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ERS Annual Congress Vienna
15 September 2012

Postgraduate Course 20 European spirometry train-the-trainer programme

Saturday, 1 September 2012 08:4517:30 Room: C8

European Spirometry Driving Licence specific teaching and training

Mrs Julie K. Lloyd Respiratory Investigation Dept Good Hope Hospital Birmingham United Kingdom julie.lloyd@heartofengland.nhs.uk

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ESDL SPECIFIC TEACHING & TRAINING

Julie Lloyd Chair Group 9.1

ESDL 2012

OVERVIEW Suggested reading Duration of training Teaching and delivery of: Part 1 Part 2 Overview of difficulties in spirometry training

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SUGGESTED READING
1. Miller MR, Hankinson J, Brusasco V, et al, Standardisation of spirometry: number 2 in series ATS/ERS Task Force: Standardisation of Lung Function Testing. Eur Respir J 2005; 26: 319-338. 2. ARTP Spirometry Handbook 2nd Edition. www.artp.org.uk. 3. SpirXpert. Quanjer P. www.spirxpert.com

ESDL 2012

BEFORE YOU START ... Before you plan your program, before you consider the appropriate teaching or learning style ... Consider the audience that you are teaching! What do the want from the course? What do they need from the course? What is their background? If you fail to do this, your course is unlikely to succed.

ESDL 2012

DURATION OF TRAINING Should comply with the specifications recommended within the ERS European Spirometry Training Programme: 9 -12 hours for Part 1 training 7-10 hours for Part 2 training. A number of training modules for Part 1 may be completed online prior to attending Part 1 classroom training. Each online module completed counts for 1 hour of training time and will reduce classroom training time for Part 1.

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AVAILABLE TEACHING FORMATS

Didactic Lectures Instructional teaching method that allows the student and teacher to effectively understand, consider and analyse the learning goal Small group hands on learning - learning by doing. Practical demonstrations and assessment of technique and interpretation, for example. e-Learning Activities Types of online learning including audio, e-text, forums, threaded discussions, web-blogs, electronic assessments, and simulation learning

ESDL 2012

AVAILABLE TEACHING FORMATS

Case-based discussions - Case-based discussion is a structured interview designed to explore professional judgement in specific cases selected by the trainee and presented for evaluation Self Directed Learning - A self-paced process of learning where individuals take initiative, formulate learning goals, and identifies resources for learning Mentoring - Mentoring is a developmental partnership through which one person shares knowledge, skills, information, and perspective to foster the personal and professional growth of someone else.

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PART 1 MODULE OUTLINE 1. Anatomy, Physiology and Pathophysiology required for Spirometry 2. Definitions of Spirometric Values 3. Spirometry Equipment. 4. Indications and Contraindications of Spirometry Testing 5. Spirometry Technique 6. Quality Assurance 7. Evaluation of Spirometric Results

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ESDL 2012

EXAMPLE PROGRAM- SESSION 1

ModuleTitle Recommendedtime required3.5 4hours

WelcomeandIntroduction Module1 Anatomy,physiologyand pathophysiologyrequiredfor spirometry Module2 DefinitionsofSpirometric Values Module3 SpirometryEquipment small grouphandsonsession

15mins 1hour

1hour 1.5hours

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EXAMPLE PROGRAM- SESSION 2

ModuleTitle Module5 SpirometryTechniqueinsmall grouphands onsessions Recommendedtime required2 4hours 2hours

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EXAMPLE PROGRAM- SESSION 3

ModuleTitle Recommendedtime required3.5 4hours forSession3

Module4

Module6 Module7 Module9

Indicationsand Contraindicationsof SpirometryTesting Qualityassurance EvaluationofSpirometric results OverviewofPartII, submissionoftheERS SpirometryWorkbook

30mins

1hour 1.5 2hours 30mins

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EXAMPLE PROGRAM- SESSION 4

ModuleTitle Knowledge Test Recommendedtime Tobeconfirmed

ESDL Part 1

SUGGESTED TEACHING FORMATS

ESDL 2012

PRE COURSE KNOWLEDGE ASSESSMENTS

Not mandatory! Helpful to assess the knowledge base of your group before you start. Ensures candidates that have used e-learning or self directed learning have understood the materials. Helps trainers focus on areas of weakness. Very useful to re-administer the test after the course to demonstrate learning Identifies areas that student learning may be less effective. Reinforces to students how much they have learned!

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MODULE 1: A&P & PATHOPHYSIOLOGY Learning outcomes: Knowledge of anatomy and physiology of the respiratory system Knowledge of pathophysiology of respiratory disorders

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MODULE 1: A&P & PATHOPHYSIOLOGY

Traditionally taught as didactic lectures, but ... may not be stimulating for participants or lecturer! Other options to consider: Self directed learning E-learning Irrespective of method used, must have some way of assessing students understanding of the materials. It is unlikely that the students will be as enthusiastic about the subject as the speaker. Consider the needs of your students.

