Course TopicsELM Methodology
ELM Program Strengths
The strengths of ELM’s education program overall, and programs individually, are demonstrated in 20 years of experience in developing, delivering and improving risk management and patient safety education. Having delivered over a quarter of a million courses since the initial pilot, future ELM clients and participants have the benefit of knowing that the coursework and user interface have been optimized through the feedback and contributions of all those who have participated before them. ELM’s experience and success as an education provider in healthcare is well established and the strength of the material is demonstrated through both client and participant feedback. We believe that this effectiveness is a result of a well developed educational method that is sensitive to healthcare provider learning experience. In addition, the courses follow a process that enables us to “Close the Education Loop.” In other words, at every opportunity, the courses reinforce learning principles and “fill in” areas of deficiency.
We believe in keeping the experience for the end-user of our courses as efficient as possible, and it is for this reason that we have designed our courses in a linear fashion. Our courses are not graphically heavy, nor do they require downloads or special plug-ins to view. We engage users with interesting, real life case sitations, ones in which they could envision occuring to illustate the complicated medical legal issues inherent in the practice of medicine today.
Online Medium
The most obvious benefit of web delivery of courseware is that it offers participants an education alternative unbound by geographic and time constraints. But, from an educational effectiveness standpoint, the Internet affords us a dynamic medium and ongoing process to respond to user feedback and testing trends to make important improvements to our programs. Not only can we make changes and improvements to courses in real-time, but we can be flexible in the specifics of a course delivered, customizing it to particular client need. For example, this allows us to effectively amend courses based on jurisdictions. So that the Informed Consent course for clients in Texas will be most relevant to them, and will be different than the Informed Consent course for clients in New York. Lastly, the online delivery also provides a turnkey mechanism for administrators to monitor participant progress and success. In addition to substantive content, ELM courses offer progress testing, targeted feedback and real-time reporting.
Problem Based Educational Method
ELM courses use problem-based training as the educational approach for health professionals which is an important part of the effectiveness of the courses. This approach uses case situations to discuss relevant medical-legal issues and principles. Situational analysis involves the deft condensation of essential facts and circumstances that define and illustrate a liability “situation” in which trainees are asked to apply specific principles, and to formulate a general principle for future application.
Subject content is authoritative enough to be an appropriate guide, relevant enough to be of practical value, and authentic enough for the trainee to identify with the “situation.” Problem-based case studies examine legal problems inherent in situations that arise in the course of clinical practice. By using cases to illustrate a negligent process, physicians become more aware of sentinel indicators of substandard professional conduct. Case analysis is directed to such fundamental legal inquiries as: What legal interests are involved? How is the satisfaction of correlative duties measured?
Learning Process
All ELM courses employ a standardized Learning Process to profile performance and provide Targeted Feedback for areas of weakness. It is in this way that “the learning loop is closed” in each topic area.
Pre-Test
Each participant in an ELM course unit begins with an initial evaluation of background knowledge.
Overview of Principles and Analyses of Cases
Each course unit explores basic foundation concepts with illustrations and examples of legal, standard of care, or clinical management issues.
Case Principle Quiz Reviews
Each unit has practice self-quizzes which is keyed to review important medical-legal analysis points in preparation for testing.
Post-Test
After completion of each course units, a formal post-test is taken. Each unit’s post test is represented separately in the testing instrument. This allows test scoring of each topic area, as well as scoring of overall performance. When a demonstrated mastery of each topic area has been achieved, the client is certified as having successfully completed the course unit.
Targeted Feedback
After each test, participants are provided with feedback materials to further strengthen any weak topic areas that the client may have passed with a low score. This targeted reinforcement is intended to support the client by reflecting the relative strength and weakness of mastery.
Supplementation
If certification level score is not achieved in any topic area, supplementary materials on that unit topic are presented to the client, and retesting is required until certification is reached.
Content Development Planning Process
The following reviews ELM’s process for new course development.
Step 1: Needs Identification and Assessment
ELM courseware is developed according to identified needs within the medical profession. As a result, the need for new courses is communicated to ELM's Editorial Staff through either of two channels. First, a healthcare organization (hospital, academic medical center, professional liability carrier, etc.) identifies areas within their institution in which medical-legal understanding is deficient. These types of requests are primarily based on patient safety and quality/risk concerns, claims experience or an analysis of claims trends.
For example, ELM has provided education for new attending and resident physicians at Client Y for many years. In the first year of this relationship, ELM provided a “Records & Disclosures” course that analyzed a physician's duty to keep accurate medical records and to keep medical information about a patient confidential. Understanding this responsibility is critical for a physician’s practice because the failure to reconcile divergence of professional thought and action reflected in medical records can have adverse implications for the determination of whether a physician's performance was clinically competent. In addition, HIPAA has brought patient confidentiality to the forefront. However, competing duties may supersede the obligation to keep confidential medical information from disclosure, establishing a duty to disclose.
