By Craig Campbell, MD and Joseph Szot, MD, Column Editors and Authors
As in every issue, Dr’s. Campbell and Szot have curated an important selection of articles for your review. These articles offer significant learnings in key topics of the day that will enhance your knowledge and practice.
Family Physician Quality Improvement Plans: A Realist Inquiry Into What Works, for Whom, Under What Circumstances.
Roy M, Lockyer J, Touchie C.
J Contin Educ Health Prof. 2023 Summer 01;43(3):155-163. doi: 10.1097/CEH.0000000000000454. Epub 2022 Jul 6. PMID: 3763867
In this article, the authors used a realist evaluation to explore the relationships between outcomes, mechanisms and contextual factors on the impact of family physician quality improvement plans as part of a national multisource feedback (MSF) program. The authors worked backwards from a report summarizing the conversation between a facilitator and the 50 participating family physicians to determine the relationship between action plan completion, the MSF ratings and comments and prescribing data. They describe two patterns: physicians who implemented all their plans within 6 months after receiving feedback and physicians who were not able to implement any plans. Key variables in implementation focused on the consistency of messaging, reviewing data prior to facilitation and constructing plans with the facilitator. This article identifies important lessons related to the importance of the interplay between resources, reasoning, and risk factors for dyscompetence.
On the advantages and disadvantages of virtual continuing medical education: a scoping review.
Cheng C, Papadakos J, Umakanthan B, Fazelzad R, Martimianakis MAT, Ugas M, Giuliani ME.
Can Med Educ J. 2023 Jun 27;14(3):41-74. doi: 10.36834/cmej.75681. eCollection 2023 Jun.
PMID: 37465741 Free PMC article. Review.
In this article the authors report on the outcomes of a scoping review that sought to synthesize the advantages and disadvantages of virtual CME (VCME) and establish the impact of VCME on inequities that physicians face along the intersections of gender, race, and location of practice. There were 282 studies included in the review. The advantages of VCME included, among others, convenience, favorable learning formats, collaboration opportunities and its effectiveness in improving knowledge and clinical practice. The disadvantages focused on technological barriers, costs and lack of sufficient technological skills. This review noted that VCME was most common in general/ family practice for physicians practicing in suburban settings. Only a minority of reports reported on gender (35%) or race (4%). There are potential future considerations for research in understanding how VBME affects vulnerable populations.
Asynchronous e-learning with technology-enabled and enhanced training for continuing education of nurses: a scoping review.
Kimura R, Matsunaga M, Barroga E, Hayashi N.
BMC Med Educ. 2023 Jul 13;23(1):505. doi: 10.1186/s12909-023-04477-w.
PMID: 37442970 Free PMC article. Review.
In this article, the authors report on a scoping review aimed to examine the technologies used in asynchronous e-learning for the continuing education of clinical nurses and their modes of delivery and effectiveness. Sixty articles met the inclusion criteria. Since 2017 there was a noticeable trend toward using diverse technology-enabled and enhanced training (TEET) options, such as interactive online modules (25 articles) and video modules (25 articles). The most commonly used enhancing technologies were scenario-based learning (nine articles), resource access (eight articles), computer simulation or virtual reality (three articles), and gamification (three articles). Among the outcomes, knowledge acquisition was the most commonly examined outcome (41 articles).
The authors reflect on the range of interactive technology-enabled and enhance training options but identified the need for objective outcome measures to determine the effects of such learning methods on knowledge acquisition and behavioral changes.
Continuing professional development (CPD) system development, implementation, evaluation and sustainability for healthcare professionals in low- and lower-middle-income countries: a rapid scoping review.
Merry L, Castiglione SA, Rouleau G, Létourneau D, Larue C, Deschênes MF, Gonsalves DM, Ahmed L.
BMC Med Educ. 2023 Jul 6;23(1):498. doi: 10.1186/s12909-023-04427-6.PMID: 37415150 Free PMC article. Review.
The authors conducted a rapid scoping review to map and synthesize what is known regarding the development, implementation, evaluation and sustainability of CPD systems for healthcare professionals in Low and lower -middle income countries (LLMICs). Fifteen articles published between 2011 to 2021 and 23 grey literature sources were included for data abstraction with the majority of the articles from Africa followed by South and Southeast Asia and the Middle East. CPD systems for both nurses and physicians required leadership and support from key stakeholders including government bodies and healthcare professional organizations. The authors promote the importance of a guiding framework, present in many national CPD accreditation systems, as an essential element for the development, implementation and sustainability of a CPD system in a LLMIC.
Teaching LGBTQ+ Health, a Web-Based Faculty Development Course: Program Evaluation Study Using the RE-AIM Framework.
Gisondi MA, Keyes T, Zucker S, Bumgardner D.
