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SCOAR: from theory to practice. PD Dr. med E . Van Gessel Geneva. Education?. Education is described as one of the « three legs » of academic medicine along with research and clinical work! - PowerPoint PPT Presentation
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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