The Extended Congress: Reimagining scientific meetings after the COVID-19 pandemic.

This article was migrated. The article was marked as recommended. The COVID-19 pandemic has profoundly impacted the medical meetings planned for 2020. This health crisis has caused the cancellation, postponement or a pivot in educational design to virtual formats. In the latter case, the format for virtual meetings has remained very similar to the cancelled face-to-face meeting, by using primarily web conferencing systems. This article intends to start a dialogue with the medical education and events community about possible delivery formats. Among them, the concept of an "Extended Congress" is introduced. The extended congress uses the extension of time, space and languages to a scientific meeting. It aims to: 1) unleash the reach of traditional meetings through the use of technology to access larger audiences in different languages, across a country and internationally, with local leaders to help interpret the knowledge and localize it, and 2) to improve knowledge translation into practice through a sequential and active learning process. An ongoing example is described as a proof of concept: the Latin American Peritoneal Dialysis Extended Congress attracted 774 remote participants from over 20 countries, 93% of whom were paid registrants. Initially designed as a hybrid (live plus remote) event scheduled for March 2020, it had to be reframed as a remote only meeting due to the COVID-19 pandemic, thus protecting the health of members while providing continued value to the organization and attendees of the event. With this experience in mind, the authors are currently designing programs in the United States, through collaboration with the University of Virginia Office of Continuing Medical Education. In summary, the design of meetings can better utilize and integrate technology and reach larger audiences with a blend of formats. Those organizations that adapt more quickly to offer these events will concentrate more of the share, as seen with the adoption of technology by other industries.

Social learning in large online audiences of health professionals: Improving dialogue with automated tools.

This article was migrated. The article was marked as recommended. Massive open online courses (MOOCs) bring about the opportunity to reach large international audiences of health professionals. However, change in clinical practice eventually needs social interaction, to validate the new knowledge with trusted peers, in the agreement and adoption phases of change. How can meaningful dialogue take place without scaling up expert tutoring? The extensive experience from social network applications such as Facebook or Twitter provides an opportunity to improve dialogue among peers and with experts automatically and seamlessly, as part of what is called social learning analytics (SLA). Large amounts of data about prior relationships among participants in a course - similar to Facebook and other social applications-, among participants and course materials - similar to Netflix or Amazon -, as well as natural language processing, could be obtained, and then analyzed and used to improve the educational processes and outcomes. In this paper, a series of examples with pilot uses of SLA in the context of massive online courses for physicians and other health care professionals are described. They include: 1) Forecasting of academic accomplishment. 2) Team-based face-to-face learning as part of massive online courses. 3) Analysis of existing connections, to ensure the most connected discussion groups of course participants. 4) Facebook-like dialogue with other course participants who are previously related, as well as with the Course Faculty. 5) Crowdsourcing and friendsourcing, for recommending useful study materials or future courses. 6) Natural language processing, to classify posts in online discussions. It should be noted that the article does not address the use of Facebook or Twitter in continuing medical education (CME), but instead, the use of their approaches in CME. The intent of this manuscript is to create awareness in the medical education community that this type of analysis is possible and potentially useful, to receive feedback on the possible functionalities as well as critique these developments, and to create a space for collaboration in research and innovation projects with other interested parties.

Raising Awareness of Acute Kidney Injury: A Latin American Experience.

INTRODUCTION: Raising awareness of acute kidney injury (AKI) is an essential strategy for minimizing the burden of this lethal syndrome. The AKI Commission of the Latin American Society of Nephrology and Hypertension conducted an educational program based on networked learning. METHODS: Two online courses with similar methodologies were developed, 1 course for nephrologists and the other for primary care physicians (PCP). The courses were developed as a distance education, asynchronous online modality with multiple educational strategies: written lessons, videos, e-rounds, and clinical simulation. Knowledge gain was explored through a 10-question test before and after course completion. RESULTS: The course for nephrologists had 779 participants from 21 countries; 52% were male, and 46% were <35 years of age. Mean qualification increased from 5.87 to 8.01 (36% gain of knowledge). The course for PCPs had 2011 participants, 81% of whom were physicians. The time from graduation was <5 years in 52%. In both courses, clinical simulation was considered the best part and lack of time the main limitation for learning. Because 48% of the nephrologist course attendees were interested in AKI activities, a Latin American AKI Network site (RedIRA) composed of a brief review, a clinical forum, a self-assessment, and a bibliography on AKI was launched on a monthly basis in November 2016. To date there are 335 users from 18 countries. CONCLUSIONS: Distance education techniques were effective for learning about AKI and are a potential tool for the development of a sustainable structure for communication, exchange, and integration of physicians involved in the care of patients with AKI.

