51
|
Day K, Bredenoord AJ, Skypala I, Spergel J, Bickford K, Noble A, Nunn AM. Addressing educational gaps through multidisciplinary team education in eosinophilic oesophagitis management. JOURNAL OF CME 2023; 12:2230033. [PMID: 37426427 PMCID: PMC10327516 DOI: 10.1080/28338073.2023.2230033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 06/13/2023] [Accepted: 06/21/2023] [Indexed: 07/11/2023]
Abstract
Once considered a rare disease, eosinophilic oesophagitis (EoE) is becoming increasingly prevalent, yet many healthcare professionals (HCPs) remain unfamiliar with the underlying pathophysiology and optimal management approaches. For this study, we developed a faculty-led, online, continuing medical education activity on EoE. The effectiveness of this activity was evaluated according to Moore's framework, with changes in knowledge and competence (Moore's Levels 3 and 4) assessed for a cohort of gastroenterologists, dietitians, allergists and immunologists (N = 300), using questionnaires completed before and after participation. Changes in HCP confidence in treating EoE were also reported and remaining educational gaps were identified. The activity was viewed by a global audience of 5,330 participants within 6 months, and significant improvements in knowledge and competence were reported following participation in the activity across all specialities, regions and experience (mean [standard deviation] score pre- versus post-activity: 4.32 [1.38] versus 5.46 [0.82]; p < 0.001). Confidence in treating EoE also increased from pre- to post-activity, with the proportion of participants reporting that they felt moderately or extremely confident increasing from 53% to 82%. Several educational unmet needs were identified, which can be used to inform the design of future educational activities in EoE.
Collapse
Affiliation(s)
- Kathy Day
- Medical and Editorial, touchIME Ltd, Stockport, UK
| | - Albert J Bredenoord
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Isabel Skypala
- Department of Allergy and Clinical Immunology, Royal Brompton & Harefield Hospitals, Part of Guys & St Thomas NHS Foundation Trust, London, UK
| | - Jonathan Spergel
- Allergy Section, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | - Anne M Nunn
- Medical and Editorial, touchIME Ltd, Stockport, UK
| |
Collapse
|
52
|
Kiselev N, Frey T, Naesbom A, Planzer R, Meyer-Heim A. Perspectives of Swiss Paediatric Health Care Professionals on Factors Influencing Physical Activity Participation in Children with Disabilities. Dev Neurorehabil 2023; 26:328-337. [PMID: 37573511 DOI: 10.1080/17518423.2023.2242483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 07/20/2023] [Accepted: 07/26/2023] [Indexed: 08/15/2023]
Abstract
AIM Investigation of the perspectives of paediatric health care professionals (PHCPs) in Switzerland regarding factors that influence participation in physical activity programs for children and adolescents with disabilities or chronic conditions (CADCCs). Evaluation of self-reported exercise counselling behavior of those professionals. METHOD A cross-sectional survey was used to collect the opinions of 171 PHCPs working with CADCCs using a structured questionnaire. The information obtained was evaluated by performing a combined quantitative and qualitative statistical analysis. RESULTS PHCPs in Switzerland think that CADCC do not get enough physical activity and see the underlying reasons in lacking information/knowledge and organizational factors. We found that the level of knowledge about disability sports opportunities among PHCPs has a positive influence on their exercise counselling behaviour. CONCLUSIONS We propose three approaches to increase the level of physical activity in CADCC: Establishing personalized exercise counseling, intensifying information about disability sports programmes towards PHCPs, and improving inclusion and integration in PE lessons or regular sports clubs.
Collapse
Affiliation(s)
- Nikolai Kiselev
- PluSport, Umbrella Organization of Swiss Disabled Sports, Volketswil, Switzerland
- Swiss Research Institute of Public Health and Addiction (ISGF), University of Zürich, Zurich, Switzerland
| | - Tanja Frey
- Swiss Children's Rehab, University Children's Hospital Zurich, Affoltern, Switzerland
- Institute of Medical Genetics, University of Zurich, Schlieren, Switzerland
| | - Annika Naesbom
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Reto Planzer
- PluSport, Umbrella Organization of Swiss Disabled Sports, Volketswil, Switzerland
| | - Andreas Meyer-Heim
- Swiss Children's Rehab, University Children's Hospital Zurich, Affoltern, Switzerland
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
53
|
Singh RP, Welch L, Longo NL, Frese M. Impact of an immersive, interactive medical education initiative on guideline-based retinal disease management knowledge/competence and effectual practice change. BMC Ophthalmol 2023; 23:285. [PMID: 37349689 DOI: 10.1186/s12886-023-03034-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 06/10/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Retinal diseases, including wet or dry age-related macular degeneration, diabetic macular edema, and diabetic retinopathy (DR), are underdiagnosed and undertreated in the United States. Clinical trials support the effectiveness of anti-vascular endothelial growth factor (anti-VEGF) therapies for several retinal conditions, but real-world data suggest underuse by clinicians, resulting in patients experiencing poorer visual outcomes over time. Continuing education (CE) has demonstrated effectiveness at changing practice behaviors, but more research is needed to understand whether CE can help address diagnostic and treatment gaps. METHODS This test and control matched pair analysis examined pre-/post-test knowledge of retinal diseases and guideline-based screening and intervention among 10,786 healthcare practitioners (i.e., retina specialists, ophthalmologists, optometrists, primary care providers, diabetes educators, pharmacists/managed care specialists, and other healthcare providers, such as registered nurses, nurse practitioners, and physician assistants) who participated in a modular, interactive CE initiative. An additional medical claims analysis provided data on practice change, evaluating use of VEGF-A inhibitors among retina specialist and ophthalmologist learners (n = 7,827) pre-/post-education, compared to a matched control group of non-learners. Outcomes were pre-/post-test change in knowledge/competence and clinical change in application of anti-VEGF therapy, as identified by the medical claims analysis. RESULTS Learners significantly improved knowledge/competence scores on early identification and treatment, identifying patients who could benefit from anti-VEGF agents, using guideline-recommended care, recognizing the importance of screening and referral, and recognizing the importance of early detection and care for DR (all P-values = 0.003 to 0.004). Compared with matched controls, learners' incremental total injections for anti-VEGF agents for retinal conditions increased more after the CE intervention (P < 0.001); specifically, there were 18,513 more (new) anti-VEGF injections prescribed versus non-learners (P < 0.001). CONCLUSIONS This modular, interactive, immersive CE initiative resulted in significant knowledge/competence gains among retinal disease care providers and changes in practice-related treatment behaviors (i.e., appropriate consideration and greater incorporation of guideline-recommended anti-VEGF therapies) among participating ophthalmologists and retina specialists compared to matched controls. Future studies will utilize medical claims data to show longitudinal impact of this CE initiative on treatment behavior among specialists and impact on diagnosis and referral rates among optometrists and primary care providers who participate in future programming.
Collapse
Affiliation(s)
- Rishi P Singh
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
- Cleveland Clinic Martin Health, Stuart, FL, USA
| | - Lauren Welch
- Med Learning Group, 17th St #4, New York, NY, 10011, USA.
| | - Nicole L Longo
- Med Learning Group, 17th St #4, New York, NY, 10011, USA
| | - Matt Frese
- Med Learning Group, 17th St #4, New York, NY, 10011, USA
| |
Collapse
|
54
|
Gaxiola-García MA, Villalpando-Casas JDJ, García-Minjares M, Martínez-González A. National examination for medical residency admission: academic performance in a high-stakes test and the need for continuing education. Postgrad Med J 2023; 99:599-604. [PMID: 37319154 DOI: 10.1136/postgradmedj-2022-141607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 04/07/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Performance and selection rate of non-newly graduated physicians in a medical residency admission test as an indicator for the need of continuing education. METHODS A database comprising 153 654 physicians who took a residency admission test in the period 2014-2018 was analysed. Performance and selection rates were assessed in relation to year of graduation and performance in medical school. RESULTS The whole sample scored at a mean of 62.3 (SD ±8.9; range 1.11-91.11). Examinees who took the test in their year of graduation performed better (66.10) than those who took the test after their year of graduation (61.84); p<0.001.Selection rates differed accordingly; 33.9% for newly graduated physicians compared with 24.8% in those who took the test at least 1 year after graduation; p<0.001. An association between selection test performance and medical school grades was established using Pearson's correlation: r=0.40 for newly graduated physicians and r=0.30 for non-newly graduated physicians. There were statistically significant differences in selection rates for every ranking group of grades in medical school based on the χ2 test (p<0.001). The selection rates are decreased years after graduation even for candidates with high grades in medical school. DISCUSSION There is an association between performance in a medical residency admission test and academic variables of the candidates: medical school grades and time elapsed from graduation to test taking. The evidence of decrease in retention of medical knowledge since graduation highlights the pertinence of continuing education interventions.
Collapse
Affiliation(s)
| | | | | | - Adrián Martínez-González
- CUAIEED, Universidad Nacional Autónoma de México, UNAM, Mexico City, Mexico
- Public Health Department, Universidad Nacional Autónoma de México, UNAM, Mexico City, Mexico
| |
Collapse
|
55
|
MacNeill H, Paton M, Schneeweiss S, Wiljer D. Perceived Advantages and Disadvantages of Online Continuing Professional Development (CPD) During COVID-19: CPD Providers' Perspectives. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023; 44:147-150. [PMID: 37201550 DOI: 10.1097/ceh.0000000000000512] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
ABSTRACT COVID-19 precipitated many CPD providers to develop new technology competencies to create effective online CPD. This study aims to improve our understanding of CPD providers' comfort level, supports, perceived advantages/disadvantages, and issues in technology-enhanced CPD delivery during COVID-19. A survey was distributed to CPD providers at the University of Toronto and members of the Society for Academic Continuing Medical Education and analyzed using descriptive statistics. Of the 111 respondents, 81% felt very to somewhat confident to provide online CPD, but less than half reported IT, financial, or faculty development supports. The top reported advantage to online CPD delivery was reaching a new demographic; top disadvantages included videoconferencing fatigue, social isolation, and competing priorities. There was interest in using less frequently used educational technology such as online collaboration tools, virtual patients, and augmented/virtual reality. COVID-19 precipitated an increased comfort level in using synchronous technologies to provide CPD, giving the CPD community an increased cultural acceptance and skill level to build on. As we move beyond the pandemic, it will be important to consider ongoing faculty development, particularly toward asynchronous and HyFlex delivery methods to continue expand CPD reach and negate negative online experiences such as videoconferencing fatigue, social isolation, and online distractions.
Collapse
Affiliation(s)
- Heather MacNeill
- Dr. MacNeill: Faculty Lead, Educational Technologies, Continuing Professional Development, Temerty Faculty of Medicine; Associate Professor, Department of Medicine, University of Toronto, Toronto. Canada. Dr. Paton: Education Research Coordinator, Continuing Professional Development, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Dr. Schneeweiss: Continuing Professional Development, Temerty Faculty of Medicine; Department of Paediatrics, University of Toronto, Toronto, Canada. Dr. Wiljer: Academic Director, Continuing Professional Development, Temerty Faculty of Medicine; Professor, Department of Psychiatry, Temerty Faculty of Medicine and the Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Canada; Executive Director, Digital, Education Technology Innovation, University Health Network
| | | | | | | |
Collapse
|
56
|
Tan A, Copley J, Fleming J. Clinical utility of a decision-making aid for upper limb neurorehabilitation: applying the Hypertonicity Intervention Planning Model across cultures. Brain Inj 2023; 37:572-580. [PMID: 37122142 DOI: 10.1080/02699052.2023.2205661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND The Hypertonicity Intervention Planning Model (HIPM) is a decision-making aid which guides clinical reasoning in individualizing upper limb (UL) neurorehabilitation. AIM To examine the HIPM's clinical utility across cultures, using therapists' perceptions of its usefulness and challenges when applied in clinical practice. METHODS Interpretive description methodology guided qualitative data collection and analysis because it produces clinically practical applications. Forty-four occupational therapists working in Australia or Singapore participated. Three group discussions were conducted using a modified nominal group technique. RESULTS Three themes were: (1) The HIPM guides systematic clinical decision-making for assessment, goal-setting, and intervention; (2) Utility was influenced by systemic or organizational supports and barriers including availability of time, resources, and funding; organizational readiness to change; multidisciplinary and transorganizational collaboration; (3) Therapists' skills and confidence to apply the HIPM, and openness to changing practice, influenced utility. CONCLUSIONS Therapists strongly support HIPM use for structuring and communicating clinical reasoning in UL neurorehabilitation. However, organizational support is key to optimizing clinical utility. Incorporating decision-making aids into documentation and referral processes may strengthen multidisciplinary and transorganizational teamwork, enhancing clinical use. Different training tiers to suit therapist experience levels, refresher courses, and supplementary resources may improve therapists' skills and confidence, thereby boosting utility.
Collapse
Affiliation(s)
- Amelia Tan
- School of Health Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Jodie Copley
- School of Health Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Jennifer Fleming
- School of Health Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| |
Collapse
|
57
|
Nunes GS, Guterres BD, Machado ACO, Dangui AJM, Schreiner RA, Benincá IL, Haupenthal A. Where do Physiotherapists Search for Information? Barriers in Translating Scientific Information into Clinical Practice. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023; 44:75-78. [PMID: 37053570 DOI: 10.1097/ceh.0000000000000508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
INTRODUCTION Comprehending scientific information have been reported as a barrier in evidence-based practice (EBP) adoption. This survey research aimed to verify the preferred sources of information for acquiring knowledge about physiotherapy and the association between types of information source and barriers in EBP implementation. METHODS A total of 610 physiotherapists were included and answered an online questionnaire about the preferred sources for searching physiotherapy-related information and possible barriers in EBP implementation. RESULTS Physiotherapists reported scientific resources as the preferred source of information, scientific databases (31%), followed by scientific articles (25%). The main barrier cited in EBP implementation was the difficulty in obtaining full-text articles (34%), followed by lack of statistical knowledge (30%). The use of peer-reviewed resources as the most preferred source of information is associated with the presence of issues in comprehending scientific information. DISCUSSION Although the positive attitude toward the use of scientific information, the findings raised question regarding the proper translation of scientific information to clinical practice. The importance of scientific information seems to be a well-established attitude among physiotherapists. However, there is a clear need for strategies aiming to improve the understanding of scientific information and consequently facilitate EBP implementation.
