Continuing Education Of Health Professionals Research Articles

Outline for Empathy-Based Medical Education

Empathy has been recognized in recent years to play a central role for the successful practice of medicine. Hence, developing empathetic skills needs to be the underlying objective during the training of undergraduate medical students as well as in continuous education of health professionals. However, during the process of medical education, the quality of empathy that is naturally present within the student has been found to decline. The task is to achieve the process of learning medicine and at the same time preserve and foster the quality of empathy. Spontaneous learning based on one’s own interest, is a form of self-directed learning that taps the student’s sense of curiosity about the problem and concern for the patient. Knowledge is acquired in a case-centered manner. All evaluations to be done through case-based discussions. The textbooks in each subject are to be treated as knowledge repositories for choosing the topics that need to be learnt. The ‘self-directed spontaneous learning’ ensures creativity in approach to problems, optimum utilization of one’s time and avoids stress. The student’s connection with his or her own ‘inner self’ is crucial for a focused and creative mind; therefore, its cultivation through the process of meditation is important. Empathy-based medical education-EBME facilitates the training of doctors who are competent as well as empathetic. Keeping the subjective aspect of education as the base while acquiring the objective aspect, leads to balance between competence and empathy.

Modelo de cuidado a gestantes e puérperas: perspectiva de profissionais da saúde da família

Objetivo: compreender o modelo que orienta o cuidado à gestante e à puérpera na Estratégia Saúde da Família. Método: estudo qualitativo. Participaram das entrevistas semiestruturadas oito profissionais da saúde de uma equipe de uma Estratégia Saúde da Família, entre março e abril de 2019, no Estado do Rio Grande do Sul, Brasil. Os dados foram analisados conforme análise de conteúdo temática. Resultados: o modelo de cuidado à gestante e à puérpera na Atenção Primária à Saúde desenvolvido pelos profissionais da saúde mostra-se incipiente e com predomínio no modelo biomédico, pois não considera a integralidade, a coordenação e a longitudinalidade do cuidado. Conclusão: é necessário investimento em educação permanente e continuada dos profissionais da saúde para que atuem em prol do modelo proposto pela Atenção Primária, pautado na humanização e em relações de vínculo e que garantam uma assistência integral às gestantes e às puérperas.

Comment] Ethical and practical considerations on cancer recommendations during COVID-19 pandemic.

National and international authorities and societies have recently published important cancer treatment recommendations in order to propose extra measures that should be taken during the COVID-19 pandemic, such as prioritisation of intend-to-cure treatments and younger patients, omission of non-urgent cases, and reduction of personnel present. These measures raise important ethical considerations, since they prioritise protection of Health Systems and Professionals without seemingly taking cancer patient feelings of stress into consideration. This could lead to an erosion of the physician-patient relationship, which is considered the core element of medical ethics. Moreover, they raise practical concerns about the continuous education of Health Professionals, the status of reference centres and the evaluation of the hitherto cancer treatments.

Healthcare Professionals' Perceptions of Type 2 Diabetes Mellitus Care in the Mediterranean Region.

