Continuing education meetings and workshops: effects on professional practice and health care outcomes

BACKGROUND

Educational meetings are widely used for continuing medical education. Previous reviews found that interactive workshops resulted in moderately large improvements in professional practice, whereas didactic sessions did not.

OBJECTIVES

To assess the effects of educational meetings on professional practice and healthcare outcomes.

SEARCH STRATEGY

We updated previous searches by searching the Cochrane Effective Practice and Organisation of Care Group Trials Register and pending file, from 1999 to March 2006.

SELECTION CRITERIA

Randomised controlled trials of educational meetings that reported an objective measure of professional practice or healthcare outcomes.

DATA COLLECTION AND ANALYSIS

Two authors independently extracted data and assessed study quality. Studies with a low or moderate risk of bias and that reported baseline data were included in the primary analysis. They were weighted according to the number of health professionals participating. For each comparison, we calculated the risk difference (RD) for dichotomous outcomes, adjusted for baseline compliance; and for continuous outcomes the percentage change relative to the control group average after the intervention, adjusted for baseline performance. Professional and patient outcomes were analysed separately. We considered 10 factors to explain heterogeneity of effect estimates using weighted meta-regression supplemented by visual analysis of bubble and box plots.

MAIN RESULTS

In updating the review, 49 new studies were identified for inclusion. A total of 81 trials involving more than 11,000 health professionals are now included in the review. Based on 30 trials (36 comparisons), the median adjusted RD in compliance with desired practice was 6% (interquartile range 1.8 to 15.9) when any intervention in which educational meetings were a component was compared to no intervention. Educational meetings alone had similar effects (median adjusted RD 6%, interquartile range 2.9 to 15.3; based on 21 comparisons in 19 trials). For continuous outcomes the median adjusted percentage change relative to control was 10% (interquartile range 8 to 32%; 5 trials). For patient outcomes the median adjusted RD in achievement of treatment goals was 3.0 (interquartile range 0.1 to 4.0; 5 trials). Based on univariate meta-regression analyses of the 36 comparisons with dichotomous outcomes for professional practice, higher attendance at the educational meetings was associated with larger adjusted RDs (P < 0.01); mixed interactive and didactic education meetings (median adjusted RD 13.6) were more effective than either didactic meetings (RD 6.9) or interactive meetings (RD 3.0). Educational meetings did not appear to be effective for complex behaviours (adjusted RD -0.3) compared to less complex behaviours; they appeared to be less effective for less serious outcomes (RD 2.9) than for more serious outcomes.

AUTHORS' CONCLUSIONS

Educational meetings alone or combined with other interventions, can improve professional practice and healthcare outcomes for the patients. The effect is most likely to be small and similar to other types of continuing medical education, such as audit and feedback, and educational outreach visits. Strategies to increase attendance at educational meetings, using mixed interactive and didactic formats, and focusing on outcomes that are likely to be perceived as serious may increase the effectiveness of educational meetings. Educational meetings alone are not likely to be effective for changing complex behaviours.

Continuing education meetings and workshops: effects on professional practice and health care outcomes

BACKGROUND

Educational meetings are widely used for continuing medical education. Previous reviews found that interactive workshops resulted in moderately large improvements in professional practice, whereas didactic sessions did not.

OBJECTIVES

To assess the effects of educational meetings on professional practice and healthcare outcomes.

SEARCH STRATEGY

We updated previous searches by searching the Cochrane Effective Practice and Organisation of Care Group Trials Register and pending file, from 1999 to March 2006.

SELECTION CRITERIA

Randomised controlled trials of educational meetings that reported an objective measure of professional practice or healthcare outcomes.

DATA COLLECTION AND ANALYSIS

Two authors independently extracted data and assessed study quality. Studies with a low or moderate risk of bias and that reported baseline data were included in the primary analysis. They were weighted according to the number of health professionals participating. For each comparison, we calculated the risk difference (RD) for dichotomous outcomes, adjusted for baseline compliance; and for continuous outcomes the percentage change relative to the control group average after the intervention, adjusted for baseline performance. Professional and patient outcomes were analysed separately. We considered 10 factors to explain heterogeneity of effect estimates using weighted meta-regression supplemented by visual analysis of bubble and box plots.

