Competent Patient Care Research Articles

The Importance of Competency-Based Programmatic Assessment in Graduate Medical Education.

The Importance of Competency-Based Programmatic Assessment in Graduate Medical Education.

The Milestones 2.0 Development Process.

The Milestones 2.0 Development Process.

Knowledge and attitudes of U.S. medical students regarding the care of Asian American patients: a cross-sectional survey study

BackgroundAsian Americans (AsAm) are a rapidly growing population in the U.S. With this growing population, U.S. healthcare providers must be equipped to provide culturally competent care for AsAm patients. This project surveyed U.S. medical students on their knowledge of and attitudes towards AsAm to assess predictors of readiness to care for AsAm patients.MethodThis cross-sectional study surveyed medical students who had completed at least one clinical rotation. The survey was distributed online to nine medical schools throughout the U.S. The survey measured self-rated knowledge of, comfort with, cultural competency (CC) towards, and explicit biases towards AsAm patients. The first three domains were analyzed in a multivariate regression model including sociodemographic characteristics and past clinical, curricular, and social experiences with AsAm. Explicit bias questions were reported descriptively.ResultsThere were 688 respondents. Asian race, AsAm-prevalent hometown, AsAm-related extracurricular activities, Asian language knowledge, and having taken a population health course predicted increased AsAm knowledge. Social interactions with AsAm increased comfort with AsAm patients. Increasing year in medical school, more frequent exposure to AsAm patients on rotations, and prior travel to an Asian country were predictors of increased CC toward AsAm. Importantly, having completed a CC course was a significant predictor in all domains. In terms of explicit bias, students felt that AsAm patients were more compliant than Caucasian patients. Students also believed that Caucasian patients were generally more likely to receive self-perceived “preferred” versus “acceptable” care, but that in their own clinical experiences neither group received preferred care.ConclusionExperience with and exposure to AsAm prior to and during medical school and CC courses may increase medical student knowledge, comfort, and CC with AsAm patients. Standardized and longitudinal CC training, increased simulations with AsAm patients, diverse student recruitment, and support for students to engage in AsAm-related activities and interact with AsAm may improve CC of future physicians towards AsAm patients and possibly other minority populations.

Racism and Kidney Health: Turning Equity Into a Reality

Kidney disease continues to manifest stark racial inequities in the United States, revealing the entrenchment of racism and bias within multiple facets of society, including in our institutions, practices, norms, and beliefs. In this perspective, we synthesize theory and evidence to describe why an understanding of race and racism is integral to kidney care, providing examples of how kidney health disparities manifest interpersonal and structural racism. We then describe racialized medicine and "colorblind" approaches as well as their pitfalls, offering in their place suggestions to embed antiracism and an "equity lens" into our practice. We propose examples of how we can enhance kidney health equity by enhancing our structural competency, using equity-focused race consciousness, and centering investigation and solutions around the needs of the most marginalized. To achieve equitable outcomes for all, our medical institutions must embed antiracism and equity into all aspects of advocacy, policy, patient/community engagement, educational efforts, and clinical care processes. Organizations engaged in kidney care should commit to promoting structural equity and eliminating potential sources of bias across referral practices, guidelines, research agendas, and clinical care. Kidney care providers should reaffirm our commitment to structurally competent patient care and educational endeavors in which empathy and continuous self-education about social drivers of health and inequity, racism, and bias are integral. We envision a future in which kidney health equity is a reality for all. Through bold collective and sustained investment, we can achieve this critical goal.

Radiology residency training in China: results from the first retrospective nationwide survey

ObjectivesThis was the first study to systematically landscape and examine China’s nationwide standardized residency training in radiology.MethodsIn this retrospective cross-sectional study, we used data from the 2019 national survey of the first two cohorts of 3679 radiology residents who completed training in 2017 and 2018 across all 31 provinces in China. A total of 1163 (32%) residents participated in the survey. Multivariable logistic regression was used to examine the implementation frequency of 24 identified training tasks (categorized into six competencies) by region, demographics, and other residency information.ResultsAmong the 1163 respondents, 592 (51%) were trained in the more developed eastern region. Of the 24 identified training tasks, 15 were implemented significantly differently across regions, while the frequency of the most frequently conducted tasks (e.g., CT, MR, and radiograph interpretation and reporting) was consistent. The top 10 tasks all fell into the patient care and medical knowledge competency domains, while other competencies tended to be neglected. We found region and marital status were the most influential factors of training task implementation frequencies. Respondents trained in the northeast and the west were more likely to report, for instance, radiological examination recommendation (OR = 1.91, 95%CI = 1.27–2.88), as “very frequent.” Married respondents were more likely to report first-line night shift as “very frequent” (OR = 1.71, 95%CI = 1.29–2.26).ConclusionsDespite the fast-win achievements of developing a national radiology residency training program, there is a gap to train quality and homogeneous radiologists across regions. Future improvement should be more tailored to residents’ personal characteristics and emphasize some “soft” competencies (e.g., communication skills).

