Presentation on theme: "L.E.A.P Learning Essential Approaches to Palliative Care"— Presentation transcript:
1L.E.A.P Learning Essential Approaches to Palliative Care
2Course Goals Empower Primary Care Introductory course on providing care for the terminally ill for primary health professionals.Knowledge, skills & attitudesPromote interprofessional collaboration.Showcase/credibility local palliative care coordinators & resourcesIdentify local champions.Catalyze local change.Educate local community- Press release
3Considerations Principal target learners: MDs, RNs, Pharmacists Target various settings.Ability to repackage course.Divided into parts/series.Various settings (undergraduate, postgraduate)Ability to vary audienceHospital-based MDs, RNs, etcAbility to use components.Medical, nursing, pharmacy students & residents.Objects (online repository)Master copy of modules
4Considerations Basic principles & essentials Refer to more advanced materialsE.g. Ian Anderson, Victoria Course, Hamilton interdisciplinary courseNot just cancerCPD creditsEvidence-best practices based.Interprofessionalbut also respect needs of individual disciplinesNot TTT modelIterative design process
5Curriculum Development Kern’s Model Problem Identification.General needs assessmentNeeds assessmentof targeted learners(& technology)Evaluation & feedbackImplementationGoals & objectivesEducation strategiesKern DE, Thomas PA, Howard DM, Bass EB. Curriculum development for medical education: a six-step approach. The Johns Hopkins University Press, Baltimore. USA
6Course development history Pallium Phase IInitial 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 IICurriculum working groupRomayne 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.
7Revision 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)
8Courses to date Over 23 course over western Canada Being used I undergraduate and postgraduate curriculaCalgaryEdmonton
9Pedagogical undercurrents Various learning styles.Reflective learning & constructivismCombination of learning methods.“Theory bursts”.Cognitive psychology: inductive, forward vs hypothetico-deductive processes.HooksCase-based Group learningApply theory, nurture reflection, prompt discussion.Lead by experienced facilitator/content expertConstructive learningLarge group discussionsInterprofessional dialogueReflective exercisesSelf-awareness, suffering.
10Pedagogical 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 courseEthical decision-making, communication.Repetition
11Course materials Local planning guide Facilitator’s kit Manual: Facilitator notes (suggested questions, reminder of key points, theory & evidence)Videos, postersParticipants’ manual
12Suggested Delivery Time ModuleThemesLearning ActivitiesSuggested Delivery Time1Creating ContextSelf-awareness exerciseWhat dying people wantDefining palliative careOrienting ourselves to the work (video)1 hour2Gastro-intestinal problemsEthical decision-making(artificial feeding)Theory burstsCase discussionsVideo discussion2 hrs25 min3Pain ManagementPrescription exerciseTheory burstCase Discussion35 min4Respiratory ProblemsCase discussion1 hr5CommunicationSocio-drama based videos that prompt discussion.6Depression, Anxiety & Suffering.Video and group discussion7Grief & Bereavement30 min8Delirium1hr10min9Palliative SedationLarge group discussion30min10Last days & Hours11Working as a Team
13Suggested Delivery Time ModuleThemesLearning ActivitiesSuggested Delivery Time1Creating ContextSelf-awareness exerciseWhat dying people wantDefining palliative careOrienting ourselves to the work (video)1 hour2Gastro-intestinal problemsEthical decision-making(artificial feeding)Theory burstsCase discussionsVideo discussion2 hrs25 min3Pain ManagementPrescription exerciseTheory burstCase Discussion35 min4Respiratory ProblemsCase discussion1 hr5CommunicationSocio-drama based videos that prompt discussion.6Depression, Anxiety & Suffering.Video and group discussion7Grief & Bereavement30 min8Delirium1hr10min9Palliative SedationLarge group discussion30min10Last days & Hours11Working as a Team
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.
19Group 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
20Group FacilitationGoing 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.
21Group facilitation Key messages “This is an important point-this is a take-home message”.4 or 5 key take home messages for each moduleIdentify “take home messages” during discussionFacilitator notes are at times comprehensive- you do not have to cover each point in notes. Pick out main message.
22Group 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
23Course Evaluation (Dr. J Lockyer & CME Unit at U of Calgary) Learners’ reactionsModifications of attitudesAcquisition of knowledge/skillsChange in individual behaviourChange in organizational behaviourBenefit to patientsChanges in organization itself to systematize palliative care- i.e. new policies & procedures, new equipment, community education, increased team work, fundraising etcCosts
24Course evaluation Pre-course survey Post Course Demographics Comfort levelIdentify learning needsKnowledge quiz(Attitude survey)Post CourseCourse evaluationComfort levelsCommitment to change3-6 mths Post CourseCommitment to change review(Comfort levels)(Knowledge test)