Planning for CBD: Initiatives & Innovations · Planning for CBD: Initiatives & Innovations ......

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Planning for CBD: Initiatives & Innovations

for a New Culture Change Author: Sara Cover

Date: October 2017



I do not have an affiliation (financial or otherwise) with a pharmaceutical, medical device or communications organization.

Je n’ai aucune affiliation (financière ou autre) avec une entreprise pharmaceutique, un fabricant d’appareils médicaux ou un cabinet de communication.

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Agenda

• Clinical Module Map & Schedules

• Competency Committee Worksheets

3

Introduction

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• Things you should know about the NOSM Anesthesia Program

• 2 resident in-take per year; no fellowship programs at NOSM

• One site program (within a distributed school) • We are NOT service based; we do not have

seamless call • Our academic schedule and clinical scheduled

are not based on each other – they run separate from each other

• One learner per OR

Who’s here?

6

Competency By Design What is the best thing about CBD?

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What challenges do you foresee?

Where did we start?

8

Step one: Form an IMPLEMENTATION GROUP This group will make key decisions regarding:

Needs Assessment

Program Organization

Organizational Structure

Suggest Funding

plans

Plan for Resident

Orientation

Our Members: PA, PD, CID

5 Faculty Members 1 Resident (PGY2)

Implementation Group

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Meeting Topics • Draft a 24 month schedule (TTD & Foundations) • Plan integration of academic program • Competency Committee • Organizational Structure (Funding) • Funding (Organizational Structure) • Faculty Development • ePortfolio/assessment strategy for each EPA; Tour ePortfolio • Academic Coaches/Advisors • Program Evaluation • FPA CCC and CBD Integration • Non-CBD aspects of CanMEDs 2015

Step 2: Paint a picture….

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• Literally! Paint a picture

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Picture to Paper

Personalized Learning Block (PLB)

• Traditional Stream: PGY2-5, 1 block/year between January & June Residents are required to:

» Identify learning objectives for a 1 month block of anesthesia • Must include at least one intrinsic CanMeds role

» Determine an appropriate assessment strategy » Formulate 1 new learning objective at the end of the block,

based on reflection of their PLB

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Personalized Learning Block

13

• CBD Stream:

Same requirements as our traditional stream.

Strategically placed throughout their years to accommodate flexibility of obtaining experiences that will allow them to complete their EPA’s.

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start of Yr1 start of Yr2

Month July Aug Sept Oct Nov Dec Jan Feb Mar Apr May June June July Aug Sept Oct Nov Dec Jan Feb MarBlocks 1 2 3 4 5 6 7 8 9 10 11 12 13 1 2 3 4 5 6 7 8 9

Stage of Training

Core Academics

Module

Discipline ANE ANE ANE ANE OB ANE PLB GEN SX IM ER PEDS COMM ANE ANE ANE ANE PLB ANE PLB ICU ANE ANE ANE ANE PLB ANE PLB ANE PLB

SchedulingOff-Service

Based on Learner Needs

EPAsF19, F20, F22

F2, F4, F5, F7, F15, F29

F4, F5, F7, F15

F4, F7, F8, F14

F27, F28F24, F25, F27

Required Training Experiences

Longitudinal RTE's

Summer Series First Cycle of Academics Second Cycle of Academics

OB AnePEDS Ane

Based on Learner NeedsBased on Learner Needs

-Pre/Intra/Post Op Care- Clinical/OR/APS/ PACU

OB ANE Rooms

Periop Care-Consults-APS-OR

Module 4

NOSM's Competency By Design Schedule

Transition to Discipline

(TTD)

TTD Module

Foundations (16-20, max 24)

Module 1 Module 2 Module 3Mod 2 & 3

ANE PLB

2.2 ACLS2.3 ATLS

1.3. Assessment of patients in the Emergency Room (F4, F8, F14)

1.4. General Surgery (or any surgical specialty) inpatient unit including consultations (F3, F4, F5, F7, F15, F29)

1.5. Internal Medicine (or any medical subspecialty) inpatient unit including consultations (F4, F5, F7)

1.6. Pediatrics: medical or surgical inpatient unit including consultations and/or ambulatory clinics and/or emergency department (F27, F28)

3.4 Trauma Team

F1, F2, F3, F16, F20, F29

3.3. Rapid response or emergency response team (F4)

Foundations Wrap Up

Increased Complex Room Assignments: Vascular,

Thoracics, Cardiac, Neuro?

