Reaching out to your referring physicians Part I

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Reaching out to your referring physicians Part
I Physician Education

• David E. Weissman, MD
• End-of-Life Physician Education Resource Center
  (EPERC)
• Palliative Care Leadership Center
• Froedtert Hospital, Medical College of Wisconsin

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Learning Objectives

• Learn the three educational topics most
  requested by physicians.
• Learn three non-lecture strategies for providing
  physician education.
• Discuss three ways to motivate physicians to
  learn about palliative care.
• Develop three strategies to improve physician
  referral to palliative care clinical services.
• Develop an Action Plan for physician education at
  your institution.

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Understand what you hope to achieve.

• Education to improve patient care?
• Increase referrals to Pall Care Program?
• Decrease hospital costs?
• Enhance institutional stature?
• All the above?

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Understand the limitations of PC education

• The goal of education is to change behaviors but
  
• Most EOL education is geared toward knowledge
• Attitudes form the core of the problem, not
  knowledge deficits...
• Attitudes resist change
• Learners must be ready to change.

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Why does education fail to change behavior?

• Learner issues
• Death-taboo subject,
• Personal/professional failure
• Ethical/legal misunderstandings
• ConfidenceCompetence gap
• Attitude domains trump knowledge
• Change in medical practice
• Loss of professionalism
• Malpractice fears

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• Education should make up only one aspect of
  systems change
• Standards, guidelines, policies
• Quality improvement based on standards of care
• Education

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Educational Domains

• Pain assessment / treatment
• Non-pain symptoms / syndromes
• Communication skills
• Ethics / law
• Hospice / community resources
• Terminal care / pt-family experience
• Personal reflection

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Planning your teaching

1. Determine your audience.
2. Determine your learners tension points.
3. Write learning objectives.
4. Match objectives to teaching formats
5. Write a lesson plan

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Tension for Learning

• Adult Learners--Need to know
• Patient encounterwhat do I do for X?
• Testing
• Fears
• Malpractice
• Ethical or Legal impropriety
• Peer pressure

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Physician Needs Assessment

• Ask them
• what is difficult about caring for seriously ill
  patients and families?
• Test them
• a few brief questions to build tension for
  learning
• Show them
• demonstrate a difficult communication skill

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Most requested topics?

• Dealing with families
• Conflict
• Futility
• Time management
• Pain/Symptom management

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Educational FormatsPlay the matching game!

• Attitudes (feelings)
• How does the situation make you feel?
• Case study discussion
• Role play
• Knowledge (facts)
• Lecture
• Self-Study
• Audio/Video tape
• Test review

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• Skills (doing something)
• Demonstrate comm. Skill
• Equianalgesic calculations
• Care planning
• Writing prescription

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Non-traditional learning formats

• Test Review
• Question by question
• Role play with discussion
• Real or simulated (videotape)
• Discussion/Q A/Practice
• Whats hard
• QA
• Skill PracticeSimulated cases
• Writing orders

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Education as Marketing

• All education should be used for marketing.
• Link your education objectives to maximize your
  marketing message
• Dealing with conflict
• Dealing with futility requests
• Pain/Symptom management
• Time management
• Gather data for next program

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Keep it Simple

• Simple handout
• Pocket Cards Pain, Family Conference template
• Referral cards

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Resources

• EPEC (www.epec.net)
• UNIPACs (www.aahpm.org)
• Powerpoint Presentations/CME (www.eperc.mcw.edu)
• Fast Facts (www.eperc.mcw.edu)
• Pocket Cards (www.mcw.edu/pallmed)

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Palliative Care Leadership Centers

• Medical College of Wisconsin
• Milwaukee, WI
• Fairview Health Services
• Minneapolis, MN
• Massey Cancer Center of the VCU Medical Center
• Richmond, VA
• Mount Carmel Health System Palliative Care
  Service
• Columbus, OH
• Palliative Care Center of the Bluegrass
• Lexington, KY
• University of California
• San Francisco, CA

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New Academic PCLC

• Regular PCLC
• Academic mentoring
• Academic education planning
• Content specific to the AMC
• MCW
• UCSF
• VCU Medical Center

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Design your next program

1. Who is your audience?
2. What is your specific topic?
3. Write 3 learning objectives/hour
4. Match objectives to formats
5. Write a Lesson Plan
6. Coordinate teaching materials
7. Time Line

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Write an Action Plan

• What?
• Who?
• By When?