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CMPA Medical Student Internship Orientation
10/30/2015 CanMEDS 2015 – How will I teach my residents about patient safety? (Co-developed Workshop) I do not have an affiliation (financial or otherwise) with a pharmaceutical, medical device or communications organization. Dr. Ellen Tsai and Ms. Tunde Gondocz, CMPA Friday October 23, 2015 Je n’ai aucune affiliation (financière ou autre) avec une entreprise pharmaceutique, un fabricant d’appareils médicaux ou un cabinet de communication. Dr. Ellen Tsai and Ms. Tunde Gondocz, CMPA Friday October 23, 2015 The International Conference on Residency Education | La Conférence internationale sur la formation des résidents Workshop Outline The International Conference on Residency Education | La Conférence internationale sur la formation des résidents How do you teach patient safety? • Consider how to incorporate patient safety into competency-based curricula • Learn short cuts to find resources in the CMPA Good Practices Guide • Work in small groups to develop ideas to assess CanMEDS milestones © The Canadian Medical Protective Association cmpa-acpm.ca © The Canadian Medical Protective Association cmpa-acpm.ca Q: What is competency-based medical education (CBME)? A: An approach to designing medical training that is focused on outcomes in the form of the abilities of graduates. © The Canadian Medical Protective Association cmpa-acpm.ca 1 10/30/2015 CSHM Conference Pre-Course Transitions of Care Dr. Ellen Tsai, Physician Risk Manager, CMPA Dr. Marcel Doré, McMaster University Ms. Tunde Gondocz, Manager, Education Programs, CMPA September 24, 2015 © The Canadian Medical Protective Association cmpa-acpm.ca © The Canadian Medical Protective Association Multiple Transition Points Admission In-hospital transfers © The Canadian Medical Protective Association cmpa-acpm.ca Learning Objectives Discharge cmpa-acpm.ca Workshop Agenda 1. Using realistic examples, such as handovers, recognize and manage high risk situations that arise during transitions of care in an acute care inpatient setting 2. Develop methods to effectively communicate and document transitions of care to patients, families and other healthcare practitioners © The Canadian Medical Protective Association cmpa-acpm.ca Workshop Competencies Communication at transitions of care Documentation of transfers of care • CSHM Core Competencies in Hospital Medicine: Care of the Medical Inpatient (Phase 1) • Draft CanMEDS 2015 Physician Competency Framework Communication with patients/families © The Canadian Medical Protective Association cmpa-acpm.ca © The Canadian Medical Protective Association cmpa-acpm.ca 2 10/30/2015 Collaborator: Inpatient Management 20.Communicate with consultants, other health care providers re: Course, revisions, diagnosis, management, etc. 22.Ensure effective handover. 24.Promote patient safety through effective health care communication. © The Canadian Medical Protective Association cmpa-acpm.ca CanMEDS 2015 Collaborator Role • Key competency 3. Hand over the care of a patient to another health care professional to facilitate continuity of safe patient care • Enabling competency 3.2 Demonstrate safe handover of care, using both verbal and written communication, during a patient transition to a different health care professional, setting, or stage of care © The Canadian Medical Protective Association cmpa-acpm.ca Hospital handover by resident https://www.youtube.com/watch?list=P Ln6q6RfYBIXX9bCORVJZ0kl71aEyuH9iW &v=arcN9mZRiWA 50% Over of communication breakdowns occur during handoffs © The Canadian Medical Protective Association cmpa-acpm.ca Suggestions for Improving Handovers © The Canadian Medical Protective Association cmpa-acpm.ca Standardizing Content • Limit interruptions, distractions • Allow appropriate time, prioritize with most sick • Face-face exchange allowing interactive questioning © The Canadian Medical Protective Association cmpa-acpm.ca © The Canadian Medical Protective Association cmpa-acpm.ca 3 10/30/2015 Structured Handover Tools • • • • • • www.ipasshandoffstudy.com SBAR/ ISBAR SIGNOUT ANTICipate DeMIST/ MIST HANDOFFS I PASS the BATON • Implementation of bundle associated with 30% reduction in preventable AEs • I-PASS Handoff Bundle – Resident training (theory and simulation) – Change in institutional culture – Faculty development and observation tools [Am J Med Qual 2009:24(3);196-204] © The Canadian Medical Protective Association cmpa-acpm.ca © The Canadian Medical Protective Association cmpa-acpm.ca Role Play Exercise Patient #1 • Work in groups of 3 • 3 different clinical scenarios • I-PASS template – Write notes for 1 scenario – Verbally handover case – Observer completes checklist • Rotate roles Illness severity Patient summary Action list Situational awareness Contingency plan Synthesis by receiver © The Canadian Medical Protective Association cmpa-acpm.ca When Trainees Involved (MIMEPS) 1. Lack of technical competence 2. Lack of Teamwork factors supervision contributed to 70% 3. Handoff of trainee errors problems 4. Excessive workload [Singh Arch Intern Med 2007] © The Canadian Medical Protective Association • Universal standards • Training and CPD for all physicians Policy Statement: Handover Education in Canadian Residency Programs (published April 2014) © The Canadian Medical Protective Association cmpa-acpm.ca US Malpractice Study (MIMEPS) Handoff problems more common in claims involving trainees: 19% [Singh Arch Intern Med 2007] cmpa-acpm.ca © The Canadian Medical Protective Association cmpa-acpm.ca 4 10/30/2015 Competencies and Milestones • Competency – observable ability of a health care professional that develops through stages of expertise from novice to master clinician • Milestone – expected ability of a health care professional at a stage of expertise © The