151
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Kawczak S, Mustafa S. Manuscript review continuing medical education: a retrospective investigation of the learning outcomes from this peer reviewer benefit. BMJ Open 2020; 10:e039687. [PMID: 33234636 PMCID: PMC7689103 DOI: 10.1136/bmjopen-2020-039687] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES This study investigates the learning outcomes for peer reviewers participating in a manuscript review continuing medical education (CME) process. CME from serving as a peer reviewer is one of the many benefits of serving as a reviewer. DESIGN This is a descriptive study retrospectively analysing learning outcomes self-reported by peer reviewers from 2013 to 2017 using a CME assessment framework. SETTING, PARTICIPANTS AND PRIMARY OUTCOME MEASURES Participant data are from 1985 peer reviewers who completed 2413 manuscript reviews over 32 medical journals from 2013 to 2017 and completed the CME process after their prepublication manuscript review. 417 reviewer responses were practice behaviour change(s) that were studied in depth using an assessment framework on changes in knowledge, competence and performance. RESULTS The results show positive learning outcomes reported by reviewers at the knowledge, competence and performance behaviour levels as a result of reviewing manuscripts. Higher levels of learning outcomes are more frequently achieved when reviewers consult multiple sources when conducting reviews. Reviewer demographics, such as gender or years of experience, did not have a significant association to learning outcomes. CONCLUSIONS Manuscript Review CME is an effective way that learning within the peer reviewer process can occur and helps reviewers gain knowledge, improve competence and make changes to their professional practice at all stages of their careers. Journal publishers should emphasise and support reviewers through offering CME to reviewers and encourage consultation of multiple sources when conducting reviews, which is an added benefit and resource to help professionals continue their development.
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Affiliation(s)
- Steven Kawczak
- Education Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sultana Mustafa
- Graduate Medical Education, NewYork-Presbyterian Hospital, New York, New York, USA
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152
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Gomes CM, de Bessa J, Nunes RV, Prezotti J, Bruschini H, Gomes MM. Impact of a 1-day urodynamic course on knowledge, perceptions, and attitudes of urology residents. Neurourol Urodyn 2020; 40:443-450. [PMID: 33205844 DOI: 10.1002/nau.24581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/21/2020] [Accepted: 11/04/2020] [Indexed: 11/08/2022]
Abstract
AIMS No evidence-informed educational curriculum is available for designing urodynamics (UDS) courses. We evaluated the learning outcomes of a short-lasting urodynamic course for urology residents. METHODS Urology residents of postgraduate years 4 and 5 (n = 13 and n = 1316, respectively) attended a 1-day urodynamic course. Learning objectives included patient preparation, indication and technique, terminology, trace interpretation, and impact on patient management. Instructional methods consisted of short lectures (3 h) and case-based discussions (7.5 h). Learners' reactions, modifications of perceptions and attitudes, and acquisition of knowledge and skills were assessed by three written tests with a single group, pretest, posttest 1, and posttest 2 design. Tests were conducted precourse, 1 week after, and 4 months after the course. RESULTS All participants felt more confident in several urodynamic competencies after the course, including patient preparation, urodynamic indication and technique, terminology, trace interpretation, and impact for patient management. These perceptions remained unchanged after 4 months. Most became stricter in the indication of UDS, including 20 (87.0%) at posttest 1 and 8 (66.7%) at posttest 2. The mean number of correct answers in the knowledge evaluation was 52.2% versus 61.4% versus 56.7%, respectively at pretest, posttest 1, and posttest 2; p = 0.535). All participants rated the course as very useful or useful in both posttest evaluations. CONCLUSIONS Our study demonstrates that a 1-day urodynamic course can promote lasting improvements in self-reported perceptions, attitudes, and urodynamic-related competencies of urology residents. Further studies using evidence-informed educational principles are needed to determine the effect of specific educational interventions on urodynamic competencies in different contexts.
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Affiliation(s)
- Cristiano M Gomes
- Division of Urology, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Jose de Bessa
- Department of Surgery, State University of Feira de Santana, Feira de Santana, Bahia, Brazil
| | - Ricardo V Nunes
- Clinic of Urology, Military Hospital of Sao Paulo Area, Sao Paulo, Brazil
| | - Jose Prezotti
- Division of Urology, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Homero Bruschini
- Division of Urology, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Marcio M Gomes
- Department of Pathology and Laboratory Medicine, Royal College of Physicians and Surgeons of Canada, Ottawa Hospital Research Institute, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
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153
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Kennedy AG, Regier L, Fischer MA. Educating community clinicians using principles of academic detailing in an evolving landscape. Am J Health Syst Pharm 2020; 78:80-86. [DOI: 10.1093/ajhp/zxaa351] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Amanda G Kennedy
- Vermont Academic Detailing Program, Larner College of Medicine Office of Primary Care, University of Vermont, Burlington, VT
| | - Loren Regier
- Centre for Effective Practice (CEP) Academic Detailing Service, Toronto, Canada
- RxFiles Academic Detailing Service, College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada
| | - Michael A Fischer
- National Resource Center for Academic Detailing, Division of Pharmacoepidemiology & Pharmacoeconomics, Brigham & Women’s Hospital, Boston, MA
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154
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Stephenson CR, Bonnes SL, Sawatsky AP, Richards LW, Schleck CD, Mandrekar JN, Beckman TJ, Wittich CM. The relationship between learner engagement and teaching effectiveness: a novel assessment of student engagement in continuing medical education. BMC MEDICAL EDUCATION 2020; 20:403. [PMID: 33148231 PMCID: PMC7640708 DOI: 10.1186/s12909-020-02331-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/26/2020] [Indexed: 05/09/2023]
Abstract
BACKGROUND Continuing medical education (CME) often uses passive educational models including lectures. However, numerous studies have questioned the effectiveness of these less engaging educational strategies. Studies outside of CME suggest that engaged learning is associated with improved educational outcomes. However, measuring participants' engagement can be challenging. We developed and determined the validity evidence for a novel instrument to assess learner engagement in CME. METHODS We conducted a cross-sectional validation study at a large, didactic-style CME conference. Content validity evidence was established through review of literature and previously published engagement scales and conceptual frameworks on engagement, along with an iterative process involving experts in the field, to develop an eight-item Learner Engagement Instrument (LEI). Response process validity was established by vetting LEI items on item clarity and perceived meaning prior to implementation, as well as using a well-developed online platform with clear instructions. Internal structure validity evidence was based on factor analysis and calculating internal consistency reliability. Relations to other variables validity evidence was determined by examining associations between LEI and previously validated CME Teaching Effectiveness (CMETE) instrument scores. Following each presentation, all participants were invited to complete the LEI and the CMETE. RESULTS 51 out of 206 participants completed the LEI and CMETE (response rate 25%) Correlations between the LEI and the CMETE overall scores were strong (r = 0.80). Internal consistency reliability for the LEI was excellent (Cronbach's alpha = 0.96). To support validity to internal structure, a factor analysis was performed and revealed a two dimensional instrument consisting of internal and external engagement domains. The internal consistency reliabilities were 0.96 for the internal engagement domain and 0.95 for the external engagement domain. CONCLUSION Engagement, as measured by the LEI, is strongly related to teaching effectiveness. The LEI is supported by robust validity evidence including content, response process, internal structure, and relations to other variables. Given the relationship between learner engagement and teaching effectiveness, identifying more engaging and interactive methods for teaching in CME is recommended.
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Affiliation(s)
| | - Sara L. Bonnes
- Division of General Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905 USA
| | - Adam P. Sawatsky
- Division of General Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905 USA
| | - Lukas W. Richards
- Division of General Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905 USA
| | - Cathy D. Schleck
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN USA
| | | | - Thomas J. Beckman
- Division of General Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905 USA
| | - Christopher M. Wittich
- Division of General Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905 USA
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155
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McGinness HT, Caldwell PHY, Gunasekera H, Scott KM. An educational intervention to increase student engagement in feedback. MEDICAL TEACHER 2020; 42:1289-1297. [PMID: 32805145 DOI: 10.1080/0142159x.2020.1804055] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND The learner has a central role in feedback. We developed a feedback workshop for medical students grounded in two concepts: (1) Student agency in feedback and its interplay in the context of brief clinical attachments; (2) The educational alliance. AIMS To determine whether a brief feedback training workshop prior to a series of two-week clinical attachments improves agentic student feedback behaviour (e.g. seeking, recognising, evaluating and utilising feedback) and student satisfaction with feedback. METHODS We conducted surveys among three consecutive student cohorts undertaking three fortnightly paediatric clinical attachments. We pilot tested a workshop with Cohort 1 and implemented it for the entire Cohorts 2 (n = 58) and 3 (n = 68). Participants completed the same survey at the start and end of term, with different free-text items. Quantitative and qualitative responses were compared between groups. RESULTS Student-reported agentic feedback behaviour increased across all outcomes except for feedback utilisation. Overall student satisfaction with feedback increased during the term in Cohorts 2 (23-65%, p = 0.002) and 3 (40-70%, p = 0.003) but not in Cohort 1 non-participating students (27-42%, p = 0.42). CONCLUSIONS A brief one-off student-directed feedback workshop may improve agentic student feedback behaviours (e.g. feedback-seeking) and student satisfaction with feedback.
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Affiliation(s)
- Hannah T McGinness
- Discipline of Child and Adolescent Health, The University of Sydney, Sydney, Australia
- The Children's Hospital at Westmead, Sydney, Australia
| | - Patrina H Y Caldwell
- Discipline of Child and Adolescent Health, The University of Sydney, Sydney, Australia
- The Children's Hospital at Westmead, Sydney, Australia
| | - Hasantha Gunasekera
- Discipline of Child and Adolescent Health, The University of Sydney, Sydney, Australia
- The Children's Hospital at Westmead, Sydney, Australia
| | - Karen M Scott
- Discipline of Child and Adolescent Health, The University of Sydney, Sydney, Australia
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Rubinstein PF, Middleton B, Goodman KW, Lehmann CU. Commercial Interests in Continuing Medical Education: Where Do Electronic Health Record Vendors Fit? ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:1674-1678. [PMID: 32079950 DOI: 10.1097/acm.0000000000003190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The Accreditation Council for Continuing Medical Education (ACCME) will not accredit an organization that it defines as a commercial interest, that is an entity that produces, markets, resells, or distributes health care goods or services consumed by, or used on, patients. Thus, commercial interests are not eligible to be accredited organizations offering continuing medical education (CME) credit to physicians. This decision is based on the concern that commercial interests may use CME events to market their products or services to physicians, who then might inappropriately prescribe or administer those products or services to patients. Studies have shown that CME events supported by pharmaceutical companies, for example, have influenced physicians' prescribing behaviors.Currently, however, the ACCME does not recognize electronic health record (EHR) vendors, which are part of a multi-billion-dollar business, as commercial interests, and it accredits them to provide or directly influence CME events. Like pharmaceutical company-sponsored CME events, EHR vendor activities, which inherently only focus on use of the sponsoring vendor's EHR system despite its potential intrinsic limitations, can lead to physician reciprocity. Such events also may inappropriately influence EHR system purchases, upgrades, and implementation decisions. These actions can negatively influence patient safety and care. Thus, the authors of this Perspective call on the ACCME to recognize EHR vendors as commercial interests and remove them from the list of accredited CME providers.
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Affiliation(s)
- Pesha F Rubinstein
- P.F. Rubinstein is director, continuing and professional education, American Medical Informatics Association, Bethesda, Maryland
| | - Blackford Middleton
- B. Middleton is chief informatics and innovation officer, Apervita, Inc., Chicago, Illinois; ORCID: https://orcid.org/0000-0002-1819-1234
| | - Kenneth W Goodman
- K.W. Goodman is founder and director, Institute for Bioethics and Health Policy, University of Miami Miller School of Medicine, Miami, Florida
| | - Christoph U Lehmann
- C.U. Lehmann is professor, Departments of Pediatrics, Population and Data Sciences, and Bioinformatics, University of Texas Southwestern Medical Center, Dallas, Texas; ORCID: https://orcid.org/0000-0001-9559-4646
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157
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Kawczak S, Mooney M, Mitchner N, Senatore V, Stoller JK. The impact of a quality improvement continuing medical education intervention on physicians' vaccination practice: a controlled study. Hum Vaccin Immunother 2020; 16:2809-2815. [PMID: 32238041 PMCID: PMC7734119 DOI: 10.1080/21645515.2020.1737457] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 02/28/2020] [Indexed: 12/15/2022] Open
Abstract
This study investigated the impact of a longitudinal quality improvement continuing medical education (CME) intervention on influenza and pneumococcal vaccination rates for patient populations at high-risk or aged ≥ 65. An observational cohort design with a propensity score to adjust for vaccine eligibility between the intervention and control cohorts was utilized to assess the impact of the intervention among primary care physicians. The intervention was a three-stage quality improvement initiative with CME learning activities. Stage A was an assessment of practice to establish baseline performance. Stage B was participation in learning interventions and individualized action planning for practice change, and Stage C was practice reassessment. Data were also collected for a control group of clinicians who did not participate during the same period. One hundred primary care physicians completed all 3 intervention stages10/14 - 7/15. Altogether, 361,528 patient records of vaccine receipt were compared for those physicians who completed the educational intervention and those who did not. The percentage of physicians' adult patients receiving influenza or pneumococcal vaccination increased on all measures. The difference between intervention versus control groups was 3.4% higher for influenza ≥ 65 years, 2.1% for influenza high-risk, 0.6% for pneumococcal ≥ 65 years, and 1.4% for pneumococcal high-risk. These results show that physician participation in a quality improvement CME initiative can be an effective strategy to improve vaccination administration. The findings strengthen the evidence that CME learning interventions can advance quality improvement goals and more favorably affect physicians' practice when educational strategies are utilized.
