SES09: Teaching the Competencies: Thinking Outside-of-the-Box 2010 ACGME Annual Education Conference Bardia Behravesh, MA & Alice Edler, MD, MA, MPH Department of Graduate Medical Education

Session Objectives Identify innovative teaching methods used by your residency programs and share them across programs. Leverage existing resources within your institution to teach the ACGME General Competencies. Use a systematic curriculum design approach to develop curriculum.

Background In 2008, Stanford GME conducted a needs assessment with the goal of identifying ways in which it could better serve its residency programs. 63 of 75 Program Directors responded to an online survey. Following the survey, 69 of 75 Program Directors were interviewed.

Findings 46% of respondents requested centralized teaching of the competencies (i.e. delivered by the Dept of GME). 23% of respondents requested more information about educational techniques and resources. 19% of respondents requested web-based learning modules that teach the competencies.

Goals Identify educational techniques and resources to share across programs. Identify avenues for centrally teaching the competencies (including the utilization of web-based learning modules).

Goal 1: Techniques & Resources Initial approach: Searched the web for teaching and evaluation methods (best practices) to post to the Dept of GME web site. Challenges: Limited resources available online Cost Thinking Outside-of-the-Box: Which programs are currently using innovative methods to teach the core competencies (i.e. what ideas can we borrow from our own programs and share across all programs)?

Program Innovations Solicited voluntary submission of innovative teaching strategies by Program Directors. Flagged innovative teaching strategies during internal program reviews. Collected strategies into a spreadsheet and posted to the Dept of GME web site.

Exercise 1 Review the learning activities described in the handout. Using the blank fields, describe an innovative activity developed by your own program that you could potentially share with other programs within your institution.

Goal 2: Centralized Education Initial approach: Looked at developing and/or purchasing web-based learning modules. Challenges: In-house development is costly. Off-the-shelf solutions do not fit needs exactly. Customization of off-the-shelf solutions difficult/costly. Thinking Outside-of-the-Box: What existing content (already available at our institution) can we leverage to teach the competencies?

Regulatory Compliance Training Stanford satisfies various regulatory requirements through the use of online training. Topics include: Patient Rights HIPPA Emergency Codes Quality Management Cultural Diversity Residents are required to complete the modules on a yearly basis.

Mapping Content to Competencies Determined what web-based learning modules were available. Used a spreadsheet to map the modules to the competencies. Posted spreadsheet to the Dept of GME web site.

Mapping Content to Competencies Module Length (min) Frequency ACGME Competency MK PC PBLI CIS Prof SBP Patient Rights (PA) 30 Yearly   X Rapid Regulatory 60 Bi-Annual LIFE Curriculum: Fatigue Code of Conduct 20 Cultural Diversity Emergency Codes 5 1x HIPAA Quality Improvement Respiratory Precautions 25 Restraints/Seclusion

E-learning as a “springboard” A web-based learning module should not be thought of as PRIMARY and SUFFICIENT for competency education. Pre-existing curriculum can act as a springboard for additional learning. Partner the goals and objectives of the pre-existing curriculum with those of additional learning activities.

Systematic Curriculum Development Two commonly used curriculum design approaches in medical education: Tyler’s principles for curriculum and instruction Tyler R, “ Basic Principles of Curriculum and instruction” Chicago, University of Chicago Press, 1949 Kern’s six step approach to curriculum development Kern D, Thomas P, Howard D, Bass E, “Curriculum Development for Medical Education”, Baltimore, Johns Hopkins University Press 1998

Pro’s of Tyler Rationale Simple and straight forward Starts with Goals and Objectives Good for institutional curriculum development Good for modification of pre-existing curriculum Teacher-oriented

Tyler’s Four Questions What educational purposes should the curriculum seek to attain? What learning experiences should be selected to achieve these goals and objectives? How should these learning experiences be organized? How can the effectiveness of these experiences be evaluated?

Goals and Objectives Goals: Overall outcomes Objectives: Criteria by which the educational materials are selected and the content is outlined. Based on: Values Needs Learner Society

Objectives = The Desired Educational Ends The changes in learner behavior/attitudes Not what the teacher does Not a content list Not a vague abstraction but concrete change

Behavioral and Attitudinal Aspects of Objectives Understanding of the important facts and principles Familiarity with the sources of information Ability to interpret data Ability to apply principles Ability to interpret results of investigation Broad and mature interests

Selecting Educational Experiences Real and attainable Satisfying to the learner Multiple and reinforcing

Organization of Educational Experiences Sequencing Increasing complexity, if needed (graduated responsibility) Reinforcing

Implementation Political support for program Procurement of resources (room, standardized patients, etc) Piloting, if possible Introduction Barriers to implementation

Evaluation of the Curriculum Multi-source evaluation of the Written Curriculum Educational Milieu Administration of the Curriculum Faculty Learner

Exercise 2 Review the sample e-learning module and consider the following questions: What competency-based goals and objectives could this module address? If we were to use this module as a springboard, what additional learning experiences could we combine with this module to develop a competency-based curriculum? How would you sequence the learning experiences, including the use of this module? How would you evaluate the effectiveness of your new curriculum in teaching the desired competencies?

Summary Resident learning need not be bounded by program-specific curricula. Rather than develop completely from scratch, look for pre-existing practices and content that can be leveraged. Look across programs for best practices. Look at the institutional level for resources.

Questions? Feel free to contact us: Bardia Behravesh, MA – bbehrave@stanford.edu Alice Edler, MD, MA, MPH – aedler@stanford.edu

Basics of Kern Iterative, Action Research Approach Assumes that you are starting denovo with needs assessment Multi-directional Interactions Good for denovo curriculum planning at the program level

Kern Six Step Curriculum Model

Example Problem Identification: Needs of Targeted Learners provision of care to HIV-AIDS positive patients Needs of Targeted Learners For Family Practice residents Preventative care for HIV infected patients Avoidance of HIV-AIDS, homosexual and substance abuse patients in general Development of Goals and Objectives

Example (continued) Educational Strategies Content Methods Use of ARV drugs Cultural competency with substance abuse patients Methods Use of ARV drugs: didactics followed by test for learning and comprehension Cultural competency with substance abuse patients: role play, Standardized patients

Pro’s Can start from nothing Best used with homogenous set of learners