Training the trainers TTT – demonstration of a workshop

1. Training the trainersTTT – demonstration of a workshop 25th EBCOG and 15th TSOG Congress May 17 – 21, 2017, Antalya, Turkey May 17, 14.00 – 15.30 Hall G Prof Živa Novak Antolič, MD, PhD Ljubljana, SLOVENIA EBCOG TTT working party

2. Training the trainers, basic, demonstrationWednesday, May 17th, 2017 14:00 - 15:30, HALL G 14.00 Welcome; goals of the workshop 14.05 Short lecture and exercise on feedback 14.20 Short lecture and exercise on training practical skills 14.35 Short lecture and exercise on assessment, appraisal and multi-source feedback 15.00 Short lecture and exercise on professionalism and burnout 15.15 Short lecture on parallel thinking (6 thinking hats)

3. Description of a perfect trainer • Having inner will to teach • Having inner power to teach • Ability to observe and discuss • Ability to listen, reflect and ask • Be positive and understanding • Be patient • Understands the topic well herself/ himself

4. The story of TTT 2007 • European Board and College of Obstetrics and Gynecology, EBCOG • European Network of Trainees in Obstetrics and Gynecology, ENTOG • ENTOG demanded that trainers are minimally trained to train • RCOG organized TTT for EBCOG trainers

5. TTT training the trainers84 (72 basic workshops, 12 advanced) more than 800 participants Basic TTT • Feedback • Cognitive skills training • Assessment • Appraisal and MSF • Parallel thinking Advanced TTT2 • How not to burn out • Basics of professionalism • (Self) reflection • Basics of negotiation

6. Prof Živa Novak AntoličUniversity Of Ljubljana, Medical Faculty, University Medical Centre Ljubljana, SLOVENIA Division for Perinatology 6300 deliveries per year

7. FEEDBACK EBCOG TTT 14.05

8. correct and effective feedback is essential for good training

9. TRAINER’S MAIN TASK • Trainer’s main task is to give effective feedback regarding all three domains of learning: • Knowledge • Skills • Attitude

10. FEEDBACK Is essential for progress in training Helps trainee to take responsibility for hers/ his own training

11. If you want to be heard: Use positive words when giving feedback • Try to say: • “it would be better…” • “can we discuss together what you are going to do” • Instead of: “do not do that!”

12. EFFECTIVE FEEDBACK Praise in public Criticize in private 5 : 1 positive : negative

13. Be specific (“the use of vacuum extraction in that situation was problematic”) Focus on actions not personality Constructive Frequent, in small steps EFFECTIVE FEEDBACK

14. Encourage self-reflection • “tell me about this event” • “what would you do differently next time”

15. Exercise: mini talk • Mini talk • Non medical • 2 minutes maximum • prepare to give feedback (Pendelton’s points 1 and 3) • The „trainer“: prepare to give feedback (points 2 and 4)

16. Pendelton’s rule • Let the trainee comment what s/he did good • Let the trainer comment what trainee did good • Let the trainee comment what s/he could do better • Let the trainer comment what trainee could do better

17. TEACHING APRACTICAL SKILLON THE JOBoffice – ward – operating room14.20 – 14.35 EBCOG TTT

18. Three domains of teaching/ learning knowledge behaviour and attitude practical skills

19. Office – ward – operating room 2. Possibility: trainer is in his/hers office, trainee is in the other Calls the trainer if s/he needs an advice The trainer can call the trainee if s/he has an interesting patient 1. Possibility: sitting in Trainer works Trainer explains and asks

20. OFFICE WORK 3. Possibility: with follow-up training At the end of the working day the trainer and the trainee discuss the patients’ cases 4.Possibility: planned training (ideal) Appointments are made in such a way that trainer and trainee can discuss each case immediately after they see the patient

21. HOSPITAL TRAINING IN THE WARD Ward round only Planning phase & ward round Ward round and follow up phase Planning phase & ward round &follow up phase

22. HOSPITAL Non surgical skills for surgeons (NOTSS) www.abdn.ac.uk/iprc/notss 1. SITUATION AWARENESS 2. DECISION MAKING 3. COMMUNICATION AND TEAMWORK 4. LEADERSHIP

23. Development of skills unconsciously competent consciously competent consciously incompetent unconsciously incompetent

24. Trainer has to step down! consciously competent

25. FOUR-STEP COGNITIVE METHOD FOR TEACHING A PRACTICAL SKILL • Trainer does a run through without commentary (motivation) • Trainertalks through & trainer does • Trainee talks through & trainer does only what is correct: as a control to prevent mistakes • Trainee talks through & trainee does

