Journal of CME最新文献

As the number and needs of cancer survivors grow, innovative ways to enhance survivorship expertise are needed. This pilot study evaluated a 12-week cancer survivorship curriculum delivered to two cohorts of providers at affiliated sites within the Mercy Health System, utilising the Project ECHO® model, on provider self-efficacy (SE), knowledge (KN), and professional improvement (PI). Providers received six 1-hour sessions, informed by provider needs assessment, over 12 weeks. Participants completed pre- and post-session surveys evaluating SE, KN, and PI domains. The average score for survey items overall and within each domain was compared in pre- and post-session survey results. Twenty-six participants completed the baseline survey and 22 completed the post-session survey. For cohort 1, the overall score (0.94, 95% CI [0.45,1.42] p = 0.0023), SE (1.1, [95% CI [0.5,1.7] p = 0.003), and KN domain (1.03, 95% CI [0.45,1.62] p = 0.0036) scores significantly increased. For cohort 2, the overall score (0.617, 95% CI [0.042,1.193] p = 0.0378), SE (0.728, 95% CI [0.048,1.407] p = 0.0379), and KN domains (0.665, 95% CI [0.041,1.289] p = 0.0387) increased significantly. The PI score did not change for either cohort (PI -0.09, 95% CI [-0.67, 0.49] p = 0.726 and 0.000, 95% CI [-0.790,0.790] p > 0.999). This Cancer Survivorship ECHO pilot resulted in a statistically significant increase in provider self-efficacy and knowledge. All 22 participants rated the Cancer Survivorship ECHO pilot experience as having a positive (greater than neutral) result on their training. The Cancer Survivorship ECHO model may serve as a scalable strategy for building cancer survivorship care capacity in community-based oncology practices by equipping multidisciplinary teams to meet the needs of cancer survivors within their communities. Further research is needed to assess the implementation of this model in novel settings and evaluate its impact on patient outcomes and professional improvement.

The aims of this regional assessment of continuing medical education (CME)/continuing professional development (CPD) systems in Latin America were to describe the current requirements, if any, for physicians to engage in CME/CPD, explore perceptions of national CME/CPD systems from in-country subject matter experts (SMEs), to describe the perceptions of interprofessional continuing education (IPCE) and independent CME/CPD from in-country physicians and to provide recommendations that may be adopted by organisations/countries to improve the quality and effectiveness of their current CME/CPD systems and better meet their learners' needs. An assessment of 11 CME/CPD systems in Latin America was conducted using a mixed-methods approach that included 1:1 interviews with in-country SMEs and an electronic survey capturing qualitative and quantitative data from practicing in-country physicians. This assessment reflected countries with CME/CPD systems that are in various stages of maturity. Only three countries have systems that are self-regulated by the profession, several systems lack independence from pharmaceutical influence, and educational activities are described more in terms of traditional CME/CPD as compared to education focused on individual or team gaps or population health care needs. There was little description of incorporating learner self-assessment and evaluation of change and little focus on interprofessional education. This mixed-method assessment of 11 Latin American countries demonstrated CME/CPD systems that are developing in maturity. Participation was often voluntary, and there was relatively little regulation. Physicians overall have been resistant to regulation and have preferred to use a voluntary, incentive-based model. There was a relatively high degree of influence by the pharmaceutical industry. Affordability and access remain challenges. There is an opportunity to better tie country/population health outcomes to CME/CPD, implement interprofessional continuing education, increase faculty skills and learner engagement, and increase funding and access across geographic regions.

Diet and nutrition have an important impact on chronic disease and mortality and have spurred growth in the food is medicine approach. Yet, in the United States (US), post-graduate nutrition education and training for physicians remain limited. This may change as American policies focused on nutrition security, quality care and health equity advance and create new incentives for practicing clinicians to engage in nutrition-focused education and training. This viewpoint summarises why nutrition is essential for quality medical care, nutrition knowledge of US physicians, evolving US policies and advocacy for nutrition in medicine and opportunities for nutrition-focused continuing medical education and training. Clinicians trained in nutrition are important to lead innovation and research in nutrition-focused clinical care and to define best practices and optimise population health.

