An international study of trainee-trained transitions: Introducing the transition-to-trained-doctor (T3D) model.

Background: Throughout their careers, doctors and other healthcare professionals experience numerous transitions. When supporting transitions, opportunities for development and learning should be maximized, while stressors having negative impacts on well-being should be minimized. Building on our international data, this study aimed to develop a conceptual model of the trainee-trained transition (i.e. the significant transitions experienced by doctors as they complete postgraduate training moving from trainee/resident status to medical specialist roles).Methods: Employing Multiple and Multidimensional Transitions (MMT) theory and current conceptualizations of clinical context, this study undertook secondary analysis of 55 interviews with doctors from three countries (Netherlands, Cananda and the UK) undergoing trainee-trained transitions.Results: Through this analysis, the Transition-To-Trained-Doctor (T3D) conceptual model has been developed. This model takes into consideration the multiple contexts and multiple domains in which transitions take place.Discussion: This model is significant in that it has several uses and is applicable across countries: to remind doctors, managers and medical educators of the complexity of transitions; to frame and facilitate supportive conversations; and as a basis to teach about transitions.

Digital vs face-to-face information provision in patient counselling for prenatal screening: A noninferiority randomized controlled trial.

OBJECTIVE: To evaluate face-to-face information provision in patient counselling for prenatal screening compared with two forms of digital information provision, namely, noninteractive instructional video or interactive video. METHOD: We performed a prospective, noninferiority, cluster-randomized controlled trial comparing face-to-face (usual care) with two forms of digital information provision (intervention) in counselling for prenatal screening. This study was performed in the Amsterdam UMC, the Netherlands, in 2017, and included women in the first trimester of pregnancy. Main outcomes were knowledge gained by the patient and counselling duration. We performed a noninferiority analysis. RESULTS: One hundred forty-one women were included, randomized, and analysed. The baseline characteristics were comparable. The intervention group was noninferior compared with the control group regarding the level of satisfaction. The knowledge grade difference was higher after using intervention, and the duration was significantly longer in the face-to-face group at 23 minutes versus 16 minutes. The addition of interaction with the video made no difference in any of the outcomes. CONCLUSION: Adding an instructional video to patient counselling is of added value to improve patient's knowledge and shorten time consumption of the counsellor, therefore possibly saving costs. But this form of counselling maintains the same level of satisfaction.

Development of an Instructional Design Evaluation Survey for Postgraduate Medical E-Learning: Content Validation Study.

BACKGROUND: E-Learning has taken a firm place in postgraduate medical education. Whereas 10 years ago it was promising, it now has a definite niche and is clearly here to stay. However, evaluating the effect of postgraduate medical e-learning (PGMeL) and improving upon it can be complicated. While the learning aims of e-learning are evaluated, there are no instruments to evaluate the instructional design of PGMeL. Such an evaluation instrument may be developed by following the Association for Medical Education in Europe (AMEE) 7-step process. The first 5 steps of this process were previously performed by literature reviews, focus group discussion, and an international Delphi study. OBJECTIVE: This study will continue with steps 6 and 7 and answer the research question: Is a content-validated PGMeL evaluation survey useful, understandable, and of added value for creators of e-learning? METHODS: There are five phases in this study: creating a survey from 37 items (phase A); testing readability and question interpretation (phase B); adjusting, rewriting, and translating surveys (phase C); gathering completed surveys from three PGMeL modules (phase D); and holding focus group discussions with the e-learning authors (phase E). Phase E was carried out by presenting the results of the evaluations from phase D, followed by a group discussion. There are four groups of participants in this study. Groups A and B are experienced end users of PGMeL and participated in phase B. Group C are users who undertook e-learning and were asked to complete the survey in phase D. Group D are the authors of the e-learning modules described above. RESULTS: From a list of 36 items, we developed a postgraduate Medical E-Learning Evaluation Survey (MEES). Seven residents participated in the phase B group discussion: 4 items were interpreted differently, 3 were not readable, and 2 items were double. The items from phase B were rewritten and, after adjustment, understood correctly. The MEES was translated into Dutch and again pilot-tested. All items were clear and were understood correctly. The MEES version used for the evaluation contained 3 positive domains (motivation, learning enhancers, and real-world translation) and 2 negative domains (barriers and learning discouragers), with 36 items in those domains, 5 Likert scale questions of 1 to 10, and 5 open questions asking participants to give their own comments in each domain. Three e-learning modules were evaluated from July to November 2018. There were a total of 158 responses from a Dutch module, a European OB/GYN (obstetrics and gynecology) module, and a surgical module offered worldwide. Finally, 3 focus group discussions took place with a total of 10 participants. Usefulness was much appreciated, understandability was good, and added value was high. Four items needed additional explanation by the authors, and a Creators' Manual was written at their request. CONCLUSIONS: The MEES is the first survey to evaluate the instructional design of PGMeL and was constructed following all 7 steps of the AMEE. This study completes the design of the survey and shows its usefulness and added value to the authors. It finishes with a final, publicly available survey that includes a Creators' Manual. We briefly discuss the number of responses needed and conclude that more is better; in the end, however, one has to work with what is available. The next steps would be to see whether improvement can be measured by using the MEES and continue to work on the end understandability in different languages and cultural groups.

