Effective in-service training design and delivery: evidence from an integrative literature review

BACKGROUND

In-service training represents a significant financial investment for supporting continued competence of the health care workforce. An integrative review of the education and training literature was conducted to identify effective training approaches for health worker continuing professional education (CPE) and what evidence exists of outcomes derived from CPE.

METHODS

A literature review was conducted from multiple databases including PubMed, the Cochrane Library and Cumulative Index to Nursing and Allied Health Literature (CINAHL) between May and June 2011. The initial review of titles and abstracts produced 244 results. Articles selected for analysis after two quality reviews consisted of systematic reviews, randomized controlled trials (RCTs) and programme evaluations published in peer-reviewed journals from 2000 to 2011 in the English language. The articles analysed included 37 systematic reviews and 32 RCTs. The research questions focused on the evidence supporting educational techniques, frequency, setting and media used to deliver instruction for continuing health professional education.

RESULTS

The evidence suggests the use of multiple techniques that allow for interaction and enable learners to process and apply information. Case-based learning, clinical simulations, practice and feedback are identified as effective educational techniques. Didactic techniques that involve passive instruction, such as reading or lecture, have been found to have little or no impact on learning outcomes. Repetitive interventions, rather than single interventions, were shown to be superior for learning outcomes. Settings similar to the workplace improved skill acquisition and performance. Computer-based learning can be equally or more effective than live instruction and more cost efficient if effective techniques are used. Effective techniques can lead to improvements in knowledge and skill outcomes and clinical practice behaviours, but there is less evidence directly linking CPE to improved clinical outcomes. Very limited quality data are available from low- to middle-income countries.

CONCLUSIONS

Educational techniques are critical to learning outcomes. Targeted, repetitive interventions can result in better learning outcomes. Setting should be selected to support relevant and realistic practice and increase efficiency. Media should be selected based on the potential to support effective educational techniques and efficiency of instruction. CPE can lead to improved learning outcomes if effective techniques are used. Limited data indicate that there may also be an effect on improving clinical practice behaviours. The research agenda calls for well-constructed evaluations of culturally appropriate combinations of technique, setting, frequency and media, developed for and tested among all levels of health workers in low- and middle-income countries.

Globalization of continuing professional development by journal clubs via microblogging: a systematic review

Background

Journal clubs are an essential tool in promoting clinical evidence-based medical education to all medical and allied health professionals. Twitter represents a public, microblogging forum that can facilitate traditional journal club requirements, while also reaching a global audience, and participation for discussion with study authors and colleagues.

Objective

The aim of the current study was to evaluate the current state of social media–facilitated journal clubs, specifically Twitter, as an example of continuing professional development.

Methods

A systematic review of literature databases (Medline, Embase, CINAHL, Web of Science, ERIC via ProQuest) was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search of Twitter, the followers of identified journal clubs, and Symplur was also performed. Demographic and monthly tweet data were extracted from Twitter and Symplur. All manuscripts related to Twitter-based journal clubs were included. Statistical analyses were performed in MS Excel and STATA.

Results

From a total of 469 citations, 11 manuscripts were included and referred to five Twitter-based journal clubs (#ALiEMJC, #BlueJC, #ebnjc, #urojc, #meded). A Twitter-based journal club search yielded 34 potential hashtags/accounts, of which 24 were included in the final analysis. The median duration of activity was 11.75 (interquartile range [IQR] 19.9, SD 10.9) months, with 7 now inactive. The median number of followers and participants was 374 (IQR 574) and 157 (IQR 272), respectively. An overall increasing establishment of active Twitter-based journal clubs was observed, resulting in an exponential increase in total cumulative tweets (R²=.98), and tweets per month (R²=.72). Cumulative tweets for specific journal clubs increased linearly, with @ADC_JC, @EBNursingBMJ, @igsjc, @iurojc, and @NephJC, and showing greatest rate of change, as well as total impressions per month since establishment. An average of two tweets per month was estimated for the majority of participants, while the “Top 10” tweeters for @iurojc showed a significantly lower contribution to overall tweets for each month (P<.005). A linearly increasing impression:tweet ratio was observed for the top five journal clubs.

Conclusions

Twitter-based journal clubs are free, time-efficient, and publicly accessible means to facilitate international discussions regarding clinically important evidence-based research.

