Improving pediatric problem-based learning sessions in undergraduate and graduate medical education.

PURPOSE OF REVIEW: Problem-based learning (PBL) sessions have become common alternatives to traditional didactic-style sessions in medical education, including within pediatric education. The creation and execution of PBL sessions, however, can vary among institutions and even between educators at a given institution. Coupling the personal experiences of a recently-graduated medical student with that of a knowledgeable medical educator, the authors sought to analyze two PBL session experiences of the medical student during her second year with the goal of pinpointing specific elements that add value for both learners and facilitators. RECENT FINDINGS: Through this analysis, the authors propose enhancements to PBL sessions that may make them more optimal for developing knowledge in pediatric medicine. These include utilizing an interactive video of the clinical problem to more uniformly assess the learner's knowledge gaps, supporting the creation and evolution of peer-to-peer learning communities, and helping to educate facilitators in how to guide dialogue in this type of educational setting. SUMMARY: The PBL enhancements identified by the authors provide educators with innovative suggestions to better engage pediatric trainees in building social capital, acquiring knowledge, and helping learners retain that knowledge beyond their assessments.

Introducing a multimedia course to enhance health professionals' skills to facilitate communities of practice.

PURPOSE: Scholarship about communities of practice (COP) is uncovering evidence that interactivity between community members contributes to improvement in practice. Leadership and facilitation are crucial elements of successful COP implementation. The purpose of this paper is to describe an innovative COP facilitator's course and report on the experiences of participants in the first course. DESIGN/METHODOLOGY/APPROACH: In response to this need and emerging evidence, an on-line COP facilitator's course was developed and implemented in Alberta, Canada, in 2011. This course included a home-based COP practicum, introductory face-to-face session, an on-line discussion board moderated by faculty and on-line learning modules. Evaluation of the course was formalized in a qualitative study incorporating content analysis of postings, semi-structured interviews of successful participants and narrative responses to questions in a post course survey. FINDINGS: A total of 15 of 22 participants perceived they acquired basic knowledge about community facilitation by completing the self-learning modules and assignments. Many did not establish home-based COP and only partially participated in the interactive components of the course. Six participants successfully completed the course by establishing home-based COP and actively participating in the social and interactive components of the course. They perceived they met course objectives and greatly benefited from participation in the course, in particular when they pushed themselves to facilitate in new and different ways, and when they were actively engaged with their home-based COP where they could practice and receive feedback. RESEARCH LIMITATIONS/IMPLICATIONS: While the main reasons why participants dropped out or failed to complete all course components were reported, the experiences and perceptions of six participants who successfully completed all course components form the major part of the evaluation of the course and hence introduce bias. A more in depth analysis of why learners are reluctant to engage in participatory learning could be the focus of further studies. PRACTICAL IMPLICATIONS: The following key recommendations emerged in the study alongside recommendations for further study of best practices in supporting COP facilitation. First, a formal interview before enrollment into the COP facilitator's course is recommended to reinforce the comprehensiveness, time commitment and the practical applications intended within the course. Second, methods of "aggressive facilitation" with skilled COP facilitators can best model facilitation to those involved in the course. Third, supporting course participants to trial out a diversity of community facilitation skills in the safety of the course is crucial to success. ORIGINALITY/VALUE: The collaboration, networking and interactivity of interdisciplinary health care workers is of tremendous consequence to health outcomes and a vital concern to practitioners and administrators. Little is currently understood of the leadership and facilitation of the COP models and these discoveries lend a timely contribution to the field.

Role understanding and effective communication as core competencies for collaborative practice.

The ability to work with professionals from other disciplines to deliver collaborative, patient-centred care is considered a critical element of professional practice requiring a specific set of competencies. However, a generally accepted framework for collaborative competencies is missing, which makes consistent preparation of students and staff challenging. Some authors have argued that there is a lack of conceptual clarity of the "active ingredients" of collaboration relating to quality of care and patient outcomes, which may be at the root of the competencies issue. As part of a large Health Canada funded study focused on interprofessional education and collaborative practice, our goal was to understand the competencies for collaborative practice that are considered most relevant by health professionals working at the front line. Interview participants comprised 60 health care providers from various disciplines. Understanding and appreciating professional roles and responsibilities and communicating effectively emerged as the two perceived core competencies for patient-centred collaborative practice. For both competencies there is evidence of a link to positive patient and provider outcomes. We suggest that these two competencies should be the primary focus of student and staff education aimed at increasing collaborative practice skills.

Networked Learning and Network Science: Potential Applications to Health Professionals' Continuing Education and Development.

