Niels Kjaer - Sunstainable continous developement for all of us

Transcript

This transcript is AI generated and may contain errors.

Elvira, I have a question for you.

Am I cleared for takeoff?

What?

Am i cleared to take off?

Yes, from the tower.

Cleared for takoff, yes.

Then let us fly in this very renewable 80 years old Danish-built aircraft and have look on professional educational development a bit from above.

A point of departure is Sønderborg in Denmark where we have a very nice located university campus and hospital at the waterfront and a much smaller, much more humble but for me very significant GP clinic where I have worked as a GP for more than 40 years.

And I was told to declare conflicts.

I feel very privileged by all the trust and attitudes I've met from patients working as a doctor for more than 40 years.

Therefore, I have a strong bias towards a proper qualified care in general practice.

My second conflict is my very first job was in Sweden.

in Bregebyn, Ungermaland.

And ever since that, I've had a very positive attitude towards Swedish colleague and Swedish health care staff.

Thank you very much.

Our vision for continuous professional development, CPD, is that CPC programs have to be sustainable and they have support excellent care in general practice and include all the GPs.

And they also have the staff working in the general practices.

Therefore, CBD activities must do more than just provide textbook knowledge.

They also have to focus on competence and performance.

And I would like to challenge the understanding of GP's competence by inviting you inside the brain of a GP.

try to explore how education can support the complex competences of GPs and discuss sustainability and CPD.

We'll start with a small reflective exercise.

Try to imagine a GP's core competence.

What does the knowledge, skills, attitudes and wisdom of a GEP look like?

Here we have a picture of a GP.

We are allowed to look into the professional part of her brain.

What do we expect to find?

Well, we will find an awful lot of textbook knowledge, evidence-based medicine, the very foundation of the medical profession.

But we also find a very important and very interesting experience- based knowledge which we should explore more in the future and we have to support it in our education.

we find a profound understanding of the context in which she is working in.

It's not only social values, relations, resources, it's also about illness prevalences in the populations she serves.

And this context understanding is very important and I'll return to that later.

We find a strong motivation.

This doctor wants to be a good doctor for her patients and she wants develop her expertise over time.

And if we look closer.

We also see an ability to reflect, an able to manage feedback, not only the formal feedback or data-driven feedback but also the ability search all kinds of informal feedback and to use it in monitoring own clinical performance.

We see the abilities to build patient relations and we see she can feel empathy.

And then we detect something even more important.

We find the ability to generate trust between her and her patients.

And how many of you are GPs?

Wow.

Your profile are the same.

You also have this combination of competence in you.

And when you are planning your CPD, you have to remember to consider how to support these different areas of your expertise.

Because when your combine these area, your goal from knowledge to performance.

When you reflect and use this informal feedback, You go from competence to preformance and to medical expertise And if I may have a close look on your expertise, we can see that it contains both a horizontal expertise which is a kind of overview ability to combine things, expertise.

And there's also a vertical expertise that's the specific knowledge and skills in a specific area which we use when we solve a difficult clinical task.

The horizontal experts are very important in the diagnostic process.

And USGPs are very strong on the horizontal expertise.

And in healthcare system, which focus very much on subspecialization, a form for vertical expertise, horizontal expertize is a necessity for a sustainable and efficient healthcare systems.

Healthcare systems relying heavily on subspecialization without some kind of horizontal expertise embedded very easily become highly fragmented and extraordinarily expensive.

This ability or competence also allow you to navigate in what Donald Schoen called the swampy lowland of general practice instead of sitting in an ivory tower built on highly specialized evidence.

It approached It provides an ability to handle or even embrace the uncertainty, which is when you treat patients in society, is an inevitable condition for GPs, like it or not.

We need to have the ability handle the uncertainties.

We saw that there was ability to make sound doctors patient relations and that's important because it support empathy and it also support the willingness to involve the patient in the decision and involving patients in decisions shared decision-making is a cornerstone in high healthcare outcome.

Understanding the value of these relations also show us that resilience and empathy are not countries.

And when you are building your professionalism on patient relations, it supports your motivation.

We also have a growing body of literature supporting the importance of continuity.

