Journal of Continuing Education in the Health Professions最新文献

Introduction: Comprehending scientific information have been reported as a barrier in evidence-based practice (EBP) adoption. This survey research aimed to verify the preferred sources of information for acquiring knowledge about physiotherapy and the association between types of information source and barriers in EBP implementation.

Methods: A total of 610 physiotherapists were included and answered an online questionnaire about the preferred sources for searching physiotherapy-related information and possible barriers in EBP implementation.

Results: Physiotherapists reported scientific resources as the preferred source of information, scientific databases (31%), followed by scientific articles (25%). The main barrier cited in EBP implementation was the difficulty in obtaining full-text articles (34%), followed by lack of statistical knowledge (30%). The use of peer-reviewed resources as the most preferred source of information is associated with the presence of issues in comprehending scientific information.

Discussion: Although the positive attitude toward the use of scientific information, the findings raised question regarding the proper translation of scientific information to clinical practice. The importance of scientific information seems to be a well-established attitude among physiotherapists. However, there is a clear need for strategies aiming to improve the understanding of scientific information and consequently facilitate EBP implementation.

Introduction: Contextual factors can influence healthcare professionals' (HCPs) competencies, yet there is a scarcity of research on how to optimally measure these factors. The aim of this study was to develop and validate a comprehensive tool for HCPs to document the contextual factors likely to influence the maintenance, development, and deployment of professional competencies.

Methods: We used DeVellis' 8-step process for scale development and Messick's unified theory of validity to inform the development and validation of the context tool. Building on results from a scoping review, we generated an item pool of contextual factors articulated around five themes: Leadership and Agency, Values, Policies, Supports, and Demands. A first version of the tool was pilot tested with 127 HCPs and analyzed using the classical test theory. A second version was tested on a larger sample (n = 581) and analyzed using the Rasch rating scale model.

Results: First version of the tool: we piloted 117 items that were grouped as per the themes related to contextual factors and rated on a 5-point Likert scale. Cronbach alpha for the set of 12 retained items per scale ranged from 0.75 to 0.94. Second version of the tool included 60 items: Rasch analysis showed that four of the five scales (ie, Leadership and Agency, Values, Policies, Supports) can be used as unidimensional scales, whereas the fifth scale (Demands) had to be split into two unidimensional scales (Demands and Overdemands).

Discussion: Validity evidence documented for content and internal structure is encouraging and supports the use of the McGill context tool. Future research will provide additional validity evidence and cross-cultural translation.

Introduction: Health numeracy (numerical literacy) refers to an individual's ability to use numerical information to make effective health decisions. Numeracy is fundamental in the role of a health care provider, forming the basis of evidence-based medicine and effective patient-provider communication. Despite a high level of education, many health care providers struggle with numeracy. Numeracy is often integrated into training curricula; however, teaching modality, competencies covered, learner satisfaction, and effectiveness of these educational interventions varies.

Method: A scoping review was conducted to explore and summarize what is known about numeracy skills education programs for health care providers. A comprehensive literature search was conducted from January 2010 to April 2021 in 10 databases. Controlled vocabulary terms and text words were used. The search was restricted to human studies, adults, and the English language. Articles were included if they were related to numeracy education for health care providers or trainees and provided details regarding methods, evaluation, and results.

Results: The literature search retrieved 31,611 results and 71 met the inclusion criteria. Most interventions were conducted in a university setting, and targeted nursing students, medical students, resident physicians, and pharmacy students. Common numeracy concepts included statistics/biostatistics, medication calculations, evidence-based medicine, research methodology, and epidemiology. A variety of teaching modalities were used, which most often combined active approaches (eg, workshops, laboratories, small-group exercises, and discussion boards) with passive approaches (eg, traditional lectures and didactic teaching). Measured outcomes included knowledge and skills, self-efficacy, attitudes, and engagement.

Discussion: Although efforts have been made to incorporate numeracy into training curricula, greater emphasis should be placed on developing strong numeracy skills in health care providers, particularly given the role numerical information plays in clinical decision making, evidence-based practices, and patient-provider communication.

