Teaching about Audit
and making it fun!
Are you sitting comfortably?
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Does it matter?
Why?
A bit of educational theory…
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Remember Pavlov’s dogs?
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if you teach in conditions that produce pleasure
that subject will produce feelings of pleasure
“conditioning”.
How can you achieve this?
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Comfortable setting
Uninterrupted/bleep-free environment
Relaxed, non-threatening approach
Interaction
Enjoyable session
Make it fun.
Some more theory…
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Approaches to Learning (Gibbs G, 1992)
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Surface approach
Deep approach.
Surface Approach
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Teacher
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selects content
presents material
tests whether it has 'stuck'
Learner tries to remember list of unconnected facts.
Deep Approach
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Learner functions independently
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with the facilitation of the teacher
Learner attempts to make sense of what is to be
learnt
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thinks about ideas and concepts
seeks integration between components
'plays' with ideas.
Does their approach matter?
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Surface approach leads to rapid forgetting
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even on tests of factual recall
a week later, surface approach students score far
lower
Knowledge which involves understanding
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little forgotten even 11 years later.
So, how can we promote a deep
approach to learning about audit?
Avoid overloading with…
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Long teaching sessions
Excessive course material
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So – Less is More!
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Aim for
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Motivation
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Learner activity
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enthusiasm
with time for reflection and “processing”
Interaction with others
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easier to discuss meaning of concepts
playing with ideas.
The traditional approach to
lecturing
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Tell them what you’re going to tell them
Tell them
Tell them what you’ve told them.
Boring!
Instead – start by asking what
they’d like to cover
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Gives you a check-list
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helps you gauge their needs
you may get some surprises
Effectively, it tells them what you’re going to
tell them.
And at the end - get them to
tell you what they’ve learnt
Don’t assume any knowledge
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Ask if they know what the audit cycle is
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someone will nod
ask that person to draw it on a flip-chart
get the others to modify it if needed.
Check everyone has
understood
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No point going further unless they understand
the “audit cycle” concept.
Get them to discuss the
concept
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Challenge them
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“Does audit really matter?”
Get them to discuss the
concept
“Why is it a cycle?”
 “What’s the most difficult part of the
cycle?”
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Get them to show off
“Have any of you
been involved in
audits already?”
 “What did you
do?”
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Ask them to define “criteria”
and “standards”
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Give a pro-forma for criterion and standard
statements
“All patients with xxx should have had
yyy in the last zz months”
 “This should have happened in xx% if
cases”
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Get them to give examples
Check everyone is happy.
Choosing a subject
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Ask them to come up with ways to identify
what needs auditing.
Give tips on choice
“Choose something that interests you“
 “Talk to others that will be involved with
making changes”
 “Do they agree with your proposal?”
 “You won’t get changes made if people
aren’t with you from the start.”
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Give tips on choice
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“Don’t audit something that is already
being done well”
 “You’ll find plenty of areas that do need
improvement!”
Help them prioritise
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“To help yourself prioritise possible audits,
ask yourself:”
 “Is the problem common?”
 “Does it have serious consequences?”
 “Can I do something about it?”
KISS
Give advice on keeping it
simple
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“Make sure there is evidence for your criterion –
check the literature”
“Ensure that the criterion is measurable –
 ‘all asthmatics should have had yearly peak
flows’ is difficult to measure (how many
years will you go back?);
 ‘all asthmatics should have had a PF recorded
in the past year’ is more practical.”
More advice on keeping it
simple
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“If possible, make sure that what you are doing
is fairly easy to measure”
“Think about how reliably all the points in your
criteria are coded or recorded”
“Delegate!”
“Important - don’t try to audit too many criteria
at once – one or two will keep you busy enough.”
Ways to collect data
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Get them to think about methods of gathering data.
Comparing results with
standards
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Start them thinking broadly about why
standards may not be met, e.g.
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Patient reasons
Nurse/Doctor reasons
Organisational reasons.
Implementing change
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Suggest common errors in trying to
implement change
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“Simply saying ‘We’ve got to do better’
won’t result in change.”
Give practical advice
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“You need to think through in detail
 what needs to be done
 who’s going to do it
 when and how.”
"Closing the loop"
“Audit is a continuous cycle”
 “If you didn’t meet the standard and
you’ve planned changes…
 …repeat the audit to see whether the
changes have happened.”
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Instant audit
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Give them a fun audit exercise
“Think of an activity that you aim to do
a few times each week, but suspect you
don't do as often as you should. It can be
as silly (or lewd) as you like”
 “(Examples of activities: the amount of
exercise you've had in the last week; the
number of glasses of wine)”
 “Now audit it and plan changes.”
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Instant audit
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Ask for examples of the fun audits
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reinforce the good points.
Have they grasped the
concepts?
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Ask everyone to come up with one real-life
criterion that they might audit
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give time to think about it, e.g. over coffee.
Have they grasped the
concepts?
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Go round group one by one
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ask rest of group to comment
Ensure
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good points reinforced
poor ideas are addressed and discussed
positively
 “You
could make it even better by…”
 “Have you thought about…”
Commitment to doing an audit
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Try to get them to commit to doing an audit
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suggest setting a deadline
offer to meet with them to hear the results.
A little more theory…
Preferred learning styles
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We have different ways that we prefer to
learn
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activists
reflectors
theorists
pragmatists
Which are you?
Activists
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involve themselves fully in new experiences
are enthusiastic about anything new
thrive on the challenge of new experiences
are bored with implementation
as soon as the excitement from one activity is over,
look for the next.
Activists also…
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like to learn something new
prefer a wide variety of different activities
wish to let their hair down and have fun
like tough problems and challenges.
Reflectors
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like to stand back to ponder experiences and
observe them from many different perspectives
prefer to think about data thoroughly before
coming to any conclusion
philosophy is to be cautious.
Reflectors also…
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prefer adequate time to consider, assimilate
and prepare
want opportunities to assemble relevant
information
like opportunities to listen to other people's
points of view.
Theorists
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think problems through in a vertical, logical way
won't relax until things fit neatly into a rational
scheme
feel uncomfortable with subjective judgments,
lateral thinking and flippancy.
Theorists also…
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prefer lots of opportunities to question
like the programme to indicate a clear
structure and purpose
want to encounter complex ideas and
concepts that are likely to stretch them
expect the approaches to be 'respectable' sound and valid.
Pragmatists
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like making practical
decisions and
solving problems
wish to get on with
things
are impatient with
open-ended
discussions.
Pragmatists also…
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prefer opportunities to practice
like lots of practical tips and techniques
wish to address real problems
expect the session to result in action plans to
tackle their current problems
want experts who can do it themselves.
How can we satisfy these
different learning styles?
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We tend to teach in the way we’d like to learn
Try to include something for each learning
style.
How can we satisfy these
different learning styles?
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Activists:
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Reflectors:
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breaks for discussion; time to think; opportunity to
review at later date
Theorists:
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fun audit; opportunity to “take the pen”
“audit cycle” model; structured approach
Pragmatists:
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lots of practical tips; planning an actual audit.
Ending the session
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Give out audit guide & simple pro-forma
Feedback sheet.
Ending the session
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On-line audit study guide
 www.mharris.eurobell.co.uk/contents.htm
Ending the session
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“Tell me one thing that you’ve learnt from
the session”
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This is
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a form of reflection
reinforcement of what has been learnt
a suggestion of what should have been learnt
involving everyone
“telling them what you’ve told them”.
End on a high…