Factors influencing rural health care professionals' access to continuing professional education

Outcome disparities in acute coronary syndrome patients from rural versus urban settings: A narrative review of causes, and strategies to minimize them

Acute coronary syndrome (ACS) remains an important cause of morbidity and mortality worldwide. Critical elements of improving outcomes in ACS patients include timely access to acute care including prompt revascularization if indicated, and subsequent ongoing secondary prevention and risk factor modification, ideally with cardiovascular specialists. It is being increasingly realized that ACS patients from rural settings suffer from inferior outcomes compared to their urban counterparts due to factors such as delayed diagnosis, delayed access to acute care, and less accessibility to specialized follow up. This narrative review will examine the importance of timely access to care in ACS patients, particularly in ST-elevation myocardial infarction; how barriers in access to care affects outcomes in various rural populations; and strategies that have been shown to improve such access, and therefore hopefully achieve more equitable health outcomes compared to patients who live in urban settings.

Expert consensus on the attributes and competencies required for rural and remote junior physicians to work effectively in isolated indonesian communities

Indonesian physicians working in rural and remote areas must be equipped not only with generic competencies but also with the attributes and skills necessary to provide health care services without compromising quality. This study sought to reach a consensus on the attributes and competencies that are viewed as essential and important for working effectively as an early career doctor in rural and remote practice in Indonesia. A two-round Delphi study was conducted by reference to 27 consenting physicians working in rural and remote Indonesia. Forty-three items covering 9 attributes and 34 competencies were sent to these physicians to be rated on a Likert scale ranging from 1 to 5 in terms of their importance for effective rural and remote practice. Nine attributes and 29 competencies progressed to Round 2. All nine attributes and 29 competencies were identified as essential or important for junior physicians' ability to be effective in their practice. The essential attributes included professional quality related to prioritising the rural community. The essential competencies included medical skills, professional behaviour, interprofessional skills, health promotion and connection to the rural community. The consensus thus reached on these essential and important attributes and competencies can inform curriculum development for the undergraduate and postgraduate training of junior rural and remote physicians.

Capacity building for providers of cognitive rehabilitation in Queensland: a needs analysis survey

Background Cognitive rehabilitation of people with traumatic brain injury is a complex and challenging area of practice. Practitioners working in cognitive rehabilitation require ongoing training to stay abreast of new research and best practice interventions. A needs analysis was conducted to inform the development of a capacity building program for cognitive rehabilitation providers. Methods A cross-sectional online survey of providers of cognitive rehabilitation services in Queensland collected data on demographic information, perceptions of knowledge, skills and confidence in cognitive rehabilitation, previously completed training, desired training opportunities and delivery methods, and barriers and facilitators to engaging in training. Results The 103 respondents included 67 occupational therapists, 17 speech pathologists, 12 psychologists and seven social workers with a broad range of practice experience. Participants perceived a need for further training, with executive function and functional cognition the most desired topics. The number of topics previously trained on was significantly correlated with levels of knowledge, skills and confidence (P   Conclusion Cognitive rehabilitation providers in Queensland reported a need for further training, delivered flexibly, with a focus on managing complex cognitive impairments.

Perceptions of Learners and Specialists Toward ECHO Palliative Care Project in Thailand

INTRODUCTION

The Extension of Community Health Outcomes (ECHO) is a global movement that aims to decentralize the knowledge of specialists to primary care. A pilot, ECHO palliative care project in Thailand, was introduced to enhance the implementation of palliative care practice.

OBJECTIVE

To assess learners' and palliative care specialists' perceptions toward the ECHO palliative care project to improve and expand the project in the future.

SETTING

A total of 15 hospitals in 7 provinces in Northern Thailand, including provincial and district hospitals.

METHODS

A qualitative study was conducted among learners (primary care providers) and palliative care specialists who participated in the pilot program. Semi-structured interviews were used to explore the potential impact of the project on clinical practice, the strengths and weaknesses of the ECHO program and platform in the Thai context, and suggestions for expansion. Thematic analysis was used for qualitative analysis. Pre- and post-confidence scores, using a 5-point Likert Scale, for palliative care practice among learners were analyzed using paired T-tests.

RESULTS

Twenty participants were interviewed: 15 learners and 5 palliative care specialists. The confidence in practicing palliative care after participating in the ECHO palliative care project significantly increased for the learners, from 2.93 (95% CI, 2.49-3.38) to 3.93 (95% CI, 3.68-4.19) points (P = .003). Three themes emerged through the process evaluation of the pilot ECHO palliative care project: (1) applicable lessons that can translate to practice, (2) an effective learning program and assessable platform, and (3) suggestions for expansion.

CONCLUSION

The ECHO palliative care project increased confidence in providing palliative care for primary care providers in Thailand. Through capacity building, participants reported applying the knowledge to improve local health services and develop a network for consultations and referrals. There is potential for expansion of the ECHO palliative care project in Thailand.

TACTICS VR Stroke Telehealth Virtual Reality Training for Health Care Professionals Involved in Stroke Management at Telestroke Spoke Hospitals: Module Design and Implementation Study

BACKGROUND

Stroke management in rural areas is more variable and there is less access to reperfusion therapies, when compared with metropolitan areas. Delays in treatment contribute to worse patient outcomes. To improve stroke management in rural areas, health districts are implementing telestroke networks. The New South Wales Telestroke Service provides neurologist-led telehealth to 23 rural spoke hospitals aiming to improve treatment delivery and patient outcomes. The training of clinical staff was identified as a critical aspect for the successful implementation of this service. Virtual reality (VR) training has not previously been used in this context.

OBJECTIVE

We sought to develop an evidence-based VR training module specifically tailored for stroke telehealth. During implementation, we aimed to assess the feasibility of workplace deployment and collected feedback from spoke hospital staff involved in stroke management on training acceptability and usability as well as perceived training impact.

METHODS

The TACTICS VR Stroke Telehealth application was developed with subject matter experts. During implementation, both quantitative and qualitative data were documented, including VR use and survey feedback. VR hardware was deployed to 23 rural hospitals, and use data were captured via automated Wi-Fi transfer. At 7 hospitals in a single local health district, staff using TACTICS VR were invited to complete surveys before and after training.

RESULTS

TACTICS VR Stroke Telehealth was deployed to rural New South Wales hospitals starting on April 14, 2021. Through August 20, 2023, a total of 177 VR sessions were completed. Survey respondents (n=20) indicated a high level of acceptability, usability, and perceived training impact (eg, accuracy and knowledge transfer; mean scores 3.8-4.4; 5=strongly agree). Furthermore, respondents agreed that TACTICS VR increased confidence (13/18, 72%), improved understanding (16/18, 89%), and improved awareness (17/18, 94%) regarding stroke telehealth. A comparison of matched pre- and posttraining responses revealed that training improved the understanding of telehealth workflow practices (after training: mean 4.2, SD 0.6; before training: mean 3.2, SD 0.9; P<.001), knowledge on accessing stroke telehealth (mean 4.1, SD 0.6 vs mean 3.1, SD 1.0; P=.001), the awareness of stroke telehealth (mean 4.1, SD 0.6 vs mean 3.4, SD 0.9; P=.03), ability to optimally communicate with colleagues (mean 4.2, SD 0.6 vs mean 3.7, SD 0.9; P=.02), and ability to make improvements (mean 4.0, SD 0.6 vs mean 3.5, SD 0.9; P=.03). Remote training and deployment were feasible, and limited issues were identified, although uptake varied widely (0-66 sessions/site).

CONCLUSIONS

TACTICS VR Stroke Telehealth is a new VR application specifically tailored for stroke telehealth workflow training at spoke hospitals. Training was considered acceptable, usable, and useful and had positive perceived training impacts in a real-world clinical implementation context. Additional work is required to optimize training uptake and integrate training into existing education pathways.

Expanding on the professional role of dental hygienists as key managers of medical-dental and hospital-dental clinic collaboration in a local Japanese hospital without a dentistry department: From a questionnaire survey after a web seminar

INTRODUCTION

Perioperative oral management (POM) was introduced into the Japanese universal health insurance system in 2012. Collaboration with dental clinics is important for hospitals without a dentistry department. A dental hygienist newly assigned as a member of the patient flow management centre led a seminar to promote collaboration via the web. This study represents the first step to explore the possible role of the hospital-based dental hygienist in the field of regional medical-dental cooperation of POM by assessing their willingness to participate in providing this type of care by a survey.

METHODS

The rate of attendees' satisfaction and the current problems of the collaboration for POM were evaluated through a questionnaire survey after the web seminar.

RESULTS

All respondents reported satisfaction with the web seminar although it was the first experience of an online seminar for half of the respondents. All hospital dentists, but only 47.8% of dentists working at clinics, had participated in POM. Dental hygienist tended to show greater desire to participate in POM than dentists. All respondents appreciated the role played by the dental hygienist as a key manager of medical-dental collaboration between the hospital and local clinics.

CONCLUSION

The hospital-based dental hygienist can play a role in planning and management of web seminars for POM, to raise awareness and promote regional medical-dental cooperation of POM.

