Using chart reviews to evaluate a continuing medical education (CME) program.

Context Moore's Expanded Outcomes Framework is a 7 level framework commonly used to assess the outcomes of continuing medical education (CME) programs. Levels 1 to 5 are provider-level outcomes (participation, satisfaction, knowledge, competence, and performance) while levels 6 and 7 are patient- and community-level outcomes. Chart reviews are one method to assess level 5 (performance). ECHO Ontario Chronic Pain and Opioid Stewardship ("ECHO") is a CME telementoring program that aims to increase capacity and access for primary care providers (PCPs) who manage patients with chronic pain. Objective This study uses chart reviews to evaluate ECHO's impact on PCP performance and to discuss the feasibility of performing chart reviews for evaluation purposes as per Moore's framework. Study Design Retrospective chart review Setting The practices of 12 primary care providers across Ontario who attended ECHO between June 2014 to August 2018. The inclusion criteria for PCPs was 1) attended a minimum of four ECHO sessions, and 2) clinic site must be approving of a site visit for chart reviews. Population Studied 47 patient charts were included. For each patient chart reviewed, PCPs were asked to choose patients in their practice on whom they had used ECHO-taught knowledge. Inclusion criteria for patients was 1) have chronic pain and be managed by the ECHO-participating PCP, 2) was prescribed opioids during the time frame of the study, and 3) not presented during ECHO sessions. Informed consent was obtained prior to each site visit. 1) Increased use of ECHO-taught pain and opioid management strategies 2) Feasibility of using chart reviews to evaluate PCP performance following a CME activity Results 25 (53%) patients were male and the average age was 59 (± 14) years. 24 (51%) patients had two or more pain diagnoses at baseline, with musculoskeletal pain being the most prevalent at 81%. 26 (55%) patients had comorbid mental health conditions and 13 (28%) had sleep disorders. Trends in results showed marginal, but non-significant, improvements in PCP performance after ECHO as indicated by increased use of pain and opioid management strategies. Conclusions Conducting chart reviews was a challenging method to assess provider performance. Future work to assess provider performance should include a qualitative component (in-depth interviews or focus groups) in order to complement the quantitative data and provide context for care and management decisions.

Is online learning during the COVID-19 pandemic associated with increased burnout in medical learners?: A medical school's experience.

INTRODUCTION: The COVID-19 pandemic necessitated a shift to virtual curriculum delivery at Canadian medical schools. At the NOSM University, some learners transitioned to entirely online learning, while others continued in-person, in-clinic learning. This study aimed to show that medical learners who transitioned to exclusively online learning exhibited higher levels of burnout compared to their peers who continued in-person, clinical learning. Analysis of factors that protect against burnout including resilience, mindfulness, and self-compassion exhibited by online and in-person learners at NOSM University during this curriculum shift were also explored. METHODS: As part of a pilot wellness initiative, a cross-sectional online survey-based study of learner wellness was conducted at NOSM University during the 2020-2021 academic year. Seventy-four learners responded. The survey utilized the Maslach Burnout Inventory, the Brief Resilience Scale, Cognitive and Affective Mindfulness Scale-Revised, and the Self-Compassion Scale-Short Form. T-tests were utilized to compare these parameters in those who studied exclusively online and those who continued learning in-person in a clinical setting. RESULTS: Medical learners who engaged in online learning exhibited significantly higher levels of burnout when compared with learners who continued in-person learning in a clinical setting, despite scoring equally on protective factors such as resilience, mindfulness, and self-compassion. CONCLUSION: The results discussed in this paper suggest that the increased time spent in a virtual learning environment during the COVID-19 pandemic might be associated with burnout among exclusively online learners, as compared to learners who were educated in clinical, in-person settings. Further inquiry should investigate causality and any protective factors that could mitigate negative effects of the virtual learning environment.

Extension for Community Healthcare Outcomes (ECHO) Chronic Pain & Opioid Stewardship in Northwestern Ontario: A Thematic Analysis of Patient Cases.