After completing this course, and recognizing the Joint Commission’s increased attention to a physician’s duty to make disclosures, and in particular, disclose error or adverse outcomes to their patients, Client Y requested that ELM develop a course that delves deeper into Disclosure. In response, ELM’s faculty authored, “Communication: Disclosure of Adverse Outcomes,” to explore in more detail a physician’s responsibilities in making information disclosures and methods for doing so more effectively.
The second impetus for course development is physicians themselves. All ELM course participants are asked to complete a post-course survey, designed to identify areas in which current courses can be improved or new courses should be developed. These surveys have been collected, evaluated and utilized throughout ELM's history.
For example, ELM’s flagship curriculum was designed as fundamental coursework. It took a physician through the different stages of a physician-patient encounter and was intended to cut across specialty. However, as more and more physicians participated in this coursework, they told ELM, through surveys and e-mails to the ELM support staff, that with this new fundamental understanding of medico-legal issues, they sought to understand how these issues affected their specialties more specifically. In response, ELM faculty authored and launched specialty specific Standards of Care courses in 22 specialties.
Prior to launch, Dr. Fiscina presented a medical-legal workshop for 15 different specialists at four different academic centers. This allowed him to gather information on what these various specialty departments felt were their most pressing, medical-legal training needs.
In addition to these outside channels, ELM's Editorial Board monitors malpractice claims and litigation activity to identify trends and generalized themes in legal medicine. ELM's Editorial Board is comprised of MD, JDs experienced in analyzing medical malpractice and liability issues. Their input and expertise in identifying educational needs are critical components to our Needs Assessment Process.
Step 2: Initial Casebook Authoring
Once a need has been identified, Sal Fiscina, MD, JD directs the development of course materials to address the needs. Cases are identified, redacted and synthesized into a congruent format for interactive presentation. Once this material has been formulated for both primary and supplementary coursework, testing material is developed. Informally, various medical, legal and managerial advisors are asked to use their qualifications and experience to critically comment on the material. This process is very much a dialogue and assessments are made, and revisions implemented through constant contact with clients and experts. The casebook is then delivered to ELM's engineering and production team.
Step 3: Web Implementation and Content Quality Assurance
The Casebook is converted to the online format. This implementation is tested for usability to ensure that the participants' experience and interaction is adequate. Once the online interaction has been completed, the editorial staff undertakes an online review of the content to ensure that the flow of material and presentation of coursework is correct and effective. Any necessary revisions are made before the course is tested by users outside of the ELM staff.
Step 4: Course Pilot and Advisory Board Review
Before implementing a new course, ELM utilizes advisor specialists to serve as a physician advisory board, participating as course users and evaluating the presentation material, its effectiveness in meeting stated objectives, the value and applicability to their practice, ease of use, etc.
Step 5: Initial Results, Feedback Review and Optimization
Feedback and testing data obtained in the pilot process is then reviewed by the editorial staff. At this stage, ELM re-evaluates the effectiveness and appropriateness of all elements of the course including course materials, case studies, test questions, etc. Participants are asked to evaluate the program based on its effectiveness in meeting the stated objectives.
Step 6: Participation and Ongoing Feedback
Once a course is launched, all course participants are surveyed at the end of their course experience. As in the pilot phase, we ask that they evaluate the course from a number of perspectives including course effectiveness, relevance to their practice, achievement of the goals and objectives set forth, etc.
Activity Evaluation
In evaluating our CME Activities, ELM gives weight to three sources for feedback.
1. Physician Participants (40%)
All participants are asked to give feedback about their experience with and opinion of ELM programs. This includes evaluations of perceived effectiveness, success in meeting stated goals and objectives, applicability to clinical practice, course satisfaction, etc. These survey results are reported to the editorial and engineering staffs quarterly for review. This review process requires that the appropriate ELM team provide a plan to address any areas of deficiency or potential improvement identified by the feedback report.
2. Healthcare Organizations/Institutions (40%)
The quarterly feedback reviews described above are also shared with their corresponding sponsoring healthcare institutions. This presents a formal opportunity for administrators to add their own evaluation of the programs to the feedback of their organizations participants. The combination of these participant evaluations and the administration's claims experience, or focus, steers the direction and development of their programs. We have collected this feedback for over 20 years and, therefore, benefit from a critical mass of evaluations and comments.
3. Test Performance (20%)
Trends in participant test performance are evaluated for above (or below) average pass/fail rates. In this way tests are optimized and the effectiveness of course material in meeting course goals is evaluated. Test performance is monitored constantly and appropriate action is taken immediately to address issues identified. In addition, general reviews of course tests are completed twice a year.
These sources are then evaluated by the Dr. Fiscina and appropriate members of the Editorial Board and operations staff on a semi-annual. However, ELM also prides itself on the ability to respond to needs for more immediate changes as necessary. Where deficiencies are identified and improvements developed, they are implemented in real-time online.