OB ANEPain

Consults

3.4 Trauma Team

Oct: LMCC Part 2

1.1.1. Pre-operative assessment (F1, F2, F24)1.1.2. Anesthesiology consult service (F1, F2, F8, F24)

1.1.3. Acute pain service (F29)1.1.4. Perianesthetic areas including post-anesthetic care unit (F2, F3, F9, F10, F11, F12, F13, F14, F15, F16, F17, F18, F29)

1.2. Labour and delivery unit (anesthesiology and obstetrical perspective ) (F19, F20, F21, F22, F23)3.4. Trauma Team (F8)

F9, F10, F11, F12, F16, F17

F3, F7, F8, F13, F14, F15, F17, F18, F22, F23, F29

Orientation to:-CBD/ePortfolio/ Assessment-NOSM Program-Simulation - more of this in first two months-Machine Check Assessment

Resident WellnessBuddy Call - Must have PGY3 and above for buddy call

TTD1, TTD2, TTD3, TTD4

Questions this lead to:

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"PGY 1"Month July December JuneBlocks 1 2 3 4 5 6 7 8 9 10 11 12 13

Stage of Training

Core AcademicsModule

Description

Other Program Review Program Review

"PGY 2" Month July December JuneBlocks 1 2 3 4 5 6 7 8 9 10 11 12 13

Stage of Training

Core AcademicsModule Periop Med 1

Description see next line

Other Program Review Program Review


Stage of Training


Description ANE PLB

Other Program Review


Stage of Training


Description ANE PLBSR EM & POCUS

Other Program ReviewProgram Review


Stage of Training


Description ANE PLB ANE PLB ANE PLB

Other

Royal College Written Exam

Program Review

Management of High Risk Patients 2

Foundations (16-20, max 24)

Anesthesia - Perioperative care, Obstetrics and Obstetrical Anesthesia, PLB

Off Service - EM, IM, Pediatrics, Surgery Anesthesia - Comprehensive perioperative care and community anesthesia

Foundations Wrap Up Mgmt of the High Risk Patient

Core Foundations (16-20, max 24)

Second Cycle of Academic Program

Thoracic/ Vascular Periop Medicine 2 Neuro/ ICU PainPeriop Medicine 1

1 Block of Cardiology, 2 blocks of anesthesia including PAC

and PACU

1 Block of Thoracic and 1 Block of Vascular

Anesthesia

IM rotations: Geriatrics, Nephrology and Respirology

2 Blocks of MS ICU with a focus on neuro/trauma topics, 1 block of Neuro

anesthesia

Regional Anesthesia and Chronic Pain

Pediatric anesthesia (HSC Toronto)1 block of community anesthesia, senior

OB and 2 weeks protected time for scholarly activity

2 blocks of Cardiac Anesthesia, 1 block of CVICU, Longitudinal experience in TEE

Module 2&3 ANE PLB Module 4

Core (30-36 months, max 42)

Introduction to advanced anesthesia topics and the complex patient

Program Review

Pediatrics Consolidative Module Periop Cardiac

Core (30-36 months, max 42)

2 Blocks of MS ICU, 1 Anesthesia for the complex patient

NOSM Anesthesiology Competency By Design Overview

Royal College Oral Exams

Program Review

Core Wrap Up

Transition to Practice

Transition to Discipline (TTD)

Summer Series First Cycle of Academic Program

Third Cycle of Academics

Core

TTD Module Module 1 Module 2 Module 3

ANE HIGH RISK ANE

Introduction to anesthesia concepts, CBD, HSN and Buddy

Call

• How will CBD schedules integrate with current residents’ schedules?

• What will this look for multiple residents in the same cohort?

