Journal of Continuing Education in the Health Professions最新文献

Introduction: Despite regular cardiopulmonary resuscitation (CPR) training, emergency medical technicians (EMTs) often struggle to transfer learned skills into real-world performance. This study explores how system-level and contextual factors affect learning transfer in Taiwan, using the Systems Engineering Initiative for Patient Safety and Kirkpatrick frameworks.

Methods: We employed a mixed-methods design involving 123 EMTs. Data sources included quality cardiopulmonary resuscitation simulation scores, 125 video-recorded out-of-hospital cardiac arrest events, and EMTs' open-ended reflections. Quantitative analyses examined associations between CPR performance and training or demographic variables. Qualitative data were analyzed thematically, guided by Systems Engineering Initiative for Patient Safety domains and Kirkpatrick levels 2 to 3.

Results: Automated external defibrillator voice prompts were significantly associated with improved compression rates (P = .03 in regression analysis), whereas no demographic factor predicted compression depth or recoil, and the regression model explained only a small fraction of performance variance (adjusted R2 = 0.04). Video data revealed frequent field errors such as equipment misplacement, delayed automated external defibrillator use, and poor team coordination. Reflections highlighted environmental barriers and lack of structured debriefing.

Discussion: Findings suggest that real-world CPR performance is more influenced by systemic and contextual obstacles than by individual competencies. Enhancing psychological realism, team-based simulations, and debriefing practices may improve learning transfer from training to field performance. The integration of simulation, field video, and EMT reflections underscores that training-performance gaps must be addressed through system-level reforms rather than isolated technical retraining.

Introduction: Traditional evaluation models, often linear and outcome-focused, are increasingly inadequate for the complexities of modern medical education, which demands more comprehensive and nuanced assessment approaches.

Methods: A standardized continuing professional development activity evaluation instrument was developed and implemented. An iterative process was performed, using a repeat Rasch analysis, to improve reliability of the evaluation instrument. Category Probability Curves and Test Information Function were generated by the Rasch analysis to refine the construction of the assessment. All educational activities completed between 2022 and 2024 were eligible for inclusion. The study incorporated a diverse range of educational activities and included multiple health care professions.

Results: The pilot analysis included 250 educational activities with 26,554 individual learners completing evaluations for analysis. Initial Rasch findings demonstrated a need to remove redundancies and change from a five to four-point rating scale. The final instrument validation included 21 activities and 529 learners. Improvement was seen in reliability after modifications, with an increase in Cronbach alpha from 0.72 to 0.80.

Discussion: Use of psychometrics to improve assessments can yield a more reliable and less redundant evaluation instrument. This research demonstrates a psychometrically informed, flexible evaluation tool that can inform future educational efforts and serve as a data driven metric to enhance the quality of continuing professional development programs.

Abstract: A participatory arts- and narrative-based approach for knowledge translation was utilized in a rare disease educational session at a medical conference, combining stakeholder storytelling with the presentation of relevant empirical evidence and frameworks to deepen clinicians' understanding of patient and caregiver quality of life. Before the conference, patient/caregiver perspectives were solicited via a six-word story creative writing prompt (n = 94); during the session, clinicians utilized these stories to cocreate three visual pieces representing the complexity of patient and caregiver experiences and symbolizing the common threads that appear when many "rare" experiences come together. Session attendees reported highly positive feedback, with most clinicians reporting that the knowledge gained from the session would result in a change in their clinical practice. We propose arts- and narrative-based approaches hold great promise for centering patient voices in health care education.

Abstract: Continuing professional development (CPD) and quality improvement (QI) are both dedicated to improving clinical practice and health outcomes. Although leaders in both disciplines have long recommended closer alignment, few case studies have demonstrated how such alignment can be developed and sustained within a health care system. Kaiser Permanente Colorado is an integrated health care delivery system in the United States that has worked toward coordination of CPD and QI for >20 years. Alignment of departmental reporting structures, interdisciplinary teams of educators, incorporation of quality concerns into continuing education (CE) activities, coordination of CE activities with implementation of decision support tools, and reliance on evidence-based educational practices have all contributed to a unique organizational culture of education. Published research has shown that their approach can lead to sustainable practice change. Many elements of this approach are potentially applicable to other systems, including consistent use of interprofessional teams, recognizing the organizational context, development of a theory of change to address education and quality gaps, coordination of CE and quality interventions, and using educational and clinical data to evaluate the effectiveness of these interventions. Because these changes have occurred within an evolving environment of real-world practice, the effectiveness of specific components or the interactions between them are difficult to establish. Nonetheless, the Kaiser Permanente Colorado model provides one example of coordination between CPD and QI experts to achieve their shared goal of improving clinician practice, patient care, and system performance.

Introduction: Implementing evidence-based physical activity (PA) counseling for clients with spinal cord injury (SCI) may help address the decline in PA typically observed after discharge from rehabilitation. Engaging practitioners in educational intervention development may improve uptake of such a practice change. The purpose of this study is to (1) describe the theory-based development of a PA counseling education intervention and (2) evaluate the intervention's effects on PA counseling behavior and determinants (eg, knowledge, skills, confidence) among rehabilitation hospital physiotherapists and community SCI peers.

Methods: The Knowledge to Action (KTA) Framework supplemented by the quality implementation framework was used to guide the engagement of physiotherapists and SCI peers in developing a PA counseling education intervention. A within-subjects, repeated measures design was used to evaluate the effects of the intervention. PA counseling behavior and determinants were evaluated using a survey guided by the theoretical domains framework, administered before and immediately after training, 2 months post, and 6 months post-training. Data were analyzed using one-way repeated-measures ANOVAs.

