Identifying educational influentials for formal and informal continuing medical education in the province of British Columbia

Is there a "net generation" in veterinary medicine? A comparative study on the use of the Internet and Web 2.0 by students and the veterinary profession

Introduction: Informal and formal lifelong learning is essential at university and in the workplace. Apart from classical learning techniques, Web 2.0 tools can be used. It is controversial whether there is a so-called net generation amongst people under 30.

Aims: To test the hypothesis that a net generation among students and young veterinarians exists.

Methods: An online survey of students and veterinarians was conducted in the German-speaking countries which was advertised via online media and traditional print media.

Results: 1780 people took part in the survey. Students and veterinarians have different usage patterns regarding social networks (91.9% vs. 69%) and IM (55.9% vs. 24.5%). All tools were predominantly used passively and in private, to a lesser extent also professionally and for studying.

Outlook: The use of Web 2.0 tools is useful, however, teaching information and media skills, preparing codes of conduct for the internet and verification of user generated content is essential.

Implementing the work disability prevention paradigm among therapists in Hong Kong: facilitators and barriers

INTRODUCTION

This is a discussion paper to examine the issues surrounding management of work-related injuries by physiotherapists and occupational therapists in Hong Kong. Therapists working in public hospitals are faced with managing injured workers with limited resources and this frequently results in suboptimal outcomes.

METHODS

In this paper, five experienced therapists critically reviewed the current practices in the physiotherapy and occupational therapy professions in Hong Kong, with regard to managing patients with work injuries. In many hospitals, therapists still practice with a disease-based model focusing on symptom relief and restoration of general physical function. We collated information about current programs initiated by physiotherapists and occupational therapists to provide more strategic intervention strategies for early screening of high-risk patients and adaptive biopsychosocial interventions targeting return-to-work outcomes. Clinical and system-level barriers and facilitators of a major paradigm shift towards work disability prevention are discussed.

CONCLUSION

Physiotherapists and occupational therapists need to develop more strategic collaborations and actively voice out the need for major systematic changes within the local healthcare system, in order to provide a more effective management approach in line with the concept of Work Disability Prevention.

Can criteria for identifying educational influentials in developed countries be applied to other countries? A study in Iran

INTRODUCTION

There are published criteria for identifying educational influentials (EIs). These criteria are based on studies that have been performed in developed countries. This study was performed to identify criteria and characteristics of EIs in Iran.

METHODS

The study was conducted on residents, interns, and clerks at a major educational hospital in Iran. This study had 3 stages: (1) preparation of an inclusive list of EI characteristics through 3 focus group discussions with 22 individuals, in which 30 primary characteristics of EIs were found; (2) reducing the number of characteristics by examining 154 individuals for exploratory factor analysis and internal consistency evaluation by Cronbach's alpha, after which the characteristics were reduced to 25; (3) finalizing the criteria through discriminant validity.

RESULTS

Fifteen characteristics were identified in 4 domains: (1) knowledge (high level of clinical knowledge, being up-to-date and an expert, high level of clinical skills); (2) communication skills (good communication with others, easily accessible, good public relations, and oratory); (3) taking into account the stakeholders (involving patients in decision making, allowing students to identify problems, delivering decisions to others, and interest in transfer of material); and (4) professional ethics (pursuing the patients' maximum benefit, observing ethics in education and research). Overall, they have a sensitivity and specificity of 87% and 74%, respectively.

DISCUSSION

Three of the four domains we found were already identified in other studies; however, the "taking into account the stakeholders" domain has not been previously reported. The other domains and criteria were similar to those found in developed countries.

The difficulty of recruiting speakers for continuing medical education

BACKGROUND

Obtaining speakers for various continuing medical education (CME) programs can be a challenging and sometimes frustrating process.

PURPOSE

The goal of this study was to quantify the difficulty in recruiting speakers for CME.

METHODS

A retrospective review of planning documents from three CME programs for family physicians was conducted. Descriptive analysis and analysis of variance testing was performed on the data collected.

RESULTS

In all three programs, obtaining speakers has become more difficult over the past 3 years with 1.75 [standard deviation (SD)=1.46] to 2.32 (SD=1.85) mean requests. Finding speakers for rural programs is more challenging than local CME sessions with 2.11 (SD=1.78) compared with 1.68 (SD=1.12) mean requests, respectively. University faculty represent 45.7% of CME speakers.

CONCLUSIONS

This is the first study to document the increasing difficulty of recruiting speakers for CME. This significant difficulty in speaker recruitment has several implications for the CME offices and physician learners.

Quality Initiative in Rectal Cancer Strategy: A Qualitative Study of Participating Surgeons

BACKGROUND

The Quality Initiative in Rectal Cancer (QIRC) Strategy randomized 16 hospitals across Ontario to the QIRC strategy versus minimal intervention. The strategy included a workshop, recruitment of a local opinion leader (OL), operative demonstrations, postoperative checklists, audit, and feedback. Surgeons at each intervention hospital used a standardized approach to select a local OL from their ranks. We assessed the experiences of OL and non-OL surgeons in the QIRC strategy.

STUDY DESIGN

Semi-structured qualitative telephone interviews were completed with 8 OLs and 8 non-OL surgeons. Interviews were guided by Grounded Theory. Initial interviews were assessed to ensure that domains of interest were fully explored. Two investigators (FW, MF) independently reviewed all final transcripts and identified themes. Consensus among all investigators was achieved for final themes.