Pharmacist perceptions of patient care competency: A survey in Vietnam

Context: In order to perform effectively in professional practice, a pharmacist should demonstrate crucial competencies on delivery of patient care. Aims: To evaluate current pharmacists’ perceptions on their delivery of patient care competencies. Methods: The evaluation divided into 8 domains of competencies with 35 behavioral statements was distributed to hospital and community pharmacists. Respondents were asked to self-evaluate their competencies on a four-point Likert scale. Results: Of 207 responses returned, there were 106 hospital pharmacists and 89 community pharmacists. The mean score ranged from 2.2 to 3.5. Respondents perceived themselves as the most competent in “Drug Specific Issues” and “Provision of drug product” cluster (3.5 ± 0. 68, 3.3 ± 0.84, respectively), whereas the lowest performance was noted in “Patient Consultation” and “Evaluation of Outcomes” (2.8 ± 1.01 and 2.8 ± 0.88, respectively). Pharmacists demonstrated the best performance in the behavioral statements pertaining to the “Appropriate route is ensured” (3.6 ± 0.63). The two behaviors with the lowest performance were “Recording Consultations” (2.2 ± 1.02) and “Record of contributions” (2.7 ± 0.93). There were no statistically significant differences in the competence cluster scores in terms of types of pharmacists, sex, age, education level, years of experience (p>0.05). Conclusions: This research represents the first self-assessment of Vietnamese pharmacists in patient care practice. Areas for additional professional education which were determined include recording patient consultation, obtaining patient consent, prioritization of drug-related problems, referrals to doctors, and assessment of patient outcomes.

Exploring Students Nurses’ Preparedness and Readiness for to Care for Critically ILL Patients and Implication for Patient’s Safety

Background: Unsafe nursing care provided to critically ill patients by unqualified nurses can cost a patient’slife. When nursing care falls short of standards because nurses are lacking knowledge and or practical skills,nursing education programs shoulder much of the responsibility.Aims: aims of the current study were to explore the students’ nurses (senior students) preparednessand readiness to care for critically ill patients, determine the students’ nurses’ perceptions toward theirpreparedness and readiness to practice as critical care nurse and, compare between the students’ nursesclinical knowledge and their self – perceptions.Method: To fulfill the aims of the study, senior students in the Faculty of Nursing at the University ofAlexandria were recruited during the last month of the internship year. Three tools were used to collect thedata. Tool one “Generation of Core Competencies” that was aimed at identifying crucial competencies thatare required for new students’ nurses to provide competent and safe patient care. Tool two “Exploring thestudents’ nurses’ preparedness and readiness to care for critically ill patients” that was aimed to exploringthe clinical knowledge of the students’ nurses (objective tool) and Tool three “Casey-Fink Readiness forPractice Survey (CFRPS)” that was aimed to determining the students’ nurses’ perceptions toward theirpreparedness and readiness to practice as critical care nurse (subjective tool).Results: Results of the current study revealed that the median knowledge score was generally low (MD:14) denoting insufficient students nurses’ knowledge. The average number of correctly answered questionsby participants was only 14 out of 50 (mean, SD 14.12, 4.03).However, the nurses’ perceptions or attitudestoward their preparedness and readiness to practice as a critical care nurse were generally positive and high.About 50% of nurses answered at least 11 questions as “strongly agree” out of 15 questions of perception.Conclusions: Although the study was conducted at the end of the internship year as the clinical internshipexperience improved the nurses’ knowledge and perceptions of readiness for practice, there was acontradiction between the student nurses’ knowledge (low) and perceptions of their readiness (high).

