Continuing Medical Education Sessions Research Articles

Asking About Pets Enhances Patient Communication and Care: A Pilot Study.

This research explored whether asking patients about their pets would enable better environmental/social history taking, and improve patient communication/care. Primary health care providers (PHPs) were surveyed about prevalence of patients living with pets, the health impact of pets, and influences on patient communication. Following an educational intervention, they committed to asking patients about their pets. A follow-up survey was conducted electronically. PHPs were recruited at a continuing medical education (CME) conference and at CME workshops. All 225 participants were PHPs. At the conference, participants were educated one-on-one about the clinical relevance of pets in the family. CME sessions were large or small group teaching. Baseline and final surveys measured awareness of pets in patients’ families, assessment of determinants of health, impact on rapport with patients, and patient care. A sign test assessed difference in scores using repeated-measures analysis. Binomial outcomes were assessed using Fisher’s exact test. Comments were themed. Ninety-four PHPs (42%) completed the study. Pet-related discussions opened communication with patients. Two-thirds of participants identified positive effects on practice and on relationships with patients. PHPs were able to leverage the health benefits of pets (zooeyia) and mitigate zoonotic risk. Asking patients about pets in the family reveals clinically relevant information, improves communication, and strengthens the therapeutic alliance.

Nephrologists' perceptions regarding dialysis withdrawal and palliative care in Europe: lessons from a European Renal Best Practice survey.

There is a variation in dialysis withdrawal rates, but reasons for this variation across European countries are largely unknown. We therefore surveyed nephrologists' perceptions of factors concerning dialysis withdrawal and palliative care and explored relationships between these perceptions and reports of whether withdrawal actually occurred in practice. We developed a 33-item electronic survey, disseminated via an email blast to all European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) members. In our data analyses, we distinguished those respondents who reported occurrence from those reporting no dialysis withdrawal in their unit. With multilevel logistic regression, we investigated the association between respondents' characteristics and perceptions and whether they reported occurrence of dialysis withdrawal or not. Five hundred and twenty-eight nephrologists from 45 countries completed the questionnaire; 42% reported occurrence of withdrawal in their unit in the past year, and 56% perceived that stopping life-prolonging treatment in terminally ill patients was allowed. Few respondents reported presence in their unit of protocols on withdrawal decision making (7%) or palliative care (10%) or the common involvement of a geriatrician in withdrawal decisions (10%). The majority stated that palliative care had not been part of their core curriculum (74%) and that they had not recently attended continuous medical education sessions on this topic (73%). Respondents from Eastern and Southern Europe had a 42 and 40% lower probability, respectively, of reporting withdrawal compared with those from North European countries. Working in a public centre [odds ratio (OR), 2.41; 95% confidence interval (CI), 1.36-4.25] and respondents' perception that stopping life-prolonging treatment in terminally ill patients was allowed (OR, 1.96; 95% CI, 1.23-3.12), that withdrawal decisions were commonly shared between doctor and patient (OR, 1.97; 95% CI, 1.26-3.08) and that palliative care was reimbursed (OR, 1.81; 95% CI, 1.16-2.83) increased the odds of reporting occurrence of withdrawal. Reports of dialysis withdrawal occurrence varied between European countries. Occurrence reports were more likely if respondents worked in a public centre, if stopping life-prolonging treatments was perceived as allowed, if withdrawal decisions were considered shared between doctors and patients and if reimbursement of palliative care was believed to be in place. There is room for improvement regarding protocols on withdrawal and palliative care processes and regarding nephrologists' training and education on end-of-life care.

