The Why, What and How of ICE-Integrated Community Experiences

We have no conflicts of interest to declare

• Frances Kilbertus• Sarah Newbery• Sheila Renton• Cheri Bethune • ICE 108/110 sub committee (Nicole Bessette, Luke Wu)

Learning Objectives

1. Describe strategies to create an effective clinical learning environment for ICE 108/110.

2. Demonstrate “assessment for learning skills” and their role in fostering student progress in ICE placements.

3. Compare and share different educational approaches in early clinical experience in ICE placements.

Workshop Outline

• Introductions – who are you and why are you here?• Background to ICE curricular changes• WHY• WHAT• HOW• “Phoenix” activity • Best practices • Consolidation of concepts and next steps

Why did we do this anyway?• Because we were asked: ICE 108/110 as foundational

NOSM experience, opportunity for transformational learning that had not been changed in over 10 years

• To address the challenge of inconsistent quality of ICE 108/110 placements

• To define clear and appropriate learning objectives for the placements

• To address learners’ concerns around clerkship preparedness

• To address NOSM’s concerns with poor LMCC results• To address preceptor concerns about scheduling problems

during ICE 108/110

What did we do?

• Set up the matrix: aligning learning objectives with teaching and learning activities and assessment tools

• Use reflection as an important underlying strategy: a process for understanding, integrating and deepening learning, and explore evolving professional identity

• Create a workbook tool to plan, monitor and integrate activities and learner progress

• Set up a program of evaluation for ICE 108/110• Base the revision of ICE 108/110 on strong theoretical foundations

Week and Theme Intended Learning outcomes Suggested Teaching and Learning Activities

Week # and Focus Intended Learning Outcomes Suggested Teaching and Learning Activities

1.Patient‐doctor relationship 1. Describe essential concepts of an effective doctor‐patient interview

2. Apply interviewing skills with patients

1. Observe a patient interview

2. Discuss the interview

3. Retell and write the patient’s story

4. Conduct a directly observed history portion of a patient encounter

5. Conduct a mental health exam

6. Attendance at community learning session (CLS)

2. Patient centered clinical method

1. Demonstrate patient centred clinical assessment of patients in various primary care rural contexts. 

2. Use the SOAP format to synthesize and provide written documentation of patient encounters

3. Show an appreciation of the impact of illness on patients.

4. Relate to patients and their families and demonstrate empathy

5. Establish confidence in patient and family interactions:  meeting, interviewing and examining patients 

1. Participation in clinical care with preceptors and interprofessionalproviders in multiple settings

2. Conduct a complete patient interview

3. Synthesize interview into SOAP written format

4. Patient case presentations to preceptor/team

5. Attendance at community learning session (CLS)

Week and Theme Intended Learning outcomes Suggested Teaching and Learning Activities

Week # and Focus Intended Learning Outcomes Suggested Teaching and Learning Activities

3. Resource to a patient 1. Explain how living conditions and access to health care services affects the health of patients.

2. Describe the ethical dimensions of patient care.

3. Describe a specific   determinant of health for this community (e.g.: poverty) and how to explore it in the clinical setting.

1. Case presentation using ethical framework from ‘Doing Right’

2. Patient interview with focus on identified learning issue, critical synthesis of information and translation to patient situation

3. Employ a strategy in the clinical setting to assess the impact of a determinant of health (e.g.: poverty tool)

4. Attendance at community learning session (CLS)

4. Community –healthcare relationship

1. Explore teamwork in healthcare with a focus on how communication happens and how language is used in different professions

2. Explain and demonstrate the practical relevance of the theory and skills learned in the curriculum to date 

3. Summarise the advantages and challenges of rural practice in the ICE placement community  the impact on how you see yourself as a physician

1. Participate in an interprofessional team in a rural primary care setting  

2. Participate in an interprofessional discussion about care of a patient 

3. Formal and informal interaction with interprofessional clinical team

4. Identify strategies to manage personal and professional relationships within the community

5. Attendance at community learning session (CLS)

What guiding educational principles?

