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Author: Brian S McGowan, PhD

ABSTRACT: Integrating Interprofessional Education into Continuing Education: A Planning Process for Continuing Interprofessional Education Programs

Informal continuing interprofessional education (CIPE) can be traced back decades in the United States; however, interest in formal CIPE is recent. Interprofessional education (IPE) now is recognized as an important component of new approaches to continuing education (CE) that are needed to increase health professionals’ ability to improve outcomes of care. Although there are examples of CIPE programs that are being successfully implemented, a clearly articulated, step-by-step planning process to help guide educators in providing effective CIPE programs is lacking. This lack of guidance poses a significant barrier to increasing the number of CIPE programs in the United States. In this article, we describe a process for developing, implementing, and evaluating CIPE programs using the familiar systematic CE planning process. Limitations of traditional CE also are addressed, and the relationship between CIPE and other new approaches to CE is clarified. Four examples of CIPE programs are provided to illustrate how the planning process can be adapted to include IPE, while implementing recommended changes in traditional CE offerings. The article is concluded with a discussion of some of the challenges that will face CE educators in moving toward a new vision of CE integrated with IPE.

via Integrating Interprofessional Education into Continuing Education: A Planning Process for Continuing Interprofessional Education Programs – Owen – 2013 – Journal of Continuing Education in the Health Professions – Wiley Online Library.

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ABSTRACT: A Framework for Assessing Continuing Professional Development Activities for Satisfying Pharmacy Revalidation Requirements

Introduction:
The United Kingdom’s pharmacy regulator contemplated using continuing professional development (CPD) in pharmacy revalidation in 2009, simultaneously asking pharmacy professionals to demonstrate the value of their CPD by showing its relevance and impact. The idea of linking new CPD requirements with revalidation was yet to be explored. Our aim was to develop and validate a framework to guide pharmacy professionals to select CPD activities that are relevant to their work and to produce a score sheet that would make it possible to quantify the impact and relevance of CPD.

Methods:
We adapted an existing risk matrix, producing a CPD framework consisting of relevance and impact matrices. Concepts underpinning the framework were refined through feedback from 5 pharmacist teacher-practitioners. We then asked 7 pharmacists to rate the relevance of the framework’s individual elements on a 4-point scale to determine content validity. We explored views about the framework through focus groups with 6 participants and interviews with 17 participants who had used it formally in a study.

Results:
The framework’s content validity index was 0.91. Feedback about the framework related to 3 themes of penetrability of the framework, usefulness to completion of CPD, and advancement of CPD records for the purpose of revalidation.

Discussion:
The framework can help professionals better select CPD activities prospectively, and makes assessment of CPD more objective by allowing quantification, which could be helpful for revalidation. We believe the framework could potentially help other health professionals with better management of their CPD irrespective of their field of practice.

via A Framework for Assessing Continuing Professional Development Activities for Satisfying Pharmacy Revalidation Requirements – Donyai – 2013 – Journal of Continuing Education in the Health Professions – Wiley Online Library.

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ABSTRACT: Internists’ Views of Maintenance of Certification: A Stages-of-Change Perspective

Introduction:
Board certification has evolved from a “point-in-time” event to a process of periodic learning and reevaluation of medical competence through maintenance of certification (MOC). To better understand MOC participation, the transtheoretical model (TTM) was used to describe physicians’ perceptions of MOC as a sequence of attitudinal changes.

Method:
Data were from a survey of internal medicine (IM) physicians’ attitudes toward periodic reevaluation through MOC. An overall importance or decisional balance score was computed for each physician by summing his or her ratings across the 10 quality measures. The decisional balance score was used to classify physicians according to their acceptance of MOC, aligned with the 3 early TTM stages-of-change groups—precontemplation (PC), contemplation (C), and preparation (P)—where PC was least accepting and P was most accepting. Effect sizes assessed whether differences in attitudes toward reevaluation via MOC were of sufficient magnitude to support the TTM principles.

Results:
The difference in degree of acceptance of MOC between the P group and the PC and C groups was significant (p < 0.001), but the effect size was lower than predicted by the “strong” principle. Resistance to MOC for the PC and C groups was significantly greater than the P group (p < 0.001) and supported the “weak” principle. Physicians’ beliefs about how often they should demonstrate performance on quality measures aligned well with the American Board of Internal Medicine’s MOC requirements, with the P group believing in more frequent assessments than the PC and C groups (p < 0.001).

Conclusions:
Results show that physicians in the Preparation stage had overcome resistance to MOC as predicted by the “weak” principle of the TTM, but their attitude scores about the benefits of MOC were below what was expected by theory. This suggests that the structure of MOC may have made it easier for physicians to overcome barriers to MOC participation but may have lacked adequate resources to promote the benefits of participating in the process. More effort is needed to understand the specific benefits of MOC for reevaluating competencies, how to engage physicians and other stakeholders in the design of MOC, and how to communicate the rationale and evidence to those who are less accepting of MOC.

via Internists’ Views of Maintenance of Certification: A Stages-of-Change Perspective – Arnold – 2013 – Journal of Continuing Education in the Health Professions – Wiley Online Library.