Online continuing interprofessional education on hospital-acquired infections for Latin America

Abstract Introduction: Latin America is a large and diverse region, comprising more than 600 million inhabitants and one million physicians in over 20 countries. Resistance to antibacterial drugs is particularly important in the region. This paper describes the design, implementation and results of an international bi-lingual (Spanish and Portuguese) online continuing interprofessional interactive educational program on hospital-acquired infections and antimicrobial resistance for Latin America, supported by the American Society for Microbiology. Methods: Participation, satisfaction and knowledge gain (through pre and post tests) were used. Moreover, commitment to change statements were requested from participants at the end of the course and three months later. Results: There were 1169 participants from 19 Latin American countries who registered: 57% were physicians and 43% were other health care professionals. Of those, 1126 participated in the course, 46% received a certificate of completion and 54% a certificate of participation. There was a significant increase in knowledge between before and after the course. Of 535 participants who took both tests, the grade increased from 59 to 81%. Commitments to change were aligned with course objectives. Discussion: Implementation of this educational program showed the feasibility of a continent-wide interprofessional massive course on hospital acquired-infections in Latin America, in the two main languages spoken in the region. Next steps included a new edition of this course and a "New Challenges" course on hospital-acquired infections, which were successfully implemented in the second semester of 2015 by the same institutions.

Online continuing interprofessional education on hospital-acquired infections for Latin America.

INTRODUCTION: Latin America is a large and diverse region, comprising more than 600 million inhabitants and one million physicians in over 20 countries. Resistance to antibacterial drugs is particularly important in the region. This paper describes the design, implementation and results of an international bi-lingual (Spanish and Portuguese) online continuing interprofessional interactive educational program on hospital-acquired infections and antimicrobial resistance for Latin America, supported by the American Society for Microbiology. METHODS: Participation, satisfaction and knowledge gain (through pre and post tests) were used. Moreover, commitment to change statements were requested from participants at the end of the course and three months later. RESULTS: There were 1169 participants from 19 Latin American countries who registered: 57% were physicians and 43% were other health care professionals. Of those, 1126 participated in the course, 46% received a certificate of completion and 54% a certificate of participation. There was a significant increase in knowledge between before and after the course. Of 535 participants who took both tests, the grade increased from 59 to 81%. Commitments to change were aligned with course objectives. DISCUSSION: Implementation of this educational program showed the feasibility of a continent-wide interprofessional massive course on hospital acquired-infections in Latin America, in the two main languages spoken in the region. Next steps included a new edition of this course and a "New Challenges" course on hospital-acquired infections, which were successfully implemented in the second semester of 2015 by the same institutions.

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.

Online Continuing Medical Education for the Latin American Nephrology Community.

A continuing medical education (CME) course was implemented for Latin American nephrologists in 2013. The topic was Immunopathology in native and transplanted kidneys. The course was given in Spanish and Portuguese. The activities included a distance education seven-week asynchronous online modality with multiple educational strategies. Thirty hours of study workload were estimated to complete the course. Four hundred and ninety-eight physicians coming from 18 countries registered for the course; 442 of them participated in it. Of those who participated, 51% received a certificate of completion and 29% a certificate of participation. Sixty-five percent of registrants participated in the case discussions. Eighty-six percent were very satisfied and 13% were satisfied. Lack of time to devote to the course was the main limitation expressed (62%), while Internet access or difficulties in the use of technology were considered by only 12 and 6% of participants, respectively. There was a significant increase in knowledge between before and after the course; the average grade increased from 64 to 83%. In conclusion, technology-enabled education demonstrated potential to become an instrument for Latin American nephrologists.