Training family physicians in shared decision making for the use of antibiotics for acute respiratory infections: a pilot clustered randomized controlled trial

BACKGROUND

Experts estimate that the prevalence of antibiotics use exceeds the prevalence of bacterial acute respiratory infections (ARIs).

OBJECTIVE

To develop, adapt and validate DECISION+ and estimate its impact on the decision of family physicians (FPs) and their patients on whether to use antibiotics for ARIs.

DESIGN

Two-arm parallel clustered pilot randomized controlled trial.

SETTING AND PARTICIPANTS

Four family medicine groups were randomized to immediate DECISION+ participation (the experimental group) or delayed DECISION+ participation (the control group). Thirty-three FPs and 459 patients participated.

INTERVENTION

DECISION+ is a multiple-component, continuing professional development program in shared decision making that addresses the use of antibiotics for ARIs.

MAIN OUTCOME MEASURES

Throughout the pilot trial, DECISION+ was adapted in response to participant feedback. After the consultation, patients and FPs independently self-reported the decision (immediate use, delayed use, or no use of antibiotics) and its quality. Agreement between their decisional conflict was assessed. Two weeks later, patients assessed their decisional regret and health status.

RESULTS

Compared to the control group, the experimental group reduced its immediate use of antibiotics (49 vs. 33% absolute difference = 16%; P = 0.08). Decisional conflict agreement was stronger in the experimental group (absolute difference of Pearson's r = 0.26; P = 0.06). Decisional regret and perceptions of the quality of the decision and of health status in the two groups were similar.

DISCUSSION AND CONCLUSIONS

DECISION+ was developed successfully and appears to reduce the use of antibiotics for ARIs without affecting patients' outcomes. A larger trial is needed to confirm this observation.

International trends in lifelong learning for pharmacists

Lifelong learning for community pharmacists is shifting from continuing education (CE) towards continuing professional development (CPD) in some countries. The objectives of this report were to compare lifelong learning frameworks for community pharmacists in different countries, and determine to what extent the concept of CPD has been implemented. A literature search was conducted as well as an Internet search on the web sites of professional pharmacy associations and authorities in 8 countries. The results of this review show that the concept of CPD has been implemented primarily in countries that have a long tradition in lifelong learning, such as Great Britain. However, most countries have opted for the CE approach, eg, France, or for a combination of CE and CPD, eg, New Zealand. This approach combines the controllability by regulatory organizations that CE requires with the advantage of sustained behavior change seen in successful CPD programs.

A five-state continuing professional development pilot program for practicing pharmacists

OBJECTIVE

To determine whether a structured educational intervention would support pharmacists' utilization of a continuing professional development (CPD) model compared to pharmacist control subjects.

METHODS

A prospective, randomized, observational case-control study of CPD was conducted in which pharmacists participated in several educational interventions, and study and control groups completed prestudy and poststudy survey instruments.

RESULTS

Survey data from 57 pharmacists (n = 28 study, n = 29 control) were analyzed and significant outcomes from the CPD stages of reflect, plan, act, evaluate, and record were found between matched study subjects and study and control group comparisons.

CONCLUSIONS

With appropriate training and support, pharmacists can utilize a CPD approach to their lifelong learning and professional development.

A comprehensive approach to preceptor development

OBJECTIVE

To assess the impact of a comprehensive preceptor development program.

DESIGN

A comprehensive preceptor development program was designed that included live and recorded online programming, a preceptor manual, a preceptor newsletter, live events (local and regional), and one-on-one practice site visits.

ASSESSMENT

Over 5,000 evaluations (1,900 pre-implementation and 3,160 post-implementation) of preceptor performance were completed by students. Students rated preceptors higher in items related to providing helpful midpoint and final evaluations after program implementation. Over 1,000 Web-based preceptor development activities were completed by preceptors from 2007 to 2011. Preceptors felt activities enhanced their current knowledge, skills, attitudes, and values, and more than 90% felt the core development activities would improve their current practice.

CONCLUSION

A comprehensive approach to preceptor development that offered a variety of development and training opportunities received positive evaluations from preceptors and resulted in improved student evaluations of preceptors. A comprehensive development program should be made available to preceptors to foster their continuing professional development.