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Affiliation(s)
- Steven Kawczak
- Education Institute Professional Development, Center for Continuing Education, Cleveland Clinic, Cleveland, OH, USA
| | - Molly Mooney
- Center for Continuing Education, Cleveland Clinic, Cleveland, OH, USA
| | | | | | - James K. Stoller
- Education Institute, Jean Wall Bennett Professor of Medicine, Samson Global Leadership Academy Endowed Chair, Cleveland Clinic, Cleveland, OH, USA
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158
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Griebenow R, Mills P, Stein J, Herrmann H, Kelm M, Campbell C, Schäfer R. Outcomes in CME/CPD - Special Collection: How to make the "pyramid" a perpetuum mobile. J Eur CME 2020; 9:1832750. [PMID: 33194316 PMCID: PMC7599014 DOI: 10.1080/21614083.2020.1832750] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Continuing medical education (CME) should not be an end in itself, but as expressed in Moore's pyramid, help to improve both individual patient and ultimately community, health. However, there are numerous barriers to translation of physician competence into improvements in community health. To enhance the effect CME may achieve in improving community health the authors suggest a kick-off/keep-on continuum of medical competence, and integration of aspects of public health at all levels from planning to delivery and outcomes measurement in CME.
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Affiliation(s)
| | - Peter Mills
- European Cardiology Section Foundation (ECSF), Cologne, Germany
| | - Jörg Stein
- European Cardiology Section Foundation (ECSF), Cologne, Germany
| | - Henrik Herrmann
- European Cardiology Section Foundation (ECSF), Cologne, Germany
| | - Malte Kelm
- European Cardiology Section Foundation (ECSF), Cologne, Germany
| | - Craig Campbell
- European Cardiology Section Foundation (ECSF), Cologne, Germany
| | - Robert Schäfer
- European Board for Accreditation in Cardiology (EBAC), Cologne, Germany
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159
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Emami Z, Kouhkan A, Khajavi A, Khamseh ME. Knowledge of physicians regarding the management of Type two Diabetes in a primary care setting: the impact of online continuous medical education. BMC MEDICAL EDUCATION 2020; 20:374. [PMID: 33081765 PMCID: PMC7574317 DOI: 10.1186/s12909-020-02212-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 08/28/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND To explore the impact of an online continuing medical education (CME) program on physicians' knowledge about the management of type two diabetes. METHODS An online CME program was designed and uploaded in the CME platform, Department of Education, Ministry of health, Iran. A 28-item questionnaire was used for the assessment. In the beginning, a case scenario was introduced. Then, participants were asked to follow and answer to a pretest assessment. Details of the educational content were provided afterward. Finally, the participants took part in the same post-test exam 4 weeks later. The Wilcoxon matched-pairs signed-ranks test was used to compare the measurements. In addition, the Mann-Whitney test was applied to compare knowledge indices between the general practitioners (GPs) and internists. RESULTS Five hundred twenty-six primary care physicians participated in this study. There was a significant positive effect regarding diagnosis confirmation (10.3% difference, P = 0.0001). Moreover, a smaller effect was observed in relation to the importance of glycosylated hemoglobin (HbA1c) at diagnosis (5.2% difference, P = 0.0006). The effect was positive in relation to the self-reported HbA1c testing frequency: more than 90% of the participants answered correctly in the post-test exam (7.6% difference, P = 0.0001). Considering improved knowledge in the treatment of diabetes, there was a very significant difference in response to questions targeting advice on a healthy diet, and physical activity; 27.7% (P = 0.000), and 18.7% (P = 0.000), respectively. In addition, the program had a positive impact on various aspects of treatment with oral glucose-lowering drugs (OGLDs). Moreover, the intervention difference was 25, and 34.4% for the questions targeting the appropriate type of insulin, and insulin initiation regimen after OGLD failure. Subgroup analyses revealed that the intervention increased the rate of correct responses among the GPs in various domains of knowledge in diagnosis and treatment. The initial differences between the GPs and internists no longer remained significant after the intervention. CONCLUSION Knowledge of Iranian primary health care professionals in diabetes management has significant shortcomings. This is concerning because they are at the front line of patient care. We demonstrate the effectiveness of online CME on improving GPs knowledge in the management of type 2 diabetes.
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Affiliation(s)
- Zahra Emami
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Tehran, Iran, No. 10, Firoozeh St, Vali-asr Ave, Vali-asr Sq, Tehran, Iran
| | - Azam Kouhkan
- Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
- Department of Diabetes, Obesity and Metabolism, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Alireza Khajavi
- Student Research Committee, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad E Khamseh
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Tehran, Iran, No. 10, Firoozeh St, Vali-asr Ave, Vali-asr Sq, Tehran, Iran.
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160
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Baillargeon JP, St-Cyr-Tribble D, Xhignesse M, Brown C, Carpentier AC, Fortin M, Grant A, Simoneau-Roy J, Langlois MF. Impact of an educational intervention combining clinical obesity preceptorship with electronic networking tools on primary care professionals: a prospective study. BMC MEDICAL EDUCATION 2020; 20:361. [PMID: 33054845 PMCID: PMC7556981 DOI: 10.1186/s12909-020-02248-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 09/23/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Primary care providers' (PCPs) attitude toward obesity is often negative, and their confidence level for helping patients manage their weight is low. Continuing professional development (CPD) on the subject of obesity is often based on a single activity using a traditional passive approach such as lectures known to have little effect on performance or patient outcomes. The aim of this study was to evaluate the impact of an educational intervention for obesity management on PCPs' attitude, self-efficacy, practice changes and patient-related outcomes. METHODS Prospective interventional study with 12 months follow-up. A two-day clinical obesity preceptorship was offered where participants were actively involved in competence building using real-life situations, in addition to electronic networking tools, including a discussion forum and interactive monthly webinars. Thirty-five participants (12 nurses and 23 physicians) from seven Family medicine groups were enrolled. Questionnaires were used to evaluate the impact on primary care nurses' and physicians' attitudes and self-efficacy for obesity management. Practice changes and patient outcomes were evaluated using clinical vignettes, de-identified electronic patient records and qualitative analyses from group interviews. RESULTS Physicians' general attitude towards patients with obesity was improved (61 ± 22 mm vs 85 ± 17 mm, p < 0.001). Self-efficacy for obesity management and lifestyle counselling were also improved immediately and 1 year after the intervention (all Ps < 0.05). De-identified patient records and clinical vignettes both showed improvement in recording of weight, waist circumference and evaluation of readiness to change lifestyle (all Ps < 0.05) that was confirmed by group interviews. Also, 15% of patients who were prospectively registered for weight management had lost more than 5% of their initial weight at the time of their last visit (P < 0.0001, median follow-up of 152 days). CONCLUSION A multimodal educational intervention for obesity management can improve PCPs'attitude and self-efficacy for obesity management and lifestyle counselling. This translates into beneficial practice changes and patient-related outcomes. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01385397 . Retrospectively registered, 28 June 2011.
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Affiliation(s)
- Jean-Patrice Baillargeon
- Division of Endocrinology, Department of Medicine, Université de Sherbrooke, Sherbrooke, Québec J1H 5N4 Canada
| | | | - Marianne Xhignesse
- Department of Family Medicine, Université de Sherbrooke, Sherbrooke, Québec J1H 5N4 Canada
| | - Christine Brown
- Division of Endocrinology, Department of Medicine, Université de Sherbrooke, Sherbrooke, Québec J1H 5N4 Canada
| | - André C. Carpentier
- Division of Endocrinology, Department of Medicine, Université de Sherbrooke, Sherbrooke, Québec J1H 5N4 Canada
| | - Martin Fortin
- Department of Family Medicine, Université de Sherbrooke, Sherbrooke, Québec J1H 5N4 Canada
- Family Medicine Group, Centre Intégré Universitaire de Santé et de services sociaux du Saguenay-Lac St-Jean, Chicoutimi, Québec G7H 5H6 Canada
| | - Andrew Grant
- Department of Biochemistry, Collaborative Research for Effective Diagnosis research unit, Université de Sherbrooke, Sherbrooke, Québec J1H 5N4 Canada
| | - Judith Simoneau-Roy
- Department of Pediatrics, Université de Sherbrooke, Sherbrooke, Québec J1H 5N4 Canada
| | - Marie-France Langlois
- Division of Endocrinology, Department of Medicine, Université de Sherbrooke, Sherbrooke, Québec J1H 5N4 Canada
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161
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Ratelle JT, Wittich CM, Yu RC, Newman JS, Jenkins SM, Beckman TJ. Effect of Pause Procedures on Participant Reflection and Commitment-to-Change in Continuing Medical Education. TEACHING AND LEARNING IN MEDICINE 2020; 32:552-560. [PMID: 32749160 DOI: 10.1080/10401334.2020.1779070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Problem: Conferences are the most common form of continuing medical education (CME), but their effect on clinician practice is inconsistent. Reflection is a critical step in the process of practice change among clinicians and may lead to improved outcomes following conference-based CME. However, reflection requires time to process newly-learned material. Adequate time for reflection may be noticeably absent during many conference presentations. Intervention: The pause procedure is a 90-second 'pause' during a 30-minute presentation so learners can review and discuss content. The goal of the pause procedure is to stimulate learners' active engagement with newly learned material which will, in turn, promote learner reflection. Context: Fifty-six presentations at two hospital medicine CME conferences were assigned to the pause procedure or control. Study outcomes provided by conference participants were validated reflection scores and commitment-to-change (CTC) statements for each presentation. A post-hoc survey of the intervention group was conducted to assess presenters' experiences with the pause procedure. Impact: A total of 527 conference participants completed presentation evaluations (response rate 72.7%). Presentations incorporating the pause procedure failed to lead higher participant reflection scores (percentage 'top box' score; intervention: 39.2% vs. control: 41.7%, p = 0.40) or participant CTC rates (median [IQR]; intervention: 4.64 [3.04, 10.57] vs. control: 8.16 [5.28, 17.12], p = 0.13) than control presentations. However, the majority of presenters (16 out of 17 survey respondents) had never before used the intervention and little active engagement among learners was noted during the pause procedure. Lessons Learned: Adding the pause procedure to CME presentations did not lead to greater reflection or CTC among clinician learners. However, presenters had limited experience with the intervention, which may have reduced their fidelity to the educational principles of the pause procedure. Faculty development may be necessary when planning a new educational intervention that is to be implemented by conference presenters.
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Affiliation(s)
- John T Ratelle
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Roger C Yu
- Division of Hospital Medicine, Scripps Clinic, La Jolla, California, USA
| | - James S Newman
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sarah M Jenkins
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Thomas J Beckman
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Collins D, Inglin L, Laatikainen T, Ciobanu A, Curocichin G, Salaru V, Zatic T, Anisei A, Chiosa D, Munteanu M, Alexa Z, Farrington J. Implementing a package of noncommunicable disease interventions in the Republic of Moldova: two-year follow-up data. Prim Health Care Res Dev 2020; 21:e39. [PMID: 32993832 PMCID: PMC7576543 DOI: 10.1017/s1463423620000420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/06/2020] [Accepted: 08/29/2020] [Indexed: 11/18/2022] Open
Abstract
Noncommunicable diseases (NCDs) are a growing challenge in the Republic of Moldova. A previously reported pilot cluster randomized controlled trial aimed to determine the feasibility of implementing and evaluating essential interventions for NCDs (e.g. cardiovascular risk scoring, hypertension management, statin treatment, etc.) in primary health care in the Republic of Moldova, with a view toward national scale up. One-year follow-up data (previously published) demonstrated modest improvements in NCD risk factor identification and management could be achieved. Herein, we report the second-year follow-up data and conclude that sustainable improvements in NCD risk factor control (e.g. hypertension control) can be achieved in primary health care in low resource settings by adapting existing resources (e.g. WHO PEN) and conducting focused clinical training and support. If scaled to a national level, these improvements in risk factor control could significantly translate to reductions in premature mortality from NCDs.
