This document discusses research into continuing medical education (CME) for general practitioners (GPs) in palliative care. It finds that current CME offerings are uncoordinated, have large gaps, and have low attendance. GPs prefer lifelong learning and find current CME inefficient. Workplace learning with palliative home care teams is preferred. When nurses on these teams are trained as facilitators, it can enhance GPs' learning by exploring opportunities, giving feedback, and facilitating reflection. This workplace learning approach views the healthcare team as a complex adaptive system that can adapt and improve its functioning through learning.

1. Peter Pype MD, PhD
Peter Pype – EGPRN - Antwerp 2012 pag. 1
Ghent University - Belgium

2. Presenter Disclosure
• Faculty: Peter Pype
• This program has received financial support
from :
Kom op tegen Kanker, campaign of the Vlaamse
Liga tegen Kanker VZW.
There has been no influence of the funding body
on the content of the study.

3. 1. Background
1. Most palliative patients prefer to stay at home
2. General Practitioners (GP) are responsible for patient care
3. Palliative Home Care Teams (PHCT) provide advice and support
General Research Aim:
How do GPs keep up their palliative care competences?

4. 2. Research Questions
RQ1: What is the current CME offer in palliative care for GPs?
RQ2: What are GPs’ views and preferences toward lifelong learning in
palliative care?
RQ3: What are features of workplace learning in primary palliative care?
RQ4: Can WPL be enhanced by training PHCT nurses as facilitator of
physicians’ learning?

5. 3. Results – RQ1: Current CME
• Uncoordinated
• Large content gaps
• Mostly lectures
• Low attendance rate

6. 3. Results – RQ2: Preferences GPs
• Lifelong learning acknowledged
• Basic versus expert
• Current CME inefficient
• Mismatch with actual learning needs
• Alternatives
• Workplace learning with palliative home care teams

7. 3. Results – RQ3: Features of WPL
• Workplace learning is reciprocal
• Content items (e.g. patient symptoms) more than proces items
(e.g. teamwork)
• Discussion and reflection – listening and observing more than
learning from mistakes – receiving feedback
• Individual characteristics seem not important

8. 3. Results – RQ4: training nurses as facilitator
Training content:
1. Recognising and exploring learning opportunities
2. Shifting specific questions to generic ones
3. Giving positive and negative feedback
4. Critical incident analysis
5. Debriefing the collaboration

9. Full day training
Small group sessions
Interactive
Role play
Individual reflection
Group reflection
Practice based
Three months
practice
Practice experience
Home work
Progress report
Individual feedback
Half day training
Small group sessions
Interactive
Role play
Individual reflection
Group reflection
Practice based
Summative assessment
Training format
Interviews (video)

10. 3. Results – RQ4: training nurses as facilitator
• Implementation depends on:
• Personal factors (e.g. professional identity)
• Interpersonal factors (e.g. relationship with GP)
• Team factors (e.g. preparing a conversation)
• Context factors (e.g. workload – phone call versus
meeting)
• Style-preference according to context
• Importance of ‘mentoring period’

12. 3. Results – RQ4: training nurses as facilitator
• Palliative care nurses learn as well as the GPs
• Palliative care nurses change attitudes toward GPs
• No more ‘good and bad doctors’
• Caring for GP as team member
• Home care nurses get involved
• GPs ‘change’
• Notice new style
• Make more time

13. • Traditional CME seems insufficient to support GPs in their
palliative care tasks
• Workplace learning seems a suitable and feasible complement
• Workplace learning can be influenced by training team members
as facilitators
4. Conclusion

14. 5. Discussion
• Linear cause-effect relationships are insufficient to explain results
• System thinking:
‧ Complexity Science
‧ Complex Adaptive Systems

15. Health Care team as Complex Adaptive System
Workplace learning
 Adaptive behavior of a care team (‘Adaptability’)
 To a ‘changing environment’ (internal of external change)
 Resulting in team-functioning on a higher level