2. Click Next to continue.
Introduction: Course Objectives
At the end of this module, learners will be able to:
• Describe the benefits of holding a practice inquiry
colleague group in their facility
• Identify the key components of the PI model and
apply that model to a clinical problem
• Identify strategies to engage group members to
participate in sessions
• Describe strategies for documentation to be in
compliance with CME requirements
3. Click Next to continue.
Help:What to do if you get stuck
• Click on in the upper right corner to return to the list of modules.
• To review the previous section of content click .
• To advance to the next section of content click .
If you have any other questions about this program, please email Diane Purcille
at diane.m.purcille@kp.org
4. Module 1: Introduction to Practice Inquiry
• Clinical practice uncertainty
• What is Practice Inquiry?
• Facilitator Role
• Benefits of Practice Inquiry
Module 2: Applying the Practice Inquiry Model
• Practice Inquiry Matrix Inputs
• Facilitation strategies
• Practice
Module 3: CME review
• Clinical practice change
• Documentation Requirements
Menu
6. What is practice inquiry?
Click Next to continue.
a small-group, collaborative
learning method …
designed to assist physicians in
better managing patient-based
clinical uncertainty
Groups meet weekly, bi-weekly, or monthly for one hour.
7. What is practice inquiry?
Click Next to continue.
un cer tain ty noun
1 state of doubt or not being sure
2 perception of not knowing what to do
The goal is to explore
ideas to address
dilemmas and
facilitate reflection on
practice…
…not tell doctors how to do their work.
• diagnostic
• doctor – patient relationship
• patient care management
• ethical
examples in clinical areas
9. Click each role to learn more. Then click Next to continue.
Practice Inquiry Model: What is the faculty’s role in Practice Inquiry?
Facilitating a practice inquiry session requires several skills. Click on the images below to
learn more.
What is it like to be a facilitator in practice inquiry?
10. Individual
• The presenter walks away with ideas about how they can approach
their dilemma.
• All colleagues have the opportunity to reflect on their own practices
and experiences.
• All colleagues can learn new ways to address their own problematic
situations.
Group
• Discussion can reveal variations in practices or systems issues that
need to be addressed.
• The group has opportunity to share strategies and best practices.
• Group can identify practice changes they would like to implement to
increase efficiencies and quality.
What are the benefits to practice inquiry?
Click Next to continue.
11. Disorienting
dilemmas
Analysis &
Problem
solving
Reflection /
Discussion
Strategies &
Approaches
Summary: Reflection Questions
Take a few moments to reflect on the following questions:
• What are the barriers to dealing with clinical uncertainty in your practice?
• How would you describe the purpose of practice inquiry sessions to others?
• What is the benefit to facilitated discussion around uncertainty?
12. Module 2: Applying the Practice Inquiry Model
• Practice Inquiry Matrix Inputs
• Facilitation strategies
• Practice
13. - Clinical experience
- Resources and
evidence based
recommendations
- Next steps
- Feedback process of
the group
Dilemma?
Patient Context?
Physician Context?
Clinical Experience?
Evidence?
Clarify Agreement
Patient and
physician
Relationshi
p
Chart Matrix
MatrixTool for Practice Inquiry facilitation
Click on next page to learn more about the chart matrix
14. Click Start to begin the activity.
Amy Pratt, MD
Group Facilitator
Roberta Chan, MD
Case presenter
Welcome to the Practice Inquiry Session!
Listen to the case presentation. Try to identify strategies the facilitator is
using to coach the group.
Click Start to begin.
Start
Facilitation strategies: Guiding through questions
George Wilcox, MD
Group Participant
15. Strategies for Facilitators – Sample questions
To read through the example facilitator questions for each of the 7 input areas, click on the box.
16. Facilitator strategies
Let’s check out tips from the experts about facilitating practice inquiry groups. As you
read, think about the following questions:
• Which strategies do you already use?
• Which strategies are new to you?
• How is facilitating practice inquiry different from facilitating other session activities?
Dr Green
Dr Pratt
Dr Bell
17. Dr Ralls is struggling getting her group to contribute to case
discussions. What should she do to get the group to add to the
conversation?
Click on the strategy you would recommend.
Go around the room calling
on members of the group
until someone shares
something
Now it’s your turn to practice
Don’t say anything, just
wait for a group member
to speak.
Tell the group she is
stumped by this too and ask
the group for suggestions on
how they approach similar
situations.
