Workshops
Wednesday 27 August 2008 11:00am
"ENDURING WITNESS - A DOCTOR'S HISTORY". PREVENTING BURN OUT AND COMPASSION FATIGUE IN GENERAL PRACTICE
Dr Hilton Koppe
North Coast GP Training (NCGPT)
“Enduring witness” is a 30 minute DVD produced by North Coast GP Training. It was written and directed by Hilton Koppe, senior medical educator with NCGPT.
The DVD traces the fictional relationship between a GP (Geoff) and one of his female patients (Lisa) as she make the transition from adolescence to young adulthood, through snippets from consultations about contraception, marriage, pregnancy and caring for her young children. Lisa then develops breast cancer, and we watch how Geoff manages breaking the news, assisting her with treatment, remission, relapse and palliative care. Issues relating to after care for Lisa’s family are covered at the end.
Some of Geoff’s “qualities” as a doctor (empathy, openness, patient-centredness) are the very same factors which put him at risk of burn out and compassion fatigue.
The story is told primarily through the eyes of the doctor, and we gain access to some of his “hidden thoughts”.
The primary goal of the DVD is to promote discussion about preventing burnout which can occur from managing emotionally draining situations in general practice. There is further opportunity to explore issues such as breaking bad new, support for colleagues, boundary issues and surviving the ups and downs of clinical practice.
The DVD will be shown at the start of the workshop. This will then be followed by a facilitated discussion between participants. Discussion will focus on both personal responses of participants to the DVD, and also on how as educators we can best equip registrars and supervisors to deal with the emotional challenges that arise in general practice.
The DVD was produced to assist in education for both registrars and experienced GPs, including supervisors. It fills a gap in educational resources for this purpose.
INTIMIDATION AND HARASSMENT IN THE TEACHING ENVIRONMENT: MEDICAL STUDENTS, RESIDENTS
Prof Jacques Frenette
This workshop is open to medical students, registrars, attendings and medical educators. To respect accreditation requirements, training programs, universities and providers have to: Define the standards of conduct in the teacher-student relationships; Develop and publicise procedures; Develop faculty development activities to promote appropriate behaviours; Assure an equitable and rapid processing of complaints.
Using 12 vignettes where medical students, registrars, attendings and medical educators are involved in a teacher-student situation, we will work together to: Help attendings, registrars and medical students to recognize intimidation, discrimination, abuse and harassment situations; Sensitize the participants about the non pedagogical and often detrimental aspects of such behaviours vis-à-vis the students’ development; Promote appropriate behaviours; Inform the participants of the process to be followed when a complaint is made.
DUMMY TEACHING FOR BRIGHT YOUNG (AND OLDER) THINGS - SIMPLE, EFFECTIVE TEACHING THAT ANYONE CAN DO
Dr John Buckley
Central and Southern Queensland Training Consortium
This workshop is aimed at GP registrars but other participants are welcome. The workshop will engage participants in a discussion about and practise in some simple approaches to teaching. The aim is to demystify teaching or, as I like to say it “Taking away the work of teaching just leaves the fun!”
The processes described are particularly included with a view to helping GP registrars in teaching roles with medical students and other Registrars, both one-to-one and in small groups.
Key principles include:
- It is about what is learnt, not what is taught
- Get the learner to do the work – it’s easier and they learn more too
- Simple ‘rules’ and approaches
- Grab the ‘teaching moments’
- An honest teacher is respected
- Trust the group
- Planning helps (but it can be quick and easy
- Teacher =/= expert
- Not everyone will love you
- Learning by teaching
My role at CSQTC is as Director of Medical Education, abbreviated as DME, pronounced as Dummy. GP registrars are bright amazing people. If a Dummy can teach so can you!
