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3rd National CPD Accreditation Conference - Ottawa September 27, 2011

Integrating CanMEDS Roles in CPD Programs


Conflict Of Interest Declaration

Kate Hodgson DVM, MHSc, CCMEP • No relevant conflicts of interest

James Meuser MD, CCFP, FCFP • No relevant conflicts of interest


Workshop Learning Objectives

After active engagement during this workshop you will be better able to: • Explain the seven CanMEDS Roles and their relevance to CPD • Describe key approaches to the use of the CanMEDS framework in the identification of needs assessment and evaluation strategies • Discuss the role for CanMEDS in both self-learning and assessment


Explore integrating the CanMEDS Roles

In the context of a specific Comprehensive Program


CPSO Processes that lead to need for Comprehensive Program

Assessments through QA Investigations through ICRC Change of Scope of Practice Re-Entry to Practice


Current Approach at CPSO to Physician Enhancement

• Specific courses of study • Some CPSO educational programs e.g.

record-keeping, prescribing • CPSO arranges formal preceptorships

• Nothing exists that is comprehensive


CPSO Identified Need o Educational Program for Physicians with

needs that provides MORE than clinical information in an educationally evidence-informed format

o Family Medicine best place for pilot o Approached CEPD and DFCM at

University of Toronto o Program development grant from CPSO


Medical Education Literature Review

• Longitudinal • Small Group • Interaction with peers • Practice-based • Directed self-assessment • Opinion leaders • Preceptoring


Curriculum Committees and Program Pilot

• Inclusive Curriculum Committees • April 2010 • CACHE April 2011 • June 2011 • July 2011

• 2010-2011 Pilot Program with 10 participants


CanMEDS Roles


Proposed Program Components • Recruitment- Intake and assessment –

appropriate participants • Shared small group learning (“5

Weekends”) designed around CanMEDS-FM Roles: using multiple teaching methods (interactive, case-based, standardized patients, PBSGL modules)

• Between-session “homework” • Matched Preceptors • Exit documentation and evaluation


Weekend Design

Content/Topics: Competencies Friday Afternoon and Evening

Ice Breaker- Building community of practice rapport Describe and analyze practice, patients, and health care team Professional, Manager and Advocate

Saturday Morning Interactive presentations Workshops Standardized patients Medical Expert, Collaborator and Communicator

Saturday Afternoon Problem Based Small Group Learning Medical Expert

Sunday Morning Interactive presentations Workshop Manager, Scholar, and Collaborator


Therapeutic Themes

Family Medicine relevant Therapeutic Theme established

for each weekend


CFPR Program

Mild Remedial Re-entry

Change of Scope

Personal desire to maintain clinical competence and

practice standards

Practising IMGs

Mature Physicians


Discussion

• Have you identified a need for a comprehensive CE program based on ALL CanMEDS Roles in your health care community? • De-emphasize Medical Expert? • Address all Roles?


Curriculum Development

Using the CanMEDS – FM Roles Matrix


Therapeutic Themes

Weekend Therapeutic Themes

One Chronic Disease

Two Family Medicine across the Life Cycle

Three Health Promotion and Disease Prevention

Four Mental Health

Five Challenging Clinical Situations


CanMEDS


medical expert communicator collaborator manager scholar advocate professional

Welcome- Introductions

Patient-centered care; Standardized patients

Office-based team - Collaborative Care Model

Improvement in Family Practice -Why Quality Improvement

Computer Lab: Formulating and Answering Clinical Questions; Web-searching

Non-medical determinants of health

Exploring Professionalism -- Collegial Conversations

Overview of Comprehensive Family Practice Review Program; Family Practice in the 21st Century- CANMEDS

Share Practice Profile – 5Ps

CPD Professional Practice Profile; Identifying CPD needs relevant to practice

PBSG: Diabetes Type 2: What's New?