• What will this look like with all CBD cohorts? (i.e.: in 4 yrs., in 5yrs.)

• How do we know that our numbers will balance out (i.e. not having all resident off service at the same time)

CBD Overview Clinical Schedule

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FPA Residents

First Name

Home Base

Year

Sam Sudbury 1

Julie Sudbury 1

Melanie Sudbury PGY5

Kenneth Sudbury PGY5

Fady SudburyPGY4

Alexandre SudburyPGY4

Liam Sudbury PGY3

Cassandra Sudbury PGY3

Krista Sudbury PGY1/2

Scott Sudbury PGY2

ShellonHamilton

Guyana PGY 3

Clinical Schedule for Dept. of Anesthesia Sudbury2017-2018

First Year of CBDBlock 1

OrientationBlock 2

ABCBlock 3 Block 4 Block 5 Block 6

FPA CaRMSBlock 7xmas

Block 8CBD CaRMS

Legend for CC Meeting rows: Pre CBD/ Current Residents CBD Residents in Foundations CBD Residents in Core CBD Residents in TTP

Block 9 Block 10March Break

Block 11 Block 12 Block 13

May 7- June 3 June 4- June 30

Transition to Discipline Foundations Module 1 Foundations Module 2 Foundations Module 3

Competency Committee Meetings

Nov. 20-Dec.17 Dec. 18-Jan 14 Jan. 15-Feb. 11 Feb. 12-Mar.11 Mar.12-Apr.8 Apr.9-May 6

CC meeting:

2 FPA

Transition to

Practice meeting: 2 FPA

Transition to

Foundations

meeting:

Voting members: TTD lead, Chief,

and Fac. Member2 CBD2 FPA

CC meeting2 CBD

4 pre CBD

Anes SUD Anes SUD Anes SUD OB Anes SUD Anes SUD PLB PEDS

General Surgery IM: SelectiveAnes SUD Anes SUD Anes SUD Anes SUD OB Anes SUD PLB

ER

Jul 1-30 July 31 - Aug 27 Aug. 28-Sept. 24 Sept. 25 - Oct. 22 Oct. 23-Nov. 19

IM: Selective General Surgery Anes SUD Anes SUDCommunity

Anes

Anes SUDER PEDSCommunity

AnesAnes SUD

4 5 4 4 5

Emerg

Number of residents on service

7 4 6 6 5 6 55

CC meeting4 pre CBD

CC meeting4 pre CBD

CC meeting4 pre CBD

2 FPA

Anes SUD

ICU ICU Anes SUD ElectiveAnes SUDTHORACIC

Julien Marti

IM: GeriatricsMcElhaney/

ClarkeElective

Anes SUDPLB

Rya BoscariolIM: Cardiology

Anes SUDRegional/PACU

Anes SUDVASCULAR

Sumit Sharan

Anes SUDOBS

Rob AndersonAnes SUD

Anes SUDPLB

Rya BoscariolAnes SUD

Anes SUD ICU ICUIM: Respirology

(Tbay)IM: Infectious

Disease

Anes SUDTHORACIC

Julien MartiAnes SUD Senior ICU Senior ICU

Anes. TbayJen

Whittingham

IM: Respirology (Tbay)

Anes SUDOBS

Rob Anderson

Emergency Medicine SR Anes. HSN

Anes SUDRegional/PACU

ElectiveAnes SUD

PLBRya Boscariol

Elective Anes SUD

Senior ICU Senior ICU ElectiveIM: Hematology

ShivakumarIM: Respirology

(Tbay)

Anes. TbayJen

Whittingham


Anes SUDNEURO

Ashleigh Farrell

Anes SUDPLB

Rya BoscariolAnes PEDS Toronto


IM: Cardiology Elective

Anes PEDS Toronto Anes SUD IM: Cardiology**Emergency

Medicine SR Anes. HSN

IM: ICU HSNAnes SUD

NEUROAshleigh Farrell

IM: Respirology (Tbay)

