Continuing Medical Education Research Articles

Significant improvement of physicians' knowledge and clinical practice: an opportune, effective, and convenient continuing medical education program on functional dyspepsia.

This cohort study aimed to explore the effect of a one-day online continuing medical education (CME) on the improvement of physicians' knowledge and clinical practice on functional dyspepsia (FD). Physicians were invited to participate in this CME via medical education applications. FD training videos made in advance were sent to participants via a weblink. Before and after training, participants were required to finish the FD knowledge test and provide case information of FD patients. McNemar test, Wilcoxon rank-sum test, Freidman test, Chi-square test, quantile regression, and generalized estimating equations (GEE) were used to perform statistical analysis. There were 397 of 430 (92.33%) physicians finished this CME program. The total score of the FD knowledge test after training was significantly higher compared with before training [488.3 (468.3-510.0) vs. 391.7 (341.7-450.0), p < 0.001]. Particularly, physicians from primary hospitals show more increase in total scores than physicians from secondary and tertiary hospitals. According to the GEE model, receiving this online training was an independent predictor of physicians' choice of upper gastrointestinal endoscopy in patients with FD [OR 1.73, 95%CI (1.09-2.73), p = 0.020], especially in PDS. Also, it was an independent predictor of physicians' choice of acid-suppressive drugs in patients with FD [OR 1.30, 95%CI (1.03-1.63), p = 0.026], especially in EPS and PDS overlapping EPS. This one-day online CME program effectively and conveniently improved physicians' knowledge and clinical practice, providing new ideas for future CME and facilitating precise clinical management of FD patients with different subtypes especially in primary hospitals.

Parkinson's Disease Psychosis and the Marketing of Pimavanserin.

In 2016, Nuplazid (pimavanserin) became the first FDA-approved treatment for Parkinson's Disease Psychosis (PDP). We explored the possibility that PDP was a term created to market Nuplazid. We examined trends in perceptions of psychosis in Parkinson's disease from the 1990s to 2020 through MEDLINE search term frequency, neurology textbooks, guidance from professional societies, Acadia annual reports, sponsored websites, and a sponsored meeting held by the National Institutes of Health (NIH). We analyzed continuing medical education (CME) activities on PDP and analyzed the connection between payments by the manufacturer of pimavanserin and prescriptions. Our analysis of nine sponsored CME activities reveals misleading themes, including: PDP is common, progressive, and not always drug-induced; there is no such thing as a benign hallucination, and psychotic symptoms always worsen; PDP increases mortality; and competing treatments are ineffective or dangerous while pimavanserin is safe and effective for treating PDP. Industry-sponsored CME was used to disseminate inaccurate and misleading marketing messages on psychosis related to Parkinson's disease. Some professional societies and some textbooks also resisted the PDP label. Reframing PDP as a unique condition is a typical example of condition branding. The establishment of PDP expanded the use of pimavanserin and is likely to have resulted in many avoidable deaths.

Neurocinema: Expanding a Multimodal Approach Across the Continuum of Medical Education (P7-7.004)

Neurocinema: Expanding a Multimodal Approach Across the Continuum of Medical Education (P7-7.004)

Online Survey Provides Insights into Neurologist Preferences Relating to the Consumption of Certified Continuing Medical Education Programming Relative to Other Educational Sources (P7-7.003)

Online Survey Provides Insights into Neurologist Preferences Relating to the Consumption of Certified Continuing Medical Education Programming Relative to Other Educational Sources (P7-7.003)

Understanding antibiotic knowledge, attitudes, and practices: a cross-sectional study in physicians from a Colombian region, 2023.

