An Innovative Educational Model for Junior Doctors in a Tertiary Hospital

1. An Innovative Educational Model for Junior Doctors in a Tertiary Hospital Suzanne White Principal Medical Education Officer Medical Education & Training Service (METS) Royal Brisbane & Women’s Hospital 8 November 2011

2. MIMI Multi-disciplinary Internal Medicine for Interns • A collaboration between METS & IMAC • MIMI- an innovative education program that aims to increase intern training capacity in medicine & enhance interns’ learning (WHO 2006) (Productivity Commission 2005) • Management of acute medical conditions in the older person (Bell, et al 2009) • Interprofessional communication (Zwarenstein 2009) (Hammick, 2007) • Multidisciplinary medical teams (Mudge 2006)

3. MIMI

4. MIMI Project Framework Education Planning (Harden,1986) • Management of the process • Education program need & structure • Aims & objectives • Content • Methods and educational strategies • Assessment/outcomes • Curriculum communication • Environment • Evaluation Framework (Kirkpatrick,1994)

5. Evidence based framework The steps included: (Ruiter, 2010) • Intern learning needs analysis-focus grps, gaps ACFJD • literature review - junior doctors and their learning in a interprofessional context • Evaluation framework -demonstrate educational outcomes-justify connection to the learning objectives

6. Modules MIMI modules: • Clinical Reasoning • Multidisciplinary • Therapeutics & Prescribing

7. Educational Basis • Constructivism- “Acquisition of information in itself does not bring about a change, but the way we structure that information and think with it does” (Crotty, 1998) (Biggs, 1999). • Concept attainment- spiral curriculum (Bruner, 1977) • MIMI - designed to question interns established biases and assumptions • Instruction - authentic tasks - experiences are contextually based and facilitate construction

8. Miller’s Pyramid (Miller 1990) Does (action) Shows how (performance) Knows how (competence) Knows (Knowledge)

9. Clinical Reasoning • Play Video Clip

10. Bloom's Taxonomy of Learning (Bloom, 2011)

11. Clinical Reasoning

12. Clinical Reasoning

13. Clinical Reasoning

14. 1.Reaction 2.Learning Attitudes, knowledge, skills 3.Behaviour Organisational change 4.Results Patient benefits Kirkpatrick’s model of evaluation

15. 1. Reaction & 2. Learning Clinical Reasoning self reported CR Session evaluation data: 2008 n=284, 2009 n=307, 2010 n=356

16. 3. Behaviour - AUDIT DATA% of intern entries P=0.005

17. AUDIT DATAby patient % of intern entries P=0.05

18. Summary of Results Written communication on the patient shared care plan improved following the education intervention Interns self report that their clinical reasoning skills are improving Interns self report the clinical reasoning sessions will assist in assessing & initiating management for patients Interns report they will change day to day work practice in their assessment & management of patients

19. Conclusions • Collaborations of educator and clinician allow evidence based medical education to be developed in the postgraduate space • Structured education has direct application to clinical practice • A paradigm shift and social accountability (O’Sullivan, Stoddard et al. 2010) • Ongoing implementation of MIMI with funding

20. Contact Details Suzanne_white@health.qld.gov.au Ph: 0423 563 435 Acknowledgement Dr Alison Mudge, Consultant PhysicianRBWH Alison_mudge @health.qld.gov.au

21. References • Bell, C., Dunston, R., Fitzgerald,T., Hawke,G., Lee, A.,Lee,A.,Matthews,L.,Nisbet,G.,Pockett,R, Slade,D.,Thistlethwaite,J., White, J. . (2009). Interprofessional Health Education in Australia: The Way Forward: University of Technology, Sydney, University of Sydney, Sydney. • World Health Organization. (2006) The Word Health Report 2006: working together for health. Geneva: World Health Organization. • Productivity Commission. (2005). Australia's health workforce. Canberra: Productivity Commission. • Zwarenstein M, Goldman J, Reeves S. (2009). Interprofessional education: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews 2009(1). • Hammick, M., Freeth, D., Koppel, I., Reeves, S., Barr, H. (2007). A best evidence systematic review of interprofessional education: BEME Guide no.9. Medical Teacher, 29(8), 735-751. • Mudge A, Laracy S, Richter K, Denaro C. Controlled trial of multidisciplinary care teams for acutely ill medical inpatients: enhanced multidisciplinary care. Internal Medicine Journal 2006;36 (9):558–63 • Harden,R. (1986). Ten questions to ask when planning a course or curriculum. Medical Education, 20(4), 356-365 • Kirkpatrick's book Evaluating Training Programs (originally published in 1994; now in its 3rd edition - Berrett-Koehler Publishers). • Ruiter, D. J., M. T. R. Kesteren, et al. (2010). "How to achieve synergy between medical education and cognitive neuroscience? An exercise on prior knowledge in understanding." Advances in Health Sciences Education. • Crotty, M (1998) The Foundations of Social Research: Meaning and perspective in the research program. Crows Nest, Australia: Allen & Unwin. • Biggs (1999). "What the Student Does: teaching for enhanced learning." Higher Education Research & Development Vol. 18(No. 1, 1999): 57-75. • Bruner, J. S. (1960, revised edition 1977) The Process of Education, Harvard University Press • Miller, G. E. The assessment of clinical skills/competence/performance Academic Medicine 1990 Sep;65(9 Suppl):S63-7 • http://www.nwlink.com/ ~donclark/hrd/bloom.html • O’Sullivan, P. S., H. A. Stoddard, et al. (2010). "Collaborative research in medical education: a discussion of theory and practice." Medical Education44(12): 1175-1184.