The educational effectiveness of problem-based learning discussions as evaluated by learner-assessed satisfaction and practice change

Continuing professional development (CPD) for anesthetists: A systematic review

BACKGROUND

In accordance with the focus on patient safety and quality in healthcare, continuing professional development (CPD) has received increasing levels of attention as a means to ensure physicians maintain their clinical competencies and are fit to practice. There is some evidence of a beneficial effect of CPD, though few studies have evaluated its effect within anesthesia. The primary aim of this systematic review was to establish which CPD activities anesthetists are engaged in and their effectiveness. The secondary aim was to explore which methods are employed to evaluate anesthetists' clinical performance.

METHODS

Databases searched: Medline, Embase and Web of Science, in May 2023. Additional papers were identified through searching the references of included studies. Eligible studies included anesthetists, either exclusively or combined with other healthcare professionals, who underwent a learning activity or assessment method as part of a formalized CPD program or a stand-alone activity. Non-English language studies, non-peer reviewed studies and studies published prior to 2000 were excluded. Eligible studies were quality assessed and narratively synthesized, with results presented as descriptive summaries.

RESULTS

A total of 2112 studies were identified, of which 63 were eligible for inclusion, encompassing more than 137,518 participants. Studies were primarily of quantitative design and medium quality. Forty-one studies reported outcomes of single learning activities, whilst 12 studies investigated different roles of assessment methods in CPD and ten studies evaluated CPD programs or combined CPD activities. A 36 of the 41 studies reported positive effects of single learning activities. Investigations of assessment methods revealed evidence of inadequate performance amongst anesthetists and a mixed effect of feedback. Positive attitudes and high levels of engagement were identified for CPD programs, with some evidence of a positive impact on patient/organizational outcomes.

DISCUSSION

Anesthetists are engaged in a variety of CPD activities, with evidence of high levels of satisfaction and a positive learning effect. However, the impact on clinical practice and patient outcomes remains unclear and the role of assessment is less well-defined. There is a need for further, high-quality studies, evaluating a broader range of outcomes, in order to identify which methods are most effective to train and assess specialists in anesthesia.

Evaluation of the star family doctors training program: an observational cohort study of a novel continuing medical education program for general practitioners within a compact medical consortium: a quantitative analysis

INTRODUCTION

To determine the effectiveness of the Star Family Doctors Training Program, a comprehensive Continuing professional development (CPD) program for general practitioners (GPs) in a compact medical consortium.

PATIENTS AND METHODS

Observational cohort study with a quantitative analyses in primary health care institutions in Sichuan Province. The interventions were as following: (1) The Star Family Doctors Training Program is a full-time, local government allocation program certified by the Health Department of Sichuan Province, emphasizing small group learning and practice, and using standard patients and medical patient simulators; 30 participants were selected by their institutions. (2) The control group underwent a self-financed after-work CPD program using conventional lectures; 50 participants were self-selected. Short-term effectiveness assessed using immediate post-training tests and self-evaluations; long-term (1 year) effectiveness evaluated using self-reported surveys.

RESULTS

The study involved 80 GPs (28.75% men; mean age: 38.2 ± 9.2 years). The average post-training total score was higher in the STAR group than in the control group (72.83 ± 5.73 vs. 68.18 ± 7.64; p = 0.005). Compared to the controls, STAR participants reported seeing more patients (all p < 0.05), and had more patients who signed family-doctor contracts (p = 0.001) as well as increased patient satisfaction (p = 0.03), respectively. STAR-group trainees appraised the program higher and were more willing to recommend it to colleagues (90% vs. 64%, p = 0.011).

CONCLUSION

The Star Family Doctors Training Program achieved good responses and provides a reference for future CPD programs.

