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Paired or Pooled Analyses in Continuing Medical Education, Which One is Better? 继续医学教育中的配对或汇总分析,哪个更好?
Pub Date : 2023-01-01 DOI: 10.1080/28338073.2023.2217371
Jessica H Robles, Kathleen J Harb, Sarah A Nisly

In data analyses, pairing participant responses is often thought to yield the purest results. However, ensuring all participants answer all questions can be challenging. Concerns exist that pooling all responses together may diminish the robustness of a statistical analysis, but the practical insights may still exist. Data from a live, in-person, continuing education series for health professionals was analysed. For each topic, identical questions were asked prior to the educational content (pre), immediately following the content (post), and on a rolling 4 to 6 week follow-up survey (follow-up). For each educational topic, responses were matched by participant for a paired analysis and aggregated for a pooled analysis. A paired analysis was done for matched responses on pre vs post and pre vs follow-up questions. A pooled analysis was done for the aggregate responses on pre vs post and pre vs follow-up questions. Responses from 55 questions were included in the analysis. In both the paired and pooled pre vs post analyses, all questions yielded a statistically significant improvement in correct responses. In the paired pre vs follow-up analysis, 59% (n = 33) of questions demonstrated a statistically significant improvement in correct responses, compared to 62% (n = 35) in the pooled pre vs follow-up analysis. Paired and pooled data yielded similar results at the immediate post-content and follow-up time periods.

在数据分析中,配对参与者的回答通常被认为是产生最纯粹的结果。然而,确保所有参与者回答所有问题可能具有挑战性。人们担心,将所有的反应集中在一起可能会降低统计分析的稳健性,但实际的见解可能仍然存在。对卫生专业人员现场、面对面继续教育系列的数据进行了分析。对于每个主题,在教育内容之前(pre),内容之后(post)以及滚动4至6周的随访调查(follow-up)中询问相同的问题。对于每个教育主题,参与者的回答进行配对分析,并进行汇总分析。对前后、前后和后续问题的匹配回答进行配对分析。对调查前与调查后、调查前与调查后的问题进行汇总分析。分析中包含了55个问题的回答。在配对和合并的前后分析中,所有问题的正确回答都有统计学上的显著提高。在配对前与随访分析中,59% (n = 33)的问题在正确回答方面表现出统计学上显著的改善,而在合并前与随访分析中,这一比例为62% (n = 35)。配对和汇总数据在内容后和随访期间产生了类似的结果。
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引用次数: 1
Evaluating the Impact of Continuing Medical Education in the Interdisciplinary Team: A Novel, Targeted Approach. 评估继续医学教育在跨学科团队中的影响:一种新颖的、有针对性的方法。
Pub Date : 2023-01-01 DOI: 10.1080/28338073.2022.2161730
Billy Jenkins, Katrina Lester, Alex Nobel, Helen Such, Barbara Yawn, Alison Scott

In order to maximise the learning potential of medical education programmes aimed at interdisciplinary or multidisciplinary teams, it is important to understand how the effectiveness of these programmes can vary between healthcare professionals from different specialities. Measuring the impact of educational activities between specialities may facilitate the development of future interdisciplinary and multidisciplinary education programmes, yielding enhanced learner outcomes and, ultimately, improving outcomes for patients. In this analysis, we report on a new approach to measuring change in knowledge and competence among learners from different physician specialities. We did this by tailoring post-activity competency assessments to three specialities - primary care physicians, pulmonologists and immunologists caring for patients with severe asthma. Our findings revealed that primary care physicians had markedly improved knowledge, measured using assessment questions, compared with the other specialities after completing the activity. We also report on differences between these specialities in intention to change clinical practice, confidence in clinical practice, and remaining educational gaps. Understanding how different members of the interdisciplinary team have benefited from an educational activity is essential for designing future educational activities and targeting resources.

