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Postgraduate Course 1 Spirometry – train the trainer course

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Postgraduate Course 1 Spirometry – train the trainer course

AIMS: The ERS spirometry train-the-trainer programme will provide participants with the knowledge and tools to teach high quality spirometry. More specifically, this training programme is a pre-requisite for those who would like to train and certify participants for the ERS Spirometry Driving Licence Part 1 and Part 2. TARGET AUDIENCE: All those interested in how to train spirometry are welcome to attend the course. The ERS Spirometry train-the-trainer programme is also aimed at those who would like to become directors or instructors of the Spirometry Driving Licence training. Once you have participated in the ERS spirometry train-the-trainer programme participants are encouraged to apply to the ERS to deliver a spirometry training programme. However, further qualifications are also recommended.

1. Certified degree in respiratory physiology or a related field 2. Experience in procedures and instrumentation for spirometry testing 3. Experience in interpretation of spirometry 4. At least 5 years experience in the supervision of a pulmonary function laboratory or

extensive spirometry service 5. It is mandatory that the programme director has attended the HERMES train-the-trainer

programme Pre-requisites for the course:

1. All participants must be familiar with the ERS HERMES spirometry documentation before attending the course;

2. All participants must prepare written feedback of a mini spirometry workbook; Learning outcomes

Course directors will have an understanding of each of the key subject areas including: 1. The ERS spirometry training process; 2. Techniques of teaching and learning styles; 3. ERS spirometry-specific teaching and training styles; 4. Presentation and facilitation styles; 5. Feedback skills; 6. Principles of assessment 7. Assessment processes for the ERS spirometry training programme and awarding the ERS

Spirometry Driving Licence; 8. Criteria required to organise an ERS spirometry training course;

ORGANISING COMMITTEE I. Steenbruggen (Zwolle, Netherlands), B. Cooper (Birmingham,

United Kingdom)

COURSE PROGRAMME PAGE

09:00 Welcome and introduction to the course O. Van Eck (Waalre, Netherlands)

09:40 Overview of the European Spirometry Driving License training programmes 7 B. Cooper (Birmingham, United Kingdom), I. Steenbruggen (Zwolle, Netherlands)

10:10 Principles of teaching and learning 44 W. van Mook (Maastricht, Netherlands)

10:50 Break

11:10 European Spirometry Driving Licence specific teaching and training Overview of problem areas in spirometry training Practicing in workplace with mentor support 90 J. Lloyd (Birmingham, United Kingdom)

11:40 Practical session on presentation and facilitation skills 137 V. Habes (Ultrecht, Netherlands) O. Van Eck (Waalre, Netherlands)

12:10 Presentation from participants

12:50 Lunch

13:50 Providing effective feedback 138 W. van Mook (Maastricht, Netherlands)

14:30 Discussion and feedback practical session including: written feedback on spirometry tests, practice feedback skills, feedback on feedback skills and feedback session based on workbook assessment 166 V. Habes (Ultrecht, Netherlands) O. Van Eck (Waalre, Netherlands)

15:10 Break

15:40 Principles of assessment 167 W. van Mook (Maastricht, Netherlands)

16:10 Assessment of the European Spirometry Driving Licence programme Part II – practical assessment (role play) and use of standardised assessment materials. Testing practical knowledge, skills and communication 225 J. Lloyd (Birmingham, United Kingdom)

16:50 Organising a European spirometry training programme including: role of the course director and the application process 257 F. Burgos (Barcelona, Spain) Guidelines for the certification of ERS Spirometry training programmes 276 ERS Spirometry Training Programme Information Handbook 294 Spirometry assessment instructions for ERS trainers and examiners 298 Guidelines to complete the ERS Spirometry Portfolio Workbook 304

17:05 Evaluation

Additional course resources

Harmonising spirometry education with HERMES: training a new generation of qualified spirometry practitioners across Europe 306

Standardisation of spirometry 309 General considerations for lung function testing 329

Faculty disclosures 338

Faculty contact information 339

To help you provide advice to your patients, ELF produces factsheets on lung health and disease. These are informed by patient and professional interviews and written in language that is easy to understand.

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EUROPEANLUNGFOUNDATION

Bringing together patients and the public with respiratory professionals

Overview of the European Spirometry Driving Licence training

Brendan G. Cooper Lung Function & Sleep

Queen Elizabeth Hospital Birmingham, Mindelsohn Way Edgbaston B15 2WB, Birmingham UNITED KINGDOM

[email protected]

Irene Steenbruggen Pulmonary Laboratory

Isala klinieken loc Wl C2 42950, PO box 10500

8000 GM, Zwolle NETHERLANDS

[email protected] AIMS The following article ‘HERMES Spirometry: the European Spirometry Driving Licence’ will give a

complete overview of this project. The article was prepared by the spirometry HERMES task force and published in March 2011.

7

HERMES Spirometry: theEuropean Spirometry DrivingLicence

IntroductionSpirometry testing is the most widely prac-ticed, most common and adaptable of all lungfunction tests and spirometers are used as akey instrument in the diagnosis of patientswith respiratory disease [1]. As a leadingcause of death worldwide responsible forsome 9.4 million deaths [2], and furtherincreases predicted by 2020, the manage-ment of lung disease becomes even moredependent on spirometry testing. Yet evidenceof widespread under-diagnosis [3] and, as aconsequence, reduced quality of life andpremature death [4] present cause forconcern.

The grim reality evident in the presentedstudies highlights a real lack of training [5],under-utilisation of spirometers [6] and diag-nosis based on inaccurate results [7]. It isreported that chronic obstructive pulmonarydisease (COPD), the most prevalent of thelung diseases, is under-diagnosed in 75% ofcases [3]. The outcome of delayed diagnosisdeters effective management and treatment,which ultimately aims to relieve symptoms,prevent disease progression, improve healthstatus and prevent premature death [4]. Whileeducational modalities were introduced at anational level to train spirometry practice insome European countries, a survey carried outby the European Respiratory Society (ERS) in2008 confirms that no formal training in,assessment of, or qualification in spirometrytakes place in many other countries. Using theHERMES project framework (HarmonisedEducation of Respiratory Medicine inEuropean Specialties), a new Spirometry initia-tive aspires to train and qualify healthcare

professionals best able to deliver high-qualityspirometry. The potential benefits of standar-dised educational documents and training inthe practice of spirometry are real andsignificant, strengthening patient care andimproving quality of life for respiratory diseasepatients.

HERMESBegun in 2005, the value of the HERMESinitiative is that it provides consensus-basedstandards and indicators to improve qualityand practice of education and healthcare, andestablishes a guide for teachers and studentsof sub-speciality respiratory medicine. To date,the Adult HERMES and Paediatric HERMESprojects have produced internationally recog-nised educational documents and activities. Ifwe consider the nature of these projects, it isclear that both the Adult and Paediatricprojects appeal to a specific target audience,specialising in precise fields of respiratorymedicine. The very essence of the SpirometryHERMES project is, in fact, different. For thispurpose, a new proposed structure of four keydevelopment areas shall be implemented toensure all facets of the educational cycle arecovered (fig. 1)

1. Complete Training Programmes2. Guidelines for certification of ERS Spiro-metry Training Programmes3. Development of educational materialsincluding training manuals, supporting onlinemodules, videos and a knowledge test for part I4. Assessment guidelines, production ofassessments and assessment criteria to testSpirometry Theory and Spirometry Practice

HERMES syllabus link: moduleD.1

B.G. Cooper (co-chair)I. Steenbruggen (co-chair)S. MitchellT. SeverinE. OostveenF. BurgosH. MatthysH. NormandJ. KivastikJ. LeuppiM. FlezarM. AgnewO. PedersenS. SorichterV. BrusascoW. TomalakP. Palange

DOI: 10.1183/20734735.026310 Breathe | March 2011 | Volume 7 | No 3 2598

This process of establishing ERS educationalstandards in spirometry are international in theirdevelopment and actively overseen by an expertTask Force representing 13 countries acrossEurope (fig. 2). The very essence of theHERMES initiative is to offer structured supportfor educational reform to take place. Evolution ofthe HERMES ideology presupposes that eachproject phase recommends uniform educationalcriteria to be adopted and considered as bestpractice in training. Considering the statisticaldata confirming the gravity of lung diseaseworldwide, the mission of the HERMES spiro-metry project is to follow this intricate path totrain and qualify health professionals to perform

high-quality spirometry tests as well as increasingthe number of accurate and repeatable spiro-metric measurements to be used in the diagnosisof patients with respiratory symptoms. Thepurpose of this publication is to present theoutcome of the first two phases of the HERMESSpirometry Driving Licence project.

Historical backgroundStandardisation of spirometry [8], access to spiro-meters [4] and use of accurate and repeatablespirometry measurements [3] are requirementscentral to the diagnosis, management and treat-ment of lung diseases. The scale of the rolespirometry plays in identifying patients at risk ofdisease or of perioperative pulmonary complica-tions such as COPD, lung cancer, heart attack,stroke and asthma [9] dictates that the toolsrequired to practice spirometry be given pre-cedence within the medical arena. The availablestatistics echo the true reality that spirometersare under-utilised due to absence of teachingpractices [6], and there is an extensive call foreducational reform in the training of spirometrywithin this medical domain [1, 3–7, 10].

If the aforementioned requirements topractice quality spirometry are considered, tosome extent the ERS/American Thoracic Society2005 Guidelines in Spirometry Practice and, inrecent years, development of the spirometer,guaranteeing widespread distribution, offer somerelief to spirometry practitioners. Yet, based onanalysis of 14 countries within Europe, only fourreported the opportunity to attend a spirometrytraining course approved by a professional body(fig. 3).

With the intention of producing a drivinglicence in spirometry for health professionalsto reach competency level, the Task Forcepresents the first of the educational docu-ments; Part I Spirometry Knowledge and Skills,Part II Knowledge and Competence in Spiro-metry Measurement (leading to the EuropeanSpirometry Driving Licence Level II) andGuidelines for the Certification of ERSSpirometry Training Programmes.

MethodologyThe HERMES European Spirometry DrivingLicence (ESDL) project was officially launchedat the ERS Annual Congress in Berlin 2008 withthe aim of harmonising training in spirometrythroughout Europe to establish and raise

Better PatientCare

EducationalMaterials

Guidelinesfor

Certification

AssessmentCriteria

Phase 2

Phase 4

Phase 3

CompleteTraining

Programme

Phase 1

Figure 1The four key areas of HERMES lead to better patientcare.

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Figure 2

European Spirometry Driving Licence

260 Breathe | March 2011 | Volume 7 | No 3 9

European standards in the skills required toqualify and practice as an expert in this field.Rationale for the project was justified followingresults of the ERS benchmark analysis carried outin 2008. As well as confirming a clear disconnectin spirometry training practices, insight intoexpectations of structure, duration, delivery andassessment that a spirometry training programmeshould possess were offered. Laying the founda-tions to move forward, the first step the Task Forcewould take was to produce a training programmeoutline utilising the well established consensusprocess, the Delphi technique [11].

Phase 1 – Development of theTraining Programme OutlineWithin the framework of the Delphi methodology,and following the steps taken by the HERMESgiants, Adult and Paediatric, the Task Force beganthe process of designing knowledge items whichshould be included in a training programme forspirometry. A further panel of experts from 10European countries was also identified as keycontributors to project development. In line withthe Delphi technique, the Task Force prepared afirst survey round and received responses from673 experts. The aim of this survey was to gathera larger representation from spirometry practi-tioners of both qualitative and quantitative dataon the perceived skills required for training toendorse a qualification in spirometry practice.

At the ERS Annual Congress in 2009 inVienna, results of the first survey round werepresented during a plenary session including allTask Force and national respondents. Highconsensus levels for each of the items assumethat the target of the survey was reached. With theinclusion of some new items and modification of

existing items based on comments within thesurvey, a second Delphi round of 230 expertsconfirmed the final training programme outlinewhich was approved by the Task Force in May2010.

As the training programme items were nowin place, a new process of developing rationalefor training including the course aim, targetaudience, pre-requisites for training and teachingformat would need to be developed. A skeletonstructure utilising a number of references [12,13],was presented to the Task Force in May 2010and so began the final steps in the developmentof the European Spirometry Driving LicenceTraining Programme (fig. 4).

Phase 2 – Developmentguidelines for certification ofERS Spirometry TrainingProgrammes documentA further output from this landmark May 2010Task Force meeting was the generation of anumber of operational issues relating to theSpirometry Training Programme. Questions sur-rounding venue specifications, trainer qualifica-tions and minimum numbers of spirometry tests tobe performed, only served to highlight imminentcomplexities that would need to be addressed.

Between May and the upcoming September2010 Task Force meeting, the need to stipulate a

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Delphi Round I

Delphi Round II

Phase 1 - Training Programme Outline

September 2009: Plenary Workshop

September 2008: Launch of HERMES spirometry project

Finalise knowledge items Training rationale composed and approved by Task Force

May 2010: Task Force Workshop

ERS European Spirometry Training ProgrammePart I - Spirometry Knowledge and Skills

Part II - Knowledge and Competence in Spirometry Measurement

Figure 4The first phase in the European Spirometry Driving Licence Training Programme.


Breathe | March 2011 | Volume 7 | No 3 26110

robust structure including measurable elementsand criteria to ensure best practices in trainingand dissemination of the ESDL became obvious.

Guided by the Criteria for Accreditationof ERS European Training Centres in AdultRespiratory Medicine document generated fromthe Adult HERMES Task Force [14], the frame-work provided fundamental standards for train-ing programmes to follow. By September 2010,six sections were presented and approved andthe Guidelines for the certification of ERSSpirometry Training Programmes document wasestablished (fig. 5).

ResultsIf we consider the objective of the first twoproject phases to produce a training programmeoutline and the rationale and guidelines tolaunch a complete spirometry training pro-gramme, the presented documents symbolisethe first challenge to lead this initiative towardits end goal, each constituting the minimumrecommended criteria that training programmesshould consist of for the training of spirometry ata European level.

Phase 1 – Development of theTraining Programme OutlineDrafted by the Task Force during the first of theirmeetings, 47 knowledge items and skills were

presented and included in the first Delphi round.Slight modifications and the addition of newitems were made following the first Delphi.Following a second survey round, the trainingprogramme was agreed by the Task Force in May2010, consisting of eight modules and 63 itemsincluding prerequisites for training. To ensure allcomponents of an educational training pro-gramme were covered, and supported by the ERSeducation department, further development ofthe rationale for training was completed by theTask Force during the May meeting.

In order to train practically competent healthprofessionals, it was necessary that the trainingprogramme be divided into two distinct trainingparts:

1. Part I Spirometry Knowledge and Skillscovering important spirometry theory anddemonstrate best practices in spirometry technique2. Part II Knowledge and Competence inSpirometry Measurement will ensure participantsperfect technique, consider pitfalls and errors inspirometric measurements and award a qualifi-cation to merit participants as practicallycompetent to perform high quality spirometrytests

In order to prepare for Part II, the Task Forcerecognised the need to allow time for practicalexperience and first hand exposure betweentraining programmes and so have stipulated inthe guidelines that all participants must com-plete the ERS Spirometry Workbook beforeattending Part II.

Published documents on the completeTraining Programme of both Part I SpirometryKnowledge and Skills and Part II Knowledge andCompetence in Spirometry Measurement are theresult of the first project phase.

Phase 2 – Developmentguidelines for accreditation ofERS Spirometry TrainingProgrammes documentThe objective of this phase was to generate astructured, simple and flexible model to allowdissemination of training across all healthprofessional settings who practice and teachspirometry across Europe. Utilising specificationswithin the training programme outline, each ofthe six sections within the document lists theminimum measurable elements for trainingprogrammes to follow to qualify certification


Identification of key criteria

Development of document content

Phase 2 - Guidelines for Certification

September 2010: Task Force Workshop

May 2010: Task Force meeting

Finalise criteria for certification

September – December 2010

Guidelines for the certification of ERS SpirometryTraining Programme document

Figure 5The second phase in the European Spirometry Driving Licence Training Programme.



and award ERS European Spirometry DrivingLicence. In September 2010, the documentsections were approved and a comprehensivedocument outlining Guidelines for the certifica-tion of ERS Spirometry Training Programmes wascompleted.

DiscussionThe variety of HERMES initiatives are evolvingbased on an increasing demand for improvedand systematic practices of education inspecialist areas of respiratory medicine.Evidence of a current gap in training needs formedical practitioners merely offer conviction tothe HERMES Task Forces and remind them of theneed to supply this demand. The HERMESspirometry initiative is also the product of thisinherent path, emerging from an evidentdisparity in training criteria in the training ofspirometry. Yet producing, implementing andmaintaining robust educational activities anddocuments in specialist medicine are not withoutchallenges.

Challenges

Application and qualityassuranceEnsuring all healthcare institutions demonstratethe ability to apply predetermined standards setout within the HERMES documents is embeddedin complexity. The overarching goal of thisproject milestone, phase 2, was to produce asolid foundation of structured guidelines forcertification of spirometry training programmesto follow. As the Task Force progresses throughthe project continuum, a new emphasis movesfrom documenting minimum criteria to applica-tion. In fact, the final section of the Guidelinesfor certification of ERS Spirometry TrainingProgrammes was established to produce thoseprocedures required for the certification process.For the first time, consideration of the approvalbody, the application process, the certificationprocess and costs is realised, project successdemands a vigorous, adaptable and inexpensivemodel.

To certify is to apply standards as a basis ofquality assurance. Traditionally, accreditation orcertification of educational programmes withinthe medical arena has been based on thewell-established practice of site visitation [15].However, site visitation is a resource-dependantprocess, the costs beared by the training centre

and, as a consequence, too often excludingthose unable to afford external and voluntarycertification. The next stages will address thisprocess of certification and it is the intention ofthe Task Force to publish Section 7 ApprovalProcess and Distribution of ESDL Certificates at alater date which will employ new and diversemethods of quality assurance including prepara-tion of standardised educational materials to beused during training, online training modules,and use of generic assessment methods allcontributing as a means of quality control.

Dissemination of the EuropeanSpirometry Training ProgrammeApplying minimum standards not only offersguidance for trainers of spirometry to follow butalso present an incentive to improve, or for somecountries introduce, structured training andconsequently dissemination of a Europeanspirometry qualification. To accomplish successat this project step and indeed looking to futuredevelopments for the project, the initiativenecessitates distribution to a wide audience ofhealth professionals across a number of medicalsettings. Consequently, achievement demandseducational documents which are simple, robustand adaptable. It is intended that the documentsprovide a guideline for training programmes ofspirometry to follow and to allow flexibilityacross international, cultural and regionalboundaries, which will allow delivery at locallevel. Support for ESDL trainers will be providedthrough standardised educational materials aswell as a ‘‘Train-the-Trainer’’ course, which will beheld each year at the ERS Annual Congress.Moreover, this HERMES project finds itselfconfronted with the fresh challenge of transla-tion. A new wave of HERMES now looks towardsdistributing educational documents and activitiesto national delegates and respondents fortranslation. Reaching the intended audiencerequires coherence within ERS and acrossnational societies.

ConclusionSpirometry practitioners have the opportunity totake ownership to improve and measure theirknowledge and practice of spirometry, emphasis-ing commitment to education and value ofattaining a European qualification. For the firsttime, harmonisation of training in spirometryoffers an objective process for evaluation withinEurope. With a training programme outline and



Breathe | March 2011 | Volume 7 | No 3 26312

guidelines for certification of ERS trainingprogrammes now in place, the Task Force looksto putting theory into practice with a real focuson application. To facilitate a training model, thenext project steps intend to design and utiliseeducational materials, online modules andassessment criteria aligned to concrete standardsset out by the Task Force, further strengtheningthe value of the spirometry HERMES project.

