Kazakhstan Health Technology Transfer and Institutional Reform Project Clinical Teaching Post...
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Transcript of Kazakhstan Health Technology Transfer and Institutional Reform Project Clinical Teaching Post...
Kazakhstan Health Technology Transfer and Institutional Reform Project
Clinical TeachingPost Graduate Medicine
A WorkshopDrs. Henry Averns and Lewis Tomalty
Kazakhstan Health Technology Transfer and Institutional Reform Project
Post Graduate Medicine Structure
•Personnel•Administrative Assistant for each program•Program Director: faculty member responsible for administering the overall conduct of the residency program•Program Directors form an overall Program Committee that meets monthly
Kazakhstan Health Technology Transfer and Institutional Reform Project
Post Graduate ProgramObjectives
• Objectives are approved by Program Committee• Based on the national objectives as approved by
the Royal College (specialties) or the College of Family Physicians
• http://www.royalcollege.ca/public/credentials/specialty_information
• http://www.cfpc.ca/Home/• Clinical objectives and non clinical objectives (eg
professionalism, scholar, manager etc)
Kazakhstan Health Technology Transfer and Institutional Reform Project
Internal Medicine Program Overview
Kazakhstan Health Technology Transfer and Institutional Reform Project
• 3 year program• Primarily hospital based• Graded responsibility
Kazakhstan Health Technology Transfer and Institutional Reform Project
Year 1 Year 2 Year 3
Clinical teaching unit Allergy Elective
Palliative care Infectious diseases Clinical teaching unit
Clinical teaching unit Elective Gastroenterology
Cardiology Intensive care unit Elective
Elective Intensive care unit Hematology
Clinical teaching unit Rheumatology Clinical teaching unit
Specialty elective Clinical teaching unit Nephrology
Community medicine Respirology Consults and clinics
Emergency medicine Clinical teaching unit Cardiology
Clinical teaching unit Oncology Clinical teaching unit
Elective Night float Endocrinology
Clinical teaching unit Elective Clinical teaching unit
Intensive care unit Clinical teaching unit neurology
Kazakhstan Health Technology Transfer and Institutional Reform Project
Clinical teaching units• Fundamentals of acute emergency
management and in patient care of undifferentiated medical conditions
• Acute and chronic medical conditions
Kazakhstan Health Technology Transfer and Institutional Reform Project
Formal Education Activities• Morning Report (sign in rounds)
– Conference where CTU teams present and discuss recent admissions
• Academic Half Days– Weekly academic rounds where core general internal medicine
topics discussed• Core Medicine Rounds
– Twice weekly. Case conferences, patient safety rounds, case of the month, rotating subspecialty presentations
• Departmental Conferences– Grand rounds and weekly morbidity and mortality conferences
Kazakhstan Health Technology Transfer and Institutional Reform Project
Formal Education Activities• Journal Club– Critical appraisal skills – review of EBM
• Simulation Lab– Simulation teaching and procedural training
Kazakhstan Health Technology Transfer and Institutional Reform Project
Evaluation• Twice yearly meetings with Program Director• Mid Rotation and end of rotation in-training
Evaluation Reports • American Board Internal Medicine exam annually• Multi-Source Feedback (Peer-Peer and Nurse-
Resident) feedback• Annual practice OSCE• First year residents take a national OSCE exam• E-portfolio system recently implemented
Kazakhstan Health Technology Transfer and Institutional Reform Project
Evaluation• Mini-CEX• Used to assess learners in real life settings• Can be used for formative or summative assessment• Process: real life clinical encounter with a patient (15
minutes)• Teacher observes• Debrief the encounter immediately to discuss areas for
improvement and to provide positive feedback – most important part of process (10 minutes)
• Formally assessed either on paper or on line
Kazakhstan Health Technology Transfer and Institutional Reform Project
Curriculum• 2 year program• Triple C Curriculum
• Comprehensive Learning• Continuity of Patient Care, supervision and
curriculum• Family medicine CENTERED
Kazakhstan Health Technology Transfer and Institutional Reform Project
Comprehensive learning• Learning objectives structured around Domains of clinical
care– Maternity and Newborn Care– Care of Children and Adolescents– Care of the Elderly– Palliative Care– Care of Adults– Global Health (Care of vulnerable and underserviced
populations)
– All training through the lens of family medicine (eg FM preceptors in obstetrics, long term care etc)
Kazakhstan Health Technology Transfer and Institutional Reform Project
Development of Physician Characteristics
• Communication• Professionalism• Ethics• Patient Centered Approach• Practice Management
Kazakhstan Health Technology Transfer and Institutional Reform Project
Continuity of Learning
• Continuity of Patient Care
– Responsible for own defined group of patients by sharing preceptor’s patients
– Build relationships with patients over the two year program
Kazakhstan Health Technology Transfer and Institutional Reform Project
Continuity of Learning
• Continuity of Supervision
– Academic advisor that meets regularly with each resident
– Same core family medicine preceptors for extended periods
Kazakhstan Health Technology Transfer and Institutional Reform Project
Continuity of Learning
• Continuity of Curriculum– Build on each learning experience- topics revisited
with a different perspective or level of complexity. Eg pediatrics in first and second year
Kazakhstan Health Technology Transfer and Institutional Reform Project
Centered in Family Medicine• Learning is always through the lens of a Family
Physician• Majority of time working in Family Medicine
clinics• Work with Family Physicians who are
hospitalists, care for obstetrical patients, practice palliative medicine, do minor surgery etc
Kazakhstan Health Technology Transfer and Institutional Reform Project
Evaluation• Competency based• Portfolio• Objective: observed clinical encounters and
summative evaluation forms (Mini-CEX)• Reflective: Self evaluation, reflective exercises,
feedback• Majority of assessment happens in clinic• Interim and final evaluation forms• National testing: OSCE and written exams
Kazakhstan Health Technology Transfer and Institutional Reform Project
Faculty Development• Ongoing• Compulsory versus voluntary• Issues particularly for Post Graduate Training
– Time, money, importance• Competencies (national plan)
– Student assessment and faculty evaluation– Communication skills– Scholarship– Leader– Information and Communication technologies– Teacher/Educator
Kazakhstan Health Technology Transfer and Institutional Reform Project
Faculty Development in Post Graduate Medicine Priorities• Assessment
• Teacher as a facilitator of learning• Providing Feedback• Teaching clinical skills• Professionalism in the clinical setting• Communication skills for both teacher and
learner• EBM (using I.T. appropriately and effectively)• Others? Do you agree with this list?