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Author: Brian S McGowan, PhD

MANUSCRIPT: Learning to collaborate: a case study of performance improvement CME [2008]

INTRODUCTION:
Performance Improvement Continuing Medical Education (PI CME) is a mechanism for joining quality improvement (QI) in health care to continuing medical education (CME) systems together. Although QI practices and CME approaches have been recognized for years, what emerges from their integration is largely unfamiliar, because it requires the collaboration of CME providers and stakeholders within the health care systems who traditionally have not worked together and may not have the same understanding of QI issues to close performance gaps. This study describes how an academic institution and a community-based primary care practice collaborated to enhance patient care in the area of hypertension. It offers lessons learned from a PI CME activity in the area of hypertension.
METHODS:
This was an observational case study. Data were collected through interviews, observations of educational events, and review of documents such as learning logs, which were designed to: (1) help physicians learn and change, (2) satisfy requirements for CME credit, (3) serve as the basis for reimbursement, and (4) provide data for the case study.
RESULTS:
Nine clinicians from one clinic completed the PI CME activity, achieved measurable improvements in their practice, and contributed to systems change. The study highlighted (1) the value of shared goals and agreement on the process among the participants, planners, and others involved; (2) the advantage of a multidisciplinary approach; (3) the importance of supporting clinicians’ continuing motivation to participate; and (4) the need to allow sufficient time to enable the initiative to evolve.
DISCUSSION:
PI CME required unprecedented collaboration between CME planners and QI stakeholders to enable change in clinical practice.

via Learning to collaborate: a case st… [J Contin Educ Health Prof. 2008] – PubMed – NCBI.

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ABSTRACT: Collaborative online learning: a new approach to distance CME [2002]

OBJECTIVE:
Continuing medical education (CME) has not taken advantage of the ability to communicate and collaborate online. Collaborative learning is an important learning principle, yet online CME programs are generally completed in a one-on-one relationship between the computer and the learner. This limits opportunities for reflective learning, and does not access the rich learning available from interacting with peers. We believe online CME will benefit from interaction between learners and from opportunities for reflection.
DESCRIPTION:
We implemented a prototype online course designed to improve the skills of general practitioners (GPs) in the care of patients with type 2 diabetes. The course design reflects adult learning principles but, uniquely, applies them to online learning. Currently, 20 GPs from England are enrolled, including one based in Bosnia, and one GP from New Zealand. The course uses BlackBoard(TM) software. Participants log in twice weekly for seven weeks to study one of seven interactive modules on diabetes from evidence-based sources. Modules provide for branched learning via links to additional resources. Subsequently, GPs engage in two online discussions, which are at the learner’s convenience rather than requiring adherence to a set schedule. One discussion group is for reflection on the modules, with an assignment to discuss how the material is being applied clinically. Participants also respond to colleagues’ postings each week. In a second discussion group, learners apply concepts from the modules to the collaborative management of a problem-based case of a patient with newly diagnosed diabetes. The patient is presented via an online medical chart and streaming videos. She returns each week of the course to mimic 18 months of care. Faculty facilitate the discussion groups and provide feedback.
DISCUSSION:
We are in the last week of the class and the participant feedback has been overwhelmingly positive. Many note how well the course design and timing match their learning styles and schedule constraints. A powerful feature has been our ability to identify additional educational needs, and quickly add corresponding content online. So far, participants have provided 340 postings, which include evidence of course effectiveness and documentation of application of course objectives and disease management strategies to change actual practice patterns. GPs report changing: screening practices for diabetic renal disease; prescribing of diabetic medications; screening protocols for diabetes; and organizing practice management systems to better track diabetic care. After diagnosing and managing a new diabetic patient during the course, one participant wrote: “It was fantastic to feel that I am offering an up-to-date evidence-based approach in something that I am deskilled in.” This course is unique in online CME. It is international in scope, collaborative, asynchronous in delivery, flexible, responsive to learner needs in real time, and has yielded evidence of its effectiveness in changing the actual clinical practices of participants. It will next enroll GPs in Singapore and additional UK-based GPs. Additional CME courses will be developed using this method.

via Collaborative online learning: a new approach to di… [Acad Med. 2002] – PubMed – NCBI.

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ABSTRACT: Effect of a Performance Improvement CME Activity on Management of Patients With Diabetes.