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Affiliation(s)
| | - Laura Inglin
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Tiina Laatikainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- National Institute for Health and Welfare, Helsinki, Finland
- Joint municipal authority for North Karelia health and social services (Siun sote), Joensuu, Finland
| | - Angela Ciobanu
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Ghenadie Curocichin
- Family Medicine Department, Nicolae Testemitanu State Medical and Pharmaceutical University, Chisinau, Republic of Moldova
| | - Virginia Salaru
- Family Medicine Department, Nicolae Testemitanu State Medical and Pharmaceutical University, Chisinau, Republic of Moldova
| | - Tatiana Zatic
- Primary, Emergency and Community Health Policies Department, Ministry of Health, Labour and Social Protection, Chisinau, Republic of Moldova
| | - Angela Anisei
- Department on Quality Management of Health Services, National Public Health Agency, Chisinau, Republic of Moldova
| | - Diana Chiosa
- Family Medicine Department, Nicolae Testemitanu State Medical and Pharmaceutical University, Chisinau, Republic of Moldova
| | - Maria Munteanu
- Family Medicine Department, Nicolae Testemitanu State Medical and Pharmaceutical University, Chisinau, Republic of Moldova
| | - Zinaida Alexa
- Endocrinology Department, Nicolae Testemitanu State Medical and Pharmaceutical University, Chisinau, Republic of Moldova
| | - Jill Farrington
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
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Papaioannou A, Ioannidis G, McArthur C, Hillier LM, Feldman S, Giangregorio L, Jaglal S, Jain R, Van der Horst ML, Adachi J. Preventing Fractures in Long-Term Care: Translating Recommendations to Clinical Practice. J Am Med Dir Assoc 2020; 22:36-42. [PMID: 32800745 DOI: 10.1016/j.jamda.2020.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 10/23/2022]
Abstract
The Ontario Osteoporosis Strategy for long-term care (LTC) aims to support fracture risk-reduction. LTC specific recommendations for fracture prevention were developed in 2015. This article describes the use of the Knowledge-to Action framework to guide the development and application of research evidence on fracture prevention in older adults. Knowledge translation activities highlighted fractures as a significant source of morbidity in LTC, significant gaps in fracture risk assessment and treatment, and barriers and facilitators to guideline implementation. Multifaceted knowledge translation strategies, targeting staff in LTC homes in Ontario, Canada to support fracture guideline implementation have included education, audit and feedback, team-based action planning, and engagement of LTC residents, their families, and health professionals. Provincial administrative databases were accessed to monitor fracture rates between 2005 and 2015. Our research has identified enablers and barriers to knowledge use such as limited knowledge of osteoporosis, fracture risk, and prevention. Province-wide over a 10-year period, hip fracture rates in LTC decreased from 2.3% to 1.9%, and any fracture rates decreased from 4% to 3.6%. This body of work suggests that multifaceted knowledge translation initiatives are feasible to implement in LTC and can improve the uptake of clinical recommendations for fracture prevention. A key aspect of our fracture prevention knowledge translation activities has been the full engagement of key stakeholders to assist in the co-development and design of knowledge translation products.
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Affiliation(s)
- Alexandra Papaioannou
- McMaster University, Hamilton, Ontario, Canada; GERAS Center for Aging Research, Hamilton, Ontario, Canada.
| | - George Ioannidis
- McMaster University, Hamilton, Ontario, Canada; GERAS Center for Aging Research, Hamilton, Ontario, Canada
| | - Caitlin McArthur
- McMaster University, Hamilton, Ontario, Canada; GERAS Center for Aging Research, Hamilton, Ontario, Canada
| | | | - Sid Feldman
- GERAS Center for Aging Research, Hamilton, Ontario, Canada; Baycrest Health Sciences, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Lora Giangregorio
- GERAS Center for Aging Research, Hamilton, Ontario, Canada; University of Waterloo, Waterloo, Ontario, Canada; Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
| | - Susan Jaglal
- GERAS Center for Aging Research, Hamilton, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Ravi Jain
- Osteoporosis Canada, Toronto, Ontario, Canada
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Liu J, Mao Y. Continuing medical education and work commitment among rural healthcare workers: a cross-sectional study in 11 western provinces in China. BMJ Open 2020; 10:e037985. [PMID: 32753451 PMCID: PMC7406025 DOI: 10.1136/bmjopen-2020-037985] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 07/03/2020] [Accepted: 07/07/2020] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Continuing medical education (CME) and work commitment are important for rural healthcare workers (RHWs) and rural medical work. The significant association between continuing education and work commitment has been reported in many studies from several different industries. However, very few studies have analysed the association of CME with work commitment among healthcare workers, let alone among RHWs. This study aimed to identify the significance of CME for the work commitment of RHWs (doctors and nurses) in China. DESIGN AND SETTING The cross-sectional study interviewed RHWs from 11 western provinces in China. PARTICIPANTS In total, 4118 RHWs, consisting of 2490 doctors and 1628 nurses who were working clinically, were included in the study. PRIMARY OUTCOME MEASURES Work commitment (ie, the relative importance of work to one's sense of self) focussing on the affective component was the dependent variable, and it included four subdomains: pride, concern, and dedication, extracted by exploratory factor analysis of a 5-point Likert scale, and turnover intent, measured by a dichotomous question. CME (ie, a variety of educational and training activities to maintain, develop or increase knowledge, skills and professional performance and relationships) was the independent variable, including three subdomains: opportunity, participation and expectation, measured by three dichotomous questions. RESULTS Of the 4118 respondents, 91.2% reported insufficient opportunities for CME, 21.3% had never participated in CME and 83.3% had a high expectation of CME. The mean scores of pride in, concern for and dedication to work were 3.54, 3.81 and 3.61 (out of a maximum of 5), respectively, and 30.6% presented turnover intent. After adjusting for gender, age, marriage, education, technical title, income and type of rural healthcare organisation, the multivariate analyses suggested that there was a significant positive association between CME and work commitment among RHWs. RHWs who had a significant high-level work commitment were those who reported a sufficient opportunity for CME (β and 95% CI for pride in, concern for and dedication to work: 0.33, 0.23 to 0.43; 0.19, 0.09 to 0.28; and 0.25, 0.15 to 0.35), had participated in CME (β and 95% CI for pride in, concern for and dedication to work: 0.11, 0.04 to 0.19; 0.09, 0.02 to 0.15; and 0.10, 0.03 to 0.17) and had a high expectation of CME (β and 95% CI for pride in, concern for and dedication to work: 0.22, 0.15 to 0.30; 0.21, 0.13 to 0.28; and 0.28, 0.20 to 0.36), and having sufficient opportunities for CME significantly increased the odds of having no turnover intent (OR and 95% CI: 1.70, 1.26 to 2.28). Age, marriage, education, technical title, income and type of rural healthcare organisation were significantly associated with the work commitment of RHWs. Differences were observed between rural doctors and nurses in the association of CME with work commitment. CONCLUSIONS CME has a significant positive association with the work commitment of RHWs in China. RHWs' work commitment should be further improved in future rural health workforce management. In addition, governments, healthcare organisations and professional associations should establish a professional and complete CME system in China to provide sufficient opportunities for CME for RHWs, encourage them to participate and meet their expectations.
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Affiliation(s)
- Jinlin Liu
- Research Center for the Belt and Road Health Policy and Health Technology Assessment, Xi'an Jiaotong University, Xi'an, China
- Walter H. Shorenstein Asia-Pacific Research Center, Stanford University, Stanford, California, USA
| | - Ying Mao
- Research Center for the Belt and Road Health Policy and Health Technology Assessment, Xi'an Jiaotong University, Xi'an, China
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Baumgartner J, Bradley C, Clark B, Janes C, Johnstone E, Rouse M, Whetstone A. Global Forum on Quality Assurance in CE/CPD: Assuring Quality across Boundaries. PHARMACY 2020; 8:pharmacy8030114. [PMID: 32659955 PMCID: PMC7558479 DOI: 10.3390/pharmacy8030114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/03/2020] [Accepted: 07/07/2020] [Indexed: 11/17/2022] Open
Abstract
As a result of the globalization of access and provision of continuing education and continuing professional development (CE/CPD), the national CE/CPD accreditation organizations of Australia, Canada, Ireland, New Zealand, South Africa, United Kingdom and United States formed the Global Forum on Quality Assurance of Continuing Education and Continuing Professional Development (GFQACE) to investigate and develop means of recognizing CE/CPD across boundaries. Two priorities were identified at their first meeting in 2016: (1) the development of an accreditation framework and (2) the identification of models and approaches to mutual recognition. The GFQACE approved an accreditation framework and facilitated review approach to mutual recognition in 2018 and is currently working on implementation guides. As background to the work of the GFQACE, this article provides a brief history of continuing education (CE) and continuing professional development (CPD) and discusses the value and benefits of CE/CPD to professional development of pharmacy professionals, innovation of pharmacy practice and the provision of quality patient care. Due to the essential role of CE/CPD accreditation in enabling recognition across boundaries, the nature and role of accreditation in defining, assuring and driving quality CE/CPD is described. Four conclusions regarding the broad sharing of perceptions of quality CE/CPD, the potential for expansion of the GFQACE and the benefits to pharmacy professionals, providers and pharmacy practice are discussed.
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Affiliation(s)
- Jennifer Baumgartner
- Continuing Pharmacy Education (CPE) Provider Accreditation, Accreditation Council for Pharmacy Education, Chicago, IL 60603, USA
- Correspondence:
| | - Catriona Bradley
- Irish Institute of Pharmacy, Royal College of Surgeons in Ireland, Dublin D02 FP84, Ireland;
| | - Bronwyn Clark
- Australian Pharmacy Council, Canberra, ACT 2609, Australia;
| | - Colleen Janes
- Canadian Council on Continuing Education in Pharmacy, St. John’s, NL A1B 1W1, Canada; (C.J.); (A.W.)
| | - Elizabeth Johnstone
- Professional Development, College Education and Training, Pharmaceutical Society of New Zealand, Wellington 6142, New Zealand;
| | - Michael Rouse
- International Services Program, Accreditation Council for Pharmacy Education, Chicago, IL 60603, USA;
| | - Arthur Whetstone
- Canadian Council on Continuing Education in Pharmacy, St. John’s, NL A1B 1W1, Canada; (C.J.); (A.W.)
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Valanci-Aroesty S, Alhassan N, Feldman LS, Landry T, Mastropietro V, Fiore J, Lee L, Fried GM, Mueller CL. Implementation and Effectiveness of Coaching for Surgeons in Practice - A Mixed Studies Systematic Review. JOURNAL OF SURGICAL EDUCATION 2020; 77:837-853. [PMID: 32057740 DOI: 10.1016/j.jsurg.2020.01.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 01/02/2020] [Accepted: 01/18/2020] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Despite recent changes to medical education, surgical training remains largely based on the apprenticeship model. However, after completing training, there are few structured learning opportunities available for surgeons in practice to refine their skills or acquire new skills. Personalized observation with feedback is rarely a feature of traditional continuing medical education learning. Coaching has recently been proposed as a modality to meet these educational gaps; however, data are limited, and few coaching programs presently exist. The purpose of this study is to summarize the characteristics of coaching programs for surgeons in practice including participant satisfaction, program outcomes, and barriers to implementation, in the published literature. METHODS A mixed studies systematic review was conducted according to PRISMA guidelines to identify all original studies describing or investigating coaching for practicing surgeons up to 06/2019. Quantitative analysis was used to summarize numerical data, and qualitative analysis using grounded theory methodology for descriptive data was used to summarize the results into themes across studies. RESULTS After identification of articles, 27 were included in the final synthesis. Twenty-six articles described execution of a coaching program. Programs varied widely with 18/26 focusing on teaching new skills, and the remainder on refinement of skills. Thematic analysis identified 2 major data categories that guided deeper analysis: outcomes of and barriers to coaching. Of the 16 (62%) programs that reported outcomes of coaching, 42% to 100% of participants reported changes in clinical practice directly associated with coaching. Positive satisfaction after completion of a program was reported by 82% to 100% of participants. Reported barriers to participating in a coaching program emerged along 3 main themes: logistical constraints, surgical culture, and perceived lack of need. CONCLUSIONS Coaching for surgeons in practice is highly rated by participants and often results in clinical practice changes, while cultural and logistical issues were identified as barriers to implementation. A better understanding of these factors is required to guide coaching program development and implementation.
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Affiliation(s)
- Sofia Valanci-Aroesty
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, Montreal General Hospital, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Noura Alhassan
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, Montreal General Hospital, Department of Surgery, McGill University, Montreal, Quebec, Canada; Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Liane S Feldman
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, Montreal General Hospital, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Tara Landry
- McGill University Health Centre, Montreal General Hospital, Library, Montreal, Quebec, Canada
| | - Victoria Mastropietro
- McGill University Health Centre, Montreal General Hospital, Library, Montreal, Quebec, Canada
| | - Julio Fiore
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, Montreal General Hospital, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Lawrence Lee
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, Montreal General Hospital, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Gerald M Fried
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, Montreal General Hospital, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Carmen L Mueller
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, Montreal General Hospital, Department of Surgery, McGill University, Montreal, Quebec, Canada.
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Casey AN, Islam MM, Schütze H, Parkinson A, Yen L, Shell A, Winbolt M, Brodaty H. GP awareness, practice, knowledge and confidence: evaluation of the first nation-wide dementia-focused continuing medical education program in Australia. BMC FAMILY PRACTICE 2020; 21:104. [PMID: 32522153 PMCID: PMC7285709 DOI: 10.1186/s12875-020-01178-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 05/28/2020] [Indexed: 01/04/2023]
Abstract
Background Dementia is under-diagnosed in primary care. Timely diagnosis and care management improve outcomes for patients and caregivers. This research evaluated the effectiveness of a nationwide Continuing Medical Education (CME) program to enhance dementia-related awareness, practice, knowledge and confidence of general practitioners (GPs) in Australia. Methods Data were collected from self-report surveys by GPs who participated in an accredited CME program face-to-face or online; program evaluations from GPs; and process evaluations from workshop facilitators. CME participants completed surveys at one or more time-points (pre-, post-program, six to 9 months follow-up) between 2015 and 2017. Paired samples t-test was used to determine difference in mean outcome scores (self-reported change in awareness, knowledge, confidence, practice) between time-points. Multivariable regression analyses were used to investigate associations between respondent characteristics and key variables. Qualitative feedback was analysed thematically. Results Of 1352 GPs who completed a survey at one or more time-points (pre: 1303; post: 1017; follow-up: 138), mean scores increased between pre-CME and post-program for awareness (Mpost-pre = 0.9, p < 0.0005), practice-related items (Mpost-pre = 1.3, p < 0.0005), knowledge (Mpost-pre = 2.2, p < 0.0005), confidence (Mpost-pre = 2.1, p < 0.0005). Significant increases were seen in all four outcomes for GPs who completed these surveys at both pre- and follow-up time-points. Male participants and those who had practised for five or more years showed greater change in knowledge and confidence. Age, years in practice, and education delivery method significantly predicted post-program knowledge and confidence. Most respondents who completed additional program evaluations (> 90%) rated the training as relevant to their practice. These participants, and facilitators who completed process evaluations, suggested adding more content addressing patient capacity and legal issues, locality-specific specialist and support services, case studies and videos to illustrate concepts. Conclusions The sustainability of change in key elements relating to health professionals’ dementia awareness, knowledge and confidence indicated that dementia CME programs may contribute to improving capacity to provide timely dementia diagnosis and management in general practice. Low follow-up response rates warrant cautious interpretation of results. Dementia CME should be adopted in other contexts and updated as more research becomes available.
