Applying a social theory of learning to explain the possible impacts of continuing professional development (CPD) programs

Measuring the added value of virtual communities of practice for developing the educator role of critical care professionals

In healthcare settings, workplace learning is often supported by clinicians who strive to combine service provision and educator roles. We evaluated an international 12-month programme that supports widely distributed critical care health professional educators (HPEs) through a virtual community of practice (vCoP). Specifically, we evaluate if and how the vCoP approach affects learning experiences using an innovative evaluation framework in medical education-the value-creation framework (VCF). We used a mixed-methods approach to evaluation, including an anonymous survey and semistructured interviews. Themes from data sources were identified using the VCF as the common thread. Themes discussed by at least two-thirds of interview participants were analysed using narrative inquiry. 27 of 66 participants responded to the survey, and 15 participated in interviews. Positive and negative indicators of value creation were extracted and organised according to the framework's eight value cycles. Framework analysis made value-creation and potential flow-on effects in one value-creation cycle to another visible, offering insight into relationships. Themes from narrative inquiry elaborated on the results of the framework analysis. Using the VCF to evaluate the Incubator programme brings to bear the complexity of boundary-crossing HPE faculty development for critical care educators. The framework can be a valuable tool for evaluating a vCoP associated with faculty development programmes.

Online learning in health professions education. Part 2: Tools and practical application: AMEE Guide No. 163

Part 1 of the AMEE Guide Online learning in health professions education focused on foundational concepts such as theory, methods, and instructional design in online learning. Part 2 builds upon Part 1, introducing technology tools and applications of these foundational concepts by exploring the various levels (from beginner to advanced) of utilisation, while describing how their usage can transform Health Professions Education. This Part covers Learning Management Systems, infographics, podcasting, videos, websites, social media, online discussion forums, simulation, virtual patients, extended and virtual reality. Intertwined are other topics, such as online small group teaching, game-based learning, FOAM, online social and collaboration learning, and virtual care teaching. We end by discussing digital scholarship and emerging technologies. Combined with Part 1, the overall aim of Part 2 is to produce a comprehensive overview to help guide effective use online learning in Health Professions Education.

Big Assumptions in Online and Blended Continuing Professional Development: Finding Our Way Forward Together

ABSTRACT

Continuing professional development (CPD) providers and faculty face a practice gap between our knowledge of effective practices in CPD and our implementation of them, particularly in online environments. Developmental psychologists Bob Kegan and Lisa Lahey have attributed such knowledge-implementation gaps to an "Immunity to Change" rooted in tacit "Big Assumptions." These Big Assumptions produce fears or worries, reveal competing commitments, and result in actions or inactions that hinder intended change. We sought to understand the barriers to change in online and blended CPD, to support CPD leaders in pursuing their goals for optimal use of technology in CPD. This inquiry arose from the 13th National Continuing Professional Development Accreditation Conference of the Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada, a virtual conference held in October 2022. After introducing the Immunity to Change framework and best practices in online and blended learning, we invited audience members to list Big Assumptions in CPD through chat and polling software. These responses were analyzed and grouped into five interrelated Big Assumptions that suggest a number of key barriers to optimal implementation of online CPD. We present data that counter each Big Assumption along with practical approaches to facilitate desired change for CPD.

Continuing professional development opportunities for Australian endorsed for scheduled medicines podiatrists-What's out there and is it accessible, relevant, and meaningful? A cross-sectional survey

BACKGROUND

Non-medical prescribing is a valuable strategy to enable equitable access to medications in the context of the increasing demands on health services globally. Australian podiatrists have been able to seek endorsement for scheduled medicines (ESM) for over a decade. This project investigates the perceptions and habits of ESM podiatrists in meeting the extra continuing professional development (CPD) requirements associated with their ESM status.

METHODS

Australian ESM podiatrists completed an anonymous, online survey capturing demographics; CPD engagement; and self-reflections of CPD activities.

RESULTS

Twenty percent (n = 33) of Australian ESM registered podiatrists (N = 167) responded to the survey (18 female; median ESM status 2.5 years, (IQR 1.0, 9.0)). For the previous registration period, 88% (n = 29) completed the mandatory CPD hours, with only 35% (n = 11) completing a CPD learning goal plan. Over 80% identified their last ESM CPD activity as accessible, affordable, and could recommend to colleagues. Conversely, 50% or less agreed the activity increased confidence; changed their practice; improved communication skills; or enabled networking. Most respondents (81%, n = 27) indicated improvements should be made to the content, relevance, accessibility, and meaningfulness of CPD. These findings were supported by responses to the open-ended questions.

