A Qualitative Study to Understand the Cultural Factors That Influence Clinical Data Use for Continuing Professional Development.

INTRODUCTION: The use of data to inform lifelong learning has become increasingly important in continuing professional development (CPD) practice. Despite the potential benefits of data-driven learning, our understanding of how physicians engage in data-informed learning activities, particularly for CPD, remains unclear and warrants further study. The purpose of this study was to explore how physicians perceive cultural factors (individual, organizational, and systemic) that influence the use of clinical data to inform lifelong learning and self-initiated CPD activities. METHODS: This qualitative study is part of an explanatory sequential mixed-methods study examining data-informed learning. Participants were psychiatrists and general surgeons from Canada and the United States. Recruitment occurred between April 2019 and November 2019, and the authors conducted semistructured telephone interviews between May 2019 and November 2019. The authors performed thematic analysis using an iterative, inductive method of constant comparative analysis. RESULTS: The authors interviewed 28 physicians: 17 psychiatrists (61%) and 11 general surgeons (39%). Three major themes emerged from the continuous, iterative analysis of interview transcripts: (1) a strong relationship between data and trust, (2) a team-based approach to data-informed learning for practice improvement, and (3) a need for organizational support and advocacy to put data into practice. CONCLUSION: Building trust, taking a team-based approach, and engaging multiple stakeholders, such as data specialists and organizational leadership, may significantly improve the use of data-informed learning. The results are situated in the existing literature, and opportunities for future research are summarized.

Exploring Systemic Influences on Data-Informed Learning: Document Review of Policies, Procedures, and Legislation from Canada and the United States.

INTRODUCTION: Despite the support for and benefits of data-driven learning, physician engagement is variable. This study explores systemic influences of physician use of data for performance improvement in continuing professional development (CPD) by analyzing and interpreting data sources from organizational and institutional documents. METHODS: The document analysis is the third phase of a mixed-methods explanatory sequential study examining cultural factors that influence data-informed learning. A gray literature search was conducted for organizations both in Canada and the United States. The analysis contains nonparticipant observations from professional learning bodies and medical specialty organizations with established roles within the CPD community known to lead and influence change in CPD. RESULTS: Sixty-two documents were collected from 20 Canadian and American organizations. The content analysis identified the following: (1) a need to advocate for data-informed self-assessment and team-based learning strategies; (2) privacy and confidentiality concerns intersect at the point of patient data collection and physician-generated outcomes and need to be acknowledged; (3) a nuanced data strategy approach for each medical specialty is needed. DISCUSSION: This analysis broadens our understanding of system-level factors that influence the extent to which health information custodians and physicians are motivated to engage with data for learning.

Simulation-based education for selected communication skills: exploring the perception of post-graduate dental students.

PURPOSE: The role of simulation-based education (SBE) in enhancing communication has been established in the literature. To ensure achieving desired outcomes from SBE initiative, the individual learners, their experiences, and environments need to be considered. This study aimed at exploring the perception of post-graduate dental students regarding their participation in SBE sessions, around selected communication skills, designed in alignment with the assumptions of adult learning theory and steps of Kolb's experiential learning cycle. METHODS: This study utilized a qualitative design. Six focus-group sessions were conducted following the SBE sessions. The generated data was inductively investigated using a multi-staged participant-focused approach to thematic analysis, based upon constructivist epistemology. NVivo was utilized to facilitate text Fragments' coding and categorization. RESULTS: Forty-three post-graduate dental students participated. The analysis resulted in 16 categories spread across five sequential phases of the SBE experience. The "input" theme referred to the resources needed for the SBE process, and included three categories: facilities, personnel, and teaching materials. The second theme included steps of SBE "process": pre-brief, simulation, and debrief. The third, fourth, and fifth themes constituted the short- and longer-term results of the SBE intervention. The participants reported instant benefits on confidence in their expertise in communicating with patients and their guardians. Additionally, perceived effects on the empathy and professionalism were reported. CONCLUSION: SBE, that is based upon adult and experiential learning theories, and developed after thorough consideration of the individual learners, and their experiences and learning environments, holds potential in enhancing communication skills among post-graduate dental students.

A qualitative study of trainer and trainee perceptions and experiences of clinical assessment in post-graduate dental training.