The significance and impact of spirometry asa measure of global health and a predictor ofmorbidity and mortality resonate throughout theliterature [16], and presuppose that spirometrytesting receive priority within the medical arena.Yet evidence of a substantial lack of training andinconsistencies in standards across manyEuropean countries, there is most certainly scopeto improve spirometry practice and reinforcequality patient care. At the core of thisimpending challenge, the Spirometry HERMESinitiative attempts to produce consensus-based

documents and guidelines fundamental to thedelivery of best practices in spirometry training. Itis hoped that project potential will be realised,establishing coherence across national societies,ERS members and all practitioners of spirometry.Building on the shoulders of the previousHERMES projects, with confidence the Spiro-metry HERMES Task Force takes the first steptowards attaining their final mission: delivery ofthe best possible training to certify spirometrypractitioners and improving quality health carefor respiratory disease patients.

AcknowledgementsThe following experts participated as nationalrespondents: E. Derom (Belgium), A. Schneider(Germany), R. Pellegrino (Italy), T. Schermer(Netherlands), A. Langhammer (Norway), P. Boros(Poland), H. Hedenstrom (Sweden), M. Arne(Sweden) and M. Fletcher (UK).

References1. Ferguson GT, Enright PL, Buist AS, et al. Office spirometry for lung health assessment in adults: a consensus

statement from the National Lung Health Education Program. Chest 2000; 117: 1146–1161.2. Loddenkemper R, Gibson GJ, Sibille Y. The Burden of Lung Disease, In European Lung White Book: The First

Comprehensive Survey on Respiratory Health in Europe. Sheffield, European Respiratory Society/European LungFoundation, 2003; pp. 2–13.

3. Derom E, Van Weel C, Liistro G, et al. Primary Care Spirometry. Eur Respir J 2008; 31: 197–203.4. Rabe KF, Hurd S, Anzueto A, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic

Obstructive Pulmonary Disease GOLD Executive Summary. Am J Respir Crit Care Med 2007; 176: 532–555.5. Yawn BP, Enright PL, Lemanske RF Jr, et al. Spirometry can be done in family physicians’ offices and alters clinical

decision in management of Asthma and COPD. Chest 2007; 132: 1162–1168.6. Bellia V, Pistelli R, Catalano F, et al. Quality control of spirometry in the elderly: The S.A.R.A. study: Salute

Respiration nell’Anziano - Respiratory Health in the Elderly. Am J Respir Crit Care Med 2000; 161: 1094–1100.7. Cleland J, Mackenzie M, Small I, et al. Management of COPD in Primary Care in North-East Scotland. Scott Med J

2006; 51: 10–14.8. Miller MR, Hankinson J, Brusasco V, et al. Standardisation of spirometry. Eur Respir J 2005; 26: 319–338.9. Petty TL. John Hutchinson’s mysterious machine revisited. Chest 2002; 121: 219S–223S.10. Townsend M, Hankinson J, Lindesmith L. Is my lung function really that good? Flow type spirometer problems that

elevates test results. Chest 2004; 125: 1902–1909.11. Keeney S, McKenna H. Research guidelines for the Delphi survey technique. J Adv Nurs 2000; 32: 1008–1015.12. Instructional Methods and the Clinical Learning Setting: An educational guide for the implementation of the

Paediatric HERMES curriculum. JO Busari, et al. in press. 2010 This document is a work in progress and should not bereferenced unless and until it is approved and published. Until such time as this Editor’s Note is removed, the inclusionof the above document is for informational purposes only.

13. Talbot M. Monkey see, monkey do: a critique of the competency model in graduate medical education. MedicalEducation 2004; 38: 587–592.

14. R. Loddenkemper, T. Severin, S. Mitchell, et al. Adult HERMES: criteria for accreditation of ERS European trainingcentres in adult respiratory medicine. Breathe 2010; 7: 170–188.

15. Zach MS, et al. Paediatric respiratory training in Europe: syllabus and centres. Eur Respir J 2002; 20: 1587–1593.16. Ferguson GT, Enright PL, Buist AS, et al. Office spirometry for lung health assessment in adults: a consensus

statement from the national lung health education program. Chest 2000; 117: 1146–1161.




265Breathe March 2011 Volume 7 No 3

Part I – spirometry knowledge and skills

Successful course participants will be awarded the

Level I - European Spirometry Driving Licence

Course informationThe ERS European Spirometry Training Programme Level I and Level II, is designed to cover all aspects of spirometry that will enable participants to gain suffi cient knowledge in spirometry practice and to become high-quality performers of spirometric tests. Level I of this in training programme is a 9 - 12 hour course covering spirometry theory and practice utilising online modules and classroom learning. Participants will only be awarded Level I of the European Spirometry Driving Licence certifi cate after passing a knowledge based test at the end of the training programme. Level I provides participants with the knowledge and skills to complete an ERS Spirometry workbook and attend Level II training. Participants who successfully complete Level I will acquire knowledge and basic skills but are not yet considered competent in the practice of spirometry. Before commencing Level II, a number of assignments relating to the practice of spirometry must be completed in the ERS Spirometry workbook. This workbook will form the basis of Level II competency based training and assessment. It is recommended that participants complete Level II training within 6 - 12 calendar months after completing Level I.Level II of the training is a 7 - 10 hour training course which will focus on competency - based training and will require participants to complete exercises and submit portfolios of spirometry tests. Examination and the award of the European Spirometry Driving Licence Level II will be dependent on a competency assessment.

Aim of Level I trainingThe aim of Level I Spirometry Knowledge and Skills is to ensure that participants acquire the knowledge and basic skills in spirometry best practice. The training programme is designed to cover the theory required to pass the Level I knowledge test and equip participants with the skills needed to perform spirometic tests and successfully complete a Spirometry workbook.

Target audienceLevel I Level I of the training programme is aimed at all healthcare professionals who require a comprehensive understanding and the basic skills in spirometry practice.

Pre-requisites for the training programmeLevel IThe stipulated pre-requisites are outlined below to ensure that participants have the general knowledge and basic computer skills to participate on the European Spirometry Training Programme. It is the responsibility of the participant who will register to attend that they are competent for each of the prerequisites specifi c to the Level I of the European Spirometry Driving Licence.

General knowledge • Understand and perform basic math operations (multiplication, division, decimals and percentages). • Demonstrate an understanding of calculating ratios. • Use basic functions of a calculator. • Read a manual in the native language.

Basic PC skills • Use basic functions of a computer. • Basic mathematics skills. • Demonstrate ability to use drop down menus, select and accept options, etc.

If the training programme requires participants to complete some of the training modules online, then it is mandatory for participants to produce a certifi cate for each training module completed prior to the course. Participants will not be permitted to sit the knowledge examination unless all modules of the Training Programme are completed.

Course goalsParticipants will gain specifi c knowledge of the key areas of Spirometry including; • Anatomy, physiology and pathophysiology of the respiratory system.

The course will also cover the current international standards in spirometry and aims to; a. provide defi nitions and explain principles of spirometry. b. offer an understanding of spirometry systems and reference values and their limitations. c. present state-of-the-art knowledge on recognising indications and contraindications for spirometry. d. recognise normal and abnormal spirometry results.

Learning outcomes At the end of the training programme, participants will be able to clearly explain and understand each of the key subject areas of spirometry practice including; • defi nitions of spirometric values. • knowledge of anatomy, physiology and pathophysiology required for spirometry. • spirometry equipment including strengths and weaknesses, pitfalls and infl uencing factors to reference values. • Indications and contraindications of spirometry testing. • how to perform quality spirometry and recognition of poor quality manoeuvres. • how to interpret spirometry tests. • quality assurance, including ability to correctly describe, document, and ensure quality stan dards and practice.

Format • Didactic Lectures - Instructional teaching method that allows the student and teacher to effectively understand, consider and analyse the learning goal. • Small group hands on learning - learning by doing. Practical demonstrations and assessment of technique and interpretation, for example. • e-Learning Activities - Types of online learning include CD and audio, e-text, forums, threaded discussions, web-blogs, electronic assessments, and simulation learning. • Case-based discussions - Case-based discussion is a structured interview designed to explore professional judgement in specifi c cases selected by the trainee and presented for evaluation. • Self Directed Learning - A self-paced process of learning where individuals take initiative, formulate learning goals, and identifi es resources for learning. • Mentoring – Mentoring is a developmental partnership through which one person shares knowledge, skills, information, and perspective to foster the personal and professional growth of someone else.

14

266 Breathe March 2011 Volume 7 No 3

Part I – spirometry knowledge and skills

Training programme contentMODULE 1 – ANATOMY, PHYSIOLOGY AND PATHOPHYSIOLOGY REQUI RED FOR SPIROMETRY • Knowledge of anatomy and physiology of the respiratory system. • Knowledge of pathophysiology of respiratory disorders.

MODULE 2 – DEFINITIONS OF SPIROMETRIC VALUES • Explain the principle of spirometry. • Defi ne FEV1, FVC, FEV1/FVC. • Defi ne PEF, FEF25-75, PIF (NEW ITEM). • Defi ne VC, IRV, ERV, IC. • Explain the characteristics of a fl ow-volume curve. • Explain the characteristics of a volume-time curve. • Explain the relationship between volume-time and fl ow-volume curve.

MODULE 3 - SPIROMETRY EQUIPMENT • Describe the minimum recommendations for spirometry systems. • Describe strength and weaknesses of your spirometer. • Recognise pitfalls of the instrument. • Describe the factors that infl uence reference values.

MODULE 4 – INDICATIONS AND CONTRAINDICATIONS OF SPIROMETRY TESTING • Summarise indications and contra-indications for spirometry. • Summarise the limitations of spirometry.

Note: Indications can be found in SERIES ‘‘ATS/ERS Task Force: Standardisation of Lung Function Testing’’ Edited by V. Brusasco, R. Crapo and G. ViegiNumber 2 in this Series Standardisation of spirometry

Contra-indications can be found in SERIES ‘‘ATS/ERS TASK FORCE: STANDARDISATION OF LUNG FUNCTION TESTING’’Edited by V. Brusasco, R. Crapo and G. ViegiNumber 1 in this SeriesGeneral considerations for lung function testing

MODULE 5 – SPIROMETRY TECHNIQUE • Prepare equipment required for testing. • Demonstrate the correct use of the spirometry device. • Summarise preparation of subject. • Describe the correct position to perform spirometry. • Demonstrate height and weight measurement. • Record type, dosage and time of relevant medication. • Explain testing procedure to subject. • Demonstrate the procedure to subject. • Demonstrate subject coaching. • Obtain accurate spirometry measurement according to international guidelines (to include examples of international guidelines). • Recognise improperly performed manoeuvres. • Demonstrate appropriate corrective actions. • Demonstrate injury prevention knowledge. • Identify and use standard personal protective equipment. • Demonstrate awareness of confi ned spaces, including potential hazards, and safety standards. • Document relevant events that occurred during the spirometric assessment. • Demonstrate correct method of administering a bronchodilator. • Summarise issues related to the choice of bronchodilator.

MODULE 6 – QUALITY ASSURANCE • Describe and perform a control spirometry using a subject with known lung function (biological control). • Describe and perform calibration or verifi cation check of equipment. • Describe methods for prevention of infection transmission. • Explain the rationale for regular cleaning. • Summarise the requirements for equipment quality control. • Recognise abnormal traces due to technical or patient errors. • Describe the advantages of regular over-reading of traces by external experts (samples).

MODULE 7 – EVALUATION OF SPIROMETRIC RESULTS • Document the acceptability criteria. • Document the repeatability criteria. • Document reversibility criteria. • Summarise test result selection. • Describe selection of best curve. • Compare test results with reference values. • Basic understanding of limitations of reference values. • Basic understanding of errors of using the percentage predicted and the advantages of using the lower limit of normal. • Evaluate change in individual subjects. • Recognise and describe the normal pattern as well as restrictive and obstructive pattern in the volume time curve. • Recognise and describe the normal pattern as well as restrictive and obstructive pattern in the fl ow volume curve. • Knowledge of storage/electronic data.

COURSE ASSIGNMENTSUnderstand the next steps to be taken to complete and submit the ERS Spirometry Workbook including training exercises, portfolio of tests and the assessment process for Level II training

OPTIONAL MODULEHistory of Spirometry

15

267Breathe March 2011 Volume 7 No 3

Level II – spirometry knowledge and skills

Successful course participants will be awarded the

Level II - European Spirometry Driving Licence

Course InformationThe ERS European Spirometry Training Programme Level I and Level II, is designed to cover all aspects of spirometry that will enable participants to gain suffi cient knowledge in spirometry practice and to become high-quality performers of spirometric tests. Level I of this in training programme is a 9 - 12 hour course covering spirometry theory and practice utilising online modules and classroom learning. Participants will only be awarded Level I of the European Spirometry Driving Licence certifi cate after passing a knowledge based test at the end of the training programme. Level I provides participants with the knowledge and skills to complete an ERS Spirometry workbook and attend Level II training. Participants who successfully complete Level I will acquire knowledge and basic skills but are not yet considered competent in the practice of spirometry. Before commencing Level II, a number of assignments relating to the practice of spirometry must be completed in the ERS Spirometry workbook. This workbook will form the basis of Level II competency based training and assessment. It is recommended that participants complete Level II training within 6 - 12 calendar months after completing Level I.Level II of the training is a 7 - 10 hour training course which will focus on competency - based training and will require participants to complete exercises and submit portfolios of spirometry tests. Examination and the award of the European Spirometry Driving Licence Level II will be dependent on a competency assessment.

Aim of Level II TrainingThe aim of Level II of the training programme is to ensure that participants have acquired the skills and competencies to perform high quality spirometry tests. The training programme will help participants complete a Spirometry workbook, discussing common errors and how to problem solve issues relating to spirometry testing. Level II of the training programme will assist participants with the fi nal preparations to carry out the practical assessment to be awarded the Level II - European Spirometry Driving Licence.

Target AudienceLevel II Level II is aimed at all healthcare professionals who wish to become practically competent in the performance of spirometry and who have successfully completed Level I Interactive course on Spirometry and hold the provisional Spirometry Driving Licence.

Pre-requisites for Level II Training ProgrammeIn order to attend Level II Knowledge and Competence in Spirometry Measurement, participants will be required to present their Level I certifi cation of the European Spirometry Driving Licence.Practical experience and fi rst-hand exposure are crucial in the learning of spirometric technique to pass Level II and be certifi ed with the ERS European Spirometry Driving License. The number of spirometry tests performed by those participating on the course is not a suffi cient measure of competence to practice spirometry. It is mandatory that candidates submit 10 good quality spirometry tests and 5 rejected spirometry tests. Therefore following the successful completion of Level I Spirometry Knowledge and Skills, participants will be required to begin preparations to collect the specifi ed spirometric tests. This information is to be recorded and completed in an Spirometry Workbook and must accompany participants to the Level II Knowledge and Competence in Spirometry Measurement. Participants should be reminded that all clinical details of the subjects as well as tests performed on patients must be anonymous.

Course GoalsParticipants will gain the specifi c knowledge, skills and competencies required to perform high quality spirometry tests and cover the key areas of Spirometry practice.

Level II Knowledge and Competence in Spirometry Measurement will ensure participants practice spirometry according to current international standards. Following the course participants will; a. understand the importance of best practice in spirometry service management. b. correctly perform high quality spirometry and reversibility testing, and fully competent to practice spirometric tests.

Learning Outcomes At the end of the training programme, participants will have gained knowledge, skills and competencies in a number of key areas.The learning outcomes for Level II of the training course will ensure that participants • Possess a comprehensive understanding of how to perform quality spirometry and recognition of poorquality manoeuvres. • Acquire a basic knowledge of how to interpret spirometry tests. • Perform quality assurance tests, including ability to correctly describe, document, and ensure quality standards and practice. • Possess the ability to understand, perform and audit spirometry services including equipment maintenance according to international guideline.

Format • Didactic Lectures - Instructional teaching method that allows the student and teacher to effectively understand, consider and analyse the learning goal. • Small group hands on learning - learning by doing. Practical demonstrations and assessment of technique and interpretation, for example. • e-Learning Activities - Types of online learning include CD and audio, e-text, forums, threaded discussions, web-blogs, electronic assessments, and simulation learning. • Case-based discussions - Case-based discussion is a structured interview designed to explore professional judgement in specifi c cases selected by the trainee and presented for evaluation. • Self Directed Learning - A self-paced process of learning where individuals take initiative, formulate learning goals, and identifi es resources for learning • Mentoring – Mentoring is a developmental partnership through which one person shares knowledge, skills, information, and perspective to foster the personal and professional growth of someone else.

16

268 Breathe March 2011 Volume 7 No 3

Level II – spirometry knowledge and skills

Training programme contentSPIROMETRY EQUIPMENT (SMALL GROUP HANDS-ON LEARNING) • Review of workbook assignments.

TECHNIQUE FOR PERFORMING SPIROMETRY (SMALL GROUP HANDS-ON SESSIONS) Completion of Spirometry workbook to • Administer spirometric tests. • Prepare equipment. • Practice testing technique. • Recognise pitfalls of spirometry and methods to improve testing technique. • Recognition of improperly performed manoeuvers etc….

QUALITY ASSURANCE

• Didactic Lectures and use of educational materials and workbooks to. • Problem –solve issues relating to calibration and verifi cation. • Calibration and verifi cation check of equipment. • Recognition of abnormal traces due to technical or patient errors.

EVALUATION OF SPIROMETRIC RESULTS (SMALL GROUP HANDS-ON LEARNING AND CASE-STUDY PRESENTATIONS)

• Use of educational materials and workbooks to evaluate Spirometric Results.

SPIROMETRY SERVICE MANAGEMENT • Understands the importance of keeping all results stored safely and accessibility to health care users. • Performs and records infection control procedures. • Performs and records quality control procedures. • Awareness of audit processes and self assessment of the spirometry service to ensure suffi cient clinical skills are maintained and quality is upheld. • Plans and provides consumables for spirometry service (mouthpieces, nose-clips, paper) and ensures routine maintenance of equipment.

17

SPIROMETRY HERMES

OVERVIEW OF THEERS SPIROMETRY DRIVING LICENCE (SDL)

Brendan CooperIrene SteenbruggenCo-Chairs, ESDL Task Force

18

Dr Brendan Cooper have the following, real or perceived conflicts of interest that relate to this presentation:

I receive occasional loans of lung function equipment to my department for validation purposes.

This event is accredited for CME credits by EBAP and EACCME and speakers are required to disclose their potential conflict of interest. The intent of this disclosure is not to prevent a speaker with a conflict of interest (any significant financial relationship a speaker has with manufacturers or providers of any commercial products or services relevant to the talk) from making a presentation, but rather to provide listeners with information on which they can make their own judgments. It remains for audience members to determine whether the speaker’s interests, or relationships may influence the presentation. The ERS does not view the existence of these interests or commitments as necessarily implying bias or decreasing the value of the speaker’s presentation. Drug or device advertisement is forbidden.

19

SESSION 1

Introduction

Poster Viewing

Share & tell

Summary

20

ERS Spirometry Training Overview

Prerequisites and online modules

Part ISpirometry Knowledge and Basic Skills

+ online modules

Spirometry Workbook

+ calibration logs and spirometry tests

Part IIKnowledge and competence in Spirometry Measurement

Knowledge based test

Practical Assessment

Spirometry Driving Licence Part 1


21

Spirometry Training Programme

This training programme is designed to ensure that participants reach competence in spirometry testing

Prerequisites and ERS Spirometry website

Part ISpirometry Knowledge and Skills

+ online modules

Spirometry Workbook



Knows

Knows How

Shows How

Does

com

pete

nce

22

POSTER DISCUSSION

Rotate to each of the posters and discuss in your group the following questions;

- How would you teach the module items?(choose 1 or 2 from the poster)

- In your experience, what is the most challenging aspect of teaching spirometry?

