Diane purcille practice inquiry v7
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Diane purcille practice inquiry v7

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  • Hello and welcome to the Permanente Medical Group’s presentation on Practice Inquiry.To begin, click the start button.
  • Let’s start with a story. After you have finished reading, click next to continue.
  • Take a few moments to reflect on the following questions.
  • Like a Balint group, practice inquiry focuses on a case presented by one of the group. The case is presented succintly and the group goes through the case together, asking clarifying questions, sharing their own clinical experience and practices, as well as researching evidence based guidelines and resources. The critical difference between practice inquiry and Balint is the focus and facilitation. Practice inquiry is not solely focused on analyzing the patient – physician relationship. Practice inquiry integrates this into a larger discussion of what is going on in the situation but focuses on the patient care experience and the dilemmas that arise from clinical practice.
  • Practice inquiry is focus around clinical uncertainty. What is clinical uncertaintyhttp://www.learnersdictionary.com/search/uncertainty
  • One way to address these needs is with practice inquiry collegue groups. Click on the boxes to learn more about what Practice Inquiry is.
  • One way to address these needs is with practice inquiry collegue groups. Click on the boxes to learn more about what Practice Inquiry is.
  • One way to address these needs is with practice inquiry collegue groups. Click on the boxes to learn more about what Practice Inquiry is.
  • One way to address these needs is with practice inquiry collegue groups. Click on the boxes to learn more about what Practice Inquiry is.
  • Click on each item to learn more about what it means to be a facilitator:
  • Like the host or hostess of a party, the facilitator’s role includes making sure the group feels comfortable. In practice inquiry, that means all participants feel welcome to share their thoughts and their uncertainties without fear of ridicule or judgment.
  • Admitting what we don’t know is challenging for most of us, but is a necessary to find out what we need to know. Facilitators encourage openness and curiosity in others by modeling their own comfort with uncertainty
  • Facilitators in practice inquiry function like guides rather than the content experts. Their main goal is to help the group ask the right questions and to collaborate to come up with a range of options to address a problem. Through this process clinicians have the opportunity to think more reflectively and challenge their own assumptions.
  • Click on the boxes to learn ahout how the model works
  • The chart matrix contains 7 boxes that are used to organize critical details about the caseThe elements on the grid are meant to represent all the elements that impact our problem solving/ decision making/ and work process. You also can use it to document individual and collective learnings during the evaluation part of the process. Use a camera phone to photograph the matrix and send it out to the group as a reminder of key points after the session is done.
  • The matrix is a tool that canhelp the group to focus and keep track of the various inputs into discussion. Capturing inputs to the case, thoughts, ideas and various resources as they are shared also helps the group see what is available for discussion and analysis. Capturing information also helps the group see if there are areas that need to be further investigated. The matrix also can serve as the documentation of the outcomes from the group discussion. The information gathered details the knowledge gaps and changes to close those gaps. Outcomes can be seen as changes in knowledge, competency, and commitment to performing a change in practice.Finally the matrix can be helpful as a reinforcement tool sent to the group after the sessions so they can review and refer back to them at a later date should they need to. Take a picture of the matrices filled in and send to the group, as well as your local CME office.
  • To read through the example facilitator questions for each of the 7 input areas, click on the box. To return to the matrix click back.
  • As facilitator it’s your job to ensure the group feels safe to share their concerns and the areas they struggle with. But facilitating isn’t the same as giving a lecture.As you read the tips from the experts about facilitating practice inquiry groups take a few moments to think about the strategies that you’ve used in the past.Which strategies do you already use? Which strategies are new to you? How is facilitating practice inquiry different from facilitating other session activities?
  • Now it’s your turn to practiceDrWellsly is struggling getting her group to contribute to case discussions. What should she do to get the group to add to the conversation? Looking at the list of strategies below, which would you recommend and why?
  • Go around the room calling on members of the group is not the best approach.Since it can make people feel uncomfortable. A facilitators main job is to enable physician to feel that they have compfortable and welcomig place to share their uncertainty, so this is deficnitely not the right approach/ .
  • Not saying anythingcan potentially work. People often need some time to think through and gather their thoughts so it is recommended to give people time to think. However the group also would benefit from their facilitator helping them to make connections to their relevant experiences.
  • Great Call!In this way, DrWellsly encourages others to share and doesn’t come across like she knows all the answers. Asking about approaches in similar situations also opens up the conversation to other relevant experiences. This will allow the group to think more broadly and explore other options.
