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DISTRIBUED MEDICAL EDUCATION:DISTRIBUED MEDICAL EDUCATION:BUILDING OUR FUTURE TOGETHERBUILDING OUR FUTURE TOGETHER

2007 MEDICAL EDUCATION 2007 MEDICAL EDUCATION CONFERENCECONFERENCE

DISTRIBUTED MEDICAL EDUCATION:DISTRIBUTED MEDICAL EDUCATION:WILL IT MAKE A DIFFERENCEWILL IT MAKE A DIFFERENCE

TO THE HEALTH OF CANADIANS?TO THE HEALTH OF CANADIANS?

07 May 200707 May 2007

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To be good is noble. To tell To be good is noble. To tell others how to be good is others how to be good is even nobler and a lot less even nobler and a lot less trouble.trouble.

Mark TwainMark Twain

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The rules break like a thermometer . . .The rules break like a thermometer . . .Quicksilver spills across charted systems.Quicksilver spills across charted systems.We’re out in a country that has no language, We’re out in a country that has no language,

no lawsno lawsChasing the raven and the wren Chasing the raven and the wren

through gorges unexplored since through gorges unexplored since dawn.dawn.

Whatever we do together is pure invention.Whatever we do together is pure invention.The maps they gave us were out of date The maps they gave us were out of date

by years. by years. Adrienne Rich,Adrienne Rich, Twenty-one Love Poems Twenty-one Love Poems

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MY REFLECTIONSMY REFLECTIONS

Setting the ContextSetting the Context Today’s CanadiansToday’s Canadians Citizens’ Expectations Citizens’ Expectations

regarding Health regarding Health Citizens’ Expectations of Citizens’ Expectations of

Physicians Physicians Citizens’ Expectations of Citizens’ Expectations of

Distributed Medical EducationDistributed Medical Education Leadership Role re DMELeadership Role re DME

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DISTRIBUTED MEDICAL DISTRIBUTED MEDICAL EDUCATIONEDUCATION

Diverse definitions and broad range of activities

Undergraduate, postgraduate and continuing medical education

Educational events and activities involving learners and teachers who are outside immediate classroom or clinical site

Partner and satellite campuses = ambulatory facilities, community-based facilities, regional hospital facilities, online learning sites, videoconferencing, separate university campuses

Short and long-distance travel AFMC Study (2006)

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““DISTRIBUTED”DISTRIBUTED”

Distributed computing is a method of Distributed computing is a method of computer processing in which computer processing in which different parts of a program run different parts of a program run simultaneously on two or more simultaneously on two or more computers that are communicating computers that are communicating with each other over a network (not with each other over a network (not parallel but integrated processes). parallel but integrated processes). Main goal: to connect users and Main goal: to connect users and resources in a transparent, open resources in a transparent, open and scalable way.and scalable way.

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ELEMENTS OF DMEELEMENTS OF DME

Common curriculum shared across Common curriculum shared across sitessites

Distance between learners/teachers Distance between learners/teachers and central siteand central site

Multiple settings and diverse Multiple settings and diverse settings for learningsettings for learning

Some elements have existed in some Some elements have existed in some programs for some timeprograms for some time

Advanced communication Advanced communication technologiestechnologies

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FUNDAMENTAL FUNDAMENTAL PEDAGOGICAL PEDAGOGICAL PERSPECTIVESPERSPECTIVES

CognitiveCognitive = cognitive processes involved = cognitive processes involved in learning as well as how the brain worksin learning as well as how the brain works

EmotionalEmotional = emotional aspects of learning, = emotional aspects of learning, like motivation, engagement, fun, etclike motivation, engagement, fun, etc

Behavioural Behavioural = skills and behavioural = skills and behavioural outcomes of the learning process, role-outcomes of the learning process, role-playing and application to on-the-job playing and application to on-the-job settingssettings

ContextualContextual = environmental and social = environmental and social aspects which can stimulate learning, aspects which can stimulate learning, interaction with other people, interaction with other people, collaborative discovery and the collaborative discovery and the importance of peer support as well as peer importance of peer support as well as peer pressurepressure

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CHANGING SOCIETYCHANGING SOCIETY

Demographic shiftsDemographic shiftsCultural diversityCultural diversity Increasing urbanizationIncreasing urbanization Impact of technologyImpact of technologyReality of poverty & violenceReality of poverty & violencePollution of the environmentPollution of the environmentRole of womenRole of womenExpectations of public serviceExpectations of public serviceDeclining deference to leaders and Declining deference to leaders and

authorityauthority

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CHANGING SOCIETYCHANGING SOCIETY

