human factors science in the undergraduate medicine curriculum at dundee
DESCRIPTION
Human Factors Science in the Undergraduate Medicine Curriculum at Dundee. Dr Evridiki ( Evie ) Fioratou Lecturer Medical School Lead for Behavioural & Social Science. Human Factors Workshop , 2G12 Dalhousie, 18.12.2013. Outline. Teaching Agenda Progress Challenges Strategic Vision. - PowerPoint PPT PresentationTRANSCRIPT
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University of Dundee School of Medicine
Dr Evridiki (Evie) FioratouLecturer
Medical School Lead for Behavioural & Social Science
Human Factors Workshop, 2G12 Dalhousie, 18.12.2013
Human Factors Science in the Undergraduate Medicine
Curriculum at Dundee
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Outline
Teaching Agenda
Progress
Challenges
Strategic Vision
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Teaching Agenda
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Teaching Agenda
Development of Human Factors Science in the undergraduate medical curriculum
Integration of teaching and research
Critical thinking development
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GMC’s Tomorrow’s Doctors (2009) Outcomes To be Addressed by
Human Factors Science Teaching
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Ensuring GMC’s Tomorrow’s Doctors (2009) Outcomes
The doctor as a scholar &
scientist
The doctor as a practitioner
The doctor as a professional
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Outcomes 1The doctor as a scholar & a scientist
9 Apply psychological principles, method & knowledge to medical practice(a) Explain normal human behaviour at an individual
level
12 Apply scientific method & approaches to medical research(b) Formulate simple relevant research question in … psychosocial science … and design appropriate studies or experiments to address the questions
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Outcomes 3 The doctor as a professional
21 Reflect, learn & teach others(c) Continually & systematically reflect on practice …(e) Recognise own personal & professional limits …
22 Learn & work effectively within a multi-professional team(b) Understand the contribution that effective interdisciplinary teamworking makes to the delivery of safe & high-quality care(d) Demonstrate ability to build team capacity & positive working relationships & undertake various team roles …
23 Protect patients & improve care(a) Place patients’ needs & safety at the centre of the care process(b) Deal effectively with uncertainty & change(c) Promote, monitor & maintain health & safety in the clinical setting,
understanding how errors can happen in practice, applying the principles of quality assurance, clinical governance & risk management to medical practice, & understanding responsibilities within the current systems for raising concerns about safety & quality
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Human Factors Science: Design & Delivery
EvaluatingImplementingDevelopingPlanning
An interactive and continuously evolving process
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Planning I
Agreement on key Human Factors topics for undergraduate medicine*
Clinical colleagues’ needs assessment*
Identification of Human Factors topics within the extant curriculum
Students’ needs assessment Environmental needs assessment SSCs
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Planning II
Teaching Delivery Methods Lectures and workshops Individual and Group projects (teaching–research link
is mutually beneficial)
Assessment Tools In line with the Medical School: e.g.,
formative/summative, written reports, verbal presentations, reflective portfolios, as well as integrated assessment within OSCE, DOPS, mini-CEX and CBD
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Developing
Define learning outcomes for: whole Human Factors programme, SiP and PiP phases, SSCs
Identify relevant diverse resource materials for the study guides and the teaching sessions
Develop case scenarios from different medical areas with the help of clinical colleagues to instill HF practice and relevance and to ensure seamless integration (cf. TDGs: Patey, Fioratou, Friar, & Flin, 2011: AME)
Develop diverse research opportunities for transfer of learning from the lab to the medical world (cf. Fioratou, Flin & Glavin, 2010: Anaesthesia)
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Implementing (albeit fragmentarily at the moment!)
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Fundamental Characteristics of Human Factors
It takes a systems approach
It is design driven
It focuses on two closely related outcomes: performance and well-being
Dul et al. (2012; Ergonomics)
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Progress
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Year 1
Principles BlockSystems thinking[Clinical human factors skills & IPL] Respiratory BlockIntegration of systems thinking and clinical human factors skills GI Block (in preparation)Application of systems thinking and clinical human factors skills
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Principles Lecture
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Learning Objectives
Define Human Factors Science
Develop an understanding of systems thinking & its applicability
Explain the relevance of Human Factors Science to clinical practice
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Human Factors/Ergonomics Definition
Ergonomics (or human factors) is the scientific discipline concerned with the understanding of the interactions among humans and other elements of a system, and the profession that applies theoretical principles, data and methods to design in order to optimize human well being and overall system performance.