MAIN RESULTS

In updating the review, 49 new studies were identified for inclusion. A total of 81 trials involving more than 11,000 health professionals are now included in the review. Based on 30 trials (36 comparisons), the median adjusted RD in compliance with desired practice was 6% (interquartile range 1.8 to 15.9) when any intervention in which educational meetings were a component was compared to no intervention. Educational meetings alone had similar effects (median adjusted RD 6%, interquartile range 2.9 to 15.3; based on 21 comparisons in 19 trials). For continuous outcomes the median adjusted percentage change relative to control was 10% (interquartile range 8 to 32%; 5 trials). For patient outcomes the median adjusted RD in achievement of treatment goals was 3.0 (interquartile range 0.1 to 4.0; 5 trials). Based on univariate meta-regression analyses of the 36 comparisons with dichotomous outcomes for professional practice, higher attendance at the educational meetings was associated with larger adjusted RDs (P < 0.01); mixed interactive and didactic education meetings (median adjusted RD 13.6) were more effective than either didactic meetings (RD 6.9) or interactive meetings (RD 3.0). Educational meetings did not appear to be effective for complex behaviours (adjusted RD -0.3) compared to less complex behaviours; they appeared to be less effective for less serious outcomes (RD 2.9) than for more serious outcomes.

AUTHORS' CONCLUSIONS

Educational meetings alone or combined with other interventions, can improve professional practice and healthcare outcomes for the patients. The effect is most likely to be small and similar to other types of continuing medical education, such as audit and feedback, and educational outreach visits. Strategies to increase attendance at educational meetings, using mixed interactive and didactic formats, and focusing on outcomes that are likely to be perceived as serious may increase the effectiveness of educational meetings. Educational meetings alone are not likely to be effective for changing complex behaviours.

[Work-related stress in healthcare workers: evaluation of effectiveness of a short training course in the hospital environment]

The efficacy evaluation of training courses in organizations is not widespread; however it is a fundamental issue for an appropriate allocation of available economic resources. The aim of this work is the evaluation of efficacy of a training course for the development of human resources attended by health professionists in S. Gerardo Hospital, Monza. A structured questionnaire was administered to evaluate efficacy. An experimental group of 300 health professionists attending the training course and a control group of 300 health professionists not attending the course, were asked to fill-in the questionnaire at baseline (t0), one month later--after the course--(t1: post-test), and six months later (t2: follow-up). Results highlight the medium-term (t1) efficacy of the training course and a reduced long-term (t2) efficacy in promotion of psychological adjustment and personal resources. This experience is an example of efficacy evaluation of training course in organizations using ad hoc experimental design.

Perceived educational needs and preparation of adult protective services workers for practice with end-of-life issues

As the number of older adults in the United States increases, so will the expected number of allegations of elder abuse. Adult protective services (APS) staff are likely to handle much more complex situations, and in growing numbers, due to the presence of chronic and life-limiting conditions of their clients. The APS workers, in this national study, identified frequent encounters with older adults with serious illnesses. However, less than one half received educational content about issues of death and dying in their degree programs, and only slightly more than one half reported ever attending a continuing education program on these topics. They perceived the greatest educational need for content about practical resources, the use of advance directives, and making end-of-life decisions. The indication also given by these respondents was that end-of-life issues were among the most difficult situations they faced in practice. This warrants a call for increased end-of-life content in educational degree programs and continuing education.

Echocardiography practice, training and accreditation in the intensive care: document for the World Interactive Network Focused on Critical Ultrasound (WINFOCUS)

Echocardiography is increasingly used in the management of the critically ill patient as a non-invasive diagnostic and monitoring tool. Whilst in few countries specialized national training schemes for intensive care unit (ICU) echocardiography have been developed, specific guidelines for ICU physicians wishing to incorporate echocardiography into their clinical practice are lacking. Further, existing echocardiography accreditation does not reflect the requirements of the ICU practitioner. The WINFOCUS (World Interactive Network Focused On Critical UltraSound) ECHO-ICU Group drew up a document aimed at providing guidance to individual physicians, trainers and the relevant societies of the requirements for the development of skills in echocardiography in the ICU setting. The document is based on recommendations published by the Royal College of Radiologists, British Society of Echocardiography, European Association of Echocardiography and American Society of Echocardiography, together with international input from established practitioners of ICU echocardiography. The recommendations contained in this document are concerned with theoretical basis of ultrasonography, the practical aspects of building an ICU-based echocardiography service as well as the key components of standard adult TTE and TEE studies to be performed on the ICU. Specific issues regarding echocardiography in different ICU clinical scenarios are then described. Obtaining competence in ICU echocardiography may be achieved in different ways - either through completion of an appropriate fellowship/training scheme, or, where not available, via a staged approach designed to train the practitioner to a level at which they can achieve accreditation. Here, peri-resuscitation focused echocardiography represents the entry level--obtainable through established courses followed by mentored practice. Next, a competence-based modular training programme is proposed: theoretical elements delivered through blended-learning and practical elements acquired in parallel through proctored practice. These all linked with existing national/international echocardiography courses. When completed, it is anticipated that the practitioner will have performed the prerequisite number of studies, and achieved the competency to undertake accreditation (leading to Level 2 competence) via a recognized National or European examination and provide the appropriate required evidence of competency (logbook). Thus, even where appropriate fellowships are not available, with support from the relevant echocardiography bodies, training and subsequently accreditation in ICU echocardiography becomes achievable within the existing framework of current critical care and cardiological practice, and is adaptable to each countrie's needs.

