What Influences Choice of Continuing Medical Education Modalities and Providers? A National Survey of U.S. Physicians, Nurse Practitioners, and Physician Assistants

Current status and continuing medical education need for general practitioners in Tibet, China: a cross-sectional study

BACKGROUND

The Tibetan area is one of China's minority regions with a shortage of general practice personnel, which requires further training and staffing. This research helps to understand the current condition and demand for general practitioner (GP) training in Tibetan areas and to provide a reference for promoting GP education and training.

METHODS

We conducted a cross-sectional survey using stratified sampling targeting 854 GPs in seven cities within the Tibetan Autonomous Region, utilizing an online questionnaire. Achieving a high response rate of 95.1%, 812 GPs provided invaluable insights. Our meticulously developed self-designed questionnaire, available in both Chinese and Tibetan versions, aimed to capture a wide array of data encompassing basic demographics, clinical skills, and specific training needs of GPs in the Tibetan areas. Prior to deployment, the questionnaire underwent rigorous development and refinement processes, including expert consultation and pilot testing, to ensure its content validity and reliability. In our analysis, we employed descriptive statistics to present the characteristics and current training needs of GPs in the Tibetan areas. Additionally, chi-square tests were utilized to examine discrepancies in training needs across various demographic groups, such as age, job positions, and educational backgrounds of the participating GPs.

RESULTS

The study was completed by 812 (812/854, 95.1%) GPs, of whom 62.4% (507/812) were female. The top three training needs were hypertension (81.4%, 661/812), pregnancy management (80.7%, 655/812), and treatment of related patient conditions and events (80.5%, 654/812). Further research shows that the training required by GPs of different ages in "puncturing, catheterization, and indwelling gastric tube use" (64.6% vs. 54.8%, p = 9.5 × 10- 6) varies statistically. GPs in various positions have different training needs in "community-based chronic disease prevention and management" (76.6% vs. 63.9%, p = 0.009). The training needs of GPs with different educational backgrounds in "debridement, suturing, and fracture fixation" (65.6% vs. 73.2%, p = 0.027) were also statistically significant.

CONCLUSIONS

This study suggests the need for targeted continuing medical education activities and for updating training topics and content. Course developers must consider the needs of GPs, as well as the age, job positions, and educational backgrounds of GPs practicing in the Tibetan Plateau region.

TRIAL REGISTRATION

Not applicable.

Self-reported preferences and barriers to continued professional development in primary care physicians: a cross-sectional web-based survey in Qatar

INTRODUCTION

High quality and effective primary healthcare is a national priority in Qatar. Continuing professional development (CPD) for physicians is a cornerstone of this objective, yet little is known about physicians' preferences or barriers to CPD participation.

METHOD

A needs assessment was conducted using a cross-sectional web-based survey of primary care physicians registered with the Department of Healthcare Practitioners (DHP) between March and June 2017.

RESULTS

Two-hundred-and-eighty-one complete surveys were submitted representing physicians in both public (N = 129) and private sectors (N = 152). Physicians completed medical degrees and postgraduate training across multiple countries, and most had been practicing in Qatar for 5 years or less. 'Activities during working hours', 'cost' and 'work commitments' were the most common barriers. There was little consensus regarding the optimal timing of CPD activities, although public sector physicians were more likely to indicate weekend activities as a barrier to participation (30% vs. 9%). Over 90% of participants preferred traditional lectures, workshops, case-based sessions, small group and online self-paced learning as formats for CPD delivery, however alternative modes of delivery were also deemed acceptable (> 80% agreement).

CONCLUSION

Understanding primary care physicians' barriers and preferences is an essential component of a larger necessitated needs assessment of CPD in primary care practitioners in Qatar. Further research is warranted to understand the underlying beliefs driving physicians' choices and the apparent variation between those working in the public and private sectors. CPD developers should consider approaches to mitigate perceived barriers and understand preferences to maximize the quality of participation.

Continuing education for advanced practice nurses: A scoping review

AIM

The aim of the study was to identify the nature and extent of scientific research addressing continuing education for advanced practice nurses.

DESIGN

A scoping review.