Do Continuing Medical Education (CME) Events Cover the Content Physicians Want to Know? A Content Analysis of CME Offerings

The purpose of this study is to assess whether annual refresher session offerings match the needs of physicians by coding and comparing session syllabi to physician questions collected electronically at the point of care. Thirteen syllabi from annual refresher continuing medical education (CME) events offered to family physicians in Canada were collected and their session titles and descriptions entered into a database. Titles and descriptions were coded using the International Classification for Primary Care version 2 (ICPC-2). Titles and descriptions were further coded depending on whether the sessions involved a drug treatment/medication component. Syllabi content was compared to previously determined questions asked by physicians at the point of care. Of the original 701 session titles, 625 (89.2%) were suitable for analysis. CME sessions focused on musculoskeletal, digestive, skin, urologic, and general categories were underrepresented in comparison to point-of-care questions. The reverse was true for the psychological/mental health category. Differences between questions asked by physicians at the point of care and the content of contemporaneous CME refresher courses can be analyzed to identify gaps in CME offerings. This knowledge could be used to develop CME curricula and highlight areas of need for inclusion in refresher courses.

Pakistani physicians knowledge and attitude towards reporting adverse drug reactions

The present study was designed to investigate the knowledge and attitude of Pakistani physicians towards adverse drug reaction (ADR) reporting. In this study, five hundred and fifty survey forms were distributed among the physicians belonging to different private and public sector clinics and hospitals of Karachi through email or direct correspondence. Two hundred and twenty five physicians provided consent to show their responses for research purposes. Hence, the response rate for filling the questionnaire was 40.9%. Most of the doctors that participated in the study were consultants. The previously validated questionnaire was adopted that sought the demographics of the physicians, their knowledge and attitudes towards ADR reporting. Descriptive statistics were employed to report the response of respondents to questionnaire items. The association of the position and organization on the responses of participants towards ADR reporting was determined by using a chi-square. Majority of the participants (88%) were aware about the ADRs; 31.5% were aware of pharmacovigilance; 7.5% had an access to ADR reporting system; and only 9.7% were informed about the availability of ADR reporting system. Physicians (64%) were considered to be the most qualified health professionals to report ADRs. The knowledge of ADRs among physicians working in different hospitals of Karachi was quite sufficient, but their attitude toward ADR reporting was lacking. Physicians strongly suggested the need of training through frequent continuous medical education sessions to improve reporting. Key words: ADR reporting, knowledge, attitude, physicians.

Factors associated with vaccination for hepatitis B, pertussis, seasonal and pandemic influenza among French general practitioners: A 2010 survey

Our objectives were to describe the vaccine coverage (VC11VC: Vaccine coverage.) for some occupational vaccines (hepatitis B, pertussis, seasonal and pandemic influenza) among French General Practitioners (GPs22GPs: General practitioners.) and to study the factors associated with being vaccinated for each of these four diseases. We surveyed a representative national sample of 1431 self-employed GPs in France. Self-reported VC was 76.9% for 2009/10 seasonal influenza, 73.0% for hepatitis B, 63.9% for pertussis and 60.8% for A/H1N1 pandemic influenza. The factors associated with reporting being vaccinated were quite different from one vaccine to another. For some or all four vaccines, we found a significant positive association (p<0.05) with the following factors in the multivariate analysis: GP's male gender, high volume of activity, no particular mode of exercise (e.g. homoeopathy), no use of Internet at the practice, Continuing Medical Education sessions, discussing the benefits and risks of vaccination with the patients and performing prevention investigations for oneself (lipid profile). Being vaccinated for one vaccine also increased the VC for some or all three other studied vaccines. All these findings argue for public health campaigns using messages adapted to each vaccine.

B116 Implementation of Cervical cancer screening services at 9 IHV/PEPFAR supported ART clinics in Uganda; Successes and challenges

