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Difficult patient encounters
Educational and skills gap can be addressed by presenting an approach using some basic info and showing a video and then doing practice role playing.
The motivational gap could be addressed by linking the acquisition of this skill to reducing one source of stress in practice leading to potential burnout.

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Knowledge gap-people do not realize how dangerous toboganning is
Communication gap-
Motivation-people are not motivated to buy and wear helmets
External-pressure from children to not wear helmets as not cool

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Noor H: student readiness for clinical practice

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Noor H: student readiness for clinical practice

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Skills gap may be addressed by educational and instructional activities- but the question remains are to whether the current instructional activities are not robust, or just require more time to be effective.
The external gaps may also be addressed by educational activities, this time targeting the clinical supervisors on how they may create an environment that is less stressful and conducive to learning.

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COVID fear/lockdown causing health decline as messaging focuses only on "staying home"

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COVID fear/lockdown causing health decline as messaging focuses only on "staying home"

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communication gap
- instruction in the form of public messaging, commercials, websites, advertising could make a difference

external gap
- if government, while making lockdown changes as required, could also address the need for outdoor space to move and exercise and give specific instruction on where/how/when this can take place, perhaps even opening up spaces that are currently underused because of the pandemic to allow for people to be outdoors and to engate in physical activity

motivation gap
- difficult, but again, if messaging were to address this issue, perhaps this would slowly change in those that are feeling like that can't get up off their couch

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Knowledge: this gap is easily addressed by sharing the literature about improved patient and resource outcomes when GOC discussions occur in a timely and sensitive way.

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Knowledge: this gap is easily addressed by sharing the literature about improved patient and resource outcomes when GOC discussions occur in a timely and sensitive way.

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The motivational gap is also address by sharing data that relationships between patients and caregivers are not harmed when GOC discussions are done well, and in fact patients desire these conversations.
The skill and motivation gaps are addressed by providing high quality skills training and practical, adapatable tools to be used in the moment.

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Addressing the Knowledge gap regarding the importance of screening : in 53,000 cervical cancer screening patient backlog there are 60 invasive cancers which is only the routine screening achievement of 60%. This shocking awareness in KTE is a knowledge gap
Communication is a gap between physicians as well as between doctors and patients. In an overwhelmed environment, barely managing to vaccinate flu shots and now organize COVID and the new job of vaccinating all grade 7/8 students in the office, the communication is down. CCO cancelled the reminder letters and patients are afraid of entering the office.
Motivation - validation and assistance in the offices to achieve success in reducing backlog will improve motivation. Collaboration and community will enhance wellbeing and reduce burnout.

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Incorrect death certificates leading to incorrect death statistics

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Incorrect death certificates leading to incorrect death statistics

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Louise McN-F
Motivation/environmental gap: Because there are so many competing motivating factors and time constraints in a busy clinical environment, a learning intervention would really need to be "just in time" , with instructions and feedback embedded into the actual task. I could see this working with an e-solution for death certificates, as you could program feedback immediately after completion.

Knowledge/motivation/external factors gap: I could see being addressed by making death certificate completion training mandatory for trainee supervisors, with appropriate CME credits, as an on-line asynchronous course with modules addressing all important areas (helping with the time constraints).

Motivation/Knowledge gap:  Supervisors can train residents "on the job", a kind of practical train the trainer scenario, which would again be a "just in time" approach. Trainers would learn as they teach and possibly residents could be  required to complete 10 death certificates correctly (with oversight), in real time, before you can pass your residency.

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Addressing the knowledge gaps would be addressed by an education program such as providing strategies for exercise counseling, and strategies to suggest to patients for adherence to exercise. Attitudinal/ motivational issues may not so easily addressed by an education program as these can be more difficult to change. For example, the sense that asking about and counseling patients about exercise is a difficult perception - a discussion about the topic plus providing some strategies about talking to patients about exercise may help.