Anaesthetic assistant competencies: our experience

The purpose of this article is to share our findings since introducing the recently-developed anaesthetic assistant competencies (NHS Education for Scotland 2006). The term 'anaesthetic assistant' will be used throughout this article to refer to those who support the anaesthetist during anaesthesia. It is in no way meant to be derogatory to any person practising currently in this speciality.

Learning curve for Doppler assessment of ductus venosus flow at 11 + 0 to 13 + 6 weeks' gestation

OBJECTIVE

To determine the number of scans necessary for training sonographers to examine accurately the ductus venosus at 11 + 0 to 13 + 6 weeks' gestation.

METHODS

Ten sonographers with prior extensive experience in the measurement of nuchal translucency thickness were given practical training in the accurate assessment of the ductus venosus. They were then asked to examine the ductus venosus during the routine 11 + 0 to 13 + 6 weeks' scan. Each scan was assessed by an experienced sonographer and classified as being successful or unsuccessful (failure to obtain a waveform, poor quality image with contamination or wrong classification of the A-wave). Each sonographer performed a total of 300 examinations, the data were analyzed in 15 groups of 20 examinations and in each group the percentage of unsuccessful examinations was calculated.

RESULTS

In the total 3000 cases examined by the 10 sonographers there were 2849 (95.0%) successful examinations and 151 unsuccessful, including 104 failures to obtain a waveform, 30 cases where the quality of the image was considered to be inadequate and 17 cases in which the classification of the A-wave was wrong. The overall frequency of unsuccessful examinations decreased significantly with the number of scans carried out (r = 0.982, P < 0.0001). The sonographers required an average of 80 examinations before they could successfully examine the ductus in at least 19 of a group of 20 scans. Although one of the 10 trainees achieved this standard within the first block of 20 scans some of the sonographers required training in 100 cases.

CONCLUSION

Competence in Doppler assessment of the ductus venosus is achieved only after extensive supervised training.

[Application of systems NACCP of reference attached to examination sanitary and hygienic of milk processing manufactures of Republic Uzbekistan]

With the goal of harmonizing the application of analysis of dangerous factors and critical points of reference (NACCP), a health assessment was done on milk processing enterprises of medium and small capacity in Uzbekistan. It was revealed that application of health recommendations, in the framework of application of analysis of dangerous factors and critical points of reference, can present a problem for all milk processing enterprises of medium and small capacity and requires training among given manufacturers.

Software supporting planning, quality assurance, accreditation and operation of interdisciplinary healthcare professional education

The purpose of the present study was the development of software supporting Planning, Quality Assurance, Accreditation, and Operation of interdisciplinary Healthcare Professional Education. The form of the tool-kit is that of a secure website including fourteen principal screens, corresponding to the main aspects of the course under evaluation.

Evaluation of the sustained implementation of a mental health learning initiative in long-term care

BACKGROUND

This paper describes an innovative education program for the management of mental health problems in long-term care (LTC) homes and the evaluation of its longer-term sustainability. Since 1998, the "Putting the P.I.E.C.E.S. Together" learning initiative has been providing education sessions and related learning strategies aimed at developing the knowledge and skills of health professionals who care for older persons with complex physical and mental health needs and associated behaviors, in Ontario, Canada. A major focus of this province-wide initiative was the development of in-house Psychogeriatric Resource Persons (PRPs). Evaluation of this initiative included the completion of pre- and post-education questionnaires (over three data collection time periods) assessing learner confidence (N = 1,024 and 792, for pre- and post-education, respectively) and session evaluation questionnaires gathering feedback on the session (N = 2,029 across all sessions). A survey of LTC homes in Ontario (N = 439, 79% of the homes in the province) was conducted to assess longer-term sustainability.

RESULTS

Ratings of the sessions indicated that they were relevant to learners' clinical practice. There were significant increases in ratings of ability to recognize and understand challenging behaviors and mental health problems, and in ability to use a variety of assessment tools. Few homes (15%) do not have a PRP; over 50% of the staff who completed the first session in 1999 continue to serve as a PRP and to apply learned skills.

