L.E.A.P Learning Essential Approaches to Palliative Care

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L.E.A.PLearning Essential Approaches to
Palliative Care
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Course Goals

• Empower Primary Care
• Introductory course on providing care for the
  terminally ill for primary health professionals.
• Knowledge, skills attitudes
• Promote interprofessional collaboration.
• Showcase/credibility local palliative care
  coordinators resources
• Identify local champions.
• Catalyze local change.
• Educate local community- Press release

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Considerations

• Principal target learners MDs, RNs, Pharmacists
• Target various settings.
• Ability to repackage course.
• Divided into parts/series.
• Various settings (undergraduate, postgraduate)
• Ability to vary audience
• Hospital-based MDs, RNs, etc
• Ability to use components.
• Medical, nursing, pharmacy students residents.
• Objects (online repository)
• Master copy of modules

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Considerations

• Basic principles essentials
• Refer to more advanced materials
• E.g. Ian Anderson, Victoria Course, Hamilton
  interdisciplinary course
• Not just cancer
• CPD credits
• Evidence-best practices based.
• Interprofessional
• but also respect needs of individual disciplines
• Not TTT model
• Iterative design process

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Curriculum DevelopmentKerns Model
Problem Identification. General needs assessment
Needs assessment of targeted learners (
technology)
Evaluation feedback
Goals objectives
Implementation
Education strategies
Kern DE, Thomas PA, Howard DM, Bass EB.
Curriculum development for medical education a
six-step approach. The Johns Hopkins University
Press, Baltimore. USA. 1998.
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Course development history

• Pallium Phase I
• Initial course draft (Mazuryk Pereira)
• Advice from Dr. Jocelyn Lockyer (PhD, CME)
• Pilot phase of 6 courses- (ongoing revisions
  based on evaluations Cheryl Smith, Shannon
  Pyziak, Cornie Woelk, Ron Spice, Fiona Crow,
  Robert Wedel, Doreen Oneschuk).
• Phase II
• Curriculum working group
• Romayne Gallagher (MD), Cheryl Smith (SW),
  Shannon Pyziak (RN), Pat Tichon (Pharm), Gillian
  Fyles (MD), Fraser Black (MD), Doreen Oneschuk
  (MD), Ron Spice (MD), Jocelyn Lockyer (PhD).
• To date 4 major revisions.

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Revision August 2004

• Blind review process
• Romayne Gallagher MD (BC.)
• Cheryl Smith RN (MB)
• Shannon Pyziak RN (MB)
• Pat Trozzo Pharm. (MB)
• Gillian Fyles MD (BC.)
• Fraser Black MD (BC.)
• Ron Spice MD (AB)
• Robin Love MD (BC.)
• Merle Teetaert RN (Sk)
• Rob Wedel MD (AB)
• Jose Pereira MD (AB)

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Courses to date

• Over 23 course over western Canada
• Being used I undergraduate and postgraduate
  curricula
• Calgary
• Edmonton

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Pedagogical undercurrents

• Various learning styles.
• Reflective learning constructivism
• Combination of learning methods.
• Theory bursts.
• Cognitive psychology inductive, forward vs
  hypothetico-deductive processes.
• Hooks
• Case-based Group learning
• Apply theory, nurture reflection, prompt
  discussion.
• Lead by experienced facilitator/content expert
• Constructive learning
• Large group discussions
• Interprofessional dialogue
• Reflective exercises
• Self-awareness, suffering.