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ABSTRACT: Multisource Feedback: Can It Meet Criteria for Good Assessment?

Introduction:
High-quality instruments are required to assess and provide feedback to practicing physicians. Multisource feedback (MSF) uses questionnaires from colleagues, coworkers, and patients to provide data. It enables feedback in areas of increasing interest to the medical profession: communication, collaboration, professionalism, and interpersonal skills. The purpose of the study was to apply the 7 assessment criteria as a framework to examine the quality of MSF instruments used to assess practicing physicians.

Methods:
The criteria for assessment (validity, reproducibility, equivalence, feasibility, educational effect, catalytic effect, and acceptability) were examined for 3 sets of instruments, drawing on published data.

Results:
Three MSF instruments with a sufficient body of research for inclusion—the Canadian Physician Achievement Review instruments and the United Kingdom’s GMC and CFEP360 instruments—were examined. There was evidence that MSF has been assessed against all criteria except educational effects, although variably for some of the instruments. The greatest emphasis was on validity, reproducibility, and feasibility for all of the instruments. Assessments of the catalytic effect were not available for 1 of the 2 UK instruments and minimally examined for the other. Data about acceptability are implicit in the UK instruments from their endorsement by the Royal College of General Practice and explicitly examined in the Canadian instruments.

Discussion:
The 7 criteria provided a useful framework to assess the quality of MSF instruments and enable an approach to analyzing gaps in instrument assessment. These criteria are likely to be helpful in assessing other instruments used in medical education.

via Multisource Feedback: Can It Meet Criteria for Good Assessment? – Lockyer – 2013 – Journal of Continuing Education in the Health Professions – Wiley Online Library.

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ABSTRACT: (Mis)perceptions of Continuing Education: Insights From Knowledge Translation, Quality Improvement, and Patient Safety Leaders

Introduction:
Minimal attention has been given to the intersection and potential collaboration among the domains of continuing education (CE), knowledge translation (KT), quality improvement (QI), and patient safety (PS), despite their overlapping objectives. A study was undertaken to examine leaders’ perspectives of these 4 domains and their relationships to each other. In this article, we report on a subset of the data that focuses on how leaders in KT, PS, and QI define and view the domain of CE and opportunities for collaboration.

Methods:
This study is based on a qualitative interpretivist framework to guide the collection and analysis of data in semistructured interviews. Criterion-based, maximum variation, and snowball sampling were used to identify key opinion leaders in each domain. The sample consisted of 15 individuals from the domains KT, QI, and PS. The transcripts were coded using a directed content analysis approach.

Results:
The findings are organized into 3 thematic subsections: (1) definition and interpretation of CE, (2) concerns about relevance and effectiveness of CE, and (3) opportunities for collaboration among CE and the other domains. While there were slight differences among the data from the leaders of each domain, common themes were generally reported.

Discussion:
The findings provide CE leaders with information about KT, QI, and PS leaders’ (mis)perceptions about CE that can inform future strategic planning and activities. CE leaders can play an important role in building upon initial collaborations among the domains to enable their strengths to complement each other.

via (Mis)perceptions of Continuing Education: Insights From Knowledge Translation, Quality Improvement, and Patient Safety Leaders – Kitto – 2013 – Journal of Continuing Education in the Health Professions – Wiley Online Library.

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MANUSCRIPT: Confronting complexity: medical education, social theory and the ‘fate of our times’

If we were to paint a canvas reflecting what is capturing our imaginations as medical education researchers, we would use rich, bold colours and overlapping strokes to convey our deep and diverse investment in developingways to train clinicians to provide effective and compassionate care. We would then paint thick black lines across the canvas to represent how these efforts are compromised or eroded, sometimes by our own educational practices. The articles comprising this issue help us make sense of this paradox.

http://onlinelibrary.wiley.com/doi/10.1111/medu.12086/pdf

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ABSTRACT: Reconstructing a lost tradition: the philosophy of medical education in an age of reform.

CONTEXT:
At the 100th anniversary of Abraham Flexner’s landmark report on medical education, critical reassessment of the direction of medical education reform evinced valuable interdisciplinary contributions from biomedicine, sociology, psychology and education theory. However, to date, philosophy has been absent from the discussion despite its long standing contribution to studies on education in other professions.
METHODS:
This discussion paper examines how the philosophical tradition can contribute to scholarship in medical education. It begins with an explanation of the scholarly tradition of philosophy of education and its role in thinking in education more generally. It then makes links between this tradition and the context of medical education in the Flexner era of education reform. The paper then argues that this tradition is necessary to the understanding of medical education reform post-Flexner and that doctors must benefit from an education derived from this tradition in order to be able to carry out their work.
DISCUSSION:
These foundations are characterised as a hidden, but always present, tradition in medical education. Two ways in which this ‘lost tradition’ can inform medical education theory and practice are identified: firstly, by the establishment of a public canon of medical education texts that express such a tradition, and, secondly, by the incorporation of a variety of ‘signature pedagogies’ exemplary of liberal education.

via Reconstructing a lost tradition: the philosophy of … [Med Educ. 2013] – PubMed – NCBI.