Medical writers assist continuing medical education (CME)/continuing professional development (CPD) providers in planning and delivering educational programmes. Their responsibilities include developing needs assessments and instructional content for accredited CME-CPD. However, to the best of our knowledge, a competency model for training writers who develop CME-CPD materials does not exist. We used a modified Delphi method to identify knowledge areas, skills, attitudes, and deliverables (KSADs) to include in a model for training the next generation of CME writers. Over 3 rounds of questionnaires, we asked a diverse panel of stakeholders to rate an initial set of KSADs, suggest additional KSADs, and provide rationales for their ratings. Panellists rated each KSAD from 1 (strongly disagree) to 5 (strongly agree) based on whether it should be included in the model. Panellists received anonymised reports of results between rounds and could change their previous ratings. Of 22 panellists who agreed to participate, 20 (90.9%) completed all 3 rounds. Of 83 suggested KSADs, 44 (53%) received a final average rating of at least 4, meeting predefined criteria for consensus. In total, we identified 38 KSAs necessary for CME writers to excel. These KSAs cover a wide range of topics from various fields, including accredited continuing education, medicine and healthcare, and medical writing and communications. We also identified 6 in-demand deliverables, including needs assessments, outcomes questions, slide decks, interactive patient case studies, agendas for proposed educational programmes, and scripts for video or audio recordings. This new competency model may help guide the development of training programmes for medical writers specialising in CME-CPD.

Clinician-scientists, physicians who conduct research, may fulfil a bridging role in networks of health care researchers and practitioners. Within clinician-scientists' networks, knowledge sharing is thought to play a vital role in the continuing professional development of themselves and their colleagues. However, little is known about networks of clinician-scientists and how this impacts continuing professional development. Rooted in social capital theory, this study provides a mixed methods exploration of clinician-scientists' networks. Ego-level social network data were collected via semi-structured interviews on professional interactions about evidence-based practice with 15 clinician-scientists in the area of general practice and elderly care. Quantitative analysis revealed that professional networks of clinician-scientists varied in size, composition, and frequency of interactions depending on appointed research time and experience. Less experienced clinician-scientists interacted most frequently with other clinician-scientists while experienced clinician-scientist experienced more sporadically with clinicians. Clinician-scientists with more research time interacted more frequently with scientists and had a slightly larger professional network than those with less research time. The thematic qualitative analysis revealed different decision-making processes of clinician-scientists on mobilising their social capital and connecting to others in the network: (1) deliberate decision about initiating connections; (2) reactive behaviour without a decision; (3) ad-hoc decision. Clinician-scientists exchange knowledge to enhance their own continuing professional development mainly but also contribute to the professional development of clinicians, scientists, and other clinician-scientists.

We aimed to measure the sustainability of health professionals' intention to have serious illness conversations with patients using the Serious Illness Conversation Guide (SICG) after individual-focused training versus team-based training. In a cluster randomised trial, we trained healthcare professionals in 40 primary care clinics and measured their intention to hold serious illness conversations immediately (T1), after 1 year (T2) and after 2 years (T3). Primary care clinics (n = 40) were randomly assigned to individual-focused training (comparator) or team-based training (intervention). Average age of the 373 participants was 35-44 years, 79% were women. On a scale of 1 to 7, at T1, the mean intention was 5.33 (SD 0.20) in the individual-focused group and 5.36 (SD 0.18) in the team-based group; at T2, these scores were 4.94 (SD 0.23) and 4.87 (SD 0.21) and at T3, 5.14 (SD 0.24) and 4.59 (SD 0.21), respectively. At T3, the difference in mean intention between study groups had a significant p-value of 0.01. Intention to have serious illness conversations was lower at T2 and T3 after team-based training than after individual-focused training, with a significant difference at 2 years in favour of individual-focused training. Health professionals reported not enough time during consultations for serious illness conversations as a major barrier.

Registration number: ClinicalTrials.gov (ID NCT03577002) for the parent clinical trial.