INTRODUCTION:
Primary care in the United States faces unprecedented challenges from an aging population and the accompanying prevalence of chronic disease. In response, continuing medical education (CME) initiatives have begun to adopt the principles of performance improvement (PI) into their design, although currently there is a dearth of evidence from national initiatives supporting the effectiveness of this methodology. The specific aim of this study was to demonstrate the value of a national PI-CME activity to improve the performance of physicians treating patients with diabetes.
METHODS:
We analyzed data from the American Academy of Family Physicians’ METRIC® PI-CME activity in a cohort of family physician learners. The study utilized the 3-stage design standard approved for PI-CME. Baseline and follow-up performance data across a range of clinical and systems-based measures were compared in aggregate.
RESULTS:
Data were assessed for 509 learners who completed the activity. Statistically significant changes occurred both for self-assessment of a range of practice aspects and for diabetes care measures. Learners recognized that the organization of their practices had improved, and mechanisms were in place for better staff feedback, as well as aspects of patient self-management. Based on the clinical data obtained from 11 538 patient charts, 6 out of 8 diabetes measures were significantly improved.
DISCUSSION:
The activity appears to have had a positive, measurable impact on the medical practice of learners and suggests that, when appropriately designed and executed, PI-CME on a national scale can be a useful vehicle to influence performance change in physicians and to inform future CME activities.

via Effect of a Performance Improvemen… [J Contin Educ Health Prof. 2013] – PubMed – NCBI.

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ABSTRACT: Cultural competence education for practicing physicians: lessons in cultural humility, nonjudgmental behaviors, and health beliefs elicitation.

INTRODUCTION:
Although numerous studies have examined cultural competence training, debate still exists about efficacious approaches to this training. Furthermore, little focus has been placed on training and evaluating practicing physicians.
METHODS:
A skills-based course on culturally competent diabetes care was developed and subsequently tested in a controlled trial of primary physicians caring for patients enrolled in one state’s Medicaid program. We hypothesized that physicians completing the course would show higher levels of self-reported cultural competence as measured by a Cultural Competence Assessment Tool (CCAT) than those in the control group. Differences in CCAT subscale scores were also compared.
RESULTS:
Ninety physicians completed the study, with 41 in the control and 49 in the intervention group. Most were female (66%), with an average age of 44, and 12 years in practice. There were no significant differences on total CCAT score (212.7 ± 26.7 for control versus 217.2 ± 28.6 for intervention, p = .444) or subscales measuring cultural knowledge. There were significant positive differences on the subscales measuring physicians’ nonjudgmental attitudes/behaviors (subscale score 2.38 ± 0.46 for control versus 2.69 ± 0.52 for intervention, p = .004) and future likelihood of eliciting patients’ beliefs about diabetes and treatment preferences (3.11 ± 0.53 for control versus 3.37 ± 0.45 for intervention, p = .014). There was, however, a significant negative difference on the subscale measuring cultural self-awareness (3.48 ± 0.36 for control versus 3.26 ± 0.48 for intervention, p = .018).
DISCUSSION:
A predominantly skills-based approach to training physicians did not change aggregate measures of cultural competence, but did affect key attitudes and behaviors, which may better reflect the goals of cultural competence training.

via Cultural competence education for … [J Contin Educ Health Prof. 2013] – PubMed – NCBI.

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ABSTRACT: Evolution of a Remedial CME Course in Professionalism: Addressing Learner Needs, Developing Content, and Evaluating Outcomes

INTRODUCTION:
Scant information is available about the nature of the professional violations resulting in referral of physicians for remedial continuing medical education (CME). The CME program at Case Western Reserve University (CWRU) School of Medicine has developed the Intensive Course in Medical Ethics, Boundaries, and Professionalism (medical ethics course) for physician referrals due to ethical breaches. In this report, the authors present 7 years of data regarding the type of behavior that resulted in course referral as well as information regarding course and outcome evaluation development and participant demographics.
METHODS:
The medical ethics course has been designed in consultation with licensure agencies to address the learning needs of physicians with problems in the areas of boundary maintenance and ethics. Teaching methods and outcome evaluations include lectures, case discussions, multiple-choice question tests, skill practice sessions, and writing a reflective essay based on the participants’ ethical lapse. Information is also gathered regarding participant demographics, training, and practice characteristics.
RESULTS:
Between September 2005 and February 2012, 358 learners participated in the course. The average age was 52 years and 73% were board certified. Of the 269 physicians who wrote a reflective essay, the reasons for referral included prescribing of controlled drugs, sexual boundary issues, providing services to family or friends, not maintaining proper medical records, and billing issues.
DISCUSSION:
This report outlines the strategies used by CWRU to develop remedial CME courses using the medical ethics course as an example for course and outcome evaluation development. This is the first report characterizing the type and frequency of the medical ethics violations that result in mandatory participation in remedial CME.
Copyright © 2013 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education

via Evolution of a Remedial CME Course… [J Contin Educ Health Prof. 2013] – PubMed – NCBI.

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MANUSCRIPT: “Best Practice” Skills Lab Training vs. a “see one, do one” Approach in Undergraduate Medical Education: An RCT on Students’ Long-Term Ability to Perform Procedural Clinical Skills.

