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AIM: The aim of this study was to determine the status of retrieval practice in original research of nursing education. BACKGROUND: The science of learning is an emerging interdisciplinary field that offers evidence-based strategies to improve learning. One of the most highly effective strategies is retrieval practice, which involves recalling previously learned information from long-term memory prior to additional study. METHOD: Searching PubMed, CINAHL, Scopus, Psych INFO, and ERIC, an interprofessional team followed a formal scoping review framework and utilized the PRISMA Extension for Scoping Reviews to report the findings. RESULTS: The review included 25 research studies, with all but one at the prelicensure level. Quantitative designs were most common, and outcomes reflected objective and subjective measures. If present, terms were varied and inconsistent with supporting research. Documentation of many characteristics was lacking. CONCLUSION: Retrieval practice is an increasingly common strategy being studied at the prelicensure level. Opportunities for improvement include consistent use of standard terminology, documentation of important characteristics, and more attention to subjective outcomes and to graduate and continuing education levels.
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AIM: The aim of this study was to describe the status of distributed practice in research of nursing education. BACKGROUND: The science of learning has compiled evidence-based strategies that should be integral to nursing education. One long-standing strategy, distributed practice, involves spacing, placing cognitive breaks between study or practice sessions with priority information. METHOD: Reviewing literature published over 20 years at every level of nursing education, the authors conducted a scoping review to determine the extent to which research of nursing education includes attention to distributed practice. RESULTS: In the 13 articles meeting criteria, distributed practice was most common in continuing professional development, with an emphasis in learning psychomotor skills. Study authors used a variety of terms and descriptions in referring to the strategy. CONCLUSION: By way of research, distributed practice appears underutilized in nursing education, especially at prelicensure and graduate levels, and could benefit from clear and consistent use of terminology.
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Educación en Enfermería , Atención de Enfermería , Humanos , AprendizajeRESUMEN
Learning science is an emerging interdisciplinary field that offers educators key insights about what happens in the brain when learning occurs. In addition to explanations about the learning process, which includes memory and involves different parts of the brain, learning science offers effective strategies to inform the planning and implementation of activities and programs in continuing education and continuing professional development. This article provides a brief description of learning, including the three key steps of encoding, consolidation and retrieval. The article also introduces four major learning-science strategies, known as distributed learning, retrieval practice, interleaving, and elaboration, which share the importance of considerable practice. Finally, the article describes how learning science aligns with the general findings from the most recent synthesis of systematic reviews about the effectiveness of continuing medical education.
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Educación Médica Continua/organización & administración , Aprendizaje/fisiología , Humanos , Consolidación de la Memoria/fisiologíaRESUMEN
BACKGROUND: The patient-centered medical home is a model for delivering primary care in the United States. Primary care clinicians and their staffs require assistance in understanding the innovation and in applying it to practice. PURPOSES: The purpose of this article is to describe and to critique a continuing education program that is relevant to, and will become more common in, primary care. METHODS: A multifaceted educational strategy prepared 20 primary care private practices to achieve National Committee for Quality Assurance Level 3 recognition as Patient-Centered Medical Homes. RESULTS: Eighteen (90%) practices submitted an application to the National Committee for Quality Assurance. On the first submission attempt, 13 of 18 (72%) achieved Level 3 recognition and 5 (28%) achieved Level 1 recognition. CONCLUSION: An interactive multifaceted educational strategy can be successful in preparing primary care practices for Patient-Centered Medical Homes recognition, but the strategy may not ensure transformation. Future educational activities should consider an expanded outcomes framework and the evidence of effective continuing education to be more successful with recognition and transformation.
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Difusión de Innovaciones , Educación Médica Continua/métodos , Práctica Clínica Basada en la Evidencia , Atención Dirigida al Paciente , Calidad de la Atención de Salud , Connecticut , Educación Médica Continua/normas , Femenino , Humanos , Masculino , Modelos Organizacionales , Atención Primaria de Salud , Evaluación de Programas y Proyectos de SaludRESUMEN
Colorectal and breast cancer represent serious and common public-health problems in the United States. While effective screening tests exist for both types of cancer, Connecticut lacks a consistent source of data about screening rates to guide improvement efforts. Beginning in 2011, the Connecticut Department of Public Health commissioned Qualidigm, the state's Medicare Quality Improvement Organization, to conduct an analysis of the most recent fee-for-service Medicare claims data to determine screening rates for colorectal cancer (2000-2009) and breast cancer (2008-2009). This article highlights key findings of this analysis in order to increase awareness of opportunities for improvement in colorectal and breast cancer screening. The article also offers recommendations about next steps that primary care clinicians can consider to improve cancer screening among their patient populations.