Background: Cervical cancer is largely preventable by effective screening programs and considerable reduction in cervical cancer incidence and deaths has been achieved in developed countries with systematic cytological smear screening programs. In September 2011, IHV Uganda in partnership with St Francis Hospital Nsambya Hospital conducted two central trainings to equip health workers with knowledge and skills in screening for cervical pre-cancerous lesions by Visual Inspection Using Acetic Acid (VIA). Facility ART coordinators were tasked to select health care workers that were currently working with the ART clinic and Post natal clinic. This assessment seeks to evaluate the success and challenges encountered following the training. Description: A standard check-list was administered to focal persons of cervical cancer screening services during routine technical assistance visits between May and June 2012 at 9 PEPFAR supported ART clinics. All Health Facilities had at least a clinician and a nurse trained in basic cervical cancer screening by Visual Inspection Using Acetic-acid. Majority of health facilities (7/9, 77.8%) were actively screening women in reproductive age for cervical precancerous lesions. 3/9 (33.3%) facilities performed screening within the MCH department and 4/9 (44.4%) within the ART clinic and 2/9 in OPD. All sites registered no stock out of Trichloroacetic acid. Women with positive results were referred to the nearest regional referral hospital for further evaluation and treatment. There was no record of follow up appointments at 8/9 (89%) health facilities. Colposcopy services were available at 1/9 sites. A total 2807 women were screened by VIA across the 9 sites, 149 (5.3%) women showed Aceto-white lesions and 9 (0.3%) showed observable cancer lesions. Lessons learned: ART clinics with Health Care workers trained in cervical cancer screening are likely to screen and refer women with pre-cancerous cervical lesions. 2) Use of a checklist is helpful in monitoring and comparing cervical cancer screening services delivered at sites. 3) Need to implement colposcopy as a point of care service. 4) Lack of space was a major barrier to provision of active cervical cancer screening. Next steps: Strengthen cervical cancer screening by implementing Point Of Care Colposcopy services, Develop standard cervical cancer screening guidelines, Broaden cervical cancer screening, linkage to care and treatment through Continuing Medical Education sessions and onsite mentorships. Build site capacity in treatment of cervical precancerous lesions.

CME that impacts most physicians: a survey

PurposeThe purpose of this paper is to objectively assess the best type of continuing medical education (CME) activity that makes the most impact on the physicians’ behavior in changing their practices and to derive future needs for planning effective CME activities.Design/methodology/approachThis paper presents a survey. A questionnaire was designed, pilot‐tested and administered in a CME session to all the health physicians of a private medical university in Sind province of Pakistan. The questionnaire incorporated seven core items that assessed the impact of different types of CME activities on the physicians. The respondents rated the impact of CME based on their competence, performance, patient care processes and management on a five‐point Likert scale. Respondents’ responses in terms of type, committed time, usefulness, sponsorships and settings were also analyzed.FindingsA total of 194 health physicians completed the questionnaire (response rate=100 per cent); 56 per cent of the responses were from female physicians. A majority of the respondents in their replies ranked local large‐group lectures, symposiums and workshops higher than journal clubs, conferences and on‐line CMEs. More than half of the respondents rated the impact of CMEs on a five‐point Likert scale as good or very good. This was in relevance to increase in their competence, performance, patient care processes and change in management style.Research limitations/implicationsThe data generated through the survey are subject to desirability bias and may over‐represent the responses. The other limitation was the single university setting.Practical implicationsThe methodology can thus be adaptable by CME planners within the region to assess the impact of the current CME activities in improving physicians’ competence and professionalism, and in designing effective academic activities for the future.Originality/valueThere is no other study that demonstrates the impact of the types of CME on physicians in the Pakistani medical profession and hence this paper is of high interest.

The landscape of postgraduate education in palliative care for general practitioners: results of a nationwide survey in Flanders, Belgium

ObjectiveTo describe the offer of continuing medical education (CME) in palliative care in Flanders, Belgium and to explore the way providers of CME address the preferences of general practitioners (GP's) towards CME. MethodsQuestionnaire-survey among official providers of formal CME. ResultsThe response rate was 43%, equally distributed over all 5 provinces of Flanders. Data show large content gaps, an under usage of appropriate educational techniques and an absence of evaluation of the impact of CME on clinical practice. Providers of CME explain how they take the preferences of GP's concerning education in palliative care into account. ConclusionsThe present offer of CME is insufficient to educate GP's in palliative care. The absence of quality criteria and the lack of coordination between different providers results in an unattractive labyrinth of courses leaving GP's and their patients in the cold. Practice implicationsA comprehensive offer of CME sessions should be installed in a coordination between all providers. This could render the use of means (logistics and speakers) more efficient. Further research could look into other ways of acquiring palliative care competences such as evaluating the learning effect of GP's working together with specialized palliative home care teams.