RESULTS

All approached surgeons participated in interviews. Seven themes were identified: surgical OLs with subspecialist expertise were supported; surgical OL requires technical expertise; limited role for local OL on changing physician practice in rectal cancer operations; limited effect of identifying local OL on local interactions; operative demonstrations supported; characteristics of operative demonstrator were important; and perceived positive effect of the QIRC strategy on practice.

CONCLUSIONS

The experience of local OLs in this trial appears to be mixed. Although some of the themes support the concept of a local OL, other themes suggest the local OL had a limited role and effect. The overall QIRC strategy, and in particular the operative demonstration, was viewed positively and was perceived to have a positive longterm effect on participants' practice.

A blended knowledge translation initiative to improve colorectal cancer staging [ISRCTN56824239]

BACKGROUND

A significant gap has been documented between best practice and the actual practice of surgery. Our group identified that colorectal cancer staging in Ontario was suboptimal and subsequently developed a knowledge translation strategy using the principles of social marketing and the influence of expert and local opinion leaders for colorectal cancer.

METHODS/DESIGN

Opinion leaders were identified using the Hiss methodology. Hospitals in Ontario were cluster-randomized to one of two intervention arms. Both groups were exposed to a formal continuing medical education session given by the expert opinion leader for colorectal cancer. In the treatment group the local Opinion Leader for colorectal cancer was detailed by the expert opinion leader for colorectal cancer and received a toolkit. Forty-two centres agreed to have the expert opinion leader for colorectal cancer come and give a formal continuing medical education session that lasted between 50 minutes and 4 hours. No centres refused the intervention. These sessions were generally well attended by most surgeons, pathologists and other health care professionals at each centre. In addition all but one of the local opinion leaders for colorectal cancer met with the expert opinion leader for colorectal cancer for the academic detailing session that lasted between 15 and 30 minutes.

DISCUSSION

We have enacted a unique study that has attempted to induce practice change among surgeons and pathologists using an adapted social marketing model that utilized the influence of both expert and local opinion leaders for colorectal cancer in a large geographic area with diverse practice settings.

Identifying educationally influential specialists: issues arising from the use of "classic" criteria

INTRODUCTION

Educationally influential physicians (EIPs) are identified by their colleagues as people who (1) encourage learning and enjoy sharing their knowledge, (2) are clinical experts and always seem up to date, and (3) treat others as equals. We aimed to identify surgical and pathologist EIPs for colorectal cancer (CRC) in Ontario as part of a blended knowledge transfer program.

METHODS

A population-based cohort of surgeons (n = 794) and pathologists (n = 449) were sent surveys modeled on the Hiss method for identifying EIPs. Four formal mailings (including incentives) and telephone calls and faxes were completed. This labor-intensive process identified "general" EIPs and surgery or pathology EIPs for CRC. The characteristics of EIPs in these groups were studied.

RESULTS

The response rate was 41% for surgeons and 42% for pathologists. One hundred eighteen general EIPs were identified and substantially more surgical EIPs for CRC (n = 63) than pathology EIPs for CRC (n = 6) were recognized. Forty-two of 81 medical centers in Ontario identified an EIP We also identified a cohort of "domain experts, " physicians whose opinion was valued for CRC but who did not meet the Hiss EIP criteria. This cohort of "domain experts" was larger than the cohort of ElPs for CRC for both surgeons (63 vs. 154) and pathologists (6 vs. 154).

DISCUSSION

In this population study, we identified EIPs for CRC using the Hiss method, although significantly more surgical than pathology EIPs for CRC were recognized. The educational influence of domain experts who do not fulfill the Hiss characteristics compared with EIPs for CRC remains to be determined.

Achieving cardiovascular health through continuing interprofessional development

In order to achieve cardiovascular health for all Canadians, the ACHIC (Achieving Cardiovascular Health in Canada) partnership advocates that health promotion for healthy lifestyles be incorporated into practice, and that the consistent messages and professional skills required to motivate patients and the public be acquired through interprofessional education and development. Professional education specialists are essential members of health care promotion teams with expertise to develop educational interventions that impact behaviours of health professionals and subsequent patient outcomes. Continuing medical education (CME) is in evolution to continuing professional development (CPD), and then to continuing inter-professional development (CID). Providers of health promotion, public health, and health care can work with health educators to complete the cascade of learning, change in practice, and improvement in patient outcomes. The Canadian health care system can empower Canadians to achieve cardiovascular health, the most important health challenge in the 21st century.

Educationally influential physicians: the need for construct validation

INTRODUCTION

Educationally influential physicians may be a valuable resource in continuing medical education. Although the idea driving this research--informal learning--converges with research in adult education, organizational learning, marketing, and knowledge diffusion, the results of interventions have proven inconclusive. To actualize the promise of the educationally influential physician (EIP) construct, it is argued that researchers must return to the "classic" studies in this area and resume the process of validating the meaning of the construct.

METHODS

A literature review and the occasion of an educationally influential physician identification survey provided an opportunity to contribute to development of this construct. We compared three identification rules used to study 212 physicians.

RESULTS

Each rule may identify different people as EIPs.

DISCUSSION

To improve the use of educational influentials, research must be completed to validate their role in informal learning.