PLANNING IS PRICELESS PLANS ARE USELESS....PLANS ARE USELESS. Why are backwards planning and...
Transcript of PLANNING IS PRICELESS PLANS ARE USELESS....PLANS ARE USELESS. Why are backwards planning and...
PLANNING IS PRICELESSPLANS ARE USELESS.Why are backwards planning and instructional design
priceless in medical education?
Jo Varney, Ogilvy Healthworld
Thursday 7 December 2017, 14:00–15:00 GMT (London)
1. Describe a basic backwards
planning learning process
2. List three features of
an instructional design model
WHAT ARE THE LEARNING OBJECTIVES FOR THIS WEBINAR?
3. Recall the three components
of COM-B
4. Explain why reflection is one of the most
important elements of learning and
improving performance
By the end of this session, you should be able to:
Eisenhower photograph
DWIGHT D. EISENHOWER (1890–1969)
Plans are useless
but the planning is
priceless“ “
Why is
planning
priceless?
AUSTRIA, CIRCA 1900: Auditorium filled with students at a lecture of Julius Wagner-Jauregg, physician and psychiatrist, who became famous for his treatment of mental disease by inducing a fever, which earned him the Nobel Prize in Medicine in 1927. Photo by Imagno/Getty Images.
WIGGINS & McTIGHE CODIFIED ‘BACKWARDS PLANNING’ INTO A THREE-STAGE PROCESS
How will you know if learners have achieved the desired results?
Determine acceptable evidence2
What materials and resources are best suited to accomplish these goals?
Plan learning 3
First, set the goal. What are the outcomes, performance, knowledge needed?
Identify desired results 1
Wiggins G, McTighe J. Understanding by design. Alexandria, VA: Association for Supervision and Curriculum Design; 2005. (p. 8).
THE INFLUENTIAL WORK OF MOORE, ET AL. (2009) DRAWS UPON WIGGINS & McTIGHE
COMMUNITY HEALTH7
PATIENT HEALTH6
PERFORMANCE5
COMPETENCE4
KNOWLEDGE3
SATISFACTION2
PARTICIPATION1
Moore DE, et al. J Contin Educ Health Prof 2009;29:1–15.
A learning needs assessment identifies the gap
between ‘what is currently happening’ (the
current state) and ‘what should be happening’
(the desired state).
GAP: NEEDS ASSESSMENT
WHAT IS CURRENTLY
HAPPENING?
a%
WHAT SHOULD BE
HAPPENING?
b%x%
b−a = x%
A CARDINAL PRINCIPLE OF GOOD EDUCATION IS TO FIRST UNDERTAKE A GAP ANALYSIS
Moore DE, et al. J Contin Educ Health Prof 2009;29:1–15.
A clear and measurable practice gap
identified through chart audits.
AN ELEGANT GAP ANALYSIS IN PRACTICE GAP: NEEDS ASSESSMENT
WHAT IS CURRENTLY
HAPPENING?
58.4%
WHAT SHOULD BE
HAPPENING?
100%41.6%
100−58.4 = 41.6%
Zisblatt L, et al. J Contin Educ Health Prof 2013;33:206–14.
Woman >65 should be tested for bone mineral
density
Woman >65 currently being tested for bone mineral density
1. An adult learning instructional model
2. A model of health promotion
3. A model for describing behaviour
4. A model for behaviour change
interventions
5. A post-education event debriefing model
QUESTION #1
What does the COM-B model describe?
COM-B: A MODEL FOR DESCRIBING BEHAVIOUR
MOTIVATION BEHAVIOUR
CAPABILITY
OPPORTUNITY
COM-B, capability, opportunity, motivation and behaviour.Michie S, et al. Implement Sci 2011;6:42.
COM-B COULD HELP DESCRIBE THE GAPS BETWEEN WHAT IS CURRENTLY HAPPENING AND WHAT SHOULD BE HAPPENING
Reflective
MOTIVATIONAutomatic
BEHAVIOUR
Psychological
CAPABILITYPhysical
Physical
OPPORTUNITYSocial
CAPABILITY can be:
• PSYCHOLOGICAL – having knowledge, psychological
skills, strength or stamina to engage in necessary processes
• PHYSICAL – having the physical skills,
strength or stamina to perform the behaviour
OPPORTUNITY can be:
• PHYSICAL – what the environment allows in terms of
time, resources, locations, cues, physical barriers, etc.
• SOCIAL – including interpersonal influences, social cues
and cultural norms
MOTIVATION may be:
• REFLECTIVE – involving self-conscious
evaluations and planning (Type 2, ‘slow’ thinking)
• AUTOMATIC – emotional reactions, desires, impulses,
inhibitions, habits and reflex responses (Type 1, ‘fast’ thinking)
COM-B, capability, opportunity, motivation and behaviour.Michie S, et al. Implement Sci 2011;6:42.
