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

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

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

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 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 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 Curriculum Development Kern’s Model
Problem Identification. General needs assessment Needs assessment of targeted learners (& technology) Evaluation & feedback Implementation Goals & objectives Education strategies 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 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 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 Courses to date Over 23 course over western Canada
Being used I undergraduate and postgraduate curricula Calgary Edmonton

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

12 Suggested Delivery Time
Module Themes Learning Activities Suggested Delivery Time 1 Creating Context Self-awareness exercise What dying people want Defining palliative care Orienting ourselves to the work (video) 1 hour 2 Gastro-intestinal problems Ethical decision-making (artificial feeding) Theory bursts Case discussions Video discussion 2 hrs 25 min 3 Pain Management Prescription exercise Theory burst Case Discussion 35 min 4 Respiratory Problems Case discussion 1 hr 5 Communication Socio-drama based videos that prompt discussion. 6 Depression, Anxiety & Suffering. Video and group discussion 7 Grief & Bereavement 30 min 8 Delirium 1hr 10min 9 Palliative Sedation Large group discussion 30min 10 Last days & Hours 11 Working as a Team

13 Suggested Delivery Time
Module Themes Learning Activities Suggested Delivery Time 1 Creating Context Self-awareness exercise What dying people want Defining palliative care Orienting ourselves to the work (video) 1 hour 2 Gastro-intestinal problems Ethical decision-making (artificial feeding) Theory bursts Case discussions Video discussion 2 hrs 25 min 3 Pain Management Prescription exercise Theory burst Case Discussion 35 min 4 Respiratory Problems Case discussion 1 hr 5 Communication Socio-drama based videos that prompt discussion. 6 Depression, Anxiety & Suffering. Video and group discussion 7 Grief & Bereavement 30 min 8 Delirium 1hr 10min 9 Palliative Sedation Large group discussion 30min 10 Last days & Hours 11 Working as a Team

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


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