Canadian Medical Protective Association cmpa-acpm.ca ? ? CanMEDS 2015 Collaborator Role • Enabling competency 3.2 Demonstrate safe handover of care, using both verbal and written communication, during a patient transition to a different health care professional, setting, or stage of care • Milestone – Foundations of discipline Communicate with health care professionals during transitions in care, clarifying issues after transfer as needed © The Canadian Medical Protective Association cmpa-acpm.ca 5 10/30/2015 Develop Your Own Checklist The CMPA Good Practices Guide Working in small groups or on your own: 1. Select stage of expertise and relevant milestone 2. Review sample checklist 3. Create/modify checklist based on the stage of practice/relevant milestone © The Canadian Medical Protective Association cmpa-acpm.ca © The Canadian Medical Protective Association “If we really want to improve medical care, maybe we need to expand our educational offerings to target medical students.” History of the GPG CMPA EMBARKS ON PLAN TO INCREASE INVOLVEMENT IN MEDICAL SCHOOLS CMPA Good Practices Guide FACULTY SECTION RELEASED 91,236 CMPA physician and resident members © The Canadian Medical Protective Association 2007 Medical Trainee Program 2009 CMPA HOSTS EXPERT CONSULTATION MEETING 2012 CMPA Good Practices Guide OFFICIALLY LAUNCHED 2015 … WHAT’S NEXT FOR THE CMPA Good Practices Guide? 2013 11,565 Canadian UGME students cmpa-acpm.ca cmpa-acpm.ca © The Canadian Medical Protective Association cmpa-acpm.ca GPG Student Section Investment in the future of the profession • Face-to-face presentations to medical students and residents across Canada • Medical student internship program • CMPA Good Practices Guide • Faculty development workshops © The Canadian Medical Protective Association cmpa-acpm.ca © The Canadian Medical Protective Association cmpa-acpm.ca 6 10/30/2015 GPG Faculty Section © The Canadian Medical Protective Association cmpa-acpm.ca Real-Life Case Studies © The Canadian Medical Protective Association cmpa-acpm.ca Quizzes © The Canadian Medical Protective Association cmpa-acpm.ca Interactive Activities © The Canadian Medical Protective Association cmpa-acpm.ca Using the GPG Student Section • Self-directed learning • Foundational knowledge • “Reverse classroom” © The Canadian Medical Protective Association cmpa-acpm.ca © The Canadian Medical Protective Association cmpa-acpm.ca 7 10/30/2015 What’s New for the GPG? eCommunication and Social Media in 2016 © The Canadian Medical Protective Association cmpa-acpm.ca GPG Faculty Section © The Canadian Medical Protective Association cmpa-acpm.ca GPG Videos on YouTube! cmpa-acpm.ca Index Mapped to CanMEDS 2015 © The Canadian Medical Protective Association © The Canadian Medical Protective Association cmpa-acpm.ca © The Canadian Medical Protective Association cmpa-acpm.ca Filter by Type of Activity © The Canadian Medical Protective Association cmpa-acpm.ca 8 10/30/2015 Resources Organized by Domain Coming soon: • Additional filters • Print button • MCC Objectives • Mobile functionality • “Want to learn more” © The Canadian Medical Protective Association cmpa-acpm.ca © The Canadian Medical Protective Association cmpa-acpm.ca Engagements We are here to build future physicians… © The Canadian Medical Protective Association Workshops cmpa-acpm.ca © The Canadian Medical Protective Association cmpa-acpm.ca Contemporary Assessment Tools • • • • • • • • • © The Canadian Medical Protective Association cmpa-acpm.ca Written tests – SAQs, essays, MCQs Structured oral examinations Direct observation OSCEs and OSPREs Standardized patients Multi-source feedback (360˚ evaluation) Portfolios and logbooks Simulation-based assessment Encounter cards © The Canadian Medical Protective Association cmpa-acpm.ca 9 10/30/2015 Milestones and EPAs Develop an Assessment Plan • Milestone – observable marker of individual's ability along developmental continuum – Milestones used for planning and teaching • Entrustable Professional Activity (EPA) – task in clinical setting that may be delegated to resident once sufficient competence has been demonstrated – Typically, each EPA integrates multiple milestones – EPAs used for overall assessment © The Canadian Medical Protective Association cmpa-acpm.ca Activity Debrief Help us improve. Your input matters. cmpa-acpm.ca cmpa-acpm.ca • Consider how to incorporate patient safety into competency-based curricula • Learn short cuts to find resources in the CMPA Good Practices Guide • Work in small groups to develop ideas to assess CanMEDS milestones © The Canadian Medical Protective Association cmpa-acpm.ca Aidons-nous à nous améliorer. Votre opinion compte. • Download the ICRE App, • Téléchargez l’application de la CIFR • Visit the evaluation area in the West Ballroom Foyer, near Registration, or • Visitez la zone d’évaluation, foyer de la salle de bal Ouest, près du comptoir d’inscription, ou • Go to: http://www.royalcollege.ca/ icreevaluations to complete the session evaluation. • Visitez le http://www.collegeroyal .ca/evaluationscifr afin de remplir une évaluation de la séance. You could be entered to win 1 of 3 $100 gift cards. © The Canadian Medical Protective Association Workshop Outline • What are your challenges in teaching and assessing residents? • Do you have ideas to share with others on competency-based medical education? © The Canadian Medical Protective Association Working in small groups or on your own: 1. Choose a key and enabling competency 2. Select stage of expertise and relevant milestone 3. Find suitable resources (student and faculty) in the CMPA Good Practices Guide 4. Create an assessment plan Vous courrez la chance de gagner l’un des trois chèques-cadeaux d’une valeur de 100 $. The International Conference on Residency Education | La Conférence internationale sur la formation des résidents 10