- How have you tested/assessed spirometry module items?(choose 1 or 3 from the poster)

23

DISCUSSION

Guidelines for certification of ERS spirometry training programmes

24

Guidelines for Certification

This document provides trainers with all the information they will need to deliver a Spirometry Training Programme

For example- Duration of training- Structure of training- Trainer specifications- Venue and equipment specifications- Assessment guidelines

25

Published Document

26

Guidelines for Certification

All information on the HERMES website under spirometry activities is relevant to you if you intend to deliver an ERS spirometry approved course

This updated document is within your educational materials

29

DISCUSSION POINT

Supporting Educational Tools and Educational Materials

30

Supporting Educational Tools

A set of training guidelines for certification

Standardised educational materials for trainers includingpresentations and other resources

Assessment criteria including an online knowledge test and guidelinesfor practical assessment

A spirometry website with supporting educational tools for trainers andparticipants

A Spirometry train-the-trainer course programme which is mandatory forthose wishing to become course directors

31

Educational Materials

Specific educational materials have been designed to support trainers deliver this Spirometry Training Programme

• ERS Spirometry Website• ERS Spirometry Workbook

• Case Studies• Classroom

assignments/assessments

32


ERS Spirometry Website: All registered participants will be given access to this website. The website includes

Online modulesTest questions on each moduleOnline knowledge test to be completed after Part I

Presentations for trainers: Core presentations and educational supports have been designed. This information must be used for trainingAdditional slides or information can be included by the individual trainers at the discretion of the course director.

Part I Knowledge and Basic Skills

33


ERS Spirometry Workbook: At the end of Part I of the training, participants will receive a workbook (also available on the ERS website) which will need to be completed with;

Background informationSpecific assignments in spirometry equipment, quality assurance,

spirometry technique, spirometry resultsCalibration logsA portfolio of spirometry tests

Educational Materials for trainers: An example of a completed spirometry workbook is availableGuidelines for marking the spirometry workbook will be provided

ERS Spirometry Workbook

34


Part II training materials:Case studies Classroom assignments for practical assessments

Educational Materials for trainers: Core presentations and educational supports have been designed. This information must be used for training

Guidelines for delivering practical hands-on sessions to assess participants competence

Part II Knowledge and Competence

35

DISCUSSION POINT

Assessment

36

Assessment

Prerequisites and online modules

Part ISpirometry Knowledge and Skills

+ online modules

Spirometry Workbook



Knowledge based test

Practical Assessment

Spirometry Driving Licence Part I


1. Assessment

Part I

3. Assessment

Part 22.

WorkbookAssessment

37

Assessment

Participants must meet minimum criteria for all assessment parts including;

• Online Knowledge Test

• ERS Spirometry Workbook

• Practical Assessment

38

Assessment

Online Knowledge Test:This test will be available to all participants after the course

They must complete the test within the time period allocated in the assessment guidelines

After successful completion of the test, participants must print a copy of their certificate. This certificate is a pre-requisite to continue to Part 2

39

Assessment

ERS Spirometry Workbook:The objective of the workbook is to determine whether a course participant has gained sufficient competence in spirometry measurement

All participants must meet the minimum criteria as indicated in the assessment guidelines

The course director is responsible to oversee the assessment of workbooks

40

Assessment

Practical Assessment:This assessment will take place during training day 2 – Part 2 knowledge and competence in measurement

The practical assessment must use the standardised documents provided by ERS

The course director is responsible to oversee the assessment of workbooks before Part 2

41

Questions and Answers

42

THANK YOU

43

Principles of teaching and learning in the clinical workplace

Dr Walther van Mook Maastricht University Medical Centre

P. Debyelaan 25 Maastricht 6229 HX

NETHERLANDS [email protected]

SUMMARY This session will be attempt to blend evidence and theory on medical education with daily practice in the (para)medical sciences. During the process of knowledge acquisition, the learner’s prior knowledge is important for learning

and the quality of what is learnt is dependent on the activation of prior knowledge, the degree of elaboration of the knowledge or skill being learnt and the effective transfer of the prior knowledge in the new learning context. Therefore, effective instructional methods and the knowledge of their strengths and weaknesses are crucial for effective learning in the clinical learning environment. This session will focus on societal changes and associated contemporary professonal role changes, and touch upon more recent changes in concepts of medical education. The so-called Three C’s of medical education impact on current medical school and workplace based learning. The learning styles by Kolb and the extent to which knowledged is retained over time is touched upon. The relevance of contemporary competency-based training, the importance of context (and assessment) and establishing a good learning climate as prerequisates for learning is thereafter discussed. The session will be concluded by practically relevant take home messages. Further reading (a few suggestions) from the extensive literature 1. Spencer J. ABC of learning and teaching in medicine: Learning and teaching in the clinical

environment British Medical Journal 2003; 326:591-94 2. Parsell G, Bligh J. Recent perspectives on clinical teaching. Med Educ 2001; 35:409-14. 3. Durning, Steven J. and Cate, Olle Th. J. ten Peer teaching in medical education, Medical Teacher,

29: 6, 2007, 523 — 524 4. Stallmeijer R, Dolmans DHJM, Wolfhagen IHAP et al. The Maastricht Clinical Teaching

Questionnaire (MCTQ) as a valid and reliable instrument for the evaluation of the clinical teachers. Acad Med 2010;85, 11: 1732-1738

5. Boor K, Van Der Vleuten CPM, Teunissen P, Scherpbier A, Scheele F. Development and analaysis of D-RECT, an instrument measuring residents’ learning climate. Med Teach 2011,

33,10: 820-827 6. Slootweg IA, Lombarts KM, Boerebach BC, Heineman MJ, Scherpbier AJ, van der Vleuten CP.

Development and validation of an instrument for measuring the quality of teamwork in teaching teams in postgraduate medical training (TeamQ). Plos One 2014, 13,9(11): e112805

44

Principles of teaching and learning: a practical perspective

Dr. Walther N.K.A. van Mook Internist-intensivist,

Chair of Professional Behaviour Committee Faculty of Health, Medicine and Life Sciences

Maastricht University Medical Centre

45

http://www.mundo.unimaas.nl/mundo.html

Outline

societal changes and professonal role changes

curriculum changes and changes in concepts of medical education

the Three C’s of medical education, consequences medical school/workplace

learning styles, retention of what is learned

competency based training and importance of context

learning climate

take home messages

46

internal quality control (re)registration

higher demands patient(organisations)

‘shared care’, ‘care’ vs ‘cure’, teamwork

costs

healthcare management

philosophy patientcare

patients/doctors

(r)evolution informationtechnology

knowledge skills, technology

complexity of care

private vs professional life part-time work

attitude

WBIG, WGBO hours restriction

external quality control legislation

feminisation

2005

cardiac surgery Nijmegen

errors, patient safety

Societal changes

47

Contemporary professional

Accountable to others

Partnership model, teamwork

Shared decision making

Evidence-based practice

Continuous professional development mandatory

External quality control

Knowledge and information overload

Care

Art

Traditional professional

Accountable to oneself

Solo, individual

Decision made by doctor

Experience-based practice

Attention to professional development lacking

Internal quality control

Very gradual increase in knowledge and information

Cure

Science

Present Past

Professional role changes

48

Medicine used to be simple, ineffective, and relatively safe. Now it is complex, effective, and potentially dangerous.

Or….

Lit. Chantler. Lancet 1996:353: 9159: 1178-81 49

Traditional to integrated curricula

Traditional curriculum

teacher-centred determined by disciplines, departments and deans no over-all design, no integration theory/practice few educational formats

Integrated curriculum

student-centred determined by societal needs and graduate profile thematic, modular structure variety of educational formats

50

Changes in concepts of ME

Teaching Transfer of knowledge skills professionalism context to context

Individual learning Isolated knowledge Theoretical knowledge

Learning Construction of knowledge

Collaborative learning Contextual learning Theory and practice + application in practice + problem solving

51

How?

More authentic problems

Increasing complexity

Real life projects

Authentic assessment C ontextual

C onstructive

C ollaborative 52

Context influences learning

influence of social pressure

average pressure, average task: correlation 0.41

strong pressure, difficult task: correlation 0.31

9% of variance of person’s behaviour

determined by individuals attitude!

akrasia

challenge not ‘hard’ cases

tempting to leave the clearly visible path, driven by day-to-day routine (fatigue, hunger, stress etc)

Lit.:Acad Med 2007 82(1): 46-50 Rees; BMJ 1995 311(6998): 182-4 Mays 53

Importance of context

Lit.: Rev Gen Psych 2005 9: 214-227 Wallace

Professional lapse

54

How?

Less direction

Increasing independent learning

More demand driven

Portfolio assessment; self/peer assessment C ontextual

C onstructive

C ollaborative 55

How?

Smaller groups

Group assignments

More ICT support

Learning task = assesment; include group work in assessment C ontextual

C onstructive

C ollaborative 56

Consequences medical school

skills labs small group sessions problem-orientated experience-based early introduction of patients student-centred teacher-guided

57

Consequences workplace?

ideal environment for learning motivating authentic directed towards practical application direct observation/feedback many different tasks

variety of patients

58

Workplace based learning

learning by doing

on the job training job-embedded learning

59

http://www.google.nl/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCL3i6si7t8cCFcddGgodeSIBMg&url=http%3A%2F%2Ffunnyizm.com%2Ffighter-jet-pilot-learning-on-the-job%2F&ei=qa3VVf3pCse7afnEhJAD&bvm=bv.99804247,d.d2s&psig=AFQjCNGWp_GDUR0wnYq61oHXleObvxAHNQ&ust=1440153360287271

What the literature tells us…

limited observation

limited supervision

limited direct feedback many routine tasks depending on patient mix in the department learning by doing, see one, do one, teach one learning from near accidents role models not always ideal relative lack of attention for generic competency

domains

60

Other lessons….

Effective experiential learning requires deliberate practice feedback reflection workplace should be more structured role modeling/role of teacher domain independent skills, e.g. PB

61

Kolb cycle (1983)

62

Learning phases and styles

concrete experience starts by experiencing: activists

reflective observation reserved, tests the water: reflectors

abstract conceptualising explanatory models, concepts, constructs:

theoretisists

active experimenting: test theory in practice: pragmatists

63

Four learning styles

64

Perception/processing continuum

65

And…

not always in the same order we learn differently we tend to enter the cycle at preferred points

not always in the same degree/intensity we learn best if we move thru the cycle

we all learn from our own experience origin of the typical styles distinction thinker, doer

66

Four typologies

67

Also specialty dependent?

68

The cone of learning

.

Participatory Teaching Methods

Passive Teaching Methods

National Training Laboratories, Bethel, Maine, USA Bales, E. 1996

69

http://www.google.nl/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCO-4k_KKo8cCFUTSGgodbnsIVQ&url=http%3A%2F%2Fmikedsummers.com%2Fmultiple-learning-formats%2F&ei=Q_7KVa-LLMSka-72oagF&bvm=bv.99804247,d.d2s&psig=AFQjCNFP_OFJzoRRHrnGTdpgl6Nl0x_aDg&ust=1439453051621774

http://www.google.nl/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCPjA_fGLo8cCFQPVGgod86wEXA&url=http%3A%2F%2Fdesignformeded.com%2F2013%2F04%2F07%2Fdeep-thoughts-on-lectures-and-the-learning-pyramid%2F&ei=T__KVbjdMIOqa_PZkuAF&bvm=bv.99804247,d.d2s&psig=AFQjCNHlxyFUOflgHi03kswzlpwqIpfR3A&ust=1439453254339496

An itterative process

70

Experiencing/acting

Reflection on action

Conceptualisation of essential aspects

Develop and choose alternatives

Apply to new contexts and situations

1

5

2

3

4

Korthagen, F.A.J. (2002)

Applicable the workplace

71

discipline-orientated curricula

theme-orientated curricula

problem-orientated curricula

competence-orientated (or outcome- directed)

Back to history….

72

Nowadays….

• Canadian (CanMEDs) structure Medical expert Communicator Collaborator Manager Health advocate Scholar Professional

• American (ACGME) structure Patient care Medical knowledge Practice-based learning

& improvement Interpersonal and

communication skills Professionalism Systems-based

practice

73

http://www.acgme.org/acWebsite/home/home.asp

Nowadays….

• Canadian (CanMEDs) structure Medical expert Communicator Collaborator Manager Health advocate Scholar Professional

74

31

An overarching competence?

Classical CanMEDs flower Modifications van Mook/van Luijk

All professionals are experts, but not all experts are professional! 75

farmer sports public maintenance

doctor conductor businessman

Generic?

76

Paraguay Punjab Jordan

Malaysia United States Spain

Generic?

77

Most important….

• patient mix/exposure to practice • opportunities for supervised/independent examinations • supervision and feedback received • organisation quality • limited number of students at one time • educational sessions • positive attitude of staff towards students • student being part of a team

78

Measures to improve effectiveness….

student study guides/navigation plan ‘teach the teacher’ trainings/FDPs more direct observation and feedback include protected time for selfstudy integration of learning and assessing in the workplace by using mini-CEX, logbooks etc.

79

Hallmarks of a good teacher.

.

is critical provides and aks for feedback respects the trainee schedules time for educational issues contributes/creates a safe learning

environment is enthousiastic stimulates gradual independence modeling, coaching, fading

• stimulates reflection

Boendermaker, P.(2003) 80

Faculty of Health Medicine & Life Sciences – Department of Educational Development and Research

Cognitive apprenticeship Cognitive apprenticeship

Modelling Exploration

Reflection Articulation

Coaching Scaffolding

Modelling demonstreert, denkt hard op, gedraagt zich als rolmodel

Coaching Observeert, geeft feedback, biedt assistentie

Scaffolding Biedt ondersteuning, stelt het niveau van de student vast,

bouwt ondersteuning geleidelijk af

Articulatie Stelt vragen aan de student

en stimuleert de student om zelf vragen te stellen

Reflectie Stimuleert student te reflecteren op zijn sterktes/zwaktes

Exploratie Stimuleert student om leerdoelen te formuleren Learning climate

Collins, Brown & Newman, 1989 Stalmeijer, 2011

Learning climate

81

Learning and teaching climate

.

D-RECT: Dutch Education Climate Test: 11 factors, 50 questions

MCTQ: Maastricht Clinical Teaching Questionnaire: 5 factors, 21 questions

Team Q

Plos One 2014 Slootweg et al: Team Q Med Teacher 2011 Boor et al: D-RECT Acad Med 2010 Stallmeijer et al: MCTQ 83

medical school

student

residency

resident

life long learning

specialist

cooperation/teamwork working climate non-compliance guidelines errors complaints

Evidence? (literature study)

Lit. Med Educ 2005 Stern; NEJM 2005 Papadakis; Ann Int Med 2008 Papadakis 84

http://www.annals.org/

Learning curve….

Communication problems

Knowledge/skilss problems

Maslow, A. H. (1954) 85

http://www.google.nl/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCPX16YKFo8cCFWtH2wod3HgA7w&url=http%3A%2F%2Fredcatco.com%2Fleadership%2Flearning%2Fyou-live-you-learn-learn-to-learn-learn-to-live%2F&ei=HPjKVfX3BOuO7Qbc8YH4Dg&bvm=bv.99804247,d.ZGU&psig=AFQjCNH3sxY9oF-EPyhU5AuIBI4MZA20ig&ust=1439451519469657

Take home messages

.

clear navigational plan for students/teachers faculty development programmes specific and generic skills informal, experience based learning,

complemented with formal sessions observe, feedback, reflect, discuss gradual independence complement with assessment safe learning climate

86

“It may not be a perfect wheel, but it’s a state-of-the-art wheel.”

87

End

Walther N.K.A. van Mook MD PhD Internist-intensivist Department of Intensive Care Maastricht University Medical Centre+ P. Debyelaan 25 PO Box 5800 6202 AZ Maastricht, Netherlands E-mail: [email protected]

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mailto:[email protected]

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Copyright

89

ERS Spirometry Driving Licence specific teaching and training

Ms. Julie Lloyd Good Hope Hospital

Rectory Road Sutton Coldfield B75 7RR

UNITED KINGDOM [email protected]

AIMS At the end of this session, delegates will:

Be familiar with the educational requirements of ESDL Part I and Part II. Be aware of a range of teaching formats that can be used to deliver the required training. Be able to select an appropriate teaching format to deliver the required training

90


Julie LloydVice Chair ARTP (UK)

ESDL SPECIFIC TEACHING & TRAINING

92

I have no real or perceived conflicts of interest that relate to this presentation:

Affiliation/Financial Interest Commercial Company

Grants/research support:

Honoraria or consultation fees:

Participation in a company sponsored bureau:

Stock shareholder:

Spouse/partner:

Other support/potential conflict of interest:


93

OVERVIEW

• Suggested reading• Duration of training• Teaching and delivery of:

– Part 1

– Part 2

• Overview of difficulties in spirometry training

94

SUGGESTED READING

1. Miller MR, Hankinson J, Brusasco V, et al, Standardisation of spirometry: number 2 in series – ATS/ERS Task Force: Standardisation of Lung Function Testing. EurRespir J 2005; 26: 319-338.

2. ARTP Spirometry Handbook 2nd Edition. www.artp.org.uk.

3. SpirXpert. Quanjer P. www.spirxpert.com

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http://www.artp.org.uk/

http://www.spirxpert.com/

BEFORE YOU START ...

• Before you plan your program, before you consider the appropriate teaching or learning style ...

• Consider the audience that you are teaching:– What do the want from the course?

– What do they need from the course?

– What is their background?

• If you fail to do this, your course is unlikely to succeed.

96

DURATION OF TRAINING

• Should comply with the specifications recommended within the ERS European Spirometry Training Programme:– 9 -12 hours for Part 1 training

– 7-10 hours for Part 2 training.

• A number of training modules for Part 1 may be completed online prior to attending Part 1 classroom training.

• Each online module completed counts for 1 hour of training time and will reduce classroom training time for Part 1.

97

AVAILABLE TEACHING FORMATS

• Didactic Lectures– Instructional teaching method that allows the student and

teacher to effectively understand, consider and analyse the

learning goal

• Small group hands on learning - learning by doing. – Practical demonstrations and assessment of technique and

interpretation, for example.

• e-Learning Activities – Types of online learning including audio, e-text, forums,

threaded discussions, web-blogs, electronic assessments,

and simulation learning

98

AVAILABLE TEACHING FORMATS

• Case-based discussions - Case-based discussion is a structured interview designed to

explore professional judgement in specific cases selected by the trainee and presented for evaluation

• Self Directed Learning- A self-paced process of learning where individuals take

initiative, formulate learning goals, and identifies resources for learning

• Mentoring- Mentoring is a developmental partnership through which

one person shares knowledge, skills, information, and perspective to foster the personal and professional growth of someone else.

99

PART 1 MODULE OUTLINE

1. Anatomy, physiology and pathophysiology required for Spirometry2. Definitions of spirometric values3. Spirometry equipment.4. Indications and contraindications of spirometry testing5. Spirometry technique6. Quality assurance7. Evaluation of spirometric Results

100

EXAMPLE PROGRAM- SESSION 1

Module Title Recommended time

required 3.5 – 4 hours

Welcome and Introduction 15 mins

Module 1 Anatomy, physiology and

pathophysiology required for

spirometry

1 hour

Module 2 Definitions of Spirometric

Values

1 hour

Module 3 Spirometry Equipment

(small group hands on session)

1.5 hours

101



required 2– 4 hours

Module 5 Spirometry Technique

(small group hands-on sessions)

2 hours

102

EXAMPLE PROGRAM- SESSION 3Module Title Recommended time

required 3. 5 – 4 hours

for Session 3

Module 4 Indications and

contraindications of

spirometry testing

30 mins

Module 6 Quality assurance 1 hour

Module 7 Evaluation of spirometric

results

1.5 – 2 hours

Module 9 Overview of Part II,

submission of the ERS

Spirometry Workbook

30 mins

103



Knowledge Test To be confirmed

104

SUGGESTED TEACHING FORMATS

ESDL Part 1

105

PRE COURSE KNOWLEDGE ASSESSMENTS

• Not mandatory!• Helpful to assess the knowledge base of your group before you

start.– Ensures candidates that have used e-learning or self directed learning have

understood the materials.

