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Postgraduate Education:

Postgraduate Education:

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  1. Postgraduate Education: Why, what, who and how? Dr Barbara Ryan Co-Director Wales Optometry Postgraduate Education Centre

  2. Why, what, who and how? • Why should we continue to learn? • What should we learn? • Who should teach us? • How should we learn?

  3. Why should we continue to learn? Why, what, who and how?

  4. Why should we continue to learn? • To keep up with clinical advancements

  5. Why should we continue to learn? • 1970 The first extended wear lens • 1987   Introduction of disposable soft contact lenses • 1996   Introduction of daily disposable soft lenses Permalens (c. 1972) • 'Spofa' soft contact lenses (c.1988)

  6. Why should we continue to learn?

  7. Why should we continue to learn?

  8. Why should we continue to learn? • To keep up with clinical advancements • To revise what we should know • To enable us to extend the scope of our practice

  9. The Welsh Low Vision Service • Practitioners trained and accredited • 5 Theoretical modules (distance learning) with MCQs • 2 Practical training days and assessment

  10. 149 optometrists and opticians accredited to provide the WLVS173 optometry practices

  11. Estimated prevalence of people with low vision (Binocular VA < 6/18) requiring rehabilitation services in Wales (using 2007 population census data) and projected prevalence in Wales in 2031. a based on 2000/2001 registration data (Tate et al 2005) b based on MRC trial ( Evans et al 2002) c based on 2006 Census- based Wales population projections( http://www.statswales.wales.gov.uk) *excluding those with treatable conditions # 95% C

  12. Why should we continue to learn? • To keep up with clinical advancements • To revise what we should know • To extend the scope of our practice • Because we have to

  13. In UK, since 2004, Continuing Education and Training (CET) has been compulsory for General Optical Council Registration • 36 CET credits every 3 years (about 36 hours learning)

  14. Why, what, who and how? • Why should we continue to learn? • What should we learn?

  15. What should we learn? • Revise and update our knowledge • Keep abreast of advancements • Topics that enable us to extend our practice

  16. The purpose of continuing education is to maintain and improve clinical performance Levine HG, Moore DE, Pennington HC. Continuing education for health professionals: developing, managing and evaluating for maximum impact on patient care. In: Green JS, ed. Evaluating continuing education and outcomes. San Francisco, CA: Jossey Bass, 1984.

  17. What should we learn? Clinical Audit • Audit promotes learning by answering the following questions:  • What am I doing?  • How am I doing it?  • Why am I doing it in that way?  • Can I do it better?

  18. The Primary Eyecare Acute Referral Scheme - PEARS

  19. The Welsh Eye Health Examination - WEHE

  20. Evaluation of PEARS/ WEHE Initial training 2003/4 Evaluation 2007- 6432 record cards

  21. 51% inappropriate management decisions were with posterior vitreous detachment (PVD) Next was corneal conditions which were the most common reason for referral Sheen N J L, Fone D, Phillips et al Novel optometrist-led all Wales primary eye-care services: evaluation of a prospective case series Br J Ophthalmol 2009;93:435-438

  22. Re-accreditation Distance Learning and MCQs • flashes & floater symptoms • corneal conditions • AMD

  23. Objective Structured Clinical Examination (OSCE)

  24. What should we learn? • Revise and update our knowledge • Keep abreast of clinical advancements • Topics that enable us to extend our practice • Things we could do better

  25. What should we learn? “ a poor correlation between doctors' self assessment of their knowledge and their subsequent performance in objective tests of their knowledge” Tracey J, Arroll B, Barham P, Richmond D. The validity of general practitioners’ self assessment of knowledge: cross sectional study. BMJ 1997;315:1426­8.

  26. What should we learn? If given the opportunity clinicians choose educational events that fit in with what they already know When the same clinicians were encouraged to cover topics that were not their preferred choice, their quality of care rose significantly compared with a control group Sibley JC, Sackett DL, Neufeld V, Gerrard B, Rudnick KV, Fraser W. A randomized trial of continuing medical education. N Engl J Med 1982;306:511­5.