Evaluating a Project Extension for Community Health Outcomes Pediatric Behavioral Health Series in a Rural and Frontier State: An Exploratory Investigation

BACKGROUND

Idaho, a predominately rural state, has a high prevalence of mental illness with minimal access to care. Barriers in diagnosis and treatment of pediatric behavioral health disorders could be mitigated with an accessible and effective specialty training program.

METHODS

A 10-session Project Extension for Community Health Outcomes (ECHO) series was designed to expand provider knowledge about pediatric behavioral health conditions and improve perceived clinical practice skills. Pre- and postseries evaluation surveys and individual session evaluations were used to assess the program.

RESULTS

A total of 148 individuals attended at least 1 of the 10 sessions. Participants reported high satisfaction with individual sessions and indicated that attendance positively impacted their knowledge and competency. Participants also reported that the knowledge and skills gained from the series would benefit more than half of their patients or clients.

CONCLUSION

The short ECHO series appears to be a viable and valuable option to provide Idaho providers with effective specialty training that is well attended and well received.

Understanding Training Needs in Pediatric Feeding for Allied Health Professionals: An Australian Perspective

PURPOSE

Clinician experience and confidence can negatively impact pediatric feeding service availability, but limited research has investigated what training allied health professionals (AHPs) need to increase these factors. This study developed and distributed a survey investigating Australian AHPs' self-reported confidence and anxiousness, training needs, factors impacting training access, and training preferences.

METHOD

This study was conducted over two phases. Phase 1 involved development and refinement of the survey, and Phase 2 involved distribution to Australian AHPs. Questions pertained to general demographics, feeding experience, feeding confidence and skills perception, and training needs. The questions were composed of multiple-choice, Likert scale, and short-response options.

RESULTS

Overall, 198 complete responses were received. Participants reported significantly lower confidence and higher anxiousness working with infants compared to older children (p < .01). Increased frequency of service provision predicted higher self-reported confidence and lower anxiousness (p < .01). Practical training opportunities including case discussion, videos, and clinical feedback were preferred. Access facilitators were online, on-demand training; however, respondents reported preferring hands-on training opportunities. Common barriers included cost, time, competing professional development priorities, and distance/travel.

CONCLUSIONS

Findings have highlighted that recency and frequency of practice impact self-reported confidence and anxiousness, and that AHPs self-report lowest confidence and highest anxiety working with infants compared to older age groups. Overall, the findings highlight the need for flexible, practical, and remotely accessible training opportunities, as well as the need for access to regular clinical supervision and a pediatric feeding caseload.

The feasibility and acceptability of a falls prevention e-learning program for physiotherapists

OBJECTIVE

To examine the feasibility and acceptability of a falls prevention e-learning program for physiotherapists working with people with osteoarthritis (OA).

METHODS

A prospective pre-post quasi-experimental approach was adopted. An e-learning program on falls prevention specific to the OA population was developed and delivered. Feasibility and acceptability data were obtained from recruitment records, Moodle^TM activity logs, multiple choice quizzes and customized surveys.

RESULTS

Of the 65 physiotherapists and near-graduate physiotherapy students who met the eligibility criteria, 50 (77%) completed the e-learning program. Participants were satisfied and considered the program to be acceptable. The program met their expectations (n = 45; 90%) and was highly relevant to their work (median 8-10 [interquartile range (IQR)] 2; range 0 [not at all relevant] to 10 [extremely relevant]). An overall improvement in knowledge was also observed (mean percentage difference 8%; 95% CI -3.49, -1.27).

DISCUSSION

Given a heightened risk of falls among people with OA, ensuring physiotherapists are skilled in falls prevention is important. Our acceptability and outcomes data indicate that a falls prevention e-learning program can be feasibly delivered to physiotherapists working in OA care. Future research should assess subsequent changes in clinical practice to determine whether physiotherapists deliver care reflective of contemporary falls prevention evidence.

Researching the Impact of Service provider Education (RISE) Project - a multiphase mixed methods protocol to evaluate implementation acceptability and feasibility

BACKGROUND

Health and social service providers receive limited education on recognizing and responding to family violence. With adequate education, providers could be prepared to identify individuals subjected to family violence and help reduce the risk of associated impairment. Informed by the Active Implementation Frameworks, our research will determine the scope of strategies needed for the uptake and sustainability of educational interventions focused on family violence for providers. It will also determine the acceptability, feasibility, and proof-of-concept for a new educational intervention, called VEGA (Violence, Evidence, Guidance, Action), for developing and improving primary care provider knowledge and skills in family violence.

METHODS

This paper details the protocol for the Researching the Impact of Service provider Education (RISE) Project. The RISE Project follows a sequential multiphase mixed method research design; qualitative and quantitative data are being collected and integrated over three conceptually and methodologically linked research phases. Activities primarily occur in Ontario, Alberta, and Quebec. Phase 1 uses a sequential exploratory mixed method research design to characterize the scope and salience of learning and implementation needs and preferences for family violence education. Phase 2 will use an embedded mixed method research design to determine whether VEGA technology supports providers to achieve their family violence learning goals with effectiveness, efficiency, and satisfaction. Phase 3 will use a concurrent mixed method research design to determine acceptability, feasibility, and proof-of-concept for evaluating whether VEGA improves primary care providers' knowledge and skills in family violence. This final phase will provide information on implementation strategies for family violence education in the "real world." It will also generate data on provider recruitment, retention, and data completeness, as well as exploratory estimates of the effect for provider outcome measures proposed for a randomized controlled trial.

DISCUSSION

The RISE Project comprehensively integrates an implementation approach to improve family violence education for the health and social service professions. It will provide important information about factors that could influence the uptake and effectiveness of a health profession's educational intervention into the real world, as well as provide foundational evidence concerning the tenability of using a randomized controlled trial to evaluate the impact of VEGA in primary care settings.

Project ECHO: Enhancing palliative care for primary care occupational therapists and physiotherapists in Ireland

Project ECHO (Extension for Community Healthcare Outcomes) uses videoconferencing technology to support and train healthcare professionals (HCPs) remotely. A 4-month fortnightly ECHO programme was developed and implemented to enhance palliative care provision by primary care therapists. Teaching and case-based discussions were facilitated by palliative care specialists. A mixed-methods cohort study was used to evaluate the project. ECHO participants completed pre- and post-programme questionnaires regarding their knowledge and skills across key palliative care domains. Focus groups were held before programme commencement to explore participants' attitudes and experiences of palliative care and after programme conclusion to explore their experiences of ECHO. Twenty-six primary care HCPs commenced the ECHO programme. Mean scores in self-rated confidence in knowledge and skill improved significantly (p < .002) following the programme. Twenty-one primary care HCPs completed the post-ECHO surveys and scores of self-rated confidence in knowledge and skills were significantly higher than pre-ECHO scores. Ninety-five percent of participants (n = 19) reported ECHO met their learning needs and was an effective format to enhance clinical knowledge. Eighty-five percent of participants (n = 17) would recommend ECHO to their colleagues. Project ECHO improved palliative care knowledge and skills of primary care HCPs in Ireland, with potential to address the growing need for integrated palliative care services.

Integration of sex and gender in a continuing professional development course on diabetes and depression: a mixed methods feasibility study

OBJECTIVES

Assess the feasibility and impact of a continuous professional development (CPD) course on type 2 diabetes and depression on health professionals' intention to include sex and gender considerations in patient care.

DESIGN AND SETTING

In collaboration with CPD organisations and patient-partners, we conducted a mixed-methods feasibility controlled trial with postintervention measures in three Canadian provinces.

PARTICIPANTS

Of 178 eligible health professionals, 127 completed questionnaires and 67 participated in semistructured group discussions.

INTERVENTION AND COMPARATOR

An interactive 1 hour CPD course, codesigned with patient-partners, on diabetes and depression that included sex and gender considerations (innovation) was compared with a similar course that did not include them (comparator).

OUTCOMES

Feasibility of recruitment and retention of CPD organisations and patient-partners throughout the study; adherence to planned activities; health professionals' intention to include sex and gender considerations in patient care as measured by the CPD-Reaction questionnaire; and barriers and facilitators using the Theoretical Domains Framework.

RESULTS

All recruited CPD organisations and patient-partners remained engaged throughout the study. All planned CPD courses occurred. Overall, 71% of eligible health professionals participated (63% under 44 years old; 79.5% women; 67.7% practising in French; 66.9% practising in Quebec; 78.8% in urban practice). After training, mean intention scores for the innovation (n=49) and control groups (n=78) were 5.65±0.19 and 5.19±0.15, respectively. Mean difference was -0.47 (CI -0.95 to 0.01; p=0.06). Adjusted for age, gender and practice settings, mean difference was -0.57 (CI -1.09 to -0.05; p=0.03). We identified eight theoretical domains related to barriers and six related to facilitators for providing sex-adapted and gender-adapted diabetes and depression care.

CONCLUSIONS

CPD training on diabetes and depression that includes sex and gender considerations is feasible and, compared with CPD training that does not, may prompt health professionals to modify their care. Addressing identified barriers and facilitators could increase intention.