Reflective journaling of nursing students on weight bias

BackgroundSelf-reflection, combined with clinical experience, has been shown to enhance clinical and didactic knowledge among undergraduate nursing students. Reflective journaling is a valuable educational tool that builds critical thinking skills and raises self-awareness through the purposeful inspection of beliefs and attitudes. However, there are little data available on reflective journaling during clinical education exploring weight bias as part of a weight sensitivity training program. ObjectivesThe study aimed to explore the use of reflective journals as a tool to raise self-awareness and self-reflection of weight bias as part of a weight sensitivity training program. SettingsThe project was conducted at a four-year pre-licensure baccalaureate nursing program with third-year clinical students in a private Catholic university in southeastern Pennsylvania, USA. ParticipantsAll third-year students enrolled in a medical-surgical clinical practicum were eligible to participate from August to December 2017. Design & methodsFor this qualitative study, data were collected during the 15-week medical-surgical clinical practicum, in which students completed five journal entries. De-identified data were analyzed using thematic analysis. ResultsA total of 98 students, 18 years of age and older consented, and 280 journal entries were analyzed. Four themes emerged from a majority of the journal entries: 1) increased self-awareness of personal weight bias; 2) acknowledgment of obesity as a chronic disease and not a choice; 3) insufficient resources or training may perpetuate weight bias; and 4) opportunity for weight sensitivity training to improve patient care. ConclusionsThrough reflective journaling, nursing students were able to periodically self-reflect on their personal weight bias as it pertained to caring for patients with obesity. This introspective self-reflection as part of a weight sensitivity training may lead to not only improving clinical competencies in patient care but also in reducing weight bias in clinical practicum.

"What Do You Want to Learn or Work on Today?": Benefits and Barriers to Asking Residents for Self-identified Learning Goals.

In the emergency department (ED), residents and attendings may have a short-term relationship, such as a single shift. This poses challenges to learner assessment, instructional strategy selection, and provision of substantive feedback. We implemented a process for residents to identify goals for ED shifts; characterized residents' goals; and determined how goal identification affected learning, teaching, and feedback. This was an observational study in a large, tertiary pediatric ED using mixed methods. Residents were asked to identify learning goals for each shift and were asked postshift if they had identified, accomplished, and/or received feedback on these goals. Goals were categorized by Accreditation Council for Graduate Medical Education Core Competencies. Predictors of goal identification, accomplishment, and receipt of feedback were determined. Residents and attendings were interviewed about their experiences. We collected 306 end-of-shift surveys (74% response rate) and 358 goals and conducted 29 interviews. We found that: 1) Goal setting facilitated perceived learning. Residents identified goals 54% of the time. They accomplished 89% of and received feedback on 76% of goals. 2) Residents' perceived weaknesses, future practice settings, and available patients informed their goals. Most goals mapped to patient care (59%) or medical knowledge (37%) competencies. 3) Goal identification helped attendings determine residents' needs. 4) Ideal goals were specific and achievable. 5) Common barriers were busyness of the ED and difficulty creating goals. Residents were less likely to identify goals (odds ratio [OR]= 0.62, 95% confidence interval [CI]= 0.41 to 0.94) and receive feedback on busy evening shifts (OR= 0.19, 95% CI=0.10 to 0.37) and were most likely to receive feedback overnight (OR= 3.66, 95% CI= 1.87 to 7.14). Asking residents to identify goals for ED shifts as an instructional strategy facilitated perceived learning, goal accomplishment, and receipt of feedback. Resident-driven goal identification is a simple and effective instructional strategy that physicians can incorporate into their precepting in the ED.

Using Simulation to Educate Rural NP students About Cultural Congruence

Between 2000 and 2010, the Hispanic population grew by 44% in rural areas. This community faces barriers to health care. Future nurse practitioners must be educated to provide culturally competent care for patients and families in a primary care setting. A simulation-based learning experience was used evaluate learning modules regarding rural health and Spanish language and culture. A “1 group: pretest–posttest” preexperimental design using the Transcultural Self-Efficacy Tool (TSET) was used to obtain quantitative and qualitative data from nurse practitioner students participating in a simulation-based learning experience to measure students’ self-perceptions of cross-cultural competence. All TSET measures achieved Cronbach’s alpha values of 0.98 or higher.

The INSÉPArable portfolio tool to sustain continued education and the professional development of nurses for a full scope of nursing practice and enhanced patient safety competencies: An ethnographic study.

