2Objectives of the session At the end of the session the students shouldbe able to define clinical auditImportance of clinical auditAble to discuss the audit cycleAble to identify the structure, process and outcome indicatorsAble to discuss types of clinical audit and methods used in clinical audit
3What is clinical audit?The systematic critical analysis of the quality of health care, includingthe procedures used for diagnosis, treatment and care,the use of resources and the resulting outcome and quality of life for patients.it embraces the work of all healthcare professionals"
4What we do in clinical audit? 1. Critical analysis of your own skills and ways of working for self improvement2. Critical look at the system that delivers care to your patients (i.e. your environment)
5What does clinical audit achieve? Best practiceBest outcome
6Planning an audit Choose the audit topic Study the current situation Analysis and compare with standardsIdentify causes for not meeting the standardsIdentify the changes to be doneWrite a plan for implantation and Implementation of changesRe-audit
7The audit cycleThe clinical audit process seeks to identify areas for service improvement, develop & carry out action plans to rectify or improve service provision and then to re-audit to ensure that these changes have an effect
8Audit topic “SMART” Specific Measureable Achievable Realistic Timely way
9What is required for an audit? Criteria are those aspects of care that you wish to examine.A criterion is a measurable outcome of careThis should be in the form of a statement.Standards are the pre-stated or implicit levels of success that you wish to achieve (Target)we usually express it as a percentage
10Criterion & Standard Criterion This should be in the form of a statemente.g. All patients with hypertension who smoke should be offered smoking cessation advice.e.g. The temperature of the refrigerator in the immunization roomStandardWhen the criterion hasbeen defined at a numericallevel, it is referred to as astandard.e,g.100% patients with hypertension who smoke should be offered smoking cessation advice.e.g. The temperature of the refrigerator in the immunization room should not exceed + 8oC
11Criteria and standards Criteria should bePreciseClearEffectiveMeasureableQuality- orientedStandards should beComprehensivePracticalScientificRelevantEfficaciousEffectiveEfficientFeasible
12WHAT AREAS CAN YOU ‘AUDIT’? A useful framework has been provided by Donabedian (1966) who classified topics under three headings:Structure: The availability of resources and personnel of an organizationProcess: The activities undertaken, that is what is done with the service’s resources.Outcome: The effect of the activities on the ‘health/well-being’ of the service user.
13List the indicators under the following headings STRUCTURE INDICATORS , PROCESS INDICATORS , OUTCOME INDICATORSWell trained physiciansWell trained nurseHealth educatorClinical guidelinesRelevant historyMeasuring wt,htMeasure and recording B.PConducting CVS ExaminationConducting Fundi ExaminationConducting Feet ExaminationMedical recordsIndividual diabetic file(POMR)DM RegisterReferral registerComplete data base(including smoking)Problems listRelevant historyMeasuring TC/TG/HDL/LDLMeasuring HbA1CHealth education (diet, exercise, drugs,fastingfoot care, travelling, complications)Assessment of compliance to ( diet, treatment, exercise)Health education materialsWell equipped laboratoryTrained lab technicianAppointment systemAction plan for diabetes careDrugs(Insulin, syringes)Good control(FBS<126mg/dl)Poor Control(FBS>140mg/dl)OverweightObesityComplicationsSmokersAnnual Check up
14Types of clinical audits Standards based auditsTo see if standards are met or are being improvedAdverse / critical incidentScreening of such incidentsMonitoring of such incidentsPeer reviewWas the quality of care optimal. Case reviews and discussions (often multidisciplinary)Patient surveysPatients point of view of the quality of service
15The main methods used in audit of the quality of care are: Direct observationChecklistsDocumentation auditQuestionnairesInterviewsCase review
16Comparison Between Clinical Research & Clinical Audit CharacteristicClinical ResearchClinical AuditPurposeCharacterFunctionSample SizeBases for MeasurementMethodsOutcomePROVEIMPROVEScientific InquirySystematic MeasurementSets StandardsCompares StandardsStatistical SignificanceCommitment to ActTesting HypothesisStandard of PracticeNew TreatmentNo New TreatmentIncreased KnowledgeImproved Practice
17RememberClinical audit is not research, but it does make use of research methodology in order to assess practice.
