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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.

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Human factors science in the undergraduate medicine curriculum at dundee

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
Outline Curriculum at Dundee

  • Teaching Agenda

  • Progress

  • Challenges

  • Strategic Vision


Teaching agenda

Teaching Agenda Curriculum at Dundee


Teaching agenda1
Teaching Agenda Curriculum at Dundee

  • Development of Human Factors Science in the undergraduate medical curriculum

  • Integration of teaching and research

  • Critical thinking development


Gmc s tomorrow s doctors 2009 outcomes to be addressed by human factors science teaching
GMC’s Tomorrow’s Doctors (2009) Outcomes Curriculum at DundeeTo be Addressed by Human Factors Science Teaching



Outcomes 1 the doctor as a scholar a scientist
Outcomes Curriculum at Dundee1The doctor as a scholar & a scientist

9 Apply psychological principles, method & knowledge to medical practice

  • 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


Outcomes 3 the doctor as a professional
Outcomes 3 Curriculum at DundeeThe 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

  • Place patients’ needs & safety at the centre of the care process

  • Deal effectively with uncertainty & change

  • 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


Human factors science design delivery
Human Factors Science: Curriculum at DundeeDesign & Delivery

An interactive and continuously evolving process


Planning i
Planning I Curriculum at Dundee

  • 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


Planning ii
Planning II Curriculum at Dundee

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


Developing
Developing Curriculum at Dundee

  • 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)


Implementing albeit fragmentarily at the moment
Implementing Curriculum at Dundee(albeit fragmentarily at the moment!)


Fundamental characteristics of human factors
Fundamental Characteristics of Human Factors Curriculum at Dundee

  • 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)


Progress

Progress Curriculum at Dundee


Year 1
Year 1 Curriculum at Dundee

  • Principles Block

    Systems thinking

    [Clinical human factors skills & IPL]

  • Respiratory Block

    Integration of systems thinking and clinical human factors skills

  • GI Block (in preparation)

    Application of systems thinking and clinical human factors skills


Principles lecture

Principles Lecture Curriculum at Dundee


Learning objectives
Learning Objectives Curriculum at Dundee

  • Define Human Factors Science

  • Develop an understanding of systems thinking & its applicability

  • Explain the relevance of Human Factors Science to clinical practice


Human factors ergonomics definition
Human Factors/Ergonomics Definition Curriculum at Dundee

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 ~


Definition reinforced
Definition – Reinforced Curriculum at Dundee

“… 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.


S ystems e ngineering i nitiative for p atient s afety seips model
S Curriculum at Dundeeystems 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


The wayne jowett case
The Wayne Jowett Case Curriculum at Dundee

  • Identify the SEIPS elements involved in this case

    http://www.smd.qmul.ac.uk/risk/videos.html#



Human factors science in the undergraduate medicine curriculum at dundee

  • Recognise that Curriculum at Dundeeinteractions 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

How do you apply SEIPS Systems Thinking in practice?


Respiratory lecture

Respiratory Lecture Curriculum at Dundee


Learning objectives1
Learning Objectives Curriculum at Dundee

  • 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


Integrating systems thinking clinical human factors skills
Integrating Systems Thinking & Clinical Human Factors Skills Curriculum at Dundee

Decision making

Managing stress

Coping with fatigue

Communication

Team working

Situation awareness

Leadership


Human factors science in the undergraduate medicine curriculum at dundee

Problem Solving in Action Curriculum at Dundee


Try to solve the following problem in groups of no more than 3 people you have 5 minutes
Try to solve the following Curriculum at Dundeeproblem 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


Human factors science in the undergraduate medicine curriculum at dundee

The Solution to the Curriculum at DundeeCheap 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


Systems thinking in problem solving
Systems Thinking in Problem Solving Curriculum at Dundee

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?


Application to clinical practice

Application Curriculum at Dundeeto

clinical practice


The elaine bromiley case
The Elaine Curriculum at DundeeBromiley 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?


Linking the bromiley case to the cnp problem solving performance
Linking the Curriculum at DundeeBromiley case to the CNP problem solving performance

In the CNP

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

  • 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

Failure to escape fixation by capitalising on cues in the environment


Suggested actions from an independent review 2005
Suggested Actions from an Independent Review (2005) Curriculum at Dundee

  • 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



Summary
Summary Curriculum at Dundee

  • 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


Gi workshops in preparation

GI Workshops Curriculum at Dundee(in preparation)


Year 2
Year 2 Curriculum at Dundee

  • Dermatology Block

  • Child & Family Block (in preparation)


Dermatology online module

Dermatology Curriculum at DundeeOnline Module


Learning objectives2
Learning objectives Curriculum at Dundee

  • 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


Child family workshops in preparation

Child & Family Workshops Curriculum at Dundee(in preparation)


Year 4 transition block 2 workshops

Year 4 Curriculum at DundeeTransition Block 2 Workshops


Learning objectives3
Learning Objectives Curriculum at Dundee

  • 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


Evaluating
Evaluating Curriculum at Dundee

  • Feedback from students*

  • Feedback from clinical teachers

  • Learn from the feedback and improve the programme accordingly…


Challenges

Challenges Curriculum at Dundee


Integrating human factors principles in clinical training and practice
Integrating Human Factors principles in Curriculum at Dundeeclinical 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…


Solutions
Solutions? Curriculum at Dundee

Human Factors integration throughout the spiral curriculum

Co-ordination with clinical colleagues but also acceptance of individual differences & contextual issues

Cultural change via leadership


Strategic vision

Strategic Vision Curriculum at Dundee

To enhance the synergy between Research and Teaching and ensure sustainability


The dundee medical graduate
The Dundee Medical Curriculum at DundeeGraduate

  • 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


Strategies for sustainability research teaching initiatives
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


Thank you

Thank you! Initiatives)

e.fioratou@dundee.ac.uk