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PALLIUM 1 L.E.A.P Learning Essential Approaches to Palliative Care.

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Presentation on theme: "PALLIUM 1 L.E.A.P Learning Essential Approaches to Palliative Care."— Presentation transcript:

1 PALLIUM 1 L.E.A.P Learning Essential Approaches to Palliative Care

2 PALLIUM 2 Course Goals Empower Primary Care Introductory course on providing care for the terminally ill for primary health professionals. –Knowledge, skills & attitudes Promote interprofessional collaboration. Showcase/credibility local palliative care coordinators & resources Identify local champions. Catalyze local change. Educate local community- Press release

3 PALLIUM 3 Considerations Principal target learners: MDs, RNs, Pharmacists Target various settings. Ability to repackage course. –Divided into parts/series. –Various settings (undergraduate, postgraduate) Ability to vary audience –Hospital-based MDs, RNs, etc Ability to use components. –Medical, nursing, pharmacy students & residents. –Objects (online repository) Master copy of modules

4 PALLIUM 4 Considerations Basic principles & essentials Refer to more advanced materials –E.g. Ian Anderson, Victoria Course, Hamilton interdisciplinary course Not just cancer CPD credits Evidence-best practices based. Interprofessional –but also respect needs of individual disciplines Not TTT model Iterative design process

5 PALLIUM 5 Curriculum Development Kern’s Model Problem Identification. General needs assessment Needs assessment of targeted learners (& technology) Goals & objectives Education strategies Implementation Evaluation & feedback Kern DE, Thomas PA, Howard DM, Bass EB. Curriculum development for medical education: a six-step approach. The Johns Hopkins University Press, Baltimore. USA

6 PALLIUM 6 Course development history Pallium Phase I –Initial course draft (Mazuryk & Pereira) –Advice from Dr. Jocelyn Lockyer (PhD, CME) –Pilot phase of 6 courses- (ongoing revisions based on evaluations: Cheryl Smith, Shannon Pyziak, Cornie Woelk, Ron Spice, Fiona Crow, Robert Wedel, Doreen Oneschuk). Phase II –Curriculum working group Romayne Gallagher (MD), Cheryl Smith (SW), Shannon Pyziak (RN), Pat Tichon (Pharm), Gillian Fyles (MD), Fraser Black (MD), Doreen Oneschuk (MD), Ron Spice (MD), Jocelyn Lockyer (PhD). To date: 4 major revisions.

7 PALLIUM 7 Revision August 2004 Blind review process Romayne Gallagher MD (BC.) Cheryl Smith RN (MB) Shannon Pyziak RN (MB) Pat Trozzo Pharm. (MB) Gillian Fyles MD (BC.) Fraser Black MD (BC.) Ron Spice MD (AB) Robin Love MD (BC.) Merle Teetaert RN (Sk) Rob Wedel MD (AB) Jose Pereira MD (AB)

8 PALLIUM 8 Courses to date Over 23 course over western Canada Being used I undergraduate and postgraduate curricula –Calgary –Edmonton

9 PALLIUM 9 Pedagogical undercurrents Various learning styles. Reflective learning & constructivism Combination of learning methods. –“Theory bursts”. Cognitive psychology: inductive, forward vs hypothetico-deductive processes. Hooks –Case-based Group learning Apply theory, nurture reflection, prompt discussion. Lead by experienced facilitator/content expert Constructive learning –Large group discussions Interprofessional dialogue –Reflective exercises Self-awareness, suffering.

