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Lyu X, Li S. Professional medical education approaches: mobilizing evidence for clinicians. Front Med (Lausanne) 2023; 10:1071545. [PMID: 37575990 PMCID: PMC10419302 DOI: 10.3389/fmed.2023.1071545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 07/07/2023] [Indexed: 08/15/2023] Open
Abstract
Rapidly proliferating high-quality evidence supports daily decision-making in clinical practice. Continuing professional medical education links this evidence to practicing clinicians who are strongly motivated to improve the quality of their care by using the latest information. Approaches to professional education vary, and their effects depend on specific scenarios. This narrative review summarizes the main approaches for professional medical education that facilitate the mobilization of evidence for clinicians. It includes traditional learning (passive and active dissemination of educational materials, lectures, and mass media dissemination), constructivist learning (engaging in local consensus processes and education outreach visits, interfacing with local opinion leaders, conducting patient-mediated interventions, employing audit and feedback processes, and utilizing clinical decision-supporting systems), and blended learning approaches (the integration of in-person or online passive learning with active and creative learning by the learners). An optimized selection from these approaches is challenging but critical to clinicians and healthcare systems.
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Affiliation(s)
- Xiafei Lyu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Sheyu Li
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
- Division of Guideline and Rapid Recommendation, Cochrane China Center, MAGIC China Center, Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
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Main PAE, Anderson S. Evidence for continuing professional development standards for regulated health practitioners in Australia: a systematic review. HUMAN RESOURCES FOR HEALTH 2023; 21:23. [PMID: 36941655 PMCID: PMC10026429 DOI: 10.1186/s12960-023-00803-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Health practitioner regulators throughout the world use continuing professional development (CPD) standards to ensure that registrants maintain, improve and broaden their knowledge, expertise and competence. As the CPD standard for most regulated health professions in Australia are currently under review, it is timely that an appraisal of the evidence be undertaken. METHODS A systematic review was conducted using major databases (including MEDLINE, EMBASE, PsycInfo, and CINAHL), search engines and grey literature for evidence published between 2015 and April 2022. Publications included in the review were assessed against the relevant CASP checklist for quantitative studies and the McMaster University checklist for qualitative studies. RESULTS The search yielded 87 abstracts of which 37 full-text articles met the inclusion criteria. The evidence showed that mandatory CPD requirements are a strong motivational factor for their completion and improves practitioners' knowledge and behaviour. CPD that is more interactive is most effective and e-learning is as effective as face-to-face CPD. There is no direct evidence to suggest the optimal quantity of CPD, although there was some evidence that complex or infrequently used skills deteriorate between 4 months to a year after training, depending on the task. CONCLUSIONS CPD is most effective when it is interactive, uses a variety of methods and is delivered in a sequence involving multiple exposures over a period of time that is focused on outcomes considered important by practitioners. Although there is no optimal quantity of CPD, there is evidence that complex skills may require more frequent CPD.
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Affiliation(s)
| | - Sarah Anderson
- Research and Evaluation Team, Australian Health Practitioner Regulation Agency, Melbourne, VIC, Australia.
- School of Allied Health, Human Services and Sport , La Trobe University, Bundoora, VIC, Australia.