Applying the Principles of Bloom's Taxonomy to Managing Tachyarrhythmia: Results of a Tachyarrhythmia Workshop

Introduction Resident physicians are routinely required to evaluate and manage patients with tachyarrhythmias. We developed a comprehensive workshop in an effort to improve residents' competence and confidence at managing tachyarrhythmias. Methods A total of 55 residents attended the workshop and underwent pre- and post-testing to assess their competence of identifying and managing different arrhythmia. The participants were also asked to describe the comfort level managing these patients. After the pre-test, they participated in an interactive one hour session in which a cardiologist discussed common tachyarrhythmias and their management. For the next hour, the residents were then divided into groups of four to five. Using mannequins connected to heart monitors, the residents would be provided with a clinical vignette and asked to identify the heart rhythm and suggest management. A mock medication cart, and actual cardioverters-defibrillators were available. If the resident physician were to deliver cardioversion appropriately, the rhythm would change to sinus, and the patient's hemodynamics would improve, thus providing live feedback for correct management. Results Amongst the 55 residents that participated in this study, the mean scores were 13.1 for pre-testing and 17.9 for post-testing, respectively (p = 0.0001). Residents' mean comfort levels at managing tachyarrhythmias were 2.6 prior to testing and 3.6 post-testing (p = 0.0001). Conclusion We demonstrate that a two-hour focused tachyarrhythmia workshop significantly improved residents' comfort level and competence in managing patients with tachyarrhythmia. By focusing on the higher levels of Bloom's taxonomy such as analysis, synthesis and evaluation, we were able to improve the educational experience for our resident physicians.

Quality Improvement Initiative to Improve Postoperative Pain with a Clinical Pathway and Nursing Education Program

BACKGROUND AND AIMS

We created a multicomponent intervention to improve pain management in the immediate postoperative period with the goal of improving the quality of patient recovery.

DESIGN

A multicomponent intervention to improve pain management in the immediate postoperative period with the goal of improving the quality of patient recovery.

SETTINGS

Pain management education of postanesthesia recovery room nurses through a practical intervention has the potential to improve patient pain experience, especially in those with a history of opioid tolerance.

PARTICIPANTS/SUBJECTS

Postanesthesia recovery nurses/postanesthesia patients.

METHODS

The intervention included two components: a clinical pain pathway on multimodal analgesia for both opioid-naïve and opioid-tolerant patients undergoing surgery and an educational program on pain management for frontline clinical nurses in the postanesthesia care unit (PACU). We measured the intervention's impact on time to pain relief, PACU length of stay, and patient satisfaction with pain management, as measured by self-report.

RESULTS

Patient PACU surveys indicated a decrease in the percent of patients with opioid tolerance who required more than 60 minutes to achieve adequate pain relief (from 32.7% preintervention to 21.3% postintervention). Additionally, after the intervention, the average time from a patient's PACU arrival to his or her discharge criteria being met decreased by 53 minutes and PACU stay prolongation as a result of uncontrolled pain for opioid-tolerant patients decreased from 45.2% to 25.7%. The sample size was underpowered to perform statistical analysis of this improvement.

CONCLUSIONS

After the combined intervention of a clinical pain pathway and interactive teaching workshop, we noted shortened PACU length of stay, reduced time to reach pain control, and improved overall patient satisfaction. Although we could not determine statistical significance, our findings suggest improved management of acute postoperative pain, especially for patients who are opioid tolerant. Because of the paucity of data, we were not able to conduct the analysis needed to evaluate quality improvement projects, as per SQUIRE 2.0. could be adopted by any institution.

Continuing medical education for general practitioners: a practice format

Introduction

Our current knowledge-based society and the many actualisations within the medical profession require a great responsibility of physicians to continuously develop and refine their skills. In this article, we reflect on some recent findings in the field of continuing education for professional doctors (continuing medical education, CME). Second, we describe the development of a CME from the Academic Center for General Practice (ACHG) of the KU Leuven.

Methods

First, we performed a literature study and we used unpublished data of a need assessment performed (2013) in a selected group of general practitioners. Second, we describe the development of a proposal to establish a CME programme for general practitioners.

Results

CME should go beyond the sheer acquisition of knowledge, and also seek changes in practice, attitudes and behaviours of physicians. The continuing education offerings are subject to the goals of the organising institution, but even more to the needs and desires of the end user.

