L.E.A.P Learning Essential Approaches to Palliative Care

1. L.E.A.PLearning Essential Approaches to Palliative Care

2. Course Goals • Empower Primary Care • Introductory course on providing care for the terminally ill for primary health professionals. • Knowledge, skills & attitudes • Promote interprofessional collaboration. • Showcase/credibility local palliative care coordinators & resources • Identify local champions. • Catalyze local change. • Educate local community- Press release

3. Considerations • Principal target learners: MDs, RNs, Pharmacists • Target various settings. • Ability to repackage course. • Divided into parts/series. • Various settings (undergraduate, postgraduate) • Ability to vary audience • Hospital-based MDs, RNs, etc • Ability to use components. • Medical, nursing, pharmacy students & residents. • Objects (online repository) • Master copy of modules

4. Considerations • Basic principles & essentials • Refer to more advanced materials • E.g. Ian Anderson, Victoria Course, Hamilton interdisciplinary course • Not just cancer • CPD credits Evidence-best practices based. • Interprofessional • but also respect needs of individual disciplines • Not TTT model • Iterative design process

5. Curriculum DevelopmentKern’s Model Problem Identification. General needs assessment Needs assessment of targeted learners (& technology) Evaluation & feedback Implementation Goals & objectives Education strategies Kern DE, Thomas PA, Howard DM, Bass EB. Curriculum development for medical education: a six-step approach. The Johns Hopkins University Press, Baltimore. USA. 1998.

6. Course development history • Pallium Phase I • Initial course draft (Mazuryk & Pereira) • Advice from Dr. Jocelyn Lockyer (PhD, CME) • Pilot phase of 6 courses- (ongoing revisions based on evaluations: Cheryl Smith, Shannon Pyziak, Cornie Woelk, Ron Spice, Fiona Crow, Robert Wedel, Doreen Oneschuk). • Phase II • Curriculum working group • Romayne Gallagher (MD), Cheryl Smith (SW), Shannon Pyziak (RN), Pat Tichon (Pharm), Gillian Fyles (MD), Fraser Black (MD), Doreen Oneschuk (MD), Ron Spice (MD), Jocelyn Lockyer (PhD). • To date: 4 major revisions.

7. Revision August 2004 • Blind review process • Romayne Gallagher MD (BC.) • Cheryl Smith RN (MB) • Shannon Pyziak RN (MB) • Pat Trozzo Pharm. (MB) • Gillian Fyles MD (BC.) • Fraser Black MD (BC.) • Ron Spice MD (AB) • Robin Love MD (BC.) • Merle Teetaert RN (Sk) • Rob Wedel MD (AB) • Jose Pereira MD (AB)

8. Pedagogical undercurrents • Various learning styles. • Reflective learning & constructivism • Combination of learning methods. • “Theory bursts”. • Cognitive psychology: inductive, forward vs hypothetico-deductive processes. • Hooks • Case-based Group learning • Apply theory, nurture reflection, prompt discussion. • Lead by experienced facilitator/content expert • Constructive learning • Large group discussions • Interprofessional dialogue • Reflective exercises • Self-awareness, suffering.

9. Pedagogical undercurrents • Trigger tapes & video vignettes • "ill-structured situations“ • NOT ideally modeled, uses "reflective questions" to prompt "reflective conversation" • a.. What is going on here? • b.. What issues does this raise for you? • c.. What could have been done differently? J Moon. Reflection in Learning and Professional Development. (1999, London: Kogan Page) • Integrating & weaving themes throughout course • Ethical decision-making, communication. • Repetition

10. Course materials • Local planning guide • Facilitator’s kit • Manual: Facilitator notes (suggested questions, reminder of key points, theory & evidence) • Videos, posters • Participants’ manual

17. “Theory burst” • Short • Main messages • Limit intense discussions but do not stifle questions or discussion either. • Introduce personal clinical experiences & short stories- not too many and not too long.

18. Group facilitation • Role of facilitator • PBL in purist form Studies show no superiority over other methods with respect to knowledge & skills, but more enjoyable and consistent with constructive learning theory. • Process facilitator vs content expert vs process & content facilitator

19. Group Facilitation • Going from “sage on the stage” to “guide on the side” • Don’t give “answers” right away. • Pose reflective questions. • Don’t “shoot down” what appears to be “incorrect” • Do provide alternative perspective.

20. Group facilitation • Key messages • “This is an important point-this is a take-home message”. • 4 or 5 key take home messages for each module • Identify “take home messages” during discussion • Facilitator notes are at times comprehensive- you do not have to cover each point in notes. Pick out main message.

21. Group facilitation • Respect input. • Reframe if necessary. • Ask questions that prompt reflection. • Attitudinal objectives: • Don’t have to agree or disagree (unless unsafe practice), but introduce different perspective. • Find common values. • Reframe discussion: “This is what we will experience when dealing with a difficult patient/family/colleague situation. SO how can we process through this?” • Need not agree but acknowledge. • Highlight practical ideas. • Focus on the problem, not the person

22. Course Evaluation (Dr. J Lockyer & CME Unit at U of Calgary) • Learners’ reactions • Modifications of attitudes • Acquisition of knowledge/skills • Change in individual behaviour • Change in organizational behaviour • Benefit to patients • Changes in organization itself to systematize palliative care- i.e. new policies & procedures, new equipment, community education, increased team work, fundraising etc • Costs

23. Course evaluation • Pre-course survey • Demographics • Comfort level • Identify learning needs • Knowledge quiz • (Attitude survey) • Post Course • Course evaluation • Comfort levels • Knowledge quiz • Commitment to change • (Attitude survey) 3-6 mths Post Course • Commitment to change review • (Comfort levels) • (Knowledge test) • (Attitude survey)