Implementación y evaluación de un curso semipresencial sobre enfermedad por reflujo gastroesofágico para médicos de América Latina / Implementation and evaluation of a blended learning course on gastroesophageal reflux disease for physicians in Latin America

La integración de guías clínicas basadas en la evidencia sobre la enfermedad por reflujo gastroesofágico en la práctica médica representa una tarea de primer orden en América Latina, dada su alta prevalencia en la región. El objetivo de este proyecto fue implementar y evaluar una intervención educativa sobre enfermedad por reflujo gastroesofágico, dirigida a médicos de atención primaria de América Latina, con contenidos basados en las guías clínicas disponibles. El curso incluyó actividades de lanzamiento, presenciales o a distancia, y un período de 2 meses de estudio e interacción por Internet. Se realizó una prueba piloto en Uruguay, y luego se aplicó en 5 países (México, Colombia, Venezuela, Argentina y, nuevamente, Uruguay). Se hizo un diseño global, que luego fue adaptado a cada uno de los países; para esto, participaron instituciones y líderes locales. Cuando correspondía, se solicitaron créditos localmente a los efectos de la recertificación. La participación fue gratuita. De los 3.110 médicos invitados a participar, 1.143 (36,8%) comenzaron el curso. De ellos, 587 (51,4%) accedieron al menos a la mitad de los materiales de estudio y 785 (68,7%) participaron en las discusiones clínicas. Trescientos treinta y ocho (29,6%) completaron todos los requerimientos del curso y recibieron un certificado. Entre aquellos médicos que realizaron tanto el pretest como el postest de conocimientos, los resultados pasaron de un promedio de 60 a 80% (p<0,001). El 92% de los compromisos de cambio estuvieron relacionados con los objetivos pedagógicos del curso. En conclusión, se implementó exitosamente un curso multifacético, secuencial, de educación médica continua en Latinoamérica, con un diseño global y una adecuación a cada país. La determinación de las necesidades específicas y la participación de expertos nacionales fue un elemento fundamental para el resultado obtenido (AU)

Integrating evidence-based clinical practice guidelines on gastroesophageal reflux disease into medical practice is of prime importance in Latin America, given its high prevalence in this region. The aim of this project was to implement and assess an educational intervention on gastroesophageal reflux disease, aimed at primary care physicians in Latin America, with contents based on current clinical guidelines. The course included initial activities, whether face-to-face or through distance learning, and a 2-month period of Internet study and interaction. A pilot test was carried out in Uruguay, which was then repeated in 5 countries (Mexico, Colombia, Venezuela, Argentina and again in Uruguay). A global template was designed, which was then adapted to each of the countries: this was done with the participation of local institutions and leaders. Local credits were given for recertification. Participation was free. Of 3,110 physicians invited to participate, 1,143 (36.8%) started the course. Of these, 587(51.4%) accessed at least half the contents of the course and 785 (68.7%) took part in the clinical discussions. A total of 338 (29.6%) completed all the requirements of the course and received a certificate. Among physicians who took both the pre- and post-intervention knowledge tests, scores improved from 60 to 80% (P<.001). Ninety-two percent of planned changes in clinical practice were related to the pedagogic aims of the course. In conclusion, a multifaceted, 2-phase continuing education course was successfully imparted in Latin America, with an overall design that was adapted to each country. Determination of specific needs and the participation of national experts were fundamental to the success of the course (AU)

[Implementation and evaluation of a blended learning course on gastroesophageal reflux disease for physicians in Latin America]. / Implementación y evaluación de un curso semipresencial sobre enfermedad por reflujo gastroesofágico para médicos de América Latina.

Integrating evidence-based clinical practice guidelines on gastroesophageal reflux disease into medical practice is of prime importance in Latin America, given its high prevalence in this region. The aim of this project was to implement and assess an educational intervention on gastroesophageal reflux disease, aimed at primary care physicians in Latin America, with contents based on current clinical guidelines. The course included initial activities, whether face-to-face or through distance learning, and a 2-month period of Internet study and interaction. A pilot test was carried out in Uruguay, which was then repeated in 5 countries (Mexico, Colombia, Venezuela, Argentina and again in Uruguay). A global template was designed, which was then adapted to each of the countries: this was done with the participation of local institutions and leaders. Local credits were given for recertification. Participation was free. Of 3,110 physicians invited to participate, 1,143 (36.8%) started the course. Of these, 587 (51.4%) accessed at least half the contents of the course and 785 (68.7%) took part in the clinical discussions. A total of 338 (29.6%) completed all the requirements of the course and received a certificate. Among physicians who took both the pre- and post-intervention knowledge tests, scores improved from 60 to 80% (P<.001). Ninety-two percent of planned changes in clinical practice were related to the pedagogic aims of the course. In conclusion, a multifaceted, 2-phase continuing education course was successfully imparted in Latin America, with an overall design that was adapted to each country. Determination of specific needs and the participation of national experts were fundamental to the success of the course.

