Embed Size (px)
Citation preview
Medical Education Planning & Development
Nancy Davis, PhD
Associate Professor, Family & Community Medicine Assistant Dean, Faculty Development
Ruth Weber, MD, MSEd Associate Program Director
Wesley Family Medicine Residency Program
University of Kansas School of Medicine-Wichita
Disclosures
Neither Dr Davis nor Dr Weber have any financial affiliations to disclose
Objectives • Develop effective educational activities
based on adult learning principles that are appropriate for learner level
• Create specific, measureable, achievable, realistic and time-based learning objectives centered on learner needs
• Evaluate educational activities to assess effectiveness based on stated objectives
Your Needs--Introductions What are your challenges in developing new educational activities (or revising existing ones)?
LEARNER CENTERED EDUCATION
Learner Needs Assessment • Perceived needs
– Individuals preferences – Practice attributes
• Actual needs – Practice/systems data – Observation/feedback – Regulation/mandates
Dreyfus Model: Novice Expert
Dreyfus and Dreyfus, 1982
Methods for Stage of Learner Pathman/PRECEDE Examples
Stage/Method Awareness Agreement Adoption Adherence
Predisposing Lecture Grand rounds
Enabling Champions Clinical precepting Problem-based small group
Clinical precepting Simulation
Reinforcing Role-play Feedback in practice
Reminders Audit/Feedback
Davis DA, et al. The case for knowledge translation: shortening the journey from evidence to effect. BMJ 2003;327:33
DEFINING COMPETENCE
Competency is defined as the observable behavior that combines knowledge, skills, values, and attitudes related to a specific activity
Medical Knowledge Patient Care Interpersonal Communication Professionalism Systems-based Practice Practice-based Learning and Improvement
ACGME Core Competencies
Family Medicine Competencies • Disease prevention and health
promotion • Critical thinking skills in patient
care • Patient safety • Advocating for individual and
community health • Coordination of team based care
EDUCATIONAL DEVELOPMENT
Educational Development Cycle 1. Problem
Identification & Needs
Assessment
2. Goals & Objectives
3. Educational Strategies
4. Implementation
5. Evaluation & Feedback
LEARNING OBJECTIVES
Your Overarching Goals and Objectives
Program (activity) goal/aim What do you hope to accomplish? Program Objectives Specific outcomes
Goals/Objectives: SMART
case studies projects
exercises projects critiques
problems simulations case studies appraisals
creative exercises problems develop plans EVALUATION exercises constructs appraise
case studies simulations assess exercises critical incidents choose practice discussion SYNTHESIS estimate
demonstrations questions arrange evaluate questions projects test collect judge discussion sketches compose measure
review simulations ANALYSIS construct rate test role play analyze create revise
assessment microteach calculate design score reports compare formulate select
lecture learner APPLICATION contrast organize value visuals presentations apply criticize manage
video writing demonstrate debate plan audio dramatize diagram prepare
examples COMPREHENSION employ differentiate propose illustrations describe illustrate distinguish set up analogies discuss interpret experiment
Cognitive Processing Dimension
explain operate inspect → KNOWLEDGE express practice inventory define Identify perform question
list recognize schedule relate record restate shop test
Learning Objectives
repeat translate sketch use
Adapted from: Bloom, B.S. (Ed.), Engelhart, M.D., Furst, E.J., Hill, W.H., & Krathwohl, D.R. (1956). Taxonomy of educational objectives: The classification of educational goals. Handbook 1: Cognitive domain. New York: David McKay. Ellen F. Goldman, EdD 11-1-2010
Interface of Learning Objectives and Teaching Strategies
Cognitive Level Action Verbs Behavioral Learning Objective Example Teaching Strategies Examples Assessment Strategies
Knowledge Learners will “know” something new
Define Describe List Record Repeat
Learners will be able to list the five risk factors of MI
Lecture Video Audio
Written exams Oral exams Pre/Post
Comprehension Learner will be able to “convey” their new knowledge.
