Loss of relationship: a qualitative study of families and healthcare providers after patient death and home-based palliative care ends.

BACKGROUND: Home-based palliative care is care of the patient in their home, while doctors and other healthcare providers (HCPs) make visits as required. Family involvement naturally cultivates a relationship between HCPs and the family. Once the patient dies and home-based palliative care ends, this relationship is abruptly terminated, which may be challenging to both the family and the HCPs. The objective of this study was to understand the thoughts and opinions of HCPs and families on their encountered loss of relationship at the end of home-based palliative care. METHODS: Perceptions of 63 participants (32 HCPs and 31 family members) were explored using semi-structured interviews and the qualitative research methodologies of grounded theory. HCPs were interviewed at the Temmy Latner Centre for Palliative Care (TLCPC), a home-based palliative care group of physicians, and 2 hospitals in Toronto, while family members were recruited from TLCPC's records of deceased patients. RESULTS: Six overarching themes, relating to HCP-family relationship dynamics, the experience of loss of relationship, and potential solutions, were derived from the data: (I) home palliative care is intimate; (II) dissatisfaction is experienced with abrupt relationship ending; (III) families benefit from open communication, especially after patient death; (IV) HCPs recognize the insufficiency in bereavement resources; (V) benefits are recognized for a system to ease loss of relationship, and lastly; (VI) challenges with introducing such a system concern HCP. CONCLUSIONS: Overall, families and HCPs do not like the loss of relationship post-patient death, and recognize the potential benefits of an approach that would allow for communication going forward.

Evolving Alignment in International Continuing Professional Development Accreditation.

Several of the world's accreditation systems for continuing professional development (CPD) are evolving to encourage continuous improvement in the competence and performance of health care providers and in the organizations in which they provide patient care. Clinicians learn best when they can to choose from a diverse array of activities and formats that are relevant and meet their needs. Since choice and diversity are key to meeting clinicians' needs, several CPD accreditors have been engaging in deliberate, concerted efforts to identify a core set of principles that can serve as the basis for determining substantive equivalency between CPD accreditation systems. Substantive equivalency is intended to support the mobility of learners, allowing them to access accredited learning activities that are recognized by various CPD accreditation systems in a manner that maximizes the value of those accreditation systems, while minimizing the burden of adhering to their requirements. In this article, we propose a set of core principles that all CPD accreditation systems must express as the basis for determining substantive equivalency between CPD accreditation systems. The article will illustrate how five CPD accreditation systems (two in the USA, two in Canada, and one in Qatar), differing in focus (activity-based versus provider-based), context, and culture, express these values and metrics, and concludes by identifying the value of substantive equivalency for learners, medical regulators, and CPD accreditation systems.

Game-based versus traditional case-based learning: comparing effectiveness in stroke continuing medical education.

OBJECTIVE: To evaluate family physicians' enjoyment of and knowledge gained from game-based learning, compared with traditional case-based learning, in a continuing medical education (CME) event on stroke prevention and management. DESIGN: An equivalence trial to determine if game-based learning was as effective as case-based learning in terms of attained knowledge levels. Game questions and small group cases were developed. Participants were randomized to either a game-based or a case-based group and took part in the event. SETTING: Ontario provincial family medicine conference. PARTICIPANTS: Thirty-two family physicians and 3 senior family medicine residents attending the conference. INTERVENTION: Participation in either a game-based or a case-based CME learning group. MAIN OUTCOME MEASURES: Scores on 40-item immediate and 3-month posttests of knowledge and a satisfaction survey. RESULTS: Results from knowledge testing immediately after the event and 3 months later showed no significant difference in scoring between groups. Participants in the game-based group reported higher levels of satisfaction with the learning experience. CONCLUSION: Games provide a novel way of organizing CME events. They might provide more group interaction and discussion, as well as improve recruitment to CME events. They might also provide a forum for interdisciplinary CME. Using games in future CME events appears to be a promising approach to facilitate participant learning.