MSK Practice Support Program

Train the Trainer 2

Faculty Development

“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

Objectives for Today

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

Where’s the Gap ?

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.

Helping Physicians Learn

Facilitating High Yield Learning

• 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)

Know what I Know

Know what I Don't Know

Don't know what I Know

Don't Know what I Don't Know

Unskilled and Unaware

• 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.

Physician Self Assessment• 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 of Competence:A Systematic Review, JAMA, Sept. 2006, vol 96(9)

Strategy

1. Adult Learners

2. Reflective Practice

3. Role Modeling

Motivating the Adult Learner

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

.

Describe your learning experience

Adult LearnersR- Relevance

E- Experienced Contributor

S- Self-directed

P- Practical

E- Equality

C- Connections

T - Timely Goals

Strategy

1. Adult Learners

2. Reflective Practice

3. Role Modeling

Reflective Practitioner

•

Reflective Practitioner

• SURPRISE

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

Clinical Responses

• Aware • Acknowledge• Investigate • Analyze• Integrate

Reflection

Reflection on Action

Gap: Guidelines to Practice Time and Logistics

Solutions Synthesize Disseminate Implement●

How do improve hand washing ?

Strategy

1. Adult Learners

2. Reflective Practice

3. Role Modeling

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

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.

Strategies for Role Modeling

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]

Longitudinal teaching programs

Focus on: Interviewing, physical examination, and management of psychosocial issues.

Encouraging collaborative and self-directed learningFaculty developmentStrengthening assessment and feedback procedures. .

Top 5 Valued Learning Qualities

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 Teaching Qualities

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

● .....Not Necessarily the Expert !

Teaching with Video

Teaching with Video1. 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

2. Real Model Evaluation Seek realistic teaching examples

What worked and was well done … What could have clearer or improved…

Teaching with Video

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….

Case Builder Process

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

Video Vignettes-Osteoarthritis

Ms. Irene Genou is a 58 year old retired elementary school teacher who has come to your office for her annual health evaluation and complains of increasing right knee pain and intermittent 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

Teaching with Clinical Tools

Selection Criteria

Relevant to Primary CareDiagnosisClinical Decision MakingManagement

Realistic in GP timePatient visitsDocumentation

Integration into Clinical Process

Language, Behaviour, Clinical Decisions

Checklist

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

Can we translate to teaching?

Role Modeling

Case based Application

Reflection on Practice

SIMPLIFY the SPINE