Influencing factors in the implementation of postgraduate medical e-learning: a thematic analysis.

BACKGROUND: Postgraduate medical e-learning (PGMeL) is being progressively used and evaluated. Its impact continues to grow, yet there are barriers to its implementation. Although more attention is now being paid to quality evaluation models, little has been written about the successful implementation of PGMeL. This study aims to determine factors and define themes influencing the successful implementation of PGMeL. METHODS: We performed 10 semi-structured interviews with experienced e-learning creators, after which we carried out a thematic analysis to name and describe factors and themes. RESULTS: Although this was not the objective of the study, the participants stressed the importance of a definition of success. Associated with this definition were: reaching your target audience, achieving learning aims, satisfying your audience and maintaining continuity. Three themes were identified containing eleven factors that influence successful implementation. The themes were named and defined after the group that had the most influence on the factors. We named them creator-, organization- and learner-dependent factors. The creator dependent factors are: the learning aim, pedagogical strategies, content expertise, evaluation and the creators motivational path. The organization dependent factors are management support, recourse and culture. Finally, the learner dependent factors are technology, motivators/barriers and value. CONCLUSIONS: This study shows that implementing PGMeL has creator-, organization- and learner-dependent factors which should be taken into account during the creating of the PGMeL. Although creator- and learner-dependent factors are mentioned in other studies, the present study also stresses the importance of organization-dependent factors. Innovation implementation theories such as Rogers' diffusion of innovation or Kotter's eight steps of change management show a great overlap with these factors. Future studies can both evaluate the use of these innovation models in creating PGMeL and assess the effect of the organizational factors in greater depth.

Clarifying learning experiences in student-run clinics: a qualitative study.

BACKGROUND: Student-run clinics (SRCs) are outpatient clinics run and organized by undergraduate medical students. While these clinics offer participating students multiple learning opportunities, little is known about how participation in an SRC contributes to learning and how this learning is influenced. METHODS: In this qualitative clarification study, we conducted semi-structured interviews with a purposive sample of 20 students and student-coordinators participating in our learner-centred SRC (LC-SRC), to gain in-depth insight into their experiences and learning. These interviews were analysed using Glaser's approach to grounded theory. RESULTS: Analysis revealed that responsibility, authenticity, and collaboration described how SRC participation contribute to learning. Responsibility encompassed the responsibility students had for their patients and the responsibility that the student coordinators had for the students. Authenticity reflected the context and tasks in the LC-SRC. Collaboration covered collaboration with other students, with student coordinators, and with clinical supervisors. These three themes are interrelated, and together enhanced motivation and promoted patient-centred learning in both the LC-SRC and the regular curriculum. CONCLUSIONS: Learning in an LC-SRC is highly dependent on students' feelings of responsibility for real authentic tasks and is stimulated by extensive collaboration with fellow students and supervising doctors.

