1 Ambulatory Pediatric Association Educational Guidelines for Pediatric Residency Tutorial 4 Source: Kittredge, D., Baldwin, C. D., Bar-on, M. E., Beach, P. S., Trimm, R. F. (Eds.). (2004). APA Educational Guidelines for Pediatric Residency. Ambulatory Pediatric Association Website. Available online: ©2004 Ambulatory Pediatrics Association. All Rights Reserved.

2 Ambulatory Pediatric Association Educational Guidelines for Pediatric Residency Educational Planning: Part of a Bigger Picture Successful innovations fit into the program as a whole. They can:  Meet needs and fill gaps  Create variety in teaching/learning methods  Use unique faculty skills or community resources Successful innovators consider interests of all stakeholders:  Leaders  Faculty  Learners  Patients

3 Ambulatory Pediatric Association Educational Guidelines for Pediatric Residency So… Before You Begin Assess needs and opportunities and aim for the “sweet spots” Seek allies among leaders and players Develop supportive resources Create a flexible, strategic game plan

4 Part 1 Creating Educational Change in a Residency Program

5 Ambulatory Pediatric Association Educational Guidelines for Pediatric Residency Challenges to Educational Innovation Challenge #1: A health care system must balance education needs with service demands  Resident and faculty time are stretched to the maximum  Scheduling is complex (hence rather inflexible)  Patient flow fluctuates unpredictably  Novices are rarely efficient or cost effective  Compensation for teaching is often inadequate, so its importance is questioned by “bottom liners”

6 Ambulatory Pediatric Association Educational Guidelines for Pediatric Residency Challenges to Educational Innovation Challenge #2: Tradition is powerful in medicine and medical education!  Many feel threatened by change ( Does it mean I wasn’t well trained? )  Change demands growth and flexibility—and physicians already face many growth demands  Doing anything a new way entails time and risk  Leaders and instructors must be persuaded that the risks and effort are worth it!

7 Ambulatory Pediatric Association Educational Guidelines for Pediatric Residency Opportunities for Educational Innovators 1.Become the solution, not the problem:  Meet a recognized need  Fill a gap  Fix something that is broken 2.Offer benefits to as many people as possible  Save your colleagues work or time  Offer stimulation or challenge  Provide academic advancement opportunities  And always make the boss look good!

8 Ambulatory Pediatric Association Educational Guidelines for Pediatric Residency Opportunities for Educational Innovators 3.Identify required resources in advance:  Develop a budget  Apply for a grant  Balance costs with potential cost savings  Work to win support from administrative leaders 4. Plan carefully and work toward clearly identified goals 5. Combine resourcefulness with persistence

9 Part 2 Qualities of Sound Learning Experiences

10 Ambulatory Pediatric Association Educational Guidelines for Pediatric Residency Sound Educational Methods: Authenticity As adult learners, residents want and need:  Real world learning opportunities  Learning with immediate applicability  Chances to apply theory to practice  Skills for life-long learning In world of competency-based education, experiential learning in the practice setting is key to enhancing performance

11 Ambulatory Pediatric Association Educational Guidelines for Pediatric Residency Sound Educational Methods: Variety Create a balance of experiences to suit different learning styles and use a variety of faculty teaching styles Match methods to content:  Didactic: complex sets of facts and concepts  Interactive: more depth from multiple perspectives  Experiential: skills practiced in authentic settings

12 Ambulatory Pediatric Association Educational Guidelines for Pediatric Residency Sound Educational Methods: Richness and Depth Residents thrive on:  Self-directed learning with choices  Active learning in practical settings  Interactive enrichment  Flexible learning experiences that are adaptable to individual learner needs  Novelty: new approaches, new types of patients, new settings

13 Ambulatory Pediatric Association Educational Guidelines for Pediatric Residency Sound Educational Methods: Good Planning Goal-oriented learning activities and evaluations Efficient use of residents’ time with flexible alternatives Good use of faculty teaching strengths Variety of learning settings Faculty orientation and development Integration of new experience with program as a whole

14 Part 3 How to Plan a Competency-based Learning Experience (with examples from a case study)

15 Ambulatory Pediatric Association Educational Guidelines for Pediatric Residency Step 1: Set Aside Time to Think and Plan Give yourself time to do it right! Build a sound foundation by:  Reviewing program context  Assessing needs and opportunities  Cultivating stakeholders  Developing resources  Creating a step-by-step plan of action

16 Ambulatory Pediatric Association Educational Guidelines for Pediatric Residency Step 1: Example from a Case Study Program Director and Associate Program Director had multiple discussions with GME committee members and OPD faculty Identified rotation for residents which needed further development Created time/space within current rotation by hiring extra staff This freed senior residents ½ day per week to participate in new Residents-as-Teachers Rotation

17 Ambulatory Pediatric Association Educational Guidelines for Pediatric Residency Step 2: Define Educational Outcomes & Set Goals Begin by deciding where you want the process to end: the physician competent in medical practice Translate desired outcomes into learning goals Set priorities to keep goals lists focused Use goals and objectives to structure all subsequent planning decisions

18 Ambulatory Pediatric Association Educational Guidelines for Pediatric Residency Step 2: Example from Residents-as-Teachers Key players developed goals and objectives for Residents-as-Teachers Curriculum Planned outcomes: Residents would be prepared to  Observe and evaluate student performance  Give structured feedback to students  Prepare and present educational conferences

