The Dynamic GP trainingCritical appraisal training ‘in action’

C. Tulinius

Who

• GP trainees• Teachers • The Steering Group

C. Tulinius

Fish Cats

In this introduction…

• Aims of the workshop• Background for CAT• Content & structure of CAT• The continuous development of CAT• Structure of the workshop

C. Tulinius

Aims of the workshop

• To demonstrate the different elements of CAT with the possibility to observe or participate

• Parallel fishbowls• Precise rules for how and when to participate • Plenary discussion with the possibility to ask trainees

and teachers

C. Tulinius

BACKGROUND FOR CAT

C. Tulinius

Critical reflection

Teaching

Managing several perspektives

Quality assurance and research

Applyingknowledge

Learning and development

Theoreticalframes of reference

The scholar/academic

Critical reflection

Critical reflection

Critical reflection

Critical reflection

Critical reflection

Critical reflection

Critical reflection

Critical reflection Critical

reflection

Overall aim for CAT

Aims:To develop the skills to find and digest new knowledge and apply it to the clinical work

Rationale:To support understanding of an approach that can provide the foundation for life-long learning

C. Tulinius

Learning objectives for CAT

• Describe a topic in the context of current clinical practice and illustrate existing knowledge – and gaps

• Review current knowledge by way of a systematic literature search

• Critically interpret results from the literature – proposing solutions for the problem

• Summarize the results, communicate these to colleagues

• Use research results to evaluate the organizational, economic and ethical consequences of changing practice

C. Tulinius

Medical postgraduate education in Denmark

10

3 regions, different programs. The experiences is from the Eastern Region

East

North

South

CONTENT AND STRUCTURE OF CAT

C. Tulinius

An educational experiment out of control

What exactly are we testing with this, Bob?

Haven’t got a clue!

12

GP specialist training in DK : 5 years

12

30

6

6Introduction to General Practice

General Practice – phase 1

6

Hospital

General Practice – phase 2

General Practice – phase 3

Months

17 days 3 days

All within12 months

13

= Seminar-days Groups of 10 trainees or less with a seminar leader. Discussions and presentations of project including feedback.

= Course-daysCritical appraisal of the literature in small groups and literature search in Relevant databases.

= Work in groups

= Home working days

20 days…

Academic supervision

Based on experiences with research training of GPs and GP trainees

• Based on their own experiences– Relevant to general practice• Participant activating & problem-based learning

• Working in groups of 3-4 to support the training of working in teams

• Critical reflection as a learning strategy• Formative and summative assessment strategy

Educational principles for CAT and the training of the teachers

The continuous development of CAT

C. Tulinius

Challenges

• Cutting down from 60 to 20 days• 90-100 trainees a year, a small handful of research

supervisors had to be trained– Defining curriculum for each teacher’s role– Designing and delivering teaching of basic and specific

medical education to the different kinds of teachers– Supporting the trainers and teachers working together

generally and around the individual trainee– Designing the review as an action research project

• General resistance , research as a non-value• Specific for general practice clinical work

The development of CATObserve

(research/data collection)

Reflect(critical reflexivity)

Plan(strategic action plan)

ActImplementation)

Observe

Reflect

Plan

Act

ObserveO’Leary’s cycles of research

Observations: Problem in forming the groups –

new focus point, or follow up on applied

new strategy

Application of strategy

Suggestions for changes

New teaching day with forming of

groups – how did it work out?

Suggestions: new strategies

Evaluation strategy

New observations

C. Tulinius

Status

• 95 trainees have been through CAT in the Eastern Region, all passed

• 36 motivated teachers and research supervisors, trained especially to their teaching role in the research training

Rewards

• Evaluation shows trainees training to the curriculum, and beyond

• Trainees are going further into research• Teachers are taking on the role as developers and

researchers on their own process• GP trainers talk about ‘their’ regional research

trainers• Educational research getting on the list of research

interests among GP trainers, teachers and trainees

Structure of the workshop

C. Tulinius

Aims of the workshop

• To demonstrate the different elements of CAT with the possibility to observe or participate

• Parallel fishbowls• Precise rules for how and when to participate • Plenary discussion with the possibility to ask trainees

and teachers

C. Tulinius

Workshop structure

C. Tulinius

Literature search

Critical reading 5th seminar day

Supervision

bell

Workshop structure

FOUR fishbowls2 x 20 minutes• Literature search• Critical reading of an article• 5th seminar day • SupervisionQuestions and discussion

C. Tulinius

A decision you have to make…

• Cat ….

• … …………………………………………… or fish ?

C. Tulinius

Workshop structure

C. Tulinius

Literature search

Critical reading 5th seminar day

Supervision

bell

Little helpers….

• Meta communication, translation,… supporting your understanding

C. Tulinius

Fish bowl messages

• Literature search: to show how that it is relevant to know how to do a literature search, and that a focused search gives a focused answer to your questions

• Critical reading: to show that it is possible to teach trainees to read an article in a systematic way

• Supervision: To show how you can supervise two groups with different project topics at the same time

• 5th seminar day: To show how the end assessment of the trainees can be done by the trainees themselves in a process facilitated by the seminar leader

C. Tulinius

C. Tulinius

C. Tulinius