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Affiliation(s)
- Anne-Nicole Casey
- Dementia Centre for Research Collaboration, University of New South Wales (UNSW) Sydney, AGSM Building, Sydney, NSW, 2052, Australia.,Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - M Mofizul Islam
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Heike Schütze
- School of Health and Society, University of Wollongong, Wollongong, NSW, 2522, Australia.,School of Public Health and Community Medicine, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Anne Parkinson
- Department of Health Services Research & Policy, Research School of Population Health, Australian National University, Canberra, NSW, 2601, Australia
| | - Laurann Yen
- Department of Health Services Research & Policy, Research School of Population Health, Australian National University, Canberra, NSW, 2601, Australia
| | - Allan Shell
- Dementia Centre for Research Collaboration, University of New South Wales (UNSW) Sydney, AGSM Building, Sydney, NSW, 2052, Australia
| | - Margaret Winbolt
- Dementia Training Australia, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Henry Brodaty
- Dementia Centre for Research Collaboration, University of New South Wales (UNSW) Sydney, AGSM Building, Sydney, NSW, 2052, Australia. .,Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Sydney, Sydney, NSW, 2052, Australia. .,Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick, NSW, 2031, Australia.
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168
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van Huyssteen M, Bheekie A, Srinivas SC, Essack A. Continuous Professional Development for Public Sector Pharmacists in South Africa: A Case Study of Mapping Competencies in a Pharmacists' Preceptor Programme. PHARMACY 2020; 8:E96. [PMID: 32503119 PMCID: PMC7356960 DOI: 10.3390/pharmacy8020096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/18/2020] [Accepted: 05/20/2020] [Indexed: 11/17/2022] Open
Abstract
Lifelong learning among healthcare practitioners is crucial to keep abreast of advances in therapeutic and service delivery approaches. In South Africa, continuous professional development (CPD) was mandated (2019) for re-registration of pharmacists to illustrate their learning according to the South African Pharmacy Council's (SAPC) competency standards. This paper uses a preceptor programme linked to the University of the Western Cape School of Pharmacy's service learning programme to map the competencies employed by pharmacist preceptors in primary care public healthcare facilities in Cape Town in an attempt to encourage completion of their annual CPDs and strengthening the academic-service partnership. Competencies identified were divided into input competencies related to the preceptor's role in designing and implementing the educational programme in their facilities and assisting students to complete their prescribed learning activities, and output/outcome competencies that emerged from preceptors identifying the facility needs and employing their input competencies. Input competencies pertained to education, leadership, patient counselling, collaborative practice and human resources management. Output competencies related to pharmaceutical infrastructure, quality assurance, professional and health advocacy, primary healthcare, self-management and patient-centred care. The preceptor programme enabled pharmacist preceptors to employ several competencies that are aligned with the SAPC's competency framework.
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Affiliation(s)
- Mea van Huyssteen
- School of Pharmacy, University of the Western Cape, Private bag X17, Bellville, Cape Town 7535, South Africa; (A.B.); (A.E.)
| | - Angeni Bheekie
- School of Pharmacy, University of the Western Cape, Private bag X17, Bellville, Cape Town 7535, South Africa; (A.B.); (A.E.)
| | | | - Azeezah Essack
- School of Pharmacy, University of the Western Cape, Private bag X17, Bellville, Cape Town 7535, South Africa; (A.B.); (A.E.)
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169
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Downes SR, Lykina T. Closing the Gap in Global Neurosurgical Education via Online Conference: A Pre-Covid Survey. Cureus 2020; 12:e8015. [PMID: 32399375 PMCID: PMC7212709 DOI: 10.7759/cureus.8015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Introduction A reliable network for peer review and feedback can lead to an increase in knowledge and improving patient care. As opportunities to participate in online continuing medical education (CME) increase, there is a reduction in the worldwide knowledge gap often due to a lack of resources to attend conferences and advanced training in person. Methods A total of 64 participants completed a 10-item anonymous online questionnaire to assess how their knowledge and applied practical skills improved by participating in online conferences, and whether this education modality adequately addresses challenges for countries with limited access to conferences or training. Results While an overall positive response toward this mode of neurosurgical education was expected, interesting insights were gained from the short-answer section, demonstrating a direct influence on clinical practice through online conference participation. Conclusion While limited in size, the study results support the expectation of a positive attitude toward neurosurgical e-learning, which translates directly to improving patient care and lessening the worldwide gap in neurosurgical education.
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Affiliation(s)
| | - Tatiana Lykina
- Allergy and Immunology, Oceania University of Medicine, Saint Petersburg, RUS
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170
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Gonzalez-Reyes A, Schuster T, Grad R, Pluye P. Will this benefit my patients? Expected benefits of information from a continuing medical education program may lead to higher participation rates by family physicians. EDUCATION FOR INFORMATION 2020. [DOI: 10.3233/efi-200371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Tibor Schuster
- Department of Family Medicine, McGill University, Montréal, QC, Canada
- Canada Research Chair in Biostatistical Methods for Primary Health Care Research, McGill University, Montréal, QC, Canada
| | - Roland Grad
- Department of Family Medicine, McGill University, Montréal, QC, Canada
- Lady Davis Institute, Montréal, QC, Canada
- Herzl Family Practice Centre, Jewish General Hospital, Montréal, QC, Canada
| | - Pierre Pluye
- Department of Family Medicine, McGill University, Montréal, QC, Canada
- FRQS Senior Research Scholar, QC, Canada
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171
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Daley MF, Arnold Rehring SM, Glenn KA, Reifler LM, Steiner JF. Improving Antibiotic Prescribing for Pediatric Urinary Tract Infections in Outpatient Settings. Pediatrics 2020; 145:peds.2019-2503. [PMID: 32127361 DOI: 10.1542/peds.2019-2503] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/11/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To determine if a multicomponent intervention was associated with increased use of first-line antibiotics (cephalexin or sulfamethoxazole and trimethoprim) among children with uncomplicated urinary tract infections (UTIs) in outpatient settings. METHODS The study was conducted at Kaiser Permanente Colorado, a large health care organization with ∼127 000 members <18 years of age. After conducting a gap analysis, an intervention was developed to target key drivers of antibiotic prescribing for pediatric UTIs. Intervention activities included development of new local clinical guidelines, a live case-based educational session, pre- and postsession e-mailed knowledge assessments, and a new UTI-specific order set within the electronic health record. Most activities were implemented on April 26, 2017. The study design was an interrupted time series comparing antibiotic prescribing for UTIs before versus after the implementation date. Infants <60 days old and children with complex urologic or neurologic conditions were excluded. RESULTS During January 2014 to September 2018, 2142 incident outpatient UTIs were identified (1636 preintervention and 506 postintervention). Pyelonephritis was diagnosed for 7.6% of cases. Adjusted for clustering of UTIs within clinicians, the proportion of UTIs treated with first-line antibiotics increased from 43.4% preintervention to 62.4% postintervention (P < .0001). The use of cephalexin (first-line, narrow spectrum) increased from 28.9% preintervention to 53.0% postintervention (P < .0001). The use of cefixime (second-line, broad spectrum) decreased from 17.3% preintervention to 2.6% postintervention (P < .0001). Changes in prescribing practices persisted through the end of the study period. CONCLUSIONS A multicomponent intervention with educational and process-improvement elements was associated with a sustained change in antibiotic prescribing for uncomplicated pediatric UTIs.
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Affiliation(s)
- Matthew F Daley
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado; .,Departments of Pediatrics and
| | - Sharisse M Arnold Rehring
- Departments of Pediatrics and.,Department of Medical Education, Colorado Permanente Medical Group, Denver, Colorado
| | - Karen A Glenn
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado
| | - Liza M Reifler
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado
| | - John F Steiner
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado.,Department of Medical Education, Colorado Permanente Medical Group, Denver, Colorado.,Medicine, School of Medicine, University of Colorado, Aurora, Colorado; and
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172
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Karas M, Sheen NJL, North RV, Ryan B, Bullock A. Continuing professional development requirements for UK health professionals: a scoping review. BMJ Open 2020; 10:e032781. [PMID: 32161156 PMCID: PMC7066625 DOI: 10.1136/bmjopen-2019-032781] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 01/27/2020] [Accepted: 01/30/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES This paper sets out to establish the numbers and titles of regulated healthcare professionals in the UK and uses a review of how continuing professional development (CPD) for health professionals is described internationally to characterise the postqualification training required of UK professions by their regulators. It compares these standards across the professions and considers them against the best practice evidence and current definitions of CPD. DESIGN A scoping review. SEARCH STRATEGY We conducted a search of UK health and social care regulators' websites to establish a list of regulated professional titles, obtain numbers of registrants and identify documents detailing CPD policy. We searched Applied Social Sciences Index and Abstracs (ASSIA), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, EMCare and Scopus Life Sciences, Health Sciences, Physical Sciences and Social Sciences & Humanities databases to identify a list of common features used to describe CPD systems internationally and these were used to organise the review of CPD requirements for each profession. RESULTS CPD is now mandatory for the approximately 1.5 million individuals registered to work under 32 regulated titles in the UK. Eight of the nine regulators do not mandate modes of CPD and there is little requirement to conduct interprofessional CPD. Overall 81% of those registered are required to engage in some form of reflection on their learning but only 35% are required to use a personal development plan while 26% have no requirement to engage in peer-to-peer learning. CONCLUSIONS Our review highlights the wide variation in the required characteristics of CPD being undertaken by UK health professionals and raises the possibility that CPD schemes are not fully incorporating the best practice.
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Affiliation(s)
- Marek Karas
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, South Glamorgan, UK
| | - Nik J L Sheen
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, South Glamorgan, UK
| | - Rachel V North
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, South Glamorgan, UK
| | - Barbara Ryan
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, South Glamorgan, UK
| | - Alison Bullock
- School of Social Sciences, Cardiff University, Cardiff, UK
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Jolly J, Bowie P, Dawson L, Heslington L, Dinwoodie M. Evaluation of a simulation-based Risk Management and Communication Masterclass to reduce the risk of complaints, medicolegal and dentolegal claims. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2020; 6:69-75. [PMID: 35516079 PMCID: PMC8936816 DOI: 10.1136/bmjstel-2018-000392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 12/15/2018] [Indexed: 11/16/2022]
Abstract
Objectives To understand clinicians' experiences, learning and professional impacts following participation in a Risk Management and Communication Masterclass (RMCM) designed and delivered by Medical Protection Society. To identify the course's strengths and areas for enhancement. Design Mixed method study including semistructured telephone interviews. Interviews were conducted between October and December 2017, 6-30 months after course participation. Data were subjected to a thematic analysis. Quantitative analysis of participants' feedback ratings (n=486) on RMCMs delivered between December 2014 and May 2017 was also undertaken. Setting RMCMs were delivered to Doctors and Dentists based in the UK and Ireland and South Africa. Participants: A sample of 12 volunteer doctors (Obstetricians/Gynaecologists, Orthopaedic/Spinal Surgeons, General Surgeons, Paediatricians, General Practitioners) and dentists chosen to represent different clinical specialities accepted the invitation to participate. Results Study participants reported examples of person-centred communication skills such as empathy, shared-decision making and managing patient expectations in their workplaces following participation in the RMCM. Many clinicians gave examples describing how they used the communication models they learned when back at work. They also demonstrated a better understanding of the motivations for patients to complain or claim. RMCM course participants' high feedback ratings provided further evidence that the course was valuable and met learning objectives. Conclusions It may prove difficult to demonstrate quantitatively that liability improves as a direct result of risk management and communications training. Our results on other dimensions (reactions, learning, behaviour change and impact) suggest that the RMCM has a positive and durable effect based on participant feedback.
