End-of-life care education: Design from the National agenda Flinders University Adelaide, Australia Kim Devery - Project Lead Flinders University Adelaide, Australia Good morning. My name is Caroline Litster and I am a project officer on the End-of-Life Essentials team. Today I will be presenting our project and the framework behind our education on behalf of Kim Devery, the lead on this project, who is currently overseas.

Kim Devery & Jennifer Tieman End-of-Life Essentials Palliative & Supportive Services School of Health Sciences Flinders University This talk draws on the substantial pedagogical work behind the End-of-life Essentials eLearning. The project is funded by the Commonwealth Government. Led by Flinders University; Partnered with the CareSearch Palliative Care Knowledge Network Group who provided the infrastructure for the eLearning and website; and also developed the second phase of the project – the implementation toolkit. We also received advice from the Australian Commission on Safety and Quality in Health Care.

Outline of presentation Brief discussion of the educational resource Introduce the four dimensional curriculum framework1 “Issues that matter” Outline how this framework provided the conceptual map for the pedagogy 1. Lee A, Steketee C, Rogers G, Moran M. Towards a theoretical framework for curriculum development in health professional education. Focus on Health Professional Education: A Multi-disciplinary Journal. 2013 Jun;14(3):70. Today I’m going to; Give a brief overview of the educational resource we developed; I will also introduce the four dimensional curriculum framework underpinning the End-of-Life Essentials project that was based on the paper by Lee and colleagues. Each of the elements conveys a message about “Issues that matter”; And I will also outline how this framework provided the conceptual map for the pedagogy. This talk will demonstrate how a coherent and reflexive approach was used to link educational practice with national policy initiatives as well as workforce and inter-professional practice.

The impetus and framework for this education initiative has come from the Australian Commission on Safety and Quality in Health Care’s 2015 National Consensus Statement: Essential elements for safe and high-quality end of life care. This National Consensus Statement was a major undertaking by the Commission and was developed in partnership with health consumers and carers, experts in the field, representatives from public and private hospitals and health services, professional colleges, state and territory health departments, and other government health agencies. Here are the essential elements identified in this document.

End-of-Life Essentials eLearning Developed from Australian Commission on Safety and Quality in Health Care - National Consensus Statement: Essential elements for safe and high-quality end-of-life care eLearning and quality resources on end-of-life care for doctors, nurses and allied health professionals who work in acute hospitals We took this valuable work from the Commission’s Consensus Statement and from it we developed eLearning and quality practice change resources on end-of-life care for doctors, nurses and allied health professionals who work in acute hospitals.

End-of-Life Essentials eLearning Doctors, Nurses & Allied Health Professionals 6 online modules Implementation toolkit Website www.caresearch.com.au/EndofLifeEssentials All Free Evidence-based Peer-reviewed Despite being targeted at acute care, many health care professionals who care for deteriorating patients in other settings also access our eLearning. The eLearning consists of 6 online modules, and an implementation toolkit, to help health care professionals extend their expertise and improve the quality and safety of end-of-life care in hospitals. We have a website– which is located within the CareSearch website All resources – both modules and toolkit - are free, evidence-based and peer-reviewed for quality and relevance. The first 3 modules were launched June 2016; second three were released in October 2016; and the Implementation Toolkit was released in April of this year.

The website serves as the entry point to the modules and the implementation toolkit. The 6 modules help HCPs develop the skills to recognise end-of-life issues, enhance communication strategies, and gain confidence in caring for patients and their families. HCPs can register and access the modules on the homepage, and also through the individual module webpages where you can find more information relating to each specific module, associated references, tools and videos HCPs can also develop their own personal toolkit which will sustain and support what they have learnt in the modules, and help them apply this knowledge to their practice. To date we’ve had over 100,000 visits to our website; over 4,000 HCPs registering to complete the eLearning; and over 500 hard copies of the toolkit distributed – this is also now available on the website for downloading.

eLearning Topics / Modules Dying, a normal part of life Patient-centred communication and shared-decision making Recognising the end of life Planning End-of-Life care / Goals of care Teams and continuity for the patient Responding to concerns The Consensus Statement identified essential elements relating to the way in which end-of-life care should be approached and delivered, and the module topics were derived from the first 5 essential elements. The topics covered by our education include: Dying, a normal part of life Patient-centred communication and shared-decision making Recognising dying Planning End-of-Life care / Negotiating goals of care Effective teamwork; and How to respond when things aren’t going well

Four-dimensional curriculum framework “Issues that matter” What will be known What will be done Why, how and by whom1 1. Lee A, Steketee C, Rogers G, Moran M. Towards a theoretical framework for curriculum development in health professional education. Focus on Health Professional Education: A Multi-disciplinary Journal. 2013 Jun;14(3): p. 75. To guide curriculum development of the eLearning, the four-dimensional framework by Lee, Steketee, Rogers and Moran was used. Each of the 4 elements conveys a message about the “issues that matter”, for example, what will be known, done, why, how and by whom.

