Reflections on the experience of NSW: Moving from a PMC to IMET to CETI to HETI.

A 20 year journey

Professor Steven Boyages Clinical Education and Training Institute

9th November 2011

Timeline and Definitions

Postgraduate Medical Council (PMC)

Institute of Medical Education and Training (IMET)

Clinical Education and Training (CETI)

Health Education and Training Institute (HETI)

Constants of health

• Clinician patient relationship

• Clash of cultures

Change Drivers

• Patient experience and safety

• Staff experience and safety

• Demography

Resilience

• Individual, self efficacy, social cognitive theory

• Organisational

Adaptability and Agility

• New models of education and learning

• Technology

Health is a knowledge based profession

• Research

• Development

Generate Knowledge

• Education

• Training

Impart Knowledge

• Care

• Prevention

Apply

Knowledge

Constants of Health TO RECHON him who taught me this Art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required; to look up his offspring in the same footing as my own brothers, and to teach them this art, if they shall wish to learn it, without fee or stipulation; and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of the Art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath according the law of medicine, but to none others. (Hippocrates 460-370 BC)

The nature of patient care is a constant

High Touch High

Tech

Team and Workflow

Platform

Technology

Platform

Health work is a balanced matrix

Planetary orbits are constant Managers are from Mars and Clinicians are from Venus

These “language” differences may lead to a clash of cultures

A crisis is usually an opportunity for change

Institute of Medical Education and Training (IMET)

Vocational Networks

HSP

Postgraduate Medical Council

Standards & Accreditation Allocation, Supervision

Changing Health Patterns

Need for new models of care

Technology Increasing consumer

expectations

Rising cost of health care

The Perfect Storm

Patient Safety

Staff Experience

Intergenerational report 2010

Future workforce growth at Feb 2010 Future industry job growth – Australia 5 years from 2009-10 to 2014-15

(‘000) - DEEWR projections

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Four Pillars

CETI CEC ACI BHI

Clinical Education and Training Institute (CETI)

Allied Health

Nursing

Medical

Oral Health

Rural

Centre for Learning and

Teaching

Institute of Medical Education and Training (IMET)

Vocational Networks

HSP

Postgraduate Medical Council

Standards & Accreditation Allocation, Supervision

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What are we trying to do?

To improve teamwork, communication and

collaboration for safer patient-centred care, and

better staff experiences

Why are we trying to do this?

Increased staff motivation, well-being and retention

Decrease in staff turnover

Increased patient and carer satisfaction

Increased patient safety

Increase in appropriate use of specialist clinical resources

Reductions in patient mortality and critical incidents

Increase in access to and coordination of health services

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What do we mean by Team Work?

Interprofessional Education (IPE)

Occasions when two or more professions learn from, with and

about each other to improve collaboration and the quality of care

Interprofessional Practice (IPP)

Occurs when two or more professions work together as a team with

a common purpose, commitment and mutual respect (Freeth et al,

2005).

Team Health

Foundations – Right Start

• Individual

• Roles and Responsibilities

• Risks and Rewards

High Performance Teams

• Roles

• Reflection

• Respect

• Resilience

Advanced Settings of Care

• Advanced Clinical Modules

• Simulation

What Is Self-Efficacy?

According to Albert Bandura, self-efficacy is “the belief in one’s capabilities to organize and execute the courses of action required to manage prospective situations” (1995, p. 2).

In other words, self-efficacy is a person’s belief in his or her ability to succeed in a particular situation. Bandura described these beliefs as determinants of how people think, behave, and feel (1994).

Sources of self efficacy

1. Mastery Experiences • "The most effective way of developing a strong sense of efficacy is through mastery experiences," Bandura

explained (1994). Performing a task successfully strengthens our sense of self-efficacy. However, failing to adequately deal with a task or challenge can undermine and weaken self-efficacy.

2. Social Modeling • Witnessing other people successfully completing a task is another important source of self-efficacy.

According to Bandura, “Seeing people similar to oneself succeed by sustained effort raises observers' beliefs that they too possess the capabilities master comparable activities to succeed” (1994).

3. Social Persuasion • Bandura also asserted that people could be persuaded to belief that they have the skills and capabilities to

succeed. Consider a time when someone said something positive and encouraging that helped you achieve a goal. Getting verbal encouragement from others helps people overcome self-doubt and instead focus on giving their best effort to the task at hand.

4. Psychological Responses • Our own responses and emotional reactions to situations also play an important role in self-efficacy.

Moods, emotional states, physical reactions, and stress levels can all impact how a person feels about their personal abilities in a particular situation.

• Bandura, A. (1995). Self-Efficacy in Changing Societies. Cambridge University Press.

Review Article American Medical Education 100 Years after the

Flexner Report

Molly Cooke, M.D., David M. Irby, Ph.D., William Sullivan, Ph.D., and Kenneth M. Ludmerer, M.D.

N Engl J Med Volume 355(13):1339-1344

September 28, 2006

Figure 1

Source: The Lancet (DOI:10.1016/S0140-6736(10)61854-5)

Terms and Conditions

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What is the literature saying?

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Figure 12

Source: The Lancet (DOI:10.1016/S0140-6736(10)61854-5)

Terms and Conditions

We need to embrace social media

Health Education and Training Institute

Undergraduate

Vocational Training

Leadership and Management

Clinical

Clinical Education and Training Institute (CETI)

Allied Health

Nursing

Medical

Oral Health

Rural

Institute of Medical Education and Training (IMET)

Vocational Networks HSP

Postgraduate Medical Council

Standards & Accreditation

Allocation, Supervision

HETI Function Domains

Undergraduate clinical placements

Vocational Education and Training

Post graduate clinical prevocational and vocational training

Management and Leadership Development

Investment and Risk Strategy

Staff Shortages

Competency gaps

Poor staff utilisation and productivity

Poor Staff Morale

Increased Medical Error

Poor Economic Development

“Storm Damage”

Bridging the Gap

Reflections

Constants of health

• Clinician patient relationship

• Clash of cultures

Change Drivers

• Demography

• Patient experience and safety

• Staff experience and safety

Resilience

• Individual, self efficacy, social cognitive theory

• Organisational

Adaptability and Agility

• New models of education and learning

• Technology