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CAREERS IN CANCER EDUCATION: INFINITE OPPORTUNITIES DURING CHANGING TIMES Ajit K. Sachdeva, M.D., F.R.C.S.C., F.A.C.S. Director, Division of Education.

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Presentation on theme: "CAREERS IN CANCER EDUCATION: INFINITE OPPORTUNITIES DURING CHANGING TIMES Ajit K. Sachdeva, M.D., F.R.C.S.C., F.A.C.S. Director, Division of Education."— Presentation transcript:

1 CAREERS IN CANCER EDUCATION: INFINITE OPPORTUNITIES DURING CHANGING TIMES Ajit K. Sachdeva, M.D., F.R.C.S.C., F.A.C.S. Director, Division of Education American College of Surgeons 55 TH ANNUAL SAMUEL C. HARVEY MEMORIAL LECTURE AMERICAN ASSOCIATION FOR CANCER EDUCATION Saturday, October 14, 2006

2 Samuel C. Harvey, M.D., Ph.B., F.A.C.S

3 SAMUEL C. HARVEY, M.D., Ph.B., F.A.C.S. A consummate surgeon, scholar, educator, role model, historian, and philosopher Chairman, Department of Surgery, Yale University School of Medicine for 23 years President, American Surgical Association; First Chairman, Coordinators of Cancer Teaching Introduced active learner-centered education (“Yale System”) Enjoyed a cigar or pipe, a book, and a desire to stay longer in bed!

4 A CAREER IN CANCER EDUCATION It is October 2016 A Surgeon-Educator, Dr. John Smith, has been invited to deliver the 65 th Annual Harvey Memorial Lecture at the AACE Meeting in San Diego Dr. Smith reflects on the past 10 years, that have shaped his career as a cancer educator A History of the Future

5 2006: A MILIEU OF CHANGE IN CANCER EDUCATION Unprecedented scientific and technologic advances Changes in clinical practice Different roles of physicians and other health care professionals within high performance teams Intense focus on competence, accountability, and patient safety

6 2006: A MILIEU OF CHANGE IN CANCER EDUCATION Impact of new regulations and mandates Definition of the six core competencies Restrictions on resident duty hours Emphasis on increasing efficiencies and documenting outcomes of educational interventions Change in demographics of the workforce Advances in medical and health sciences education

7 THE PARADIGM SHIFT Continuing Medical Education Continuous Professional Development

8 KEY DIFFERENCES BETWEEN TRADITIONAL CME AND CPD Episodic interventions for Lifelong learning for group of learnersindividual learners Teacher-centered and Learner-centered and teacher-drivenlearner-driven Principal focus clinicalComprehensive in scope Lecture formats Variety of learning commonly usedformats and media used Mostly conducted in Conducted in different formal settingsvenues CME CPD Sachdeva, Arch Surg, 2005

9 Identify Area for Improvement Engage in Learning Apply New Knowledge and Skills to Practice Check for Improvement CYCLE OF PRACTICE-BASED LEARNING AND IMPROVEMENT Sachdeva & Blair, Surg Cl N Am, 2004

10 KEY CONCEPTS IN CPD AND PBLI Based on specific individual learning needs identified through review of clinical practice and benchmarking data Ongoing, contextually relevant education Emphasis on helping clinicians achieve requisite levels of competence and performance and not on punitive measures Focus on expertise and mastery Key Concepts

11 NEW DIRECTIONS IN MEDICAL EDUCATION Learner-centered educational approaches Experiential teaching and learning methods Structured clinical skills teaching, learning, and assessment Structured technical skills teaching, learning, and assessment

12 ASSESSMENT OF THE CLINICAL SKILLS OF ENTERING SURGICAL RESIDENTS Model: 18-station OSCE (9 couplets) Length of SP stations - 15 min. Length of PN stations - 7 min. Total testing time hours Results: Overall reliability = 0.91 ANOVAs revealed significant variation in individual residents’ clinical skills as assessed by SPs (F = 4.56, p < 0.01), PNs (F = 11.09, p < 0.001), or both (F = 10.9, p < 0.001) Sachdeva et al, Surgery, 1995

13 ACS OSCE FOR ENTERING SURGICAL RESIDENTS TO ADDRESS PATIENT SAFETY

14 OBJECTIVE STRUCTURED ASSESSMENT OF TECHNICAL SKILLS (OSATS) Model:R-1 to R-6 surgical residents (n=48) 8 bench model simulations Length of each station - 15 min. Total testing time - 2 hours Specific checklists and global ratings completed by surgeons Results: Reliability = 0.78 for checklists and 0.84 for global ratings Construct validity demonstrated Reznick, et al, Am J Surg, 1997

