CLIC Conference 2
Professor Geoff Solarsh and Dr Natalie Radomski attended the Consortium for Longitudinal Integrated Clerkships (CLIC), International Conference, Big Sky Montana 29 September – 2 October, 2013. Geoff gives his impressions of the conference and an outline of his PeArLS session.
Conference report
Given our interest and involvement in longitudinal models for community-based health professions education, the annual CLIC conference was a particularly relevant forum to present and compare our educational programs and research interests with international peers. Since 2007, when David Hirsh’s paper on ‘Continuity in Medical Education’ appeared in the New England Journal of Medicine, many medical schools have latched onto this idea as a theoretical framework to reconceptualise existing education programs or to design new ones.
This plethora was on full display at the opening poster session at which longitudinal models of different length, involving a wide range of disciplines and based in varied geographical and health care settings were presented. It soon emerged that many of these short and long programs were based on quite different interpretations of ‘continuity’ and what passed for longitudinal educational models. While there was richness in this diversity, there was also a palpable level of ‘dis-ease’ for some participants interested in channelling this work into international comparisons based on shared definitions and pooled educational outcome measures.
I attended all the plenaries and many of the PeArLS sessions. Some of the highlights were:
Educating Health Professionals in an Era of Ubiquitous Knowledge or “Skating to where the puck is”
The main focus of this presentation by a professor of health informatics was on understanding the rapid technological advances that are occurring in health service delivery and information management and how this affects the direction and priorities of medical and health professions education programs for future practitioners. Most recently enrolled students in US medical schools will enter practice in or after 2020, by which time all users of the US health care system are expected to be on a single shared electronic health record and all health practice will be supported by a “knowledge cloud”. This so-called cloud might include knowledge elements such as clinical guidelines, drug interactions, genomic influences on illness and health, access to biomedical literature and decision models, as well as systems to curate these data and services to provide on-line help with queries. Three core competencies needed to operate in this world will be:
- knowing what you do or don’t know
- knowing where to find this information in the knowledge cloud
- knowing how to weight and evaluate information in this repository.
In such a system, he suggests, you need scaffolding for knowledge and the ability to ask the right questions. Students need to be provided with extensive opportunity to use the cloud during their training and examinations should test for scaffolding rather than detailed knowledge and open cloud exams should be considered. Certainly points to how we will train their heads but not sure about their hearts.
Challenges in Health Professions Education and Role of Longitudinal Integrated Clerkships (George Thibault – Josiah Macy Foundation)
This was a good presentation though it did go over well-covered ground. He listed six challenges in contemporary medical and health professions education:
- Educational standards are not sufficiently attuned to societal needs
- There is agreement that team-based care is needed in health practice but there are very few exemplars of good inter-professional education
- Clinical education is still predominantly hospital-based and focused on acute episodic care in spite of the fact that chronic disease represents 70% of the disease burden in most countries
- We are good at teaching the biological and physical sciences, but population health, social sciences, health systems and professionalism lag way behind
- We consistently under-invest in faculty development and in the careers of faculty devoted to education
- We need to move to a competency-based approach that is more efficient and more customized to the educational needs of individual learners.
The one comment that I would make is that our WoSSP model effectively addresses at least five of these six challenges and though it’s not without its own challenges we do need to persevere with it.
Changing a curriculum: Lessons from the field (Lindsey Henson)
This was a presentation by a very experienced educator responsible for curriculum change in 4 major medical schools in the US. She cites a number of predictors for effective curriculum change, some of which are quite intuitive and will be familiar to many of us. They include:
- Change should be compatible with institution’s missions and goals
- It needs a strong and influential internal advocate and stable and participatory leadership throughout the process
- Institution has clear cross-departmental curriculum governance
- Scope must be large enough to justify the effort but not so large as to be overwhelming
- It needs a cooperative work climate that rewards risk taking
- It needs frequent formal and informal communication and should include dissenters.
Electronic Health Records – do they help or hinder teaching of longitudinal learners in the outpatient setting (Joseph Jackson)
I had an interest in this PeArLS presentation for a couple of reasons. It essentially deals with the task of integrating medical students as effective participants in a paediatric outpatient clinic, something we have been working on for the past couple of years in Bendigo. Central to their conceptualisation of medical student participation is use of the electronic health record (EHR), how students record their findings within it, how students are supervised and audited in this task and how simple paediatric clinical guidelines can be built into the EHR to improve student performance and enhance their learning.
One of the challenges for us has been how we guarantee good service provision and safe decision making for the patients while providing the students with a useful and active learning experience. Their experience with and adaptation of EHRs provides quite a useful framework for managing these dual demands. EHRs set quite clear standards for practice particularly when supplemented with clinical practice guidelines and are also potentially amenable to formal systems of audit. I have had some follow-up correspondence with Joe Jackson and we are exploring ways in which we might be able to work together on this.
PeArLS presentation
I made a short PeArLS presentation on Continuity of Care in CBME in Different Health Care Systems on behalf of myself Natalie and Shah Yasin. In this presentation we wanted to specifically explore constructs for continuity of care in different health care systems and the implications this has for educational continuity in these health systems. These concepts have been prepared for publication, so we were interested in seeing how people responded to them.
We posed the following questions:
- Do we need different ways of looking at educational continuity in community-based programs?
- Does the bio-psycho-social paradigm fully address our curriculum design needs?
- Is it equally relevant for industrialised and lesser developed countries
- Do ‘total systems of care’ and ‘whole of system student placements’ provide useful constructs for educational continuity in CBME programs?
This presentation was scheduled for the last session on the last day so was not particularly well attended though David Hirsh did join us and suggested that continuity of health systems was a concept that had not been covered in his original paper on ‘Continuity in Medical Education’ and had been an omission. A small penny that dropped for me at the conference was the importance of distinguishing between Longitudinality and Continuity in medical education, which are often slurred in the way we talk about them.