Are we saddling clinical education with an unrealistic yoke to carry?
First of all, apologies to those who thought this would be cool stuff about gadgets and manikins.
About two years ago, I began a relieving post that involved attending hospital governance meetings in an educator capacity. In the first meeting I attended (hoping to sit quietly and keep my mouth shut), I was bemused to observe the receipt of audit results relating to medication chart compliance and the almost immediate reaction “well it seems we need to do some education.” My mouth was open before my frontal lobe could kick into gear, “really… do we think nurses don’t know how they are meant to sign a drug chart?”
On later reflection, I considered that this actually happens a great deal in clinical education. Problem (audit/RCA/Adverse event = obvious need for more education. Take a second and consider the alternatives, if it is not lack of knowledge that caused the shortfall. Pretty unsavoury options, wilful disregard, flawed process, individual or system incompetence. If we are honest, these things exist in every large system comprised of people. In a rousing plenary at the Rapid Response Systems Conference in 2012, Dr Rinaldo Bellomo beautifully analogised his hospital with an autistic savant child, capable of inconceivable brilliance, such as organ transplantation and yet incapable of simple attentive observation and communication. So what does that mean for clinical education and if we take on time consuming education targeted at issues in which the route cause is actually system or performance, are we actually even educating? That is, will there be any change?
Point One – it is imperative, in the resource starved health system we work in, to evaluate what we do and deliver “needs” based education rather than “wants” based instruction.
Point Two – in the evaluation process, it is important not to burden an education program/strategy/technique with unrealistic expectations. An interesting example comes to mind. A colleague presented recently on his findings from a pilot program of simulation in a local residential aged care facility. This program evolved greatly from origins in a passionate ad hoc endeavour to a well formed, researched and standards based education unit. Following a q and a session at the end, another colleague accessed data gathered in her role looking at hospital avoidance. We received a deflated phone call the following day stating that, unfortunately, the admissions had gone up from that time period when compared to the previous six months (she was very disappointed). So the education was a waste of time right? (I would love comment/views on this)
Point Three – it is irresponsible to claim direct success in terms of a measurable change mapped directly back to an education program (unless stringently controlled for other variables and stats analysed for significance). A hypothetical example “Educator ran workshop on blood transfusion management for clinical specialty and transfusion errors reduced at next audit cycle.” What else happened in that time?
Point Four – denominators matter. If we had 39 MET calls January 2012 (fictional number) and then 63 in January 2013 (also made up) is that meaningful? The Australian Commission on Healthcare Standards has metrics and guides for comparison of data and trend interpretation. http://www.achs.org.au/publications-resources/clinical-indicator-program/
Thanks for taking the time to read my first blog (rant). This has been something I am very passionate about because I believe education resources should be directed to providing education and not reactive remediation of process or performance failures.
A few points to provoke debate –
Falls prevention education measurable outcome = reduction in falls in hospital?
MET call and recognition and management of deteriorating patient initiatives measurable outcome = reduction in MET calls?
Hospital avoidance education in aged care measurable outcome = reduction in hospital admissions?
Tim Harford’s TED talk inspired me in ways I recall often Trial and Error vs God Complex