Quality specifications in postgraduate medical e-learning: an integrative literature review leading to a postgraduate medical e-learning model.

BACKGROUND: E-learning is driving major shifts in medical education. Prioritizing learning theories and quality models improves the success of e-learning programs. Although many e-learning quality standards are available, few are focused on postgraduate medical education. METHODS: We conducted an integrative review of the current postgraduate medical e-learning literature to identify quality specifications. The literature was thematically organized into a working model. RESULTS: Unique quality specifications (n = 72) were consolidated and re-organized into a six-domain model that we called the Postgraduate Medical E-learning Model (Postgraduate ME Model). This model was partially based on the ISO-19796 standard, and drew on cognitive load multimedia principles. The domains of the model are preparation, software design and system specifications, communication, content, assessment, and maintenance. CONCLUSION: This review clarified the current state of postgraduate medical e-learning standards and specifications. It also synthesized these specifications into a single working model. To validate our findings, the next-steps include testing the Postgraduate ME Model in controlled e-learning settings.

Exploration of perceived effects of innovations in postgraduate medical education.

CONTEXT: Many studies have examined how educational innovations in postgraduate medical education (PGME) impact on teaching and learning, but little is known about effects in the clinical workplace outside the strictly education-related domain. Insights into the full scope of effects may facilitate the implementation and acceptance of innovations because expectations can be made more realistic, and difficulties and pitfalls anticipated. Using workplace-based assessment (WBA) as a reference case, this study aimed to determine which types of effect are perceived by users of innovations in PGME. METHODS: Focusing on WBA as a recent instance of innovation in PGME, we conducted semi-structured interviews to explore perceptions of the effects of WBA in a purposive sample of Dutch trainees and (lead) consultants in surgical and non-surgical specialties. Interviews conducted in 2011 with 17 participants were analysed thematically using template analysis. To support the exploration of effects outside the domain of education, the study design was informed by theory on the diffusion of innovations. RESULTS: Six domains of effects of WBA were identified: sentiments (affinity with the innovation and emotions); dealing with the innovation; specialty training; teaching and learning; workload and tasks, and patient care. Users' affinity with WBA partly determined its effects on teaching and learning. Organisational support and the match between the innovation and routine practice were considered important to minimise additional workload and ensure that WBA was used for relevant rather than easily assessable training activities. Dealing with WBA stimulated attention for specialty training and placed specialty training on the agenda of clinical departments. CONCLUSIONS: These outcomes are in line with theoretical notions regarding innovations in general and may be helpful in the implementation of other innovations in PGME. Given the substantial effects of innovations outside the strictly education-related domain, individuals designing and implementing innovations should consider all potential effects, including those identified in this study.

New consultants mastering the role of on-call supervisor: a longitudinal qualitative study.

CONTEXT: The supervision of specialty registrars during on-call shifts is essential to ensure the quality of both health care and medical education, but has been identified as a major novelty and stressor for new consultants in the transition from specialty training. There is a paucity of research on how consultants deal with their new supervisory roles and which factors influence this process. These issues are addressed in a prospective study designed to gather insights that can inform measures to ensure the provision of high-quality supervision and specialty training. METHODS: A longitudinal qualitative study was performed in the Netherlands. Semi-structured interviews were conducted with new consultants. The study was guided by an interpretative phenomenological approach until saturation was reached. At 3-month intervals between July 2011 and March 2012, eight novice consultants in internal medicine were interviewed three times each about their supervisory role while on call. Interviews focused on their preparation for the role in training, the actions they took to master the role, and their progression over time. RESULTS: Three interrelated domains of relevant factors emerged from the data: preparedness; personal characteristics, and contextual characteristics. Preparedness referred to the extent to which new consultants were prepared by training to take full responsibility for registrars' actions while supervising them from a distance. Personal characteristics, such as coping strategies and views on supervision, guided consultants' development as supervisors. Essential to this process were contextual characteristics, especially those concerning the extent to which the consultant knew the registrar, was familiar with departmental procedures, and had access to support from colleagues. CONCLUSIONS: New consultants should be prepared for their supervisory role by training and by being given a proper introduction to their workplace. The former requires progressive independence and exposure to supervisory tasks during specialty training; the latter requires an induction programme to enable new consultants to familiarise themselves with the departmental environment and the registrars they will be supervising.

