Practice Based Small Group (PBSG) Learning Program
Celebrating 25 Years of
the PBSG Program
The goal of the PBSG program is to encourage family physician members to reflect on their individual practices and to identify gaps between their current practice and best practice. This is accomplished through small group discussions using evidence-based educational modules and sharing practice experiences related to real-life patient cases. PBSG members identify specific barriers to planned practice changes and formulate implementation strategies to facilitate those changes.
Elements of PBSG
The PBSG Learning process consists of:
• A small group of family physicians willing to reflect on their individual practices and to recognize gaps between their current practice and best practice.
• A trained peer facilitator to guide group discussion.
• Educational Modules consisting of real-life cases and evidence based best practice information.
• Practice reflection tools which encourage contemplation on new learning and desired practice changes.
Each component is critical to the PBSG learning process and to the facilitation of practice change, and together provides an exceptional learning experience.
Small Group Process
Groups of 4–10 family physicians form a PBSG learning group in their own community, meeting for an average of 1.5 to 2 hours approximately once a month.
During the small group sessions, the group peer facilitator focuses the discussion around patient cases and the best practice information provided to identify practice gaps and strategies to narrow these gaps, and enhance practice change. Group discussion allows for sharing of practice experiences concerning the implementation of practice change and overcoming anticipated barriers. At the conclusion of each group meeting, PBSG members are guided by use of a practice reflection tool, to reflect on the discussion, to explore how new knowledge might be translated into daily practice, and to explicitly commit to make a change in practice or confirm their current practice. Ongoing meetings provide the opportunity to reflect on the success of planned practice changes. Over time, small groups evolve into communities of learners.
The peer facilitator plays a vital role in the enduring success of each practice-based small group. The facilitator is selected by the group, and trained in a standardized one day workshop conducted by experienced PBSG facilitator trainers. The workshop provides each new facilitator with experience leading a small group using the PBSG modules, with feedback concerning the management of the PBSG learning process. The critical roles of the facilitator are to focus discussion on real practice issues and to encourage the group to identify the factors that assist or hinder implementation of new knowledge or skills into their individual practices. This role can be fulfilled only if the facilitators have fostered a safe, supportive environment that enhances the identification of practice gaps and encourages the discussion of sensitive patient care issues (e.g., medical errors or ethical issues).
Development of Educational Modules
Currently, 14 modules are produced each year. The topics cover a wide array of primary care practice issues. Module topics are selected using a rigorous process which includes input from PBSG members and facilitators, followed by the rating of these topics by our authors, editors , and a selected group of PBSG facilitator group from across the country and our regional Directors. This vetting process is used to determine what clinical topics are most relevant to practising family physician members.
The development team for each module includes a family physician editor, a professional medical writer and an experienced module coordinator to work with the family physician authors. Each module takes approximately nine months to develop. Module development involves roundtable discussion by representative PBSG members, pilot testing by two PBSG groups, and review by two content experts. Development of each module topic begins with a search of the literature to determine the “gap” between current physician practice and "best practice" based on available evidence. This “gap” becomes the focus of the module. Module authors and editors provide real patient cases to promote group discussion around the identified gap and to stimulate participants’ recall of similar patients in their own practice. Stimulus questions are added to cases to encourage reflective practice and support the facilitators in exploring current practice. Commentaries accompany the cases to provide a possible approach to the application of the new information. Supporting information points are provided with levels of evidence indicated. Appendices provide clinical algorithms, patient handouts, chart aids, and other tools to assist in practice implementation.
Accompanying each module is a practice reflection tool (PRT), which provides a structure for promoting reflection on the topic discussed at the group meeting, identifying practice gaps and planning how to implement change(s) to practice.
There are two parts to this tool– Impact on Practice and Follow-up Review:
• Impact on Practice – this tool encourages reflection on the topic covered and explicitly asks participants to place themselves along a practice change continuum.
• The Follow-up Review – is a form to guide and document a follow-up session after the initial Impact to Practice is completed. It provides a formal process for reflecting on and sharing experiences in making the planned changes to practice.
The “commitment-to-change” section is a particularly important strategy to capture proposed changes in practice and possible barriers to change. At a subsequent meeting, groups revisit commitment-to-change statements and explore the success of the implementation strategies employed and/or the barriers encountered in practice.