为了最大限度地发挥针对跨学科或多学科团队的医学教育方案的学习潜力,重要的是要了解这些方案的有效性如何在不同专业的医疗保健专业人员之间有所不同。衡量不同专业之间的教育活动的影响可能会促进未来跨学科和多学科教育计划的发展,从而提高学习者的学习效果,并最终改善患者的治疗效果。在本分析中,我们报告了一种新的方法来衡量不同医师专业的学习者在知识和能力方面的变化。为此,我们将活动后能力评估调整为三个专业——初级保健医生、肺科医生和治疗严重哮喘患者的免疫学家。我们的研究结果显示,在完成活动后,与其他专业相比,初级保健医生的知识有了明显的提高,用评估问题来衡量。我们还报告了这些专业在改变临床实践的意图、对临床实践的信心和剩余的教育差距方面的差异。了解跨学科团队的不同成员如何从教育活动中受益,对于设计未来的教育活动和定位资源至关重要。
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引用次数: 1
Addressing educational gaps through multidisciplinary team education in eosinophilic oesophagitis management. 通过多学科团队教育解决嗜酸性食管炎管理方面的教育差距。
Pub Date : 2023-01-01 DOI: 10.1080/28338073.2023.2230033
Kathy Day, Albert J Bredenoord, Isabel Skypala, Jonathan Spergel, Katie Bickford, Alex Noble, Anne M Nunn

Once considered a rare disease, eosinophilic oesophagitis (EoE) is becoming increasingly prevalent, yet many healthcare professionals (HCPs) remain unfamiliar with the underlying pathophysiology and optimal management approaches. For this study, we developed a faculty-led, online, continuing medical education activity on EoE. The effectiveness of this activity was evaluated according to Moore's framework, with changes in knowledge and competence (Moore's Levels 3 and 4) assessed for a cohort of gastroenterologists, dietitians, allergists and immunologists (N = 300), using questionnaires completed before and after participation. Changes in HCP confidence in treating EoE were also reported and remaining educational gaps were identified. The activity was viewed by a global audience of 5,330 participants within 6 months, and significant improvements in knowledge and competence were reported following participation in the activity across all specialities, regions and experience (mean [standard deviation] score pre- versus post-activity: 4.32 [1.38] versus 5.46 [0.82]; p < 0.001). Confidence in treating EoE also increased from pre- to post-activity, with the proportion of participants reporting that they felt moderately or extremely confident increasing from 53% to 82%. Several educational unmet needs were identified, which can be used to inform the design of future educational activities in EoE.

嗜酸性粒细胞性食管炎(EoE)曾经被认为是一种罕见的疾病,但现在正变得越来越普遍,然而许多医疗保健专业人员(hcp)仍然不熟悉其潜在的病理生理学和最佳的治疗方法。在这项研究中,我们开发了一个由教师主导的在线继续医学教育活动。该活动的有效性根据Moore的框架进行评估,对胃肠病学家、营养师、过敏症学家和免疫学家(N = 300)的知识和能力(Moore’s level3和level4)的变化进行评估,并在参与前后完成问卷调查。还报告了治疗EoE时HCP信心的变化,并确定了剩余的教育差距。该活动在6个月内被全球5330名参与者观看,所有专业、地区和经验的参与者在参与该活动后,知识和能力都有了显著提高(活动前后的平均[标准差]得分:4.32[1.38]对5.46 [0.82];p
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引用次数: 0
Faculty Development of CPD Teachers in Low-Resource Environments Post-COVID-19. 低资源环境下CPD教师队伍建设
Pub Date : 2023-01-01 DOI: 10.1080/28338073.2022.2161784
Heather Mack, Karl Golnik, Helena Prior Filipe
The COVID-19 pandemic accelerated online faculty development (FD), particularly in under-resourced regions where travel by international teachers was curtailed. This promoted creation of virtual communities of practice (CoP) of clinical educators that are intended as hubs of education experience, enabling group mentoring, group facilitation and peer mentoring. We discuss our experiences in this environment, and concepts and structures to support post-COVID online FD. Ophthalmology FD in under-resourced regions has been traditionally performed by visiting international teachers, for example Training-The-Trainers programme in Africa [1]. In 2019, our group of international ophthalmologists with expertise in continuing medical education, volunteering with the International Council of Ophthalmology (ICO), created a 10-unit online FD programme [2–4]. This combined online learning with social constructivist [5] and experiential learning [6] paradigms and included virtual group-mentoring, opportunities to reflect and receive feedback, problem-solving exercises, and encouraged formation of a CoP. We sought to create a non-hierarchical, interactional learning space to mobilise knowledge and ultimately to prepare future knowledge mobilisers [7]. In 2019–2020, two cohorts of ten ophthalmologists’ educators working in teaching hospitals in sub-Saharan African countries (one English-speaking, one Lusophone) approached the ICO and undertook the programme which was devised for them, with the aim to improve their educational competence in surgical simulation. In brief, we found the learning experience was welcome, learning and competence improvement, and CoPs developed in the short term [3,4]. We assumed that faculty would transition seamlessly to online teaching. However, the need for faculty to develop skills in online teaching is now recognised, and structured courses are being designed, implemented and evaluated [8,9]. Kuntz et al. recently highlighted the usefulness of rapid iteration based on feedback as multi-week courses were developed in a just-in-time manner [10]. A key element of FD in under-resourced environments is “cascading” of skills from international trainers to a pyramid of locally based trainers capable of further cascading knowledge and teaching skills [1]. Prompted by the COVID-19 pandemic these cascading CoP [11,12] have rapidly transitioned to entirely online virtual CoP (VCoP) [13,14] of educators, including both our cohorts [3,4]. Extending the original definition of CoP, VCoP membership must include experts in CPD teaching, members must participate in collective learning, and social structures must be created within the community to assist in knowledge creation and sharing. VCoP is not limited to concepts; development of surgical simulators has enabled surgical skill transfer virtually [14]. Buckley recently reported FD bringing four dispersed medical faculty groups together online. She reported usefulness of a co-facilitator to “read
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引用次数: 0
Editorial - New Journal Title. 社论-新期刊标题。
Pub Date : 2023-01-01 DOI: 10.1080/28338073.2023.2202094
Robin Stevenson
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引用次数: 0
Development of a European Centre of Excellence (Coe) for Research in Continuing Professional Development (UPGRADE). 为持续专业发展(UPGRADE)研究建立欧洲卓越中心(Coe)。
Pub Date : 2023-01-01 DOI: 10.1080/28338073.2022.2160092
Catherine Fitzgerald, Giuseppe Aleo, Dyanne Affonso, Witold Orlik, Paulann Grech, Cristina García-Vivar, Nina Kilkku, Jane Wray, Aisling Culhane, Zoltán Balogh, Manuel Lillo-Crespo, Nigel Harrison, Mario Gazić, Thomas Kearns

