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Newer Competencies

Newer Competencies for Medical Teachers Zubair Amin Batch K 42; Dhaka Medical College Associate Professor; Dept of Pediatrics School of Medicine National University of Singapore Senior Consultant and Head; Dept of Neonatology National University of Singapore paeza@nus.edu.sg. 1.

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Newer Competencies

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  1. Newer Competencies for Medical TeachersZubair Amin Batch K 42; Dhaka Medical CollegeAssociate Professor; Dept of PediatricsSchool of MedicineNational University of SingaporeSenior Consultant and Head; Dept of NeonatologyNational University of Singaporepaeza@nus.edu.sg 1

  2. Newer Competencies • Developing content knowledge as an integral part of competencies as teacher • Importance of understanding the context ofmedical practice and applying those into teaching • Integrating education with the healthcare

  3. Timeline to Become a Specialist

  4. What Do We Know will be Different in Future? • Changes in healthcare delivery • Aging population • Explosion of biomedical knowledge • Emergence of new technologies • Rising healthcare cost • Emerging new diseases • Increasing public and student expectation • New learning technologies • Challenges to ethics and professionalism • New generation of learners

  5. Demographic Changes in Developing World Global Impact of Demographic Changes. IMF Working Paper. 2006. WP 06/9

  6. Planning an Evidence-Based Education

  7. Changes in Disease Patterns Ten projected leading cause of Disability Adjusted Life Years (DALYs) in Developing World by 2020. Murray and Lopez. Lancet 1997. 349: 1498-1504.

  8. Traditional Model Upcoming Model Health and well-being Acute care Chronic disease management Elective procedures Palliative care • Medicine • Surgery • Pathology • Radiology • Et cetra

  9. Future of Health Care

  10. Addressing the National Needs • Health and well being • Elderly and adolescent population • Mental health • Ethics and professionalism

  11. Learning Among Millennial Generation • Doing is more important than knowing • Knowledge is no longer perceived to be the ultimate goal (the half-life of information is so short). Results and actions are considered more important than accumulation of facts • Learning more closely resembles Nintendo that logic • Nintendo symbolizes a trial-and-error approach to solving problems; loosing is the fastest way to mastering a game because loosing represents learning. Millennials: Our Newest Generation in Higher Education. Northern Illinois University, Faculty Development and Instructional Design Center; www.niu.edu/facdev

  12. Learning Among Millennial Generation • There is a zero tolerance for delays • Millennials were raised in just-in-time, service-oriented culture. They expect and demand quick turn around in today’s 24X7 culture and do not easily accept delays. • Consumers and creators are blurring • In a file-sharing, cut-and-paste world, distinctions between creator, owner, and consumer of information are fading. The operative assumption is often that if something is digital, it is everyone property. Millennials: Our Newest Generation in Higher Education. Northern Illinois University, Faculty Development and Instructional Design Center; www.niu.edu/facdev

  13. Stress Among Medical Students Hamza Abdulghani. Stress and depression among medical students: A Cross Sectional Study at a medical college is Saudi Arabia. Pakistan J of Medical Sciences. 2008: 24(1).

  14. Hamza Abdulghani. Stress and depression among medical students: A Cross Sectional Study at a medical college is Saudi Arabia. Pakistan J of Medical Sciences. 2008: 24(1).

  15. Higher Education in Digital Age Economist. The Future of Universities: Digital Degree. June 28th. 2004

  16. Higher Education in Digital Age • What can we offer to the students that online e-learning platform can not deliver? • How can we harness the power of technology? • Who would drive the education in the era of rapid development of technology?

  17. Newer Competencies Adding values to existing practice Broadening the range of competencies

  18. A Framework for Newer Competencies • What medical teachers are able to do • How medical teachers approach their teaching • Medical teachers as professionals

  19. A Framework for Newer Competencies • What medical teachers are able to do • Knowledge competencies • Skills competencies • How medical teachers approach their teaching • Scientific underpinning of teaching and learning • Understanding the context of practice • Medical teachers as professionals • Scholarship

  20. What a Medical Teacher Should be Able to Do Knowledge competencies Skills competencies

  21. Knowledge Competencies: Emerging Opportunities • Health • Aging • Mental health • Patient safety • Preventive medicine • Emerging infectious diseases • Genetics, epigenetics, and genomics

  22. Examples: Aging • Biochemistry • Why do we age? • What are the biomolecular changes during aging? • Pathophysiology • What are the changes that take place in organ function during the aging? • Anatomy • What are the changes that take place in musculoskeletal systems during the aging? • What are the modifiable factors in aging?

