Nutrition in Geriatrics-Focused Continuing Medical Education

Shining Light on the Sunshine Act

Guidelines by the European Federation of Neurological Societies (EFNS) subcommittee for Continuing Medical Education (CME) – modification 2003

Attitudes and policies about conflict of interest in medical education have evolved rapidly in the last several years. Temporally and conceptually, these changes have paralleled the rise of the relatively new field of behavioral economics in explaining commercial relationships. The traditional view of economics holds that in any transaction, all inputs and outcomes are simply the result of decisions by rational participants making choices that optimize their goals; however, the past decades have seen a reassessment of this “expected utility theory” with the growing awareness that unconscious biases and emotional factors profoundly affect behavior.1 The same insight has begun to influence how we think about medical education and the messages that are sent by and received from industry-sponsored speakers and programs. Because cardiology addresses the most common illnesses in developed societies and employs the most widely used and costly drugs and devices, these issues have been especially acute in this field. Response by Harrington and Califf see p 2228 Unquestionably, the drug and device industries make important contributions to the development of products that reduce the morbidity and mortality of cardiovascular disease. Industry is also a major source of both funding for and collaboration in cardiology research, and it provides substantial support for professional cardiology societies, topics that are beyond the scope of this report. But in the realm of teaching, whether of medical students, house officers, or practitioners, there is growing concern that educational activities should not be supported or influenced by companies whose profitability and very existence depend on the sales volume of the products they make.2 Our position that industry should not directly support educational programs is not ideologically driven. Rather, it is based on the expectation that medical knowledge can be transferred most efficiently and with the least distortion if those responsible for this …

Education: “The process or art of imparting knowledge, skill and judgment; Facts, skills and ideas that have been learnt, either formally or informally.” — Wikipedia 1 The term profession is applied to those persons who have specialized and technical skill or knowledge which they apply, for a fee, to certain tasks that ordinary and unqualified people cannot ordinarily undertake. The term derives from the Latin: “to swear (an oath) …” . — Wikipedia 2 Let’s consider how we as cardiovascular medicine specialists spend our days in the care of people with cardiovascular disease. In the office or making rounds in the hospital, we prescribe drugs and order diagnostic tests; in the noninvasive laboratory, we obtain and interpret images of the heart; in the electrophysiology and cardiac catheterization laboratories, we program and implant devices in patients. When antithrombotic and fibrinolytic drugs are administered, and primary percutaneous coronary intervention is done using balloon catheters and intracoronary stents, lives are saved among patients with acute myocardial infarction. Response by Avorn and Choudhry see p 2221 The mortality risk from heart failure decreases and quality of life increases from the proper and appropriate use of angiotensin-converting enzyme inhibitors and β-blockers. Lipid lowering through the use of statin drugs saves lives and reduces serious cardiovascular complications such as myocardial infarction and stroke when properly prescribed to patients with a variety of manifestations of atherosclerotic vascular diseases. According to a recent publication by Ford and colleagues,3 deaths due to coronary heart disease in the United States declined substantially from 1980 to 2000, resulting in >340 000 fewer deaths in 2000. The authors attributed approximately half of this decline to changes in cardiac risk factors and half to the application of evidence-based therapies. An underlying theme in all of this is that the pharmaceutical, biotechnology, and …

Women physicians are underrepresented in leadership positions across medical specialties. Understanding factors that improve women’s promotion metrics may lead to career and leadership advancement. This study examined if a woman-centered Continuing Medical Education (CME) conference is associated with differences in productivity metrics toward career advancement. The authors conducted a cross-sectional survey study of women physicians attending a national woman-centered CME conference for professional growth, wellness and networking in September 2019. The survey measured promotion metrics achieved in the year prior to the conference and compared them with previous attendees. Of 425 women attendees of the conference, 389 (91.5%) respondents completed the survey. Respondents were divided into two groups for analysis: first time (FT) attendees, and those that attended the conference previously (PV). In the year preceding the survey, PV attendees were more likely to have published a manuscript as first-author or co-author in a peer-reviewed journal (17.5% vs. 9.7%, p = 0.029), given a talk in their area of practice (48.3% vs. 27.9%, p < 0.001) and to have mentored at least one peer (40.8% vs. 27.5%, p = 0.009) and to have asked for a promotion (15.8% vs. 8.6%, p = 0.033) than FT. As compared to first-time conference attendees, women physicians who previously attended a woman-centered CME conference were more likely to achieve career performance metrics including publications and speaking engagements in the preceding year. This study demonstrated a positive association of Women-centered CME conferences in career advancement metrics for women in medicine and suggests further studies on this and other women-centered CME conferences.