The European Centre of Excellence (CoE) for Research in Continuing Professional Development (UPGRADE) is a pan-European network of researchers, clinicians, regulators, educators, and professional bodies, established in 2020 through a consensus group of experts, who defined its mission, vision, values, aims and objectives. The Centre's aim is to advance the science of Continuing Professional Development (CPD) for healthcare professionals through research and dissemination of best practices for CPD. Debate among UPGRADE partners and interchange of research data will yield best practices across countries to optimise quality CPD programmes. Collaboration, information exchange and communication among CPD experts will be facilitated through UPGRADE via an online Community of Inquiry (CoI). UPGRADE aims to evolve as a driving force network of academics and health professional leaders in research, education, professional regulation, and clinical practice whose collaborative work ensures quality and safe person-centred care. UPGRADE members are from 22 European countries, represented by strategic leaders in diverse sectors of health, policy, academia, and professional organisations. Three research-working groups constitute the pillars of UPGRADE, which addresses gaps in research, collect and create critical databases, and solidify the effectiveness of CPD.

欧洲持续专业发展研究卓越中心(CoE)是一个由研究人员、临床医生、监管机构、教育工作者和专业机构组成的泛欧网络,通过专家共识小组于2020年建立,他们确定了其使命、愿景、价值观、目标和目标。该中心的目标是通过研究和传播持续专业发展的最佳实践,推动医疗专业人员的持续专业发展科学。升级方案合作伙伴之间的辩论和研究数据的交换将在各国之间产生最佳做法,以优化高质量的持续发展规划。持续专业进修专家之间的合作、资讯交流和沟通,将透过网上查询社区(CoI)的UPGRADE得以促进。UPGRADE的目标是发展成为一个由研究、教育、专业监管和临床实践方面的学者和卫生专业领袖组成的推动力网络,他们的协作工作确保了质量和安全的以人为本的护理。升级小组成员来自22个欧洲国家,由卫生、政策、学术界和专业组织各部门的战略领导人代表。三个研究工作组构成了升级方案的支柱,旨在解决研究方面的差距,收集和创建关键数据库,并巩固持续专业发展方案的有效性。
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引用次数: 1
Outcomes and Observations of On-line CME Activities during the Pandemic. 大流行期间在线CME活动的结果和观察。
Pub Date : 2023-01-01 DOI: 10.1080/28338073.2023.2167286
Michela Fiuzzi