Discuss Explain Express Identify Recognize Restate Translate
Learners will be able to explain the Krebs Cycle Question Discussion Learner presentations Writing
Written exams Oral exams Pre/Post Learner presentations Writing critique
Analysis Learners will be able to “analyze and interpret” new information
Analyze Calculate Compare Contrast Criticize Diagram Differentiate Distinguish Experiment Question
Learners will be able to analyze a fishbone diagram for cause and effect of a problem
Problems Exercises Case Studies Critical incident analysis Discussion
Assessment of: Problems Exercises Case Studies Critical incident analysis Root Cause Analysis
Evaluation Learners will be able to “evaluate” situations or concepts based on what they’ve learned
Appraise Assess Choose Estimate Evaluate Measure Revise Score Select Value
Learners will be able to evaluate best treatment plan based on efficacy and cost
Case Studies Projects Exercises Critiques Simulations Appraisals
Assessment of: Case Studies Projects Exercises Critiques Simulations Appraisals
Assessment Based on Objectives
1. Create a stem… – After completing the lesson, the learner will be able to . . . – After this unit, the learner will have . . . – By completing the activities, the learner will . . . – At the conclusion of the course/unit/study the learner will .
.
2. Add an action verb – Use verbs from Bloom’s taxonomy list – Determine the actual product, process, or outcome.
Writing Educational Objectives
http://www.educationoasis.com/curriculum/LP/LP_resources/lesson_objectives.htm
Goal/Aim: 25% of all Family Medicine residents will complete a longitudinal QI project over the next academic year.
AVOID CHOOSE
• Vague verbs Explain, describe, discuss “Know how to …”
• General terms Be as specific as possible
Example of Program/Activity Objective
Examples of Learner Objectives Not so good: The resident will understand quality improvement methodology and the relevance to their future careers in medicine. BETTER:
After completing the year-long curriculum, each resident will be able to:
• Define steps of a PDSA cycle (knowledge) • Explain the importance of quality improvement in medicine
(comprehension) • Perform a RCA (application) • Diagram a process map (analysis) • Design a QI project (synthesize) • Evaluate performance data (evaluation)
Another Good Example After completion of this course the learner will be able to: define Root Cause Analysis (RCA); recognize which clinical situations require RCA; explain why RCA is important; demonstrate mutual respect on interprofessional teams; and have performed an interprofessional mock RCA.
*What is the highest level of cognitive processing this faculty expects her learners to achieve?
Your Project
Develop SMART Objectives for: -Your activity -Your learners
EDUCATIONAL STRATEGIES
case studies projects
exercises projects critiques
problems simulations case studies appraisals
creative exercises problems develop plans EVALUATION exercises constructs appraise
case studies simulations assess exercises critical incidents choose practice discussion SYNTHESIS estimate
demonstrations questions arrange evaluate questions projects test collect judge discussion sketches compose measure
review simulations ANALYSIS construct rate test role play analyze create revise
assessment microteach calculate design score reports compare formulate select
lecture learner APPLICATION contrast organize value visuals presentations apply criticize manage
video writing demonstrate debate plan audio dramatize diagram prepare
examples COMPREHENSION employ differentiate propose illustrations describe illustrate distinguish set up analogies discuss interpret experiment
Cognitive Processing Dimension
explain operate inspect → KNOWLEDGE express practice inventory define Identify perform question
list recognize schedule relate record restate shop test
Learning Objectives
repeat translate sketch use
Adapted from: Bloom, B.S. (Ed.), Engelhart, M.D., Furst, E.J., Hill, W.H., & Krathwohl, D.R. (1956). Taxonomy of educational objectives: The classification of educational goals. Handbook 1: Cognitive domain. New York: David McKay. Ellen F. Goldman, EdD 11-1-2010
Interface of Learning Objectives and Teaching Strategies
Educational Strategies • Content ---Flows from learning objectives
– Schedule of events – Written material – Resources for additional learning
• Educational Methods – Cognitive, affective, psychomotor – Use multiple educational methods – Feasible with available resources
Cognitive Objectives
• Readings • Lecture • Discussion • Technology based materials • Problem based learning
Affective Objectives
• Targeted Reading • Exposure • Facilitation of openness, introspection and
reflection • Role models
Psychomotor Objectives
• Supervised clinical experience • Simulations • Role-plays
Learner Centeredness
• Formal/informal assessment of learner needs
• Tailoring of content/methods to meet learners’ needs – Modify /add to curriculum – What objectives are critical, desirable but not
critical, feasible
Special Considerations Practice-Based Learning and Improvement
• Locates, appraises and assimilates evidence from scientific studies related to patients health problems
• Demonstrates self-directed learning • Improves systems in which the physician
provides care Methods: Independent learning projects Individual learning plans Self assessment/chart audits
Special Considerations Systems-Based Practice and Teamwork
• Provides cost-conscious medical care • Emphasizes patient safety • Advocates for individual and community health • Coordinates team based care
Methods: • inclusive health care teams • feedback on cost of care • work in disease management programs • participate in QI and safety teams
Special Considerations Professionalism
• Demonstrates professional conduct and accountability
• Demonstrates humanism and cultural proficiency
Methods: • Role modeling • Facilitated reflection/discussion of experiences
embodying professionalism • Peer evaluations • Honor Council
Your project…..