CONCLUSIONS

Our findings suggest ESM podiatrists engage in CPD that is accessible rather than learning goal driven. Concerningly, CPD activities resulted in low translation of learnings to practice. This brings in to question the value of mandatory CPD systems based on minimum hours, rather than meaningfulness.

Are We Ever Going Back? Exploring the Views of Health Professionals on Postpandemic Continuing Professional Development Modalities

INTRODUCTION

The COVID-19 pandemic has profoundly altered the ways in which health care professionals engage with continuing professional development (CPD), but the extent to which these changes are permanent remains unknown at present. This mixed-methods research aims to capture the perspectives of health professionals on their preferences for CPD formats, including the conditions that inform preferences for in-person and online CPD events and the optimum length and type of online and in-person events.

METHODS

A survey was used to gain a high-level perspective on health professionals' engagement with CPD, areas of interest, and capabilities and preferences in relation to online formats. A total of 340 health care professionals across 21 countries responded to the survey. Follow-up semistructured interviews were conducted with 16 respondents to gain deeper insights into their perspectives.

RESULTS

Key themes include CPD activity before and during COVID, social and networking aspects, access versus engagement, cost, and time and timing.

DISCUSSION

Recommendations regarding the design of both in-person and online events are included. Beyond merely moving in-person events online, innovative design approaches should be adopted to capitalize on the affordances of digital technologies and enhance engagement.

'Maybe what I do know is wrong…': Reframing educator roles and professional development for teaching Indigenous health

Settler colonisation continues to cause much damage across the globe. It has particularly impacted negatively on Indigenous peoples' health and wellbeing causing great inequity. Health professional education is a critical vehicle to assist in addressing this; however, non-Indigenous educators often feel unprepared and lack skill in this regard. In this qualitative study, 20 non-Indigenous nursing, physiotherapy and occupational therapy educators in Australia were interviewed about their experiences and perspectives of teaching Indigenous health. Findings from the inductive thematic analysis suggest educators require skill development to: identify their discomfort in teaching cultural safety; contextualise the sources of this discomfort and; reflect on how this understanding can improve their teaching. Additionally, educators require professional training to become practitioners of cultural humility and to be facilitators and colearners (rather than experts) of the Aboriginal-led curriculum. Of relevance to this is educator training in how to decentre non-Indigenous needs and perspectives. Educators can also renew their teaching practices by understanding what a dominant settler paradigm is, identifying if this is problematically present in their teaching and knowing how to remedy this. Crucial to improved cultural safety teaching is institutional support, which includes Indigenous leadership, institutional commitment, relevant policies, and well-designed professional development.

Promoting Transfer of Learning to Practice in Online Continuing Professional Development

Leveraging online learning tools and encouraging transfer of learning to practice remains a critical challenge to successful continuing professional development (CPD) offerings. Four sets of factors are essential to the transfer of learning from CPD into practice: learner characteristics, instructional design, content, and environment. Through incorporating elements of educational theories/frameworks into the planning of online CPD activities, educators can maximize opportunities for learning transfer. In this article, we highlight four educational theories/frameworks that provide useful insight to tackle these interrelated factors in online CPD: Self-Determination Theory considers the intrinsic and extrinsic motivation of participants, which can be encouraged through flexibility, customization, and choices available in online formats. Practical Inquiry Model encourages intentionally planning and embedding opportunities for reflection and dialogue in online activities to enhance knowledge application. Virtual Communities of Practice can be used to transcend spatial and temporal boundaries, promoting interactions and relationships where participants learn from peers. Finally, Professional Learning Networks can be fostered through developing interpersonal connections and sharing resources for informal and flexible learning. Online CPD is likely to increase in the future, and educators should consider elements of these educational theories/frameworks in the design and delivery of CPD to support participants' application of newly acquired knowledge.

Pediatric Emergency Medicine ECHO (Extension for Community Health Care Outcomes): Cultivating Connections to Improve Pediatric Emergency Care

BACKGROUND

An Extension for Community Health Care Outcomes (ECHO) provides the opportunity for specialists at academic medical centers (AMCs) and frontline community generalists to engage in bidirectional learning. Specialists provide generalists with the current best evidence, and generalists share the local challenges applying this evidence to their practice. All ECHO participants strategize how to navigate these challenges together. Pediatric emergency medicine (PEM) may benefit from this knowledge translation strategy because most children seek emergency care from generalists in community emergency departments (CEDs) where variations in care between the AMC and the CED have been reported.