19 Ambulatory Pediatric Association Educational Guidelines for Pediatric Residency Step 3: Coordinate with Program Director Program Directors must ensure that the program as a whole meets all accreditation requirements:  All competencies taught and evaluated  All structural requirements met (e.g., time allotments in each curricular area)  All required functions performed (e.g., quality improvement activities) In the competency-based environment, innovators must fit new educational experiences into the larger picture

20 Ambulatory Pediatric Association Educational Guidelines for Pediatric Residency Step 3: Example from Residents-as-Teachers Associate Program Director and OPD faculty:  Kept PD informed of plans  Confirmed that no essential training requirements would be jeopardized by implementation of program

21 Ambulatory Pediatric Association Educational Guidelines for Pediatric Residency Step 4: Select Learning Activities Avoid redundancy with other program components Offer rich learning value for a variety of learners Use time and resources efficiently Involve other faculty Include plans for skill maintenance and reinforcement Combine education with evaluation wherever feasible

22 Ambulatory Pediatric Association Educational Guidelines for Pediatric Residency Step 4: Example from Residents-as-Teachers A variety of activities were identified, including: Resident observes students performing H&P and gives structured feedback Resident conducts Brief Structured Observation as part of a student encounter in clinic and gives structured feedback Faculty observes resident teaching students (with feedback) Resident prepares and presents a teaching conference (with feedback)

23 Ambulatory Pediatric Association Educational Guidelines for Pediatric Residency Step 5: Plan Faculty Roles You will need other faculty to help with:  Teaching  Supervision  Coordination  Evaluation Encourage them to reinforce your educational goals in their own settings Get them involved early in the planning process!

24 Ambulatory Pediatric Association Educational Guidelines for Pediatric Residency Step 5: Example from Residents-as-Teachers Identified initial faculty willing to participate in observation and feedback Later, recruited additional faculty to:  Help with observation of residents and feedback to them  Give residents guidance in development of teaching conference

25 Ambulatory Pediatric Association Educational Guidelines for Pediatric Residency Step 6: Develop Instructional Materials For essential learning activities:  List of goals and objectives (for self- assessment, individualized educ planning)  Schedule of required activities  Learning tools (manuals, checklists, computer programs)  Resource lists (people, readings, websites)  Evaluation forms and processes For supplementary activities:  Self-directed learning options  Independent learning tools and resources

26 Ambulatory Pediatric Association Educational Guidelines for Pediatric Residency Step 6: Example from Residents-as-Teachers Developed forms to:  Document resident participation  Guide resident feedback sessions Wrote materials to:  Describe Brief Structured Observation  Give format for teaching conference Also developed other activities related to teaching

27 Ambulatory Pediatric Association Educational Guidelines for Pediatric Residency Step 7: Create a Realistic Time Plan How to fit it all in the time available?  Prioritize and focus your goals and objectives!  Teach principles, then encourage independent practice  Supervise and evaluate a planned sample of performance  Provide choices for self-directed learning  Coordinate follow-up learning activities in other parts of the program

28 Ambulatory Pediatric Association Educational Guidelines for Pediatric Residency Step 7: Example from Residents-as-Teachers Resident activities a natural outgrowth of current work in an existing rotation Resident time availability carefully planned in advance Pilot of rotation conducted to coincide with clinic reorganization and implementation of EMR

29 Ambulatory Pediatric Association Educational Guidelines for Pediatric Residency Step 8: Conduct Faculty Development Orient faculty to purpose and processes of new curriculum Ask for input and use it! Identify key performance outcomes required of learners and teach faculty how to evaluate them Explain and demonstrate use of evaluation forms Provide opportunities to practice new teaching skills (e.g., by role plays) Stress importance of sharing goals and objectives with learners

30 Ambulatory Pediatric Association Educational Guidelines for Pediatric Residency Step 8: Example from Residents-as-Teachers All faculty oriented to the new rotation Participating faculty were taught to conduct Brief Structured Observations Faculty recruitment and faculty development often occurred simultaneously

31 Ambulatory Pediatric Association Educational Guidelines for Pediatric Residency Step 9: Develop Evaluation Tools and Processes Focus evaluation on highest priority goals and objectives Share tools and rules with learners on Day 1 For efficiency, use web-based systems Systematically sample performance Incorporate evaluation/feedback into teaching whenever possible Encourage self-evaluation as a life-long habit

32 Ambulatory Pediatric Association Educational Guidelines for Pediatric Residency Step 10: Periodically Re-evaluate the Experience Learning experiences need to change over time to stay fresh, meet changing needs Plan for an iterative evaluation process that includes:  Program Director: Are original purposes being met? Could program-wide needs be better served?  Residents: Is it still vital and interesting? Are its lessons duplicated elsewhere in program?  Faculty: Are they getting stale in teaching the experience? What might enliven it as an instructional vehicle?

33 Ambulatory Pediatric Association Educational Guidelines for Pediatric Residency Step 9 and 10: Examples from Residents-as-Teachers Sought specific feedback on rotation from resident focus group, which facilitated rapid modification of program Rotation now part of routine resident and program evaluation system Periodic reevaluation is also planned

34 A Final Encouraging Word Conclusion

35 Ambulatory Pediatric Association Educational Guidelines for Pediatric Residency Educational innovation need not happen in a vacuum! Your work will be enriched if you:  Seek out a trusted colleague to provide morale support and guidance  Try out your new ideas on a few residents, and get their feedback  Call an expert on the phone and get their advice  Consult with your Program Director— for help and for approval