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Affiliation(s)
- John Jolly
- Educational Services, Medical Protection Society Leeds, Leeds, UK
| | - Paul Bowie
- Instituteof Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Lauren Dawson
- Insight Development, Medical Protection Society Leeds, Leeds, UK
| | | | - Mark Dinwoodie
- Insight Development, Medical Protection Society Leeds, Leeds, UK
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Capoocia A. Value of the Continuing Certification Modules and Challenging the Status Quo. J Osteopath Med 2020; 120:128-132. [DOI: 10.7556/jaoa.2020.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Ring M, Majd I, Mehta DH. Keeping Integrative Medicine Continuing Medical Education on the Cutting Edge—and Compliant. J Altern Complement Med 2020; 26:166-171. [DOI: 10.1089/acm.2020.0037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Melinda Ring
- Osher Center for Integrative Medicine at Northwestern University, Chicago, IL
| | - Iman Majd
- Osher Clinic for Integrative Medicine, University of Washington, Seattle, WA
| | - Darshan H. Mehta
- Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA
- Benson-Henry Institute for Mind-Body Medicine at Massachusetts General Hospital, Boston, MA
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176
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Dowling S, Last J, Finnegan H, Bourke J, Daly P, Hanrahan C, Harrold P, McCoombe G, Cullen W. How does small group continuing medical education (CME) impact on practice for rural GPs and their patients, a mixed-methods study. EDUCATION FOR PRIMARY CARE 2020; 31:153-161. [PMID: 32089106 DOI: 10.1080/14739879.2020.1728704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Studies which report outcomes of continuing medical education (CME) interventions for rural general practitioners (GPs) are limited. This mixed methods study recruited GPs from four CME small group learning (SGL) tutor groups based in different rural locations in the Republic of Ireland. A two-hour teaching module on deprescribing in older patients was devised and implemented. Assessment of educational outcomes was via questionnaires, prescribing audits and qualitative focus groups. All GPs (n = 43) in these CME-SGL groups agreed to participate, 27 of whom (63%) self-identified as being in rural practice. Rural GPs were more likely to be male (56%), in practice for longer (19 years), and attending CME for longer (13 years). The questionnaires indicated learning outcomes were achieved knowledge increased immediately after the education, and was maintained 6 months later. Twenty-four GPs completed audits involving 191 patients. Of these, 152 (79.6%) were de-prescribed medication. In the qualitative focus groups, GPs reported sharing experiences with their peers during CME-SGL helped them to improve patient care and ensured that clinical practice is more consistent across the group. For rural GPs, CME-SGL involving discussion of cases and the practical implementation of guidelines, associated with audit, can lead to changes in patient care.
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Affiliation(s)
- Stephanie Dowling
- University College Dublin School of Medicine, Health Sciences Centre, UCD , Dublin City, Ireland
| | - J Last
- University College Dublin School of Medicine, Health Sciences Centre, UCD , Dublin City, Ireland
| | - H Finnegan
- Irish College of General Practice, Dublin, Ireland
| | - John Bourke
- Irish College of General Practice, Dublin, Ireland
| | - Pat Daly
- Irish College of General Practice, Dublin, Ireland
| | | | - Pat Harrold
- Irish College of General Practice, Dublin, Ireland
| | - Geoff McCoombe
- University College Dublin School of Medicine, Health Sciences Centre, UCD , Dublin City, Ireland
| | - W Cullen
- University College Dublin School of Medicine, Health Sciences Centre, UCD , Dublin City, Ireland
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Mitin T, Degnin C, Chen Y, Shirvani S, Gillespie E, Hoffe S, Latifi K, Nabavizadeh N, Dengina N, Chernich M, Usychkin S, Kharitonova E, Egorova Y, Pankratov A, Tsimafeyeu I, Thomas CR, Tjulandin S, Likhacheva A. Radiotherapy for Hepatocellular Carcinoma in Russia: a Survey-Based Analysis of Current Practice and the Impact of an Educational Workshop on Clinical Expertise. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:105-111. [PMID: 30467774 DOI: 10.1007/s13187-018-1447-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Radiation therapy (RT) is an effective treatment modality for hepatocellular carcinoma (HCC), but globally, it is underutilized. In Russia, practice patterns with regard to liver-directed radiation are unknown. Under the auspices of Russian Society of Clinical Oncology (RUSSCO), our team conducted an IRB-approved contouring workshop for Russian radiation oncologists. Pre- and post-workshop surveys were analyzed to determine baseline clinical experience and patterns of care for liver-directed RT among Russian providers. The effect of the contouring workshop on participants' knowledge was tested using mixed effects model. Forty pre-workshop and 24 post-workshop questionnaires were analyzable with a 100% response rate. Sixty percent of respondents had never evaluated a patient with HCC and only 8% (3 out of 40) reported treating an HCC patient with liver-directed RT. Nonetheless, 73% of respondents were comfortable offering liver-directed RT prior to the workshop. After the workshop, 85% of respondents felt comfortable treating a patient with HCC with liver-directed RT and 50% were comfortable recommending stereotactic body radiation therapy (SBRT). Measures of knowledge pertaining to evaluation of HCC patients and selection for appropriate liver-directed therapies were dramatically improved after the workshop. Liver-directed RT is not commonly used in Russia in the management of patients with HCC, and few centers are equipped for motion management. Our contouring workshop resulted in dramatically improved understanding of the evaluation and management of HCC patients. We recommend starting with a more protracted fractionated RT and building experience through attendance of additional educational activities, participation in multidisciplinary liver tumor boards, and prospective analysis of treatment toxicity and outcomes.
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Affiliation(s)
- Timur Mitin
- Department of Radiation Medicine, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
- International Design and Implementation Group for Radiation Oncology workshops (INDIGO), Moscow, Russia
| | - Catherine Degnin
- Biostatistics Shared Resources, OHSU Knight Cancer Institute, Portland, OR, USA
| | - Yiyi Chen
- Biostatistics Shared Resources, OHSU Knight Cancer Institute, Portland, OR, USA
| | - Shervin Shirvani
- Department of Radiation Oncology, Banner MD Anderson Cancer Center, 2946 E Banner Gateway Dr, Gilbert, AZ, 85234, USA
| | - Erin Gillespie
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sarah Hoffe
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Kujtim Latifi
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Nima Nabavizadeh
- Department of Radiation Medicine, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
| | - Natalia Dengina
- International Design and Implementation Group for Radiation Oncology workshops (INDIGO), Moscow, Russia
- Department of Radiotherapy, Ulyanovsk Regional Cancer Center, Ulyanovsk Oblast, Russia
| | - Marina Chernich
- International Design and Implementation Group for Radiation Oncology workshops (INDIGO), Moscow, Russia
- N.N. Blokhin Russian Cancer Center, Moscow, Russia
| | - Sergey Usychkin
- International Design and Implementation Group for Radiation Oncology workshops (INDIGO), Moscow, Russia
- Medscan Clinic, Moscow, Russia
| | | | - Yulia Egorova
- Russian Society of Clinical Oncology (RUSSCO), Moscow, Russia
| | - Alexandr Pankratov
- International Design and Implementation Group for Radiation Oncology workshops (INDIGO), Moscow, Russia
- PET-Technology Center, Balashikha, Russia
| | - Ilya Tsimafeyeu
- Russian Society of Clinical Oncology (RUSSCO), Moscow, Russia
- PET-Technology Center, Balashikha, Russia
- Kidney Cancer Research Bureau, Moscow, Russia
| | - Charles R Thomas
- Department of Radiation Medicine, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
| | | | - Anna Likhacheva
- International Design and Implementation Group for Radiation Oncology workshops (INDIGO), Moscow, Russia.
- Department of Radiation Oncology, Banner MD Anderson Cancer Center, 2946 E Banner Gateway Dr, Gilbert, AZ, 85234, USA.
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Kadhum M, Sinclair P, Lavy C. Are Primary Trauma Care (PTC) courses beneficial in low- and middle-income countries - A systematic review. Injury 2020; 51:136-141. [PMID: 31679834 DOI: 10.1016/j.injury.2019.10.084] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/23/2019] [Accepted: 10/24/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Injuries remain an important public health concern, resulting in considerable annual morbidity and mortality. In low- and middle-income countries (LMICs), the lack of appropriate infrastructure, equipment and skilled personnel compound the burden of injury, leading to higher mortality rates. As Advanced Trauma Life Support (ATLS) courses remain uneconomical and inappropriate in LMICs, the Primary Trauma Care (PTC) course was introduced to provide an alternative that is both sustainable and appropriate to local resources. METHODS A systematic review was performed in May 2019, utilising MEDLINE, EMBASE, Cochrane Library and Google Scholar. All studies reporting patient related outcomes (mortality and morbidity rates) and course participant related outcomes (knowledge, confidence and skills) in LMICs were included. PRISMA guidelines were adhered to throughout. RESULTS Nine observational studies were identified (Level 3 evidence). Six studies reported improved knowledge in injury management post-PTC course (p < 0.05). Two studies reported improvements in confidence (p < 0.05) and one on skill attainment (p < 0.0001). One study reported a reduction in mortality rates post-PTC course (p < 0.01). CONCLUSION Departmental, institutional and personal improvements may occur in clinical practice as a result of formal PTC training of trauma team members in LMICs. Further high-quality research is needed to evaluate this course's effects on observed change in clinical practice and patient outcomes. This may require long-term observational and epidemiological studies to assess improvements in morbidity and mortality. PROSPERO Registration Number: CRD42019133986.
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Affiliation(s)
- Murtaza Kadhum
- Oxford University Clinical Academic Graduate School, Oxford University; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University.
| | - Pierre Sinclair
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University.
| | - Chris Lavy
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University.
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Kapoor A, Amroze A, Vakil F, Crawford S, Der J, Mathew J, Alper E, Yogaratnam D, Javed S, Elhag R, Lin A, Narayanan S, Bartlett D, Nagy A, Shagoury BK, Fischer MA, Mazor KM, Saczynski JS, Ashburner JM, Lopes R, McManus DD. SUPPORT-AF II: Supporting Use of Anticoagulants Through Provider Profiling of Oral Anticoagulant Therapy for Atrial Fibrillation. Circ Cardiovasc Qual Outcomes 2020; 13:e005871. [DOI: 10.1161/circoutcomes.119.005871] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Previous provider-directed electronic messaging interventions have not by themselves improved anticoagulation use in patients with atrial fibrillation. Direct engagement with providers using academic detailing coupled with electronic messaging may overcome the limitations of the prior interventions.
Methods and Results:
We randomized outpatient providers affiliated with our health system in a 2.5:1 ratio to our electronic profiling/messaging combined with academic detailing intervention. In the intervention, we emailed providers monthly reports of their anticoagulation percentage relative to peers for atrial fibrillation patients with elevated stroke risk (CHA
2
DS
2
-VASc ≥2). We also sent electronic medical record-based messages shortly before an appointment with an anticoagulation-eligible but untreated atrial fibrillation patient. Providers had the option to send responses with explanations for prescribing decisions. We also offered to meet with intervention providers using an academic detailing approach developed based on knowledge gaps discussed in provider focus groups. To assess feasibility, we tracked provider review of our messages. To assess effectiveness, we measured the change in anticoagulation for patients of intervention providers relative to controls. We identified 85 intervention and 34 control providers taking care of 3591 and 1908 patients, respectively; 33 intervention providers participated in academic detailing. More than 80% of intervention providers read our emails, and 98% of the time a provider reviewed our in-basket messages. Replies to messages identified patient refusal as the most common reason for patients not being on anticoagulation (11.2%). For the group of patients not on anticoagulation at baseline assigned to an intervention versus control provider, the adjusted percent increase in the use of anticoagulation over 6 months was 5.2% versus 7.4%, respectively (
P
=0.21).
Conclusions:
Our electronic messaging and academic detailing intervention was feasible but did not increase anticoagulation use. Patient-directed interventions or provider interventions targeting patients declining anticoagulation may be necessary to raise the rate of anticoagulation.
Clinical Trial Registration
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT03583008.
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Affiliation(s)
- Alok Kapoor
- University of Massachusetts Memorial Health Care, Worcester (A.K., A.A, E.A., R.E., D.D.M.)
- University of Massachusetts Medical School, Worcester (A.K., S.C., J.M., E.A., S.J., R.E., A.L., S.N., A.N., K.M.M., J.S.S., D.D.M.)
- Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester (A.K., A.A., K.M.M., D.D.M.)
| | - Azraa Amroze
- University of Massachusetts Memorial Health Care, Worcester (A.K., A.A, E.A., R.E., D.D.M.)
- Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester (A.K., A.A., K.M.M., D.D.M.)
| | - Fatima Vakil
- Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH (F.V.)
| | - Sybil Crawford
- University of Massachusetts Medical School, Worcester (A.K., S.C., J.M., E.A., S.J., R.E., A.L., S.N., A.N., K.M.M., J.S.S., D.D.M.)
| | | | - Jomol Mathew
- University of Massachusetts Medical School, Worcester (A.K., S.C., J.M., E.A., S.J., R.E., A.L., S.N., A.N., K.M.M., J.S.S., D.D.M.)
| | - Eric Alper
- University of Massachusetts Memorial Health Care, Worcester (A.K., A.A, E.A., R.E., D.D.M.)
- University of Massachusetts Medical School, Worcester (A.K., S.C., J.M., E.A., S.J., R.E., A.L., S.N., A.N., K.M.M., J.S.S., D.D.M.)
| | - Dinesh Yogaratnam
- Mass College of Pharmacy and Health Sciences, Worcester, MA (D.Y., D.B.)
| | - Saud Javed
- University of Massachusetts Medical School, Worcester (A.K., S.C., J.M., E.A., S.J., R.E., A.L., S.N., A.N., K.M.M., J.S.S., D.D.M.)
| | - Rasha Elhag
- University of Massachusetts Memorial Health Care, Worcester (A.K., A.A, E.A., R.E., D.D.M.)
