Improving Practice and Decision Making: Acute Coronary Syndromes

1. BMJ Learning Product backgroundModulesCMEUser trainingDr. Kieran WalshBMJ LearningNovember 2008

2. Overview • Problem • Traditional medical education • BMJ Learning • Resources • Improving practice and decision making • Site demo

3. Problem Acute coronary syndromes • Diagnosis - tests • Local management • Drugs available • Now

4. Traditional medical education…attendance and non-attendance

5. We now have 2 problems – coronary syndromes and traditional medical education • Passive • Variable quality • Variable evidence • Not up to date • Learning things you don’t need to know • Not learning things you need to know • One size fits all • Points driven • No training in team work • No training in communication skills • Training doesn’t change in response to users’ needs • People who really need training are least likely to go for it • People who don’t need training are most likely to go for it • Assessment not fit for purpose

6. BMJ Learning Launched as a full service in 2004 • Learning needs assessment/curricula • PDP • Learning resources

7. Problem solving: assess your learning needs • Six different types of assessment tool • Some involve self assessment, others require input from colleagues and patients

8. Curriculum-driven learning • Junior doctors • Vast number of learning needs • Show the curriculum • Learning resources mapped to the curriculum

9. Your plan and record • A rucksack OR • Automatically records any learning needs discovered by needs assessment • Automatically records completed BMJ modules • Covers non clinical categories as well • Manual input of traditional CPD events • Keeps track of learning achieved and deadlines hit • It is confidential

10. Charles Dickens – “Hard Times” • Facts • Think - learning outcomes • Content - - - Outcomes • On completion of the learning I will be able to competently diagnose and manage patients with acute coronary syndromes

11. Learning resources • Interactive case histories • Just in time • Read reflect respond • Multimedia • Podcasts

12. Interactive case histories – how much will you remember in one month’s time? • preview what you are about to learn (P) • ask yourself questions that you would like to find the answers to (Q) • read the material (R) • recite the material to yourself (S) and • then test yourself by trying to recall the facts that you have learned (T). • PRETEST - CASES – POSTEST (DECISIONS)

13. Just in time • Are you still listening? • Bite sized chunks • Short evidence based review with assessment questions at the end – available when you need it

14. Read reflect respond • Reflective learning • Ethical and professional issues • Reviews

15. Multimedia • Diagnosis • Simulation • C Difficile

16. Podcasts • Lectures to a wider audience • Your questions answered

17. What makes a good doctor? • Knowledge, skills, attitudes, behaviours • Must have a combination – blended learning • JIT – knowledge • ICH - skills • RRR – attitudes • Multimedia - behaviours • Podcasts – knowledge and attitudes

18. Assessment? • Valid and reliable assessment • Multiple choice question

19. A 60 year old man A 60 year old man complains of severe central chest pain. His ECG shows ST elevation in II III and AvF. What is the likely diagnosis? • myocarditis • heart burn • inferior myocardial infarction • chest wall pain

20. The way to a man’s heart The way to a man’s heart is through his…? • Aorta • Pulmonary vein • Pulmonary artery • Stomach

21. A 40 year old man comes to see you with a rash on his abdomen. What is the most likely diagnosis? Mycosis fungoides Atopic eczema Psoriasis Discoid lupus erythematosus Assessment questions

22. Usage 2005 80 000 modules completed 2006 98 000 modules completed 2007 130 000 + modules completed

23. Popular “Excellent learning resource” “ Great and just in time for me” “I now realise my knowledge deficits” “I will change my practice in light of this learning resource”

24. The evidence - have you learned something? The pre-test and post-test scores are as follows: • Mean pretest score 66.2 (24.4) • Mean post-test score 94.3 (4.2) • Mean improvement in score: 28 (95% confidence interval 25.9 to 30.1, p value < 0.001) • Doing the module enabled users to improve their knowledge and skills by a statistically significant amount

25. An academic exercise or has it affected your clinical practice? • 70-80% have changed their practice or confirmed their correct practice as a result of their learning • 80% say they will change their practice as a result of their learning

26. Learning resources • BMJ Learning – commissioned authors/team • Clinical Evidence • BMJ • Heart • GUT • The EMJ • Journal of Clinical Pathology • Guideline-producer – the National Institute of Clinical Excellence • The National Patient Safety Agency • National Cancer Screening This is who you are relying on.

27. Learning resources – improved care • Rheumatology – published in WBLPC • Cardiology – published in PMJ • NPSA – modules are now mandatory in some trusts • C Difficile in association with the Department of Health – part of induction in some trusts

28. CPD for doctors – what is the future? • Excellent learning content • Valid and reliable assessment • Registration • Getting tougher • Learning and clinical practice together

29. BMJ Learning • Allows you assess your knowledge • Regularly updated • Changing in response to users needs • Any time, any place, anywhere! • Tangible proof you have learned something • Self-paced (save and exit) • Multimedia • Interactive

30. What you don’t have to pay for • Trainer accommodation • Trainer travel and subsistence • Learner accommodation • Learner travel and subsistence • Classrooms • Equipment • Off-the-job time • Print costs

31. Content is king BMJ Learning content is • Reliable • Evidence based • Up to date • Comprehensive

32. Coronary syndromes • Find an answer online

33. Site demo • All content • Text and image modules • Simulation centre • Diagnosis • Patient safety • Podcast