REVIEW METHODS

The Joanna Briggs Institute's methodology for scoping reviews.

DATA SOURCES

Electronic search was conducted on 17 September 2023 via CINAHL, PsycINFO, PubMed, Scopus, Web of Science, Cochrane Library and the Joanna Briggs Institute's Evidence-Based Practice Database for research articles published between 2012 and 2023.

RESULTS

Nineteen papers were included in this review. Scientific research on continuing education for advanced practice nursing roles (i.e. nurse practitioner, clinical nurse specialist) has primarily been conducted in the United States and mostly addresses online-delivered continuing education interventions for clinical care competency. Most of the interventions targeted nurse practitioners.

CONCLUSION

Continuing education has a pivotal role in supporting advanced practice nursing competency development. In addition to clinical care, future continuing education research should focus on other advanced practice nursing competencies, such as education, leadership, supporting organizational strategies, research and evidence implementation.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Continuing education programmes for advanced practice nurses should be rigorously developed, implemented and evaluated to support the quality and effectiveness of patient care.

IMPACT

Continuing education for advanced practice nursing roles is an understudied phenomenon. This review highlights future research priorities and may inform the development of continuing education programmes.

REPORTING METHOD

PRISMA-ScR.

The Role of Specialty Certification in Career-Long Competence

Across the medical profession there is broad acceptance of the critical role of continuing medical education (CME) in enabling physicians to adapt to both new information and evolving expectations within the profession. In the presence of widespread participation in CME, some have attempted to question, discredit, or marginalize the role of ongoing lifelong assessment of physician knowledge and skills through specialty continuing certification, advocating instead for a participatory standard based only on engagement with CME. This essay outlines the limitations of physician self-evaluation and clarifies the need for external assessments. Certification boards' role is to set specialty-specific standards for competence, assess to those standards, and assure the public that certified physicians are adequately maintaining their skills and abilities; doing so credibly necessarily requires, in part, independent assessments of physician competence. In these contexts, the specialty boards are taking approaches to identify performance gaps and leverage intrinsic motivation to facilitate physician engagement in targeted learning. Specialty board continuing certification plays a unique role, distinct from and complementary to the CME enterprise. Calls to eliminate continuing certification requirements beyond self-directed CME are contradictory to the evidence and fail the profession and the public.

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.

Video-Based (Livestream) and In-Person Continuing Professional Development: Participant and Course Features Associated With Choice

PURPOSE

Information on factors influencing learner choice between in-person and video-based continuing professional development (CPD) would help course leaders with planning and implementation. This study aimed to investigate how registration patterns differ between in-person and video-based offerings for the same CPD course.

METHOD

The authors obtained data from 55 CPD courses offered in-person (at various U.S. locations) and via livestreamed video, January 2020 to April 2022. Participants included physicians, advanced practice providers, allied health professionals, nurses, and pharmacists. Registration rates were compared by participant and course features including professional role, age, country of residence, distance to and perceived desirability of the in-person destination, and timing of registration.

RESULTS

Analyses included 11,072 registrations, of which 4,336 (39.2%) were for video-based learning. There was significant heterogeneity in video-based registrations across courses, ranging 14.3% to 71.4%. Multivariable analysis showed higher video-based registrations for advanced practice providers (vs physicians; adjusted odds ratio [AOR] 1.80 [99% confidence interval, 1.55-2.10]), non-U.S. residents (AOR 3.26 [1.18-9.01]), longer distance (AOR 1.19 [1.16-1.23] for each doubling of distance), and courses in July-September 2021 (vs January-April 2022; AOR 1.59 [1.24-2.02]); video-based registrations were lower for current or former employees or trainees of our institution (AOR 0.53 [0.45-0.61]), destinations of moderate or high desirability (vs low; AOR 0.42 [0.34-0.51] and 0.44 [0.33-0.58], respectively), and early registration (AOR 0.67 [0.64-0.69] for each doubling of days between registration and course start). There was no significant difference by age (AOR 0.92 [0.82-1.05] for participants > 46 years old vs younger participants). The multivariable model correctly predicted actual registration 78.5% of the time.