The COVID-19 pandemic created an environment where the majority of continuing medical education (CME) and continuing professional development (CPD) activities needed to be delivered digitally. Producing digital materials for 16 separate learning activities (four learning journeys for each of four topic areas) in 2021 provided challenges and raised points of interest and discussion for a small, Italy-based provider of CME and CPD. This study presents outcome metrics from four live, interactive webinars. A variety of promotional efforts, including the strategic use of social media, generated interest and participation; feedback from the European Accreditation Council for Continuing Medical Education standard questionnaire to participants provided rates of satisfaction; subject knowledge and self-reported competence was measured by responses to pre- and post-event and follow-up (after 3 months) questionnaires. Post-event analysis of processes prompted introspection on the learning journey outcomes and methods of analysis. This paper discusses these observations, including potential innovations for future activities (e.g. reconfiguring the e-learning platform to capture time spent on learning activities), and also discusses issues in learner behaviour that impact CME provision and evaluation.

COVID-19大流行创造了一个环境,大多数继续医学教育(CME)和持续专业发展(CPD)活动需要以数字方式提供。2021年,为16个独立的学习活动(四个主题领域中的每个领域有四个学习旅程)制作数字材料,为意大利一家小型CME和CPD提供商提供了挑战,并提出了兴趣点和讨论点。本研究展示了四个现场互动网络研讨会的结果指标。各种推广努力,包括策略性地使用社交媒体,产生兴趣和参与;欧洲继续医学教育认证委员会向参与者提供的标准问卷反馈提供了满意度;通过对事件前后和随访(3个月后)问卷的回答来测量受试者知识和自我报告的能力。对过程的事后分析促使了对学习过程、结果和分析方法的反思。本文讨论了这些观察结果,包括未来活动的潜在创新(例如,重新配置电子学习平台以捕获花费在学习活动上的时间),并讨论了影响CME提供和评估的学习者行为问题。
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引用次数: 0
The Impact of Multisource Feedback on Continuing Medical Education, Clinical Performance and Patient Experience: Innovation in a Child and Adolescent Mental Health Service. 多源反馈对继续医学教育、临床表现和患者体验的影响:儿童和青少年心理健康服务的创新。
Pub Date : 2023-01-01 DOI: 10.1080/28338073.2023.2202834
Yasser Saeed Khan, Mohamed Adil Shah Khoodoruth, Adeel Ghaffar, Abdullatif Al Khal, Majid Alabdullah
ABSTRACT This paper reiterates the importance of the role of multisource feedback (MSF) in continuing medical education/continuing professional development (CME/CPD) and its impact on doctors’ performance and patient experience globally. It summarises a unique initiative of robust utilisation of internationally recognised multisource feedback tools in an outpatient child and adolescent mental health service (CAMHS) in Qatar. The process involved the effective adoption and administering of the General Medical Council’s (GMC) self-assessment questionnaire (SQ), patient questionnaire (PQ), and colleague questionnaire (CQ) followed by the successful incorporation of these tools in CME/CPD. The original version of the PQ questionnaire and the instructions to the patient document were translated into Arabic through the blind back-translation technique. This initiative of introducing gold-standard MSF tools and processes into clinical practice, among other quality-improvement projects, has contributed to the improvement of service standards and doctors’ clinical practice. Patient satisfaction was measured through the annual patient experience analysis using the Experience of Service Questionnaire (ESQ) whereas changes in doctors’ performance were evaluated by comparing annual appraisal scores before and after implementation of this initiative. We have demonstrated that when MSF is obtained impartially and transparently using recognised and valid tools, it can improve patient experience and enhance doctors’ performance
本文重申了多源反馈(MSF)在继续医学教育/持续专业发展(CME/CPD)中的重要作用及其对全球医生绩效和患者体验的影响。它总结了卡塔尔门诊儿童和青少年心理健康服务(CAMHS)中强有力利用国际公认的多源反馈工具的独特举措。这一过程包括有效地采用和管理总医学委员会(GMC)的自我评估问卷(SQ)、患者问卷(PQ)和同事问卷(CQ),随后成功地将这些工具纳入CME/CPD。通过盲反翻译技术将PQ问卷的原始版本和患者文件的说明翻译成阿拉伯语。在其他质量改进项目中,这项将无国界医生的黄金标准工具和流程引入临床实践的倡议,有助于提高服务标准和医生的临床实践。通过使用服务体验问卷(ESQ)的年度患者体验分析来衡量患者满意度,而通过比较实施该计划前后的年度评估分数来评估医生绩效的变化。我们已经证明,当使用公认和有效的工具公正透明地获得无国界医生数据时,它可以改善病人的体验,提高医生的表现。
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引用次数: 0
Continuing Medical Education Outcomes are Much More Than Statistical Significance. 继续医学教育的效果远高于统计学意义。
Pub Date : 2023-01-01 DOI: 10.1080/28338073.2023.2236893
Katie Stringer Lucero, Donald E Moore
Dear Editor, An article published by the Journal of CME in 2023 by Robles and colleagues [1] reports the results of an evaluation of a continuing education programme, a free live continuing education (CE) series of activities primarily for primary care advanced practice providers offered in 2019 by a medical education company (Practicing Clinicians Exchange) and discusses the potential value of pooled samples in comparison to paired samples in examination of percentage of correct responses preand post-continuing medical education (CME). The focus of the article is statistical significance and sample size. It is well known in the research literature that statistical significance alone is not sufficient to accept that a certain set of outcomes was the result of participation in a series of educational activities. Rather, it is now regarded as necessary to report effect size as well. The effect size is the magnitude of the difference between two groups, like the preand post-groups in this study [2–4]. Robles and colleagues [1] mention effect size but do not report it. We also would like to take a step back and challenge the field to think about preand post-assessment questions serving several purposes:
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引用次数: 0
Building Trust in Medical Use of Artificial Intelligence - The Swarm Learning Principle. 在人工智能的医疗应用中建立信任——群体学习原则。
Pub Date : 2023-01-01 DOI: 10.1080/28338073.2022.2162202
Joachim L Schultze