The CanMEDS framework: relevant but not quite the whole story.

BACKGROUND: Despite acknowledgement that the Canadian Medical Educational Directives for Specialists (CanMEDS) framework covers the relevant competencies of physicians, many educators and medical professionals struggle to translate the CanMEDS roles into comprehensive training programmes for specific specialties. AIM: To gain insight into the applicability of the CanMEDS framework to guide the design of educational programmes for specific specialties by exploring stakeholders' perceptions of specialty specific competencies and examining differences between those competencies and the CanMEDS framework. METHODS: This case study is a sequel to a study among ObsGyn specialists. It explores the perspectives of patients, midwives, nurses, general practitioners, and hospital boards on gynaecological competencies and compares these with the CanMEDS framework. RESULTS: Clinical expertise, reflective practice, collaboration, a holistic view, and involvement in practice management were perceived to be important competencies for gynaecological practice. Although all the competencies were covered by the CanMEDS framework, there were some mismatches between stakeholders' perceptions of the importance of some competencies and their position in the framework. CONCLUSION: The CanMEDS framework appears to offer relevant building blocks for specialty specific postgraduate training, which should be combined with the results of an exploration of specialty specific competencies to arrive at a postgraduate curriculum that is in alignment with professional practice.

The transition to hospital consultant: Denmark and the Netherlands compared on preparedness for practice, perceived intensity and contextual factors.

INTRODUCTION: Danish and Dutch new consultants' perceptions regarding the transition to consultant were compared to gain insight into this period, particularly the influence of contextual factors concerning the organisation of specialty training and health care therein. Preparation for medical and generic competencies, perceived intensity and burnout were compared. Additionally, effects of differences in working conditions and cultural dimensions were explored. METHODS: All consultants registered in the Netherlands in 2007-2009 (n = 2643) and Denmark in 2007-2010 (n = 1336) received in June 2010 and April 2011, respectively, a survey about their preparation for medical and generic competencies, perceived intensity and burnout. Power analysis resulted in required sample sizes of 542. Descriptive statistics and independent t-tests were used for analysis. RESULTS: Data were available of 792 new consultants in the Netherlands and 677 Danish new consultants. Compared to their Dutch counterparts, Danish consultants perceived specialty training and the transition less intensely, reported higher levels of preparation for generic competencies and scored lower on burnout. CONCLUSIONS: The importance of contextual aspects in the transition is underscored and shows that Denmark appears to succeed better in aligning training with practice. Regulations regarding working hours and progressive independence of trainees appear to facilitate the transition.

The transition to hospital consultant and the influence of preparedness, social support, and perception: A structural equation modelling approach.

