Review of the flinders model

WELCOME

• Why it is important to teach GEMP students about chronic condition management

• Critique of the current methods of teaching chronic condition management

• Proposal – how the Flinders Program could be better integrated into the GEMP course

Why is it important for GEMP students to learn about chronic condition management?

• The major concerns of the 20th century healthcare systems were acute infectious diseases

• Chronic conditions currently account for more than half of the global disease burden and are increasing

• Training of the healthcare workforce remains based on 20th century healthcare models that emphasise diagnosis and treatment of acute disease

Pruitt, S, Epping-Jordan, J 2005, ‘Preparing the 21st century global healthcare workforce’, BMJ, vol. 330, pp. 637-639World Health Organisation 2002, ‘Innovative care for chronic conditions: building blocks for action’, Global Report, <www.who.int>.

Why is it important for GEMP students to learn about chronic condition management?

• WHO, World Medical Association, World Health Professionals Alliance & the International Alliance of Patients’ Organisations recognise these training models as inadequate for a growing population of patients with chronic health problems

• Training needs to be restructured to include a new set of core competencies to prepare 21st century health workers to deal with health problems that persist across decades or lifetimes.


• Learn how to move from reactive care to proactive, planned and preventative care

• Learn how to negotiate individualised care plans that are client-centred• Learn how to support patients’ efforts at self-management• Learn how to organise and implement group medical visits for patients who

share common health problems• Use information systems to exchange patient information• Learn to think beyond caring for one patient at a time to a population, or public

health, perspective• Develop a broad perspective of care of patients across the continuum from

clinical prevention to palliative care

It is recommended that healthcare workers should be exposed to the following as part of their training:


Review of the Flinders Model: Chronic Condition Self Management online module

Lauren CampbellTed de’Lisle-Tarr

Supervisor: Rene Pols

Project summary• The Flinders Model of Chronic Condition Management is an

ongoing education program aimed at reforming the way health professionals interact and manage patients with chronic conditions.

• This course was originally, solely taught via a two-day workshop

• The online course was developed and incepted late last year to allow health professionals to teach themselves the Flinders Model in their own time

Flinders Model of Chronic Condition Management - Classic

• A 10-15 hour online course divided into 19 lessons, each with a specific focus

• Material is conveyed via text, linked readings, A/V PowerPoint presentations with handouts, and some video-examples from educational DVDs

• Participants pair up to learn the new material and practice a series of role-plays that exercise covered topics

• Assessment is in the form of forum-questions and 3 care-plans submitted within the due-dates

Summary• Reviewing the FM for possible use in the

GEMP course• Both of have been taught the FM in TCP, 2nd

year.• Some of us remember that teaching better

than others! :-S

Methods• Completed the online course as a participant,

completing the readings and the forums• Also made notes of things that weren’t working• Then once completed, with time recorded, we

went back through it a second time and looked at it with a critical eye.

• Thought about parts of the course that didn’t seem logical, that were difficult, that didn’t flow.

Methods• Considered from the position of a GEMP

student using this to learn the FM as part of their GEMP studies

• Although this presentation makes many recommendations for alterations to the existing project it wouldn’t be feasible to list them all

• Hence Lauren solved this problem by compiling an example FM-online workshop that we hope illustrates many of the points we raise

Overall• Effective at reinforcing the previous teaching I

have had with the FM• Got it’s message across effectively• The online format is second nature to both of

us – We think this aspect will function perfectly with GEMP students

General Maintenance• Page 4: The ‘next’ button on the third screen of the lesson

does not advance to the next page (references page). The reference page- link to the WHO document was broken

• Page 5: There are 7 Principles of self management in K, I, C, MR, I, L, S. Lesson 5 states there are 6 in the lesson-text, and 7 in the PowerPoint from screen 4.

• Page 9: The text on the lesson pages states that discussion on a score is indicated for 4 and above. The powerpoint states 4 and below (which we know to be true)

General Maintenance• Page 11: Goal Statement forum, ‘What [why]

do you think it is important for your client to identify a goal to address their problem?’

• : When accessing ‘Case study “Tom” Forum’ from screen 6 of the lesson, we find the link is broken. The forum can still be accessed via the other routes.

General Maintenance

• Page 16: Motivational interviewing text by Rollnick and Moyers linked on the ‘Reading’ page is broken, with is because the URL has ‘www’ inserted when it should not be. You can still access the text from the ‘References’ page however.Correct address: http://pegasus.cc.ucf.edu/~drbryce/Motivational%20Interviewing%20and%20Resistance.pdf

Questions we asked ourselves• The context of the review was based on

several questions we asked ourselves… (some of which we did not have answers for)

• How would a student perceive this? What would they want?

