Continuous professional development: raising the bar for pediatricians

Perspectives on Professional Development Among University and Community Pediatric Hospitalists

Multiple professional societies have emphasized the importance of professional development for physicians. This qualitative study aimed to explore pediatric hospitalists' perceptions of professional development needs and to refine a framework for professional development in pediatric hospital medicine (PHM). We conducted four focus groups in April to May 2019 with 19 pediatric hospitalists at six clinical sites within a single institution. Participants identified key components of professional development including skill development, personal growth, career satisfaction, and individualization. Hospitalists agreed upon 8 domains of professional development: clinical excellence, advocacy, global health, health care administration, informatics, medical education, quality improvement, and research. They also identified missing the mentorship necessary to change their passions into career advancement, highlighted barriers and facilitators, and noted that an alignment in personally meaningful projects to what is meaningful to the institution was in everyone's best interests. Faculty programs should build infrastructure to aid pediatric hospitalists in achieving their career goals.

Objective evaluation of tongue diagnosis ability using a tongue diagnosis e-learning/e-assessment system based on a standardized tongue image database

Background

In Kampo medicine, tongue examination is used to diagnose the pathological condition "Sho," but an objective evaluation method for its diagnostic ability has not been established. We constructed a tongue diagnosis electronic learning and evaluation system based on a standardized tongue image database.

Purpose

This study aims to verify the practicality of this assessment system by evaluating the tongue diagnosis ability of Kampo specialists (KSs), medical professionals, and students.

Methods

In the first study, we analyzed the answer data of 15 KSs in an 80-question tongue diagnosis test that assesses eight aspects of tongue findings and evaluated the (i) test score, (ii) test difficulty and discrimination index, (iii) diagnostic consistency, and (iv) diagnostic match rate between KSs. In the second study, we administered a 20-question common Kampo test and analyzed the answer data of 107 medical professionals and 56 students that assessed the tongue color discrimination ability and evaluated the (v) correct answer rate, (vi) test difficulty, and (vii) factors related to the correct answer rate.

Result

In the first study, the average test score was 62.2 ± 10.7 points. Twenty-eight questions were difficult (correct answer rate, <50%), 34 were moderate (50%-85%), and 18 were easy (≥85%). Regarding intrarater reliability, the average diagnostic match rate of five KSs involved in database construction was 0.66 ± 0.08, and as for interrater reliability, the diagnostic match rate between the 15 KSs was 0.52 (95% confidence interval, 0.38-0.65) for Gwet's agreement coefficient 1, and the degree of the match rate was moderate. In the second study, the difficulty level of questions was moderate, with a correct rate of 81.3% for medical professionals and 82.1% for students. The discrimination index was good for medical professionals (0.35) and poor for students (0.06). Among medical professionals, the correct answer group of this question had a significantly higher total score on the Kampo common test than the incorrect answer group (85.3 ± 8.4 points vs. 75.8 ± 11.8 points, p < 0.01).

Conclusion

This system can objectively evaluate tongue diagnosis ability and has high practicality. Utilizing this system can be expected to contribute to improving learners' tongue diagnosis ability and standardization of tongue diagnosis.

Impact of a multifaceted pediatric sedation course: self-directed learning versus a formal continuing medical education course to improve knowledge of sedation guidelines

Background:

Procedural sedation guidelines were established for a tertiary care pediatric emergency department (ED). We developed a pediatric procedural sedation course to disseminate these guidelines.

Objective:

Our objective was to evaluate the effectiveness of a sedation course in improving physicians' knowledge of pediatric procedural sedation practices and guidelines, relative to individual self-directed learning.

Methods:

We recruited emergency staff physicians and fellows as well as fourth-year pediatric residents in a tertiary care pediatric ED to participate in a randomized, controlled, educational intervention. All consenting physicians received pediatric sedation educational material for individual study 2 weeks before a learning assessment. Participants were randomly assigned to one of 2 groups. The self-directed learning group (n= 24) completed a multiple-choice examination without receiving any formal teaching. The study group (n= 24) participated in a 4-hour formal multi-faceted sedation course before writing the multiple-choice examination.

