Learning to prescribe - Acquiring competence in an interprofessional context Tim Dornan.

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Presentation transcript:

Learning to prescribe - Acquiring competence in an interprofessional context Tim Dornan

Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research Why is conversation so easy? Garrod and Pickering 2004 Consider spending 20 minutes: –Conversing with.. –Addressing.... one or more other people Which is: –Easier? –More complex? Task switching, multitasking, timing etc

Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research

Conversation is so easy because … Garrod and Pickering 2004 … humans are designed for dialogue rather than monologue Consider how children learn to speak

Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research Interprofessional education

Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research Interprofessional education

Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research

Conversation 1 – in reality …the Registrar came, reviewed him and said,No, no we should give Tazocin, penicillin. And, erm, by that stage I'd forgotten that he was penicillin allergic and I just wrote it on the chart without thinking. I say without thinking, cos it, I had thought of it already, but, erm, I suppose it was because of the security of thinking, Gosh, someones finally come to help me with this patient, I just, kind of, and did as I was told and, and, you know, didnt look at the allergy box for a second time. EQUIP 2009

Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research N1 and Physician are monitoring the patient: Applying oxygen on a masque, adrenalin inhalation, and an i.v. syringe. N1: Do you want me to prepare medicine for extraction? P: I think we should infuse saline. And monitor the patient. N1 calls for N2. N1: Would you please put on some monitoring device on the patient. She is pregnant, 31 weeks and has been stung by a bee. She has a bit of stridor. (The patient gets more dizzy and tired) P is listening to the patients chest sounds. P: Lets do an ABC. We are dealing with an A-problem. N1 (interrupting): She is having an anaphylactic reaction. Ill give some Tavegyl 1 mg i.v. Charlotte Paltved and Peter Musaeus, Århus, DK Conversation 2 – in simulation

Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research Interprofessional education Identity…

Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research Conversation 1 – in reality …the Registrar came, reviewed him and said,No, no we should give Tazocin, penicillin. And, erm, by that stage I'd forgotten that he was penicillin allergic and I just wrote it on the chart without thinking. I say without thinking, cos it, I had thought of it already, but, erm, I suppose it was because of the security of thinking, Gosh, someones finally come to help me with this patient, I just, kind of, and did as I was told and, and, you know, didnt look at the allergy box for a second time. EQUIP 2009

Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research N1 and Physician are monitoring the patient: Applying oxygen on a masque, adrenalin inhalation, and an i.v. syringe. N1: Do you want me to prepare medicine for extraction? P: I think we should infuse saline. And monitor the patient. N1 calls for N2. N1: Would you please put on some monitoring device on the patient. She is pregnant, 31 weeks and has been stung by a bee. She has a bit of stridor. (The patient gets more dizzy and tired) P is listening to the patients chest sounds. P: Lets do an ABC. We are dealing with an A-problem. N1 (interrupting): She is having an anaphylactic reaction. Ill give some Tavegyl 1 mg i.v. Charlotte Paltved and Peter Musaeus, Århus, DK Conversation 2 – in simulation

Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research What is the task of prescribing? McLellan et al 2012

Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research What is the task of prescribing? McLellan et al 2012 x x x x xx xx x x x xxxx x x xxx xx xx x xx x x x x x x x x x x x xxx x x xxxxx x x x xx x

Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research Conversation 3 – in Maastricht LMcC and TD: How can we design a prescribing training intervention? JvM and AdeB: Find how an expert does it and do a task decomposition? LMcC and TD: Hmmm. Perhaps we could study F1s and F2s JvM: That is like asking a pig to design a slaughterhouse

Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research Conversation 3 – in Maastricht LMcC and TD: How can we design a prescribing training intervention? JvM and AdeB: Find how an expert does it and do a task decomposition? LMcC and TD: Hmmm. Perhaps we could study F1s and F2s JvM: That is like asking a pig to design a slaughterhouse Jeroen van Merriënboer

Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research Conversation 3 – in Maastricht LMcC and TD: How can we design a prescribing training intervention? JvM and AdeB: Find how an expert does it and do a task decomposition? LMcC and TD: Hmmm. Perhaps we could study F1s and F2s JvM: That is like asking a pig to design a slaughterhouse

Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research Some time later ….. LMcC: You know, Ive been thinking about what Jeroen said. No one individual is the expert TD: Aha … Ahaa … Ahaaa … Ahaaa … Ahaaaa … etc

Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research Later still in a northern UK city… Norris et al in preparation BN (Y4 medical student) does ethnographic research observing how Y5 medical students learn to prescribe in the shadowing period Sees them being left behind by ward rounds and learning fragments of the prescribing task in relative social isolation from ANYBODY

Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research Identity development & emotions - 1 Pearson et al in preparation Figured Worlds –Identity theory –Discourse analysis 54 emotionally salient events in the daily learning lives of Y3 UK medical students (audio diaries and interviews) Who were the figures in medical students identity construction?

Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research … this GP really inspired me … we went on a home visit to this patient, shed just stopped taking all her pills, she was about 70 or 80 … she was like dont stress yourself I dont care … as long as youre OK and youre healthy and youre taking your medication … Identity development & emotions - 2 Pearson et al in preparation

Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research Identity development & emotions - 3 Pearson et al in preparation … And its really nice seeing how caring people can be and how you can still maintain compassion once youre a doctor … I learned the most in that recent GP block … cos she inspired me … I was constantly motivated and engaged and I just sucked up knowledge

Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research Interprofessional education

Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research Interprofessional education Your education as a health professional? –Which decade was it? –In what culture was it? What identity were you educated into? –Individual or an inter-professional identity? –How hierarchical was the culture within/between professions?

Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research

To be grasped … The (re)habilitation of learning by socialisation Inequalities of status and power within and between professions Developing individual vs developing collective identities –Social (Marxist) vs individualistic (capitalist) theories of identity

Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research A point of clarification Interprofessionalism works brilliantly when it comes about naturally –Diabetes health care teams

Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research In the meantime … Keep conversing with enthusiasm and humility with anybody and everybody –Its easy! Keep doing the innovative educational work youre doing but dont be too starry-eyed about what you can expect to achieve in the short term –True interprofessionalism requires major social change