GETTING THE BEST OUT OF YOUR REGISTRAR
Dr George Zaharias
Victorian Metropolitan Alliance
Registrars that are underperforming or experiencing difficulties are a concern for medical educators and GP supervisors alike. While most, if not all training providers, have processes in place for dealing with such registrars, what of the registrar who is performing well or even excelling? Using two case examples as a basis for discussion, this workshop will explore strategies for enhancing the learning, as well as the general practice experience, of registrars who are performing well and those who aren’t. A further outcome of the workshop will be the collation of these strategies for broader dissemination and discussion.
Workshops
Wednesday 27 August 2008 01:30pm
ASSESSMENT DURING TRAINING - WHAT CAN WE LEARN FROM EACH OTHER?
Dr Tim Senior
Medical Educator WentWest
This workshop is an opportunity for regional training provider (RTP) staff, supervisors and college representatives get together to present and discuss models of assessment during training. It will be based on sharing of current ideas and experience to produce systematic and rigorous Assessment During Training (ADT) models and influence future trends.
Learning Objectives
At the end of this workshop participants will
Be able to describe approaches taken in different RTPs to their Assessment During Training of GP registrars.
Discuss the strengths and weaknesses of these approaches in relation to the different requirements of ADT, including identification of underperforming registrars and formative assessment of all registrars.
Take back ideas, strategies and tools regarding Assessment During Training to RTPs that will enhance the training of all GP registrars for future practice.
Structure and Content
The workshop will open with brief presentations outlining current approaches to Assessment During Training in different RTPs, followed by facilitated discussions testing the way they work in practice, and their strengths and weaknesses. Participants will be able to reflect on which parts of these could work in their area according to local needs and priorities and have an opportunity to identify trends and gaps for the future.
SIMULATION IN GENERAL PRACTICE EDUCATION: DOING IT ON THE CHEAP
Dr Edi Albert
General Practice Training Tasmania
Simulation is playing an increasingly large role in medical education at both undergraduate and post-graduate levels, due to changes in patient expectations, changing medical practice, increasing numbers of trainees, and changes in concepts of medical education.
Simulation often conjures up images of expensive equipment used for resuscitation in large tertiary centres. However, simulation can be used in a wide range of medical education settings relevant to general practice and rural and remote medicine. Simulation need not always be an expensive exercise.
This workshop describes simulation and clinical skills training from both educational theory and practical perspectives. It examines how they can be incorporated into educational programs, and provides ideas and insights into how it may be done cheaply and effectively. Examples are provided from a range of different clinical situations.
Participants will work together to produce their own workshops or teaching sessions that incorporate simulation in a manner that meets the learning needs of their registrars.
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Workshops
Thursday 28 August 2008 11:00am
CONSULTATION INTERRUPTUS - CONCEIVING BETTER LEARNING OUTCOMES
Dr Gerard Ingham, Dr Ewa Piejko
Victoria Felix Medical Education
Brief opportunistic teaching during the clinical day should epitomise the complex and dynamic skills of clinical supervision. Instead some days can consist of a series of unproductive interruptions to the consultations of both registrar and supervisor. This session will explore the issues present in these consultation interruptions and look at how outcomes can be improved for supervisors, registrars and their patients.
Learning objectives:
- Explore the issues around opportunistic teaching episodes that occur during the consulting day
- Identify the mismatches between the needs of patients, registrars and supervisors
- Develop systems and strategies to reduce this conflict and improve outcomes for all
Structure and Content:
A video of a typical consultation interruption and supervisor response will be shown. In small facilitated groups the participants will step through the issues raised by the video. The approach used by the supervisor in the video will be critiqued by the group and alternative options will be explored.
CRITICAL ANALYSIS OF PERFORMANCE AND TEAMWORK IN A SIMULATED ENVIRONMENT: DOES YOUR DEBRIEFING REFLECT PATIENT CARE OUTCOMES?
