DISTRIBUED MEDICAL EDUCATION: BUILDING OUR FUTURE TOGETHER 2007 MEDICAL EDUCATION CONFERENCE

1. DISTRIBUED MEDICAL EDUCATION:BUILDING OUR FUTURE TOGETHER2007 MEDICAL EDUCATION CONFERENCE DISTRIBUTED MEDICAL EDUCATION: WILL IT MAKE A DIFFERENCE TO THE HEALTH OF CANADIANS? 07 May 2007

2. To be good is noble. To tell others how to be good is even nobler and a lot less trouble. Mark Twain

3. The rules break like a thermometer . . . Quicksilver spills across charted systems. We’re out in a country that has no language, no laws Chasing the raven and the wren through gorges unexplored since dawn. Whatever we do together is pure invention. The maps they gave us were out of date by years. Adrienne Rich, Twenty-one Love Poems

4. MY REFLECTIONS • Setting the Context • Today’s Canadians • Citizens’ Expectations regarding Health • Citizens’ Expectations of Physicians • Citizens’ Expectations of Distributed Medical Education • Leadership Role re DME

5. DISTRIBUTED MEDICAL EDUCATION • Diverse definitions and broad range of activities • Undergraduate, postgraduate and continuing medical education • Educational events and activities involving learners and teachers who are outside immediate classroom or clinical site • Partner and satellite campuses = ambulatory facilities, community-based facilities, regional hospital facilities, online learning sites, videoconferencing, separate university campuses • Short and long-distance travel AFMC Study (2006)

6. “DISTRIBUTED” Distributed computing is a method of computer processing in which different parts of a program run simultaneously on two or more computers that are communicating with each other over a network (not parallel but integrated processes). Main goal: to connect users and resources in a transparent, open and scalable way.

7. ELEMENTS OF DME • Common curriculum shared across sites • Distance between learners/teachers and central site • Multiple settings and diverse settings for learning • Some elements have existed in some programs for some time • Advanced communication technologies

8. FUNDAMENTAL PEDAGOGICAL PERSPECTIVES • Cognitive = cognitive processes involved in learning as well as how the brain works • Emotional = emotional aspects of learning, like motivation, engagement, fun, etc • Behavioural = skills and behavioural outcomes of the learning process, role-playing and application to on-the-job settings • Contextual = environmental and social aspects which can stimulate learning, interaction with other people, collaborative discovery and the importance of peer support as well as peer pressure

9. CHANGING SOCIETY • Demographic shifts • Cultural diversity • Increasing urbanization • Impact of technology • Reality of poverty & violence • Pollution of the environment • Role of women • Expectations of public service • Declining deference to leaders and authority

10. CHANGING SOCIETY Four generations of citizens and patients • Elders/Traditionalists/Silent Generation (pre-1946) • Boomers (1946-1965) • Generation X (1965 – 1980) • Millennials (1980 - ) Three generations of teachers • Elders (pre-1946) • Boomers (1946-1965) • Generation X (1965 – 1980) • Three generations of students • Boomers (1946-1965) • Generation X (1965 – 1980) • Millennials (1980 –

11. DEFINING EVENTS • Elders: Patriotism, families, Great Depression, World War II, golden age of radio, labour unions • Boomers: Prosperity, children in the spotlight, television, suburbia, assassinations, Medicare, Cold War, women's liberation, space race • Generation X: AIDS, stagflation, latchkey kids, single parents, MTV, computers, fall of the Berlin Wall, glasnost • Millennials: Internet chat, school violence, TV reality shows, multiculturalism, the Gulf War, Iraq

12. CORE VALUES • Elders: Dedication, sacrifice, hard work, conformity, law and order, patience, respect for authority, duty before pleasure, adherence to rules, honour • Boomers: Optimism, teamwork, personal gratification, health and wellness, personal growth, youth, work, involvement • Generation X: Diversity, thinking globally, balance, techno-literacy, fun, informality, self-reliance, pragmatism • Millennials: Confidence, civic duty, achievement, sociability, morality, diversity, street smarts

13. PERSONALITY • Elders: Conformists, conservative spenders, past-oriented, belief in logic not magic • Boomers: Driven, soul-searchers, willing to "go the extra mile," love-hate relationship with authority • Generation X: Risk-takers, skeptical, family-oriented, bosses as colleagues, focused on the job not work hours • Millennials: Optimistic, prefer collective action, tenacious

14. EMERGING NETWORK AGE • From the Industrial Age to the Information Age to the Network Age • Network Age • Distributed culture • Decentralized • Citizen-centered not institution-centered

