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Palliative Care Education Across the VA and Beyond

Palliative Care Education Across the VA and Beyond. September 1, 2010 Department of Veterans Affairs Audio Conference 1:30 – 2:30 PM EST. Scott T. Shreve, DO National Director Hospice and Palliative Care Program Department of Veterans Affairs

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Palliative Care Education Across the VA and Beyond

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  1. Palliative Care Education Across the VA and Beyond September 1, 2010 Department of Veterans Affairs Audio Conference 1:30 – 2:30 PM EST Scott T. Shreve, DO National Director Hospice and Palliative Care Program Department of Veterans Affairs Medical Director, Hospice and Palliative Care Unit Lebanon VA Medical Center Lebanon, PA E-mail: scott.shreve@va.gov David E. Weissman, MD, FAAP Education Consultant Center to Advance Palliative Care Professor Emeritus Medical College of Wisconsin President and CEO, Palliative Care, LLC Milwaukee, WI E-mail: dweissma@mcw.edu

  2. Learning Objectives • In this audio conference, you will: • Review a six-step process of curriculum design. • Learn two techniques for increasing learner engagement in palliative care educational experiences. • Provide one example of how to implement a tailored educational dissemination plan.

  3. Instructional Goals There are typically two instructional goals when palliative care teams begin to think about health professional education. 1. Help clinicians improve their palliative care knowledge/skills 2. Help clinicians know why/how/when to contact the palliative care service. This audio conference will focus on Goal 1.

  4. Instructional Goal #1 • Acquisition of attitudes/knowledge/skills in palliative care to • become a more competent clinician.* • The goal of this instruction is a change in behavior: using • new clinical knowledge/skills to improve patient care. • * In most settings, instruction to improve clinical care is at the level of primarypalliative care: basic knowledge and skills that all clinicians need to master to be competent when caring for seriously ill patients.

  5. Attitudinal Barriers • Palliative care, unlike most other domains of medical • education, is fraught with many deeply held attitudinal • barriers to competent care: • Fear of opioid addiction and regulatory scrutiny • Fear of harm by providing bad news or prognosticating • Fear of inducing emotional reactions • Fear of violating ethical or legal standards • Palliative care is only appropriate after all life prolonging treatments have failed

  6. Attitudinal Barriers (continued) • Attitudinal barriers prevent the transformation of new • knowledge and skills into behavior change. • Example ... • Teaching the facts about morphine dosing will not be translated into behavioral change by physicians or nurses if they are fearful of causing addiction.

  7. Attitude Barrier: Self Confidence For many clinicians, there is a large confidence-competence gap!

  8. Self Confidence 26 Palliative Care Clinical Tasks

  9. Knowledge Exam Results

  10. The Realities of Palliative Care Education • The goal of education is to change behaviors; but … • Most palliative care educational programs are • geared toward knowledge … but, • Attitudes form the core barrier to behavioral change, • not knowledge deficits, and, • Attitudes resist change, thus, • Palliative care educational program development • must be carefully designed to fulfill the goal of true • behavioral change.

  11. Instructional Design Principles • Steps in the instructional design process ... • The needs assessment • Writing objectives • Matching objectives to a learning format • Lesson planning • Develop an assessment/evaluation plan

  12. Step 1. The Needs Assessment • The key questions. • Who will be attending? • Why are coming? • What do they already know about the topic? • What are their needs? • - What are their tension points? • What do you have to offer them? • What are the logistics? • Adapted from: How to talk so people will listen: Connecting in today’s • marketplace. Hamlin S. HarperCollins, 2006.

  13. …. The Needs Assessment Needs assessment can be found at Implementation Center share point: (Haylin Genoa for access) https://vaww.visn3.portal.va.gov/sites/NationalImplementationCenter/default.aspx

  14. How Do You Know What the Tension Points Are? • Reflect on your own experiences • What gave (or still gives) you the most anxiety about a • particular topic/case. • Ask the learners • “What do you find most challenging/difficult/anxiety • provoking about (topic)?” • “What are you struggling with?”

  15. Step 2. Learning Objectives • The purpose of objectives ... • Objectives define what the student should be able to • learn/do as a result of the instruction, not what the • teacher intends to say • Communicates your intent to learners, course • directors, and CME directors • Allows for detailed lesson planning • Forms the basis of evaluating outcome.