CONCLUSIONS

A learning initiative with supportive and reinforcing strategies can develop in-house PRPs to enhance the care of the elderly in LTC. Incorporation of PRP functions into job descriptions and management support contributed to the success of this initiative. This study highlights the importance of work environments that support and reinforce the use of learned skills to the success of continuing education and quality improvement initiatives in LTC.

Online Continuing Education Course Enhances Nutrition and Health Professionals’ Knowledge of Food Safety Issues of High-Risk Populations

OBJECTIVE

To develop and evaluate the efficacy of an online continuing education course for professionals who provide food safety information to high-risk populations.

DESIGN

A 2-credit graduate-level class was converted into six web-based modules (overview of foodborne illness, immunology, pregnancy, human immunodeficiency virus, cancer and transplants, and lifecycle) and offered to nutrition and health professionals. Participants had 8 weeks to complete the modules, pre and post questionnaires, and course evaluation. Those who successfully completed the protocol received six continuing education units from one of three professional associations. Change in knowledge was measured using pre and post questionnaires. Course efficacy was evaluated using a post-course questionnaire.

SUBJECTS/SETTING

A convenience sample of 140 registered dietitians/dietetic technicians registered, nurses, and extension educators were recruited through professional conferences and electronic mailing lists to take the course.

STATISTICAL ANALYSES

Analysis of variance was used to evaluate differences in knowledge scores for all groups across five main effects (attempt, module, profession, age, and education). Course evaluation responses were used to assess course effectiveness.

RESULTS

For each module, knowledge scores increased significantly (P<0.001) from pre to post questionnaire. Overall, knowledge scores increased from 67.3% before the modules to 91.9% afterwards. Course evaluation responses were favorable, and participants indicated that course objectives were met.

CONCLUSIONS

Online continuing education courses, such as "Food Safety Issues for High Risk Populations," seem to be a convenient, effective option for dietetics professionals, nurses, and extension educators seeking knowledge about food safety issues of high-risk populations. Online learning is a promising delivery approach for the continuing education of health professionals.

Variables influencing physical therapists' perceptions of continuing education

BACKGROUND AND PURPOSE

As of October 1, 2002, physical therapy continuing education (CE) in Illinois was mandated. Research examining the recent mandate for physical therapists to engage in CE is limited. The purposes of this study were to examine the perceptions of physical therapist clinicians and managers concerning the barriers to and facilitators of CE and to identify how physical therapists perceive the role of their department in the CE process.

SUBJECTS

Participants were 23 physical therapists at 6 hospitals.

METHODS

Qualitative methodology was used to analyze data.

RESULTS

Four themes were identified: negotiating and managing the variables associated with CE, providing and promoting opportunities that meet physical therapists' CE needs, identifying the elements of employment environments that foster CE, and perceived implications of mandating CE.

DISCUSSION AND CONCLUSION

This investigation highlights the need to identify the core set of variables associated with engaging in CE and to promote the elements of employment environments that foster CE.

[Training, skill and competences' follow-up]

Blood transfusion safety is a public health requirement, which is claimed by public health authorities and blood users too. In order to comply with transfusion safety, available national regulatory requirements must be strictly followed (or applied) by blood transfusion workers, caring nurses and physicians. Transfusion's good practices are based on knowledge of the process and the skill in blood transfusion fields. Quality systems, risks management, audits, inspections and certification programs implemented by blood establishments and patients' care services should lead to efficiency. All professionals involved in blood banking and transfusion processes (blood donation, preparation and storage of blood products, transfusion therapy...) must be qualified. They have to follow a program of continued training education. Their competence or ability must also be periodically assessed and documented to let continue and perform tasks safely.

A novel antibacterial gene transfer treatment for multidrug-resistant Acinetobacter baumannii-induced burn sepsis

