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Using the CMPA Good Practice Guide to enhance clinical teaching
4/29/2014 Faculty / Presenter Disclosure Faculty: Dr. Ellen Tsai Employee of: CMPA Using the CMPA Good Practice Guide to enhance clinical teaching Ellen Tsai MD MHSc FRCPC Physician Risk Manager, CMPA Northern Constellations, NOSM April 4, 2014 © The Canadian Medical Protective Association Relationships with commercial interests: None - Grants / Research Support: __________________________ - Speakers Bureau / Honoraria: _________________________ - Consulting Fees: ___________________________________ - Other: ___________________________________________ Conflict of Interest - I have no financial or professional affiliation with any organization that can be perceived as a conflict of interest in the context of this presentation Copyright - Not to be distributed without written permission of CMPA. No audio recording, video recording, or photography is allowed without CMPA's permission. Information is for general educational purposes only and is not intended to provide specific professional medical or legal advice or constitute a “standard of care”. cmpa-acpm.ca © The Canadian Medical Protective Association Learning Objectives cmpa-acpm.ca The CMPA Good Practices Guide • Familiarize and access educational materials from the CMPA Good Practices Guide • Develop a patient safety educational session for either undergrad or postgrad learners © The Canadian Medical Protective Association cmpa-acpm.ca © The Canadian Medical Protective Association cmpa-acpm.ca The CMPA Good Practices Guide Text here Text here Text here Text here cmpa-acpm.ca/gpg ou cmpa-acpm.ca/gbp © The Canadian Medical Protective Association cmpa-acpm.ca © The Canadian Medical Protective Association cmpa-acpm.ca 1 4/29/2014 GPG Student Section Learner Engagement Text here © The Canadian Medical Protective Association cmpa-acpm.ca Text here © The Canadian Medical Protective Association Interactions cmpa-acpm.ca Interactive Case Studies Text here Text here © The Canadian Medical Protective Association cmpa-acpm.ca © The Canadian Medical Protective Association Quizzes cmpa-acpm.ca How a Learner Can Use the GPG Text here Text here • Self-directed learning – Easy navigation encourages browsing • Assigned homework – Statements of completion – “Reverse classroom” • Exam preparation (e.g., MCC) © The Canadian Medical Protective Association cmpa-acpm.ca © The Canadian Medical Protective Association cmpa-acpm.ca 2 4/29/2014 GPG Faculty Section • • • • • Narrative exercises Text and video case studies Trigger questions and suggestions Role-play scenarios Quick activities © The Canadian Medical Protective Association cmpa-acpm.ca © The Canadian Medical Protective Association cmpa-acpm.ca © The Canadian Medical Protective Association cmpa-acpm.ca How a Teacher Can Use the GPG Text here Text here © The Canadian Medical Protective Association cmpa-acpm.ca Activity Sheets Domain 2 – Teams Text here © The Canadian Medical Protective Association cmpa-acpm.ca Text here © The Canadian Medical Protective Association cmpa-acpm.ca 3 4/29/2014 Domain 3 – Communication © The Canadian Medical Protective Association cmpa-acpm.ca Domain 3 – Communication Techniques to Enhance Team Communication © The Canadian Medical Protective Association cmpa-acpm.ca Using SBAR • • • • • Briefings Debriefings Readback SBAR Crew resource management • Checklists • Simulations © The Canadian Medical Protective Association cmpa-acpm.ca Hospital handover by resident © The Canadian Medical Protective Association cmpa-acpm.ca Trigger Questions 1. What factors contributed to this poorly performed handover? 2. What measures could the residents have taken to prevent the patient’s clinical outcome? 3. How could a poor handover contribute to an adverse event? 4. How would you feel if you received this information on handover? © The Canadian Medical Protective Association cmpa-acpm.ca © The Canadian Medical Protective Association cmpa-acpm.ca 4 4/29/2014 Practice Handover with a Partner SBAR DRAW • • • • • • • • Situation Background Assessment Recommendation Domain 3 – Communication Diagnosis Recent changes Anticipated changes What to watch for in the next interval of care READ-BACK (and clarification) © The Canadian Medical Protective Association cmpa-acpm.ca © The Canadian Medical Protective Association Quick Activity – Unintended breaches of confidentiality A 41-year-old female with a history of recurrent depression and multiple hospital admissions is separating from her husband. Although custody is in dispute, she plans to move to a new city with her daughter and requests copies of their medical records from the family physician. A staff member in the office copies both records and puts them in an envelope for pick up. The staff member is unaware of the patient’s change in marital status and the custody dispute. © The Canadian Medical Protective Association Text here Within several days, the ex-husband also requests a copy of his daughter’s medical record. The office staff member mistakenly gives him the envelope that also contains his ex-wife’s medical record. • What is an appropriate office policy or procedure to prevent such a breach of patient confidentiality? © The Canadian Medical Protective Association Text here © The Canadian Medical Protective Association Quick Activity – Unintended breaches of confidentiality cmpa-acpm.ca Domain 4 – Managing risk cmpa-acpm.ca cmpa-acpm.ca cmpa-acpm.ca Domain 6 – Adverse events Text here Text here © The Canadian Medical Protective Association cmpa-acpm.ca 5 4/29/2014 Disclosure Road Map Text here Missed mammogram Text here © The Canadian Medical Protective Association cmpa-acpm.ca Trigger Questions © The Canadian Medical Protective Association cmpa-acpm.ca Domain 7 – Professionalism 1. What could have been done better in this scenario? 2. Does this represent a disclosure discussion? 3. Did the physician meet the patient’s clinical, emotional and information needs? 4. How could the family physician have better disclosed the situation? 5. Was the apology appropriate in this situation? © The Canadian Medical Protective Association cmpa-acpm.ca Quick Activity – The “slippery slope” You have taken the history of a university student who is suffering from anxiety. You seem to have developed a rapport with her. You discuss your own experience with anxiety during your first 2 years of university and how yoga classes seemed to help you. You even offer to take her to one of your classes. © The Canadian Medical Protective Association cmpa-acpm.ca © The Canadian Medical Protective Association cmpa-acpm.ca Quick Activity – The “slippery slope” At the end of the interview she asks to be your friend on Facebook. • How should you respond to the student’s request? • What are the boundary issues in this case? • Discuss how boundary crossings can lead to boundary violations. © The Canadian Medical Protective Association cmpa-acpm.ca 6 4/29/2014 Education Session Worksheet • Develop your own patient safety education session • Share ideas at table • Present ideas to large group – Innovative proposals – “I have some questions” – Help with challenges © The Canadian Medical Protective Association cmpa-acpm.ca Integrating Patient Safety • “Just-in-time” teaching at the bedside – Vulnerabilities in processes of care – Pitfalls in diagnosis • Debrief individual and team activities • Review patient safety articles at journal club • Trainees complete QI project © The Canadian Medical Protective Association cmpa-acpm.ca “Safer patients – every patient, every time” © The Canadian Medical Protective Association cmpa-acpm.ca 7
