ePoster Manager

Lean based learning among residents and registrars in a Dermatology Department

Authors

Anne Braae Olesen
Mette Deleuran
Henrik Lorentzen

Theme

Postgraduate Education

INSTITUTION

University Hospital of Aarhus , MEDU
Department of Dermatology
Marselisborg Centret, Denmark

Background

Our standardized training programme in laser and surgery implies insufficient levels og skills to manage approximately 10 percent of the dermato-surgical consultations.
Instead of pushing young doctors into sceduled introduction and training - (learning one competence at the time)
We introduce lean based pull processing in the postgraduate education of all doctors.
Stream mapping identify waste in the process of competence achievement and is eliminated.

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Summary of Results

The competence level is measured before project start, during and after 12 months (Traffic Light System).
All diagnoses, treatment codes and biopsy quality on all patients one month before project start and after 10 months of implementation will be measured and compared.
A measure of mean time to 75 and 100 percent competence acquirements for young doctors will be calculated for both involved and uninvolded doctors.
The quality of life and work enviroment is studied during the project period by questionnaires and interview in selected groups of doctors.

Take-home Messages

Lean based learning may increase the learning curve of the trainees and minimize waste consultations.

Summary of Work

The pivotal management tool is the Traffic light System; a table listing required skills (rows) for each doctor (columns). The individual cells are coloured according to the level of expertice:

Red: want to learn; Yellow: can perform; Green: can perform and teach

All green skilled doctors can teach all red skilled doctors every day.
All patients are sceduled to the laser /surgery center everyday no matter the trained status of the doctor. The doctor pulls the needed skills to her whenever there is a patient need.
The motivation for learning and education is moved from the supervisor and educational programmes to the young doctors themselves.

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Conclusion

Lean based pull processing in education may increase the trainees skills and competences more and faster because the young doctors are driven by the patient need for specific diagnosis and treatments and their own wish for learning partly due to the public visibility of the Traffic Light System in the Department of Dermatology.

References

1. Traffic light System - Henrik Lorentzen, Personal communication.

2. The Lean Toolbox. The Essential Guide to Lean Transformation. Fourth Edition. John Bicheno, Matthias Holweg. PICSIE BOOKS, UK 2009.

Background

The Danish postgraduate educational programme for Dermato-venerologists in Denmark involve 56 medical competences among others 15 concerning laser and surgery competences with more than 150 seperate skills. Instead of education driven by the programmes and plans made by the supervisors the young doctor ask for new competences every day when the skill is demanded by a patient with the specific need.

As a consequence the daily work programmes has been changes an all doctors are now working - specialists and registrars side by side everyday looking at all types of patients. For example a young doctor who has never been in the laser/surgery may have four laser patients, two cancer patients, two condyloma patients and in the afternoon patients with hair problems or hyperhidrosis. In our normal programmes these competences would be planed to be learned within a timespan of 2 years - using workingplans 3 months at the time