There have been several sessions about it here today and yesterday.

And some systems are better in supporting continuity than others, to say it diplomatically.

But maybe CBD can inform us how important it is and engage GPs and try to strengthen it in whatever system they work in.

With these reflections in mind, you could try to make a checklist.

You apply on CBD activities, whether they support the complexity of your excellent competences and expertise.

Of course, it has to support knowledge update, but it should also support ability to search knowledge in action in the clinics.

It should facilitate the exchange of knowledge among peers.

it should also see does it allow us to adjust our knowledge with colleagues, detect our own shortcomings and help us having a better awareness about our performance.

And of course, it has to support the implementation from knowledge to performance.

It also have to emphasize patient care, strengthen our mutual ethical values and the professional identity, allow or even facilitate social professional togetherness among peers and support our motivation, engagement and working joy.

To achieve these aims, of course, require different formats.

And it's very important we choose a format that fits the objectives.

For instance, if we want to emphasize how we work with patient relations, participating in a reflection group, barreling group or supervision group is a very good format to do so.

But please remember choosing the right format.

Do not outperform dedicated course planning and preparation.

This brings us to the ecosystem of education.

I talk about the importance of context.

It's very important because, as a GP, you navigate in the pre-diagnostic and even no-dia-gnose area.

Most of our patients don't have a diagnosis when they go to the doctor, to a G.P., and many contacts between GPs and patients and doctors do not need to result in a diagnose.

And the majority of the population, they live in the no-diagnose era.

They are not sick.

they don't have any diagnosis.

And I think we should let most of them stay there.

So therefore we need some kind of symptom based approach to our education instead of the classical diagnose based education.

And it's also very important when we are making arranging these courses that a profound understanding of general practice is a necessity for competence development by GPs.

We also have to be inclusive to remember our colleagues who do not attend conferences like this or other CPD activities.

In Denmark, it's a little less than 10% who seems not to attend.

What shall we do with them?

Shall we force them We know from the literature that forced education seldom facilitates competence development.

And who knows the learning needs of a GP better than the GP herself?

Before we are lining up the heavy artillery against those not attending, I think we should start asking who are they and what barriers are facing.

In my country and maybe also in yours, they can roughly be divided into three groups the busy GPS who's busy doing something else research teaching research work union work politics, whatever something like me for instance.

We have the personal affected doctor in some kind of a crisis and we have a small group, less half the size than the two others, of GPs who come from clinics with apparently no tradition for CBD participation.

How can we reach out without destroying their motivation?

Well, it's easy to praise the active GPs in public and then behind the door, close door tell them that even top doctors need the CPD and their patient needs qualified doctors in clinic.

We can also be supportive towards our colleagues who are affected.

They maybe need something else than CPC for a time.

But how do we reach the colleagues with no tradition?

How do you give them a gentle notch?

We can look at their preferences and the barriers.

And they request easy access to education close to where they live.

They are open to group-based learning, they are opened to activities in their own clinic, and they're open for shorter local activities, CBD activities.

But we have to remember to invite them in.

We should develop educational material which can be used in the clinics, ideally where we stimulate two or three small local clinics to join in to such an activity together.

And we could arrange after our shorter CPD events locally.

We could also discuss mandatory education, but if there are easy access, I think that the number is so small it doesn't make any sense to have heavy bureaucracy in mandatory educational.

And maybe we are asking the wrong question.

So I'll suggest that we instead are discussing how to meet the learning need of the individual GP and how the meet learning for the GP profession.

By asking the question, what do I as a GP needs to learn more about, and what we as the GP profession need to know more.

That means we have to define both individual learning objectives, which shall be done by the GPs, him or herself.

maybe together with a trusted colleague.

And then we have to find out how to define our mutual learning objectives.

It has to be a very, very thorough process where we also engage with people we collaborate with and it has also to have scientific arguments.

Please know impulsive political interventions.

We have done such a process in Denmark and it was pretty demanding And therefore it's very easy.

Could we have some kind of shortcut?

What about asking a chatbot?

What do DPs need to learn?

Artificial intelligence are already here.

It will no doubt play an even stronger role in the future.

Can chatbots be an educational shortcut?