TRIAL REGISTRATION NUMBER

NCT03928132 with ClinicalTrials.gov; Post-results.

Complexities of Continuing Professional Development in Context: Physician Engagement in Clinical Coaching

INTRODUCTION

Effective continuing professional development (CPD) is critical for safe and effective health care. Recent shifts have called for a move away from didactic CPD, which often fails to affect practice, toward workplace learning such as clinical coaching. Unfortunately, coaching programs are complex, and adoption does not guarantee effectiveness. To resolve this problem, thus ensuring resources are well spent, there is a critical need to understand what physicians try to achieve and how they engage. Therefore, we examined the types of change physicians pursue through clinical coaching and the impact of context on their desired changes.

METHODS

In the context of two clinical coaching programs for rural physicians, we applied a generic qualitative approach. Coachees (N = 15) participated in semistructured interviews. Analysis involved iterative cycles of initial, focused, and theoretical coding.

RESULTS

Coachees articulated desired practice changes along a spectrum, ranging from honing their current practice to making larger changes that involved new skills outside their current practice; changes also ranged from those focused on individual physicians to those focused on the practice system. Desired changes were affected by factors in the learning/practice environment, including those related to the individual coachee, coach, and learning/practice context.

DISCUSSION

These results suggest that the current focus on acquiring new knowledge through CPD may miss important learning that involves subtle shifts in practice as well as learning that focusses on systems change. Moreover, an appreciation of the contextual nature of CPD can ensure that contextual affordances are leveraged and barriers are acknowledged.

Development and Pilot Implementation of TACTICS VR: A Virtual Reality-Based Stroke Management Workflow Training Application and Training Framework

Delays in acute stroke treatment contribute to severe and negative impacts for patients and significant healthcare costs. Variability in clinical care is a contributor to delayed treatment, particularly in rural, regional and remote (RRR) areas. Targeted approaches to improve stroke workflow processes improve outcomes, but numerous challenges exist particularly in RRR settings. Virtual reality (VR) applications can provide immersive and engaging training and overcome some existing training barriers. We recently initiated the TACTICS trial, which is assessing a "package intervention" to support advanced CT imaging and streamlined stroke workflow training. As part of the educational component of the intervention we developed TACTICS VR, a novel VR-based training application to upskill healthcare professionals in optimal stroke workflow processes. In the current manuscript, we describe development of the TACTICS VR platform which includes the VR-based training application, a user-facing website and an automated back-end data analytics portal. TACTICS VR was developed via an extensive and structured scoping and consultation process, to ensure content was evidence-based, represented best-practice and is tailored for the target audience. Further, we report on pilot implementation in 7 Australian hospitals to assess the feasibility of workplace-based VR training. A total of 104 healthcare professionals completed TACTICS VR training. Users indicated a high level of usability, acceptability and utility of TACTICS VR, including aspects of hardware, software design, educational content, training feedback and implementation strategy. Further, users self-reported increased confidence in their ability to make improvements in stroke management after TACTICS VR training (post-training mean ± SD = 4.1 ± 0.6; pre-training = 3.6 ± 0.9; 1 = strongly disagree, 5 = strongly agree). Very few technical issues were identified, supporting the feasibility of this training approach. Thus, we propose that TACTICS VR is a fit-for-purpose, evidence-based training application for stroke workflow optimisation that can be readily deployed on-site in a clinical setting.

A Unique Model for Developing Continuing Education Resources for Health Professionals in Geographically Dispersed Health Organizations

The provision of high quality, equitable, and accessible education resources is a key to supporting continuing professional development (CPD) in health organizations. The Health Education and Training Institute (HETI) and its operational model for districts (District HETI Operational Model), is a novel approach that supports this imperative for over 155,000 staff working across the state of New South Wales (NSW), Australia. The model uses three principles in education and training development. These include collaborative partnerships, rapid resource development, and effective leadership within virtual teams. A state-wide learning management system has been implemented to support this initiative. Over 451 standardized, education, and training online modules have been developed for medical, nursing and midwifery, dental, allied health, and nonclinical NSW Health employees since 2013. These educational resources are accessible 24 hours a day. Cost-effective online programs have enabled more than 13.6 million learner completions. Program evaluations highlight the value of these resources in providing a positive learning experience. Furthermore, the District HETI Operational Model has been recognized by multiple national and international excellence awards in learning and development. The principles of the District HETI Operational Model apply to other health organizations that may choose to adopt a similar model. Such a model may support equity of access to contemporary, standardized, evidence-based education resources for health professionals working across geographically and clinically diverse environments. Implementation of a similar model for future CPD interventions warrants consideration by practitioners, researchers, and policymakers.

Child maltreatment online education for healthcare and social service providers: Implications for the COVID-19 context and beyond

Evidence indicates that healthcare and social service providers (HSSPs) receive inadequate education related to recognizing and responding to child maltreatment. This is despite the fact HSSPs are identified as an important factor in the primary, secondary, and tertiary prevention of this childhood exposure. The need for online education for HSSPs' is highlighted during the COVID-19 pandemic restrictions and will continue to be relevant afterward. The objective of this commentary is to provide an overview of: (a) educational interventions for HSSPs' related to recognizing and responding to child maltreatment; (b) the development of VEGA (Violence, Evidence, Guidance, Action), which is an online platform of educational resources to support HSSPs to recognize and respond to child maltreatment; and (c) the RISE (Researching the Impact of Service provider Education) project, which is an ongoing multi-province evaluation of VEGA in Canada. It is important to consider ongoing ways that HSSPs can receive education related to recognizing and responding to child maltreatment. The virtual implementation of VEGA and the RISE Project provide a necessary opportunity to continue to increase the capacity of Canada's HSSPs to adequately and safely recognize and respond to child maltreatment, while simultaneously advancing education scholarship for the field of child maltreatment and which will have relevance for the COVID-19 context and beyond.

Exploring the Cost of eLearning in Health Professions Education: Scoping Review

BACKGROUND

Existing research on the costs associated with the design and deployment of eLearning in health professions education is limited. The relative costs of these learning platforms to those of face-to-face learning are also not well understood. The lack of predefined costing models used for eLearning cost data capture has made it difficult to complete cost evaluation.

OBJECTIVE

The key aim of this scoping review was to explore the state of evidence concerning cost capture within eLearning in health professions education. The review explores the available data to define cost calculations related to eLearning.

METHODS

The scoping review was performed using a search strategy with Medical Subject Heading terms and related keywords centered on eLearning and cost calculation with a population scope of health professionals in all countries. The search was limited to articles published in English. No restriction was placed on literature publication date.

RESULTS

In total, 7344 articles were returned from the original search of the literature. Of these, 232 were relevant to associated keywords or abstract references following screening. Full-text review resulted in 168 studies being excluded. Of these, 61 studies were excluded because they were unrelated to eLearning and focused on general education. In addition, 103 studies were excluded because of lack of detailed information regarding costs; these studies referred to cost in ways either indicating cost favorability or unfavorability, but without data to support findings. Finally, 4 studies were excluded because of limited cost data that were insufficient for analysis. In total, 42 studies provided data and analysis of the impact of cost and value in health professions education. The most common data source was total cost of training (n=29). Other sources included cost per learner, referring to the cost for individual students (n=13). The population most frequently cited was medical students (n=15), although 12 articles focused on multiple populations. A further 22 studies provide details of costing approaches for the production and delivery of eLearning. These studies offer insight into the ways eLearning has been budgeted and project-managed through implementation.

CONCLUSIONS

Although cost is a recognized factor in studies detailing eLearning design and implementation, the way cost is captured is inconsistent. Despite a perception that eLearning is more cost-effective than face-to-face instruction, there is not yet sufficient evidence to assert this conclusively. A rigorous, repeatable data capture method is needed, in addition to a means to leverage existing economic evaluation methods that can then test eLearning cost-effectiveness and how to implement eLearning with cost benefits and advantages over traditional instruction.

Motivations and Career Decisions in Occupational Therapy Course: A Qualitative Inquiry of Asia-Pacific International Students in Australia

PURPOSE

This study aims to understand the motivations of academic voyage and post-graduation career decisions of occupational therapy international students in Australia. The following two research questions guided this study: why do international students choose to study in Australia instead of ones in their own countries? And why do international students choose to study occupational therapy program(s) in Australia instead of ones in their own countries?

PATIENTS AND METHODS

A qualitative design with phenomenology was employed to recruit 20 participants for the data collection procedures, including interview sessions, focus group activity, and member checking interview. The participants were studying one of the accredited occupational therapy programs in Australia as international students.

RESULTS

Six themes were yielded. All participants expressed that due to the excellent education, reasonable tuition fees and living standard, and the positive career opportunities, almost all expressed their positive experiences of their Australian voyage as international students and tended to stay in Australia after they gained the registration career development. More importantly, the notions of contribution to Australian communities are captured as many considered Australia as an important place in their lives.

CONCLUSION

University leaders may wish to take action in upgrading their international students' services, particularly career development services. Government agencies may take this study as a blueprint for upgrading the current regulations for international students, particularly in establishing a targeted immigration visa for recent graduates who want to establish their own businesses or invest in Australia.