COM-B COULD INFORM LEARNING DOMAINS TO HELP US FOCUS ON AND TACKLE AUTOMATIC MECHANISMS OF MOTIVATION
Reflective
MOTIVATIONAutomatic
BEHAVIOUR
Psychological
CAPABILITYPhysical
Physical
OPPORTUNITYSocial
KNOWLEDGE – An individual’s cognitive capacity to engage in the
activity concerned; having knowledge; psychological skills, or stamina
SKILL – An individual’s physical capacity to engage in the activity
concerned; having physical skills, strength or stamina
MOTIVATION – An individual’s reflective processes involving
evaluations and plans (Type 2, ‘slow’, reflective, effortful thinking)
ATTITUDE – An individual’s automatic processes (involving emotional
reactions, impulses, inhibitions, habits and reflexes (Type 1, ‘fast’ thinking)
SYSTEM – Factors that lie outside the individual that make behaviour
possible or not; systems-level domains include ecosystem infrastructure
COM-B, capability, opportunity, motivation and behaviour.Michie S, et al. Implement Sci 2011;6:42.
RECAP: THREE TAKE-HOME MESSAGES
Three-stage process:start with the end in mind
Backwards planning1
Backwards planning and gap analysis ensures learning is learner-centric and outcomes focused
Learner-centric2
Potentially elegant way of analysing gaps across Moore’s outcomes levels
COM-B3
COM-B, capability, opportunity, motivation and behaviour.
Predisposing–enabling–
reinforcing, one of
the most commonly
used instructional
models in health
CASE STUDY
CME-accredited HCP training to increase radiologists’ knowledge,
skills and confidence in performing and interpreting breast MRI,
thereby improving patient care
PREDISPOSING–ENABLING–REINFORCING INSTRUCTIONAL MODEL PROVIDED AN OVERARCHING FRAMEWORK
Green LW, Kreuter MW. Health promotion planning: an educational and environmental approach. Mountain View, CA: Mayfield Publishing Co.; 1991. (p. 151–77).
The training conducted under auspices of EUSOBI and CME-accredited by EACCME.
BREAST MRI
EUSOBI, European Society for Breast Imaging; EACCME, European Accreditation Council for Continuing Medical Education.
PREDISPOSING ACTIVITIES
Elicit a ‘learning moment’ in the
mind of the learner, meaning they
will be more likely to pursue the
learning.
Needs analysis: pre-course
online survey
Self-reported knowledge and
confidence gaps identified.
Predisposing language
Language in invitation and advertising
materials to create cognitive
dissonance.
Key needs identified in
needs analysis included:
• Lack of knowledge
around specific breast
imaging interpretation
• Lack of skill in using
MRI in clinical
diagnostics
Moore DE, et al. J Contin Educ Health Prof 2009;29:1–15.
ENABLING ACTIVITIES
Supply learners with knowledge/
resources they need along with
opportunities to use knowledge in
'authentic' situations.
Mix of instructional
methodologies
• Expert plenary lectures
• Case-based learning: practice and
feedback
Working through case studies in small
groups at workstations was the main
learning format.
Case-based learning
ensured the learning was
as close as possible to a
‘real-world’ work setting.
Authentic cases provided
learning opportunities
that are considered
relevant to HCPs.
Cervero & Gaines’ (2015) systematic review concluded that learning activities that lead to more positive outcomes in clinical behaviour and patient outcomes are characterised by being focused on outcomes considered important to physicians. Cervero RM, Gaines JK. J Contin Educ Health Prof 2015;35:131–8.
ENABLING ACTIVITIES: CASE-BASED LEARNING
Small working groups: six or seven
delegates.
Workstations allowed delegates to view
large images and DICOM series files,
and work through cases together.
Expert faculty on hand to provide
feedback and facilitate group discussion.
REINFORCING ACTIVITIES
Happen after the learning
intervention as follow up.
Post-course confidence levels in
knowledge and skill improved
considerably from pre-course
levels.
Pre-course (n=72)
Post-course (n=76)
Learning objective 1: Describe the history of breast MRI, from NMR to unenhanced and contrast-enhanced MRI.
Learning objective 2: Explain how sensitivity and specificity can be maximised in clinical practice.
CASE STUDY
Using taxonomy of 93 BCTs (behaviour change techniques)
ADHERENCE SUPPORT: WHY DON’T PATIENTS JUST TAKE THEIR MEDS?
Increasing the effectiveness
of adherence interventions
may have a far greater
impact on the health of the
population than any
improvement in specific
medical treatments
Sabate E. Adherence to long-term therapies: evidence for action. Geneva, Switzerland: World Health Organization; 2003.
“ “
DEFINING THE PROBLEM & DESIGNING A SOLUTION:PERSONAL BUT NOT COMPLEX
OGILVY PROPRIETARY CASE
STUDY
AN EVIDENCE-BASED APPROACH TO A PATIENT SUPPORT PROGRAMME: TAXONOMY OF 93 BCTs
1 Goals & planning
2 Feedback & monitoring
3 Social support
4 Shaping knowledge
5 Natural consequences
6 Comparison of behaviour
7 Associations
8 Repetition and substitution
9 Comparison of outcomes
10 Reward and threat
11 Regulation
12 Antecedents
13 Identity
14 Scheduled consequences
15 Self-belief
16 Covert learning
BCTs, behaviour change techniques.Michie S, et al. Ann Behav Med 2013;46:81–95.
