Assoc Prof Tim Shaw, Director Workforce Education & Development Group (WEDG), The University of...
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Transcript of Assoc Prof Tim Shaw, Director Workforce Education & Development Group (WEDG), The University of...
Assoc Prof Tim Shaw, Director Workforce Education & Development Group (WEDG), The University of Sydney
James Nicholson, Educational Development Manager, WEDG,
The University of SydneyDr Anna DiMarco, Director of Training, Hospital Skills Program
SES & IS Local Health Districts
The Challenge‘Traditional types of CME have only a modest impact on clinician’s knowledge retention and
clinical behaviour’Cochrane Database of Systematic Review
2009(2) Forsetlund et al
The Challenge
JMO Context
• Vulnerable
• Workloads, inexperience and competing learning
opportunities potentially places the JMO at increased
risk of being involved in adverse outcomes
• Gen Y and Z enjoy electronic based media
HSP Context• Enhance the HSP workshops by reinforcing learning
objectives
• Impacts on HSP participant knowledge and
behaviour
• Is quick to complete
• Supports objectives of patient safety and governance
Spaced Education – in a nutshell
• Only takes a few minutes each day
• Course is spread out over a period of weeks
• Proven in randomised trials to improve knowledge
retention and improve behaviour better than traditional
online learning
• Works extremely well on smart-phones (optimised for
iPhone, Android and BlackBerry) or a desktop computer.
Spaced Education is a novel form
of evidence based online education
based on 2 core psychological
research findings of spacing and
testing effects
A novel approach
The testing effect
The spacing effect
Spacing effect – refers to the
finding that educational
encounters repeated over time
leads to knowledge acquisition
and retention
Testing effect – refers to the finding
that ‘the process of testing’
measures knowledge and alters the
learning processes to significantly
improve knowledge retention
Each Spaced Ed Case Study consists of an:
1. Educative component eg MCQ
2. Evaluative component (correct answer and
feedback with a detailed explanation of
correct and incorrect answers)
3. Spaced Ed item is repeated – fixed number
of times
Vol 211, No 3, September 2010 Kerfoot et al Spaced Education Generates Skill Transfer
Vol 211, No 3, September 2010 Kerfoot et al Spaced Education Generates Skill Transfer
Vol 211, No 3, September 2010 Kerfoot et al Spaced Education Generates Skill Transfer
Vol 211, No 3, September 2010 Kerfoot et al Spaced Education Generates Skill Transfer
HSP Program – Spaced Ed
• 2 x 20 Spaced Ed Cases
• Post test evaluation survey
• Not a randomised control trial
• Behavioural changes not examined
Child – Elbow PainA 6 year old child presents with a painful elbow after an unwitnessed injury.Attached is his X-ray:
Aims
Which of the following is most correct? A. There is no obvious injury and so a pulled elbow is likely B. The medial epicondyle is displaced suggesting an avulsion fracture C. There is no evidence of a fat pad sign, so a soft tissue injury is likely D. The x-rays are inadequate and further views are needed
Answer D
Case studies which reinforce previous LBOSs
Take home message
When assessing an injury understand the signs of possible injury, but ensure you have the appropriate view to make your assessment.
In this case the x-rays are inadequate and further views are needed.
Feedback
Pulled elbows do not require x-rays and are diagnosed with an appropriate history (remember that 50% of pulled elbows DO NOT give
a history of being pulled), and an examination that generally has no area of tenderness or upper limb joint dysfunction, other than a
reluctance to, and stress associated with, attempted gentle pro and supination of the forearm. It is rare over the age of 5 to suffer a
pulled elbow.
A 6 year old should have 3 ossification centres – capitellum, radius, medial epicondyle. These x-rays confirm these are present. A child
over the age of 5 year old should not have the medial epicondyle visible on an adequate lateral x-ray. An adequate lateral x-ray should
have the ‘hour glass’ sign visible at the lower end of the humerus.
These xrays suggest the medial epicondyle is posteriorly displaced, but the view is NOT an adequate lateral as the hourglass is
absent.
