Journal of Continuing Education in the Health Professions最新文献

Introduction: The nominal group technique (NGT) is a structured focus group that gathers opinion and generates consensus from groups on topics of interest. Previous studies using online NGTs (ONGTs) in health have been conducted in regions of high population density and internet connectivity. This activity aimed to determine the feasibility and utility of ONGTs in gathering opinion and reaching consensus on curriculum topics for a continuing research education program for health professionals dispersed across various locations in Southern Queensland.

Methods: Fifteen clinical education academics from a range of health professions participated in 1-hour ONGT sessions from 2 University Department of Rural Health sites or their home offices. The traditional NGT was adapted for online use, using two free online platforms (Zoom for videoconferencing and Wooclap for voting and response collation).

Results: The chosen platforms were effective in presenting ONGTs, allowing active and effective contributions to research topic ideas from all participants, including those with low internet connectivity. Silent generation enabled sharing, open discussion, and clarification of generated ideas. Wooclap was effective in reviewing and voting on generated responses and providing real-time feedback on voting outcomes. Outcomes were consistent with group consensus and useful in prioritizing research training topics.

Discussion: The modified ONGT is effective in gathering opinion and gaining consensus from a geographically dispersed health workforce with varied levels of internet connectivity and experience with online platforms. It represents a cost-effective and time-effective alternative to face-to-face NGTs that is less likely to be affected by workforce disruptions.

Introduction: Health professions education often includes teaching observation to inform faculty development (FD) and indirectly improve student performance. Although these FD approaches are well received by faculty, they remain underused and/or underreported, with limited opportunities to receive feedback in workplace contexts. The goal of our study was to map the depth and breadth of education literature on the use of observation of teaching as a tool of professional development in medical education.

Methods: Following the methodology by Arksey and O'Malley, we conducted a scoping review and searched four databases for articles published in English (final searches in April 2022).

Results: Of 2080 articles identified, 45 met the inclusion criteria. All observation activities were associated with one of the following FD approaches: peer observation of teaching (23 articles, 51%), peer coaching (12, 27%), peer review (9, 20%), and the critical friends approach (1, 2%). Thirty-three articles (73%) concerned formative versions of the observation model that took place in clinical settings (21, 47%), and they tended to be a voluntary (27, 60%), one-off (18, 40%), in-person intervention (29, 65%), characterized by limited institutional support (13, 29%). Both barriers and challenges of teaching observation were identified.

Discussion: This review identified several challenges and shortcomings associated with teaching observation, such as inadequate methodological quality of research articles, inconsistent terminology, and limited understanding of the factors that promote long-term sustainability within FD programs. Practical strategies to consider when designing an FD program that incorporates teaching observation are outlined.

Introduction: As a workforce crisis is causing recruitment and retention issues for new to practice GPs, we designed Catalyst, a one-year pilot career development program aiming to help new to practice GPs develop the skills of advanced generalist practice and build capacity for the complex work of primary care. In this paper, we report the findings of our evaluation of Catalyst.

Methods: We used normalization process theory to investigate how Catalyst was contributing to the participants' understanding and implementation of generalist practice. We conducted 36 interviews and six focus groups investigating the participants' clinical practice and experience with the program and analyzed data using framework analysis.

Results: Establishing a shared language and reframing professional identity helped GPs develop an understanding of their role through generalist lenses. Generalist practice was legitimized by access to scientific evidence and facilitated interactive learning. Integration of scientific, applied knowledge and quality improvement work fostered the enactment of such practice. Structured reflection and research-informed quality improvement projects contributed to the participants' awareness of the primary care context.

Discussion: Knowledge creation activities observed through interactive learning and the integration of different types of knowledge facilitated the implementation of advanced generalist practice. The participants valued the community of practice gained through the program and would come to rely on programs designed to encourage networking and enable peer support. Finally, research-informed quality improvement projects built to analyze problems and monitor solutions are crucial for an early career physician to develop a sense of agency that shapes their primary care practice.

