navigating the cdhm continuing competency program joanna asadoorian aas(dh), bscd(dh), msc associate...

NAVIGATING THE CDHM CONTINUING COMPETENCY PROGRAM

Joanna Asadoorian AAS(DH), BScD(DH), MSc

Associate Professor

School of Dental Hygiene, Faculty of Dentistry

University of Manitoba

Navigating the CDHM Continuing Competency

Program The CDHM mandate is to protect the

public by ensuring safe, quality oral health care

What is quality…where does competence fit? “degree to which health services for individuals and

populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge”

Blumenthal, 1996

Knowledge, skill and appropriateness of health care Structure and process to ensure best outcomes Competence and daily performance Measurement and improvement of the entire profession

Asadoorian, J., CDHM Presentations Spring 2010 © 7/30/10

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Diffusion of Innovations: Problems & Recommendations

A considerable lag time exists between new research findings and general application into practice settings

Research shows almost a twenty year lapse between dissemination and implementation

Significant time delays reflect a failure to implement newer, more effective procedures and the discontinuation of ineffective or harmful ones

Implies a delay of best practices available to patients

Known as the theory practice gap “Education allowance systems” as in those based

on CE time requirements have been described as failures to the

profession…” (Grant, 2002)

“Conducting a needs assessment is essential in directing the educational process.” (Cantillon and Jones, 1999)


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Self-Assessment (SA): Panacea or Part of the

Problem

Incapability of self-assessing accurately

SA used to protect one’s self concept Need to preserve

confidence and positive attitudes

Learning activities chosen based on areas we excel

SA is an over and misused term Not intended to be an

individualistic activity Multiple sources of

external feedback recommended

(Eva & Regehr, 2007)

Provide direction to one’s learning

Promotes increased efficiency in learning

Generates motivation to one’s learning and for implementing change

(Asadoorian & Batty, 2005)

Rationale for Conducting Self-Assessments

Problems with Self-Assessment


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Self-directed Assessment Seeking

What is Self-directed Assessment Seeking? Collecting data about one’s professional

performance through: honest reflective introspection (internal) requesting unbiased feedback from others (external)

Creating an awareness of deficiencies, opportunities for improvement and continuing competency needs specific knowledge topics, skills, client problems and

practice issues Indicating the continuing competency goals that one should ideally address

1. Self-directed

Assessment


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Self-directed Assessment Seeking (SDAS)

Internal evaluation should be conducted in a meaningful and structured way

Use of tools for thinking about one’s own practice performance 1. Reflection-on-

practice 2. Competencies &

Practice Standards 3. Evidence-based

Practice 4. Self-assessment tests

External evaluation should be intentional, ongoing activity and increasingly relied upon

Use multiple sources: Include appraisal by

peers, experts, clients and others to help expose areas in need of improvement

Tools available to carry out

Internal External

1. Self-directed

Assessment

How to accomplish a meaningful SDAS:


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Internal: 1. Reflection on Practice Defined: “an important human activity in which

people recapture their experience, think about it, mull it over and evaluate it” (Boud)

Reflect on and learn from: Day-to-day practice problems

client care including complex medical conditions, communication challenges, procedural difficulties and poor treatment outcomes– surprises!

Ongoing challenges from one’s practice environment Antiquated office policies, conflicting treatment

philosophies and structural inadequacies Practice problems often generate emotional

responses: Emotional cues help identify competency challenges Maintaining a practice log aids in recalling challenges for

later reflection

1. Self-directed

Assessment


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Self-directed Assessment Seeking: Reflection on

Practice

1. Self-directed

Assessment

5 Good Reasons: 1. Links theory & practice

2. Uses our own (clinical) experiences

3. Helps make sense of real practice problems“messy swamplands”

4. Encourages a different kind of learning- deep rather than superficial

5. Generates a different kind of knowing“transformative” knowing that motivates

change


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Keys to Using Reflection in Practice: Foundation is concrete experience; start

with meaningful experiences Structure may help; use a model for a

framework Many available: Kolb, Mezirow, Boud…

Use your feelings; trigger the need to reflect Reflect regularly Start with a Journal or practice log