  27. What should we learn? • Revise and update our knowledge • Keep abreast of clinical advancements • Topics that enable us to extend our practice • Things we could do better • Some things we don’t choose

  28. Why, what, who and how? • Why should we continue to learn? • What should we learn? • Who should teach us?

  29. Who should teach us? • Adult learners • are self directed • have experience- a rich resource for learning • value learning that integrates with everyday life • will seek out new information and retain it only when they have the “need to know” • Knowles MS. Introduction: the art and science of helping adults learn. In: Androgogy in action. Applying modem principles of adult learning.San Francisco: Jossey-Bass, 1984:1-21. • Kaufman DM and Mann KV Teaching and learning and medical education: how theory can inform practice Understanding Medical Education . ASME 2007

  30. Who should teach us? • A good postgraduate educator • understands what problems are common in everyday practice • translates relevant research • is provocative and challenging • has experience they can share • reflects on their own failures in clinical practice • Knowles MS. Introduction: the art and science of helping adults learn. In: Androgogy in action. Applying modem principles of adult learning.San Francisco: Jossey-Bass, 1984:1-21. • Kaufman DM and Mann KV Teaching and learning and medical education: how theory can inform practice Understanding Medical Education . ASME 2007 • Allen F Shaughnessy AF and Slawson DC Are we providing doctors with the training and tools for lifelong learning? BMJ 1999; 171: 325-328

  31. Why, what, who and how? • Why should we continue to learn? • What should we learn? • Who should teach us? • How should we learn?

  32. Learning not teaching causes a change in practice Fox RD, Bennett NL. Learning and change: implications for continuing medical education. BMJ 1998;316:466­8

  33. What changed your practice? • Something you read/ a lecture • A skills/ interactive workshop • Informal e.g. a patient/ chat with colleague

  34. How should we learn? “On the job” • a starting point for learning • an opportunity to refine and consolidate what we learnt earlier Teunissen PW & Dornan T (2008) The competent novice: lifelong learning at work. BMJ 336 667-669

  35. How should we learn?

  36. What doesn’t change practice for community doctors? How should we learn? • lecture format teaching • influence of opinion leaders • journal articles • unsolicited printed material (including clinical guidelines) Peter Cantillon, Roger Jones. Does continuing medical education in general practice make a difference? BMJ May 1999 The least effective measures on their own are:

  37. How should we learn? What changes practice for doctors? • sequenced interventions over time • interaction with other learners • outreach events • opportunities to practice skills learnt • local connection • strategies that involve multiple educational interventions • peer review and group learning models Mazmanian PE & Davis DA (2002) Continuing medical education and the physician as learner. JAMA 288(9) 1057-1060 Mansouri M & Lockyer J (2007) A meta-analysis of continuing medical education effectiveness. J Cont Educ Health Prof27(1), 6-15 Peter Cantillon, Roger Jones. Does continuing medical education in general practice make a difference? BMJ May 1999

  38. Kiessling A and Henriksson P. Efficacy of case method learning in general practice for secondary prevention in patients with coronary artery disease: randomised controlled study. BMJ 2002;325:877–80 Patients with high cholesterol n=37 Mean Low Density Cholesterol 4.1 Mean Total Cholesterol 6.2 n=41 Mean Low Density Cholesterol 4.2 Mean Total Cholesterol 6.3 Baseline Lectures & national guidelines posted Lectures & national guidelines posted 3 or 4 case based learning sessions with 4 – 7 GPs over 2 years Mean Low Density Cholesterol 4.1 Mean Total Cholesterol 6.3 (+0.7% and +1.8% respectively) Mean Low Density Cholesterol 3.7 Mean Total Cholesterol 5.8 (-9.3% and -6% respectively) After 2 years

  39. How are we learning now?

  40. Why, what, who and how? • Why should we continue to learn? • What should we learn? • Who should teach us? • How should we learn?

  41. Thanks to: Alison Bullock Professor Postgraduate Medical and Dental Education Cardiff University Dr Nick Sheen Co-Director, WOPEC School of Optometry and Vision Sciences Cardiff University

  42. Take home messages • Interactive learning works best • Don’t always choose the easy option • Develop case based peer review locally • Audit