A healthy lifestyle is fundamental for the prevention and treatment of cardiovascular disease and other noncommunicable diseases (NCDs). Investment in primary prevention, including modification of health risk behaviors, could result in a 4-fold improvement in health outcomes compared with secondary prevention based on pharmacological treatment. The American Heart Association (AHA) emphasized the importance of lifestyle in its 2020 goals for cardiovascular health promotion and disease reduction. In addition to defining “cardiovascular health” based on criteria for blood pressure and biochemical markers (lipids and glycemia), the AHA Strategic Planning Committee further identified lifestyle characteristics of central importance: nutrition, physical activity, smoking, and maintenance of a healthy body weight.1 The World Health Organization estimated that ≈80% of NCDs could be prevented if 4 key lifestyle practices were followed: a healthy diet, being physically active, avoidance of tobacco, and alcohol intake in moderation.2 To support healthy lifestyle initiatives, major changes are necessary at the societal level to improve population health. Numerous strategies might help to create a culture that promotes and facilitates healthy behaviors, including creating laws and regulations, mounting large-scale public awareness and education campaigns, implementing local community programs, and providing individual counseling.3 Physicians are uniquely positioned to encourage individuals to adopt healthy lifestyle behaviors: Approximately 80% of Americans visit their primary care physician at least once a year. Physicians directly communicate with their patients during clinical encounters across numerous settings, and research indicates that patients highly value recommendations provided by their physicians.4,5 However, data further indicate that lifestyle counseling does not routinely occur in physicians’ offices, thereby representing a lost opportunity. Physicians report that they perform lifestyle counseling during ≈34% of clinic visits.4 Patients, in turn, report an even lower frequency of physician lifestyle counseling. For example, obese patients reported receiving physical activity and …

Physicians-in-training are educated through the paradigm of competency-based medical education (CBME), which promotes progressive development of expertise. To better support CBME, the Accreditation Council for Graduate Medical Education (ACGME) introduced the Milestones assessment framework across all ACGME-accredited graduate medical education (GME) training programs.1,2 Milestones are behavioral descriptions of the developmental trajectory of trainees in the GME environment, which provide longitudinal and trajectory-based metrics along domains of physician competency. These metrics aim to promote lifelong learning and ensure residents and fellows are “ready for autonomous practice” at graduation. Yet, such “readiness for autonomous practice” at the completion of training does not equate with the completion of professional learning, nor does it preclude the development of further levels of expertise.

Introduction to Nutrition Education in Training Medical and Other Health Care Professionals

Background:There is a lack of data regarding the current state of lactation accommodations at continuing medical education (CME) events to guide best practice recommendations.Objective:To evaluate CME attendee attitudes, experiences, and preferences as it pertains to lactation support accommodations at CME events.Design:A cross-sectional study utilizing an electronic-based survey.Methods:Surveys were administered electronically to attendees of seven CME courses from August 2022 to October 2023, and de-identified data were collected to a secure database. Attitudes regarding lactation accommodations, personal preferences for lactation accommodations, and experiences with lactation at CME events were analyzed.Results:Of the 337 survey respondents, 169 had personal experience with lactation and 47 had experience with lactation at a CME course within the past 10 years. The majority of respondents agreed that lactation accommodations should be a priority (n = 264, 83%) and are a medical need (n = 285, 89%). Of those with recent experience lactating at a CME course, only 19% (n = 9) indicated adequate lactation accommodations were provided. Due to inadequate accommodations, 77% (n = 36) of respondents experienced decreased participation in the CME course content, 70% (n = 33) claimed fewer hours of CME credit, and 74% (n = 35) experienced decreased satisfaction in the CME course. Preferences for lactation accommodations included proximity to the meeting, audio–visual streaming of content, privacy, security, and signage supporting lactation in addition to an adequate designated space with access to an electrical plug and water supply.Conclusions:The current state of lactation accommodations at CME courses is inadequate and contributes to inequitable experiences for lactating participants. Course participants are supportive of lactating healthcare professionals at CME courses and recognize lactation accommodations as a priority. Further work is needed to inform and institute changes to lactation accommodations for healthcare professionals.

Training Generations of Clinician Educators: Applying the Novel Clinician Educator Milestones to Faculty Development

Considerable time and money are invested in continuing medical education (CME) for family physicians (FPs) but the effectiveness is uncertain. The participation of FPs as coordinators and teachers is not well known. The goal of this project was to describe the role of FPs in organizing and teaching CME events that are accredited for FPs. Information about accredited CME events occurring in Alberta and Nova Scotia was requested from universities, provincial chapters of the College of Family Physicians of Canada, and pharmaceutical companies. Location, coordinating site, organizing committee members, teaching faculty, and format were recorded from each event. The number and proportion of FPs involved in both organizing and teaching CME events accredited for FPs were calculated and compared. A total of 314 CME events were collected, comprising a total of 1,472 hours of CME. From the CME events collected, there were 1,730 organizing committee members and 1,647 teachers. FPs constitute 59% of the organizing committees and 17% of the teachers. Significant differences in the numbers of FP planners and teachers were related to organizing group, format, location, and expected audience composition. The accreditation requirement for FPs on organizing committees likely helps preserve a reasonable proportion of FP organizers but not teachers in FP CME. The proportions of true FP planners and teachers may actually be lower than planning documents indicate. Low level of family physician teachers in CME may be due to FPs' not selecting FP teachers, the FP teaching pool's being inadequate, or the organizing committee's being unaware of FPs who are knowledgeable in particular areas.