Four generations of citizens and patientsFour generations of citizens and patients Elders/Traditionalists/Silent Generation (pre-Elders/Traditionalists/Silent Generation (pre-

1946)1946) Boomers (1946-1965)Boomers (1946-1965) Generation X (1965 – 1980)Generation X (1965 – 1980) Millennials (1980 - )Millennials (1980 - )

Three generations of teachersThree generations of teachers Elders (pre-1946)Elders (pre-1946) Boomers (1946-1965)Boomers (1946-1965) Generation X (1965 – 1980)Generation X (1965 – 1980)

Three generations of studentsThree generations of students Boomers (1946-1965)Boomers (1946-1965) Generation X (1965 – 1980)Generation X (1965 – 1980) Millennials (1980 –Millennials (1980 –

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DEFINING EVENTSDEFINING EVENTS

EldersElders: Patriotism, families, Great : Patriotism, families, Great Depression, World War II, golden age of Depression, World War II, golden age of radio, labour unionsradio, labour unions

BoomersBoomers: Prosperity, children in the : Prosperity, children in the spotlight, television, suburbia, spotlight, television, suburbia, assassinations, Medicare, Cold War, assassinations, Medicare, Cold War, women's liberation, space racewomen's liberation, space race

Generation XGeneration X: AIDS, stagflation, latchkey : AIDS, stagflation, latchkey kids, single parents, MTV, computers, fall kids, single parents, MTV, computers, fall of the Berlin Wall, glasnostof the Berlin Wall, glasnost

MillennialsMillennials: Internet chat, school violence, : Internet chat, school violence, TV reality shows, multiculturalism, the TV reality shows, multiculturalism, the Gulf War, IraqGulf War, Iraq

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CORE VALUESCORE VALUES

EldersElders: Dedication, sacrifice, hard work, : Dedication, sacrifice, hard work, conformity, law and order, patience, respect conformity, law and order, patience, respect for authority, duty before pleasure, for authority, duty before pleasure, adherence to rules, honouradherence to rules, honour

BoomersBoomers: Optimism, teamwork, personal : Optimism, teamwork, personal gratification, health and wellness, personal gratification, health and wellness, personal growth, youth, work, involvementgrowth, youth, work, involvement

Generation XGeneration X: Diversity, thinking globally, : Diversity, thinking globally, balance, techno-literacy, fun, informality, balance, techno-literacy, fun, informality, self-reliance, pragmatismself-reliance, pragmatism

MillennialsMillennials: Confidence, civic duty, : Confidence, civic duty, achievement, sociability, morality, diversity, achievement, sociability, morality, diversity, street smartsstreet smarts

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PERSONALITYPERSONALITY

EldersElders: Conformists, conservative : Conformists, conservative spenders, past-oriented, belief in logic spenders, past-oriented, belief in logic not magicnot magic

BoomersBoomers: Driven, soul-searchers, willing : Driven, soul-searchers, willing to "go the extra mile," love-hate to "go the extra mile," love-hate relationship with authorityrelationship with authority

Generation XGeneration X: Risk-takers, skeptical, : Risk-takers, skeptical, family-oriented, bosses as colleagues, family-oriented, bosses as colleagues, focused on the job not work hoursfocused on the job not work hours

MillennialsMillennials: Optimistic, prefer collective : Optimistic, prefer collective action, tenaciousaction, tenacious

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EMERGING NETWORK EMERGING NETWORK AGEAGE

From the From the Industrial AgeIndustrial Age to the to the Information AgeInformation Age to the to the Network Network AgeAge

Network AgeNetwork Age Distributed culture Distributed culture Decentralized Decentralized Citizen-centered not institution-Citizen-centered not institution-

centeredcentered

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TODAY’S CULTURAL TODAY’S CULTURAL MINDSETMINDSET

Computers are not technology but part of Computers are not technology but part of lifelife

Internet is better than TVInternet is better than TV Reality is no longer realReality is no longer real Doing is more important than knowingDoing is more important than knowing Learning more closely resembles Nintendo Learning more closely resembles Nintendo

than logicthan logic Multitasking is a way of lifeMultitasking is a way of life Typing is preferred to handwritingTyping is preferred to handwriting Staying connected is essentialStaying connected is essential There is zero tolerance for delaysThere is zero tolerance for delays Consumer and creator of information are Consumer and creator of information are

blurringblurring

Jason Frand (2002)Jason Frand (2002)

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UNDERSTANDING OF UNDERSTANDING OF HEALTHHEALTH

Health is a state of complete physical, Health is a state of complete physical, emotional, social and spiritual well-emotional, social and spiritual well-being; it is a resource for everyday being; it is a resource for everyday living.living.