  16. Learning Objectives • Learning objectives are classified into three domains ... • Attitude Objectives • - Feelings, attitudes, values • Knowledge Objectives • - Facts • Psychomotor (Skill) Objectives • - Doing things

  17. Learning Objectives (continued) Components of an objective Audience – physicians Behavior – calculate a starting dose of IV morphine Conditions – for cancer patients in pain Degree – correctly (usually implied)

  18. Step 3. Match Learning Objectives to a Teaching Method • If the objective is attitudinal, learners will need time to • reflect, process and talk. • If the objective is knowledge, learners will need time • to acquire new facts and ways to relate the facts to • their existing knowledge and experience. • If the objective is a skill, learners will need time to first • acquire knowledge of the skill, then time to practice • the skill. (example below) • Knowledge: Learn the six steps of Giving Bad News • Skill: Demonstrate Giving Bad News to a simulated • patient

  19. Examples of Objective-Based Teaching Methods • Attitude Objectives (feelings) • Provocative questioning: How does the situation make you feel? • Case study with small-group discussion • Group sharing/processing personal attitudes • Knowledge (facts) • Teaching Lecture • Case study with small-group discussion • Self-Study: reading, CD/Video content • Problem based learning • Games • Psychomotor (skills) • Demonstrate a communication skill • Equianalgesic calculations • Writing a prescription

  20. Ideas to Make Lecture More Interesting 1. Ask questions 2. Small group interaction 3. Self-study 4. Testing 5. Self Reflection 6. Demonstrate

  21. Lecture: Style Matters! • Energy • Talk, don’t read • Vary the pace • Comedic relief

  22. Insert Slide Title

  23. Lecture: Getting Their Attention! • The Opening • What you do in the first five minutes of a lecture will • impact who will stay and what they will learn. • Suggestions • Avoid the “cold start”: try to arrive early; interact with • learners prior to starting the lecture. • Use the first five minutes to build tension for learning: • Ask, “what is hard/anxiety provoking about this topic?” • Pose a difficult, yet common, clinical situation • Ask a test question • Show a provocative interaction (e.g. video or role play)

  24. Jeopardy Single Jeopardy Double Jeopardy Final Jeopardy

  25. SINGLE JEOPARDY Partners are Forever What’s the Policy? Who is that Vet VA is Doing What? VAnguard in EOL Care 100 100 100 100 100 200 200 200 200 200 300 300 300 300 300 400 400 400 400 400 500 500 500 500 500 Final Jeopardy Double Jeopardy

  26. Step 4. Lesson Planning • A lesson plan is an organized outline of one • instructional period: • What you plan to do • In what order • Using what method • For how long

  27. Step 5. Evaluation A common way to think about instructional evaluation is in four tiers: Level 1: Was the learner happy with the instruction? Level 2: Did immediate learning occur? Level 3: Did behavior change as a result of the instruction? Level 4: Did the instruction impact the larger clinical enterprise? Adapted from: Kirkpatrick, D.L. (1994). Evaluating Training Programs: The Four Levels. San Francisco, CA: Berrett-Koehler.

  28. Pre and Post Test Scores

  29. Self Efficacy

  30. Knowledge

  31. Department of Veterans Affairs FY 11 Core Program Goals • Palliative care teams in place with core training (Veteran-specific) • At least 55% of inpt deaths have a palliative care consult at every facility • Bereaved family survey results driving quality in every facility • Palliative care leadership in every VISN to disseminate expertise and improve care

  32. Education Action Plan

  33. Summary/Conclusions • Your impact as an educator will be directly • related to your design and preparation of the • instructional session. • - Is the instruction meeting a need of the audience? • - Is the information presented in a coherent and • engaging manner? • Have fun!

  34. References Tools for Teaching. Barbara Gross Davis. Jossey Bass, 1993 Curriculum Development for Medical Education: A Six-Step Approach. David E. Kern, Patricia A. Thomas, Donna M. Howard. Johns Hopkins University Press, 1998 What the best college teachers do. Ken Bain, Harvard University Press, 2004 How to talk so people will listen: Connecting in today’s marketplace. Hamlin S. HarperCollins, 2006. Evaluating Training Programs: The Four Levels Kirkpatrick, D.L. San Francisco, CA: Berrett-Koehler. 1994

  35. Additional Resources Powerful Presentation Techniques URL: http://www.slideshare.net/theWebChef/ppt-powerful-presentation-techniques 2. End-of-Life/Palliative Education Resource Center URL: www.eperc.mcw.edu 3. CAPC Education Resources Go to: http://www.capc.org/palliative-care-professional-development/education-resources/ 4. Teaching Tips Go to: http://honolulu.hawaii.edu/intranet/committees/FacDevCom/guidebk/teachtip/teachtip.htm#criticalthink

  36. Question & Answer Period Thank you for joining us today! ABOUT CAPC The Center to Advance Palliative Care (CAPC) provides health care professionals with the tools, training and technical assistance necessary to start and sustain successful palliative care programs in hospitals and other health care settings. Located at Mount Sinai School of Medicine, CAPC is a national organization dedicated to increasing the availability of quality palliative care services for people facing serious, complex illness.

  37. Audio Conference Evaluation At the conclusion of this audio conference, complete the following short evaluation to provide us with your feedback. Go to: http://www.surveymonkey.com/s/Palliative_Care_Education_Across_VA_and_Beyond NOTE: This survey will only be available for 7 days following the presentation of this audio conference.

  38. Continue the Discussion! At the conclusion of this audio conference, we welcome you to continue the discussion with VA faculty and your peers. Post your questions and comments on the VHA National HPC Mail Group! • Go to the Global Address Book in Outlook • Scroll down to VHA National Hospice & Palliative Care” • Post your message and comments

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