Choosing an Opportunity for Improvement

PBSG: Hypertension: When it's Difficult to Treat

PBSG: Postmenopausal Women's Health

Medical Record Keeping

Framework for Family Practice; Family Genogram Practice Tool

QI Model for Improvement; Structuring an Improvement- Aim, Measures, Changes

CPD Plan; Learning Objectives; Knowledge, Skill, Practice multiple interventions

Computer Lab: Patient-Family Education on the Web

Ethical issues across the Family Life Cycle

PBSG: Fever in children

Your Medical Career Life Cycle

Using Clinical Practice Guidelines; Evidence-based Medicine

Motivational Interviewing Referral process QI PDSA Cycle;

Process Tools

CPD Professional Learning Project; Linking Learning to Practice; Professional

Working with the Public Health Department

Periodic Health Exam

Computer Lab: Optimal use of CPD web-based resources

PBSG: TBD PBSG: TBD

PBSG: TBDComplex Communication- Conflict; SHERPA

Computer Lab: Optimal Use of Community Web-based Health Resources

QI Data Collection; Data Analysis

Review PLP

Role and limitations of Family Physician as Advocate

Work/Life Balance

PBSG: TBD Cultural SensitivityColleagues in Distress/PHP Program

I CAN PRESCRIBE Telephone/Email Medicine

Working with your Pharmacist Share QI Posters

Review CFPR Program; Update CPD Plan for the coming year;Commitments to Change

Managing patient expectations

Family Physicians: The Leadership Role

PBSG: TBD

Difficult Patients and Families in Crisis; Standardized Patients

PBSG: TBD

session themecompetency

1 Chronic Disease

2

Family Medicine

across the Life Cycle

3

Preventive Medicine/

Health Promotion

4 Mental Health

5Challenging Situations in Practice


CanMEDS-FM: Communicator Oral and written communication skills Ability to establish therapeutic relationships

with patients/families Effective information gathering and synthesis Effective sharing of information


Curriculum Focus

Patient-Centred Care Medical Record Keeping Motivational Interviewing Complex Communications Cultural Sensitivity Telephone/Email medicine Difficult Patients & Families

in Crisis


CanMEDS-FM: Collaborator Participation in collaborative practice Maintenance of positive working environment


Curriculum Focus

Expanding influence: Co-workers: Office-

based team Family context: Family

genogram Specialists: Referral

Process Community: Web-based

resources Inter-professional:

working with allied professions


CanMEDS-FM: Manager Management of practice time and career Management of resources Management of practice/organizations/ systems

to maintain effectiveness


Curriculum Focus

Quality Improvement in Family Practice


CanMEDS-FM: Scholar Ongoing self-directed learning, based on

reflective practice Information management & critical appraisal Educator

• Patients, families, other HCPs, public, etc. Research


Curriculum Focus

Continuing Professional Development


CanMEDS-FM: Health Advocate Respond to individual health needs Respond to community health needs Identify determinants of health within the

community Health promotion


Curriculum Focus

Non-medical determinants of health

Patient-family education Working with Public

Health Role & limitations of

Family Physician as Advocate

Managing patient expectations


CanMEDS-FM: Professional

Commitment to patients, profession, society through ethical practice

Respect of regulatory practices Commitment to physician health and

sustainable practice Commitment to reflective practice


Curriculum Focus Exploring

professionalism Ethical issues Medical Career Life

Cycle Work/life balance Colleagues in distress Family Physicians as

Leaders


CanMEDS-FM: Family Medicine Expert Integration of all other CanMEDS roles Knowledge, skills and attitudes; procedural

skills Proficient patient-centered assessment and

management; complex clinical situations Coordination of patient care


Curriculum Focus

PBSGs 2 per weekend session Clinical questions

assigned as homework; debriefed at the following session

Using clinical practice guidelines

Periodic Health Exam I CAN PRESCRIBE


Discussion

CanMEDS Roles: • Advantages of using CanMEDS

Framework to build curriculum?

• Challenges of using CanMEDS Framework to build curriculum?


