1 The Need for Professional Educational Competences in Diabetes Management by Prof. Morsi Arab

Causes of Failure of Patients Education 1- unqualified educators 2- pour resourses 3- patient uncompliance

The Education Triangle Objectives Evaluation Strategy ( Test ) ( Methods of teaching )

Teaching and Education * Teaching competence :an “art “ or a “ science” ? * Only by an inborn talent, or a science with rules to be learned and skills to be acquired…….?.

Adjusting the Education to the Community Needs : Steps…… 1. The needs of the community for certain jobs. 2. job description,by defining the tasks needed. 3. Set objectives ( acquiring certain knowledge, skills and attitudes) 4. Design curriculum 5. Evaluate achievement of objectives.

Task Analysis * Each task requires (i) Specific knowledge (ii) Specific skills. (iii) Specific attitudes

Example of task selection needed for the job of : “Podologist “ 1- Examine feet: 2- Diagnose problems 3- Manage 4- Educate patients

Task analysis: requirements for Podologist) Attitudes (viz how to learn) Skills (viz how to learn) Knowledge - Show respect - Accuracy - Showing care & sympathy…etc. - Cutting nails: technique, instruments. - Debridement..etc - Anatomy - Factors foot vulner. - Mechanics of walking - Circulation - Pain sensation…etc

Objectives

Objective Domains : 1- Cognitive ( knowledge) 2- Skills - psychomotor - communication - cognition 3- Attitudes

The selection of objectives depends on what the learner needs and is going to do (tasks) during the job, and at which level of competence

In an Education Course : N.B.: You can not teach everything,… So stick to “selected” priorities : 1- obligatory to learn 2- useful to learn 3- if possible to learn

Objectives General Considerations 1- Set clear-cut objectives. 2- in behavioral terms( i.e. describing what the learner ultimately can do) e.g.: 1- If cognitive e.g. describe, enumerate 2- In skills e.g. inject, do blood testing etc. 3- In attitudes e.g. demonstrate punctuality, sympathy, etc…. -

Objectives ( cont.): 3- The education Faculty: (team work) … ( to avoid contradictions ) 4- Different objectives to different learners 5- Different teaching methods to suit different objectives.

Objectives ( cont.): 6- Different objectives at different stages of the disease. 7- Overloading leads to confusion, depression and hopelessness. 8- Only achievable objectives.

Some variables that define different patient objectives: 1- Their existing Knowledge about DM. 2- Their general educational competence (eg. if illiterate?). 3- Their belief, perception of their illness, mis-conceptions., etc. 4- Psychological stage and readiness to learn 5- State of illness: controlled ? complicated, ? handicapped.?,etc. 5- Socioeconomics: cost feasibility, etc.

STRATEGY

To prepare for an educational presentation : 1- identify the need of the learners for the set objectives. 2- identify their background (what they already know). Repetition (as revision) may be useful as enforcement. 3- select the content : never “tell all” (only the useful and appropriate) 4- focus objectives to the outcome: (what they can do, think, believe and know, at the end of the lecture, which they could not do before ).

The Big Group Presentation The Beginning ( Introduction) : - gain attention and interest : e.g.by a question, a story,problem, case presentation, etc….. (or) - provide a skeleton of the contents to be covered

The Flow of the presentation: I- To keep capturing attention : 1- repeat significant points. 2- check perception of the main points. 3- have reasonable sense of humor. 4- face audience and distribute eye contact. 5- keep logical sequence: chronological, cause and effect, less complex to more complex, problem and solution, etc.

The flow of the presentation ( cont.) 6- change your methods. 7- avoid : jargon, stereotyped phrases, unclear expressions, sophisticated words above learner’s level of comprehension; long complicated sentences. 8- avoid : monotony, mannerism. 9- ensure that everybody sees and hears well.

The flow of the presentation ( cont.) 10- Use properly selected A.V. aids e.g.charts, slides (minimal, readable material),models, specimens etc. 11- Be aware of the time allowed. 12- Prepare for the unexpected mishaps (projector lamps, power failure, chart slipping, etc.

The Audience : Respect and get feed back from the Audience : 1- show respect and interest:( punctuality, dress?) 2- be concerned with negative responses:, yawns, expressions of perplexion, whispering questions, looks of unbelief or disapproval, etc. …Don’t ignore !! 3- do not be angered or intimidated by negative responses but react by re-shaping the presentation. 4- get final feedback e.g. by distributing & collecting handouts……… (later)

The End : 1- Draw conclusions, …or invite independent conclusions. 2- Make end flows naturally from introduction (e.g. answering the questions, solve the problem …). 3- Simple summary…. (pin point important aspects.) 4- Tie up loose points, to make the whole presentation as a unit.. 5- Suggest ways for application and benefits. 6- suggest ways for continued learning.

Small Group Education - Select suitable size of the group ? - Educate, not teach (active participation). - Monitor Group behavior dynamics at different stages. - Control individual dynamics: *positive behaviours…(encourage) * negative behaviours..(checked )

The One-to-One Education 1- Listen. 2- Motivate. 3- Individualize (quality) according to * stage of disease. * educational level…etc. 4- Not too much (quantity). 5- Reward, more than blame.

