Column Editors: Craig Campbell, MD and Joseph Szot, MD
This issue, our editors have selected articles that address some of the most controversial and challenging topics of the day
Teaching the Teachers: Development and Evaluation of a Racial Health Equity Curriculum for Faculty. Falusi O, Chun-Seeley L, de la Torre D, Dooley DG, Baiyewu M, Gborkorquellie TT, Merrill CT, Davis E, Ward MC. MedEdPORTAL. 2023 Mar 28;19:11305. doi: 10.15766/mep_2374-8265.11305. eCollection 2023. PMID: 36999061 Free PMC article. Review.
These authors describe the development of curriculum to support faculty to teach about the impact of racism on health and to model the principles of health equity. The curriculum was designed based on a literature review and needs assessment. The four synchronous virtual 1-hour sessions described in the article utilized a variety of educational strategies and covered topics on the history of racism, racism in health care, interacting with trainees and colleagues, and racial equity in policy. Evaluation consisted of surveys at the beginning and end of the curriculum and a survey after each session which demonstrated the self-reported impact of the curriculum.
Designing and Building a Portfolio of Individual Support Resources for Physicians. Brazeau CMLR, Trockel MT, Swensen SJ, Shanafelt TD. Acad Med. 2023 May 23. doi: 10.1097/ACM.0000000000005276. Online ahead of print. PMID: 37220390
The authors discuss the importance of health care organizations optimizing the work environment by providing support for individual clinicians using a variety of approaches, including mentoring, group-based peer support, individual peer support, coaching, and psychotherapy. They discuss the distinct benefits and complementary aspects of each of these approaches. Individuals may utilize different methods at different career stages to address different challenges. The authors argue for the development of a stepped care model using a population health approach as a potential cost-effective way to promote mental health and prevent occupational distress and general psychiatric symptoms.
Professional Coaching as a Continuing Professional Development Intervention to Address the Physician Distress Epidemic. Boet S, Etherington C, Andreas C, Denis-LeBlanc M. J Contin Educ Health Prof. 2023 Apr 1;43(2):126-132. doi: 10.1097/CEH.0000000000000450. Epub 2022 Jun 14. PMID: 37249344
The authors discuss and suggest that coaching should be considered as both a continuing professional development intervention as well as an integral part of a balanced and proactive solution to physician distress and burnout. Unlike other interventions, coaching is intended to help individuals gain clarity in their life, rather than to treat a mental health condition or to provide advice, support, guidance, or knowledge/skills. Although coaching has been shown to enhance performance and reduce vulnerability to distress and burnout, it has yet to be systematically implemented in medicine. By empowering physicians to discover and implement solutions to challenges, regain control over their lives, and act according to their own values, coaching can position physicians to become leaders and advocates for system-level change, while simultaneously prioritizing their own well-being.
Using Administrative Data in Primary Care to Evaluate the Effectiveness of a Continuing Professional Development Program Focused on the Management of Patients Living With Obesity. Zevin B, Morkem R, Soleas E, Dalgarno N, Barber D.J Contin Educ Health Prof. 2023 Apr 1;43(2):104-108. doi: 10.1097/CEH.0000000000000445. Epub 2022 Jun 14. PMID: 37249343
The article describes the development of an interdisciplinary CPD program focused on practical approaches to the management of patients living with obesity. Utilizing a self-reported survey and health administrative data, 94% of participants reported changes to their knowledge, comfort, and confidence (Kirkpatrick Level 2), as well as expected change in their future behaviour (Kirkpatrick Level 3) following the CPD program. However, there was no detectable changes in clinical practice(level 4). The authors discuss options to enhance the evaluation of Level 4 outcomes utilizing students of the effectiveness of CPD interventions.
Defining Scholarship for Today and Tomorrow. Milner RJ, Flotte TR, Thorndyke LE. J Contin Educ Health Prof. 2023 Apr 1;43(2):133-138. doi: 10.1097/CEH.0000000000000473. Epub 2022 Dec 21. PMID: 36728995 Review.
In this article, the authors describe the historical context of the definition of scholarship and their institution’s process to construct their own definition of scholarship with three essential elements: advancement of knowledge, dissemination for critical review, and impact on a discipline, practice, or community. Application of this definition to team science and digital scholarship is also described. Following a widespread continuing education initiative, implementation of the new definition within promotion and tenure processes of the medical, nursing, and graduate schools resulted in broad acceptance across the institution. This article provides lessons in leading an academic health sciences institution to reassess academic processes and is a resource for advancing the vigorous debate on the evolving meaning and evaluation of scholarship.
Designing a Road Map for Action to Address Bias and Racism Within a Large Academic Medical Center. Butts GC, Abner P, Hess L, Palermo AS, Cotilletta B, Gianelli A, Richardson LD. Acad Med. 2023 Jun 5. doi: 10.1097/ACM.0000000000005289. Online ahead of print. PMID: 37279452
In this article, the authors describe the Road Map for Action to Address Racism, developed by a 51-member Task Force to Address Racism, comprising faculty, staff, students, alumni, health system leaders, and trustees. Grounded in the principles of Collective Impact, the task force developed a set of 11 key strategies to effect system wide change. The strategies affected all aspects of the organization: business systems and financial operations, delivery of care, workforce development and training, leadership development, medical education, and community engagement. The authors describe Road Map implementation, currently in process, including the appointment of strategy leaders, evolution of a governance structure integrating stakeholders from across the health system, development of an evaluation framework, communication and engagement efforts, and process measures concluding with progress to date. Lessons learned include the importance of recognizing the work of dismantling racism as integral to, not apart from, the institution’s day-today work, and the need for specialized expertise and a significant investment of time to coordinate Road Map implementation. Going forward, rigorous assessment of quantitative and qualitative outcomes and a commitment to sharing successes and challenges will be critical to eradicating systems that have perpetuated inequities in the biomedical sciences and medicine and in the delivery of health care.