– Helps trainers focus on areas of weakness.

• Very useful to re-administer the test after the course to demonstrate learning– Identifies areas that student learning may be less effective.

– Reinforces to students how much they have learned!

106

MODULE 1: A&P & PATHOPHYSIOLOGY

• Learning outcomes:– Knowledge of anatomy and physiology of the

respiratory system

– Knowledge of pathophysiology of respiratory

disorders

107

MODULE 1: A&P & PATHOPHYSIOLOGY

• Traditionally taught as didactic lectures, but ... may not be stimulating for participants or lecturer!

• Other options to consider:– Self directed learning

– E-learning

– Video’s

– Any other suggestions …?

• Irrespective of method used, must have some way of assessing students understanding of the material.

• Consider the needs of your students.• It is unlikely that the students will be as enthusiastic about the

subject as the speaker!

108

MODULE 2: SPIROMETRY DEFINITIONS

• Learning Outcomes:– Explain the principle of spirometry

– Define FEV1, FVC, FEV1/FVC

– Define PEF, FEF25-75, PIF

– Define VC, IRV, ERV, IC

– Explain the characteristics of a flow-volume curve

– Explain the characteristics of a volume-time curve

– Explain the relationship between volume-time and flow-

volume curve

109

MODULE 2: SPIROMETRY DEFINITIONS

• Didactic lecture easiest way to deliver information, – What are the weaknesses in using

only this method?

• Useful to support with practical demonstration of where the indices come from.

110

MODULE 3: SPIROMETRY EQUIPMENT

• Learning Outcomes:– Describe the minimum recommendations for spirometry

systems

– Describe strength and weaknesses of your spirometer

– Recognise pitfalls of the instrument

– Describe the factors that influence reference values

111

MODULE 3: SPIROMETRY EQUIPMENT

• Not helpful just to teach facts – students need to know why this information is important.– Show examples e.g. PEF error due to low range device being issued

• To understand the strengths & weaknesses of their device, they have to see other devices:– Make it ‘competitive’ e.g. ‘this spirometer is better because...’ etc!

• Reference values– Try to get participants to calculate ‘long-hand’ and then students can

see the effect of a change in height or sex makes to them.

112

EXAMPLE WORK SHEETS

For the FVC and FEV1, calculate the predicted values, the %predicted and a reference range for these patients:

Patient 1: Mr L-C, aged 65 years, 1.72 m.Spirometry results FVC = 2.5 LFEV1 = 1.4 LFEV% = 65%PEF = 320 L/minFor FVC:(4.3 x 1.72) – (0.029 x 65) – 2.497.396 – 1.885 – 2.49 = 3.021LRange = 3.02 + (0.51 x 1.645) = 3.02 + 0.84 = 3.86L

3.02 - (0.51 x 1.645) = 3.02 – 0.84 = 2.18L

113

MODULE 4: INDICATIONS AND CONTRAINDICATIONS

• Learning Outcomes:– Summarise indications and contra-indications for

spirometry

– Summarise the limitations of spirometry

114

MODULE 4: INDICATIONS AND CONTRAINDICATIONS

• Present open questions to your group:– What is spirometry used for?

– Who wouldn’t you do spirometry on and why?

• Flip charts are helpful and depending on the size of your group, smaller breakout groups with their own flip chart work well.

• Have slides or handouts prepared with the complete and correct answers for after the discussion.

115

MODULE 5: SPIROMETRY TECHNIQUE

• Prepare equipment required for testing• Demonstrate the correct use of the spirometry device• Summarise preparation of subject• Describe the correct position to perform spirometry• Demonstrate height and weight measurement• Record type, dosage and time of relevant medication• Explain testing procedure to subject• Demonstrate the procedure to subject• Demonstrate subject coaching• Obtain accurate spirometry measurement according to international

guidelines (to include examples of international guidelines)

116


• Recognise improperly performed manoeuvres• Demonstrate appropriate corrective actions• Demonstrate injury prevention knowledge• Identify and use standard personal protective equipment• Demonstrate awareness of confined spaces, including potential

hazards, and safety standards.• Document relevant events that occurred during the spirometric

assessment• Demonstrate correct method of administering a bronchodilator• Summarise issues related to the choice of bronchodilator

117


• Large topic best taught by practical, hands on experience.

• Need more facilitators for this session to keep group sizes small.

• Demonstrate good technique using a patient/operator pair:– Good patient/bad operator

– Bad patient/good operator etc!

• Mimic patient and technical errors and use teaching traces to support this.

• You can have lots of fun with this bit!!!!

118

OTHER OPTIONS – VIDEO PRESENTATION

• Use of video really works if you don’t have many facilitators.

• Can create scenarios and ask students to feedback the good, the bad and the ugly!

• Can also video the students and ask them to critique one another – needs care.

• Ensure you have a good selection of bronchodilator devices for candidates to explore.

• Any other suggestions …?

119

MODULE 6: CALIBRATION & QA

• Describe and perform a control spirometry using a subject with known lung function

• Describe and perform calibration or verification check of equipment• Describe methods for prevention of infection transmission• Explain the rationale for regular cleaning• Summarise the requirements for equipment quality control• Recognise abnormal traces due to technical or patient errors• Describe the advantages of regular over-reading of traces by

external experts (samples)

120

MODULE 6: CALIBRATION & QA

• Lends itself to a range of teaching styles.• What would you try …?

• Can use didactic lecture– What are the weaknesses of this?

• Practical demonstration– Particularly useful for calibration technique and for cleaning of device

• Group work:– Provide sets of values to calculate physiological range from.

– Provide traces with patient and technical errors for discussion and feed back to

the group.

– Provide examples of completed QC data and try calibrating ranges

121

MODULE 7: EVALUATION OF RESULTS

• Document the acceptability criteria• Document the repeatability criteria• Document reversibility criteria• Summarise test result selection• Describe selection of best curve• Compare test results with reference values

122


• Basic understanding of limitations of reference values• Basic understanding of errors of using the % predicted and the

advantages of using the LLN• Evaluate change in individual subjects• Recognise and describe the normal pattern as well as restrictive and

obstructive pattern in the volume time curve.• Recognise and describe the normal pattern as well as restrictive and

obstructive pattern in the flow volume curve.• Knowledge of storage/electronic data

123


• Another Module that lends itself to a range of teaching styles.• Obvious is didactic lecture.• Group work:

– Provide sets of values for review with some patient background.

– Students need to comment on the quality of the data and provide a technical

report.

– If quality standards are met, students provide a clinical interpretation of the

data.

– Present the patient back to the group and group discusses.

124

MODULE 9: COURSE ASSIGNMENTS

• Understand the next steps to be taken to complete and submit the ERS Spirometry Workbook including training exercises, portfolio of tests and the assessment process for Part II training

125

MODULE 9: COURSE ASSIGNMENTS

• Group discussion of potential problems or difficulties.– Work place support

– Time!

– Conflicting demands etc.

• Examples of completed Work Books for review• Agreed mentoring sessions and ‘practice’ assessments with

students.

126

SUGGESTED TEACHING FORMATS

ESDL Part 2

127

BACKGROUND

• Before commencing Part II, a number of assignments relating to the practice of spirometry must be completed in the ERS Spirometry workbook.

• This workbook will form the basis of Part II competency based training and assessment.

• It is recommended that participants complete Part II training within 6 - 12 calendar months after completing Part I.

128

PART 2 – DURATION

• Part II is a 7 - 10 hour training course which will focus on competency-based training and requires participants to complete exercises and submit a portfolio of spirometry tests.

• Training techniques mirror those used for Part 1 training and should be led by the needs of the group.

• The award of the European Spirometry Driving Licence will be dependent on a competency assessment.

129


Module Title Recommended time required

3.5 – 4 hours Welcome and Introduction 10 – 15 minutes

Module 4 Spirometry Equipment

Review of workbook assignments

(small group hands-on learning)

1 hour

Module 7 Quality Assurance

Didactic Lectures and use of educational materials and workbooks to:

Problem –solve issues relating to calibration and verification

Calibration and verification check of equipment

Recognition of abnormal traces due to technical or patient errors

1 hour

130



2– 4 hours

Module 5 Technique for performing spirometry

(small group hands-on sessions)

Completion of ERS workbook to

•Administer spirometric tests

•Prepare equipment

•Practice testing technique

•Recognise pitfalls of spirometry and

methods to improve testing technique

•Recognition of improperly performed

manoeuvers etc…

1.5 hours

131



3. 5 – 4 hours for Session 3

Module 7 Evaluation of Spirometric Results

(Small group hands-on learning and case-study

presentations)

Use of educational materials and workbooks to evaluate

Spirometric Results

1 hour

The magical

return of

Module 8

Spirometry Service Management

Understands importance of keeping all results stored safely and

accessibility to health care users

Performs and records infection control procedures

Performs and records quality control procedures

Awareness of audit processes and self assessment of the spirometry

service to ensure sufficient clinical skills are maintained and quality is

upheld

Plans and provides consumables for spirometry service (mouthpieces,

nose-clips, paper) and ensures routine maintenance of equipment

30 mins

132



required 2– 4 hours

Final ‘questions and answers’

session and opportunity for hands

on practice

30 – 60 mins

133

EXAMPLE PROGRAM- FINAL ASSESSMENT

Module Title Recommended

assessment time 30

minutes /candidate

Module 9 Assessment of competence in

Spirometry practice

Collection of complete ERS

Spirometry workbooks

oAccording to the ERS guidelines for certification there should be no more than a 10:2 participant: teacher ratio equating to 2.5 hours assessment time

oAll assessments to certify candidates with the European Spirometry Driving Licence should strictly follow ERS Criteria for certification

134

DIFFICULTIES IN SPIROMETRY TRAINING

• Requires lots of preparation– Time consuming

– Organisational issues

– Lunch, no lunch!

• The teaching plan and the group don’t match.

• Unrealistic expectations– Teacher and student!

• Unmotivated students• Lack of workplace support

– Theory

– Study time

– Patients

• Any others you can think of?

135

QUESTIONS AND COMMENTS?

136

Practical session on presentation and facilitation skills

Ms. Vera Habes Health Care Faculty, University of Utrecht

Bolognalaan 101, Kamer 2.106, Postbus 85182 3508 AD Utrecht, Netherlands

[email protected]

Dr Odile van Eck 5583 XK Waalre

Netherlands [email protected]

137

Principles of effective feedback




SUMMARY This session will be attempt to blend evidence and theory on providing feedback as derived from the medical education with daily practice in the (para)medical sciences. We all know that what what should and can be ideally done, is different from actual performance in practice. Rhetoric and reality differ regarding teaching and learning in the workplace. This is also true for providing and receiving feedback. Having acknowledged this fact, the session will subsequently touch upon the history of feedback and the lack of a operational definition regarding feedback in clinical practice. The literature on the topic of feedback in medical education in general is briefly reviewed, and in an eight year period 439 papers were identified. Two recent thesis on the topic, by Dr. Rachell Kamp, and Monica De Ridder (2013, resp. 2015) were also acknowledged. The issues learned from these papers/thesis are presented. Having acknowledged the theoretical background regarding feedback, the session subsequently touches upon how feedback should be ideally conveyed and received in daily practice, and who can be approached as assessors. A summary of the session will be provided by several take home messages. Further reading (a few suggestions) from the extensive literature 1. Monica De Ridder. Feedback in Medical Education. Thesis, 2015. ISBN 978-90-393-

6372-0 2. Rachelle Kamp. Peer feedback to enhance learning in problem-based tutorial groups.

Thesis 2013. ISBN 978-90-8891-731-8

Examples of publications 3. Kamp R, Dolmans DHJM, van Berkel HJM, Schmidt H. Can students adequately evaluatie the

activities of their peers in PBL? Medical Teacher 2011, 33(2): 145-50 4. Van de Ridder JMM, Stokking KM, McGaghie WC, Ten Cate OThJ. What is feedback in clinical

education? Med Educ 2008, 42: 189-197 5. Van de Ridder JMM, Stokking KM, McGaghie WC, Ten Cate OThJ. Variables that effect the

process and outcome of feedback, relevant for medical training: a meta-review. Med Educ 2015, in press

138

Principles of feedback: another practical perspective




139


Outline

rhetoric and reality differ

meaning/definition

concepts

focus of literature

proposal clinical definiton

benefits of feedback:

what was learned?

feedback in practice

take home messages

2013

2015

140

Rhetoric and reality…

Effective practice requires

exposure to practice/deliberate practice

feedback

reflection

But:

learning by doing AND error

unstructured/unsafe learning environment

limited direct observation

limited/meaningless feedback

focus on domain-specific skills and ‘negative’ feedback

self reflection rare (student and teacher)

141

Definition

Lacking!

Dates back to Hipocrates

Term introduced in “electronics” in 1920s “The return of a fraction of the oputput signal from one stage of the

circuit…… to the input of the same or a peceeding stage….. Tending to increase or decrease the amplification”

In social sciences 1943 “Feedback signifies that the behaviour of an object is controlled by

the margin of error at which the object stands at a given time with reference to a relatively specific goal”

So: cycles that connect input and output

142

Concepts

Literature comparison of 36 definitions

Feedback as information

Feedback as reaction (where information is included):

interaction

Feedback as cycle (involving information and reaction)

consequential (message outcome, e.g. response improvement)

Literature on medical education

439 papers 2006 - 2013

143

Focus

Feedback literature 2006 – 2013

439 papers

To improve human performance

To improve programmes

Feedback process - General overview - Feedback recipient - Feedback content - Feedback provider

Feedback effects - Learning process - Paitents health - General working

Feedback methods - Feedback providing - Feedback improvement

Programme evaluation - Towards aspects of

feedback process - Towards programmes

144

Proposal

Proposal for operational definition for clinical practice:

“Specific information about the comparison between a trainee’s observed performance and a standard given with the intent to improve the trainees’ performance”

Med Educ 2008 M. De Ridder et al 145

What was learned?

Feedback

Marks vs words (written/verbally)

Negative associations with marks, induce competetion

Marks have limited value for learning

Generic skills, e.g. PB, difficult to grasp using marks

Criteria (checklists) vs descriptions of groups of behaviours (rubrics, typologies)

For learning (formative), of learning (summative)

Discrepancies between perception medical educators and trainees

90% of surgeons, 17% of surgical residents, c

comparable in EM

Med Teacher 2005 Sender et al; Med Teacher 2008 Perrera et al

146

A rubric

147

What was learned?

Students

clearly defined, task oriented, simple and timely feedback, provided by content expert, in safe environment = most useful!

Good teacher’s feedback skills:

aware of and able to handle emotional responses, encouraged self-problem solving, able to handle conflicts, focused on the learner’s needs

148

But…

However 1

written feedback often not specific, unclear, not focused on behaviour, often only negative, and no plan for future action

However 2

verbal feedback difficult: emotional response, reduction in popularity, destruction teacher-trainee relationship

149

What was learned?

Tailor the feedback towards students’ learning style maximizes the likelihood of applying the feedback.

Courses in feedback provision result immediate and long term improvements

Seeking feedback is useful for developing competencies Learning goal orientation

Benefits

Etc

150

What was learned?

Feedback from residents and specialists equally instructive

peers, administrators, managers voiced concerns less often; consultants and nurses more often

Feedback can be tactile, visual (graphics), audiovisual (mannequins), numerical (scores), programmed worded feedback, feedback from other (verbally ict writing)

The effect of feedback is often moderate to small regarding effectiveness

151

What was learned?

FPs credibility contributes to trainees’ satisfaction, and improves delayed (not immediate) performance

A 9 scale, 46 item Perceptions towards feedback in clinical setting (P-FICS) measures student perception of quality and usefullness of feedback.

Stimulate reflection

Guide discussions on how to handle feedback

A 3 scale, 34 item Maastricht Peer Activity Rating Scale (M-PARS) was developed for tutoral groups

Submitted M. De Ridder et al; de Ridder Med Teacher 2014; Med Teacher 2011 Kamp et al

152

What was learned?

Variable Effect, outcome measure

Observation, interpretation and rating

FP rating high complexity tasks Decrease of interrator agreement

FPs having high task familiarity Increase of interrator agreement

FPs trained in using observation instruments

Decrease of rating errors

FPs using rubrics Increase of reliability of scoring

FPs and FRs having similar cultural background

Higher performance ratings

FPs having time to build a relationship with FR

HIgher correlations between subjective and objective performance measures

Med Educ 2015 M. De Ridder et al 153

What was learned?


Observation, interpretation and rating

FP rating high complexity tasks Decrease of interrator agreement

FPs having high task familiarity Increase of interrator agreement

FPs trained in using observation instruments

Decrease of rating errors

FPs using rubrics Increase of reliability of scoring

FPs and FRs having similar cultural background

Higher performance ratings

FPs having time to build a relationship with FR

HIgher correlations between subjective and objective performance measures

Med Educ 2015 M. De Ridder et al


Feedback effect FRs having low initial task performance

High feedback effect

Feedback message is threat to FRs self esteem

Low feedback effect

FRs having goal setting behaviour Increase of feedback effect

Feedback part of multi-facetted intervention

Increase of feedback effect

Feedback content: encouraging, specific, elaborate

Increase of feedback effect

Feedback message frequently given Increase of feedback effect

154

Guidelines

guidelines on effective feedback: many “ gut” feeling, best practice

155

In practice

Feedback addresses three principle questions

Where am I going?

How am I going?

Where to next?

156

Providing feedback

Announce that feedback will be provided

The feedback should be aimed at observed behaviour, use first hand data, not hearsay: “I have observed, I got the impression”

The feedback should be provided immediately after the observation, not in third persion

The feedback should be concrete, and specific

The feedback should contain positive as well as negative feedback (but constructive)

Avoid words like “a little”, “somewhat”

157

Providing feedback

Focus on remediable issues

The feedback should be accompanied by concrete learning goals and plans for follow-up

The feedback should be documented

158

Phases providing feedback

• Phase 1 I Describe the observation

• Phase 2 I Describe the effect = impression, behaviour, result

• Phase 3 You Is this recognisable? Can you understand my reasoning/my impression?

• Phase 4 You(I) Describe wish, or proposal: either ask what the student’s idea for improvement are, or propose a plan

159

Receiving feedback

Listen Do not go into defence mode, be receptive Repeat Probe into rationales Accept only feedback relating to observed behaviour Asks others for feedback as well

Submitted M. De Ridder et al; de Ridder Med Teacher 2014

160

Who can be assessors?

Submitted M. De Ridder et al; de Ridder Med Teacher 2014; R Kamp et al Med Teacher 2011

Self

Staff members

Co-workers Patients

Peers

Reflection, lifelong learning,

Expert feedback; responsibility

Unique observations and interpretations of professional behaviours

Reflective practice, teamwork

161

Take home messages

.

A lot is learned on feedback over recent years

Rhetoric is still different from practice

Different sources provide different feedback

Faculty development programmes are paramount for learning feedback skills (same for students)

162

“It may not be a perfect wheel, but it’s a state-of-the-art wheel.”