Recruitment and retention of occupational therapists and physiotherapists in rural regions: a meta-synthesis

BACKGROUND

Significant efforts have been made to address the shortage of health professionals in rural communities. In the face of increasing demand for rehabilitation services, strategies for recruiting and retaining occupational therapists (OTs) and physiotherapists (PTs) have yielded limited success. This study aims to broaden the understanding of factors associated with recruitment and retention of OTs and PTs in rural regions, through a synthesis of evidence from qualitative studies found in the literature.

METHODS

A systematic search of three databases was conducted for studies published between 1980 - 2009 specific to the recruitment and retention of OTs and PTs to rural areas. Studies deemed eligible were appraised using the McMaster Critical Review Form. Employing an iterative process, we conducted a thematic analysis of studies and developed second order interpretations to gain new insight into factors that influence rural recruitment and retention.

RESULTS

Of the 615 articles retrieved, 12 qualitative studies met the eligibility criteria. Our synthesis revealed that therapists' decision to locate, stay or leave rural communities was influenced to a greater degree by the availability of and access to practice supports, opportunities for professional growth and understanding the context of rural practice, than by location. The second-order analysis revealed the benefits of a strength-based inquiry in determining recruitment and retention factors. The themes that emerged were 1) support from the organization influences retention, 2) with support, challenges can become rewards and assets, and 3) an understanding of the challenges associated with rural practice prior to arrival influences retention.

CONCLUSIONS

This meta-synthesis illustrates how universally important practice supports are in the recruitment and retention of rehabilitation professionals in rural practice. While not unique to rural practice, the findings of this synthesis provide employers and health service planners with information necessary to make evidence-informed decisions regarding recruitment and retention to improve availability of health services for rural residents.

US and international health professions' requirements for continuing professional development

There is not a comprehensive global analysis of continuing professional development (CPD) and continuing education (CE) in the major health professions in published literature. The aim of this article is to summarize findings from the US and international literature on CPD and CE practices in the health professions, comparing the different requirements and frameworks to see what similarities and challenges exist and what the future focus should be for the pharmacy profession. A literature review was conducted on CPD and CE in selected health professions, namely pharmacy, medicine, nursing, ophthalmology, dentistry, public health, and psychology. Over 300 papers from the health professions were retrieved and screened. Relevant articles based on the abstracts and introductions were summarized into tabular form by profession, minimum requirements for licensure, nature of credits, guidelines on how to record CE and CPD activities, and specific CE and CPD definitions. Wide variations exist among the health professions. Lessons learned from this information can be used to further clarify and define the role of CE and CPD and self-directed lifelong learning in pharmacy and the health professions.

Pharmacists' perceptions of facilitators and barriers to lifelong learning

OBJECTIVES

To reevaluate facilitators of and barriers to pharmacists' participation in lifelong learning previously examined in a 1990 study.

METHODS

A survey instrument was mailed to 274 pharmacists who volunteered to participate based on a prior random sample survey. Data based on perceptions of facilitators and barriers to lifelong learning, as well as self-perception as a lifelong learner, were analyzed and compared to a similar 1990 survey.

RESULTS

The response rate for the survey was 88%. The top 3 facilitators and barriers to lifelong learning from the 2003 and the 1990 samples were: (1) personal desire to learn; (2) requirement to maintain professional licensure; and (3) enjoyment/relaxation provided by learning as change of pace from the "routine." The top 3 barriers were: (1) job constraints; (2) scheduling (location, distance, time) of group learning activities; and (3) family constraints (eg, spouse, children, personal). Respondents' broad self-perception as lifelong learners continued to be highly positive overall, but remained less positive relative to more specific lifelong learning skills such as the ability to identify learning objectives as well as to evaluate learning outcomes.

CONCLUSIONS

Little has changed in the last decade relative to how pharmacists view themselves as lifelong learners, as well as what they perceive as facilitators and barriers to lifelong learning. To address factors identified as facilitators and barriers, continuing education (CE) providers should focus on pharmacists' time constraints, whether due to employment, family responsibilities, or time invested in the educational activity itself, and pharmacists' internal motivations to learn (personal desire, enjoyment), as well as external forces such as mandatory CE for relicensure.

Individualized education and competency development of Croatian community pharmacists using the general level framework

OBJECTIVES

To measure Croatian community pharmacists' progress in competency development using the General Level Framework (GLF) as an educational tool in a longitudinal study.

METHODS

Patient care competencies of 100 community pharmacists were evaluated twice, in 2009 and in 2010 in a prospective cohort study. During this 12-month period, tailored educational programs based on the GLF were organized and conducted, new services and standard operating procedures were implemented, and documentation of contributions to patient care in the pharmacist's portfolio became mandatory.

