“Three E’s One R”
Evidence, Experience, Emotional Intelligence
Reflection- the glue that holds them all together
1st GCC Conference
Evidence–based Healthcare Professional Development
Session 4: Efficient trends in health- care Professional Training
Professor Jean Ker
Professor Mairi Scott
College of Medicine Dentistry and Nursing
University of Dundee
Evidence based Practice
Clinical
Expertise
Research
Evidence
Patient
Values
The best available evidence modified by patient
circumstances and preference is applied to improve the
quality of clinical judgments
McMaster Clinical Epidemiology Group 1997
Background - Evidence
DEATHS from chronic disease in 2008:
DIABETES
CHRONIC RESPIRATORY DISEASES
Affects 366 million people (6.4% of world population)
Accounts for 4.2 million deaths (12% of all deaths)
Number affected will increase to 552 million by 2030
Asthma affects 300 million people globally
CANCER
Accounts for 7.6 million deaths (21% of all deaths)
Estimated to rise to 21.4 million by 2030
CARDIOVASCULAR DISEASE
Accounts for 17.3 million deaths (48% of all deaths)
Estimated to rise to 23.6 million by 2030
Background - Evidence
Total lives lost per year
HAZARDOUS
(>1/1000)
100,000
REGULATED
Health Care
ULTRA-SAFE
(<1/100K)
Driving
10,000
1,000
Scheduled
Airlines
100
Mountain
Climbing
Bungee
Jumping
10
1
1
10
100
Chemical
Manufacturing
Chartered
Flights
1,000
10,000
100,000 1,000,00 10,000,0
0
00
Number of encounters for each fatality
Leape and Amalberti
2005
European
Railroads
Nuclear
Power
Evidence
Benefits of simulation in Healthcare
•
Benefits to Patients
•
•
•
Benefits to Learners
•
•
•
•
Risks of harm to patients avoided
Undesired interference is reduced
Skills can be practised repeatedly (simple to complex)
Training can be tailored to individuals and teams
Can provide effective feedback to individuals and teams and organisations
Benefits to Health Care Organisations
•
•
•
•
•
•
Tasks/scenarios can be created to demand and aligned to policy
Retention and accuracy are increased
Provide “pre-trained” novice
Transfer of training from classroom to real situation is enhanced
Systems redesign
Standards against which to evaluate performance and diagnose educational
needs are enhanced
Maran and Glavin 2004, Issenberg 2005, Ker and Bradley 2014
For Further Information Contact:
Background Experiential Learning
Use of experiential learning cycle
• What did I do?
• What did it mean and how do I feel?
• How did it relate to previous
knowledge and experience ?
• What will I do next time in different
context ?
Kolb 1974
Clinical method
• Deepening the quality of the learning
using narrative skills in a safe
simulated environment
Greenhalgh 1999
Background - Experience
Lab
Data
Pharmacy
CHI
AHPs
GP
Hospital
Eye Van
Investigations
Screening
Promoting the Development of Managed Clinical Networks in
NHS Scotland, HDL(2002)69
For Further Information Contact:
Scottish Diabetes Survey 2002-2007
Analysis of Key Biomedical Markers
100%
Percentage of Patients
HbA1c
80%
60%
Blood
pressure
40%
Cholester
ol
20%
0%
2002 2003 2004 2005 2006 2007
Data recorded within the previous 15 months
Source: Scottish Diabetes Survey
Background - Emotional Intelligence
Reflection
• Reflective Practitioner
– Reflection in action
– Reflection on action
– Self- awareness
Espoused theories
Theory in action
Reflection – “the glue”
Experience
Emotional
Intelligence
Evidence
The Kuwait-Scotland eHealth
Innovation Network
• Aims
– Deliver clinical service development using a
comprehensive informatics system
– Capacity building through training and development of
staff
– Scientific advance through engagement with international
research community
13
The Context
The elements for transformational capacity
Choice
Element
Certificate
60 SCQF Credits
CORE +
1 Education +
1 Other
Core
Module 2
Module 3
Module 4
Module 5
Module 6
Modern
Diabetes
Care
20 Credits
SCQF
Level 11
20 Credits
SCQF
Level 11
20 Credits
SCQF
Level 11
20 Credits
SCQF
Level 11
20 Credits
SCQF
Level 11
20 Credits
SCQF
Level 11
Transfer Event
MSc/ or Doctoral Study
Diploma
120 SCQF
credits
CORE +
1 Education +
2 Organisation +
1 Research +
1 Other
Available Modules
Programme Board
Thesis Monitoring Committee
MSc
Taught MSc Dissertation Module(60 credits)
Thesis/Professional Project and relevant taught material
SCQF11
60 Credits SCQF 11
=180 SCQF credits
MSc
M Phil
PhD
Professional Doctorate or PhD
Research or Professional Project
SCQF12
PG Cert/Diploma/MSc in Diabetes Care and Education
Clinical
1. Enhanced Self Care in
Diabetes
2. Advanced Nutrition
3. Continuous Subcutaneous
Insulin Infusion
4. Advanced Podiatry
5. Retinal Imaging
6. Safety in Clinical
Communication
7. Advanced Diabetes Practice
Education
1. Training the Trainers
2. Facilitation
3. Learning Organisations
4. Enhanced Self Care in
Diabetes
5. Clinical skills and
simulation for education and
practice
6. Use of simulation for I-P
clinical skills educators
Organisational
1. Reflective Professional
Practice
2. Patient Safety & Quality
Improvement in Diabetes
3 Organisational Approaches
to Delivery of Care
4. Leadership
5. Managing Change
6. Facilitation
7. Learning Organisations
8. Knowledge Management
9. Strategic Partnering
Research*
1. Research Methods
2. E-Health Records Research
CPD
Subunits
= to be added
*Further
modules
University of Dundee Dasman
CPD Certificate
Safety in Clinical Communication
•
Critically appraise evidence of importance of effective
communication in ensuring safe clinical practice
•
Analyse the roles and responsibilities of specific health
care practitioners in ensuring safe and effective