IntroductionThis study aimed to assess the adherence to guidelines by practitioners working in the Mediterranean region and to identify the reasons for non-compliance.MethodsA opportunistic self-administered questionnaire was circulated among members of the Mediterranean Group for the Study of Diabetes (MGSD) and regional diabetic associations. The study was limited to the Mediterranean region; 2841 medical practitioners participated in the study. Intervention involved a self-administered questionnaire enabling demographic and personal details to be correlated to relevant information related to practice and continuing health professional education (CHPE) attitudes, perceptions related to diabetes and healthcare systems in the community, and physicians’ attitudes to healthcare practices and target goals relevant to type 2 diabetes mellitus (T2DM). The main outcome measure was adherence to evidence-based guidelines.ResultsWhile the majority of respondents (69.9%) reported being confident in managing these patients, and 79.2% reported being aware of the availability of local guidelines; only a fifth opted to manage patients by strictly targeting an HbA1c value below 6.5%, while 3.3% were happy to maintain an HbA1c value of up to 8.0%. These goals appeared to be tempered by fear of eliciting hypoglycaemia in the belief that patients and their families do not have the skills to manage the complication. Endocrinologists/internists preferred more rigid control.ConclusionIt is clear that the promulgation of evidence-based guidelines cannot assume automatic adoption in clinical practice since adoption is tempered by on-the-ground practice circumstances that make the practitioner reluctant to fully endorse and adopt the targets defined by the guidelines. The evidence-based guidelines need to be modified for local or regional circumstances.FundingThis study and the Rapid Service Fee were supported by a financial grant from the Mediterranean Group for the Study of Diabetes which is supported by an unrestricted educational grant from Servier.Electronic Supplementary MaterialThe online version of this article (10.1007/s13300-019-00675-2) contains supplementary material, which is available to authorized users.

Measuring the impact of genetic knowledge on intentions and attitudes of the community towards expanded preconception carrier screening

BackgroundPreconception carrier screening (PCS) provides the potential to empower couples to make reproductive choices before having an affected child. An important question is what factors influence the decision to use...

Evaluation of the Immunization Program in the Federation of Bosnia and Herzegovina - Possible Modalities for Improvement.

Introduction:Immunization is a lifelong preventive activity that helps prevent/reduce disease, prevent/ reduce mortality and prevent disability from specific infectious diseases.Material and Methods:Authors of this paper researched the WHO extended program of mandatory immunization of children from birth to the age of 18 years and analyzed how it has been implemented in the Federation of Bosnia and Herzegovina (FB&H), because the guidelines of the specialist physician societies on immunization of adults, elderly people and risk groups of the population are missing.Results:The paper presents the basic characteristics of the immunization program in the FB&H and the world, points to the most frequent problems that the doctor practitioner has in carrying out immunization, and also presents possible modalities of improving immunization. It is pointed out the need to develop the national guidelines and individual immunization booklets, introduction of electronic registration of immunization, and continuous education of health professionals of all profiles, population, educators, teachers and harmonious partnership relations of health workers, population, social entities and the media with the aim of achieving an appropriate lifelong vaccination.

Using a predictive model of clinician intention to improve continuing health professional education on cancer survivorship.

Cancer survivorship is a chronic disease that places patients in limbo between oncologists and primary care clinicians. Strategies have been proposed to ease the shift in coordination of care, including broad-based educational outreach to primary care providers. Guided by the theory of planned behavior (TPB), predictors of intention to provide survivorship care, including credentials, experience, perception of barriers, and personal survivorship status, were evaluated using logistic regression with a cohort of physicians, nurse practitioners, and registered nurses participating in an unprecedented online continuing medical education/continuing education survivorship care course. Results showed that physicians were significantly less likely to express intent to provide survivorship care (odds ratio [OR] = .237, p = .0001) compared to the other groups. Overall, clinicians with 6-10 years of experience were 3 times more likely to express intent to provide survivorship care (OR = 2.86, p = .045) than those with less or more experience. When clinicians perceived the presence of a barrier, they were nearly twice as likely to have diminished intent (OR = 1.89, p = .035). Most participants (66%; n = 1185) selected two barriers: lack of survivorship care plans and treatment summaries (45.4%; n = 821) and lack of education (20.1%; n = 364). Barriers to the delivery of survivorship care can influence clinicians' intention to provide survivorship care, which varied by years of experience in this study. Interdisciplinary educational strategies featuring midcareer provider champions who have successfully incorporated survivorship care and can offer specific solutions to these barriers are recommended for future interventions.

Pursuing Competence Through Continuing Education

Health professionals have traditionally kept up-to-date with the latest medical and scientific knowledge and technologic advances in health care through a process known as continuing education (CE). However, comprehensive examinations of the current CE system have exposed weaknesses and vulnerabilities and raised questions about the relationship between CE and the professional competency of health professionals. This article reviews historical foundations of CE and its current state, and it projects future options of CE for health professionals.