Antibiotic resistance has been identified as a global health threat. Knowledge, attitudes, and inappropriate prescription practices of antibiotics by physicians play a crucial role in this problem. In Colombia, research addressing this issue is scarce. A cross-sectional study involving 258 physicians was conducted. A scale with questions on sociodemographic aspects, level of education, satisfaction with antibiotic education received, and knowledge, attitudes, and practices was administered. The scale was designed for each item to be analyzed individually or as a total score ranging from 0 to 100 (0 being the lowest and 100 the highest). 31.5% of physicians rated the education received on antibiotics as fair to poor. The knowledge score was 80.1 (IQR 70.5-87.5); however, 25.2% agreed to some extent that amoxicillin is useful in treating most respiratory infections, and 15% agreed that antibiotics are effective in treating upper respiratory infections. Attitudes scored 80.2 (IQR 75.0-86.5), with 99% stating that bacterial resistance is a public health problem in Colombia, but only 56.9% considering it a problem affecting their daily practice. Practices scored 75.5 (IQR 68.8-81.2), and 71.7% affirmed that if they refuse to prescribe antibiotics to a patient who does not need them, the patient can easily obtain them from another physician. General practitioners were found to have lower scores in all three indices evaluated. The study reveals enduring misconceptions and concerning practices in antibiotic prescription, particularly among general practitioners. Enhancing knowledge necessitates the implementation of continuous medical education programs that focus on updated antibiotic guidelines, and resistance patterns. Fostering positive attitudes requires a culture of trust and collaboration among healthcare professionals. Practical enhancements can be realized through the establishment of evidence-based prescribing guidelines and the integration of regular feedback mechanisms. Moreover, advocating for the inclusion of antimicrobial stewardship principles in medical curricula is crucial, emphasizing the significance of responsible antibiotic use early in medical education.

Instructions for Obtaining Anesthesiology Continuing Medical Education (CME) Credit

Instructions for Obtaining A<scp>nesthesiology</scp> Continuing Medical Education (CME) Credit

Impostor phenomenon: Prevalence among 1st year medical students and strategies for mitigation

Impostor phenomenon (IP) is described as a pattern typified by doubting one's accomplishments and a persistent fear of being exposed as a fraud. These feelings of self-doubt are pervasive along the medical education continuum, beginning with medical students where IP has been associated with emotional stress, physical exhaustion, depression, and anxiety. We, therefore, conducted an interactive workshop with first-year medical students to educate them about the manifesting patterns and risk factors of IP and strategies to mitigate these feelings. The 60-min workshop began with participants voluntarily completing the Young Imposter Scale (YIS) followed by an interactive presentation that reviewed the literature related to IP and its prevalence in medicine. Participants were then assigned to small groups where they discussed three cases of IP in academia and the medical profession. Medical school faculty acted as facilitators and utilized pre-designed prompt questions to stimulate discussion. Students re-convened for a large group report out, where each group shared main discussion points. The session ended with facilitators discussing IP mitigation strategies that can be implemented at the individual, peer, and institutional levels. Participants were also invited to complete a post-workshop evaluation. Fifty first-year medical students participated in the session. A total of 49 (96 %) completed the YIS and post-workshop evaluation. Nineteen (40 %) participants obtained scores on the YIS to indicate a positive finding of IP. The percentage of female medical students meeting the threshold for IP was significantly higher (84 %, n = 41 vs 16 %, n = 7) than male medical students. The workshop was effective at identifying IP and associated risk factors and providing mitigation strategies, with 95.8 % of participants agreeing or strongly agreeing. In qualitative feedback, participants reported that the workshop was “very interactive”, “provided strategies to manage impostor syndrome” and “helped me become more vulnerable with my peers.” This workshop provided a novel interactive and effective method to increase medical students' awareness about IP which can be employed as a strategy to enhance student's wellness.

Assessment of Trichomoniasis Prevalence and Healthcare Provider Knowledge among Pregnant Women: A Study at Luweero General Hospital, Uganda

Trichomoniasis, a prevalent sexually transmitted infection caused by Trichomonas vaginalis, significantly impacts maternal and fetal health, particularly during pregnancy. This study investigated trichomoniasis prevalence and healthcare provider knowledge among pregnant women attending antenatal services at Luweero General Hospital in Uganda. A cross-sectional study involving 385 pregnant women was conducted, with vaginal swabs examined for T. vaginalis presence. Additionally, healthcare providers' knowledge regarding trichomoniasis was assessed. Results indicated a low prevalence (1.8%) of trichomoniasis among the study population. Notably, midwives and nursing aides demonstrated the highest levels of knowledge. The age group most affected was 16-25 years old. These findings highlight the importance of continuous medical education for healthcare providers and targeted interventions to increase awareness among pregnant women, ultimately mitigating the burden of trichomoniasis in maternal health. Keywords: Trichomoniasis, Trichomonas vaginalis, pregnant women, antenatal services, prevalence, healthcare providers, knowledge, Uganda, sexually transmitted infections, maternal health