Dimension 1: Big picture decisions – the why? The ACSQHC (the Commission) Dying poorly ‘done’ in acute hospitals Majority of health professionals in the workforce have had little or no undergraduate training in end-of-life care provision 52% of Australians die in acute hospitals In the first dimension, Big picture decisions – the why. The Commission‘s work on end-of-life care underscored the education and created the significant bigger picture about why. The areas of knowledge gap identified in the Commission’s Consensus Statement were that: Dying poorly ‘done’ in acute hospitals. The majority of HCPs in the workforce have had little or no undergraduate training in end-of-life care provision. Many Australians spend their last year of life going in and out of hospital, and more than half of those who die each year do so in acute care settings.

Dimension 1: Big picture decisions – the why? The interests and visions encoded into the curriculum design actively shaped the design Peer-reviewed and user tested by Advisory Group, the Commission, clinical leaders and experts, acute hospitals & over 45 health care professionals Further on dimension 1, the interests and visions encoded into the curriculum design actively shaped the design of our eLearning. The education was peer-reviewed and user tested by The National Advisory Group – The Commission, clinical leaders and experts, acute hospitals & over 45 professionals – showing clearly that we consulted widely.

Dimension 2: Capabilities of learners – the what? The process of identification of learning outcomes - ‘what works in the real world’ Interplay between ‘knowing, doing and being’ A peer-reviewed process to gain consensus about boundaries of education, pitch, scope and even the time to complete Dimension 2 - Capabilities of learners – the what - is concerned with identifying sets of learning outcomes. This second dimension describes the knowledge, capabilities and attributes health professionals require and is the primary place where ‘knowing, doing and being’ is articulated. It is concerned with ‘what works in the real world’, that is, becoming and being a health professional is substantially learned on the job, through practising and systematic critical reflection on practice. Again, a peer-reviewed process to gain consensus about boundaries of education, pitch, scope and even the time to complete the education were all from community consultation.

Dimension 3: Teaching, learning and assessment – the how? How will the core educational activities of dimension 3, drive the Dimension 1 and Dimension 2? A metacognitive approach was considered to be vital in terms of increasing capacity of learners across the essential elements in improving quality end-of-life care the why? the what? The third dimension is concerned with the actual development and design of appropriate teaching, learning and assessment activities How will the core educational activities of dimension 3, drive the first dimension (which is the big picture decisions – the why) and the second dimension (which is the capabilities of learners – the what) A metacognitive approach was considered to be vital in terms of increasing capacity of learners across the essential elements identified as core to improving quality EoL care and I’ll talk more about this in the next presentation.

Dimension 4: Organisation - the where? This educational project is pitched at practicing professionals What is important is how we ‘Market’ our education to individual professionals Work with existing quality and safety networks and systems in acute hospitals The fourth dimension considers the organisational context in which curriculum is structured, implemented and experienced – the where? This educational project is not necessarily pitched at universities, but instead at practicing professionals. So what is important is how we: ‘market’ our education to individual professionals; and how we Work with existing quality and safety networks and systems in acute hospitals

Dimension 4: Organisation, the where? Marketing is a huge part of our project Informs our growing learner base of latest evidence and industry news Social media Twitter LinkedIn Facebook Newsletters Direct engagement emails Marketing across multiple platforms has been a huge part of our project in order to create awareness of our education amongst doctors, nurses and allied health professionals. Digital media – particularly social media - has been our primary method to increase brand awareness, encourage engagement and feedback, and provide content that is useful to our target audience to drive them to our eLearning. We regularly post latest evidence, sector news and project updates on Twitter and LinkedIn We have shot interview style films with HCPs relating to end-of-life care and uploaded these to YouTube and Vimeo. Links to these are on our website and we also use these in our social media posts We create targeted adverts to specific healthcare professions and run these through the Flinders University FB page We craft articles for inclusion in the newsletters of targeted organisations, peak bodies and associations to promote our project We send specific direct engagement emails to our newly registered users and current learners to increase module completion rates Marketing also drives our pedagogy informing our growing learner base of latest evidence and industry news

Visit our website or join our networks Website - https:// www.caresearch.com.au/EndofLifeEssentials Twitter - https://twitter.com/EOLessentials LinkedIn - https://www.linkedin.com/in/eolessentials/ Contact: kim.devery@flinders.edu.au Please check out our website, register for our eLearning, or join our networks through these links. If there are any questions relating to curriculum development or module content – Kim Devery, the project lead, is best-placed to answer these queries when she returns later this month – I have included her email contact I am happy to answer any questions relating to the day-to-day running of the project now or I can move straight onto the next presentation and leave the question time to the end?