10x10 comes full circle: Spanish version back to United States in Puerto Rico.

The adaptation of the 10x10 certificate program in health information systems for a Puerto Rican audience is described. The 10x10 program was initially developed in the USA by the Oregon Health Sciences University (OHSU), then adapted to Latin America by Hospital Italiano de Buenos Aires. Puerto Rico is in the intersection of the United States and Latin America, in terms of government, health care system, culture and language. Therefore, it seemed reasonable to re-adapt the program back to the USA, in Spanish, taking into account these facts and the experience of the team in delivering blended learning adapted to local needs. Forty professionals from Puerto Rico are currently taking the first version of the course, supported by the Regional Extension Center for Puerto Rico and the US Virgin Islands, and endorsed by the American Medical Informatics Association (AMIA).

Teaching tobacco cessation skills to Uruguayan physicians using information and communication technologies.

INTRODUCTION: Since 2004, with the ratification of the Framework Convention on Tobacco Control, Uruguay has implemented a wide range of legal restrictions designed to reduce the devastating impacts of tobacco. This legal process generated an increase in demand for tobacco cessation treatment, which led to the need to train a large number of physicians. Information and Communication Technologies (ICTs) are evolving constantly, creating new opportunities to make online education more interactive. The evolution of ICTs presents an opportunity to develop innovative continuing medical education (CME) experiences to meet the increasing demand for this topic. METHODS: A blended-learning course on tobacco cessation was developed and implemented, combining face-to-face and online activities. Educational strategy focused on (1) facilitating interaction among generalists and between generalists and experts, and (2) providing high impact CME incorporating multifaceted interventions with wiki-type collaborative construction of practical knowledge. Multiple-choice tests and commitments-to-change were used for evaluation. RESULTS: Three hundred thirty-five health professionals participated in the course. Of these, 145 (43.3%) attended the on-site workshop, 216 (64.5%) participated in the online activities, and 109 (32.5%) completed both phases. Fifty of the 105 (47.6%) participants completing the pretest had a passing score, while 78.1% received a passing score on the final test (p < .001). Differences between mean pretest and posttest scores among those who completed both phases compared with those who only did the online phase were statistically significant (p = .003 and p = .009, respectively). DISCUSSION: The need to train physicians on tobacco cessation skills can be addressed via ICTs and educational activities that include participant interaction.

A countrywide clinical informatics project in Uruguay.

FEMI is a federation of 23 private not-for-profit health care organizations across Uruguay. It covers approximately 700 thousand people (20 percent of the Uruguayan population) and owns a tertiary center in Montevideo. Pressure from ongoing national changes in health funding and regulation have pushed FEMI to develop a project, in order to improve efficiency in health care through the use of information and communications technologies. In particular, a federal electronic health record and a strategic management system are pursued. This project is supported by the Inter American Development Bank. The project has four lines of action: Specification, construction and implementation of the systems; Alignment through the use of standards; Cultural change through training and prototype systems; and Infrastructure. Short term results include a federal balanced scorecard, federal identification and authorization services, a terminology service, telemedicine applications and massive training of interdisciplinary teams at the local level. The importance of collaboration at the regional level and the advantages of having a multi-institutional commitment are stressed.

Building a health informatics workforce in developing countries.

Information and communication technology can be used to improve the quality and safety of health care and to lower costs. But in both developed and developing countries, there is an inadequate supply of skilled individuals who have the technical skills to use this technology to improve health care. Some studies project workforce needs of tens of thousands in English-speaking developed countries, but it is not known what size workforce will be required in the developing world. It is important to identify and develop the skills, training, and competencies-consistent with local cultures, languages, and health systems-that will be needed to realize the full benefits of these technologies. We present a framework for answering these questions and for developing estimates of the size and scope of the workforce that may be needed.

Distance education for physicians: adaptation of a Canadian experience to Uruguay.