CONCLUSIONS

Video-based livestreamed CPD is popular (chosen by nearly 40% of participants), although choices varied widely by course. Professional role, institutional affiliation, distance traveled, location desirability, and registration timing have small but statistically significant associations with choice of video-based vs in-person CPD.

Web-Based Learning for General Practitioners and Practice Nurses Regarding Behavior Change: Qualitative Descriptive Study

BACKGROUND

Supporting patients to live well by optimizing behavior is a core tenet of primary health care. General practitioners and practice nurses experience barriers in providing behavior change interventions to patients for lifestyle behaviors, including low self-efficacy in their ability to enact change. Web-based learning technologies are readily available for general practitioners and practice nurses; however, opportunities to upskill in behavior change are still limited. Understanding what influences general practitioners' and practice nurses' adoption of web-based learning is crucial to enhancing the quality and impact of behavior change interventions in primary health care.

OBJECTIVE

This study aimed to explore general practitioners' and practice nurses' perceptions regarding web-based learning to support patients with behavior change.

METHODS

A qualitative, cross-sectional design was used involving web-based, semistructured interviews with general practitioners and practice nurses in Queensland, Australia. The interviews were recorded and transcribed using the built-in Microsoft Teams transcription software. Inductive coding was used to generate codes from the interview data for thematic analysis.

RESULTS

In total, there were 11 participants in this study, including general practitioners (n=4) and practice nurses (n=7). Three themes emerged from the data analysis: (1) reflecting on the provider of the Healthy Lifestyles suite; (2) valuing the web-based learning content and presentation; and (3) experiencing barriers and facilitators to using the Healthy Lifestyles suite.

CONCLUSIONS

Provider reputation, awareness of availability, resources, content quality, usability, cost, and time influence adoption of web-based learning. Perceived quality is associated with culturally tailored information, resources, a balance of information and interactivity, plain language, user-friendly navigation, appealing visual presentation, communication examples, and simple models. Free web-based learning that features progress saving and module lengths of less than 2 hours alleviate perceived time and cost barriers. Learning providers may benefit by including these features in their future behavior change web-based learning for general practitioners and practice nurses.

Barriers and facilitators to the uptake of the Concussion Awareness Training Tool as continuing medical education in primary care

Aim

Continuing medical education (CME) informs physicians on current research. The Concussion Awareness Training Tool (CATT) provides education on concussion diagnosis and treatment. The aims of this study were to explore physician CME practices and preferences, understand barriers and facilitators to implementing the CATT as CME, and provide recommendations.

Materials & methods

Physicians in British Columbia, Canada participated in an online survey and telephone interview. Descriptive analysis of quantitative data, and text-based data analysis were undertaken to identify themes.

Results

Barriers included lack of time and awareness of the resource. Facilitators were its ease of use, accessibility, conciseness and comprehensiveness.

Conclusion

The perceptions of barriers and facilitators reported by physicians are important to understand and better promote the use of the CATT.

Using "Big Data" to Provide Insights into Early Adopters of Continuing Professional Development: An Example from Project ECHO

INTRODUCTION

Mental health care is often managed in primary care with limited specialist support, particularly in rural and remote communities. Continuing professional development programs (CPD) can offer a potential solution to further mental health training; however, engaging primary care organizations (PCOs) can be challenging. The use of "big data" to identify factors influencing engagement in CPD programs has not been well studied. Therefore, the aim of this project was to use administrative health data from Ontario, Canada to identify characteristics of PCOs associated with early engagement in a virtual CPD program, Project Extension for Community Healthcare Outcomes (ECHO) Ontario Mental Health (ECHO ONMH).

METHODS

Ontario health administrative data for fiscal year 2014 was used to compare the characteristics of ECHO ONMH-adopting PCOs, and their patients, to nonadopter organizations (N = 280 vs. N = 273 physicians).

RESULTS

ECHO-adopting PCOs did not differ with respect to physician age or years of practice, although PCOs with more female physicians were somewhat more likely to participate. ECHO ONMH adoption was more likely in regions with lower psychiatrist supply, among PCOs using partial salary payment models, and those with a greater interprofessional complement. Patients of ECHO-adopters did not differ on the basis of gender or health care utilization (physical or mental health); however, ECHO-adopting PCOs tended to have patients with less psychiatric comorbidity.