Collapse
Affiliation(s)
- Guilherme S Nunes
- Dr. Nunes: Adjunct Professor, Department of Physiotherapy and Rehabilitation, Federal University of Santa Maria, Santa Maria/RS, Brazil. Ms. Guterres: Physiotherapist, Department of Physiotherapy and Rehabilitation, Federal University of Santa Maria, Santa Maria/RS, Brazil. Ms. Machado: Physiotherapist, Department of Physiotherapy and Rehabilitation, Federal University of Santa Maria, Santa Maria/RS, Brazil. Ms. Dangui: Physiotherapist, Department of Physiotherapy and Rehabilitation, Federal University of Santa Maria, Santa Maria/RS, Brazil. Ms. Schreiner: Physiotherapist, Department of Physiotherapy and Rehabilitation, Federal University of Santa Maria, Santa Maria/RS, Brazil. Ms. Benincá: Researcher, Department of Health Sciences, Federal University of Santa Catarina, Araranguá/SC, Brazil. Dr. Haupenthal: Adjunct Professor, Department of Health Sciences, Federal University of Santa Catarina, Araranguá/SC, Brazil
| | | | | | | | | | | | | |
Collapse
|
58
|
Barenie RE, Frederick KD, Heidel RE, Wheeler JS. A Survey of Hiring and Non-hiring Pharmacists' Perceptions of a Primary Care Certificate Training Program. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2023; 87:ajpe9072. [PMID: 36319073 PMCID: PMC10159027 DOI: 10.5688/ajpe9072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/27/2022] [Indexed: 05/03/2023]
Abstract
Objective. To survey pharmacists, including those who make or contribute to hiring decisions, regarding certificate training programs and specifically about a primary care certificate for pharmacists.Methods. We conducted a cross-sectional survey of pharmacist registrants of the Office of Continuing Professional Development at the University of Tennessee Health Science Center College of Pharmacy's listserve, including both hiring and non-hiring pharmacists. The 40-question survey probed perceptions of various types of postgraduate training and the design of a primary care certificate training program for pharmacists. Data were collected between November and December 2020.Results. A total of 230 pharmacists participated in this study (14% response rate), and most reported practicing in the community (n=126, 57%). Nearly half of the respondents reported making or contributing to hiring decisions of other pharmacists (n=94, 41%), and, of those, most reported that completion of a primary care certificate program by a candidate would increase their likelihood of hiring that candidate (n=50, 78%). Both groups (hiring and non-hiring pharmacists) most commonly reported that a primary care certificate training program should be 30 hours total and 12 weeks in length, ranked communication as the most important topic to be included, and indicated the didactic and simulation/experiential components should be similarly weighted.Conclusions. Pharmacists, including those who make or contribute to hiring decisions, reported valuing certificate training programs. Developing a certificate training program that is at least 30 hours in length over 12 weeks may serve as an opportunity to address gaps in primary care in the United States.
Collapse
Affiliation(s)
- Rachel E Barenie
- The University of Tennessee Health Science Center, College of Pharmacy, Memphis, Tennessee
| | - Kelsey D Frederick
- The University of Tennessee Health Science Center, College of Pharmacy, Memphis, Tennessee
| | - R Eric Heidel
- The University of Tennessee Graduate School of Medicine, Knoxville, Tennessee
| | - James S Wheeler
- The University of Tennessee Health Science Center, College of Pharmacy, Memphis, Tennessee
| |
Collapse
|
59
|
Stephenson CR, Yudkowsky R, Wittich CM, Cook DA. Learner engagement and teaching effectiveness in livestreamed versus in-person CME. MEDICAL EDUCATION 2023; 57:349-358. [PMID: 36454138 DOI: 10.1111/medu.14996] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 11/22/2022] [Accepted: 11/28/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Engaging learners in continuing medical education (CME) is challenging. Recently, CME courses have transitioned to livestreamed CME, with learners viewing live, in-person courses online. The authors aimed to (1) compare learner engagement and teaching effectiveness in livestreamed with in-person CME and (2) determine how livestream engagement and teaching effectiveness is associated with (A) interactivity metrics, (B) presentation characteristics and (C) medical knowledge. METHODS A 3-year, non-randomised study of in-person and livestream CME was performed. The course was in-person for 2018 but transitioned to livestream for 2020 and 2021. Learners completed the Learner Engagement Inventory and Teaching Effectiveness Instrument after each presentation. Both instruments were supported by content, internal structure and relations to other variables' validity evidence. Interactivity metrics included learner use of audience response, questions asked by learners and presentation views. Presentation characteristics included presentations using audience response, using pre/post-test format, time of day and words per slide. Medical knowledge was assessed by audience response. A repeated measures analysis of variance (anova) was used for comparisons and a mixed model approach for correlations. RESULTS A total of 159 learners (response rate 27%) completed questionnaires. Engagement did not significantly differ between in-person or livestream CME. (4.56 versus 4.53, p = 0.64, maximum 5 = highly engaged). However, teacher effectiveness scores were higher for in-person compared with livestream (4.77 versus 4.71 p = 0.01, maximum 5 = highly effective). For livestreamed courses, learner engagement was associated with presentation characteristics, including presentation using of audience response (yes = 4.57, no = 4.45, p < .0001), use of a pre/post-test (yes = 4.62, no = 4.54, p < .0001) and time of presentation (morning = 4.58, afternoon = 4.53, p = .0002). Significant associations were not seen for interactivity metrics or medical knowledge. DISCUSSION Livestreaming may be as engaging as in-person CME. Although teaching effectiveness in livestreaming was lower, this difference was small. CME course planners should consider offering livestream CME while exploring strategies to enhance teaching effectiveness in livestreamed settings.
Collapse
Affiliation(s)
- Christopher R Stephenson
- Division of General Internal Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Rachel Yudkowsky
- Department of Medical Education, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Christopher M Wittich
- Division of General Internal Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - David A Cook
- Division of General Internal Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| |
Collapse
|
60
|
Zevin B, Morkem R, Soleas E, Dalgarno N, Barber D. Using Administrative Data in Primary Care to Evaluate the Effectiveness of a Continuing Professional Development Program Focused on the Management of Patients Living With Obesity. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023; 43:104-108. [PMID: 37249343 DOI: 10.1097/ceh.0000000000000445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION There are guidelines for referral to medical and/or surgical weight loss interventions (MSWLI) in Ontario; however, only about one-third of eligible patients in our region are being referred for consideration of MSWLI. METHODS A planning committee, including a registered dietician, psychiatrist, endocrinologist, bariatric surgeon, family physician, and educationalists, developed an interdisciplinary continuing professional development (CPD) program focused on practical approaches to the management of patients living with obesity. The Kirkpatrick model was used to evaluate the educational outcomes of the CPD program specifically focusing on Level-2, -3, and -4 outcomes based on self-reported questionnaire and health administrative data. RESULTS Eighteen primary care providers from the CPD program agreed to participate in this study, and 16 primary care providers (89%) completed the postintervention questionnaire and granted us access to their MSWLI referral data; 94% of study participants reported changes to their knowledge, comfort, and confidence (Level 2), as well as expected change in their future behaviour (Level 3) following the CPD program. However, there was no change in Kirkpatrick Level-4 outcomes, despite more than 90% of participants indicating that they will be making changes to their practice after the program. DISCUSSION The CPD program in our study was overwhelmingly well received and participants reported knowledge (Level 2) and behavioural (Level 3) changes following participation; however, there was no detectable change in their clinical practice (Level 4). The methodology described in our proof-of-concept study can be modified and adopted to evaluate Level-4 outcomes in other studies of effectiveness of CPD interventions.
Collapse
Affiliation(s)
- Boris Zevin
- Dr. Zevin: Associate Professor, Department of Surgery, Queen's University, Kingston, Ontario. Ms. Morkem: Research Associate, Centre for Studies in Primary Care, Queen's University, Kingston, Ontario. Dr. Soleas: Director of Continuing Professional Development and Adjunct Assistant Professor, Office of Professional Development and Educational Scholarship, Queen's University, Kingston, Ontario. Dr. Dalgarno: Director of Education Research and Adjunct Assistant Professor, Office of Professional Development and Educational Scholarship, Queen's University, Kingston, Ontario. Dr. Barber: Network Director and Assistant Professor, Centre for Studies in Primary Care, Queen's University, Kingston, Ontario
| | | | | | | | | |
Collapse
|
61
|
Kim B, Merlo AV. Domestic Homicide: A Synthesis of Systematic Review Evidence. TRAUMA, VIOLENCE & ABUSE 2023; 24:776-793. [PMID: 34510978 DOI: 10.1177/15248380211043812] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Domestic homicide (DH) is the most extreme form of domestic violence (DV). There has been a growing worldwide interest in DH offenses and the characteristics of perpetrators and victims, and it is evidenced in part by the increase in the number of primary research studies in this area. The findings of a large number of the available primary literature have already been summarized into several systematic reviews. The principal purposes of this study were to identify what types and aspects of DH have been reviewed systematically (research trends), to synthesize findings from recent systematic reviews of the theoretical and empirical literature on the different types of DH (main findings), and to consider what existing reviews can tell us about the implications for policy and practice as well as future primary research (implications). The current study utilized a systematic review approach to locate systematic reviews of studies on DH. The final sample included 25 systematic review articles published from 2010 to 2020, including 12 on intimate partner homicide, eight on child homicide, and five on familicide. The main research questions varied across systematic reviews, but they included risk factors, statistics on incidence and prevalence, theories, risk assessment tools, punishment and disposition, and prevention strategies. Building on the synthesis findings, the current study concludes with suggestions for future systematic review research and implications for practice and policy efforts.
Collapse
Affiliation(s)
- Bitna Kim
- Department of Criminology and Criminal Justice, Indiana University of Pennsylvania, PA, USA
| | - Alida V Merlo
- Department of Criminology and Criminal Justice, Indiana University of Pennsylvania, PA, USA
| |
Collapse
|
62
|
Main PAE, Anderson S. Evidence for continuing professional development standards for regulated health practitioners in Australia: a systematic review. HUMAN RESOURCES FOR HEALTH 2023; 21:23. [PMID: 36941655 PMCID: PMC10026429 DOI: 10.1186/s12960-023-00803-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Health practitioner regulators throughout the world use continuing professional development (CPD) standards to ensure that registrants maintain, improve and broaden their knowledge, expertise and competence. As the CPD standard for most regulated health professions in Australia are currently under review, it is timely that an appraisal of the evidence be undertaken. METHODS A systematic review was conducted using major databases (including MEDLINE, EMBASE, PsycInfo, and CINAHL), search engines and grey literature for evidence published between 2015 and April 2022. Publications included in the review were assessed against the relevant CASP checklist for quantitative studies and the McMaster University checklist for qualitative studies. RESULTS The search yielded 87 abstracts of which 37 full-text articles met the inclusion criteria. The evidence showed that mandatory CPD requirements are a strong motivational factor for their completion and improves practitioners' knowledge and behaviour. CPD that is more interactive is most effective and e-learning is as effective as face-to-face CPD. There is no direct evidence to suggest the optimal quantity of CPD, although there was some evidence that complex or infrequently used skills deteriorate between 4 months to a year after training, depending on the task. CONCLUSIONS CPD is most effective when it is interactive, uses a variety of methods and is delivered in a sequence involving multiple exposures over a period of time that is focused on outcomes considered important by practitioners. Although there is no optimal quantity of CPD, there is evidence that complex skills may require more frequent CPD.
Collapse
Affiliation(s)
| | - Sarah Anderson
- Research and Evaluation Team, Australian Health Practitioner Regulation Agency, Melbourne, VIC, Australia.
- School of Allied Health, Human Services and Sport , La Trobe University, Bundoora, VIC, Australia.
| |
Collapse
|
63
|
|
64
|
Muhetaer A, Yang H, Liu Y, Huang C. Three-dimensionally printed implant surgical guide-related experience, knowledge, attitude, and professional behaviors among 2028 dentists in China: A cross-sectional study. J Prosthet Dent 2023; 129:448.e1-448.e8. [PMID: 36739217 DOI: 10.1016/j.prosdent.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/03/2023] [Accepted: 01/03/2023] [Indexed: 02/05/2023]
Abstract
STATEMENT OF PROBLEM Research on the current place of 3-dimensionally printed implant surgical guides (3D-ISGs) among practicing dentists worldwide is lacking, with little research focused on dentists' experience, knowledge, attitude, or professional behavior related to 3D-ISG or on the main obstacle to adoption. PURPOSE The purpose of this cross-sectional study was to identify the adoption of 3D-ISG in dental practice in China and to determine factors that influence its further application and dentists' attitudes and willingness. MATERIAL AND METHODS Semistructured questionnaires were sent to a sample of Chinese dentists composed of users and nonusers of 3D-ISG. The questionnaires were displayed and distributed through a professional online survey system (http://www.wjx.cn) and a social media platform (WeChat). The responses were analyzed with multivariable generalized equations, and the effect of various demographic variables was determined, including dentist experience, academic degree, and type of practice (public or private). RESULTS A total of 2028 valid questionnaires were collected. In dental practice, 39.3% of the respondents used 3D-ISG. Respondents with a PhD (62.4%) used the 3D-ISG more than twice as frequently as respondents with a junior college degree or below (31.8%). The majority of the members of implantology departments (81.7%) applied 3D-ISG, but doctors in other departments used it at a rate of less than half. The 3D-ISG was most frequently used in the maxillary anterior area (78.4%), followed by the edentulous maxilla and mandible (61.0% and 60.5%, respectively). The main barriers were high initial cost, complex and time-consuming digital design, and lack of expertise in the proper use of 3D-ISG. CONCLUSIONS Most dentists did not use 3D-ISG in dental practice. The 3D-ISG application rate was significantly associated with sex, academic degree, years of dental practice, department, monthly income, and type of healthcare facility. To improve the popularity of 3D-ISG, particularly among dentists without advanced degrees, it would be important to optimize the digital design software program and provide sufficient training.