Empathy in family medicine postgraduate education: A mixed studies systematic review

Purpose Empathy is an important construct in patient-physician relationships, particularly critical in family physicians’ daily practice. We aimed to understand how empathy has been conceived and integrated into family medicine postgraduate training. Materials and Methods Medline, PsyINFO, and Embase were searched in this systematic mixed studies systematic review. Two independent reviewers screened abstracts and full texts. Disagreements were solved through research team consensus-based discussion. Included studies were synthesized thematically. Results A total of 18 studies were included. Four themes were identified. (1) Empathy definition. Included studies stressed the cognitive component of empathy, paired either with a behavioural or an affective response. (2) Empathy modifiers. Starting residency right after medical school, having a role model, having high empathy levels before residency, having children, being married, and being exposed to patient involvement in education were found to have a positive impact on empathy. (3) Empathy-burnout relationship. Whereas greater burnout was related to lower empathy levels, excess empathy seems to favour burnout through ‘compassion fatigue.’ (4) Educational programs for empathy development. Five programs were identified: a communication workshop, a patient-led program, a mindfulness program, a family-oriented intervention, and an arts-based program. Conclusions Studies mostly measured the cognitive component of empathy. The moral component of empathy was underrepresented in the conceptualization of empathy and the development of educational interventions. Conflicting evidence exists regarding the decline of empathy levels during the family medicine residency. Longitudinal designs should be privileged when exploring the evolution of empathy levels across the continuum of medical education.

Seeking American Society of Clinical Oncology-Quality Oncology Practice Initiative (ASCO-QOPI) certification in a northern New England rural health system and cancer care network.

In 2006 following several years of preliminary study, the American Society ofClinical Oncology (ASCO) launched the Quality Oncology Practice Initiative (QOPI). This cancer-focused quality initiative evolved considerably over the next decade-and-a-half and is expanding globally. QOPI is undoubtedly the leading standard-bearer for quality cancer care and contemporary medical oncology practice. The program garners attention and respect among federal programs, private insurers, and medical oncology practices across the nation. The MaineHealth Cancer Care Network (MHCCN) has undergone expansive growth since 2017. The network provides cancer care to more than 70% of the cases in Maine in a largely rural health system in Northern New England. In fall 2020, the MHCCN QOPI project leadership, following collaborative discussions with the ASCO-QOPI team, elected to proceed with a health system-cancer network-wide QOPI certification. Key themes emerged over the course of our two-year journey including: (1) Developing a highly interprofessional team committed to the project; (2) Capitalizing on a single electronic medical record for data transmission to CancerLinQ; (3) Prior experience, especially policy development, in other cancer-focused accreditation programs across the network; and (4) Building consensus through quarterly stakeholder meetings and awarding Continuing Medical Education (CME) and American Board of Medical Specialists (ABMS) Maintenance of Certification (MOC) credits to oncologists. All participants demonstrated a genuine spirit to work together to achieve certification. We report our successful journey seeking ASCO-QOPI certification across our network, which to our knowledge is the first-of-its-kind endeavor.

Virtual Learning Decreases the Carbon Footprint of Medical Education.

The environmental impact of holding in-person academic conferences and continuing medical education (CME) programs can be significant. In-person conferences provide a unique social and professional platform to engage in networking and foster professional development; however, there is an opportunity for hybrid and virtual platforms to provide CME for broader audiences looking to improve their clinical skills and strengthen their knowledge base. This study seeks to describe the reduction in carbon emissions associated with a webinar hosted by an online dermatology-focused medical education platform. This cross-sectional study used the location of deidentified virtual attendees of a webinar to predict the carbon emissions produced if attendees had instead traveled to the location of the most recent Integrative Dermatology Symposium (Sacramento, CA). Following collection of each virtual attendee's location, the mode of transportation was predicted on the basis of each participant's distance to the conference. The estimated carbon emissions were calculated for 576 participants. The total estimated, unadjusted carbon emissions for both attendees predicted to fly or drive was 370,100kg CO2. The emissions produced per participant from those expected to fly to an in-person CME after adjusting for all additional passengers on every flight were 4.5kg CO2. The emissions produced per participant from those expected to drive were 42.7kg CO2. The use of a virtual CME webinar led to a significant reduction in travel-related carbon dioxide emissions when compared to running the same program in-person event. When accounting for all passengers traveling via plane on any flight, driving to an event produced more emissions per participant than flying.