BackgroundDespite widespread recognition of the undeniable impact of nurses on patient safety, important barriers relating to the organization of health systems still hinder the full expansion of the role of these professionals. In Quebec (Canada), nurses work overtime and increased adverse events are preoccupying and point to a possible lack of contemporary tools for continuous professional development. Innovative training tools should foster a more reflective practice focused on a holistic view of the patient in order to support the full scope of nursing practice and ensure continuous improvement in the quality of care. Such tools would make it possible to better understand their practice, according to their own perception, as well as its applicability in the emergence of a professional conscience which is essential to lasting safety competencies. This study's overarching goal was to propose a model and a portfolio prototype to support nurses’ training.MethodBased on a humanistic and reflective perspective on patient care and safety competencies, a design approach was used to develop a portfolio prototype. Ethnography was used to collect and analyse data using shadowing observations of 10 nurse/patient dyads, followed by interviews about their care experience. The research was conducted in acute and long-term care settings of the Quebec City area. The iteration process resulted in a first version of the prototype that was then presented to various stakeholders during a co-design workshop aimed at better understanding the clinical applicability of this prototype.FindingsThe INSÉPArable project is illustrated in two interrelated figures, which reflects a complete inductive representation supporting sustainable patient safety from nursing practice experience. First, nursing practice status has been depicted as an iceberg metaphor where the essence of care, the « art of nursing » is hidden. Second, a sphere illustrates the direction to the full emergence of nursing practice that helps to enhance the hidden “art of nursing” by leading nurses towards optimal conditions conscience.DiscussionINSÉPArable turned out to be more than an individual reflective tool as it also highlights the need for collective awareness among nurse managers regarding their responsibility in implementing and sustaining healthy work environments, in which optimal conditions are better supported. This also implies a renewed mode of governance and the implementation of more humanistic processes that redefine the contemporary professionalism of nurses, which are closely linked to patient safety.

Icahn School of Medicine at Mount Sinai.

Icahn School of Medicine at Mount Sinai.

Culturally Competent Care for LGBT Patients in Dermatology Clinics

Lesbian, gay, bisexual, and transgender (LGBT) patients face unique health disparities.1 Routine collection of sexual orientation and gender identity (SOGI) data can optimize patient-provider interactions.2 Gender-neutral bathrooms promote inclusivity for LGBT patients.3 There is limited data on the extent to which dermatology practices make use of such features to deliver culturally competent care to LGBT patients.

Development of Student Survey on Writing Nursing Care Plan: An exploratory sequential mixed-methods study.

To come up with a newly developed survey tool that will measure the students' level of quality in writing nursing care plans (NCPs). Exploring various challenges of students in writing NCP would enlighten educators to design innovative strategies on how to mitigate gaps between nursing education and practice. This study utilized an exploratory sequential mixed-methods design in three stages. In phase 1, qualitative semi-structured interviews of 22 students were conducted, and the data were analysed using the Colaizzi method. In phase 2, qualitative results were transformed into survey components, constructs and items, and the data were developed into a new survey tool based on the nursing process system (NPS) model. In phase 3, a quantitative cross-sectional survey of 195 nursing students was conducted to measure their level of quality in writing NCP, and the data were analysed using descriptive statistics of the SPSS software. In the first (qualitative) phase, five themes emerged from various challenges of nursing students in writing care plans: (a) data gathering; (b) identifying clients' problems; (c) formulating sustainable goals; (d) providing appropriate interventions; and (5) recognizing client's outcomes. In the second phase, a valid and reliable tool called the Student Survey on Writing Nursing Care Plan (SSW-NCP) was developed and tested. Lastly, in the third (quantitative) phase, the nursing students have shown a 'very good' level of quality in writing NCP. Determining students' level of quality in writing NCP would come up with comprehensive ways of improving student competencies in patient care management. The survey tool that is formulated from the study will provide relevant information for nurse educators and managers in managing students' and registered nurses' capabilities in writing an excellent care plan.