- University of Massachusetts Medical School, Worcester (A.K., S.C., J.M., E.A., S.J., R.E., A.L., S.N., A.N., K.M.M., J.S.S., D.D.M.)
| | - Abraham Lin
- University of Massachusetts Medical School, Worcester (A.K., S.C., J.M., E.A., S.J., R.E., A.L., S.N., A.N., K.M.M., J.S.S., D.D.M.)
| | - Siddhartha Narayanan
- University of Massachusetts Medical School, Worcester (A.K., S.C., J.M., E.A., S.J., R.E., A.L., S.N., A.N., K.M.M., J.S.S., D.D.M.)
| | - Donna Bartlett
- Mass College of Pharmacy and Health Sciences, Worcester, MA (D.Y., D.B.)
| | - Ahmed Nagy
- University of Massachusetts Medical School, Worcester (A.K., S.C., J.M., E.A., S.J., R.E., A.L., S.N., A.N., K.M.M., J.S.S., D.D.M.)
| | - Bevin Kathleen Shagoury
- The National Resource Center for Academic Detailing, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Boston, MA (B.K.S., M.A.F.)
| | - Michael A. Fischer
- The National Resource Center for Academic Detailing, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Boston, MA (B.K.S., M.A.F.)
| | - Kathleen M. Mazor
- University of Massachusetts Medical School, Worcester (A.K., S.C., J.M., E.A., S.J., R.E., A.L., S.N., A.N., K.M.M., J.S.S., D.D.M.)
- Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester (A.K., A.A., K.M.M., D.D.M.)
| | - Jane S. Saczynski
- University of Massachusetts Medical School, Worcester (A.K., S.C., J.M., E.A., S.J., R.E., A.L., S.N., A.N., K.M.M., J.S.S., D.D.M.)
- Northeastern University, Boston, MA (J.D., J.S.S.)
| | - Jeffrey M. Ashburner
- Division of General Internal Medicine, Massachusetts General Hospital, Boston (J.M.A.)
| | - Renato Lopes
- Duke Clinical Research Institute, Durham, NC (R.L.)
| | - David D. McManus
- University of Massachusetts Memorial Health Care, Worcester (A.K., A.A, E.A., R.E., D.D.M.)
- University of Massachusetts Medical School, Worcester (A.K., S.C., J.M., E.A., S.J., R.E., A.L., S.N., A.N., K.M.M., J.S.S., D.D.M.)
- Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester (A.K., A.A., K.M.M., D.D.M.)
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Luconi F, Rochette A, Grad R, Hallé MC, Chin D, Habib B, Thomas A. A multifaceted continuing professional development intervention to move stroke rehabilitation guidelines into professional practice: A feasibility study. Top Stroke Rehabil 2020; 27:401-441. [PMID: 31960782 DOI: 10.1080/10749357.2019.1711339] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Rehabilitation post-stroke is critical for maximizing patient outcomes. This study assessed the feasibility of implementing and evaluating a continuing professional development (CPD) intervention aimed at increasing the uptake of stroke best practice guidelines among physiotherapists (PTs), occupational therapists (OTs) and speech-language pathologists (SLPs) in six university-affiliated stroke rehabilitation centers in Quebec, Canada. METHOD Twelve stroke best practice recommendations with reflective tools were sent weekly by e-mail. Participants' eligibility criteria included: a) profession; b) practicing more than 1 year in a stroke rehabilitation program; c) fluency in French or English; and d) basic computer literacy. Feasibility (operationalized via participation, satisfaction and relevance), cognitive impact, perceived application in practice and expected patient outcomes were measured over 24 weeks using three questionnaires and analyzed using descriptive statistics. RESULTS The sample totaled 62 of 133 eligible (47%) clinicians. Satisfaction, relevance and cognitive impact of delivered information varied across disciplines and recommendations. Agreement with the recommendations was high across disciplines. On average, three-interdisciplinary recommendations (related to post-stoke depression, post-stoke fatigue and patients' and caregivers' learning needs) were rated as the most relevant for at least one patient. The majority of clinicians would use the recommendations for a specific patient and expected health benefits by applying those recommendations. CONCLUSION This study demonstrated the feasibility of assessing the impact of a CPD intervention in stroke rehabilitation uptake and informed the design of a research program aimed at increasing the use of stroke evidence-based rehabilitation interventions.
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Affiliation(s)
- Francesca Luconi
- Continuing Professional Development (CPD), McGill University , Montreal, Quebec, Canada
| | - Annie Rochette
- CRIR - IUDPM, École de réadaptation, Université de Montréal , Montréal, Québec, Canada
| | - Roland Grad
- Department of Family Medicine, McGill University , Montréal, Québec, Canada
| | - Marie-Christine Hallé
- School of Physical and Occupational Therapy, McGill University , Montréal, Québec, Canada
| | - Diana Chin
- Chef d'administration de programme en réadaptation, CIUSSS Centre-Ouest-de-l'île-de-Montréal , Montréal, Québec, Canada
| | - Bettina Habib
- Continuing Professional Development, McGill University , Montréal, Québec, Canada
| | - Aliki Thomas
- School of Physical and Occupational Therapy, Centre for Medical Education, McGill University , Montréal, Québec, Canada
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Developing delirium best practice: a systematic review of education interventions for healthcare professionals working in inpatient settings. Eur Geriatr Med 2020; 11:1-32. [DOI: 10.1007/s41999-019-00278-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 12/03/2019] [Indexed: 10/25/2022]
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182
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Bird GC, Kozakowski SM, Mullins A, Campbell E. Impact of Educational Format on Learner Commitment to Change and Satisfaction. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2020; 40:207-210. [PMID: 32898121 DOI: 10.1097/ceh.0000000000000301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION The value proposition of CME lies in its ability to elicit change in learners so new knowledge and skills are used to improve patient outcomes. In this study, we test the hypothesis that, in contrast to passive learning, education with an active engagement component has a greater impact on the motivation of learners to make changes in their practice. METHODS We analyzed nine educational formats produced by the American Academy of Family Physicians. CME program between 2015 and 2017. Postactivity learner evaluations were used to measure both satisfaction and "commitment to change"-the percentage of learners who committed in making a change in their practice as a result of their participation. RESULTS We found education that was interactive and leveraged elements of social learning theory produced the greatest commitment to change the score. Lower scores were obtained for more passive education formats. By contrast, satisfaction scores were not significantly different between formats. DISCUSSION Our data demonstrate differences between commitment to change and educational format that could inform how format types might be better used to promote a behavior change. We also demonstrate that learner satisfaction has little or no value as a measure of educational efficacy.
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Affiliation(s)
- Gary C Bird
- Dr. Bird: Education Research and Analytics Strategist, American Academy of Family Physicians. Dr. Kozakowski: Former Medical Education Division Director, American Academy of Family Physicians; Dr. Mullins: Medical Director, Quality and Science, American Academy of Family Physicians; and Ms. Campbell: Senior Manager, Online Education, American Academy of Family Physicians
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Musick D, Arulraja E, Whicker S, Shaver K, Wells L, Dallas AP. Assessment of a continuing medical education intervention designed to change physician practice regarding blood transfusion. GLOBAL JOURNAL OF TRANSFUSION MEDICINE 2020. [DOI: 10.4103/gjtm.gjtm_6_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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184
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D'Aloja P, Maraschini A, Lega I, Andreozzi S, Sampaolo L, Valetto MR, Dri P, Donati S. Acceptance of e-Learning Programs for Maternity Health Care Professionals Implemented by the Italian Obstetric Surveillance System. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2020; 40:289-292. [PMID: 33284182 DOI: 10.1097/ceh.0000000000000304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Distance learning efficacy on physician performances and patient health outcomes has been demonstrated. This study explored the participation and evaluation of CME e-learning courses for Italian health care professionals addressing leading causes of maternal mortality identified by the Italian Obstetric Surveillance System (ItOSS) at the Italian National Health Institute, namely postpartum hemorrhage and pregnancy hypertensive disorders. METHODS A model for two online free 12-hour case-based training courses was used. Data on participants were collected, anonymized, and transferred to the Italian National Health Institute for later analysis. Participants were requested to sign an online informed consent form. RESULTS Twenty-one thousand five hundred thirty-two health care professionals enrolled to the courses from 2014 to 2017 as follows: midwives (14,187, 65.9%); obstetricians (3,716, 17.2%); anesthesiologists (1,896, 8.8%); and other medical specialists (1,733, 8.0%). Overall, 85% of participants acquired CME credits. Participants' satisfaction on quality, efficacy, and relevance was very high. DISCUSSION ItOSS courses were able to reach a substantial number of different professional profiles involved in perinatal care all over the country; ItOSS courses can be considered an effective way to spread evidence-based good clinical practices. Nevertheless, further studies are needed to verify the improvement in professional health care skills and patient outcomes.
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Affiliation(s)
- Paola D'Aloja
- Dr. D'Aloja: Senior Researcher,National Centre for Diseases Prevention and Health Promotion, Italian National Health Institute, Rome, Italy; Dr. Maraschini: Senior Researcher, National Centre for Diseases Prevention and Health Promotion, Italian National Health Institute, Rome, Italy; Dr. Lega: Senior Researcher, National Centre for Diseases Prevention and Health Promotion, Italian National Health Institute, Rome, Italy; Ms. Andreozzi: Grafic Designer, National Centre for Diseases Prevention and Health Promotion, Italian National Health Institute, Rome, Italy; Ms. Sampaolo: Information Specialist, National Centre for Diseases Prevention and Health Promotion, Italian National Health Institute, Rome, Italy; Dr. Valetto: Science Journalist, Zadig, Scientific Publisher, Milan, Italy;Dr. Dri: Chief Director, Zadig, Scientific Publisher, Milan, Italy: Dr. Donati: Head of Department, National Centre for Diseases Prevention and Health Promotion, Italian National Health Institute, Rome, Italy
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Lee L, Hillier LM, Weston WW. "Booster Days": An educational initiative to develop a community of practice of primary care collaborative memory clinics. GERONTOLOGY & GERIATRICS EDUCATION 2020; 41:4-19. [PMID: 28873041 DOI: 10.1080/02701960.2017.1373350] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This study explores the value of a Booster Day education initiative for clinicians working in interprofessional Primary Care Collaborative Memory Clinics (PCCMC) to share updates in dementia care, challenging cases, key lessons learned, and best practices, as a mechanism to foster learning and support the PCCMC Community of Practice (CoP). Between 2010 and 2016, 17 annual Booster Days were delivered to health professionals who completed the PCCMC training program. All participants were invited to complete an evaluation survey in which they identified the ways in which the sessions have been helpful; 89% (1361/1530) completed surveys. The Booster Days were valued as opportunities for networking to learn from other clinicians, fostering a sense of community, learning new information, learning to support practice improvements, and team building. An annual Booster Day that incorporates active participant engagement, information sharing, and networking may effectively support CoPs, learning, team building, and practice change within interprofessional teams.
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Affiliation(s)
- Linda Lee
- Centre for Family Medicine Family Health Team, Kitchener, Ontario, Canada
- Schlegel-UW Research Institute for Aging Waterloo, Ontario, Canada
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Loretta M Hillier
- Geriatric Education and Research in Aging Sciences Centre, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - W Wayne Weston
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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186
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Konnyu KJ, McCleary N, Presseau J, Ivers NM, Grimshaw JM. Behavior Change Techniques in Continuing Professional Development. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2020; 40:268-273. [PMID: 33284178 DOI: 10.1097/ceh.0000000000000319] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Continuing professional development (CPD) is a widely used and evolving set of complex interventions that seeks to update and improve the knowledge, skills, and performance of health care professionals to ultimately improve patient care and outcomes. While synthesized evidence shows CPD in general to be effective, effects vary, in part due to variation in CPD interventions and limited understanding of CPD mechanisms of action. We introduce two behavioral science tools-the Behavior Change Technique Taxonomy version 1 and the Theoretical Domains Framework-that can be used to characterize the content of CPD interventions and the determinants of behaviour potentially targeted by the interventions, respectively. We provide a worked example of the use of these tools in coding the educational content of 43 diabetes quality improvement trials containing clinician education as part of their multicomponent intervention. Fourteen (of a possible 93; 15%) behavior change techniques were identified in the clinician education content of the quality improvement trials, suggesting a focus of addressing the behavioral determinants beliefs about consequences, knowledge, skills, and social influences, of diabetes care providers' behavior. We believe that the Behavior Change Technique Taxonomy version 1 and Theoretical Domains Framework offer a novel lens to analyze the CPD content of existing evidence and inform the design and evaluation of future CPD interventions.