  • Hi. I’m Dr Fair. I’m one of the new faculty members for the Practice Inquiry sessions. Can you help me figure out what I need to do to get CME for my session? Sure, I’m glad to. What is your question?I’m looking at the application and its asking about gaps, and practice changes and outcomes. What is that about? CME accredited activities must be designed around. CME is supposed to support physician development, so to do that we need to create activities that are addressing what is needed by the physician audience. Gaps are the difference between where the learner is now and where we want them to be. So what is needed to bridge that gap? A change in knowledge, competence, or performance. The desired outcome is what you want the learner to be able to do after participating. Oh, I see. So the activity has to link to performance somehow? Isn’t it enough to try to understand something new? Understanding is part of the learning process, but that isnt the end goal. For activities to be considered for CME they need to go further. CME has to be designed to change practice in specific ways to address identified problem areas. I have an idea. What if I ask my friend from med school to present about an innovative way to treat this rare disease? She is expert and it would be great to hear about all the new technology that we don’t have yet! The best way to gauge it would be to ask – How will participating in the activity address a need of the learner? What will they be able to do differently or better as a result of participating in the activity? Even though that topic is educational, if they can’t apply the information then how will it improve their practice? Hmm. Ok. Well The great thing about practice inquiry then is its all about issues seen in practice. You’ve been a lot of help – thanks!
  • Thank you so much for checking out this introduction to Practice Inquiry. To find a practice inquiry group to observe in the East Bay, visit the physician education calendar at TPMG physcianed.orgTo sign up for a future facilitator course, contact the Diane Purcille at the Physcian Education Department.Thanks so much and have a great day.

Diane purcille practice inquiry v7 Diane purcille practice inquiry v7 Presentation Transcript

  • FAMILY MEDICINEPHYSICIANSFACULTY TRAINING:Practice Inquiry Modelfor Continuing MedicalEducationCopyright The Permanente Medical Group, Inc. 2013Start
  • Click Next to continue.Introduction: Course ObjectivesAt the end of this module, learners will be able to:• Describe the benefits of holding a practice inquirycolleague group in their facility• Identify the key components of the PI model andapply that model to a clinical problem• Identify strategies to engage group members toparticipate in sessions• Describe strategies for documentation to be incompliance with CME requirements
  • Click Next to continue.Help:What to do if you get stuck• Click on in the upper right corner to return to the list of modules.• To review the previous section of content click .• To advance to the next section of content click .If you have any other questions about this program, please email Diane Purcilleat diane.m.purcille@kp.org
  • Module 1: Introduction to Practice Inquiry• Clinical practice uncertainty• What is Practice Inquiry?• Facilitator Role• Benefits of Practice InquiryModule 2: Applying the Practice Inquiry Model• Practice Inquiry Matrix Inputs• Facilitation strategies• PracticeModule 3: CME review• Clinical practice change• Documentation RequirementsMenu
  • Click next tocontinueNextClinical practice uncertainty
  • What is practice inquiry?Click Next to continue.a small-group, collaborativelearning method …designed to assist physicians inbetter managing patient-basedclinical uncertaintyGroups meet weekly, bi-weekly, or monthly for one hour.
  • What is practice inquiry?Click Next to continue.un  cer  tain  ty noun1 state of doubt or not being sure2 perception of not knowing what to doThe goal is to exploreideas to addressdilemmas andfacilitate reflection onpractice……not tell doctors how to do their work.• diagnostic• doctor – patient relationship• patient care management• ethicalexamples in clinical areas
  • Clarifying the dilemmaExplorationAnalysisClosingWhat happens during a practice inquiry session?Click the boxes to learn more. Click Next to continue.Opening
  • Click each role to learn more. Then click Next to continue.Practice Inquiry Model: What is the faculty’s role in Practice Inquiry?Facilitating a practice inquiry session requires several skills. Click on the images below tolearn more.What is it like to be a facilitator in practice inquiry?
  • Individual• The presenter walks away with ideas about how they can approachtheir dilemma.• All colleagues have the opportunity to reflect on their own practicesand experiences.• All colleagues can learn new ways to address their own problematicsituations.Group• Discussion can reveal variations in practices or systems issues thatneed to be addressed.• The group has opportunity to share strategies and best practices.• Group can identify practice changes they would like to implement toincrease efficiencies and quality.What are the benefits to practice inquiry?Click Next to continue.
  • DisorientingdilemmasAnalysis &ProblemsolvingReflection /DiscussionStrategies &ApproachesSummary: Reflection QuestionsTake a few moments to reflect on the following questions:• What are the barriers to dealing with clinical uncertainty in your practice?• How would you describe the purpose of practice inquiry sessions to others?• What is the benefit to facilitated discussion around uncertainty?