RESULTS

Pharmacists' development of all GLF patient care competencies was significant with the greatest improvements seen in the following competencies: patient consultation, monitoring drug therapy, medicine information and patient education, and evaluation of outcomes.

CONCLUSIONS

This study, which retested the effectiveness of an evidence-based competency framework, confirmed that GLF is a valid educational tool for pharmacist development.

Radiologist-initiated double reading of abdominal CT: retrospective analysis of the clinical importance of changes to radiology reports

Background

Misinterpretation of radiological examinations is an important contributing factor to diagnostic errors. Consultant radiologists in Norwegian hospitals frequently request second reads by colleagues in real time. Our objective was to estimate the frequency of clinically important changes to radiology reports produced by these prospectively obtained double readings.

Methods

We retrospectively compared the preliminary and final reports from 1071 consecutive double-read abdominal CT examinations of surgical patients at five public hospitals in Norway. Experienced gastrointestinal surgeons rated the clinical importance of changes from the preliminary to final report. The severity of the radiological findings in clinically important changes was classified as increased, unchanged or decreased.

Results

Changes were classified as clinically important in 146 of 1071 reports (14%). Changes to 3 reports (0.3%) were critical (demanding immediate action), 35 (3%) were major (implying a change in treatment) and 108 (10%) were intermediate (requiring further investigations). The severity of the radiological findings was increased in 118 (81%) of the clinically important changes. Important changes were made less frequently when abdominal radiologists were first readers, more frequently when they were second readers, and more frequently to urgent examinations.

Conclusion

A 14% rate of clinically important changes made during double reading may justify quality assurance of radiological interpretation. Using expert second readers and a targeted selection of urgent cases and radiologists reading outside their specialty may increase the yield of discrepant cases.

A systematic review of the factors that influence the quality and effectiveness of telesupervision for health professionals

Introduction Whilst telesupervision (clinical supervision undertaken using communication technology) is being used more frequently, there is limited information on what factors influence its effectiveness and quality. We undertook this systematic review to address this gap. Methods Eligible telesupervision studies were identified following targeted search of electronic databases and the grey literature. Data were synthesised thematically, resulting in development of core themes. Results We identified 286 papers for initial relevancy screening by title and abstract. The full text of 36 papers were then retrieved and assessed for further relevance. A total of 11 papers were included in the final analysis. We identified eight themes that contribute to effective and high-quality telesupervision: supervisee characteristics, supervisor characteristics, supervision characteristics, supervisory relationship, communication strategies, prior face-to-face contact, environmental factors and technological considerations. Conclusion From the available evidence, telesupervision can be a feasible and acceptable form of clinical supervision if set up well. Further studies with robust designs are required to strengthen the existing evidence on what makes telesupervision effective, as well as to examine its cost-effectiveness.

Physician revalidation in Europe

Despite the increasing attention on patient mobility, there remains a lack of European-level interest in assuring the sustained competence of health professionals. Specifically, the existing European legal framework fails to recognise the introduction of periodic revalidation and requirements to participate in continuing professional development in some countries. This study shows that the definitions and mechanisms of revalidation vary significantly across member states. While some countries, eg Austria, Germany and Spain, look to continuing medical education as a means to promote recertification and quality of care, other countries, eg Belgium, France and the Netherlands, also incorporate peer review. In the UK the proposed revalidation scheme would include elements of relicensure through appraisal and feedback as well as physician recertification. Divergence between countries also exists in monitoring and enforcement. The European Commission should explore the implications for professional mobility of the diversity in the regulation of the medical profession.

Continuing professional development requirements for UK health professionals: a scoping review

OBJECTIVES

This paper sets out to establish the numbers and titles of regulated healthcare professionals in the UK and uses a review of how continuing professional development (CPD) for health professionals is described internationally to characterise the postqualification training required of UK professions by their regulators. It compares these standards across the professions and considers them against the best practice evidence and current definitions of CPD.

DESIGN

A scoping review.

SEARCH STRATEGY

We conducted a search of UK health and social care regulators' websites to establish a list of regulated professional titles, obtain numbers of registrants and identify documents detailing CPD policy. We searched Applied Social Sciences Index and Abstracs (ASSIA), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, EMCare and Scopus Life Sciences, Health Sciences, Physical Sciences and Social Sciences & Humanities databases to identify a list of common features used to describe CPD systems internationally and these were used to organise the review of CPD requirements for each profession.

