Just what is a lifelong learning portfolio and what are its primary uses? Dr. Clyman moderates a discussion where participants can address these questions head on. A synthesis of ideas will be captured online. Other discussion questions:
- Healthcare professionals' data are strewn across many places and exist in incompatible formats. Should portfolios be based on centralized data models or distributed data models (with real-time compilation)? What are the potential benefits and pitfalls for different approaches?
- What are the security and confidentiality issues? Can they be addressed by building a secure wall between "public" and "private" data?
- What steps can the profession take to move towards a lifelong learning portfolio?
Recommended reading prior to the session: eFolio: A Secure Personal Data Manager Serving Physicians
If there are specific ideas you would like to discuss at the Unconference on May 14, 2008, enter them here, indicating your name and institution. Ideas from the conference will be captured on this web page. Images and other items to support your content may be uploaded as an attachment to this page as well.
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Introduction by Steve Clyman
What is the vision of a lifelong learning portfolio How can we provide data that is useful for lifelong learning?
What is impeding our progress toward this lifelong learning portfolio?
- When I show up in Med School, I arrive with a customized curriculum- By 3rd year, I'm very accustomed to using this learning environment
- Mentoring is a key in this process - the technologies are there to suggest learning approaches based upon learning profile, learning interests and level of competencies.
- In residency, the information relevant to my residency application is sent to that program
- Right now, residency is a fixed length - why shouldn't it be competency-based learning?
- In Practice:
o I can easily bring up the description of the patients in my profile and target my clinical professional development based upon those patients
§ I can keep current on various competencies and learn new ones as topics become relevant.
It sounds like you're describing a relational database and it's just how you run reports on competencies and evaluation.
We have a different, more humanistic view on personal learning preferences. We frontload it with learning strategies and reflection.
- Needs to be a shift from a model of handing someone the answers and putting the onus on the individual to learn how to learn
- I agree once someone is in practice, but I wouldn't be comfortable with a plastic surgeon who just learned on their own.
- Will this be driven by QI - hospital driven or PI - provider driven
o We should address this in our groups
- Learning portfolio is almost like a playpen - I decide what toys I have in it, but some of the areas of the playpen have evaluation processes in it. Those freedoms give you an opportunity to customize your experience.
- I can picture an Amazon-like system that suggests learnings to you, but the challenge is in building such a system.
What we will do for the rest of the session:
- What are the issues we need to grapple with in order to move ahead with such learning systems?
- What are the guiding principles that will help set the road map for getting to such a learning system?
- Should such a "database" exist in a central repository or be distributed?
- What are confidentiality/privacy issues? Should this information be available publically?
- Continuous versus discontinuous information - should all information move forward through a lifetime or should it "fade away" over time?
- International issues versus custom, local design?
- Control of information - who owns it, shapes it?
- How do we deal with data quality issues? It's easy to make a database, but hard to fill it with quality data
- What other questions do you have that you can answer?
Group Readouts
- World Hunger Group
o Pressing issue: Security and authority to provisioning the data
§ Where the data sits - centralized or geographically dispersed - looking at trusted agents
§ Doc retains authority to release the information - something akin to social networking
§ State licensing boards, federal data sets, local (hospital, health care network) data sources
§ Didn't want to address how publically available this network is
§ Loopback notifications can help
- Retain information just as we would our own personal information (like SSN)
- Culture Warriors
o Look at the top level issues - what is the purpose
§ Used by the doc and only by the doc? Used for licensing bodies? Public information
§ Has to be only number one - for the learning purposes of the doctor
- International perspective - creating this information where you are tracking this information
o Long-term tracking and privacy is not as much of a concern in other countries
- Dyspepsia Group
o Talked about buy-in also
o Describing it adequately for the funders and end users
o If you start thinking about portfolio with a capital P, it is difficult, but if you start with the end services that have perceived value to the users, that can be more useful.
- VA-Enabled Group
o Three levels of information
§ Credentials - already have the data available for this and could put it together with other data to make a useful resource
§ Patient Records - VA enabled - unique among systems has comprehensive records of patients - would be possible to assemble a patient dossier
§ Patient Outcomes - not just what you treated - means you may have to follow patients beyond their initial treatment and track outcomes
o Centralized
§ Better distributed then assembled as needed
o Control
§ Should be available to public, but under the control of the docs
- Wayne's Pretty Good Group
o Talked about acceptance
§ Carrot versus stick
§ Stick gets used a lot, but ultimately there have to be carrots if it's going to be accepted.
- Information flow to credentialing boards that are useful to a broad group of people and uses.
§ Comes down to culture - providing them the tools beyond just the portfolio itself
§ Take a more holistic approach
- Playpen Group
o Didn't want anything developed without collaboration because then someone would own it and we didn't want it to be a regulated, heavyweight type of thing. Think of a tabbed notebook with different resources
§ Public section for maintenance of certification
§ Don't start with MCAT, but at the bedside - share with his or her colleagues - some you may not want to be public
o All saw the complexities
§ To actually identify all the learning objectives - this is a service that could be provided by a company
§ Start simply - Google notes is an example. The tech is not the problem - getting folks to use it is.
- Existentialist Group
o Why are we doing this?
§ Number of different stakeholders that would have an impact on how it is designed, how it is used. Pay for performance,
- Patients deciding whom they want to see
- Performance measure would take on a very different role
- Educational advancement role
- 3 Designers and a Tech Guy
o Who owns the data?
§ Depends on what stage of your career
§ Ultimately it's the doc who decides.
o Need assessment points, define mastery, looking at the holistic view of the portfolio
o Capacity and resources - don't have the manpower or money to do this. We're not the only specialty, so how do we collaborate on this so we have a shared
- Begin with the Beginning Group
o What is the purpose
§ Practitioners in our specialty are able to self-identify learning needs
- Not being used very much
§ As a practitioner, we want to focus on self-driven learning
o Privacy
§ I don't know a lot about treating asthma - does a patient or insurance company find out about it?
- BS-Enabled Group (BSEG)
o Good Informatics Practices (GIP)
§ Two perspectives
- Performance-based competencies
- Chargeable units
§ Unrealistic schedules
- Customers wanting functions before we can build it.
o Process should be a part of care, just as decision support should be connected to the point of care. To what degree can the healthcare system identify those moments
o Use the patient more than we may have thought about
§ Communication competencies - patient documents the performance of the clinician on their ability to communicate
- The Last Group
o Making the ePortfolio easy to use - give med students a reason to use it - easy to use rather than forcing them to use it.
§ Otherwise, they'll just put the minimum amount of information in it
§ Standards to make it easy to transfer the data
- Sharing and portability
- Who owns the objects of a learning portfolio?
§ Moving from one school, hospital, setting to another
o Standards
§ Med Student, resident, physician, specialty
- Different requirements for each group