Sepsis caused by multidrug-resistant bacterial infections in critically injured patients has become a major clinical problem. Recently, Acinetobacter baumannii (AB) wound infections, especially in our critically injured soldiers fighting in Iraq and Afghanistan, is posing a major clinical problem and an economic burden. ConjuGon, Inc., has developed a novel antibacterial therapeutic technology using bacterial conjugation. The donor cells are attenuated Escherichia coli carrying a conjugative plasmid. The expression of bactericidal genes cloned on the plasmid is tightly repressed in the donor cells but becomes de-repressed once mobilized into a pathogen and disrupts protein synthesis. Here, we tested the efficacy of this novel conjugation technology to control and eradicate a drug-resistant clinical isolate of AB wound infection both in vitro and in a murine burn sepsis model. C57Blk/6J mice were divided into burn (B) and burn sepsis (BS) groups. All animals received a 12% TBSA dorsal scald full-thickness burn. The BS group was inoculated with multidrug-resistant AB (1 x 10(5) colony-forming units [CFU]) at the burn wound site. BS animals were either untreated or treated with increasing concentrations (10(3) - 19(10) CFU) of attenuated donor E. coli encoding bactericidal proteins. The survival rate was monitored for 10 days. The ability of donor cells to significantly diminish AB levels in the burn wound 24 hours after injury was determined by quantitative cultures. Donor cells were highly effective in killing AB in vitro. In the burn sepsis model, 90% B group animals survived, and 40% to 50% BS animals survived with no treatment in 5 to 6 days. Treatment with donor cells at 10(10) to 10(6) provided significant survival advantage (P < .05). Quantitative cultures of burn wounds revealed that AB numbers increased from 3 x 10(4) CFU to 7.8 +/- 4.4 x 10(9) CFU in 24 hours in the untreated group. Single treatment with donor cells (10(10) CFU) significantly reduced AB in the burn wound to less than the levels seeded into the wound (1.23 +/- 0.5 x 10(4) CFU; P < .05). Taken together, these results indicate that this novel technology is an efficient method to control drug-resistant AB burn wound infections and prevent their systemic spread.

Findings from a European survey on current bioethics training activities in hospitals

While much work has been done on improving undergraduate education in bioethics, particularly in medicine, less has been said about continuing education of health care workers, particularly non-medical and nursing personnel. Hospitals bring together a variety of professional and non-professional groups in the place where clinical dilemmas are daily events, and would seem ideal places to conduct an ongoing bioethics dialogue. Yet evidence that this is being achieved is sparse. The European Hospital (-Based) Bioethics Program (EHBP) brings together both current and aspirant members of the EU as partners in a project that aims to assess the current situation with regard to bioethics education in hospitals, identify shortfalls, and address these. In order to achieve the first objective of the EHBP a survey of the current training activities (focused on activities in hospitals) in clinical bioethics in Europe was carried out. The results are presented in this paper, along with a discussion about the implications for the EHBP to address these issues.

Supporting disaster healthcare professionals: a practical and virtual approach

In this paper, we report on a questionnaire undertaken to evaluate an innovative programme of education for healthcare professionals in the field of aid and disaster healthcare that has been delivered by a partnership of three Higher Education Institutions (HEIs) across Europe since 1999. The development of this programme was a direct response to the stated needs of Non Government Organisations (NGOs) and military healthcare professionals as well as those aspiring to enter this complex area of healthcare. The aim of the project was to evaluate whether the programme was meeting the needs of students and to elicit what improvements could be made to the programme in order to enhance the learning experience. A questionnaire was developed to gather data across seven areas. It was subsequently analysed using the report and statistics features available within WebCT's Quiz/Questionnaire tool, in addition to the spreadsheet software MS Excel. The results of the questionnaire confirm that the programme, while successful in many ways, needs to be modified on a regular basis to reflect relevant worldwide changes and would benefit greatly from increased interaction between faculty and students.

'Informal' learning to support breastfeeding: local problems and opportunities

This study explored 'informal' learning opportunities in three health economies, both for National Health Service (NHS) staff and lay people wishing to promote and support breastfeeding and for new mothers wishing to breastfeed. The word 'informal' indicates local learning opportunities that are not part of recognized academic or professional training courses. Semi-structured telephone interviews were conducted with 31 key informants, including health visitors, midwives, infant feeding advisers, Sure Start personnel, voluntary organization representatives, Strategic Health Authority representatives, senior nurses and trainers. The results were analysed thematically. In each site, there were regular training events for NHS staff to acquire or update knowledge and skills. Training was provided by a small number of enthusiasts. Midwives and health visitors were the groups who attend most frequently, although many find it difficult to make time. Although many training events were multidisciplinary, few doctors appeared to attend. Individual staff also used additional learning opportunities, e.g. other courses, conferences, web-based learning, and training by voluntary organizations. Services offered to lay people by the NHS, Sure Start and voluntary organizations included parentcraft, antenatal and post-natal classes, breastfeeding support groups, 'baby cafés' and telephone counselling. Interviewees' organizations did not have a specific breastfeeding strategy, although action groups were trying to take the agenda forward. Local opportunities were over-dependent on individual champions working in relative isolation, and support is needed from local health economies for the facilitation of coordination and networking.