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Innovation and Regulations in Medical Education

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Innovations in Medical Education are needed to align it with 21st Century needs and aspirations. Globally efforts are under way since the release of Lancet Commission report in Dec-2010 on Transforming Health Professions in the 21st Century

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Innovation and Regulations in Medical Education

  1. 1. Innovation, Advances & Regulations in Medical Education Prof KR Sethuraman. MD, PGDHE. VC – Sri Balaji Vidyapeeth. Puducherry
  2. 2. “The Physicians of Tomorrow are taught by the Teachers of Today using Curricula of yesterday.” - Sethuraman KR (2000) 2NCHPE 20-11-2015 The Current Problem
  3. 3. Dedication Innovate for the New Generation 3NCHPE 20-11-2015
  4. 4. Objectives for this talk… • Compare creativity and innovation • Discuss the stages in creative and innovative processes • Consider barriers to & assessment of innovation • Survey the ongoing innovations in USA • Invite comments on our reasons, rights and responsibilities to foster innovation in Med Edu 4NCHPE 20-11-2015
  5. 5. Innovation – What, How & Why REASON RIGHTS RESPONSIBILITY 5NCHPE 20-11-2015
  6. 6. Creativity in Stages Graham Wallas (1858 – 1932) In The Art of Thought (1926), he proposed this model of the creative process: 6NCHPE 20-11-2015
  7. 7. 7NCHPE 20-11-2015
  8. 8. 8NCHPE 20-11-2015
  9. 9. Steps in Innovative Processes • Permit a Creative Environment • Generate Ideas • Present & Discuss the Ideas • Filter & Choose the best • Do Pre-Validation • Implement the Prototype • Do Evaluation & Post-validation • Plan for Dissemination 9NCHPE 20-11-2015
  10. 10. Avoid these 8 Idea Killers! • “We tried that already – • “We don't do it that way here - • “Not in our budget - • “Not an interesting problem - • “We don't have time - • “People won't like it - • “How stupid are you? “ • “You are smarter with your mouth shut!” from Scott Berkun's book, The Myths of Innovation, Sebastopol: O'Reilly Media, Inc., 2010. 10NCHPE 20-11-2015
  11. 11. Can We Teach Innovation?... • Rigid training does not help innovation and can even harm the processes. • Knowledge is important but formal qualification is not essential • Requires new approaches and different ways of looking at problems. – Some are naturally more creative - ‘creative gene’ • Education can help in identifying barriers to innovation • Innovation can be cultivated by teaching skills such as lateral thinking. 11NCHPE 20-11-2015
  12. 12. Developing Creativity - i • Brainstorming – invented by an American businessman Alex Osborn – it encourages the generation of possible solutions to a well defined problem • Synectics – to explore relationships between apparently unconnected elements of a problem using analogy and metaphors 12NCHPE 20-11-2015
  13. 13. Developing Creativity - ii • Lateral Thinking – reject standard methods for solutions – take a fresh perspective, involving spatial or visual support for ideas • Problem Solving – Break down the problem into smaller solvable components – Generate possible solutions, consider pro’s and con’s of each and choose the most appropriate 13NCHPE 20-11-2015
  14. 14. Evaluation of Educational Innovations 14NCHPE 20-11-2015
  15. 15. Story: OSCE as a formative tool to impart error-free ‘must do’ skills • Reason was through Epiphany (1987 exams) – A final MBBS student did not know-how to use a sphygmomanometer (kept mercury column flat!) • Responsibility (all should do ‘Must Do’ Skills) • Rights (as a Unit Head) • Resistance to overcome – educators / HOD • Spin offs (The first manual on OSCE – 1988) • Sustainability (Formative OSCE still going on) 15NCHPE 20-11-2015
  16. 16. Story: Motivating the students to learn the local language • Reason (importance of talking with patients) • Responsibility - to create LRM (1988) • Resistance to overcome – student apathy • Epiphany – Alumnus feedback from NEFA • Lesson: Tools + Motivation = Success • Outcome – (1995 to 2005) all learnt Tamil • Dissemination – JIPMER / AIMST / MGMCRI 16NCHPE 20-11-2015 http://jipmer.edu.in/wp-content/uploads/2013/01/tamil-bk.pdf
