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Assoc Prof Tim Shaw, Director Workforce Education & Development Group (WEDG), The University of Sydney James Nicholson, Educational Development Manager, WEDG, The University of Sydney Dr Anna DiMarco, Director of Training, Hospital Skills Program SES & IS Local Health Districts

Assoc Prof Tim Shaw, Director Workforce Education & Development Group (WEDG), The University of Sydney James Nicholson, Educational Development Manager,

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Page 1: Assoc Prof Tim Shaw, Director Workforce Education & Development Group (WEDG), The University of Sydney James Nicholson, Educational Development Manager,

Assoc Prof Tim Shaw, Director Workforce Education & Development Group (WEDG), The University of Sydney

James Nicholson, Educational Development Manager, WEDG,

The University of SydneyDr Anna DiMarco, Director of Training, Hospital Skills Program

SES & IS Local Health Districts

Page 2: Assoc Prof Tim Shaw, Director Workforce Education & Development Group (WEDG), The University of Sydney James Nicholson, Educational Development Manager,
Page 3: Assoc Prof Tim Shaw, Director Workforce Education & Development Group (WEDG), The University of Sydney James Nicholson, Educational Development Manager,

The Challenge‘Traditional types of CME have only a modest impact on clinician’s knowledge retention and

clinical behaviour’Cochrane Database of Systematic Review

2009(2) Forsetlund et al

Page 4: Assoc Prof Tim Shaw, Director Workforce Education & Development Group (WEDG), The University of Sydney James Nicholson, Educational Development Manager,

The Challenge

Page 5: Assoc Prof Tim Shaw, Director Workforce Education & Development Group (WEDG), The University of Sydney James Nicholson, Educational Development Manager,

JMO Context

• Vulnerable

• Workloads, inexperience and competing learning

opportunities potentially places the JMO at increased

risk of being involved in adverse outcomes

• Gen Y and Z enjoy electronic based media

Page 6: Assoc Prof Tim Shaw, Director Workforce Education & Development Group (WEDG), The University of Sydney James Nicholson, Educational Development Manager,

HSP Context• Enhance the HSP workshops by reinforcing learning

objectives

• Impacts on HSP participant knowledge and

behaviour

• Is quick to complete

• Supports objectives of patient safety and governance

Page 7: Assoc Prof Tim Shaw, Director Workforce Education & Development Group (WEDG), The University of Sydney James Nicholson, Educational Development Manager,

Spaced Education – in a nutshell

• Only takes a few minutes each day

• Course is spread out over a period of weeks

• Proven in randomised trials to improve knowledge

retention and improve behaviour better than traditional

online learning

• Works extremely well on smart-phones (optimised for

iPhone, Android and BlackBerry) or a desktop computer.

Page 8: Assoc Prof Tim Shaw, Director Workforce Education & Development Group (WEDG), The University of Sydney James Nicholson, Educational Development Manager,

Spaced Education is a novel form

of evidence based online education

based on 2 core psychological

research findings of spacing and

testing effects

Page 9: Assoc Prof Tim Shaw, Director Workforce Education & Development Group (WEDG), The University of Sydney James Nicholson, Educational Development Manager,

A novel approach

The testing effect

The spacing effect

Page 10: Assoc Prof Tim Shaw, Director Workforce Education & Development Group (WEDG), The University of Sydney James Nicholson, Educational Development Manager,

Spacing effect – refers to the

finding that educational

encounters repeated over time

leads to knowledge acquisition

and retention

Page 11: Assoc Prof Tim Shaw, Director Workforce Education & Development Group (WEDG), The University of Sydney James Nicholson, Educational Development Manager,

Testing effect – refers to the finding

that ‘the process of testing’

measures knowledge and alters the

learning processes to significantly

improve knowledge retention

Page 12: Assoc Prof Tim Shaw, Director Workforce Education & Development Group (WEDG), The University of Sydney James Nicholson, Educational Development Manager,

Each Spaced Ed Case Study consists of an:

1. Educative component eg MCQ

2. Evaluative component (correct answer and

feedback with a detailed explanation of

correct and incorrect answers)

3. Spaced Ed item is repeated – fixed number

of times

Page 13: Assoc Prof Tim Shaw, Director Workforce Education & Development Group (WEDG), The University of Sydney James Nicholson, Educational Development Manager,

Vol 211, No 3, September 2010 Kerfoot et al Spaced Education Generates Skill Transfer