BACKGROUND: The implementation of workplace-based assessment (WBA) needs to ensure the achievement of pre-set competences but may look different across varying contexts, such as in post-graduate dental education. The purpose of this study is to explore the perception of residents, faculty members and alumni concerning their experience with clinical assessment, and what configurations they consider as optimal to maximise the entailed learning experience. METHODS: This study relied on a qualitative descriptive design using two data collection tools: focus group sessions, and semi-structured, one-to-one interviews. Data were triangulated from three sources: residents, faculty members and alumni. The data were inductively analysed based on constructivist epistemology. This was done using the Thematic Analysis approach, facilitated by NVivo software. RESULTS: The analysis revealed two mutually exclusive themes: process and people. Within process, variables related to quality, workflow and feedback surfaced. As for the people theme, the main two group of stakeholders referred to in the related analysis were the trainees and the trainers. DISCUSSION: There are many variables that need to be considered when developing an evidence-driven WBA. In addition, factoring into the design of the WBA the perception of the main stakeholders will enable contextualisation which is expected to raise the reliability of the adapted tools. CONCLUSION: This study introduced a framework that could support post-graduate universities in their journey towards developing context-specific WBA.

Hospitalization Rates Related to Coordinated Home Health Care Services With a Community Oncology Practice.

PURPOSE: Oncology care reimbursement has been shifting from a traditional fee-for-service model to either 1- or 2-sided risk models during the past 5 years. A major expense associated with the total cost of care is hospitalization cost. The study set out to investigate whether the creation of an Advanced Community Care Model (ACCM) of home health care would affect 60-day hospitalization and 30-rehospitalization rates in a community oncology setting. METHODS: In conjunction with a single home health care organization, an ACCM was modified for oncology care to include intervention protocols to address antiemetic issues, pain control, dehydration, shortness of breath, diarrhea, and fever. Weekly and monthly joint management meetings began. Quality metrics were defined. RESULTS: Overall, 457 unique home health care admissions were evaluated. Hospitalization associated with intervention protocols was evaluated. Sixty-day hospitalization rates decreased from 14% to 8%. Thirty-day rehospitalization rates decreased from 25% to 10%. CONCLUSION: An oncology ACCM, as created in this study, appears to have reduced both 60-day hospitalization and 30-day rehospitalization rates.

Exploring the value of the learners' perception of teaching effectiveness in informing faculty development needs: A mixed-methods study.

This article was migrated. The article was marked as recommended. The evaluation of a faculty development intervention needs to start at the outset, and not as an afterthought. Moreover, it is important to evaluate the degree to which the predefined impact is attained as a result to the learning and development opportunity. This calls for the engagement of the ultimate receivers: the students, who are well-positioned to identify gaps in the teaching performance of their own instructors. Accordingly, this mixed-methods study aims at shedding light on a Continuous Quality Improvement system where feedback from undergraduate and postgraduate students is assembled to pinpoint faculty development needs, based on which professional development opportunities are devised. Data was extracted from an annual survey that evaluates the students' satisfaction. Qualitative data was thematically analysed, and quantitative data was analysed using SPSS. The qualitative analysis resulted in six categories of recommendations, that were fit into two themes: dynamic between the instructors and students, and organization and delivery of the program. As for the quantitative analysis, the students indicated opportunities for improvement in the following two areas: student academic advising process (55.17%), and communication between instructors and students (50.59%). The study concluded that there is added value in capturing and effectively assembling the learners' perception of faculty performance. It raises the reliability of the implemented evaluation framework, and has the potential of improving the rigor of faculty development initiatives.

Examining Associations Between Physician Data Utilization for Practice Improvement and Lifelong Learning.

INTRODUCTION: Practice data can inform the selection of educational strategies; however, it is not widely used, even when available. This study's purpose was to determine factors that influence physician engagement with practice data to advance competence and drive practice change. METHODS: A practice-based, pan-Canadian survey was administered to three physician subspecialties: psychiatrists (Psy), radiation oncologists (RO), and general surgeons (GS). The survey was distributed through national specialty society membership lists. The survey assessed factors that influence the use of data for practice improvement and orientation to lifelong learning, using the Jefferson Scale of Physician Lifelong Learning (JeffSPLL). Linear regression was used to model the relationship between the outcome variable frequency of data use and independent predictors of continuous learning to improving practice. RESULTS: A total of 305 practicing physicians (Psy = 203, RO = 53, GS = 49) participated in this study. Most respondents used data for practice improvement (n = 177, 61.7%; Psy = 115, 40.1%; RO = 35; 12.2%; GS = 27, 9.4%) and had high orientation to lifelong learning (JeffSPLL mean scores: Psy = 47.4; RO = 43.5; GS = 45.1; Max = 56). Linear regression analysis identified significant predictors of data use in practice being: frequency of assessing learning needs, helpfulness of data to improve practice, and frequency to develop learning plans. Together, these predictors explained 42.9% of the variance in physicians' orientation toward integrating accessible data into practice (R = 0.426, P < .001). DISCUSSION: This study demonstrates an association between practice data use and perceived data utility, reflection on learning needs and learning plan development. Implications for this work include process development for data-informed action planning for practice improvement for physicians.