  17. 17. Story: Emergency Care Posting • Reason & Responsibility (experiential T-L in ER) • Creative problem solving: – Once a week posting from 4 pm to 10 pm in the emergency dept (“casualty”) in groups of 2 or 3 – Shadow the Medical team on duty and clerk cases – 50% of Viva voce in internal exam based on this posting of around 10 sessions (60 + hours) – Other depts (Surgery, Paeds) also replicated this • Outcome assessment by external examiners was supportive of gains 17NCHPE 20-11-2015
  18. 18. Objectivising Clinical/Practical Exams • MCI – ’97 has recommended ‘Objectivising Clinical/Practical Exams’ • Only a lip-service by most institutions • At SBVU: a year-long capacity building effort • OSCE/OSPE was ‘do-able’ in the summative assessment (field-tested blue-print; years 1-5) • National expert group meeting to endorse the report and submit to the regulatory body • Still waiting for the “Nod” from MCI 18NCHPE 20-11-2015
  19. 19. Barriers to Innovations - i • Internal Barriers – Culture of Blame (discomfort with new ideas) – Staff Motivation (non-risk taking and inept) – Unapproachable Management (lack of foresight) – Management Systems (Not tuned to innovate) – Inexperience – Investment Capital (Human resource, time, fund) 19NCHPE 20-11-2015
  20. 20. Barriers to Innovations - ii • External Barriers – National Regulations – Local Regulations – Opposition from Interest groups Source: http://akri.org/thinking/innovation-process.html 20NCHPE 20-11-2015
  21. 21. “Attitude-Spectrum” to Innovations • A – LEADER. • B – COLLABORATOR • C – SUPPORTER. • D – ACCOMMODATOR OPPONENTS: • G – PARTICIPATING ~ • H – PASSIVE~ • I – RESISTING ~ • J – HOSTILE ~E – INDIFFERENT. F - UNINFORMED 21NCHPE 20-11-2015
  22. 22. MEDICAL EDUCATION IN 21ST C Current Advances & Focus Following Lancet Commission Report, 2010 22NCHPE 20-11-2015
  23. 23. AMSA - Students' Voices • Current curricular lacunae: – a narrow technical focus without contextual understanding in a holistic manner – poor teamwork – predominant hospital orientation at the expense of primary health care – quantitative and qualitative imbalances in the health professions (market forces) http://media.amsa.org.au/policy/2012/201206_medical_curricula_for_the_2 1st_century_professional_policy.pdf 23NCHPE 20-11-2015
  24. 24. AMSA – Curricular Needs for 21st C • Instill respect for the rights and dignity of the individual and community, • inculcate leadership & advocacy skills to respond to the health needs & priorities of the community, • promote an understanding that actions within healthcare settings have broader social and economic implications • provide graduates with the skills necessary to apply global research and resources to local practice and health priorities 24NCHPE 20-11-2015
  25. 25. AMSA – Curricular Needs - ii • provide the skills and attitudes necessary to engage in interdisciplinary and trans-disciplinary collaborations with key stakeholders – from health and non-health professions • Recognize the expertise of other health disciplines with the aim of improving patient care in multidisciplinary teams • Embody transformative learning methods that foster leadership skills to be enlightened change agents http://media.amsa.org.au/policy/2012/201206_medical_curricula_for_the_2 1st_century_professional_policy.pdf 25NCHPE 20-11-2015
  26. 26. Obstacles to Curriculum Change • Status quo: a culture of conservatism • Opposition: teachers not convinced about the benefits of change • Cost of the proposed changed: the increased workload of implementing the change • Process of change: teachers’ work not being rewarded • Conflict of interest: teachers’ conflicting interests of research and clinical care • AMEE 2013 Conference, Prague: http://medine2.com/Public/docs/MEDINE2-WP5.pdf 26NCHPE 20-11-2015
