1. “Three E’s One R” Evidence, Experience, Emotional Intelligence Reflection- the glue that holds them all together 1 st GCC Conference Evidence–based Healthcare Professional Development Session 4: Efficient trends in health- care Professional Training Professor Jean Ker Professor Mairi Scott College of Medicine Dentistry and Nursing University of Dundee

3. The best available evidence modified by patient circumstances and preference is applied to improve the quality of clinical judgments McMaster Clinical Epidemiology Group 1997 Clinical Expertise Research Evidence Patient Values Evidence based Practice

4. DEATHS from chronic disease in 2008: CARDIOVASCULAR DISEASE Accounts for 17.3 million deaths (48% of all deaths) Estimated to rise to 23.6 million by 2030 Accounts for 17.3 million deaths (48% of all deaths) Estimated to rise to 23.6 million by 2030 CANCER Accounts for 7.6 million deaths (21% of all deaths) Estimated to rise to 21.4 million by 2030 Accounts for 7.6 million deaths (21% of all deaths) Estimated to rise to 21.4 million by 2030 CHRONIC RESPIRATORY DISEASES Accounts for 4.2 million deaths (12% of all deaths) Asthma affects 300 million people globally Accounts for 4.2 million deaths (12% of all deaths) Asthma affects 300 million people globally DIABETES Affects 366 million people (6.4% of world population) Number affected will increase to 552 million by 2030 Affects 366 million people (6.4% of world population) Number affected will increase to 552 million by 2030 Background - Evidence

5. Leape and Amalberti 2005

6. For Further Information Contact: Evidence Benefits of simulation in Healthcare Benefits to Patients Risks of harm to patients avoided Undesired interference is reduced Benefits to Learners Skills can be practised repeatedly (simple to complex) Training can be tailored to individuals and teams Can provide effective feedback to individuals and teams and organisations Benefits to Health Care Organisations Tasks/scenarios can be created to demand and aligned to policy Retention and accuracy are increased Provide “pre-trained” novice Transfer of training from classroom to real situation is enhanced Systems redesign Standards against which to evaluate performance and diagnose educational needs are enhanced Maran and Glavin 2004, Issenberg 2005, Ker and Bradley 2014

7. Background Experiential Learning Use of experiential learning cycle What did I do? What did it mean and how do I feel? How did it relate to previous knowledge and experience ? What will I do next time in different context ? Clinical method Deepening the quality of the learning using narrative skills in a safe simulated environment Kolb 1974 Greenhalgh 1999

8. For Further Information Contact: Background - Experience GP Hospital Eye Van Pharmacy Lab Data CHIInvestigations Screening AHPs Promoting the Development of Managed Clinical Networks in NHS Scotland, HDL(2002)69

9. Percentage of Patients Data recorded within the previous 15 months Source: Scottish Diabetes Survey Scottish Diabetes Survey 2002-2007 Analysis of Key Biomedical Markers

10. Background - Emotional Intelligence

11. Reflection Reflective Practitioner – Reflection in action – Reflection on action – Self- awareness Espoused theories Theory in action Disconnect

12. Reflection – “the glue” Experience Emotional Intelligence Evidence

13. The Kuwait-Scotland eHealth Innovation Network Aims – Deliver clinical service development using a comprehensive informatics system – Capacity building through training and development of staff – Scientific advance through engagement with international research community 13

14. The Context The elements for transformational capacity

15. Clinical 1. Enhanced Self Care in Diabetes 2. Advanced Nutrition 3. Continuous Subcutaneous Insulin Infusion 4. Advanced Podiatry 5. Retinal Imaging 6. Safety in Clinical Communication 7. Advanced Diabetes Practice Education 1. Training the Trainers 2. Facilitation 3. Learning Organisations 4. Enhanced Self Care in Diabetes 5. Clinical skills and simulation for education and practice 6. Use of simulation for I-P clinical skills educators Organisational 1. Reflective Professional Practice 2. Patient Safety & Quality Improvement in Diabetes 3 Organisational Approaches to Delivery of Care 4. Leadership 5. Managing Change 6. Facilitation 7. Learning Organisations 8. Knowledge Management 9. Strategic Partnering Research* 1. Research Methods 2. E-Health Records Research Available Modules CPD Subunits = University of Dundee Dasman CPD Certificate PG Cert/Diploma/MSc in Diabetes Care and Education Certificate 60 SCQF Credits CORE + 1 Education + 1 Other Diploma 120 SCQF credits CORE + 1 Education + 2 Organisation + 1 Research + 1 Other *Further modules to be added MSc Taught MSc Dissertation Module(60 credits) Thesis/Professional Project and relevant taught material SCQF11 60 Credits SCQF 11 =180 SCQF credits Professional Doctorate or PhD Research or Professional Project SCQF12 M Phil PhD Transfer Event MSc/ or Doctoral Study Programme Board Thesis Monitoring Committee MSc Core Modern Diabetes Care 20 Credits SCQF Level 11 Module 2 20 Credits SCQF Level 11 Module 4 20 Credits SCQF Level 11 Module 6 20 Credits SCQF Level 11 Module 3 20 Credits SCQF Level 11 Module 5 20 Credits SCQF Level 11 Choice Element