Abstract: COVID-19 unleashed a maelstrom of distress on health care professionals. The pandemic contributed to a host of stressors for workers because of the need for rapid acquisition of new knowledge and skills to provide best treatment while simultaneously dealing with personal safety, limited resources, staffing shortages, and access to care issues. Concurrently, problems with systemic racial inequality and discrimination became more apparent secondary to difficulties with accessing health care for minorities and other marginalized groups. These problems contributed to many health care professionals experiencing severe moral injury and burnout as they struggled to uphold core values and do their jobs professionally. Some left or disengaged. Others died. As continuing professional development leaders focused on all health professionals, we must act deliberately to address health care professionals' distress and mental health. We must incorporate wellness and mental health as organizing principles in all we do. We must adopt a new mental model that recognizes the importance of learners' biopsychosocial functioning and commit to learners' wellness by developing activities that embrace a biopsychosocial point of view. As educators and influencers, we must demonstrate that the Institute for Healthcare Improvement's fourth aim to improve clinician well-being and safety (2014) and fifth aim to address health equity and the social determinants of health (2021) matter. It is crucial that continuing professional development leaders globally use their resources and relationships to accomplish this imperative call for action.

Introduction: In health care, cost-effectiveness analysis evaluates changes in health outcomes as a function of costs. The cost-effectiveness of continuing professional development for health care providers has not been historically well characterized despite substantial investment. This literature review identified publications considering the costs and cost-effectiveness of accredited continuing medical education activities.

Methods: Searches were conducted for English language records in PubMed and the gray literature using a 10-year lookback period from March 10, 2023. Search terms included concepts related to continuing medical education, cost, effect, and utilization. One reviewer conducted title/abstract screening, full-text review, and data extraction, with direction and adjudication of search and screening concepts provided by the lead advisor. Publications were categorized as related to costs of an educational intervention (Concept 1) and/or the impact of education on health care costs (Concept 2). Results were summarized using descriptive statistics.

Results: A total of 668 database records were screened, 125 (19%) underwent full-text review, and 25 of 125 (20%) were accepted; 7 of 351 (2%) gray literature sources were accepted for a total of 32 included records. The most common reason for rejection was not being an accredited activity. Of the 32 records, 27 (84%) were related to Concept 1 only, 3 (9%) to Concept 2 only, and 2 (6%) to both Concepts 1 and 2. Approximately half (n = 19, 59%) mentioned costs without supporting data.

Discussion: These findings show that considerations of cost and cost-effectiveness are rare in the accredited continuing medical education literature, which may limit how the value of continuing medical education is characterized.

Introduction: Physician burnout is a common problem for which self-compassion training has shown positive effects. In this program evaluation, we explore the effects of a synchronous online continuing medical education program (Self-Compassion for Healthcare Communities, SCHC) to improve physician burnout and related outcomes.

Methods: The SCHC program was delivered online via Zoom and consisted of six 1-hour weekly sessions to enhance self-compassion and well-being. The primary outcome was the "burnout" subscale of the Professional Quality of Life scale; compassion satisfaction, secondary traumatic stress, self-compassion, resilience activation and decompression, and job satisfaction were evaluated, and qualitative data were also collected.

Results: A total of 116 physicians attended at least one session of the program, 48 of whom completed both the preprogram and postprogram surveys. The results showed that physicians experienced a reduction in their burnout levels (P = .001) as well as improvements in compassion satisfaction (P = .027), secondary traumatic stress (P = .001), self-compassion (P < .001), resilience decompression (P = .012), and job satisfaction (P = .038). Qualitative data, obtained from a total of 91 participants who attended at least one session, indicated that participants were satisfied with the SCHC program: they found it useful for learning to be compassionate with themselves and they highly valued having the chance to connect with other colleagues who experience similar struggles.

Discussion: The live online SCHC program showed benefits on physician burnout and related outcomes such as compassion satisfaction, secondary traumatic stress, self-compassion, resilience decompression, and job satisfaction. Nonetheless, in addition to individual-focused well-being programs, systemic changes in health care delivery were also deemed necessary to decrease burnout.

Introduction: Professional identity formation is central to physicians' identity over their full careers. There is little guidance within military service on how to leave careers as clinician educator faculty in graduate medical education programs. The objective of our study was to explore how leaving this community of practice (COP) affects a clinician educator's professional identity.

Methods: We used reflexive thematic analysis with Communities of Practice as a sensitizing construct. Fifteen semi-structured interviews were conducted among active-duty clinician educators at the point of their retirement from the military. Interview questions focused participants' lived experiences as clinician educators and professional identity changes leading to and resulting from the decision to retire.

Results: We found the clinician educators' journey through a time of professional transition led to three connected themes: Loss Precedes Growth, Fallow Season-Liminal Space, and New Growth.

Discussion: The experiences of military clinician educators retiring from active duty demonstrate how leaving one COP emanates across a range of professional identities. In addition, the decision to leave a professional COP can lead to a sense of disloyalty to that community. Normalizing this transition in a way that honors the community's values offers the opportunity to enable the decision to retire. Understanding retirement as a process that first involves identity loss, followed by the discomfort of a liminal space before achieving new growth creates the opportunity to engage in rituals that celebrate the service of departing community members, releasing them to grow into new identities.