Results:

The groups did not differ significantly in demographic characteristics or self-perceived knowledge of pediatric sedation. The formal teaching group's median examination score (83.3%; range 75.8%–96.5%) was significantly higher (p&lt; 0.0001) than the median examination score of participants in the self-directed study group (73.3%, range 43.5%–86.6%).

Conclusion:

The multifaceted sedation course was more effective in improving physician knowledge and understanding of sedation guidelines and practices than unstructured, self-directed learning.

Applying adult learning practices in medical education

The application of the best practices of teaching adults to the education of adults in medical education settings is important in the process of transforming learners to become and remain effective physicians. Medical education at all levels should be designed to equip physicians with the knowledge, clinical skills, and professionalism that are required to deliver quality patient care. The ultimate outcome is the health of the patient and the health status of the society. In the translational science of medical education, improved patient outcomes linked directly to educational events are the ultimate goal and are best defined by rigorous medical education research efforts. To best develop faculty, the same principles of adult education and teaching adults apply. In a systematic review of faculty development initiatives designed to improve teaching effectiveness in medical education, the use of experiential learning, feedback, effective relationships with peers, and diverse educational methods were found to be most important in the success of these programs. In this article, we present 5 examples of applying the best practices in teaching adults and utilizing the emerging understanding of the neurobiology of learning in teaching students, trainees, and practitioners. These include (1) use of standardized patients to develop communication skills, (2) use of online quizzes to assess knowledge and aid self-directed learning, (3) use of practice sessions and video clips to enhance significant learning of teaching skills, (4) use of case-based discussions to develop professionalism concepts and skills, and (5) use of the American Academy of Pediatrics PediaLink as a model for individualized learner-directed online learning. These examples highlight how experiential leaning, providing valuable feedback, opportunities for practice, and stimulation of self-directed learning can be utilized as medical education continues its dynamic transformation in the years ahead.

Effectiveness of an enhanced peer assessment program: introducing education into regulatory assessment

INTRODUCTION

The College of Physicians and Surgeons of Ontario developed an enhanced peer assessment (EPA), the goal of which was to provide participating physicians educational value by helping them identify specific learning needs and aligning the assessment process with the principles of continuing education and professional development. In this article, we examine the educational value of the EPA and whether physicians will change their practice as a result of the recommendations received during the assessment.

METHODS

A group of 41 randomly selected physicians (23 general or family practitioners, 7 obstetrician-gynecologists, and 11 general surgeons) agreed to participate in the EPA pilot. Nine experienced peer assessors were trained in the principles of knowledge translation and the use of practice resources (tool kits) and clinical practice guidelines. The EPA was evaluated through the use of a postassessment questionnaire and focus groups.

RESULTS

The physicians felt that the EPA was fair and educationally valuable. Most focus group participants indicated that they implemented recommendations made by the assessor and made changes to some aspect of their practice. The physicians' suggestions for improvement included expanding the assessment beyond the current medical record review and interview format (eg, to include multisource feedback), having assessments occur at regular intervals (eg, every 5 to 10 years), and improving the administrative process by which physicians apply for educational credit for EPA activities.

CONCLUSIONS

The EPA pilot study has demonstrated that providing detailed individualized feedback and optimizing the one-to-one interaction between assessors and physicians is a promising method for changing physician behavior. The college has started the process of aligning all its peer assessments with the principles of continuing professional development outlined in the EPA model.

Information resource preferences by general pediatricians in office settings: a qualitative study

Background

Information needs and resource preferences of office-based general pediatricians have not been well characterized.

Methods

Data collected from a sample of twenty office-based urban/suburban general pediatricians consisted of: (a) a demographic survey about participants' practice and computer use, (b) semi-structured interviews on their use of different types of information resources and (c) semi-structured interviews on perceptions of information needs and resource preferences in response to clinical vignettes representing cases in Genetics and Infectious Diseases. Content analysis of interviews provided participants' perceived use of resources and their perceived questions and preferred resources in response to vignettes.

Results

Participants' average time in practice was 15.4 years (2–28 years). All had in-office online access.

Participants identified specialist/generalist colleagues, general/specialty pediatric texts, drug formularies, federal government/professional organization Websites and medical portals (when available) as preferred information sources. They did not identify decision-making texts, evidence-based reviews, journal abstracts, medical librarians or consumer health information for routine office use.

