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PALLIUM
L.E.A.PLearning Essential Approaches
to Palliative Care
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PALLIUM
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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PALLIUM
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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PALLIUM
Curriculum DevelopmentKern’s Model
Problem Identification. General needs assessment
Needs assessment of targeted learners
(& technology)
Goals & objectives
Education strategies
Implementation
Evaluation & feedback
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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PALLIUM
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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PALLIUM
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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PALLIUM
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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PALLIUM
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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PALLIUM
Course materials
• Local planning guide• Facilitator’s kit
– Manual: Facilitator notes (suggested questions, reminder of key points, theory & evidence)
– Videos, posters
• Participants’ manual
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PALLIUM
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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PALLIUM
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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PALLIUM
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PALLIUM
“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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PALLIUM
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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PALLIUM
Group Facilitation
• Going from “sage on the stage” to “guide on the side”– Don’t give “answers” right away.– Pose reflective questions.– Don’t “shoot down” what appears to be
“incorrect” – Do provide alternative perspective.
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PALLIUM
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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PALLIUM
Group facilitation• Respect input. • Reframe if necessary.• Ask questions that prompt reflection.• Attitudinal objectives:
– Don’t 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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PALLIUM
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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PALLIUM
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)
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