CONCLUSION

Models such as Project ECHO, which deliver CPD to primary care, are advanced to address lack of access to specialist health care. These findings support the use of administrative health data to assess the implementation, spread, and impact of CPD.

Physicians' continuing medical education activities and satisfaction with their ability to stay current in medical information and practice: A cross-sectional study

Background and Aims

Little is known about physicians' approaches to continuing medical education (CME) for continuing professional development despite the rapid evolution of CME offerings. We sought to identify the extent to which demographic, career, and experiential CME-activity variables were independently associated with physicians' satisfaction with their ability to stay current on medical information and practice.

Methods

Using the 2019 Association of American Medical Colleges' National Sample Survey of Physicians data, we ran multivariable logistic regression models examining demographic, career, and experiential (participation in 11 CME activities in the past year) variables for their associations with physicians' satisfaction (satisfied vs. not satisfied/neutral) with their ability to stay current.

Results

Of 5926 respondents, 90% (5341/5926) were satisfied with their ability to stay current. Significant (each two-sided p < 0.05) predictors of respondents who were satisfied included (among others) a surgery specialty (vs. primary care; adjusted odds ratio [AOR] = 1.41, 95% confidence interval [CI] = 1.06-1.88), an academic affiliation (vs. none; AOR = 1.35, 95% CI = 1.10-1.66), and participation (vs. no participation) in each of professional meetings (AOR = 1.31, 95% CI = 1.07-1.60) and journal-based CME (AOR = 1.29, 95% CI = 1.07-1.56). Respondents who self-identified as a race/ethnicity underrepresented in medicine (vs. white; AOR = 0.68, 95% CI = 0.48-0.97) and were between ages 40 and 49 years (vs. 50-59; AOR = 0.74; 95% CI = 0.58-0.94) were less likely to be satisfied. Gender, board certification status, and medical degree type did not independently predict satisfaction (each p > 0.05).

Conclusion

We observed independent associations between physicians' satisfaction with their ability to stay current in medical information and practice and each specialty, academic affiliation, race/ethnicity, age, and CME activity type (for 2 of 11 examined). Findings may be relevant to organizations and institutions designing and implementing CME activities in the current context of COVID-19 pandemic-related in-person activity limitations and can inform targeted interventions addressing differences in the satisfaction we observed to better support physicians' CME.

Continuing professional development needs in pain management for Canadian health care professionals: A cross sectional survey

Background

Continuing professional development is an important means of improving access to effective patient care. Although pain content has increased significantly in prelicensure programs, little is known about how postlicensure health professionals advance or maintain competence in pain management.

Aims

The aim of this study was to investigate Canadian health professionals' continuing professional development needs, activities, and preferred modalities for pain management.

Methods

This study employed a cross-sectional self-report web survey.

Results

The survey response rate was 57% (230/400). Respondents were primarily nurses (48%), university educated (95%), employed in academic hospital settings (62%), and had ≥11 years postlicensure experience (70%). Most patients (>50%) cared for in an average week presented with pain. Compared to those working in nonacademic settings, clinicians in academic settings reported significantly higher acute pain assessment competence (mean 7.8/10 versus 6.9/10; P < 0.002) and greater access to pain specialist consultants (73% versus 29%; P < 0.0001). Chronic pain assessment competence was not different between groups. Top learning needs included neuropathic pain, musculoskeletal pain, and chronic pain. Recently completed and preferred learning modalities respectively were informal and work-based: reading journal articles (56%, 54%), online independent learning (44%, 53%), and attending hospital rounds (43%, 42%); 17% had not completed any pain learning activities in the past 12 months. Respondents employed in nonacademic settings and nonphysicians were more likely to use pocket cards, mobile apps, and e-mail summaries to improve pain management.

Conclusions

Canadian postlicensure health professionals require greater access to and participation in interactive and multimodal methods of continuing professional development to facilitate competency in evidence-based pain management.