Conclusions

Integrated education is crucial to meet the conditions for efficient and effective continuing education. The ACHG KU Leuven decided to offer a postgraduate programme consisting of a combination of teaching methods: online courses (self-study), contact courses (traditional method) and a materials database.

Use of a problem-based learning discussion format to teach anesthesiology residents research fundamentals

STUDY OBJECTIVE

To present a new research problem-based learning discussion (PBLD) conference and to evaluate its effect on residents.

DESIGN

Retrospective observational study of resident education before and after implementation of a research PBLD.

SETTING

Large U.S. academic anesthesiology department.

SUBJECTS

93 anesthesiology residents with research PBLD exposure in the academic year (AY) 2010 and AY 2011, and 85 residents without research PBLD exposure in AY 2008 and AY 2009.

MEASUREMENTS

Since AY 2010, a PBLD format has been used to teach residents clinical research fundamentals. The annual 90-minute PBLD addressed residents' perceived barriers to research and introduced research resources available via the Clinical and Translational Science Institute (CTSI). Data recorded were: 1) number of residents who made CTSI consultation solicitations as a new investigator, and 2) number of new research projects proposed by the residents and designed with CTSI consultation. Each outcome was compared between the prePBLD group (AY 2008 [n=43] and AY 2009 [n=42]) and the postPBLD group (AY 2010 [n=43] and AY 2011 [n=50]).

MAIN RESULTS

The number of residents who consulted the CTSI as new investigators increased from 4 of 85 residents (4.7%) in the prePBLD group to 13 of 93 residents (14.0%) in the postPBLD group (P = 0.042). The number of new research projects for which the residents consulted CTSI increased from 10 to 20 (100% increase).

CONCLUSION

A PBLD format for research education of anesthesiology residents is effective.

A comparison of problem-based learning and conventional teaching in nursing ethics education

The aim of this study was to compare the learning effectiveness of peer tutored problem-based learning and conventional teaching of nursing ethics in Taiwan. The study adopted an experimental design. The peer tutored problem-based learning method was applied to an experimental group and the conventional teaching method to a control group. The study sample consisted of 142 senior nursing students who were randomly assigned to the two groups. All the students were tested for their nursing ethical discrimination ability both before and after the educational intervention. A learning satisfaction survey was also administered to both groups at the end of each course. After the intervention, both groups showed a significant increase in ethical discrimination ability. There was a statistically significant difference between the ethical discrimination scores of the two groups (P < 0.05), with the experimental group on average scoring higher than the control group. There were significant differences in satisfaction with self-motivated learning and critical thinking between the groups. Peer tutored problem-based learning and lecture-type conventional teaching were both effective for nursing ethics education, but problem-based learning was shown to be more effective. Peer tutored problem-based learning has the potential to enhance the efficacy of teaching nursing ethics in situations in which there are personnel and resource constraints.

[Problem/case-based learning compared to lectures for acquiring knowledge of air embolism in continuing medical education]

OBJECTIVE

The efficacy of continuing medical education in anesthesiology has been examined very little. This study compared the efficacy of a lecture on air embolism to that of a class that used a problem/case-based learning approach.

MATERIAL AND METHODS

Prospective, randomized study enrolling 52 experienced anesthesiologists participating in a professional development course. Twenty-six anesthesiologists attended a lecture on air embolism in anesthesia and 25 attended a problem-based class. The objectives were the same for both groups and had been defined previously. The participants' knowledge was evaluated before and after the instruction with tests based on 2 cases dealing with the same knowledge areas: risk factors and symptoms, diagnosis, monitoring, and treatment.

RESULTS

No significant between-group differences were found for any of the knowledge areas before or after the classes. After instruction, participants who listened to the lecture improved their scores for knowledge of monitoring (P = .03) and treatment (P = .001). Participants in the problem-based learning group also improved their scores for knowledge of treatment (P = .003).

CONCLUSIONS

No between-group differences in participants' knowledge outcomes were detected; improvements were minimal. The study design allowed the knowledge acquired to be evaluated objectively.