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Xavier Carcopino - Training the trainers

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Carcopino

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Xavier Carcopino - Training the trainers

  1. 1. Xavier Carcopino MD PhD Department of Obstetrics and Gynecology, Hôpital Nord Marseille, France xcarco@free.fr TRAINING THE TRAINERS
  2. 2. BECOMING A COLPOSCOPIST The challenge of training • Objectives of training • Theoretical knowledge: basic and advanced courses • Practical knowledge: - Precisely localise TZ - Recognize normal and abnormal TZ - Characterize abnormal TZ / classification - Clinical skills: Punch biopsy, LLETZ… • Patients’ further information, management and follow up
  3. 3. MODEL OF COMPETENCE Miller GE Acad Med1990 Knows Knows how Shows how Behaviour~ skills/attitudes Cognition~ knowledge Does Professionalauthenticity
  4. 4. COLPOSCOPY TRAINING AND ASSESSMENT ACROSS EUROPE Moss et al. EJOGRB 2015
  5. 5. COLPOSCOPY TRAINING AND ASSESSMENT ACROSS EUROPE Moss et al. EJOGRB 2015 TRAINING CASE LOAD Stipulated minimum number of cases seen and managed • New cases (86.2%) : Median 50 (range: 15-300) • Cases under supervision (80%) : Median 40 (range: 5-300)
  6. 6. EXAMINATION UNDER DIRECT SUPERVISION Experience Self confidence Accuracy of colposcopy Transient images TRAINER
  7. 7. WHO CAN BE A TRAINER? Those who have: • Experience in colposcopy • Experience in other areas of clinical training • Knowledge of the training programme • Time and enthusiasm to support trainee (weekly meeting) • Adequate numbers of cases • Offer training clinics with 5-8 patients • Time and experience to mentor a trainee and help trainees with difficulties
  8. 8. INFLUENCE OF GUIDELINES CHANGES Keehbauch Fam Med 2012 P=0.13 P<0.01
  9. 9. WHY TRAINING THE TRAINERS? • Complex training requires professional trainers • Training skills can be learned (and can be taught) • Trainers need some knowledge of - learning theories - practical applications - giving effective feedback - structures that govern training & assessment
  10. 10. QUALITY STANDARDS IN COLPOSCOPY Luyten et al. EJOGRB 2015
  11. 11. COLPOSCOPY TRAINING AND ASSESSMENT ACROSS EUROPE Moss et al. EJOGRB 2015
  12. 12. ROLE OF THE TRAINER • Enable trainee to complete training • Assess if trainee has satisfactorily completed training • Complete work place assessments throughout training • Monitor trainee’s progress with regular meetings and review of progress • Provide advice and feedback
  13. 13. THE PROBLEM WITH TRAINERS • Buzy people • Buzy clinic • Difficult to catch…
  14. 14. BECOMING A COLPOSCOPIST What’s easy and what’s hard EASY • Basic and theoretical knowledge • Colposcopy courses • Colposcopy books & dvds HARD (time…) • Experience • Clinical skills • Patients’ management and follow up • Self confidence
  15. 15. THE TRAINER SHOULD… Be aware of the difficulties the trainee will go through • Colposcope settings and use / focus • Identify and define the TZ / SCJ • Memorize different images / signs identified at the different times of colposcopic examination • Acquire enough experience / confidence
  16. 16. COLPOSCOPE SET UP
  17. 17. DIFFICULTIES IN TRAINING
  18. 18. MEMORIZING IMAGES Without coloration Acetic Acid Lugol
  19. 19. GIVE FEEDBACK AND MAKE AN ACTION PLAN Ian Lang 1991 Teaching without testing is like cooking without tasting or writing without reading
  20. 20. GIVE FEEDBACK AND MAKE AN ACTION PLAN Feedback • Identify good practice • Identify how to improve practice • Benefit from the experience of the trainer Purposes • For patients : « Is this trainee ok to progress? » • For the trainee : « How am I doing? » & « How can I improve ? »
  21. 21. GIVE FEEDBACK AND MAKE AN ACTION PLAN Feedback: technique Techniques used have a huge influence on impact – Appropriate location – Ask trainee to give their own view early – Non judgemental – Specific comments – Right amount vs. too much
  22. 22. GIVE FEEDBACK AND MAKE AN ACTION PLAN Pendleton’s rules 1. Check the learner wants and is ready for feedback. 2. Let the learner give comments. 3. The learner states what was done well. 4. The observer(s) state what was done well. 5. The learner states what could be improved. 6. The observer(s) state how it could be improved. 7. An action plan for improvement is made.
  23. 23. GIVE FEEDBACK AND MAKE AN ACTION PLAN • Don’t forget the trainee’s emotional response. • Don’t criticise without recommending action. • Don’t comment on personal attributes (that cannot be changed). • Don’t generalise. • Don’t be dishonestly kind – if there is room for improvement be specific and explore alternative approaches.
  24. 24. Action plan • Action plan leads to change • “Feedback alone does not cause change, it is the goals that people set in response to feedback” • Ensure you agree together on the plan • Colposcopy is often a short episode and an action plan may be a single action or reflection for future practice GIVE FEEDBACK AND MAKE AN ACTION PLAN Hewson 1998
  25. 25. TRAINING MODELS Hefler et al. Am J Obstet Gyn 2012
  26. 26. IFCPC DISTANCE LEARNING PROGRAM Distance learning program across the world : english, spanish, russian, french… Online lectures Local trainers : • Cases under supervision • Mini Clinical Evaluation Exercices (CEX) • Cases loads : colposcopic examinations and LETTZs Final assessment / OSCE and graduation
  27. 27. CONCLUSIONS Trainers are essential to optimal training in colposcopy Training the trainers : • Optimize practical training and feedback • Homogenize the training The trainers should know about • Common difficulties in colposcopic practical training • How provide feedback and make action plan • Identify when the training is completed
  28. 28. THE LONG ROAD TO COLPOSCOPY The human eye may be wrong… It takes some time and experience to properly analyze what you see
  29. 29. Thank you for your attention…

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