The Effectiveness of Workshop and Multimedia Training Methods on the Nurses' Decision-Making Skills Regarding Weaning From Mechanical Ventilation

BACKGROUND

Nurses can safely and effectively wean patients from mechanical ventilation (MV) by the use of proper instruments and planning.

OBJECTIVE

The aim of this study was to compare the effectiveness of 2 training methods on the decision-making skill of intensive critical care (ICU) nurses with regard to weaning from MV.

METHODS

In this quasi-experimental study, 80 nurses working in ICUs participated in 1 of 2 educational groups in 2016. The interventions were workshop and multimedia training for decision-making skill regarding weaning from MV. The data were gathered from a questionnaire based on the Burns Weaning Assessment Program tool before and 1 month after the intervention. Data were analyzed by independent t test, the χ test, and the Fisher exact test using the software SPSS v. 17.

RESULTS

The decision-making skill with regard to awareness of weaning factors (physiological and respiratory) increased in both groups after the intervention (P ≤ .001), but the difference between the 2 groups was not statistically meaningful. Considering the mean scores before and after the intervention, the general skill of decision-making regarding weaning from MV was higher in the multimedia training group compared with the workshop training group (P ≤ .001).

CONCLUSION

The multimedia training method, which has been more successful, is recommended owing to its characteristics of virtual education, such as accessibility, flexibility, learner centeredness, and expansibility, as well as nurses' lack of time.

Psychosocial strategies for physiotherapy: A qualitative examination of physiotherapists' reported training preferences

Physiotherapists report using a range of psychosocial strategies in their practice, yet, barriers to implementation include lack of time, limited knowledge, and minimal training. This research aimed to establish what training physiotherapists have had with regards to psychosocial strategies, why they think they would benefit from more training, what training they want, and delivery preferences. Content analysis of answers to four open-ended, online survey questions collected from Australian physiotherapists (N = 208) was conducted. Physiotherapists reported having minimal training specific to psychosocial strategies. Physiotherapists reported wanting training in assessment and management of psychosocial issues, and practical application of specific psychosocial strategies. Didactic and interactive training delivered by experts who understand the psychosocial needs of their patients, and the constraints of physiotherapy practice was preferred. These findings suggest that training in psychosocial strategies at the undergraduate level and continued professional development are necessary. Specifically, training in the assessment and management of psychosocial factors, and in referral processes is warranted, and should be applicable and appropriate for rehabilitation settings. Training should be both didactic and interactive as outlined in the proposed framework.

Exploring Beliefs About Exercise Among Pregnant Women in Rural Communities

INTRODUCTION

Women who are pregnant in rural communities are disproportionally impacted by obesity and sedentary behavior, and this could be related to having negative beliefs about exercise during pregnancy, leading to inactivity. The purpose of this study was to identify self-reported beliefs about exercise among pregnant women in a rural community.

METHODS

Pregnant participants (N = 70) between 8 and 16 weeks' gestation were recruited from an obstetric clinic serving a rural population. An open-ended questionnaire addressing beliefs about exercise and based on the constructs of the theory of planned behavior was administered. Descriptive survey results were analyzed by calculating means and frequencies. Open-ended responses were assessed by inductive content analysis.

RESULTS

Commonly reported advantages of exercise during pregnancy included improved perinatal health outcomes and weight management. Commonly reported disadvantages included an increase in fatigue and concerns for maternal and fetal safety. Common facilitators of exercise included access to resources, free time or a decrease in demands from work, and support systems including family and friends. Common barriers to exercise included a lack of time, physical changes including feelings of nausea and fatigue, and lack of access to resources.

DISCUSSION

This study was the first to report beliefs about exercise during pregnancy in a rural setting. Responses in the current study suggest potential gaps in knowledge of evidence-based information regarding physical activity during pregnancy. Beliefs as well as reported barriers and facilitators of physical activity during pregnancy were similar those reported in other populations. In addition, access to resources (or lack of) appears to be an important facilitator (or barrier) among women in rural settings; thus, developing strategies designed to overcome this barrier, specifically in rural areas, is critically important. Future intervention strategies need to be tailored specifically to the needs of women living in rural areas.

Challenges in Managing Acute Cardiovascular Diseases and Follow Up Care in Rural Areas: A Narrative Review

This narrative review explores relevant literature that is related to the challenges in implementing evidence-based management for clinicians in rural and remote areas, while primarily focussing on management of acute coronary syndrome (ACS) and follow up care. A targeted literature search around rural/urban differences in the management of ACS, cardiovascular disease, and cardiac rehabilitation identified multiple issues that are related to access, including the ability to pay, transport and geographic distances, delays in patients seeking care, access to diagnostic testing, and timely treatment in an appropriate facility. Workforce shortages or lack of ready access to relevant expertise, cultural differences, and complexity that arises from comorbidities and from geographical isolation amplified diagnostic challenges. Given the urgency in management of ACS, rural clinicians must act quickly to achieve optimal patient outcomes. New technologies and quality improvement approaches enable better access to rapid diagnosis, as well as specialist input and care. Achieving an uptake of cardiac rehabilitation in rural and remote settings poses challenges that may reduce with the use of alternative models to centre-based rehabilitation and use of modern technologies. Expediting improvement in cardiovascular outcomes and reducing rural disparities requires system changes and that clinicians embrace attention to prevention, emergency management, and follow up care in rural contexts.

Imminent birth education for rural and remote settings: An evaluation study

OBJECTIVE

To describe the development and evaluation of an educational resource that aimed to provide the non-midwifery workforce in rural and remote health facilities with basic knowledge and skills to assist women who present when birth is imminent.

DESIGN

Descriptive methods using surveys were employed to evaluate the resource named the Imminent Birth Education Program.

PARTICIPANTS

Health professionals employed in Queensland Health rural and remote non-birthing facilities.

INTERVENTION

An evidence-based, blended educational program comprising an online component, a face-to-face workshop and an education package for midwives to facilitate the workshop in their health service.

RESULTS

More than 600 participants completed the online course component, and the majority of these participants were employed in non-birthing facilities. Throughout the project, two project officers facilitated face-to-face workshops, training participants to facilitate the workshop in their own health services. The reach of the Imminent Birth Education Program was statewide with clinical staff from all 16 Hospital and Health Services participating.

CONCLUSION

The uptake of the Imminent Birth Education Program has been widespread across the state and positively evaluated by the rural and remote non-midwifery workforce in non-birthing facilities. This evidence-based program is an effective way to provide the knowledge, skills and confidence to assist health professionals to care for women who present to these facilities when birth is imminent.

Learning From eHealth Implementations Through "Implementomics": A Multidimensional Annotation Model Applied to eHealth Projects of the RAFT Network

The implementation of digital health technologies has increased globally, producing substantial amounts of information and knowledge. While there are still areas in digital health that are understudied, concurrently there is an exponential increase in published articles, guidelines, methods, projects, and experiences, many of which fail to reach critical mass (pilotitis). Semantically describing and documenting this implementation knowledge and the effectiveness of these tools will help to avoid the duplication of efforts, to reduce preventable implementation obstacles, and to assure that investments are targeted to the most important technological innovations. The RAFT annotation model, presented in this paper, enables to semantically describe all elements of various outputs and implementation projects that were developed, are used, or are part of the RAFT network. This model was initially developed to annotate various implementations and outputs of the RAFT network to facilitate knowledge documentation and sharing, and to be used as a proof of concept for the Implementome. The Implementome will be an interconnected knowledge system that enables the user to navigate on multiple dimensions through metadata annotated projects, people, and information, and can serve as base for consensus building, best practices and guidelines. The RAFT annotation model can be further developed to enable the annotation of outputs, implementations, people, initiatives, and projects of the digital health domain in general.

Opening the Black Box: Identifying Common Practice Approaches in Urban and Rural Rape Crisis Centers

This study sought to open the black box of services at rape crisis centers (RCCs), particularly related to counseling, to better understand what is available to survivors in urban and rural settings. Findings from a survey of directors and counselors in Texas RCCs reveal a number of strengths: supporting services for survivors of sexual assault and insights that can help to further advance the implementation of evidence-based trauma treatments in this sector. Although many areas of congruence were found between urban and rural settings, differences were noted that have implications for implementation of evidence-based trauma treatments.

Adoption and Use of Mobile Learning in Continuing Professional Development by Health and Human Services Professionals

INTRODUCTION

Health and human services professionals are increasingly using mobile devices to support clinical decision-making and evidence-based practice. However, research on self-directed learning in an era of growing digital technology utilization is underdeveloped. This study explored the adoption and use of mobile learning as a continuing professional development (CPD) activity.

METHODS

A mixed-methods case study using semistructured interviews and a web-based questionnaire was conducted with health and human services professionals in Newfoundland and Labrador, Canada.