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Affiliation(s)
- Kristin J Konnyu
- Dr. Konnyu: Assistant Professor, Center for Evidence Synthesis in Health, School of Public Health, Brown University, Providence, RI, and Department of Health Services, Policy & Practice, School of Public Health, Brown University, Providence, RI. Dr. McCleary: Postdoctoral Fellow, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada, and Postdoctoral Fellow, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada. Dr. Presseau: Scientist, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada, Associate Professor, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada, and School of Psychology, University of Ottawa, Ottawa, Ontario, Canada. Dr. Ivers: Family Physician, Family Practice Health Centre, Women's College Research Institute, and Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada, and Associate Professor, Department of Family and Community Medicine, and Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. Dr. Grimshaw: Senior Scientist, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada, Full Professor, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada, and Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Chekijian SA, Simonyan H, Yaghjyan G. A post-Soviet Republic in Transition: A Novel Amplification Programme to Address the Crisis of Continuing Medical Education and Challenges Facing Regional Physicians in the Republic of Armenia. J Eur CME 2020; 9:1815370. [PMID: 33354407 PMCID: PMC7738310 DOI: 10.1080/21614083.2020.1815370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background After the fall of the Soviet Union in 1991, the existing process of Continuing Medical Education (CME) was decimated. The Fund for Armenian Relief (FAR) was able to leverage competitive educational fellowship programmes in existence, and harness new knowledge gained by returning fellows thus amplifying the impact on education and patient care in the regions of the republic of Armenia. Aims This manuscript describes a replicable novel amplification programme using a “train the trainer” model for CME in the republic of Armenia. We sought to identify challenges specific to physicians from the regions, and to examine the strengths of the CME programme that can serve as a model for programme development and improvement in countries facing similar challenges. Methods The manuscript details a descriptive and mixed method study that includes in-depth interviews and focus group discussions from 2015–2016. Conceptual content analysis was used to identify major themes from the transcripts. Results Challenges facing regional physicians in post-Soviet counties in transition, exemplified by Armenia, are profound. Exploration of themes related to perceived barriers to care in the regions included, physicians’ personal financial constraints, lack of up-to-date knowledge and equipment, lack of confidence, fear of criticism and of making incorrect diagnoses. Conclusions The FAR/CME programme presents an innovative way to amplify the knowledge of Armenian physicians upon their return from educational programme participation abroad in order to address challenges facing regional physicians.
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Affiliation(s)
| | | | - Gevorg Yaghjyan
- International Center for Professional Development, Yerevan, Armenia
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Hoque L, Amroze A, Gilvaz V, Abraham S, Lal A, Mishra A, Crawford S, Mazor K, McManus DD, Kapoor A. Assessing Anticoagulation Management and Shared Decision-Making Documentation From Providers Participating in the SUPPORT-AF II Study. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2020; 40:76-80. [PMID: 32404775 DOI: 10.1097/ceh.0000000000000293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND A previously tested intervention featured educational outreach with modified academic detailing (AD) to increase anticoagulation use in patients with atrial fibrillation. Currently, this study compares providers receiving and not receiving AD in terms of inclusion of AD educational topics and shared decision-making elements in documentation. METHODS Physicians reviewed themes discussed with providers during AD and evaluated charts for evidence of shared decision-making. Frequencies of documentation of individual items for providers receiving AD versus non-AD providers were compared. To understand baseline documentation practices of AD providers, encounters of AD providers before their AD participation were randomly selected. RESULTS There were 113 eligible encounters in the four months after AD-36 from AD providers and 77 from non-AD providers. Thirty-five encounters were identified from AD providers before participating in the intervention. Providers infrequently documented many reviewed items (% documenting): anticoagulation mentioned (44%), multiple options for anticoagulation (5%), CHA2DS2-VASc score (11%), bleeding risk factors (2%). Compared with non-AD providers, AD providers had statistically significant higher percentages for the following items: mention of anticoagulation (64% versus 35%), stroke risk (11% versus 0%), anticoagulation benefits (8% versus 0%), and patient involvement (17% versus 0%). There was no improvement, however, for AD providers compared with baseline documentation percentages. DISCUSSION Providers infrequently documented important items in anticoagulation management and shared decision-making. AD participation did not improve documentation. Improving adoption of AD educational items may require more prolonged interaction with providers. Improving shared decision-making may require an intervention more focused on it and its documentation.
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Affiliation(s)
- Laboni Hoque
- Ms. Hoque: University of Massachusetts Medical School, Worcester, MA. Ms. Amroze: University of Massachusetts Medical School, Worcester, MA and Meyers Primary Care Institute, Worcester, MA. Dr. Gilvaz: Department of Internal Medicine, St. Vincent Hospital, Worcester, MA. Dr. Abraham: Department of Internal Medicine, St. Vincent Hospital, Worcester, MA. Dr. Lal: Department of Medicine, Mayo Clinic, Rochester, MN. Dr. Mishra: Department of Internal Medicine, St. Vincent Hospital, Worcester, MA. Dr. Crawford: Division of Preventative and Behavioral Medicine, University of Massachusetts Medical School, Worcester, MA, and Meyers Primary Care Institute, Worcester, MA. Dr. Mazor: Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, MA, and Meyers Primary Care Institute, Worcester, MA. Dr. McManus: Division of Cardiology, University of Massachusetts Medical School, Worcester, MA, Meyers Primary Care Institute, Worcester, MA, and University of Massachusetts Memorial Health Care, Worcester, MA. Dr. Kapoor: Division of Hospital Medicine, University of Massachusetts Medical School, Worcester, MA, Meyers Primary Care Institute, Worcester, MA, and University of Massachusetts Memorial Health Care, Worcester, MA
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Tello JE, Barbazza E, Waddell K. Review of 128 quality of care mechanisms: A framework and mapping for health system stewards. Health Policy 2020; 124:12-24. [PMID: 31791717 PMCID: PMC6946442 DOI: 10.1016/j.healthpol.2019.11.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 10/29/2019] [Accepted: 11/18/2019] [Indexed: 12/30/2022]
Abstract
Health system stewards have the critical task to identify quality of care deficiencies and resolve underlying system limitations. Despite a growing evidence-base on the effectiveness of certain mechanisms for improving quality of care, frameworks to facilitate the oversight function of stewards and the use of mechanisms to improve outcomes remain underdeveloped. This review set out to catalogue a wide range of quality of care mechanisms and evidence on their effectiveness, and to map these in a framework along two dimensions: (i) governance subfunctions; and (ii) targets of quality of care mechanisms. To identify quality of care mechanisms, a series of searches were run in Health Systems Evidence and PubMed. Additional grey literature was reviewed. A total of 128 quality of care mechanisms were identified. For each mechanism, searches were carried out for systematic reviews on their effectiveness. These findings were mapped in the framework defined. The mapping illustrates the range and evidence for mechanisms varies and is more developed for some target areas such as the health workforce. Across the governance sub-functions, more mechanisms and with evidence of effectiveness are found for setting priorities and standards and organizing and monitoring for action. This framework can support system stewards to map the quality of care mechanisms used in their systems and to uncover opportunities for optimization backed by systems thinking.
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Affiliation(s)
- Juan E Tello
- Integrated Prevention and Control of NCDs Programme, Division of NCDs and Promoting Health through the Life-Course, WHO Regional Office for Europe, Copenhagen, Denmark.
| | - Erica Barbazza
- Academic UMC, Department of Public Health, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; WHO European Centre for Primary Health Care, Almaty, Kazakhstan.
| | - Kerry Waddell
- McMaster Health Forum, McMaster University, Hamilton, Canada; WHO European Centre for Primary Health Care, Almaty, Kazakhstan.
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190
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Marriott JP, Pérez-Ramos JG, Choi SH, Gonsalves-Domond G, Aladin B, Barbosu M, Smith C, Dye T. Assessing Training Interests of Latin American and Caribbean Immigrant-serving HIV/AIDS, STD, and Hepatitis C Providers in New York State, United States. Int J MCH AIDS 2020; 9:186-190. [PMID: 32704406 PMCID: PMC7370271 DOI: 10.21106/ijma.373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Healthcare providers may be ill-equipped to address the specific care needs of refugee/immigrant (RI) patient populations. We assessed continuing education (CE) training interests among HIV/AIDS, STD, and Hepatitis C (HASH) providers in New York State (NYS), United States, who serve RI patients from Latin America and the Caribbean (LAC). An online survey was completed by 156 HASH providers during a three-month period in Spring 2018. HASH providers serving LAC patients indicate interest in additional training to address the unique needs of the RI community. We noted a strong interest for more tailored learning opportunities in issues that impact refugee health.
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Affiliation(s)
- Jahron P Marriott
- Department of Obstetrics and Gynecology Research, University of Rochester, 601 Elmwood Ave, Rochester NY, 14642, USA
| | - José G Pérez-Ramos
- Department of Obstetrics and Gynecology Research, University of Rochester, 601 Elmwood Ave, Rochester NY, 14642, USA
| | - Song Hoa Choi
- Department of Obstetrics and Gynecology Research, University of Rochester, 601 Elmwood Ave, Rochester NY, 14642, USA
| | - Gersandre Gonsalves-Domond
- Department of Obstetrics and Gynecology Research, University of Rochester, 601 Elmwood Ave, Rochester NY, 14642, USA
| | - Beatrice Aladin
- New York State Department of Health AIDS Institute, 897 Crotona Park N, Bronx, NY, 10460, USA
| | - Monica Barbosu
- Department of Obstetrics and Gynecology Research, University of Rochester, 601 Elmwood Ave, Rochester NY, 14642, USA
| | - Cheryl Smith
- New York State Department of Health AIDS Institute, 897 Crotona Park N, Bronx, NY, 10460, USA
| | - Timothy Dye
- Department of Obstetrics and Gynecology Research, University of Rochester, 601 Elmwood Ave, Rochester NY, 14642, USA
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Searchfield GD, Fok C, Donaldson T, Durai M, Kleinstäuber M, Linford T, Maslin M. An Evaluation of a Continuing Education Workshop for Audiologists on the Assessment and Management of Tinnitus. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2020; 40:125-130. [PMID: 32175932 DOI: 10.1097/ceh.0000000000000285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Tinnitus assessment and management is an important component of audiology. The benefits of continuing education (CE) workshops in the field of tinnitus have not been published. This study evaluated the outcomes of a workshop centered around a Sound Therapy and Aural Rehabilitation for Tinnitus (START) framework. Our hypotheses were that a CE workshop would (1) be useful, (2) improve clinician's knowledge and willingness to undertake tinnitus practice, and (3) result in learners using knowledge gained in their practice. METHODS Twenty-five participants attending a 3-day tinnitus workshop were invited to complete an evaluation immediately and 3 months after the workshop's completion. The workshop consisted of seminars and practical sessions. The pedagogical approaches employed were experiential (theory building, reflection, and testing) and community of practice (shared experiences). RESULTS Participants reported on a 5-point Likert scale (1 = not useful-5 = excellent) a high level of satisfaction both immediately after the workshop (ratings of usefulness: mean, 4.8; SD, 0.4; willingness to practice: 4.6; SD. 0.6; ability to manage: 4.6; SD, 0.5; all "excellent" ratings) and 3 months later (ratings of usefulness: mean, 4.2; SD, 0.9, "very useful;" willingness to practice: 4.6; SD, 0.6, "excellent;" ability to manage: 4.1; SD. 0.5, "very useful"). Open-ended questions indicated participants made changes in their practice that reflected material provided in the CE. CONCLUSION The workshop was successful in improving knowledge and confidence of audiologists in undertaking tinnitus assessment and management, but the need for ongoing support and supervision was a common theme.
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Affiliation(s)
- Grant D Searchfield
- Dr. Searchfield: Associate Professor, Eisdell Moore Centre, Audiology Section, School of Population Health, The University of Auckland, Auckland, New Zealand, Centre for Brain Research, The University of Auckland, Auckland, New Zealand, and Brain Research New Zealand, New Zealand. Ms. Fok: Research Assistant, Eisdell Moore Centre, Audiology Section, School of Population Health, The University of Auckland, Auckland, New Zealand. Mr. Donaldson: Head Project Manager, University Strategic Programme Office, The University of Auckland, Auckland, New Zealand. Dr. Durai: Research Fellow, Eisdell Moore Centre, Audiology Section, School of Population Health, The University of Auckland, Auckland, New Zealand. Dr. Kleinstäuber: Senior Lecturer, Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand. Ms. Linford: Audiologist, Eisdell Moore Centre, Audiology Section, School of Population Health, The University of Auckland, Auckland, New Zealand. Dr. Maslin: Research Fellow, Eisdell Moore Centre, Audiology Section, School of Population Health, The University of Auckland, Auckland, New Zealand
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192
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Lockyer J, DiMillo S, Campbell C. An Examination of Self-Reported Assessment Activities Documented by Specialist Physicians for Maintenance of Certification. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2020; 40:19-26. [PMID: 32149945 DOI: 10.1097/ceh.0000000000000283] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Specialists in a Maintenance of Certification program are required to participate in assessment activities, such as chart audit, simulation, knowledge assessment, and multisource feedback. This study examined data from five different specialties to identify variation in participation in assessment activities, examine differences in the learning stimulated by assessment, assess the frequency and type of planned changes, and assess the association between learning, discussion, and planned changes. METHODS E-portfolio data were categorized and analyzed descriptively. Chi-squared tests examined associations. RESULTS A total of 2854 anatomical pathologists, cardiologists, gastroenterologists, ophthalmologists, and orthopedic surgeons provided data about 6063 assessment activities. Although there were differences in the role that learning played by discipline and assessment type, the most common activities documented across all specialties were self-assessment programs (n = 2122), feedback on teaching (n = 1078), personal practice assessments which the physician did themselves (n = 751), annual reviews (n = 682), and reviews by third parties (n = 661). Learning occurred for 93% of the activities and was associated with change. For 2126 activities, there were planned changes. Activities in which there was a discussion with a peer or supervisor were more likely to result in a change. CONCLUSIONS AND DISCUSSION Although specialists engaged in many types of assessment activities to meet the Maintenance of Certification program requirements, there was variability in how assessment stimulated learning and planned changes. It seems that peer discussion may be an important component in fostering practice change and forming plans for improvement which bears further study.