BACKGROUND: Insight into the transition from specialist registrar to hospital consultant is needed to better align specialty training with starting as a consultant and to facilitate this transition. AIMS: This study investigates whether preparedness regarding medical and generic competencies, perceived intensity, and social support are associated with burnout among new consultants. METHOD: A population-based study among all 2643 new consultants in the Netherlands (all specialties) was conducted in June 2010. A questionnaire covering preparedness for practice, intensity of the transition, social support, and burnout was used. Structural equation modelling was used for statistical analysis. RESULTS: Data from a third of the population were available (32% n = 840) (43% male/57% female). Preparation in generic competencies received lower ratings than in medical competencies. A total of 10% met the criteria for burnout and 18% scored high on the emotional exhaustion subscale. Perceived lack of preparation in generic competencies correlated with burnout (r = 0.15, p < 0.001). No such relation was found for medical competencies. Furthermore, social support protected against burnout. CONCLUSIONS: These findings illustrate the relevance of generic competencies for new hospital consultants. Furthermore, social support facilitates this intense and stressful stage within the medical career.

How lead consultants approach educational change in postgraduate medical education.

CONTEXT: Consultants in charge of postgraduate medical education (PGME) in hospital departments ('lead consultants') are responsible for the implementation of educational change. Although difficulties in innovating in medical education are described in the literature, little is known about how lead consultants approach educational change. OBJECTIVES: This study was conducted to explore lead consultants' approaches to educational change in specialty training and factors influencing these approaches. METHODS: From an interpretative constructivist perspective, we conducted a qualitative exploratory study using semi-structured interviews with a purposive sample of 16 lead consultants in the Netherlands between August 2010 and February 2011. The study design was based on the research questions and notions from corporate business and social psychology about the roles of change managers. Interview transcripts were analysed thematically using template analysis. RESULTS: The lead consultants described change processes with different stages, including cause, development of content, and the execution and evaluation of change, and used individual change strategies consisting of elements such as ideas, intentions and behaviour. Communication is necessary to the forming of a strategy and the implementation of change, but the nature of communication is influenced by the strategy in use. Lead consultants differed in their degree of awareness of the strategies they used. Factors influencing approaches to change were: knowledge, ideas and beliefs about change; level of reflection; task interpretation; personal style, and department culture. CONCLUSIONS: Most lead consultants showed limited awareness of their own approaches to change. This can lead them to adopt a rigid approach, whereas the ability to adapt strategies to circumstances is considered important to effective change management. Interventions and research should be aimed at enhancing the awareness of lead consultants of approaches to change in PGME.

Implementing the pharmacy technician role in existing pharmacy settings: Stakeholders views of barriers and facilitators.

BACKGROUND: The field of pharmacy will benefit from pharmacy technicians, a higher educated mid-level support workforce. They support pharmacists in providing pharmaceutical patient care through delegated roles and responsibilities. Empirical research on pharmacy technicians within pharmacy practice community and hospital pharmacy practices tends to focus on the practical outcomes of this workforce addition. It mostly addresses the 'WHAT' of service delivered by pharmacy technicians. Literature on the 'HOW' of their role development in practice is scarce. Furthermore, it seems difficult for most pharmacy technicians to effectively fulfil this professional role. OBJECTIVE: This qualitative study explored factors influencing role development of pharmacy technicians in community and hospital pharmacies. METHODS: On site, individual and small-group interviews were conducted with pharmacy technicians (n = 10), and two colleagues: pharmacists (n = 7) and pharmacy assistants (n = 6). Interviews were based on a semi-structured interview guide. Participants were asked to describe specific incidents and organisational, relational and pharmaceutical care perspectives, illustrative of the process of developing and implementing the pharmacy technician role. Template analysis was used to develop a list of codes representing themes identified in the data. RESULTS: Five interrelated themes influenced development and implementation of the pharmacy technician role. Two of them were at a more contextual level: (a) experiencing a lack of vision on added value of the new role within the field of pharmacy and (b) learning climate. The other three were related to personal interactions between staff members: (c) role expectations and organisational fit, (d) personal traits of pharmacy technicians and (e) support of pharmacy technicians through task delegation and role enhancement. CONCLUSIONS: The data showed that development and implementation of pharmacy technician roles is a complicated process. A detailed plan for addressing and remediating the five identified themes is important to promote role development of pharmacy technicians.