Data and Lifelong Learning Protocol: Understanding Cultural Barriers and Facilitators to Using Clinical Performance Data to Support Continuing Professional Development.

Continuing professional development (CPD) can support delivery of high-quality care, but may not be optimized until we can understand cultural barriers and facilitators, especially as innovations emerge. Lifelong learning (LLL), linked with quality improvement, competence, and professionalism, is a core competency in medical education. The purpose of this study is to examine cultural factors (individual, organizational, and systemic) that influence CPD and specifically the use of clinical data to inform LLL and CPD activities. This mixed-method study will examine the perceptions of two learner groups (psychiatrists and general surgeons) in three phases: (1) a survey to understand the relationship between data-informed learning and orientation to LLL; (2) semistructured interviews using purposive and maximum variation sampling techniques to identify individual-, organizational-, and system-level barriers and facilitators to engaging in data-informed LLL to support practice change; and (3) a document analysis of legislation, policies, and procedures related to the access and the use of clinical data for performance improvement in CPD. We obtained research ethics approval from the University Health Network in Toronto, Ontario, Canada. By exploring two distinct learner groups, we will identify contextual features that may inform what educators should consider when conceptualizing and designing CPD activities and what initial actions need to be taken before CPD activities can be optimized. This study will lead to the development of a framework reflective of barriers and facilitators that can be implemented when planning to use data in CPD activities to support data adoption for LLL.

What Is Implementation Science and What Forces Are Driving a Change in Medical Education?

Evidence-based interventions to improve health care and medical education face multiple complex barriers to adoption and success. Implementation science focuses on the period following research dissemination, which is necessary but insufficient to address important gaps in clinician performance and patient outcomes. This article describes the forces on health care institutions, medical schools, physician clinicians, and trainees that have created the imperative to design educational interventions to address the gap between evidence and practice. These forces include accreditation, certification, licensure, and regulatory and research funding initiatives focused on improving the quality of health professions education and clinical practice. Medical educators must expand their focus on "what to change" to include "how to change" in order to prepare health care professionals and institutions to effectively adopt new evidence-based practices to improve patient, and ultimately population, outcomes.

What Do We Need to Protect, at All Costs, During the 21st Century? Reflections From a Curated, Interactive Co-Created Intellectual Jazz Performance.

The question that forms the title of this article, "What do we need to protect, at all costs, during the 21st century?," speaks to the sizable changes in health care systems and settings that surround the continuing professional development (CPD) provider, and the need to establish a core set of principles and practices as the field moves forward from both theoretical and practical aspects. It also provided the focus for one of the five keynote lectures presented during the 2016 World Congress on Continuing Professional Development. As the planners of this keynote session, we sought to evoke answers to the question, not from the speaker, but from the audience itself, a process enabled by a highly engaging presentation style and powered by interactive digital technologies. Further, we believed that the session would not directly lead to suggestions to improve the theory and practice of CPD, but rather to create the biopsychosocial context-a sort of platform-on which such discussions can occur.

Manejo de factores de riesgo cardiovascular en Venezuela mediante educación de los médicos que trabajan en atención primaria de salud / Management of cardiovascular risk factors in Venezuela by educating physicians working in primary healthcare services