Exploring the Study of Simulation as a Continuing Professional Development Strategy for Physicians

INTRODUCTION

Practicing physicians have the responsibility to engage in lifelong learning. Although simulation is an effective experiential educational strategy, physicians seldom select it for continuing professional development (CPD) for reasons that are poorly understood. The objective of this study was to explore existing evidence on simulation-based CPD and the factors influencing physicians' engagement in simulation-based CPD.

METHODS

A scoping review of the literature on simulation-based CPD included MEDLINE, Embase, and CINAHL databases. Studies involving the use of simulation for practicing physicians' CPD were included. Information related to motivations for participating in simulation-based CPD, study objectives, research question(s), rationale(s), reasons for using simulation, and simulation features was abstracted.

RESULTS

The search yielded 8609 articles, with 6906 articles undergoing title and abstract screening after duplicate removal. Six hundred sixty-one articles underwent full-text screening. Two hundred twenty-five studies (1993-2021) were reviewed for data abstraction. Only four studies explored physicians' motivations directly, while 31 studies described incentives or strategies used to enroll physicians in studies on simulation-based CPD. Most studies focused on leveraging or demonstrating the utility of simulation for CPD. Limited evidence suggests that psychological safety, direct relevance to clinical practice, and familiarity with simulation may promote future engagement.

DISCUSSION

Although simulation is an effective experiential educational method, factors explaining its uptake by physicians as a CPD strategy are unclear. Additional evidence of simulation effectiveness may fail to convince physicians to participate in simulation-based CPD unless personal, social, educational, or contextual factors that shape physicians' motivations and choices to engage in simulation-based CPD are explored.

Development and Implementation of an Online Pain Management Continuing Education Program

BACKGROUND

Multiple studies indicate a lack of pain management training across a range of healthcare specialties. The online Joint Pain Education Program (OJPEP) was created to provide content covering various topics that range from general pain science to integrative care to pain management. The present study evaluates the feasibility of an interdisciplinary, self-guided, online pain management continuing education program, the OJPEP.

PARTICIPANTS/SUBJECTS

A total of 228 learners participted in this study. Of the 228 learners, 58 learners identified as registered nurses and 12 learners identified as nurse practitioners.

DESIGN

Prospective single-arm education feasibility study.

METHODS

Potential learners were provided invitations to participate via emails from clinic leadership and postings to hospital intranet websites. Learners registered online and could select up to eight modules, based on the materials developed from a Department of Defense/Veterans Administration project. Learners evaluated their satisfaction with module quality and applicability.

RESULTS

A variety of providers, predominately non-prescribers, across many health care specialties, registered for modules. Across all modules except one, less than half of participants who registered completed the selected module. Time stamps indicated many learners skipped module content. Of those who completed the continuing education evaluation to obtain certificates, the majority indicated the content was of high-quality, appropriate, and evidence-based. One-third to approximately one-half of learners indicated that they would apply content in their clinical practice. Completion of the intended 3-month follow-up survey was poor.

CONCLUSIONS

Though modules were acceptable per learner responses, future work is needed to: develop modules that are more engaging (e.g., interactive) and applicable to learners; and improve implementation methods to include dissemination and evaluation metrics.

Effectiveness of interprofessional shared decision-making training: A mixed-method study

OBJECTIVE

This study evaluated the learning effects and examined the participants' perceptions of an interprofessional shared decision-making (IP-SDM) training program.

METHODS

This mixed-method study used a quasi-experimental pretest-posttest design in the quantitative phase and semi-structured interviews in the qualitative phase. The 6-week curriculum design, based on Kolb's experiential learning cycle, consisted of two simulated objective structured clinical examinations with standardized patients and blended teaching methods through various course modules.

RESULTS

A total of 39 multidisciplinary healthcare personnel completed the 6-week training program, and 32 of them participated in qualitative interviews. The IP-SDM training program effectively improved the SDM process competency of the participants from the perspectives of the participants, standardized patients, and clinical teachers. The interviews illustrated how the curriculum design enhanced learning; the effectiveness results indicated improvements in learners' attitude, knowledge, skills, and teamwork.