163

End


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Copyright

165

Discussion and feedback

Ms. Vera Habes Health Care Faculty, University of Utrecht

Bolognalaan 101, Kamer 2.106, Postbus 85182 3508 AD Utrecht, Netherlands

[email protected]

Dr Odile van Eck 5583 XK Waalre

Netherlands [email protected]

166

Principles of assessment




SUMMARY This session will be attempt to blend evidence and theory on assessment as derived from the medical education with daily practice in the (para)medical sciences. Much of what is presented is learned from experts on assessment, Prof. Dr. Van de Vleuten (Maastricht University, The Netherlands) and Prof. Dr. Schuwirth(Flinders University, Adelaide, Australia). This sesssion will discuss why assessment is important, and what purposes it serves, explaines the rationale and identifying the different axiomes regarding assessment. The shift from individual, isolated assessments towards contemporary so called programmatic assessment is touched upon. The factors that contribute to creating a good test are discussed in detail using the so—called utility equation by van Der Vleuten, and practical examples are used where applicable. The different, currently used tools, their strenghts and limitations will subsequently be discussed more generally, as well as the use of portfolio for purposes of logging, learning, and evaluation. Since ‘bad apples’ are

identified every now and than when assessing, a structure for dealing with disfunctioning trainees is thereafter briefje touched upon. The sessions concludes with practically relevant take home messsages. Further reading (a few suggestions) from the extensive literature 1. Van der Vleuten CPM, Schuwirth LWT, Driessen EW, Dijkstra J, Tigelaar D, Baartman LKJ,

Tartwijk van J. A model for programmatic assessment fit for purpose. Medical Teacher 2012; 34: 205-214.

2. Van der Vleuten CPM, Schuwirth LWT, Driessen EW, Govaerts MJB, Heeneman S. 12 tips for programmatic assessment. 2014, 1-6

3. Van der Vleuten Schuwirth LW. Assessing professional competence: from methods to programmes. Med Educ 2005;39(3): 309-17

4. Van Mook WNKA van Luijk SJ, Zwietering PJ, Southgate L, Schuwirth LT, van der Vleuten CPM. The threat of the discompetent resident. A plea to make the implicit more explicit. Adv Health Sc Educ 2015

167

Principles of assessment




Acknowledge the work of

Prof. Van der Vleuten, and Prof. Dr. Schuwirth

168


why assess? forms and programmes of assessment utility equation in assessment reliability, validity, educational impact, costs,

acceptance

tools in the toolbox Miller’s pyramid checklists, rating scales, soft skills

Outline

169

Why assess?

certifying role accountability to society forming/shaping role confirming/corroborating role

determine whether the student is competent

feedback on the quality of the education

steer/influence student learning behaviour

170

Assessment drives learning

formative assessment, low stakes

= feedback = guidance, coaching

= assessment for learning

summative assessment, high stakes

= decision making assessment of learning

for individual

for institution

for society

171

individual ↓

society

formative aspect

summative aspect

all students

some students

If it can’t be measured, it can’t be improved

No feedback, no learning

They don’t respect

what you expect,

whereas they respect

what you inspect

Assessment drives learning +

Axiomas regarding assessment

Lit. Med Educ 2006 40 (7): 607-17 Cohen 172

Programmatic assessment

Integral approach to the design of an assessment program with the intent to optimise

Its learning function

Its curriculum quality assurance function

Its decision making function

Med Teacher 2015 van der Vleuten et al 12 tips for programmatic assessment 173

0

Collecting Information

Com

bini

ng

Info

rmat

ion

Valu

ing

Info

rmat

ion

PURP

OSE

OF

THE

PRO

GRA

MM

E

Supporting the programme

Justifying the programme

Improving the programme

STAKEHOLDERS

Documenting the programme

Construction Support

Optimizing current assessment

Pre- and Post- administration

procedures Faculty development

Taking Action (reporting)

Programme in Action

INFRASTRUCTURE

Political & Legal Support

Acceptability Stakeholder involvement

Appeal

Rules & Regulations

Learning Environment

R&D Programme Evaluation Closing the

feedback loop

Effectiveness Scientific Research

Evidence based Best practice

External review Panel of experts Benchmarking

Efficiency Cost-Effectiveness

Resources

Change Management

Needs Momentum

Faculty Support

Domain Mapping Dynamic Tool

Optimal Representation

Acceptability Political & Legal

Justification Transparent governance

Confidentiality

174

Simple, isn’t it?

test

pass

fail

competent

incompetent

=

=

177

Simple, isn’t it?

competent incompetent

pass

fail

178

What is good test?

U = Rw Vw Ew Cw Aw × × × ×

R = reliability

V = validity

E = educational impact

C = cost efficiency

A = acceptance

w = weight Lit. Med Educ 2005 Van der Vleuten et al

179

reliability validity

educational impact

feasibility (cost) acceptability

Requirements for assessment

180


educational impact



181

Reliability

58%

48%

68%

Repeatability (test-hertest)

Internal consistency (inter-itemcorrelation )

A number between 0 en 1

100%

0%

182

Test = sample!

Total competency domain(s)

183

Assessment and pixels

184

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Stakes continuum + data points

No stake

Very high stake

One Data point:

• Focused on information

• Feedback oriented

• Not decision oriented

Intermediate progress decisions:

• More data points needed

• Focus on diagnosis, remediation, prediction

Final decisions on promotion or selection:

• Many data points needed

• Focused on a (non-surprising) heavy decision

185

Same for problem solving

186

Another example

187

Sampling versus objectivity!

Experts

Prof. Schuwirth Mozart

Artistic qualities Strength in composition etc

188

Test-

Time in Hours

1

2

4

8

MCQ1

0.62

0.76

0.93

0.93

Short case

based Essay2

0.68

0.73

0.84

0.82

PMP1

0.36

0.53

0.69

0.82

Oral3

0.50

0.69

0.82

0.90

Patient exam4

0.60

0.75

0.86

0.90

OSCE5

0.54

0.69

0.82

0.90

Practice Video Obser- vation7

0.62

0.76

0.93

0.93

1Norcini et al., 1985 2Stalenhoef-Halling et al., 1990 3Swanson, 1987

4Wass et al., 2001 5Van der Vleuten, 1988 6Norcini et al., 1999

In- cognito

SPs8

0.61

0.76

0.82

0.86

Mini-CEX6

0.73

0.84

0.92

0.96

7Ram et al., 1999 8Gorter, 2002

Reliability versus assesment time

189

Assessment time

1

2

3

4

No cases

2 4 8

12

Same examinor for each

case

0.31

0.47

0.47

0.48

Different examinor for each

case

0.50

0.69

0.82

0.90

Two other examinors for each

case

0.61

0.76

0.86

0.93

Reliability oral examination

(Swanson, 1987) 190

Aggregation across methods

Method Mini-CEX OSATS MSF

Sample needed

when used as stand-alone

8 9 9

Sample needed

when used as a composite

5 6 2

191


educational impact



192

Do we measure what we want to measure? Indirect: score.

Experts do better than non experts. Analysis/measurements: Correlations Differences in mean scores Factor analysis

Validity

193

Direct: content.

Each assessment is an examination is a collection of concrete, practice-relevant assignments and must be validated accordingly, by blue printing item construction quality control

Validity

194

Examples

1. Which of the following pairs has won the greatest number of Abby awards?

A. Jones & Smith B. Smith & White C. Smith & Taylor D. White & Allen

2. How many pounds of pressure are exerted by a callam? A. 2.6 B. 150 C. 260 D. 2600

195


educational impact



196

Educational impact

curriculum assessment

teacher student

content

format

scheduling

regulations

197

Aspects of assessment

many resits? publish the test content after the test? pop quizzes/assessments? detailed blue printing? group assignments? invite students to criticise items?

198

Cost efficiency

high quality assessment is expensive centralise quality control collaboration item banking efficient methods

199


educational impact



200

Cost efficiency

high-quality assessment is expensive

centralise quality control

collaboration

item banking

efficient methods

201


educational impact



202

Acceptance

involve teachers in set up of assessment

train en educate teachers in assessment

train en educate students

administrative support support for teachers

support teachers with item analyses, etc.

support a teacher on his/her decisions

minimalise bureaucracy 203

self-assessment by faculty by peers by patients by other healthcare workers (e.g. nurses) by standardised patients multi-source/multi-perspective (360°) evaluation

using OSCE’s rating scales mini-CEX’s critical incident reports ……

Tools in the toolbox

Lit. Eur J Int Med 2009 van Mook et al 204

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DOES

SHOWS HOW

KNOWS HOW

KNOWS

Behaviour

Cognitive

Performance ‘in vivo’

- actual performance in practice

- incognito standardised patients, portfolio, video, 360 degrees, rating scales

Performance ‘in vitro’

- performance in simulated environments

- standardised patients, OSCE

Clinical context based tests

- applied knowledge

- MCQ, oral examination

Factual test

-factual knowledge,

-MCQ, oral examination

Knows

Knows how

Shows how

Does

Post

grad

uate

Unde

rgra

duat

e

Lit.: Miller, G. E., The assessment of clinical skills/competence/performance. Acad Med. 1990; 65.; 9 Suppl. S63-7.

Competence = multi-dimensional

205

Classical aggregation

Method 1 to assess skill A Σ

Method 2 to assess skill B Σ

Σ

Σ

Method 3 to assess skill C

Method 4 to assess skill C

206

More meaningful?

Method 1

Σ

Method 2

Σ

Method 3

Σ

Method 4

Σ

Skill A

Skill B B

Skill C

Skill D

207

structuring has limitations trivialisation rititualisation

rating scales have limitations central tendency halo effect leniency error

soft skills often better in wording, subjective, holistic judgments

Limitations

209

Effect of the user

210

Principles of teaching and learning

Assessment

Lit. oa NEJM 2006 355: 1794-9 Stern

Time available

Multiple assessors

Longitudinal follow-up

Formative: feedback

Early

Multiple contexts

Frequent

Trained assessors

Remediation

Summative: consequences

Year 1- 6

Divers tools

Guidance

Mentor

Portfolio

211

Portfolio

Follow-up

Evaluation/assessment

Materials

Guidance/advising

Reflections/discussions

Overview

1Van Tartwijk, J., Driessen, E., Hoeberigs, B., Kösters, J., Ritzen, M., Stokking, K., Van der Vleuten, C.P.M. (2003) Werken met een elektronisch portfolio. Groningen: Wolter-Noordhoff.

Logbook

Learning portfolio/PDP

Assessmentportfolio

Ideal portfolio

212

DOES

SHOWS HOW

KNOWS HOW

KNOWSsingle ‘unprofessional’ incidents

apparent pattern

pattern persists

no change

adeq

uate

facu

lty tr

aini

ng a

nd

inst

ruct

ion

low

thre

shol

d fo

r

repo

rtin

g la

pses

majority of students: no professionalism issues

disciplinary intervention

e.g. Examination Committee, Dean, IA arbitration committee

awareness intervention

e.g. Committee on Professional Behaviour, student advisors

(in)formal intervention

e.g tutors, clinical teachers, mentor

authority intervention

e.g. Committee on Professional Behaviour, Examination Committee

stro

ng le

ader

ship

severe unprofessional behaviourreports, and legally mandated issues

freq

uenc

y de

crea

se, s

ever

ity u

incr

ease

Iudicium Abeundi legally (WHOO) founded guidelines

Consilium Abeundi national consensus guidelines faculties of dentistry and (veterinary) medicine

surveillance and reporting

stimulation, motivation, reflection

remediation, guidance, follow-up (check)

feedback, documentation

sanctioning: termporary suspension, permanent dismissal

Dealing with unprofessional behaviour

Lit. van Mook et al Adv Health Sc Educ 2015 213

Take home messages

(WPB) assessment limits shortcomings of workplace-based learning by stimulating feedback, reflection, observation….

Incorporate assessment in the WP, but…

Faculty development = paramount, user detemines effect

Feedback more important than score!

214

Take home messages

Stop thinking in individual assessment methods!

One measure = no measure More measurements, more contexts, more assessors,

different tools, systematic, programmatic, longitudinal!

Subjectivity is nothing to be afraid off Sampling, procedural bias reducation as solution

Professional judgment as (para)medical staff!!

215

Take home messages

Holistic judgements are a good as checklist/rating scales

Assessment requires a safe environment!

216

End


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Copyright

218

Time

Assessment Activities

Training Activities

Supporting Activities

Artifacts of learning - Outcome artifacts: Products of learning tasks - Process artifacts: Learning or working activities

v v

Learning task - PBL case - Patient encounter - Operation - Project - Lecture - Self-study

219

Time


Training Activities


Individual data points of assessment - Fit for purpose - Multiple/all levels of Miller - Learning oriented, Information rich documentation, meaningful (quantitative, qualitative) - Low stake

Certification of mastery-oriented learning tasks - Rescuscitation - Normal delivery of infant

v v

220

Time


Training Activities


Supportive social interaction - Coaching/mentoring/supervision - Peer interaction (intervision)

(P)Reflective activity by learner - Interpretation of feedback - Planning new learning objectives and tasks

v v

221

Time


Training Activities


Intermediate evaluation - Aggregate information held against performance standard - Committee of examiners - Decision making: diagnostic, therapeutic, prognostic - Remediation oriented, not repetition oriented - Informative - Longitudinal - Intermediate stake

v v

Firewall dilemma - Dilemma between access to rich information and compromising relationship supporting person(s) and learner

222

Time


Training Activities


v v v v

223

Time


Training Activities


v v v v v v

Final evaluation - Aggregate information held against performance standard - Committee of examiners - Pass/fail(/distinction) high stake decision - Based on many data points and rich information - Decision trustworthiness optimized though procedural measures, inspired qualitative methodology strategies - High stake

224

Assessment of the ERS Spirometry Driving Licence programme

Ms. Julie Lloyd Good Hope Hospital

Rectory Road Sutton Coldfield B75 7RR

UNITED KINGDOM [email protected]

SUMMARY The assessment of the learning outcomes for this course is an essential part of the preparation and the delivery of ERS Spirometry Training Programmes and awarding the ERS Spirometry Driving Licence. It is essential that course directors follow the assessment processes to ensure high quality education programmes and standardisation of the certification process. Within this document you will find

1. Assessment guidelines 2. Workbook template including tips for trainers

Assessment Guidelines [1] This section provides information on the assessment process that must be followed for each training part. Different assessment methods will be employed for different parts. It is essential that course instructors and directors strictly follow the assessment guidelines to ensure that each test appropriately measures the knowledge and skills required for each module. Additional support tools including an examination blueprint, marking sheets and instructions for practical assessment are also available for course directors to follow. Part I Assessment Guidelines Process Participants who complete Part I training will be expected to complete an online written MCQ online test within 4 weeks of attending the course. Each participant will receive an online access code to access the test on the ERS website. The test consists of 30 items, sorted by different types of questions. For each type, ‘Type A’ questions and ‘k prime’ questions, candidates will find an explanation. The duration of the online test is a maximum of 1 hour. Candidates will have the opportunity to comment on the test questions, which will be monitored and collated by ERS headquarters. This information can be shared with the course director on request. All examination candidates will be provided with their certificate once they have successfully completed the test. Candidates will not be able to attend Part 2 training without this certificate. Workbook Assessment Guidelines Participants are required to complete the ERS Spirometry Workbook prior to attending Part 2 training, which they must bring with them to the Part 2 training. The Workbook will form part of the assessment process. The Workbook must be submitted to the course organiser digitally (if possible) at least 1 month before the Part 2 course. Workbook assignments must be marked and graded by the

1 Note to trainers: Trainers who apply to deliver the ERS Spirometry training programme will be provided with the information and documentation necessary to complete the assessment process and award the ERS Spirometry Driving Licence. The ERS office will support trainers preparing to assess candidates to take the test for both part 1 and part 2.

225


course instructors and course directors and this marking must follow the ERS marking sheet designed to help guide instructors through this process. Part 2 Assessment Guidelines Who can assess? The participant should only be assessed either by the course director or a course instructor. Other instructors who have completed the ERS Spirometry Train the Trainer may also assist the course director with the assessment process. All examiner names must be provided on the application form. How are the practical skills assessed? The spirometry practical skills are assessed by direct observation of the participant. Directly observed procedural skills (DOPS) is an assessment method designed specifically for the assessment of practical skills. The participant should be assessed on the practical procedure of spirometry as well as communication, and professionalism. All performance criteria are listed on the marking sheet. This process should take no more than 30 minutes. The assessor will than spend 5-10 minutes providing immediate feedback and completing the assessment form with the participant present. Who is required for the examination process? Examiner The examiner will be expected to follow the exam processes and use the documentation and instructions provided by ERS. Candidate ERS strongly recommend that the participant perform the practical assessment on the previous candidate. Therefore candidates will first perform the test and then become the test subject.

What preparation is required before an examination? There are a number of steps that must be prepared prior to the examination. All supporting assessment tools can be found in the educational materials for trainers. Clear instructions for the examiner – Examiners must follow a specific marking sheet which covers items in the pre-spirometry test criteria and items covered during the spirometry testing. A copy of the candidate’s instructions should also be given to the examiner. Candidate – the candidate must be informed of the test process and fully understand what they must achieve during the examination. List of equipment required for examination – Height measuring device, spirometer (ensure sufficient number are available), mouthpieces, nose clips, hand washing facilities (or anti-bacterial hand gel). Reference document for equipment ERS/ATS Spirometry guidelines 2005. Marking sheet and feedback form – these documents should include all of the aspects required to test spirometry, and how long the test should take.

226

How are the candidates graded? Participants will be graded on pass / fail criteria only.

What feedback should be provided to candidates? a. To maximize the educational impact of this assessment method, not only should the assessor offer

feedback on improvement areas, but should not fail to mention areas that have been covered particularly well by the participant.

b. Feedback should be given to each participant individually in a private area of the training centre. Instructors inform participants if they have successfully passed based on the practical assessment.

Awarding the ERS Spirometry Driving Licence Part 2 The outcome of the assessment is a professional judgment of the assessor that the trainee has completed the spirometry test to the standard expected and outlined in the learning outcomes. The trainee must be informed if they had passed or failed on the day of the practical assessment. Fail criteria for candidates who have not passed the practical test If candidates fail: 1. Part 1 online MCQ test – they must repeat the course and re-sit the online test 2. Workbook – they must resubmit the failed workbook section (A OR B) within 6 weeks after the

Part 2 and practical test. Candidates may still successfully pass Part 2 if the second attempt is passed within this time.

3. Part 2 practical test – Candidates may re-sit the practical exam on the same day with a different examiner where possible. If the candidate fails the test on the second attempt they must register again to attend Part 2 of the European Spirometry training programme again

Workbook template including tips for trainers

Spirometry Workbook A workbook must consist of the following sections: SECTION A The contents page

Curriculum Vitae that must include only:

a. Name b. Educational Background c. Professional Background d. Previous spirometry training experience (if any) e. Do you perform spirometry? Yes/No

i. If yes, how many tests do you perform monthly? f. Indicate the number of years performing or practicing spirometry measurements

Your Spirometry Training Course attendance certificate and/or accreditation of prior

learning

227

Background information about your work environment, which should include [2]: a. Local arrangements for spirometry testing b. Method of referral e.g. GP, nurse led clinics etc. c. Number of spirometry tests performed in your service monthly

A copy of your local protocol for performing spirometry including the guidelines that you

use. This must be a document that you or your team uses and not a photocopy of guidelines. If you do not have a protocol, you should design or develop a working protocol. The protocol should include:

a. The indications for performing spirometry b. The contraindications to performing spirometry. c. A brief description of the instructions that the patient should receive PRIOR to having

spirometry performed. d. The importance of keeping all results stored safely and accessibility to health care users e. Awareness of audit processes and self-assessment of the spirometry service to ensure

sufficient clinical skills are maintained and quality is upheld f. Measurement principle of your device:

i. With the aid of a diagram, describe the way in which your spirometer measures spirometry values. You should state the measurement principle of your device (e.g. is it flow measuring or volume measuring device?). [3]

Calibration or Verification [4] This section consists of TWO parts:

a. A written piece of work (maximum 200 words) must be submitted explaining why your spirometer must be calibrated or verified regularly and a description of how you would do this. It should include a brief description of what you did/or would do if the calibration/verification was outside the expected value or range. For syringe calibration (physical control), a 3L calibration syringe should be used. If a syringe is not available, calibration/verification of the spirometer should be undertaken at another practice or hospital. This is good practice for future measurements to ensure quality control.

b. Produce a calibration/verification record for your spirometer. [5] If your spirometer produces a hard copy, provide evidence of at least 20 calibrations or verifications performed by you. These must be performed over a minimum of a one month period.