  27. 27. Faculty & Students* speak out 1. Exclude redundant information from curriculum. 2. Make medical training more patient-centered. 3. Future physicians to usher change in Health care delivery 4. Increase diversity in medical education. 5. Include massive open online courses (MOOC) and Create curricula for a “Medical school without walls.” 6. Entrance Exams (Step-1 USMLE etc) be modified as they promote a "parallel curriculum“ diverting students’ focus? 7. Effective ways to shorten student training by "outcomes based" approach. *Faculty & students from 110 institutions at CHANGEMEDED conf Oct-2015 http://www.ama-assn.org/ama/ama-wire/post/9-challenges-medical-educators-want-solve-right-now 27NCHPE 20-11-2015
  28. 28. AMA – A PROACTIVE REFORMIST 28NCHPE 20-11-2015
  29. 29. AMA - Accelerating Change in Medical Education Six key themes for the 11-member consortium: 1. Developing flexible, competency-based pathways 2. Teaching & assessing new content in health care delivery sciences 3. Working with health care delivery systems in novel ways 4. Making technology solutions to support learning and assessment 5. Envisioning the master adaptive learner 6. Shaping tomorrow’s leaders (In Nov,2015, consortium added 21 more to make 32 members) https://www.ama-assn.org/resources/doc/about-ama/x-pub/ace-monograph-interactive.pdf 29NCHPE 20-11-2015
  30. 30. AMA’s Innovation Push – 1 1. Mayo: to prepare students for patient-centered, community-oriented, science-driven care and lead collaborative care teams that deliver high-value care. 2. Warren Alpert: to educate a new type of physician leader equipped to promote the health of the population 3. University of Michigan: to transform its curriculum to graduate physician change agents who will improve health care at a systems and patient level. 4. Vanderbilt University: to create master adaptive learners who are embedded in the health care workplace throughout their undergraduate medical education 30NCHPE 20-11-2015
  31. 31. AMA’s Innovation Push – 2 5. Oregon Health & Science University: to implement a learner-centered, competency- based curriculum that enables students to follow individualized learning plans 6. San Francisco School of Medicine: to learn to work expertly in inter-professional teams to advance science and improve health care. 7. NYU School of Medicine: to implement a three- year, flexible, individualized, technology- enabled blended curriculum to improve care coordination and quality improvement. 31NCHPE 20-11-2015
  32. 32. AMA’s Innovation Push – 3 8. Davis School of Medicine: to create a 3-year medical school pathway, the Accelerated Competency-based Education in Primary Care (3+3) program. 9. The Brody School of Medicine: to implement a new comprehensive Longitudinal Core Curriculum in patient safety for all medical students. 10. Penn State College of Medicine: to design educational experiences that align medical education with health system needs. 11. Indiana University: to teach electronic medical record (tEMR) to ensure competencies in clinical decision- making as well as system-, team- and population- based health care. http://www.ama-assn.org/sub/accelerating-change/grant-projects.shtml 32NCHPE 20-11-2015
  33. 33. REGULATION OF HEALTH PROFESSIONS EDUCATION IN INDIA REASON RIGHTS RESPONSIBILITY 33NCHPE 20-11-2015
  34. 34. Regulation in India is the proverbial “elephant in the room” • Plan 4+ • Organize 2+ • Lead effectively 1+ • Implement +/- • Co-ordinate & Collaborate 2 (– ) • Evaluate outcomes & impact 4(– ) – Ex PM Rajiv Gandhi 34NCHPE 20-11-2015
  35. 35. Declarative vs. Procedural Tussle Declarative sentences, well articulated by the regulatory bodies, since it is a conscious, considered and explicit act Innovative, tacit and exploits any loop-hole in the declared regulations to “Some-How” fulfill the stated requirements 35NCHPE 20-11-2015
  36. 36. Summing Up: Regulations can delay the inevitable But, • “Enlightened educators need to push the agenda to innovate and usher in reforms • As Tagore put it, “The Next Generation deserves it.” – Let us not limit them 36NCHPE 20-11-2015

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