Family physicians understanding about Mantoux test: A survey from a high endemic TB country

BackgroundTuberculosis is a global health emergency and is a big challenge to diagnose and manage it. Family physicians being first contact health persons should be well competent to diagnose and manage the patients with tuberculosis.AimsThis study was aimed to assess the level of understanding about Mantoux Test amongst Family Physicians in Karachi, Pakistan and to determine the difference of level of understanding by gender and number of tuberculosis patients seen in a month.MethodsA cross sectional survey was conducted among 200 Family Physicians working in Karachi; the largest city and economic hub of Pakistan. Family Physicians who attended Continuous Medical Education sessions were approached after taking consent. Pre-tested, self administered questionnaire was filled consisting of: basic demographic characteristics, questions regarding knowledge about Mantoux Test, its application and interpretation. Data of 159 questionnaires was analyzed for percentages, as rest were incomplete. Chi square test was used to calculate the difference of understanding levels between various groups.ResultsAlmost two thirds of respondents were males and above 35 years of age. Majority of Family Physicians were private practitioners and seeing more than five tuberculosis patients per month. Overall, a big gap was identified about the knowledge of Mantoux Test among study participants. Only 18.8% of Family Physicians secured Excellent (≥ 80% correct responses). This poor level of understanding was almost equally distributed in all comparative groups (Male = 20.8% versus Female = 15.9%; p - 0.69) and (Seen < 5 tuberculosis patients per month = 18.6% versus seen ≥ 5 tuberculosis patients per month = 19.3%; p - 0.32). A huge majority of Family Physicians (92%) however, showed keen interest in obtaining further knowledge regarding Mantoux Test and amongst them 72% suggested Continued Medical Education sessions as preferable mode of updating themselves.ConclusionOur study revealed an overall major deficit in understanding and interpretation of Mantoux Test amongst Family Physicians which needs to be addressed. Continues Medical Education sessions for Family Physicians should be organized in regular basis for upgrading their knowledge in this regards.

Perceptions of continuing medical education, professional development, and organizational support in the United Arab Emirates *

This paper investigates the views of health care providers on continuous medical education (CME). To our knowledge, this is one of the first surveys to examine perspectives of CME in the United Arab Emirates (UAE). A 6-part questionnaire focused on the following areas of CME: the workshop leaders/trainers, the training experience, the relevance of CME information provided in the training session, the training approach, the convenience of CME sessions, and organizational support. Results from 147 respondents indicated moderate satisfaction with these 6 CME areas. Respondents did not indicate satisfaction with organizational support received. Furthermore, participants agreed with the importance of CME to professional development. In our sample of UAE health care workers, they agree on the importance and relevance of CME to the development of their profession, even though the majority of health care workers are expatriates. However, several issues must be addressed, such as organizational, logistical, and financial support to attend CME programs. These issues must be addressed in order to sustain the viability of healthcare workers attending CME.

Early intervention service for psychosis: views from primary care

Although General Practitioners (GPs) have a pivotal role in early detection and treatment of psychosis, there is sparse information on their views of early intervention (EI) services and how information related to EI should be delivered. Since inception, DETECT (Dublin East Treatment and Early Care Team), Ireland's pilot EI project, mailed information packs and provided information through the local GP continuing medical education (CME) network. After 1 year, we surveyed GPs within DETECT's catchment area for their views on the service being provided. One hundred and twenty-six (36%) responded and 80% found the EI service very/extremely useful. GPs reported that the combination of CME session and information packs were more useful than information packs alone. Those who attended CME meetings were significantly more likely to refer suspected cases (P < 0.01) and more likely to find the service useful (P < 0.001). The EI service for psychosis is well-received among GPs. Information about EI delivered through CME appears to have a greater impact on referral rates and satisfaction levels than mailed information.

