Journal of Continuing Education in the Health Professions最新文献

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.

Abstract: Health professionals' motivation is a key determinant of their continuing professional development (CPD) outcomes. Therefore, CPD providers must ensure that they design CPD activities to support health professionals' motivation; this process is referred to as motivational design. The aim of this article is to introduce CPD providers to the PACE (purpose, autonomy, confidence, engrossment) model of motivational design, and describe how we applied the PACE model to create two online modules for an interprofessional audience. The PACE model builds on other available models of motivation design by offering theoretically informed strategies to support autonomous motivation, a specific quality of motivation that is associated with more effective learning processes and outcomes. Our experience suggests that CPD providers can use the PACE model to guide their motivational design efforts. We also encourage CPD researchers to test the theoretical assumptions that inform the PACE model.

Introduction: Peer mentoring programs can be a valuable support mechanism for new faculty transitioning from clinical practice to academia. Mentors play a crucial role in this process. This study described mentors' perceived competence in 21 areas of the mentor role and their experiences as mentors following the first year of a structured peer mentoring program.

Methods: This study employed a mixed-methods approach, using the Mentoring Competency Assessment-21 alongside open-ended questions. These instruments were electronically administered to a convenience sample consisting of eight mentors with varying experience ranging from 2 to 16 years in the nursing program at a mid-sized university, following an intentional first-year peer mentoring program.

Results: The highest-performing items were "Establishing a relationship based on trust" (M 6.50, SD 0.53), "Considering how personal and professional differences may impact expectations" (M 6.25, 0.83), and "Acknowledging your mentee's professional contributions" (M 6.13, SD 0.99). The lowest scores were focused on estimating scientific knowledge and scholarly productivity. Responses to the Mentoring Competency Assessment-21 indicated that mentors felt at least moderately competent in the various aspects of the faculty mentor role. Mentors valued the professional development and supporting materials provided by the development team. An identified area for improvement was the support provided to assist the mentees' scholarly development.

Discussion: This study underscores the importance of supportive materials, such as handbooks and regular communication, in fostering mentor competence and facilitating successful nursing faculty peer mentoring programs. Future research implications include assessment of mentor competence by mentees and long-term follow-up of program outcomes.

Abstract: The science of learning (learning science) is an interprofessional field that concerns itself with how the brain learns and remembers important information. Learning science has compiled a set of evidence-based strategies, such as distributed practice, retrieval practice, and interleaving, which are quite relevant to continuing professional development. Spreading out study and practice separated by cognitive breaks (distributed practice), testing oneself to check mastery and memory of previously learned information (retrieval practice), and mixing the learning of separate but associated information (interleaving) represent strategies that are underutilized in continuing professional development. Participants and planners alike can benefit from learning science recommendations to inform their decisions. Elaboration, the subject of this article, is another evidence-based strategy that relates to how one studies or practices priority information.

Introduction: Demand for genetic testing has expanded exome sequencing (ES) utilization into subspecialty clinics without genetics providers. This trend forces non-genetics physicians (NGPs) to facilitate patient consent for genetic testing. However, research on NGPs' knowledge of consent elements (CK) required for ES has not been explored.

Methods: Columbia University NGPs were invited to take a survey (premodule survey [PrS]) assessing CK for ES. Educational modules on ES were then created and sent to NGP participants. A postmodule survey (PoS) was sent to NGPs a month later to assess the change in CK scores. Alpha was set at ≤0.05.

Results: Nineteen participants completed the PrS and PoS. Overall PrS CK scores were low (mean = 8, SD 1.6). There was no difference in PrS CK scores between attendings and residents/fellows (P = .2), and PrS CK scores did not correlate with time since medical school graduation (P = .9). PoS CK scores were higher than PrS CK scores (P = .03). Most NGPs (74%) were satisfied with the module.

Conclusions: Our findings suggest a need for continuing education of both new and experienced NGPs on best practices for consenting for ES. An online module with information tailored to different specialties could be an effective format for delivering this education.

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: 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.

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.