Transplant Program. Education REPORT

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1 Transplant Program Education REPORT 2007

2

3 MESSAGE FROM THE VICE-PRESIDENT OF EDUCATION Dr. Richard Reznick The Transplant Program at UHN is leading the charge in successfully moving forward its educational agenda! The program has implemented numerous initiatives and has developed several resources to facilitate patient, family, student and health care professional education in transplant and its related fields. This report provides an overview of the many education endeavours and achievements within the program. Education is clearly a priority for this program and is a cornerstone to its continued success. MESSAGE FROM THE TRANSPLANT PROGRAM DIRECTOR Dr. Gary Levy With a focused effort, the Transplant Program has actively improved its education activities and endeavors over the past several years. This is reflected in our phenomenal output of education materials and our ability to attract clinical fellows from around the world. Learners seek experiences in our program because of our stellar reputation, our exceptional educationalists and the unique fields in which we train, including: regenerative medicine, transplant psychiatry and infectious diseases. We look forward to reporting on our progress with our education pursuits on an ongoing basis. MESSAGE FROM THE TRANSPLANT PROGRAM DEPUTY DIRECTOR Dr. Heather Ross When speaking of our educational successes, it is essential to note that we have expanded our focus to ensure that progress in our educational activities is increasingly interprofessional in nature. This is echoed in the achievements outlined in this report, many of which arise as suggestions and ideas of our front-line staff. Our medical and surgical staff, nurses, allied health professionals, pharmacy staff and clinical technicians have worked together to improve the outcomes of our patients. Their collaboration is evident in interprofessional rounds and improvements in their day-today teamwork! 1

4 I. INTRODUCTION The Transplant Program at UHN undertakes numerous educational activities within medicine, nursing, allied health, pharmacy, the technical health care professions and in the training of support service personnel. Education endeavors in the program are accomplished under the direction of the Transplant Program Education Committee, which consists of interprofessional membership. This committee provides guidance to those program members with specific interests in education activities and to the clinical teachers, masters' teachers and clinical educators that function within the program. The teams within the Transplant Program are integrated and therefore education is often multidisciplinary in nature - integrating the organs of specialty and the medical and surgical fields. The program prides itself on being sought after not only among clinical fellows but also by numerous international transplant programs for educational opportunities, expertise and resources. In addition, the program takes a leadership role in the teaching of patients, their families and their local care providers. Nurses, allied health professionals and pharmacists are an integral component of the clinical program and essential members of a strong interprofessional team. Students at all levels seek unique learning opportunities in UHN's specialized clinical setting where innovative educational programs have been pioneered in partnership with local universities and colleges. In fact, the UHN Transplant Program is a preferred clinical placement for nursing students demonstrating high clinical and academic achievement. This report summarizes the Transplant Program's educational accomplishments and profiles the future educational endeavors that the program is planning toward. 2

5 II. EDUCATION ACHIEVEMENTS 1. Medical and Surgical Education Medical and surgical fields within the Transplant Program have long been key areas of educational activity. The UHN Transplant Program has an international reputation as a leader in advancing transplant care and as such attracts students on a global scale. The program accepts and trains students at every level including medical students, residents, clinical fellows, and international observers. These students have opportunities within each of the program's organ specific areas: heart, kidney/pancreas, liver and lung. Teaching occurs in daily ward rounds, weekly rounds, and structured didactic teaching rounds. Student Residents Fellows CIHR Fellows in Regenerative Medicine Program CFI Fellows in Immune Tolerance International Observers Volume 30/year 15-20/year (50%international) 15-20/year 3/year 20/year Over the course of the past several years, one of the major education challenges within the Transplant Program has been improving the attractiveness of the residents' rotations. To address this issue, the program has modified the residents' activities to ensure that they are increasingly relevant to the specific resident. Medical residents are focusing on issues in an ambulatory setting and surgical residents are being directed to more surgical related issues including pre- and postoperative care. In addition, the program is addressing concerns regarding workload especially those voiced by internal medicine residents. To achieve this the Transplant Program removed rotating residents from night call and hired acute nurse care practitioners to work with residents and reduce workload. To further improve the attractiveness of the Transplant Program for internists, the program has recently identified a champion in Internal Medicine to assist in the development of an international program in transplant education for internists. This champion will provide mentorship to the Transplant Education Committee. The Transplant Program offers numerous ongoing education activities for the medical and surgical students and staff and is continually expanding these offerings. The program participates in and/or offers: Medical Grand Rounds, Surgical Grand Rounds, Weekly Transplant Program Rounds, Weekly Multidisciplinary Rounds, and a Bi-weekly Core Curriculum Lecture Series for Transplant Program Fellows. Each of the specialty organ groups also offer organ specific education such as Journal Clubs, Fellow Seminars, Research Rounds, Morbidity and Mortality Rounds, Pathology Review and Biopsy Rounds. In addition, the Transplant Program offers and participates in specialized educational events. Among some the most successful are: The Transplant Program Fellows Training Workshop on Writing Publishable Articles in Organ Donation Crisis in Ontario: Finding Solutions Symposium in Day in Transplantation in Nephrology Citywide Rounds and Northern Network (with a monthly topic transplant specific). Clearly there is no shortage of educational opportunities for the program s medical and surgical staff and the medical students that train within the program. The list of educational achievements and activities offered continues to grow and most importantly is responsive to the changing climate of transplant care and the needs of the Transplant Program s team members. 3