OR

2 NOTE TO TRAINERS: I am a Practice Nurse that works in a busy Primary Care practice in a large inner city. Patients are referred for spirometry by the Doctor to diagnose and assess the severity of any lung disease. The majority of our patients are assessed for possible COPD or asthma. There are 2 experienced practice nurses (>10 years qualified) that perform ~ 20 full spirometry tests per week on adults only. Interpretation of the results is performed by the Senior Nurse Practitioner. 3 NOTE TO TRAINERS: the candidate should be able to name the device (MicroLab rotating vane, EasyOne ultrasonic, Vitalograph pneumotachograph etc.). They should demonstrate that they understand how it makes the measurement and include a labelled diagram. This can be hand drawn or a picture and should identify the important technical features. 4 Note: The following sections should contain evidence gathered by you during your working practice. It must consist of traces, and logs of verification and cleaning

Calibration or verification of your spirometer Quality assurance of your spirometry service Cleaning of your spirometer

5 NOTE TO TRAINERS: This is an opportunity for the candidate to demonstrate that they understand the difference between calibration and verification. You should be confident that the candidate can do this. The candidate should be able to take basic remedial action should calibration/verification fail. A candidate should not fail if they have only a 1L syringe, but you would expect them to demonstrate that they understand the limitations of this.

228

If your spirometer does not produce a hard copy, design a system for recording your calibrations or verifications and record at least 20 results. These must be performed over a minimum of a one month period.

Quality Control

This section consists of TWO parts. a. Briefly explain (200 words maximum) the purpose of Quality Control in the context of

your spirometry service. b. Create a Quality Control record using either yourself or a member of your team. The

person used for your QC record should have normal lung function. i. Perform spirometry daily/weekly, on the same person. At least 10 results of each in total

should be collected. ii. Record the values in a table

iii. Calculate the mean value for the following values that you have recorded in your Quality Control record: o The FEV1 o The FVC

iv. Calculate an acceptable range by using + 2SD of the mean value of the measurements obtained.

Record all the spirometry results in your Workbook.

229

Cleaning

This section consists of TWO parts. a. Provide a cleaning procedure and a copy of the work schedule to show that cleaning has

been completed regularly for the spirometer in your care. b. Describe what contingency plans you have in place for dealing with potentially infectious

patients

230

SECTION B Patient Tests

You must produce 15 spirometry traces with relevant technical comments for FEV1, FVC, FEV1/FVC% and VC (where possible) that you have recorded, along with the predicted normal values. If it is possible with your device, include all curves and all data recorded.

a. Please ensure all patient data included in your portfolio is anonymised. Failure to do so will constitute a breach of patient confidentiality and will result in an automatic fail being awarded.

b. You must include the height, subject age, and date of test for each patient included in this section

c. From the values obtained for each test, you must highlight which values you would select for each patient.

d. You must include a signed witness statement from a senior member of staff at the place where you are employed indicating that all of the traces included have been performed by you.

Problems Encountered During Testing

You must describe a minimum of 3 problems that you encountered during spirometry testing and explain what you did/would do to overcome the problems. The problems may include:

a. patient errors i. cough

ii. sub-maximal effort b. technical errors

iii. slow start iv. early termination

231

c. equipment issues

v. calibration errors You should include any available patient traces to explain your description. If traces are not available you should provide a sketch or drawing in your explanation.

232

Julie Lloyd

Vice Chair ARTP (UK)

Assessment of the ESDL Program

233






Stock shareholder:

Spouse/partner:



234

OVERVIEW

• Components of the assessment– Part 1

• ERS online knowledge test

– Multi-choice questions

– Part 2

• Spirometry workbook assessment

• Assessment of practical skills including understanding,

communication and technical performance

235

ESDL Part 1

Online Knowledge Test and MCQ’s

236

ON-LINE KNOWLEDGE ASSESSMENT

• Ensures participants have:– the knowledge and basic skills in spirometry best practice.

– the skills needed to perform spirometric tests.

– the skills to successfully complete the spirometry workbook.

237

TYPES OF QUESTIONS

• Type A questions – single choice– To each question there is only ONE correct answer.

• Type K prime questions – quadruple correct/incorrect decision– To each question or statement there are four answers or statement

completions.

– For each one, it must be decided whether they are correct or incorrect

and marked accordingly e.g. (+) or (-)

238

EXAMPLE OF TYPE A

A technologist correctly performs an expiratory Peak Flow measurement on a young, healthy adult, with no history of pulmonary disease. The expected results would approach, or exceed, which of the following:

• 10 L/s• 20 L/s• 30 L/s• 40 L/s• 50 L/s

ANSWER: A

239

EXAMPLE OF TYPE A

A patient reports decreased Peak Expiratory Flows measured with a home peak flow meter. Which of the following would best validate the peak flow?

a) Volume-time curveb) FVCc) FEV1

d) Flow-volume loope) FEF25-75

ANSWER: D

240

EXAMPLE OF TYPE A

According to ATS/ERS standards, the minimum time, in seconds, that a spirometry system should be able to measure the accumulated volume during a forced expiration is:

a) 7 b) 9c) 11d) 13 e) 15

ANSWER: E

241

EXAMPLE OF KPRIME

Which of the following is/are indication/s for performing spirometry?

a) To assess risks of surgery.b) To assess a therapeutic intervention.c) To assess the pathology of lung disease.d) To monitor people exposed to injurious agents.

ANSWER: + + - +

242

EXAMPLE OF K PRIME

Which of the following condition/s can most likely lead to reduced lung function results when compared to the normal reference range?

a) Chest or abdominal pain of any causeb) Oral or facial pain exacerbated by a mouthpiecec) Dementia or confusional state.d) Severe pulmonary restriction

ANSWER: - - - +

243

The Spirometry Workbook

What is it and why is it required?

244

RATIONALE

• Following successful completion of Part I.– Demonstrates sufficient knowledge.

• Prior to attendance at Part 2.– To demonstrate sufficient technical skills.

– All course participants submit a completed Spirometry Workbook.

245

ERS SPIROMETRY WORKBOOK

• A detailed record of students background and current practice in spirometry.

• Must include 15 technically acceptable spirometries.• Full details in the ERS spirometry workbook template

– Includes important tips for trainers

• May be found in your educational materials

246

THE SPIROMETRY TRACES

• Provide 15 traces that meet ERS/ATS acceptability criteria.

• Supply ALL efforts, even those that may be invalid for: – FEV1

– FVC

– FEV1/FVC%

– PEF

– VC (where possible)

247

FOR EACH TEST SUBMITTED

• Include:– Predicted normal values.

– Patients’ height, age and sex

– Diagnosis

– Smoking history (if available)

– Current drug therapy.

• Highlight the test results that would be reported for each patient from those performed.

248

IMPORTANT DETAILS

• All patient data must be anonymised. – Failure to do so is a breach of patient confidentiality.

– The rest of the Workbook will not be marked to avoid any further

possible breeches in confidentiality.

– This will result in an automatic fail being awarded.

• A signed witness statement from a senior member of staff at the place of work indicating that all of the traces included have been performed by the candidate must be included.

249

12. PROBLEMS DURING TESTING

• Describe at least 6 problems that have been encountered when performing the test procedures.

• Provide an explanation what was done to overcome the problems.

• Include traces or results from invalid blows– may reference these from the previous section if some have been

included.

– May include sketches of what a problem would look like.

250

INTERACTIVE SESSION

• Review of a patient test and how to mark this test using the ERS workbook marking sheet

251

ESDL Part 2

Practical Skills Assessment

252

PRACTICAL ASSESSMENT

• Formal examination of spirometry practical competencies matched against EDL spirometry performance criteria

• Lasting 30 minutes and including:• Calibration/verification

• Measurements of FEV1/FVC/VC and PEF

• Presentation and reporting of the results

• Follow the assessment guidelines and use of standardised marking sheets

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ROLE-PLAY EXERCISE

254

SPIROMETRY QUESTIONS

Spirometry measurement Correct/

Incorrect

Comments

Define classification of severity of airflow obstruction Why is it important to measure VC

What would you expect to see in the FEV1/FVC ratio and FEV1 and FVC in restrictive lung diseaseWhat would you do if you did not achieve reproducibility criteriaWhen may you want to refer for further tests

255

QUESTIONS?

256

Organising an ERS spirometry training programme

Prof. Felip Burgos Servei de Pneumologia

Hospital Clínic CIBER de Enfermedades Respiratorias (CibeRes) Universitat de Barcelona

Villarroel 170 08036 Barcelona

SPAIN [email protected]

Reference documents in this handbook

Guidelines for the certification of ERS Spirometry training programmes ERS Spirometry Training Programme Information Handbook Spirometry assessment instructions for ERS trainers and examiners Guidelines to complete the ERS Spirometry Portfolio Workbook

257

ORGANISING A SPIROMETRY TRAINING PROGRAMME

258






Stock shareholder:

Spouse/partner:



259

DISCUSSION POINTS

o Course Director Responsibilities

o Application Process

260

Training Programme

Prepare your application to ERS

Scheduling of all training parts (Part 1, Workbook, Part 2)

Registration of participants

Reviewing educational materials

Access to the ERS website (organisation of access codes)

Communication to participantsBefore Part 1 to review the online contentAfter Part 1 to complete the online testBetween Part 1 and Part 2 to complete the workbook

Course Director Responsibilities

261

Trainers

Recruitment of qualified trainers

Communications with ERS

Assessment including;o Part 1 knowledge test – preparing the participantso Workbook – each trainer is responsible to mentor

participants and correct the workbookso Part 2 practical assessment

Course Director Responsibilities

262

DISCUSSION POINT

o Application Process

263

Application Process

Step 1 Step 2 Step 3 Step 4

Attend the ERS

spirometrytrain-the-

trainer

Do you your qualifications

fit to ERS recommended

criteria?

Complete the online application process on

the HERMES website

Delivery of training

264

Do you your qualifications fit to ERS recommended criteria?

Certified degree in respiratory physiology or arelated field

Extensive experience in procedures andinstrumentation for spirometry testing

Experience in interpretation of spirometry

It is mandatory that the programme director hasattended the ERS spirometry train-the-trainer

Five years supervision of a pulmonary function(or extensive spirometry) service

265

Attend the ERS SpirometryTrain-the-Trainer

Aim: to provide spirometry trainers with the skills, knowledge and educational tools to teach high-quality spirometry testing

Mandatory for the course director

Highly recommended for all of the course instructors to attend

266

Complete the online application process on the HERMES website

1. Complete the application form2. Prepare your course programme including dates

and a list of trainers3. Before the course, send a completed list of

participants to the ERS office.

http://hermes.ersnet.org

267

Website http://hermes.ersnet.org

268

Website http://hermes.ersnet.org

269

http://hermes.ersnet.org

270

Complete the online application processon the HERMES website

ERS Spirometry WebsiteAs part of the application process a fee of €350 will be requested to be paid to ERS.

An additional fee will also be requested per participant which will coverAccess to the ERS spirometry website Online modulesOnline knowledge test at the end of Part ICertification of the ERS Spirometry

Driving Licence Part 1 & 2

271

As well as finding extensive information on each of the core modules, the website will also have information on

The application process for course directorsA list of approved ERS spirometry coursesA list of certified spirometry trainersInformation on mentorship and how to manage the mentor-mentee relationshipA participant information pageA spirometry trainer information page

ERS - Spirometry Driving LicenceWEBSITE

272

Trainers Information

1. ERS Website http://hermes.ersnet.org

2. Train-the-trainer - educational materials

3. ERS Office

273

http://hermes.ersnet.org/

THANK YOU

274

Questions and Answers

275

Guidelines for the certification of ERS Spirometry training

programmes

276

Guidelines for the certification of ERS Spirometry training programmes February 2015

ERS Spirometry Task Force and Committee PAGE 2

Table of Contents

Introduction .................................................................................................................................................. 3

Section 1: Minimum Components for training for the ERS Spirometry Driving Licence Part I and Part 2 ... 4

a. Duration of training........................................................................................................................... 4

b. Optional Training .............................................................................................................................. 4

c. Part I and Part 2 Training .................................................................................................................. 4

Section 2: Educational Experience ................................................................................................................ 5

d. Educational goals .............................................................................................................................. 5

e. Educational Materials ....................................................................................................................... 5

f. Educational Methods ........................................................................................................................ 6

g. Assessment and Certification............................................................................................................ 6

h. Evaluation ......................................................................................................................................... 7

i. Endorsement ..................................................................................................................................... 7

Section 3: Assessment Guidelines................................................................................................................. 8

j. Part I Assessment Guidelines ............................................................................................................ 8

k. Workbook Assessment Guidelines .................................................................................................... 8

l. Part 2 Assessment Guidelines ........................................................................................................... 9

m. Awarding the ERS Spirometry Driving Licence Part 2 ................................................................. 10

Section 4: Organisation of the Training Programme .................................................................................. 10

n. Course Director ............................................................................................................................... 11

o. Course Instructor ............................................................................................................................ 11

p. Assistant Instructor ......................................................................................................................... 12

Section 5: Other Organisational Issues ....................................................................................................... 12

q. Minimum numbers of training personnel ....................................................................................... 12

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r. Other educational opportunities .................................................................................................... 13

s. Equivalent Qualifications ................................................................................................................ 13

t. Recertification ................................................................................................................................. 13

u. Language ......................................................................................................................................... 13

v. Registration Fees ............................................................................................................................. 14

w. Sponsorship ..................................................................................................................................... 14

Section 6: Venue specifications .................................................................................................................. 15

x. Space and Equipment ..................................................................................................................... 15

Section 7: Requirements for Specific Facilities ........................................................................................... 15

Section 8: Approval Process and Distribution of ERS Spirometry Driving Licence certificates ................... 16

y. Approval body ................................................................................................................................. 16

z. Application and Approval ................................................................................................................ 16

aa. ERS Participation ......................................................................................................................... 17

bb. Certificate of Accreditation ......................................................................................................... 17

cc. Costs ............................................................................................................................................ 17

Introduction

The Guidelines for the certification of ERS Spirometry Training Programme document marks the

completion of Phase 2 of the Spirometry HERMES (Harmonised Education in Respiratory Medicine for

European Specialists) project. The project was launched to address disparities in training practices and

qualifications in spirometry across Europe. The purpose of this document is to offer training centres a

series of recommendations and measurable criteria so those who successfully complete the training

programme and assessment have the opportunity to be awarded the ERS Spirometry Driving Licence

Part 1 and Part 2.

This document provides a guideline for best practice for course directors of spirometry training

programmes to follow. To successfully implement an approved spirometry course, a specific process has

been established

1. The course director must complete the HERMES Train-the-Trainer programme at the annual ERS

congress

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2. An application must be fully completed and submitted for review

3. The application submitted by the course director may be accepted and the training programme

will receive recognition for excellence in spirometry training

During the development of the project, it was decided to divide training into two distinct parts, Part 1

Spirometry Knowledge and Skills and Part 2 Knowledge and Competence in Spirometry Measurement, to

ensure that participants on the course have the opportunity to reach competency level and complete

training workbooks outside of the classroom environment. Therefore, the objective of the project is to

ensure that those who complete Part I receive the knowledge and basic skills in Spirometry testing. Only

participants who complete Part 2 of training will be considered fully competent spirometry

practitioners. The Guidelines for the certification of ERS Spirometry Training Programme is intended to

offer trainers and instructors descriptions of functions and roles as well as other key criteria important

to achieve high-quality Spirometry training and certification.

Section 1: Minimum Components for training for the ERS Spirometry Driving Licence Part 1

and Part 2

a. Duration of training

Duration of training should comply with the specifications recommended within the ERS

Spirometry Training Programme, 9 – 12 hours for Part I training and 7 – 10 hours for Part 2

training. Trainers must follow the minimum recommended training time per module as outlined

in the application form. It will be the decision of the trainer to determine if training for each part

should take place over one or more days.

A number of training modules for Part 1 may be completed by the participants online prior to

attending the Part I classroom training. Each online module completed by the participants

accounts for 1 hour of training time and may reduce classroom training time for Part I.

b. Optional Training

Should the training centre wish to do so, optional modules may also be included in the ERS

Spirometry Training Programme. Optional training modules must take place in addition to the

recommended 9-12 hours for Part 1 and 7-10 hours for Part 2 of training.

c. Part 1 and Part 2 Training

To be awarded the ERS Spirometry Driving Licence, participants must successfully complete Part

1 Spirometry Knowledge and Skills, a spirometry workbook and Part 2 Knowledge and

Competence in Spirometry Measurement.

Part 1 incorporates the training items (Module 1 – 7) and assessment will fundamentally be

based on a knowledge exam after all modules have been covered. It is advisable that module 1

and module 4 be completed online before the course. If the course director wishes to

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incorporate online training, it is their responsibility to ensure that participants produce

certification of completion of each online module. Successful participants will be awarded Part 1

of the ERS Spirometry Driving Licence.

The ERS Spirometry Portfolio Workbook should be explained to all participants during Part 1

training and must be completed before attending Part 2. The following processes should be

followed by participants;

1. The workbook will need to be fully completed by participants before attending Part 2 of the

spirometry training programme

2. All sections of the workbook are mandatory and must be fully completed by participants

3. A copy of the completed workbook will need to be sent (if possible electronically) to the

local course director at least 6 weeks before attending Part 2

4. The original workbook will be brought to Part 2 of the spirometry training programme and

will form an important part of the assessment process. Candidates may be required to

answer a number of questions on their workbook. This is not a mandatory assessment

method but may be incorporated at the discretion of the course director.

5. The course director will be required to send three examples of workbooks including one

pass, one borderline and one fail on request by ERS

Part 2 examines the competence of the individual to put knowledge into practice. Merit to

award Part 2 of the ERS Spirometry Driving Licence will be decided based on practical

assessment, submission of the completed workbook and if necessary, oral assessment of the

completed workbook.

Rationale within the training programme outline including length of training time, and pre-

requisites must be adhered to, ensuring that the learning outcomes for participants are reached.

It is recommended that participants complete Part 2 training within 6-12 calendar months after

completing Part I.

Section 2: Educational Experience

d. Educational goals

The training programme must allow all those who attend to reach the course goals as outlined in Part I

and Part 2 within the ERS Spirometry Training Programme.

e. Educational Materials

Educational materials including a spirometry workbook and educational manuals must be used to aid

participants to successfully complete both Part I and Part 2 training.

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f. Educational Methods

Specific educational methods have been determined to ensure that every course participant maximises

their educational experience on the course. Specific teaching practices for the teaching faculty to

consider include;

i. Didactic Lectures - Instructional teaching method that allows the student and teacher to

effectively understand, consider and analyse the learning goal

ii. Small group hands on learning - learning by doing. Practical demonstrations and assessment of

technique and interpretation, for example.

iii. e-Learning Activities - Types of online learning including audio, e-text, forums, threaded

discussions, web-blogs, electronic assessments, and simulation learning

iv. Case-based discussions - Case-based discussion is a structured interview designed to explore

professional judgement in specific cases selected by the trainee and presented for evaluation

v. Self Directed Learning - A self-paced process of learning where individuals take initiative,

formulate learning goals, and identifies resources for learning

vi. Mentoring – Mentoring is a developmental partnership through which one person shares

knowledge, skills, information, and perspective to foster the personal and professional growth

of someone else.

g. Assessment and Certification

i. The course director will be responsible to distribute Part I of the ERS Spirometry Driving Licence

on successful completion of Part I training and assessment.

ii. The course director will be responsible to distribute Part 2 of the ERS Spirometry Driving Licence

certificate to those who successfully complete training and assessment for Part 2 within 6-12

calendar months after completing Part I assessment.

iii. The teaching faculty should encourage trainees to continue to learn and gain sufficient

knowledge and experience

iv. Assessment of the ERS spirometry training programme should follow specific assessment criteria

for Part I and Part 2

1. Part I:

Objective: To determine if a course participant has acquired the knowledge of spirometry in

practice

v. Mandatory Assessment Method: All candidates will be requested to pass an online knowledge

test established by ERS.