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MODULE 2: SPIROMETRY DEFINITIONS

Learning Outcomes: Explain the principle of spirometry Define FEV1, FVC, FEV1/FVC Define PEF, FEF25-75, PIF Define VC, IRV, ERV, IC Explain the characteristics of a flow-volume curve Explain the characteristics of a volume-time curve Explain the relationship between volume-time and flowvolume curve

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MODULE 2: SPIROMETRY DEFINITIONS

Didactic lecture easiest way to deliver information, but doesnt ensure they understand. Useful to support with practical demonstration of where the indices come from.

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MODULE 3: SPIROMETRY EQUIPMENT Learning Outcomes: Describe the minimum recommendations for spirometry systems Describe strength and weaknesses of your spirometer Recognise pitfalls of the instrument Describe the factors that influence reference values

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MODULE 3: SPIROMETRY EQUIPMENT

Not helpful just to teach facts students need to know why this information is important. Show examples e.g. PEF error due to low range device being issued To understand the strengths & weaknesses of their device, they have to see other devices: Make it competitive e.g. this spirometer is better because... etc! Reference values should be calculated long-hand and then students can see the effect of a change in height or gender makes to them.

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EXAMPLE WORK SHEETS

For the FVC and FEV1, calculate the predicted values, the percent predicted and a reference range for these patients: Patient 1: Mr L-C, aged 65 years, 1.72 m. Spirometry results FVC = 2.5 L FEV1 = 1.4 L FEV% = 65% PEF = 320 L/min For FVC: (4.3 x 1.72) (0.029 x 65) 2.49 7.396 1.885 2.49 = 3.021L Range = 3.02 + (0.51 x 1.645) = 3.02 + 0.84 = 3.86L 3.02 - (0.51 x 1.645) = 3.02 0.84 = 2.18L

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MODULE 4: INDICATIONS AND CONTRAINDICATIONS Learning Outcomes: Summarise indications and contra-indications for spirometry Summarise the limitations of spirometry

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MODULE 4: INDICATIONS AND CONTRAINDICATIONS

Present open questions to your group: What is spirometry used for? Who wouldnt you do spirometry on and why? Flip charts are helpful and depending on the size of your group, smaller breakout groups with their own flip chart work well. Have slides or handouts prepared with the complete and correct answers for after the discussion.

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ESDL 2012

MODULE 5: SPIROMETRY TECHNIQUE

Prepare equipment required for testing Demonstrate the correct use of the spirometry device Summarise preparation of subject Describe the correct position to perform spirometry Demonstrate height and weight measurement Record type, dosage and time of relevant medication Explain testing procedure to subject Demonstrate the procedure to subject Demonstrate subject coaching Obtain accurate spirometry measurement according to international guidelines (to include examples of international guidelines)

ESDL 2012

MODULE 5: SPIROMETRY TECHNIQUE

Recognise improperly performed manoeuvres Demonstrate appropriate corrective actions Demonstrate injury prevention knowledge Identify and use standard personal protective equipment Demonstrate awareness of confined spaces, including potential hazards, and safety standards. Document relevant events that occurred during the spirometric assessment Demonstrate correct method of administering a bronchodilator Summarise issues related to the choice of bronchodilator

ESDL 2012

MODULE 5: SPIROMETRY TECHNIQUE Large topic best taught by practical, hands on experience. Need more facilitators for this session to keep group sizes small. Demonstrate good technique using a patient/operator pair: Good patient/bad operator Bad patient/good operator etc! Mimic patient and technical errors and use teaching traces to support this. You can have lots of fun with this bit!!!!

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OTHER OPTIONS VIDEO PRESENTATION

Use of video really works if you dont have many facilitators. Can create scenarios and ask students to feedback the good, the bad and the ugly! Can also video the students and ask them to critique one another needs care.

ESDL 2012

MODULE 6: CALIBRATION & QA

Describe and perform a control spirometry using a subject with known lung function Describe and perform calibration or verification check of equipment Describe methods for prevention of infection transmission Explain the rationale for regular cleaning Summarise the requirements for equipment quality control Recognise abnormal traces due to technical or patient errors Describe the advantages of regular over-reading of traces by external experts (samples)

ESDL 2012

MODULE 6: CALIBRATION & QA

Lends itself to a range of teaching styles. Obvious is didactic lecture. Practical demonstration Particularly useful for calibration technique Group work: Provide sets of values to calculate physiological range from. Provide traces with patient and technical errors for discussion.