Program Evaluation Strategies • Three main areas to evaluate:

• Perceived program impact • Did it change behaviour and how?

• Sustainability • Can the program continue beyond the pilot and

what will it take for this to happen? • Transferability

• What would it take to implement the curriculum in other (Non-Toronto) settings?


Multi-Source Feedback

1. Feedback on each session over 5 weekends. 2. Discussion and evaluation on the Sunday

morning of the 5th weekend. 3. Collegial feedback from Canadian Association of

Continuing Health Education (CACHE).


Results so far… • Uniformly positive evaluations • PBSG modules very popular

• Group planning on staying together AFTER the program is finished

• Recognition of the importance of all the CanMEDS-FM Roles and the need to specifically address and develop those competencies


I write more detailed referral letters with specific questions – including who is responsible for

follow-up. As a result, I get more detailed reports from specialists, and my patients

receive better care.


I’m more thorough in researching patient history

before composing referral letters – a learning experience for

myself about the clinical condition and our EMR system.


I am now allowing time for making notes in the appointment

time. My notes are more complete, I’m no longer taking work home, and my billing is

more accurate.


The cumulative patient profile facilitates better medicine,

especially when the patient is seen by a colleague. My

colleagues have adopted this practice.


The QI approach to change in practice has been implemented

nationally.


Program Goal 2011 – 2012

To equip primary care physicians with high quality skills for 21st century practice.


Learning Objectives 2011 – 2012 Improve their approach to managing clinical

conditions. Use technology to answer clinical questions

effectively. Provide better patient-centred care. Collaborate and communicate more effectively

with others in the healthcare system. Develop an individualized approach to life-long

learning & professional development.


Weekend Format 2011-2012

Begin at 2:00 PM Friday. Community-building reflective activity on

Friday. Have a computer lab each weekend. Keep the PBSGs on Saturday afternoon. End each weekend with/at lunch on

Sunday.


Therapeutic Themes 2011-2012

Weekend Therapeutic Themes One Chronic Disease

Two Family Medicine across the Life Cycle

Three Preventive Medicine – Health Promotion

Four Mental Health

Five Challenging Situations in Practice


Therapeutic Themes – PBSGs

Include 2 PBSG modules relevant to therapeutic theme in each weekend session. Chosen by faculty for first 2 weekends. Balance to be selected by participants

using Delphi process. Clinical question arising from each PBSG

to be assigned as homework. Homework to be debriefed during the

following session.


Longitudinal Themes

Additional longitudinal themes throughout the five weekends: Quality Improvement Continuing Professional Development Use of technology

Use standardized patients on the 1st and 5th weekends only.

CPD coaches to support participants’ learning throughout the course.


Coaching Component of CFPR

2010 – 2011: Preceptors

2011-2012: Coaches


Coaching

Intentional, consistent, collaborative process.

Supports the development of peers.

Helps colleagues take responsibility for their own initiatives.


Coach

Facilitator – not authority or auditor.

Asks more than tells.

Listens more than speaks.

Empowers – does not direct.


Skills of a Coach

Confidence

Competence

Candour

Commitment

Clarity


Coaching Component of CFPR

Support CFPR Program.

Provide informal advice on a specific step or element of CFPR.

Support successful adaptation and completion of CFPR.

Make recommendations and refer to resources.


Coaching Support

Application to practice. Adapt generic tools to

specifics of practice.


Coaching Support

Expand collaborative influence and action.


Coaching Support

Completion of QI project over the course of CFPR.


Coaching Support

Navigate the challenges of advocacy.

Explore complexity.


Coaching Support

Refine CPD focus. Identify multiple,

actionable learning interventions.

Structure PLP.


Coaching Support

Act as role model.


Coaching Support Sounding board. Guide to resources for

clinical questions.


Discussion

• What are the advantages and challenges of Preceptors and Coaches in a CPD Program which integrates all the CanMEDS Roles?


Questions?

Integrating CanMEDS Roles in CPD Programs - Home | The College of Family · PDF...

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