practice3. Role Modeling

Strategy

20

•

Reflective Practitioner

21

• SURPRISE

• a brief emotional state experienced as the result of an unexpected significant event

Reflective Practitioner

22

• Aware • Acknowledge• Investigate • Analyze• Integrate

Clinical Responses

23

Reflection

24

Gap: Guidelines to Practice Time and Logistics

Solutions Synthesize Disseminate Implement

Reflection on Action

25

How do improve hand washing ?

26

1. Adult Learners2. Reflective Practice3. Role Modeling

Strategy

27

Clinical Competence  Excellent knowledge / skills

Effective communication

Sound clinical reasoning

Teaching Skills Aware of role

Explicit about model

Respect for learner needs

Provides feedback

Encourages reflection

Personal Qualities Compassionate

Enthusiastic for practice

Effective interpersonal skills 

Commitment to excellence

Demonstrates humour

28

The Importance of Role Models

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]

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.

29

Longitudinal teaching programs

Focus on: Interviewing, physical examination, and management of psychosocialissues.

Encouraging collaborative and self-directed learningFaculty developmentStrengthening 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 AmericanMedical Colleges [1995, 70(10):898-931]

Strategies for Role Modeling

30

Motivated to seek new information Set Realistic Goals Ability to reflect on new information Critical Thinker Confident to take risk

....not necessarily the highest marks!

Top 5 Valued Learning Qualities

31

Able to provide Interactive Setting Creative thinker Flexible in methodology Commitment and passion Supportive of learner needs

.....not necessarily the expert!

Top 5 Valued Teaching Qualities

www.pspbc.ca

Teaching with Video

33

34

1. Patient and doctor relationship Apply to new and related scenarios

How would the physicians response change if the patient said ….

How would the patient’s response change if the physician said…..

Teaching with Video

35

2. Real Model Evaluation Seek realistic teaching examples

› What worked and was well done …

› What could have clearer or improved…

Teaching with Video

36

3. Translate into Principles Link with guideline evidence Link with clinical decision making

› What principles would you want your resident to understand …

› What key messages are you trying to give to your patient….

Teaching with Video

37

38

Case Histories Curriculum Key Messages Learner Competency Outcomes Scripted Standardized Patients Training Taping and Editing

Case Builder Process

39

Ms. Irene Genou is a 58 year old retired elementary school

teacher who has come to your office for her annual healthevaluation and complains of increasing right knee pain

andintermittent swelling.

Patient History - Inflammatory Screening History /PHQ9/ Pain and Function Follow-up

Physical Examination//Investigations /Indication for Surgical Referral / Pain and Function Follow-up

Treatment and Management Options / Medication /Patient Self-Management

Video Vignettes-Osteoarthritis

www.pspbc.ca

Teaching with Clinical Tools

41

Relevant to Primary Care

› Diagnosis

› Clinical Decision Making

› Management

Realistic in GP time

› Patient visits

› Documentation

Selection Criteria

42

Language, Behaviour, Clinical Decisions

Integration into Clinical Process

43

Explain Principle Concepts Relevance to Primary Care Demonstrate – Video Reflection Practice Feedback

Checklist

44

Role ModelingCase based ApplicationReflection on Practice

SIMPLIFY the SPINE

Can we translate to teaching?

45