Collapse
Affiliation(s)
- Aihemaiti Muhetaer
- Doctoral student, The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory for Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, PR China
| | - Hongye Yang
- Associate Professor, The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory for Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, PR China
| | - Yan Liu
- Doctoral student, Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, PR China
| | - Cui Huang
- Professor, The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory for Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, PR China.
| |
Collapse
|
65
|
Hospital Mortality and Trainee Experiences: How General Medical Council Survey Findings Correlate With Summary Hospital-Level Mortality Indicator. J Patient Saf 2023; 19:79-85. [PMID: 36728852 DOI: 10.1097/pts.0000000000001095] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES This study aimed to investigate whether components of junior doctor satisfaction are associated with patient mortality within the United Kingdom. METHODS We conducted a cross-sectional study of publicly available data (the General Medical Council [GMC] National Survey and the Summary Hospital-level Mortality Indicator [SHMI]) pertaining to subjective physician trainee satisfaction and patient mortality within 80 United Kingdom-based healthcare institutions. The direction and strength of correlation between components of the GMC National Survey and relative patient mortality as described by the SHMI were calculated. Additional outcomes included mean GMC survey scores for reported domains and mean SHMI by healthcare institution. RESULTS SHMI for included healthcare institutions ranged from 0.69 to 1.21 (mean [SD], 1.01 [0.1]). Mean GMC domain scores ranged between 44.61 and 88.62 (mean [SD], 71.16 [10.84]). Statistically significant correlations were observed for clinical supervision, clinical supervision out of hours, rota design, overall satisfaction, and teamwork. After application of Bonferroni correction, statistically significant correlations remained for both clinical supervision and clinical supervision out of hours. CONCLUSIONS There is a significant association between components of subjective trainee satisfaction and patient mortality within the United Kingdom. Further investigation to examine these relationships, perhaps to target intervention, may prevent avoidable patient harm.
Collapse
|
66
|
Sepucha K, Han PKJ, Chang Y, Atlas SJ, Korsen N, Leavitt L, Lee V, Percac-Lima S, Mancini B, Richter J, Scharnetzki E, Siegel LC, Valentine KD, Fairfield KM, Simmons LH. Promoting Informed Decisions About Colorectal Cancer Screening in Older Adults (PRIMED Study): a Physician Cluster Randomized Trial. J Gen Intern Med 2023; 38:406-413. [PMID: 35931908 PMCID: PMC9362387 DOI: 10.1007/s11606-022-07738-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 07/01/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND For adults aged 76-85, guidelines recommend individualizing decision-making about whether to continue colorectal cancer (CRC) testing. These conversations can be challenging as they need to consider a patient's CRC risk, life expectancy, and preferences. OBJECTIVE To promote shared decision-making (SDM) for CRC testing decisions for older adults. DESIGN Two-arm, multi-site cluster randomized trial, assigning physicians to Intervention and Comparator arms. Patients were surveyed shortly after the visit to assess outcomes. Analyses were intention-to-treat. PARTICIPANTS AND SETTING Primary care physicians affiliated with 5 academic and community hospital networks and their patients aged 76-85 who were due for CRC testing and had a visit during the study period. INTERVENTIONS Intervention arm physicians completed a 2-h online course in SDM communication skills and received an electronic reminder of patients eligible for CRC testing shortly before the visit. Comparator arm received reminders only. MAIN MEASURES The primary outcome was patient-reported SDM Process score (range 0-4 with higher scores indicating more SDM); secondary outcomes included patient-reported discussion of CRC screening, knowledge, intention, and satisfaction with the visit. KEY RESULTS Sixty-seven physicians (Intervention n=34 and Comparator n=33) enrolled. Patient participants (n=466) were on average 79 years old, 50% with excellent or very good self-rated overall health, and 66% had one or more prior colonoscopies. Patients in the Intervention arm had higher SDM Process scores (adjusted mean difference 0.36 (95%CI (0.08, 0.64), p=0.01) than in the Comparator arm. More patients in the Intervention arm reported discussing CRC screening during the visit (72% vs. 60%, p=0.03) and had higher intention to follow through with their preferred approach (58.0% vs. 47.1, p=0.03). Knowledge scores and visit satisfaction did not differ significantly between arms. CONCLUSION Physician training plus reminders were effective in increasing SDM and frequency of CRC testing discussions in an age group where SDM is essential. TRIAL REGISTRATION The trial is registered on clinicaltrials.gov (NCT03959696).
Collapse
Affiliation(s)
- Karen Sepucha
- Division of General Internal Medicine, Massachusetts General Hospital Health Decision Sciences Center, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Paul K J Han
- Center for Interdisciplinary Population and Health Research, Maine Medical Center, Portland, ME, USA
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, USA
| | - Yuchiao Chang
- Division of General Internal Medicine, Massachusetts General Hospital Health Decision Sciences Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Steven J Atlas
- Division of General Internal Medicine, Massachusetts General Hospital Health Decision Sciences Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Neil Korsen
- Center for Interdisciplinary Population and Health Research, Maine Medical Center, Portland, ME, USA
| | - Lauren Leavitt
- Division of General Internal Medicine, Massachusetts General Hospital Health Decision Sciences Center, Boston, MA, USA
| | - Vivian Lee
- Division of General Internal Medicine, Massachusetts General Hospital Health Decision Sciences Center, Boston, MA, USA
| | - Sanja Percac-Lima
- Division of General Internal Medicine, Massachusetts General Hospital Health Decision Sciences Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Brittney Mancini
- Division of General Internal Medicine, Massachusetts General Hospital Health Decision Sciences Center, Boston, MA, USA
| | - James Richter
- Harvard Medical School, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA
| | - Elizabeth Scharnetzki
- Center for Interdisciplinary Population and Health Research, Maine Medical Center, Portland, ME, USA
| | - Lydia C Siegel
- Harvard Medical School, Boston, MA, USA
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - K D Valentine
- Division of General Internal Medicine, Massachusetts General Hospital Health Decision Sciences Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Kathleen M Fairfield
- Center for Interdisciplinary Population and Health Research, Maine Medical Center, Portland, ME, USA
| | - Leigh H Simmons
- Division of General Internal Medicine, Massachusetts General Hospital Health Decision Sciences Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| |
Collapse
|
67
|
Dale CM, Cioffi I, Novak CB, Gorospe F, Murphy L, Chugh D, Watt-Watson J, Stevens B. Continuing professional development needs in pain management for Canadian health care professionals: A cross sectional survey. Can J Pain 2023; 7:2150156. [PMID: 36704362 PMCID: PMC9872952 DOI: 10.1080/24740527.2022.2150156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background Continuing professional development is an important means of improving access to effective patient care. Although pain content has increased significantly in prelicensure programs, little is known about how postlicensure health professionals advance or maintain competence in pain management. Aims The aim of this study was to investigate Canadian health professionals' continuing professional development needs, activities, and preferred modalities for pain management. Methods This study employed a cross-sectional self-report web survey. Results The survey response rate was 57% (230/400). Respondents were primarily nurses (48%), university educated (95%), employed in academic hospital settings (62%), and had ≥11 years postlicensure experience (70%). Most patients (>50%) cared for in an average week presented with pain. Compared to those working in nonacademic settings, clinicians in academic settings reported significantly higher acute pain assessment competence (mean 7.8/10 versus 6.9/10; P < 0.002) and greater access to pain specialist consultants (73% versus 29%; P < 0.0001). Chronic pain assessment competence was not different between groups. Top learning needs included neuropathic pain, musculoskeletal pain, and chronic pain. Recently completed and preferred learning modalities respectively were informal and work-based: reading journal articles (56%, 54%), online independent learning (44%, 53%), and attending hospital rounds (43%, 42%); 17% had not completed any pain learning activities in the past 12 months. Respondents employed in nonacademic settings and nonphysicians were more likely to use pocket cards, mobile apps, and e-mail summaries to improve pain management. Conclusions Canadian postlicensure health professionals require greater access to and participation in interactive and multimodal methods of continuing professional development to facilitate competency in evidence-based pain management.
Collapse
Affiliation(s)
- Craig M. Dale
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada,Tory Trauma Program, Sunnybrook Health Sciences Centre, Toronto, Canada,CONTACT Craig M. Dale Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, #130–155 College Street, Toronto, ON M5T1P8, Canada
| | - Iacopo Cioffi
- Faculty of Dentistry, University of Toronto, Toronto, Canada
| | | | - Franklin Gorospe
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada,Toronto General Hospital, University Health Network, Toronto, Canada
| | - Laura Murphy
- Department of Pharmacy, University Health Network, Toronto, Canada,Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Deepika Chugh
- Faculty of Dentistry, University of Toronto, Toronto, Canada,Department of Dentistry, Mount Sinai Hospital, Toronto, Canada
| | - Judy Watt-Watson
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Bonnie Stevens
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada,Research Institute, The Hospital for Sick Children (SickKids), Toronto, Canada
| |
Collapse
|
68
|
Stock G, McDermott C. The effects of physicians on operational and financial performance in United States hospitals: staffing, human capital and knowledge spillovers. INTERNATIONAL JOURNAL OF OPERATIONS & PRODUCTION MANAGEMENT 2023. [DOI: 10.1108/ijopm-07-2022-0457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PurposeThe authors examine how physician staffing, human capital and knowledge spillovers are related to multiple dimensions of hospital operational and financial performance at the organizational level.Design/methodology/approachThe authors use a data set assembled from multiple sources for more than 1,300 US hospitals and employ hierarchical linear regression to test this study’s hypotheses. The authors use multiple quality, efficiency and financial measures of performance for these hospitals.FindingsThe authors find that higher levels of staffing, skills and knowledge spillovers associated with physicians were positively associated with multiple dimensions of hospital performance. The authors find linear and nonlinear relationships between experience and performance, with the relationships primarily negative, and nonlinear relationships between spillovers and quality performance.Practical implicationsHospital managers should consider increasing physician staffing levels if possible. In addition, the overall Final MIPS Score from the Centers for Medicare and Medicaid Services might be included as a factor in determining which physicians practice in a hospital. Finally, if possible, encouraging physicians to practice at multiple hospitals will likely be beneficial to hospital performance.Originality/valueThis study’s findings are original in that they explore how physician-specific staffing and human capital, which have received comparatively little attention in the literature, are related to several different dimensions of hospital-level operational and financial performance. To the best of the authors’ knowledge, this paper is also the first to examine the relationship between the construct of physician knowledge spillovers and hospital-level operational and financial performance.
Collapse
|
69
|
Bogers S, Schim van der Loeff M, Boyd A, van Dijk N, Geerlings S, van Bergen J. Improving provider-initiated testing for HIV and other STI in the primary care setting in Amsterdam, the Netherlands: Results from a multifaceted, educational intervention programme. PLoS One 2023; 18:e0282607. [PMID: 36877664 PMCID: PMC9987818 DOI: 10.1371/journal.pone.0282607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/18/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND In the Netherlands, general practitioners (GPs) play a key role in HIV testing. However, the proportion of people diagnosed with late-stage HIV remains high, and opportunities for earlier diagnosis are being missed. We implemented an educational intervention to improve HIV and STI testing in primary care in Amsterdam, the Netherlands. METHODS GPs were invited to participate in an educational program between 2015 and 2020, which included repeat sessions using audit and feedback and quality improvement plans. Data on HIV, chlamydia and gonorrhoea testing by GPs were collected from 2011 through 2020. The primary outcome was HIV testing frequency, which was compared between GPs before and after participation using Poisson regression. Secondary outcomes were chlamydia and gonorrhoea testing frequencies, and positive test proportions. Additional analyses stratified by patient sex and age were done. FINDINGS GPs after participation performed 7% more HIV tests compared to GPs before participation (adjusted relative ratio [aRR] 1.07, 95%CI 1.04-1.09); there was no change in the proportion HIV positive tests (aRR 0.87, 95%CI 0.63-1.19). HIV testing increased most among patients who were female and ≤19 or 50-64 years old. After participation, HIV testing continued to increase (aRR 1.02 per quarter, 95%CI 1.01-1.02). Chlamydia testing by GPs after participation increased by 6% (aRR 1.06, 95%CI 1.05-1.08), while gonorrhoea testing decreased by 2% (aRR 0.98, 95%CI 0.97-0.99). We observed increases specifically in extragenital chlamydia and gonorrhoea testing. CONCLUSIONS The intervention was associated with a modest increase in HIV testing among GPs after participation, while the proportion positive HIV tests remained stable. Our results suggest that the intervention yielded a sustained effect.