  23. Examples: Aging • Pharmacology • How do drug-drug, drug-disease interactions affect elderly patients? • How does aging affect metabolism of drugs? • Preventive Medicine: • Why do people age differently? • How can be compress the period of morbidity? • Paediatrics • What are the similarities between approach to problems in paediatrics and elderly population? • What is the impact of death and disability of grandparents on a tri-generational family?

  24. Prerequisites • High level of integration • Continuous faculty development and updating of knowledge • Radical change in the educational planning and delivery

  25. Harden RM. Integration Ladder.

  26. Inter-professional collaboration Medical, nursing, allied health, pharmacy, medical students Interdisciplinary collaboration Science, engineering, public health, epidemiology Harden RM. Integration Ladder.

  27. Technical Competencies: Existing Paradigm • Delivering an effective lecture • Teaching at the bedside • Using simulator/simulation to teach • Providing effective feedback • Facilitating a PBL • Creating a contextual MCQ • Conducting an OSCE • Developing a module

  28. Rationale for Simulation Use • Safe environment, mistake forgiving • Trainee focused versus patient focused • Controlled, structured, and proactive patient exposure • Reproducible, standardized objectives • Opportunity for immediate feedback • Increase public trust in the profession Scalese, Issenberg 2005; McGaghie 2007

  29. Ethical Reason for Use of Simulation “The use of simulation wherever feasible conveys a critical educational and ethical message to all: patients are to be protected whenever possible and they are not commodities to be used as conveniences of training.” Ziv A et al; Academic Medicine. 2003;78:783–788.

  30. Putting the Patient First: Repeated Practice

  31. Putting the Patient First: Infrequent Clinical Situations

  32. Putting the Patient First: : Emergency Team Drills

  33. Putting the Patient First: Privacy and Comfort

  34. Putting the Patient First: Sharpening the Clinical Skills

  35. Learning Outcomes Intubation Suture Heart sounds Pelvic examination Available Options Video >> Simulator >> Real Patient (RP) Plastic model >> Animal tissue >> RP Audio, video >> self-learning modules >> Harvey >> RP Anatomical model >> Standardized patients >> Anesthetized RP >> RP Curriculum Integration & Progressive Exposure

  36. Technical Competencies are Insufficient • Technical competencies alone are not enough to meet the need for the future • Knowledge and skills in pedagogy are closely linked together • We should not repeat what others’ can do better

  37. Value Creation Low volume High complexity manpower cost complexity Moderate volume Moderate complexity High volume Low complexity Volume

  38. Value Creation Value Creation Integrated Seminar Expert Lectures manpower cost complexity TBL, PBL, Simulation, Tutorial Internet resources Study Guides Volume

  39. Critical thinking Clinical judgement Application of knowledge Value Creation Low volume High complexity manpower cost complexity Problem-based learning Simulation Task based learning Moderate volume Moderate complexity Facts Basic concepts High volume Low complexity Volume

  40. "We must acknowledge again that the most important, indeed, the only, thing we have to offer our students is ourselves. Everything else they can read in a book or discover independently, usually with a better understanding than our efforts can convey.” Daniel Tosteson. Dean, Harvard Medical School Learning in Medicine. NEJM. 1979: 301 (13): 690-4.

  41. How Medical Teachers Approach Their Teaching Understanding the Context of Practice

  42. “The knowledge of the world is only to be acquired in the world, not in a closet.” Lord Chesterfield, Letters to his son

  43. Green et all. The Ecology of Medical Care Revisited: NEJM. 2001; 344:2021-5

  44. Leading causes of preventable death worldwide WHO Global Burdon of Diseases

  45. Understanding the Context of Practice • Medical education needs to be firmly linked to the practice of healthcare • Integrating the teaching with the larger context of healthcare is paramount for value creation • The risk of ignoring the environment is akin to burying the your head in the sand during a sandstorm

  46. Medial Teachers as Professionals Scholarship in Education Faculty Development

  47. “Comprehensive faculty development, which is more important today than ever before, empowers faculty members to excel as educators and to create vibrant academic communities that value teaching and learning.” Wilkerson and Irby, 1998. Acad Med 73: 387-396

  48. First Who; Then What • Getting the right people on the team before vision, strategy, and tactics • Getting the right people on the bus, and getting the wrong people off the bus • Put your best people for the greatest opportunities, not for the biggest problem James C Collins. Good to Great. 2001

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