communication strategies
•
Identify, implement and evaluate strategies for
employing safe communication practices with patients
carers or colleagues within a specific clinical setting
•
Critically review methods for evaluating the impact of
communication skills training within a healthcare
organisation
•
Critically reflect upon individual healthcare practice and
clinical communication strategies for enhancing patient
safety through effective healthcare and management
Cert/Dip/MSc Diabetes Care and Education
Challenge of Long Term Conditions
Over 50s in Kuwaitdoctor diagnosed
prevalence
Hypertension
53.4%
Diabetes
50.6%
Heart Disease
17.5%
Diabetes Prevalence Kuwaiti nationals >50 yrs;
Shah et al (2009) Medical Principles and Practice
Top Causes of Adverse Events
– Communication
• 60% of errors
• 70% poor team communication
– Prescribing
– Patient assessment
– Procedural compliance
– Environmental security
– Leadership
Joint Commission of Accreditation of Healthcare
Organisations 2005,
NPSA 2006
For Further Information Contact:
Evidence of simulation
Effective learning from simulation based education
–
–
–
–
–
–
–
Providing feedback (47%)
Repetitive practice (39%)
Integrated into curriculum (25%)
Task difficulty (14%)
Variety of clinical conditions (10%)
Controlled environment (9%)
Defined outcomes (6%)
Issenberg et al (2005) BEME Review Features and uses of high fidelity
medical simulation that lead to effective learning Med Teacher :27(1)
10-28
Methods
• Safety in Clinical Communication
– Use of simulation
• Participants
– Cohort of 18 students
• Evidence, Experience and Emotional
intelligence
• Assignment assessment on reflective
capability
• Evaluation of teaching
Results
1. Evidence for safety in clinical communication
•
•
•
•
•
•
•
•
•
•
•
•
•
Leape L 1994 Errors in medicine JAMA vol273 (23) 1851-1857
Robins J 2008 Saying sorry law society gazette
Tingle J 2010 Being open with patients and learning how to apologise BJN vol19 no 2
Entwhislte et al 2010 Speaking up about safety concerns: multi-setting qualitative study of patients
views and experiences QSHC 19 e33
Vincent C 2003 patient safety understanding and responding to adverse events NEJM 348 1051-1056
Sorensen et al 2008 Health care professionals’ views of implementing a policy of open disclosure of
errors Journal of health services research and policy Vol 13 no 4 227- 232
Baker et al 2005 medical team training programs in health care Advances in patient safety 4 253-267
BMA 2004 Safe handover: safe patients guidance on clinical handover fro patients and managers
CAA 2006 crew resource management training guidance for flight crew CRM instructors and CRM
instructor examiners CAP 737 2 Gatwick CAA
Flin et al 2009 Human factors in patient safety: review of topics and tools WHO
Haig et al 2006 SBAR a shared mental model for improving communication between clinicians Joint
commission Journal on Quality and Patient safety 32 167-175
Leonard et al 2004 The Human factor the critical importance of effective team work and communication
in providing safe care QSHC 13 85-90
Woods 2006 How communication complicates the patient safety movement Patient safety quality health
care
Results
2.Experience of safe communication in healthcare
•
•
•
•
•
•
•
Poor handover across HC settings
Lack of speaking up
No communication training on new developments
Medication errors common
Patients misinformed
Lack of time
Hierarchy
22
Results
3.Experience of Safety tool for clinical communication
•
•
•
•
•
•
Calgary Cambridge
SBAR
Conflict resolution
Team huddle
Daily Briefing
Safety checklist
Results
4.Emotional intelligence
Challenges of communication within the healthcare team
• Busyness
• Having a shared common goal
• Who is in the team
• Challenge to being patient centred
• Not delivering evidence based protocols and
guidelines
• Lack of respect
• Language
Results
Reflection
•Workplace based Projects
A project is an endeavor, having a defined beginning and
end (usually constrained by date, but can be by funding or
deliverables), undertaken to meet unique goals and
objectives, usually to bring about beneficial change or
added value
•Reflection
“There are three methods to gaining wisdom.
• The first is Reflection , which is the highest.
The second is limitation, which is the easiest.
The third is experience, which is the bitterest.”
Confucius
Reflection in Assignments
• Reflection in action
– Connects experience to theory and standards (E)
• Reflection on action
– Analysis of experience (E)
– Sets goals, objectives and strategies
• Self -awareness
– Demonstrates insight (E)
• Resilience, empathy, trustworthiness, feelings
– Assesses own growth
“I cannot teach anybody anything: I can only make
them think. The unexamined life is not worth living”
Socrates 470-399 BC
Evidence – Reflection on Module
6
5
4
3
Series1
2
1
0
Overall rating [5 = Excellent Quality of Relevance of Clarity of Organisation Activities in Feedback [5 = Excellent AVERAGE
of four days - 1 = Very face to face
module
Outcomes of sessions
sessions
from tutors - 1 = Very
Poor]
programme
Poor]
Results
Reflection - the most useful aspects of teaching
• Face to face section, the stations we made were
useful and exciting.
• Communication role models
• I learned about human errors and how we can easily
fall into them. Mostly, I learned not to judge.
• Team work- Learn and practice about project.
• Discuss the challenges in work place.
• The hands on work
• Group working. Positive thinking
Evidence, Experience and Emotional Intelligence
Reflection is the glue
It is what makes us change our behavior
Thank You