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MSK Practice Support Program
Train the Trainer 2Faculty Development
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“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
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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
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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 ?
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Helping Physicians Learn
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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.
• 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
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Know what I Know
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Know what I Don't Know
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Don't know what I Know
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Don't Know what I Don't Know
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• 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.
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Unskilled and Unaware
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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 ofCompetence:A Systematic Review, JAMA, Sept. 2006, vol 96(9)
Physician Self Assessment
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1. Adult Learners2. Reflective Practice3. Role Modeling
Strategy
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Social relationships External Expectations Social Welfare Personal Advancement Need Stimulation/Diversity Inquisitive Interest
Motivating the Adult Learner
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Describe your learning experience
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R- Relevance E- Experienced ContributorS- Self-directedP- Practical E- Equality C- Connections T - Timely Goals
Adult Learners
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1. Adult Learners2. Reflective Practice3. Role Modeling
Strategy
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Reflective Practitioner
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• SURPRISE
• a brief emotional state experienced as the result of an unexpected significant event
Reflective Practitioner
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• Aware • Acknowledge• Investigate • Analyze• Integrate
Clinical Responses
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Reflection
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Gap: Guidelines to Practice Time and Logistics
Solutions Synthesize Disseminate Implement
Reflection on Action
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How do improve hand washing ?
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1. Adult Learners2. Reflective Practice3. Role Modeling
Strategy
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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
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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.
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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
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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
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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
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Teaching with Video
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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
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2. Real Model Evaluation Seek realistic teaching examples
› What worked and was well done …
› What could have clearer or improved…
Teaching with Video
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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
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Case Histories Curriculum Key Messages Learner Competency Outcomes Scripted Standardized Patients Training Taping and Editing
Case Builder Process
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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
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Teaching with Clinical Tools
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Relevant to Primary Care
› Diagnosis
› Clinical Decision Making
› Management
Realistic in GP time
› Patient visits
› Documentation
Selection Criteria
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Language, Behaviour, Clinical Decisions
Integration into Clinical Process
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Explain Principle Concepts Relevance to Primary Care Demonstrate – Video Reflection Practice Feedback
Checklist
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Role ModelingCase based ApplicationReflection on Practice
SIMPLIFY the SPINE
Can we translate to teaching?
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