CONCLUSION

This IP-SDM training program improved multidisciplinary healthcare personnel's competency, self-efficacy, and intention to engage in IP-SDM.

PRACTICE IMPLICATIONS

Applying Kolb's experiential learning cycle and blended teaching methods to develop and implement the IP-SDM training program can improve multidisciplinary healthcare personnel's knowledge, attitude, skills, and teamwork in IP-SDM.

Effectiveness of end-stage renal disease communication skills training for healthcare personnel: a single-center, single-blind, randomized study

BACKGROUND

Given that the consequences of treatment decisions for end-stage renal disease (ESRD) patients are long-term and significant, good communication skills are indispensable for health care personnel (HCP) working in nephrology. However, HCP have busy schedules that make participation in face-to-face courses difficult. Thus, online curricula are a rising trend in medical education. This study aims to examine the effectiveness of online ESRD communication skills training (CST) concerning the truth-telling confidence and shared decision-making (SDM) ability of HCP.

METHODS

For this single-center, single-blind study, 91 participants (nephrologists and nephrology nurses) were randomly assigned to two groups, the intervention group (IG) (n = 45) or the control group (CG) (n = 46), with the IG participating in ESRD CST and the CG receiving regular in-service training. Truth-telling confidence and SDM ability were measured before (T0), 2 weeks after (T1), and 4 weeks after (T2) the intervention. Group differences over the study period were analyzed by generalized estimating equations.

RESULTS

IG participants exhibited significantly higher truth-telling confidence at T1 than did CG participants (t = 2.833, P = .006, Cohen's d = 0.59), while there were no significant intergroup differences in the confidence levels of participants in the two groups at T0 and T2. Concerning SDM ability, there were no significant intergroup differences at any of the three time points. However, IG participants had high levels of satisfaction (n = 43, 95%) and were willing to recommend ESRD CST to others (n = 41, 91.1%).

CONCLUSIONS

ESRD CST enhanced short-term truth-telling confidence, though it is unclear whether this was due to CST content or the online delivery. However, during pandemics, when face-to-face training is unsuitable, online CST is an indispensable tool. Future CST intervention studies should carefully design interactive modules and control for method of instruction.

Barriers and facilitators to implementing a continuing medical education intervention in a primary health care setting

BACKGROUND

Continuing medical education (CME), as a systematic attempt to facilitate change in General Practitioners' (GPs) practices, is considered crucial, assuming that if physicians are up-to-date, they will change and improve their practice, resulting in better performance and ultimately better patient care. However, studies continue to demonstrate considerable gaps between the real and ideal performance and patient-related outcomes. The objective of this study was to explore GP's perception of the factors affecting the implementation of a CME digital platform in a primary health care setting in Portugal.

METHODS

Our work is framed in a larger effectiveness-implementation hybrid type 1 study, where a Digital Behaviour Change Intervention (DBCI), called ePrimaPrescribe, was developed and implemented with the aim of changing benzodiazepines (BZD) prescribing patterns. Our design used mixed methodologies to obtain an enriched knowledge on GPs' perspectives on the facilitators and barriers to implementing a Digital Behaviour Change Intervention (DBCI) applied to CME. To do so, we used data coming from an onsite questionnaire, an adapted version of the Barriers and Facilitators Assessment Instrument (BaFAI) and in-depth interviews.

RESULTS

From the 47 GPs successfully included in the intervention arm of our cluster-randomized effectiveness study, we collected 37 onsite questionnaires, 24 BaFAIs, and performed 12 in-depth interviews. GPs reported as the main barriers to CME a lack of time, a perception of work overload, a lack of digital competence, a lack of digital infrastructure, and motivational and emotional factors. They reported as facilitators to CME delivered through a DBCI the convenience of the delivery method, the practical and pragmatic characteristics of the content, and the possibility for CME to be mandatory.

CONCLUSIONS

The perceptions of the barriers and facilitators reported by GPs represent an important contribution to improving knowledge regarding the factors influencing the implementation of CME in primary health care settings. We consider that our study might bring useful insights to other countries where primary health care plays a central role in the provision of care.

TRIAL REGISTRATION

ClinicalTrials.gov number NCT04925596 .