Dr Michal Wozniak 1, Dr Peter Clements 1, Ms Collette
Lancaster-Lockwood 2, Ms Val Follows 2
1 Sturt Fleurieu, SA, 2 Clinical Simulation Unit, School of Medicine, Flinders University, SA
Background
Simulation has been used for some time now to improve health professionals’ performance and teamwork. A critical element of teaching and learning begins once the simulation scenario has ended. The facilitator must guide participants through a debriefing to explore how their doctor-patient, nurse-patient, and nurse-doctor interactions will contribute to positive patient outcomes.
Since it is not possible to “stop time’ for critical analysis within the simulation itself, it is a valuable skill to be able to recognise common elements of performance and teamwork during diagnosis and treatments which reflect outcomes that may or may not be best possible practice.
Aims
To actively participate in debriefing that is focused on:
- choose what issues are to be discussed at debriefing, based on the learning objectives of the session
- interpret and act upon what you have just seen
- construct a debriefing based on a simulation
- explore misconceptions and assumptions that are displayed by participant behaviour
- recognise common pitfalls in debriefing and explore strategies to avoid them
Methods
Through viewing a “virtual debriefing” environment, workshop participants will develop and practise skills for analysing performance and teamwork that can be transferred to a variety of teaching environments.
Results
Learning outcomes are to:
- develop and apply a plan for a facilitated debriefing
- discuss behaviours with participants that reflect key performance issues
- incorporate validated evidence-based guidelines into the debriefing
- create a positive environment which allows the participants to reflect on their performance
"MOCK EXAMS: YOU CAN DO IT TOO"
Dr Andrew Moreton 1, Dr Sandra Mendel 1, Dr Christina Carroll 1
1 GPlogic General Practice Training
Registrars welcome the opportunity to undertake a mock examination before sitting for the real thing. This workshop aims to demystify how to run a mock clinical exam based on the experience of providing practice exams over the past ten years. The learning objectives for this workshop will include: identifying key concepts required to conduct a mock clinical exam; illustrating how to write cases; arranging examiner selection and training; demonstrating the resources required and discussing the reliability between a mock clinical exam and RACGP exam results.
This workshop aims to be interactive and provide some practical solutions to problems with exam preparation courses. It will be divided into the following segments.
Why? A defence for exam-specific training;
What? The content of the mock clinical; case writing; examiner training and quality assurance;
Who? Participants, examiners, actors, administrators;
When? Timing of the exam and a preparation timetable;
Where? What facilities are required;
How? The key secrets and tips to making it successful. The workshop will be designed to provide professional development for medical educators and supervisors but would be very useful to registrars preparing for the exam to understand the complexity that exists behind a clinical exam
A GUIDE TO HELPING SUPERVISORS STRUCTURE REGISTRAR TEACHING SESSIONS
Dr Katriona Herborn 1,4, Dr Andrew Knight 2, Dr Nigel Gray 3, Dr Steve Sylvester 5
1GP Supervisor and Supervisor Liaison Officer (SLO)WentWest, 2 Acting General Manager Education and Training WentWest, NSW, 3SLO and Medical Education (ME), Northern Territory General Practice Education (NTGPE), 4Chair Of Gneral Practice Supervisor Liaison Officer Network (GPSLON), 5GP Supervisor and SLO
The aim of this workshop is to formulate a list of activities that can be used by all supervisors to provide ideas for dedicated registrar teaching sessions.
It is a collaborative workshop with input from Katriona Herborn, chair of the SLON and SLO for WentWest, Andrew Knight senior medical educator with WentWest, Nigel Gray ME and SLO with the Northern Territory regional training provider (RTP) and Steve Sylvester from the Hunter Valley.
WentWest had done work looking at what range of activities supervisors do with their registrars in teaching sessions. A summary of this work will be presented along with reflections on the presentation by Roger Neighbour on the apprenticeship model of GP training.
We will then break into small groups to identify and expand as many teaching ideas and tools as is possible. The group will finally develop a list of suggestions for registrar teaching activities which will be disseminated through the supervisor liaison network.
