Journal of Continuing Education in the Health Professions最新文献

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.

Introduction: Point-of-care ultrasound (POCUS) technology has evolved rapidly and is being embraced by many health professionals as a valuable clinical tool. Sonographers are now teaching ultrasound skills to other health professionals in the clinical setting, including doctors, nurses, midwives, paramedics, and physiotherapists. The purpose of this study was to understand the breadth of the opportunities, transitions, and challenges experienced by sonographer educators navigating new interprofessional teaching roles.

Methods: Sonographers, who had participated in an initial phase Delphi study defining sonographer competencies in POCUS education, were invited to participate in a follow-up interview. Semi-structured interviews were conducted, and the interview data were thematically analyzed to understand the experiences and perceptions of participants.

Results: Twenty sonographer educators were interviewed. Participants were clinically experienced sonographers from Australia and New Zealand with diverse professional experience in clinical teaching, university academic, ultrasound leadership, health management, and corporate roles. The transition to teaching interprofessional cohorts of learners in different clinical settings was substantial. The experiences of sonographers undertaking these new roles were described under the themes of "sonographer perceptions"; "educator knowledge"; "understanding learners"; "teaching dynamics"; and "ultrasound evolution."

Conclusion: This study is the first to describe the experiences of sonographers engaged in interprofessional POCUS teaching. The results provide insight into the training needs of sonographers in this emerging area and will be used to inform the development of continuing education resources.

Introduction: The Family Medicine Certification Longitudinal Assessment (FMCLA) is an open book spaced alternative to the traditional 1-day Family Medicine Certification Examination (FMCE). We studied whether FMCLA improves test scores beyond predicted scores.

Methods: We used American Board of Family Medicine data from 2008 to 2023, with scores reported on a scale from 200 to 800. We built a predictive model of FMCE performance using linear regression with the 2008 exam cohort. We then applied that model to the 2009 to 2011 cohorts, who could opt for FMCLA beginning in 2019, controlling for choice of exam mode using an inverse probability weight for selecting FMCE.

Results: Our final sample sizes were 9699 for the FMCE predictive model and 12,851 for the FMCLA versus FMCE analysis. Physicians who opted for FMCLA were more likely to be younger, female, US medical graduates, and have lower prior FMCE scores. Adjusted analyses controlling for propensity to select FMCE revealed that FMCLA was associated with an increase of 39 points (95% CI 36.2-42.0) over predicted score with physicians on the high end scoring 100 more points than predicted, while physicians predicted to fail did worse. Modality of exam had no impact near the passing score.

Discussion: FMCLA was associated with gains in scores over a 1-day exam. This supports cognitive psychology principles such as spaced repetition and immediate feedback that can strengthen long-term knowledge retention. There was little impact of exam delivery method on scores near the passing score, which suggests that important functions of assessing knowledge can be retained in longitudinal assessment.

Abstract: Microaggressions are common in medicine and are increasingly recognized as significant barriers to inclusion, belonging, and effective patient care. In 2020, an interprofessional group of educators set out to develop a microaggression workshop based on research available at the time. The workshop was launched in early 2022 and has been attended by over 1400 participants to date. This report outlines the approach taken, the workshop's effectiveness, and the lessons learned from 2 years of offering the workshop to multiple audiences virtually and in person. Participants completed pre- and postsurveys, and surveys 1 and 3 months after the workshop. After the workshop, participants' confidence in recognizing microaggressions and responding to microaggressions increased significantly, almost 20 points on a 100-point scale in each category from the presurvey to the postsurvey and remained increased at both the 1- and 3-month time points. Results are consistent with research demonstrating that such workshops are effective and further demonstrate that they can be delivered effectively at scale. Based on the authors' experience facilitating dozens of workshop sessions, they conclude that storytelling is more effective to engage the audience than sharing research data, that facilitators must remain sensitive to the potential for retraumatization of participants, and that knowledge differences among participants are notable.

Introduction: Despite evidence supporting active learning techniques to enhance learning, they are seldom used during large-group continuing education (CE) sessions. This project sought to describe which active learning techniques are acceptable, feasible, and with which learners are likely to engage.

Methods: Active learning techniques derived from a literature review were rated for two rounds by two Delphi panels, one composed of medical education experts (n = 10) and the other of CE attendees (n = 12). Each technique received five ratings: experts rated appropriateness for use in large-group didactic CE and feasibility for in-person and virtual use, and attendees rated their likelihood to engage in-person and virtually.

Results: Out of 30 active learning techniques, 13 (43%) received the highest ratings on all 5 measures. The remainder of the techniques did not achieve consensus on at least one measure. Only two techniques reached consensus for not being appropriate for large-group didactic CE.

Discussion: We provide consensus evidence for the feasibility, appropriateness, and likelihood to engage for a variety of active learning techniques. This list can serve as a guide for their implementation in large-group didactic education and as a starting point for future study.