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Adult education skills for those doing training at social service agencies

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Adult education skills for those doing training at social service agencies

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Knowledge and skills could be covered by an educational/instructional activity; however, the environmental and motivational issues cannot. These would need changes or support that would be needed at the organizational level to either give dedicated time to build their knowledge/skills and/or to decide to commit to a more formal role of a “trainer” who would be hired already having those skills.

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OBESITY UNDERDIAGNOSED Confidence in patients can be built by incorporating motivational skills and external environmental skills. By use of communication  skills with frequent reminders will narrow the skill gap. 

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OBESITY UNDERDIAGNOSED Confidence in patients can be built by incorporating motivational skills and external environmental skills. By use of communication  skills with frequent reminders will narrow the skill gap. 

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Learning and reasons why there could be a problem

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Learning and reasons why there could be a problem

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knowledge may not have been acquired prior to the activity that can be addressed for further learning
Skill issues to be addressed by testing observation analysis
correction if appropriate
Motivation does your lerner want to aquire skill Going to do medicine and is not interested in forceps delivery
environment not conducive to skill being aquired
Communication always a problem good communication skills must be constantly reviews Am I communicating effectively wrong language for example

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Most learning gaps could presumably be improved by educational activities. The success of the activities would depend on all of the factors described above. The activities would need to be targeted appropriately, be quality products, not be overwhelming, provide the info to fill the gaps, and opportunities for skill building when the gaps involve using knowledge

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We developed an app to be a repository of short < 1 min videos on procedures. The gap was access to point of care review material by resident learners and while the app provided that, the environmental gap of access to good wifi was always an issue with Sunnybrook. For me, constantly re-evaluating the tool identified other gaps that were either always there or developed as a result of addressing a gap. Gaps can create gaps

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1. Skill, Knowledge and communication gaps can be addressed with a well designed course that uses simple language and visual components with practice sessions for proficiency

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1. Skill, Knowledge and communication gaps can be addressed with a well designed course that uses simple language and visual components with practice sessions for proficiency

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2. Motivation can be addressed by explaining the reasons / issues to patients and potential bad outcomes
3. external barriers such as poor wifi cannot be addressed

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Endometriosis diagnosis and early treatment

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Endometriosis diagnosis and early treatment

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Increasing knowledge about the condition amongst healthcare providers and patients can be improved by an instructional video but it can't motivate patients to seek care by a healthcare provider. Some healthcare providers also may not change their practice if they are not motivated to do so. Even with the knowledge, if they have never prescribed the medications, they may be hesitant to start and so they may just find it easier to refer to a specialist regardless of the information taught.

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Knowledge gap: The "look" aspect of the MSK exam can be done via zoom sessions and inviting volunteers and showing pictures. The "move and feel" aspect of the MSK exam cannot be done virtually; Small group sessions where trainees practice on each other could be done.
Skill gap: Can design a Flipgrip type scenario where trainees record their physical exam and send it to their instructors for feedback.

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Patient's access to accurate medical information is limited . Google is more accessible but can be misleading

Knowledge gap: Patients can access a reliable source/educational tool through which they can read about diseases

Skill: Patients can learn to read or self-educate about diseases.

Motivation: easy access to reliable medical information

Communication: Physicians/hospitals should motivate patients and proc=vide access to those resources

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The sharing of knowledge to the general public as vaccine information evolves is a challenge. Using reliable sources such as specific news outlets, expert sources, our trusted health experts is important. However, in developing an education/instructional design activity, knowledge, skills and communication are probably the easiest, whereas motivation can be more difficult to assess for successful interventions using digital technologies. Environmental barriers would be important to acknowledge as the right education strategy launched at the wrong time (ie too early or too little, too late) is ineffective, so situational awareness of all stakeholders is important to ensure success for education/instructional design activities. A communication strategy is key to help develop awareness of an educational/instructional activity, and ways to measure participant or learner access.

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Vaccine hesitancy among marginalized communities

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Knowledge and skill gaps can be addressed relatively easily. We can hope to built confidence which could help with motivation/attitude. We could gather info about the environmental barriers from the participants and then use that info to tackle that problem separately.

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