Collapse
Affiliation(s)
- Saskia Bogers
- Amsterdam UMC Location University of Amsterdam, Internal Medicine, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, The Netherlands
- * E-mail:
| | - Maarten Schim van der Loeff
- Amsterdam UMC Location University of Amsterdam, Internal Medicine, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, The Netherlands
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Anders Boyd
- Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, The Netherlands
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Stichting HIV Monitoring, Amsterdam, The Netherlands
| | - Nynke van Dijk
- Department of General Practice, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Suzanne Geerlings
- Amsterdam UMC Location University of Amsterdam, Internal Medicine, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, The Netherlands
| | - Jan van Bergen
- Department of General Practice, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- STI AIDS Netherlands, Amsterdam, The Netherlands
| | | |
Collapse
|
70
|
Wong R, Kitto S. Rethinking Context in Continuing Professional Development: From Identifying Barriers to Understanding Social Dynamics. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023; 43:S9-S17. [PMID: 38054488 DOI: 10.1097/ceh.0000000000000543] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
INTRODUCTION For continuing professional development (CPD) to reach its potential to improve outcomes requires an understanding of the role of context and the influencing conditions that enable interventions to succeed. We argue that the heuristic use of frameworks to design and implement interventions tends to conceptualize context as defined lists of barriers, which may obscure consideration of how different contextual factors interact with and intersect with each other. METHODS We suggest a framework approach that would benefit from postmodernist theory that explores how ideologies, meanings, and social structures in health care settings shape social practices. As an illustrative example, we conducted a Foucauldian discourse analysis of diabetes care to make visible how the social, historical, and political conditions in which clinicians experience, practice, and shape possibilities for behavior change. RESULTS The discursive construction of continuing education as a knowledge translation mechanism assumes and is contingent on family physicians to implement guidelines. However, they enact other discursively constituted roles that may run in opposition. This paradoxical position creates a tension that must be navigated by family physicians, who may perceive it possible to provide good care without necessarily implementing guidelines. DISCUSSION We suggest marrying "framework" thinking with postmodernist theory that explores how ideologies, meanings, and social structures shape practice behavior change. Such a proposed reconceptualization of context in the design of continuing professional development interventions could provide a more robust and nuanced understanding of how the dynamic relationships and interactions between clinicians, patients, and their work environments shape educational effectiveness.
Collapse
Affiliation(s)
- René Wong
- Dr. Wong: Associate Professor, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. Dr. Kitto: Professor, Department of Innovation in Medical Education, University of Ottawa, Ottawa, Ontario, Canada
| | | |
Collapse
|
71
|
Albaz N, Agha S. Medical Education in the Context of the Eastern Mediterranean Region: Professional Development Activity of Health Professionals. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2023; 14:463-471. [PMID: 37168458 PMCID: PMC10166095 DOI: 10.2147/amep.s395015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 04/20/2023] [Indexed: 05/13/2023]
Abstract
Background The development and maintenance of a high-quality medical education workforce depend on continuing medical education (CME). Traditionally, CME is delivered face-to-face, but due to COVID-19 and geographical distances, it is challenging to conduct professional development activities for several days. Using a webinar on advancement in medical education in the context of the eastern Mediterranean, we aimed to assess the participants' perspectives towards the professional development activity using a synchronous learning approach. Methods We used a cross-sectional survey-based study design. We invited faculty members from King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) and United Arab Emirates University for Health Sciences (UAEU). We assessed their perspectives on the relevance of the content and effectiveness of the activity on their knowledge and skills after the two days' webinar series. A self-designed questionnaire was administered post-webinar immediately. Open-ended responses were analyzed thematically. Results One hundred thirty-six registered healthcare professionals attended day 1, and 97 registered participants joined on the second day of the webinar. Most participants appreciated the diversity of the contents, the quality of the presentations, and the expertise of the facilitators. They reported that the content optimized their knowledge and understanding of new concepts such as assessment in simulation teaching, programmatic assessment, insight into the implementation of IPE and EPAs in CBME, and so on. The e-learning platform's user accessibility, online tutor interaction, and the addition of more scenario-based case studies were all recommended for improvement. Conclusion Overall the two days webinar series presentations were informative and highlighted the transformation in medical practices. Suggestions to improve the quality of the webinars and content were discussed.
Collapse
Affiliation(s)
- Noof Albaz
- Department of Medical Education, College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), King Abdullah International Medical Research Centre, Riyadh, Kingdom of Saudi Arabia
- Correspondence: Noof Albaz, Medical Education, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia, King Abdullah International Medical Research Center, P.O. Box 3660, Riyadh, 11481, Kingdom of Saudi Arabia, Tel +966 11 429 9999 Ext. CPD/ 91070, COM/95212, Email ;
| | - Sajida Agha
- Department of Medical Education, College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), King Abdullah International Medical Research Centre, Riyadh, Kingdom of Saudi Arabia
| |
Collapse
|
72
|
McMahon GT. Incentivising Higher Level Outcome Achievement in Continuing Education: Five-Year Experience from the ACCME Commendation Criteria. J Eur CME 2023; 12:2141937. [PMID: 36386120 PMCID: PMC9665099 DOI: 10.1080/21614083.2022.2141937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The Accreditation Council for Continuing Medical Education (ACCME®) Menu of Criteria for Commendation was created to incentivise a variety of behaviours and outcomes from accredited providers. ACCME analysed data from among the 1,053 accreditation decisions made between November 2017 and March 2022, of which 122 had applied for commendation. Accredited providers plan for higher level outcomes in their activities at an increasing rate over the past five years. Since 2017, 49 (40%) of the 122 organisations that applied for commendation under ACCME's new Menu of Criteria for Commendation were awarded this distinction. Of the organisations applying for commendation, 62%, 48% and 31% sought commendation using the "performance", "quality" and "community health" criteria, respectively. The success rate for each of these criteria was 78%, 68% and 66% respectively. Accreditation incentives can change the performance of educational providers and augment the quality and efficacy of continuing education.
Collapse
Affiliation(s)
- Graham T McMahon
- President and Chief Executive Officer, Accreditation Council for Continuing Medical Education, USA
| |
Collapse
|
73
|
Price DW. To Effectively Address Complex Healthcare Problems, Continuing Professional Development Must Evolve. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023; 43:S59-S63. [PMID: 38054493 DOI: 10.1097/ceh.0000000000000537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
ABSTRACT Continuing professional development aims to provide health professionals with the knowledge, skills, and competencies needed to improve care. Physicians and other clinicians increasingly practice within complex health care delivery organizations aiming to improve the care of populations of patients with multiple problems and differing needs. These organizations are composed of local units in different departments and venues; these teams and the patients they care for change over time. Improving outcomes within constantly changing complex organizations delivering population care takes time and persistence. It takes time to equip critical masses of clinicians and other personnel with knowledge and skills to effect change. Although some changes might be simple, those involving new workflows require implementation support. Not all change will be smooth; individuals need opportunities to learn from and adjust their early intervention efforts, measure effectiveness of change, and sustain successful practices. Longitudinal support is necessary to affect change over complex organizations. This essay proposes that to be more supportive and valuable to health care delivery organizations, continuing professional development needs to intentionally participate in longitudinal, collaborative, context-specific, team-based interventions. An expanded menu of evaluation approaches will better describe the role of continuing professional development in helping health care professionals and organizations address increasingly complex health care delivery problems and improve patient and population outcomes. Selected concepts to achieve these ends are introduced at a high level in this article. Readers are invited to explore concepts that resonate with their current situation in further detail.
Collapse
Affiliation(s)
- David W Price
- Dr. Price: Department of Family Medicine, University of Colorado Anschutz School of Medicine, Aurora, CO; and American Board of Family Medicine, Lexington, KY
| |
Collapse
|
74
|
Murray S, Langdahl B, Casado E, Brooks K, Libanati C, Di Lecce L, Lazure P. Preparing the Leaders of Tomorrow: Learnings from a Two-Year Community of Practice in Fragility Fractures. J Eur CME 2022; 11:2142405. [DOI: 10.1080/21614083.2022.2142405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Suzanne Murray
- Department of Research, AXDEV Group Inc, Brossard, QC, Canada
| | - Bente Langdahl
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Enrique Casado
- Department of Rheumatology, University Hospital Parc Taulí, I3PT Research Institute, Sabadell, Barcelona, Spain
| | | | | | | | - Patrice Lazure
- Department of Research, AXDEV Group Inc, Brossard, QC, Canada
| |
Collapse
|
75
|
Stoevelaar H, Bahl A, Helsen N, Michels NR, Smets L, Speakman MJ, Stranne J, Toelen J, Van der Aa F, Van Ruysevelt L, Yperman J, Zilli T, Tombal BF, Michel MC. Personalised versus non-individualised case-based CME: A randomised pilot study. J Eur CME 2022; 11:2153438. [DOI: 10.1080/21614083.2022.2153438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
| | - Amit Bahl
- University Hospitals Bristol National Health Service Foundation Trust-Bristol Haematology and Oncology Centre, Bristol, UK
| | | | - Nele R.M. Michels
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | | | - Mark J. Speakman
- International Society for the Study and Exchange of Evidence from Clinical Research and Medical Experience (ISSECAM), Lier, Belgium
- Department of Urology, Musgrove Park Hospital, Somerset Foundation Trust, Taunton, UK
| | - Johan Stranne
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Urology, Sahlgrenska University Hospital-Västra Götaland, Gothenburg, Sweden
| | - Jaan Toelen
- International Society for the Study and Exchange of Evidence from Clinical Research and Medical Experience (ISSECAM), Lier, Belgium
- Department of Development and Regeneration, Leuven, Belgium
- Department of Paediatrics, University Hospitals Leuven, Leuven, Belgium
| | - Frank Van der Aa
- Department of Development and Regeneration, Leuven, Belgium
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Luc Van Ruysevelt
- International Society for the Study and Exchange of Evidence from Clinical Research and Medical Experience (ISSECAM), Lier, Belgium
- e-HIMS, Lier, Belgium
| | | | - Thomas Zilli
- Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland
| | - Bertrand F. Tombal
- International Society for the Study and Exchange of Evidence from Clinical Research and Medical Experience (ISSECAM), Lier, Belgium
- Urology, Cliniques universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - Martin C. Michel
- International Society for the Study and Exchange of Evidence from Clinical Research and Medical Experience (ISSECAM), Lier, Belgium
- Department of Pharmacology, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| |
Collapse
|
76
|
Solomon ED, Mozersky J, Goodman M, Parsons MV, Baldwin KA, Friedrich AB, Harris JK, DuBois JM. A randomized implementation trial to increase adoption of evidence-informed consent practices. J Clin Transl Sci 2022; 7:e28. [PMID: 36721403 PMCID: PMC9884547 DOI: 10.1017/cts.2022.520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 11/28/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Several evidence-informed consent practices (ECPs) have been shown to improve informed consent in clinical trials but are not routinely used. These include optimizing consent formatting, using plain language, using validated instruments to assess understanding, and involving legally authorized representatives when appropriate. We hypothesized that participants receiving an implementation science toolkit and a social media push would have increased adoption of ECPs and other outcomes. Methods We conducted a 1-year trial with clinical research professionals in the USA (n = 1284) who have trials open to older adults or focus on Alzheimer's disease. We randomized participants to receive information on ECPs via receiving a toolkit with a social media push (intervention) or receiving an online learning module (active control). Participants completed a baseline survey and a follow-up survey after 1 year. A subset of participants was interviewed (n = 43). Results Participants who engaged more with the toolkit were more likely to have tried to implement an ECP during the trial than participants less engaged with the toolkit or the active control group. However, there were no significant differences in the adoption of ECPs, intention to adopt, or positive attitudes. Participants reported the toolkit and social media push were satisfactory, and participating increased their awareness of ECPs. However, they reported lacking the time needed to engage with the toolkit more fully. Conclusions Using an implementation science approach to increase the use of ECPs was only modestly successful. Data suggest that having institutional review boards recommend or require ECPs may be an effective way to increase their use.
Collapse
Affiliation(s)
- Erin D. Solomon
- Bioethics Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Jessica Mozersky
- Bioethics Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Melody Goodman
- School of Global Public Health, New York University, New York, NY, USA
| | - Meredith V. Parsons
- Bioethics Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Kari A. Baldwin
- Bioethics Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Annie B. Friedrich
- Bioethics Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Jenine K. Harris
- George Warren Brown School of Social Work, Washington University, St. Louis, MO, USA
| | - James M. DuBois
- Bioethics Research Center, Washington University School of Medicine, St. Louis, MO, USA
| |
Collapse
|
77
|
Shinkaruk K, Carr E, Lockyer JM, Hecker KG. Exploring the development of interprofessional competence and professional identity: A Situated Learning Theory study. J Interprof Care 2022; 37:613-622. [DOI: 10.1080/13561820.2022.2140129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Affiliation(s)
- Kelly Shinkaruk
- Department of Anesthesiology, Perioperative, and Pain Medicine, Faculty of Medicine, Cumming School of Medicine, University of Calgary, T2N 4Z6, Calgary, AB, Canada
| | - Eloise Carr
- Faculty of Nursing, PF3238 Professional Faculties Building, 2500 University Drive NW, University of Calgary, T2N 1N4, Calgary, AB, Canada
| | - Jocelyn M Lockyer
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Dr NW, T2N 4Z6, Calgary, AB, Canada
| | - Kent G. Hecker
- Department of Veterinary Clinical and Diagnostic Sciences, Faculty of Veterinary Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, T2N 4Z6, Calgary, AB, CANADA
| |
Collapse
|
78
|
Balis LE, Houghtaling B, Harden SM. Using implementation strategies in community settings: an introduction to the Expert Recommendations for Implementing Change (ERIC) compilation and future directions. Transl Behav Med 2022; 12:965-978. [PMID: 36039843 DOI: 10.1093/tbm/ibac061] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
In this commentary, we introduce public health practitioners and researchers to implementation science through an established compilation of implementation strategies. We provide terminology and examples for community settings so public health practitioners and researchers can use implementation strategies and document efforts using standard terminology. We also discuss the need for future work to determine the extent to which these implementation strategies work and are most useful in community settings, and ultimately, how health behaviors are impacted. We intend this commentary to serve as a dissemination strategy for implementation strategies and to contribute to knowledge in the growing field of implementation science in community settings.