An Internal Medicine Learning Collaborative Facilitating a Virtual Continuing Medical Education Program in Guyana and the Wider Caribbean During the COVID-19 Pandemic.

To collaborate and share medical knowledge between US and Caribbean physicians during the COVID-19 pandemic via a free online continuing medical education (CME) series. Method: This was a multi-institution collaborative effort between the Southern Regional Area Health Education Center and Cape Fear Valley Medical Center, both located in North Carolina, USA, and its Caribbean partners, the Guyana Medical Council and Ministry of Health, and the University of the West Indies Medical Alumni Association, Jamaica. The lecture series ran from July 2021 to October 2022. The Zoom (Zoom Video Communications Inc., San Jose, CA, USA) meeting platform was used for the monthly lectures on the fourth Thursday between 7 and 8 p.m. Eastern Standard Time (EST). Results: Analysis of program data from July 2021 through October 2022 (excluding December 2021) found 1,105 unique individuals engaged in the 15 continuing education sessions. The series had a cumulative total of 2,411 participants, with a mean session participation of 161 and a range of 94 to 299 participants per lecture. An outcome survey assessing the reasons for attendance identified that the most significant factors in their participation in the series were: a) the quality of educational content (83.21%), b) the ease of access and Zoom platform (81.76%), and c) the lectures being offered at no cost (61.31%), and 80.84% gained new medical knowledge leading to practice changes. Conclusion: The Internal Medicine Learning Collaborative (IMLC) model can be easily replicated by following the steps outlined. It overcomes barriers such as travel and quarantine restrictions and is cost-effective to initiate and maintain. It allows physicians with access to resources and specialty training in the United States to share medical knowledge with colleagues in the developing world where such access may be limited, thus promoting health care and continuing education activity in their respective regions using freely available technologies.

Assessing Knowledge, Competence, and Performance Following Web-Based Education on Early Breast Cancer Management: Health Care Professional Questionnaire Study and Anonymized Patient Records Analysis.

Web-based learning activities are key components of continuing medical education (CME) for health care professionals (HCPs). However, the published outcomes of web-based educational interventions for early breast cancer (EBC) are limited. This study aims to objectively assess knowledge, competence, and performance among HCPs following participation in 2 EBC-focused CME activities and to identify the remaining educational gaps. We developed 2 CME-accredited web-based educational activities addressing high-risk EBC, including integration of shared decision-making to optimize patient care (touchMDT) and stratification for early identification of high-risk patients and novel treatment strategies (touchPANEL DISCUSSION). Knowledge, competence, and performance were assessed before and after the activities against an expanded outcomes framework (levels 1-5) using self-reported questionnaires and an analysis of anonymized data extracted from patient records. Six months after the launch of the activity, 7047 and 8989 HCP participants engaged with touchMDT and touchPANEL DISCUSSION, respectively. The overall satisfaction was 82% (a total score of 20.6 out of 25) for the touchMDT and 88% (a total score of 21.9 out of 25) for the touchPANEL DISCUSSION. For the evaluation of knowledge and competence (50 respondents before the activity and 50 learners after the activity), there was a significant increase in the mean number of correctly answered questions from pre- to postactivity (touchMDT: median 4.0, IQR 3.0-5.0 to median 5.5, IQR 4.0-7.0; mean 4.00, SD 1.39 to mean 5.30, SD 1.56 and touchPANEL DISCUSSION: median 4.0, IQR 4.0-5.0 to median 6.0, IQR 5.0-7.0; mean 4.32, SD 1.30 to mean 5.88, SD 1.49; both P<.001). A significant improvement in self-reported performance (50 respondents before the activity and 50 learners after the activity) was observed in a combined analysis of both activities (median 3.0, IQR 2.0-3.0 to median 4.0, IQR 3.0-5.0; mean 2.82, SD 1.08 to mean 4.16, SD 1.45; P<.001). Patient record analysis (50 respondents before the activity and 50 learners after the activity) showed that the HCPs used a range of measures to determine EBC recurrence risk and revealed no significant differences in adjuvant therapies used before and after the activity (P=.97 and P>.99 for Ki-67 <20% and Ki-67 ≥20% tumors, respectively). The remaining educational gaps included strategies for implementing shared decision-making in clinical practice and the use of genetic and biomarker testing to guide treatment selection. Brief, web-based CME activities on EBC were associated with an improvement in HCP knowledge, competence, and self-reported performance and can help identify unmet needs to inform the design of future CME activities.