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Neoplasias de la Mama/prevención & control , Colonoscopía/estadística & datos numéricos , Neoplasias Colorrectales/prevención & control , Mamografía/estadística & datos numéricos , Sigmoidoscopía/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/epidemiología , Neoplasias Colorrectales/epidemiología , Connecticut/epidemiología , Femenino , Humanos , Masculino , Medicare , Estados UnidosRESUMEN
INTRODUCTION: In 2015, the Centers for Medicare and Medicaid Services developed a national quality bundle for the management of patients with severe sepsis and septic shock (SEP-1). Despite performance improvement measures, compliance remains low. This needs assessment is the first stage of a quality improvement initiative to improve SEP-1 compliance. Using a conceptual outcomes framework, this needs assessment analyses SEP-1 compliance data, knowledge, and competence to identify gaps in care and educational opportunities. METHODS: The needs assessment began with a review of national and statewide SEP-1 compliance data to identify a need for improvement. The needs assessment proceeded with a retrospective chart review to evaluate process measures and identify which providers would most likely benefit from educational interventions. A focus group provided perspective on the chart review findings. RESULTS: During the period of 1 April 2017-31 March 2018, national SEP-1 compliance was 51% and compliance at the studied institution was 19%. The chart review included 51 patients (66.7% severe sepsis, 33.3% septic shock). Frequently missed SEP-1 measures included administration of intravenous fluids (0% severe sepsis, 58.8% septic shock), repeat lactate levels (52.6% severe sepsis, 60% septic shock), documentation of volume and tissue perfusion assessment (58.8%), vasopressor administration (73.3%) and administration of broad-spectrum antibiotics (76.5%, severe sepsis). Focus group perceptions identified themes related to gaps in declarative and dispositional knowledge. CONCLUSIONS: This educational needs assessment highlights gaps in SEP-1 clinician performance, competence and knowledge. A multifaceted education programme is the next step for this performance improvement project. Education should include a series of meetings, activities, and workshops that include declarative knowledge, procedural knowledge and dispositional knowledge. Simulation activities can provide an opportunity for providers to demonstrate competence. Point-of-care prompts and performance measurement and feedback of patient care data can support clinician performance. This needs assessment underscores the need for a multifaceted approach to clinician education and performance to improve SEP-1 compliance.
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Sepsis , Choque Séptico , Anciano , Humanos , Estados Unidos , Evaluación de Necesidades , Estudios Retrospectivos , Medicare , Sepsis/terapiaRESUMEN
ABSTRACT: Interleaving is an evidence-based, learning-science strategy that is relevant to the planning and implementation of continuing professional development (CPD). Mixing related but different areas of study forces the brain to reconcile the relationship between the areas while understanding each area well. By doing so, interleaving increases the likelihood of mastery and memory. Research from cognitive psychology and neuroscience provides the rationale for interleaving, and examples of its implementation in health profession education have begun to appear in the literature. If utilized appropriately, some common CPD interventions can leverage interleaving. Through increased understanding, CPD participants can benefit from interleaving by making more-informed educational choices, and CPD planners can benefit in efforts to improve educational activities.
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Educación Médica Continua , Aprendizaje , HumanosRESUMEN
Colorectal cancer represents a serious public-health problem in the United States, with important geographic differences and disparities of care evident in its detection and treatment. While effective screening tests exist, Connecticut lacks current data about rates of colorectal cancer screening. The Connecticut Department of Public Health commissioned Qualidigm, the federally designated Quality Improvement Organization, to conduct an analysis of 2008 fee-for-service Medicare claims data to determine screening rates. This article reports the findings of this analysis to increase awareness of opportunities for improvement in colorectal cancer screening and to highlight demographic and geographic variations that may require particular attention in Connecticut.
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Neoplasias Colorrectales , Tamizaje Masivo , Informe de Investigación , Anciano , Anciano de 80 o más Años , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/epidemiología , Connecticut/epidemiología , Demografía , Detección Precoz del Cáncer , Femenino , Disparidades en Atención de Salud , Humanos , Masculino , Tamizaje Masivo/métodos , Tamizaje Masivo/organización & administración , Medicare/estadística & datos numéricos , Persona de Mediana Edad , Mejoramiento de la Calidad , Sigmoidoscopía , Estados UnidosRESUMEN
ABSTRACT: Retrieval practice is an evidence-based, science of learning strategy that is relevant to the planning and implementation of continuing professional development (CPD). Retrieval practice requires one to examine long-term memory to work with priority information again in working memory. Retrieval practice improves learning in two ways. It improves memory for the information itself (direct benefit), and retrieval practice provides feedback about what needs additional effort (indirect). Both benefits contribute significantly to durable learning. Research from cognitive psychology and neuroscience provides the rationale for retrieval practice, and examples of its implementation in health professions education are increasingly available in the literature. Through appropriate utilization, CPD participants can benefit from retrieval practice by making more-informed educational choices, and CPD planners can benefit in efforts to improve educational activities.