Collapse
Affiliation(s)
- Laura E Balis
- Louisville Center, Pacific Institute for Research and Evaluation, Louisville, Kentucky, USA
| | - Bailey Houghtaling
- Gretchen Swanson Center for Nutrition, Omaha, Nebraska, USA.,Louisiana State University (LSU) and LSU Agricultural Center, Baton Rouge, Louisiana, USA
| | - Samantha M Harden
- Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, Virgina, USA
| |
Collapse
|
79
|
Löffler C, Altiner A, Blumenthal S, Bruno P, De Sutter A, De Vos BJ, Dinant GJ, Duerden M, Dunais B, Egidi G, Gibis B, Melbye H, Rouquier F, Rosemann T, Touboul-Lundgren P, Feldmeier G. Challenges and opportunities for general practice specific CME in Europe - a narrative review of seven countries. BMC MEDICAL EDUCATION 2022; 22:761. [PMID: 36344994 PMCID: PMC9641932 DOI: 10.1186/s12909-022-03832-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/24/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Several changes have led to general practitioners (GPs) working in a more differentiated setting today and being supported by other health professions. As practice changes, primary care specific continuing medical education (CME) may also need to adapt. By comparing different primary care specific CME approaches for GPs across Europe, we aim at identifying challenges and opportunities for future development. METHODS Narrative review assessing, analysing and comparing CME programs for general practitioners across different north-western European countries (UK, Norway, the Netherlands, Belgium (Flanders), Germany, Switzerland, and France). Templates containing detailed items across seven dimensions of country-specific CME were developed and used. These dimensions are role of primary care within the health system, legal regulations regarding CME, published aims of CME, actual content of CME, operationalisation, funding and sponsorship, and evaluation. RESULTS General practice specific CME in the countries under consideration are presented and comparatively analysed based on the dimensions defined in advance. This shows that each of the countries examined has different strengths and weaknesses. A clear pioneer cannot be identified. Nevertheless, numerous impulses for optimising future GP training systems can be derived from the examples presented. CONCLUSIONS Independent of country specific CME programs several fields of potential action were identified: the development of curriculum objectives for GPs, the promotion of innovative teaching and learning formats, the use of synergies in specialist GP training and CME, the creation of accessible yet comprehensive learning platforms, the establishment of clear rules for sponsorship, the development of new financing models, the promotion of fair competition between CME providers, and scientifically based evaluation.
Collapse
Affiliation(s)
- Christin Löffler
- Institute of General Practice, Rostock University Medical Center, Doberaner Str. 142, 18057 Rostock, Germany
| | - Attila Altiner
- Institute of General Practice, Rostock University Medical Center, Doberaner Str. 142, 18057 Rostock, Germany
| | - Sandra Blumenthal
- Institute of General Practice and Family Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Speaker section advanced training German Society for General Practice and Family Medicine (DEGAM), Berlin, Germany
| | - Pascale Bruno
- Centre Hospitalier Universitaire de Nice, Département de Santé Publique, Université Côte d’Azur, Nice, France
| | - An De Sutter
- Department of Public Health and Primary Care, Centre for Family Medicine, Ghent University, Ghent, Belgium
| | - Bart J. De Vos
- National Institute for Health and Disability Insurance, Brussels, Belgium
| | - Geert-Jan Dinant
- School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Martin Duerden
- Centre for Medical Education, Cardiff University, Cardiff, UK
| | - Brigitte Dunais
- Centre Hospitalier Universitaire de Nice, Département de Santé Publique, Université Côte d’Azur, Nice, France
| | - Günther Egidi
- General Practice Bremen Germany, Deputy Speaker section advanced training German Society for General Practice and family medicine (DEGAM), Bremen, Germany
| | - Bernhard Gibis
- National Association of Statutory Health Insurance Physicians (KBV), Berlin, Germany
| | - Hasse Melbye
- General Practice Research Unit, UIT the Arctic University of Norway, Tromsø, Norway
| | | | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Pia Touboul-Lundgren
- Centre Hospitalier Universitaire de Nice, Département de Santé Publique, Université Côte d’Azur, Nice, France
| | - Gregor Feldmeier
- Institute of General Practice, Rostock University Medical Center, Doberaner Str. 142, 18057 Rostock, Germany
| |
Collapse
|
80
|
Hyer CF, Casciato DJ, Rushing CJ, Schuberth JM. Incidence of Scholarly Publication by Selected Content Experts Presenting at National Society Foot and Ankle Meetings From 2016 to 2020. J Foot Ankle Surg 2022; 61:1317-1320. [PMID: 35659159 DOI: 10.1053/j.jfas.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/21/2022] [Accepted: 04/23/2022] [Indexed: 02/03/2023]
Abstract
Continuing medical education (CME) is an important element to maintain licensing requirements, enhance professional competence, and disseminate up to date, evidence-based, treatment recommendations. A key resource of CME are the 2 annual society meetings hosted by the American College of Foot and Ankle Surgeons (ACFAS) and American Orthopedic Foot and Ankle Society (AOFAS). It is assumed that the selected speakers at these meetings are content experts, providing validated expertise on treatment recommendations, rather than anecdotal experience or opinion. Across all medical specialists, peer-reviewed publication(s) on a particular subject matter have long bestowed the ultimate validity of "expertise." The purpose of this study was to assess the incidence of scholarly publication for invited speakers at the ACFAS and AOFAS annual meetings from 2016 to 2020, in relation to the topic they were selected to present. A review of invited lectures given at the ACFAS and AOFAS annual meetings from 2016 to 2020 was conducted, and lecturer demographics were categorized into predetermined content areas for assessment. Selected speakers were individually cross-referenced with content-specific peer-reviewed published literature, and overall h-index using Scopus. Topic and society specific comparisons were then made. Overall, 1028 lectures were identified during the temporal period. Only 300 (29.18%) presentations were given by a speaker with least one or more publication on the society specific lecture-topic presented. The greatest proportion of lecturers with content-specific publications was Charcot reconstruction (67.57%) followed by ankle fusion/replacement (55%). The average presenter h-index was greatest among total ankle replacement/ankle fusion (12.16 ± 6.90) and Charcot reconstruction (11.27 ± 7.10) content. The results of the present study illustrate a disparity of expertise among different content areas. While both meetings provide well-published lecturers, this study reveals areas for improvement.
Collapse
|
81
|
Educating Crisis Supporters About Self-Harm and Suicide in Older Adults. Am J Geriatr Psychiatry 2022; 30:1212-1220. [PMID: 34799248 DOI: 10.1016/j.jagp.2021.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/01/2021] [Accepted: 10/12/2021] [Indexed: 01/25/2023]
Abstract
OBJECTIVES This study aimed to describe existing knowledge of crisis supporters (volunteers responding to crisis calls/texts/messages) regarding self-harm and suicide in older adults and investigate knowledge translation through use of a novel online adaptive learning tool. METHODS The online educational tool was tested in an Australian national sample of crisis supporters (trained volunteers) aged 18+. Knowledge Transfer was evaluated utilizing a pre/post intervention methodology for data collection. The collaboratively developed online educational tool comprised a pre-test (10 questions), middle learning module (individualised for participant's incorrect pre-test responses) and post-test (10 questions) on suicidal behaviours in older adults. Data analysed included the demographic characteristics of the participants, individual question scores, and summed pre- and post-tests scores. Group differences in change scores were assessed with either one-way between subjects ANOVA or independent samples t-test, depending on the number of groups within each variable. Pre-post education comparisons on individual change in scores were made using a paired samples t-test. Statistical significance was defined as p <0.05. RESULTS 104 crisis supporters completed the tool (pre-test, middle lesson and post-test). There was significant improvement in knowledge of crisis supporters after the intervention (pre-test scores Mean (M) = 4.56, SD = 1.62 and post-test scores M = 7.61, SD = 1.60; t (103) = 17.242, p <0.001.). CONCLUSION Dedicated training about suicidal behaviors in older adults is needed given their high rates of suicide and differing underlying reasons and needs compared to younger adults.
Collapse
|
82
|
Farkas AH, Merriam S, Frayne S, Hardman L, Schwartz R, Kolehmainen C. Retaining Providers with Women's Health Expertise: Decreased Provider Loss Among VHA Women's Health Faculty Development Program Attendees. J Gen Intern Med 2022; 37:786-790. [PMID: 36042098 PMCID: PMC9427435 DOI: 10.1007/s11606-022-07575-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 04/01/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Veterans Health Administration (VHA) provides care for over 500,000 women. In 2010 VHA instituted a policy requiring each facility to identify a designated women's health provider (WH-PCP) who could offer comprehensive gender-specific primary care. Access to WH-PCPs remains a challenge at some sites with high turnover among WH-PCPs. Faculty development programs have been demonstrated to foster professional development, networks, and mentorship; these can enhance job satisfaction and provide one potential solution to address WH-PCP turnover. One such program, the VHA's Women's Health Mini-Residency (WH-MR), was developed in 2011 to train WH-PCPs through case-based hands-on training. OBJECTIVE The objective of this program evaluation was to determine the association of WH-MR participation with WH-PCP retention. DESIGN Using the Women's Health Assessment of Workforce Capacity-Primary Care survey, we assessed the relationship between WH-MR participation and retention of WH-PCP status between fiscal year 2018 and 2019. PARTICIPANTS All WH-PCPs (N = 2664) at the end of fiscal year 2018 were included. MAIN MEASURES We assessed retention of WH-PCP status the following year by WH-MR participation. For our adjusted analysis, we controlled for provider gender, provider degree (MD, DO, NP, PA), women's health leadership position, number of clinical sessions per week, and clinical setting (general primary care clinic, designated women's health clinic, or a combination). KEY RESULTS WH-MR participants were more likely to remain WH-PCPs in FY2019 in both unadjusted analyses (OR 1.91, 95%CI 1.54-2.36) and adjusted analyses (OR 1.96, 95%CI 1.58-2.44). CONCLUSIONS WH-PCPs who participate in WH-MRs are more likely to remain WH-PCPs in the VHA system. Given the negative impact of provider turnover on patient care and the significant financial cost of onboarding a new WH-PCP, the VHA should continue to encourage all WH-PCPs to participate in the WH-MR.
Collapse
Affiliation(s)
- Amy H Farkas
- Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
- Department of Medicine, Milwaukee VA Medical Center, Milwaukee, WI, USA.
- Office of Women's Health, Veterans Health Administration, Washington, DC, USA.
| | - Sarah Merriam
- Office of Women's Health, Veterans Health Administration, Washington, DC, USA
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Medicine, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Susan Frayne
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Lisa Hardman
- Office of Women's Health, Veterans Health Administration, Washington, DC, USA
| | - Rachel Schwartz
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA
- WellMD Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Christine Kolehmainen
- Office of Women's Health, Veterans Health Administration, Washington, DC, USA
- Division of Internal Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| |
Collapse
|
83
|
Agic B, Fruitman H, Maharaj A, Taylor J, Ashraf A, Henderson J, Ronda N, McKenzie K, Soklaridis S, Sockalingam S. Advancing Curriculum Development and Design in Health Professions Education: A Health Equity and Inclusion Framework for Education Programs. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2022; 43:S4-S8. [PMID: 35940600 DOI: 10.1097/ceh.0000000000000453] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
ABSTRACT The COVID-19 pandemic has exacerbated pre-existing health inequities in vulnerable and marginalized patient populations. Continuing professional development (CPD) can be a critical driver of change to improve quality of care, health inequities, and system change. In order for CPD to address these disparities in care for patient populations most affected in the health care system, CPD programs must first address issues of equity and inclusion in their education development and delivery. Despite the need for equitable and inclusive CPD programs, there remains a paucity of tools and frameworks available in the literature to guide CPD and broader education providers on how best to develop and deliver equitable and inclusive education programs. In this article, we describe the development and application of a Health Equity and Inclusion (HEI) Framework for education and training grounded in the Analyze, Design, Develop, Implement, and Evaluate model for instructional design. Using a case example, specifically a hospital-wide trauma-informed de-escalation for safety program, we demonstrate how the HEI Framework can be applied practically to CPD programs to support equity and inclusion in the planning, development, implementation, and evaluation phases of education program delivery. The case example illustrates how the HEI Framework can be used by CPD providers to respect learner diversity, improve accessibility for all learners, foster inclusion, and address biases and stereotypes. We suggest that the HEI Framework can serve as an educational resource for CPD providers and health professions educators aiming to create equitable and inclusive CPD programs.
Collapse
Affiliation(s)
- Branka Agic
- Dr. Agic: Independent Scientist, Centre for Addiction and Mental Health, Toronto, Ontario, Canada, and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Fruitman: Instructional Designer, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. Maharaj: Director, Community and Continuing Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. Taylor: Editor, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. Ashraf: Manager, Health Equity, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. Dr. Henderson: Professor and Director, Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health; Senior Scientist, Centre for Addiction and Mental Health, Toronto, Ontario, Canada, and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada. Dr. Ronda: Chair, School of Workforce Development, Continuing Education and Online Learning, CAMH, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. Dr. McKenzie: Professor, CEO of Wellesley Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada, and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada. Dr. Soklaridis: Associated Professor, Senior Scientist, Centre for Addiction and Mental Health, Toronto, Ontario, Canada, and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada. Dr. Sockalingam: Professor, Vice-President Education & Clinician Scientist, Centre for Addiction and Mental Health, Toronto, Ontario, Canada, and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | | | | | | | | | |
Collapse
|
84
|
Müller MA, Scholtes MA, Louis C, Dörje F, Lehr T. [Pilot survey on continuing education for pharmacists in Germany]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2022; 172:78-91. [PMID: 35715321 DOI: 10.1016/j.zefq.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/01/2022] [Accepted: 04/12/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Continuing education (CE) for pharmacists is mandatory in Germany. However, the findings on CE activities of pharmacists are limited. The aim of this study was to conduct a pilot survey on the CE situation of pharmacists in Germany, including licensed and future pharmacists, to determine the commitment to CE, the attitude towards CE and an obligation to provide evidence, the extent of CE considered necessary and the application of CE content in professional practice. METHODS A cross-sectional study was conducted in the form of an online survey using SoSci survey, which was addressed to licensed pharmacists, pre-registration pharmacists, and pharmacy students. The online survey was promoted by pharmaceutical professional societies, trade media and interest groups. RESULTS In total, 880 participants were included in the study: 695 pharmacists, 136 pharmacy students and 49 pre-registration pharmacists. Only 50.0% of the participants were aware of their CE obligations. Among the pharmacists, 44.9% reported that they held the voluntary advanced training certificate issued by the Chambers of Pharmacists. 551 participants reported the CE points of the past twelve month. On average, 56.2 ± 50.2 CE points were collected (x̅ = 210.8 CE minutes per month). Pharmacists not holding the voluntary advanced training certificate of the Chamber of Pharmacists collected significantly fewer (p < 0.001) CE points (39.5 ± 32.0 points; x̅ = 148.1 CE minutes per month). On average, the study population considered a minimum number of 33.9 ± 20.9 CE points per year (x̅ = 127.1 CE minutes per month) to be adequate to meet the CE requirements. DISCUSSION Although the majority participated in CE, the introduction of nationwide CE commitment monitoring was rejected. On the one hand, this may be linked to a lack of willingness to engage in lifelong learning. On the other hand, it should be borne in mind that, despite the same common nationwide legal basis, the different Chambers of Pharmacists districts have set up different rules concerning the minimum yearly CE commitment, the proof of compliance with CE requirements and fines for non-compliance. Therefore, the introduction of nationwide standard regulations may result in a greater acceptance of CE commitment checks. CONCLUSION Pharmacists' willingness to CE participation has so far been dependent on intrinsic motivation. Although many licensed pharmacists were in possession of the advanced training certificate issued by the Chambers of Pharmacists, the majority of participants did not support the introduction of a nationwide CE commitment monitoring. 127.1 CE minutes per month were considered appropriate to fulfill the CE obligations, which is significantly less than the 187.5 CE minutes per month which are required to obtain the advanced training certificate of the Chambers of Pharmacists.