Evaluation of Critical Care Nurses' Compliance with the External Ventricular Drain Care Bundle for Critically ill Patients at Kenyatta National Hospital

ntroduction: The External Ventricular Drain (EVD) care bundle involves insertion, maintenance, troubleshooting, and monitoring for issues related to EVD, which is primarily the responsibility of nurses. Despite significant efforts to address external ventricular drain-related infections (ERIs) in CCUs and other critical care units, current studies suggest a high prevalence rate of external ventricular-related infections, particularly in LMICs and low-resource settings. Material and Method: A mixed-method study was conducted at KNH Critical Care Units with a sample of 81 nurses. Data analysis of Quantitative continuous data was summarized using medians and interquartile ranges, and Categorical data was summarized using frequencies and proportions. Qualitative data was analyzed using manual thematic analysis. Results: Most respondents were between 30 and 40 years old, 43.2%, females were 75.3%, higher diplomas were 54.3%, and 4.9% specialized in EVD care. 48.1% had good knowledge of the EVD care bundle, 46.9% had fair knowledge, and 5% had poor knowledge. Binary logistic regression and chisquare tests showed no factors associated with knowledge of the EVD care bundle (P&gt;0.05 chi-square). A basic diploma and no specialization in EVD care were associated with higher odds of a poor or fair knowledge of the EVD care bundle. Conclusion: Most nurses exhibited fair practice of EVD care bundle but Lacked continuous medical education on EVD care, poor supervision and feedback on EVD care practice, and guidelines on EVD care not being easily accessible and understandable emerged as substantial perceived barriers to EVD care bundle utilization.

Barriers for continuous medical education: a cross-sectional questionnaire study among Danish GPs.

GPs' participation in continuous medical education (CME) is essential for patient care, GPs' wellbeing, and healthcare expenditure. However, one-quarter of Danish GPs did not use their reimbursement for CME in 2022. Knowledge of barriers for participating in CME is limited. To analyse the barriers GPs face to participation in CME, and patterns in perceived barriers. A cross-sectional questionnaire study design was used. The study population comprised all 3257 GPs in Denmark who, in May 2023, were registered as entitled to reimbursement for CME. The response rate was n = 1303/3257 (40%). Based on a question about use of CME, the responders were divided into 'frequent', 'partial', and 'seldom' users. Partial and seldom users answered questions about barriers related to CME (n = 726). The presence of barriers was quantified, and a latent class analysis (LCA) was used to stratify GPs according to their barrier patterns. The most frequent barriers were as follows: too busy (67%); fully booked courses (45%); and no substitute or locum doctor (39%). Based on the LCA, we found three distinctive patterns, clustering around the following: GPs from clinics with no tradition for CME (class 1, 17%); GPs who used time on professional work outside clinic (teaching, organisational work) (class 2, 43%); and GPs who were personally or professionally affected (class 3, 40%). Singled-handed and male GPs were slightly overrepresented among seldom users. We have identified barriers for CME. We found three different profiles of GPs who perceived different patterns of barriers. Identified patterns in barriers should be considered in future CME initiatives.