Note your feelings and/or practice problems

1. Self-directed

Assessment

Self-directed Assessment Seeking:

Reflection on Practice


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A Suggested Model of Reflection An integration of the literature…

TriggerDescribe theExperience

Develop an Awareness

Analyse theSituation

Relate the Experience

Develop a newPerspective

Validate newPerspective

Non-reflectors

Reflectors

Critical Reflectors

Asadoorian, 2005


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A Suggested Model of Reflection An integration of the literature…

TriggerDescribe theExperience

Develop an Awareness

Analyse theSituation

Relate the Experience

Develop a newPerspective

Validate newPerspective

Non-reflectors

Reflectors

Critical Reflectors

Asadoorian, 2005

What was your emotional response

Give a descriptive account of

what happened

What was occurring before and after; what

other things were influencing you

Take the experience apart and examine it

What knowledge do you have that relates to this;

what knowledge is

missing

Transformed thinking results and

compels change

Trying out new

thinking and seeing

how it works in practice


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What, why, how? Helpful for determining professional strengths and

weaknesses and directing one’s continuing competency goals

Using these documents involves comparing one’s own practice performance to the competency/standard outlined in the document Look for new National Competencies document on

CDHA website (September) To determine if one has competency in the specific

item or if additional development is required— often due to insufficient knowledge, skill and/or experience

The dental hygienist is cued in to develop a corresponding continuing competency goal

1. Self-directed

Assessment


Internal: 2. Competencies & Standards


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1. Self-directed

Assessment


Internal: Competencies & Standards

ASSESSMENT (67 Competencies) √

29 Assesses health status of dental implants

30 Assesses hard and soft deposits

31 Assesses intraoral hard tissues


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Internal: Evidence-Based Practice3. EBP: The rationale

“the most cost-effective opportunity to improve patient outcomes over the next quarter century will likely come not from discovering new therapies but from discovering how to deliver therapies that are known to be effective” (Berenholz & Pronovost, 2003)

Even the most robust evidence supporting optimal clinical care typically fails to be implemented

Failures in knowledge application results in gaps between best practice and actual performance

In health care practice, practitioners may be unaware of what they do not know

Dental hygienists may not realize that current research does not support a specific routine procedure

1. Self-directed

Assessment


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Internal: Evidence Based Practice Reading professional journals and articles, attending professional conferences and lectures, searching databases, conducting research and participating in journal clubs provide valuable opportunities for exposure to new research

Databases: “PubMed” (Medline) Cochrane Collaboration- Reviews

Search, by topic Oral health

1. Self-directed

Assessment


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Internal: 4. Self-Assessment Tests Read article and then take SA test

immediately Take SA test first to determine if reading

article is necessary Take SA test later for retention and

application

1. Self-directed

Assessment


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External: Questions, Discussion and Feedback

Increasingly rely on external sources for feedback about performance

Highlights topics or issues that one has limited knowledge about or contradicts one’s current beliefs It is human nature to dismiss or rationalize negative feedback

or conflicting philosophies Opportunities may occur spontaneously (i.e. client

questions, employer/colleague comment and discussions), but more often individuals must solicit others for feedback Questions, discussions, and feedback from peers,

employers and clients provide excellent resources for identifying deficiencies and opportunities for improvement: Continuing competency goals

1. Self-directed

Assessment


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External: Questions, Discussion and Feedback

1. Self-directed

Assessment

DENTAL HYGIENIST SELF-DIRECTED FEEDBACK FORMName:Date:Please return feedback by:Thank you for agreeing to provide your valuable feedback to me

regarding my dental hygiene practice. Your feedback will assist me in addressing my learning needs.

On the following sheet(s) please make written comments about the area(s) indicated below.

When you are providing the feedback please be specific, clear and descriptive. Please include examples where possible.

I would also appreciate meeting briefly with you to discuss your feedback. Perhaps we can schedule some time to meet after you have returned the written feedback.

1.__________________________________________________________________ 2.__________________________________________________________________ 3.__________________________________________________________________

Asadoorian, J., CDHM Presentations Spring 2010 ©

It is important to ask for others to be specific and limit feedback:

7/30/10

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1.