Collapse
Affiliation(s)
| | | | - Chiara Louis
- Klinische Pharmazie, Universität des Saarlandes, Saarbrücken, Deutschland
| | - Frank Dörje
- Apotheke des Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - Thorsten Lehr
- Klinische Pharmazie, Universität des Saarlandes, Saarbrücken, Deutschland.
| |
Collapse
|
85
|
Stabel LS, McGrath C, Björck E, Elmberger A, Laksov KB. Navigating Affordances for Learning in Clinical Workplaces: A Qualitative Study of General Practitioners' Continued Professional Development. VOCATIONS AND LEARNING 2022; 15:427-448. [PMID: 35818439 PMCID: PMC9261199 DOI: 10.1007/s12186-022-09295-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/28/2022] [Indexed: 06/15/2023]
Abstract
Medical specialists' lifelong learning is essential for improving patients' health. This study identifies affordances for learning general practitioners (GPs) engage in, and explores what influences engagement in those affordances. Eleven GPs were interviewed and the interview transcripts were analysed thematically. Stephen Billett's theoretical framework of workplace participatory practices was used as an analytical lens to explore the topic. Challenging patient cases were identified as the main trigger for engagement in learning. Local, national and international colleagues from the same and other specialties, were found to be an important affordance for learning, as was written material such as websites, journals and recommendations. Other inputs for learning were conferences and courses. Workplace aspects that were essential for GPs to engage in learning related to: place and time to talk, relevance to work, opportunity for different roles, organisation of work and workload, and working climate. Importantly, the study identifies a need for a holistic approach to lifelong learning, including spontaneous and structured opportunities for interaction over time with colleagues, establishment of incentives and arenas for exchange linked to peer learning, and acknowledgement of the workplace as an important place for learning and sufficient time with patients. This study contributes with a deepened understanding of how GPs navigate existing affordances for learning both within and outside their workplaces.
Collapse
Affiliation(s)
- Linda Sturesson Stabel
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Cormac McGrath
- Department of Education, Stockholm University, Stockholm, Sweden
| | - Erik Björck
- Department of Clinical Genetics, Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Agnes Elmberger
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Klara Bolander Laksov
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Department of Education, Stockholm University, Stockholm, Sweden
| |
Collapse
|
86
|
Roy M, Lockyer J, Touchie C. Family Physician Quality Improvement Plans: A Realist Inquiry Into What Works, for Whom, Under What Circumstances. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2022; 43:155-163. [PMID: 37638679 DOI: 10.1097/ceh.0000000000000454] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
INTRODUCTION Evaluation of quality improvement programs shows variable impact on physician performance often neglecting to examine how implementation varies across contexts and mechanisms that affect uptake. Realist evaluation enables the generation, refinement, and testing theories of change by unpacking what works for whom under what circumstances and why. This study used realist methods to explore relationships between outcomes, mechanisms (resources and reasoning), and context factors of a national multisource feedback (MSF) program. METHODS Linked data for 50 physicians were examined to determine relationships between action plan completion status (outcomes), MSF ratings, MSF comments and prescribing data (resource mechanisms), a report summarizing the conversation between a facilitator and physician (reasoning mechanism), and practice risk factors (context). Working backward from outcomes enabled exploration of similarities and differences in mechanisms and context. RESULTS The derived model showed that the completion status of plans was influenced by interaction of resource and reasoning mechanisms with context mediating the relationships. Two patterns were emerged. Physicians who implemented all their plans within six months received feedback with consistent messaging, reviewed data ahead of facilitation, coconstructed plan(s) with the facilitator, and had fewer risks to competence (dyscompetence). Physicians who were unable to implement any plans had data with fewer repeated messages and did not incorporate these into plans, had difficult plans, or needed to involve others and were physician-led, and were at higher risk for dyscompetence. DISCUSSION Evaluation of quality improvement initiatives should examine program outcomes taking into consideration the interplay of resources, reasoning, and risk factors for dyscompetence.
Collapse
Affiliation(s)
- Marguerite Roy
- Roy: Adjunct Professor, Department of Innovation in Medical Education, University of Ottawa, Ottawa, Canada. Lockyer: Professor, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada. Touchie: Professor of Medicine, Department of Medicine, University of Ottawa and the Ottawa Hospital, Ottawa, Canada, and Department of Innovation in Medical Education, Medical Council of Canada, Ottawa, Canada
| | | | | |
Collapse
|
87
|
McEvoy MD, Dear ML, Buie R, Edwards DA, Barrett TW, Allen B, Robertson AC, Fowler LC, Hennessy C, Miller BM, Garvey KV, Bland RP, Fleming GM, Moore D, Rice TW, Bernard GR, Lindsell CJ. Effect of Smartphone App-Based Education on Clinician Prescribing Habits in a Learning Health Care System: A Randomized Cluster Crossover Trial. JAMA Netw Open 2022; 5:e2223099. [PMID: 35881398 PMCID: PMC9327570 DOI: 10.1001/jamanetworkopen.2022.23099] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
IMPORTANCE Effective methods for engaging clinicians in continuing education for learning-based practice improvement remain unknown. OBJECTIVE To determine whether a smartphone-based app using spaced education with retrieval practice is an effective method to increase evidence-based practice. DESIGN, SETTING, AND PARTICIPANTS A prospective, unblinded, single-center, crossover randomized clinical trial was conducted at a single academic medical center from January 6 to April 24, 2020. Vanderbilt University Medical Center clinicians prescribing intravenous fluids were invited to participate in this study. INTERVENTIONS All clinicians received two 4-week education modules: 1 on prescribing intravenous fluids and 1 on prescribing opioid and nonopioid medications (counterbalancing measure), over a 12-week period. The order of delivery was randomized 1:1 such that 1 group received the fluid management module first, followed by the pain management module after a 4-week break, and the other group received the pain management module first, followed by the fluid management module after a 4-week break. MAIN OUTCOMES AND MEASURES The primary outcome was evidence-based clinician prescribing behavior concerning intravenous fluids in the inpatient setting and pain medication prescribing on discharge from the hospital. RESULTS A total of 354 participants were enrolled and randomized, with 177 in group 1 (fluid then pain management education) and 177 in group 2 (pain management then fluid education). During the overall study period, 16 868 questions were sent to 349 learners, with 11 783 (70.0%) being opened: 10 885 (92.4%) of those opened were answered and 7175 (65.9%) of those answered were answered correctly. The differences between groups changed significantly over time, indicated by the significant interaction between educational intervention and time (P = .002). Briefly, at baseline evidence-concordant IV fluid ordered 7.2% less frequently in group 1 than group 2 (95% CI, -19.2% to 4.9%). This was reversed after training at 4% higher (95% CI, -8.2% to 16.0%) in group 1 than group 2, a more than doubling in the odds of evidence-concordant ordering (OR, 2.56, 95% CI, 0.80-8.21). Postintervention, all gains had been reversed with less frequent ordering in group 1 than group 2 (-9.5%, 95% CI, -21.6% to 2.7%). There was no measurable change in opioid prescribing behaviors at any time point. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, use of smartphone app learning modules resulted in statistically significant short-term improvement in some prescribing behaviors. However, this effect was not sustained over the long-term. Additional research is needed to understand how to sustain improvements in care delivery as a result of continuous professional development at the institutional level. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03771482.
Collapse
Affiliation(s)
- Matthew D. McEvoy
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mary Lynn Dear
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Reagan Buie
- Episodes of Care, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David A. Edwards
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Tyler W. Barrett
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Brian Allen
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Amy C. Robertson
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Leslie C. Fowler
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Cassandra Hennessy
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Bonnie M. Miller
- Department of the Office of Health Sciences Education, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kim V. Garvey
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert P. Bland
- Department of HealthIT Architecture and Integration, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Geoffrey M. Fleming
- Department of Pediatrics, Vanderbilt Children’s Hospital, Nashville, Tennessee
| | - Don Moore
- Professor of Medical Education and Administration, Emeritus, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Todd W. Rice
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gordon R. Bernard
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | |
Collapse
|
88
|
McConnell MM. The Importance of Sociocultural Factors in Moderating the Applicability of Test-Enhanced Learning to Continuing Professional Development. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2022; 42:190-196. [PMID: 36007517 DOI: 10.1097/ceh.0000000000000434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Many studies have shown that repeated testing promotes learning, an effect known as test-enhanced learning. Although test-enhanced learning has been well-established within health care trainees, there are mixed findings of whether testing facilitates learning within continuing professional development (CPD) contexts. This piece argues that for testing to support learning in CPD, there is need to understand the various social, cultural, and structural factors that influence clinicians' willingness to participate in regular testing activities. The solution to this problem is conceptual in nature, whereby CPD programs must consider how learning cultures shape practicing clinicians' perspectives toward testing.
Collapse
Affiliation(s)
- Meghan M McConnell
- Dr. McConnell: Associate Professor, Department of Innovation in Medical Education and Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
89
|
Nowicki M, Berg BW, Okada Y, Yagi MS, Tomisawa T, Kawahara C, Ouchi G, Moritoki Y, Otori T. A Patient Safety Champion Program for Interprofessional Health Care Educators: Implementation and Outcomes. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2022; 42:211-218. [PMID: 35916888 DOI: 10.1097/ceh.0000000000000438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Health care educators are challenged with helping clinicians develop competencies beyond their foundational training. In health care systems where continuing professional development is not integral to practice, clinicians may have few opportunities. We describe the design, implementation, and evaluation of a professional development program in patient safety for Japanese clinical educators to acquire simulation instructional skills and become Patient Safety Champions at their organizations. METHODS Mixed methods were used in a longitudinal pre/post study design. The Kirkpatrick evaluation model was used to evaluate outcomes of a workshop, overall program, on-site training experiences, and impact as Patient Safety Champions. Self-assessment data on skills and knowledge of patient safety, simulation instructional methods, interprofessional collaboration, and leadership were collected and analyzed. RESULTS Eighty-nine percent of participants facilitated on-site patient safety training within 6 months of workshop completion. Skills and knowledge improvement were observed immediately postworkshop in four categories: patient safety, simulation instructional methods, interprofessional collaboration and communication, and leadership as a patient safety champion. Skills and knowledge increased at 6 months after facilitation of on-site safety training. Program mean satisfaction scores ranged from 84% to 92%. Mean Patient Safety Champion in-facility evaluations were 4.2 to 4.7 on a 5-point scale. DISCUSSION High levels of knowledge, skill retention, and behavior change are attributed to goal setting, outcome-oriented pedagogy, and reflective sessions. The Patient Safety Champion model and experiential learning approach gave Japanese clinical educators in medicine, nursing, and pharmacy an opportunity to learn from each other in simulations reflecting the practice environment.
Collapse
Affiliation(s)
- Mariko Nowicki
- Dr. Nowicki: Adjunct Faculty, School of Nursing and Health Professions, Chaminade University of Honolulu, Honolulu, HI; previous affiliation Education Specialist/International Program Coordinator at SimTiki Simulation Center, John A. Burns School of Medicine, University of Hawaii where the project was completed, and Founder and Co-President, Japan Pacific Healthcare Alliance, Nara, Japan. Dr. Berg: Professor of Medicine and Director of Simulation at SimTiki Simulation Center, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI. Mr. Okada: Graduate Research Associate, Epidemiology, University of Hawaii Cancer Center, Honolulu, HI. Dr. Yagi: Adjunct lecture, Medical Education Center, Jichii Medical University, Tochigi, Japan, and Research Fellow, SimTiki Simulation Center, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI. Dr. Tomisawa: Professor, Department of Nursing Sciences, Hirosaki University Graduate School of Health Sciences, Aomori, Japan. Dr. Kawahara: Senior Assistant Professor, Simulation Center, Aichi Medical University, Aichi, Japan. Dr. Ouchi: Lecturer, School of Medicine, University of the Ryukyus, Okinawa, Japan, and Adjunct Assistant Professor, SimTiki Simulation Center, John A. Burns School of Medicine, University of Hawaii. Dr. Moritoki: Associate Professor (specially-appointed), Center for Medical Education and Training, Akita University Hospital, Akita, Japan, and Adjunct Assistant Professor, SimTiki Simulation Center, John A. Burns School of Medicine, University of Hawaii. Dr. Otori: Professor, School of Pharmacy, Kindai University, Osaka, Japan, and Founder and Co-President, Japan Pacific Healthcare Alliance
| | | | | | | | | | | | | | | | | |
Collapse
|
90
|
González-Cano-Caballero M, García-Gámez M, Fernández-Fernández E, Fernández-Ordoñez E, Cano-Caballero MD, Guerra-Marmolejo C. Continuing education programme on vaccines for primary healthcare professionals: mixed-method protocol. BMJ Open 2022; 12:e060094. [PMID: 35697454 PMCID: PMC9196173 DOI: 10.1136/bmjopen-2021-060094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Vaccination is a fundamental intervention in disease prevention; therefore, the advice and recommendations of health professionals have a major influence on the population's decision to be vaccinated or not. Professionals must have sufficient competencies to carry out their work and recommend vaccination with evidence-based knowledge. The aim is to design and validate a strategy to improve professional competencies in vaccination to positively influence adherence and increase vaccination rates in the population. METHODS AND ANALYSIS Training will be designed based on evidence and previous studies and piloted with healthcare providers. To test changes in knowledge, a pretest and post-test will be conducted. To test feasibility, a think-aloud method will be used with participants and triangulated with focus groups using SWOT (strengths, weaknesses, opportunities and threats) analysis. Transfer will be measured using the questionnaire 'factors for the indirect evaluation of transfer' and an efficacy questionnaire 1½ months later; for satisfaction, an ad hoc questionnaire will be used. A summative approach will be used for the analysis of the focus groups and descriptive and bivariate statistics for the questionnaires. ETHICS AND DISSEMINATION This study was approved by the Andalusian Research Ethics Committee, Spain (approval number: 0524-N-20). The results will be made available to the public at journal publications and scientific conferences.