• Adult learning: life experiences need to know• Experiential learning (authentic experience)• Self-directed learning and self-regulation (goals and

plans)• Assessment as learning (self and preceptor)• Guided self assessment, lifelong learning• Reflective learning

How will this be achieved?• Faculty development and engagement with underlying concepts• Creating safe learning environments in the ICE communities • Including learners in the ‘community of practice’ • Providing learning opportunities and tasks appropriate for the

individual learners aligned with learning objectives• Assessment for learning, of learning, as learning • Reflection as a strategy to model and mentor• Workbook as an organizational tool• Undertaking program evaluation, including learner and preceptor

feedback, clerkship performance, LMCC results

Questions?

© NL Dept. Tourism

And now, an activity

• Reflection as a tool for learning and change

• Appreciative inquiry as a tool to build on what works

Reflection…a simple tool…

• What?

• So What?

• Now What?

Appreciative inquiry

• Appreciative Inquiry is a way of being and seeing. It is both a worldview and a process for facilitating positive change in human systems, e.g., organizations, groups, and communities. Its assumption is simple:

Every human system has something that works right–things that give it life when it is vital, effective, and successful. AI begins by identifying this positive core

and connecting to it in ways that heighten energy, sharpen vision, and inspire action for change.

Reflection… a simple tool…

• What? – What went well? What worked for you, your learner, your community?

- think about the whole experience- think about the workbook and structured exercises

• So what?– Why does that matter? – What does that mean for you and your colleagues? Your community?

• Now what?– Tangibly, what will you do to build on that success? – What specifically can you do to have more of that good stuff in the next placement

experience?

Using those questions for reflection….

• Spend 3-4 minutes reflecting on your own about those questions • Spend 5-6 minutes sharing with a partner

– Your job when sharing your thoughts is to be as clear and specific as possible

– Your job when listening is to ask clarifying questions, and help to identify and think through barriers to implementation in order to better support future success

Then we’ll share your partnered conversations – 1-2 minutes each to share back with the larger group.

Reflect on…

• What? – What went well? What worked for you, your learner, your community?

- think about the whole experience- think about the workbook and structured exercises

• So what?– Why does that matter? – What does that mean for you and your colleagues? Your community?

• Now what?– Tangibly, what will you do to build on that success? – What specifically can you do to have more of that good stuff in the next placement

experience?

Best practices

• How can we take some of the examples shared here back to our own context and community of practice?

• (learning plan for our teaching community)

Our action plan

• Your reflections will be noted and can be shared back to you as a group to support you in a ‘community of practice’

• ICE committee will bring back your ideas to help inform future work.

Learning objectives: Review

1. Describe strategies to create an effective clinical learning environment for ICE 108/110.

2. Demonstrate “assessment for learning skills” and their role in fostering student progress in ICE placements.

3. Compare and share different educational approaches in early clinical experience in ICE placements.

Consolidation and Next steps

Key references • Taylor D, Hamdy H. Adult Learning Theories: Implications for learning and teaching in medical education: AMEE Guide No.

83, 2013 Medical Teacher; 35:e1561-e1572.• Yardley S, Teunissen P, Dornan T. Experiential Learning: AMEE Guide No.63, 2012 Medical Teacher; 34:e102-e115. • Dornan T et al. How can experience in clinical and community settings contribute to early medical education? A BEME

systematic review. 2006 Medical Teacher; 28:3-18.• Strasser R. Learning in Context: education for remote rural health care. 2016 Rural and Remote Health 16:4033. • Maley M, Lockyer-Stevens V, Playford D. Growing rural doctors as teachers: A rural community of medical education

practice. 2010 Medical Teacher; 32:983-989.• Van Schalkwyk S, Bezuidenhout J, deVilliers, M. Understanding rural clinical learning spaces: Being and becoming a

doctor: 2014 Medical Teacher:1-6.• Cruess R, Cruess S, Steinert Y. Medicine as a community of practice: Implications for Medical education. 2018 Academic