15. TODAY’S CULTURAL MINDSET • Computers are not technology but part of life • Internet is better than TV • Reality is no longer real • Doing is more important than knowing • Learning more closely resembles Nintendo than logic • Multitasking is a way of life • Typing is preferred to handwriting • Staying connected is essential • There is zero tolerance for delays • Consumer and creator of information are blurring Jason Frand (2002)

16. UNDERSTANDING OF HEALTH Health is a state of complete physical, emotional, social and spiritual well-being; it is a resource for everyday living. Implications: • Value of one’s own experiences • Social, psychological and spiritual factors • Gender as health determinant • Health of person, family, community, population and earth

17. EXPECTATIONS OF CITIZENSTavistock Principles (2001) • Rights – to health and health care • Balance – individuals and populations • Comprehensiveness = treat illness, ease suffering, minimize disability, prevent disease, promote health • Cooperation – with those served, with each other, with those in other sectors • Improvement • Safety • Openness = being open, honest and trustworthy

18. WHAT WE ASK OF OUR PHYSICIANS • Does my doctor have good medical knowledge? Is she keeping up to date with advancing medical knowledge? • Does my doctor know how to appropriately use that knowledge? Does he have good clinical skills? • Does my doctor treat me respectfully and well? Does she listen? Does she treat my family/loved ones well? • Is my doctor ethical in his behaviour towards me? Does he sometimes use me for other purposes – to do research, to make a political statement, to get a change he wants?

19. WHAT WE ASK OF OUR PHYSICIANS • Does my doctor work well with other health professionals as a true member of the team? • Is my doctor respectful of the other people who work in her organization? • Does my doctor work towards the overall health of people not just his individual patients? • Does my doctor know how the rest of the system works? Is she working to make it better? • Does my doctor work to make his profession better?

20. PROFESSIONALISM • Professional status is given in trust by society • Professions exist because society needs and wantsthem to exist • Society must feel and see the profession’s trustworthiness • Professionalism is about both individuals and groups of professionals

21. RCPSC: CanMEDS 2000 • Medical Expert • Communicator • Collaborator • Manager • Health Advocate • Scholar • Professional

22. CFPC: Principles of Family Medicine • The patient/physician relationship is central to the role of the family physician. • The family physician is an effective clinician. • Family Medicine is a community based discipline. • The family physician is a resource to a defined practice population.

23. CHANGING HEALTH PROFESSIONS • Move from traditional inward-looking, reactive culture to outward-looking, proactive culture • Shift from profession-centred to patient-centred culture • Shift away from solo practices • Blurring professional boundaries • Changes in law re scope of practice/responsibilities • Increased expectations of inter-professional collaboration in education and practice • Focus on evidence-informed practice • Increasing demands for accountability/transparency • Internationalization

24. CITIZEN EXPECTATIONS OF DME • Pedagogically sound, inclusive of cognitive, emotional, behavioural and contextual perspectives • Inclusive of domains of knowledge, clinical skills, and professionalism • Ways found to maintain compassionate approach and personal touch in the midst of a highly technological communications environment

25. CITIZEN EXPECTATIONS OF DME • Inter-professional learning and skills development • Interaction of medical students/residents in the distributed clinical settings with nursing students, pharmacy students, social work students, etc. • Exposure across the spectrum of health organizational settings • Linkages with other social systems (e.g., education, social services, employment initiatives, housing, justice)

26. CITIZEN EXPECTATIONS OF DME • Sustainable re human resources and financial resources • Effective use of technology • Influence on the development and application of technology both in health care and education • Research as an essential component

27. OUTCOMES HOPED FOR BY CITIZENS • Improved recruitment and retention in less favoured areas, geographically and professionally • Better distribution of physicians in rural and remote areas and among specialties • Physicians more understanding of urban/rural divide, cultural and generation diversity

28. CITIZENS’ QUESTIONS RE DME • Will this approach to medical education become the norm or will it always be used on an exceptional basis? • Will the current normative approach be the model for this approach or will this approach change and strengthen the current normative approach? • Will this approach create two classes of physicians depending on where education happens? • Will the members of the public be invited to help design and develop DME?

30. OUR ROLES AS LEADERS • Visionary • Catalyst • Decision-maker • Inspirer • Facilitator • Partner • Implementer • Evaluator

31. A Blessing May the light of your soul guide you. May the light of your soul bless the work that you do with the secret love and warmth of your heart. May you see in what you do the beauty of your own soul. May the sacredness of your work bring healing, light and renewal to those who work with you and to those who see and receive your work. May your work never weary you. May it release within you wellsprings of refreshment, inspiration and excitement.

32. May you be present in what you do. May you never become lost in bland absences. May the day never burden. May dawn find you awake and alert, approaching your new day with dreams, possibilities and promises. May evening find you gracious and fulfilled. May you go into the night blessed, sheltered and protected. May your soul calm, console and renew you. John O'Donoghue, Anam Cara