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Aprendizaje , HumanosRESUMEN
ABSTRACT: Distributed practice is an evidence-based, learning-science strategy that is relevant to the planning and implementation of continuing professional development (CPD). Spacing-out study or practice over time allows the brain multiple opportunities to process new and complex information in an efficient way, thus increasing the likelihood of mastery and memory. Research from cognitive psychology and neuroscience provide the rationale for distributed practice, and examples of its implementation in health professions education have begun to appear in the literature. If used appropriately or extended creatively, some common CPD interventions can fully leverage distributed practice. Through increased understanding, CPD planners can benefit from distributed practice in efforts to improve educational activities, and CPD participants can benefit by making more informed educational choices.
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Aprendizaje , Enseñanza/tendencias , Educación de Postgrado en Medicina/tendencias , HumanosRESUMEN
In response to the growing incidence and prevalence of diabetes, quality and disparity of care concerns, and the increasing diversity of the US and Connecticut's populations, the Connecticut Health Foundation funded Qualidigm to implement the Equity and Quality (EQual) Health-Care Project. Now in its second full year, the EQualHealth-CareProject is helping eight primary-care practices in Connecticut improve the equity and quality of diabetes care through technology, education, and quality improvement.
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Diabetes Mellitus/epidemiología , Disparidades en Atención de Salud/organización & administración , Indicadores de Calidad de la Atención de Salud , Connecticut , Diabetes Mellitus/prevención & control , Fundaciones , Disparidades en Atención de Salud/estadística & datos numéricos , Humanos , Atención Primaria de Salud , Garantía de la Calidad de Atención de SaludRESUMEN
INTRODUCTION: The authors sought to identify how physician specialty certification is defined in the North American literature. METHODS: A rigorous, established six-stage scoping review framework was used to identify the North American certification literature published between January 2006 and May 2016 relating to physician specialty certification. Data were abstracted using a charting form developed by the study team. Quantitative summary data and qualitative thematic analysis of the purpose of certification were derived from the extracted data. RESULTS: A two stage screening process identified 88 articles that met predefined criteria. Only 14 of the 88 articles (16%) contained a referenced purpose of certification. Eighteen definitions were identified from these articles. Definitional concepts included lifelong learning and continuous professional development, assessment of competence and performance, performance improvement, public accountability, and professional standing. DISCUSSION: Most articles identified in this scoping review did not define certification or describe its purpose or intent. Future studies should provide a definition of certification to further scholarly examination of its intent and effects and inform its further evolution.
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Certificación/clasificación , Médicos/tendencias , Certificación/tendencias , Humanos , América del Norte , Médicos/clasificaciónRESUMEN
The objective of this study was to describe the experience of a Quality Improvement Organization (QIO) providing educational outreach to promote use of quality improvement (QI) tools in primary care private practice. Two QIO outreach workers conducted visits with physicians and targeted staff. Data were analyzed on physician demographics, visits, and use of QI tools using standard quantitative and qualitative methods. QIO staff frequently encountered difficulty in accessing physicians and administrative staff and reported many barriers to QI. Despite these challenges, outreach visits were associated with adoption of QI tools, and certain physician characteristics were associated with greater numbers of outreach visits and tools adopted. QIOs and other external parties who seek to improve quality of care in private practice primary care physician offices face challenges in gaining access to physicians and administrative personnel. Additional study is needed to better understand associations between physician characteristics, educational outreach visits, and adoption of QI tools.
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Educación/organización & administración , Atención Primaria de Salud/organización & administración , Práctica Privada/organización & administración , Garantía de la Calidad de Atención de Salud/organización & administración , Femenino , Accesibilidad a los Servicios de Salud/organización & administración , Humanos , Reembolso de Seguro de Salud , Masculino , Guías de Práctica Clínica como Asunto , Investigación Cualitativa , Factores de TiempoRESUMEN
Interaction refers to what happens within the minds of individuals participating in a CME activity. While peer-to-peer and peer-to-presenter discussion maybe helpful, internal engagement of the learner with the material is the type of interaction that is necessary for deep learning and change. The choice of which interactive method to use depends on the learning objectives of the specific CME program being planned.
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Educación Médica Continua/métodos , Aprendizaje , Enseñanza , Conducta Cooperativa , Escolaridad , Humanos , Modelos EducacionalesRESUMEN
Commitment to change is an educational practice that encourages participants to commit to doing something differently in their respective practices based on an educational activity. Evidence suggests that such commitment increases the likelihood that changes in behavior will occur above and beyond what might be expected from participation without explicit commitments. Educators should consider options for incorporating this practice into their educational activities.
