Tracey Adams’s design narrative: Advanced clinical assessment protocol workshop
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31 March 2017
I was asked to assist a group of senior clinicians in discussing a complex clinical assessment protocol for their country.
The proposed learning event was a one day workshop. I hadn’t met the clinicians before or visited their country so had limited knowledge of the key personalities involved and the healthcare provision available. I was not given information about the room, the number of people attending but I was assured that they were “advanced” and needed a critical ”deep dive” of information rather than introductory basic lectures.
The key actors were my colleague, the Country manager (who invited me) and the team manager of the clinicians. In addition there were clinicians from independent clinics attending (that is to say there were a mix of internal and external staff present).
From the information I received I was under the impression that the clinicians had a belief that there was a protocol available, that they should be following it to be able to better advise potential patients, to get better value for money by improving patient selection and a desire to provide the best possible care for their patients.
According to my research there is no published standard protocol available globally however the group assembled feel that a protocol should be provided.
In my experience of this clinical assessment in different countries and from published literature, the clinical assessment protocols vary depending on the age of the subject, the equipment available, the experience and the needs of the clinician (what they are trying to show to whom).
The task I was trying to achieve was to bring together ideas in the room concerning appropriate basic test criteria to ascertain whether a subject is a candidate for a particular clinical treatment. In order for the outcome to be successful the discussion needed to be owned by the clinicians attending the event and not imposed by me or managers present. To get to that conclusion they must first decide who they are testing, why and what they need to know (for the patient, for them, for funders, for research).
The measure of success for me would be if we could produce a list of tests that the majority of clinicians present thought were required, appropriate and achievable given the standards of care and equipment available in their clinics.
My first task were practical – finding out about the level of knowledge in the room, the background of the situation and how they had tried to resolve it in the past. I also needed to ensure that simultaneous translation would be available to enable discussion. I imagined that discussion could be stilted by translation and needed to take account of this in the design plan.
Next I carried out background research on the clinical condition and papers published that showed test protocols. I looked for a Cochrane review of outcomes. I summarised these findings in a brief introduction lecture and used one of the key evidence papers to show typical test methods.
A discussion workshop was then planned around discussing this paper and the tests used. The plan was to come up with a gold standard of test protocol and a second more practical one. I expected the discussion to be amongst small groups with the groups summarising and leading to a joint plan. Having not met the clinicians or worked in the country before it was difficult to judge whether large group discussion would be inhibit discussion as it does in some cultures.
Due to the level of the English that the local responsible manager had it was difficult to get clear ideas about the clinicians or how the workshop would run. The organisation was not clear, the timings variable and the set up unknown. This was frustrating but is not unusual. As a result I needed to be prepared to adapt the workshop to suit the needs of the audience as the day progressed.
The workshop was planned with timed goals along the way and submitted to the manager responsible for the region. In order to legitimise the discussion I asked for the clinicians to submit case studies that we could discuss.
I had not considered the set-up of the room layout. It was too small for breakouts. The teacher at the front and the introductory lecture could have led the attendees to feel that the invited expert will tell us, I should have considered what the layout of the room would infer to the learner or as Michael Wesch puts it: “what does our classroom say?”
Small discussions were not possible because of the layout and because unless the speaker held the microphone I could not understand (through translation). This stilted the conversation flow and led to a more formal turn taking that I had envisioned.
This made the introduction extremely important; I needed to encourage discussion from the start, to set the expectation that they would be co-collaborators rather than pupils. Fortunately the group were happy to share their opinions (many were extremely vocal) and this made the large group format successful. It could have failed if this had not been the case.
Case studies were not submitted but they did bring them on the day. I did not get to review them and had to look at them without preparation. This format was not unsuccessful, although stressful for me, as we looked them as a group in relation to our proposed protocol and made adjustments, suggestions and comments as a group. In hind sight this flowed very nicely and was in the main accepted (that I wasn’t going to give an answer, only my opinion along with everyone else) and once the group got into this it worked much better than I expected. It could have failed if none of the group offered ideas or asked questions.
Because the discussion was more formal it took less time than originally planned and the local manager asked me to give another presentation, this one on a deep technical dive into the key clinical tools available to adjust the hearing instrument for complex recipients. This was rather off topic and much more in a lecture mode but to keep them engaged I tried to provide clinical patient stories and asked them to give their own experiences for each tool. This was not ideal however and I felt it detracted from the key aims of the day.
Although the aim had been to provoke a discussion that would result in a protocol proposal, an additional outcome was that the group realised that they had all the information they needed and an organised workshop had led them to come up with the protocol. On summing up my main conclusion points were that all the answers were in the room and that they had designed the protocol and could have similar discussions to review it after a period of use.
I should spend more time on finding out about the audience! I know this can reduce my stress levels (as I don’t have to adjust agendas and rely on my ability to adapt and the task can be better designed to suit the situation and learner). I feel like I’m asking the impossible when I request this type of information so I must not be explaining myself or why I need the information properly.
I did not plan the outcomes well, my aims were very limited. An outcome was that the bones of a good clinical protocol were established but no method agreed to take it forward and flesh it out.
On reflection I should have spent more time looking at how they could provide this level of interaction (without me there to run a face to face workshop) and move the project forward. I would have liked to introduce the Delphi technique (Hill et al 2012) which involves collaborative agreement on statements and has been successfully used in setting up clinical protocol. I should have also spent more time discussing the technology required to enhance this discussion (Padlet or Google Docs) and making concrete action plans to move the project forward. As a result I have been left with finishing the project, and being separated geographically from the participants it is now hard for me to get their further collaboration.
Michael Wesch ( Oct 12, 2010) TEDxKC From Knowledgeable to Knowledge-Able Available online https://www.youtube.com/watch?v=LeaAHv4UTI8 Accessed 27/03/2017
Hill P, Norman G, Davison T, Andrew R, Shanks M, Johnson I, Burrell S, Reid A, Archbold S. Adult bone anchored hearing aid services in the United Kingdom: building a consensus for development. Cochlear Implants Int. 2012 Nov;13(4):228-36. doi: 10.1179/1754762811Y.0000000031. PubMed PMID: 23340028.
Using the CompendiumLD to show the learning design
Version 1: Linear representation with time notes
Version 2: Organised around a wiki
Using the Pedagogical Patterns Collector.
The following PCC file was based on the 'Customising Procedures' pattern and adapted to suit a basic discussion on clincal candidacy to produce a successful assessment protocol.
To access the file (and then open it in the Pedagogical Patterns Collector) download from the following dropbox link: SSD Candidacy and a Successful Assessment Protocol
15:25 on 1 April 2017