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PubMed2006

Continuing medical education, continuing professional development, and knowledge translation: improving care of older patients by practicing physicians.

Many community-based internists and family physicians lack familiarity with geriatrics knowledge and best practices, but they face overwhelming fiscal and time barriers to expanding their skills and improving their behavior in the care of older people. Traditional lecture-and-slide-show continuing medical education (CME) programs have been shown to be relatively ineffective in changing this target group's practice. The challenge for geriatrics educators, then, is to devise CME programs that are highly accessible to practicing physicians, that will have an immediate and significant effect on practitioners' behavior, and that are financially viable. Studies of CME have shown that the most effective programs for knowledge translation in these circumstances involve what is known as active-mode learning, which relies on interactive, targeted, and multifaceted techniques. A systematic literature review, supplemented by structured interviews, was performed to inventory active-mode learning techniques for geriatrics knowledge and skills in the United States. Thirteen published articles met the criteria, and leaders of 28 active-mode CME programs were interviewed. This systematic review indicates that there is a substantial experience in geriatrics training for community-based physicians, much of which is unpublished and incompletely evaluated. It appears that the most effective methods to change behaviors involved multiple educational efforts such as written materials or toolkits combined with feedback and strong communication channels between instructors and learners.

Community Medicine↗
PubMed1998

Using the Delphi technique to identify the content and context of nurses' continuing professional development needs.

In order to identify and prioritize the development needs of medical and surgical nurses, their possible approaches to learning, and the contextual factors influencing their professional development, a Delphi survey was carried out using a panel of 28 participants. Current development needs included skills in essential clinical care, specialist nursing, changing roles, patient care management, research and practice development. Although there was ambivalence about changing nurses' clinical roles, participants expected roles to diversify in the future. The need for responsiveness to change was emphasized, as was the need to maintain current areas of expertise. Professional development activity could take many forms, but fostering an organizational climate in which development was inherent in everyday working practices was felt to be as valuable as formal course attendance. Restricting factors included lack of time, resources, support and recognition. The survey has enabled professional and practice development activities to be prioritized locally, and the method used could be readily applied to other settings.

Attitude of Health Personnel↗
PubMed2005

The new paradigm of continuing education in surgery.

Concerns regarding the shortcomings of traditional continuing medical education (CME) have led to widespread acceptance of the concept of continuous professional development (CPD). Continuous professional development focuses on the individual learning needs of physicians across the continuum of their professional careers and encompasses a broad range of educational activities. Continuous professional development activities of practicing surgeons should be integrated with the core competency of practice-based learning and improvement (PBLI), which involves a cycle of 4 steps-identifying areas for improvement, engaging in learning, applying new knowledge and skills to practice, and checking for improvement. The effectiveness of CPD and PBLI should be objectively evaluated by assessing their impact on surgeons' learning and performance and on patient care outcomes. A portfolio may be used to document CPD and PBLI activities and can serve as a valuable learning and assessment tool. It should contain information on the personal learning projects pursued by the surgeon. Continuous professional development of the entire surgical team and education of patients and their families need to be considered within the context of the surgeon's CPD efforts to positively affect patient care. Thus, a concept of global 360 degrees education should be embraced. Continuous professional development integrated with PBLI can help surgeons address their specific learning needs and play a pivotal role in surgeons' providing the best care to patients.

Education, Medical, Continuing↗
PubMed2002

Continuing Professional Development. Anaphylactic shock.

The causes of anaphylactic shock and presenting features are not clearly understood. In addition, the treatment of people suffering from anaphylactic or anaphylactoid reactions has not always been effectively provided. This article aims to rectify some of the current areas of concern, especially highlighting the recent work carried out by the Resuscitation Council (UK) on this subject (Resuscitation Council UK 1999/2001). After reading this article you should be able to: Explain the circulation of the blood and changes that occur during an anaphylactic reaction. Summarise the antigen/antibody mechanism especially in relation to allergic reactions. Describe the difference between anaphylactic and anaphylactoid reactions. Recognise the presenting signs and symptoms of anaphylaxis and shock. Describe the assessment and appropriate intervention for a patient suffering from an anaphylactic reaction. Explain what prevention/support services are available to suffers.