Air bubbles traveling upwards from within a liquid, burst at the free surface and eject droplets into the air. The liquid droplets produced from the bursting of air bubbles at the free surface of the ocean have long been considered as constituting a significant fraction of the marine aerosol production. This process plays an important role in the transfer of mass and energy between the ocean and atmosphere. The droplets are generated by two distinct mechanisms which characterize the drops as either `jet droplets' or `film droplets.' The goal of this study is to obtain statistical data about the size of these droplets produced by air bubbles bursting on a non-quiescent free surface and study effects of surfactant on the droplet distribution. Two different surface conditions are created by using "clean" water and a 0.4% v/v aqueous solution of Triton X-100 surfactant. A bubble field is created with air injected through an array of hypodermic needles arranged in a grid pattern and five different bubble production rates are studied for each surface condition. Measurements of the bubble diameters as they approach the free surface are obtained with diffuse light shadowgraph images. A laser-light high-speed cinematic shadowgraph system is employed to record and measure the diameters and motions of the droplets. The movies are processed on a custom-built MATLAB code which measures droplets as small as 100 &amp;mu;m to within 7% error. Droplets with diameters between 50 and 100 &amp;mu;m are also measured, but with lower accuracy. The droplet size distributions as a function of the production rate and surfactant conditions are reported. The results show a clear distinction between the droplet distributions obtained in clean water and the surfactant solution. A bimodal droplet distribution is observed for clean water with at least two dominating diameter peaks. For the surfactant solution, a single distribution peak is seen.

Introduction: The medical profession plays a crucial role in preventing and treating substance use disorders. However, the quality of addiction-focused medical education, considering only graduate medical education (GME) and continuing medical education (CME) programs, varies across countries. This study aimed to explore the variety of published programs and curriculum components in competency-based approach to addiction medicine education for physicians and to highlight key areas in this field. Methods: This study involves a systematic review of literature to identify quality standards for competency-based education in GME and CME related to addiction. Electronic databases were searched, including PubMed, EBSCO, SCOPUS, and Web of Science, for relevant key terms following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) methodology. Studies included any English language text addressing educational competency-based models and standards for education within GME or CME in the UA and European Union. The process included identifying, screening, and reviewing articles and studies for relevance. The goal was to delineate existing competency-based training programs and highlight quality standards in education and training for physicians in a field of GME and CME. Results: The result of this work led to the evaluation of curriculum topic standardization and agreement on core competencies to ensure that education in GME and CME is professionally consistent across states and universities. Our study included 55 articles describing models and standards for training programs in addiction medicine. In the final sample, articles that included specific information according to set criteria were included (n = 9). Conclusions: The description of specific competing interest educational evidence-based models and standards in GME and CME in addiction medical education is not sufficiently represented in published texts and is generally referred to general standards and models of individual institutions or universities.

Trends and Developments in Continuing Medical Education

Continuing Medical Education (CME) is crucial for the professional development of physicians and allied healthcare professionals, ensuring they maintain and update their skills to provide high-quality patient care. In Graduate Medical Education (GME) programs, CME supports the training of medical residents and fellows as they transition to independent practice. However, challenges in tracking, documenting, and verifying CME activities persist, hindering the assessment of trainees’ progress and the identification of learning gaps. This study analyzes the current state of CME tracking in GME programs, exploring the challenges faced by program directors, educators, and trainees. It aims to identify strategies for standardizing and improving CME tracking, including digital platforms, centralized databases, and needs assessments. By reviewing literature, case studies, and real-world experiences, the study provides insights and recommendations for optimizing CME management. The search yielded a diverse range of research approaches, encompassing commentary/opinion articles, conference reports, literature reviews, and tracking in GME. Ensuring activities are relevant, engaging, and effective in enhancing the overall educational experience of medical trainees. However, tracking, and documenting CME activities for trainees pose significant challenges due to the lack of a standardized system. This study aims to analyze the current state of CME tracking within GME programs, identify challenges, and propose strategies for improvement. By reviewing literature, case studies, and real-world experiences, the study will explore methods such as digital platforms and centralized databases to enhance CME tracking, ultimately improving medical education and patient care.