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www.cepd.utoronto.ca
3rd National CPD Accreditation Conference - Ottawa September 27, 2011
Integrating CanMEDS Roles in CPD Programs
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Conflict Of Interest Declaration
Kate Hodgson DVM, MHSc, CCMEP • No relevant conflicts of interest
James Meuser MD, CCFP, FCFP • No relevant conflicts of interest
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Workshop Learning Objectives
After active engagement during this workshop you will be better able to: • Explain the seven CanMEDS Roles and their relevance to CPD • Describe key approaches to the use of the CanMEDS framework in the identification of needs assessment and evaluation strategies • Discuss the role for CanMEDS in both self-learning and assessment
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Explore integrating the CanMEDS Roles
In the context of a specific Comprehensive Program
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CPSO Processes that lead to need for Comprehensive Program
Assessments through QA Investigations through ICRC Change of Scope of Practice Re-Entry to Practice
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Current Approach at CPSO to Physician Enhancement
• Specific courses of study • Some CPSO educational programs e.g.
record-keeping, prescribing • CPSO arranges formal preceptorships
• Nothing exists that is comprehensive
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CPSO Identified Need o Educational Program for Physicians with
needs that provides MORE than clinical information in an educationally evidence-informed format
o Family Medicine best place for pilot o Approached CEPD and DFCM at
University of Toronto o Program development grant from CPSO
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Medical Education Literature Review
• Longitudinal • Small Group • Interaction with peers • Practice-based • Directed self-assessment • Opinion leaders • Preceptoring
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Curriculum Committees and Program Pilot
• Inclusive Curriculum Committees • April 2010 • CACHE April 2011 • June 2011 • July 2011
• 2010-2011 Pilot Program with 10 participants
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CanMEDS Roles
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Proposed Program Components • Recruitment- Intake and assessment –
appropriate participants • Shared small group learning (“5
Weekends”) designed around CanMEDS-FM Roles: using multiple teaching methods (interactive, case-based, standardized patients, PBSGL modules)
• Between-session “homework” • Matched Preceptors • Exit documentation and evaluation
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Weekend Design
Content/Topics: Competencies Friday Afternoon and Evening
Ice Breaker- Building community of practice rapport Describe and analyze practice, patients, and health care team Professional, Manager and Advocate
Saturday Morning Interactive presentations Workshops Standardized patients Medical Expert, Collaborator and Communicator
Saturday Afternoon Problem Based Small Group Learning Medical Expert
Sunday Morning Interactive presentations Workshop Manager, Scholar, and Collaborator
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Therapeutic Themes
Family Medicine relevant Therapeutic Theme established
for each weekend
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CFPR Program
Mild Remedial Re-entry
Change of Scope
Personal desire to maintain clinical competence and
practice standards
Practising IMGs
Mature Physicians
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Discussion
• Have you identified a need for a comprehensive CE program based on ALL CanMEDS Roles in your health care community? • De-emphasize Medical Expert? • Address all Roles?
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Curriculum Development
Using the CanMEDS – FM Roles Matrix
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Therapeutic Themes
Weekend Therapeutic Themes
One Chronic Disease
Two Family Medicine across the Life Cycle
Three Health Promotion and Disease Prevention
Four Mental Health
Five Challenging Clinical Situations
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CanMEDS
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medical expert communicator collaborator manager scholar advocate professional
Welcome- Introductions
Patient-centered care; Standardized patients
Office-based team - Collaborative Care Model
Improvement in Family Practice -Why Quality Improvement
Computer Lab: Formulating and Answering Clinical Questions; Web-searching
Non-medical determinants of health
Exploring Professionalism -- Collegial Conversations
Overview of Comprehensive Family Practice Review Program; Family Practice in the 21st Century- CANMEDS
Share Practice Profile – 5Ps
CPD Professional Practice Profile; Identifying CPD needs relevant to practice
PBSG: Diabetes Type 2: What's New?