An avalanche of medical data is starting to be build up. With the digitalisation of medicine and novel approaches such as the omics technologies, we are conquering ever bigger data spaces to be used to describe pathophysiology of diseases, define biomarkers for diagnostic purposes or identify novel drug targets. Utilising this growing lake of medical data will only be possible, if we make use of machine learning, in particular artificial intelligence (AI)-based algorithms. While the technological developments and chances of the data and information sciences are enormous, the use of AI in medicine also bears challenges and many of the current information technologies (IT) do not follow established medical traditions of mentoring, learning together, sharing insights, while preserving patient's data privacy by patient physician privilege. Other challenges to the medical sector are demands from the scientific community such as "Open Science", "Open Data", "Open Access" principles. A major question to be solved is how to guide technological developments in the IT sector to serve well-established medical traditions and processes, yet allow medicine to benefit from the many advantages of state-of-the-art IT. Here, I provide the Swarm Learning (SL) principle as a conceptual framework designed to foster medical standards, processes and traditions. A major difference to current IT solutions is the inherent property of SL to appreciate and acknowledge existing regulations in medicine that have been proven beneficial for patients and medical personal alike for centuries.

大量的医疗数据开始堆积起来。随着医学的数字化和新方法,如组学技术,我们正在征服更大的数据空间,用于描述疾病的病理生理学,定义用于诊断目的的生物标志物或识别新的药物靶点。只有利用机器学习,特别是基于人工智能(AI)的算法,才能利用这一不断增长的医疗数据湖。虽然数据和信息科学的技术发展和机会是巨大的,但人工智能在医学中的应用也面临着挑战,目前的许多信息技术(IT)没有遵循既定的医疗传统,即指导、共同学习、分享见解,同时通过患者医生的特权保护患者的数据隐私。医疗部门面临的其他挑战是来自科学界的要求,如“开放科学”、“开放数据”、“开放获取”原则。需要解决的一个主要问题是如何引导IT部门的技术发展,以服务于完善的医疗传统和流程,同时使医学从最先进的IT的许多优势中受益。在这里,我提供群体学习(SL)原则作为一个概念框架,旨在促进医疗标准,流程和传统。与当前IT解决方案的主要区别在于SL的固有属性,即理解和承认几个世纪以来已被证明对患者和医务人员都有益的现有医学法规。
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引用次数: 0
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