Page 14: Assoc Prof Tim Shaw, Director Workforce Education & Development Group (WEDG), The University of Sydney James Nicholson, Educational Development Manager,

Vol 211, No 3, September 2010 Kerfoot et al Spaced Education Generates Skill Transfer

Page 15: Assoc Prof Tim Shaw, Director Workforce Education & Development Group (WEDG), The University of Sydney James Nicholson, Educational Development Manager,

Vol 211, No 3, September 2010 Kerfoot et al Spaced Education Generates Skill Transfer

Page 16: Assoc Prof Tim Shaw, Director Workforce Education & Development Group (WEDG), The University of Sydney James Nicholson, Educational Development Manager,

Vol 211, No 3, September 2010 Kerfoot et al Spaced Education Generates Skill Transfer

Page 17: Assoc Prof Tim Shaw, Director Workforce Education & Development Group (WEDG), The University of Sydney James Nicholson, Educational Development Manager,

HSP Program – Spaced Ed

• 2 x 20 Spaced Ed Cases

• Post test evaluation survey

• Not a randomised control trial

• Behavioural changes not examined

Page 18: Assoc Prof Tim Shaw, Director Workforce Education & Development Group (WEDG), The University of Sydney James Nicholson, Educational Development Manager,

Child – Elbow PainA 6 year old child presents with a painful elbow after an unwitnessed injury.Attached is his X-ray:

Aims

Which of the following is most correct? A. There is no obvious injury and so a pulled elbow is likely B. The medial epicondyle is displaced suggesting an avulsion fracture C. There is no evidence of a fat pad sign, so a soft tissue injury is likely D. The x-rays are inadequate and further views are needed

Answer D  

Case studies which reinforce previous LBOSs

Page 19: Assoc Prof Tim Shaw, Director Workforce Education & Development Group (WEDG), The University of Sydney James Nicholson, Educational Development Manager,

Take home message

When assessing an injury understand the signs of possible injury, but ensure you have the appropriate view to make your assessment.

In this case the x-rays are inadequate and further views are needed.

Feedback

Pulled elbows do not require x-rays and are diagnosed with an appropriate history (remember that 50% of pulled elbows DO NOT give

a history of being pulled), and an examination that generally has no area of tenderness or upper limb joint dysfunction, other than a

reluctance to, and stress associated with, attempted gentle pro and supination of the forearm. It is rare over the age of 5 to suffer a

pulled elbow.

A 6 year old should have 3 ossification centres – capitellum, radius, medial epicondyle. These x-rays confirm these are present. A child

over the age of 5 year old should not have the medial epicondyle visible on an adequate lateral x-ray. An adequate lateral x-ray should

have the ‘hour glass’ sign visible at the lower end of the humerus.

These xrays suggest the medial epicondyle is posteriorly displaced, but the view is NOT an adequate lateral as the hourglass is

absent.

Normally on a lateral view of the elbow flexed in 90° a fat pad is seen on the anterior aspect of the joint. This is normal fat located in the

joint capsule. Normallyon the posterior side no fat pad is seen since the posterior fat is located within the deep intercondylar fossa.

Distention of the joint with blood from an injury will cause the anterior fat pad to become elevated and/or the posterior fat pad to

become visible.

An elevated anterior lucency and/or a visible posterior lucency on a true lateral radiographof an elbow flexed at 90° is described as a

positive fat pad sign. This patient does not have a true lateral, so it is difficult to comment.

Below is a true lateral Xray demonstrating

1. ‘Hour glass’ sign at distal end humerus.

2. Pathological anterior fat pad (enlarged, ‘Sail sign’)

3. Posterior fat pad (usually not present).

4. Breach in anterior cortex of distal humerus.

5. Posterior angulation of distal humerus.

6. Appropriate hidden position of medial epicondyle.

Page 20: Assoc Prof Tim Shaw, Director Workforce Education & Development Group (WEDG), The University of Sydney James Nicholson, Educational Development Manager,

That is with an adequate lateral there are a number of true pathological signs consistent with a supracondylar fracture, and the loss of a false +ve medial epicondyle displacement.

Page 21: Assoc Prof Tim Shaw, Director Workforce Education & Development Group (WEDG), The University of Sydney James Nicholson, Educational Development Manager,

Case Study which reinforce recommendations of CEC

Septic Shock 4

• Cognitive errors

• Triage errors

• MomentumSource: CDRS (Cognitive Dispositions To Respond) (Profiles In Patient Safety:”A Perfect Storm” in the

Emergency Department (Samuel G.Campbell,Pat Croskerry,William Bond:Academic Emergency

Medicine 2007) can steer a physicians cognitive processes and provide impediments to patient safety

and need to be managed within the context of working on a busy ED shift.