• How would it work practically?

Questions we wish to ask the faculty

• Where in the GEMP course was this online module intended to be inserted?

• Will it be in conjunction with the established teaching?

• What aspects of this course are to be emphasised to the students?

Perceived directions• GEMP students could graduate with the

certification in place – WHO text justifies this• Insert the FM-online workshop into late first year,

because PBL groups provide small manageable teams.

• Students would complete a lesson of the revised FM workshop each week, with maybe an additional week added for lessons that require the completion of the various tools. A large block of teaching can become a bit daunting.

Perceived directions• Each lesson will more-or-less be the same as the

current lessons: stick with what works• Lesson-text should remain more or less the same,

that summarises the objectives and main points.• Readings for the students to complete, both

mandatory and optional. • Finally, the forum as an assessment tool at the end

of each lesson to gauge the student’s comprehension of each lesson’s material. To check they have completed the readings.

Perceived Directions - Readings

• The readings, in general were quite good. Those would transfer over quite nicely.

• ?? A few of your own studies in hyperlink to make them more accessible

• The WHO reading should probably have an assessment forum concerning its main points, Lauren and I felt it was quite important, if long

Perceived Directions – The PowerPoint and videos

• Although its always good to have information in several formats… the PPs attached to the online module were repetitive, and a bit stale. They offered little more than what was on the lesson-pages

• If they contained blow-by-blow worked examples, such as PIH scores and C&R and problem statement goals and Careplan- forms filled out then this would be more informative

• Some of the diagrams were unintelligible• Maybe a more interesting commentary than reading the slides• Additionally the videos were also a bit stale. • Students will likely lose interest quite quickly in these resources

and it would be a shame to waste them.

Perceived directions – Assessment of completion

• The forums provide the opportunity for assessment of a student’s performance during a given lesson

• Additionally, telling the students it will be examined is a good incentive… the forums should be similar to the PBLs in respect to exam revision.

• The system would have an electronic ‘completion-counter’ that logs when a student has posted on a forum and marks that requirement as completed

Perceived directions - Forums• Idea that forum questions could be changed a little. Many of the

existing forums are reflection type questions. • Students may not be too impressed with these questions and

may prefer more comprehension type questions. Especially those pertaining to a case study eg ‘Tom case study-style’ (students like right and wrong answers)

• Work on a timed system of 1 lesson per week• Each lesson forum question is allotted to one student to

complete for the group, as though they were explaining or presenting this answer

• Each other member of the group will then reflect on this answer, prompted by a separate reflection question in the forum

Perceived Directions – Discussing the types of forum questions

• Examples of good questions were those relating to case study Tom:

• The motivational interviewing question for example:• What are the major advantages of utilising Motivational

Interviewing with clients? • How does Motivational Interviewing differ from counselling? • Where in the process has there been some implicit use of

Motivational Interviewing techniques. • How does the Flinders Program support clients and health

professionals to utilise Motivational Interviewing strategies?

More examples of good questions• Using the “Level of Confidence Scale” you ask Tom (client from

"Structured Problem Solving" and "Change") to rate his answer on a scale of 1 – 10, with 1 being not very confident at all and 10 being very confident: “How confident are you with quitting smoking?”

• Tom tells you that his confidence scale is “5” . • You then ask Tom: “How much do you believe that quitting will

benefit you?” and he replies that he thinks that the benefits of quitting would be “10”.

• What questions could you ask to determine why Tom doesn’t feel more confident?

• What strategies could you use to boost his confidence score to > 7?

Perceived directions - Moderating• Forum moderating very labour intensive• Instead randomly moderate a few groups per

week• Have a flagging-system in place, where students

can anonymously flag their forum for review if they are unsure or unsatisfied by their posts

• Have an electronic system that registers when the whole group have posted on their forum and marks that forum as posted

Our Perceived directions• Is it possible for the three care plans to be split

up to better fit the teaching:• Eg: At the end of first year, at the end of

second year with the TCP teaching and during COC in third year.

• This way the FM is constantly reviewed by students, rather than ‘done and forgotten’ the online workshop would also provide a revision-aid

• The history of the FM, while useful for GPs runs the risk of being glossed over by students

• Conjoining the PIH and C&R lessons together, as the PIH lesson as it stands is 2 pages long

• Do we want students to role-play on each other? Or would we prefer them to use patients on the wards?

• Any questions?

Review of the flinders model

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