METHODS

Our objective was to use ECHO to cultivate a PEM community of practice that facilitated knowledge translation and generated future CED pediatric improvement initiatives. As such, we developed, implemented, and evaluated a PEM ECHO. We conducted general and targeted needs assessments to inform our curriculum and formatted the sessions to generate bidirectional learning. A postparticipation evaluation collected self-reported perceptions about knowledge translation, planned provider practice changes, and perceptions of the formation of a community of practice. Additionally, we solicited information on the implementation of any pediatric improvement activities attributed to the PEM ECHO.

RESULTS

Thirteen 1-hour sessions covered the chosen PEM topics. Participants represented diverse CEDs, with varied experience and roles in caring for children. All respondents (13/13) appreciated the ECHO learning format, reported improved PEM knowledge, and perceived the cultivation of a community of practice. Nine (85%) individuals attributed implementation of new pediatric improvement activities to the PEM ECHO.

CONCLUSIONS

Our PEM ECHO was associated with improved perceptions of PEM knowledge, cultivated a community of practice, and facilitated the implementation of CED pediatric improvement activities. The PEM ECHO's bidirectional learning format generated new initiatives and partnerships aiming to improve the emergency care of children.

Measuring impacts of continuing professional development (CPD): The development of the CPD impacts survey (CPDIS)

INTRODUCTION

Evaluating continuing professional development (CPD) programs is essential to demonstrate their value to participants and their institutions, and to inform the improvement and quality of CPD programs. Existing surveys measure a narrow range of impacts. This study developed a survey that can measure a broad range of impacts of CPD programs, not just those that are easily measured such as knowledge, skills, attitudes and confidence.

METHOD

The development of the CPD Impacts Survey (CPDIS) was informed by best practice guidelines. A systematic scoping review, qualitative interviews, and existing survey instruments were used to develop the initial survey items. Past participants from two international health professions education institutes completed the survey (n = 292). Principal component analysis (PCA) was used to refine the survey.

RESULTS

The PCA provided a three-component solution. Component 1 (learnings and self-efficacy), Component 2 (networking and building community), and Component 3 (achievement and validation) comprising 47, 14, and 13 items, respectively. The three components had high internal consistency (α = .98, α = .95, α = .92, respectively).

CONCLUSION

The CPDIS is the first survey to assess a broader range of impacts of CPD programs. Given the substantial financial and opportunity costs of participation in CPD, the CPDIS will allow more efficient and accurate evaluation of the utility and value of CPD programs.

Doctors' maintenance of professional competence: a qualitative study informed by the theory of planned behaviour

BACKGROUND

Medical regulators worldwide have implemented programmes of maintenance of professional competence (MPC) to ensure that doctors, throughout their careers, are up to date and fit to practice. The introduction of MPC required doctors to adopt a range of new behaviours. Despite high enrolment rates on these programmes, it remains uncertain whether doctors engage in the process because they perceive benefits like improvements in their practice and professional development or if they solely meet the requirements to retain medical registration. In this study, we aimed to explore the relationship between doctors' beliefs, intention and behaviour regarding MPC through the lens of the Theory of Planned Behaviour (TPB) to make explicit the factors that drive meaningful engagement with the process.

METHODS

We conducted a qualitative study using semi-structured interviews. From a pool of 1258 potential participants, we purposively selected doctors from multiple specialities, age groups, and locations across Ireland. We used thematic analysis, and the TPB informed the analytic coding process.

RESULTS

Forty-one doctors participated in the study. The data analysis revealed doctors' intention and behaviour and the factors that shape their engagement with MPC. We found that attitudes and beliefs about the benefits and impact of MPC mediated the nature of doctors' engagement with the process. Some participants perceived positive changes in practice and other gains from participating in MPC, which facilitated committed engagement with the process. Others believed MPC was unfair, unnecessary, and lacking any benefit, which negatively influenced their intention and behaviour, and that was demonstrated by formalistic engagement with the process. Although participants with positive and negative attitudes shared perceptions about barriers to participation, such perceptions did not over-ride strongly positive beliefs about the benefits of MPC. While the requirements of the regulator strongly motivated doctors to participate in MPC, beliefs about patient expectations appear to have had less impact on intention and behaviour.

CONCLUSIONS

The findings of this study broaden our understanding of the determinants of doctors' intention and behaviour regarding MPC, which offers a basis for designing targeted interventions. While the barriers to engagement with MPC resonate with previous research findings, our findings challenge critical assumptions about enhancing doctors' engagement with the process. Overall, our results suggest that focused policy initiatives aimed at strengthening the factors that underpin the intention and behaviour related to committed engagement with MPC are warranted.