In response to clinical vignettes in Genetics and Infectious Diseases, participants identified Question Types about patient-specific (diagnosis, history and findings) and general medical (diagnostic, therapeutic and referral guidelines) information. They identified specialists and specialty textbooks, history and physical examination, colleagues and general pediatric textbooks, and federal and professional organizational Websites as information sources. Participants with access to portals identified them as information resources in lieu of texts.

For Genetics vignettes, participants identified questions about prenatal history, disease etiology and treatment guidelines. For Genetics vignettes, they identified patient history, specialists, general pediatric texts, Web search engines and colleagues as information sources. For Infectious Diseases (ID) vignettes, participants identified questions about patients' clinical status at presentation and questions about disease classification, diagnosis/therapy/referral guidelines and sources of patient education. For ID vignettes, they identified history, laboratory results, colleagues, specialists and personal experience as information sources.

Conclusion

Content analysis of office-based general pediatricians' responses to clinical vignettes provided a qualitative description of their perceptions of information needs and preferences for information resource for cases in Genetics and Infectious Diseases. This approach may provide complementary information for discovering practitioner's information needs and resource preferences in different contexts.

Are Residents Ready for Self-Directed Learning? A Pilot Program of Individualized Learning Plans in Continuity Clinic

Changes in training and certification requirements demand that trainees and practitioners take charge of planning and documenting their ongoing learning. Individualized learning plans (ILPs) have been proposed as a tool to guide this process. We report on a pilot program using ILPs as part of the pediatric continuity clinic experience.

OBJECTIVE

The goal of the project was to explore residents' and faculty members' reactions to using ILPs when ILPs were offered as an optional tool.

METHODS

A group of 42 residents and 13 faculty members volunteered to use ILPs in continuity clinic. Nine months into the intervention, residents and faculty completed questionnaires about their experiences using ILPs. We performed a content analysis of questionnaire responses to identify perceived benefits and barriers to using ILPs.

RESULTS

ILP users reported that the program was helpful in providing a framework and focus for learning and in amplifying their awareness of the learning process. Barriers to using ILPs included lack of time and difficulty establishing and working with learning goals.

CONCLUSIONS

Our results suggest that residents are unaccustomed to taking active roles in planning their own learning. To prepare trainees for lifelong learning and continuous professional development, residency programs need to provide explicit education in the process of self-directed learning.

The state of pediatrics residency training: a period of transformation of graduate medical education

Graduate medical education is in a period of transformation. This article reviews the state of pediatrics residency training by summarizing the changing demographics within training programs, examining the new educational paradigm with an emphasis on competency-based education and continuous professional development, and describing forces influencing the workplace and the focus on work-life balance. Strategies are suggested for leaders in graduate medical education to meet the challenges experienced during this period of transformation.

Physicians' Internet information-seeking behaviors

INTRODUCTION

Our understanding about the role of the Internet as a resource for physicians has improved in the past several years with reports of patterns for use and measures of impact on medical practice. The purpose of this study was to begin to shape a theory base for more fully describing physicians' information-seeking behaviors as they apply to Internet use and applications for continuing education providers to more effectively support learning.

METHODS

A survey about Internet use and physician information seeking was administered by facsimile transmission to a random sample of 3,347 physicians.

RESULTS

Almost all physicians have access to the Internet, and most believe it is important for patient care. The most frequent use is in accessing the latest research on specific topics, new information in a disease area, and information related to a specific patient problem. Critical to seeking clinical information is the credibility of the source, followed by relevance, unlimited access, speed, and ease of use. Electronic media are viewed as increasingly important sources for clinical information, with decreased use of journals and local continuing medical education (CME). Barriers to finding needed information include too much information, lack of specific information, and navigation or searching difficulties.

DISCUSSION

The Internet has become an important force in how physicians deliver care. Understanding more about physician information-seeking needs, behaviors, and uses is critical to CME providers to support a self-directed curriculum for each physician. A shift to increased use of electronic CME options points to new demands for users and providers. Specific information about how physicians create a question and search for resources is an area that requires providers to develop new skills.