A considerable amount of continuing professional development (CPD) for health professionals is online and voluntary. There is evidence that some CPD activities impact clinical practice outcomes from self-reported and objective, administrative data. Some studies have shown that there is a potential mediating effect of knowledge/competency and/or self-efficacy between participation in CPD activities and the outcomes of that participation, specifically clinical practice. However, because clinical practice in those studies has been self-report, little is known about how this relationship impacts real world clinical practice. The purpose of the current study is to examine the relationship between knowledge/competency, self-efficacy, and real-world clinical practice so that we can begin to understand whether our focus on knowledge/competency and self-efficacy to change real-world clinical practice is empirically supported. We employed secondary data analysis from pre-participation questionnaire and medical and pharmacy claims data originally collected in three evaluations of online CPD interventions to examine if the relationship between knowledge/competency and self-efficacy contributed to physicians' real-world clinical practice. Results show an association between knowledge/competency scores and ratings of self-efficacy and suggest unique contributions of knowledge/competency and self-efficacy to clinical practice. Study results support the value of knowledge/competency scores and self-efficacy ratings as predictors of clinical practice. The effect size was larger for self-efficacy suggesting it may be a more practical indicator of clinical practice for CPD evaluators because its process of question development is simpler than the process for knowledge and case-based decision-making questions. However, it is important to conduct thorough need assessments which may include knowledge/competency assessments to identify topics to cover in CPD activities that are more likely to increase self-efficacy and ultimately, clinical practice.

Continuous professional development (CPD) is crucial for physicians to maintain and enhance their skills. In response to the changing context of CPD and health care, this study applied a design thinking approach to transform and modernise the Royal College of Physicians and Surgeons of Canada's Maintenance of Certification (MOC) Program. A member-wide survey and co-design sessions with physicians, CPD leaders, and patient representatives were conducted, emphasising the importance of their insights and experiences. The data revealed key themes for the programme such as fostering meaningful learning, addressing barriers to CPD, supporting collaboration, and responding to the need for modern, flexible CPD delivery methods. Using "empathy", "define", "ideate", "prototype", and "test" phases, we continuously refined the MOC framework of CPD activities based on comprehensive user experiences and needs insights. The revised framework was iteratively prototyped and validated to ensure it was user-friendly and aligned with professional and regulatory requirements. The findings underscore the effectiveness of the design thinking approach in creating a dynamic, responsive MOC framework that supports CPD and meets the evolving needs of medical professionals. This approach not only demonstrates the effectiveness of design thinking but also the importance of engaging users in the development process, making them feel valued and integral to the transformation of the MOC Program.

In the United States, women account for one-fourth of people living with HIV. Most women living with HIV are Black or Hispanic and acquired HIV from heterosexual contact. Many face significant barriers to appropriate medical care, with lower retention in care and viral suppression than men who acquire HIV from male-to-male sexual contact. Many factors contribute to these disparities, including high rates of alcohol abuse, substance use, intimate partner violence, depression, and socioeconomic marginalisation. HIV, substance use, and violence each contribute independently to the collective health burden on women. The co-occurrence of these factors, termed the SAVA (substance abuse, violence, and HIV/AIDS) syndemic, is particularly hard to address, as the conditions act synergistically to negatively influence health outcomes. In addition, mental health conditions frequently coexist and further contribute to adverse outcomes. Unfortunately, clinician knowledge of this syndemic is low, and patients living with HIV and other elements of SAVA, including depression, are not recognised and referred for appropriate services. In this paper we describe our pilot educational and quality improvement program and the subsequent educational program we developed to increase knowledge of SAVA with the goal of improving health outcomes for women living with HIV.

The purpose of this study was to compare student performance and question discrimination of multiple-choice questions (MCQs) that followed a standard format (SF) versus those that do not follow a SF, termed here as non-standard format (NSF). Medical physiology exam results of approximately 500 first-year medical students collected over a five-year period (2020-2024) were used. Classical test theory item analysis indices, e.g. discrimination (D), point-biserial correlation (r_pbis), distractor analysis for non-functional distractors (NFDs), and difficulty (p) were determined and compared across MCQ format types. The results presented here are the mean ± standard error of the mean (SEM). The analysis showed that D (0.278 ± 0.008 vs 0.228 ± 0.006) and r_pbis (0.291 ± .006 vs 0.273 ± .006) were significantly higher for NSF questions compared to SF questions, indicating NSF questions provided more discriminatory power. In addition, the percentage of NFDs was lower for the NSF items compared to the SF ones (58.3 ± 0.019% vs 70.2 ± 0.015%). Also, the NSF questions proved to be more difficult relative to the SF questions (p = 0.741 ± 0.007 for NSF; p = 0.809 ± 0.006 for SF). Thus, the NSF questions discriminated better, had fewer NFDs, and were more difficult than SF questions. These data suggest that using the selected non-standard item writing questions can enhance the ability to discriminate higher performers from lower performers on MCQs as well as provide more rigour for exams.