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Affiliation(s)
- Jocelyn Lockyer
- Dr. Lockyer: Professor, Department of Community Health Sciences, Cumming School of Medicine, Calgary, Canada. Ms. DiMillo: Senior Data and Research Analyst, Health Policy and Advocacy, Royal College of Physicians and Surgeons of Canada, Ottawa, Canada. Dr. Campbell: Principal Senior Advisor, Competency-based CPD and interim Director, Continuing Professional Development, Office of Specialty Education, Royal College of Physicians and Surgeons of Canada, and Associate Professor, Department of Medicine, University of Ottawa, Ottawa, Canada
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193
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Gea J. The Current Accreditation System for Pulmonologists in Spain and Europe. OPEN RESPIRATORY ARCHIVES 2020. [DOI: 10.1016/j.opresp.2019.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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194
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Vinas EK, Schroedl CJ, Rayburn WF. Advancing Academic Continuing Medical Education/Continuing Professional Development: Adapting a Classical Framework to Address Contemporary Challenges. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2020; 40:120-124. [PMID: 32167961 DOI: 10.1097/ceh.0000000000000286] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Lifelong learning is essential for the practicing physician, yet continuing medical education (CME) and continuing professional development (CPD) units at academic medical centers (AMCs) have been historically underappreciated and under-resourced. Their integration into AMC leadership structures continues to vary widely among institutions. Without necessary resources and leadership alignment, many units are less able to focus on advancing CME/CPD to offer and study innovative educational opportunities that may enhance learner and patient outcomes. Using benchmarking data and recommendations from national leaders in the field, a CPD Hierarchy of Needs was created to frame the strategic development of CME/CPD units. This five-level hierarchy includes priorities such as (1) securing investment, (2) building infrastructure, (3) integrating into AMC leadership structures, (4) promoting data-driven interventions, and (5) advancing educational innovation. Recommendations to use the CME/CPD Hierarchy of Needs are described to convey the significance of CME/CPD units to AMCs and to the lifelong learning of practicing physicians.
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Affiliation(s)
- Emily K Vinas
- Dr. Vinas: Assistant Professor and Director of CME, The University of Texas at Austin Dell Medical School, Austin, TX. Dr. Schroedl: Assistant Professor and Medical Director of CME, Northwestern University Feinberg School of Medicine, Chicago, IL. Dr. Rayburn: Distinguished Professor and Associate Dean of CME, University of New Mexico School of Medicine, Albuquerque, NM
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Seki M, Fujinuma Y, Matsushima M, Joki T, Okonogi H, Miura Y, Ohno I. How a problem-based learning approach could help Japanese primary care physicians: a qualitative study. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2019; 10:232-240. [PMID: 31877111 PMCID: PMC7246125 DOI: 10.5116/ijme.5de7.99c7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 12/04/2019] [Indexed: 05/09/2023]
Abstract
OBJECTIVES This study aimed to identify training needs among primary care physicians in Japan who had no formal primary care training. METHODS We conducted a focus group interview with seven Japanese primary care physicians who had not previously undergone specialist training in primary care and had been recruited to a family medicine training program that used a problem-based learning approach. At the start of the program, the physicians attended the interview. The discussion was recorded, and the transcribed interview was analyzed using the Steps for Coding and Theorization method. RESULTS Three main themes emerged. First, there is a lack of standard re-education programs for physicians who move away from their specializations into primary care. Second, there is insufficient training on primary care in undergraduate and postgraduate medical education in Japan. Third, continuing professional development programs should cover the communication skills, attitudes, and behaviors necessary for primary care practice. CONCLUSIONS This study clarified the needs to be addressed in our training program for primary care physicians involved in retraining in primary care. It is important to consider how to best include the communication skills, attitudes, and behaviors necessary for primary care among the topics covered in the program. As the program undergoes further iteration, it will be important to check whether it meets the needs of primary care practitioners. It will be necessary to investigate the needs of re-education programs for more physicians in many areas, and to emphasize the importance of primary care re-education in these abilities in undergraduate and postgraduate medical education.
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Affiliation(s)
- Masayasu Seki
- Division of General Medicine, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Yasuki Fujinuma
- Centre for Family Medicine Development, Japanese Health and Welfare Co-operative Federation, Tokyo, Japan
| | - Masato Matsushima
- Division of Clinical Epidemiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Tatsuhiro Joki
- Division of General Medicine, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Hideo Okonogi
- Division of General Medicine, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Yasuhiko Miura
- Division of General Medicine, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Iwao Ohno
- Division of General Medicine, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
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196
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Younes NA, AbuAlRub R, Alshraideh H, Abu-Helalah MA, Alhamss S, Qanno' O. Engagement of Jordanian Physicians in Continuous Professional Development: Current Practices, Motivation, and Barriers. Int J Gen Med 2019; 12:475-483. [PMID: 31920365 PMCID: PMC6935275 DOI: 10.2147/ijgm.s232248] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 11/20/2019] [Indexed: 11/23/2022] Open
Abstract
Background Mandatory relicense of all physicians in Jordan went into effect at the beginning of May 2018. The bylaw states that all physicians should engage in Continuing Professional Development (CPD) in order to upgrade their knowledge and maintain competency as a prerequisite to renew their license every 5 years. The characteristics of effective CPD are different from one country to another. Jordan has decided to link CPD to mandatory relicense; however, no research has been done to identify the factors that influence CPD offerings, needs, practices, experiences, and effectiveness in the healthcare sector in Jordan. This paper reviews the history of CPD and CME, and the different options to upgrade and improve the competence of physicians. It explores the current practices, motivation, and barriers for physicians to get engaged in CPD activities in Jordan. Purpose The purpose of this research was to provide a better understanding of the state of CPD in the healthcare sector in Jordan with a view to informing the development of Jordan’s first CPD framework. The findings of this research will provide policymakers with baseline information concerning current CPD practices, experiences, and attitudes of physicians towards CPD, and enablers and contributors to effective CPD in Jordan. Methods Stratified clustered self-selected participants that represented physicians working at all healthcare sectors in Jordan were used in this study. A structured pre-tested self-reported questionnaire was used to collect the data. A total of 457 physicians were included in the sample according to one-proportion sample size calculation method, and they were distributed among the healthcare sectors based on their shared proportions. Conclusion Despite considerable evidence supporting the role of CPD in maintaining competency of physicians, participating in CPD activities in Jordan is compromised by lack of mandatory laws and barriers related to staff shortage, heavy workload, limited funds, lack of time, and cost. Personal interests and career progression are the top motivators for CPD. Most Jordanian physicians are interested in CPD activities related to health/medical informatics and enhancing their skills in evidence-informed practice. We recommend that future interventions and health policy directions should be informed by these findings in order to optimize uptake of CPD programs in Jordan.
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Affiliation(s)
- Nidal A Younes
- Department of Surgery, Faculty of Medicine, University of Jordan, Amman, Jordan
| | - Raeda AbuAlRub
- Department of Community and Mental Health, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Hussam Alshraideh
- Industrial Engineering Department, Faculty of Engineering, Jordan University of Science and Technology, Irbid, Jordan.,Industrial Engineering Department, American University of Sharjah, Sharjah, UAE
| | - Munir A Abu-Helalah
- Department of Public Health, Faculty of Medicine, Mutah University, Alkarak, Jordan
| | - Sohaib Alhamss
- Department of Surgery, Faculty of Medicine, University of Jordan, Amman, Jordan
| | - Omar Qanno'
- Department of Surgery, Faculty of Medicine, University of Jordan, Amman, Jordan
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Binstadt ES, Dahms RA, Carlson AJ, Hegarty CB, Nelson JG. When the Learner Is the Expert: A Simulation-Based Curriculum for Emergency Medicine Faculty. West J Emerg Med 2019; 21:141-144. [PMID: 31913834 PMCID: PMC6948691 DOI: 10.5811/westjem.2019.11.45513] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 11/03/2019] [Indexed: 11/18/2022] Open
Abstract
Emergency physicians supervise residents performing rare clinical procedures, but they infrequently perform those procedures independently. Simulation offers a forum to practice procedural skills, but simulation labs often target resident learners, and barriers exist to faculty as learners in simulation-based training. Simulation-based curricula focused on improving emergency medicine (EM) faculty’s rare procedure skills were not discovered on review of published literature. Our objective was to create a sustainable, simulation-based faculty education curriculum for rare procedural skills in EM. Between 2012 and 2019, most EM teaching faculty at a single, urban, Level 1 trauma center completed an annual two-hour simulation-based rare procedure lab with small-group learning and guided hands-on instruction, covering 30 different procedural education sessions for faculty learners. A questionnaire administered before and after each session assessed EM faculty physicians’ self-perceived ability to perform these rare procedures. Participants’ self-reported confidence in their performance improved for all procedures, regardless of prior procedural experience. Faculty participation was initially mandatory, but is now voluntary. Diverse strategies were used to address barriers in this learner group including eliciting learner feedback, offering continuing medical education credits, gradual roll-out of checklist assessments, and welcoming expertise of faculty leaders from EM and other specialties and professions. Participants perceived training to be most helpful for the most rarely-encountered clinical procedures. Similar curricula could be implemented with minimal risk at other institutions.
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Affiliation(s)
- Emily S Binstadt
- University of Minnesota, Regions Hospital Emergency Department, St. Paul, Minnesota
| | - Rachel A Dahms
- University of Minnesota, Regions Hospital Emergency Department, St. Paul, Minnesota
| | - Amanda J Carlson
- St. Mary's Medical Center Essentia Health, Department of Emergency Medicine, Duluth, Minnesota
| | - Cullen B Hegarty
- University of Minnesota, Regions Hospital Emergency Department, St. Paul, Minnesota
| | - Jessie G Nelson
- University of Minnesota, Regions Hospital Emergency Department, St. Paul, Minnesota
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Cullen MW, Geske JB, Anavekar NS, McAdams JA, Beliveau ME, Ommen SR, Nishimura RA. Reinvigorating Continuing Medical Education: Meeting the Challenges of the Digital Age. Mayo Clin Proc 2019; 94:2501-2509. [PMID: 31806103 DOI: 10.1016/j.mayocp.2019.07.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 06/17/2019] [Accepted: 07/05/2019] [Indexed: 12/18/2022]
Abstract
Clinicians in today's health care environment face an overwhelming quantity of knowledge that requires continued education and lifelong learning. However, traditional continuing medical education (CME) courses cannot meet these educational needs, particularly given the proliferation of knowledge and increasing demands on clinicians' time and resources. CME courses that previously offered only in-person, face-to-face education must evolve in a learner-centric manner founded on principles of adult learning theory to remain relevant in the current era. In this article, we describe the transition of the Mayo Clinic Cardiovascular Review for Cardiology Boards and Recertification (CVBR) from a traditional course with only live content to a course integrating live, online, and enduring materials. This evolution has required leveraging technology to maximize learner engagement, offering faculty development to ensure content alignment with learner needs, and strong leadership dedicated to providing learners an unparalleled educational experience. Despite stagnation in growth of the traditional live course, these changes have increased the overall reach of the Mayo Clinic CVBR. Learners engaging with digital content have demonstrated larger increases in knowledge with less educational time commitment. Courses seeking to implement similar changes must develop formal learning objectives focused on learner needs, build an online presence that includes an assessment of learner knowledge, enlist a cohort of dedicated faculty who teach based on principles of adult learning theory, and perpetually refresh educational content based on learner feedback and performance. Following these principles will allow traditional CME courses to thrive despite learners' resource constraints and alternative means to access information.
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Affiliation(s)
- Michael W Cullen
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
| | - Jeffrey B Geske
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - Julie A McAdams
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - Steve R Ommen
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Rick A Nishimura
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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199
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Karageorge A, Lancaster J, Prager S, Nash L. Where do Peer Review Groups fit in the international Continuing Professional Development literature? Australas Psychiatry 2019; 27:651-654. [PMID: 31535568 DOI: 10.1177/1039856219871880] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To describe what is reported in the Continuing Professional Development (CPD) literature on small group learning formats in medicine, including the Royal Australian and New Zealand College of Psychiatrists (RANZCP) CPD Peer Review Groups (PRGs). METHOD A literature review of international peer-reviewed publications in relation to the use of small group learning formats for CPD in medicine. RESULTS Small groups are commonly used as a learning format in medical CPD, primarily in general practice, but are little researched. Such groups take differing forms and they are valued by participants for a range of purposes, having effects on professionalism, clinical performance and doctors' wellbeing. CONCLUSION We believe that the contribution of these groups to medical CPD should be further explored. To this end, this review forms the first part of a research project focussing on the RANZCP PRG model used by Australian and New Zealand psychiatrists.
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Affiliation(s)
- Aspasia Karageorge
- Research Associate, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | | | - Shirley Prager
- Consultant Psychiatrist, Private Practice, Melbourne, VIC, Australia
| | - Louise Nash
- Associate Professor, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
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200
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Harapan H, Mudatsir M, Indah R, Utomo PS, Anwar S, Wahyuniati N, Maulana R, Ichsan I, Aletta A, Ikram I, Ramadana MR, Rajamoorthy Y, Setiawan AM, Wagner AL, Andalas M. Knowledge towards Zika among medical students, interns and general practitioners in Indonesia: A cross-sectional study in Aceh. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2019. [DOI: 10.1016/j.cegh.2018.12.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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