Practical Tips for identifying Unperceived needs
Sam J Daniel, MD, FRCSC
Director Pediatric Otolaryngology,
McGill University
Disclosures
• Speaker Abbott
• Advisory panel Merck
Objectives
At the end of this workshop participants will be able to:
• Describe the differences between perceived and
unperceived needs
• Utilize strategies to identify practice / performance
gaps of physicians
• Explain the barriers and challenges to identifying and
integrating unperceived needs within CPD planning
processes
Learning need
The gap in
• knowledge,
• skill,
• attitude,
• practice
between what currently exists and what is desired.
Needs assessment
• The tool that we use to identify and measure the gap.
• should be conducted to identify perceived and unperceived
educational needs of the target audience.
• Intended to identify an absence or lack of necessary
knowledge or skill that creates a variance between current
practice and best practice activities.
• The needs assessment process should be used to identify
the content and format of the educational event.
Perceived Needs
• I know
what I want and/or need to know
Unperceived needs
• I don’t know
what I don’t know and/or need to know
Applies to any field
There are known knowns. These are things we
know that we know. There are known
unknowns. That is to say, there are things that
we don’t know. But there are also unknown
unknowns. These are things we don’t know we
don’t know.
Donald Rumsfeld, US Secretary of Defence, 2002
Foot in the Mouth Award Winner 2003
Johari Window
Known to
Others
Unknown to
Others
Known to Self
Unknown to
Self
Open Arena
Blind Spots
Facade
Unknown
(Hidden
depths)
Perceived needs
Determining perceived needs
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Surveys
Solicited topics- open-ended questionnaires
Interviews
Focus group
Planning committee
Evaluations from previous CPD events
Requests from the target audience
Unperceived needs
Determining unperceived needs
• Can be very difficult.
• Unperceived needs are outside the awareness
of the learner.
• if someone is not aware of a need to learn
something new it is unlikely that they will.
• Also referred to as “objective needs”.
Determining unperceived needs
• Assessment activities provide physicians with
tools and a process that generates data and
provides feedback to facilitate an assessment of
multiple aspects of a competence and
performance in relation to external standards.
• This allows us to identify previously unperceived
needs.
Physician self-assessment
Davis DA, Mazmanian PE, Fordis M, Van Harrison R, Thorpe KE, Perrier L.
Accuracy of physician self-assessment compared with observed measures of
competence: a systematic review. JAMA. 2006 Sep 6;296(9):1094-102.
The ability of physicians to accurately evaluate their
own knowledge, skills and performance without
external measures is limited.
Physician self-assessment
Perhaps of greatest concern are the findings that
those who perform the least well by external
assessment also self-assess less well.
Determining unperceived needs
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Knowledge test
Simulation
Chart audit
Critical incident
Expert advisory group
Patient feed-back
Quality assurance data from hospitals
Combo
Knowledge test:
• Learners are asked to respond to questions that
test their knowledge.
• These can be multiple choice quizzes, a true/false
quiz, a presentation of cases with questions or any
variation thereof.
• An Audience Response System can be used in large
group settings.
Interactive case:
• Presenting a case with numerous opportunities for
participants to reflect on their own practice vs.
what is recommended.
Disorienting case:
• Presenting a “disorienting dilemma” to the
audience in which something that is commonly
believed to be true is proven to be false (or vice a
versa).
Performance assessment
• Can occur in a simulated environment or in the
actual practice environment of an
• individual (personal performance, assessment),
• group of physicians or inter-professional health
team (collective performance assessment).
Broad range of situations
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clinical,
education,
research,
administrative practice.
Simulation:
• Simulation activities reflect a broad range of
fidelity (from standardized patients and joint
models to programmed mannequins) and can be
designed to be administered through the web or
face to face.
• Simulations lead to effective learning by providing
feedback during the learning experience and by
enabling physicians to identify unperceived needs.
Virtual Patients
“Specific type of computer program that
simulates real-life clinical scenarios; learners
emulate the roles of health care providers to
obtain a history, conduct a physical exam, and
make diagnostic and therapeutic decisions.”