Meeting Nursing Staff Education through Learning Need Assessment

Nursing workforce needs continuous education in order to maintain their current knowledge and skills. Nurses’ learning needs could be assessed through several tools and strategies. The aim of this study is to identify nurses ‘s (at all levels) deficits in knowledge and skills through conducting a learning need assessment tool and meet their educational needs in order to enable them practicing safe, effective, deemed competent and efficient patient care. Method: A descriptive quantitative and qualitative design adapting an Education Needs Assessment Model. Instrument used was anonymous SurveyMonkey and target population was all nurses at different levels working at King Fahad Specialist Hospital, Dammam, and Kingdom of Saudi Arabia. The survey was constructed through literatures utilizing multiple database such as Pubmed and CINAHL and then through meetings the expert educators and stakeholders. The survey contained nine (9) educational domains that would identify their learning deficits using Likert scale. The survey was piloted to examine both face validity and content validity and then IRB approval was granted from the hospital. Results: Data were collected and analyzed following descriptive analysis frequency statistics using Excel Spreadsheet. Response rate was 34% although the targeted response rate was 67%. Nurses with all levels and from all divisions with various years of experience had identified their learning needs on the nine domains. The major performance gap was related to research utilization and Evidence Based Practice. Another gap was found in Leadership and Management Courses to support their nurse leaders. The study recommended that nurse educators have to look at the quality of clinical teaching when they conduct inservice educational sessions in terms of when to conduct it, which learning style to adopt, where to conduct it and for how long. Conclusion: Survey Monkey is a comprehensive learning assessment tool used to identify current nurses’ knowledge and skills. Further studies and researches using different designs and instruments are strongly needed.

SIMplifying Palliative Extubations: A Two-Part OSCE in a Simulation Center to Assess Entrustable Professional Activities (EPAs) in Hospice and Palliative Medicine (TH315)

•Identify the critical steps of a palliative extubation procedure.•Assess how the Palliative Extubation objective structured clinical exam (OSCE) applies to the clinical competencies of EPAs in Hospice and Palliative Medicine.•Demonstrate the innovative Palliative Extubation OSCE simulation.•Construct an educational toolkit in order to adapt and implement the Palliative Extubation OSCE simulation to your own institution. Healthcare professionals require education and practice to master their communication and procedure skills, especially in potentially distressing circumstances such as palliative extubations. Palliative extubation refers to removal of mechanical ventilator support when, based on an individual's goal of care, it is thought to be prolonging the dying process rather than helping to support through a reversible illness. Removing the endotracheal tube will allow a natural death to occur. In order to provide competent and compassionate care for patients and family members before, during, and after a palliative extubation, healthcare providers must provide a clear explanation of this complex procedure, show proficiency in performing the procedure, and demonstrate leadership skills. One method of evaluating a healthcare provider's competency in the domains of performing a palliative extubation and communication, is through use of an objective structured clinical exam (OSCE). An OSCE in a simulation center is an effective method to teach theoretical knowledge, improve hands-on skills, and assess clinical competencies while also reducing the risk of harm to patients and providers, especially for scenarios that do not occur on a daily basis. A simulation provides the advantage of providing a controlled, standardized situation, allowing for multiple interventions to be applied. This concurrent session describes an innovative Palliative Extubation OSCE in a simulation center using a mannequin as the patient and a standardized patient (SP) actor as a family member. The OSCE is divided into two parts—part 1: the family meeting and part 2: the extubation procedure. This session describes how the OSCE is structured to teach and assess the clinical competencies of the 17 EPAs in Hospice and Palliative Medicine. The session will conclude with a demonstration of the Palliative Extubation OSCE followed by small group discussions on how to implement the OSCE at participants' own institutions.

Understanding Assessment Systems for Clinical Competency Committee Decisions: Evidence from a Multisite Study of Psychiatry Residency Training Programs.

This multisite study examines how clinical competency committees in Psychiatry synthesize resident assessments to inform milestones decisions to provide guidelines that support their use. The study convened training directors and associate training directors from three psychiatry residency programs to examine decision-making processes of clinical competency committees. Annual resident assessments for one second year and one third year resident were used in a mock clinical competency committee format to assign milestones for two consecutive reporting periods. The committees reflected on the process and rated how the assessment tools impacted the assessment of milestones and evaluated the overall process. The authors compared reliability of assessment between the mock committees and examined both reliability of end of rotation assessments and their composite scores when combined with clinical skills evaluations. End of rotation evaluations were the most informative tool for assigning milestones and clarifying discrepancies in performance. In particular, the patient care and medical knowledge competencies were the easiest to rate, while the systems-based practice and practice-based learning and improvement were the most difficult. Reliability between committees was low although higher number of available evaluations improved reliability in decision-making. The results indicate that the medical knowledge and patient care competencies are the easiest to rate and informed most by end of rotation evaluations and clinical skills examinations. Other evaluation tools may better capture performance on specific sub-competencies beyond workplace-based assessment, or it may be helpful to reconsider the utility of how individual sub-competencies are evaluated.