Demonstration project on epilepsy in Brazil: situation assessment

To provide a situation assessment of services for people with epilepsy in the context of primary health care, as part of the Demonstration Project on Epilepsy in Brazil, part of the WHO/ILAE/IBE Global Campaign 'Epilepsy out of the shadows'. We performed a door-to-door epidemiological survey in three areas to assess the prevalence of epilepsy and its treatment gap. We surveyed a sample of 598 primary health care workers from different regions of Brazil to assess their perceptions of the management of people with epilepsy in the primary care setting. The lifetime prevalence of epilepsy was 9.2/1,000 people [95% CI 8.4-10.0] and the estimated prevalence of active epilepsy was 5.4/1,000 people. Thirty-eight percent of patients with active epilepsy were on inadequate treatment, including 19% who were taking no medication. The survey of health workers showed that they estimated that 60% of patients under their care were seizure-free. They estimated that 55% of patients were on monotherapy and that 59% had been referred to neurologists. The estimated mean percentage of patients who were working or studying was 56%. Most of the physicians (73%) did not feel confident in managing people with epilepsy. The epidemiological survey in the areas of the Demonstration Project showed that the prevalence of epilepsy is similar to that in other resource-poor countries, and that the treatment gap is high. One factor contributing to the treatment gap is inadequacy of health care delivery. The situation could readily be improved in Brazil, as the primary health care system has the key elements required for epilepsy management. To make this effective and efficient requires: i) an established referral network, ii) continuous provision of AEDs, iii) close monitoring of epilepsy management via the notification system (Sistema de Informação da Atenção Básica - SIAB) and iv) continuous education of health professionals. The educational program should be broad spectrum and include not only medical management, but also psycho-social aspects of epilepsy.

Paediatrics & Child Health: A different kind of journal

Paediatrics & Child Health is a publication that serves as a means of communication, a documentary record, and the voice of the Canadian Paediatric Society (CPS). Moreover, by design, it is a tool for improving the health and health care of children and youth in Canada. Recently, the editor-in-chief asked the CPS Board to initiate a review to see if Paediatrics & Child Health was “on target”. Did it meet the mission that had been established for it? Was it meeting the needs of the readers and the needs of the society of professionals that sponsors it? The CPS was fortunate to be able to engage Dr Robert Haggerty for this external review. Dr Haggerty is renowned as the editor of Pediatrics in Review, emeritus professor at the University of Rochester, Rochester, New York, and founder of the Ambulatory Pediatric Association. If anyone understands the dual mandate of continuing health professional education and advocacy, it is Dr Haggerty. In fall 2003, Dr Haggerty met with the editorial board, the staff and the publisher of Paediatrics & Child Health. His report applauds the CPS for establishing a unique role for the journal. Mission of Paediatrics & Child Health To advocate for the health of all children and youth in Canada. To provide educational material and information to all providers of health care to children in Canada. View it in a separate window The emphasis on advocacy distinguishes Paediatrics & Child Health from other Canadian medical publications. It enables the CPS to use position statements on issues such as nutrition, immunization and injury prevention to make real changes. Paediatrics & Child Health is sent to Ministers and Deputy Ministers of Health, Medical Officers of Health and others who make things happen in Canada. We know that it is used by federal and provincial officials who formulate government policy and allocate resources. Dr Haggerty applauded the use of Paediatrics & Child Health theme issues for this purpose. Dr Haggerty was impressed by the quality of the articles and the position statements. This reflects the work of the editor (Dr Noni MacDonald), associate editor (Dr Lee Ford-Jones) and senior editorial coordinator (Colette Laplante), who put much effort into the “writes and rewrites” of the material. Drs MacDonald and Ford-Jones view this extra effort to nurture the writing abilities of contributors as a “labour of love”. Readability is a very practical consideration. In Noni’s words, “if no one reads an article, the article won’t change anything.” A key issue of the review was whether Paediatrics & Child Health should put greater effort into getting Index Medicus citation status. At present, Paediatrics & Child Health is cited in EMBASE/Excerpta Medica and is distributed to 15,500 paediatricians and family physicians across Canada. Articles are chosen expressly for this target audience. Obtaining citation status could require solicitation and publication of much more original research. Obtaining citation status could mean that Paediatrics & Child Health could attract the best in Canadian paediatric research. However, these articles would likely crowd out the review articles and position statements, which are used so extensively by our readers. Dr Haggerty counselled against dramatically modifying the journal to win Index Medicus approval. On the contrary, he felt that, considering the increasing emphasis on translational research, Index Medicus may eventually sanction journals such as Paediatrics & Child Health that focus on the distillation of research literature and advocacy for societal change. The review produced several practical suggestions. Among these were adding page numbers to the articles listed on the cover to better draw in the reader, adding graphs to certain articles to heighten reader interest, and soliciting more articles on topics in child development and adolescent medicine. The availability of the journal through the Web site of the publisher, Pulsus Group Inc, was seen as a big plus. Increasingly, professional audiences use the Internet to search for new information and review previously published guidelines and policies. The fact that articles in Paediatrics & Child Health are used to formulate questions for Royal College certification exams keeps paediatric residents attuned to our publication. Lastly, the review underscored that this remarkable publication is produced by a skeletal staff. The Paediatrics & Child Health senior editorial coordinator, Colette Laplante, is also responsible for the coordination of CPS position statements. Dr Noni MacDonald turns the publisher’s editorial fees back to the journal to help with operating expenses. Dr Lee Ford-Jones does extensive editorial work without recompense. The CPS owes an enormous debt of gratitude to these three individuals. Dr Haggerty’s final remarks suggest that “the journal is a very visible vehicle of the CPS and needs to be publicized as a jewel in their crown”. We know that the CPS membership regards Paediatrics & Child Health as their top member benefit. Clearly, we know quality when we read it.

