Journal of Continuing Education in the Health Professions最新文献

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: 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.

Abstract: Teamwork is a necessity for effective care of patients in the current health care environment. Continuing education providers are best positioned to teach health care professionals about teamwork. However, health care professionals and continuing education providers largely operate in single-profession-based environments and thus need to change their programs and activities to achieve team improvement education goals. Joint Accreditation (JA) for Interprofessional Continuing Education is designed to advance teamwork to improve quality care through education programs. However, achieving JA requires significant changes to an education program that are multifaceted and complex to implement. Although challenging, implementation of JA is an effective way to advance interprofessional continuing education. Here, we discuss numerous practical strategies that can aid education programs to prepare for and achieve JA, such as attaining organizational alignment and provider adaptation to expand curriculums, reinventing the education planning process, and implementing tools to help manage the joint accredited program.

Introduction: The purpose of this program evaluation was to investigate the efficacy of simulation-based primary care procedural skills training to increase participant confidence, knowledge, and skill in performing the procedures included in the training and to evaluate the cost-effectiveness of the training.

Methods: A retrospective, within-subjects analysis of the change in perceived confidence, skill, and knowledge in procedure performance after the simulation-based primary care procedural skills training program measured by pretraining and post-training Likert scale surveys and change in clinical procedure performance frequency for abscess incision and drainage and laceration repair up to 6 months before and 6 months after the training in the outpatient setting was performed.

Results: Participants self-reported higher median confidence, perceived skill, and perceived knowledge of all procedures included in the training course, with statistically significant increases for all procedures. A mean increase in laceration repairs in the clinical setting of 10% after training was found. Higher median performance of abscess incision and drainage after training (median = 20.00%, n = 25) compared with before training (median = 0.00%, n = 25) and a mean increase in performance of abscess incision and drainage in the clinical setting of 6% after training was found, but increases were not statistically significant.

Discussion: Participation in a 2-day simulation-based primary care procedural skills training program was an effective method to increase confidence, perceived skill, and knowledge of outpatient procedures among practicing providers. Further evaluation to establish return on investment is needed, because statistically significant increases in clinical procedure performance were unable to be demonstrated.

Introduction: Although concern related to conflicts within health care teams has been discussed in the literature, most studies have focused on individuals' personal conflict management style identification or on managers resolving workplace conflicts between parties. The purpose of this review was to identify significant components in the field of conflict with particular attention to conceptual findings that may be integrated into understanding interprofessional health care team conflict and its resolution.

Methods: A critical review of the conflict literature across many fields was undertaken using the method identified by Grant and Booth, incorporating literature-search, appraisal, synthesis, and analysis.

Results: This critical review explored existing models and schools of thought to provide an overview of how conflict is conceptualized, its focus on interpersonal and workplace issues, team conflict application and training in team conflict resolution, and finally a summary of this review's contribution to interprofessional health care team conflict and its resolution.

Conclusions: Team conflict is comprised of three forms-relationship, task, and process. When team building occurs that incorporates training in the use of an adapted constructive controversy approach, there is a greater opportunity to enhance the quality of a cooperative approach to patients' care planning. Training in team conflict resolution is needed as a key ingredient to ensure all team members can enhance the effectiveness and quality of interprofessional client-centered collaborative practice. This benefits not only the health providers in the team, but also their clients/patients who are recipients of their shared teamwork.

Introduction: To compensate for the shortage of health workers and effectively use the available health workforce to provide access to health services at various levels of the health system, several countries are implementing task-shifting and task-sharing (TSTS). This scoping review was conducted to synthesize evidence on health professions education (HPE) strategies applied to enhance capacities for TSTS implementation in Africa.

Methods: This scoping review was conducted using the enhanced Arksey and O'Malley's framework for scoping reviews. The sources of evidence included CINAHL, PubMed, and Scopus.

Results: Thirty-eight studies conducted in 23 countries provided insights on the strategies implemented in various health services contexts including general health, cancer screenings, reproductive, maternal, newborn, child and adolescent health, HIV/AIDS, emergency care, hypertension, tuberculosis, eye care, diabetes, mental health, and medicines. The HPE strategies applied were in-service training, onsite clinical supervision and mentoring, periodic supportive supervision, provision of job aides, and preservice education.

Discussion: Scaling up HPE based on the evidence from this study will contribute immensely to enhancing the capacity of health workers in contexts where TSTS are being implemented or planned to provide quality health services based on the population's health needs.

Abstract: Continuing professional development (CPD) providers and faculty face a practice gap between our knowledge of effective practices in CPD and our implementation of them, particularly in online environments. Developmental psychologists Bob Kegan and Lisa Lahey have attributed such knowledge-implementation gaps to an "Immunity to Change" rooted in tacit "Big Assumptions." These Big Assumptions produce fears or worries, reveal competing commitments, and result in actions or inactions that hinder intended change. We sought to understand the barriers to change in online and blended CPD, to support CPD leaders in pursuing their goals for optimal use of technology in CPD. This inquiry arose from the 13th National Continuing Professional Development Accreditation Conference of the Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada, a virtual conference held in October 2022. After introducing the Immunity to Change framework and best practices in online and blended learning, we invited audience members to list Big Assumptions in CPD through chat and polling software. These responses were analyzed and grouped into five interrelated Big Assumptions that suggest a number of key barriers to optimal implementation of online CPD. We present data that counter each Big Assumption along with practical approaches to facilitate desired change for CPD.