Absolute Cardiovascular Disease Risk and Shared Decision Making in Primary Care: A Randomized Controlled Trial

We wanted to determine the effect of promoting the effective communication of absolute cardiovascular disease (CVD) risk and shared decision making through disseminating a simple decision aid for use in family practice consultations. The study was based on a pragmatic, cluster randomized controlled trial (phase III) with continuing medical education (CME) groups of family physicians as the unit of randomization. In the intervention arm, 44 physicians (7 CME groups) consecutively recruited 550 patients in whom cholesterol levels were measured. Forty-seven physicians in the control arm (7 CME groups) similarly included 582 patients. Four hundred sixty patients (83.6%) of the intervention arm and 466 patients (80.1%) of the control arm were seen at follow-up. Physicians attended 2 interactive CME sessions and received a booklet, a paper-based risk calculator, and individual summary sheets for each patient. Control physicians attended 1 CME-session on an alternative topic. Main outcome measures were patient satisfaction and participation after the index consultation, change in CVD risk status, and decisional regret at 6 months' follow-up. Intervention patients were significantly more satisfied with process and result (Patient Participation Scale, difference 0.80, P<.001). Decisional regret was significantly lower at follow-up (difference 3.39, P = .02). CVD risk decreased in both groups without a significant difference between study arms. A simple transactional decision aid based on calculating absolute individual CVD risk and promoting shared decision making in CVD prevention can be disseminated through CME groups and may lead to higher patient satisfaction and involvement and less decisional regret, without negatively affecting global CVD risk.

The Difficulty of Recruiting Speakers for Continuing Medical Education

Background: Obtaining speakers for various continuing medical education (CME) programs can be a challenging and sometimes frustrating process. Purpose: The goal of this study was to quantify the difficulty in recruiting speakers for CME. Methods: A retrospective review of planning documents from three CME programs for family physicians was conducted. Descriptive analysis and analysis of variance testing was performed on the data collected. Results: In all three programs, obtaining speakers has become more difficult over the past 3 years with 1.75 [standard deviation (SD) = 1.46] to 2.32 (SD = 1.85) mean requests. Finding speakers for rural programs is more challenging than local CME sessions with 2.11 (SD = 1.78) compared with 1.68 (SD = 1.12) mean requests, respectively. University faculty represent 45.7% of CME speakers. Conclusions: This is the first study to document the increasing difficulty of recruiting speakers for CME. This significant difficulty in speaker recruitment has several implications for the CME offices and physician learners.

Abstracts from the Proceedings of the Research in Continuing Medical Education session of the 2007 spring meeting, Copper Mountain, Colorado

The following abstracts were peer-reviewed for presentation and publication. They were edited by Craig M. Campbell, MD, chairman, Research Committee, Society for Academic Continuing Medical Education.

CHRONIC KIDNEY DISEASE: THE CINDERELLA OF GENERAL MEDICINE

Click to increase image sizeClick to decrease image sizeKeywords: chronic kidney diseasescreeningmicro albuminuriaepidemiology

The Use of Telemedicine for Delivering Continuing Medical Education in Rural Communities

Physicians in rural communities have limited access to continuing medical education (CME) opportunities. We hypothesized that CME could be delivered via a telemedicine network as effectively as in-person. Our institution delivers CME lectures and grand rounds in Burlington, Vermont, for in-person attendees, and also via a telemedicine network that links 14 hospitals in Vermont and rural northeastern New York. All participants complete an evaluation questionnaire to receive CME credit. We compared the questionnaire responses of those attending in person with those attending via the telemedicine network. From October 1, 2000 to June 30, 2003, there were 4733 CME sessions, 650 of which had both in-person and telemedicine attendees. Responses from these 650 sessions were compared. Most questions relating to lecture quality scored higher for in-person attendees. Compared to having the presenter in the room, telemedicine attendance was judged to be "more effective" in 19% (n = 334), "as effective" in 60%, (n = 1074), and "less effective" in 21% (n = 367). Eighteen percent of telemedicine attendees said they would have traveled to attend the session. Telemedicine-delivered CME was considered at least as effective as in-person CME 79% of the time. Travel was avoided for 18% of the remote attendees. CME was delivered where it would not have been obtained for 82% of the remote attendees. Telemedicine systems can be used to deliver CME, in spite of lower overall ratings compared to in-person attendance.

