IMPROVING EDUCATION: TOPICS, TIMES AND TANTALISING TEASERS

DR DANI BACHMANNMBBS , B.APP.SC (EXSS)

PMCWA CO-CHAIRPERSON

PERI-OPERATIVE RMO SCGH

© 2015 Royal College of Physicians and Surgeons of Canada

• Where have we gone wrong ? Have we gone wrong?

• Why are junior doctors failing to access education?

• Is there sufficient education provided by hospitals?

• What motivates attendance where these sessions are available?

• What impedes attendance?

• And importantly…. How can we attempt to resolve it

• Understand motivations of JMOs to attend education

• Ascertain the preferred structure of educational sessions

• Identify optimal timing

• Unearth the major limitations to attendance

• Brainstorm solutions to counteract identified limits

• Survey of 16 targeted questions and two free text options• Employment Hx: PEHS, site, PGY level• Perceived educational availability• Personal motivators, stimulators,

barriers and preferences

• Distributed by PMCWA via PGME depts.

to prevocational trainees • Interns, Residents and Service Registrars• Across WA, incl WACHS

• Each PGME was given the opportunity to

substantiate educational opportunities

• What opportunities existed?

• Availability of sessions per week?

• Average attendance as a percentage of

the cohort?

HOSPITAL What educational opportunities are offered at

your site?

How many teaching sessions

are available per week?

On average, what portion of your

employed junior workforce are able to

attend teaching sessions?

Osborne

Park

Usually we have close to 100%

attendance from our JMO’s. They all

receive a page 30 minutes before to

remind them, and the Consultants

regularly attend so they are very

supportive of their JMO’s leaving the

Ward to attend the educational

sessions.

Joondalup

Health

Campus

We have started offering train the trainer courses

with our Training and Development department

2 Post Grad and many for

each department – please

see example of weekly

education calendar

70%+

Princess

Margaret

Hospital

RMO Protected Teaching Session (Weekly);

Senior RMO Teaching Session (6 per year); Step-

Up Course (Annual); Accidental Counsellor

(Annual); Inter-Professional SIM Sessions (10-12

per year); Grand Rounds (Weekly); Clinical

Paediatric Conferences (Weekly); Departmental

Teaching (As required); Seminars on Research

Methodology; FRACP Teaching.

RMO Protected Teaching

Sessions (1 ¼ hours every

Wednesday); Grand Rounds

(Every Thursday); Clinical

Paediatric Conferences

(Every Tuesday);

Departmental Teaching

(Weekly); Others as required.

Very difficult to give a figure but on a

whole all JMOs are/should be able to

attend teaching sessions. RMO

Teaching Sessions are protected.

Hollywood

Private

Hospital

Weekly – Specialist led Cardiology (1hr protected

session)

Weekly – Specialist led General Teaching (1hr

protected session).

Fortnightly – Specialist led Surgical Teaching

(interns only)

Monthly – Specialist led Psychiatry Teaching

All Registrars/RMOs/interns are invited

to attend these sessions (with the

exception of surgical teaching which is

for interns only). The majority of RMOs

and interns are able to attend these

planned teaching sessions

Fiona

Stanley

Hospital

Intern tutorial, weekly, 1hr

RMO tutorial, weekly, 1hr

Hospital grand round, weekly, 1hr

Perioperative tutorial series, weekly, 1hr (terms 1-

3)

Hospital Out of Hours Training, weekly, 2hrs

Turbo Hospital Out of Hours Training, monthly,

2hrs

Skills workshops – cardioversion, lumbar

puncture, airway management

Prescribing workshops – insulin and pain and

analgesia

RMO to Registrar step-up, twice yearly, two days

ALS-2, quarterly, two days

SimStart, twice yearly, three days

Mentoring workshop (for RMOs being mentors of

Interns), annually, 2hrs

As per previous question – I

have listed if weekly or not

Intern teaching is upwards of 80%.

However RMO teaching and grand

rounds is more like 15%

Sir Charles

Gairdner

Grand rounds, intern teaching, skills workshops,

medical and surgical lectures, simulation

workshops, clinical signs round, renal and

immunology teaching open to all, teaching on the

run workshops, RMO to Reg transition workshop,

ALS and MET workshops, CVC course

At least one a day

Depending on the sessions but an

average of 30 for the grand rounds, 50

for intern teaching, 20 for the medical

lectures and smaller numbers for the

skills and other workshops.

Armadale

Health

Service

See attached overview of Edu and Training at

ABTC. Terms also might have additional

Departmental teaching eg Paeds Radiology

fortnightly

Multiple, generally x2 – 3

teaching sessions per week

per JMO term are available.

Nearly 100% attendance at Intern VC,

ED JMO tutes and Gen Med

Departmental teaching when JMO’s are

rostered on. Other activities optional.

Skills workshops x6 per workshop. In

addition we try and roster all JMO’s to a

1 day RRAID course during their first or

second term here.