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Pedagogical undercurrents

• Trigger tapes video vignettes
• "ill-structured situations
• NOT ideally modeled, uses "reflective questions"
  to prompt "reflective conversation"
• a.. What is going on here?
• b.. What issues does this raise for you?
• c.. What could have been done differently?
• J Moon. Reflection in Learning and Professional
  Development. (1999, London Kogan Page)
• Integrating weaving themes throughout course
• Ethical decision-making, communication.
• Repetition

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Course materials

• Local planning guide
• Facilitators kit
• Manual Facilitator notes (suggested questions,
  reminder of key points, theory evidence)
• Videos, posters
• Participants manual

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Module Themes Learning Activities Suggested Delivery Time
1 Creating Context Self-awareness exercise What dying people want Defining palliative care Orienting ourselves to the work (video) 1 hour
2 Gastro-intestinal problems Ethical decision-making (artificial feeding) Theory bursts Case discussions Video discussion 2 hrs 25 min
3 Pain Management Prescription exercise Theory burst Case Discussion 2 hrs 35 min
4 Respiratory Problems Theory burst Case discussion 1 hr
5 Communication Socio-drama based videos that prompt discussion. 2 hrs
6 Depression, Anxiety Suffering. Theory burst Video and group discussion 1 hr
7 Grief Bereavement Theory burst 30 min
8 Delirium Theory burst Case discussion 1hr 10min
9 Palliative Sedation Theory burst Large group discussion 30min
10 Last days Hours Video discussion Theory burst 30 min
11 Working as a Team Large group discussion 30 min
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Module Themes Learning Activities Suggested Delivery Time
1 Creating Context Self-awareness exercise What dying people want Defining palliative care Orienting ourselves to the work (video) 1 hour
2 Gastro-intestinal problems Ethical decision-making (artificial feeding) Theory bursts Case discussions Video discussion 2 hrs 25 min
3 Pain Management Prescription exercise Theory burst Case Discussion 2 hrs 35 min
4 Respiratory Problems Theory burst Case discussion 1 hr
5 Communication Socio-drama based videos that prompt discussion. 2 hrs
6 Depression, Anxiety Suffering. Theory burst Video and group discussion 1 hr
7 Grief Bereavement Theory burst 30 min
8 Delirium Theory burst Case discussion 1hr 10min
9 Palliative Sedation Theory burst Large group discussion 30min
10 Last days Hours Video discussion Theory burst 30 min
11 Working as a Team Large group discussion 30 min
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Theory burst

• Short
• Main messages
• Limit intense discussions but do not stifle
  questions or discussion either.
• Introduce personal clinical experiences short
  stories- not too many and not too long.

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Group facilitation

• Role of facilitator
• PBL in purist form
• Studies show no superiority over other methods
  with respect to knowledge skills, but more
  enjoyable and consistent with constructive
  learning theory.
• Process facilitator vs content expert vs process
  content facilitator

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Group Facilitation

• Going from sage on the stage to guide on the
  side
• Dont give answers right away.
• Pose reflective questions.
• Dont shoot down what appears to be incorrect
  
• Do provide alternative perspective.

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Group facilitation

• Key messages
• This is an important point-this is a take-home
  message.
• 4 or 5 key take home messages for each module
• Identify take home messages during discussion
• Facilitator notes are at times comprehensive- you
  do not have to cover each point in notes. Pick
  out main message.

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Group facilitation

• Respect input.
• Reframe if necessary.
• Ask questions that prompt reflection.
• Attitudinal objectives
• Dont have to agree or disagree (unless unsafe
  practice), but introduce different perspective.
• Find common values.
• Reframe discussion This is what we will
  experience when dealing with a difficult
  patient/family/colleague situation. SO how can we
  process through this?
• Need not agree but acknowledge.
• Highlight practical ideas.
• Focus on the problem, not the person

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Course Evaluation (Dr. J Lockyer CME Unit at U
of Calgary)

• Learners reactions
• Modifications of attitudes
• Acquisition of knowledge/skills
• Change in individual behaviour
• Change in organizational behaviour
• Benefit to patients
• Changes in organization itself to systematize
  palliative care- i.e. new policies procedures,
  new equipment, community education, increased
  team work, fundraising etc
• Costs

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Course evaluation

• Pre-course survey
• Demographics
• Comfort level
• Identify learning needs
• Knowledge quiz
• (Attitude survey)
• Post Course
• Course evaluation
• Comfort levels
• Knowledge quiz
• Commitment to change
• (Attitude survey)
• 3-6 mths Post Course
• Commitment to change review
• (Comfort levels)
• (Knowledge test)
• (Attitude survey)