Demand for Continuing Medical Education Programs on Cancer Care Among Primary Care Physicians in North Carolina

Primary care physicians have a central role in cancer prevention and control services, yet relatively little attention has been given to their needs for continuing medical education (CME) that clarify or update screening guidelines, enhance recognition of signs or symptoms of cancer, and address ongoing health issues in patients treated for cancer (e.g., pain control lymphedema, tertiary prevention). A random sample of 600 primary care physicians practicing in urban and rural locations in North Carolina was selected to assess past cancer-related CME sessions, and demand for current cancer education topics. Of 539 eligible, 231 surveys were returned (43%). Approximately 37% of respondents had attended no cancer-related CME in the last two years. Highest interest for cancer CME topics was found for screening for breast and skin cancers, general update diagnostic skills, pain management and patient/family support, side effects from treatment, lymphedema management and lymphedema diagnosis, genetic susceptibility diet and smoking cessation. Interest levels by CME topic did not vary by urban/rural practice settings. There is low access but high demand for cancer-related CME topics among primary care physicians. Strategies are needed to fill this need and to assess impact.

Physician perceptions of the effect of telemedicine on rural retention and recruitment.

We conducted a postal survey of 140 family and community specialist physicians in a predominantly rural area which had received clinical telemedicine services and videoconferenced continuing medical education (CME) for two years. The questionnaire contained 46 items. The response rate was 47%. Most respondents (83%) reported having attended videoconferenced CME sessions and 45% reported having referred patients for teleconsultation. Physicians in more rural areas used these services more frequently. Ratings of two statements assessing the value of telemedicine in community support were significantly and positively correlated with the number of videoconferenced CME sessions attended and the number of telemedicine services used. In relation to their decision to stay in their community for at least one year, respondents rated telemedicine lower in importance than all but one of 17 other factors expected to influence physician recruitment and retention in rural communities. The influences on physician rural recruitment and retention are complex. However, telemedicine was used more frequently by the more rural physicians, and there was a relationship between higher usage and higher ratings of its value as a community support.

Follow-up in train-the-trainer continuing medical education events

The purpose of train-the-trainer (TTT) programs within the context of continuing medical education (CME) is to help facilitators acquire and/or enhance their skills at leading CME sessions. The provision of follow-up is one feature of successful CME workshops over which CME providers have some control. Follow-up is defined as any encounter between participants and workshop leaders, following an initial workshop or other development session, and is designed to enhance, maintain, reinforce, transfer, extend, or support the learning from the original workshop. In this article, we elaborate on the use of audio teleconferences to provide follow-up for a TTT workshop in Saskatchewan, a largely rural province in western Canada. The teleconferences began 6 weeks after the workshop and were held at approximately 6-week intervals, with five conference calls in total. Each lasted about 45 minutes. Participants were interviewed to determine their view of the value of the teleconferences. Participants reported learning from the teleconferences and feeling more prepared to conduct CME sessions due to their participation in the teleconferences. Participants missed teleconferences only for extenuating circumstances (e.g., emergency deliveries). We have found that audio teleconferences allow for and encourage professional discussion that is crucial to changing practices. They are an effective way to incorporate follow-up to TTT workshops when participants travel great distances to attend.

XXXIV international congress of physiological sciences: It's for anatomists, Too!

XXXIV international congress of physiological sciences: It's for anatomists, Too!