Anaphylaxis↗
PubMed2004

Design, delivery and evaluation of an email-based continuing professional development course on outdoor air pollution and health.

The authors designed an email-based discussion forum with the objective of promoting and supporting peer discussion on the health effects of outdoor air pollution, linked to a recently published review article. Clinical cases served as stimulus material and participants were provided with an online toolbox of resources. Message postings from 27 participants were most frequent (92) during the first of four weeks and lowest (17) during the second, suggesting that some participants were overwhelmed by the initial volume. Evaluation of short-term impact completed by 16 participants indicated that the course was successful in improving some participants' knowledge. Evaluation three months after course completion by 20 participants revealed an impact on clinical practice. As an alternative to email, requiring participants to visit a web page to view and submit postings may avoid problems related to volume of messages. Controlled delivery of small portions of information tied to specific self-directed tasks is also recommended.

Air Pollution↗
PubMed2003

Continuing professional development (CPD): GPs' perceptions of post-graduate education-approved (PGEA) meetings and personal professional development plans (PDPs).

BACKGROUND: Conventional post-graduate meetings-typically 'lunchtime' meetings outside practices-have been heavily criticized. Revalidation is also impending, and there has been associated pressure for the widespread introduction of personal development plans (PDPs). However, there is very little empirical evidence about the usefulness to GPs of different kinds of educational meeting or of PDPs. OBJECTIVES: Our aim was to assess the utility to GPs of different types of post-graduate meeting and PDPs. METHODS: A postal questionnaire was sent to 921 GP principals in three health authorities, who were asked to recall their most recent post-graduate education-approved (PGEA) meetings (practice-based and 'outside') and the latest major learning 'undertaken' in their PDP. RESULTS: A total of 698 GPs (76%) returned questionnaires. A substantial minority (208; 30%) had a PDP. Most had undertaken education recently [median time elapsed (weeks): meeting 'outside' practice, 4; 'practice-based', 5; PDP, 3]. Education had not changed clinical practice for many GPs ('practice-based' 39% reported no change; 'outside' meetings 50% and PDPs 57%). A change in practice after a practice meeting was related to relevance to everyday practice [disagree/neutral, agree, strongly agree odds ratios: 1.00, 4.22 (95% CI 2.1-8.6) and 5.9 (2.6-13.3), respectively], to lecturer factors (enthusiasm, summarizing important points, handouts) and to social enjoyment. PDPs were less likely to be perceived relevant to practice (practice-based meeting, 'outside' meeting, PDPs: 89, 87 and 72%, respectively), as a break from practice (54,72 and 18%), good socially (63, 72 and 15%), good for professional networking (54, 70 and 19%) and glad to have done it (84, 86 and 44%). Being glad to use a PDP was more likely if the learning was clinically relevant, a break from practice, and incorporated professional networking. CONCLUSION: Changes in practice after post-graduate meetings are not only related to clinical relevance and lecturer factors, but also to professional and social factors. PDPs may not be providing better learning opportunities or enjoyment than traditional meetings, although GPs who are glad to use PDPs incorporate clinical relevance, a break from practice and networking. Post-graduate tutors should probably continue to support and monitor the lecturer quality and clinical relevance of a balanced portfolio of both practice-based and 'outside' meetings.

Adult↗
PubMed2005

Continuing professional development: racial and gender differences in obstetrics and gynecology residents' perceptions of mentoring.

