İlk olarak STE’nin tek bir etkin yöntemi olmadığı bilinmelidir. Bir erişkin olarak doktorların bazıları kitap ve dergilerden, bazıları “workshop” ve seminerlerden, bazıları da arkadaşlarıyla ve konunun uzmanlarıyla yaptıkları söyleşilerden öğrenir (Kolb 1984, Schon 1983 & 1987). Erişkinlerin gereksinimlerine göre öğrenecekleri gerçeği göz önüne alınarak STE / SMG programları hazırlanmalıdır. Geleneksel yöntemlerin dışında değişik eğitim yöntemleri kullanılmalı, katılımcılara yöntem seçme hakkı tanınmalıdır. Motivasyon konusu unutulmamalıdır. Bu konu en iyi Maslow’un Hierarşi Piramidi ile açıklanabilir (Tablo 2).
Tablo 2. Maslow’un Hiyerarşi Piramidi
ERİŞKİNİN TEMEL GEREKSİNİMLERİ :
Temel fizyolojik gereksinimler
Güvenlik gereksinimi
Aidiyet ve sosyal gereksinimler
ÖĞRENME GEREKSİNİMİ
Saygı ve statü gereksinimi
Kendini gerçekleştirme ve doyum gereksinimi
Bilindiği gibi, erişkinler en iyi kendileri yönlendirildiklerinde, gereksinimini hemen karşılayacaksa, kendi katılımlarıyla, deneyimlerine dayanarak, yansıtılırsa, geribildirim yapılırsa, saygı gösterildiğinde, güven içindeyse ve çevre rahatsa öğrenirler. Pedogoji ve androgojinin de öğrenme konusunda önemli farklılıkları vardır. Pedagojide, birey sınıfta ve örgün bir eğitim alır. Androgojide ise, birey erişkindir ve eğitim örgün değildir. “Öğrencinin Rolü” ne baktığımızda pedagojide, birey talimatları izler, pasif alıcıdır, bilgiyi kabul eder ve öğrenmede sorumluluğu azdır. Buna karşın androgojide, “Öğrencinin Rolü” ne baktığımızda, deneyimlerine dayanarak fikirlerini sunar, bağıntı kurar, aktif katılır ve öğrenmeden sorumludur. Pedagojide, “öğrenme için motivasyon”, dıştan gelir (Toplum zoruyla), öğrenici hemen yararını görmez; androgojide ise, “öğrenme için motivasyon”, içten gelir ve öğrenici hemen uygulayabilir. Pedagojide, “içerik seçimi”, öğretmenin kontrolündedir, öğrencinin seçiminin önemi yok ya da azdır, “yöntem” ise bilgi ve durumları öğrenme şeklindedir, androgojide ise, “içerik seçimi”, öğrenci tarafından işiyle ya da yaşamıyla ilgili yapılır ve problemler olarak ifade edilir; “yöntem” ise bilgi ve deneyimleri paylaşma, oluşturma şeklindedir. Sonuç olarak, erişkinin öğrenme döngüsü, deneyim, deneyimi yansıtma, deneyimi genelleme ve uygulama şeklindedir.
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SMG'lerin uygulama yapılan her kurumda yapılması gerektiği vurgulanıyor. Yani kişiler işinin başındayken de eğitim alabilmeliler. Bunun dışında da SMG'nin önemli prensipleri 2006 yılında Lüksemburg'da düzenlenen bir konsensus raporunda dile getiriliyor. Gerçekleştirilmesi oldukça zor. Ama bir gelecek planı yapmak şart. Konsensus raporunu aşağıya ekledim.
CPD Improving Healthcare
Luxembourg ,14 December 2006
2/2
CONSENSUS STATEMENT
5) Doctors are very familiar with learning, but learn in individual ways; recognition must be
given to this. Doctors should be supported in being able to use the learning methods that
they prefer, based on an assessment of their learning needs, and educational
opportunities must be sufficiently varied to provide for this. However, doctors should also
be encouraged to develop new ways of learning, and to learn how to make the most of
new technologies that can assist with medical education.
6) Every practising doctor must maintain those components of CPD that apply for all
doctors, such as good communication, team-working, learning from audit and research.
Similarly, each doctor must engage in “specialised” aspects of CPD, which are specific
for each speciality, or sub-speciality, and are relevant to their individual area of medical
practice.