18Analyse & presentation of audit data Analyse data and write the reportpresent findings should provide an unbiased picture of actual practiceLink findings with the objectives and standardsShow overall pattern of actual practice compared to the measures used in the auditInformation which helps to explain variancesData for an audit should be analysed completely and accurately to provide an unbiased picture of actual practice.Useful information about the cases, episodes, events, situations or circumstances represented in the audit.The overall pattern of actual practice compared to the measures used in the audit.Information which helps to explain cases which do not meet the audit measures.Adjust the preliminary audit findings, if appropriate, to take account of any cases or situations which did not conform to the audit measures but were found through structured peer review to be acceptable for clinically-sound reasons.9
20Objectives of the session To define the Self-directed Learning (SDL)To identify the characteristics of a Self-directed LearnerTo understand the importance of Self-Directed LearningTo describe the Self-Directed Learning StrategiesTo understand the importance of Self-directed learning & MedicineTo find out the Sources of learning
21Self-directed learning & Medicine Half of what you'll learn in medical school will be shown to be out of date within five years of your graduation; the trouble is that nobody can tell you which half—so the most important thing to learn is how to learn on your own Dr. Dave SackettSelf-directed learning (SDL) has been identified as an important skill for medical graduates.To meet the challenges in today's healthcare environment, self-directed learning is most essential.
22Self-directed learning & Medicine Before beginning, you might want to read: What is Critical Appraisal? - Critical appraisal is the process of carefully and systematically examining research to judge its trustworthiness, and its value and relevance in a particular context.What is Evidence Based Medicine Evidence-based medicine is the meticulous, explicit and judicious use of current best evidence in making decisions about the care of individual patients.
23What is Self-directed Learning (SDL) Self-directed learning is the method used when a learner, rather than an institution or teacher , controls both the learning objectives and the means of learning.A process in which students take the initiative. It involves five stepsdiagnose their learning needs,formulate learning goals,identify resources for learning,select and implement learning strategies,evaluate learning outcomes.
24Why Self-Directed Learning ? First reason is that there is convincing evidence that people who take the initiative in learning, learn more things and learn better than people who sit at the feet of teachers passively waiting to be taught.The second reason is that self-directed learning is more in tune with our natural processes of psychological development; an essential aspect of maturing is developing the ability to take increasing responsibility of our own lives to become increasingly self-directed.The third reason is that many of the new developments in education put a heavy responsibility on the learners to take a good deal of initiative in their own learning.Fourth reason is that it can tackle one of the most enduring problems in medical education: the exponential growth in knowledge. It is a fact that the course cannot teach everything that doctors consider relevant, and continued additions can lead to what Abrahamson (1978) describes as "curriculum hypertrophy."
25Characteristics of a Self-directed Learner IndependenceSelf-directed learners are fully responsible people who can independently analyze, plan, execute, and evaluate their own learning activities.Self-managementSelf-directed learners can identify what they need during the learning process, set individualized learning goals, control their own time and effort for learning, and arrange feedbacks for their work.Desire for learningFor the purpose of knowledge acquisition, self-directed learners’ motivations for learning are extremely strong.Problem-solvingIn order to achieve the best learning outcomes, self-directed learners make use of existing learning resources and feasible learning strategies to overcome the difficulties which occur in the learning process.
26skills help you succeed at being a self-directed learner 'Learning to learn' is a crucial skill.The following skills help you succeed at being a self-directed learner.Study them and think of your own abilities.Are you able to question, inquire and solve problems,keep an open mind to others' points of view, scan data and quickly choose relevant resources,collect data on your performance through self-observation and feedback from others,set goals to improve your personal performance, observe and model others' performance to improve your own,make a firm commitment to working on your goals, move through the full learning cycle,continually motivate yourself ?Be proactive for SDLTake note of the skills that you feel comfortable with and also note which ones you would like to strengthen.Think of how you can work on them and improve them. Then make a conscious effort to do it.
27Sources of learning Sources of learning Online learning supports the self-directed learner in pursuing individualized, self-paced learning activities.Students can visitlibraries, museums and various institutes world-wide,talk to professionals,access recent research, and read newspapers and peer reviewed scholarly journals online.
28Medical Journals in KSA Saudi Arabia Medical JournalThe Annals of Saudi MedicineKAU (King Abdulaziz Univeristy) Medical JournalThe Annals of Thoracic MedicineJournal of family & community medicineJournal of the Saudi Heart associationNeuro sciencesSaudi Dental JournalSaudi Journal of disability & RehabilitationSaudi Journal of GastroenterologySaudi Journal of Kidney Diseases &TransplantationSaudi Journal of Obstetric & GynecologySaudi Journal of OphthalmologySaudi Journal of Sports Medicine AssociationSaudi Journal of AnesthesiaJournal of Infection and Public HealthJournal of Parasitology ResearchSaudi Journal of Biological Sciences