PD Dr. med E. Van GesselGeneva

SCOAR: from theory to practice

Education?Education is described as one of

the « three legs » of academic medicine along with research and clinical work!

As research is necessary for the creation of new knowledge, effective education is essential to generate new doctors

Competence?Being a good Anesthesiologist requires

more than strong scientific knowledge and excellent clinical and technical skills

Key qualities also required are: communicate effectively with patients and

colleagues,act in a professional manner, cultivate an awareness of one's own values and

prejudices, provide care with an understanding of the

cultural and spiritual dimensions of patients' lives.

Carr SJ PMJ 2003

Going beyond the “see one, do one, teach one”

Not only a good “knower” but an accountable one

Less theory and more practice-based knowledge

Maintain standards and quality of care

Assessment: Progress defined by competencies achieved and NOT by underlying educational process or knowledge only

Greaves JD BJA 1997; Leung WC BMJ 2002

Assessment drives the curriculum

To ensure that trainees are competent to practice medicine we should include:Consistent guidanceMeasurement of performanceSystemic and structured feed-back

Assessment should take place during residency and not afterwards only (using exams)

The ultimate intended goal is the impact on patient safety!

Rodriguez-Paz JM PMJ 2009

‘Killing season' on NHS wards: Patients at risk when junior doctors start new jobs, says health boss’-7,000 medical students start foundation year in August-Hospital death rates rise 8% during the period-NHS chief Sir Bruce Keogh vows to end 'killing season' scandal-From 2013 it'll be compulsory for all juniors to shadow senior doctors

By Jenny Hopehttp://www.dailymail.co.uk/news/article-2163382/NHS-wards-Patients-risk-junior-doctors-start-new-jobs-says-health-boss-Sir-Bruce-Keogh.html

The DAILY MAIL

The question?

How to make competencies concrete…

so that they can be clearly assessed?

The SGAR competence-based curriculum or SCOARDocument defines:

RolesDomains of competence Competences as well as Level to be achieved

A Has knowledge of, describes…B Performs, manages, demonstrates under supervisionC Performs, manages, demonstrates independentlyD Teaches or supervises others in performing,

managing, demonstrating

Learning objectives (& syllabus for more precision) Knowledge / Technical skills / Clinical and Case-management

skills / Drills / Specific attitudes (including professionalism, specialist practice and patient consideration)

CanMeds framework and the SGAR

Medical Expert: Knowledge/clinical and procedural skills/professional attitudes that are practice-based and contextual:

Collaborator: Team work/consultants Communicator: Doctor/patient relationshipManager: Healthcare organization, resources;

sustainable practicesScholar: International patient-safety

movement; learning from errors; life-long learning

Professional: attitudes and values (integrity, respect, responsibility…)

Health advocate: health promotion, communities and population

Updated 2005

Example of our roles: Professional

Domains of Competence

The competences

Levels of achievement

The learning objectives

Another example: Obstetrics

Another example: Obstetrics

The matrix (EPAs) tenCate et al. AcadMed

2007

Masters the anesthetic management of cesarean section and other operative deliveries under regional or general anesthesia (level D)

Manages the high -risk obstetric situations (level C)…

Knowledge of the possible indications for C-sections and their level of emergency

X X

Knowledge of the potential complications of regional analgesia for labor and C-section (unsatisfactory analgesia or anesthesia, neurological complications, postdural puncture headaches, toxicity of local anesthetics, high block)…

X

Rapid sequence induction with specific consideration for difficult airway in the pregnant patient

X X

Teaching, learning, assessing…

Wong A Can J Anaesth 2011

Context

Consistent Guidance

PerformanceMeasurement

Feed-back

It is impossible!

WORK

TRAINING

Pers

onal Life

??

Personal Life??

The pluses of AnesthesiologyMajority of learning occurs in clinical settingsAssessment:

OR: one to one allows formative interactionsGuidance and MotivationAccurate feed-back (prescriptive, relevant, focused)Visible technical skills

Different settings (OR, consultation, labour, emergency, etc…)

More “linear” training => Duration of time of training can be varied

Use of simulation toolsPossibilities of focusing only on certain competencies,

interactions…(e.g, team-working)Questions on thought process and decision-making

Kathirgamanathan-Woods. BJA-Cont Educ in Anaesth, Crit care & Pain 2011

The minuses of Anesthesiology

OR: uncomfortable experience for the noviceNon-verbal communicationPatient safety is an issue, patient as primary

focusLearners may have a more passive role in

challenging casesMaintaining efficiency of the OR listLarge number of different clinical teachers =>

variety in practice is confusing!Rapid OR case turnover = no time for

questions and discussionIdentifying “teachable moments”

Bould et al. Can J Anaesth 2011

Where we areNew curriculum since 2008 = new training

paradigm!The cultural change is a difficult one:

Collaborative process between teacher and learner

No prescription on how the teacher must teach or the resident must learn…

Agreement upon the assessment of competence and progressive independence of the trainee (certification)

Supervision of juniors should never occur without adequate formative assessment and feed-back

Major influence on the European curriculum

European CurriculumThe differences are small! Switzerland has pioneered the EBA

curriculumROLES: major difference? Only 4Concept of Leadership, comprises

Manager-Communicator-Collaborator (and Health advocate)

Other roles: Medical Expert, Professional, Scholar

European CurriculumDomains of competence: near identicalPolitical issues of Emergency, ICM

European CurriculumFor each domain, the competences were

discussed twice and rewritten

European Curriculum

European Curriculum

Many different writers from different cultures, backgrounds, trainings…

Confusion between competences and activities/learning objectives

Political issues to be discussed

Some good news: 25% countries endorsed the new curriculum; 25% will do

it over the next year; 50% are thinking about it!

SCOARA tool…

Context

Consistent Guidance

PerformanceMeasurement

Feed-back

SCOAR: what will it help you to do?

Progressive independence of the trainee (certification)

Assessment of competence(Outcome)Fit for p

ractice

and not

dangerous!

Independent and

accountable!

What we will have to discuss Working VS Training?Change in our cultureChange in our tradition of trainingTrain tutorsHelp training centresMoney…

THANK YOU