Page 22: Assoc Prof Tim Shaw, Director Workforce Education & Development Group (WEDG), The University of Sydney James Nicholson, Educational Development Manager,

Case Study which reinforce recommendations of Safety & Governance Committees

In 2009, the Clinical Excellence Commission published a Clinical focus Report after a review of IIMs NSW data showed 167 incidents in 18 months. As a result of this report, the CEC joined the ECI (Emergency Care Institute) and the agency for Clinical Innovation in developing the sepsis pathway. See link for further resources to the sepsis pathway www.cec.health.nsw.gov.au/programs/sepsis.

Page 23: Assoc Prof Tim Shaw, Director Workforce Education & Development Group (WEDG), The University of Sydney James Nicholson, Educational Development Manager,

• 60 doctors have started the course

• Completed: 38 (63.3%)

• Still Working through: 5 (8.3%)

• Off track – unlikely to complete: 17 (28.3%)

Evaluation – Completion (defined by answering each case study correctly twice)

Page 24: Assoc Prof Tim Shaw, Director Workforce Education & Development Group (WEDG), The University of Sydney James Nicholson, Educational Development Manager,

Strongly Agree / Agree

NeutralDisagree / Strongly

Disagree

The HSP Spaced Education / WEDG course was effective in reinforcing educational objectives previously taught to me during the Hospital Skills Program workshop days

91.6% 8.3% 0.0%

I believe the Spaced Education / WEDG course has changed my approach to how I practice as an ED Doctor

75.0% 16.7% 8.3%

The Spaced Education course was effective as a method to learn or reinforce key knowledge points of Emergency Department diagnosis and treatment

91.7% 8.3% 0.0%

I found the Spaced Education course enjoyable 91.7% 8.3% 0.0%

Context

Page 25: Assoc Prof Tim Shaw, Director Workforce Education & Development Group (WEDG), The University of Sydney James Nicholson, Educational Development Manager,

Q. There are many forms of internet-based learning or e-learning. How does Spaced Education compare to other e-learning techniques?

1) Short Online Quizzes

Strongly prefer / prefer Spaced Ed

NeutralPrefer / Strongly prefer

Online QuizzesUnsure

58.4% 25.0% 16.7% 0.0%

2) Webinars

Strongly prefer / prefer Spaced Ed

NeutralPrefer / Strongly prefer

WebinarsUnsure

58.4% 33.3% 0.0% 8.3%

3) Online Case-Based Discussion Forums

Strongly prefer / prefer Spaced Ed

NeutralPrefer / Strongly prefer

online case-based discussion forums

Unsure

66.6% 16.7% 0.0% 16.7%

Q. I would like to undertake other health related programs if offered in the Spaced Education format

Strongly Agree Agree NeutralDisagree / Strongly

Disagree

50.0% 50.0% 0.0% 0.0%

Page 26: Assoc Prof Tim Shaw, Director Workforce Education & Development Group (WEDG), The University of Sydney James Nicholson, Educational Development Manager,

Evidence

Page 27: Assoc Prof Tim Shaw, Director Workforce Education & Development Group (WEDG), The University of Sydney James Nicholson, Educational Development Manager,

Questions

Page 28: Assoc Prof Tim Shaw, Director Workforce Education & Development Group (WEDG), The University of Sydney James Nicholson, Educational Development Manager,

Qstream

• Free Public Site

app.qstream.com

(Formerly Spaced Education)

• Enterprise sites

Page 29: Assoc Prof Tim Shaw, Director Workforce Education & Development Group (WEDG), The University of Sydney James Nicholson, Educational Development Manager,

Qstream creation

Page 30: Assoc Prof Tim Shaw, Director Workforce Education & Development Group (WEDG), The University of Sydney James Nicholson, Educational Development Manager,

Creating a Qstream Course• Simple to create a quick Qstream course BUT…

• Creating an interesting, engaging and useful eLearning

experience is never simple

• Relevance

• Levels of learning – remembering vs understanding vs

analysing … (Bloom’s Taxonomy)

• Good Multiple Choice Questions

• Media – images, videos, sounds …

Page 31: Assoc Prof Tim Shaw, Director Workforce Education & Development Group (WEDG), The University of Sydney James Nicholson, Educational Development Manager,

Questions