SMARTr improving training

A Better Training Better Care Pilot
What is SMARTr
“Its not the hours you put in
It’s what you put in the hours”
(Elmer G Letmann)
•The SMART rota (SMARTr) takes what currently
happens anyway (service) and does it SMART(e)r
producing quality training and better patient care.
Currently
adhoc activities
DUMBr
WPBAs
SMARTr blocks
similar colours togeter
Elective
Post
DSU/RAC
Intra
EPAGU
Ante
GOPD
HFH
Theatre
SMARTphone
Definition: a cell
phone that includes
additional software
functions
SMARTrota
Definition:
a rota of blocks
that include
additional
functions
mapped to
curriculum
Module
Read
WPBA
Audit
Course
Forum
Diary
Traine Present Duties
r
EPAGU Block
Modules to
sign off
Core module
16: early preg
TAS early
preg (8-12)
Basic Clinical
Skills
Service/ how
achieved
EGU
ERPC list
A&E
Knowledge
WPBAs
Time given to
complete
knowledge
component
Miscarriage –
StratOG
medical,
Pre- and
OSAT - USS
surgical,
Pro-test
conservative
Ectopic OSAT - lap Audit eg MVA
medical,
A&E forum
OSAT surgical,
ERPC
conservative
Trophoblastic
disease
Weekly
specific
CBD/ CEX
Read and
present
guidelines
Intrapartum Block
Module sign Service/ how
off
achieved
CM 10: Mgt
Labour Ward
of labour
CM 11: Mgt
of delivery
Basic Clinical
Skills
Caesarean
list
HFH
Activities
WPBAs
Pre-test
Pro-test
FBS
Opening and
closing
Perineal
repair
Guideline dept/ RCOG
Time given to
complete
Knowledge
component
StratOG
module
MROP
Audit
Weekly CBD/
Presentation
CEX
Audit
Levels
• Level 1 - basic or observation - understand
principles including indication and common
complications
• Level 2 - intermediate or direct supervision perform under supervision
• Level 3 - advanced or independent practice ability and confidence to perform
GPVTS vs FT vs StR
same phone but different colours/ apps
Proformas
Building evidence
into practice
Detailed teaching
proformas
Based on
guidelines
Cut consultation
time
SMARTr portfolio
Objective Challenges
Objective Solutions
•
outcome based quality management;
•
support initiatives to support excellence.
•
bring service and education closer together;
•
training seen as “a privilege and not a right”,
•
centres of excellence will be rewarded, and training will
be withdrawn from providers where training or clinical
care are judged to be poor.
•
The overall aim of this reorganisation of postgraduate
medical education is:
Specific
• In nature and content of
blocks which matches
curricula
• Progressive vs regressive
training
• Activities allow not just
competence but excellence
Measurable
• Inherent qualitative and
quantitative metrics to judge
provision and quality of
training
• Measurable framework for
ownership of responsibility
for training
Aligned with
• Clinical leadership and
trainee engagement as
trainee involved in mapping
opportunities and tailoring
blocks under supervision
on educationalists
Relationships
• Strengthens relationships
needed to integrate service
with training
• Multi-professional trainers
• Interprofessional training
and learning
Patient Relationships
ignorant NOT stupid
• recent BMA discussion paper (BMA, 2008)
need for a shift in the relationship between
doctor, learner and patient towards patientcentered learning, a more active role for
patients and involving patients as partners
in the education process.
Feedback, shadowing, lectures
Time
• Time for training
• Time for assessments
Why we are confident it is
SMART
We are what we repeatedly do.
Excellence, then, is not an act, but a habit.
~ Aristotle
I hear and I forget. I see and I remember. I do
and I understand. ~ Confucius
(Tell me and I will forget, show me and I may
remember, involve me and I will surely learn).
Teaching
(spoon fed)
Learning
(getting stuck in)
planned/prepared
opportunist
trainer-led
trainee specific
Didactic
interactive lecturing
small group teaching
one to one
away from work situation
patient based
• a design principle, says,
“Repetition means keeping
design for similar themes
consistent….It reinforces
communication and ultimately
helps the reader understand.”
• Repetition is most effective
when it is not over done. You
can try repeating visual
elements through out your
work.
Millers triangle, 1990
•
‘knows’ level -assessed using simple
knowledge tests, e.g. (MCQs).
•
‘knows how’ level -assessed using
unfolding patient management
problems (PMPs) or essay questions.
•
‘shows how’ level - Objective
Structured Clinical Examinations
(OSCEs
IT IS THE DOES WHICH IS DIFFICULT TO
ASSESS in professional practice & refers
to performance in context. SMARTr ethos
Neurobiology
connections, memory, schema hypothesis
Kolb
• theorized that four processes (to make up a
learning cycle) must be present for learning to
occur – SMARTr aim
Want not just solved
cube = competence
Training for excellence
world leader, cutting edge, pioneer
Campaign for SMARTr
training