"Clinical and Educational Innovation in Daily Practice : An Achievable Goal"?

1. "Clinical and Educational Innovation in Daily Practice: AnAchievable Goal"? Brian Hodges MD, PhD, FRCPC Wilson Centre for Research in Education University of Toronto

2. What is innovation?

3. …the successful introduction of something new and useful, for example introducing new methods, techniques, or practices Wikipedia

4. Learning and innovation go hand in hand. The arrogance of success is to think that what you did yesterday will be sufficient for tomorrow. William Pollard

5. What makes an innovation useful? • Solves an existing problem or improves an existing process • Solves more problems than it creates (caution with technology!) • Novel approach, different from what is routine • Not necessarily “evidence-based” or widely accepted

6. Improves something that is problematic

7. Turns a failure into a success

8. Innovation is part of expertise • A routine expert excels on well known, routinized tasks… (But tends to use the same routines over and over) • An adaptive expertis able to adopt an innovative orientation to their practice…using problem solving as an opportunity to innovate, thereby creating new knowledge Maria Mylopolous 2008

9. Too many are waiting for the research • In culture of evidence-based medicine, the process of improving practice focuses on the adoption of innovations developed through systematic research • Thus we wait for innovations to be “produced by researchers”

10. A critical dissociation The emphasis on externally produced and institutionally sanctioned innovations has marginalized the perceived value and impact of knowledge produced by practitioners in the course of their daily practice. Mylopolous

11. Innovation: part of the culture By fostering a workplace where knowledge produced in daily practice is an object of reflection and collaborative idea improvement, we could potentially generate solutions to many of the problems that occur regularly in health care practice. Mylopolous

12. 3 Case Studies

13. Case 1: As a teacher • Neuroscience small group teaching • The Basal Ganglia! • Year after year, boring, forgettable and frustrating

14. This is Parkinson's Disease

15. But so is this

16. Case 2: Course Level • Brain and Behaviour course • Topic: Mental Health • One week, 4 h/day, 20 lecturers • A bit of every disorder and all the science for each • Lowest ratings in the entire course

17. Brain storm with the best • Got the best (but not too many!) • Asked “What do we want to achieve?” • ‘Questioning science’ • How psychotherapy rewires the brain • Created only 3 really good lectures (4 hours each) with: • Interactive demonstrations - teaching skills • Videos, SPs and real patients • Top ratings ever since

18. Case 3: Departmental Level • “Rift” between basic science teachers and clinical teachers in psychiatry • Basic scientists uncomfortable with teaching/little access • Clinicians anxious about their basic science knowledge • Solution? The Pedagogical Partners Program

19. Pedagogical Partners Program • One year program • 10 basic scientists, 10 clinical teachers put together in pairs • “Get to know you” approach • Shared project work: case writing, OSCE station writing, recommendations • Co-teaching and observation partnerships • Result: change of culture, involvement, but also presentations and a publication

20. Sustained Innovation: Try something and keep refining it

21. Start with an idea

22. Your first efforts may not be perfect

23. It might even get worse

24. Success comes through sustained effort

25. Sustained innovation is a commitment In this way, knowledge is produced as an activity of practice… …and innovation is understood as a process embedded in daily practice. Mylopolous

26. Is my fiddling really interesting to anyone? • “…if you take a look at what’s really considered innovative, its probably people who came up with initial discoveries; the light bulb, the steam engine…” • “I think that those little things [that I do] are just so minor, it’s kind of just what you do on the side to make things work a little more smoothly…its not really that innovative”

27. The original

28. The fiddlers

33. Programmed Patient • Simulated Patient • Patient Educator • Patient Partner • Standardized Patient • Virtual Patient

34. OSCE OSPE OSATS OSTE CEX PAME

35. Why should I bother sharing my ideas?

36. “Sometimes I tell people what I do, but do they adopt that process? I have no idea” • “I’d probably be embarrassed talking about it to anyone else…I don’t think I’ve done anything worthy of sharing to be honest”

37. “Improvable Ideas” The purpose of sharing knowledge is not for the purpose of encouraging wide-spread, uniform adoption… …but for the purpose of making these improvable ideas available to the larger community for adaptation and improvement Mylopolous

38. How do I share? • Write it up: • Medical Education Really good stuff • Medical Teacher • Present it: • AMEE • APMEC • SIMEC!

39. The blue sky exercise Make a commitment to create an innovation in teaching

40. In what situation/class/course could you make a commitment to create an innovation?

41. If you're not failing every now and again, it's a sign you're not doing anything very innovative.Woody Allen Thank you!

42. Reference • Mylopolous M et al. Physicians perspectives on their innovations in daily practice: Implications for knowledge building in health care, Medical Education 2008 In press