fieldnotes: experience and lessons from the anaesthesia ... · fieldnotes: experience and lessons...
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Fieldnotes: Experience and lessons from the Anaesthesia Training Programme in Ireland
Authors: Sheena Durnin, Deirdre Bennett, Rebecca Fanning, Patricija Ecimovic, David Moore, Shelley Ross and Josephine Boland Date: 30 September 2016
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I do not have an affiliation (financial or otherwise) with a pharmaceutical, medical device or communications organization.
College of Anaesthetists of Ireland • Funding for the research study • Conference support
Presenter: Dr Josephine Boland Director of Medical Educaiton College of Anaethetistis of Ireland
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1. Context 2. Research study 3. Selected findings 4. Lessons learned for the next phase 5. Conclusions
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Need for � a 'culture shift’ � assessment of trainees’ clinical performance � constructive feedback � support for struggling trainees “Safe and effective clinical learning cannot take place without feedback; and providing feedback is a critical competency for clinical teachers”.
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CBME Framework
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: � Quality of patient care � Reduced 6-year programme � EWTW directive � ‘Your Learning Counts’ � Learning from other contexts
Focus on feedback
CBME Framework
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Brown N, Cooke L. Giving effective feedback to psychiatric trainees. Adv. Psy. Treat. 2009;15(2):123-8.
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� 10 weeks � Four hospitals � Trainees � Tutors � Consultants
Informed by:
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� Brief summary of an experience/event in a clinical setting � Initiated by a trainee or consultant � Feedback from consultant � Reflection/action points by trainee � ‘Low stakes’ in nature
� Part of a collection of evidence � May contribute to progression decisions/remediation plans.
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Durnin S. (2006) ‘Evaluation of a Pilot Study of Fieldnotes in Anaesthetic Trainees in Ireland’ Thesis submitted in partial fulfilment of the Masters in Clinical Education, National University of Ireland Galway
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� Evaluate the feasibility and acceptability of Fieldnotes to trainees and tutors
� Audit the domains and competencies recorded by Fieldnotes
� Inform the planning of a national launch of Fieldnotes by the College
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Research Design � Pragmatic � Sequential � Mixed methods
Methods � On-line questionnaire � Semi-structured interviews
Data analysis � Content analysis � Constant comparison approach.
Participants • Trainees (51) • Consultant Tutors (4)
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"So it’s pretty much on an ad hoc (basis) really, you may
get feedback on a particular aspect of your
performance but that would tend to be if something had
gone really, really well. Or something had gone really,
really badly"
(TR16S).
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Incentives for Change
• Increased feedback • Quick and easy to complete
Innovation Itself
• Empower trainees to initiate feedback
Individual Professional
• Increased collaboration Social Context
• Evidence for decision to progress Organisational Context
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“It captures that moment that might be otherwise lost. So you capture something, you do it instantly and then it’s done dusted, gone then we move on. " (CT3).
◦ 2 -10 minutes to complete a Fieldnote ◦ Some prompted a prolonged discussion.
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◦ "So… I haven’t used Fieldnotes often - probably because it’s not compulsory … But I had liked the times that I have used Fieldnotes. I did actually think that it was useful" (TR2S).
◦ "I would say I probably have gotten about a quarter done that I have attempted to initiate" (TR1S).
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Barriers to Change
• Issues with paper-based format Innovation Itself
• Trainee & Consultant reluctance to engage
Individual Professional
• Feedback culture • Time & service pressures Social Context
• Lack of direct consultant supervision • Consultant training
Organisational Context
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� Need for further training � CPD credits for consultants � Mandatory minimum no. for trainees � A Smart Mobile Application
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� The powerful discourse of ‘assessment’ ◦ Assure trainees of the ‘low stakes’ ◦ Revise the language of assessment � ‘Feedback Reports’
� Use Fieldnotes where they add value ◦ Non-technical skills/professionalism ◦ More modest expectations (min. no.)
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� EPAs in ◦ Vascular Access ◦ Managing Pain in Labour ◦ Pediatric Anaesthesia (ASA I-II)
� ‘Orientation’ of tutors and lead trainees � Mandatory min. no. of reports
� Communicating the message
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Direct Observation of Procedural Skill (DOPS) Fieldnotes
Case Based Discussion
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DOPS
Case Based Discussions Fieldnotes
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DOPS � For Clinical Skills
Case Based Discussion � For Clinical Reasoning
Fieldnotes � For ‘non-technical’ skills: � Professionalism � Collaboration and teamwork � Communication � Relating to patients
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DOPS � For Clinical Skills
Case Based Discussion � For Clinical Reasoning
Fieldnotes � For ‘non-technical’ skills: � Professionalism � Collaboration and teamwork � Communication � Relating to patients
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� Challenge of introducing change in a complex, busy clinical environment.
� Cultural barriers are more challenging than organisational and logistical ones.
� Focus on where we can add value
� We just need to make a start! .
CBME World Summit 2016 J Boland et al CAI.
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References � Boland J (2016) “Entrustable Professional Activities: Placing trust at the centre of
education, training and assessment in anaesthesia” CAI Annual Congress, UCD, Dublin, May 2016
� Brown N, Cooke L. Giving effective feedback to psychiatric trainees. Adv. Psy. Treat. 2009;15(2):123-8.
� Durnin S (2006) “Evaluation of a Pilot Study of Fieldnotes in Anaesthetic Trainees in Ireland” Thesis submitted in partial fulfilment of the Masters in Clinical Education, National University of Ireland Galway
� Harrison C, and Val Wass (2016). "The challenge of changing to an assessment for learning culture." Medical Education 50 (7) pp704-706.
� Medical Council (2014) Your Training Counts Report: Results of the National trainee Experience Survey Dublin: Medical Council
� Ross S, Poth, CN, Donoff, M, Humphries, P. Steiner I, Schipper S, Janke, F, Nichols D (2011) "Competency-Based Achievement System Using formative feedback to teach and assess family medicine residents’ skills. "Canadian Family Physician 57 (9) e323-e330.
� Rudolph JW, Simon R, Rivard P, Dufresne,R., and Raemer D. (2007)“Debriefing with Good Judgment: Combining Rigorous Feedback with Genuine Inquiry” Anaesthesiology Clinics, 25 (2) pp 361-376, ISSN 1932-2275
� Sabah R and Krackov SK (2013) "Twelve tips for giving feedback effectively in the clinical environment." Medical teacher 34(10) pp 787-791.
� ten Cate O, Chen HC, Hoff RG, Peters H, Bok H & van Der Schaaf M. (2015). “Curriculum development for the workplace using Entrustable Professional Activities (EPAs): AMEE Guide No. 99”. Medical Teacher, 1-20. doi: 10.3109/0142159X.2015.1060308
� Voyer S, and Hatala R. (2015) "Debriefing and feedback: two sides of the same coin?." Simulation in Healthcare 10 (2) pp 67-68.
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Fieldnotes: Experience and lessons from the Anaesthesia Training Programme in Ireland
Sheena Durnin, Deirdre Bennett, Rebecca Fanning, Patricija Ecimovic, David Moore, Shelley Ross and Josephine Boland