Coaching for Competence in

Collaborative Practice: Practical

Resources for the Clinical Preceptor
Deborah Kopansky-Giles, BPHE, DC, FCCS, MSc.
Scott Dunham, BSc, DC, MSc, Med.
Conflict of Interest

Speakers:

Deborah Kopansky-Giles, BPHE, DC, FCCS, MSc

Scott Dunham, BSc, DC, MSc, MEd.

We have no conflicts of interest to declare with respect to this

presentation
Workshop Goal

To promote and support a

clinical coaching approach
which enhances the teaching
and assessment of integrated
person-centred collaborative
practice competencies in
health professional training.
Workshop Objectives

By the end of this session participants will be able to:

1. Identify opportunities to teach and assess the

collaborator role in their teaching context.
2. Describe CBME strategies for the collaborator role
3. Access and apply the CanMEDS Collaborator Role
teaching and assessment resources.
Outline

• Introduction
• Background and Rationale
• CanMEDS and the Canadian Context
• Competency Based Education
• CFPC Collaborator Role Tools
• Application activities
• Wrap-Up
Rationale

• Competency based education

• Recognition of the importance of the intrinsic (Non-
Medical Expert) CanMEDS Roles
• Health system changes to team based care (ex.
Primary Care Homes and Primary Care Networks).
• Competency: An observable ability of a health
professional that integrates knowledge, skills,
values and attitudes
What is Competency-Based Education?

An outcomes-based approach to the design,

implementation, assessment, and evaluation of medical
education programs, using an organizing framework of
competencies

The International CBME Course,

Royal College of Physicians & Surgeons of Canada, 2015
Competency-Based Education Fundamentals
1. Graduate competencies = program outcomes
2. Defined stepwise progression of expertise
3. Programmatic, authentic assessment
4. Time is a resource, not the basis for competence

The International CBME Course,

Royal College of Physicians & Surgeons of Canada, 2015
Courtesy of Ronald Harden
“What Does a Clinical Competency Curriculum Look Like?” Assessment of Learners
Stephen R. Smith, http.//www. DFCM Basics for New Faculty, 2015
Aavmc.org/meetings_events/documents/StephenSmithpowerpoint
.pps ,
Courtesy of Ronald Harden
“What Does a Clinical Competency Curriculum Look Like?” Assessment of Learners
Stephen R. Smith, http.//www. DFCM Basics for New Faculty, 2015
Aavmc.org/meetings_events/documents/StephenSmithpowerpoint
.pps ,
Courtesy of Ronald Harden
“What Does a Clinical Competency Curriculum Look Like?” Assessment of Learners
Stephen R. Smith, http.//www. DFCM Basics for New Faculty, 2015
Aavmc.org/meetings_events/documents/StephenSmithpowerpoint
.pps ,
Courtesy of Ronald Harden
“What Does a Clinical Competency Curriculum Look Like?” Assessment of Learners
Stephen R. Smith, http.//www. DFCM Basics for New Faculty, 2015
Aavmc.org/meetings_events/documents/StephenSmithpowerpoint
.pps ,
Miller’s Triangle of Competence

A Vergis, K Hardy. Principles of Assessment: A Primer for Medical Educators in the Clinical
Years. The Internet Journal of Medical Education. 2009 Volume 1 Number 1.
 Assessment in Competency-Based Medical
Education
• CBME requires enhanced assessment tools and
processes

• Direct observation while trainees provide care is the

cornerstone of assessment and evaluation process

• CBME requires greater involvement by faculty

because of the need for direct observation and
increased frequency and quality of formative
assessment.

Assessment of Learners
DFCM Basics for New Faculty, 2015
 The International CBME Course,
Royal College of Physicians & Surgeons of Canada,16 2015
Canadian Competency Context

• CanMEDS 2005

• CanMEDS FM 2009

• CanMEDS 2015

• CanMEDS FM 2017
20
CMCC context

21
CPFC National Survey Results
• Program directors in DFCMs across Canada were surveyed
in 2015 and their responses thematically analyzed
• N = 26 responses from 7 provinces/regions
• Structured (formal) approach to teaching the CR?
• 59% said NO
• 41% said YES
• Structured (formal) approach to assessing the CR?
• 55% said NO
• 45% said YES
 Individual and
Team Exercise: 1 minutes 2 minutes 5 minutes

1. Take 1 minute and think about some of the strategies

that you currently use to teach and assess the
collaborator role in your context
2. Spend 2 minutes, discussing these strategies with a
partner.
3. Take 5 minutes to share with your table group
CMCC example - OSCE