6 II. EDUCATION ACHIEVEMENTS cont d. 2. Nursing & Allied Health Education The Nursing profession has had exceptional success in its educational achievements. The Transplant Program was the first to develop a yearlong final placement for nursing students in partnership with Ryerson University, which spans the continuum of transplant care. The program now flourishes with 6-8 students/year. This initiative has since been implemented in the Neuro & Cardiac Transplant Programs at UHN and has proven to be an important source of new staff recruits. In 2007/2008, the Transplant Program is introducing a Transplant Nursing Fellowship designed as a 4-year program to enhance the depth and breadth of knowledge in transplant nursing. The Fellowship will generate expert nurses in the specialty of organ transplant, with Canadian & International credentials. Among the other accomplishments in nursing education are the development of: New Transplant Program Nursing Staff Orientation Acute Care Unit Orientation Annual Recertification of critical competencies and practice standards Clinical Resource Nursing Program - designed to provide specialty training and education in a variety of clinical areas relevant to transplant nursing e.g. Wound Care and Pain with anticipated expansion into and a Diabetes, Palliative Care, Vascular Access, Psychosocial & Spiritual Support, Gerontology and Infection Control elearning for all staff In-services for staff focusing on new technologies, new procedures, immunotherapy, etc. to develop nursing transplant expertise (also attended by multidisciplinary staff ) 11 national and international presentations in 2006 Students from several other disciplines seek clinical placement opportunities within the specialized environment of the Transplant Program. In most cases the Transplant Program serves as one of the senior/final clinical placement opportunities due to the complexity of the patients and the need for full integration of skills and knowledge required by practitioners in these fields. The program accommodates clinical placements for students in the following university undergraduate programs: Pharmacy, Physiotherapy, Nutrition, Social Work, and; Occupational Therapy. Nurses, allied health professionals and pharmacists participate in the numerous educational sessions and opportunities offered within the Transplant Program. In addition, these staff members are major contributors to the durable materials and the educational mentorship described in the education resources and educational partnerships sections that appear below. 4

7 II. EDUCATION ACHIEVEMENTS cont d. 3. Interprofessional Education The Transplant Program has always exhibited interprofessional care, integrating the knowledge of health care professionals from varying fields of expertise. As the concept of interprofessional care expands in the clinical community, the Transplant Program is making an increased effort to undertake more formalized interprofessional activities. Each of the organ specific teams (Lung, Heart, Liver, Kidney) conduct an offsite retreat which include participation from medicine, surgery, nursing, allied health, pharmacy and other health professional groups. The retreats address issues relating to: program activity and outcomes, research (individual project reviews and program research reviews), algorithms and protocols, nutrition, social work and psychiatry, strategic growth, team building and future directions. Several education resources have been created by the Transplant Program that are targeted to an interprofessional audience. Often, these resources are sought after by international transplant care providers. The following is a list of the most recent resources. Interprofessional Manuals Handbook of Solid Organ Transplantation Lung Transplant Manual Lung Transplant - Current Drugs and Complications Protocol Heart Transplant Memory Stick of Program Protocols & Pertinent References 4. Patient Education - Resources and Durable Materials The Transplant Program has excelled in achieving its strategic objective of producing high quality, patient education materials. These manuals and videos have a significant impact not only at UHN but also on the world community. The videos have been an invaluable patient teaching tool throughout the Transplant Program and are mandatory viewing for all transplant recipients. They are award-winning, have been marketed to the international community and have been purchased for use by transplant centers throughout the US, Europe and Australia. Manuals Lung Transplant Patient Manual Patient & Family Heart Transplant Manual Patient Education Update on Implantable Left Ventricular Assist Devices Patient Manual for Live Liver Donors Patient Manual for Liver Recipients Patient Manual for Renal Transplant Patient Manual for Pancreas/Kidney Transplant Videos Nature of Things video A change of heart - issues surrounding cardiac transplant. Patient Teaching Videos on: Infection Rejection Lifestyle adaptations Transplant Complications 5