Strengths I have noticed:A

B

C

Enhancements that could be made:A

B

C

Date Written: Date Reviewed:


7/30/1019

Self-directed Assessment Self-directed Assessment

Self Directed Assessment: CCR

How did you determine that you had a professional need or deficiency? (See pages 10 & 11 in Section 2 of the CCP Package)

Practice problems & reflection

Using the CDHM Competencies/Standards/Code of Ethics

Questions, discussions or external feedback

Evidence-based practice

Other: (Specify) ________________________________________

FILLING OUT THE FORM! Step One:


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Program Professional Development Component:

CCR

1. Self-directed

Assessment

2. Goals Development

& Activity Planning

3. Activity Implementati

on & Evaluation


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Goal Development &

Planning Activity Self-directed assessment seeking strategies assist in

detecting deficiencies and opportunities for improvement Step two involves developing continuing competency goals

and associated plans to address identified deficiencies Two typical types of goals:

knowledge attainment goals action oriented goals

action oriented goals often require change to practice and may require activities to support the behavior change from the clinician or other practice members

Practice deficiencies must be prioritized to determine if which require immediate attention and those that should be deferred

Planned activities should address some aspect of achieving one’s goal and chosen based on resources and preference one to several activities will be needed to support achievement of goals use traditional methods and new online and digital resources

2. Goal Development

& Planning Activity


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Goal Development

Once “cued in”, describe in detail the perceived practice deficiency/opportunity for improvement May be just a hunch at this

point Include:

What led to this observation?

What do you already know? Is it possible this

knowledge could be updated?

Is it possible that practice is not currently based on evidence?

In one sentence, define a goal that captures the need you have identified Include a subject,

action, timeline and measurable outcome

Example: “Within 6 months, I will

ensure that the dental implant care I provide/recommend is based on the most current evidence available”

Developing the goal Defining the goal

2. Goal Development

& Planning Activity


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Goal Development

I have been out of school for several years and have not really ever incorporated ultrasonic scaling into my clinical practice; I practice with a new graduate dental hygienist and she uses the ultrasonic scaler along with hand scaling with virtually every client. She explains to her clients that ultrasonics is the latest technology and that it has several therapeutic benefits over and above hand scaling. This makes me feel uncomfortable for several reasons. First, I am not sure how accurate the information she is sharing is, but I feel a little out of date on my knowledge surrounding power scalers and therefore not well-equipped to have a discussion about it. Second, I would prefer that we practice in a more standardized way based on the most recent evidence. Lastly, I am wondering if my clients feel short-changed that they are not receiving ultrasonic debridement because they may over hear what she is telling her clients.

Developing the goal

2. Goal Development

& Planning Activity


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Goal Development

I will use the ultrasonics/power scalers in my dental hygiene practice in accordance with the most recent research/evidence within 6 months.

Be specific Be realistic Include only one goal Will you be able to measure your

success?

Defining the goal

2. Goal Development

& Planning Activity


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Planning Activity

Once the goal is developed and defined, determine some objectives (mini-goals) to meet the goal

Think about the learning component AND what will be needed to ensure implementation of the goal into practice: be realistic and detailed

Consider what resources will be available and what you prefer to use for achieving goals This may require some research Try to incorporate new methods

(i.e. internet searches, online learning programs)

This is a plan, and may require some modifications later


2. Goal Development

& Planning Activity

Objectives/mini-goals: What do I need to achieve and

learn? i.e. latest ultrasonics

information/research How am I going to do it?

(potential ideas) Do PubMed/Cochrane search

Download relevant articles See if any courses/workships

coming up on topic MDHA, CDHA, industry

Call an expert Educator, researcher, colleagues

Then what? Implement!! Read, attend, consult, buy…Make

Changes To Practice!