RESULTS

CPD is now mandatory for the approximately 1.5 million individuals registered to work under 32 regulated titles in the UK. Eight of the nine regulators do not mandate modes of CPD and there is little requirement to conduct interprofessional CPD. Overall 81% of those registered are required to engage in some form of reflection on their learning but only 35% are required to use a personal development plan while 26% have no requirement to engage in peer-to-peer learning.

CONCLUSIONS

Our review highlights the wide variation in the required characteristics of CPD being undertaken by UK health professionals and raises the possibility that CPD schemes are not fully incorporating the best practice.

Developing the first national antimicrobial prescribing and stewardship competences

Antimicrobial resistance is a national and worldwide threat to the future of healthcare. Educating both healthcare staff and the public in the prudent use of antimicrobials is an essential part of antimicrobial stewardship programmes that aim to contain and control resistance and preserve the usefulness of currently available antibiotics. Using current available evidence, regulatory documents and national antimicrobial stewardship guidance for primary and secondary care, five dimensions for antimicrobial prescribing and stewardship competences have been developed in England, through an independent multiprofessional group led by the Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infection (ARHAI) of the Department of Health (England). They are designed to complement the generic competency framework for all prescribers from the UK National Prescribing Centre (now part of National Institute for Health and Care Excellence) and are relevant to all independent prescribers, including doctors, dentists and non-medical practitioners. The antimicrobial prescribing and stewardship competences published jointly by ARHAI and PHE in 2013 are believed to be the first of their kind. Implementation of these competences will be an important contribution to the delivery of the UK government's 5 year Antimicrobial Resistance Strategy.

Career development: graduate nurse views

AIMS AND OBJECTIVES

To explore recent Singapore nursing graduates' experience of and views about their career development and progress.

BACKGROUND

The recruitment and retention of an adequate number of registered nurses is a continuing workforce issue in Singapore and other major cities.

DESIGN

Survey of recent nursing graduates.

METHODS

Recent nursing graduates from the Bachelor programme (n = 147) were sent an individual survey; a response rate of 54% was achieved.

RESULTS

Findings show that nurses rated their self-concept in a positive manner and were most satisfied (moderately to very) with helping patients and providing effective care, and the level of patient involvement. They were least satisfied (moderately to only a little) with prestige among the general medical community and the general public, hours of work, lifestyle factors and research opportunities. The following four factors were identified as significant impediments to career development; lack of support in the work place; perceived insufficient clinical career development opportunities; excessive work hours; and limited access to merit-based places in further education.

CONCLUSIONS

Suggestions made to overcome perceived career development barriers are as follows: broad multifactorial healthcare system changes; decreased and more flexible working hours; and fairer access to further clinical and higher education.

RELEVANCE TO CLINICAL PRACTICE

Results highlight the value clinical nurses place on having access to career development opportunities, merit-based further education and work place supports. These factors also have the potential to influence patient care and impact on the retention of nurses in their present job and satisfaction with their nursing career.

A Continuing Professional Development Program for Pharmacists Implementing Pharmacogenomics into Practice

A continuing professional development (CPD) program for pharmacists practicing in community and team-based primary care settings was developed and evaluated using Moore’s framework for the assessment of continuing medical education. The program had three components: online lectures, a two-day training workshop, and patient case studies. Knowledge (pre-post multiple choice test); attitudes, readiness, and comfort with applying pharmacogenomics in their practices (pre-post surveys); and experiences of implementing pharmacogenomics in practice (semi-structured interviews) were assessed. Twenty-one of 26 enrolled pharmacists successfully completed the program, and were satisfied with their experience. Almost all achieved a score of 80% or higher on the post-training multiple choice test, with significantly improved scores compared to the pre-training test. Pre- and post-training surveys demonstrated that participants felt that their knowledge and competence increased upon completion of the training. In the follow-up, 15 pharmacists incorporated pharmacogenomics testing into care for 117 patients. Ten pharmacists participated in semi-structured interviews, reporting strong performance in the program, but some difficulty implementing new knowledge in their practices. This multi-component CPD program successfully increased pharmacists’ knowledge, readiness, and comfort in applying pharmacogenomics to patient care in the short-term, yet some pharmacists struggled to integrate this new service into their practices.