8 II. EDUCATION ACHIEVEMENTS cont d. 5. Educational Partnerships The Transplant Program has established numerous partnerships to facilitate its educational objectives. Those listed below capture the more significant relationships. Partner University of Toronto St. John s Rehabilitation Centre Ryerson Nursing Training Program York University University of Ontario Institute of Technology (UOIT) University of Western Ontario Humber/University of New Brunswick Nursing Programs Initiative Faculty of Medicine - medical students, resident rotations and fellowship opportunities Department of Immunology - undergraduate and graduate teaching Undergraduate & Graduate Acute Care Nurse Practitioner Programs (clinical placements) Masters in Nursing program 3 educational preceptorships Masters in Nursing/ACNP 5 educational preceptorships Transplant Clinical Educator instruction to nursing staff to support transplant specific care Instruction of staff on an ad hoc basis re: new technologies or equipment relevant to care of transplant recipients at St. John's Weekly Rehab Rounds employ a multidisciplinary approach to determine the needs and readiness of transplant patients The rounds also serve as an important forum between St John's nurses and physicians and the UHN Transplant Team for discussion, education and information sharing. BScN - trainees from Year 3, Year 4, post graduate students Newly retooled clinical placement for Year 3 Nursing program. BScN student placements Clinical opportunity for 2 international students. Developing working relationship with nursing program 1 student currently Developing working relationship with nursing program 1 student currently BScN final year placement - accommodating growing number Humber provides a 6 week Acute Care Nursing Program for UHN Transplant Program staff RNs 6

9 II. EDUCATION ACHIEVEMENTS cont d. 6. Continuing Education The Transplant Program offers extensive continuing education opportunities both within UHN and externally to the local region, the country and the world. These events continue to grow and expand on an annual basis. The events are well received and their success is well recognized. Among the events are local rounds within UHN, citywide rounds, and international rounds. Physicians in all the organ groups within the Transplant Program contribute to multiple international rounds as detailed below: Specific Organ Heart Kidney/Pancreas Liver Lung # of International Rounds/Year 20 / year 17 / year 30 / year 20 / year 7

10 III. FUTURE PLANS The Transplant Program continues to set ambitious yet achievable education goals as part of its strategic and operational planning activities. The educational leadership within the program is gaining momentum and strength and is challenging the entire clinical team to develop exciting and innovative initiatives. The Transplant Program will work toward improving its durable materials by making each of its organspecific manuals electronic and by revising and updating all patient transplant manuals. Training opportunities will be a significant area of focus through the implementation of City Wide Transplant Rounds and the expansion of interdisciplinary training as a component of retreats and educational events. The program will build upon the success of its nursing education initiatives by expanding the Clinical Nurse Resource Programs and beginning the Nursing Fellowship Program. Finally, improved partnerships between ambulatory and inpatient area within the Transplant Program will promote the breadth of understanding of the continuum of transplant care among practitioners. Clearly, the Transplant Program will continue its tradition of educational leadership both within Canada and around the world. 8

11

12 Heather Ross, MD, MHSc, FRCP(C) Director of Cardiac Tranplant Program Toronto General Hospital 585 University Ave, 11c-1203 Toronto, ON Canada M5G 2N2 Phone: (416) Fax: (416) Gary Levy, MD, FRCP(C) Director, Multi Organ Transplant Program Toronto General Hospital 585 University Ave., NCSB Toronto, ON Canada M5G 2N2 Phone: (416) Fax: (416) Richard K. Reznick, MD, MEd, FRCSC, FACS Vice-President, Education University Health Network Suite 311, 100 College Street Toronto, ON Canada M5G 1L5 Phone: (416) Fax: (416)

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