Implications:Implications:Value of one’s own experiences Value of one’s own experiences Social, psychological and spiritual Social, psychological and spiritual factors factors

Gender as health determinantGender as health determinantHealth of person, family, community, Health of person, family, community, population and earthpopulation and earth

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EXPECTATIONS OF CITIZENSEXPECTATIONS OF CITIZENSTavistock Principles (2001)Tavistock Principles (2001)

RightsRights – to health and health care – to health and health care BalanceBalance – individuals and populations – individuals and populations Comprehensiveness Comprehensiveness = treat illness, ease = treat illness, ease

suffering, minimize disability, prevent suffering, minimize disability, prevent disease, promote healthdisease, promote health

Cooperation Cooperation – with those served, with each – with those served, with each other, with those in other sectorsother, with those in other sectors

ImprovementImprovement SafetySafety OpennessOpenness = being open, honest and = being open, honest and

trustworthytrustworthy

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WHAT WE ASK OF WHAT WE ASK OF OUR PHYSICIANS OUR PHYSICIANS

Does my doctor have good medical Does my doctor have good medical knowledge? Is she keeping up to date with knowledge? Is she keeping up to date with advancing medical knowledge?advancing medical knowledge?

Does my doctor know how to appropriately Does my doctor know how to appropriately use that knowledge? Does he have good use that knowledge? Does he have good clinical skills?clinical skills?

Does my doctor treat me respectfully and Does my doctor treat me respectfully and well? Does she listen? Does she treat my well? Does she listen? Does she treat my family/loved ones well?family/loved ones well?

Is my doctor ethical in his behaviour Is my doctor ethical in his behaviour towards me? Does he sometimes use me towards me? Does he sometimes use me for other purposes – to do research, to make for other purposes – to do research, to make a political statement, to get a change he a political statement, to get a change he wants?wants?

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WHAT WE ASK OF WHAT WE ASK OF OUR PHYSICIANSOUR PHYSICIANS

Does my doctor work well with other Does my doctor work well with other health professionals as a true member health professionals as a true member of the team? of the team?

Is my doctor respectful of the other Is my doctor respectful of the other people who work in her organization?people who work in her organization?

Does my doctor work towards the Does my doctor work towards the overall health of people not just his overall health of people not just his individual patients?individual patients?

Does my doctor know how the rest of Does my doctor know how the rest of the system works? Is she working to the system works? Is she working to make it better?make it better?

Does my doctor work to make his Does my doctor work to make his profession better?profession better?

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PROFESSIONALISMPROFESSIONALISM

Professional status is given in trust Professional status is given in trust by societyby society

Professions exist because society Professions exist because society needsneeds and and wantswants them to existthem to exist

Society must feel and see the Society must feel and see the profession’s trustworthinessprofession’s trustworthiness

Professionalism is about both Professionalism is about both individuals and groups of individuals and groups of professionalsprofessionals

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RCPSC: CanMEDS 2000RCPSC: CanMEDS 2000

Medical ExpertMedical ExpertCommunicatorCommunicatorCollaboratorCollaboratorManagerManagerHealth AdvocateHealth AdvocateScholarScholarProfessionalProfessional

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CFPC: Principles of Family CFPC: Principles of Family MedicineMedicine

The patient/physician relationship is The patient/physician relationship is central to the role of the family physician. central to the role of the family physician.

The family physician is an effective The family physician is an effective clinician. clinician.

Family Medicine is a community based Family Medicine is a community based discipline. discipline.

The family physician is a resource to a The family physician is a resource to a defined practice population.defined practice population.

