Effect of Pause Procedures on Participant Reflection and Commitment-to-Change in Continuing Medical Education.

Problem: Conferences are the most common form of continuing medical education (CME), but their effect on clinician practice is inconsistent. Reflection is a critical step in the process of practice change among clinicians and may lead to improved outcomes following conference-based CME. However, reflection requires time to process newly-learned material. Adequate time for reflection may be noticeably absent during many conference presentations. Intervention: The pause procedure is a 90-second 'pause' during a 30-minute presentation so learners can review and discuss content. The goal of the pause procedure is to stimulate learners' active engagement with newly learned material which will, in turn, promote learner reflection. Context: Fifty-six presentations at two hospital medicine CME conferences were assigned to the pause procedure or control. Study outcomes provided by conference participants were validated reflection scores and commitment-to-change (CTC) statements for each presentation. A post-hoc survey of the intervention group was conducted to assess presenters' experiences with the pause procedure. Impact: A total of 527 conference participants completed presentation evaluations (response rate 72.7%). Presentations incorporating the pause procedure failed to lead higher participant reflection scores (percentage 'top box' score; intervention: 39.2% vs. control: 41.7%, p = 0.40) or participant CTC rates (median [IQR]; intervention: 4.64 [3.04, 10.57] vs. control: 8.16 [5.28, 17.12], p = 0.13) than control presentations. However, the majority of presenters (16 out of 17 survey respondents) had never before used the intervention and little active engagement among learners was noted during the pause procedure. Lessons Learned: Adding the pause procedure to CME presentations did not lead to greater reflection or CTC among clinician learners. However, presenters had limited experience with the intervention, which may have reduced their fidelity to the educational principles of the pause procedure. Faculty development may be necessary when planning a new educational intervention that is to be implemented by conference presenters.

Relationships Between Reflection and Behavior Change in CME.

INTRODUCTION: Reflection exposes performance gaps and is a step in the process of behavior change among adult learners. However, little is known about the relationships between reflection and behavior change in CME. Our objectives were to measure associations between validated reflection scores and behavior change among CME participants and to identify associations between reflection and characteristics of CME presentations. METHODS: This was a cohort study of attendees at a national hospital medicine CME course. Participants provided reflection scores for each presentation and planned commitment-to-change (CTC) statements at the conclusion of the course. Reflection scores from 1 (strongly disagree) to 5 (strongly agree) were averaged for each presentation. CTC statements were linked to their accompanying presentations. A 3-month postcourse survey was conducted to assess if planned CTCs were successfully implemented. RESULTS: In all, 223 of 281 participants (79.4%) returned evaluations. Of the 195 planned CTC statements available for postcourse analysis, 128 (65.6%) were implemented. Reflection scores correlated with the number of planned CTC statements across all presentations (Pearson correlation, 0.65; P < .001). In addition, higher reflection scores (mean [SD]) were associated with the presence of audience response opportunities (Yes: 4.13 [0.18] versus No: 3.96 [0.16]; P = .01) and the use of clinical cases (Yes: 4.09 [0.18] versus No: 3.86 [0.12]; P < .01). DISCUSSION: To our knowledge, this is the first study to show a relationship between participant reflection and CTC in conference-based CME. Presentations that incorporate clinical cases and audience response systems seem to stimulate participant reflection and behavior change.

All CLEAR? Preparing for IT Downtime.

Health care information technology (IT) outages pose a threat to patient safety and patient care continuity. Organizations' downtime plans must be updated regularly and staff at the work area level should have experience with implementing IT outage operations through downtime drills. This article describes the study institution's IT Outage Toolkit, based on the acronym CLEAR, which guides the development of a downtime plan as well as design, execution, and assessment of work area downtime drills. Self-report and external audits of downtime drills help identify performance gaps and gaps in downtime plans.

Associations between teaching effectiveness scores and characteristics of presentations in hospital medicine continuing education.

BACKGROUND: There is little research regarding characteristics of effective continuing medical education (CME) presentations in hospital medicine (HM). Therefore, we sought to identify associations between validated CME teaching effectiveness scores and characteristics of CME presentations in the field of HM. DESIGN/SETTING: This was a cross-sectional study of participants and didactic presentations from a national HM CME course in 2014. MEASUREMENTS: Participants provided CME teaching effectiveness (CMETE) ratings using an instrument with known validity evidence. Overall CMETE scores (5-point scale: 1 = strongly disagree; 5 = strongly agree) were averaged for each presentation, and associations between scores and presentation characteristics were determined using the Kruskal-Wallis test. The threshold for statistical significance was set at P < 0.05. RESULTS: A total of 277 out of 368 participants (75.3%) completed evaluations for the 32 presentations. CMETE scores (mean [standard deviation]) were significantly associated with the use of audience response (4.64 [0.16]) versus no audience response (4.49 [0.16]; P = 0.01), longer presentations (≥30 minutes: 4.67 [0.13] vs <30 minutes: 4.51 [0.18]; P = 0.02), and larger number of slides (≥50: 4.66 [0.17] vs <50: 4.55 [0.17]; P = 0.04). There were no significant associations between CMETE scores and use of clinical cases, defined goals, or summary slides. CONCLUSIONS: To our knowledge, this is the first study regarding associations between validated teaching effectiveness scores and characteristics of effective CME presentations in HM. Our findings, which support previous research in other fields, indicate that CME presentations may be improved by increasing interactivity through the use of audience response systems and allowing longer presentations.