Results: Physiotherapists and SCI peers (n = 10) demonstrated significant, medium-large-sized effects on PA counseling behaviors from baseline to 2 and 6 months ( P' s < 0.05). These behavioral improvements were supported by significant increases over time in all theoretical domains framework assessed ( P' s < 0.05), except intentions.

Discussion: The combined use of the KTA and quality implementation framework provides a structure for engaging practitioners in education intervention design. This work shows promise for the use of theory to develop an education intervention that improves both PA counseling knowledge and behavior.

Introduction: Despite increasing physician specialization, high-quality continuing professional development is needed for continual mastery learning, especially focused on multiple specialties. Board certification is considered a surrogate for competency, and some stakeholders consider it suboptimally aligned with its primary purpose. We set to explore the motivation for continued education and competence in physicians who are board certified in multiple specialties.

Methods: We performed a qualitative study using thematic analysis. Semistructured interviews were performed virtually. Landscapes of practice, an extension of communities of practice within sociocultural learning theory, was used as a theoretical framework.

Results: Fifteen internists and their related subspecialties performing continual board certification completed the study. We identified six themes describing the underlying motivation for why physicians maintain competency in multiple medical specialties: Social responsibility, Promise of expertise, Enhanced job opportunities, Widened expertise, Professional requirements, and Personal fulfillment.

Discussion: The landscape of medicine continues to evolve in how it is practiced. How a physician navigates this process, maintaining their competency, is a continuous lifelong learning process, and there are multiple ways. A portion of internal medicine physicians are motivated to practice in multiple specialties, recognizing the opportunities and challenges involved. The practical application of this study would include organizational-based education focused on hybrid learning (education explicitly focusing on overlapping or cross-discipline fields). Despite a plethora of educational opportunities, there is very little with the focus on cross-discipline education and training.

Abstract: To realize the transformative potential of artificial intelligence (AI) in health care, physicians must learn how to use AI-based tools effectively, safely, and equitably. Continuing professional development (CPD) activities are one way to learn how to do this. The purpose of this article is to describe a theory-based approach for assessing health professionals' motivation to participate in CPD on AI-based tools. An online survey, based on an AI competency framework developed from existing literature and expert consultations, was administered to practicing physicians in Ontario, Canada. Across eight subcompetencies for using AI-based tools (eg, appraise AI-based tools for their regulatory and legal status), the survey measured physicians' perception they could successfully enact the competency, the importance of the competency in meeting their practice needs, and the desirability of participating in CPD activities on the competency. Motivation scores were calculated by multiplying the three scores together. Ninety-five physicians completed the survey. The highest motivation scores were for the subcompetency of identifying AI-based tools based on clinical needs, while the lowest motivation scores were for appraising tools' regulatory and legal status. All AI subcompetencies were generally rated as important, and CPD activities were generally perceived as desirable. This survey demonstrates the utility of a theory-based approach for assessing physicians' motivation to learn. Although the survey results are context specific, the approach may be useful for other CPD providers to support decision making about future AI-related CPD activities.

Abstract: Episodes of disrespectful, biased behavior toward health care personnel occur with distressing frequency. This article describes a comprehensive approach to address this problem. This institutional change strategy includes (1) setting expectations for respectful behaviors in the health system environment through messaging and policy, (2) setting expectations among team members that when disrespectful behavior occurs, it is everyone's duty to step in, and (3) providing employees and trainees with an interactive educational experience that provides resources and skills to step in effectively when disrespectful behavior occurs, in a manner, ie, effective, consistent with our values, and that strives to engage the therapeutic relationships that characterize the health care environment. This article describes in detail the training component of this innovation, including the response framework developed for this training. We describe perceived barriers to stepping in reported by participants before the workshop, which include insecurity about how to proceed, concerns about safety and about escalating the situation, a desire to continue in a relationship with the person, and concerns about hierarchy. The pre-post and 6-month longitudinal evaluation of the training workshop demonstrates a statistically significant improvement in employees' comfort in stepping into situations of disrespect. Promoting institutional culture change requires significant time and resources but can promote sustained positive changes in addressing respect in the health care environment. The authors hope that other institutions will develop strategies appropriate for their settings that will enable their constituents to step in when the need arises.

Introduction: Empathy is of particular importance in the relationship with elderly patients. Practical exercises, and especially those that include simulation situations, are an effective tool for the development and improvement of physicians' skills. The objective was to assess the evaluation of the degree of empathy toward the elderly people by primary care physicians, using an aging simulator suit.

Methods: A quasi-experimental, randomized, controlled, multicenter study was conducted. The relationship between the difference in preintervention and postintervention Jefferson Scale of Physician Empathy scores and sociodemographic characteristics of physicians were assessed. A univariate analysis using logistic regression was conducted to ascertain the impact of sociodemographic and occupational variables on the discrepancy in preintervention and postintervention scores on the Jefferson Scale of Physician Empathy.

Results: The mean preintervention score in the intervention group was 117.92 points (SD = 14.34), while the mean postintervention score was 121.32 points (SD = 10.79). The mean difference was statistically significant (t = -2.176, P = .034). In the control group, the mean preintervention score was 119.47 points (SD = 9.82), while the mean postintervention score was 120.40 points (SD = 9.89). This mean difference was not statistically significant (t = -0.566, P = .576). A statistically significant increase between pre- and postintervention scores was observed in physicians aged 65 years and older (Odds Ratio = 9.30; P = .046), and in physicians working in the semiurban setting (Odds Ratio = 2.10; P = .041).

Conclusions: The aging simulation produced a statistically significant improvement in the empathy levels of primary health care physicians.