~ International Ergonomics Association ~
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“… the theoretical and fundamental understanding of human behaviour and performance in purposeful interacting socio-technical systems, and the application of that understanding to design of interactions in the context of real settings”
~ Wilson (2000) ~
Wilson JR. Fundamentals of ergonomics in theory and practice. Applied Ergonomics 2000; 31: 557–67.
Definition – Reinforced
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Systems Engineering Initiative for Patient Safety (SEIPS) Model
Carayon P, Hundt AS, Karsh BT, Gurses AP, Alvarado CJ, Smith M, et al. Work system design for patient safety: The SEIPS model. Quality & Safety in Health Care 2006; 15: i50–i58
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The Wayne Jowett Case
Identify the SEIPS elements involved in this case
http://www.smd.qmul.ac.uk/risk/videos.html#
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“Consultant –
Nurse – Chart”
In Consulta
tion Room
“Pharmacist –
Pharmacist – Chart –Drugs”
In Pharmac
y Departme
nt
“Consultant –
Doctor – Nurses – Receptio
nist”In
Reception Area
“Nurse – Drugs”
In Pharmac
y Storage
“Nurse – Doctor – Registrar – Patient – Drugs – Chart”
In Treatment Room
Interacting SEIPS Elements in the Wayne Jowett Case
SPA
CE
TIME
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How do you apply SEIPS Systems Thinking in practice? Recognise that interactions are central to the care you provide within a particular complex sociotechnical system Explore the interactions of different components of the complex sociotechnical system in which you find yourself Acknowledge not only the psychosocial components of your system but also its physical and organisational components and examine how they impact your patient care Embrace complexity & uncertainty
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The Old View of human error on what goes wrong
The New View of human error on what goes wrong
Human error is a cause of trouble Human error is a symptom of trouble deeper inside a system
To explain failure, you must seek failures (errors, violations, incompetence, mistakes)
To explain failure, do not try to find where people went wrong
You must find people’s inaccurate assessments, wrong decisions, bad
judgments
Instead, find how people’s assessments and actions made
sense at the time, given the circumstances that surrounded
them
The Old View of human error on how to make it right
The New View of human error on how to make it right
Complex systems are basically safe Complex systems are not basically safe
Unreliable, erratic humans undermine defences, rules and
regulations
Complex systems are trade-offs between multiple irreconcilable goals (e.g. safety and efficiency)
To make systems safer, restrict the human contribution by tighter
procedures, automation, supervision
People have to create safety through practice at all levels of an
organisation
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Respiratory Lecture
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Learning Objectives
Integrate Human Factors Principles: systems thinking & clinical human factors skills
Explore problem solving in action Develop an understanding of problem
solving theory Explore problem solving in a patient case Develop an appreciation of problem solving
theory applicability to clinical practice
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Integrating Systems Thinking & Clinical Human Factors Skills
Managing stress
Coping with fatigue
Situation awareness
Decision making
Communication
Team working
Leadership
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Problem Solving in Action
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Try to solve the following problem in groups of no more than 3 people. You have 5 minutes!
You are given 4 chains of 3 links each as shown below
It costs £2 to open a link and £3 to close a link
Your goal is to connect all chains, as shown below, at a cost of no more than £15
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The Solution to the Cheap Necklace Problem(Silveira, 1971; Fioratou & Cowley, 2009)
Fioratou, E., & Cowley, S. J. (2009). Insightful thinking: cognitive dynamics and material artifacts. Pragmatics & Cognition, 17, 549-72
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Systems Thinking in Problem Solving
Problem solving behaviour emerged from the interaction of your team members, your task, your tools, your environment & our organisation
How can we improve the interaction of our system elements to solve the CNP?
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Application to clinical practice
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The Elaine Bromiley Case
http://www.risky-business.com/talk-89-just-a-routine-operation.html
Working in groups of no more than 3 people, discuss the following for this case:
What System Elements (from SEIPS) can you identify?
What Clinical Human Factors Skills were involved? What problem solving aspects can you identify that
led to the unsuccessful management of this patient?
