Barriers and attitudes influencing non-engagement in a peer feedback model to inform evidence for GP appraisal

Comparison of two audit and feedback approaches: descriptive analysis of personal and contextual dynamics

INTRODUCTION

Audit and feedback (A&F) is a systematic intervention that can be used to improve the quality of health care. The EASY-NET Network Project proposes an innovative A&F model.

AIM

This study aimed to describe the newly proposed A&F model. An analysis was conducted, examining the participants' attitudes and their individual and interpersonal mechanisms to understand how they influence the work context and vice versa.

METHODS

Two A&F models were compared, involving emergency and rehabilitation health workers, who were divided into two groups. The classic A&F model was compared with a new model, using a desk audit followed by interactive feedback. Communication training was provided to the audit team by psychologists before commencement of the project. The experimental group underwent psychological screening using two standardized tools (COPE-NVI and ProQoL) to evaluate personal and relational dynamics using the context-mechanism-outcome (CMO) paradigm.

RESULTS

The exchange of ideas among health professionals is more effective when using face-to-face feedback than written feedback. The COPE-NVI and ProQoL questionnaires highlighted the difficulties experienced by health care professionals in implementing effective coping strategies to deal with stressful events.

CONCLUSIONS

Identifying signs of stress in health care workers is essential for improvement strategies to be implemented and for establishing new, optimal conditions. Remote feedback makes it possible to overcome logistical barriers and, in the future, this method can be used for inter-organizational collaboration.

SPANISH ABSTRACT

http://links.lww.com/IJEBH/A203.

Doctors' attitudes to maintenance of professional competence: A scoping review

CONTEXT

Recent decades have seen the international implementation of programmes aimed at assuring the continuing competence of doctors. Maintenance of Professional Competence (MPC) programmes aim to encourage doctors' lifelong learning and ensure high-quality, safe patient care; however, programme requirements can be perceived as bureaucratic and irrelevant to practice, leading to disengagement. Doctors' attitudes and beliefs about MPC are critical to translating regulatory requirements into committed and effective lifelong learning. We aimed to summarise knowledge about doctors' attitudes to MPC to inform the development of MPC programmes and identify under-researched areas.

METHODS

We undertook a scoping review following Arksey and O'Malley, including sources of evidence about doctors' attitudes to MPC in the United States, the United Kingdom, Canada, Australia, New Zealand and Ireland, and using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) as a guide.

RESULTS

One hundred and twenty-five sources of evidence were included in the review. One hundred and two were peer-reviewed publications, and 23 were reports. Most were from the United Kingdom or the United States and used quantitative or mixed methods. There was agreement across jurisdictions that MPC is a good idea in theory but doubt that it achieves its objectives in practice. Attitudes to the processes of MPC, and their impact on learning and practice were mixed. The lack of connection between MPC and practice was a recurrent theme. Barriers to participation were lack of time and resources, complexity of the requirements and a lack of flexibility in addressing doctors' personal and professional circumstances.

CONCLUSIONS

Overall, the picture that emerged is that doctors are supportive of the concept of MPC but have mixed views on its processes. We highlight implications for research and practice arising from these findings.

The benefits of appraisal: a critical (re)view of the literature

It has been acknowledged that little is known about the impact of general practice (GP) appraisal on clinical and professional practice, as may be demonstrated by identifiable or 'hard' outcomes, and further, that the way in which appraisal informs professional development is unclear. In spite of this acknowledgement and the existence of a substantial number of studies about GP appraisal, to date an overview of the field of enquiry which maps what is known, has been lacking. In this leading article we present the first extensive thematic narrative synthesis of the literature on appraisal. In it we highlight the issues and tensions around research into appraisal, based on what we found (or didn't find) in our review. Key conclusions concern the focus of existing research - which has tended to report the perceptions of change from individual appraisees, rather than specific examples of change captured from other sources and perspectives - and the scope of research - which has been limited to certain data collection methods. Based upon our review, we draw out implications for research and researchers in the future.