Cook DA, Triola MM. Virtual patients: a critical literature review and proposed next steps. Medical
education. 2009;43(4):303-11.
Virtual Patients
• Variety of VPs
– Linear vs. branched
– Individual vs. group
– Synchronous vs. asynchronous
Huwendiek S, De Leng BA, Zary N, et al. Towards a typology of virtual patients. Medical Teacher.
2009;31(8):743-748.
SimuCase Virtual Patient
Assessment (examples)
CanMEDS role
Individual
Team
System/ resources
Medical Expert
Knowledge, pt assessment,
mgmt, problem-solving…
Problem-solving, task
prioritization…
Resources for assessment &
mgmt & support…
Communicator
Share mental model, listen,
assertiveness, elicit info…
Synthesis into shared care
plan…
Systems for communication
Collaborator
Own role, delegation,
leadership, conflict resolution…
Role adaptivity, synthesis,
situational awareness, conflict
resolution
Policies on roles/
responsibilities, support for
collaboration…
Health Advocate
Recognition & system
activation…
Manager
Own role, leadership, prioritysetting, resource allocation…
Synthesize care plan, resource
optimization…
Scholar
Insight into limitations, peer
feedback…
Insight into limitations…
Professional
Ethical practice,
interprofessional attitudes…
System response mechanisms,
barriers to access care…
Support & barriers to teambased care…
Chart audit
• Systematic examination of patient charts looking
for patterns of care that can be appropriate or
inappropriate.
• Expensive and complex to perform properly.
Critical incident:
• Information using this technique can be gathered
by using a hypothetical case situation.
• Can take place as a review of clinical records after
an important event such as a missed diagnosis has
occurred.
Duplicate prescription/
health care diary:
• Prescriptions are filled out in duplicate.
• Patterns in prescribing and their effectiveness can
be determined over time.
• Can be asked to keep a practice diary for a few
weeks before a program and after a program
related to specific topics.
Patient feedback:
• Patients are asked to fill in surveys or respond to
interviews about specific aspects of their care.
• Forums / discussion boards
Rate MD etc.
Quality improvement structures
• Mortality & Morbidity Rounds:
– Learning from group discussions
– Learning from ‘others’ mistakes
• Quality improvement committees
• Incident reports
Expert Advisory group:
• Experts often know a great deal about the
unperceived needs of other health professionals
because they receive patients as a result of referrals.
• The referrals can give a lot of information on
unperceived learning needs of the target audience.
• Experts are asked many questions by HP which can
point to learning needs quite effectively.
Data from other sources
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Self-assessment programs.
CPD reporting tools – Mainport.
National examination boards.
CMPA.
Litigation expert consultants.
Quality assurance/audit data.
Provincial databases.
National benchmarks.
Data from other sources
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Epidemiological data.
Re-credential review.
Statistics Infection control data.
Surgical procedures statistics.
Professional society requirements.
News media.
Published literature
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Journal articles/literature citations
Random controlled trials, cohort studies
Clinical guidelines
Developments in scientific research
Inferred needs
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Development of new technology
New methods of diagnosis or treatment
Availability of new medications
New therapeutic indications
Experts’ input re advances in medical knowledge
Acquisition of new facilities or equipment
Legislative, regulatory or organizational changes
with direct effect on patient care
Challenges to identifying unperceived
needs within CPD planning processes
Challenges to integrating unperceived
needs within CPD planning processes
Tough questions to be asked by the
CPD planning committee
• How important is the need among the target
audience?
• How many different assessment sources have
validated this need?
• How significantly will the unfulfilled need or
knowledge gap hinder health care delivery?
• How directly is the need related to actual healthcare
provider performance?
Tough questions to be asked by the
CPD planning committee
• How likely is it that a CPD activity will change behaviour?
• How likely is it that a CPD activity will improve performance?
• How likely is it that the CPD activity will translate into
improved healthcare outcomes?
• Are sufficient resources available to effectively address this
need?
• How receptive will the target audience be to a session on
this particular topic?
Conclusion
• Unperceived needs should be a priority for
every CPD planner.
• Multiple strategies exist to identify practice /
performance gaps of physicians.
[email protected]