Survey of Distance Learning Provision in Continuing Health Professional Education in Canada

In Canada, the trend is towards greater use of distance learning technologies in the provision of continuing professional education in the health professions. Lack of access to professional development is a common deterrent to practice in rural and remote areas. Distance learning technologies have an important role to play in addressing the professional isolation challenges experienced by rural and remote health care providers. This article examines the state of distance learning provision among Canadian providers of continuing health professional education. The survey population included academic institutions, national/provincial health professional associations and non-profit health advocacy organizations, the pharmaceutical industry, and hospital/health care authority organizations. The results provide a greater understanding of the state of distance learning provision among providers of continuing health professional education in Canada and suggest a number of means to foster distance learning opportunities for rural health care provider.

Design and effectiveness of a computer-based continuing education program for orthodontists.

The design of computer-based continuing education for health professionals is an important consideration for Internet delivery because the size of graphic files greatly affects the speed with which information is delivered. Orthodontists who had indicated an interest in computer-based continuing education were shown via CD-ROM either a dynamic version of a computer continuing education program (with transitions and animations to liven up the content) or a plain version (identical content except that the transitions and animations were omitted). The program provided new information about superelastic arch wires for the initial stage of orthodontic treatment. For both versions, over 90% of the viewers thought the program was well done and provided useful information. Six of the orthodontists who received the dynamic version felt that the animations were distracting rather than helpful; only one who received the plain version felt that it was lifeless. A follow-up questionnaire showed that two-thirds of those who viewed the program had subsequently reviewed the performance data for the initial wire they were using and 20% had changed it, so the computer program was effective in changing clinical behavior. Those who saw the plain version also were more likely to have changed their clinical procedures. For Internet delivery of information to highly motivated professionals, it appears that transitions and animations are not necessary and may be more likely to decrease than increase the effectiveness of the teaching material.