The occupational stress and lifestyle of anesthesiologists living in the southern district of Tamil Nadu- A pilot questionnaire-based survey

A pilot questionnaire-based method was used to assess the qualitative data on work-related stress, family spending time and to evaluate the usefulness of this survey in managing their stress in their own feasible way among the anesthesiologists living in Tamil Nadu, Southern India.It was a cross-sectional, confidential survey conducted using a questionnaire method. It consisted of 15 questions under four headings prepared and handed over personally to 100 anesthesiologists who attended the State-level Anesthesiology Continuing medical education (CMEs), conducted in two districts of the southernmost part of Tamil Nadu. All the questions had a minimum of three multiple-choice options. They were subdivided into four sections: a) Questions on Demographic profile, b) Questions on assessment of time spent with family members: travel time, c) Questions on the assessment of personal time spent: hobbies, recreational activities, exercise, and habits of addiction d) Questions to assess the work pressure.Seventy anaesthesiologists (70%) responded to the survey. The mean age of the participants was 39.5(12.2) years. Among them, 14.3% (10) had diabetes, and 11.4% (8) had hypertension young. 24.3% (17) had&amp;#62;12 duty hours. Most of them spend (34.3%; 24) only 1-2 hours per day with family. Only 15.6% (5) exercise &amp;#62; 5 hours a week. Fifty percent of the participants were stressed during the first case of death on the table (DOT), only 17% handled with confidence and were not stressed, but 33% were stressed and did not sleep well for a few days. The overall stress levels were 61.4%. Forty-two percent (42.8%; 30) have addictive habits such as smoking and drinking alcohol. Our questionnaire-based study helped the responded Anaesthesiologists realize the amount of work-related stress, personal time, and family time is inadequate. At the end of the survey, most wanted to change their lifestyle and spend valuable family and me time for the rest of their life.

Social Media Continuing Medical Education: Next Steps

Conference Education Session Report Speakers Cindy van Dijk, Principal, Scientific Communications Allison Kickel, President and Founder, Bonum Continuing Education

Harvard Medical School Global Mental Health: Trauma and Recovery Course: What is the Global Impact? Three Year’s Results

Purpose: This paper describes and documents an innovative blended learning Global Mental Health: Trauma and Recovery certificate training course. This course combines a two-week face-to-face training in Orvieto, Italy with a five-month follow-up online virtual training as a learning experience for global health care practitioners. Continuing medical education (CME) accreditation is offered upon completion. This course utilized an innovative blended learning model with a community of practice approach, a combination of lectures and discussions, and online in-depth group case study discussions. Methodology: Data was collected by self-reported anonymous evaluation by participants of three continuous years of the CME Global Mental Health: Trauma and Recovery certificate training course sponsored by Harvard Medical School. One hundred fifty-five participants (n= 39 in 2011; n = 57 in 2012; n=59 in 2013) underwent a pre- and post-course evaluation to determine sustained confidence in performing medical and psychiatric care to traumatized patients and communities, as well as to determine their learning of the Global Mental Health Action Plan (GMHAP). Results: Over the course of three independent years, a total of 155 participants were evaluated. There was evidence for significant improvement in their confidence levels in all clinical areas (diagnosis; treatment of trauma; use of psychotropic medication) when comparing baseline to completion of the six-month course. All ten dimensions of the GMHAP and nine medical and psychiatric aspects of treatment revealed significant improvement in confidence levels. Regression analysis also indicated similar results after the adjustment of demographic covariates. Physicians and participants with mental health and social work background had significantly higher confidence. Participants who were MD’s or psychiatrists had higher confidence in most of the categories of confidence except for self-care, understanding culture, collaboration, and policy and financing. The model showed no difference in learning based upon gender and level of development of country of origin. Conclusion: The evaluation of this blended learning CME program provides evidence of significant enhancement of clinical practice and planning skills in health care practitioners working with highly traumatized patients and communities worldwide. This successful training over the past 18 years has gone far to achieve the health and mental health capacity building as requested by the Ministers of Health from post-conflict societies in the historic Rome meeting in 2004.

Instructions for Obtaining Anesthesiology Continuing Medical Education (CME) Credit

Instructions for Obtaining A<scp>nesthesiology</scp> Continuing Medical Education (CME) Credit

Investigation on the Different Needs of Practicing Doctors for Continuing Medical Education under the Three-Level Medical System in China

Investigation on the Different Needs of Practicing Doctors for Continuing Medical Education under the Three-Level Medical System in China