7/30/10

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Goal Development &

Activity Planning

Goal Development &

Activity Planning

Goal Development & Activity Planning: CCR

Please describe the professional need or deficiency perceived: (see pages 10 & 11 in Section 2 of the CCP Package)

__________________________________________________________________________________________________________________________________________________________________________________ ...CONTINUING COMPETENCY GOAL # 1: (see pages 12 & 13 in Section

2 of the CCP Package)

I will use the ultrasonics/power scalers in my dental hygiene practice in accordance with the most recent research/evidence within 6 months.

FILLING OUT THE FORM! Step Two:


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Program Professional Development Component:

CCR

1. Self-directed

Assessment

2. Goals Development

& Activity Planning


on & Evaluation


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Changing Practice: Activity Implementation & Evaluation


on & Evaluation

Knowledge Awareness ≠ Knowledge Application People, including dental hygienists, resist change

Dental hygienists have been shown to embrace traditional behaviours and maintain the status quo ~ even in the face of strong evidence

Barriers exist that contribute to making change difficult– but enhancers exist too!

Facilitating the change process: Recognize the relevance of a change Possess transformed thinking (from reflection on practice) Use more active strategies for learning

Problems carrying out change: Change is not automatic; humans do not behave completely

rationally Human change process is complex

based on individual and structural influences


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Changing Practice: Activity Implementation & Evaluation

Activity Implementation: Matching activities to practice

deficiencies ensures the most efficient use of one’s time— rather than spending numerous hours on

activities that are irrelevant to one’s practice Using a detailed and realistic activity

plan, it is relatively straightforward to carry out

Activities can be conducted over a period of time to achieve continuing competency goals

Despite the most carefully developed activity plans, some obstacles may be encountered In these cases it will be necessary to

implement a contingency plan and adjust one’s timeline accordingly



on & Evaluation

Evaluation: One of the most important continuing

competency tasks is the evaluation of goals Without evaluation it is impossible to know

how to proceed Three possible outcomes to the

evaluation are possible: goal is met goal is unmet goal is in process

Based on the outcome, think about what will need to occur next Goals are fully met: focus on new continuing

competency activity or goal Unmet or in process goals: more learning or

supplementary activities may be necessary; a need to revise the goal may also become apparent

7/30/10

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Activity Implementation

& Evaluation

Activity Implementation

& Evaluation

Activity Implementation &

Evaluation: CCR

CONTINUING COMPETENCY ACTIVITIES: What type of activities did you participate in to support the achievement of this goal? Check all that apply (see pages 14 & 15 in Section 2 of the CCP Package)

Educational Courses/Seminars Date of Course: _______ Name of Course/Presenter: __________

Online Courses Date of Course: _______ Name of Course/Presenter: __________

Advanced Formal Education Institution: ___________ Name of Course/Program of Study: ___

Professional Journals/ Articles Date Read: __________ Journal/Article Reviewed: (may attach)

Journal Clubs Date(s) Met: _________ Journal and/ or Topic Reviewed: _____

Videos or DVDs Date Viewed: _______ Title of Video/DVD/Producer: ________

Other: (Specify) _______ Please describe: ______________________________________

What was the approximate time spent participating in the activities? __________

FILLING OUT THE FORM! Step Three:


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Did these activities assist you in meeting your Continuing Competency Goal? Met Not Met Partially Met

Please Explain: ________________________________________________...

Please describe the information/skills gained from these activities:_____________________________________________________________...

What changes do you intend to make in your area of dental hygiene practice as a result of these activities?

(please include the timeframe you hope to accomplish this in - i.e. immediately,

within 1 year): __________________________________________________...

FILLING OUT THE FORM! Step Three (cont...):


Did you implement these changes into your dental hygiene practice? Yes No In-Process

Briefly Describe: ___________________________________________________________ …

If a change was made, did it help to improve your dental hygiene practice? Yes No In-Process

Briefly Describe: __________________________________________________________ …

Were there any constraints you encountered in implementing this change? Yes No

Briefly Describe: __________________________________________________________ …

FILLING OUT THE FORM! Step Three (cont...):


Navigating the CDHM CCP:In Summary

Self directed

assessment

Goals development & activity planning

Activity implement

ation & evaluation


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navigating the cdhm continuing competency program joanna asadoorian aas(dh), bscd(dh), msc associate...

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