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Chimonas S, Mamoor M, Zimbalist SA, Barrow B, Bach PB, Korenstein D. Mapping conflict of interests: scoping review. BMJ 2021; 375:e066576. [PMID: 34732464 PMCID: PMC8565086 DOI: 10.1136/bmj-2021-066576] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/16/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To identify all known ties between the medical product industry and the healthcare ecosystem. DESIGN Scoping review. METHODS From initial literature searches and expert input, a map was created to show the network of medical product industry ties across parties and activities in the healthcare ecosystem. Through a scoping review, the ties were then verified, cataloged, and characterized, with data abstracted on types of industry ties (financial, non-financial), applicable policies for conflict of interests, and publicly available data sources. MAIN OUTCOME MEASURES Presence and types of medical product industry ties to activities and parties, presence of policies for conflict of interests, and publicly available data. RESULTS A map derived through synthesis of 538 articles from 37 countries shows an extensive network of medical product industry ties to activities and parties in the healthcare ecosystem. Key activities include research, healthcare education, guideline development, formulary selection, and clinical care. Parties include non-profit entities, the healthcare profession, the market supply chain, and government. The medical product industry has direct ties to all parties and some activities through multiple pathways; direct ties extend through interrelationships among parties and activities. The most frequently identified parties were within the healthcare profession, with individual professionals described in 422 (78%) of the included studies. More than half (303, 56%) of the publications documented medical product industry ties to research, with clinical care (156, 29%), health professional education (145, 27%), guideline development (33, 6%), and formulary selection (8, 1%) appearing less often. Policies for conflict of interests exist for some financial and a few non-financial ties; publicly available data sources seldom describe or quantify these ties. CONCLUSIONS An extensive network of medical product industry ties to activities and parties exists in the healthcare ecosystem. Policies for conflict of interests and publicly available data are lacking, suggesting that enhanced oversight and transparency are needed to protect patient care from commercial influence and to ensure public trust.
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Affiliation(s)
- Susan Chimonas
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, New York, NY 10017, USA
| | - Maha Mamoor
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, New York, NY 10017, USA
| | - Sophia A Zimbalist
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, New York, NY 10017, USA
| | - Brooke Barrow
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Peter B Bach
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, New York, NY 10017, USA
- Delfi Diagnostics, Baltimore, MD, USA
| | - Deborah Korenstein
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, New York, NY 10017, USA
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Conflicts of Interest Arising from Simultaneous Service by Editors of Competing Journals or Publishers. PUBLICATIONS 2021. [DOI: 10.3390/publications9010006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
In this day and age of challenging post-publication peer review and heightened academic scrutiny, editors serve an increasingly important role in screening submissions and managing the quality of information that is published in scholarly journals. Publishers compete for an intellectual market while commercial publishers compete for a commercial share of the market. The assumption argued in this perspective is that having editorial positions in competing journals or publishers (CJPs) may represent competing intellectual, professional and/or financial interests. Thus, based on this assumption, an editor would be expected to show loyalty to a single entity (journal or publisher). Editorial positions on the editorial boards of CJPs, as well as conflicts, financial or other, should be clearly indicated for all editors on the editorial board page of a journal’s website, for transparency. In science and academia, based on these arguments, the author is of the belief that editors should thus generally not serve on the editorial boards of CJPs, or only under limited and fully transparent conditions, even if they serve as editors voluntarily. The author recognizes that not all academics, including editors, might agree with this perspective, so a wider debate is encouraged.
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Hinneburg I, Günther J, Fleer D, Schwalbe O. [Assuring the quality of continuous professional development: An analysis of accreditation documents of the chambers of pharmacists in Germany]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2019; 149:49-56. [PMID: 32085999 DOI: 10.1016/j.zefq.2019.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 11/27/2019] [Accepted: 12/05/2019] [Indexed: 06/10/2023]
Abstract
Accreditation of continuous professional training events is an important means to ensure quality. In Germany, the chambers of pharmacists accredit these events, i. e., they check the documents that the organizers of these events provide. The aim of this investigation was to compare the accreditation documents that the chambers of pharmacists publish on their websites. We developed explicit rating criteria concerning the categories quality of content, conflict of interest and sponsoring. The analysis revealed a huge discrepancy between the individual chambers of pharmacists and also in the way they addressed different items. The Federal Chamber of Pharmacists revised its accreditation requirements in early 2019, which raised the rating. However, there is still room for improvement. To ensure the quality of pharmaceutical continuous accreditation, the chambers of pharmacists should work towards establishing more stringent and uniform accreditation requirements.