RESULTS

Respondents reported using a smartphone (53.8%), tablets (50.4%), YouTube (43.0%), and mobile apps (35.8%) for CPD. The highest-rated benefits of mobile learning included improved access to information (M = 3.51); potential for enhanced knowledge acquisition (M = 3.45); staying up to date (M = 3.44); and verifying information (M = 3.40). The greatest barriers included cost of some apps and resources (M = 3.07); websites/programs not functional on mobile devices (M = 2.84); workplace barriers preventing access to digital resources (M = 2.82); and social media use linked to negative perceptions of professionalism (M = 2.65). Interview respondents described the flexibility and convenience of mobile learning, the level of autonomy it offered, and the advantages of learning on their own time. Technical issues, particularly for rural and remote practitioners, and digital professionalism also emerged as potential barriers.

DISCUSSION

A systems model organizes the factors influencing the adoption and use of mobile devices and resources to support "just-in-time" learning. Addressing policies, practices, and regulations that enable or inhibit adoption of mobile learning for CPD may foster enhanced use to support better clinical decision-making, improved accuracy, and greater patient safety.

Evaluating Online Continuing Professional Development Regarding Weight Management for Pregnancy Using the New World Kirkpatrick Model

INTRODUCTION

Clinical practice guidelines advocate the importance of continuing professional development (CPD) that supports health professionals (HPs) to discuss the sensitive topic of maternal weight management with women. However, there is a lack of accredited CPD related to this important area of preconception and antenatal care. Therefore, aims were to evaluate HPs' reactions to accredited online CPD regarding weight management for pregnancy and their knowledge, attitudes, confidence, and commitment to provide women with advice after completing the course.

METHODS

A mixed-methods evaluation was based on the New World Kirkpatrick Model (NWKM). Accredited online CPD was developed by experts in maternal nutrition and weight management. Participants completed a questionnaire before (n = 136) and after (n = 65) the weight management components of the course. McNemar and Wilcoxon signed-rank tests were used to evaluate paired data (n = 36) (p < .05). Deductive content analyses explored free-text responses (n = 65).

RESULTS

Participants' reactions to the online CPD were encouraging, facilitating increases in perceptions of the importance of weight management for pregnancy and confidence to provide advice. Quantitative measures assessed no change in participants' knowledge; however, qualitative analyses revealed an increase in participants' knowledge of communication strategies that they intend to apply in practice.

DISCUSSION

The NWKM facilitated an evaluation of HPs' encouraging reactions to online CPD and the affective constructs of education including attitudes, confidence, and commitment to provide advice. Online CPD should be developed with collaboration between universities/professional associations and health care providers, so that evaluation of organizational change and clinical outcomes is possible.

Online Medical Education for Doctors: Identifying Potential Gaps to the Traditional, Face-to-Face Modality

BACKGROUND

Online education options increasingly complement traditional face-to-face (F2F) approaches. Few studies have compared both formats on doctors, and little evidence exists to prove that the online approach is universally effective. This gap needs to be addressed to ensure that the quality of education and health care delivery is not compromised.

METHODS

A quantitative survey targeting 881 doctors that required online and F2F teaching sessions offers identical contents over a 12-month period. The surveyed doctors work in the Australian after-hours house-call (AHHC) industry, and the teachings were parts of their continuing professional development activities.

RESULTS

In all, 89 responses were received; 10 (11.2%) participated exclusively online, while 23 (25.8%) did so by F2F; 52 (58.4%) engaged through both modalities. No statistical differences existed based on sex, specialty, and post-graduate fellowship status, as well as on the perceptions with teaching structure, contents, and duration of the education programmes. However, F2F-only doctors were likely to be junior and younger than 40 years (odds ratio [OR]: 3.85; P = .01). They also admit easy access to effective teaching environment (OR: 4.07; P = .01) and receive better feedbacks (OR: 3.75; P = .01). Conversely, online-only participants were more likely to combine AHHC duties with regular-hours general practice (OR: 0.15; P = .02) and are generally more satisfied with the programme frequency (OR: 6.90; P = .01).

CONCLUSIONS

On multiple areas, no differences exist in the medical education delivered by online and the F2F methods to doctors and both should be encouraged. However, younger and junior practitioners, who tend to need feedbacks on their jobs, should participate more in the F2F sessions.

The Acceptability and Feasibility of Implementing an Online Educational Intervention With Nurses in a Provincial Prison Context

BACKGROUND

Correctional nursing requires a strong knowledge base with access to continuing education (CE) to maintain and enhance competencies. Nurses working in provincial prisons have reported many challenges in accessing CE, with online learning being identified as a potential solution. Limited research was found, however, which examined the correctional context in the development and delivery of online learning for nurses. The purpose of this study was to develop an online educational intervention tailored to correctional nurses and determine the feasibility and acceptability of implementing the intervention in a provincial prison context.

METHODS

A sequential mixed methods study was conducted. Participants included nurses from three correctional settings in the province of Ontario, Canada. Semistructured interviews examined contextual factors and educational needs. Delphi surveys determined the educational topic. Preintervention and postintervention questionnaires examined the context, educational content, and intervention's acceptability and feasibility.

RESULTS

The online intervention focused on mental health and addictions with two 30-minute webinars delivered back-to-back over 15 weeks. Respondents expressed satisfaction with the convenience of online learning at work using short webinars, as well as the topics, relevance of information, and teaching materials, but dissatisfaction with presentation style. The feasibility of the intervention was limited by access to technology, time to attend, education space, and comfort with technology.

DISCUSSION

The findings from this study provide insight to guide the future development of online CE for correctional nurses. If changes are made within correctional facilities in collaboration with nurses and managers, online learning holds the potential to facilitate access to ongoing professional development.

Nurses' experiences of working in rural hospitals: An integrative review

AIM

To critically analyse the international literature describing the experiences of nurses working in rural hospitals.

BACKGROUND

Nursing shortages in rural areas is an ongoing issue. Given the significant role nurses play in the delivery of rural health care, a sufficient workforce is essential. However, maintaining this workforce is challenging. Understanding the experiences of nurses working in rural hospitals is essential to inform strategies around job satisfaction and staff retention.

EVALUATION

An integrative review was conducted. Six primary sources were included related to the experiences of nurses working in rural hospitals.

RESULTS

Four themes emerged, namely: (a) Professional Development; (b) Workplace stressors; (c) Teamwork; and (d) Community.

CONCLUSION

There is a need for further research exploring the experiences of nurses working in rural hospitals and its impact on job satisfaction, turnover intention and patient safety.

IMPLICATIONS FOR NURSING MANAGEMENT

This review highlights some key issues impacting nurses' working in rural hospitals. This understanding can be used by nurse managers to inform strategies for recruitment and retention of nurses in these areas.

An evaluation of flipped e-learning experiences

AIM

The "flipped" classroom is an educational strategy gaining popularity for its growing evidence base that suggests it may successfully improve learning outcomes. Also known as reverse instruction, this approach has been typically implemented and studied in in-person post-secondary settings. The utilization of a flipped approach in the healthcare education literature has been examined in a wide range of contexts, but little has been written regarding continuing professional development (CPD). Therefore, with success in other contexts there is potential for the flipped classroom approach to enhance student satisfaction, learner engagement, and learning outcomes in the context of online education for CPD.

METHODS

In this paper, we describe the structure and format of such a course using a qualitative case study framework.

RESULTS

This study contributes to a more comprehensive understanding of effective ways of overcoming distributed learning challenges in online CPD using a flipped approach.

Systematic review to identify proxy indicators to quantify the impact of eHealth tools on maternal and neonatal health outcomes in low-income and middle-income countries including Delphi consensus

OBJECTIVE

To identify interventions that could serve as reliable proxy indicators to measure eHealth impact on maternal and neonatal outcomes.

DESIGN

Systematic review and Delphi study.

METHODS

We searched PubMed, Embase and Cochrane from January 1990 to May 2016 for studies and reviews that evaluated interventions aimed at improving maternal/neonatal health and reducing mortality. Interventions that are not low-income and middle-income context appropriate and that cannot currently be diagnosed, managed or impacted by eHealth (eg, via telemedicine distance diagnostic or e-learning) were excluded. We used the Cochrane risk of bias, Risk Of Bias In Non- randomised Studies - of Interventions and ROBIS tool to assess the risk of bias. A three-step modified Delphi method was added to identify additional proxy indicators and prioritise the results, involving a panel of 13 experts from different regions, representing obstetricians and neonatologists.

RESULTS

We included 44 studies and reviews, identifying 40 potential proxy indicators with a positive impact on maternal/neonatal outcomes. The Delphi experts completed and prioritised these, resulting in a list of 77 potential proxy indicators.

CONCLUSIONS

The proxy indicators propose relevant outcome measures to evaluate if eHealth tools directly affect maternal/neonatal outcomes. Some proxy indicators require mapping to the local context, practices and available resources. The local mapping facilitates the utilisation of the proxy indicators in various contexts while allowing the systematic collection of data from different projects and programmes. Based on the mapping, the same proxy indicator can be used for different contexts, allowing it to measure what is locally and temporally relevant, making the proxy indicator sustainable.

PROSPERO REGISTRATION NUMBER

CRD42015027351.