Workshops
Thursday 28 August 2008 01:30pm
360 FEEDBACK: SUPPORTING PATIENT-CENTREDNESS AND PROFESSIONALISM
A/Professor Michael Greco
CFEP
Feedback about performance is a key part of a registar’s training. Internationally, there is growing interest in the role of Multi-Source Feedback - MSF (or 360° feedback) for the purpose of helping doctors and doctors-in-training gain a better understanding of their professionalism as part of their continuing professional development.
In the transition from student to experienced professional, little has been done to prepare registrars to make good use of this required feedback.
The aims of this workshop will be to explore with participants:
º The professional values and principles that guide registrars in how to make good use of feedback from colleagues and patients. Why is listening to 360 feedback important?
º The most effective ways for feedback to occur. What are the key approaches to giving feedback that make it most useful to registrars?
º The major challenges that GP Trainers and Educators face when reviewing colleague and patient feedback with Registrars. What is difficult for Registrars in hearing the voice of patients and colleagues?
In addition, the workshop will outline the experiences of Australian and UK doctors in receiving feedback from their patients and colleagues within general practice.
References:
Narayanan, A. and Greco, M. 2007. What distinguishes general practitioners from consultants, according to colleagues? Journal of Healthcare Management and Marketing. Vol.1 No.1: 80-87
Sargeant J, Mann K, Ferrier S. Understanding family physicians reactions to MSF performance assessment: perceptions of credibility and usefulness. Medical Education, 2005. 39:497-504
Evans R, Elwyn G, Edwards A, Review of instruments for peer assessment of physicians, British Medical Journal. 2004; 328: 1240-1245
Lockyer J, Multi source feedback in the assessment of physician competencies. Journal of Continuing Education in the Health Professions, 2003; 23(1): 23: 4-12.
HAPPINESS AND WELLBEING IN GENERAL PRACTICE TRAINING
Dr Nick Cooling1, Dr Hilton Koppe2, Dr Andrew Knight3, Dr Geneveive Yates4, Dr Natalie Old4, Dr Susan Garside 4 Dr Christine Ahern2, Dr Saroja Gunasekera5
1General Practice Training Tasmania, 2North Coast GP Training (NCGPT),3WentWest, 4Central and Southern Queensland Training Consortium (CSQTC), 5CoastCityCountry Training
Objectives
By the end of the symposium participants will have:
- Been inspired by presenters about innovative ways to promote happiness and wellbeing in our RTPs and in our patients
- Experienced some ways to promote happiness and wellbeing
- Spent some time reflecting & planning on how their RTP could better foster happiness and wellbeing in their GP registrars and teachers
- An awareness of the educational principles used in the workshop
- A sense of how music, meditation, humour and self care can promote healing amongst ourselves and patients
There appears to be little understanding of how we can promote happiness and wellbeing in our GP registrars and teachers. To optimise the roles of healer, doctor, teacher and learner one has to have optimal wellbeing. In the past RTPs have focussed on psychological methods to improve wellbeing but other traditions such as spirituality, music, yoga also may have an important role. This 90 min workshop will draw on elements of the acclaimed annual Sydney convention- Happiness: Its causes.
The Symposium will explore the techniques for achieving peace and happiness and wellbeing in the context of GP training. It will consist of two invited speakers who will broaden the audience’s concept of how to promote happiness and well being, and a series of educational methods used to enhance happiness in workshops
There will be some discussion and an opportunity for recommendations on how doctors can improve their wellbeing and happiness. Finally, small groups will share how individual RTPs are promoting wellbeing and happiness and how this can be further enhanced.
THE UNDERPERFORMING REGISTRAR - RECOGNITION AND REMEDIATION - THE EXPERIENCE OF 2 RTPS IN THE FIELD AND THE SEARCH FOR BEST PRACTICE FOR BEST OUTCOMES
Dr Peter Clements 1, Dr Christine Ahern
1 Sturt Fleurieu, 2 North Coast GP Training (NCGPT)
Most registrars are skilful, motivated and self-directed learners and move through their training with no major problems. However, all regional training providers (RTPs) are at some time faced with issues around underperforming registrars and must have various strategies for approaching the problems.