Collapse
Affiliation(s)
| | - Marina García-Gámez
- Department of Nursing, Faculty of Health Sciences, University of Málaga, Málaga, Spain
| | | | | | | | | |
Collapse
|
91
|
Bergeron L, Décary S, Djade CD, Daniel SJ, Tremblay M, Rivest LP, Légaré F. Factors Associated With Specialists' Intention to Adopt New Behaviors After Taking Web-Based Continuing Professional Development Courses: Cross-sectional Study. JMIR MEDICAL EDUCATION 2022; 8:e34299. [PMID: 35476039 PMCID: PMC9204572 DOI: 10.2196/34299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 03/02/2022] [Accepted: 04/26/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Web-based continuing professional development (CPD) is a convenient and low-cost way for physicians to update their knowledge. However, little is known about the factors that influence their intention to put this new knowledge into practice. OBJECTIVE We aimed to identify sociocognitive factors associated with physicians' intention to adopt new behaviors as well as indications of Bloom's learning levels following their participation in 5 web-based CPD courses. METHODS We performed a cross-sectional study of specialist physicians who had completed 1 of 5 web-based CPD courses offered by the Federation of Medical Specialists of Quebec. The participants then completed CPD-Reaction, a questionnaire based on Godin's integrated model for health professional behavior change and with evidence of validity that measures behavioral intention (dependent variable) and psychosocial factors influencing intention (n=4). We also assessed variables related to sociodemographics (n=5), course content (n=9), and course format (eg, graphic features and duration) (n=8). Content variables were derived from CanMEDS competencies, Bloom's learning levels, and Godin's integrated model. We conducted ANOVA single-factor analysis, calculated the intraclass correlation coefficient (ICC), and performed bivariate and multivariate analyses. RESULTS A total of 400 physicians participated in the courses (range: 38-135 physicians per course). Average age was 50 (SD 12) years; 56% (n=223) were female, and 44% (n=177) were male. Among the 259 who completed CPD-Reaction, behavioral intention scores ranged from 5.37 (SD 1.17) to 6.60 (SD 0.88) out of 7 and differed significantly from one course to another (P<.001). The ICC indicated that 17% of the total variation in the outcome of interest, the behavioral intention of physicians, could be explained at the level of the CPD course (ICC=0.17). In bivariate analyses, social influences (P<.001), beliefs about capabilities (P<.001), moral norm (P<.001), beliefs about consequences (P<.001), and psychomotor learning (P=.04) were significantly correlated with physicians' intention to adopt new behaviors. Multivariate analysis showed the same factors, except for social influences and psychomotor learning, as significantly correlated with intention. CONCLUSIONS We observed average to high behavioral intention scores after all 5 web-based courses, with some variations by course taken. Factors affecting physicians' intention were beliefs about their capabilities and about the consequences of adopting new clinical behaviors, as well as doubts about whether the new behavior aligned with their moral values. Our results will inform design of future web-based CPD courses to ensure they contribute to clinical behavior change.
Collapse
Affiliation(s)
- Lysa Bergeron
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - Simon Décary
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Codjo Djignefa Djade
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
| | - Sam J Daniel
- Direction du Développement Professionnel Continu, Fédération des Médecins Spécialistes du Québec, Montreal, QC, Canada
- Department of Pediatric Surgery, McGill University, Montreal, QC, Canada
| | - Martin Tremblay
- Direction du Développement Professionnel Continu, Fédération des Médecins Spécialistes du Québec, Montreal, QC, Canada
| | - Louis-Paul Rivest
- Department of Mathematics and Statistics, Faculty of Science and Engineering, Université Laval, Quebec, QC, Canada
| | - France Légaré
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| |
Collapse
|
92
|
Valanci-Aroesty S, Feldman LS, Fiore JF, Lee L, Fried GM, Mueller CL. Considerations for designing and implementing a surgical peer coaching program: an international survey. Surg Endosc 2022; 36:4593-4601. [PMID: 34622299 PMCID: PMC8497045 DOI: 10.1007/s00464-021-08760-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/27/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Surgical peer coaching has been associated with high rates of practice change but remains largely unutilized. The purpose of this study was to survey surgeons internationally to investigate attitudes regarding peer coaching and to identify any international differences to inform the design of future coaching programs. METHODS Practicing surgeons in general surgery or related subspecialties were eligible to participate. Invitations to complete the survey were distributed through 13 surgical associations, social media, and personal e-mail invitations. Responses were obtained between June 1st and August 31st, 2020. RESULTS A total of 521 surveys were collected. The majority of participants practiced in North America (263; 50%) with remaining respondents from Asia (81; 16%), Europe (34;7%), South America (21; 4%), Africa (17; 3%), and Oceania (6; 1%). Duration of practice was equally distributed across 4 intervals (0-5 years; 6-15 years; 16-25 years; > 25 years). Respondents most frequently identified as general surgeons (290; 67%) and 325 (75%) were male. Awareness of peer coaching was reported by 275 (53%) respondents, with 197 (44%) never seeking formal feedback from peers. The majority of respondents (372; 84%) would be willing to participate in a peer coaching program, with monthly interactions the most desirable frequency reported (193; 51%). Coaching in the operating room was preferred by most participants (360; 86%). Few respondents (67; 14%) would accept coaching from someone unknown to them. Participants identified key coaching program elements as: feedback kept private and confidential (267; 63%); opportunity to provide feedback to the coach (247; 59%); personalized goal setting (244; 58%); and the option to choose one's own coach (205; 49%). The most commonly cited potential barrier to participation was logistical constraints (334; 79%). CONCLUSION This international survey of practicing surgeons demonstrated that peer feedback is rarely used in practice, but there is high interest and acceptance of the peer coaching model for continuous professional development. Findings regarding preferred program structure may be useful to inform the design of future peer coaching programs.
Collapse
Affiliation(s)
- Sofia Valanci-Aroesty
- Department of Surgery, Steinberg-Bernstein Centre for Minimally Invasive Surgery & Innovation, Montreal General Hospital, Montreal, Canada
- Department of Surgery, McGill University, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada
| | - Liane S Feldman
- Department of Surgery, Steinberg-Bernstein Centre for Minimally Invasive Surgery & Innovation, Montreal General Hospital, Montreal, Canada
- Department of Surgery, McGill University, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada
| | - Julio F Fiore
- Department of Surgery, Steinberg-Bernstein Centre for Minimally Invasive Surgery & Innovation, Montreal General Hospital, Montreal, Canada
- Department of Surgery, McGill University, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada
| | - Lawrence Lee
- Department of Surgery, Steinberg-Bernstein Centre for Minimally Invasive Surgery & Innovation, Montreal General Hospital, Montreal, Canada
- Department of Surgery, McGill University, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada
| | - Gerald M Fried
- Department of Surgery, Steinberg-Bernstein Centre for Minimally Invasive Surgery & Innovation, Montreal General Hospital, Montreal, Canada
- Department of Surgery, McGill University, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada
- Steinberg Centre for Simulation and Interactive Learning, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Carmen L Mueller
- Department of Surgery, Steinberg-Bernstein Centre for Minimally Invasive Surgery & Innovation, Montreal General Hospital, Montreal, Canada.
- Department of Surgery, McGill University, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada.
| |
Collapse
|
93
|
Abrams LM, Look K, Imhoff L. The importance of providing gender-affirming care in pharmacy practice. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 6:100135. [PMID: 35909713 PMCID: PMC9335925 DOI: 10.1016/j.rcsop.2022.100135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/07/2022] [Accepted: 04/07/2022] [Indexed: 12/05/2022] Open
Abstract
Transgender and gender diverse (TGD) individuals face bias and discrimination across many health care settings including pharmacy. While there is evidence of successful interventions to increase provider awareness of the needs of TGD individuals in medicine, nursing, and social work, little work has been done by the pharmacy profession to recognize and meet the needs of this population. This commentary examines the gaps in pharmacy practice and pharmacy research with regards to the needs of TGD individuals and looks at allied health fields for potential solutions that can be adapted by the pharmacy profession. We first examine the social pressures that TGD individuals face in multiple social contexts and describe how bias and discrimination spill over into their interactions with providers and health care systems. Solutions for improving pharmacy practice research's ability to identify TGD individuals and their needs follows as a measure that will lead to solutions for improving pharmacy practice. A discussion of TGD individuals' responses to actual and perceived discrimination by pharmacists is discussed next, and why their avoidance of pharmacy care can be problematic to their health. The remainder of the paper focuses on how pharmacy education can train future pharmacists to provide inclusive care to TGD individuals, and how interprofessional education and continuing education can enhance future and practicing pharmacists' ability to provide high quality care to TGD individuals.
Collapse
Affiliation(s)
| | - Kevin Look
- University of Wisconsin-Madison, United States of America
| | - Lisa Imhoff
- University of Wisconsin-Madison, United States of America
| |
Collapse
|
94
|
Cross AJ, Thomas D, Liang J, Abramson MJ, George J, Zairina E. Educational interventions for health professionals managing chronic obstructive pulmonary disease in primary care. Cochrane Database Syst Rev 2022; 5:CD012652. [PMID: 35514131 PMCID: PMC9073270 DOI: 10.1002/14651858.cd012652.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a common, preventable and treatable health condition. COPD is associated with substantial burden on morbidity, mortality and healthcare resources. OBJECTIVES To review existing evidence for educational interventions delivered to health professionals managing COPD in the primary care setting. SEARCH METHODS We searched the Cochrane Airways Trials Register from inception to May 2021. The Register includes records from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Allied and Complementary Medicine Database (AMED) and PsycINFO. We also searched online trial registries and reference lists of included studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) and cluster-RCTs. Eligible studies tested educational interventions aimed at any health professionals involved in the management of COPD in primary care. Educational interventions were defined as interventions aimed at upskilling, improving or refreshing existing knowledge of health professionals in the diagnosis and management of COPD. DATA COLLECTION AND ANALYSIS Two review authors independently reviewed abstracts and full texts of eligible studies, extracted data and assessed the risk of bias of included studies. We conducted meta-analyses where possible and used random-effects models to yield summary estimates of effect (mean differences (MDs) with 95% confidence intervals (CIs)). We performed narrative synthesis when meta-analysis was not possible. We assessed the overall certainty of evidence for each outcome using Grades of Recommendation, Assessment, Development and Evaluation (GRADE). Primary outcomes were: 1) proportion of COPD diagnoses confirmed with spirometry; 2) proportion of patients with COPD referred to, participating in or completing pulmonary rehabilitation; and 3) proportion of patients with COPD prescribed respiratory medication consistent with guideline recommendations. MAIN RESULTS We identified 38 studies(22 cluster-RCTs and 16 RCTs) involving 4936 health professionals (reported in 19/38 studies) and 71,085 patient participants (reported in 25/38 studies). Thirty-six included studies evaluated interventions versus usual care; seven studies also reported a comparison between two or more interventions as part of a three- to five-arm RCT design. A range of simple to complex interventions were used across the studies, with common intervention features including education provided to health professionals via training sessions, workshops or online modules (31 studies), provision of practice support tools, tool kits and/or algorithms (10 studies), provision of guidelines (nine studies) and training on spirometry (five studies). Health professionals targeted by the interventions were most commonly general practitioners alone (20 studies) or in combination with nurses or allied health professionals (eight studies), and the majority of studies were conducted in general practice clinics. We identified performance bias as high risk for 33 studies. We also noted risk of selection, detection, attrition and reporting biases, although to a varying extent across studies. The evidence of efficacy was equivocal for all the three primary endpoints evaluated: 1) proportion of COPD diagnoses confirmed with spirometry (of the four studies that reported this outcome, two supported the intervention); 2) proportion of patients with COPD who are referred to, participate in or complete pulmonary rehabilitation (of the four studies that reported this outcome, two supported the intervention); and 3) proportion of patients with COPD prescribed respiratory medications consistent with guideline recommendations (12 studies reported this outcome, the majority evaluated multiple drug classes and reported a mixed effect). Additionally, the low quality of evidence and potential risk of bias make the interpretation more difficult. Moderate-quality evidence (downgraded due to risk of bias concerns) suggests that educational interventions for health professionals probably improve the proportion of patients with COPD vaccinated against influenza (three studies) and probably have little impact on the proportion of patients vaccinated against pneumococcal infection (two studies). Low-quality evidence suggests that educational interventions for health professionals may have little or no impact on the frequency of COPD exacerbations (10 studies). There was a high degree of heterogeneity in the reporting of health-related quality of life (HRQoL). Low-quality evidence suggests that educational interventions for health professionals may have little or no impact on HRQoL overall, and when using the COPD-specific HRQoL instrument, the St George's Respiratory Questionnaire (at six months MD 0.87, 95% CI -2.51 to 4.26; 2 studies, 406 participants, and at 12 months MD -0.43, 95% CI -1.52 to 0.67, 4 studies, 1646 participants; reduction in score indicates better health). Moderate-quality evidence suggests that educational interventions for health professionals may improve patient satisfaction with care (one study). We identified no studies that reported adverse outcomes. AUTHORS' CONCLUSIONS The evidence of efficacy was equivocal for educational interventions for health professionals in primary care on the proportion of COPD diagnoses confirmed with spirometry, the proportion of patients with COPD who participate in pulmonary rehabilitation, and the proportion of patients prescribed guideline-recommended COPD respiratory medications. Educational interventions for health professionals may improve influenza vaccination rates among patients with COPD and patient satisfaction with care. The quality of evidence for most outcomes was low or very low due to heterogeneity and methodological limitations of the studies included in the review, which means that there is uncertainty about the benefits of any currently published educational interventions for healthcare professionals to improve COPD management in primary care. Further well-designed RCTs are needed to investigate the effects of educational interventions delivered to health professionals managing COPD in the primary care setting.
