Education in Anesthesiology: developments and perspectives

Report
SCOAR: from theory to
practice
PD Dr. med E. Van Gessel
Geneva
Education?
 Education is described as one of the
« three legs » of academic medicine
along with research and clinical
work!
 As research is necessary for the
creation of new knowledge,
effective education is essential to
generate new doctors
Competence?
 Being a good Anesthesiologist requires more
than strong scientific knowledge and excellent
clinical and technical skills
 Key qualities also required are:
 communicate effectively with patients and
colleagues,
 act in a professional manner,
 cultivate an awareness of one's own values and
prejudices,
 provide care with an understanding of the
cultural and spiritual dimensions of patients' lives.
Carr SJ PMJ 2003
Going beyond the “see one, do
one, teach one”
 Not only a good “knower” but an accountable
one
 Less theory and more practice-based
knowledge
 Maintain standards and quality of care
 Assessment: Progress defined by competencies
achieved and NOT by underlying educational
process or knowledge only
Greaves JD BJA 1997; Leung WC BMJ 2002
Assessment drives the curriculum
 To ensure that trainees are competent to
practice medicine we should include:
 Consistent guidance
 Measurement of performance
 Systemic and structured feed-back
 Assessment should take place during
residency and not afterwards only (using
exams)
 The ultimate intended goal is the impact on
patient safety!
Rodriguez-Paz JM PMJ 2009
The DAILY MAIL
‘Killing season' on NHS wards: Patients at
risk when junior doctors start new jobs,
says health boss’
-7,000 medical students start foundation year in August
-Hospital death rates rise 8% during the period
-NHS chief Sir Bruce Keogh vows to end 'killing season' scandal
-From 2013 it'll be compulsory for all juniors to shadow senior
doctors
By Jenny Hope
http://www.dailymail.co.uk/news/article-2163382/NHS-wards-Patients-risk-juniordoctors-start-new-jobs-says-health-boss-Sir-Bruce-Keogh.html
The question?
How to make competencies
concrete…
so that they can be clearly assessed?
The SGAR competence-based
curriculum or SCOAR
 Document defines:
 Roles
 Domains of competence
 Competences as well as Level to be achieved
 A
Has knowledge of, describes…
 B
 C
Performs, manages, demonstrates under supervision
Performs, manages, demonstrates independently
 D Teaches or supervises others in performing,
demonstrating
managing,
 Learning objectives (& syllabus for more precision)
Knowledge / Technical skills / Clinical and Case-management skills / Drills /
Specific attitudes (including professionalism, specialist practice and patient
consideration)
CanMeds framework and the SGAR
Updated 2005
 Medical Expert: Knowledge/clinical and






procedural skills/professional attitudes that are
practice-based and contextual:
Collaborator: Team work/consultants
Communicator: Doctor/patient relationship
Manager: Healthcare organization, resources;
sustainable practices
Scholar: International patient-safety movement;
learning from errors; life-long learning
Professional: attitudes and values (integrity,
respect, responsibility…)
Health advocate: health promotion,
communities and population
Example of our roles: Professional
Domains of Competence
The competences
Levels of achievement
The learning objectives
Another example: Obstetrics
Another example: Obstetrics
The matrix (EPAs)
tenCate et al. AcadMed 2007
Masters the anesthetic
management of cesarean section
and other operative deliveries
under regional or general
anesthesia (level D)
Knowledge of the possible
indications for C-sections
and their level of emergency
X
Knowledge of the potential
complications of regional
analgesia for labor and Csection (unsatisfactory
analgesia or anesthesia,
neurological complications,
postdural puncture
headaches, toxicity of local
anesthetics, high block)…
X
Rapid sequence induction
with specific consideration
for difficult airway in the
pregnant patient
X
Manages the high -risk
obstetric situations
(level C)…
X
X
Teaching, learning, assessing…
Context
Learner
Consistent
Guidance
Performance
Measurement
Teacher
Assessment
Feed-back
Wong A Can J Anaesth 2011
It is impossible!
TRAINING
WORK
The pluses of Anesthesiology
 Majority of learning occurs in clinical settings
 Assessment:
 OR: one to one allows formative interactions
Guidance and Motivation
 Accurate feed-back (prescriptive, relevant, focused)
 Visible technical skills
Different settings (OR, consultation, labour, emergency,
etc…)
More “linear” training => Duration of time of training can
be varied
Use of simulation tools
Possibilities of focusing only on certain competencies,
interactions…(e.g, team-working)
Questions on thought process and decision-making






Kathirgamanathan-Woods. BJA-Cont Educ in Anaesth, Crit care & Pain 2011
The minuses of Anesthesiology
 OR: uncomfortable experience for the novice
 Non-verbal communication
 Patient safety is an issue, patient as primary





focus
Learners may have a more passive role in
challenging cases
Maintaining efficiency of the OR list
Large number of different clinical teachers =>
variety in practice is confusing!
Rapid OR case turnover = no time for questions
and discussion
Identifying “teachable moments”
Bould et al. Can J Anaesth 2011
Where we are
 New curriculum since 2008 = new training
paradigm!
 The cultural change is a difficult one:
 Collaborative process between teacher and
learner
 No prescription on how the teacher must teach or
the resident must learn…
 Agreement upon the assessment of competence
and progressive independence of the trainee
(certification)
 Supervision of juniors should never occur without
adequate formative assessment and feed-back
 Major influence on the European curriculum
European Curriculum
 The differences are small!
 Switzerland has pioneered the EBA curriculum
 ROLES: major difference? Only 4
 Concept of Leadership, comprises Manager-
Communicator-Collaborator (and Health
advocate)
 Other roles: Medical Expert, Professional,
Scholar
European Curriculum
 Domains of competence: near identical
 Political issues of Emergency, ICM
European Curriculum
 For each domain, the competences were
discussed twice and rewritten
European Curriculum
European Curriculum
 Many different writers from different cultures,
backgrounds, trainings…
 Confusion between competences and
activities/learning objectives
 Political issues to be discussed
Some good news: 25% countries
endorsed the new curriculum; 25% will
do it over the next year; 50% are thinking
about it!
SCOAR
 A tool…
Context
Learner
Consistent
Guidance
Performance
Measurement
Teacher
Assessment
Feed-back
SCOAR: what will it help you to do?
Assessment of competence
(Outcome)
Progressive independence of
the trainee (certification)
What we will have to discuss
 Working VS Training?
 Change in our culture
 Change in our tradition of training
 Train tutors
 Help training centres
 Money…
THANK YOU

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