Reasons for underperformance include clinical competence, professional and ethical and motivational issues or even a simple lack of self confidence. Personality clashes can sometimes cause great difficulties. Communication difficulties and cultural differences often contribute significantly to the problems.
Other considerations exist including whether the registrar recognizes the problems and whether the supervisor and training provider education staff are aware of the problems and/ or are able or, indeed, willing to deal with them.
This workshop will explore the variety of performance issues encountered by the 2 RTPs who are facilitating. Each has had considerable experience in the field and they have used differing methods to help registrar performance. It will provide a forum for sharing experiences and ideas about how to deal with underperformance and importantly will discuss means of recognition of the “at risk registrar”.
RTPs and medical educators (MEs) will be asked to consider their role in remediation and to ponder whether they are able to provide adequate remediation from within their existing supervisors and medical educators.
The structure will be as follows:
Presentation of four case studies illustrating registrar performance issues. Small groups will discuss the cases and devise strategies on how they would proceed to remediate.
The actual remediation plan undertaken will be revealed subsequently as well as the outcome.
Small group work will address the performance and remediation issues in terms of recognition of the problem, early interventions, subsequent formal remediation, risk to the registrar, risks to the supervisor and practice, risks to the patients and risks and responsibilities to the RTP.
Small groups will share their ideas with the larger group at strategic times through the workshop.
The facilitators will introduce each topic and case and summarize their own experiences as well as the group feedback.
Learning objectives are as follows
At the end of the workshop participants will:
- Have more confidence in how to recognize problems early
- Have more confidence in how to intervene at the earliest possible time to minimize potential issues
- Have a greater awareness of interventions which are likely to work
- Have a greater understanding of the costs involved in providing satisfactory remediation to underperforming registrars
- Be better able to consider their anticipated outcomes of interventions
ADF REGISTRARS IN THE AGPT - IMPROVING THEIR EXPERIENCE AND CAPITALISING ON THEIR EXPERIENCES
Dr Reginald Michael Crampton 1, Dr Andrew Knight
1 Wentwest GP Regional Training Provider, 2 Wentwest GP Regional Training Provider
Dr. Michael Crampton, Dr Tim Senior
Medical Educators Wentwest
This workshop is an opportunity for regional training provider (RTP) staff, trainers and General Practice Education and Training (GPET), college and Australian Defence Force (ADF) representatives to get together to present and discuss issues that relate to improving and optimising opportunities for training for ADF GP registrars. For ADF GP registrars, given their frequent transfers between ADF bases, their recurrent need to attend special ADF training courses and overseas deployments and the different demographic profile of the majority of their patient cohort, their progress through the Australian General Practice Training (AGPT) is often disrupted and less than optimal.
This workshop will be based on sharing of current ideas and experience to produce a clear idea of the difficulties in satisfying AGPT program requirements facing ADF GP registrars, and a concise set of strategies to address these difficulties which satisfy the requirements of GPET, the colleges, RTPs, trainers and ADF GP registrars.
Learning Objectives
At the end of this workshop participants will:
- Be able to describe approaches taken in different RTPs in providing training for ADF GP Registrars.
- Discuss the strengths and weaknesses of these approaches in relation to the different requirements of GPET, colleges, ADF, RTPs, trainers and ADF GP Registrars.
- Formulate recommendations for consideration by GPET, colleges, ADF, RTPs and trainers to improve and optimise training opportunities for ADF GP Registrars.
Structure and Content
The workshop will open with brief presentations outlining current requirements and approaches to training for ADF GP registrars in different RTPs, followed by facilitated discussions identifying problems and possible solutions. Participants will be able to reflect on changes which could be implemented now in their area according to local needs and priorities, and formulate recommendations to ADF, GPET and colleges for policy changes which may be necessary to improve and optimise the training experiences of ADF GP registrars in the future.
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