  • Module 2: Applying the Practice Inquiry Model• Practice Inquiry Matrix Inputs• Facilitation strategies• Practice
  • - Clinical experience- Resources andevidence basedrecommendations- Next steps- Feedback process ofthe groupDilemma?Patient Context?Physician Context?Clinical Experience?Evidence?Clarify AgreementPatient andphysicianRelationshipChart MatrixMatrixTool for Practice Inquiry facilitationClick on next page to learn more about the chart matrix
  • Click Start to begin the activity.Amy Pratt, MDGroup FacilitatorRoberta Chan, MDCase presenterWelcome to the Practice Inquiry Session!Listen to the case presentation. Try to identify strategies the facilitator isusing to coach the group.Click Start to begin.StartFacilitation strategies: Guiding through questionsGeorge Wilcox, MDGroup Participant
  • Strategies for Facilitators – Sample questionsTo read through the example facilitator questions for each of the 7 input areas, click on the box.
  • Facilitator strategiesLet’s check out tips from the experts about facilitating practice inquiry groups. As youread, think about the following questions:• Which strategies do you already use?• Which strategies are new to you?• How is facilitating practice inquiry different from facilitating other session activities?Dr GreenDr PrattDr Bell
  • Dr Ralls is struggling getting her group to contribute to casediscussions. What should she do to get the group to add to theconversation?Click on the strategy you would recommend.Go around the room callingon members of the groupuntil someone sharessomethingNow it’s your turn to practiceDon’t say anything, justwait for a group memberto speak.Tell the group she isstumped by this too and askthe group for suggestions onhow they approach similarsituations.
  • Module 3: CME review• Clinical practice change• Documentation Requirements
  • Hi. I’m Dr Fair. I’m one of the new facultymembers for the Practice Inquiry sessions.Can you help me figure out what I need todo to get CME for my session?
  • Sure, I’m glad to. What is yourquestion?
  • I’m looking at the application andits asking about gaps, and practicechanges and outcomes. What isthat about?
  • CME is supposed to support physiciandevelopment, so to do that we need to createactivities that are addressing what is neededby the physician audience.Gaps are the difference between where thelearner is now and where we want them to be.So what is needed to bridge that gap?Is it a change in knowledge, competence, orperformance? It can be any of these!The desired outcome is what you want thelearner to be able to do after participating.
  • Oh, I see. So the activity has to linkto performance somehow? Isn’t itenough to try to understandsomething new?
  • Understanding is part of the learningprocess, but that isnt the end goal. For activitiesto be considered for CME they need to gofurther. CME has to be designed to changepractice in specific ways to address identifiedproblem areas.
  • I have an idea. What if I ask myfriend from medical school topresent about an innovative wayto treat cancer? She is a worldrenowned expert and her ideaswould definitely improve ourperformance. And it would begreat to hear about all the newtechnology that’s out there thatwe don’t have yet!
  • The best way to gauge it wouldbe to ask:How will participating in theactivity address the needs of thelearner? What will they be ableto do differently or better as aresult of participating in theactivity?Even though that topic iseducational, if they can’t applythe information then how will itimprove their practice?
  • Hmm. Ok. Well the great thing about practiceinquiry is that its all about issues seen inpractice. You’ve been a lot of help – thanks!
  • CME Activity SummaryCME accredited activities must be designed to enhance and improveperformance of physicians in order to improve the quality of care.Activities must go beyond general updates or “interesting” facts.Activities must demonstrate that they will address specific professionalpracticeActivities must be designed to change physician knowledge,competence or performance or patient care outcomes.