Family history-taking practices and genetic confidence in primary and tertiary care providers for childhood cancer survivors

BACKGROUND

There is growing impetus for increased genetic screening in childhood cancer survivors. Family history-taking is a critical first step in determining survivors' suitability. However, the family history-taking practices of providers of pediatric oncology survivorship care and the confidence of these providers to discuss cancer risks to relatives are unknown.

PROCEDURE

Fifty-four providers completed semistructured interviews in total, which included eight tertiary providers representing nine hospitals across two countries (63% male, 63% oncologists, 37% nurses) and 46 primary care providers (PCPs) nominated by a survivor (59% male, 35% regional practice). We used content analysis and descriptive statistics/regression to analyze the data.

RESULTS

Few tertiary (38%) or primary (35%) providers regularly collected survivors' family histories, often relying on survivors/parents to initiate discussions. Providers mostly took two-generation pedigrees (63% tertiary and 81% primary). Primary providers focused on adult cancers. Lack of time, alternative priorities, and perceived lack of relevance were common barriers. Half of all tertiary providers felt moderately comfortable discussing genetic cancer risk to children of survivors (88% felt similarly discussing risks to other relatives). Most primary providers lacked confidence: 41% felt confident regarding risks to survivors' children and 48% regarding risks to other relatives.

CONCLUSIONS

While family history-taking will not identify all survivors suitable for genetics assessment, recommendations for regular history-taking are not being implemented in tertiary or primary care. Additional PCP-targeted genetic education is warranted given that they are well placed to review family histories of pediatric cancer survivors.

The effectiveness of internet-based e-learning on clinician behavior and patient outcomes: a systematic review protocol

REVIEW QUESTION/OBJECTIVE

The objective of this systematic review is to identify, appraise and synthesize the best available evidence for the effectiveness of internet-based e-learning programs on health care professional behavior and patient outcomes.

BACKGROUND

Technological innovation has not only impacted social change in recent years but has been the prime driver of educational transformation.The newest consumers of post-secondary education, the so-called 'digital natives', have come to expect education to be delivered in a way that offers increased usability and convenience. Health care professionals (HCPs) in the clinical setting, particularly those in rural and remote communities, are no different. Today's health workforce has a professional responsibility to maintain competency in practice through achieving a minimum number of hours of continuing professional development. Consequently, HCPs seeking professional development opportunities are reliant on sourcing these independently according to individual learning needs. However, difficulties exist in some health professionals' access to ongoing professional development opportunities, particularly those with limited access face-to-face educationdue to geographical isolation or for those not enrolled in a formal program of study.These issues challenge traditional methods of teaching delivery; electronic learning (e-learning) is at the nexus of overcoming these challenges.The term e-learning originated in the mid-1990s as the internet began to gather momentum.Electronic learning can be broadly defined as any type of educational media that is delivered in an electronic form.Terms such as computer-assisted learning, online learning, web-based learning and e-learning are often used synonymously but all reflect knowledge transfer via an electronic device. This broad definition allows for a gamut of multimedia to be used for the purpose of constructing and assessing knowledge. Multimedia typically used in e-learning range from the now archaic Compact Disc Read-Only Memory (CD-ROMs), to the simple Microsoft PowerPoint, or the more advanced and complex virtual worlds such a second life. Electronic learning can be delivered in asynchronous or synchronous formats, with the latter (for example interactive online lectures via platforms such as BlackboardCollaborate or WebEx) more commonly used in formal educational settings according to set timetables of study.Person-to-person interactivity is an important enabler of knowledge generation and while functionalities such as web 1.0 (discussion board and email) and more recently web 2.0 (Wikis and blogs) allow for this to occur both synchronously and asynchronously, it is usually utilized in formal educational contexts only. However, the economy of formal education does not allow for free access to courses which proves challenging for HCPs seeking quality educational opportunities who choose not to undergo a formal program of study or are just looking to meet a specific learning need. Alternatively, asynchronous e-learning is a more learner-centred approach that affords the opportunity to engage in learning at a time and location that is convenient and enables the learner to balance professional development with personal and work commitments.These learning opportunities are self-directed and do not require a human to facilitate learning, rather, technology officiates/facilitates the learning process and, in the asynchronous e-learning context, the learner negotiates meaning independently.Health-related e-learning research has focused on several domains including media comparative designs, self-efficacy, user satisfaction, instructional design, knowledge outcomes, clinical skills development, and facilitators/barriers to its use.The benefits of e-learning are well documented in terms of increased accessibility to education, efficacy, cost effectiveness, learner flexibility and interactivity.However, some fundamental methodological and philosophical flaws exist in e-learning research, not least the use of comparative design studies. Comparison between e-learning and traditional teaching methods are illogical and methodologically flawed because comparison groups are heterogeneous, lack uniformity and have multiple confounders that cannot be adjusted for.As early as 1994, researchersin computer-assisted learning were citing these limitations and called for a fresh research agenda in this area. Cookrepeated this call in 2005 and again in 2009 and noted a paucity of research related to patient or clinical practice outcomes. Electronic learning is not an educational panacea and research needs to progress from pre- and post-interventional and comparative designs that evaluate knowledge increases and user satisfaction. It is time to move towards determining whether improved self-efficacy or knowledge gained through e-learning improves patient outcomes or influences clinical behavior change and whether these changes are sustained. In order to develop the empirical evidence base in e-learning, research needs to be guided by established theoretical frameworks and use validated instruments to move from assessing knowledge generation towards improving our understanding of whether e-learning improves HCP behavior and more importantly, patient outcomes.One suitable framework that is congruent with e-learning research is Kirkpatrick'sfour levels of evaluation. Kirkpatrick's model is hierarchically based with level one relating to student reaction and how well the learner is satisfied with the education program. Level two pertains to learning and the evaluation of knowledge, level three expands on this and considers whether the education has influenced behavior. In the context of this review, behavior change is any practice that is intrinsically linked with the outcomes of the e-learning program undertaken. Finally, level four evaluates the impact on outcomes such as cost benefit or quality improvements.The majority of e-learning research has focused on participant experience and knowledge acquisition, outcomes that correspond with the first two levels of Kirkpatrick's model.To date, few studies have examined the effectiveness of internet-based e-learning programs on HCP behavior, which aligns with Level 3 of Kirkpatrick's model.Studies exist that use self-reported measures of intention to change behavior, however self-reported intention to change does not necessarily translate into actual behavior change. Studies that have not used self-reported measures of behavior change have used objectively measured evaluation criteria including objective structured assessment of technical skills (OSATS) using various methods including simulation task trainers and clinical simulations using standardized patients scored by a panel of experts using standardized assessment tools. Carney et al. used a national reporting and data system to measure the impact of a single one hour e-learning program undertaken by radiologists (n=31) aimed at reducing unnecessary recall during mammography screening. Carney et al. reported a null effect and attributed this to the complexities of behavior change, suggesting that longer term reinforcement of principles relating to mammography recall was required to effect behavior change. These findings also suggest that a multi-modal intervention may be required in order to reduce excessive recall rates in this area, rather than a single intervention. Contrary to Carney et al., Pape-Koehler et al. and Smeekins et al. reported positive findings using randomized controlled designs to test the efficacy of e-learning interventions on individual's surgical performance and the detection of child abuse, respectively. Pape-Koehler et al. used a 2x2 factorial design to demonstrate that an e-learning intervention significantly improved novice surgeon (n=70) surgical performance of a laparoscopic cholecystectomy (change between pre-post test OSATS p 0.001) when used in isolation or in combination with a practical training session compared to practical training alone. Smeekins et al. demonstrated that a 2 hour e-learning program improved nurses' (n=25) ability to detect child abuse in an emergency department. The nurses in the intervention (n=13) group demonstrated significantly better (p=0.022) questioning techniques and consequently, higher quality history taking, to determine children at risk of child abuse when compared with the control group who received no training at all.These three exemplar studies demonstrate the broad range of applications e-learning has in HCP education, as each study used different designs, had different subject areas and target health care professionals. This reflects the conceptual and practical challenges of the area of research that addresses levels three of Kirkpatrick's model. For this reason, the e-learning research agenda in health should focus on whether knowledge generated through e-learning is able to be re-contextualized into clinical practice, and influence sustained clinical behavior change and patient outcomes.A preliminary search of PubMed, CINAHL, The Cochrane Library, The JBI Database of Systematic Reviews and Implementation Reports, ERIC and PROSPERO was conducted to determine if a systematic review on the topic of interest already existed. This search identified four systematic reviews that specifically reviewed outcome measures of knowledge and skill improvement in the domain of e-learning. Two examined research conducted in nursing, with the other two in orthodontics. Lahti et al. systematic review examined the impact of e-learning on nurses' and nursing students' knowledge, skills and satisfaction. Lahti et al. were unable to demonstrate a statistical difference between cohorts undertaking e-learning compared to conventional teaching methods, findings that were not replicated by Du et al. This may be due to the decision by Lahti et al. (ABSTRACT TRUNCATED)

An integrative review of e-learning in the delivery of self-management support training for health professionals

BACKGROUND

E-learning involves delivery of education through Information and Communication Technology (ITC) using a wide variety of instructional designs, including synchronous and asynchronous formats. It can be as effective as face-to-face training for many aspects of health professional training. There are, however, particular practices and skills needed in providing patient self-management support, such as partnering with patients in goal-setting, which may challenge conventional practice norms. E-learning for the delivery of self-management support (SMS) continuing education to existing health professionals is a relatively new and growing area with limited studies identifying features associated with best acquisition of skills in self-management support.