Prior interpersonal relationships and interactivity among members of professional associations may impact the learning process in continuing medical education (CME). On the other hand, CME programs that encourage interactivity between participants may impact structures and behaviors in these professional associations. With the advent of information and communication technologies, new communication spaces have emerged that have the potential to enhance networked learning in national and international professional associations and increase the effectiveness of CME for health professionals. In this article, network science, based on the application of network theory and other theories, is proposed as an approach to better understand the contribution networking and interactivity between health professionals in professional communities make to their learning and adoption of new practices over time.

Enhancing provider engagement in practice improvement: a conceptual framework.

Engaging individual members of clinical teams in practice improvement initiatives is a challenge. In this commentary, we first summarize evidence supporting enhanced practitioner engagement through the creation of a work environment that builds on mutually respectful relationships and valued interdependencies. We then propose a phased, collaborative process that employs practice talk, a term that describes naturally occurring, collegial conversations among members of clinical teams. Planned interactions among team members, facilitated by individuals trained in dialogic techniques, enable health care providers and support staff to share their experiences and expertise, agree on what improvements they would like to make, and test the success of these changes. Participants would be encouraged to express their own suggestions for better practice and disclose strategies that are already working. Dissent would be regarded as an opportunity rather than a barrier. Iterative, sense-making conversations would generate a shared vision, enabling team members to engage in the entire process. Given that practice improvement ultimately depends on frontline providers, we encourage the exploration of innovative engagement strategies that will enable entire clinical teams to develop the collaborative learning skills needed to accomplish their goals.

Physician communities of practice: where learning and practice are inseparable.

Physicians interact with peers and mentors to frame issues, brainstorm, validate and share information, make decisions, and create management protocols, all of which contribute to learning in practice. It is likely that working together in this way creates the best environment for learning that enhances professional practice and professional judgment. So convincing are the arguments for this view that management practices already are changing to foster the integration of learning and practice. This article describes a program of research that is planned to assess the effectiveness of information and communication technologies that purport to support and enhance learning in practice.

The Royal College experience and plans for the maintenance of certification program.

The Royal College of Physicians and Surgeons of Canada, in 2001, implemented a mandatory maintenance of certification (MOC) program that is required for fellows to maintain membership and fellowship. Participation in the MOC program is one of the recognized pathways approved by provincial medical regulatory authorities in Canada by which specialists can demonstrate their commitment to continued competent performance in practice. This article traces the historical beginnings of the MOC program, highlighting the educational foundation and scientific evidence that influenced its philosophy, goals, and strategic priorities. The MOC program has evolved into a complex system of continuing professional development to facilitate and enable a "cultural shift'' in how we conceptualize and support the continuing professional development (CPD) of specialists. The MOC program is an educational strategy that supports a learning culture where specialists are able to design, implement and document their accomplishments from multiple learning activities to build evidence-informed practices. In the future, the MOC Program must evolve from assisting fellows to use effective educational resources "for credit" to enable fellows, leveraging a competency-based CPD model, to demonstrate their capacity to continuously improve practice. This will require innovative methods to capture learning and practice improvements in real time, integrate learning during the delivery of health care, expand automation of reporting strategies, and facilitate new sociocultural methods of emergent learning and practice change. Collectively, these directions will require a research agenda that will generate evidence for how transformative cultural change in continuing professional education of the profession can be realized.

An electronic learning portfolio for reflective continuing professional development.

OBJECTIVES: These were to measure the uptake and use of an electronic learning portfolio to support reflective continuing professional development, and to characterize attitudes towards its use and obstacles to its adoption. DESIGN: Uncontrolled, longitudinal intervention study with quantitative and qualitative evaluation. PARTICIPANTS: Physicians with a specialty interest in endocrinology and diabetes mellitus, registered for continuing professional development with the Royal College of Physicians, London. INTERVENTION: All registered consultants were offered a 1-year free trial of PC Diary. Those who accepted were offered a training workshop. MAIN OUTCOME MEASURES: Quantitative and qualitative responses to a simple questionnaire. Two researchers independently used a template approach to analyse free-text responses and jointly agreed a final system of coding. RESULTS: 22% of registered consultants applied to participate; 14% attended training workshops. Of registered participants, 94% returned the questionnaire. PC Diary was used by 34%, but only 10% used it regularly. Among the registrants, 54% asked to continue their subscription for a second year, and 40% asked for further training. There were emotive expressions of both like and dislike, often coupled with statements about the individual's learning style. Time pressures and lack of computer access, literacy and support were dominant obstacles to adoption. CONCLUSIONS: There was considerable support for reflective learning using an electronic portfolio. Acceptability and use were influenced by individual learning style, resources, training and technical support, and these were often inadequate. The balance for consultants between workload demands and support provided did not favour a reflective type of learning.