The impact of CME on physician performance and patient health outcomes: an updated synthesis of systematic reviews

Addressing educational gaps through multidisciplinary team education in eosinophilic oesophagitis management

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.

Perspectives of Swiss Paediatric Health Care Professionals on Factors Influencing Physical Activity Participation in Children with Disabilities

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.

Impact of an immersive, interactive medical education initiative on guideline-based retinal disease management knowledge/competence and effectual practice change

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.

National examination for medical residency admission: academic performance in a high-stakes test and the need for continuing education

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.

Perceived Advantages and Disadvantages of Online Continuing Professional Development (CPD) During COVID-19: CPD Providers' Perspectives

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.

Clinical utility of a decision-making aid for upper limb neurorehabilitation: applying the Hypertonicity Intervention Planning Model across cultures

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.

Where do Physiotherapists Search for Information? Barriers in Translating Scientific Information into Clinical Practice

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.

A Survey of Hiring and Non-hiring Pharmacists' Perceptions of a Primary Care Certificate Training Program

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.

Learner engagement and teaching effectiveness in livestreamed versus in-person CME

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.

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

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.

Domestic Homicide: A Synthesis of Systematic Review Evidence

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.

Evidence for continuing professional development standards for regulated health practitioners in Australia: a systematic review

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.

Three-dimensionally printed implant surgical guide-related experience, knowledge, attitude, and professional behaviors among 2028 dentists in China: A cross-sectional study

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.

Hospital Mortality and Trainee Experiences: How General Medical Council Survey Findings Correlate With Summary Hospital-Level Mortality Indicator

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.

Promoting Informed Decisions About Colorectal Cancer Screening in Older Adults (PRIMED Study): a Physician Cluster Randomized Trial

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).

Continuing professional development needs in pain management for Canadian health care professionals: A cross sectional survey

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.

The effects of physicians on operational and financial performance in United States hospitals: staffing, human capital and knowledge spillovers

Purpose

The 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/approach

The 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.

Findings

The 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 implications

Hospital 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/value

This 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.

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

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.

Rethinking Context in Continuing Professional Development: From Identifying Barriers to Understanding Social Dynamics

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.

Medical Education in the Context of the Eastern Mediterranean Region: Professional Development Activity of Health Professionals

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.

Incentivising Higher Level Outcome Achievement in Continuing Education: Five-Year Experience from the ACCME Commendation Criteria

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.

To Effectively Address Complex Healthcare Problems, Continuing Professional Development Must Evolve

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.

A randomized implementation trial to increase adoption of evidence-informed consent practices

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.

Using implementation strategies in community settings: an introduction to the Expert Recommendations for Implementing Change (ERIC) compilation and future directions

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.

Challenges and opportunities for general practice specific CME in Europe - a narrative review of seven countries

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.

Incidence of Scholarly Publication by Selected Content Experts Presenting at National Society Foot and Ankle Meetings From 2016 to 2020

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.

Educating Crisis Supporters About Self-Harm and Suicide in Older Adults

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.

Retaining Providers with Women's Health Expertise: Decreased Provider Loss Among VHA Women's Health Faculty Development Program Attendees

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.

Advancing Curriculum Development and Design in Health Professions Education: A Health Equity and Inclusion Framework for Education Programs

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.

[Pilot survey on continuing education for pharmacists in Germany]

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.

Navigating Affordances for Learning in Clinical Workplaces: A Qualitative Study of General Practitioners' Continued Professional Development

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.

Family Physician Quality Improvement Plans: A Realist Inquiry Into What Works, for Whom, Under What Circumstances

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.

Effect of Smartphone App-Based Education on Clinician Prescribing Habits in a Learning Health Care System: A Randomized Cluster Crossover Trial

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.

The Importance of Sociocultural Factors in Moderating the Applicability of Test-Enhanced Learning to Continuing Professional Development

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.

A Patient Safety Champion Program for Interprofessional Health Care Educators: Implementation and Outcomes

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.

Continuing education programme on vaccines for primary healthcare professionals: mixed-method protocol

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.

Factors Associated With Specialists' Intention to Adopt New Behaviors After Taking Web-Based Continuing Professional Development Courses: Cross-sectional Study

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.

Considerations for designing and implementing a surgical peer coaching program: an international survey

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.

The importance of providing gender-affirming care in pharmacy practice

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.

Educational interventions for health professionals managing chronic obstructive pulmonary disease in primary care

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.

Opioid Prescribing Behavior in the Emergency Department During Routine Orthopedic Manipulations

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.

Do learners implement what they learn? Commitment-to-change following an interprofessional palliative care course

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.

Associations Between Physician Continuous Professional Development and Referral Patterns: A Systematic Review and Meta-Analysis

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.

Vive la Différence: A Comparison of CPD Quality Assurance Systems in France and The United States

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.

Pilot Testing a Series of Value-Based Care Training Courses

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.

Training Interprofessional Staff in Whole Health Clinical Care at the Veterans Health Administration

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.