METHODS

An integrative literature review examined what is known about e-learning for self-management support. This review included both qualitative and quantitative studies that focused on e-learning provided to existing health professionals for their continuing professional development. Papers were limited to those published in English between 2006 and 2016. Content analysis was used to organize and focus and describe the findings.

RESULTS

The search returned 1505 articles, with most subsequently excluded based on their title or abstract. Fifty-two full text articles were obtained and checked, with 42 excluded because they did not meet the full criteria. Ten peer-reviewed articles were included in this review. Seven main themes emerged from the content analysis: participants and professions; time; package content; guiding theoretical framework; outcome measures; learning features or formats; and learning barriers. These themes revealed substantial heterogeneity in instructional design and other elements of e-learning applied to SMS, indicating that there is still much to understand about how best to deliver e-learning for SMS skills development.

CONCLUSIONS

Few e-learning approaches meet the need for high levels of interactivity, reflection, practice and application to practice for health professionals learning to deliver effective SMS. Findings suggest that the context of SMS for patients with chronic condition matters to how health professional training is delivered, to ensure partnership and person-centred care. Further creative approaches and their rigorous evaluation are needed to deliver completely online learning in this space. Blended learning that combines e-learning and face-to-face methods is suggested to support SMS skills development for health professionals.

Southwestern Surgical Congress Jack A. Barney award competition presenters - Where are they now?

BACKGROUND

Resident research presentations at surgical conferences may encourage future research endeavors.

METHODS

2010-2016 SWSC annual meeting programs were reviewed for presenters eligible for the Jack Barney award. Award recipients from 1987 to 2016 were included.

RESULTS

There were 100 unique presenters eligible for the Jack Barney award, and 28 unique award recipients. Thirty-six (82%) presenters currently practice in a community setting, 5 (11%) at a university hospital, 2 (5%) internationally, and 1 (2%) in a military hospital. Scholarly articles were published by 41% of presenters. Sixteen of the 28 recipients (57%) practice in community hospitals, and 9 (32%) practice in university settings; 3 are still in training. Twenty recipients (71%) published after residency. Thirty percent and 25% of presenters and recipients are SWSC members, respectively.

CONCLUSIONS

Peer-reviewed publications were frequent among eligible presenters and award recipients. Encouraging presenters to become SWSC members provides an opportunity for improved retention.

Evaluation of the awareness and effectiveness of IT security programs in a large publicly funded health care system

BACKGROUND

Electronic health records are becoming increasingly common in the health care industry. Although information technology (IT) poses many benefits to improving health care and ease of access to information, there are also security and privacy risks. Educating health care providers is necessary to ensure proper use of health information systems and IT and reduce undesirable outcomes.

OBJECTIVE

This study evaluated employees' awareness and perceptions of the effectiveness of two IT educational training modules within a large publicly funded health care system in Canada.

METHOD

Semi-structured interviews and focus groups included a variety of professional roles within the organisation. Participants also completed a brief demographic data sheet. With the consent of participants, all interviews and focus groups were audio recorded. Thematic analysis and descriptive statistics were used to evaluate the effectiveness of the IT security training modules.

RESULTS

Five main themes emerged: (i) awareness of the IT training modules, (ii) the content of modules, (iii) staff perceptions about differences between IT security and privacy issues, (iv) common breaches of IT security and privacy, and (v) challenges and barriers to completing the training program. Overall, nonclinical staff were more likely to be aware of the training modules than were clinical staff. We found e-learning was a feasible way to educate a large number of employees. However, health care providers required a module on IT security and privacy that was relatable and applicable to their specific roles.

CONCLUSION

Strategies to improve staff education and mitigate against IT security and privacy risks are discussed. Future research should focus on integrating health IT competencies into the educational programs for health care professionals.

Rebooting Kirkpatrick: Integrating Information System Theory Into the Evaluation of Web-based Continuing Professional Development Interventions for Interprofessional Education

INTRODUCTION

Information system research has stressed the importance of theory in understanding how user perceptions can motivate the use and adoption of technology such as web-based continuing professional development programs for interprofessional education (WCPD-IPE). A systematic review was conducted to provide an information system perspective on the current state of WCPD-IPE program evaluation and how current evaluations capture essential theoretical constructs in promoting technology adoption.

METHODS

Six databases were searched to identify studies evaluating WCPD-IPE. Three investigators determined eligibility of the articles. Evaluation items extracted from the studies were assessed using the Kirkpatrick-Barr framework and mapped to the Benefits Evaluation Framework.

RESULTS

Thirty-seven eligible studies yielded 362 evaluation items for analysis. Most items (n = 252) were assessed as Kirkpatrick-Barr level 1 (reaction) and were mainly focused on the quality (information, service, and quality) and satisfaction dimensions of the Benefits Evaluation. System quality was the least evaluated quality dimension, accounting for 26 items across 13 studies. WCPD-IPE use was reported in 17 studies and its antecedent factors were evaluated in varying degrees of comprehensiveness.

DISCUSSION

Although user reactions were commonly evaluated, greater focus on user perceptions of system quality (ie, functionality and performance), usefulness, and usability of the web-based platform is required. Surprisingly, WCPD-IPE use was reported in less than half of the studies. This is problematic as use is a prerequisite to realizing any individual, organizational, or societal benefit of WCPD-IPE. This review proposes an integrated framework which accounts for these factors and provides a theoretically grounded guide for future evaluations.

The changing landscape of physiotherapy student clinical placements: An exploration of geographical distribution and student performance across settings

OBJECTIVE

To describe the geographical distribution of physiotherapy clinical placements and investigate the relationship between geographical setting and clinical placement marks in physiotherapy students.

DESIGN

A retrospective cohort design was used for this study.

SETTING

The University of Newcastle, New South Wales.

PARTICIPANTS

Data from entry-level Bachelor of Physiotherapy student clinical placements.

MAIN OUTCOME MEASURE(S)

Data from all clinical placements in the Physiotherapy program between 2003 and 2014 were included. For all clinical placements, student assessment mark, year of study, type of placement and placement location were collected. Placement location was then classified using the Modified Monash Model (MMM) categories: one (most metropolitan) to seven (most remote).

RESULTS

Over the 12 year period of the study 3964 placements were completed. Between 2003 and 2005 the average proportion of clinical placements occurring in metropolitan areas (MMM1) was 78% and in rural areas (MMM categories 3-6) was 22%. In 2014 these proportions had changed to 59% (MMM1) and 40% (MMM3-6). There were significant differences in clinical placement grades between MMM1 and all other categories except MMM2, with lower assessment marks in MMM1 than other categories.

CONCLUSIONS

The changing distribution of physiotherapy clinical placements may be reflective of increasing student numbers and greater efforts to support students completing rural and remote placements. This change may lead to a positive effect on the rural and remote physiotherapy workforce. Further research is required to determine the specific training and support needs of students and clinical educators in rural and remote settings.

The effectiveness of Internet-based e-learning on clinician behaviour and patient outcomes: A systematic review

BACKGROUND

The contemporary health workforce has a professional responsibility to maintain competency in practice. However, some difficulties exist with access to ongoing professional development opportunities, particularly for staff in rural and remote areas and those not enrolled in a formal programme of study. E-learning is at the nexus of overcoming these challenges. The benefits of e-learning have been reported in terms of increased accessibility to education, improved self-efficacy, knowledge generation, cost effectiveness, learner flexibility and interactivity. What is less clear, is whether improved self-efficacy or knowledge gained through e-learning influences healthcare professional behaviour or skill development, whether these changes are sustained, and whether these changes improve patient outcomes.

OBJECTIVE

To identify, appraise and synthesise the best available evidence for the effectiveness of e-learning programmes on health care professional behaviour and patient outcomes.

DESIGN

A systematic review of randomised controlled trials was conducted to assess the effectiveness of e-learning programmes on clinician behaviour and patient outcomes. Electronic databases including CINAHL, Embase, ERIC, MEDLINE, Mosby's Index, Scopus and Cochrane - CENTRAL were searched in July 2014 and again in July 2015.

QUALITY ASSESSMENT AND DATA EXTRACTION

Studies were reviewed and data extracted by two independent reviewers using the Joanna Briggs Institute standardised critical appraisal and data extraction instruments.

DATA SYNTHESIS

Seven trials met the inclusion criteria for the analysis. Due to substantial instructional design, subject matter, study population, and methodological variation between the identified studies, statistical pooling was not possible and a meta-analysis could not be performed. Consequently, the findings of this systematic review are presented as a narrative review.

RESULTS

The results suggest that e-learning was at least as effective as traditional learning approaches, and superior to no instruction at all in improving health care professional behaviour. There was variation in behavioural outcomes depending on the skill being taught, and the learning approach utilised. No papers were identified that reported the effectiveness of an e-learning programme on patient outcomes.

