Download - 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.

Practice Based Learning and Improvement

Practice Based Learning and Improvement

What Can I Do Tomorrow?

Hershey S. Bell, MD, FAAFPWhat Can I Do Tomorrow?

Hershey S. Bell, MD, FAAFP

OverviewOverview

• 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

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.

• 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



• 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



Making the Competencies KnownMaking the Competencies Known

• Posters

• Pocket guides

• Web sites

• All forms

• Philosophical integration into daily teaching

Identify Faculty Development IssuesIdentify Faculty Development Issues

• Faculty knowledge base issues

• Faculty as role models for competencies

• Incorporating this new accountability into teaching

Develop Teaching StrategiesDevelop Teaching Strategies

• Play Book Strategy– Readings– Discussion– Cases

• Stand Alone Teaching Strategies

• Integrated Teaching Strategies

• 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 professionalsFacilitate the learning of students and other health care professionals

Formative EvaluationFormative Evaluation

TaskTask

• Write A Poem– 4 lines– at least one word per line– can rhyme or not– topic can be anything you’d like it to be

PresentationPresentation

• 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

Alternative PlanAlternative 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

Formative EvaluationFormative 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

• 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 professionalsFacilitate the learning of students and other health care professionals

ACGME ToolboxACGME 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

Summative EvaluationSummative Evaluation

• Learner Accountability: on behalf of competency attainment– Gap Analysis Format– Reflective Practice/Analytic Approach

• JoHari Cycle

The Johari Cycle*The Johari Cycle*

Feedback

Revelation and Disclosure

*Bell

Summative EvaluationSummative 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

Case Discussion QuestionsCase 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?

Discussion Case PBL&I 1Discussion 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.


• 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.


• 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 nation’s largest cities. Your residency resides in a suburban community hospital outside of a wealthy southern city.


• 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.


• 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.

• 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.
