2. Faculty/Presenter Disclosure
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Faculty: Sarah Strasser
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Relationships with commercial interests:
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Grants/Research Support: Nil
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Speakers Bureau/Honoraria: Flinders have paid for my flights to/from Muster; NOSM provided in-kind support
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Consulting Fees: Nil.
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Other: Employee of HSN, Ontario Canada
3. Disclosure of Commercial Support Slide 2
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This conference has received financial support from NT Tourism, NTGPE & FCD Health Ltd in the form of an unrestricted educational grant
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This conference has received in-kind support from NT Tourism in the form of logistical support.
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Potential for conflict(s) of interest:
No payment has been received by the speaker and
No product will be discussed in this presentation
6. Vision for the NTMP:
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A medical program in the NT producing graduates who have particular skills in Indigenous Health and remote medicine; who are ready, willing and able to work in the NT; who are part of a team providing a sustainable and expanded health workforce.
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Improved health outcomes for Northern Territorians
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Positive impact on medical education through out Australia
7. Politics!
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Support within Flinders
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Support external to Flinders
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Government
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CDU/RDH/ASH
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Aboriginal community
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Capital investment
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Accreditation
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Adelaide centric curriculum
–
Content & delivery
8. Background to the project
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Graduate outcomes study by Flinders
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14 graduate outcomes
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comments about deficiencies in the curriculum
(Eg: pharmacy & anatomy)
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Relationship with Faculty:
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complaints – lack knowledge of curriculum, where is the student, lack of engagement
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Implementing the Flinders curriculum in the NT by V/C led to inequitable learning climate
(NB number of hours not a problem)
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Vagaries of V/C and lack of skills in using/etiquette
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Inappropriate case scenarios (different jurisdiction, climate etc)
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Expertise in the NT (teaching & clinical)
9. Need for improvement
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Overall, enjoyed hospital rotations with majority of comments positive about clinical experiences and interaction with hospital- based clinicians from all levels and fields.
3rd year students 2011
Dammed by faint praise!
10. Opportunity for change
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NTMP: curriculum, buildings & context
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Population, SDH, climate, time, distributed
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MD
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Research; CLIC – panel of patients
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NZ model : trainee 4th year (paid)
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Health & Hospital reform
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Activity based funding, & productivity committees
11. Curriculum development
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Traditionally:
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Everything you can think of
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Departmental structure
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New:
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Outcomes based – level of intern
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Competency based
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Core & core plus
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Assessment aligned with objectives & delivery (context)
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Evidence based
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MD
12. 10 skills and(or) common conditions that you feel medical students should have competency in by the end of their rotation/placement
13. ROME
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Core objectives for all clerkships:
1/2. Performance of problem-focus and complete history and physical exam;
3. Understanding and prioritizing of patient problems;
4. logical formation of primary and differential diagnoses;
5. Prompt and clearly written notes, orders, and other paperwork;
6/7 Selection & interpretation of appropriate tests and interventions;
8. Preventive care;
9. Identifies and addressing family, cultural, and community issues/resources;
10. Ability to locate, understand, and apply information from on=line and published medical research.
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Items 11- 18 focus on Interpersonal Skills & Professionalism. Ironically, the Professionalism issues are a frequent cause of clerkship failures, second only to exam failures.
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Each clerkship has also been assigned focus areas for patient assessment, although many of those cross clerkship boundaries:
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Family Medicine is responsible for teaching the integuement and musculskeltal exams;
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Internal Medicine the cardiovascular and pulmonary exams;
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Surgery the abdominal exams,
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Paeds neuroscience, and
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OB/Gyn are more evidenced by title.
