Maintaining the competence of Europe's workforce

A Qualitative Study to Understand the Cultural Factors That Influence Clinical Data Use for Continuing Professional Development

INTRODUCTION

The use of data to inform lifelong learning has become increasingly important in continuing professional development (CPD) practice. Despite the potential benefits of data-driven learning, our understanding of how physicians engage in data-informed learning activities, particularly for CPD, remains unclear and warrants further study. The purpose of this study was to explore how physicians perceive cultural factors (individual, organizational, and systemic) that influence the use of clinical data to inform lifelong learning and self-initiated CPD activities.

METHODS

This qualitative study is part of an explanatory sequential mixed-methods study examining data-informed learning. Participants were psychiatrists and general surgeons from Canada and the United States. Recruitment occurred between April 2019 and November 2019, and the authors conducted semistructured telephone interviews between May 2019 and November 2019. The authors performed thematic analysis using an iterative, inductive method of constant comparative analysis.

RESULTS

The authors interviewed 28 physicians: 17 psychiatrists (61%) and 11 general surgeons (39%). Three major themes emerged from the continuous, iterative analysis of interview transcripts: (1) a strong relationship between data and trust, (2) a team-based approach to data-informed learning for practice improvement, and (3) a need for organizational support and advocacy to put data into practice.

CONCLUSION

Building trust, taking a team-based approach, and engaging multiple stakeholders, such as data specialists and organizational leadership, may significantly improve the use of data-informed learning. The results are situated in the existing literature, and opportunities for future research are summarized.

Doctors on the move: a European case study on the key characteristics of national recertification systems

OBJECTIVES

With increased cross-border movement, ensuring safe and high-quality healthcare has gained primacy. The purpose of recertification is to ensure quality of care through periodically attesting doctors' professional proficiency in their field. Professional migration and facilitated cross-border recognition of qualifications, however, make us question the fitness of national policies for safeguarding patient care and the international accountability of doctors.

DESIGN AND SETTING

We performed document analyses and conducted 19 semistructured interviews to identify and describe key characteristics and effective components of 10 different European recertification systems, each representing one case (collective case study). We subsequently compared these systems to explore similarities and differences in terms of assessment criteria used to determine process quality.

RESULTS

Great variety existed between countries in terms and assessment formats used, targeting cognition, competence and performance (Miller's assessment pyramid). Recertification procedures and requirements also varied significantly, ranging from voluntary participation in professional development modules to the mandatory collection of multiple performance data in a competency-based portfolio. Knowledge assessment was fundamental to recertification in most countries. Another difference concerned the stakeholders involved in the recertification process: while some systems exclusively relied on doctors' self-assessment, others involved multiple stakeholders but rarely included patients in assessment of doctors' professional competence. Differences between systems partly reflected different goals and primary purposes of recertification.

CONCLUSION

Recertification systems differ substantially internationally with regard to the criteria they apply to assess doctors' competence, their aims, requirements, assessment formats and patient involvement. In the light of professional mobility and associated demands for accountability, we recommend that competence assessment includes patients' perspectives, and recertification practices be shared internationally to enhance transparency. This can help facilitate cross-border movement, while guaranteeing high-quality patient care.

Point of care information services: a platform for self-directed continuing medical education for front line decision makers

The structure and aim of continuing medical education (CME) is shifting from the passive transmission of knowledge to a competency-based model focused on professional development. Self-directed learning is emerging as the foremost educational method for advancing competency-based CME. In a field marked by the constant expansion of knowledge, self-directed learning allows physicians to tailor their learning strategy to meet the information needs of practice. Point of care information services are innovative tools that provide health professionals with digested evidence at the front line to guide decision making. By mobilising self-directing learning to meet the information needs of clinicians at the bedside, point of care information services represent a promising platform for competency-based CME. Several points, however, must be considered to enhance the accessibility and development of these tools to improve competency-based CME and the quality of care.

Proposal of a linear rather than hierarchical evaluation of educational initiatives: the 7Is framework

Extensive resources are expended attempting to change clinical practice; however, determining the effects of these interventions can be challenging. Traditionally, frameworks to examine the impact of educational interventions have been hierarchical in their approach. In this article, existing frameworks to examine medical education initiatives are reviewed and a novel '7Is framework' discussed. This framework contains seven linearly sequenced domains: interaction, interface, instruction, ideation, integration, implementation, and improvement. The 7Is framework enables the conceptualization of the various effects of an intervention, promoting the development of a set of valid and specific outcome measures, ultimately leading to more robust evaluation.

The importance of social and collaborative learning for online continuing medical education (OCME): directions for future development and research

BACKGROUND

There is an increasing use of online continuing medical education (OCME), but the potential use of social and collaborative learning to change professional performance and improve patient care has yet to be fully realised.

METHODS

The integration of the main themes from the presentations and comments from participants at a symposium at AMEE 2011.

RESULTS

Sociological perspectives on change in professional performance highlight the need for social and collaborative learning in OCME so that learners can share information (explicit knowledge) and opinion (tacit knowledge). The educational topic should be relevant to the complexity of professional practice and use iterative cycles of implementation and critical reflection in social networks so that proposed solutions can be tested in actual practice. The challenge of developing effective online discussions for collaborative learning is recognised.

CONCLUSION

The provision of OCME requires a shift in both policy and practice to emphasise the importance of social and collaborative learning. Further research is recommended, especially to evaluate the implementation and impact of social and collaborative learning for OCME on patient care and the use of newer Web 2.0 approaches.

[Long-life learning for medical specialists doctors in Europe: CME, DPC and qualification]

The Union européenne des médecins spécialistes (UEMS) has a mandate to lead the quality of care in Europe and harmonise the qualifications of specialists doctors. In 2000, UEMS has set the European Accreditation Council for Continuing Medical Education (EACCME), with the objective to accredit educational events and facilitate the reciprocity of CME credits obtained by attending international medical conferences. In 2010, UEMS has set the European Accreditation Council for Medical Specialist Qualification (EACMSQ). This 2-year pilot project concerns three specialties with the goal to harmonise the competencies' assessment. In 2010, 35 countries are UEMS members, corresponding to 1,5 millions specialists doctors. Each of the 38 medical specialties has a 'section' and a four-members' board. Since 2000, the Europe developed the CPD concepts, and definitions were customised per country and health systems. The Rome group defined the CPD: "Continuing professional development is the educative means of updating, developing and enhancing how doctors apply the knowledge, skills and attitudes required in their working lives. This includes CME, professional and managerial (non-clinical) competencies, and all elements of Good Medical Practice". The learning concepts must be better developed in the health care systems as it has been done in other sectors of activity. Learning is the concept considering that it's no more possible to characterise the learner as a sponge absorbing information. The virtuous cycle of CME is well-known: assess his professional needs; set the needs and objectives; implement an educational plan with the right methods; conduct the actions and get the data; assess the events according to levels (participation, satisfaction, learning, performance, patient's health, population's health). Financing of events usually is shared between payers: state, insurers, industries, doctors but in fine, the public is the major payer. Education must be independent from all influences and recommendations should be set. Countries have mandatory or voluntary CME/CPD systems but it's not a criterium of a better performance. National authorities accredit organisms or events, and that does not make any difference.