BACKGROUND:
Benefits of skills lab training are widely accepted, but there is sparse research on its long-term effectiveness. We therefore conducted a prospective, randomised controlled-trial to investigate whether in a simulated setting students trained according to a “best practice” model (BPSL) perform two skills of different complexity (nasogastral tube insertion, NGT; intravenous cannulation, IVC) better than students trained with a traditional “see one, do one” teaching approach (TRAD), at follow-up of 3 or 6 months.
METHODOLOGY AND PRINCIPAL FINDINGS:
94 first-year medical students were randomly assigned to one of four groups: BPSL training or TRAD teaching with follow-up at 3 (3M) or 6 (6M) months. BPSL included structured feedback, practice on manikins, and Peyton’s “Four-Step-Approach”, while TRAD was only based on the “see one – do one” principle. At follow-up, manikins were used to assess students’ performance by two independent blinded video-assessors using binary checklists and a single-item global assessment scale. BPSL students scored significantly higher immediately after training (NGT: BPSL3M 94.8%±0.2 and BPSL6M 95.4%±0.3 percentage of maximal score ± SEM; TRAD3M 86.1%±0.5 and TRAD6M 84.7%±0.4. IVC: BPSL3M 86.4%±0.5 and BPSL6M 88.0%±0.5; TRAD3M 73.2%±0.7 and TRAD6M 72.5%±0.7) and lost significantly less of their performance ability at each follow-up (NGT: BPSL3M 86.3%±0.3 and TRAD3M 70.3%±0.6; BPSL6M 89.0%±0.3 and TRAD6M 65.4%±0.6; IVC: BPSL3M 79.5%±0.5 and TRAD3M 56.5%±0.5; BPSL6M 73.2%±0.4 and TRAD6M 51.5%±0.8). In addition, BPSL students were more often rated clinically competent at all assessment times. The superiority at assessment after training was higher for the more complex skill (IVC), whereas NGT with its lower complexity profited more with regard to long-term retention.
CONCLUSIONS:
This study shows that within a simulated setting BPSL is significantly more effective than TRAD for skills of different complexity assessed immediately after training and at follow-up. The advantages of BPSL training are seen especially in long-term retention.

via “Best Practice” Skills Lab Training vs. a “see one,… [PLoS One. 2013] – PubMed – NCBI.

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ABSTRACT: Closing the Patient-Oncologist Communication Gap: A Review of Historic and Current Efforts

Effective communication is essential in developing any relationship-this is particularly true between oncologists and their patients. The patient-oncologist relationship is one of the most delicate in medicine, and given the strong emotions associated with cancer, successful communication plays a paramount role in the wellbeing of patients and oncologists. Significant advances to close the communication gap have occurred over the past several decades, largely by addressing deficiencies in the various stages of an oncologist’s lengthy training: undergraduate medical education, residency and fellowship, and continuing medical education. Stemming from several milestones achieved by highly motivated groups of individuals, including the creation of consensus statements and guidelines by communication education experts, progress has been made to improve patient-oncologist communication. This progress is marked by the development of evidence-based communication skills training programs, such as Oncotalk and Comskil, in addition to the creation of distant-learning modalities, such as the Studying Communication in Oncologist-Patient Encounters trial. This review article outlines the history of communication education during medical education and training, and brings to light more recent efforts to promote competent, communication-minded physicians necessary for effective cancer care.

via Closing the Patient-Oncologist Communication G… [J Cancer Educ. 2013] – PubMed – NCBI.

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RESOURCE: The 5 Best Free Note Taking Tools for Teachers

Note-taking is an essential part of the educational process in order for students to retain and fully process information. However, getting students to hand-write effective notes with a pencil and paper can be difficult. Get your class excited to take notes with the 5 Best Free Note-Taking Tools for Teachers.

via The 5 Best Free Note Taking Tools for Teachers.

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RESOURCE: How To Get More Out Of Your PLN Using Twitter

So, you’ve made a Twitter account and are completely hooked. You’re following a bunch of people, companies, institutions… and if you walk away from Twitter for more than an hour, it seems like you can’t possibly keep up. While the constant stream of information is incredible, it is also overwhelming. Too much to sift through? Doubting all the hype? Are you finding this Twitter thing to be an #epicfail?

via How To Get More Out Of Your PLN Using Twitter – Edudemic – Edudemic.

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RESOURCE: 10 Tips to Be a Great Online Teacher

Teaching online is the new Holy Grail for many young K-12 educators. They dream about how wonderful it would be to spend part of their day working from home and conduct meaningful interactions with students online while preparing dinner. To them, teaching online means never having to be anywhere at any particular time, never having to wear uncomfortable and never being asked a question without having time to research the answer.

Nevertheless, the grass is not necessarily greener on the other side of the network connection. While online teaching offers many rewards for instructors, it takes a special set of skills and attitudes to excel at it. Here are 10 tips you shall need to be a successful online teacher:

via 10 Tips to Be a Great Online Teacher – EdTechReview™ (ETR).

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