North Dakota, US
Example of shared curriculum:
14. Contextualizing the curriculum for the NT overarching objectives:
By the end of today, we will have:
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A thorough understanding of the curriculum
•
a number of different strategies to support learning in the NT
Fit for purpose curriculum
Updated program
Expanded repertoire of learning resources
Rethink the way we do things
Create more “white space” for students
Make this curriculum our own
15. Timing
Focus
Specific learning goals
9.00 – 9.20
Introductions and overview of day
9.20 -10.45
Activity 1
Indicators of Success: Graduate Outcomes Curriculum
Carousel activity
SMART objectives
Align learning to assessment
10.45–11.05
Morning tea
11.05– 11.15 Activity 2
Peer Learning exercise
Paired activity
11.15–12.00
Activity 3
Pre-requisites for students commencing year 3
Miller’s triangle
12.00 –12.45
Activity 4:
Start – End :The bit in-between
Focus on the learner
Scaffolding the curriculum
12.45–1.30 Lunch
Lunch
1.30-1.40
Activity 5
After lunch energizer
Paired activity
1.40-2.30
Activity 6
Maximizing learning opportunities in the NT, engaging students in their learning
innovation
2.30-2.45
2.45-3.30 Activity 7
Being resourceful
Expanding educational strategies
3.30-4.15
Activity 8
Developing a progressive curriculum for generic skills
Curriculum development
4.30
Wrap up, next steps, evaluation & close
16. Outcomes identified for NT Graduates
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General
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Specific
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Knowledge / Conditions
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Skills / Procedural
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Behaviours
What will a successful graduate look like?
What would you see them doing to show you they have achieved this outcome?
NB Provides strategic direction – all activities aligned
Activity 1
17. 14 Flinders Graduate Outcomes
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Cultural safety
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Integrated knowledge
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Clinical competence
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Personal & social – health & illness
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Collaborative practice
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Clinical ethics & law
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Public health
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Evidence informed clinical practice
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Personal & professional behaviour
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Learning & teaching
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Health systems
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Inquiry, research & community engagement
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Patient safety & quality
Flinders University SOM 2010-2011
Activity 1
18. Activity 1: Graduate outcomes
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Carousel activity –specify what behaviours you will see
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SMART objectives:
S
M
A
R
T
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Align learning to assessment
85 minutes
19. Indicators of success:
Review outcomes and place our dots
Red = contentious
Yellow = weak
Green = strong
Activity 1
20. Graduate outcome 5
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5. HEALTH AND CHRONIC CARE MANAGEMENT Application of health promotion and disease prevention principles to clinical practice to support patients’ health decisions and self-management regarding health, illness, injury and disability
•I can summarise key evidence for strategies that influence health outcomes for patient self-management
•I can describe strategies for supporting patient self-care
•I can demonstrate a patient-centred approach using strategies to support patient management and self-care
•I can use epidemiological information to advise patients of risk factors for preventable diseases
Activity 1
22. Outcome 5:
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JMO who can communicate with people about health promotion and disease. Prevention in other context.
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b) delete
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Being collaborative and inclusive of the patient during decision making. To assist in health prevention strategies.
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FOCUS ON INDIVIDUAL PATIENT
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BEHAVIOUR AND USE OF KNOWLEDGE EVIDENCE TO EDUCATE ART
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DEMONSTRATE OMMUNICATION SKILLS
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APPLICATION OF CULTURAL SAFETY
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DUSTINGUISH SOCIAL FACTORS RELEVANT FOR PATIENT
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Keenness to follow up/ and provide ongoing care
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Continuity of CARE
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Understand concept that chronic diseases do not have a ‘cure’.
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Digest evidence for everyday practice.
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Working with client and their knowledge and circumstances
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Understand the NT context regarding health promotion and disease prevention i.e. Contextually bound.
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Know the local context and supports/ services patients can access
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Clear communication of scientific knowledge/ complex concepts in plain language
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The principles in this are covered in the previous areas
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Able to put individual care in context of ‘big picture’
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Awareness of ch health/ public health
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These are regurgitation: a & b
23. Activity 2: scientific resources
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Peer learning
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Paired activity
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Brainstorming (if more than 2) thinking outside of the box
10 minutes
24.