Internet-based treatment for depressive symptoms in hemodialysis patients: A cluster randomized controlled trial.

OBJECTIVE: To investigate the effectiveness of a guided internet-based self-help intervention for hemodialysis patients with depressive symptoms. METHOD: Chronic hemodialysis patients from nine Dutch hospitals with a depression score on the Beck Depression Inventory - second edition (BDI-II) of ≥10, were cluster-randomized into a five modules guided internet-based self-help problem solving therapy intervention or a parallel care-as-usual control group. Clusters were based on hemodialysis shift. The primary outcome depression was measured with the BDI-II. Analysis was performed with linear mixed models. RESULTS: A total of 190 hemodialysis patients were cluster-randomized to the intervention (n = 89) or control group (n = 101). Post-intervention measurement was completed by 127 patients (67%) and more than half of the patients (54%) completed the intervention. No significant differences were found on the BDI-II score between the groups (mean difference - 0.1, 95%CI -3.0; 2.7, p = 0.94). Per protocol sensitivity analysis showed comparable results. No significant differences in secondary outcomes were observed between groups. CONCLUSIONS: Guided internet-based self-help problem solving therapy for hemodialysis patients with depressive symptoms does not seem to be effective in reducing these symptoms as compared to usual care. Future research should examine how to best design content and accessibility of an intervention for depressive symptoms in hemodialysis patients. TRIAL REGISTRATION: Dutch Trial Register: Trial NL6648 (NTR6834) (prospectively registered 13th November 2017).

Depression, anxiety and quality of life of hemodialysis patients before and during the COVID-19 pandemic.

OBJECTIVE: To investigate the impact of the coronavirus pandemic on mental health in hemodialysis patients, we assessed depression, anxiety and quality of life with valid mental health measures before and after the start of the pandemic. METHODS: Data were used from 121 hemodialysis patients from the ongoing prospective multicenter DIVERS-II study. COVID-19 related stress was measured with the Perceived Stress Scale - 10, depression with the Beck Depression Inventory - second edition (BDI-II)), anxiety with the Beck Anxiety Inventory (BAI) and quality of life with the Short Form - 12 (SF-12). Scores during the first and second COVID-19 wave in the Netherlands were compared to data prior to the pandemic with linear mixed models. RESULTS: No significant differences were found in BDI-II, BAI and SF-12 scores between before and during the pandemic. During the first wave, 33% of participants reported COVID-19 related stress and in the second wave 37%. These patients had higher stress levels (mean difference (MD) 4.7 (95%CI 1.5; 8.0), p = 0.005) and BDI-II scores (MD 4.9 (95%CI 0.7; 9.0), p = 0.021) and lower SF-12 mental component summary scores (MD -5.3 (95%CI -9.0, -1.6), p = 0.006) than patients who did not experienced COVID-19 stress. These differences were already present before the pandemic. CONCLUSION: The COVID-19 pandemic does not seem to influence mental health in hemodialysis patients. However, a substantial subgroup of patients with pre-existent mental health problems may be more susceptible to experience COVID-19 related stress.

Opportunity or threat: the ambiguity of the consequences of transitions in medical education.

