Integrating CanMEDS Roles in CPD Programs

Transcription

1 Integrating CanMEDS Roles in CPD Programs 3 rd National CPD Accreditation Conference - Ottawa September 27, 2011

2 Conflict Of Interest Declaration Kate Hodgson DVM, MHSc, CCMEP No relevant conflicts of interest James Meuser MD, CCFP, FCFP No relevant conflicts of interest

3 Workshop Learning Objectives After active engagement during this workshop you will be better able to: Explain the seven CanMEDS Roles and their relevance to CPD Describe key approaches to the use of the CanMEDS framework in the identification of needs assessment and evaluation strategies Discuss the role for CanMEDS in both selflearning and assessment

4 Explore integrating the CanMEDS Roles In the context of a specific Comprehensive Program

5 CPSO Processes that lead to need for Comprehensive Program Assessments through QA Investigations through ICRC Change of Scope of Practice Re-Entry to Practice

6 Current Approach at CPSO to Physician Enhancement Specific courses of study Some CPSO educational programs e.g. record-keeping, prescribing CPSO arranges formal preceptorships Nothing exists that is comprehensive

7 CPSO Identified Need o o o o Educational Program for Physicians with needs that provides MORE than clinical information in an educationally evidence-informed format Family Medicine best place for pilot Approached CEPD and DFCM at University of Toronto Program development grant from CPSO

8 Medical Education Literature Review Longitudinal Small Group Interaction with peers Practice-based Directed self-assessment Opinion leaders Preceptoring

9 Curriculum Committees and Program Pilot Inclusive Curriculum Committees April 2010 CACHE April 2011 June 2011 July Pilot Program with 10 participants

10 CanMEDS Roles

11 Proposed Program Components Recruitment- Intake and assessment appropriate participants Shared small group learning ( 5 Weekends ) designed around CanMEDS-FM Roles: using multiple teaching methods (interactive, casebased, standardized patients, PBSGL modules) Between-session homework Matched Preceptors Exit documentation and evaluation

12 Weekend Design Friday Afternoon and Evening Content/Topics: Competencies Ice Breaker- Building community of practice rapport Describe and analyze practice, patients, and health care team Professional, Manager and Advocate Saturday Morning Saturday Afternoon Sunday Morning Interactive presentations Workshops Standardized patients Medical Expert, Collaborator and Communicator Problem Based Small Group Learning Medical Expert Interactive presentations Workshop Manager, Scholar, and Collaborator

13 Therapeutic Themes Family Medicine relevant Therapeutic Theme established for each weekend

14 Mild Remedial Change of Scope Re-entry Practising IMGs CFPR Program Mature Physicians Personal desire to maintain clinical competence and practice standards

15 Discussion Have you identified a need for a comprehensive CE program based on ALL CanMEDS Roles in your health care community? De-emphasize Medical Expert? Address all Roles?

16 Curriculum Development Using the CanMEDS FM Roles Matrix

17 Therapeutic Themes Weekend One Therapeutic Themes Chronic Disease Two Family Medicine across the Life Cycle Three Four Health Promotion and Disease Prevention Mental Health Five Challenging Clinical Situations

18 CanMEDS

19 session theme Chronic Disease Family Medicine across the Life Cycle Preventive Medicine/ Health Promotion Mental Health Challenging Situations in Practice competency medical expert communicator collaborator manager scholar advocate professional Welcome- Introductions Overview of Comprehensive Family Practice Review Program; Family Practice in the 21st C entury- C ANMEDS PBSG: Diabetes Type 2: What's New? PBSG: Hypertension: When it's Difficult to Treat PBSG: Postmenopausal Women's Health PBSG: Fever in children Patient-centered care; Standardized patients Medical Record Keeping Using Clinical Practice Guidelines; Motivational Evidence-based Interviewing Medicine Periodic Health Exam PBSG: TBD PBSG: TBD PBSG: TBD PBSG: TBD I CAN PRESCRIBE PBSG: TBD Complex Communication- Conflict; SHERPA Patients PBSG: TBD Cultural Sensitivity Telephone/ Medicine Difficult Patients and Families in Crisis; Standardized Office-based team - Collaborative Care Model Framework for Family Practice; Family Genogram Practice Tool Referral process Computer Lab: Optimal Use of Community Webbased Health Resources Working with your Pharmacist Improvement in Family Practice - Why Quality Improvement Share Practice Profile 5Ps Choosing an Opportunity for Improvement QI Model for Improvement; Structuring an Improvement- Aim, Measures, Changes QI PDSA Cycle; Process Tools QI Data Collection; Data Analysis Share QI Posters Computer Lab: Formulating and Answering Clinical Questions; Websearching CPD Professional Practice Profile; Identifying CPD needs relevant to practice CPD Plan; Learning Objectives; Knowledge, Skill, Practice multiple interventions Non-medical determinants of health Computer Lab: Patient-Family Education on the Web CPD Professional Working with Learning Project; the Public Linking Learning to Health Practice; Department Professional Computer Lab: Optimal use of CPD web-based resources Review PLP Role and limitations of Family Physician as Advocate Review CFPR Program; Update Managing CPD Plan for the patient coming expectations year;commitments to Change Exploring Professionalism -- Collegial Conversations Ethical issues across the Family Life Cycle Your Medical Career Life Cycle Work/Life Balance Colleagues in Distress/PHP Program Family Physicians: The Leadership Role

20 CanMEDS-FM: Communicator Oral and written communication skills Ability to establish therapeutic relationships with patients/families Effective information gathering and synthesis Effective sharing of information

21 Curriculum Focus Patient-Centred Care Medical Record Keeping Motivational Interviewing Complex Communications Cultural Sensitivity Telephone/ medicine Difficult Patients & Families in Crisis