Normally on a lateral view of the elbow flexed in 90° a fat pad is seen on the anterior aspect of the joint. This is normal fat located in the
joint capsule. Normallyon the posterior side no fat pad is seen since the posterior fat is located within the deep intercondylar fossa.
Distention of the joint with blood from an injury will cause the anterior fat pad to become elevated and/or the posterior fat pad to
become visible.
An elevated anterior lucency and/or a visible posterior lucency on a true lateral radiographof an elbow flexed at 90° is described as a
positive fat pad sign. This patient does not have a true lateral, so it is difficult to comment.
Below is a true lateral Xray demonstrating
1. ‘Hour glass’ sign at distal end humerus.
2. Pathological anterior fat pad (enlarged, ‘Sail sign’)
3. Posterior fat pad (usually not present).
4. Breach in anterior cortex of distal humerus.
5. Posterior angulation of distal humerus.
6. Appropriate hidden position of medial epicondyle.
That is with an adequate lateral there are a number of true pathological signs consistent with a supracondylar fracture, and the loss of a false +ve medial epicondyle displacement.
Case Study which reinforce recommendations of CEC
Septic Shock 4
• Cognitive errors
• Triage errors
• MomentumSource: CDRS (Cognitive Dispositions To Respond) (Profiles In Patient Safety:”A Perfect Storm” in the
Emergency Department (Samuel G.Campbell,Pat Croskerry,William Bond:Academic Emergency
Medicine 2007) can steer a physicians cognitive processes and provide impediments to patient safety
and need to be managed within the context of working on a busy ED shift.
Case Study which reinforce recommendations of Safety & Governance Committees
In 2009, the Clinical Excellence Commission published a Clinical focus Report after a review of IIMs NSW data showed 167 incidents in 18 months. As a result of this report, the CEC joined the ECI (Emergency Care Institute) and the agency for Clinical Innovation in developing the sepsis pathway. See link for further resources to the sepsis pathway www.cec.health.nsw.gov.au/programs/sepsis.
• 60 doctors have started the course
• Completed: 38 (63.3%)
• Still Working through: 5 (8.3%)
• Off track – unlikely to complete: 17 (28.3%)
Evaluation – Completion (defined by answering each case study correctly twice)
Strongly Agree / Agree
NeutralDisagree / Strongly
Disagree
The HSP Spaced Education / WEDG course was effective in reinforcing educational objectives previously taught to me during the Hospital Skills Program workshop days
91.6% 8.3% 0.0%
I believe the Spaced Education / WEDG course has changed my approach to how I practice as an ED Doctor
75.0% 16.7% 8.3%
The Spaced Education course was effective as a method to learn or reinforce key knowledge points of Emergency Department diagnosis and treatment
91.7% 8.3% 0.0%
I found the Spaced Education course enjoyable 91.7% 8.3% 0.0%
Context
Q. There are many forms of internet-based learning or e-learning. How does Spaced Education compare to other e-learning techniques?
1) Short Online Quizzes
Strongly prefer / prefer Spaced Ed
NeutralPrefer / Strongly prefer
Online QuizzesUnsure
58.4% 25.0% 16.7% 0.0%
2) Webinars
Strongly prefer / prefer Spaced Ed
NeutralPrefer / Strongly prefer
WebinarsUnsure
58.4% 33.3% 0.0% 8.3%
3) Online Case-Based Discussion Forums
Strongly prefer / prefer Spaced Ed
NeutralPrefer / Strongly prefer
online case-based discussion forums
Unsure
66.6% 16.7% 0.0% 16.7%
Q. I would like to undertake other health related programs if offered in the Spaced Education format
Strongly Agree Agree NeutralDisagree / Strongly
Disagree
50.0% 50.0% 0.0% 0.0%
Evidence
Questions
Qstream
• Free Public Site
app.qstream.com
(Formerly Spaced Education)
• Enterprise sites
Qstream creation
Creating a Qstream Course• Simple to create a quick Qstream course BUT…
• Creating an interesting, engaging and useful eLearning
experience is never simple
• Relevance
• Levels of learning – remembering vs understanding vs
analysing … (Bloom’s Taxonomy)
• Good Multiple Choice Questions
• Media – images, videos, sounds …
Questions