Faculty Development for Education for Sustainable Health Care: A University System-Wide Initiative to Transform Health Professional Education. Teherani A, Nicastro T, Clair MS, Nordby JC, Nikjoo A, Collins S, Irani A, Zakaras J, Weiser SD. Acad Med. 2023 Jun 1;98(6):680-687. doi: 10.1097/ACM.0000000000005137. Epub 2023 Jan 3. PMID: 36608345
The authors describe faculty development education for sustainable healthcare (ESHC or ESH). It began with a faculty development initiative providing training to across 6 health science campuses to integrate ESH into their courses using a train the trainer model. They trained 100 faculty and led to the integration of ESH into 99 courses and reaching over 7.000 learners. This program increased empowerment, awareness and knowledge about the climate crisis and built an ESH community of practice. This university-system wide program is a transferable model to other institutions interested in developing an ESH program.
A narrative review of course evaluation methods for continuing professional development: The case of paediatric and neonatal acute-care in-service courses in low and lower-middle income countries: BEME Guide No. 76. Gifford A, Philemon R, Halbert J, Hothersall EJ, Inglis R, Hart J, Byrne-Davis L, Thirsk J, Gifford H, Howells R, Weetch S, Prentice K, Jackson A, Kirkpatrick M. Med Teach. 2023 Jul;45(7):685-697. doi: 10.1080/0142159X.2022.2137010. Epub 2022 Nov 11. PMID: 36369858 Review.
This article is a narrative review of course evaluation methods in courses addressing pediatric and neonatal acute-care in lower-middle income countries. The narrative review provides a description of evaluation methods of course content, delivery and outcome measures based on the Kirkpatrick and CIPP (context, input process and product) models. They reviewed 5265 titles and 93 articles were included after full text review and quality assessment. Evaluation methods were described by the following: context, input, process, participant satisfaction, change in learning behavior, health systems infrastructure and patient outcomes. The authors conclude that course evaluations are difficult especially with low resources, but the review offers a framework to guide course organizers can do to provide well-conducted courses with consistent outcome measures and sustainable impact.
Strategies for specialty training of healthcare professionals in low-resource settings: a systematic review on evidence from stroke care. Habibi J, Bosch J, Bidulka P, Belson S, DePaul V, Gandhi D, Kumurenzi A, Melifonwu R, Pandian J, Langhorne P, Solomon JM, Dawar D, Carroll S, Urimubenshi G, Kaddumukasa M, Hamilton L. BMC Med Educ. 2023 Jun 16;23(1):442. doi: 10.1186/s12909-023-04431-w. PMID: 37328888 Free PMC article. Clinical Trial.
The authors conducted a systematic review using the PRISMA guidelines for systematic review and searched PubMed, Web of Science and Scopus. They searched articles that evaluated or described stroke care education for hospital-based professionals in low resource settings. They aimed to determine the most effective methods of delivering education for specialty stroke care in low-resource settings. They conclude that the train-the-trainer approach is probably the most effective for specialist stroke education. Technology maybe useful if resources are available to develop it and use it. Basic knowledge education should be considered at a minimum and further research should be conducted into the development of communities of practice.
Evaluation of Continuing Professional Development for Physicians – Time for Change: A Scoping Review. Hosseini S, Allen L, Khalid F, Li D, Stellrecht E, Howard M, Chan TM. Perspect Med Educ. 2023 Jun 2;12(1):198-207. doi: 10.5334/pme.838. eCollection 2023. PMID: 37274809 Free PMC article. Review.
In this scoping review article, the authors aim to identify evaluation techniques and to determine how these techniques are implemented and to determine the quality of these techniques. They performed a search of PubMed, Embase, Web of Science and other English publications. The findings revealed shortcomings in the evaluation of CPD programs. They found a lack of attention to intervention processes, unintended outcomes, and contextual factors. The findings draw attention to gaps in the evaluation techniques employed in physician’s CPD.
Professional Development in Health Sciences: Scoping Review on Equity, Diversity, Inclusion, Indigeneity, and Accessibility Interventions. Liblik K, Desai V, Yin G, Ng R, Maho S, Cohen N, Soleas EK. J Contin Educ Health Prof. 2023 Jun 29. doi: 10.1097/CEH.0000000000000519. Online ahead of print. PMID: 37389481
The authors of this article perform a scoping review of the available quantitative data on PD programs pertaining to equity, diversity, inclusion, indigeneity, and accessibility (EDIIA) and their effectiveness. A scoping review was performed of EBSCOhost, Medline, EMBASE and CINAHL databases. This article identified key themes in effective EDIIA based CPD which include, self-reflection, skills based training, field experience and continuous integration of persons with lived experiences
Building Resilient Healthcare Teams: Insights from Analogy to the Social Biology of Ants, Honey Bees and Other Social Insects. Cristancho S, Thompson G. Perspect Med Educ. 2023 Jun 26;12(1):253-260. doi: 10.5334/pme.1051. eCollection 2023. PMID: 37397182 Free PMC article.
The authors draw attention to the sociobiology analogy that healthcare teams might find useful when at times safety and adaptability may conflict. The three underpinning principles are communication, decentralization, and plasticity. Particular attention is placed on plasticity and that role swapping is adaptive rather than maladaptive when teams are facing disruptive situations. Infusing of plasticity in health care teams requires intentional training. To increase a team’s behavioral flexibility and boost resilience this training mindset, must be second nature.
Craig Campbell, MD is Director of Curriculum, Faculty of Medicine, University of Ottawa. Joseph Szot, MD is Associate Dean for CME and Integrative Education, University of Iowa Carver College of Medicine, Iowa.