  • In order to have the practice inquiry sessions eligible to be considered forCME, facilitators must manage the application process and complete the followingadministrative steps:Contact the Richmond CMEcoordinator to request an addendumto the East Bay CME activityapplication for the RSS: Practice Inquiry- 20131Request and submit an annualfaculty disclosure form with theaddendum to the Richmond CMEcoordinator2At your first session, have allparticipants complete an annualdisclosure form.3 At each session, have allparticipants sign in on theattendance sheet.4Document session outcomes byphotographing the matrix orcreating a summary of discussionpoints and ideas generated.5
  • Multiple Choice QuestionAccreditation GuidelinesPractice Inquiry sessions will be eligible for CME credit. To bein compliance with CME accreditation guidelines, thelearning events should be designed to do what?Inform physicians about interesting or rare clinicalproblems they may see in practice.Help physicians be aware of changes or advances inclinical treatments.Change physician behaviors or practices based onevidence based recommendations.Allow physicians to share opinions on how to bestaddress clinical issues.Click a response. Then click Next to continue .Assessing and documenting outcomes: CME Knowledge Check
  • Multiple Choice QuestionAccreditation GuidelinesPractice Inquiry sessions will be eligible for CME credit. To bein compliance with CME accreditation guidelines, thelearning events should be designed to do what?Inform physicians about interesting or rare clinicalproblems they may see in practice.Help physicians be aware of changes or advances inclinical treatments.Change physician behaviors or practices based onevidence based recommendations.Allow physicians to share opinions on how to bestaddress clinical issues.Click a response. Then click Next to continue .Incorrect.Learning events may address lesscommon clinical issues but thepurpose is not solely to inform.Accreditation guidelines requirethat we create learning events thatare needs based and aimed atchanging physician practice.Assessing and documenting outcomes: CME Knowledge Check
  • Multiple Choice QuestionAccreditation GuidelinesPractice Inquiry sessions will be eligible for CME credit. To bein compliance with CME accreditation guidelines, thelearning events should be designed to do what?Inform physicians about interesting or rare clinicalproblems they may see in practice.Help physicians be aware of changes or advances inclinical treatments.Change physician behaviors or practices based onevidence based recommendations.Allow physicians to share opinions on how to bestaddress clinical issues.Click a response. Then click Next to continue .Incorrect.The purpose of learning events isnot solely to inform of changes oradvances in clinical treatments.Accreditation guidelines requirethat we create learning events thatare needs based and aimed atchanging physician practice.Assessing and documenting outcomes: CME Knowledge Check
  • Multiple Choice QuestionAccreditation GuidelinesPractice Inquiry sessions will be eligible for CME credit. To bein compliance with CME accreditation guidelines, thelearning events should be designed to do what?Inform physicians about interesting or rare clinicalproblems they may see in practice.Help physicians be aware of changes or advances inclinical treatments.Change physician behaviors or practices based onevidence based recommendations.Allow physicians to share opinions on how to bestaddress clinical issues.Click a response. Then click Next to continue .Correct!Accreditation guidelines requirethat we create learning events thatare needs based and aimed atchanging physician practice.Assessing and documenting outcomes: CME Knowledge Check
  • Multiple Choice QuestionAccreditation GuidelinesPractice Inquiry sessions will be eligible for CME credit. To bein compliance with CME accreditation guidelines, thelearning events should be designed to do what?Inform physicians about interesting or rare clinicalproblems they may see in practice.Help physicians be aware of changes or advances inclinical treatments.Change physician behaviors or practices based onevidence based recommendations.Allow physicians to share opinions on how to bestaddress clinical issues.Click a response. Then click Next to continue .Incorrect.Learning events will allow fordiscussion of experience and bestpractices, but accreditationguidelines require that we createlearning events that are needsbased and aimed at changingphysician practice.Assessing and documenting outcomes: CME Knowledge Check
  • Dilemma?Patient Context?Physician Context?Clinical Experience?Evidence?Clarify AgreementPatient andphysicianRelationshipDocumentation GuidelinesTrue or FalseTo fulfill the requirements and stay CMEcompliant, facilitators must document outcomesby photographing the inputs captured on thepractice inquiry matrix.TrueFalse
  • Dilemma?Patient Context?Physician Context?Clinical Experience?Evidence?Clarify AgreementPatient andphysicianRelationshipDocumentation GuidelinesThis is not correct.To be compliant you must documentoutcomes.That can be done in many ways which couldinclude also summarizing findings throughnotes or through post-­­session questionnaire.True or FalseTo fulfill the requirements and stay CMEcompliant, facilitators must document outcomesby photographing the inputs captured on thepractice inquiry matrix.TrueFalse
  • Dilemma?Patient Context?Physician Context?Clinical Experience?Evidence?Clarify AgreementPatient andphysicianRelationshipDocumentation GuidelinesYou are correct.To be compliant you must documentoutcomes. This can be done in many ways,including photographing the matrix, creatingsummary notes, or through post-sessionquestionnaires.True or FalseTo fulfill the requirements and stay CMEcompliant, facilitators must document outcomesby photographing the inputs captured on thepractice inquiry matrix.TrueFalse
  • Want to learn more?Visit TPMGPhysicianEd.org for more informationabout clinical education around theregion, including practice inquiry groups in the EastBay.To sign up for future facilitator training, contactDiane M. Purcille.