OBJECTIVES: The alleged medical education continuum is interrupted by a number of major transitions. After starting medical school, the first transition students encounter is that from non-clinical to clinical training. The second transition is that of graduated student to junior doctor or specialist trainee, and the third concerns the specialist trainee's transition to medical specialist. As a first step towards a better understanding of the effects of transitions, this paper provides a critical overview of how these transitions have been conceptualised in the medical education domain. The findings are complemented with perspectives from the fields of transitional psychology and organisational socialisation. The transition into medical school is not reviewed. METHODS: Using the term 'transition', six leading medical education journals were searched for relevant articles. A snowballing technique on the reference lists of the 44 relevant articles yielded 29 additional publications. Studies were reviewed and categorised as representing objectifying, clarifying, or descriptive and/or justifying research. RESULTS: When students enter clinical training, they need to relearn what they thought they knew and they must learn new things in a more self-directed way. As junior doctors or specialist trainees, their main challenges involve handling the many responsibilities that accompany the delivery of patient care while simultaneously learning from the process of providing that care. As medical specialists, new non-medical tasks and decisions on how to delegate responsibilities become issues. CONCLUSIONS: Research on transitions has objectified the challenges students and doctors face. Clarifying studies often lack conceptual frameworks that could help us to gain deeper insight into the observed phenomena. Psychology offers valuable theoretical perspectives that are applicable to medical education transitions. To transform a transition from a threat to a learning opportunity, medical education should assist students and doctors in developing the coping skills they need to effectively deal with the challenges presented by new environments.

The curriculum for the doctor of the future: messages from the clinician's perspective.

BACKGROUND: Medical curricula should focus on the future of health care. Contemporary competency frameworks for curriculum design such as Canadian Medical Education Directions for Specialists (CanMEDS), ACGME and Tomorrow's Doctors share this vision by stressing generic competencies. AIM: The objective of this study was to investigate how well a contemporary competency framework fits in with clinicians' perspectives on future health care. METHODS: Using a strategic planning approach, a semi-structured open-ended questionnaire on the future of their profession was sent to 102 Dutch gynecologists. Through inductive analysis, a future perspective and its needed competencies were identified and compared to the CanMEDS framework. RESULTS: The 62 responses showed content validity for the CanMEDS roles. Additionally, two roles were identified: advanced technology user and entrepreneur. Within the role Communicator, the focus will change through more active patient participation. The roles Collaborator and Manager are predicted to change in focus because of an increase of complex interdisciplinary teamwork and leadership roles. CONCLUSION: By studying the Dutch gynecologists' perspective of the future in a strategic planning approach, two additional roles and focus areas within a contemporary competency framework were identified. The perspective of clinicians on future health care provides valuable messages on how to design future-proof curricula.

Developing a competency framework for pharmacy technicians: Perspectives from the field.

BACKGROUND: Within the last decade and given the context of ever-growing complexity in pharmaceutical care the new profession of Pharmacy Technicians (PT) was added to the pharmacy team. Until now, pharmaceutical organizations worldwide are searching for the best way to educate and employ future PTs. OBJECTIVE: This empirical study set out to gain insight into the knowledge, skills and attitudes required to perform as a PTs. A further aim was to develop a PT competency framework on the basis of experiences and opinions of stakeholders from the Dutch pharmaceutical field. METHODS: A multi-method qualitative research design was used to develop a competency framework between 2015 and 2017. Data were collected using focus group interviews. Iterative thematic analysis led to an initial framework, which was refined using a modified Delphi-method. A competency domain was considered relevant if a minimum of 70% consensus was reached. RESULTS: Both PTs (n = 27) and pharmacists (n = 12) participated in the focus groups. The Delphi-panel consisted of PTs (n = 8), pharmacists (n = 12) and representatives of other stakeholders like patient organizations, health policy makers and all levels of pharmacy education (n = 14). The developed competency framework comprises 6 domains: Communication in patient care, Interdisciplinary collaboration, Pharmaceutical expertise, Organization of care practice, Collaborative leadership and Personal development. A detailed description about the practical implications of each domain was added to the framework. CONCLUSION: The PT competency framework provides a solid foundation for both PT training and curriculum development and is based on several rounds of scientific research. The proposed competency framework may help understand the PT role and how to best prepare for practice within pharmaceutical care.

A 9-Step Theory- and Evidence-Based Postgraduate Medical Digital Education Development Model: Empirical Development and Validation.

