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Creating Conditions for Adapting Skills to New Needs & Lifelong Learning Presenter: Tanya Horsley, PhD Date: April 27, 2010 If lifelong learning is to.

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Presentation on theme: "Creating Conditions for Adapting Skills to New Needs & Lifelong Learning Presenter: Tanya Horsley, PhD Date: April 27, 2010 If lifelong learning is to."— Presentation transcript:

1 Creating Conditions for Adapting Skills to New Needs & Lifelong Learning Presenter: Tanya Horsley, PhD Date: April 27, 2010 If lifelong learning is to be effective, physicians should enter a practice environment that is constructed in a way that fosters, promotes, and facilitates lifelong learning

2 Presentation Title - Change Text in Slide Master Recognition European Observatory on Health Systems and Policies Health Evidence Network of WHO/Europe Dr. Jeremy Grimshaw Director, Canadian Cochrane Centre, Director Centre for Best Practices, Institute of Population Health, Canada Research Chair, in Health Knowledge Transfer and Uptake Dr. Craig Campbell, Director, Office of Professional Affairs, Royal College of Physicians and Surgeons of Canada Pace of presentation (!) 2

3 Presentation Title - Change Text in Slide Master Overview Issue Overview (brief) CME CPD Lifelong Learning What is an effective lifelong learner (skills – competencies required) European Context Policy Options 3

4 Presentation Title - Change Text in Slide Master 4 Issue Proliferation in volume and complexity of biomedical knowledge and technology Challenge to healthcare professionals delivery of care Through organized or individual learning strategies – physicians need to maintain currency

5 Presentation Title - Change Text in Slide Master Issue Underfunded Inadequately staffed healthcare departments (less and less time for learning) Limited access to performance data/ current health outcomes/literature resources, appropriate learning materials Professional & public concerns related to variability in quality of care & the safety of the healthcare environment (e.g. medical errors) 5

6 Presentation Title - Change Text in Slide Master Issue No current standard approach to LLL in Europe IS acceptance that LLL of physicians to maintain competence ++ for patients Optimally, any strategy for LLL should be: Highly self-directed Content, learning methods, and learning resources specifically targeted at improving knowledge, skills, and attitudes Linked to improving patients outcomes 6

7 Presentation Title - Change Text in Slide Master CME to CPD CME model (historically) perpetuated learning as a adjunct to daily practice Educational strategies to keep physicians up- to-date of new diagnoses, management of clinical conditions, and new technologies… These were wholly divorced from the clinical environment and health system. 7 Physician Learning (clinically focused lectures, conferences, etc.) Physician Practice Physician Learning (Medical Expert, Manager, Collaborator, Scholar, Communicator, Health Advocate, Professional Self- assessment strategies Generating and resolving ?s Identifying gaps in knowledge Frank, JR. (Ed). 2005. The CanMEDS 2005 physician competency framework. Better Standards. Better Physicians. Better Care. Ottawa, The Royal College of Physicians and Surgeons of Canada.

8 Presentation Title - Change Text in Slide Master Background

9 Presentation Title - Change Text in Slide Master Beyond the Medical Expert role 9 Horsley, T. Unpublished work (2009)

10 Presentation Title - Change Text in Slide Master CanMEDS RoleN (%) Medical Expert1044 (76) Professional558 (40) Scholar446 (32) Health Advocate296 (21) Communicator197 (14) Collaborator157 (11) Manager74 (5) Physician Learning and the CanMEDS roles

11 Presentation Title - Change Text in Slide Master Lifelong Learning Infrequently defined a continually supportive process that stimulates and empowers individuals to acquire all the knowledge, values, skills, and understanding they will require throughout their lifetimes and to apply them with confidence, creativity, enjoyment in all roles, circumstances, and environments 11

12 Presentation Title - Change Text in Slide Master What does a good Lifelong Learner do? Beyond the CanMEDS competencies - what are the skills required to be an effective lifelong learner? These could be translated into implementation strategies/actions at the 1. individual 2. organizational and 3. health systems level 1. Knowing practice 2. Scanning the environment 3. Managing knowledge in practice 4. Raising and answering questions 5. Practice assessment and enhancement 12 Ability to create and use a practice profile describing the issues and problems within ones practice Ability to systematically and effectively scan the environment for new and relevant ideas. E.g. identify new innovations Ability to establish a personal knowledge management system, foundational for information literacy Ability to formulate good questions and the ability to translate these questions into learning opportunities Ability to use processes and tools to continuously assess and measure the impact of learning on enhancing knowledge, skills, and performance in practice

13 Presentation Title - Change Text in Slide Master European Context Patient and professional mobility is gaining increased attention Mobility raises concerns related to ensuring competence of physicians licensed to practice in one state when they elect to practice in another Additional challenges: No legal framework to recognize the introduction of periodic validation and requirements to participate in CPD; thus revalidation is gaining increased attention 13

14 Presentation Title - Change Text in Slide Master Question #1 What are the specific needs and issues that require reconsideration of lifelong learning concepts and processes in Europe? 14 Ensuring participation in lifelong learning activities is compulsory versus voluntary Defining the need for time limited certification and the requirements for certification Management of lifelong learning systems or activities (e.g. National or regional) Although participation in CME is currently compulsory in some countries, defining sanctions or implications for non-participation remains to be identified Developing incentive structures for effective participation in CME/CPD activities (e.g. credit systems, pay for performance options) Developing classification or taxonomies of CME activities across national systems Defining the principles, values, and metrics of CPD accreditation systems focused on either CPD providers, activities or programs or both Determining the degree to which physicians can choose to select learning activities that meet their practice specific learning needs Accreditation ex ante for providers Defining industry involvement and sponsorship of CPD activities or events Identifying key skills and competencies physician will require to be effective lifelong learners (to inform CPD needs)