I've been extraordinarily excited about AI and seen a lot of possibilities, but I think we have to replace this initial excitement with skeptical sound reflection.

Recent research indicates that I may dull the user's cognitive capacity.

Well, who cares if AI can make the better decision anyway?

Do we need cognitive capacity?

I care, and I think many of you care.

And I could ask this provocative question.

Should we stop teaching our children to learn and read?

Because voice recognition, text recognition device would be easier for them.

and IA are still unreliable in an unacceptable high number of clinical situations.

I know some have another opinion, but in a recent article which surprised me a lot in BMG, a researcher had asked a lots of healthcare questions to different chatbots, and they found that they were often slightly incorrect.

Occasionally, they are directly wrong, They identified fabricated references and something I'm very concerned about, AI do not possess the benefit of doubt.

And I think doubt is a very important part of our capacity.

All good doctors bring a little bit of doubts into their clinical decisions because humans and biology are, per definition, unpredictable.

But these answers were presented with a hyperinflated self-confidence, even where they were directly wrong.

I'm also a bit concerned about using IA more and more in general practice may shift our focus towards depersonalized care, even maybe de-socialized, away from patient-centered care.

It may work in highly specialized departments, but I am not sure it works in the swampy lowland of general practices, which is embedded in uncertainty.

And it requires a lot of energy resources.

I am of course not arguing against IA.

I'm not asking some modern Don Quijote to ride in on his horse and fight it.

But I think it's very important that the GPs in general practice harness the use of IAA, have a firm grip on the steering wheel, and only implement solution where they support Your competence and not where it dilutes your competence, and we only introduce solution with whichever purpose we can see and just because it's possible to make this and I also think that CPD has to focus on how to but contrabalance the IA side effects in the future and So, we cannot just ask a chat GPT, a Chatbot what do I need to know, sorry.

Education is not placed on a remote island.

It's deeply embedded in society, available healthcare resources, environment, politics, social values, healthcare, literacy, and also in your professionals, your personal resources, physical and mentally.

Therefore, we also need to have some kind of sustainability considerations.

If we reuse Harlem bond lands definition, we have seen that several times here at this conference We can define a sustainability in primary care as the meeting the needs of primary Care today without compromising future generations to meet their needs How can CPD support sustainability?

And here you have to help me with the answers, because I'm no expert here.

But we could start trying to look at the threats towards sustainability, and then discuss the role of CEPD.

Based on experience, reflections, and a little research, I'll give six examples.

It's only examples, there are many more.

But we know that fragmented care and discontinuity increases healthcare demand without added value for the patient.

So do depersonalized healthcare.

defensive medicine and over diagnosing sponsored CPD activities, heavy bureaucracy and excessive use of AI.

Can we address them by CBD.

Maybe we can if we are reflective see if our educational programs somehow can teach or train or make awareness of continuity in care.

We could emphasize the importance of patient centered care and personal relations.

we could support choose wisely strategies in our courses.

We could stop using sponsorship.

Sponsored courses do not only introduce over-medicamentation, it's also an extremely expensive way for society to finance GEP's education.

It should only be allowed in very rich countries where the population loves to eat many pills.

Otherwise, it should be prohibited.

And maybe we could also use wisely strategy in our administration.

Sometimes, I'm not sure they have picked up that point.

But you can also choose wisely when you define how much administration that I needed.

And maybe we could focus on how to teach knowledge search in low energy demanding databases instead of just asking IA what to do.

And we also need to have some skepticism against IE supported over documentation.

There are many more threats, and I think it's very important that you discuss that as staff meeting coffee breaks, what threats do we have?

We have to take care of not only primary care, but also the globe and try to identify the threats and ways to address them.

And some of the possibilities are looking at your CPD.

I'll end by a small reflective exercise.

How do these reflection fit into this reflection about how we learn, think, and care for a patient and the environment, how do they fit in to your CPD program back home?

And if you were appointed to reorganize the CPC back-home, where would you begin?

You are an extraordinary, competent audience.

And I feel very, very humble standing here in front of you.

Thank you very much.

I'm not finished.

Thanks a lot.

Many thanks for your attention.