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Educación Médica Continua/métodos , Difusión de Innovaciones , HumanosRESUMEN
BACKGROUND: The literature provides increasing evidence on how continuing medical education (CME) programs can change provider behavior and improve patient outcomes. Few authors discuss the application of those findings on a relatively common CME activity--grand rounds. Two recent publications about a case study of Medical Grand Rounds provide such an opportunity. DISCUSSION: Multiple opportunities exist to improve Medical Grand Rounds across each of five evidence-based practices of effective CME: needs assessment, multifaceted intervention strategy, sequencing, interaction, and commitment to change. Planners, presenters, and participants each have a distinct and important role in improving Medical Grand Rounds. CONCLUSION: This article identifies important opportunities for planners, presenters, and participants to improve Medical Grand Rounds as a vehicle for changing provider behavior and improving patient outcomes.
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Medicina Clínica/educación , Educación Médica Continua/métodos , Medicina Clínica/normas , Educación Médica Continua/normas , Humanos , Estudios de Casos OrganizacionalesRESUMEN
BACKGROUND: Grand rounds programs may not be consistently structured to bring benefit from evidence-based practices of effective continuing medical education. In order to make improvements in this common educational forum, educational leaders need to consider and possibly overcome some barriers as perceived by planners, presenters, and participants. Research on perceived barriers to improving grand rounds is lacking. METHODS: Using an instrumental case-study approach, the investigators sought to describe perceived barriers to improving a Medical Grand Rounds program held at an academic medical center in the Northeast. Perceived barriers were identified by program planners, presenters, and participants. The study used qualitative data collected from each group via key informant interviews and a focus group to assess barriers in relation to five evidence-based practices: needs assessment, multifaceted intervention strategy, sequencing, interaction, and commitment to change. The study used an intensive, inductive approach to analyze data to determine barrier themes from each group. RESULTS: Studied during 2007, program constituents of Medical Grand Rounds suggested a variety of important barriers. Understanding such barriers informs some recommendations to improve the program and possibly other programs similar to it. CONCLUSION: This study has identified important barriers to improving a specific grand rounds program and discusses the implications of such barriers on recommendations for improvement.
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Actitud del Personal de Salud , Educación Médica Continua/organización & administración , Medicina Basada en la Evidencia/educación , Rondas de Enseñanza/organización & administración , Grupos Focales , Humanos , Evaluación de Necesidades , Evaluación de Programas y Proyectos de SaludRESUMEN
PURPOSE: The study purpose was to identify barriers to mammography screening among women with different disabilities and to suggest interventions to address barriers. METHODS: Forty-two women with self-reported disabilities, ages 40 to 69 years participated. They resided in 24 Connecticut towns, and most had a prior mammogram. Data were collected through six disability-specific focus groups from women with sensory, physical, psychiatric, and cognitive/intellectual impairments. Facilitator-conducted groups used a semistructured guide. Qualitative analysis applied an iterative coding process to generate themes and categories. RESULTS: We identified four themes (i.e., access, beliefs, social support, and comfort/ accommodations) and nine subthemes that characterized barriers. In all focus groups, women mentioned physical access and physical comfort/accommodations as types of barriers. Other major subthemes were communication and professional support. Women also described mammography facilitators. CONCLUSION: Despite frequent use of health care and personal strategies to facilitate mammography screening, women with disabilities reported barriers to getting mammograms. Findings suggest a multifaceted approach to address these barriers.
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Personas con Discapacidad/psicología , Accesibilidad a los Servicios de Salud , Mamografía/estadística & datos numéricos , Tamizaje Masivo/estadística & datos numéricos , Aceptación de la Atención de Salud , Adulto , Accesibilidad Arquitectónica , Comunicación , Connecticut , Personas con Discapacidad/clasificación , Femenino , Grupos Focales , Humanos , Persona de Mediana Edad , Investigación Cualitativa , Factores de Riesgo , Apoyo SocialRESUMEN
Conducting a needs assessment is the first step in the process of planning a CME activity or program. Performing a needs assessment requires a clear sense of one's target audience. Having more than one perspective, with at least one data source being subjective and another being objective, helps educators offer a program that is meaningful and relevant to participants. A root cause analysis represents an additional step of needs assessment that offers critical details about the educational needs of the target audience.
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Educación Médica Continua , Evaluación de NecesidadesRESUMEN
Combining CME activities with other educational or quality improvement programs increases the likelihood that such activities will be successful in changing clinician behavior and improving patient outcomes. Based on the needs assessment process, educators should consider what other patient and clinician interventions are being planned by others that might have relevance to the target audience. Such investigation helps educators prioritize educational needs and find opportunities for coordination or even collaboration. Especially if external options are limited, educators should consider planning a multifaceted intervention strategy themselves.