Collapse
Affiliation(s)
- Amanda J Cross
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Dennis Thomas
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
| | - Jenifer Liang
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Johnson George
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Elida Zairina
- Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia
| |
Collapse
|
95
|
Medline A, Wham R, Kim G, Staley C, Steck A, Boissonneault A, Schenker ML. Opioid Prescribing Behavior in the Emergency Department During Routine Orthopedic Manipulations. Am Surg 2022:31348221091957. [PMID: 35522851 DOI: 10.1177/00031348221091957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The emergency department (ED) often represents the first exposure orthopedic trauma patients have to prescription opioids and thus a critical opportunity for prevention of potential long-term opioid use. This study will analyze the impact of opioid prescribing patterns among both ED providers and orthopedic surgery residents on the utilization of opioids during routine orthopedic trauma manipulations. MATERIALS AND METHODS This retrospective study reviewed opioid utilization among patients with an ankle or distal radius fracture at a large, urban, level 1 trauma center. Data on clinical providers, patient demographics, and injury severity score (ISS) were collected. Total opioid use was reported in oral morphine milligram equivalents (MME). Regression analyses were performed to determine how provider opioid prescribing intensity affected administered MME. RESULTS Five-hundred and ninety-five patients were included. The mean MME administered was 40.84 (SD 30.0) and was inversely associated with ISS (R = -.05; P = .40). Patients treated by a high-intensity ED prescriber had approximately three times higher odds of receiving over 40.84 MME (OR 2.8, 95% CI 1.33-5.90 P = .07). For those with an ISS score less than 15, the presence of a low-intensity orthopedic resident decreased the odds of receiving over 40.84 MME from 2.25 to 1.78 in the presence of a high-intensity ED prescriber. CONCLUSION For isolated orthopedic manipulations in the ED, involvement of a low-intensity prescribing orthopedic resident significantly decreased the quantity of opioids administered for those with lower ISS injuries, thus effectively mitigating the effect of high-intensity prescribing behavior prescriber.
Collapse
Affiliation(s)
- Alexandra Medline
- Department of Orthopaedics, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - Robert Wham
- Department of Orthopaedics, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - Grace Kim
- 160343Augusta University/ Medical College of Georgia, Atlanta, GA, USA
| | | | - Alaina Steck
- Department of Emergency Medicine, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - Adam Boissonneault
- Department of Orthopaedics, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - Mara L Schenker
- Department of Orthopaedics, 12239Emory University School of Medicine, Atlanta, GA, USA
| |
Collapse
|
96
|
Pereira J, Meadows L, Kljujic D, Strudsholm T. Do learners implement what they learn? Commitment-to-change following an interprofessional palliative care course. Palliat Med 2022; 36:866-877. [PMID: 35260018 PMCID: PMC9087309 DOI: 10.1177/02692163221081329] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Palliative care educators should incorporate strategies that enhance application into practice by learners. Commitment-to-change is an approach to reinforce learning and encourage application into practice; immediately post-course learners commit to making changes in their practices as a result of participating in the course ("statements") and then several weeks or months later are prompted to reflect on their commitments ("reflections"). AIM Explore if and how learners implemented into practice what they learned in a palliative care course, using commitment-to-change reflections. DESIGN Secondary analysis of post-course commitment statements and 4-months post-course commitment reflections submitted online by learners who participated in Pallium Canada's interprofessional, 2-day, Learning Essential Approaches to Palliative Care (LEAP) Core courses. SETTING/PARTICIPANTS Primary care providers from across Canada and different profession who attended LEAP Core courses from 1 April 2015 to 31 March 2017. RESULTS About 1063 of 4636 learners (22.9%) who participated in the 244 courses delivered during the study period submitted a total of 4250 reflections 4 months post-course. Of these commitments, 3081 (72.5%) were implemented. The most common implemented commitments related to initiating palliative care early across diseases, pain and symptom management, use of clinical instruments, advance care planning, and interprofessional collaboration. Impact extended to patients, services, and colleagues. Barriers to implementation into practice included lack of time, and system-level factors such as lack of support by managers and untrained colleagues. CONCLUSIONS Examples of benefits to patients, families, services, colleagues, and themselves were described as a result of participating in the courses.
Collapse
Affiliation(s)
- José Pereira
- Pallium Canada, Ottawa, Canada (Non-profit Foundation).,Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton, Canada.,Institute for Culture and Society (ICS), University of Navara, Spain
| | - Lynn Meadows
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Tina Strudsholm
- School of Health Sciences, University of Northern British Columbia, Prince George, BC, Canada
| |
Collapse
|
97
|
Cook DA, Stephenson CR, Pankratz VS, Wilkinson JM, Maloney S, Prokop LJ, Foo J. Associations Between Physician Continuous Professional Development and Referral Patterns: A Systematic Review and Meta-Analysis. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:728-737. [PMID: 34985042 DOI: 10.1097/acm.0000000000004575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Both overuse and underuse of clinician referrals can compromise high-value health care. The authors sought to systematically identify and synthesize published research examining associations between physician continuous professional development (CPD) and referral patterns. METHOD The authors searched MEDLINE, Embase, PsycInfo, and the Cochrane Database on April 23, 2020, for comparative studies evaluating CPD for practicing physicians and reporting physician referral outcomes. Two reviewers, working independently, screened all articles for inclusion. Two reviewers reviewed all included articles to extract information, including data on participants, educational interventions, study design, and outcomes (referral rate, intended direction of change, appropriateness of referral). Quantitative results were pooled using meta-analysis. RESULTS Of 3,338 articles screened, 31 were included. These studies enrolled at least 14,458 physicians and reported 381,165 referral events. Among studies comparing CPD with no intervention, 17 studies with intent to increase referrals had a pooled risk ratio of 1.91 (95% confidence interval: 1.50, 2.44; P < .001), and 7 studies with intent to decrease referrals had a pooled risk ratio of 0.68 (95% confidence interval: 0.55, 0.83; P < .001). Five studies did not indicate the intended direction of change. Subgroup analyses revealed similarly favorable effects for specific instructional approaches (including lectures, small groups, Internet-based instruction, and audit/feedback) and for activities of varying duration. Four studies reported head-to-head comparisons of alternate CPD approaches, revealing no clear superiority for any approach. Seven studies adjudicated the appropriateness of referral, and 9 studies counted referrals that were actually completed (versus merely requested). CONCLUSIONS Although between-study differences are large, CPD is associated with statistically significant changes in patient referral rates in the intended direction of impact. There are few head-to-head comparisons of alternate CPD interventions using referrals as outcomes.
Collapse
Affiliation(s)
- David A Cook
- D.A. Cook is professor of medicine and medical education, director, Section of Research and Data Analytics, School of Continuous Professional Development, and director of education science, Office of Applied Scholarship and Education Science, Mayo Clinic College of Medicine and Science, and consultant, Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0003-2383-4633
| | - Christopher R Stephenson
- C.R. Stephenson is assistant professor of medicine, Mayo Clinic College of Medicine and Science, associate program director, Mayo-Rochester Internal Medicine Residency Program, and consultant, Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0001-8537-392X
| | - V Shane Pankratz
- V.S. Pankratz is professor of internal medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico; ORCID: https://orcid.org/0000-0002-3742-040X
| | - John M Wilkinson
- J.M. Wilkinson is associate professor of family medicine, Mayo Clinic College of Medicine and Science, and consultant, Department of Family Medicine, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0003-1156-8577
| | - Stephen Maloney
- S. Maloney is professor of health professions education and deputy head of school, Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia; ORCID: https://orcid.org/0000-0003-2612-5162
| | - Larry J Prokop
- L.J. Prokop is a reference librarian, Plummer Library, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0002-7197-7260
| | - Jonathan Foo
- J. Foo is a lecturer, School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia; ORCID: https://orcid.org/0000-0003-4533-8307
| |
Collapse
|
98
|
Depaigne-Loth A, Poirat L, Natali JP, Lenoir-Salfati M, Regnier K, McMahon G, Hosansky T. Vive la Différence: A Comparison of CPD Quality Assurance Systems in France and The United States. J Eur CME 2022; 11:2068215. [PMID: 35494409 PMCID: PMC9045751 DOI: 10.1080/21614083.2022.2068215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Offering relevant, evidence based continuing professional development (CPD) to ensure the continued competence of health professionals is a universal concern. This concern will become even more crucial in a world facing global health threats and in a context of internationalisation of learning environments. While accrediting systems (i.e. external quality assurance systems for CPD) share a common goal to promote high quality CPD, each system is shaped by national history and contexts. An international movement is working to enhance the convergence of accrediting principles and processes. One of the first steps is to know and understand each other. This article serves this goal by offering a descriptive comparison of two seemingly different CPD quality assurance systems – in France and in the USA of America. The descriptions were developed by members of the accrediting bodies in both countries. The main finding of this descriptive study is that, despite stark differences in historical contexts and governance schemes, both regulators share principles of quality and independence of CPD and have endorsed a leadership role in promoting effective strategies, including interprofessional continuing education and practices. The commonalities of goals and values revealed in the study support the efforts of the International Academy for CPD Accreditation related to the globalisation of both health issues and learning environments.
Collapse
Affiliation(s)
- Anne Depaigne-Loth
- Agence nationale du Développement Professionnel Continu, Le Kremlin-Bicêtre, France
| | - Laure Poirat
- Agence nationale du Développement Professionnel Continu, Le Kremlin-Bicêtre, France
| | - Jean-Philippe Natali
- Agence nationale du Développement Professionnel Continu, Le Kremlin-Bicêtre, France
| | | | - Kate Regnier
- Accreditation Council for Continuing Medical Education (ACCME), Chicago, Illinois, USA
| | - Graham McMahon
- Accreditation Council for Continuing Medical Education (ACCME), Chicago, Illinois, USA
| | - Tamar Hosansky
- Accreditation Council for Continuing Medical Education (ACCME), Chicago, Illinois, USA
| |
Collapse
|
99
|
Kovach JV, Obanua F, Hutchins HM. Pilot Testing a Series of Value-Based Care Training Courses. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2022; 13:319-322. [PMID: 35437359 PMCID: PMC9012662 DOI: 10.2147/amep.s360027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 04/04/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE The US healthcare system currently emphasizes volume of services over value. To facilitate changing to a value-based care model, one managed care organization developed a series of online courses designed to teach clinicians value-based care principles and practices. A pilot test was conducted to obtain feedback regarding course content and design, so the courses could be revised prior to their launch. PATIENTS AND METHODS A representative cross section of the courses' target audience (n = 50) was recruited to participate in the pilot test, and data were collected through an online survey. Descriptive statistics were calculated for responses to close-ended survey questions, and affinity analysis was performed on responses to open-ended survey questions. Issues identified were then categorized as urgent/not urgent with respect to course revision. RESULTS Nearly a quarter (24%) of respondents indicated that the course contained incorrect or misleading information. Other responses noted inconsistencies in course content, eg, misspelled or mispronounced words, slides that were hard to read, etc. CONCLUSION This study demonstrates how a pilot test was used as part of a formative assessment to improve course content and design. During a pilot test, attention should be paid to making it easy for participants to provide feedback.
Collapse
Affiliation(s)
- Jamison V Kovach
- Project Management Program, University of Houston, Houston, TX, USA
| | - Faith Obanua
- Project Management Program, University of Houston, Houston, TX, USA
| | - Holly M Hutchins
- College of Education, University of North Texas, Denton, TX, USA
| |
Collapse
|
100
|
Ametrano RM, McGillicuddy ML, Sanyal S, Topor DR. Training Interprofessional Staff in Whole Health Clinical Care at the Veterans Health Administration. Glob Adv Health Med 2022; 11:2164957X221092361. [PMID: 35433116 PMCID: PMC9008845 DOI: 10.1177/2164957x221092361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/15/2022] [Accepted: 03/21/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction The Veterans Health Administration (VHA) initiated a system-wide redesign in
2011 toward a patient-centered approach called the Whole Health System (WHS)
of care. Education of VHA clinical staff in WHS-informed care, Whole Health
Clinical Care (WHCC), is one critical element of this redesign effort. At a
minimum, WHCC education should address core competencies for clinicians and
be considered satisfactory for learners. This is the first study to evaluate
learner satisfaction and perceived achievement of course objectives in WHCC
that incorporated active learning strategies. Method A large VA Healthcare System developed an in-person workshop focused on WHCC
that used multiple active learning activities. These activities included
case presentations, role playing, experiential learning, and group
discussion. Results Sixty-two interprofessional staff attended the workshop in November 2019.
Forty (64.50%) participants completed post-workshop surveys within 30 days.
Data suggest participants were highly satisfied with the workshop and that
they successfully met stated learning objectives. Conclusions We call on VHA and private-sector hospitals to train clinical staff in WHCC
that incorporates use of active learning strategies.
Collapse
|