19. Hi. I’m Dr Fair. I’m one of the new faculty
members for the Practice Inquiry sessions.
Can you help me figure out what I need to
do to get CME for my session?
21. I’m looking at the application and
its asking about gaps, and practice
changes and outcomes. What is
that about?
22. CME is supposed to support physician
development, so to do that we need to create
activities that are addressing what is needed
by the physician audience.
Gaps are the difference between where the
learner is now and where we want them to be.
So what is needed to bridge that gap?
Is it a change in knowledge, competence, or
performance? It can be any of these!
The desired outcome is what you want the
learner to be able to do after participating.
23. Oh, I see. So the activity has to link
to performance somehow? Isn’t it
enough to try to understand
something new?
24. Understanding is part of the learning
process, but that isnt the end goal. For activities
to be considered for CME they need to go
further. CME has to be designed to change
practice in specific ways to address identified
problem areas.
25. I have an idea. What if I ask my
friend from medical school to
present about an innovative way
to treat cancer? She is a world
renowned expert and her ideas
would definitely improve our
performance. And it would be
great to hear about all the new
technology that’s out there that
we don’t have yet!
26. The best way to gauge it would
be to ask:
How will participating in the
activity address the needs of the
learner? What will they be able
to do differently or better as a
result of participating in the
activity?
Even though that topic is
educational, if they can’t apply
the information then how will it
improve their practice?
27. Hmm. Ok. Well the great thing about practice
inquiry is that its all about issues seen in
practice. You’ve been a lot of help – thanks!
28. CME Activity Summary
CME accredited activities must be designed to enhance and improve
performance of physicians in order to improve the quality of care.
Activities must go beyond general updates or “interesting” facts.
Activities must demonstrate that they will address specific professional
practice
Activities must be designed to change physician knowledge,
competence or performance or patient care outcomes.
29. In order to have the practice inquiry sessions eligible to be considered for
CME, facilitators must manage the application process and complete the following
administrative steps:
Contact the Richmond CME
coordinator to request an addendum
to the East Bay CME activity
application for the RSS: Practice Inquiry
- 2013
1
Request and submit an annual
faculty disclosure form with the
addendum to the Richmond CME
coordinator
2
At your first session, have all
participants complete an annual
disclosure form.
3 At each session, have all
participants sign in on the
attendance sheet.
4
Document session outcomes by
photographing the matrix or
creating a summary of discussion
points and ideas generated.
5
30. Multiple Choice Question
Accreditation Guidelines
Practice Inquiry sessions will be eligible for CME credit. To be
in compliance with CME accreditation guidelines, the
learning events should be designed to do what?
Inform physicians about interesting or rare clinical
problems they may see in practice.
Help physicians be aware of changes or advances in
clinical treatments.
Change physician behaviors or practices based on
evidence based recommendations.
Allow physicians to share opinions on how to best
address clinical issues.
Click a response. Then click Next to continue .
Assessing and documenting outcomes: CME Knowledge Check
31. Multiple Choice Question
Accreditation Guidelines
Practice Inquiry sessions will be eligible for CME credit. To be
in compliance with CME accreditation guidelines, the
learning events should be designed to do what?
Inform physicians about interesting or rare clinical
problems they may see in practice.
Help physicians be aware of changes or advances in
clinical treatments.
Change physician behaviors or practices based on
evidence based recommendations.
Allow physicians to share opinions on how to best
address clinical issues.
Click a response. Then click Next to continue .
Incorrect.
Learning events may address less
common clinical issues but the
purpose is not solely to inform.
Accreditation guidelines require
that we create learning events that
are needs based and aimed at
changing physician practice.
Assessing and documenting outcomes: CME Knowledge Check
32. Multiple Choice Question
Accreditation Guidelines
Practice Inquiry sessions will be eligible for CME credit. To be
in compliance with CME accreditation guidelines, the
learning events should be designed to do what?
Inform physicians about interesting or rare clinical
problems they may see in practice.
Help physicians be aware of changes or advances in
clinical treatments.
Change physician behaviors or practices based on
evidence based recommendations.
Allow physicians to share opinions on how to best
address clinical issues.
Click a response. Then click Next to continue .
Incorrect.
The purpose of learning events is
not solely to inform of changes or
advances in clinical treatments.
Accreditation guidelines require
that we create learning events that
are needs based and aimed at
changing physician practice.