15 ACS/VA STRUCTURED EDUCATION MODULE TO ADDRESS MANAGEMENT OF ADVERSE SURGICAL EVENTS Model: R-2 and R-3 surgical residents (n=7) participated in a 3-part exercise involving pre-operative meeting with standardized patient and spouse; intraoperative management of massive hemorrhage from IVC in a bench model simulation; post-operative meeting with the standardized spouse. Debriefings and review of videotaped performance of residents conducted by faculty Brewster, et al, Am J Surg, 2005

16 ACS/VA STRUCTURED EDUCATION MODULE TO ADDRESS MANAGEMENT OF ADVERSE SURGICAL EVENTS Results: Residents performed at or above the expected levels; SP ratings higher than faculty ratings (p< 0.05 ); residents found model realistic, challenging, and a beneficial learning experience Brewster, et al, Am J Surg, 2005

17 SPECTRUM OF SIMULATION IN MEDICAL EDUCATION Computer-based simulations Standardized patients Part-task trainers High and low fidelity simulators Virtual reality

18 POTENTIAL APPLICATIONS OF SIMULATION IN MEDICAL EDUCATION Acquisition and maintenance of competence; demonstration of optimum performance; achievement of excellence Improvement in patient safety and outcomes of surgical care Increase in the efficiency of educational processes; assurance of educational outcomes Demonstration of greater accountability to the public and large consumer groups

19 Curriculum integration Range of difficulty level Repetitive practice Feedback USE OF HIGH FIDELITY MEDICAL SIMULATORS TO FACILITATE LEARNING Multiple learning strategies Clinical variation Controlled environment Individualized learning Issenberg, et al, Med Teach, 2005 Important Considerations

20 CURRENT LIMITATIONS IN THE USE OF SIMULATION IN MEDICAL EDUCATION Prevalence of weak curricula; technology driving the educational opportunities Insufficient fidelity of simulation for certain procedures Problems relating to costs, logistics, access Absence of large-scale research to evaluate the added value of simulation in medical education

21 ON-LINE CLINICAL INFORMATION Credibility of source Relevance Unlimited access Speed Ease of use Important Considerations Bennett, et al, JCEHP, 2004

22 ON-LINE CONTINUING EDUCATION COURSES Quality of content Interactivity; case-based formats Ease of accessibility and use Convenience in obtaining continuing education credits Factors that Encourage Participation Casebeer, et al, JCEHP, 2004

23 Greater focus on CPD and PBLI efforts Verification and documentation of knowledge and skills following participation in educational programs Regional support for innovative educational interventions; establishment of learning communities Enhancement of e-learning programs OPPORTUNITIES TO ADVANCE CANCER EDUCATION:

24 Focus on interdisciplinary work Emphasis on communication skills and professionalism Need for leadership to catalyze change Importance of mentorship in career development Involvement of patients as partners in health care Pursuit of innovative research to advance the science of cancer education OPPORTUNITIES TO ADVANCE CANCER EDUCATION:

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26 INTERDISCIPLINARY TEAMWORK IN PATIENT CARE Hypercomplexity of systems Task interdependence Mitigation of the impact of hierarchy Distributed decision-making High degree of accountability Immediate feedback Characteristics of High Reliability Organizations Baker, et al, Health Research and Educ Trust, 2006

27 INTERDISCIPLINARY TEAMWORK IN PATIENT CARE Team leadership Mutual performance monitoring Mutual support Adaptability Shared mental models Team orientation Mutual trust Team Competencies Baker, et al, Health Research and Educ Trust, 2006

28 INTERDISCIPLINARY TEAMWORK IN PATIENT CARE Technical expertise Problem-solving and decision-making skills Interpersonal skills Skill Requirements Katzenback & Smith, Harvard Bus Rev, 2005

29 INTERDISCIPLINARY TEAMWORK IN PATIENT CARE Exemplary communication skills and professionalism Active listening skills Negotiation and conflict management Special Challenges AAMC ETE Course, 2006

30 Situational awareness Problem identification Decision-making Workload distribution Time management Conflict resolution TEAM COMMUNICATION IN THE OPERATING ROOM Key Elements Davies, ACTA Anesth Scand, 2005

31 TRAINING IN INTERDISCIPLINARY TEAMWORK TO ENHANCE PATIENT CARE Role modeling in real environments Discussions of care vignettes Experiential courses Standardized, immersive experiences with feedback

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33 Delivery of optimum patient care Promotion of patient safety Increase in patient compliance Enhancement of doctor-patient relationship Reduction of liability risk Improvement in time efficiencies IMPACT OF EFFECTIVE COMMUNICATION ON PATIENT CARE

34 Situation Background Assessment Recommendation STANDARDIZED COMMUNICATION TO ENHANCE PATIENT SAFETY Leonard, et al, Qual Saf Health Care, 2004

35 BARRIERS TO SAFE PATIENT HAND-OFFS The physical setting The social setting Language barriers Medium of communication Solet, et al, Acad Med, 2005