Estudios recientes en América Latina corroboraron la prevalencia de la hipertensión arterial, el colesterol elevado en plasma, los trastornos metabólicos y otros factores de riesgo cardiovascular (FRCV), todo esto sumado a la falta de control de la enfermedad, la escasa adhesión al tratamiento y el uso de pocas medidas preventivas, lo que derivó en la necesidad de educar tanto al médico como al paciente. Se han realizado estudios limitados para demostrar la eficacia del desarrollo profesional continuo y su capacidad de influir positivamente en los indicadores de salud del paciente. En Venezuela se llevó a cabo un estudio para tratar de medir la efectividad de un curso combinado basado en actividades online y presenciales sobre el manejo de los FRCV, dirigido a médicos que trabajan en atención primaria. Un grupo piloto de 37 médicos de atención primaria del área metropolitana de Caracas completó una intervención educativa de 12 semanas, la cual consistió en sesiones semanales en línea, utilizando la estrategia educativa basada en problemas sobre el manejo de los FRCV, así como talleres presenciales relacionados con los cambios de comportamiento del médico y del paciente, utilizando los principios de la educación terapéutica. Se trabajó con una cohorte de 303 pacientes con hipertensión arterial de grado I-II no controlada y/o colesterol plasmático elevado, y se llevó a cabo un seguimiento durante seis meses. Los resultados evidenciaron cambios significativos en los médicos respecto a los aspectos cognitivos y al estilo de su práctica profesional en el manejo de los FRCV. Los participantes se mostraron muy satisfechos con el contenido y el formato de la intervención educativa. De igual manera, encontramos un resultado positivo en la inducción de cambios en toda la cohorte de pacientes, sobre todo en el perfil lipídico, la presión arterial y la modificación del estilo de vida. Sería interesante su aplicación a mayor escala para medir su efectividad a largo plazo

Recent studies in Latin-America corroborated the prevalence of hypertension, elevated plasma cholesterol, metabolic disorders and other cardiovascular risk factors (CVRF) along with lack of disease awareness. Treatment and preventive measures indicated the urgent need for patient and physician education. Limited studies have been conducted to demonstrate the effectiveness of continual professional development (CPD) and its ability to positively improve health care outcomes. A study was done in Venezuela to measure the effectiveness of a blended web-based education in the management of CVRF by primary health care physicians (PCP), working in primary care services. A pilot group of 37 PCP, from the Caracas metropolitan area, completed a 12-week educational intervention consisting of weekly online problem based sessions on CVRF management and face-to-face workshops on physician and patient behavioural changes, using principles of therapeutic education. A cohort of 303 of their patients with uncontrolled grade I-II arterial hypertension and/or elevated plasma cholesterol were included and followed up for a 6-month period. Significant changes in the cognitive aspects and attitudes about the management of CVRF occurred among the PCP, who were highly satisfied with the content and format of the educational intervention. We also found a positive role in inducing changes in the entire patient cohort, particularly on the plasma lipid profile, blood pressure, and lifestyle changes. Results of this pilot study reflect the effective use of CPD on patient care and PCP interactions in creating synergy and understanding with participating institutions. There is a need of large scale implementation and more extensive comparison with other educational approaches

Global Health Partnerships for Continuing Medical Education: Lessons from Successful Partnerships.

The past decade has witnessed an increase in global partnerships created to strengthen health systems and provide training to health professionals in low- and middle-income countries. These partnerships are complex interventions. This study focused on unpacking the characteristics of global partnerships that provide continuing education for health professionals. A realist approach underpinned the research design to identify the mechanisms that shape successful global partnerships. Two case studies focusing on global continuing medical education (CME) were studied longitudinally using a realist evaluation approach. To complement that finding, published research reports of global CME partnerships were synthesized using a realist synthesis approach. Data were collected over a three-year period and included interviews, participant observations, document reviews, and surveys. A hybrid thematic approach guided the data analysis. The study results suggested that global CME partnerships are highly dependent on human factors. On the one hand, motivational factors related to individual players help to shape the partnership goals, directions, and outcomes. On the other hand, relational factors such as trust, communication, and understanding play a key role in developing and sustaining global partnerships. As such, these partnerships highly rely on the individuals who champion the partnership at the country level or at the partnership level and in their ability to build relationships as well as empower key stakeholders.

Experiencia estratégica internacional para el desarrollo profesional continuo y su impacto en la atención primaria de salud / An international strategic experience for continuing professional development and its impact on primary health care