BACKGROUND: Digital education tools (e-learning, technology-enhanced learning) can be defined as any educational intervention that is electronically mediated. Decveloping and applying such tools and interventions for postgraduate medical professionals who work and learn after graduation can be called postgraduate medical digital education (PGMDE), which is increasingly being used and evaluated. However, evaluation has focused mainly on reaching the learning goals and little on the design. Design models for digital education (instructional design models) help educators create a digital education curriculum, but none have been aimed at PGMDE. Studies show the need for efficient, motivating, useful, and satisfactory digital education. OBJECTIVE: Our objective was (1) to create an empirical instructional design model for PGMDE founded in evidence and theory, with postgraduate medical professionals who work and learn after graduation as the target audience, and (2) to compare our model with existing models used to evaluate and create PGMDE. METHODS: Previously we performed an integrative literature review, focus group discussions, and a Delphi procedure to determine which building blocks for such a model would be relevant according to experts and users. This resulted in 37 relevant items. We then used those 37 items and arranged them into chronological steps. After we created the initial 9-step plan, we compared these steps with other models reported in the literature. RESULTS: The final 9 steps were (1) describe who, why, what, (2) select educational strategies, (3) translate to the real world, (4) choose the technology, (5) complete the team, (6) plan the budget, (7) plan the timing and timeline, (8) implement the project, and (9) evaluate continuously. On comparing this 9-step model with other models, we found that no other was as complete, nor were any of the other models aimed at PGMDE. CONCLUSIONS: Our 9-step model is the first, to our knowledge, to be based on evidence and theory building blocks aimed at PGMDE. We have described a complete set of evidence-based steps, expanding a 3-domain model (motivate, learn, and apply) to an instructional design model that can help every educator in creating efficient, motivating, useful, and satisfactory PGMDE. Although certain steps are more robust and have a deeper theoretical background in current research (such as education), others (such as budget) have been barely touched upon and should be investigated more thoroughly in order that proper guidelines may also be provided for them.

How We Evaluate Postgraduate Medical E-Learning: Systematic Review.

BACKGROUND: Electronic learning (e-learning) in postgraduate medical education has seen a rapid evolution; however, we tend to evaluate it only on its primary outcome or learning aim, whereas its effectiveness also depends on its instructional design. We believe it is important to have an overview of all the methods currently used to evaluate e-learning design so that the preferred method may be identified and the next steps needed to continue to evaluate postgraduate medical e-learning may be outlined. OBJECTIVE: This study aimed to identify and compare the outcomes and methods used to evaluate postgraduate medical e-learning. METHODS: We performed a systematic literature review using the Web of Science, PubMed, Education Resources Information Center, and Cumulative Index of Nursing and Allied Health Literature databases. Studies that used postgraduates as participants and evaluated any form of e-learning were included. Studies without any evaluation outcome (eg, just a description of e-learning) were excluded. RESULTS: The initial search identified 5973 articles, of which we used 418 for our analysis. The types of studies were trials, prospective cohorts, case reports, and reviews. The primary outcomes of the included studies were knowledge, skills, and attitude. A total of 12 instruments were used to evaluate a specific primary outcome, such as laparoscopic skills or stress related to training. The secondary outcomes mainly evaluated satisfaction, motivation, efficiency, and usefulness. We found 13 e-learning design methods across 19 studies (4% 19/418). The methods evaluated usability, motivational characteristics, and the use of learning styles or were based on instructional design theories, such as Gagne's instructional design, the Heidelberg inventory, Kern's curriculum development steps, and a scale based on the cognitive load theory. Finally, 2 instruments attempted to evaluate several aspects of a design, based on the experience of creating e-learning. CONCLUSIONS: Evaluating the effect of e-learning design is complicated. Given the diversity of e-learning methods, there are many ways to carry out such an evaluation, and probably, many ways to do so correctly. However, the current literature shows us that we have yet to reach any form of consensus about which indicators to evaluate. There is a great need for an evaluation tool that is properly constructed, validated, and tested. This could be a more homogeneous way to compare the effects of e-learning and for the authors of e-learning to continue to improve their product.