Medicine; 93(2):185-191.• Sturmberg J, Farmer L. Educating capable doctors- A portfolio approach. Linking learning and assessment. 2009 Medical

Teacher; 31:e85-89.• Ertmer P, Newby T. The expert learner: Strategic, self-regulated, and reflective. 1996 Instructional Science; 24:1-24.• Haji F, Morin MP, Parker K. Rethinking programme evaluation in health professions education: beyond ‘did it work?’. 2013

Medical Education 47: 342-351. • Mayer R. Applying the science of learning to medical education. 2010 Medical Education; 44:543-549.• Driessen E, van Tartwijk J, Dornan T. The self critical doctor: Helping students become more reflective. 2008 BMJ;336:827-

830

Thank you!

Northern Constellations Workshop 108/110 Reference list Draft

1. Taylor D, Hamdy H Adult Learning Theories: Implications for learning and teaching in medical education: AMEE Guide No. 83, 2013 Medical Teacher; 35:e1561‐e1572.

2. Yardley S, Teunissen P, Dornan T Experiential Learning: AMEE Guide No.63, 2012 Medical Teacher; 34:e102‐e115. 

3. Dornan T et al How can experience in clinical and community settings contribute to early medical education? A BEME systematic review. 2006 Medical Teacher; 28:3‐18.

4. Strasser R Learning in Context: education for remote rural health care. 2016 Rural and Remote Health 16:4033. 

5. Maley M, Lockyer‐Stevens V, Playford D. Growing rural doctors as teachers: A rural community of medical education practice. 2010 Medical Teacher; 32:983‐989.

6. Van Schalkwyk S, Bezuidenhout J, deVilliers, M Understandiong rural clinical learning spaces: Being and becoming a doctor: 2014 Medical Teacher:1‐6.

7. Cruess R, Cruess S, Steinert Y Medicine as a community of practice: Implications for Medical education. 2018 Academic Medicine; 93(2):185‐191.

8. Sturmberg J, Farmer L. Educating capable doctors‐ A portfolio approach. Linking learning and assessment. 2009 Medical Teacher; 31:e85‐89.

9. Ertmer P, Newby T The expert learner:  Strategic, self‐regulated, and reflective. 1996 Instructional Science; 24:1‐24.

10. Haji F, Morin MP, Parker K. Rethinking programme evaluation in health professions education:beyond ‘did it work?’. 2013 Medical Education 47: 342‐351. 

Northern Constellations Workshop 108/110 Reference list Draft

1. Taylor D, Hamdy H Adult Learning Theories: Implications for learning and teaching in medical education: AMEE Guide No. 83, 2013 Medical Teacher; 35:e1561‐e1572.

2. Yardley S, Teunissen P, Dornan T Experiential Learning: AMEE Guide No.63, 2012 Medical Teacher; 34:e102‐e115. 

3. Dornan T et al How can experience in clinical and community settings contribute to early medical education? A BEME systematic review. 2006 Medical Teacher; 28:3‐18.

4. Strasser R Learning in Context: education for remote rural health care. 2016 Rural and Remote Health 16:4033. 

5. Maley M, Lockyer‐Stevens V, Playford D. Growing rural doctors as teachers: A rural community of medical education practice. 2010 Medical Teacher; 32:983‐989.

6. Van Schalkwyk S, Bezuidenhout J, deVilliers, M Understandiong rural clinical learning spaces: Being and becoming a doctor: 2014 Medical Teacher:1‐6.

7. Cruess R, Cruess S, Steinert Y Medicine as a community of practice: Implications for Medical education. 2018 Academic Medicine; 93(2):185‐191.

8. Sturmberg J, Farmer L. Educating capable doctors‐ A portfolio approach. Linking learning and assessment. 2009 Medical Teacher; 31:e85‐89.

9. Ertmer P, Newby T The expert learner:  Strategic, self‐regulated, and reflective. 1996 Instructional Science; 24:1‐24.

10. Haji F, Morin MP, Parker K. Rethinking programme evaluation in health professions education:beyond ‘did it work?’. 2013 Medical Education 47: 342‐351.