Anes SUDPLB

Rya BoscariolICU ICU Elective

Anes SUDVASCULAR

Sumit Sharan

Anes. TbayJen

Whittingham

Anes SUDCARDIAC

Kirk DuguayIM: Nephro

Anes SUDCARDIAC

Kirk Duguay

IM: GeriatricsMcElhaney/

ClarkeICU ICU Anes SUD

Anes. TbayJen

Whittingham

Anes SUDVASCULAR

Sumit SharanElective

Anes SUDPLB

Rya BoscariolIM: Nephro Elective

Anes SUDTHORACIC

Julien MartiIM: Cardiology

Anes SUDAnes SUD

NEUROAshleigh Farrell

Anes SUDCARDIAC

Kirk Duguay

Anes SUDTHORACIC

Julien Marti

Anes SUD Anes SUD Anes SUD

Anes SUDAnes SUD

PLBRya Boscariol

Community Anes

Parry SoundElective IM: Nephro Anes SUD

Anes SUDPre Admin

Sylvain Cote

Anes. TbayJen

WhittinghamIM: Nephro Anes SUD

Community Anes

Huntsville

Anes SUD OB

Rob AndersonAnes SUD

Community Anes

TimminsAnes SUD Anes SUD

Anes SUDPLB

Rya BoscariolElective Anes SUD

Anes SUDAnes SUDPre Admin

Sylvain CoteAnes SUD

Anes SUD OB

Rob Anderson

Community Anes

Parry SoundAnes SUD

My Lessons Learned….

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• Very time consuming; homework • Pre-set meeting dates worked for us • Started with a birds eye view and then

zoomed in • Thought of all this from the perspective of a

resident

Scheduling

Your Turn!

• What are the major challenges that you have undergone/ foresee for your program when you think about scheduling?

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Competency Committee

• Where did we begin?

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First year with all 5 years of CBD residents at NOSM

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Sam Sudbury 5

Julie Sudbury 5

Pat Sudbury 4

Joy Sudbury 4

Ron Sudbury 3

Peter Sudbury 3

Mike Sudbury 2

Stella Sudbury 2

Sally Sudbury 1

John Sudbury 1

Competency Committee Meetings

Transition to

Foundations

meeting:

2021-20225th Year of CBD

Block 1Orientation

Block 2ABC

Block 3 Block 4 Block 5Block 6

FPA CaRMSBlock 7xmas

Block 8CBD CaRMS

Block 9Block 10

March BreakBlock 11 Block 12 Block 13

Transition to Core Meeting:

CC Meeting2 CBD

Transition to Practice 6-9 months, max 12

Anes SUD PLB Anes SUD Anes SUD Anes SUD Anes SUD Anes SUD Anes SUD

Pediatrics & Remote Locations/Periop Cardiac

Consolidative ModulePediatrics & Remote Locations/

Periop Cardiac

Anes SUD PLB

Anes SUD Anes SUD Anes SUD Sr. ICU Anes SUD PLB Anes SUD PLB Anes SUD Anes SUD Anes SUD Anes SUD

Periop Medicine 1 Thoracic/ Vascular Periop Medicine 2(Geriatrics, Nephro, Resp)

Pain

Neuro/ Senior ICU

Anes SUD CARDIAC/ Echo

Anes SUD CARDIAC/ Echo

CV/ ICU Anes SUD PLBScholarly/

High Risk OB/ NICUCommunity

AnesPediatrics (Sick Kids)

Pediatrics (Sick Kids)

Anes SUD PLBCommunity

AnesScholarly/

High Risk OB/ NICUAnes SUD

CARDIAC/ EchoAnes SUD

CARDIAC/ EchoCV/ ICU

Core: 30-36 months, max 42Cardiology Anes Tbay Anes SUD PLB

Anes SUDVASCULAR

Anes SUDTHORACIC

Elective Geriatrics Nephro Respirology Anes SUD PLB ElectiveAnes SUD

Regional/ PACUAnes SUD

Chronic Pain

Anes Tbay Cardiology Anes SUD PLBAnes SUDTHORACIC

Anes SUDVASCULAR

ElectiveAnes SUD

Regional/ PACU

Anes SUD PLB ICU Anes Tbay Anes SUD Anes SUD Anes SUD PLB Anes SUD PLB Anes SUD PLB