Choosing an Opportunity for Improvement
PBSG: Hypertension: When it's Difficult to Treat
PBSG: Postmenopausal Women's Health
Medical Record Keeping
Framework for Family Practice; Family Genogram Practice Tool
QI Model for Improvement; Structuring an Improvement- Aim, Measures, Changes
CPD Plan; Learning Objectives; Knowledge, Skill, Practice multiple interventions
Computer Lab: Patient-Family Education on the Web
Ethical issues across the Family Life Cycle
PBSG: Fever in children
Your Medical Career Life Cycle
Using Clinical Practice Guidelines; Evidence-based Medicine
Motivational Interviewing Referral process QI PDSA Cycle;
Process Tools
CPD Professional Learning Project; Linking Learning to Practice; Professional
Working with the Public Health Department
Periodic Health Exam
Computer Lab: Optimal use of CPD web-based resources
PBSG: TBD PBSG: TBD
PBSG: TBDComplex Communication- Conflict; SHERPA
Computer Lab: Optimal Use of Community Web-based Health Resources
QI Data Collection; Data Analysis
Review PLP
Role and limitations of Family Physician as Advocate
Work/Life Balance
PBSG: TBD Cultural SensitivityColleagues in Distress/PHP Program
I CAN PRESCRIBE Telephone/Email Medicine
Working with your Pharmacist Share QI Posters
Review CFPR Program; Update CPD Plan for the coming year;Commitments to Change
Managing patient expectations
Family Physicians: The Leadership Role
PBSG: TBD
Difficult Patients and Families in Crisis; Standardized Patients
PBSG: TBD
session themecompetency
1 Chronic Disease
2
Family Medicine
across the Life Cycle
3
Preventive Medicine/
Health Promotion
4 Mental Health
5Challenging Situations in Practice
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CanMEDS-FM: Communicator Oral and written communication skills Ability to establish therapeutic relationships
with patients/families Effective information gathering and synthesis Effective sharing of information
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Curriculum Focus
Patient-Centred Care Medical Record Keeping Motivational Interviewing Complex Communications Cultural Sensitivity Telephone/Email medicine Difficult Patients & Families
in Crisis
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CanMEDS-FM: Collaborator Participation in collaborative practice Maintenance of positive working environment
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Curriculum Focus
Expanding influence: Co-workers: Office-
based team Family context: Family
genogram Specialists: Referral
Process Community: Web-based
resources Inter-professional:
working with allied professions
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CanMEDS-FM: Manager Management of practice time and career Management of resources Management of practice/organizations/ systems
to maintain effectiveness
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Curriculum Focus
Quality Improvement in Family Practice
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CanMEDS-FM: Scholar Ongoing self-directed learning, based on
reflective practice Information management & critical appraisal Educator
• Patients, families, other HCPs, public, etc. Research
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Curriculum Focus
Continuing Professional Development
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CanMEDS-FM: Health Advocate Respond to individual health needs Respond to community health needs Identify determinants of health within the
community Health promotion
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Curriculum Focus
Non-medical determinants of health
Patient-family education Working with Public
Health Role & limitations of
Family Physician as Advocate
Managing patient expectations
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CanMEDS-FM: Professional
Commitment to patients, profession, society through ethical practice
Respect of regulatory practices Commitment to physician health and
sustainable practice Commitment to reflective practice
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Curriculum Focus Exploring
professionalism Ethical issues Medical Career Life
Cycle Work/life balance Colleagues in distress Family Physicians as
Leaders
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CanMEDS-FM: Family Medicine Expert Integration of all other CanMEDS roles Knowledge, skills and attitudes; procedural
skills Proficient patient-centered assessment and
management; complex clinical situations Coordination of patient care
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Curriculum Focus
PBSGs 2 per weekend session Clinical questions
assigned as homework; debriefed at the following session
Using clinical practice guidelines
Periodic Health Exam I CAN PRESCRIBE
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Discussion
CanMEDS Roles: • Advantages of using CanMEDS
Framework to build curriculum?
• Challenges of using CanMEDS Framework to build curriculum?
