MSK Practice Support Program Train the Trainer 2 Faculty Development

“Tell me and I forget, teach me and I may remember, involve me and I learn.” Benjamin Franklin Benjamin Franklin “What is a teacher? I'll tell you: it isn't someone who teaches something, but someone who inspires the student to give of her best in order to discover what she already knows.” Paulo Coelho, The Witch of PortobelloPaulo CoelhoThe Witch of Portobello “The best teacher is not the one who knows most but the one who is most capable of reducing knowledge to that simple compound of the obvious and wonderful.” H.L. Mencken H.L. Mencken

Objectives for Today 1. Able to facilitate small and large group physician learning through adult learning principles. 2. Able to demonstrate the use of clinical tools within the targeted patient population

Where’s the Gap ? Low Back Pain  In a recent study, the one-year incidence of low back pain was 19% with 40% of this population reporting persistent symptoms and 14% experiencing an aggravation of their symptoms. Canadian medical expenditures with respect to low back pain are estimated between $6 and $12 billion annually Source: Back Care Canada and American College of Physicians, National Institute for Health and Clinical Excellence.

Helping Physicians Learn

Facilitating High Yield Learning Physicians learn best when the learning is in the context of patient care, answers their questions about patient care issues, is directly applicable to their work and does not take up too much of their time. Physicians learn in response to clinical problems. Once a problem has been identified, decide to act on it by learning the things they need to know to solve the problem. They then apply this knowledge to the problem. (Slotnick) Physician learning is unique in that there is a high inclination towards autonomy and self-directed learning. (Knowles)

Know what I Know

Know what I Don't Know

Don't know what I Know

Don't Know what I Don't Know

Unskilled and Unaware Unskilled and Unaware of It: How Difficulties in Recognizing One's Own Incompetence Lead to Inflated Self-Assessments, Kruger J, Dunning D.,J Pers Soc Psychol Dec;77(6):

Physician Self Assessment In many studies, poor correlation between physician self-assessment and standardized external assessment. Got the right answer, I must have knowledge Accuracy of Physician Self-assessment Compared With Observed Measures of Competence:A Systematic Review, JAMA, Sept. 2006, vol 96(9)

Strategy 1. Adult Learners 2. Reflective Practice 3. Role Modeling

Motivating the Adult Learner  Social relationships  External Expectations  Social Welfare  Personal Advancement  Need Stimulation/Diversity  Inquisitive Interest .

Describe your learning experience

Adult Learners R- Relevance E- Experienced Contributor S- Self-directed P- Practical E- Equality C- Connections T - Timely Goals

Strategy 1. Adult Learners 2. Reflective Practice 3. Role Modeling

Reflective Practitioner

Reflective Practitioner SURPRISE a brief emotional state experienced as the result of an unexpected significant event

Clinical Responses Aware Acknowledge Investigate Analyze Integrate

Reflection

Reflection on Action Gap:  Guidelines to Practice  Time and Logistics Solutions  Synthesize  Disseminate  Implement ●

How do improve hand washing ?

Strategy 1. Adult Learners 2. Reflective Practice 3. Role Modeling

Clinical Competence Excellent knowledge / skills Effective communication Sound clinical reasoning Teaching Skills Aware of role Explicit about model Respect for learner needs Provides feedback Encourages reflection Personal Qualities Compassionate Enthusiastic for practice Effective interpersonal skills Commitment to excellence Demonstrates humour

The Importance of Role Models Teaching and learning in ambulatory care settings: a thematic review of the literature. (PMID: ) Irby DM – Academic Medicine : Journal of the Association of American Medical Colleges [1995, 70(10): ] A thematic review was conducted of the research literature on teaching and learning in ambulatory care settings for both undergraduate and graduate medical education. Included in the review were 101 data-based research articles, along with other articles containing helpful recommendations for improving ambulatory education. The studies suggest that education in ambulatory care clinics is characterized by variability, unpredictability, immediacy, and lack of continuity. Learners often see a narrow range of patient problems in a single clinic and experience limited continuity of care. Few cases are discussed with attending physicians and even fewer are examined by them. Case discussions are short in duration, involve little teaching, and provide virtually no feedback. Excellent teachers are described as physician role models, effective supervisors, dynamic teachers, and supportive persons.

Strategies for Role Modeling Teaching and learning in ambulatory care settings: a thematic review of the literature. (PMID: ) Irby DM – Academic Medicine : Journal of the Association of American Medical Colleges [1995, 70(10): ] Longitudinal teaching programs Focus on: Interviewing, physical examination, and management of psychosocial issues. Encouraging collaborative and self-directed learning Faculty development Strengthening assessment and feedback procedures..

Top 5 Valued Learning Qualities Motivated to seek new information Set Realistic Goals Ability to reflect on new information Critical Thinker Confident to take risk ●....not necessarily the highest marks !

Top 5 Valued Teaching Qualities Able to provide Interactive Setting Creative thinker Flexible in methodology Commitment and passion Supportive of learner needs ●.....Not Necessarily the Expert !

Teaching with Video

1. Patient and doctor relationship Apply to new and related scenarios How would the physicians response change if the patient said …. How would the patient’s response change if the physician said…..

Teaching with Video 2. Real Model Evaluation Seek realistic teaching examples  What worked and was well done …  What could have clearer or improved…

Teaching with Video 3. Translate into Principles Link with guideline evidence Link with clinical decision making  What principles would you want your resident to understand …  What key messages are you trying to give to your patient….

Case Builder Process Case Histories Curriculum Key Messages Learner Competency Outcomes Scripted Standardized Patients Training Taping and Editing

Video Vignettes-Osteoarthritis Ms. Irene Genou is a 58 year old retired elementary school teacher who has come to your office for her annual health evaluation and complains of increasing right knee pain and intermittent swelling. Patient History - Inflammatory Screening History /PHQ9/ Pain and Function Follow-up Physical Examination//Investigations /Indication for Surgical Referral / Pain and Function Follow-up Treatment and Management Options / Medication /Patient Self Management

Teaching with Clinical Tools

Selection Criteria Relevant to Primary Care  Diagnosis  Clinical Decision Making  Management Realistic in GP time  Patient visits  Documentation

Integration into Clinical Process Language, Behaviour, Clinical Decisions

Checklist Explain Principle Concepts Relevance to Primary Care Demonstrate – Video Reflection Practice Feedback

Can we translate to teaching? Role Modeling Case based Application Reflection on Practice SIMPLIFY the SPINE