2. Part 2:

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Objective: To determine if a course participant has gained sufficient competence to practice

high-quality spirometry tests.

Assessment: The assessments outlined below are mandatory assessment techniques that must

be utilised in the assessment of candidates to successfully be awarded the ERS Spirometry

Driving Licence Part 2.

vi. Assessment of Part 2 must be carried out locally by the entire training faculty under the direct

supervision of the course director

vii. Part 2 training must assess all core modules outlined within the Training Programme Outline for

Part 2 and within the assessment guidelines document. Assessment must apply the mandatory

assessment methods.

Mandatory Assessment Methods

1. Practical test – knowledge and skills must be demonstrated by the participant before

issuance of the ERS Spirometry Driving Licence certificate Part 2. The examiner may conduct

the practical test following assessment instructions and documentation provided by ERS

which will result in a complete and efficient test.

2. Following successful completion of Part I, if participants wish to attend Part 2, the training

centre must request that all course participants submit a completed Spirometry Workbook,

including 15 quality spirometry tests with comments which is to be signed off by the course

director/course instructor.

h. Evaluation

An evaluation will be distributed by ERS to all participants for their feedback and insight into

course organisation, content of lectures and deliver of training. The course director must

provide ERS with a complete list of participants and contact details.

i. Endorsement

Certificates will be distributed to all participants who

1. Pass part 1 online knowledge test

2. Pass part 2 practical assessment

ERS will endorse the course director to deliver the ERS Spirometry Training Programme whose

course programme and organisation strictly follow ERS guidelines. ERS endorsement allows the

course director/national societies to use the following disclosure when advertising the course

‘This training programme has been officially endorsed by the European Respiratory Society and

successful participants will be awarded the ERS Spirometry Driving Licence Part I and Part 2’

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Section 3: Assessment Guidelines

Note to trainers:. Trainers who apply to deliver the ERS Spirometry training programme will be provided with the information

and documentation necessary to complete the assessment process and award the ERS Spirometry Driving Licence. The ERS

office will support trainers preparing to assess candidates to take the test for both part 1 and part 2.

This section provides information on the assessment process that must be followed for each training

part. Different assessment methods will be employed for different parts. It is essential that course

instructors and directors strictly follow the assessment guidelines to ensure that each test appropriately

measures the knowledge and skills required for each module. Additional support tools including an

examination blueprint, marking sheets and instructions for practical assessment are also available for

course directors to follow.

j. Part I Assessment Guidelines

i. Process

Participants registered for the Part 1 training will be required to complete an online MCQ test. .

Participants will have 3 attempts to pass the test after attending Part 1

Each participant will receive an online access code to access the test on the ERS website.

It is recommended that participants should complete the online MCQ test within 4 weeks of attending

the course.

The test consists of 30 items, sorted by different types of questions. For each type, Type A questions and

k prime questions, candidates will find an explanation. The duration of the online test is a maximum of 1

hour.

Candidates will have the opportunity to comment on the test questions, which will be monitored and

collated by ERS headquarters. This information can be shared with the course director on request.

Successful candidates will receive their Part 1 certificate. Candidates will not be able to attend Part 2

training without this certificate.

k. Workbook Assessment Guidelines

Participants are required to complete the ERS Spirometry Workbook prior to attending Part 2 training,

which they must bring with them to the training day and will form part of the assessment process.

The workbook must be submitted to the course director digitally (if possible) at least 1 month before the

course.

Workbook assignments must be marked and graded by the course instructors and course directors and

this marking must follow the ERS marking sheet designed to help guide instructors through this process.

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l. Part 2 Assessment Guidelines

i. Who can assess?

The participant should only be assessed either by the course director or a course instructor. Other

instructors who have completed the ERS Spirometry Train the Trainer may also assist the course director

with the assessment process. All examiner names must be provided on the application form.

ii. Practical Assessment

Directly observed procedural skills (DOPS) is an assessment method designed specifically for the

assessment of practical skills. This process should take no more than 30 minutes. The examiner will then

spend 5-10 minutes providing immediate feedback and completing the assessment form with the

trainee present. The trainee should be assessed on the practical procedure of spirometry as well as

communication, and professionalism. All performance criteria are listed on the marking sheet.

1. Who is required for the examination process?

Examiner – The examiner will be expected to follow the exam processes and use the

documentation and instructions provided by ERS.

Candidate – ERS strongly recommend that the student perform the practical assessment on the

previous candidate. Therefore candidates will first perform the test and then become the test

subject.

2. Preparation

There are a number of steps that must be prepared prior to the examination. All supporting assessment

tools can be found in the educational materials for trainers.

Clear instructions for the examiner – Examiners must follow a specific marking sheet which covers items

in the pre spirometry test criteria and items covered during the spirometry testing. A copy of the

candidate’s instructions should also be given to the examiner.

All examiners should be provided with the guidelines for trainers document. They must sign a register to

confirm that they have received and read these guidelines.

Candidate – the candidate must be informed of the test process and fully understand what they must

achieve during the examination

List of equipment required for testing – Spirometer height measure, spirometer, mouthpieces, nose

clips, sufficient number of spirometers

Reference document for equipment ERS/ATS Spirometry guidelines 2005

Marking sheet and feedback form – these documents should include all of the aspects required to test

spirometry, and how long the test should take.

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3. Grading

Participants will be graded on pass/fail criteria only

4. Feedback

To maximise the educational impact of this assessment method, not only should the examiner offer

feedback on improvement areas, but should not fail to mention areas that have been covered

particularly well by the participant. Feedback should be given to each participant individually in a private

area of the training centre. Instructors inform participants if they have successfully passed based on the

practical assessment.

m. Awarding the ERS Spirometry Driving Licence Part 2

The outcome of the assessment is a professional judgement of the examiner that the trainee has

completed the spirometry test to the standard expected and outlined in the learning outcomes.

The trainee must be informed if they had passed or failed on the day of the practical

assessment.

n. Fail criteria for candidates who have not passed the practical test

If candidates fail

1. Part 1 online MCQ test – they must repeat the course and resit the online test

2. Workbook – they need resubmit the failed workbook section (A OR B) within 6 weeks after the

Part 2 and practical test. Candidates may still successfully pass Part 2 if the second attempt is

passed within this time.

3. Part 2 practical test – Candidates may resit the practical exam on the same day with a different

examiner where possible. If the candidate fails the test on the second attempt they must

register again to attend Part 2 of the ERS Spirometry training programme

Section 4: Organisation of the Training Programme

This section describes the roles and functions in the organisation of the ERS Spirometry Training

Programme, important to achieve high quality training. Although the structure is intended to give some

flexibility across countries applying for accreditation, the minimium specifications outlined within the

document should be adhered to. Responsibilities can be attributed to a single position depending on the

size and structure of the local programme.

To apply for accreditation and in order to distribute both Part I Spirometry Knowledge and Skills and Part

2 Knowledge and Competence in Spirometry Measurement, the training programme must be supervised

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by a course director who has the authority and qualifications to oversee the entire training programme.

Depending on the size of the programme, the following specifications determine a teaching member’s

participation:

Roles and Trainer Specifications

o. Course Director

Qualifications should ideally include;

1. Appropriate qualification in the field of clinical respiratory physiology

2. Extensive experience in procedures and instrumentation for spirometry testing

3. Experience in interpretation of spirometry results

4. 5 years supervision of a pulmonary function service or relevant experience in spirometry

5. It is mandatory that the course director has attended the HERMES Train-the-Trainer

6. It is strongly recommended that all trainers attend both Part 1 and Part 2 of the ERS Spirometry

training programme

Responsibilities include;

1 To ensure that all those who participate in instruction and teaching on the training programme

are sufficiently qualified to do so

2 To ensure that the course outline and structure are consistent with the guidelines provided by

ERS

3 Oversee that teaching materials and educational materials are up to date, relevant, available to

participants and in accordance with the ERS Spirometry training programme curricula.

4 To provide knowledge and support to instructors to assist with the delivery of the course

5 Oversee the registration process to ensure all participants are given adequate time for

preparation

6 Ensure course evaluation procedures and feedback are completed in line with the guidelines

7 Participation and supervision of all faculty members

8 Handle feedback and comments from the participants and course instructors and communicate

as appropriately to ERS Spirometry committee

9 Assessment of the course participants for Part 2 including, assessment of workbooks, and

practical and oral assessments as indicated in Section 3 Assessment guidelines

p. Course Instructor

Qualifications should ideally include;

1. Appropriate qualification in the field of clinical respiratory physiology

2. Commitment to keeping up to date

3. It is highly recommended that the course instructor has attended the HERMES Trainer-the-

Trainer

4. Strong teaching/training background in best practices of spirometry testing

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Responsibilities include;

1. Oversee progress of mentoring the trainees and offer support throughout the training

programme

2. To teach the course content according to the specifications within the training guide

3. Provide feedback on assessment

4. Offer knowledge of the key areas of Spirometry as outlined in the Training Programme

5. To organise the administration of the course and to ensure a suitable venue, with appropriate

audio-visual facilities and acceptable level of tutor:student ratios

6. Assessment of the course participants for Part 2 including, assessment of workbooks, and

practical and oral assessements as indicated in Section 3 Assessment guidelines

Note: Depending on the size and structure of the training programme, the course director and course

instructor roles maybe shouldered by one and the same person.

q. Assistant Instructor

Qualifications ideally should include;

1. Strong interest in the education and best practices of spirometry testing

2. At least some experience in the background, training, and practical aspects of collecting

spirometry data and quality control

3. Strong recommendation to complete the spirometry train-the-trainer course

Responsibilities ideally include;

1. To assist the course director and course instructor with instructional methods throughout the

training programme

2. Responsible for small group hands on sessions during the programme offering demonstrations

and ‘how to’ knowledge of high-quality spirometry testing

3. Coaching of participants

4. Assessment of the course participants for Part 2 including, assessment of workbooks, and

practical and oral assessments as indicated in Section 3 Assessment guidelines

All trainers are required to complete a Spirometry CV to be included with the application to deliver

training.

Section 5: Other Organisational Issues

r. Minimum numbers of training personnel

i. The training centre must ensure that the student: teacher ratio is sufficient to maximise learning

and that the educational goals are met as outlined in the ERS Spirometry Training Programme

Outline

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For theoretical training, the recommended student: teacher ratio is up to 30:1

For practical training, the recommended student: teacher ratio up to 5:1

For the practical assessment, the required student: teacher ratio is 1:1

s. Other educational opportunities

i. Where necessary, the training faculty must provide other educational activities such as to assist

participants find a suitable mentor, be available to answer questions or coach students outside

classroom time.

t. Equivalent Qualifications

i. Individual application for equivalent qualification

Anyone who would like to be awarded the ERS Spirometry Driving Licence Part 1 as equivalent

to their national qualification will need to take the online knowledge test for Part 1

Anyone who would like to be awarded the ERS Spirometry Driving Licence Part 2 as equivalent

to their qualifications will need to submit an ERS Spirometry workbook including 15 spirometry

tests with comments and if necessary complete a practical assessment

ii. Equivalent qualifications with national training programmes

Equivalent qualifications do apply to a number of national training programmes in spirometry. If

you have attended a spirometry training programme from one of the listed countries, you may

be automatically awarded the ERS Spirometry Driving Licence Part 1 and Part 2.

All applications to apply for equivalence in Part 1 or Part 2 can be submitted either directly to

ERS through the ERS Spirometry website or alternatively directly to their national ERS

Spirometry trainer

iii. Equivalent qualifications for trainers

If a national training programme is approved as being equivalent, national trainers of this

programme who have also attended the ERS Train-the-Trainer programme can be included in

the ERS network of spirometry trainers.

u. Recertification

i. Those who complete and are successfully awarded the ERS Spirometry Driving Licence Part I and

Part 2 will need to complete the recertification process after 3 years.

ii. Anyone who would like to be recertified will need to submit a Section B of the ERS Spirometry

Portfolio workbook and produce 15 spirometries and comments. It may be requested by the

examiner to attend a 30 minute practical/oral assessment. All must be signed off by a senior

clinician and sent to the ERS office for assessment.

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v. Language

The ERS spirometry programme may be delivered in the local language. However the online

knowledge test, online modules and supporting documentation will only be available in English.

Each national society may request to translate educational materials and deliver the contents in

their local languages. However, the following process must be followed:

o All requests must be made at the time of application.

o The National Society is responsible for assigning a translator and covering any costs incurred

with their assigned translator.

o The National Society must send a list to ERS of all materials that have been translated at least 4

months before the start of the training programme.

o ERS can, at its own discretion, ask to receive a sample of the translated materials for peer

review purposes. The National Society must provide any translated materials as requested.

o If ERS deems that any or all of the sampled material does not meet the required standard, the

National Society will be required to use additional translation services, and will be responsible

for the cost of this.

o If the translated material does not meet the required standard, ERS can cancel certification of

the training programme.

o An additional fee of €45 per participant will be charged to National Society for any request to

translate materials.

o ERS will be responsible to add translated material to the ERS Website if requested by the

national society

w. Course Participants

The course director must provide ERS with a list of course participants and contact details

x. Registration Fees

Information on registration fees for the spirometry training programme should be provided to

ERS prior to the course. This information must be included in the application form.

y. Sponsorship

Course directors may seek financial support from sponsors however this information should be

included in the application form. Sponsors may not have any influence on the educational

content of the course. If sponsorship is received, participation of sponsors must follow the

below criteria

A minimum of three sponsors (i.e. 3 educational grants) must be included for a sponsored event

Individual participants may NOT receive sponsorship from a pharmaceutical/industry company for registration on the course; however, individual participants may receive sponsorship for travel, and accommodation.

An exhibition area is forbidden

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ERS will receive royalties of 10% of all profits made from registration and sponsorship

z. Revalidation for trainers

All feedback from participants will be kept in the ERS database and a review of feedback may form part of the revalidation process.

Trainers must offer a minimum of 1 course over validation period of 3 years

Trainers who would like to revalidate their certificates must complete an online questionnaire every 3 years

Certificates for the trainers include two specific types; a. Certificate of attendance will be awarded to those trainers who have completed the ERS

spirometry train-the-trainer programme b. Official trainer certificate will be awarded to those trainers who actively take part in

training on an ERS Spirometry Training Programme (Part 1 OR Part 2)

Those who apply to deliver training and are approved will become official trainers and

receive an official certificate from the ERS. A fee may be charged to those trainers

requesting additional certificates or name changes to their certificates.

Section 6: Venue specifications

This section describes the facilities required to ensure that all participants gain adequate experience and

exposure to meet the programme objectives and comply with the guidelines provided by ERS.

aa. Space and Equipment

There must be adequate space and equipment to cope with the requirements of the content of

the programme, including the necessary number of meeting rooms with tables and electrical

equipment, AV facilities, breakout rooms, educational aids as well as electrical sockets for

spirometers.

Section 7: Requirements for Specific Facilities

The training centre must provide all facilities necessary to ensure adequate exposure to demonstrations

and hands-on learning of spirometric techniques

a. Use of Spirometers

i. The recommended minimum number of spirometers to be used during training is 1 spirometer

to every 5 students

ii. It is the responsibility of the course director to ensure there are a variety of spirometers

available for use during the course programme. It is preferable to have 2-3 different types of

spirometers.

iii. Spirometers must meet the ATS/ERS requirements outlined in Standardisation of Spirometry [1]

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Section 8: Approval Process and Distribution of ERS Spirometry Driving Licence certificates

This section of the document provides information to those wishing to apply for ERS accreditation and

certify applicants with the ERS Spirometry Driving Licence. ERS approves a spirometry training course

once the course meets the minimum ERS criteria, namely that the course director has completed the

ERS Train-the-Trainer course. Training centres should also abide by further criteria and guidelines

established within this document and the ERS Spirometry Training Programme Outline.

Upon successful completion, students are awarded with an ERS Spirometry Driving Licence.

bb. Approval body

i. ERS oversees course approval and rights to award the ERS Spirometry Driving Licence. This

approval is a quality assurance process for which criteria and minimum conditions described in

the related documents are evaluated.

ii Approval status is afforded to the course director once the ERS Train-the-Trainer programme

has been completed. It is the responsibility of the course director to ensure that minimum

criteria and conditions are followed and implemented.

cc. Application and Approval

i. Following the successful completion of the ERS Spirometry Train-the-Trainer course programme,

the course director can apply for ERS certification of the director. It is strongly

recommended that trainers have also completed both Part 1 and Part 2 of the ERS

Spirometry Training Programme. The application form must be completed and ERS may

require further information.

ii. Completed applications should be submitted at least 12 months prior to the proposed start date Each application must include a

1. Completed application form including a fee of €350 2. The full programme including any additional modules to be covered during Part I and

Part 2 training 3. Venue details and dates of the events for both training days 4. A Spirometry CV for all trainers and examiners involved in the delivery of the training

iii. Completed applications are submitted to the ERS Office headquarters for review and approval

by the Spirometry training and assessments committee

iv. Additional information must be submitted to the ERS office 1 month prior to the event including 1. A complete list of course participants with contact details 2. Sponsorship information

(See final section in Application ‘Additional Information’)

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dd. ERS Participation

i. ERS will not take financial responsibility or organisational responsibility for the organisation of the spirometry training programme organised by the national society or course director

ii. Course directors can request assistance from the ERS Headquarters, for the promotion of the course

iii. The course director is responsible for the budget, promotion and registration for the course iv. ERS reserve the right to review and visit if necessary any training programme endorsed by ERS

ee. Certificate of Accreditation

Certification will be awarded by ERS and each certificate will be forwarded to the course

director for participants who have successfully completed training and assessment. It will be the

responsibility of the course director to ensure that the minimum criteria to award certification

have been adhered to for both Part 1 and Part 2 certification, and that candidates are worthy to

receive their certificates.

There will be two individual certificates awarded: for Part 1, participants will receive the Part 1

ERS Spirometry Driving Licence Certificate. Successful completion of Part 2 will merit participants

to be awarded Part 2 of the ERS Spirometry Driving Licence.

ff. Costs

For individual trainers:

Trainers will be requested to pay a total of €350 per application to deliver a spirometry training

programme.

A cost of €30 (€45 for translated courses) per participant will be requested which will cover

Individual log-in keys to access the spirometry website, and online knowledge test for 12

months

Part 2 of the ERS Spirometry Driving Licence Certificate (PDF)

National Societies:

Should we receive requests from national societies to collaborate with ERS to deliver multiple

training programmes annually or translation of materials, a contract will be drawn up specific to

individual society needs.

gg. Appeals Procedure

If candidates feel they been unfairly assessed during any part of the assessment process, they have the right to appeal against the decision. However, your grade for the knowledge test, workbook and practical assessment cannot be altered. Candidates must discuss their case with the course director before submitting the appeal. All appeals must be submitted within 4 weeks of receiving your final grade.

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The following guidelines will ensure that the ERS Spirometry committee is able to review your appeal on its individual merits.

1. The appeal must include the following; a. What specific grievance you have b. Details confirming your appeal c. Any specific personnel concerned & any dates or times concerned d. Any other relevant information which would support your appeal

2. The appeal will be acknowledged, investigated and reviewed by a panel of experts who sit on the ERS Spirometry Training and Assessment committee within 6 weeks.

3. A formal reply and a report with the decision on your appeal will be sent directly to the candidate and a copy will be sent to the course director of the programme.