Look at your objectives….. What educational methods will be most effective and feasible? What resources are available? What time is involved? Will your curriculum involve PBLI, SBP and/or professionalism?
LEARNER ASSESSMENT & FEEDBACK
Feedback • Individual Learner
– Formative • Improve performance
– Summative • Grades/promotion
• Curriculum/Program – Formative
• Improve effectiveness – Summative
• Resources, External requirements, Promotion, Publication
Cognitive Level Action Verbs Behavioral Learning Objective Example Teaching Strategies Examples Assessment Strategies
Knowledge Learners will “know” something new
Define Describe List Record Repeat
Learners will be able to list the five risk factors of MI
Lecture Video Audio
Written exams Oral exams Pre/Post
Comprehension Learner will be able to “convey” their new knowledge.
Discuss Explain Express Identify Recognize Restate Translate
Learners will be able to explain the Krebs Cycle Question Discussion Learner presentations Writing
Written exams Oral exams Pre/Post Learner presentations Writing critique
Analysis Learners will be able to “analyze and interpret” new information
Analyze Calculate Compare Contrast Criticize Diagram Differentiate Distinguish Experiment Question
Learners will be able to analyze a fishbone diagram for cause and effect of a problem
Problems Exercises Case Studies Critical incident analysis Discussion
Assessment of: Problems Exercises Case Studies Critical incident analysis Root Cause Analysis
Evaluation Learners will be able to “evaluate” situations or concepts based on what they’ve learned
Appraise Assess Choose Estimate Evaluate Measure Revise Score Select Value
Learners will be able to evaluate best treatment plan based on efficacy and cost
Case Studies Projects Exercises Critiques Simulations Appraisals
Assessment of: Case Studies Projects Exercises Critiques Simulations Appraisals
Assessment Based on Objectives
One Minute Preceptor Microskill Strategies
1 Assess prior knowledge Assess learner knowledge/experience Establish goals for encounter
2 Get a commitment “What” questions: what is going on? What would you like to do?
3 Probe for evidence Encourage learner to think out loud Why do you think that’s so?
4 Give positive feedback Reinforce what was done right Use specific, behavioral examples
5 Identify and correct mistakes Specific and focused: “That drug is often a good choice, but not with renal failure.”
6 Teach the general rule Chose a rule at learner’s level Consider competencies other than “knowledge” eg, communication, professionalism
7 Encourage reflection and promote self directed learning
“What do you feel you did well?” “What do you need to study?”
Irby DM. The One-Minute Preceptor. First presented at the annual Society of Teachers of Family Medicine Predoctoral meeting. Orlando FL Feb 1997
Assessment in Clinical Settings Method Strengths Weaknesses
Standardized Patients Control of the case Standardized Formative or summative Less threatening environment
Cost Faculty development Case development Limited number of findings
Direct observation Better understanding of actual performance Just in time teaching/feedback
Time constraints Scheduling Faculty consistency
Practical Guide to the Evaluation of Clinical Competencies Eric Holmboe & Richard Hawkins 2008 Mosby Elsevier
Your project
• What will be evaluated? – Think of your objectives….. – Measurable
• What forms/implements will you use? • What resources will you need? • Who will do the evaluation?
IMPLEMENTATION PROGRAM EVALUATION
Start with the end in mind
Learner Outcomes
Educational Strategies • Content • Formats
Resources needed Input
Output
Outcome
SCHOLARLY WORK: MAKE IT COUNT TWICE
Dissemination Considerations
• Who else is interested in what you’re doing? • What are your career goals? • What do you enjoy? Play to your passions
• Where do you excel? • Who are your professional peers? • How do they like to learn about new
innovations?
Resources