Teaching of Skills Types of Skills 1- Psychomotor skills 2- Communication skills 3- Cognitive skills, like taking decisions to which action to take. How to Teach Skills ( 3 steps) : ( Describe- Demonstrate- Exercise) Step 1- Describe : show importance, indications, steps of performance, preparations, precautions…etc.

Teaching of Skills Step 2- Demonstrations: a) every one should be able to see the demonstration. b) may have to be repeated c) describe what you are doing during the performance ( to explain) d) support by AV aids

Teaching of Skills Step 3 :Exercising ( Training) a) everybody exercises. b) Feed back,to correct mistakes and advice for better performance. c) use helping methods: play role, simulation equipment, etc. d) give sufficient time for the training. e) initiate training in groups or projects

Teaching Attitudes Attitude = Tendency to behave in specific way.? * Could they be acquired by educational methods?

Ways to teach, develop and encourage behaviours 1- Provide relevant information: e.g. dangers of smoking (to stop smoking), or bad effects of hyperglycemia,(to encourage compliance). 2- Give example of model (good) behaviour, to inspire. 3- Acquiring a (good ) behaviour from long observation of the results of a negative (bad) behaviours. 4- From close contact e.g. working or living with individuals with positive or negative attitude (camps..) 5- Give chance to discuss (good & bad behaviours ) : in small groups; every one must share in the discussion and should be free to express.

Evaluation

Evaluation by judgment : A- Expert judgment by trained observers: * the expert observer determines “ how well”, without having to define further the concept of “well”.

Evaluation by judgment : ( cont.) B- By the use of tests and scales : - The concept “well” has to be defined beforehand. - Standardization ensures objectivity.

Evaluation General Considerations : - There is no one ideal method for evaluation. - The choice of one method depends on : 1- is it reliable? 2- is it valid? 3- Time consumed? 4- availability of its tools. 5- Gives good FB (feed-back) to the learning process 6- N ot only testing knowledge but also skills and attitude.

How to ensure” reliability” of the test By using objective methods e.g. MCQ s, check lists, rating scales and similar methods,( to help the examiners to unify their judgment under all conditions ).

To ensure “validity”, be sure that evaluation is testing for the exact requirements of the job: e.g. 1- Discard Qs on sophisticated Kn which is beyond the learner’s needs for performing the required tasks in the job. 2- Concentrate on the skills and attitudes needed ( as was defined by task analysis and job description.)

Long Essay Questions : Have minimal advantages e.g 1- Very easy to prepare ( for the examiner). 2- Tests ability of student to construct an article. Conclusion: - Better not to use it. - If necessary try to improve.

Multiple Short Essay Questions Advantages: 1- covers a large part of the curriculum 2- less unreliable 3- answered in shorter time ( by students).and also marked in shorter time ( by examiner). Disadvantages: Still tests simple knowledge and no skills or application of the knowledge in solving problems ( taking decisions).

The MCQ Type 1: Short stem + a number of choices Example: During a hypoglycemic episode : (a) there may be excessive sweating √ × (b) palpitations √ × (c ) there is hypotension √ × (d) very dry mouth √ × (e)……………………………………….. √ × N.B. Here all choices should be taken

Multiple Choice Questions (MCQ) Type 2: one stem +4-6 (usually 5) choices - Example : After describing some clinical features …………..what is the most probable diagnosis ? (To answer select only one ) ( a )………………………… Answer: e.g. (c) ( b )………………………… ( c )…………………………. ( d )…………………………. ( e )……………………………

Advantages of MCQ Test - scored in a short time and precisely. - if numerous, covers widely the syllabus. - can be used for self assessment. - high reliability. Disadvantages : - difficult and need long time and experience to prepare good MCQs. - usually test only knowledge (rarely skills e.g. in decision making ).

Oral Examination - Advantages (few): vivid, can probe increasing depth of knowledge (escalate). - Disadvantages: - induces anxiety to students (stress not existing in practical life). - consumes long time. - unreliable - can not test skills (v. rarely). - does not give good FB to the education process. Conclusion : better avoided

Evaluation by Check Lists - very useful for testing skills - Example: during a particular performance, the learner’s actions are observed by the examiner to score for each appropriately performed step. 1-……………………………………………… √ 2-……………………………………………… √ 3-……………………………………………… √ 4-……………………………………………… √ 5-……………………………………………… √ 6-……………………………………………… √ 7-……………………………………………… √ 8-……………………………………………… √ 9-……………………………………………… √ etc. - Has high reliability - Gives good feed-back to teachers. (e.g., if all the learners miss a particular step or do it with bad performance reconsider the training course.)

Check List / Rating scale, for measuring attitudes (behaviours) e.g. of a person during his training or working (job) × × ×××× × 1- shows interest 2- accepts instructions 3- cares for patients 4- shows desire to learn 5- keeps on time 6- ………………….. 0: strongly lacking…………5: strongly agree/ evident

The Follow-up Record of Proper Performance * The Record contains a number of tasks enlisted. * Each individual should fulfill the performance of all tasks. * A satisfactory achievement of each task ( separately ) is noted. * Unsatisfactory performance indicates repeat training (This method is very helpful to the learning process )

Alexandrie – Palais du Montazah Thank You