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MODULE 7: EVALUATION OF RESULTS

Document the acceptability criteria Document the repeatability criteria Document reversibility criteria Summarise test result selection Describe selection of best curve Compare test results with reference values

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MODULE 7: EVALUATION OF RESULTS

Basic understanding of limitations of reference values Basic understanding of errors of using the % predicted and the advantages of using the LLN Evaluate change in individual subjects Recognise and describe the normal pattern as well as restrictive and obstructive pattern in the volume time curve. Recognise and describe the normal pattern as well as restrictive and obstructive pattern in the flow volume curve. Knowledge of storage/electronic data

ESDL 2012

MODULE 7: EVALUATION OF RESULTS

Another Module that lends itself to a range of teaching styles. Obvious is didactic lecture. Group work: Provide sets of values for review with some patient background. Students need to comment on the quality of the data and provide a technical report. If quality standards are met, students provide a clinical interpretation of the data. Present the patient back to the group and group discusses.

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MODULE 9: COURSE ASSIGNMENTS Understand the next steps to be taken to complete and submit the ERS Spirometry Workbook including training exercises, portfolio of tests and the assessment process for Part II training

ESDL 2012

MODULE 9: COURSE ASSIGNMENTS Didactic lecture Group discussion of potential problems or difficulties. Work place support Time! Conflicting demands etc Examples of completed Work Books for review Agreed mentoring sessions and practice assessments with students.

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ESDL MYSTERY Has anyone spotted anything missing for the course so far? What happened to Module 8 ???

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ESDL Part 2 SUGGESTED TEACHING FORMATS

ESDL 2012

BACKGROUND Before commencing Part II, a number of assignments relating to the practice of spirometry must be completed in the ERS Spirometry workbook. This workbook will form the basis of Part II competency based training and assessment. It is recommended that participants complete Part II training within 6 - 12 calendar months after completing Part I.

ESDL 2012

PART 2 DURATION Part II is a 7 - 10 hour training course which will focus on competency - based training and will require participants to complete exercises and submit portfolios of spirometry tests. Training techniques mirror those used for Part 1 training and should be led by the needs of the group. The award of the European Spirometry Driving Licence will be dependent on a competency assessment.

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EXAMPLE PROGRAM- SESSION 1

ModuleTitle WelcomeandIntroduction Recommended timerequired 3.5 4hours 10 15minutes 1hour

Module4 Module7

Spirometry Equipment Review ofworkbook assignments, (small group handson learning) QualityAssurance DidacticLecturesanduseofeducational materialsandworkbooks to: Problemsolveissuesrelatingtocalibration andverification Calibration andverification checkof equipment Recognition ofabnormal tracesdueto technical orpatient errors

1hour

ESDL 2012

EXAMPLE PROGRAM- SESSION 2

ModuleTitle
Module5 Technique forperforming spirometry (smallgrouphandson sessions) Completion ofERSworkbook to Administerspirometrictests Prepareequipment Practicetestingtechnique Recognise pitfallsofspirometryand methods toimprovetestingtechnique Recognition ofimproperly performed manoeuvers etc

Recommendedtime required2 4hours

1.5hours

ESDL 2012

EXAMPLE PROGRAM- SESSION 3

ModuleTitle
Module7 EvaluationofSpirometricResults (Smallgrouphandsonlearningandcasestudy presentations) Useofeducationalmaterialsandworkbookstoevaluate SpirometricResults Spirometry ServiceManagement
Understandstheimportanceofkeepingallresultsstoredsafelyand accessibilitytohealthcareusers Performsandrecordsinfectioncontrolprocedures Performsandrecordsqualitycontrolprocedures Awarenessofauditprocessesandselfassessmentofthespirometry servicetoensuresufficientclinicalskillsaremaintainedandqualityis upheld Plansandprovidesconsumablesforspirometry service(mouthpieces, noseclips,paper)andensuresroutinemaintenanceofequipment

Recommended timerequired 3.5 4hours for Session3

1hour

Themagical returnof Module8

30mins

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EXAMPLE PROGRAM- SESSION 4

ModuleTitle Finalquestionsandanswers sessionandopportunityforhands onpractice Recommendedtime required2 4hours 30 60mins

ESDL 2012

EXAMPLE PROGRAM- FINAL ASSESSMENT

ModuleTitle Recommended assessmenttime30 minutes/candidate

Module9

Assessmentofcompetencein Spirometrypractice CollectionofcompleteERS Spirometryworkbooks

oAccordingtotheERSguidelinesforcertificationthereshouldbeno morethana10:2participant: teacherratioequatingto2.5hours assessment time oAllassessments tocertifycandidateswiththeEuropeanSpirometry DrivingLicence shouldstrictlyfollowERSCriteriaforcertification

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DIFFICULTIES IN SPIROMETRY TRAINING

Requires lots of preparation Time consuming Organisational issues Lunch, no lunch! The teaching plan and the group dont match. Unrealistic expectations Unmotivated students Lack of workplace support Theory Study time Patients

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QUESTIONS AND COMMENTS?

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