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Linking the Bromiley case to the CNP problem solving performance
In the CNP Knowledge is necessary
but not sufficient for problem solving success
Persevering with the hill-climbing leads to fixation and ultimately to failure to solve the problem
In the Bromiley case Expertise is necessary but
not sufficient for successful case management
Persevering with intubation leads to fixation and ultimately to patient death
Failure to escape fixation by capitalising on cues in the environment
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Suggested Actions from an Independent Review (2005)
Obtain and display a set of the latest DAS guidelines in each anaesthetic room
Develop a protocol to ensure that when any emergency event occurs, be it in the anaesthetic room or the operating theatre, there is someone designated to keep full contemporaneous records of the event and to provide an elapsed time prompt.
Ensure an atmosphere of good communication in the operating theatre such that any member of staff feels comfortable to make suggestions on treatment.
Organise a study day on airway management with particular reference to equipment not regularly used and any peculiarities
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Strategies to Minimise Cognitive Errors
Develop insight/awareness Provide detailed descriptions and thorough characterizations of known CDRs with multiple clinical examples illustrating their adverse effects on decision making and diagnosis formulation
Consider alternatives Establish forced consideration of alternative possibilities
Heighten metacognition Train for a reflective approach to problem-solving: stepping back from the immediate problem to examine and reflect on the thinking process
Develop cognitive forcing strategies Develop generic and specific strategies to avoid predictable CDRs in particular clinical situations
Provide specific training Identify specific flaws and biases in thinking and provide directed training to overcome them
Decrease reliance on memory Improve the accuracy of judgments through cognitive aids: mnemonics, clinical practice guidelines, algorithms, hand-held computers
Make task easier Provide more information about the specific problem to reduce task difficulty and ambiguity. Make available rapid access to concise, clear, well-organized information
Minimize time pressures Provide adequate time for quality decision making
Improve feedback Provide as rapid and reliable feedback as possible to decision makers so that errors are immediately appreciated, understood, and corrected, resulting in better calibration
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Summary
By exploring problem solving in action, we experienced how heuristics may sometimes lead us to fixation and failure to solve simple problems
The applicability of problem solving concepts in clinical practice can help us appreciate the limitations of our cognitive powers and prepare us for future fixation recovery
By exploring problem solving in the Elaine Bromiley case, we experienced how clinical human factors skills may interact with the particular system elements leading to fixation and ultimately to patient harm
We need to start learning and adopting strategies to minimise our cognitive limitations
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GI Workshops(in preparation)
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Year 2
Dermatology Block
Child & Family Block (in preparation)
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Dermatology Online Module
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Learning objectives
Understand the complexity of the dermatology consultation from a Human Factors Science approach
Explore the affective component of clinical work and understand the fundamental attribution error
Reflect on your own emotions and develop strategies against potential fundamental attribution error
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Child & Family Workshops(in preparation)
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Year 4Transition Block 2 Workshops
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Learning Objectives
Introduction to Systems Thinking within Human Factors Science
Problem solving in action – introduction to Systems Thinking in the lab & experimental methodology
Real patient cases – application of Systems thinking in healthcare & naturalistic methodology
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Evaluating
Feedback from students*
Feedback from clinical teachers
Learn from the feedback and improve the programme accordingly…
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Challenges
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Integrating Human Factors principles in clinical training and practice
Human Factors information provided before it becomes clinically relevant
Dissonance between the Human Factors & biomedical cultures
Linking with other teaching (e.g., core clinical problems, clinical skills centre, patient journey, clerking)
Inconsistent modelling of Human Factors principles in the clinical setting
My role and development as a non-clinical lecturer…
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Solutions?
Human Factors integration throughout the spiral curriculum
Co-ordination with clinical colleagues but also acceptance of individual differences & contextual
issues
Cultural change via leadership
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Strategic Vision
To enhance the synergy between Research and Teaching and ensure sustainability
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The Dundee Medical Graduate
Core Human Factors Science knowledge & skills (theory & methodology)
Participation and/or leadership in Human Factors projects impacting medical practice & education
Critical thinking in applying Human Factors in their workplace
Continuous professional development in Human Factors at postgraduate level
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Strategies for Sustainability (Research & Teaching Initiatives) Local ~ collaborations with the School of Nursing, Institute of Medical Science & Technology; ~ annual student journal publication/website/youtube (Horizon-type) production of HF research and experiences; ~ annual conference/awards/prizes for HF projects; ~ postgraduate supervision; ~ income generation (e.g., NES, HEA, CSO) National ~ e.g., collaborations with other medical
schools, SMERC, CHFG International ~ e.g., collaborations with DHI & DIMS