A los dinámicos y profundos cambios científicos, tecnológicos, demográficos y epidemiológicos en el área de la salud, se unen demandas de la población para mejores y más eficientes servicios. Se da el hecho de que la educación médica de pregrado y posgrado no garantiza las competencias de forma indefinida, lo que hace necesarios mecanismos que aseguren una mejor calidad asistencial. El Consorcio Proyecto Global (PGC) sugiere una estrategia integral de educación médica continua y de desarrollo profesional continuo estructurada, simplificada, evaluada y acreditada para contribuir a enfrentar estos desafíos. Se ejecutó el proyecto en dos países como prueba piloto (Rusia y Venezuela). Se implementó en cinco fases: construcción de relaciones institucionales, determinación de necesidades educativas, implementación y medición del impacto, difusión del mensaje y expansión de experiencias, y ajuste e institucionalización del proyecto. Se involucró a un número significativo de médicos que trabajan en los servicios de atención primaria de salud. Se identificaron y probaron estándares globales de educación médica continua y desarrollo profesional continuo, y se diseñó un currículo nuclear, comenzando con el área cardiovascular, con el objeto de mejorar los niveles de conocimiento y la práctica de los médicos participantes, y evidenciarlo en cambios positivos en indicadores de los pacientes usuarios. Finalmente, se llegó a la etapa de institucionalización y reforzamiento continuo, en la cual el PGC funcionó como un proyecto piloto de intercambio internacional y como posible proveedor de educación médica continua y desarrollo profesional continuo, con alta calidad, costos razonables y acreditación académica

Project Globe Consortium (PGC) integrated one simplified strategy in continuing medical education and continuing professional development. It was designed as an answer to the fast and intense changes in science, technology, demography, epidemiology, the increasing demands of the population, and the changing role of physicians in the current health care systems, under the awareness that the undergraduate medical education does not guarantee the required competencies indefinitely thus implying the need of necessary mechanisms to ensure quality and professional healthcare. The project was implemented in two pilot countries (Russia and Venezuela). It was developed in five phases: building up on institutional relationships, identifying local champions; identifying educational needs; implementation and impact measurement; sharing the message and experiences; maturing adjustments and institutionalization of the project. A significant number of physicians working in primary health care settings were involved. Global standards of continuing medical education and continuing professional development were identified and tested. A core curriculum was designed, starting with cardiovascular risk factors, to improve knowledge levels and professional practice of the physicians involved, along with significant changes in patient indicators as biomarkers. Finally, the project reached the stage of institutionalization and continuous reinforcement in which the PGC represented an international networking and potential continuing medical education and continuing professional development, provider of, high quality, at reasonable costs and with academic accreditation

What, why, and how care protocols are implemented in Ontario nursing homes.

The aim of this study was to better understand care protocol implementation, including the influence of organizational-contextual factors on implementation approaches, in long-term care homes operating in Ontario. We surveyed directors of care employed in all 547 Ontario LTC homes, and combined survey data with secondary organizational data on rural/urban location, nursing home size, chain membership, type of ownership, and accreditation status. Motivations for the use/selection of care protocols in nursing homes primarily derived from beliefs in continuous improvement and in evidence-based care. Protocol selection was largely participative, involving management and staff. External information sources were important for protocol implementation, and in-service education was the chief means of training and educating staff. Significant differences in approaches to implementation were evident in association with differences in ownership. Three key success factors for implementation were identified: contextualizing the practice change, adequately resourcing for implementation, and demonstrating connections between practice change and outcomes.

Assessing the volume-outcome hypothesis and region-level quality improvement interventions: pancreas cancer surgery in two Canadian Provinces.

BACKGROUND: The volume-outcome hypothesis suggests that if increased provider procedure volume is associated with improved patient outcomes, then greater regionalization to high-volume providers should improve region-level outcomes. Quality improvement interventions for pancreas cancer surgery implemented in year 1999 in Ontario, Canada were designed to regionalize surgery to high-volume hospitals and decrease operative mortality. Similar interventions were not used in Quebec, Canada. We assessed the volume-outcome hypothesis and the impact of the Ontario quality improvement interventions. MATERIALS AND METHODS: Administrative databases helped identify pancreatic resections from years 1994 to 2004 and relevant patient and hospital characteristics. Hospitals were high-volume if they provided ≥10 procedures in a given calendar year. Outcomes were regionalization of surgery to high-volume providers and rates of operative mortality. RESULTS: From 1994 to 2004 the percentage of cases in high-volume hospitals increased from 33 to 71% in Ontario and from 36 to 76% in Quebec. Annual rates of operative mortality dropped in Ontario (10.4-2.2% or less) and changed little in Quebec (7.2-9.8%). Changes in measures over time in both provinces were similar before and after year 1999. CONCLUSIONS: Regionalization was associated with improved operative mortality in Ontario but not in Quebec, undermining the volume-outcome hypothesis. The Ontario quality improvement interventions likely were of little influence since patterns in regionalization and operative mortality were similar before and after year 1999.