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Program Evaluation Strategies • Three main areas to evaluate:
• Perceived program impact • Did it change behaviour and how?
• Sustainability • Can the program continue beyond the pilot and
what will it take for this to happen? • Transferability
• What would it take to implement the curriculum in other (Non-Toronto) settings?
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Multi-Source Feedback
1. Feedback on each session over 5 weekends. 2. Discussion and evaluation on the Sunday
morning of the 5th weekend. 3. Collegial feedback from Canadian Association of
Continuing Health Education (CACHE).
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Results so far… • Uniformly positive evaluations • PBSG modules very popular
• Group planning on staying together AFTER the program is finished
• Recognition of the importance of all the CanMEDS-FM Roles and the need to specifically address and develop those competencies
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I write more detailed referral letters with specific questions – including who is responsible for
follow-up. As a result, I get more detailed reports from specialists, and my patients
receive better care.
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I’m more thorough in researching patient history
before composing referral letters – a learning experience for
myself about the clinical condition and our EMR system.
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I am now allowing time for making notes in the appointment
time. My notes are more complete, I’m no longer taking work home, and my billing is
more accurate.
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The cumulative patient profile facilitates better medicine,
especially when the patient is seen by a colleague. My
colleagues have adopted this practice.
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The QI approach to change in practice has been implemented
nationally.
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Program Goal 2011 – 2012
To equip primary care physicians with high quality skills for 21st century practice.
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Learning Objectives 2011 – 2012 Improve their approach to managing clinical
conditions. Use technology to answer clinical questions
effectively. Provide better patient-centred care. Collaborate and communicate more effectively
with others in the healthcare system. Develop an individualized approach to life-long
learning & professional development.
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Weekend Format 2011-2012
Begin at 2:00 PM Friday. Community-building reflective activity on
Friday. Have a computer lab each weekend. Keep the PBSGs on Saturday afternoon. End each weekend with/at lunch on
Sunday.
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Therapeutic Themes 2011-2012
Weekend Therapeutic Themes One Chronic Disease
Two Family Medicine across the Life Cycle
Three Preventive Medicine – Health Promotion
Four Mental Health
Five Challenging Situations in Practice
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Therapeutic Themes – PBSGs
Include 2 PBSG modules relevant to therapeutic theme in each weekend session. Chosen by faculty for first 2 weekends. Balance to be selected by participants
using Delphi process. Clinical question arising from each PBSG
to be assigned as homework. Homework to be debriefed during the
following session.
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Longitudinal Themes
Additional longitudinal themes throughout the five weekends: Quality Improvement Continuing Professional Development Use of technology
Use standardized patients on the 1st and 5th weekends only.
CPD coaches to support participants’ learning throughout the course.
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Coaching Component of CFPR
2010 – 2011: Preceptors
2011-2012: Coaches
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Coaching
Intentional, consistent, collaborative process.
Supports the development of peers.
Helps colleagues take responsibility for their own initiatives.
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Coach
Facilitator – not authority or auditor.
Asks more than tells.
Listens more than speaks.
Empowers – does not direct.
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Skills of a Coach
Confidence
Competence
Candour
Commitment
Clarity
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Coaching Component of CFPR
Support CFPR Program.
Provide informal advice on a specific step or element of CFPR.
Support successful adaptation and completion of CFPR.
Make recommendations and refer to resources.
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Coaching Support
Application to practice. Adapt generic tools to
specifics of practice.
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Coaching Support
Expand collaborative influence and action.
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Coaching Support
Completion of QI project over the course of CFPR.
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Coaching Support
Navigate the challenges of advocacy.
Explore complexity.
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Coaching Support
Refine CPD focus. Identify multiple,
actionable learning interventions.
Structure PLP.
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Coaching Support
Act as role model.
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Coaching Support Sounding board. Guide to resources for
clinical questions.
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Discussion
• What are the advantages and challenges of Preceptors and Coaches in a CPD Program which integrates all the CanMEDS Roles?
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Questions?
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