1. Kazakhstan Health Technology Transfer and Institutional Reform Project Clinical Teaching Post Graduate Medicine A Workshop Drs. Henry Averns and Lewis Tomalty

2. Kazakhstan Health Technology Transfer and Institutional Reform Project Post Graduate Medicine Structure Personnel Administrative Assistant for each program Program Director: faculty member responsible for administering the overall conduct of the residency program Program Directors form an overall Program Committee that meets monthly

3. Kazakhstan Health Technology Transfer and Institutional Reform Project Post Graduate Program Objectives Objectives are approved by Program Committee Based on the national objectives as approved by the Royal College (specialties) or the College of Family Physicians http://www.royalcollege.ca/public/credentials/sp ecialty_information http://www.royalcollege.ca/public/credentials/sp ecialty_information http://www.cfpc.ca/Home/ Clinical objectives and non clinical objectives (eg professionalism, scholar, manager etc)

4. Kazakhstan Health Technology Transfer and Institutional Reform Project Internal Medicine Program Overview

5. Kazakhstan Health Technology Transfer and Institutional Reform Project 3 year program Primarily hospital based Graded responsibility

6. Kazakhstan Health Technology Transfer and Institutional Reform Project Year 1Year 2Year 3 Clinical teaching unitAllergyElective Palliative careInfectious diseasesClinical teaching unit ElectiveGastroenterology CardiologyIntensive care unitElective Intensive care unitHematology Clinical teaching unitRheumatologyClinical teaching unit Specialty electiveClinical teaching unitNephrology Community medicineRespirologyConsults and clinics Emergency medicineClinical teaching unitCardiology Clinical teaching unitOncologyClinical teaching unit ElectiveNight floatEndocrinology Clinical teaching unitElectiveClinical teaching unit Intensive care unitClinical teaching unitneurology

7. Kazakhstan Health Technology Transfer and Institutional Reform Project Clinical teaching units Fundamentals of acute emergency management and in patient care of undifferentiated medical conditions Acute and chronic medical conditions

8. Kazakhstan Health Technology Transfer and Institutional Reform Project Formal Education Activities Morning Report (sign in rounds) – Conference where CTU teams present and discuss recent admissions Academic Half Days – Weekly academic rounds where core general internal medicine topics discussed Core Medicine Rounds – Twice weekly. Case conferences, patient safety rounds, case of the month, rotating subspecialty presentations Departmental Conferences – Grand rounds and weekly morbidity and mortality conferences

9. Kazakhstan Health Technology Transfer and Institutional Reform Project Formal Education Activities Journal Club – Critical appraisal skills – review of EBM Simulation Lab – Simulation teaching and procedural training

10. Kazakhstan Health Technology Transfer and Institutional Reform Project Evaluation Twice yearly meetings with Program Director Mid Rotation and end of rotation in-training Evaluation Reports American Board Internal Medicine exam annually Multi-Source Feedback (Peer-Peer and Nurse- Resident) feedback Annual practice OSCE First year residents take a national OSCE exam E-portfolio system recently implemented

11. Kazakhstan Health Technology Transfer and Institutional Reform Project Evaluation Mini-CEX Used to assess learners in real life settings Can be used for formative or summative assessment Process: real life clinical encounter with a patient (15 minutes) Teacher observes Debrief the encounter immediately to discuss areas for improvement and to provide positive feedback – most important part of process (10 minutes) Formally assessed either on paper or on line

12. Kazakhstan Health Technology Transfer and Institutional Reform Project FAMILY MEDICINE

13. Kazakhstan Health Technology Transfer and Institutional Reform Project Curriculum 2 year program Triple C Curriculum Comprehensive Learning Continuity of Patient Care, supervision and curriculum Family medicine CENTERED

14. Kazakhstan Health Technology Transfer and Institutional Reform Project Comprehensive learning Learning objectives structured around Domains of clinical care – Maternity and Newborn Care – Care of Children and Adolescents – Care of the Elderly – Palliative Care – Care of Adults – Global Health (Care of vulnerable and underserviced populations) – All training through the lens of family medicine (eg FM preceptors in obstetrics, long term care etc)

15. Kazakhstan Health Technology Transfer and Institutional Reform Project Development of Physician Characteristics Communication Professionalism Ethics Patient Centered Approach Practice Management

16. Kazakhstan Health Technology Transfer and Institutional Reform Project Continuity of Learning Continuity of Patient Care – Responsible for own defined group of patients by sharing preceptor’s patients – Build relationships with patients over the two year program

17. Kazakhstan Health Technology Transfer and Institutional Reform Project Continuity of Learning Continuity of Supervision – Academic advisor that meets regularly with each resident – Same core family medicine preceptors for extended periods

18. Kazakhstan Health Technology Transfer and Institutional Reform Project Continuity of Learning Continuity of Curriculum – Build on each learning experience- topics revisited with a different perspective or level of complexity. Eg pediatrics in first and second year

19. Kazakhstan Health Technology Transfer and Institutional Reform Project Centered in Family Medicine Learning is always through the lens of a Family Physician Majority of time working in Family Medicine clinics Work with Family Physicians who are hospitalists, care for obstetrical patients, practice palliative medicine, do minor surgery etc

20. Kazakhstan Health Technology Transfer and Institutional Reform Project Evaluation Competency based Portfolio Objective: observed clinical encounters and summative evaluation forms (Mini-CEX) Reflective: Self evaluation, reflective exercises, feedback Majority of assessment happens in clinic Interim and final evaluation forms National testing: OSCE and written exams

21. Kazakhstan Health Technology Transfer and Institutional Reform Project Faculty Development Ongoing Compulsory versus voluntary Issues particularly for Post Graduate Training – Time, money, importance Competencies (national plan) – Student assessment and faculty evaluation – Communication skills – Scholarship – Leader – Information and Communication technologies – Teacher/Educator

22. Kazakhstan Health Technology Transfer and Institutional Reform Project Faculty Development in Post Graduate Medicine Priorities Assessment Teacher as a facilitator of learning Providing Feedback Teaching clinical skills Professionalism in the clinical setting Communication skills for both teacher and learner EBM (using I.T. appropriately and effectively) Others? Do you agree with this list?