26. COGNITIVE METHOD • The trainee, repeating, makes a mental pattern before physically performing skill • Articulates factual (how to do it), conceptual (why to do it) and strategicknowledge (combined) of steps to perform the skill • The trainer, verbalizing the skill, moves on the trainee’s level

27. EXERCISE – 2 minutes! • how to make a knot • with your tie • with your scarf • A trick with a pencil • A trick with two corks

28. FOUR-STEP COGNITIVE METHOD FOR TEACHING A PRACTICAL SKILL • Trainer does a run through without commentary (motivation) • Trainertalks through & trainer does • Trainee talks through & trainer does only what is correct: as a control to prevent mistakes • Trainee talks through & trainee does

29. Appraisal and multi-source feedback (MSF) EBCOG TTT 14.35

30. APPRAISAL TO SET GOALS FOR THE TRAINEE

31. APERSONALPLANNINGRAISAL A Selection Standard E S S M E N T APPRAISAL vs ASSESSMENT

32. Sets goals Gives support and guidance For the trainee In house Informal Tests competence Objective measurement For licencing body Independent Formal APPRAISALvs ASSESSMENT

33. WHY APPRAISAL • Appraisal should improve education • (Assessment tests knowledge/ skills/ attitude comparing them to minimal standards)

34. Listen Support Advise Identify areas for improvement Plan Inform directly Plan next meeting Confidentiality Positive feedback Pendelton’s rules Do not talk too much Be honest EFFECTIVE APPRAISAL

35. APPRAISAL - THE EDUCATIONAL CYCLE First weekLast week Induction Regular review: FeedbackAppraisal Support Future plansContract Feedback SummativeAdditional guidance assessment(updated plan)

36. APPRAISAL: how to do it • Introductory interview 1 • In the first week after the start of training!! • Take time • Get to know the trainee (CV) • Inform about time schedules and describe hers/ his work

37. APPRAISAL: how to do it • Introductory interview 2 • Be specific about goals • Determine how you two will check the obtained goals • Set the date for next appraisal • Make a contract. Sign. LogBook

38. APPRAISAL: how to do it Regular review • Check (see PDCA cycle) • Set new goals • Take care of additional necessary knowledge/ skills/ attitude

39. Multisource Feedback (MSF) Assesses • behaviour • team working • communication skills

40. Collection of data on doctor’s performancefrom a range of co-workers Specialists Trainees Midwives Feedback collected by educational supervisor, also the self-evaluation form Multisource Feedback (MSF)

41. TRAINEE Ambitious DELEGATE LEAD Not interested DIRECT MOTIVATE Not critical. Less capable Excellent

42. Exercise – role play – 2 minutes • Induction interview or • Interview after 6 months or • Interview before final exam

43. PROFESSIONALISM and BURNOUT 15.00 Short lecture and exercise on professionalism and burnout Prof Živa Novak Antolič, MD, PhD, TTT working party, EBCOG specialist of obstetrics and gynaecology

44. Continuous educationundergraduate – postgraduate – practicing doctors Medical professionalism are knowledge, skills and attitude expected from members of the profession and include: maintaining competence, behaviour by ethical code, integrity, fairness, serving others, promotion of public good, respect, self-regulation and other.

45. Rules should be told in advance Society has changed Medicine is a place where much money can be earned Those entering medical schools might not know what is right and what is wrong Professionalism is threatened

46. PROFESSIONALISM IN MEDICINE Professionalism is so important for medicine and for society that we must have proofs: • That students/trainees/specialists have learnt cognitive basis of professionalism • That they have internalised the values • That both is visible in their attitude and behaviour Cruess RL, Cruess SR, Steinert Y (eds). Teaching medical professionalism 2009

47. Medical profession Medical profession and its members are devoted to those they serve to profession to society. This devotion is the basis for social contract between medicine and society

48. Society expects of medicine: services of the healer assured competence altruistic service integrity accountability transparency objective advice promotion of the public good Medicine expects ofsociety: trust autonomy self-regulation value-driven health care system adequate funds participation in public policy sharedresponsibility for health Social contract

49. vignette Student of the last year of medicine thinks that the surgeon about to start to operate is drunk Identify elements of professionalism, brought by case. Discuss solutions

50. From student to specialist Basic obstacle to professionalism is unprofessional behaviour of teachers. Including me Nobody is perfect Selfreflection helps