Faculty Development Advancements-Lessons Learned in a Time of Change

Faculty development (FD) activities at colleges of medicine shifted to virtual in March 2020 as the coronavirus pandemic limited in-person engagement. Medical schools delivered quality virtual faculty development (VFD) through accessing national and international experts virtually, improving faculty access to FD through recorded sessions, collaborating across institutions, and building on previous success as comfort with virtual platforms grew. Disruptive innovation and Keller's ARCS model, highlighting motivational concepts of attention, relevance, confidence, and satisfaction, guided nine faculty developers' reflections towards continuous quality improvement of VFD offerings. The convenience and low-cost availability of virtual activities mean this format will likely persist.

An Innovative Needs Assessment Approach to Develop Relevant Continuing Professional Development for Psychiatrists

OBJECTIVES

Gaps in psychiatrists' competence can interfere with the delivery of optimal patient care, particularly when these gaps have not been identified. This study aimed to assess the perceived and unperceived continuing professional development needs of psychiatrists practicing in Quebec, Canada.

METHODS

The authors sent an online cross-sectional survey (2018) to members of the 'Association des médecins psychiatres du Québec' and collected data on unperceived needs via the critical incident method (focused on managing challenging clinical cases/situations). Data were analyzed using descriptive statistics, chi-squared tests, thematic analysis, and triangulation of data. Two coders independently analyzed qualitative data.

RESULTS

Of 1150 eligible psychiatrists, 187 (16%) completed the survey. Over half were female (58%), caring for adult patients (60%), and practiced in a university hospital (49%). Top perceived and unperceived learning need areas were neurodevelopmental disorders and psychopharmacology. Three hundred forty-three factors influencing the management of reported challenges were classified as case complexity (53%), patient (22%), environment (19%), and lack of knowledge (4%). Consultation with colleagues (49%) was the most frequently accessed resource for approaching challenging cases. During the previous year and across both self-directed and group learning activities, respondents reported engaging more frequently in in-person than online activities.

CONCLUSIONS

A comprehensive needs assessment integrating perceived and unperceived needs is the cornerstone for planning relevant continuing professional development. The critical incident method is a useful tool to assess psychiatrists' unperceived needs. Critical reflection after solving complex clinical cases might provide an opportunity to optimize psychiatrists' selection of relevant continuing professional development.

Barriers to identifying and obtaining CME: a national survey of physicians, nurse practitioners and physician assistants

BACKGROUND

CPD educators and CME providers would benefit from further insight regarding barriers and supports in obtaining CME, including sources of information about CME. To address this gap, we sought to explore challenges that clinicians encounter as they seek CME, and time and monetary support allotted for CME.

METHODS

In August 2018, we surveyed licensed US clinicians (physicians, nurse practitioners, and physician assistants), sampling 100 respondents each of family medicine physicians, internal medicine and hospitalist physicians, medicine specialist physicians, nurse practitioners, and physician assistants (1895 invited, 500 [26.3%] responded). The Internet-based questionnaire addressed barriers to obtaining CME, sources of CME information, and time and monetary support for CME.

RESULTS

The most often-selected barriers were expense (338/500 [68%]) and travel time (N = 286 [57%]). The source of information about CME activities most commonly selected was online search (N = 348 [70%]). Direct email, professional associations, direct mail, and journals were also each selected by > 50% of respondents. Most respondents reported receiving 1-6 days (N = 301 [60%]) and $1000-$5000 (n = 263 [53%]) per year to use in CME activities. Most (> 70%) also reported no change in time or monetary support over the past 24 months. We found few significant differences in responses across clinician type or age group. In open-ended responses, respondents suggested eight ways to enhance CME: optimize location, reduce cost, publicize effectively, offer more courses and content, allow flexibility, ensure accessibility, make content clinically relevant, and encourage application.

CONCLUSIONS

Clinicians report that expense and travel time are the biggest barriers to CME. Time and money support is limited, and not increasing. Online search and email are the most frequently-used sources of information about CME. Those who organize and market CME should explore options that reduce barriers of time and money, and creatively use online tools to publicize new offerings.