Effectiveness of a multifaceted intervention to improve emergency department care of low back pain: a stepped-wedge, cluster-randomised trial

BACKGROUND

Overuse of lumbar imaging is common in the emergency department (ED). Few trials have examined interventions to address this. We evaluated the effectiveness of a multifaceted intervention to implement guideline recommendations for low back pain in the emergency department.

METHODS

We conducted a stepped-wedge, cluster-randomised trial in four EDs in New South Wales, Australia. After a 13-month control phase of usual care, the EDs received a multifaceted intervention to support guideline-endorsed care in a random order, based on a computer-generated random sequence, every 4 weeks over a 4-month period. All sites were followed up for at least 3 months. The primary outcome was the proportion of low back pain presentations receiving lumbar imaging. Secondary healthcare utilisation outcomes included prescriptions of opioid and non-opioid pain medicines, inpatient admissions, length of ED stay, specialist referrals and re-presentations. Clinician beliefs and knowledge about low back pain care were measured before and after the intervention. Patient-reported pain, disability, quality of life and satisfaction were measured at 1, 2 and 4 weeks post ED presentation.

RESULTS

A total of 269 ED clinicians and 4625 episodes of care for low back pain (4491 patients) were included. The data did not provide clear evidence that the intervention reduced lumbar imaging (OR 0.77; 95% CI 0.47 to 1.26; p=0.29). It did reduce opioid use (OR 0.57; 95% CI 0.38 to 0.85; p=0.006) and improved clinicians' beliefs (mean difference (MD), 2.85; 95% CI 1.85 to 3.85; p<0.001; on a scale from 9 to 45) and knowledge about low back pain care (MD, 0.48; 95% CI 0.13 to 0.83; p<0.01; on a scale from 0 to 11). There was no difference in pain scores at 1-week follow-up (MD, 0.04; 95% CI -1.00 to 1.08; p=0.94; on a scale from 0 to 10). A similar trend was observed for all other patient-reported outcomes and time points. This study found no effect on the other secondary healthcare utilisation outcomes.

CONCLUSION

It is uncertain if a multifaceted intervention to implement guideline recommendations for low back pain care decreased lumbar imaging in the ED; however, it did reduce opioid prescriptions without adversely affecting patient outcomes. Trial registration number ACTRN12617001160325.

Pediatric Project ECHO®: A Virtual Community of Practice to Improve Palliative Care Knowledge and Self-Efficacy among Interprofessional Health Care Providers

Background: Health care providers (HCPs) require ongoing training and mentorship to fully appreciate the palliative care needs of children. Project ECHO^® (Extension for Community Healthcare Outcomes) is a model for delivering technology-enabled interprofessional education and cultivating a community of practice among HCPs who care for children with life-limiting illness.

Objectives: To develop, implement, and evaluate the Project ECHO model within the pediatric palliative care (PPC) context. Specific objectives were to evaluate (1) participation levels, (2) program acceptability, (3) HCP knowledge changes, (4) HCP self-efficacy changes, and (5) perceived practice changes after six months.

Intervention: An interprofessional PPC curriculum was informed by a needs assessment. The curriculum was delivered through monthly virtual 90-minute TeleECHO sessions (didactic presentation and case-based learning) from January 2018 to December 2019. The program was freely available to all HCPs wishing to participate.

Design: A mixed-methods design with repeat measures was used. Surveys were distributed at baseline and six months to assess outcomes using 7-point Likert scales. Descriptive and inferential statistical analyses were conducted. The study was approved by the Research Ethics Board at the Hospital for Sick Children.

Results: Twenty-four TeleECHO sessions were completed with a mean of 32 ± 12.5 attendees. Acceptability scores (n = 43) ranged from 5.1 ± 1.1 to 6.5 ± 0.6. HCPs reported improvements in knowledge and self-efficacy across most topics (11 out of 12) and skills (8 out of 10) with demonstrated statistical significance (p < 0.05). Most participants reported positive practice impacts, including enhanced ability to provide PPC in their practice.

Conclusion: Project ECHO is a feasible and impactful model for fostering a virtual PPC-focused community of practice among interprofessional HCPs.