Abstract: Online learning for faculty development (FD) is expanding in low- and middle-income countries (LMICs), despite limited evidence on effectiveness. Kejela et al (JCEHP, 2023) highlight its promise in East Africa. In this short report, we present a collaboration to implement an online FD program on curriculum design between the Ophthalmology Foundation, the Congolese Society of Ophthalmology, and the Mozambican Ophthalmology College. We designed and delivered an online modular program focusing on simulation-based curriculum design, incorporating collaborative problem-solving and virtual group mentoring strategies that included peer mentoring, comentoring, and group facilitation. We aimed to strengthen teaching competence and the creation of a virtual community of practice (CoP) as an ongoing, interactive, and supportive platform. Participants were ophthalmologist educators of two Sub-Saharan African countries selected by their professional society leadership and engaged in synchronous and asynchronous activities. Both cohorts welcomed the online program, which facilitated professional identity development as clinician-educators and teaching competence. Virtual CoPs emerged as supportive networks for collaboration and mentoring. Despite challenges such as language barriers, limited connectivity, and cultural diversity, the program showed to be effective in individual and team upskilling and demonstrated scalability in underserved and remote contexts. Online FD can amplify access to education, strengthen leadership and teaching capacity, and foster CoPs as lasting anchors for professional development. This model advances health professions education with an emphasis on low- and middle-income countries and underscores the transformative potential of collaborative, contextually grounded online learning.

Introduction: Supervising in the workplace plays a key role in increasing the skills of the trainee. The shift to competence-based medical education requires both clinical expertise and pedagogical skills from the supervisor. These are distinct types of expertise. We know only a little of how competencies of supervising develop in medical education. The aim of our study is to find out what kind of professional agency in supervision general practitioners describes before their supervisor training. Professional agency refers to the individual's skills, willingness, ability, and responsibility to act with others in the professional context.

Methods: Our participants wrote a presentation of themselves before starting a supervisor training module. We studied these texts with narrative positioning analysis to examine who they are as supervisors, that is, the kind of professional agency they describe.

Results: We found three types of descriptions of professional agency: traditional master-apprenticeship supervision, clinical skills supervising with a collegial relationship, and process-oriented dialogical supervision. Supervising is mostly described as supervising the trainee on clinical skills and participants have a will to be a good supervisor, but they also express uncertainty of achieving this goal.

Conclusion: The variation in general practice supervisors' agency and pedagogical skills poses challenges for training providers in how to tailor the training to suit the best to participants with different skills. However, it gives an excellent opportunity for fruitful peer-to-peer learning. With our findings, it is possible to further develop supervisor training.

Introduction: This narrative review joins an ongoing scholarly conversation about Project ECHO, a virtual educational innovation, with an aim to understand it as a technology-enabled interface that facilitates knowledge-sharing. Critical attention is paid to how dynamics of power are accounted for in the deployment of Project ECHO, and sociomaterial attention is paid to how communication technology is described. The review is relevant to those who wish to establish, understand, or further develop virtual multiprovider knowledge-sharing interfaces.

Methods: Data collection followed processes set out by a narrative review methodology, a review methodology that provides a comprehensive and balanced critical analysis of the published literature. Analysis was informed by thematic analysis. Forty-five articles and one book chapter published between 2015 and 2024 were selected for inclusion. This review was contained to studies of Project ECHO in Canada.

Results: Our data set captures an implied awareness of dynamics of power and a desire to counter such dynamics. This is visible in the desire to mitigate a hierarchical differentiation between participants by using teaching and learning theories, a pedagogical design and processes of interaction that favour participation, and by using technology that allows participants to join from across vast geography.

Discussion: Emerging scholarly attention to how knowledge is shared and developed in Project ECHO will help develop an understanding of how technology-enabled educational innovations facilitate knowledge sharing in spaces that are imbued with complex power dynamics. Future explicit inclusion of a critical gaze and sociomaterial lens will deepen understandings of technology-enabled educational innovations.

Introduction: Rigorous rater training is necessary to ensure consistent feedback. Yet, there is a lack of published recommendations for how to train raters to provide reliable, consistent assessments for communication skills, thus making competency-based training in this area challenging. We describe a method for conducting rater training for serious illness communication skills and assess interrater reliability.

Methods: We selected a previously published and validated tool for assessing serious illness communication skills. We created a rater training program adapted from a previously described program focused on team performance, making notable adjustments to tailor the program to the assessment of serious illness communication with patients given the unique challenges these conversations pose. We assessed interrater reliability at the end of the program using kappa coefficients for dichotomous checklist items and intraclass correlation coefficients for scaled items.

Results: Five raters who are physicians with expertise in communication skills training completed the program. After training, raters assessed eight test videos. All raters achieved substantial agreement when compared to the gold standard rater for both the checklist (average overall kappa = 0.83) and scaled items (average overall intraclass correlation coefficient = 0.83).

Discussion: We demonstrate an effective method for conducting rater training to assess serious illness communication skills that builds off a previously published program for team performance. Key adjustments included conducting facilitated discussions of videos and iteratively updating the rater training guide. This approach ensures reliable assessment within communication skills training.