Fremantle

Hospital

Intern tutorial, weekly, 1hr, VC from FSH,

RMO tutorial, weekly, 1hr, VC from FSH ,

Hospital grand round, weekly, 1hr

Perioperative tutorial , 1 x per term , 1hr

Preoperative clinic x 1 per term , I hr

Sim (The deteriorating patient scenarios,

Alternate weeks, (4 JMOs rostered to attend each

fortnight)

There is also department teaching , these are not

organised by MEU

As previous question – I have

listed if weekly or not

Intern teaching is upwards of 95%. RMO

teaching 60%

Grand Round no states kept, this is a

multidisciplinary team education

Geraldton

Hospital

We like to do radiology teaching at 4 pm on tues,

didactic session at 4:30 tues, sim session on

thurs every week, focused lectures on thurs 2 pm.

Our junior rmo attendance is generally

100%. They seem to enjoy them.

Adobe Acrobat Document

C:\Users\he117108\Desktop\

JHC 31.10.2016.docx

Adobe Acrobat Document

C:\Users\he117108\Desktop\Postgrad Med Ed Calendar ABTC Nov 2016.docx

Adobe Acrobat Document

Sites• Secondary/Peripheral

vs Tertiary• Protected vs Non

Departments• General

Medicine• Emergency

Leadership• Seniority• Teams

Residents 55%

Interns30%

Service Registrar8%

Training Registrars

7%

Residents Interns Service Registrar Training Registrars

13.9

49.4

34.2

2.5

0

10

20

30

40

50

60

Daily Few per Week Weekly None

% identifi

ed a

s available

Perceived availability of sessions

97.9

87.9

83.7

81.7

70.2

66.3

57.5

0 20 40 60 80 100 120

Topic

Presenter

Senior/Team Involvement

Structure

Friends/Jnr Colleagues

Food/Beverage

CPD Points

0

10

20

30

40

50

60

70

Lecture Grand Round Teaching on the Run Simulation Procedural

Highly beneficial 18.8 14.9 44.8 55.8 60

Beneficial 68.2 50.7 44.2 35.7 36

Neutral 7.8 27.3 7.1 6.5 4

Minimally Beneficial 4.6 5.8 3.2 1.3 0

Not beneficial 0.6 1.3 0.7 0.7 0

% A

ppro

val

• Prior Knowledge of Topic

• Material distribution ?

• Interactivity

• Case based discussions

• Quizzes

• Lecturer

35.6

27.6

21

8.86.8

2

28.2

35.5

20.4

3.3

12.5

0

5

10

15

20

25

30

35

40

Lunch (12:00 -13:00)

Pre-Work (7:15 -8:00)

Afternoon (15:00) Post AM WR Post Work(17:30)

Weekends

Ideal

Realistic

Clinical Volume• Ben Hurr

AdministrativeTasks

• ABF, Training, streamlining and productivity

Support

• Senior awareness , assistance

• Registrar cover

• Ward cover

Paging• Appropriately graduated escalation by allied/nursing staff

• Hold vs divert vs Format

EducationalMaterial

Catering• Proximity to hospital cafes

• Provision of food / tea / coffee

Forgetfulness• Reminders to BasePage, CNM/CNC

• SMS notifications

….

• Topics• Procedural• MET, Common A/H Calls, Sims• Life Skills – communication, medico-legal, welfare, up-management, conflict

resolution, EOL discussions• Clinical topics (exact details can be provided)

• Times• Morning is least disruptive and therefore may be most well attended,

particularly if incorporated into rostered hours

• And Tantalising Teasers to stimulate change …

REFERENCES

• CANMEDS 2015 PHYSICIAN COMPETENCY FRAMEWORK. THE ROYAL COLLEGE OF PHYSICIANS AND

SURGEONS OF CANADA 2015.

• DEPARTMENT OF POST GRADUATE MEDICAL EDUCATION, MEDICAL EDUCATION OFFICERS

• ARMADALE KELMSCOTT HOSPITAL

• FREMANTLE HOSPITAL

• FIONA STANLEY HOSPITAL

• GERALDTON REGIONAL HOSPITAL

• HOLLYWOOD PRIVATE HOSPITAL

• JOONDALUP HEALTH CAMPUS

• OSBOURNE PARK HOSPITAL

• SIR CHARLES GAIRDNER HOSPITAL

1. Common calls/ METs – sims +++2. Life skills

o time management o dealing with bosseso Medicolegalo Team/Communication issueso Doctors welfareo Training programmes, pros and conso Surviving A/H and NDo Clinical Incident management

3. Cardiology o cases o ECGo Chest paino Arrythmia Mx

4. Diabetes – prescriptions 5. Radiology6. Psych emergencies and Code Black / Agitation Drugs7. End of life care 8. Anticoag9. AB choices10. NIV use and settings11. Pain management12. Hameatology13. Immunology14. Understanding Acid-Base15. Appreciation of beds, hospital management and flow