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Affiliation(s)
- Iris Hinneburg
- Fachbereich Evidenzbasierte Pharmazie im DNEbM, Deutschland.
| | | | - Daniel Fleer
- Fachbereich Evidenzbasierte Pharmazie im DNEbM, Deutschland
| | - Oliver Schwalbe
- Abteilung Ausbildung, Fortbildung und Arzneimitteltherapiesicherheit, Apothekerkammer Westfalen-Lippe, Münster, Deutschland
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Fauser BCJM, Macklon NS. May the colleague who truly has no conflict of interest now please stand up! Reprod Biomed Online 2019; 39:541-544. [PMID: 31540846 DOI: 10.1016/j.rbmo.2019.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | - N S Macklon
- Faculty of Medicine, University of Southampton. UK
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Ozieranski P, Csanadi M, Rickard E, Tchilingirian J, Mulinari S. Analysis of Pharmaceutical Industry Payments to UK Health Care Organizations in 2015. JAMA Netw Open 2019; 2:e196253. [PMID: 31225896 PMCID: PMC6593961 DOI: 10.1001/jamanetworkopen.2019.6253] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 05/08/2019] [Indexed: 11/14/2022] Open
Abstract
Importance Drug company payments to health care organizations can create conflicts of interest. However, little is known about such financial relationships, especially outside the United States. Objective To examine the concentration and patterns of drug company payments to health care organizations in the United Kingdom. Design, Setting, and Participants This cross-sectional study examined nonresearch payments reported in the industry-run Disclosure UK database. Companies participating in Disclosure UK in 2015 and health care organizations receiving their payments were included in the analysis. The data were analyzed descriptively at the health care organization, payment, and donor levels, considering health care organization categories, payment categories, and companies from February 5 through May 28, 2017, with follow-up checks from June 1 through August 31, 2018. Analysis was conducted from July 10 through December 20, 2018. Main Outcomes and Measures Share of funding and the Gini index (GI) to measure payment concentration (0 indicates perfect deconcentration [eg, all drug companies provide the same value of payments]; 1, perfect concentration [eg, 1 company provides the entire value of payments]) and median and interquartile range (IQR) to measure payment patterns. Results A total of 4028 health care organizations received 19 933 payments, worth US $72 110 156.6, from 100 companies. This study identified 11 categories of health care organizations, with 3-public-sector secondary and tertiary care providers, education and research providers, and professional organizations-accumulating 67.2% of funding. The health care organization categories had varying GIs (range, 0.65-0.92), medians (range, $750.3-$45 862.4), and IQRs (range, $389.1-$1843.9 to $3104.4-$199 868.2). Of 4 payment categories, the top category-donations and grants-captured 50.6% of funding. Joint working (collaborative projects with nonindustry partners) had a lower GI (0.64) than other payment categories (range, 0.79-0.84). The median and IQR were the lowest for contributions to costs of events ($366.8; IQR, $229.3-611.3) and highest for joint working ($14 903.7; IQR, $3185.0-34,748.4). The top 10 firms (58.6% of funding) had payments with varying medians (from $366.8 [IQR, $244.5-611.3] to $9781.3 [IQR, $1834.0-48 906.7]). Conclusions and Relevance Although organizations from across the health care system received funding, the payments were concentrated on a few large donors, payments, and recipients. Different payment and recipient categories had different patterns of payment values, suggesting that the industry has diversified its funding strategies across different parts of the health care system. These results suggest that Disclosure UK requires improved transparency, particularly by including built-in recipient categories, and that organizational conflicts of interest need more policy attention, including disclosure of payments independent of the industry.