36 U.S. AND CANADIAN PHYSICIANS’ ATTITUDES AND EXPERIENCES REGARDING DISCLOSURE OF ERRORS TO PATIENTS Involvement in serious error, 55%; minor error, 73%; near-miss, 62% Support for disclosing serious errors, 98%; minor errors, 78%, near-misses, 35% 66% agreed that disclosing serious errors would decrease risk of lawsuits 74% thought disclosing serious errors would be very difficult Gallagher, et al, Arch Int Med, 2006

37 Ethical practice of medicine Delivery of optimum patient care Fulfillment of responsibilities to patients, the public, and society Enhancement of the doctor-patient relationship IMPACT OF EXEMPLARY PROFESSIONALISM ON PATIENT CARE

38 Behavioral approaches Cognitive approaches Social approaches EDUCATIONAL INTERVENTIONS TO ENHANCE COMMUNICATION SKILLS AND PROFESSIONALISM Underlying Principles

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40 DIFFERENCES BETWEEN LEADERS AND MANAGERS Cope with change Cope with complexity Set a direction Plan and budget Align people Organize and staff Motivate and inspire Control and problem-solve Kotter, Harvard Bus Rev, 1998 Leaders Managers

41 DIFFERENCES BETWEEN LEADERS AND MANAGERS “Twice-born” “Once-born” Risk-takers Risk-averse Imaginative and inspiring Rational and controlled Proactive in establishing Reactive in establishing goals based on desires goals based on necessity Zaleznik, Harvard Bus Rev, 2004 Leaders Managers

42 DIFFERENCES BETWEEN LEADERS AND MANAGERS Develop fresh approaches Address problems by to problems, explore new coordinating and options balancing opposing views Send messages Send signals Very comfortable with Most comfortable solitary activities working with others Relate to others in intuitive Work with others in and empathetic ways traditional ways Zaleznik, Harvard Bus Rev, 2004 Leaders Managers

43 CREATING A CULTURE THAT SUPPORTS EFFECTIVE LEADERSHIP Kotter, Harvard Bus Rev, 1998 Developing and pursuing a clearly defined plan for leadership succession Using challenging opportunities and specific assignments to develop the skills of individuals with leadership potential Providing longitudinal educational experiences and mentoring to develop leadership skills Recognizing and rewarding mentors

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45 PROGRESSION OF THE EDUCATIONAL RELATIONSHIP BETWEEN TEACHER AND LEARNER Didactic Supervisory Collaborative Consultative Magill et al, Med Teach, 1986

46 CHARACTERISTICS OF A MENTOR O’Donnell, J Cancer Educ, 1995 Wise and trusted advisor, listener, counselor and supporter Encourages reflection Promotes personal growth and satisfaction Benefits from greater self-awareness, new insights, and improvement

47 KEY FEATURES OF MENTORSHIP Sachdeva, J Cancer Educ, 1996 Grounded in a developmental-contextual framework Long, comprehensive, intense professional relationship Involves teaching and learning activities; career advancement; personal support Both mentee and mentor reap great rewards, are transformed in the process One-on-one; may include multiple mentors

48 STAGES OF SUCCESSFUL MENTORSHIP Initiation Cultivation Separation Redefinition Kram, Acad Manag J, 1983

49 Offer training in new teaching, learning, and assessment methods Focus on the effective use of cutting-edge educational technologies Recognize and reward surgical faculty for their educational accomplishments FACULTY DEVELOPMENT AND SUPPORT TO IMPLEMENT INNOVATIVE MEDICAL EDUCATION

50 RECOGNITION AND REWARDS FOR SURGEON-TEACHERS AND SURGEON-EDUCATORS Master Educator Sachdeva, et al, Acad Med, 1999 Educator Master Teacher Teacher

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52 Support for full participation of patients in their care Dissemination of valid and reliable information Delivery of individually tailored, scientifically sound patient education Confirmation of achievement of requisite knowledge and skills ROLE OF PATIENTS AS PARTNERS IN MEDICAL CARE

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54 Learning Performance Outcomes EVALUATION OF THE IMPACT OF EDUCATIONAL INTERVENTIONS Impact on

55 Core competencies CPD and PBLI Interdisciplinary teamwork Communication skills and professionalism Leadership Mentorship Patient Education OPPORTUNITIES FOR RESEARCH IN CANCER EDUCATION

56 The key role of the American Association for Cancer Education

57 2006 – 2016: AN EXCITING CANCER EDUCATION ODYSSEY Infinite opportunities to improve cancer care through innovative education Collaboration critical in designing new approaches to cancer education Opportunities for a spectrum of rewarding careers in cancer education Pivotal role of AACE in education and career development

58 “Nothing endures but change.” Heraclitus, c B.C.

59 “For I dipped into the future, far as human eye could see, Saw the vision of the world, and all the wonder that would be.” Lord Tennyson, 1842

60 “Never give in, never, never, never.” Sir Winston Churchill, 1941


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