Utilisation of internet resources for continuing professional development: a cross-sectional survey of general practitioners in Scotland

BACKGROUND

Participation in continuing professional development (CPD) is a professional and regulatory expectation of general practitioners (GPs). Traditionally, CPD activity was undertaken face-to-face in educational settings, but internet based formats have found increasing favour. The need for doctors to use the internet for service and educational purposes is growing, particularly in support of specialty training and appraisal. We aimed to determine how GPs in Scotland utilise online resources in support of their CPD. This involved identifying which resources are used and how frequently, along with their preferences as to how and why they access these resources.

METHODS

A cross sectional study was undertaken using an online questionnaire to survey general practitioners across Scotland. Data were subjected to descriptive analysis and differences in attitudinal responses between groups and Fischer's exact tests were calculated.

RESULTS

Three hundred and eighty-three GP responses were received, with the majority being female (n = 232, 60.6%) and GP partners (n = 236, 61.6%). The majority used the internet on three or more working days per week or more frequently (n = 361, 94.3%) with the three most common reasons being to obtain information for a patient (n = 358, 93.5%), answering a clinical question (n = 357, 93.2%) and CPD purposes (n = 308, 80.4%). Of 37 online resources used by respondents, the top five were SIGN Guidelines (n = 303, 79.3%), BMJ Learning (n = 279, 73.0%), NICE Guidelines (n = 255, 66.8%), GP Notebook (n = 243, 63.6%) and Google (n = 234, 61.3%). Low use of social media such as Facebook (n = 11, 2.9%) and Twitter (n = 11, 2.9%) was reported for CPD. A majority agreed that 'reading information online' (95.0%) and 'completing online learning modules' (87.4%) were the most valued online activities. Slow internet connections (n = 240, 62.7%), website access restrictions (n = 177, 46.2%) and difficulties logging into online CPD resources (n = 163, 42.6%) were reported barriers. Significant response differences (P < 0.05) were found between groups based on high volume online usage, gender and age.

CONCLUSIONS

The majority of respondents had positive attitudes to using online resources for continuing professional development, and a preference for evidence-based and peer reviewed online resources. Information technology (IT) difficulties remain a barrier to effective utilisation. The findings have implications for future planning and design of online resources and IT infrastructure.

Framework for industry engagement and quality principles for industry-provided medical education in Europe

Lifelong learning through continuing professional development (CPD) and medical education is critical for healthcare professionals to stay abreast of knowledge and skills and provide an optimal standard of care to patients. In Europe, CPD and medical education are fragmented as there are numerous models, providers and national regulations and a lack of harmonisation of qualitative criteria. There is continued debate on the appropriate role of pharmaceutical companies in the context of medical education. Accrediting bodies such as European Accreditation Council for Continuing Medical Education do not permit active involvement of the pharmaceutical industry due to concerns around conflicts of interest and potential for bias. However, many examples of active collaboration between pharmaceutical companies and medical societies and scientific experts exist, demonstrating high integrity, clear roles and responsibilities, and fair and balanced content. Medical education experts from 16 pharmaceutical companies met to develop a set of quality principles similar to standards that have been established for clinical trials and in alignment with existing principles of accrediting bodies. This paper outlines their proposal for a framework to improve and harmonise medical education quality standards in Europe, and is also an invitation for all stakeholders to join a discussion on this integrative model.

Introduction of a continuing professional development tool for preceptors: lessons learned

Accreditation Council for Pharmacy Education (ACPE) guidelines state that preceptors should "have a systematic, self-directed approach to their own continuing professional development (CPD)." The objective of this study was to encourage preceptors to take advantage of the ACPE CPD resources and implement the concept of CPD (reflect, plan, act, evaluate, record) as a framework for guiding individual preceptor's continuing development as educators and to determine their opinion regarding the usefulness, effectiveness, and obstacles to implementation of this approach. A total of 3713 preceptors from the participating schools were encouraged to undergo CPD training and invited to respond to a series of questions. Of the initial respondents, 48% represented health system/hospital preceptors, followed by community/independent pharmacists (64 of 236, 28%). Preceptor respondents often train students from multiple schools/colleges (average = 1.9 schools/colleges per preceptor) and 90% agreed or strongly agreed with the statement, "the CPD model, as learned in the webcasts, is beneficial for ongoing preceptor development." The general consensus was that the preceptor portfolio provided motivation to reflect, plan, and set more defined and realistic goals for students, residents, and themselves as educators and could be a valuable starting point for promoting preceptors' reflection, planning, and action related to rotation management, professional teaching, and student learning goals.