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SCOAR: from theory to practice

SCOAR: from theory to practice. PD Dr. med E . Van Gessel Geneva. Education?. Education is described as one of the « three legs » of academic medicine along with research and clinical work!

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SCOAR: from theory to practice

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  1. SCOAR: from theory to practice PD Dr. med E. Van Gessel Geneva

  2. Education? • Education is described as one of the « three legs » of academic medicine along with research and clinical work! • As research is necessary for the creation of new knowledge, effective education is essential to generate new doctors

  3. Competence? • Being a good Anesthesiologist requires more than strong scientific knowledge and excellent clinical and technical skills • Key qualities alsorequired are: • communicate effectively with patients and colleagues, • act in a professional manner, • cultivate an awareness of one's own values and prejudices, • provide care with an understanding of the cultural and spiritual dimensions of patients' lives. Carr SJ PMJ 2003

  4. Going beyond the “see one, do one, teach one” • Not only a good “knower” but an accountable one • Less theory and more practice-based knowledge • Maintain standards and quality of care • Assessment: Progress defined by competencies achieved and NOT by underlying educational process or knowledge only Greaves JD BJA 1997; Leung WC BMJ 2002

  5. Assessment drives the curriculum • To ensure that trainees are competent to practice medicine we should include: • Consistent guidance • Measurement of performance • Systemic and structured feed-back • Assessment should take place during residency and not afterwards only (using exams) • The ultimate intended goal is the impact on patient safety! Rodriguez-Paz JM PMJ 2009

  6. The DAILY MAIL • ‘Killing season' on NHS wards: Patients at risk when junior doctors start new jobs, says health boss’ • 7,000 medical students start foundation year in August • Hospital death rates rise 8% during the period • NHS chief Sir Bruce Keogh vows to end 'killing season' scandal • From 2013 it'll be compulsory for all juniors to shadow senior doctors • By Jenny Hope • http://www.dailymail.co.uk/news/article-2163382/NHS-wards-Patients-risk-junior-doctors-start-new-jobs-says-health-boss-Sir-Bruce-Keogh.html

  7. The question? How to make competencies concrete… so that they can be clearly assessed?

  8. The SGAR competence-based curriculum or SCOAR • Document defines: • Roles • Domains of competence • Competences as well as Level to be achieved • AHas knowledge of, describes… • BPerforms, manages, demonstrates under supervision • CPerforms, manages, demonstrates independently • D Teaches or supervises others in performing, managing, demonstrating • Learning objectives(& syllabus for more precision) Knowledge / Technical skills / Clinical and Case-management skills / Drills / Specific attitudes (including professionalism, specialist practice and patient consideration) Swiss Catalogue of Objectives in Anesthesiology and Reanimation

  9. CanMeds framework and the SGAR Updated 2005 • Medical Expert: Knowledge/clinical and procedural skills/professional attitudes that are practice-based and contextual: • Collaborator: Team work/consultants • Communicator: Doctor/patient relationship • Manager: Healthcare organization, resources; sustainable practices • Scholar: International patient-safety movement; learning from errors; life-long learning • Professional: attitudes and values (integrity, respect, responsibility…) • Health advocate: health promotion, communities and population Communicator/Team expert

  10. Example of our roles: Professional

  11. Domains of Competence

  12. The competences Levels of achievement

  13. The learning objectives

  14. Another example: Obstetrics

  15. Another example: Obstetrics

  16. The matrix (EPAs) tenCate et al. AcadMed 2007

  17. Teaching, learning, assessing… Context Consistent Guidance Performance Measurement Feed-back Wong A Can J Anaesth 2011

  18. It is impossible! Personal Life?? TRAINING WORK Personal Life??

  19. The pluses of Anesthesiology • Majority of learning occurs in clinical settings • Assessment: • OR: one to one allows formative interactions • Guidance and Motivation • Accurate feed-back (prescriptive, relevant, focused) • Visible technical skills • Different settings (OR, consultation, labour, emergency, etc…) • More “linear” training => Duration of time of training can be varied • Use of simulation tools • Possibilities of focusing only on certain competencies, interactions…(e.g, team-working) • Questions on thought process and decision-making Kathirgamanathan-Woods. BJA-Cont Educ in Anaesth, Crit care & Pain 2011

  20. The minuses of Anesthesiology • OR: uncomfortable experience for the novice • Non-verbal communication • Patient safety is an issue, patient as primary focus • Learners may have a more passive role in challenging cases • Maintaining efficiency of the OR list • Large number of different clinical teachers => variety in practice is confusing! • Rapid OR case turnover = no time for questions and discussion • Identifying “teachable moments” Bould et al. Can J Anaesth 2011

  21. Where we are • New curriculum since 2008 = new training paradigm! • The cultural change is a difficult one: • Collaborative process between teacher and learner • No prescription on how the teacher must teach or the resident must learn… • Agreement upon the assessment of competence and progressive independence of the trainee (certification) • Supervision of juniors should never occur without adequate formative assessment and feed-back • Major influence on the European curriculum

  22. European Curriculum • The differences are small! • Switzerland has pioneered the EBA curriculum • ROLES: major difference? Only 4 • Concept of Leadership, comprises Manager-Communicator-Collaborator (and Health advocate) • Other roles: Medical Expert, Professional, Scholar

  23. European Curriculum • Domains of competence: near identical • Political issues of Emergency, ICM

  24. European Curriculum • For each domain, the competences were discussed twice and rewritten

  25. European Curriculum

  26. European Curriculum • Many different writers from different cultures, backgrounds, trainings… • Confusion between competences and activities/learning objectives • Political issues to be discussed Some good news: 25% countries endorsed the new curriculum; 25% will do it over the next year; 50% are thinking about it!

  27. SCOAR • A tool… Context Consistent Guidance Performance Measurement Feed-back

  28. SCOAR: what will it help you to do? Fit for practice and not dangerous! Assessment of competence (Outcome) Independent and accountable! Progressive independence of the trainee (certification)

  29. What we will have to discuss • Working VS Training? • Change in our culture • Change in our tradition of training • Train tutors • Help training centres • Money…

  30. THANK YOU

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