Anes SUD PLB Anes SUD PLB Anes SUD ICU Anes Tbay Anes SUD

Module 2 & 3 ANE PLBModule 4

(OB ANE, Pain, Consults & increased complex rooms)

Foundations: 16-20

months w/ max of 24 months

Anes SUDCommunity

Anes

Anes SUD ICU SUD CHEO Anes SUD Anes SUD

Anes SUD OB Anes SUD Anes SUD PLB PEDS

General Surgery IM: Selective ER PEDS

ER IM: Selective General Surgery

Anes SUD Anes SUD OB Anes SUD PLB

75 5 5 5 5 7

Anes SUDPLB

Rya Boscariol

CC meeting6 CBD2 CBD2 FPA

Transition to Practice meeting:

2 FPA2 CBD

Transition to Practice meeting: Voting

members: Core Lead, PD CCC, External

2 CBD

CC meeting:

2 FPA

Anes SUD Anes SUDCommunity

Anes

Anes SUD TTD: 1-2 months w/ max of 3

months

Elective Anes SUD

Foundations Module 1 Foundations Module 2 Foundations Module 3

MED/SX/ ICU

Anes SUD PLB ElectiveAnes SUD

Chronic Pain

Sr. ICU

Mgmt of High Risk Patients 2

SR EM & POCUSAnes SUD High

RiskAnes SUD High

Risk

Anes SUD High Risk

Anes SUD High Risk

Anes SUD

Voting members: Foundations Lead, PD, CCC, Core Lead

2 CBD

Emerg add to below numbers

Number of residents on service

7 7 8

Voting members: TTD lead, Chief,

and Fac. Member2 CBD2 FPA

CC meeting4 CBD 2 CBD

Anes SUDNEURO

SR EM & POCUS

Neuro/ Senior ICU

Core Wrap Up

7 6

Consolidated FPA - Kemora

Anes SUD Anes SUD

6

FPA Anes SUD Anes SUD Anes SUD FPA: SLO Anes SUD

Anes SUD Anes SUD

Transition to Discipline

Anes SUD PLB

MED/SX/ ICU

Core: Mgmt of High Risk Patient(ANE, MED/SX/ ICU & elective)

Elective

Elective

Anes SUDNEURO

Sr. ICU

ElectiveAnes SUD PLB Anes SUD PLB Anes SUD PLB Anes SUD

Foundations Wrap up

Nephro Respirology Geriatrics

For Argument sake right now, plugged in Anes SUD for numbers at the both

My Lessons Learned….

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• Very time consuming; collating data from many source to make it easier on the file reviewer

• Communication & Training Faculty • CQI

Competency Committee’s

Your Turn!

• What has worked best in implementing your CC and why?

• What hasn’t worked at all and why not?

OR

• How can you start planning today for your CC?

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Lessons Learned/ Recommendations

26

Scheduling: • Very time consuming; homework • Pre-set meeting dates worked for us • Started with a birds eye view and then

zoomed in • Thought of all this from the perspective of

a resident • Room for flexibility/ Individualized

programming

Competency Committee: • Very time consuming; collating data

from many source to make it easier on the file reviewer

• Communication & Training Faculty • CQI

Addressing Barriers to Change

• Lack of engaged faculty/ opportunity for new blood

• Size of program • Re-mapping EPA’s • How other’s around your

program will be affected by YOUR CBD planning

• Changing other’s mindsets • Use of multiple systems

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• Download the ICRE App,

• Visit the evaluation area in Videotron Hall, near Registration, or

• Go to: http://www.royalcollege.ca /icre-evaluations to complete the session evaluation.

Help us improve. Your input matters.

• Téléchargez l’application de la CIFR

• Visitez la zone d’évaluation qui se trouve dans l’aire Vidéotron, près du comptoir d’inscription, ou

• Visitez le http://www.collegeroyal.ca /evaluationscifr afin de remplir une évaluation de la séance.

Aidez-nous à nous améliorer. Votre opinion compte!

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