Assessing and documenting outcomes: CME Knowledge Check
33. Multiple Choice Question
Accreditation Guidelines
Practice Inquiry sessions will be eligible for CME credit. To be
in compliance with CME accreditation guidelines, the
learning events should be designed to do what?
Inform physicians about interesting or rare clinical
problems they may see in practice.
Help physicians be aware of changes or advances in
clinical treatments.
Change physician behaviors or practices based on
evidence based recommendations.
Allow physicians to share opinions on how to best
address clinical issues.
Click a response. Then click Next to continue .
Correct!
Accreditation guidelines require
that we create learning events that
are needs based and aimed at
changing physician practice.
Assessing and documenting outcomes: CME Knowledge Check
34. Multiple Choice Question
Accreditation Guidelines
Practice Inquiry sessions will be eligible for CME credit. To be
in compliance with CME accreditation guidelines, the
learning events should be designed to do what?
Inform physicians about interesting or rare clinical
problems they may see in practice.
Help physicians be aware of changes or advances in
clinical treatments.
Change physician behaviors or practices based on
evidence based recommendations.
Allow physicians to share opinions on how to best
address clinical issues.
Click a response. Then click Next to continue .
Incorrect.
Learning events will allow for
discussion of experience and best
practices, but accreditation
guidelines require that we create
learning events that are needs
based and aimed at changing
physician practice.
Assessing and documenting outcomes: CME Knowledge Check
35. Dilemma?
Patient Context?
Physician Context?
Clinical Experience?
Evidence?
Clarify Agreement
Patient and
physician
Relationshi
p
Documentation Guidelines
True or False
To fulfill the requirements and stay CME
compliant, facilitators must document outcomes
by photographing the inputs captured on the
practice inquiry matrix.
True
False
36. Dilemma?
Patient Context?
Physician Context?
Clinical Experience?
Evidence?
Clarify Agreement
Patient and
physician
Relationshi
p
Documentation Guidelines
This is not correct.
To be compliant you must document
outcomes.
That can be done in many ways which could
include also summarizing findings through
notes or through post-session questionnaire.
True or False
To fulfill the requirements and stay CME
compliant, facilitators must document outcomes
by photographing the inputs captured on the
practice inquiry matrix.
True
False
37. Dilemma?
Patient Context?
Physician Context?
Clinical Experience?
Evidence?
Clarify Agreement
Patient and
physician
Relationshi
p
Documentation Guidelines
You are correct.
To be compliant you must document
outcomes. This can be done in many ways,
including photographing the matrix, creating
summary notes, or through post-session
questionnaires.
True or False
To fulfill the requirements and stay CME
compliant, facilitators must document outcomes
by photographing the inputs captured on the
practice inquiry matrix.
True
False
38. Want to learn more?
Visit TPMGPhysicianEd.org for more information
about clinical education around the
region, including practice inquiry groups in the East
Bay.
To sign up for future facilitator training, contact
Diane M. Purcille.
Notas del editor
Hello and welcome to the Permanente Medical Group’s presentation on Practice Inquiry.To begin, click the start button.
Let’s start with a story. After you have finished reading, click next to continue.
Take a few moments to reflect on the following questions.
Like a Balint group, practice inquiry focuses on a case presented by one of the group. The case is presented succintly and the group goes through the case together, asking clarifying questions, sharing their own clinical experience and practices, as well as researching evidence based guidelines and resources. The critical difference between practice inquiry and Balint is the focus and facilitation. Practice inquiry is not solely focused on analyzing the patient – physician relationship. Practice inquiry integrates this into a larger discussion of what is going on in the situation but focuses on the patient care experience and the dilemmas that arise from clinical practice.
Practice inquiry is focus around clinical uncertainty. What is clinical uncertaintyhttp://www.learnersdictionary.com/search/uncertainty
One way to address these needs is with practice inquiry collegue groups. Click on the boxes to learn more about what Practice Inquiry is.
One way to address these needs is with practice inquiry collegue groups. Click on the boxes to learn more about what Practice Inquiry is.
One way to address these needs is with practice inquiry collegue groups. Click on the boxes to learn more about what Practice Inquiry is.
One way to address these needs is with practice inquiry collegue groups. Click on the boxes to learn more about what Practice Inquiry is.
Click on each item to learn more about what it means to be a facilitator:
Like the host or hostess of a party, the facilitator’s role includes making sure the group feels comfortable. In practice inquiry, that means all participants feel welcome to share their thoughts and their uncertainties without fear of ridicule or judgment.