15 Presentation Title - Change Text in Slide Master Policy Option #1 Compulsory engagement in continuing medical education/continuing professional development/lifelong learning systems or programs 15

16 Presentation Title - Change Text in Slide Master Policy option #1 A self-regulating profession must hold its members accountable to the public it serves for the competencies they profess to hold 16

17 Presentation Title - Change Text in Slide Master Policy option #1 Advocating for a compulsory system is based on public expectation, a professional obligation and a regulatory requirement Ideally systems should: Support the development of physician lifelong learning skills and competencies (CanMEDS – beyond the medical expert role) Be relevant to the practice profiles of each learner (relevant to ones practice context) Address perceived and unperceived needs (learners practice) Include continuous assessments (learner and health team) However, policy option does NOT recommend a one size fits all model 17

18 Presentation Title - Change Text in Slide Master Policy Option #1 Important to recognize Although mandatory systems ensure licensed physicians engage in CME/CPD and achieves minimal expectations, there remains a lack of evidence that engaging in particular types of CME/CPD improves professional practice/patient outcomes Not established to prove or disprove competence or fitness to practice Cultural shift required to see true improved outcomes Lifelong learning is a foundational concept to achieve the expectations of the profession, public, and health system 18

19 Presentation Title - Change Text in Slide Master Implementation considerations Who will fund CME/CPD activities? Employers? Medical Societies? Physicians themselves? Industry? What is the financial model each country will adopt? Access issues? How do you connect rural physicians to opportunities for lifelong learning? Who will manage the recording and documentation of learning? Example: Royal College Membership/Fellows How to deal with non-compliers? 19

20 Presentation Title - Change Text in Slide Master Policy option #2 Development of a common CPD accreditation system for providers and/or programs 20

21 Presentation Title - Change Text in Slide Master Policy option #2 Undergraduate and postgraduate education accreditation systems have been established What models could be considered? Providers-focused model Individual program or activity-focused or A combination of both 21

22 Presentation Title - Change Text in Slide Master Policy option #2 Foundational components that should be considered for any accreditation model Typically based on a set of standards (educational and ethical requirements for an activity or qualify for credits) Opportunity for mutual recognition of a National CPD accreditation system Accreditation systems could be the same or substantively equivalent Based on a set agreed upon minimum standards of principles, values and metrics Important to determine HOW these are expressed within each country / across the EU 22

23 Presentation Title - Change Text in Slide Master Policy option #3 Defining the role and expectations of the healthcare system in supporting continuous quality improvement in lifelong learning 23

24 Presentation Title - Change Text in Slide Master Policy option #3 Barriers to optimal care Structural (financial disincentives) Organizational (lack of appropriate equipment) Peer group (local standards of care not in line with desired practice) Individual (knowledge, attitudes, skill deficits) Information overload leading to acts of omission Patient expectations (direct to consumer marketing) 24

25 Presentation Title - Change Text in Slide Master Policy option #3 Alignment and synergies must occur between physicians, CPD providers, and the healthcare system (shared responsibility) An initial and important policy option is to ensure the creation of knowledge infrastructures and targeted knowledge translation activities 25 Physicians (skills) CPD Providers (resources) Health System (infrastructure)

26 Presentation Title - Change Text in Slide Master Policy option #3 Access to information is not the only issue Physicians lack skills required for lifelong learning…thus, facilitators are required: (CPD provider level) CPD providers, CME departments within Universities, etc. must develop educational tools, courses, and materials targeted at the broad spectrum of skills as outlined by the CanMEDS framework - E.g. Manager (how to develop a practice profile), scholar (how to develop a good question), communicator (e.g. how to develop rapport, trust, and ethical therapeutic relationships with patients, and professional roles (what are the concepts of ethical practice?) 26

27 Presentation Title - Change Text in Slide Master Policy option #3 (system level) Examples individual countries or collective partnerships could consider: Knowledge portals designed to organize, appraise, and summarize knowledge resources (identify relevant high quality sources) Knowledge services that screen and appraise research knowledge (ACP Journal Club) Just-in-time knowledge services that provide real time (synchronous) knowledge support (for practice based questions) Rapid response services (asynchronous) providing a scoping review (rapid, 1-2 weeks) 27

28 Presentation Title - Change Text in Slide Master Policy option #3 Practical steps for implementation are poorly identified within the literature Some interventions could be delivered via CPD mechanisms (e.g. audit and feedback, reminder systems) There is an important and highly synergistic relationship that needs to be leveraged between CPD and lifelong learning activities such as knowledge translation 28

29 Presentation Title - Change Text in Slide Master Questions to prompt discussion / reflection? Are these policy options important to /relevant for/feasible within your country? Can you provide examples of lifelong learning models/strategies that could inform the policy options/implementation issues? How is CME/CPD currently funded within your jurisdiction? Is this sustainable? What have been the major barriers? What do you see as being the biggest challenge to implementing these policy options? Are there solutions? 29


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