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Affiliation(s)
- Piotr Ozieranski
- Department of Social and Policy Sciences, University of Bath, Bath, United Kingdom
| | | | - Emily Rickard
- Department of Social and Policy Sciences, University of Bath, Bath, United Kingdom
| | - Jordan Tchilingirian
- Department of Social and Policy Sciences, University of Bath, Bath, United Kingdom
| | - Shai Mulinari
- Department of Sociology, Lund University, Lund, Sweden
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Edwards SE, Morel CM, Busse R, Harbarth S. Combatting Antibiotic Resistance Together: How Can We Enlist the Help of Industry? Antibiotics (Basel) 2018; 7:antibiotics7040111. [PMID: 30567308 PMCID: PMC6315850 DOI: 10.3390/antibiotics7040111] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 12/11/2018] [Accepted: 12/13/2018] [Indexed: 11/16/2022] Open
Abstract
The development of antibiotics needs to be supported through new financial stimuli, including help from the public sector. In exchange for public support, industry should be asked to do what is in their power to help curb the inappropriate use of antibiotics. This work discusses key areas through which industry has an important influence on antibiotic consumption and where agreements can be made alongside financial incentives, even those intended to stimulate very early research. As long as the traditional unit sale-based business model for antibiotics remains in place, profit-making incentives will likely undermine efforts to sell and utilize antibiotics in a sustainable manner. In the short-term, while we try to come to a consensus on how best to fix the market, we need measures to prevent major over-selling and inappropriate promotion—especially for new, badly needed antibiotics that reach the market. This paper explores ways in which the pharmaceutical industry could help buttress sustainable antibiotic use while we search for more long-term, constructive, mutually-beneficial ways to organize the market.
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Affiliation(s)
- Suzanne E Edwards
- Department of Health Care Management, Berlin University of Technology, Straße des 17. Juni 135, 10623 Berlin, Germany.
- Infection Control Programme, WHO Collaborating Centre, University of Geneva Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland.
| | - Chantal M Morel
- Infection Control Programme, WHO Collaborating Centre, University of Geneva Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland.
- LSE Health, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK.
| | - Reinhard Busse
- Department of Health Care Management, Berlin University of Technology, Straße des 17. Juni 135, 10623 Berlin, Germany.
| | - Stephan Harbarth
- Infection Control Programme, WHO Collaborating Centre, University of Geneva Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland.
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Abstract
Overdiagnosis, is defined as the diagnosis of a condition that, if unrecognized, would not cause symptoms or harm a patient during his or her lifetime, and it is increasingly acknowledged as a consequence of screening for cancer and other conditions. Because preventive care is a crucial component of primary care, which is delivered to the broad population, overdiagnosis in primary care is an important problem from a public health perspective and has far reaching implications. The scope of overdiagnosis as a result of services delivered in primary care is unclear, though overdiagnosis of indolent breast, prostate, thyroid, and lung cancers is well described and overdiagnosis of chronic kidney disease, depression, and attention-deficit/hyperactivity disorder is also recognized. However, overdiagnosis is a known consequence of all screening and can be assumed to occur in many more clinical contexts. Overdiagnosis can harm patients by leading to overtreatment (with associated potential toxicities), diagnosis related anxiety or depression, and labeling, or through financial burden. Many entrenched factors facilitate overdiagnosis, including the growing use of advanced diagnostic technology, financial incentives, a medical culture that encourages greater use of tests and treatments, limitations in the evidence that obscure the understanding of diagnostic utility, use of non-beneficial screening tests, and the broadening of disease definitions. Efforts to reduce overdiagnosis are hindered by physicians' and patients' lack of awareness of the problem and by confusion about terminology, with overdiagnosis often conflated with related concepts. Clarity of terminology would facilitate physicians' understanding of the problem and the growth in evidence regarding its prevalence and downstream consequences in primary care. It is hoped that international coordination regarding diagnostic standards for disease definitions will also help minimize overdiagnosis in the future.
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Affiliation(s)
- Minal S Kale
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Deborah Korenstein
- Department of Medicine and Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY 10017, USA
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Golestaneh L. Transparency in continuing medical education - Author's reply. Lancet 2018; 391:2324. [PMID: 29900872 DOI: 10.1016/s0140-6736(18)30780-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 03/19/2018] [Indexed: 11/21/2022]
Affiliation(s)
- Ladan Golestaneh
- Renal Division, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, New York City, NY 10467, USA.
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Affiliation(s)
- Graham McMahon
- Accreditation Council for Continuing Medical Education, Chicago, IL 60611, USA.
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