Use of Standardized Patients in Endocrinology Fellowship Programs to Teach Competent Transgender Care

PurposeTransgender and gender-nonconforming individuals have unique health care needs and have difficulty accessing health care services because of a lack of qualified health care providers, insurance coverage, mistreatment, and bias by the medical community. Medical trainees and physicians report a lack of education in, and exposure to, the clinical care and unique aspects of this field. We assessed the use of a standardized patient as a tool to evaluate 4 core medical competencies (patient care, medical knowledge, professionalism, and interpersonal communication) of endocrinology fellows at a single training program.MethodsEndocrine fellows were evaluated by faculty in different aspects of transgender care and completed a self-assessment before and after the exercise. Faculty viewed the fellows during the Objective Clinical Structured Examination. Fellows were provided feedback by a faculty member and the standardized patient after the exercise.ResultsDeficits were found in patient care and professionalism. Fellows scored well in medical knowledge. Fellows did not report an improvement in comfort and communication skills after the exercise. Interestingly, fellows’ self-assessment scores in several domains declined after the standardized patient encounter, highlighting an occasion for self-reflection and growth within the realms of cultural competency and medical knowledge.Main conclusionsWe conclude that use of standardized patients to teach medical competencies in transgender medicine may be one approach to improve exposure to, and training in, transgender medicine. Endocrine fellows still had discomfort treating transgender individuals after the standardized patient encounter and require other training activities that may include didactics and clinical case discussions.

Alignment of roles of near-peer mentors for medical students underrepresented in medicine with medical education competencies: a qualitative study.

BackgroundMedical student learning experiences should facilitate progressive development of competencies required for practice. Medical school training opportunities have traditionally focused on acquiring medical knowledge and patient care competencies while affording less opportunity to receive feedback on practice-based improvement and system-based practice competencies. The Prematriculation program at the University of Minnesota Medical School Duluth Campus (UM MSD) utilized near-peer mentors to support the transition of students underrepresented in medicine, including American Indian/ Alaska Natives (AI/AN) and those from rural backgrounds, into medical school. The purpose of this study is to better define the role of near-peer mentors and explore the alignment of near-peer mentorship with the ACGME core competencies.MethodsAn important component of the Prematriculation program, designed to prepare incoming under-represented students for medical school, was the inclusion of near-peer mentors. The six near-peer mentors participated in semi-structured interviews or focus groups within 1 year of serving as a near-peer mentor. Themes emerged from open-coding of the transcripts.ResultsThe near-peer mentors drew on their own experiences to transmit information that supported the socialization of the matriculating students into medical school. Direct benefits to the mentors included solidifying their own understanding of medical knowledge and execution of procedural skills. Mentors provided examples of benefits related to their own development of interpersonal communication and professionalism skills. Operating in the context of the program provided opportunities to engage mentors in practice-based improvement and system-based practice.ConclusionsServing as a near-peer mentor offers significant benefits to medical students from backgrounds underrepresented in medicine. By taking on the peer mentoring leadership role, students progressed toward the competencies required of an effective physician. Given the importance of acquiring these competencies, it is worth considering how near-peer mentoring can be applied more broadly across the medical school curriculum.

A rural approach to quality improvement for small rural hospitals: Lessons from rural Texas.

This article describes the Rural Physician Peer Review Program (RPPR©) developed by the Texas A&M Rural and Community Health Institute and presents it as an example of a program that could be implemented in rural Canada as an effective means of continuing professional development (CPD) for rural Canadian physicians. RPPR© post review survey responses from 574 physician participants across rural Texas indicate that they are highly satisfied with RPPR© and that their competency in medical knowledge and patient care improves as a result of participation. A pilot project with two to four northern Ontario hospitals would enable RPPR© to be modified to ensure applicability and feasibility in the northern Ontario context to create an RPPR© "North." New and innovative approaches to CPD for rural northern physicians need to be continually explored to decrease professional isolation, improve recruitment and retention, and ultimately improve the quality and safety of healthcare in rural areas.