CONCLUSION

This review found insufficient evidence regarding the effectiveness of e-learning on healthcare professional behaviour or patient outcomes, consequently further research in this area is warranted. Future randomised controlled trials should adhere to the CONSORT reporting guidelines in order to improve the quality of reporting, to allow evaluation of the effectiveness of e-learning programmes on healthcare professional behaviour and patient outcomes.

Exploratory Study of Rural Physicians' Self-Directed Learning Experiences in a Digital Age

INTRODUCTION

The nature and characteristics of self-directed learning (SDL) by physicians has been transformed with the growth in digital, social, and mobile technologies (DSMTs). Although these technologies present opportunities for greater "just-in-time" information seeking, there are issues for ensuring effective and efficient usage to compliment one's repertoire for continuous learning. The purpose of this study was to explore the SDL experiences of rural physicians and the potential of DSMTs for supporting their continuing professional development (CPD).

METHODS

Semistructured interviews were conducted with a purposive sample of rural physicians. Interview data were transcribed verbatim and analyzed using NVivo analytical software and thematic analysis.

RESULTS

Fourteen (N = 14) interviews were conducted and key thematic categories that emerged included key triggers, methods of undertaking SDL, barriers, and supports. Methods and resources for undertaking SDL have evolved considerably, and rural physicians report greater usage of mobile phones, tablets, and laptop computers for updating their knowledge and skills and in responding to patient questions/problems. Mobile technologies, and some social media, can serve as "triggers" in instigating SDL and a greater usage of DSMTs, particularly at "point of care," may result in higher levels of SDL. Social media is met with some scrutiny and ambivalence, mainly because of the "credibility" of information and risks associated with digital professionalism.

DISCUSSION

DSMTs are growing in popularity as a key resource to support SDL for rural physicians. Mobile technologies are enabling greater "point-of-care" learning and more efficient information seeking. Effective use of DSMTs for SDL has implications for enhancing just-in-time learning and quality of care. Increasing use of DSMTs and their new effect on SDL raises the need for reflection on conceptualizations of the SDL process. The "digital age" has implications for our CPD credit systems and the roles of CPD providers in supporting SDL using DSMTs.

Web-based social media for professional medical education: Perspectives of senior stakeholders in the nursing home sector

OBJECTIVE

Participatory web-based platforms, including social media, have been recognised as valuable learning tools in healthcare education for over a decade. Use of these platforms is now widespread in tertiary education. It is less widely accepted as a tool for continuing professional education and development at the industry level. This study explores perspectives of senior stakeholders in the nursing home sector to explore perceived benefits, barriers and risks for use in professional education.

METHODS

Qualitative data were collected through semi-structured interviews of 'high level' clinical and executive staff from a cross section of nursing home stakeholder organisations. Established printed educational material (PEM) was used as a case study for adaptation to web-based social applications. Questions were designed to gather information about the interviewee's views on the potential to apply PEM to programs such as blogs, Twitter and YouTube to deliver education and aid communication in the sector.

RESULTS

Twelve participants from eleven stakeholder organisations took part in the study. Most participants were cautious about the use of social media programs in continuing professional education. Participants described the benefits (contemporary information, delivered rapidly, varying formats) and barriers (credibility of information, potential misinterpretation, sector demographics, time constraints) to uptake of these programs. The majority of participants preferred formal e-learning programs to web-based social media applications.

CONCLUSIONS

Reservations expressed about the use of social media, such as accuracy, legal and privacy risks to the organisation reflected those previously expressed by the broader medical community.

Establishing and delivering pulmonary rehabilitation in rural and remote settings: The opinions, attitudes and concerns of health care professionals

OBJECTIVE

Pulmonary rehabilitation is recommended for people with chronic lung disease however access remains limited in rural and remote settings. The aim of this project was to explore the perspectives of rural and remote health care professionals regarding the establishment and delivery of pulmonary rehabilitation.

SETTING

Rural (NSW) and remote (NT) Australian healthcare settings.

PARTICIPANTS

Health care professionals (n = 25) who attended a training program focussing on the delivery of pulmonary rehabilitation.

MAIN OUTCOME MEASURE(S)

Surveys with open written questions were completed by participants following the training program. Key informants also participated in face-to-face interviews. Thematic analysis was undertaken of data collected on participant opinions, attitudes and concerns regarding the establishment and delivery of pulmonary rehabilitation in their individual situation.

RESULTS

Participating health care professionals (predominantly nurses and physiotherapists) identified a number of issues relating to establishing and delivering pulmonary rehabilitation; including staffing, time and case load constraints, patient and community attitudes, lack of professional knowledge and confidence and inability to ensure sustainability. The practicalities of delivering pulmonary rehabilitation, particularly exercise prescription and training, were also important concerns raised.

CONCLUSIONS

Lack of health care professional staffing, knowledge and confidence were reported to be factors impacting the establishment and delivery of pulmonary rehabilitation. This study has facilitated a greater understanding of the issues surrounding the establishment and delivery of pulmonary rehabilitation in rural and remote settings. Further research is required to investigate the contribution of health professional training and associated factors to improving the availability and delivery of pulmonary rehabilitation in rural and remote settings.

Identifying subgroups of care providers participating in a telehealth educational intervention: hierarchical cluster analysis of evaluation data

Health care providers (HCPs) serving HIV-infected patients, especially in rural and underserved areas, have limited access to continuing medical education.

OBJECTIVES

To identify subgroups of HCPs who might benefit from a telehealth training program focusing on HIV/AIDS care based on HCPs' objective for attending the training.

METHODS

Hierarchical cluster analysis combined with thematic analysis identified the subgroups.

RESULTS

A total of 56 HCPs attended between 1 and 9 of the 12 sessions conducted (mean ≈ 2, standard deviated = 1.6). Subgroups identified included knowledge (HCPs interested in gaining, increasing, or updating their knowledge in HIV care), learn-expert (HCPs interested in learning, obtaining, or providing expert opinion), and observe-apply-network (HCPs interested in observing the training, applying knowledge gained to practice, and networking). No group difference were found in the participants' reaction to the session, change in knowledge following the training, and other important characteristics.

CONCLUSION

Methodological contributions of the study are discussed.

Does delivery of a training program for healthcare professionals increase access to pulmonary rehabilitation and improve outcomes for people with chronic lung disease in rural and remote Australia?

OBJECTIVE

Access to pulmonary rehabilitation (PR), an effective management strategy for people with chronic respiratory disease, is often limited particularly in rural and remote regions. Difficulties with establishment and maintenance of PR have been reported. Reasons may include a lack of adequately trained staff. There have been no published reports evaluating the impact of training programs on PR provision. The aim of this project was to evaluate the impact of an interactive training and support program for healthcare professionals (the Breathe Easy, Walk Easy (BEWE) program) on the delivery of PR in rural and remote regions.

METHODS

The study was a quasi-experimental before-after design. Data were collected regarding the provision of PR services before and after delivery of the BEWE program and patient outcomes before and after PR.

RESULTS

The BEWE program was delivered in one rural and one remote region. Neither region had active PR before the BEWE program delivery. At 12-month follow-up, three locally-run PR programs had been established. Audit and patient outcomes indicated that the PR programs established broadly met Australian practice recommendations and were being delivered effectively. In both regions PR was established with strong healthcare organisational support but without significant external funding, relying instead on the diversion of internal funding and/or in-kind support.

CONCLUSIONS

The BEWE program enabled the successful establishment of PR and improved patient outcomes in rural and remote regions. However, given the funding models used, the sustainability of these programs in the long term is unknown. Further research into the factors contributing to the ability of rural and remote sites to provide ongoing delivery of PR is required.

Palliative care professional education via video conference builds confidence to deliver palliative care in rural and remote locations

BACKGROUND

People living in rural and remote locations are disadvantaged in accessing palliative care. This can be attributed to several factors including the role diversity and the low numbers of patients with specific conditions, as well as the difficulties rural health practitioners have in accessing opportunities for professional education. A program of multidisciplinary palliative care video conferences was presented to health practitioners across part of northern Australia in an effort to address this problem.

METHOD

The educational content of the video conferences was developed from participant responses to an educational needs assessment. Following cycles of four consecutive video conferences, 101 participants completed evaluative on-line surveys. The quantitative data were analysed using frequencies and analysis of variance tests with post-hoc analyses where appropriate, and an accessibility and remoteness index was used to classify their practice location.

RESULTS

All participants found the content useful regardless of their remoteness from the tertiary centre, their years of experience caring for palliative care patients or the number of patients cared for each year. However, change in confidence to provide palliative care as a result of attending the video conferences was significant across all disciplines, regardless of location. Doctors, medical students and allied health professionals indicated the greatest change in confidence.

CONCLUSIONS

The provision of professional education about palliative care issues via multidisciplinary video conferencing increased confidence among rural health practitioners, by meeting their identified need for topic and context specific education. This technology also enhanced the networking opportunities between practitioners, providing an avenue of ongoing professional support necessary for maintaining the health workforce in rural and remote areas. However, more attention should be directed to the diverse educational needs of allied health professionals.