Introduction: Health care educators in the practice setting are responsible for providing education to frontline staff and require knowledge and skills to interact with interprofessional health care providers and teach content in an effective way. Interprofessional education opportunities for health care educators in the practice setting may be helpful in preparing educators to meet the needs of frontline staff, yet the extant state of literature on this topic has not been recently synthesized. In this integrative review, we aimed to explore what is known about interprofessional education opportunities offered to health care educators who are responsible for educating other health care professionals in practice settings and assess how these education opportunities were described and evaluated in the literature.

Methods: We conducted an integrative literature review following the methodology put forth by Toronto and Remington.

Results: Of the 3690 publications identified, 30 met our inclusion criteria. Overall, the publications lacked rigorous methodology. Education interventions varied in content, duration, and teaching strategies. Key findings were identified: (1) educator satisfaction and content relevance, (2) impact on knowledge, skills, and confidence, (3) impact on teaching practice, (4) impact on clinical practice, (5) impact on interprofessional competencies and attitudes, (6) challenges to implementing interprofessional education opportunities, and (7) facilitators to implementing interprofessional education opportunities.

Discussion: Although interprofessional education opportunities for health care educators in the practice setting may be beneficial to educators and the frontline staff they serve, more rigorous research is needed to understand how these opportunities can influence teaching and clinical practice.

Introduction: Professionals use Twitter because of its potential to support easy and rapid communication among like-minded people. It is also used widely by educators to support the establishment of professional learning spaces. This study investigates social interactions and knowledge construction in synchronous online discussions using the Twitter hashtag #MedEdChat.

Methods: Three synchronous Twitter discussions on #MedEdChat during the early part of the COVID-19 pandemic were analyzed. Social network analysis was conducted to capture the social interactions among their participants and network dynamics. Content analysis was used to examine the nature of tweets posted on #MedEdChat, including social-related, cognitive-related, and moderation-related tweets.

Results: In all three discussions, a small number of individuals dominated the interactions, while also serving as hubs for connections with others in more peripheral positions. Very few participants were isolated nodes who never interacted with others during the online discussions. Our content analysis suggested that parties to these discussions posted social-related posts the most, followed by cognitive-related ones. Social posts focused on others' messages, continuing threads, issuing compliments and greetings, and expressing emotions. Cognitive-related posts, on the other hand, mostly focused on information exchange/sharing or asking content-related questions to promote discussion (ie, triggering event).

Discussion: By examining social dynamics and discourse moves in Twitter-supported online synchronous discussions using the #MedEdChat hashtag, this study found that Twitter has the potential to facilitate professional learning spaces in which a few highly active individuals serve as portals for connections and interactions among all discussants. In addition, in such communities, social-related and cognitive-related tweets could promote social interactions and knowledge construction.

Introduction: Since its inception in 2003, the Project Extension for Community Healthcare Outcomes (ECHO) tele-education model has reached and improved outcomes for patients, providers, and health centers through interventions in >180 countries. Utilization of this model has recently increased due to the COVID-19 pandemic and a higher demand for remote education. However, limited research has examined the methodologies used to evaluate Project ECHO interventions.

Methods: We conducted a scoping review to determine the extent and types of research methods used to evaluate outcomes and implementation success of Project ECHO interventions and to identify gaps and opportunities for future investigation. Using Arksey and O'Malley's scoping review framework and the PRISMA-ScR checklist, we reviewed study designs, temporality, analysis methods, data sources, and levels and types of data in 121 articles evaluating Project ECHO interventions.

Results: Most interventions addressed substance use disorders (24.8%, n = 30), infectious diseases (24%, n = 29), psychiatric and behavioral health conditions (21.5%, n = 26), and chronic diseases (19%, n = 23). The most frequently reported evaluation methods included cohort studies (86.8%, n = 105), longitudinal designs (74.4%, n = 90), mixed methods analysis (52.1%, n = 63), surveys (61.2%, n = 74), process evaluation measures (98.3%, n = 119), and provider-level outcome measures (84.3%, n = 102). Few evaluations used experimental designs (1.7%, n = 2), randomization (5.8%, n = 7), or comparison groups (14%, n = 17), indicating limited rigor.

Discussion: This scoping review demonstrates the need for more rigorous evaluation methods to test the effectiveness of the Project ECHO model at improving outcomes and standardized reporting guidelines to enhance the dissemination of evaluation data from future Project ECHO interventions.