24
OSCE Example - continued

25
Common Canadian Strategies
TEACHING ASSESSMENT
• Workshops, seminars, • Field notes
simulations • Observation
• Community and scholarly • Simulations
projects requiring
collaborative activity • Portfolio Reflections e
• Clinical experiences*: • In-training Assessment
Report (ITAR)
IP clinical care
• 360 evaluations
Team meetings
• SAMPs [Short Answer Management
Field notes Problems]
• SOOs [Simulated Office Orals]

From CPFC – Collaborator Competency Working Group Guide 26

 EFPO (Six-Step) Model of Feedback

1. Teacher observation of student behaviour or work

2. Ask the student for their self-assessment
3. Describe the desired behaviour
4. Ascertain that the student understands the difference
between current behaviour and desired behaviour
5. Elaborate a plan to close the gap (an educational prescription)
6. Follow-up on improvement

Merrilee Brown, Brian Hodges, J.Wakefield, Effective Feedback, 1995

 Observable Behaviours

From CPFC – Collaborator Competency Working Group Guide

 Individual and
Team Exercise: 1 minutes 2 minutes 5 minutes

1. Take 1 minute and think about some observable

behaviors associated with the collaborator role
2. Spend 2 minutes discussing these with a partner.
3. Take 5 minutes to share with your table group and be
prepared to discuss with the large group a little later in
the session.
Collaborator Role Working Group
• Christie Newton, FP – Co-Chair
• Deborah Kopansky-Giles, DC – Co-Chair, HPE*
• Steve Balkou, MSc - (Psychologist) – HPE*
• Alison Eyre, FP, Program Director
• Jose Silveira, MD, FRPC – Psychiatry
• Tanya Magee, RN – HPE*

• CFPC support: Ivy Oandasan & Aleksandra Walczak

*Health Professional Educator
CFPC.CA
 Fundamental Teaching Activities in Family
Medicine
Domains

Clinical Preceptor
• Clinical Coach
• Competency Coach

Teacher Outside the Clinical Setting

Educational Leader
• Educational Programmer
• Educational Administrator

Walsh A, Antao V, Bethune C, Cameron S, Cavett T, Clavet D, et al. Fundamental Teaching Activities in Family
Medicine: A Framework for Faculty Development. Mississauga, ON: The College of Family Physicians of Canada; 2015.
35
Case Example –
Teaching in a Clinical Setting

• Patient: H.G., a 72 year old widow, lives alone and had a recent fall in the
bathroom, with minor bruises
• Learning context: post-assessment review

During the review, your learner demonstrates good knowledge about

causes of falls in the elderly. Your learner recognized this patient’s desire
to remain independent at and would like to initiate a referral for a falls
assessment with the home care team. When asked about other health
care providers involved at home that could be helpful, your learner did
not fully understand the roles of physiotherapy, kinesiology and
occupational therapy, nor what role these professions may have in falls
prevention.
Debrief
Applying TEAMS
in Teaching and Assessment
Applying TEAMS
in Teaching and Assessment
40
41
Case Example –
Teaching Outside the Clinical Setting
You are asked to provide a primer for mixed professional learners
on pharmacological approaches to managing low back pain. This
learner is part of an IPE program about interprofessional
management of LBP.
You would like to include information related to the Collaborator
Role.
• What role competencies might you focus on?
• Where would you look for resources to support the
material development for this session?
• Are there other team members who could provide input
on this document?
• How will you engage learners in this process?
Debrief
Other teaching and assessment opportunities:

Clinical Setting
• Orientation to clinical rotation
• Chart review
• Consultation or referral letter review
• Participation in team meetings / huddles
• Patient outcome debriefing
• Direct observation and video review
• Handover / transitions of care

46
47
Other teaching and assessment opportunities:

Outside of the clinical Setting

• Facilitating a teaching session (rounds, lunch and
learn, small group session)
• Academic program or session
• Reflection on teaching and learning (portfolio)
• Formal interprofessional education sessions
• Team chart audits
• Peer feedback

48
49
Educational Leader

• To ensure programs meet IPE accreditation

requirements
• To ensure faculty are prepared to teach and assess
collaborative practice competencies across
educational contexts.

50
Cahn P. Seven dirty
words: Hot-button
language that
undermines
interprofessional
education and practice.
Academic Medicine
2017 . 92;8:1086-1090
CFPC CR Resources
CFPC Additional Resources

www.cfpc.ca/teaching
CFPC Additional Resources

www.cfpc.ca/teaching
Final comments

What:

• will you take away from this

session?
• will you bring back to your teaching
context?
• might you do differently?
QUESTIONS???