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ABSTRACT: A qualitative analysis of faculty motivation to participate in otolaryngology simulation boot camps

OBJECTIVES/HYPOTHESIS:
To characterize factors that motivate faculty to participate in Simulation-Based Boot Camps (SBBC); to assess whether prior exposure to Simulation-Based Medical Education (SBME) or duration (years) of faculty practice affects this motivation.
STUDY DESIGN:
Qualitative content analysis of semi-structured interviews of faculty.
METHODS:
Interviews of 35 (56%) of 62 eligible faculty including demographic questions, and scripted, open-ended questions addressing motivation. Interviews were recorded, transcribed, de-identified, coded and analyzed using qualitative analysis software. Demographic characteristics were described. Emerging response categories were organized into themes contributing to both satisfaction and dissatisfaction.
RESULTS:
Three major themes of faculty motivation emerged: enjoyment of teaching and camaraderie; benefits to residents, patients and themselves; and opportunities to learn or improve their own patient care and teaching techniques. Expense, and time away from work and family, were identified as challenges. Faculty with many versus few years in practice revealed a greater interest in diversity of teaching experiences and techniques. Comparison of faculty with extensive versus limited simulation experience yielded similar motivations.
CONCLUSION:
Enjoyment of teaching; benefits to all participants; and opportunities for self-improvement emerged as themes of faculty motivation to participate in SBBC. SBBC have unique characteristics which provide an opportunity to facilitate teaching experiences that motivate faculty.

via A qualitative analysis of faculty motivation to… [Laryngoscope. 2013] – PubMed – NCBI.

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MANUSCRIPT: An exploratory study of the potential learning benefits for medical students in collaborative drawing: creativity, reflection and ‘critical looking’.

BACKGROUND:
Building on a series of higher educational arts/medicine initiatives, an interdisciplinary drawing module themed on the human body was developed for both year 3 Craft students and year 3 Medicine degree students. This became the subject of a research project exploring how the collaborative approach to drawing adopted on this module impacted on the students’ learning. In this article, emphasis is given to issues thought to have most potential relevance to medical education.
METHODS:
Using an ethnographic research design, the methods adopted were: direct observation of all aspects of the module sessions, audio and video recordings and photographs of the sessions, the incorporation of a semi-structured discussion at the end of each session, and anonymous student questionnaires.
RESULTS:
A number of key themes emerged. The complex, phased and multi-sensory nature of the ‘critical looking’ skills developed through the drawing exercises was seen as of potential value in medical education, being proposed as analogous to processes involved in clinical examination and diagnosis. The experience of interdisciplinary collaborative drawing was significant to the students as a creative, participatory and responsive form of learning. The emphasis on the physical experience of drawing and the thematic use of the human body as drawing subject led to reflective discussions about bodily knowledge and understanding. There were indications that students had a meta-cognitive awareness of the learning shifts that had occurred and the sessions provoked constructive self-reflective explorations of pre-professional identity.
CONCLUSIONS:
This preliminary study suggests, through the themes identified, that there may be potential learning outcomes for medical students in this model of interdisciplinary collaborative drawing of the human body. Further research is needed to explore their applicability and value to medical education. There is a need to explore in more depth the beliefs, motivations and learning styles of medical students opting for the module, the significance and weighting of different learning and teaching elements in the module and the impact of the learning on medical students in the immediate post-module phase.

via An exploratory study of the potential learning … [BMC Med Educ. 2013] – PubMed – NCBI.

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ABSTRACT: Teaching nontechnical skills in surgical residency: A systematic review of current approaches and outcomes

BACKGROUND:A growing body of evidence suggests that nontechnical skills NTS of surgeons play an important role in patient safety in the operating room and can be improved through specific training interventions. The need to address communication and interpersonal skills in postgraduate medical education has been emphasized by the respective regulatory bodies for accreditation and certification. The present review had 2 purposes: To provide an overview of current approaches to training and assessment of NTS in surgery and to critically appraise the strength of the evidence supporting their effectiveness.METHODS:A systematic search of the literature Ovid MEDLINE; PsycINFO; Embase was conducted using predefined inclusion criteria. The evidence for the main outcome themes was appraised using the GRADE approach.RESULTS:Of the 2,831 identified records, 23 were selected for qualitative synthesis. Four randomized, controlled trials and 19 observational pre-post studies were reviewed. Significant effects of training were shown for the identified outcome themes patient-centered communication, teamwork, decision making, coping with stress, patient safety and error management. The overall strength of evidence supporting training effects on outcome measures was graded as “moderate” teamwork, “low” patient-centered communication, decision making, and coping with stress, and “very low” patient safety and error management, respectively.CONCLUSION:Training interventions can have positive effects on residents nontechnical knowledge, skills, and attitudes. Although the overall strength of evidence is moderate at best, recent interventions provide valuable information regarding instructional strategies and methods for training and assessment of NTS in modern surgical curricula.

via Teaching nontechnical skills in surgical residency: … [Surgery. 2013] – PubMed – NCBI.

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