16. Safety in Clinical Communication Critically appraise evidence of importance of effective communication in ensuring safe clinical practice Analyse the roles and responsibilities of specific health care practitioners in ensuring safe and effective communication strategies Identify, implement and evaluate strategies for employing safe communication practices with patients carers or colleagues within a specific clinical setting Critically review methods for evaluating the impact of communication skills training within a healthcare organisation Critically reflect upon individual healthcare practice and clinical communication strategies for enhancing patient safety through effective healthcare and management Cert/Dip/MSc Diabetes Care and Education

17. Over 50s in Kuwait- doctor diagnosed prevalence Hypertension53.4% Diabetes50.6% Heart Disease17.5% Diabetes Prevalence Kuwaiti nationals >50 yrs; Shah et al (2009) Medical Principles and Practice Challenge of Long Term Conditions

18. For Further Information Contact: Top Causes of Adverse Events – Communication 60% of errors 70% poor team communication – Prescribing – Patient assessment – Procedural compliance – Environmental security – Leadership Joint Commission of Accreditation of Healthcare Organisations 2005, NPSA 2006

19. Evidence of simulation Effective learning from simulation based education – Providing feedback (47%) – Repetitive practice (39%) – Integrated into curriculum (25%) – Task difficulty (14%) – Variety of clinical conditions (10%) – Controlled environment (9%) – Defined outcomes (6%) Issenberg et al (2005) BEME Review Features and uses of high fidelity medical simulation that lead to effective learning Med Teacher :27(1) 10-28

20. Methods Safety in Clinical Communication – Use of simulation Participants – Cohort of 18 students Evidence, Experience and Emotional intelligence Assignment assessment on reflective capability Evaluation of teaching

21. Results 1. Evidence for safety in clinical communication Leape L 1994 Errors in medicine JAMA vol273 (23) 1851-1857 Robins J 2008 Saying sorry law society gazette Tingle J 2010 Being open with patients and learning how to apologise BJN vol19 no 2 Entwhislte et al 2010 Speaking up about safety concerns: multi-setting qualitative study of patients views and experiences QSHC 19 e33 Vincent C 2003 patient safety understanding and responding to adverse events NEJM 348 1051-1056 Sorensen et al 2008 Health care professionals’ views of implementing a policy of open disclosure of errors Journal of health services research and policy Vol 13 no 4 227- 232 Baker et al 2005 medical team training programs in health care Advances in patient safety 4 253-267 BMA 2004 Safe handover: safe patients guidance on clinical handover fro patients and managers CAA 2006 crew resource management training guidance for flight crew CRM instructors and CRM instructor examiners CAP 737 2 Gatwick CAA Flin et al 2009 Human factors in patient safety: review of topics and tools WHO Haig et al 2006 SBAR a shared mental model for improving communication between clinicians Joint commission Journal on Quality and Patient safety 32 167-175 Leonard et al 2004 The Human factor the critical importance of effective team work and communication in providing safe care QSHC 13 85-90 Woods 2006 How communication complicates the patient safety movement Patient safety quality health care

22. Results 2.Experience of safe communication in healthcare Poor handover across HC settings Lack of speaking up No communication training on new developments Medication errors common Patients misinformed Lack of time Hierarchy 22

23. Results 3.Experience of Safety tool for clinical communication Calgary Cambridge SBAR Conflict resolution Team huddle Daily Briefing Safety checklist

24. Results 4. Emotional intelligence Challenges of communication within the healthcare team Busyness Having a shared common goal Who is in the team Challenge to being patient centred Not delivering evidence based protocols and guidelines Lack of respect Language

25. Results Reflection Workplace based Projects A project is an endeavor, having a defined beginning and end (usually constrained by date, but can be by funding or deliverables), undertaken to meet unique goals and objectives, usually to bring about beneficial change or added value Reflection “There are three methods to gaining wisdom. The first is Reflection, which is the highest. The second is limitation, which is the easiest. The third is experience, which is the bitterest.” Confucius The Rail Bridge Dundee

26. Reflection in Assignments Reflection in action – Connects experience to theory and standards (E) Reflection on action – Analysis of experience (E) – Sets goals, objectives and strategies Self -awareness – Demonstrates insight (E) Resilience, empathy, trustworthiness, feelings – Assesses own growth

27. “ I cannot teach anybody anything: I can only make them think. The unexamined life is not worth living” Socrates 470-399 BC

28. Evidence – Reflection on Module

29. Results Reflection - the most useful aspects of teaching Face to face section, the stations we made were useful and exciting. Communication role models I learned about human errors and how we can easily fall into them. Mostly, I learned not to judge. Team work- Learn and practice about project. Discuss the challenges in work place. The hands on work Group working. Positive thinking

30. Evidence, Experience and Emotional Intelligence Reflection is the glue It is what makes us change our behavior

31. Thank You