Introduction: Attrition is defined as a permanent departure from one's profession or the workforce. Existing literature on retention strategies, contributing factors to the attrition of rehabilitation professionals and how different environments influence professionals' decision-making to stay in/leave their profession, is limited in scope and specificity. The objective of our review was to map the depth and breadth of the literature on attrition and retention of rehabilitation professionals.

Methods: We used Arksey and O'Malley's methodological framework. A search was conducted on MEDLINE (Ovid), Embase (Ovid), AMED, CINAHL, Scopus, and ProQuest Dissertations and Theses from 2010 to April 2021 for concepts of attrition and retention in occupational therapy, physical therapy, and speech-language pathology.

Results: Of the 6031 retrieved records, 59 papers were selected for data extraction. Data were organized into three themes: (1) descriptions of attrition and retention, (2) experiences of being a professional, and (3) experiences in institutions where rehabilitation professionals work. Seven factors across three levels (individual, work, and environment) were found to influence attrition.

Discussion: Our review showcases a vast, yet superficial array of literature on attrition and retention of rehabilitation professionals. Differences exist between occupational therapy, physical therapy, and speech-language pathology with respect to the focus of the literature. Push , pull , and stay factors would benefit from further empirical investigation to develop targeted retention strategies. These findings may help to inform health care institutions, professional regulatory bodies, and associations, as well as professional education programs, to develop resources to support retention of rehabilitation professionals.

Introduction: Most formal continuing professional development (CPD) opportunities were offered in person until March 2020 when the COVID-19 pandemic disrupted traditional structures of CPD offerings. The authors explored the adaptations and innovations in CPD that were strengthened or newly created during the first 16 months of the pandemic.

Methods: The objectives of the narrative review were to answer the following questions: (1) what types of adaptations to CPD innovations are described? and (2) what may shape future innovations in CPD? The following databases were searched: Medline, Embase, CINAHL, and ERIC to identify the literature published between March 2020 to July 2021. The authors conducted a comprehensive search by including all study types that described adaptations and/or innovations in CPD during the stated pandemic period.

Results: Of the 8295 citations retrieved from databases, 191 satisfied the inclusion criteria. The authors found three categories to describe adaptations to CPD innovations: (1) creation of new online resources, (2) increased use of the existing online platforms/software to deliver CPD, and (3) use of simulation for teaching and learning. Reported advantages and disadvantages associated with these adaptations included logistical, interactional, and capacity building elements. The review identified five potential future CPD innovations: (1) empirical research on the effectiveness of virtual learning; (2) novel roles and ways of thinking; (3) learning from other disciplines beyond medicine; (4) formation of a global perspective; and (5) emerging wellness initiatives.

Discussion: This review provided an overview of the adaptations and innovations that may shape the future of CPD beyond the pandemic.

Abstract: Continuing education (CE) professionals are experiencing continuous changes in their practice, including situations where they see a need for change but feel overwhelmed with change implementation. This article is a reflection on our experience of (1) transitioning from independently operating health professions CE units in medicine, nursing, and pharmacy to becoming a Joint Accreditation provider of interprofessional CE and (2) developing and using a Diversity, Equity, and Inclusion Toolkit for Accredited Continuing Education. We examined these instances of substantial change to identify what made them achievable and supported our well-being throughout the process. We also considered a social cognitive theory, a schema theory, and a normalization process theory. As a result, we identified five steps of the CE planning and implementation process to be our trusted mental model and the key factor in making the changes doable for our team and supporting our resilience and a sense of well-being. Interviews with three clinician-learners, which were conducted in search of additional insights, reminded us that positive reinforcement occurs when we see the desired result. Thus, measuring the CE change and its impact on learners and their patients is also a tool to sustain emotional comfort during the turbulence of a change cascade, given the measures show progress in a desired direction. We hope this article will stimulate peer discussions, reflections, and sharing of lessons learned from similar journeys.

Introduction: Health professions preceptors require skills and knowledge to effectively meet the educational needs of interprofessional students in clinical environments. We implemented a mini-fellowship program to enhance the knowledge, skills, and self-efficacy of preceptors teaching students and applying quality improvement (QI) methods across disciplines and patient care settings.