22 CanMEDS-FM: Collaborator Participation in collaborative practice Maintenance of positive working environment

23 Curriculum Focus Expanding influence: Co-workers: Officebased team Family context: Family genogram Specialists: Referral Process Community: Web-based resources Inter-professional: working with allied professions

24 CanMEDS-FM: Manager Management of practice time and career Management of resources Management of practice/organizations/ systems to maintain effectiveness

25 Curriculum Focus Quality Improvement in Family Practice

26 CanMEDS-FM: Scholar Ongoing self-directed learning, based on reflective practice Information management & critical appraisal Educator Patients, families, other HCPs, public, etc. Research

27 Curriculum Focus Continuing Professional Development

28 CanMEDS-FM: Health Advocate Respond to individual health needs Respond to community health needs Identify determinants of health within the community Health promotion

29 Curriculum Focus Non-medical determinants of health Patient-family education Working with Public Health Role & limitations of Family Physician as Advocate Managing patient expectations

30 CanMEDS-FM: Professional Commitment to patients, profession, society through ethical practice Respect of regulatory practices Commitment to physician health and sustainable practice Commitment to reflective practice

31 Curriculum Focus Exploring professionalism Ethical issues Medical Career Life Cycle Work/life balance Colleagues in distress Family Physicians as Leaders

32 CanMEDS-FM: Family Medicine Expert Integration of all other CanMEDS roles Knowledge, skills and attitudes; procedural skills Proficient patient-centered assessment and management; complex clinical situations Coordination of patient care

33 PBSGs Curriculum Focus 2 per weekend session Clinical questions assigned as homework; debriefed at the following session Using clinical practice guidelines Periodic Health Exam I CAN PRESCRIBE

34 Discussion CanMEDS Roles: Advantages of using CanMEDS Framework to build curriculum? Challenges of using CanMEDS Framework to build curriculum?

35 Program Evaluation Strategies Three main areas to evaluate: Perceived program impact Did it change behaviour and how? Sustainability Can the program continue beyond the pilot and what will it take for this to happen? Transferability What would it take to implement the curriculum in other (Non-Toronto) settings?

36 Multi-Source Feedback 1. Feedback on each session over 5 weekends. 2. Discussion and evaluation on the Sunday morning of the 5 th weekend. 3. Collegial feedback from Canadian Association of Continuing Health Education (CACHE).

37 Results so far Uniformly positive evaluations PBSG modules very popular Group planning on staying together AFTER the program is finished Recognition of the importance of all the CanMEDS-FM Roles and the need to specifically address and develop those competencies

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39 I write more detailed referral letters with specific questions including who is responsible for follow-up. As a result, I get more detailed reports from specialists, and my patients receive better care.

40 I m more thorough in researching patient history before composing referral letters a learning experience for myself about the clinical condition and our EMR system.

41 I am now allowing time for making notes in the appointment time. My notes are more complete, I m no longer taking work home, and my billing is more accurate.

42 The cumulative patient profile facilitates better medicine, especially when the patient is seen by a colleague. My colleagues have adopted this practice.

43 The QI approach to change in practice has been implemented nationally.

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45 Program Goal To equip primary care physicians with high quality skills for 21 st century practice.

46 Learning Objectives Improve their approach to managing clinical conditions. Use technology to answer clinical questions effectively. Provide better patient-centred care. Collaborate and communicate more effectively with others in the healthcare system. Develop an individualized approach to life-long learning & professional development.

47 Weekend Format Begin at 2:00 PM Friday. Community-building reflective activity on Friday. Have a computer lab each weekend. Keep the PBSGs on Saturday afternoon. End each weekend with/at lunch on Sunday.

48 Therapeutic Themes Weekend One Two Three Four Five Therapeutic Themes Chronic Disease Family Medicine across the Life Cycle Preventive Medicine Health Promotion Mental Health Challenging Situations in Practice

49 Therapeutic Themes PBSGs Include 2 PBSG modules relevant to therapeutic theme in each weekend session. Chosen by faculty for first 2 weekends. Balance to be selected by participants using Delphi process. Clinical question arising from each PBSG to be assigned as homework. Homework to be debriefed during the following session.

50 Longitudinal Themes Additional longitudinal themes throughout the five weekends: Quality Improvement Continuing Professional Development Use of technology Use standardized patients on the 1 st and 5 th weekends only. CPD coaches to support participants learning throughout the course.

51 Coaching Component of CFPR : Preceptors : Coaches

52 Coaching Intentional, consistent, collaborative process. Supports the development of peers. Helps colleagues take responsibility for their own initiatives.

53 Coach Facilitator not authority or auditor. Asks more than tells. Listens more than speaks. Empowers does not direct.

54 Skills of a Coach Confidence Competence Candour Commitment Clarity

55 Coaching Component of CFPR Support CFPR Program. Provide informal advice on a specific step or element of CFPR. Support successful adaptation and completion of CFPR. Make recommendations and refer to resources.

56 Coaching Support Application to practice. Adapt generic tools to specifics of practice.

57 Coaching Support Expand collaborative influence and action.

58 Coaching Support Completion of QI project over the course of CFPR.

59 Coaching Support Navigate the challenges of advocacy. Explore complexity.

60 Coaching Support Refine CPD focus. Identify multiple, actionable learning interventions. Structure PLP.

61 Coaching Support Act as role model.

62 Coaching Support Sounding board. Guide to resources for clinical questions.

63 Discussion What are the advantages and challenges of Preceptors and Coaches in a CPD Program which integrates all the CanMEDS Roles?

64 Questions?

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