Two decades of dixon: The question(s) of evaluating continuing education in the health professions

In this article, we provide a brief overview of the evaluation movement in continuing health professional education, beginning with Dixon's 1978 article on evaluation criteria and strategies. We define evaluation, discuss the forces driving the evaluation movement, and present the results of a search of the continuing education literature. Examples of program evaluations drawn from the literature illustrate Dixon's four types of evaluation, as well as some of the qualitative and quantitative tools used in evaluation, particularly the role of the randomized controlled trial. We conclude with a discussion of the evaluation movement's strengths and weaknesses, and its possible future directions.

Information needs of CME providers: Research and development resource base in continuing medical education

CME providers often have information needs that are not readily met by commercial indexing services. To help address this problem, continuing education staff in the medical faculties of McMaster University and the University of Toronto have developed the Research and Development Resource Base in Continuing Medical Education (RDRB/CME). This bibliographic database collects in one place many of the references to the literature of continuing health professional education. A librarian at the University of Toronto offers a low cost literature search service to physicians, educators, administrators, and other health professionals.

Continuing health professional education: Principles for global application

A list of CHPE principles was developed through a network of 26 individuals in 14 countries. The principles provide a broad perspective and, as a result of this consultation with individuals of varying cultural circumstances, show differences in emphasis. Personal, educational and administrative CHPE principles for global application have been proposed and it is hoped that these will stimulate further discussion.

Perceptions of Upper-Level Trainees in an Interdisciplinary Geriatrics Practicum

Abstract Twenty-nine graduate and upper level trainees from multiple health professions functioned as temporary members on an established Geriatrics Team for a minimum of 10 hours per week during a semester. Each student completed a modified version of the Interprofessional Perception Scale pre— and post-training. Analysis showed changes in perceptions toward physicians but not physical therapists and no changes in how they thought those disciplines perceived themselves. A nursing/social work subgroup of students demonstrated positive changes toward physicians in the areas of status, trust, and ethics. However, nurses had a negative change in how they viewed physicians' competence. Understanding the development of interprofessional perceptions can help in establishing curriculum for both graduate and continuing health professional education.

Brief: A Case for Integrating Continuing Health Professional Education and Quality Assurance

Brief: A Case for Integrating Continuing Health Professional Education and Quality Assurance

Evaluation of continuing medical education: making a difference.

This article is the fifth in a series of continuing health professional education and it focuses on the evaluation of continuing medical education (CME). Evaluation is the final step in the overall instructional design cycle in that it measures the effectiveness of CME. This article presents a decision-making flow chart which illustrates a means of determining what kind of an evaluation is appropriate for a given educational activity. The major types of evaluations are formative and summative, each having cognitive, psychomotor and affective categories. The evaluation data sources should be triangulated and may be either objective or subjective. There should be clear linkage between the course goals/objectives, the evaluation measures and the results of the evaluation. This will improve the CME process and make it more cost effective.

Competencies for continuing education faculty in the health professions.

Formal pre- and postdoctoral health professional education and continuing health professional education are different in their designs, contents, and respective student bodies. Faculty must, therefore, acquire and use an appropriate teaching approach for each group. The competencies necessary in a continuing education setting may be unique to this setting or they may be modifications of skills used in the formal setting. They include: assessing needs, designing curricula, employing a learner-centered approach, insuring relevance, establishing a learning set, using flexible and varied methods, individualizing, and evaluating. This paper provides descriptions of rationales for these competencies.

Management of patient compliance in the treatment of hypertension. Report of the NHLBI Working Group.

Low patient cooperation erodes many of the proven benefits of antihypertensive therapy. Over the last few years, there have been important advances in our understanding of the nature and management of patient compliance in hypertension and other chronic illness. In this article we review the theoretical foundation of compliance behavior; methods of measuring compliance; established and promising approaches to managing compliance; ethical consideration in measuring, improving, and researching compliance; the current state of implementation of compliance techniques in practice settings; and the efforts to disseminate information on compliance through undergraduate and continuing health professional education programs.