Methods: The design, implementation, and evaluation of the program were informed by the faculty development literature, principles of adult learning, and preceptor needs. The 3-day program included workshops on curriculum design, clinical teaching methods, QI, social determinants of health, cultural humility, and interprofessional teamwork. Quantitative and qualitative evaluation methods were used including preprogram and postprogram knowledge and self-efficacy surveys, along with end-of-session and program evaluations.

Results: Five annual cohorts involving 41 preceptors with varied demographics, professions, and clinical practices completed the mini-fellowship program. Participants' percentage of items answered correctly on a QI knowledge test increased from 79.2% (pretest) to 85.5% (post-test), a gain of 6.3% (90% CI: 2.9-9.7%; P < .003). The average QI self-efficacy scores improved from 2.64 to 3.82, a gain of 1.18 points on a five-point scale ( P < .001). The average education/teaching self-efficacy increased from 2.79 to 3.80 on a five-point scale ( P < .001). Ultimately, 94% would recommend the program to other preceptors.

Discussion: An interprofessional preceptor development program designed to train clinicians to effectively teach in the clinical setting and to conduct QI projects with students was achievable and effective. This program can serve as a model for academic centers charged with training future health care workers and supporting their community-based preceptors' training needs.

Introduction: Mental health care is often managed in primary care with limited specialist support, particularly in rural and remote communities. Continuing professional development programs (CPD) can offer a potential solution to further mental health training; however, engaging primary care organizations (PCOs) can be challenging. The use of "big data" to identify factors influencing engagement in CPD programs has not been well studied. Therefore, the aim of this project was to use administrative health data from Ontario, Canada to identify characteristics of PCOs associated with early engagement in a virtual CPD program, Project Extension for Community Healthcare Outcomes (ECHO) Ontario Mental Health (ECHO ONMH) .

Methods: Ontario health administrative data for fiscal year 2014 was used to compare the characteristics of ECHO ONMH-adopting PCOs, and their patients, to nonadopter organizations (N = 280 vs. N = 273 physicians).

Results: ECHO-adopting PCOs did not differ with respect to physician age or years of practice, although PCOs with more female physicians were somewhat more likely to participate. ECHO ONMH adoption was more likely in regions with lower psychiatrist supply, among PCOs using partial salary payment models, and those with a greater interprofessional complement. Patients of ECHO-adopters did not differ on the basis of gender or health care utilization (physical or mental health); however, ECHO-adopting PCOs tended to have patients with less psychiatric comorbidity.

Discussion: Models such as Project ECHO, which deliver CPD to primary care, are advanced to address lack of access to specialist health care. These findings support the use of administrative health data to assess the implementation, spread, and impact of CPD.

Introduction: The effectiveness of continuing professional development as an intervention to improve health professional behavior and patient health is variable and contentious. To clarify the causal relationships underlying program outcomes and facilitate a necessary shift from outcomes-only-based approaches to outcome-based and theory-based approaches in program development and evaluation, we developed a model of mechanisms mapped to relevant outcomes.

Methods: Mechanisms identified in a prior realist synthesis of opioid agonist therapy continuing professional development programs were iteratively tested and refined using purposive and opportunistic sampling and realist approaches against two systematic reviews of programs in analgesic prescribing and palliative care. Further testing involved practical application within programs in sustainable health care and pain management.

Results: Ninety reports on 75 programs and practical application to multiple additional programs informed the final model consisting of five distinct mechanisms: motivation transformation, expert influence, confidence development, self-efficacy facilitation, and community of practice expansion. The mechanisms and related analysis emphasize that continuing professional development is heterogeneous, complex, and context dependent.

Discussion: Shifting toward outcome-based and theory-based approaches facilitates further conceptual shifts at intraprogram and interprogram and interintervention levels toward more deliberate program development and evaluation, increased program complementarity and subsequent collaboration. It clarifies opportunities for intercalation of continuing professional development with other intervention sciences. The model presents a resource for practitioners, researchers, and policymakers to advance continuing professional development planning, coordination, and evaluation.