25. Activity 3: Year 3 entry level
What do they have to learn in years 1 & 2 to be useful in the clinical setting in year 3?
Miller’s pyramid
ASK
RIME
Example:
be able to accurately and consistently take a blood pressure reading;
know anatomical landmarks
45 minutes
26. Miller’s pyramid
Knows
Knows how
Shows how
Does
Progression of skills and complexity of tasks
- competence
- assessment
28. Activity 4: the ‘bit’ in the middle
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Start – End, the in-between bit:
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What do students learn easily and what do they struggle with?
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How might we help the learner learn?
•Timeline/ learning map
•Focus on the learner Begin EOY
•Sequencing & Scaffolding the curriculum
Easy Hard
31. Working Lunch (8 days in 8 hours)
How many hours do you work? (and still feel good about it)
How many hours per day do we expect students to work and learn?
Hours per week?
How do you learn best?
What do you find are the barriers and enablers to learning?
45 minutes
32. What do students do?
0
10
20
30
40
50
60
70
Mean hours per day
Min hours per day
Max hours per day
Mean hours per
week
29.47
10.2
22.47
Patient contact time and clinical
teaching
Academic learning situations (eg
tutes/lectures/PBL)
Self-study
Patient contact time and clinical
teaching
Academic learning situations (eg
tutes/lectures/PBL)
Self-study
Totals
Mean hours per week
33. Activity 5: Challenging students to learn and move to the next level
What helps learners learn?
Assessment for learning:
“better today, than you were yesterday”
How do we know?
Professionalism: how they manage themselves,
How they manage others, how they manage the task
L. Schuwirth
34. Activity 6: maximizing learning opportunities in the NT
Part 1
What could we be using but don’t?
Thinking out of the box
Part 2
What are the best learning opportunities to capture the pearls from these encounters
50 minutes
35.
36. Activity 7: Being resourceful
What could be learnt in a different way with a better outcome?
Collegial discussion in discipline specific groups
45 minutes
37. Activity 8: progressive curriculum
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Pull together activities
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Identify across the year what common components students will learn whatever the rotation they are in
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Change structure – curriculum, reporting & assessment to reflect the progressive process
45 minutes
38.
39.
40.
41. Wrap up!
Next steps:
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Evaluation
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Report
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Confirmation of program for next year
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Assessment W/S end of November
Prof Lambert Schuwirth
(world guru on assessment)
Thank you!
42. Name three items you have learnt during the activity? Specify how you will use what you have learnt from this workshop in your teaching and what information you will pass onto your colleagues.
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The content of year 3 course.
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The nature of medical student education.
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The problems facing the Northern Territory.
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Health system approach to medical education.
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Importance of leaving core skills progressively throughout the year.
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Bed side teaching is the best method for year 3 learning.
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Things you see are learnt first.
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‘The parking lot”.
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The wall activity for brainstorming.
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Interaction.
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Importance.
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Determination.
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How complex curriculum planning is.
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Medical student curriculum – expectations of students at our clinic.
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Looking at assessment process.
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Use of reflective activities.
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Mapping skills.
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Those who are interested and their process is exciting
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Will develop some of my own program along similar lines.
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Collective minds is a better approach / more ideas generated
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Group conducted census.
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Different perspectives approach is better.
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Structure of NTMP curriculum.
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Useful in understanding student progress when teaching clinical students.
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Different perspectives regarding assessment.
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Reshaping curriculum framework.
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Inclusion of practitioners in developing the curriculum.
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Better understanding of progression in learning.
43. Changes to the Year 3 curriculum
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More organized! Value for $!
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Limited academic sessions to Monday, Wednesday & Friday afternoon ie 9 hours /week
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Brought in general practice academic session for the whole year (E. Kennedy’s Muster presentation).
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Departments given responsibility for a whole afternoon:
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Medicine & surgery 30 x3 hours/year
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Paeds, O & G, Psych 10 x3 hours/year
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Aboriginal Health, GP & Flinders sessions & self study