KEY BCTs: GOALS & PLANNING
1 Goals & planning
1.1 Goal setting (behaviour)
1.2 Problem solving
1.3 Goal setting (outcome)
1.4 Action planning
1.5 Review behavioural goals
1.6 Discrepancy between current behaviour & goal
1.7 Review outcome goal(s)
1.8 Behavioural contract
1.9 Commitment
OGILVY PROPRIETARY
CASE STUDY
1.4 Action planning
“Prompt detailed planning of performance of the behaviour (must include at least one of context, frequency, duration and intensity). Context may be environmental (physical or social) or internal (physical, emotional or cognitive)”
BCTs, behaviour change techniques.Michie S, et al. Ann Behav Med 2013;46:81–95.
KEY BCTs: SOCIAL SUPPORT OGILVY PROPRIETARY
CASE STUDY
3 Social support
3.1 Social support (unspecified)
3.2 Social support (practical)
3.3 Social support (emotional)
3.2/3.3 Social support
“Advise on, arrange, or provide practical help/emotional support (e.g. from friends, relatives, colleagues, ‘buddies’ or staff) for performance of the behaviour”
BCTs, behaviour change techniques.Michie S, et al. Ann Behav Med 2013;46:81–95.
AN EVIDENCE-BASED APPROACH TO A PATIENT SUPPORT PROGRAMME: WHY SHOULD WE PAY ATTENTION TO AUTOMATIC THINKING?
Patient Support Programme frequently
addresses a patient’s ability to think
reflectively.
But 95% of the decisions we make every
day are said to originate from automatic
thinking and habit.
Dolan P, et al. J Econ Psychol 2012;33:264–77.
MessengerIncentivesNormsDefaultsSaliencePrimingAffect CommitmentEgo
MINDSPACE EXAMPLE: MESSENGER OGILVY PROPRIETARY
CASE STUDY
MESSENGER:We are heavily influenced by who communicates information to us
sCHE, severe chronic hand eczema.Dolan P, et al. J Econ Psychol 2012;33:264–77.
MINDSPACE EXAMPLE: NORMS OGILVY PROPRIETARY
CASE STUDY
NORMS:We are strongly influenced by what others do
“Did you know that 50% of
patients decided to …”
“2 out of every 3 patients
prefer...”
Pause & Reflect
Dolan P, et al. J Econ Psychol 2012;33:264–77.
MINDSPACE EXAMPLE: COMMITMENT OGILVY PROPRIETARY
CASE STUDY
COMMITMENT: We seek to be consistent with our public promises
Dolan P, et al. J Econ Psychol 2012;33:264–77.
RECAP: TWO TAKE-HOME MESSAGES
Intuitive, straightforward instructional model, associated with effective, outcomes-based education
Predisposing–enabling–reinforcing1
Models of behaviour and behaviour change interventions now have a much sounder scientific basis than they used to
93 BCTs: evidence-based2
BCTs, behaviour change techniques.
1. Comprehension, Observation, Motivation
2. Comprehension, Opportunity, Motivation
3. Capability, Observation, Motivation
4. Capability, Opportunity, Motivation
QUESTION #2
What are the three components of the COM-B model?
Reflection, feedback
and debriefings.
Why are these critical
components of
improving
performance?
REFLECTION, FEEDBACK AND DEBRIEFINGS: WHAT’S THE EVIDENCE?
Rafael Nadal
Image courtesy of Pexel.com.
AN EXTRA DAY’S WORK A WEEK
Organisations can improve
individual and team
performance by up to 25%
by conducting effective
team debriefings.
Tannenbaum SI, Cerasoli CP. Hum Factors 2013;55:231–45.
ONE OF THE BEST KNOWN DEBRIEFING FORMATS IS THE US ARMY’S AFTER-ACTION REVIEW
1 What was supposed to happen?
2 What actually happened?
3 Why did it happen?
4 How can we improve next time?
AAR constitutes four simple questions:
AAR, after-action review.
AAR debriefing format has been incorporated
into healthcare education and practice.1
84 neonatal intensive care units participated in
the Vermont Oxford Network Days Delivery
Room Resuscitation audit:
• Of the 84 intensive care units, the audit found
only 19% conducted post-event debriefings2
POST-EVENT DEBRIEFINGS ARE A FOUNDATIONAL BEHAVIOUR OF HIGH-PERFORMING TEAMS
AAR, after-action review.1. Sawyer TL, Deering S. Simul Healthc 2013;8:388–97.2. Edwards EM, et al. Matern Health Neonatol Perinatol 2015;1:2.
Structured reflection and feedback
Post-event debriefing is where learning
comes to consciousness.
FEEDBACK IS FUNDAMENTAL TO LEARNING, BUT FEEDBACK OPPORTUNITIES ARE OFTEN TOO SCARCE
Backwards planning, and
planning structured
reflection & feedback are
priceless. But the plans
are still useless
“ “
THANK YOU