7) Specific attention must be given to the doctor’s work environment, to ensure that this is
supportive of learning “on the job”. This will encourage doctors to reflect on, and learn
from issues directly applicable to their clinical practice. As important members of
healthcare teams, doctors should also be encouraged to support multi-disciplinary, and
multi-professional team learning where that is relevant to the care of patients.
8) Doctors also should take part in medical educational activities outside the workplace,
such as learning through reading, e-learning activities, small group learning, and clinical
conferences. These support the development of learning with reference to externally-set
educational standards.
9) It is important to ensure that learning also occurs when there may have been problems
related to medical care. Accordingly, learning should be linked to clinical audit, patient
and colleague feedback, and clinical/critical incident reporting systems, thus ensuring
that these contribute to a culture of improving quality and safety.
10) Doctors should reflect on what they have learned and on how this can be applied in their
clinical practice. Every doctor, preferably in a peer dialogue, should regularly review the
outcomes of their CPD, and consider what areas need to be addressed before the next
review. To assist with this, doctors should keep a record of their CPD activities, ideally
emphasising what they have learned. In addition to being supportive of good education,
a system such as this – based on peer review of CPD goals set and achieved – also
provides the basis for accountable self-regulation.
11) In order to ensure that doctors can know that they are taking part in formal CPD activities
that fulfil appropriately high quality standards, a quality assurance system, based on
accreditation of CPD events and validation of providers, must be enforced. While usually
these are national systems, in the case of the European Accreditation Council for CME
(EACCME) accreditation can also be confirmed for international meetings.
12) There must be appropriate regulation of formal CPD activities. All providers of formal
CPD activities must adhere to policies – usually national - that ensure such CPD will be
free of any form of bias. There must be a clear declaration by organisers and lecturers of
any potential or actual conflict of interest, and transparency regarding the funding of
educational activities.
Özür dilerim ilk sayfayı eklemeyi unutmuşum. Zaten 5.şıktan yazının başladığını görenler anlamıştır eksikliği. Raporun ilk kısmını aşağıda bulacaksınız.
CONTINUING PROFESSIONAL DEVELOPMENT
IMPROVING HEALTHCARE QUALITY, ENSURING PATIENT SAFETY
CONSENSUS STATEMENT
Within our lifetimes major advances in Medicine have been, and continue to be made. The
implementation of these is dependent on doctors learning how new techniques, therapies
and clinical concepts can improve the quality and safety of care they provide for patients.
Since its establishment the medical profession has recognised the importance of education,
noting this as a core feature of its professionalism and a fundamental ethical principle.
In this new century – characterised by an accelerating pace of change, increasing
complexity, an unprecedented growth in information, and ever-increasing societal
expectations – it is essential that doctors are supported in their continuing education, from
medical school to retirement. Supported in this way, and entrusted with this responsibility,
doctors will be more able to apply the beneficial effects of education, thus developing and
improving their clinical performance.
In addition to contributing to improvements in the care of individual patients, CPD also plays
an important part in improving the quality of healthcare systems. This is through increasing
doctors’ awareness of the need for, and how to achieve improved healthcare. By virtue of
their clinical and managerial responsibilities, doctors are well-placed to implement beneficial
changes to the quality, efficiency and effectiveness of healthcare.
While primarily directed at CPD for doctors, the principles of this statement are applicable in
the context of the multi-disciplinary and multi-professional nature of modern healthcare and
can also apply to other health professions.
1) Continuing Professional Development (CPD) can be defined as the educational means
by which doctors ensure that they maintain and improve their medical competence and
clinical performance. As such CPD incorporates and goes beyond Continuing Medical
Education (CME).
2) It is an ethical and professional responsibility of every practising doctor to ensure that the
medical care they provide for patients is safe and based on valid scientific evidence. In
order to achieve this, every doctor must engage actively in CPD appropriate to their
medical practice.
3) Ultimately it is patients who benefit from the involvement of their doctor(s) in CPD –
through the improved quality and safety of medical care. Patients also benefit from the
greater availability of medical educational material, by being more able to learn about
their own health, illness and treatment. This knowledge would be even further improved
by enhancing the role of doctors in information for and communication with their patients.
4) Irrespective of the nature of the healthcare system – whether employer-based, directpaying,
or insurance-remunerated – resources must be allocated to ensure that doctors
are able to take part in CPD. Resources to support CPD include: educational activities;
access to information technology; time for doctors to engage in education; peer support
for a “learning culture”, and; financial resources and an educational structure to support
these.
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