INTRODUCTION: The production of online high-quality continuing professional development is a complex process that demands familiarity with effective program and content design. Collaboration and sharing across nations would appear to be a reasonable way to improve quality, increase access, and reduce costs. METHODS: In this case report, the process of adapting and modifying a course to improve the management of Alzheimer's disease developed for the Canadian context for use in Uruguay is described. RESULTS: Both quantitative and qualitative data on the process are shown. The original course was developed by the University of Calgary in the 1990s, and taught initially face to face and later online. The adaptation included using a distance education system developed and widely used in Uruguay, called eviDoctor. DISCUSSION: The key aspects of transforming this course from one country to another with different resources, health care systems, culture, and language are analyzed. Problems encountered are described, as well as their possible solutions.

Continuing professional development of physicians in Uruguay: lessons from a countrywide experience.

This article describes the advancement of continuing professional development (CPD) for physicians in Uruguay and explains the motivations for a CPD system, the role of the faculty of medicine and the other stakeholders, the strategic goals, and current results, including strengths and weaknesses. The work described here had three strategic objectives: (1) initiate a CPD accreditation program, (2) train physician leaders in CPD, and (3) promote the creation of a national system for CPD. By the end of 2006, the accreditation program had 34 accredited institutions. Over a 10-year period, 150 physician leaders from different regions of the country and with different specialties had been trained in the framework and methodological issues of CPD. Legislation is expected to be introduced into parliament during 2007 for coordinating CPD efforts at a national level.

[Continuing medical professional development in Uruguay as the country faces the 21st century]. / El desarrollo profesional médico continuo en el Uruguay de cara al siglo XXI.

This paper outlines the evolution of the concept of continuing medical professional development in Uruguay, as that professional development has progressed from independent and varied efforts that were not coordinated or evaluated to a plan that is aimed at improving the quality of educational activities and programs and making them accessible to all the physicians in the country. In contrast to countries where scientific societies and medical associations preside over continuing professional development, in Uruguay the Graduate School of the School of Medicine of the University of the Republic has taken on managing and developing this process. The key objective of this process is for the Graduate School to work in conjunction with other leading players in professional development to create a national system of continuing medical professional development. This system should be interinstitutional and include both public and private entities. By having the key public institutions (the Graduate School and the Ministry of Public Health) working with private entities (medical associations, scientific societies, and health care institutions), there should be an adequate balance of interests. The national professional development system should work in the most decentralized manner possible and should be based on a network of units distributed around the entire country, but with centralized coordination. The system's interinstitutional character should ensure high technical and ethical standards as well as a balance among the governmental, commercial, professional, and university components. This system should serve as the basis for extending this activity to all health personnel in Uruguay. While the national system is still being finalized, the Graduate School has implemented a process of accrediting institutions that are involved in continuing professional medical development. The aim of this accreditation process is to improve the educational offerings for physicians and to generate practical experience that will serve the future system.

El desarrollo profesional médico continuo en el Uruguay de cara al siglo XXI / Continuing medical professional development in Uruguay as the country faces the 21st century

This paper outlines the evolution of the concept of continuing medical professional development in Uruguay, as that professional development has progressed from independent and varied efforts that were not coordinated or evaluated to a plan that is aimed at improving the quality of educational activities and programs and making them accessible to all the physicians in the country. In contrast to countries where scientific societies and medical associations preside over continuing professional development, in Uruguay the Graduate School of the School of Medicine of the University of the Republic has taken on managing and developing this process. The key objective of this process is for the Graduate School to work in conjunction with other leading players in professional development to create a national system of continuing medical professional development. This system should be interinstitutional and include both public and private entities. By having the key public institutions (the Graduate School and the Ministry of Public Health) working with private entities (medical associations, scientific societies, and health care institutions), there should be an adequate balance of interests. The national professional development system should work in the most decentralized manner possible and should be based on a network of units distributed around the entire country, but with centralized coordination. The system's interinstitutional character should ensure high technical and ethical standards as well as a balance among the governmental, commercial, professional, and university components. This system should serve as the basis for extending this activity to all health personnel in Uruguay. While the national system is still being finalized, the Graduate School has implemented a process of accrediting institutions that are involved in continuing professional medical development. The aim of this accreditation process is to improve the educational offerings for physicians and to generate practical experience that will serve the future system