10 PALLIUM 10 Pedagogical undercurrents Trigger tapes & video vignettes –"ill-structured situations“ –NOT ideally modeled, uses "reflective questions" to prompt "reflective conversation" a.. What is going on here? b.. What issues does this raise for you? c.. What could have been done differently? J Moon. Reflection in Learning and Professional Development. (1999, London: Kogan Page) Integrating & weaving themes throughout course –Ethical decision-making, communication. Repetition

11 PALLIUM 11 Course materials Local planning guide Facilitator’s kit –Manual: Facilitator notes (suggested questions, reminder of key points, theory & evidence) –Videos, posters Participants’ manual

12 PALLIUM 12 ModuleThemesLearning ActivitiesSuggested Delivery Time 1Creating ContextSelf-awareness exercise What dying people want Defining palliative care Orienting ourselves to the work (video) 1 hour 2Gastro-intestinal problems Ethical decision-making (artificial feeding) Theory bursts Case discussions Video discussion 2 hrs 25 min 3Pain ManagementPrescription exercise Theory burst Case Discussion 2 hrs 35 min 4Respiratory ProblemsTheory burst Case discussion 1 hr 5CommunicationSocio-drama based videos that prompt discussion. 2 hrs 6Depression, Anxiety & Suffering. Theory burst Video and group discussion 1 hr 7Grief & BereavementTheory burst30 min 8DeliriumTheory burst Case discussion 1hr 10min 9Palliative SedationTheory burst Large group discussion 30min 10Last days & HoursVideo discussion Theory burst 30 min 11Working as a TeamLarge group discussion30 min

13 PALLIUM 13 ModuleThemesLearning ActivitiesSuggested Delivery Time 1Creating ContextSelf-awareness exercise What dying people want Defining palliative care Orienting ourselves to the work (video) 1 hour 2Gastro-intestinal problems Ethical decision-making (artificial feeding) Theory bursts Case discussions Video discussion 2 hrs 25 min 3Pain ManagementPrescription exercise Theory burst Case Discussion 2 hrs 35 min 4Respiratory ProblemsTheory burst Case discussion 1 hr 5CommunicationSocio-drama based videos that prompt discussion. 2 hrs 6Depression, Anxiety & Suffering. Theory burst Video and group discussion 1 hr 7Grief & BereavementTheory burst30 min 8DeliriumTheory burst Case discussion 1hr 10min 9Palliative SedationTheory burst Large group discussion 30min 10Last days & HoursVideo discussion Theory burst 30 min 11Working as a TeamLarge group discussion30 min

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18 PALLIUM 18 “Theory burst” Short Main messages Limit intense discussions but do not stifle questions or discussion either. Introduce personal clinical experiences & short stories- not too many and not too long.

19 PALLIUM 19 Group facilitation Role of facilitator –PBL in purist form Studies show no superiority over other methods with respect to knowledge & skills, but more enjoyable and consistent with constructive learning theory. –Process facilitator vs content expert vs process & content facilitator

20 PALLIUM 20 Group Facilitation Going from “sage on the stage” to “guide on the side” –Don’t give “answers” right away. –Pose reflective questions. –Don’t “shoot down” what appears to be “incorrect” –Do provide alternative perspective.

21 PALLIUM 21 Group facilitation Key messages –“This is an important point-this is a take- home message”. –4 or 5 key take home messages for each module –Identify “take home messages” during discussion –Facilitator notes are at times comprehensive- you do not have to cover each point in notes. Pick out main message.

22 PALLIUM 22 Group facilitation Respect input. Reframe if necessary. Ask questions that prompt reflection. Attitudinal objectives: –Don’t have to agree or disagree (unless unsafe practice), but introduce different perspective. –Find common values. –Reframe discussion: “This is what we will experience when dealing with a difficult patient/family/colleague situation. SO how can we process through this?” Need not agree but acknowledge. Highlight practical ideas. Focus on the problem, not the person

23 PALLIUM 23 Course Evaluation (Dr. J Lockyer & CME Unit at U of Calgary) Learners’ reactions Modifications of attitudes Acquisition of knowledge/skills Change in individual behaviour Change in organizational behaviour Benefit to patients Changes in organization itself to systematize palliative care- i.e. new policies & procedures, new equipment, community education, increased team work, fundraising etc Costs

24 PALLIUM 24 Course evaluation Pre-course survey –Demographics –Comfort level –Identify learning needs –Knowledge quiz –(Attitude survey) Post Course –Course evaluation –Comfort levels –Knowledge quiz –Commitment to change –(Attitude survey) 3-6 mths Post Course –Commitment to change review –(Comfort levels) –(Knowledge test) –(Attitude survey)


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