INTRODUCTION: Having a mentor during residency is often linked to greater success in professional development. The present study compares changes in the percentage of residents with mentors in 1999 and in 2004, while considering current residents' perceptions of their mentors, with particular attention focused on what role race and gender might play in resident-mentor interactions. METHOD: A survey was administered to 4, 721 residents who took the 2004 Council on Resident Education in Obstetrics and Gynecology in-training examination. Data are reported for respondents from four racial categories: white, African American, Hispanic, and Asian/Pacific Islander. Results were compared to those of a similar survey administered in 1999. Responses were analyzed by chi-square analysis and univariate analyses of variance. RESULTS: The response rate was 97%. Most residents (64.9%) reported having a mentor. White female residents were least likely to have a mentor. Compared to results from 1999, the percentage of residents with a mentor, and the percentage of residents with female mentors, has increased. For all residents, personal rapport, knowledge of the field, and similarity in professional interests were the three most important factors in choosing a mentor. The proportion of residents reporting explicit discussions about career options has declined since 1999. DISCUSSION: Ethnic minorities are more likely than white residents to have a mentor, and to report that their mentors provide helpful advice. Although the proportion of residents with a mentor has increased since 1999, the quality of the mentoring relationship is meeting resident expectations but not exceeding them.

Attitude of Health Personnel↗
PubMed2001

Continuing professional development: medico-legal aspects of epilepsy.

Generally protection against possible litigation and good clinical practice go hand in hand. Situations in which the law has special relevance for people with epilepsy, those who work with them, and their clinicians are reviewed with special reference to the topics of driving, employment, duties of social carers, the clinician's everyday role, the responsibilities of researchers and epilepsy and the criminal law. What constitutes professional negligence is discussed, with special reference to the United Kingdom. Clinicians are advised to think clearly, write clearly, communicate clearly and have a good relationship with their patients.

Automobile Driving↗
PubMed2000

Brief negotiation program for promoting behavior change: the Kaiser Permanente approach to continuing professional development.

BACKGROUND: Behavior change counseling is one of the most difficult and constant challenges faced by health providers. It has a significant impact on clinical outcomes as well as patient and provider satisfaction. By encouraging patients to participate in a partnership with health care professionals, Brief Negotiation offers techniques to motivate behavior change successfully. We review the key components of Brief Negotiation and describe how one large group model health maintenance organization was able to identify key staff members, develop educational opportunities and implement Brief Negotiation system-wide into standard care practices. OBJECTIVES: To expose a maximum number of health care professionals to a recommended model of behavior change counseling; to increase the satisfaction and confidence of health care professionals in counseling for behavior change; and to increase the likelihood of improved patient health outcomes. METHOD: Two departments created one-day, two-day, six-hour and one-to-two-hour skill-based programs targeted to physicians, nurse practitioners, care managers, clinical health educators, behavioral medicine specialists, physical therapists, pharmacists and medical assistants. Practice protocols, strategic departmental alliances and intranet sites complemented the educational interventions. RESULTS: Over 1000 health care professionals have been exposed to the Brief Negotiation model in over two years. A mailed survey to graduates of the one- and two-day programs indicated that 67% of physicians and 79% of other health professionals felt more confident about working with patients on behavior change after having attended the Brief Negotiation program. CONCLUSIONS: System-wide professional development requires multiple exposures to the Brief Negotiation model, considerable resources for curriculum development, training time and follow-up, and credible clinical trainers. Questions remain about the amount of training needed for long-term clinician behavior change and for improved health outcomes in patients.

Journal Article↗
PubMed2002

Continuing professional development: medico-legal aspects of epilepsy.

Generally protection against possible litigation and good clinical practice go hand in hand. Situations in which the law has special relevance for people with epilepsy, those who work with them, and their clinicians are reviewed with special reference to the topics of driving, employment, duties of social carers, the clinician's everyday role, the responsibilities of researchers and epilepsy and the criminal law. What constitutes professional negligence is discussed, with special reference to the United Kingdom. Clinicians are advised to think clearly, write clearly, communicate clearly and have a good relationship with their patients.

Anticonvulsants↗