Admitting what we don’t know is challenging for most of us, but is a necessary to find out what we need to know. Facilitators encourage openness and curiosity in others by modeling their own comfort with uncertainty
Facilitators in practice inquiry function like guides rather than the content experts. Their main goal is to help the group ask the right questions and to collaborate to come up with a range of options to address a problem. Through this process clinicians have the opportunity to think more reflectively and challenge their own assumptions.
Click on the boxes to learn ahout how the model works
The chart matrix contains 7 boxes that are used to organize critical details about the caseThe elements on the grid are meant to represent all the elements that impact our problem solving/ decision making/ and work process. You also can use it to document individual and collective learnings during the evaluation part of the process. Use a camera phone to photograph the matrix and send it out to the group as a reminder of key points after the session is done.
The matrix is a tool that canhelp the group to focus and keep track of the various inputs into discussion. Capturing inputs to the case, thoughts, ideas and various resources as they are shared also helps the group see what is available for discussion and analysis. Capturing information also helps the group see if there are areas that need to be further investigated. The matrix also can serve as the documentation of the outcomes from the group discussion. The information gathered details the knowledge gaps and changes to close those gaps. Outcomes can be seen as changes in knowledge, competency, and commitment to performing a change in practice.Finally the matrix can be helpful as a reinforcement tool sent to the group after the sessions so they can review and refer back to them at a later date should they need to. Take a picture of the matrices filled in and send to the group, as well as your local CME office.
To read through the example facilitator questions for each of the 7 input areas, click on the box. To return to the matrix click back.
As facilitator it’s your job to ensure the group feels safe to share their concerns and the areas they struggle with. But facilitating isn’t the same as giving a lecture.As you read the tips from the experts about facilitating practice inquiry groups take a few moments to think about the strategies that you’ve used in the past.Which strategies do you already use? Which strategies are new to you? How is facilitating practice inquiry different from facilitating other session activities?
Now it’s your turn to practiceDrWellsly is struggling getting her group to contribute to case discussions. What should she do to get the group to add to the conversation? Looking at the list of strategies below, which would you recommend and why?
Go around the room calling on members of the group is not the best approach.Since it can make people feel uncomfortable. A facilitators main job is to enable physician to feel that they have compfortable and welcomig place to share their uncertainty, so this is deficnitely not the right approach/ .
Not saying anythingcan potentially work. People often need some time to think through and gather their thoughts so it is recommended to give people time to think. However the group also would benefit from their facilitator helping them to make connections to their relevant experiences.
Great Call!In this way, DrWellsly encourages others to share and doesn’t come across like she knows all the answers. Asking about approaches in similar situations also opens up the conversation to other relevant experiences. This will allow the group to think more broadly and explore other options.
Hi. I’m Dr Fair. I’m one of the new faculty members for the Practice Inquiry sessions. Can you help me figure out what I need to do to get CME for my session? Sure, I’m glad to. What is your question?I’m looking at the application and its asking about gaps, and practice changes and outcomes. What is that about? CME accredited activities must be designed around. CME is supposed to support physician development, so to do that we need to create activities that are addressing what is needed by the physician audience. Gaps are the difference between where the learner is now and where we want them to be. So what is needed to bridge that gap? A change in knowledge, competence, or performance. The desired outcome is what you want the learner to be able to do after participating. Oh, I see. So the activity has to link to performance somehow? Isn’t it enough to try to understand something new? Understanding is part of the learning process, but that isnt the end goal. For activities to be considered for CME they need to go further. CME has to be designed to change practice in specific ways to address identified problem areas. I have an idea. What if I ask my friend from med school to present about an innovative way to treat this rare disease? She is expert and it would be great to hear about all the new technology that we don’t have yet! The best way to gauge it would be to ask – How will participating in the activity address a need of the learner? What will they be able to do differently or better as a result of participating in the activity? Even though that topic is educational, if they can’t apply the information then how will it improve their practice? Hmm. Ok. Well The great thing about practice inquiry then is its all about issues seen in practice. You’ve been a lot of help – thanks!
Thank you so much for checking out this introduction to Practice Inquiry. To find a practice inquiry group to observe in the East Bay, visit the physician education calendar at TPMG physcianed.orgTo sign up for a future facilitator course, contact the Diane Purcille at the Physcian Education Department.Thanks so much and have a great day.