JMIR Med Educ. 2023 Jul 21;9:e47777. doi: 10.2196/47777.PMID: 37477962
The authors describe a program evaluation of a massive open online faculty development course created by the Stanford School of Medicine that was designed to teach faculty about LGBTQ+. Using the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework, the authors provided data in each of the 5 domains, including evidence for learning and likelihood of practice change. Thematic analysis of open-text responses on course evaluations were conducted. Although course participation was deeded modest (1782 learners – 27.9% physicians) there was median change for the 38.1% of participants who completed pre-post tests was 30%. Most participants indicated an intention to change clinical or teaching practices. Once established, maintenance costs are minimal and the content can be further developed. This article may be instructive to CME offices considering the development of massive on-line courses.
Reading Between the Lines: Navigating Nuance in Medical Literature to Optimize Clinical Decision-Making and Health Care Outcomes.
Nelinson D, Ko L, Bass BG.Adv Med Educ Pract. 2023 Oct 19;14:1167-1176. doi: 10.2147/AMEP.S427663. eCollection 2023. PMID: 37877132 Free PMC article. Review.
The authors of this review article performed a PubMed search to answer the question, what are the challenges affecting the interpretation of clinical trial results reported in the literature that may adversely impact clinical decision making and patient outcomes as well as how these challenges may be overcome? Results of this review revealed it remains challenging for readers to fully appreciate the nuances affecting accuracy, utility and applicability of reported data and there is opportunities for future continuing professional development in this area. The objective of the article is to aid, new or aspiring or experienced practitioners in critically assessing the medical literature.
Effect of a Workshop to Break the Bias Habit for Internal Medicine Faculty: A Multisite Cluster Randomized Controlled Study.
Carnes M, Sheridan J, Fine E, Lee YG, Filut A.
Acad Med. 2023 Oct 1;98(10):1211-1219. doi: 10.1097/ACM.0000000000005271. Epub 2023 May 23. PMID: 37756500 Clinical Trial.
In this article the authors report on a multisite cluster randomized controlled study with clustering at the level of divisions within departments of medicine and participant level responses. They sought to determine the effectiveness of a single, three-hour workshop in helping department of medicine faculty overcome implicit stereotype-based bias and in improving the climate of the working environment. At 3 months, the intervention vs control divisions showed greater increase in personal bias vulnerability, bias reduction self-efficacy and taking action to reduce bias. The workshop had no effect on climate or burnout but slightly increased perception of respectfulness in division meetings. Results of this study should give confidence to those designing diversity interventions for faculty in academic medical centers, that a single workshop appears to have no harm and may have benefit in empowering faculty to break the bias habit.
From Battles to Burnout: Investigating the Role of Inter-physician Conflict in Physician Burnout.
Amick AE, Schrepel C, Bann M, Watsjold B, Jauregui J, Ilgen JS, Lu DW, Sebok-Syer SS.
Acad Med. 2023 Sep 1;98(9):1076-1082. doi: 10.1097/ACM.0000000000005226. Epub 2023 Apr 10.
PMID: 37043749
The authors of this study had a goal to explore the social processes and interpersonal interactions surrounding inter-physician conflict (I-PC) and their impact. Using conversations regarding admission between internal medicine and emergency medicine as a lens to explore IP-C in clinical practice. Using constructivist grounded theory to explore interpersonal and social dynamics of I-PC. The authors interviewed residents and attending physicians about how engaging in I-PC led to personal and professional harm. Specifically, they described it resulting in emotional distress, demoralization, diminished sense of professional attributes and job dissatisfaction. They also described how emotional residue primed the workplace for future conflicts. The authors concluded that I-PC may represent a serious yet underrecognized source of harm, not only to patient safety but also to contributing to physician well-being.
Virtual Worlds Technology to Enhance Training for Primary Care Providers in Assessment and Management of Posttraumatic Stress Disorder Using Motivational Interviewing: Pilot Randomized Controlled Trial.
Manuel JK, Purcell N, Abadjian L, Cardoos S, Yalch M, Hill C, McCarthy B, Bertenthal D, McGrath S, Seal K.
JMIR Med Educ. 2023 Aug 28;9:e42862. doi: 10.2196/42862.PMID: 37639299
In this study the authors sought to evaluate two training modalities for primary care physicians with regards to patients with PTSD. The study was a pilot randomized trial of a synchronous Virtual Worlds (a virtual world where learners immersed as avatars) versus and asynchronous web based training on PTSD and motivational interviewing (MI). results revealed that the VW training platform achieved larger gains in MI and in discussing pharmacotherapy and psychotherapy for PTSD. Both the web based and VW training led to increase in PTSD knowledge and participants self-confidence. VW training is synchronous and new for many learners requiring more time, facilitation and technical support.
Craig Campbell, MD is Director of Curriculum, Faculty of Medicine, University of Ottowa. Joseph Szot, MD is the Associate Dean for CME and Integrative Education, Carver College of Medicine, University of Iowa.