REFERENCES

[1] Miller MR, Hankinson J, Brusasco V, et al, Brusasco V, Crapo R, Viegi G eds, Standardisation of spirometry:

number 2 in series – ATS/ERS Task Force: Standardisation of Lung Function Testing. Eur Respir J 2005; 26: 319-338

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ERS Spirometry Training Programme

Information Handbook

CONTENTS BACKGROUND INFORMATION ................................................................................................................ 2

PART 1 and the ONLINE KNOWLEDGE TEST ............................................................................................ 2

ERS SPIROMETRY WORKBOOK ................................................................................................................ 3

PART 2 PRACTICAL TRAINING AND ASSESSMENT ................................................................................... 3

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ERS Spirometry training programme FEBRUARY 2015 Information Handbook PAGE 2

BACKGROUND INFORMATION

This document provides a step-by-step guide for those who wish to fully complete the ERS Spirometry

training programme Part 1 and Part 2.

Training is divided into two parts and all participants must complete and be assessed on;

Part 1 – Knowledge assessment of modules 1 – 8 of the training programme via an online knowledge

test

Workbook – Assignments and portfolio of spirometry tests to assess participants understanding and

application of spirometry in practice – assess Module 8

Part 2 – Practical assessment to assess competence in spirometry measurement including modules 1

– 8 of the training programme

PART 1 and the ONLINE KNOWLEDGE TEST

Step 1: Access to the ERS spirometry website

Each participant will be provided with an individual access code for 12 months to the ERS spirometry

website. Participants must have access to this website at least 1 month before they attend Part 1 of

the training programme. On this website, participants will have access to module content for each of

the 8 modules, as well as access to an online knowledge test in English. These codes provide individual

access for each participant.

All questions on access codes can be directed to [email protected]

Step 2: Attend Part 1 spirometry knowledge and basic skills

Step 3: Online test

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Participants will be expected to complete an online MCQ test within 4 weeks of attending the course

and will have a total of 3 attempts to complete the test.

Step 4: Awarded ERS certificate: Part 1 of the ERS spirometry driving licence

On successful completion of the test, participants will receive a certificate to prove that they have

passed the knowledge test and have been awarded Part 1 (theory only) of the ERS spirometry driving

licence. Part 1 certifies that participants have the knowledge and understanding of spirometry in

practice, however are not yet considered competent to perform spirometry measurement.

Participants must be awarded their certificate before they can register for Part 2 of the training

programme.


Step 1: When to complete the workbook

All participants must fully complete the ERS spirometry workbook before their attendance on Part 2 of

the Spirometry training programme.

Step 2: Preparing participants on how to complete the workbook

Participants will learn about the ERS spirometry workbook during the Part 1 training day. Each

participant will receive the template of the workbook and guidelines to complete the workbook.

Participants may also find support on how to complete this workbook on the ERS HERMES website

under ‘Activities’

Step 3: Mentoring participants

Participants who attend the Part 1 who would like to complete the ERS Spirometry workbook as well

as Part 2 will be assigned a mentor who may assist them with this task during the interim period

between Part 1 and Part 2 training days. All workbooks should be forwarded to assigned trainers or

course directors (ideally electronically) at least 1 month before Part 2 training day.

Step 4: Marking/Grading the ERS spirometry workbook

If participants have failed the workbook, they may be allowed to attend Part 2 and have the

opportunity to take part in the practical assessment. All participants’ workbooks must be submitted

and graded within 6 weeks after Part 2. Participants will fail to receive their Part 2 certificate if they

have not successfully completed the workbook.

Step 5: ERS support

ERS will provide support to participants with this process and all questions may be directed to

[email protected]

PART 2 PRACTICAL TRAINING AND ASSESSMENT

Step 1: Attending the Part 2 training day

Participants will be required to attend Part 2 of the training programme which will cover modules in

knowledge and competence in spirometry measurement.

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Step 2: Preparing for the practical assessment

The practical assessment will be organised during Part 2 of the spirometry training day. The ERS

workbook is intended to assist participants to prepare for the practical assessment.

This process will take no more than 30 minutes and participants will receive immediate feedback from

their examiner. Participants are assessed on the practical procedure of spirometry as well as

communication, and professionalism.

Participants will be fully informed on what to expect during the practical assessment and will receive

all necessary information on the process for the practical assessment and the modules and content

that may be assessed during the practical test prior to the exam.

Step 3: During the assessment

Participants will be assigned an examination time of 30 minutes during the Part 2 training day. During the assessment, examiners will use the completed ERS spirometry workbook as a reference, as well as conducting a practical on spirometry technique. Participants should be familiar with all of the modules covered in Part 2 of the European Spirometry training programme, as all elements may be included within the practical assessment. Participants will have the possibility to resit the examination onsite with a different examiner if they

fail on their first attempt.

Step 4: Providing feedback

Following the practical exam, all participants will receive feedback on their performance onsite..

Step 5: Awarding of the ERS Spirometry Driving Licence Part 2

Those who successfully pass the practical assessment and ERS workbook will be awarded Part 2 of the

ERS Spirometry Driving Licence, knowledge and competence in spirometry measurement.

All certificates will be sent from the ERS headquarters in Lausanne, Switzerland. A register of

successful participants will be available on the ERS HERMES website W hermes.ersnet.org

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Spirometry assessment instructions for ERS trainers and examiners

CONTENTS BACKGROUND INFORMATION ................................................................................................................ 2

PART 1 – KNOWLEDGE TEST .................................................................................................................... 2

ERS SPIROMETRY WORKBOOK ................................................................................................................ 3

PART 2 PRACTICAL ASSESSMENT............................................................................................................. 4

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ERS Spirometry training programme December 2014 Spirometry assessment instructions for spirometry trainers and examiners PAGE 2

BACKGROUND INFORMATION

This document provides a step-by-step guide for trainers on how to assess candidates and award the

ERS Spirometry Driving Licence.

The ERS Spirometry training programme is divided into two training parts and all candidates must be

assessed on:

Part 1 – Knowledge assessment of modules 1 – 7 of the training programme via an online knowledge

test

Workbook – Assignments and portfolio of spirometry tests to assess candidates understanding and

application of spirometry in practice – assess Module 8

Part 2 – Practical assessment to assess competence in spirometry measurement including modules 1

– 7 of the training programme

All spirometry trainers must work in collaboration with ERS to ensure that candidates are provided

with both the knowledge and skills to pass this assessment process.

The aim of this handbook is to provide trainers with information and a step-by-step guide on preparing

and assessing candidates for:

1. An online knowledge test

2. Completion of the ERS workbook

3. The practical assessment

PART 1 – KNOWLEDGE TEST

Step 1: Access to the ERS spirometry website

Each participant will be provided with an individual access code for 12 months to the ERS spirometry

website. Participants must have access to this website at least 1 month before they attend Part 1 of

the training programme. On this website, participants will have access to module content for each of

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the 8 modules, as well as access to an online knowledge test in English. These codes provide individual

access for each participant and are subject to a fee of €30 per participant (or €45 per participant for

translated courses) which must be collated by the course director and paid to ERS.

ERS are responsible for generating questions and maintaining up to date and accurate information for

trainers and participants to follow. Trainers may provide feedback to the ERS office on how to improve

and update this website.

Step 2: Online test

Candidates will be expected to complete the online MCQ test within 4 weeks of attending the course.

It is the responsibility of the course director and trainers to ensure that participants are aware of this

information. Candidates will have a total of 3 attempts to complete the test.

ERS highly recommend trainers to also take this online test before they give instructions to participants

so they become familiar with the process and may comment on and answer specific questions on the

test.

Step 3: Awarded ERS certificate: Part 1 of the ERS spirometry driving licence

On successful completion of the test, participants will be awarded a certificate to prove that they have

passed the knowledge test and have been awarded Part 1 theory only certificate of the ERS spirometry

driving licence. Part 1 certifies that participants have the knowledge and understanding of spirometry

in practice, however are not yet considered competent to perform spirometry measurement.

It is the responsibility of the trainer to ask participants to provide their awarded certificate before they

may register for Part 2 of the training programme. ERS will also keep information stored on who has

successfully completed the test. If requested, ERS may provide this information to the course director.

Reference documents

Trainers must be familiar with:

The assessment criteria outlined within the Guidelines for certification of ERS spirometry training

programmes where the process of the knowledge test is further explained.

ERS spirometry website

ERS online spirometry test


Step 1: When to complete the workbook

The course director is responsible to inform all trainers and participants of the ERS spirometry

workbook. All candidates must fully complete this workbook between their attendance on Part 1 and

Part 2 of the training programme.

Step 2: Preparing candidates on how to complete the workbook

At least 30 minutes of the Part 1 training day must be assigned to explain to participants about how to

complete the workbook, and how to prepare for the practical assessment for Part 2. Each participant

must receive the template of the workbook and guidelines to complete the workbook before leaving

Part 1 training day. ERS provides trainers with all of the necessary information. Trainers should refer

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to the Guidelines for certification of ERS spirometry training programmes where the process for the

workbook is further explained.

Step 3: Mentoring candidates

It is the responsibility of the course director and trainers locally to instruct participants, and to collate

and mark workbooks. ERS recommend that 5 candidates are assigned to one trainer. These trainers

should also act as mentors to participants throughout the interim period between Part 1 and Part 2

training days. All workbooks should be forwarded to assigned trainers (ideally electronically) at least 1

month before Part 2 training day.

Mentors should not assess their assigned candidates for the practical assessment.

Step 4: Marking/Grading the ERS spirometry workbook

ERS spirometry workbooks must be marked and graded using the following ERS document:

ERS spirometry workbook marking sheet

For reference, candidates must submit their workbook based on the ERS spirometry workbook

template and following the ERS spirometry workbook guidelines

All trainers must use the marking scheme assigned by ERS to ensure that grading is reliable and valid

across all spirometry training centres.

ERS fully entrust the marking of the ERS spirometry workbook to local trainers overseen by the course

director.

ERS spirometry workbooks are a pre-requisite to attending the Part 2 training day and all workbooks

must be collated and graded before the practical assessment that takes place during the training.

If participants have failed the workbook, they may be allowed to attend Part 2 and have the

opportunity to take part in the practical assessment. In this case, workbooks must be re-submitted and

graded within 6 weeks after Part 2. Candidates will fail to receive their Part 2 certificate if they have

not successfully completed the workbook.

Step 5: ERS support

ERS will provide support to spirometry trainers with this process and all questions may be directed to

[email protected]

PART 2 PRACTICAL ASSESSMENT

Step 1: Logistical preparation

The practical assessment must be organised during Part 2 of the spirometry training day. Prior to the

Part 2 training day, the course director is responsible to ensure that all logistics and equipment

required for the practical tests are available.

The following checklist of logistical and organisational items must be considered during the

preparation of Part 2:

Number of test stations required

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Equipment required including consumables (height, mouthpieces, filters, noseclips, tissues,

handgel) for each test station (please refer to Section 3: Assessment guidelines within the

Guidelines for the certification of ERS spirometry training programmes)

Number of participants assigned to each examiner

Rotation plan for candidates who move from being the candidate to the test subject

Allow within the schedule additional slots for potential resits

ERS strongly encourage the course director to prepare a meeting with all trainers/examiners taking

part in the course and assign a test timetable for each participant to maximise organisation and

planning. The rotation plan should include a plan for participants to move from the candidate to then

become the subject for the next candidate. All those involved in the assessment of candidates must

have received the required information and supporting documents, and fully understand the

assessment process.

Step 2: Marking criteria

The practical assessment must be standardised not only in the logistical set up of the test stations but

also the marking criteria and documentation used by both candidates and examiner.

The candidate must be fully informed and have received all necessary information on the test process

and the modules and content that may be assessed during the practical test.

The practical test must be assessed using the following documents:

The information provided within this document

Section 3: Assessment guidelines within the Guidelines for the certification of ERS spirometry

training programmes document

ERS SDL Practical examination marking sheet

ERS general guidelines for the practical assessment

Step 3: During the assessment

Practical test: step-by-step guide for examiners

1. Introduce yourself as the examiner and ascertain if the candidate has any objections to an observer being present (if being observed by a trainee examiner) if not, introduce observer.

2. Confirm with the candidate what they are expected to measure: Pre-test procedures and

Spirometry (guidelines and tips for candidates document) 3. Ask if the candidate has any questions prior to the assessment starting 4. Do not ask questions whilst the candidate is performing the measurements. Remember tests

should be carried out within the context of local policies for Health + Safety, Infection Control, care and well-being of the subject. INTERJECT only if the subject’s safety is at risk at any stage during the process and bring the candidate out of the testing area and explain the problem. If necessary discuss with other examiner(s) to decide if assessment should continue or not.

5. Assess and document the outcome. Remember to complete the form listing the marking criteria

and make clear notes on a) Areas that need to be improved on

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b) Deviation from guidelines, and c) Areas performed extremely well

6. Do not give indications of poor performance and only interject if the practice may put the subject

at risk. Equally, please do not give enthusiastic praise to the candidate if they have performed well. It may give the candidate falsely optimistic expectations of their outcome.

7. Complete the documentation and ensure it is passed to the course director. Step 4: Providing feedback

Following the practical exam, all candidates must receive feedback from the examiner on improvement

areas, but should not fail to mention the areas that have been covered particularly well by the

participant.

Oral feedback may be given to the candidates’ onsite of no more than 5 minutes per candidate. If the

candidate has failed to pass the practical assessment, feedback must be given immediately after the

assessment to provide an opportunity for the candidate to undertake a re-sit on the same day. The

candidate is only eligible for 1 re-sit on the day. A more detailed report on feedback can be shared with

the candidate by email or letter after the course.

The re-sit must take place with a different onsite examiner. Re-sits must be taken into account when

planning the examination schedule.

Once the examiner has completed the ERS template for feedback (this is included at the end of the

practical exam marking document), this document must be shared with the candidate no longer than

1 month following the practical assessment. All reports must be shared with the course director who

will review and ensure that candidates receive a copy of their feedback report.

Step 5: Awarding of the European Spirometry Driving Licence Part 2

The course director is responsible to inform ERS of the list of participants who have successfully

completed their workbook and passed the practical assessment and who will be awarded the

Spirometry Driving Licence Part 2. ERS reserve the right to request examples of feedback reports before

they award certificates to candidates.

All certificates will be sent from the ERS headquarters in Lausanne, Switzerland to the course director

for distribution to candidates locally.

ERS are responsible for maintaining a register of successful candidates which will be available on the

website.

Step 6: Sharing knowledge and information

Course directors and trainers may find further information on the ERS HERMES website under

‘spirometry activities’. ERS encourage trainers to discuss common challenges of delivering a course

with trainers from other countries.

The ERS office and ERS Spirometry Committee are available to support course directors and trainers

to deliver this training programme locally and are available to answer any questions at

[email protected]

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ERS SPIROMETRY TRAINING PROGAMME

GUIDELINES TO COMPLETE THE

ERS SPIROMETRY PORTFOLIO WORKBOOK

General information on completing the ERS spirometry Workbook

1. The workbook will need to be fully completed by participants before attending Part 2 of the

spirometry training programme 2. All sections of the workbook are mandatory and must be fully completed by participants.

Participants must pass both Section A and Section B. 3. A copy of the completed workbook will need to be sent electronically to the local training

director before attending Part 2 4. The original workbook will be brought to Part 2 of the spirometry training programme and will

form an important part of the assessment process. You may be asked questions on your spirometry workbook.

The examiner will be looking for all relevant information as set out below

ERS SPIROMETRY WORKBOOK SECTION A

(1 – 4): Contents, background information and overall presentation

Contents page with appropriate references, a basic summary CV based on the CV template, legible,

neat and well-presented workbook. Background information to include, place of work, number of

tests performed in your service monthly, type of patients being tested etc so the examiner has a feel

for the service you are delivering.

(4) Spirometry Performance Criteria

Give relevant pretest instructions, contra indication to testing and the local protocol for testing/

performance of spirometry. This should be in the form of an operating procedure. Ensure to include

acceptability criteria you use when performing spirometry. You must state which guidelines you use

to classify patients and interpret the results.

(5) Spirometer:

A diagram of the mechanism of the working of the spirometer (internal mechanism) and an

explanation of the operating principles, i.e flow or volume measuring device

(6) Calibration or Verification: a clear protocol and procedure should be included for the

performance of calibration/ verification. The frequency of verification and any action taken when

error is encountered should be stated. 20 datasets for evidence of the calibration / verification of

equipment (can be tabulated but extra marks will be awarded for inclusion of raw data). This data

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should be from separate sessions, it is not acceptable to include 20 verification performed on the

same day.

(7) Quality Control – QC: a clear procedure for physiological Quality Control and the reasons for QC.

Include results generated over the 10 days with calculation of mean values and normal physiological

ranges for FEV1, and FVC.

Calculate an acceptable range by using +/-2SD of the mean value of the measurements obtained.

Hard copies of results must be include within your ERS workbook. The examiner will be looking for an

understanding of the purpose and importance of QC along with accurate datasets.

(8) Cleaning: a clear procedure should be included and evidence of a cleaning log with operative

signatures. Procedures for potentially infectious patients should be documented.

SECTION B

(9) Patient tests: 15 different hard copies of patient tests with a brief patient history and technical

comments for FEV1, FVC, FEV1/FVC% AND VC (where possible), along with predicted normal values.

If it is possible with your device include all curves and all data recorded.

All efforts must be visible in the numerical form in order for the examiner to ensure acceptability

criteria were met. Of the 15 patient tests at least 10 of the traces must be technically acceptable.

The minimum number of manoeuvres must have been performed and after obtaining three

acceptable spirograms the two largest values of FVC must be within 0.15 L of each other and also the

two largest of FEV1 must be within 0.15 of each other.

The first thing the examiner will check is that results are technically acceptable (for at least 10 tests)

and meet ERS/ATS standardization in spirometry repeatability guidelines for FEV1, FVC and VC. If

they do not, that patient test will not be marked and awarded zero. If repeatability is met the

examiner will check the best test (technically) was selected.

Remember that all patient tests are confidential and therefore tests included within this section of

the portfolio must be anonymous. A signed witness statement from a senior member of staff where

you are employed should be visible stating that all spirometry tests have been performed by you.

(10) Problems encountered:

3 different hard copies / sketches of problems that can occur on tests such as slow start, cough etc.

Marks are awarded for copy of trace, identification of the error and suggestions to overcome the

problem. Sections in the portfolio that are related to the practical performance of the tests and

practical skills required to undertake a spirometry service will have more weighting and therefore

more marks are allocated to these sections.

After you have finished your portfolio, give it another check to ensure you have included all that is

required ensuring that it is neat and well presented. It is also worth reviewing the sample ERS

spirometry workbook on the ERS HERMES website.

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Faculty disclosures

Dr Brendan Cooper receives occasional loans of lung function equipment to his department for validation purposes.

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Faculty contact information

Prof. Felip Burgos Servei de Pneumologia Hospital Clínic CIBER de Enfermedades Respiratorias (CibeRes) Universitat de Barcelona Villarroel 170 08036 Barcelona SPAIN [email protected] Dr Brendan Cooper Lung Function & Sleep Queen Elizabeth Hospital Birmingham Mindelsohn Way Edgbaston B15 2WB Birmingham UNITED KINGDOM [email protected] Ms. Vera Habes Health Care Faculty, University of Utrecht Bolognalaan 101, Kamer 2.106, Postbus 85182 3508 AD Utrecht, Netherlands [email protected] Ms. Julie Lloyd Good Hope Hospital Rectory Road Sutton Coldfield B75 7RR UNITED KINGDOM [email protected]

Ms. Irene Steenbruggen Pulmonary Laboratory Isala klinieken loc Wl C2 42950, PO box 10500 8000 GM Zwolle NETHERLANDS [email protected] Dr Odile van Eck 5583 XK Waalre Netherlands [email protected] Dr Walther van Mook Maastricht University Medical Centre P. Debyelaan 25 Maastricht 6229 HX NETHERLANDS [email protected]

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Postgraduate Course 1 Spirometry train the trainer course › lrmedia › 2015 › pdf ›...

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