Background: Chronic pain (CP) is a debilitating disease that reduces quality of life, decreases productivity, and has become a primary cause of health care resource consumption. Despite this, many Canadian family physicians have received little formal education in managing CP, making it one of the most challenging areas of practice in primary care. Project Extension for Community Healthcare Outcomes Chronic Pain & Opioid Stewardship St. Joseph's Care Group (Project ECHO-SJCG) is an evidence-based educational program connecting community-based health care providers (HCPs) with an interprofessional team by videoconference to learn about management of CP in rural, remote, and underserved areas. Aims: To explore key learning points from cases presented at Project ECHO-SJCG, identify and analyze themes and improve future sessions of continuing professional development for HCPs. Methods: We completed a thematic analysis of forty cases and key learning points using the constant comparison method. We also summarized descriptive statistics for patient and provider characteristics. Results: Forty cases were presented by 31 HCPs, who received suggestions focused on assessment and diagnosis, pharmacological and non-pharmacological pain symptom management, interventional management, attention to biopsychosocial factors, and appropriate referral to other HCPs. Conclusion: Project ECHO-SJCG cases allow HCPs to gain a broad knowledge base to evaluate and manage CP in their practice. Identified themes highlight common gaps in HCPs' knowledge and will guide future sessions.

Contexte: La douleur chronique est une maladie débilitante qui réduit la qualité de vie et diminue la productivité. En outre, elle est devenue une cause principale de consommation des ressources en soins de santé. Malgré cela, de nombreux médecins de famille canadiens ont reçu peu d'éducation conventionnelle sur la prise en charge de la douleur chronique, ce qui en fait l'un des domaines de pratique les plus difficiles en soins primaires.Le Projet de vulgarisation pour des résultats de santé communautaires ­ Gestion des opioïdes et de la douleur chronique du St. Joseph' s Care Group (projet ECHOSJCG) est un programme éducatif fondé sur les données probantes qui met les prestataires de soins de santé communautaires en relation avec une équipe interprofessionnelle par vidéoconférence pour en apprendre davantage sur la prise en charge de la douleur chronique dans les zones rurales, éloignées et mal desservies.Objectifs: Explorer les principaux points d'apprentissage à partir des cas présentés au projet ECHO-SJCG, recenser et analyser les thèmes et améliorer les futures sessions de développement professionnel continu pour les professionnels de la santé.Méthodes: Nous avons effectué une analyse thématique de quarante cas et points d'apprentissage clés à l'aide de la méthode de comparaison constante. Nous avons également résumé les statistiques descriptives pour le patient et le prestataire.Résultats: Quarante cas ont été présentés par 31 professionnels de la santé ayant reçu des suggestions axées sur l'évaluation et le diagnostic, la prise en charge des symptômes de douleur pharmacologique et non pharmacologique, la prise en charge interventionnelle, l'attention aux facteurs biopsychosociaux et l'orientation appropriée vers d'autres professionnels de la santé.Conclusions: Les cas du projet ECHO-SJCG permettent aux professionnels de la santé d'acquérir une large base de connaissances pour l'évaluation et la prise en charge de la douleur chronique dans leur pratique. Les thèmes recensés mettent en évidence les lacunes communes dans les connaissances des professionnels de la santé et orienteront les sessions futures.

Project ECHO: Building capacity to manage complex conditions in rural, remote and underserved areas.

There is a need to bring specialized medical expertise to rural and remote areas. Project ECHO offers a method to move knowledge from specialists in academic centres using videoconference, case-base learning, and best-practices knowledge sharing. Ontario has implemented ECHO since 2014 and has demonstrated favourable outcomes among primary care clinicians.

Résumé Le besoin existe de transférer l'expertise médicale spécialisée dans les régions rurales et éloignées. Le projet ECHO est une méthode de transfert des connaissances des spécialistes des centres universitaires à l'aide de vidéoconférences, d'apprentissage basé sur les cas et de partage des pratiques exemplaires. L'Ontario a lancé le projet ECHO en 2014 et le projet a donné des résultats favorables chez les cliniciens de première ligne. Mots-clés: Maladie chronique, santé mentale, douleur, soins de première ligne, santé rurale.