Practice Based Learning and Improvement What Can I Do Tomorrow? Hershey S. Bell, MD, FAAFP What Can...

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Practice Based Learning and Improvement What Can I Do Tomorrow? Hershey S. Bell, MD, FAAFP What Can I Do Tomorrow? Hershey S. Bell, MD, FAAFP Slide 2 Overview What Can I Do Tomorrow? Make the Competencies Known to All Begin Identifying Faculty Development Issues Develop Teaching Strategies Develop a Formative Evaluation System Revise Summative Evaluation Slide 3 Practice-Based Learning and Improvement Residents must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices. Slide 4 Residents are expected to: analyze practice experience and perform practice- based improvement activities using a systematic methodology locate, appraise, and assimilate evidence from scientific studies related to their patients health problems obtain and use information about their own population of patients and the larger population from which their patients are drawn Practice-Based Learning and Improvement Slide 5 Residents are expected to: apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness use information technology to manage information, access on-line medical information; and support their own education facilitate the learning of students and other health care professionals Practice-Based Learning and Improvement Slide 6 Making the Competencies Known Posters Pocket guides Web sites All forms Philosophical integration into daily teaching Slide 7 Identify Faculty Development Issues Faculty knowledge base issues Faculty as role models for competencies Incorporating this new accountability into teaching Slide 8 Develop Teaching Strategies Play Book Strategy Readings Discussion Cases Stand Alone Teaching Strategies Integrated Teaching Strategies Slide 9 Who, what, when, where, why? Residents as teachers: a guide to educational practice. Second edition. Schwenk, Thomas L, Whitman, Neal. Salt Lake City: University of Utah School of Medicine, 1993. Facilitate the learning of students and other health care professionals Slide 10 Formative Evaluation Slide 11 Task Write A Poem 4 lines at least one word per line can rhyme or not topic can be anything youd like it to be Slide 12 Presentation Come to the front of the room Read your poem out loud I will then comment on the quality of your poem as openly, honestly and completely as I am able Slide 13 Alternative Plan Come to the front of the room Read your poem out loud I will provide a review of the criteria against which the poem was to be written You will assess the degree to which your poem met the criteria As an option, if you would like, you can comment on your sense of the quality of the poem Slide 14 Formative Evaluation Feedback objective, timely, behavior specific, situation appropriate, comments on alterable behavior Direction where is the learner relative to competency specific to this outcome? Encouragement Slide 15 Slide 16 You observe a senior resident working with a rising senior resident in the latter half of her second year. The senior resident is providing step by step direction relative to the admission of a heart failure patient to the teaching service. The interaction is one-way: senior to rising senior. What is the feedback? What is the direction? How is encouragement utilized? Facilitate the learning of students and other health care professionals Slide 17 ACGME Toolbox 360 Degree Chart Stimulated Recall Checklist Global Rating OSCE Standardized Patient Exam Written Exam (MCQ) Procedure, Operative or Case Logs Patient Surveys Portfolios Record Review Simulations/Models Standardized Oral Exam Slide 18 Summative Evaluation Learner Accountability: on behalf of competency attainment Gap Analysis Format Reflective Practice/Analytic Approach JoHari Cycle Slide 19 The Johari Cycle* Feedback Revelation and Disclosure *Bell Slide 20 Summative Evaluation Learner Accountability: on behalf of competency attainment Gap Analysis Format Reflective Practice/Analytic Approach JoHari Cycle Teacher Accountability: on behalf of a covenant with society Evaluation Forms Promotion, Graduation and Reference Letters Slide 21 Case Discussion Questions What is competency in this situation? How can it be taught? How is it best assessed? What are the formative evaluation issues? What are the summative evaluation issues? What further education can be provided once competency is achieved? Slide 22 Discussion Case PBL&I 1 Practice Based Improvement A resident expresses frustration over the number of patients with depression that he has seen who have not responded well to treatment. His question today revolves around either switching medications or increasing the dose of the current medication for one particular patient. Slide 23 Discussion Case PBL&I 2 Evidence A resident would like to discuss whether or not starting HRT on her 45 year-old, symptomatic patient is appropriate given the recent concerns about cancer risk. Slide 24 Discussion Case PBL&I 3 Population As part of orientation in your residency program, you ask residents about their medical school experience. One resident describes, with great passion, the excitement of training in a high-powered, tertiary care medical school environment in the center of one of the nations largest cities. Your residency resides in a suburban community hospital outside of a wealthy southern city. Slide 25 Discussion Case PBL&I 4 Appraisal of Clinical Studies As part of your curriculum, residents are expected to present grand rounds on a current topic of interest to family physicians. You serve as advisor to a resident doing a review of the latest approaches to the diagnosis and treatment of acute coronary syndromes. Slide 26 Discussion Case PBL&I 5 Information Technology During an advisory session with a resident you learn that in terms of organizational skills, this resident has a difficult time keeping track of, and following up with, lab tests and radiology results. Health maintenance audits also reveal a lack of attention to routine scheduled testing and assessment. Slide 27 Facilitate Learning Senior residents in your program are required to teach medical students and residents at junior levels. You decide to create a Resident as Teacher course to provide knowledge, skills and attitudes for rising senior residents. Discussion Case PBL&I 6