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CHANGING HEALTH CHANGING HEALTH PROFESSIONSPROFESSIONS

Move from traditional inward-looking, reactive Move from traditional inward-looking, reactive culture to outward-looking, proactive culture culture to outward-looking, proactive culture

Shift from profession-centred to patient-centred Shift from profession-centred to patient-centred cultureculture

Shift away from solo practicesShift away from solo practices Blurring professional boundariesBlurring professional boundaries Changes in law re scope of Changes in law re scope of

practice/responsibilitiespractice/responsibilities Increased expectations of inter-professional Increased expectations of inter-professional

collaboration in education and practicecollaboration in education and practice Focus on evidence-informed practiceFocus on evidence-informed practice Increasing demands for Increasing demands for

accountability/transparencyaccountability/transparency InternationalizationInternationalization

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CITIZEN EXPECTATIONS CITIZEN EXPECTATIONS OF DMEOF DME

Pedagogically sound, inclusive of Pedagogically sound, inclusive of cognitive, emotional, behavioural and cognitive, emotional, behavioural and contextual perspectivescontextual perspectives

Inclusive of domains of knowledge, Inclusive of domains of knowledge, clinical skills, and professionalismclinical skills, and professionalism

Ways found to maintain Ways found to maintain compassionate approach and personal compassionate approach and personal touch in the midst of a highly touch in the midst of a highly technological communications technological communications environmentenvironment

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CITIZEN EXPECTATIONS CITIZEN EXPECTATIONS OF DMEOF DME

Inter-professional learning and skills Inter-professional learning and skills developmentdevelopment

Interaction of medical students/residents Interaction of medical students/residents in the distributed clinical settings with in the distributed clinical settings with nursing students, pharmacy students, nursing students, pharmacy students, social work students, etc.social work students, etc.

Exposure across the spectrum of health Exposure across the spectrum of health organizational settingsorganizational settings

Linkages with other social systems (e.g., Linkages with other social systems (e.g., education, social services, employment education, social services, employment initiatives, housing, justice)initiatives, housing, justice)

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CITIZEN EXPECTATIONS CITIZEN EXPECTATIONS OF DMEOF DME

Sustainable re human resources and Sustainable re human resources and financial resourcesfinancial resources

Effective use of technologyEffective use of technology Influence on the development and Influence on the development and

application of technology both in health application of technology both in health care and educationcare and education

Research as an essential component Research as an essential component

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OUTCOMES HOPED FOR OUTCOMES HOPED FOR BY CITIZENSBY CITIZENS

Improved recruitment and Improved recruitment and retention in less favoured areas, retention in less favoured areas, geographically and professionallygeographically and professionally

Better distribution of physicians in Better distribution of physicians in rural and remote areas and among rural and remote areas and among specialtiesspecialties

Physicians more understanding of Physicians more understanding of urban/rural divide, cultural and urban/rural divide, cultural and generation diversitygeneration diversity

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CITIZENS’ QUESTIONS CITIZENS’ QUESTIONS RE DMERE DME

Will this approach to medical education Will this approach to medical education become the norm or will it always be become the norm or will it always be used on an exceptional basis?used on an exceptional basis?

Will the current normative approach be Will the current normative approach be the model for this approach or will this the model for this approach or will this approach change and strengthen the approach change and strengthen the current normative approach?current normative approach?

Will this approach create two classes of Will this approach create two classes of physicians depending on where physicians depending on where education happens?education happens?

Will the members of the public be Will the members of the public be invited to help design and develop DME?invited to help design and develop DME?

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OUR ROLES AS LEADERSOUR ROLES AS LEADERS

VisionaryVisionary CatalystCatalyst Decision-makerDecision-maker InspirerInspirer Facilitator Facilitator PartnerPartner Implementer Implementer EvaluatorEvaluator

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A BlessingA Blessing

May the light of your soul guide you. May the light of your soul guide you. May the light of your soul May the light of your soul

bless the work that you do bless the work that you do with the secret love and warmth of your with the secret love and warmth of your

heart. heart. May you see in what you do May you see in what you do

the beauty of your own soul. the beauty of your own soul. May the sacredness of your work May the sacredness of your work bring healing, light and renewal bring healing, light and renewal

to those who work with you to those who work with you and to those who see and receive your work. and to those who see and receive your work.

May your work never weary you. May your work never weary you. May it release within you wellsprings of May it release within you wellsprings of

refreshment, inspiration and excitement.refreshment, inspiration and excitement.

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May you be present in what you do. May you be present in what you do. May you never become lost in bland May you never become lost in bland

absences. absences. May the day never burden. May the day never burden.

May dawn find you awake and alert, May dawn find you awake and alert, approaching your new day with dreams, approaching your new day with dreams,

possibilities and promises. possibilities and promises. May evening find you gracious and fulfilled. May evening find you gracious and fulfilled.

May you go into the night May you go into the night blessed, sheltered and protected. blessed, sheltered and protected.

May your soul calm, console and renew you.May your soul calm, console and renew you.

John O'Donoghue, John O'Donoghue, Anam CaraAnam Cara

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