“What is an Educational Problem?” Revisited ,

What is an Educational Problem? Guidance for Authors Submitting to JCEHP ,

Optimizing Multisource Feedback Implementation for Australasian Physicians Introduction: Medical regulatory bodies in Australasia are encouraging greater use of continuing professional development activities, such as multisource feedback (MSF), which are practice-based, include facilitated feedback, and improve performance. The aim of this study was to explore the feasibility, effectiveness, and sustainability of an MSF process that includes a telephone/videoconference debrief, to better design future MSF implementation. Method: Thirty-seven Australasian physician participants sought feedback from patients and colleagues and debriefed their feedback report with a trained facilitator. The impact was evaluated using quantitative and qualitative measures including surveys and semistructured interviews. Results: The feasibility of the MSF process was impacted by the level of support for the participant to complete the MSF, the nature and location of participants' work, and the use of telephone/videoconference to deliver the debrief. Regarding effectiveness, the MSF stimulated reflection on practice and action on areas identified for improvement. In addition, the quality of rater feedback and the inclusion of a debrief impacted participant and facilitator reports of effectiveness. The absence of a culture of feedback, the formative nature of the MSF, and the confidentiality of the results were factors impacting sustainability. Discussion: Optimizing MSF is important to encourage broad uptake in the wider medical community in Australasia. Although several factors were identified as having an impact, it is clear that inclusion of a quality debrief will increase the perceived value and the effectiveness of MSF. Delivering that debrief through telephone/videoconference can be effective and will increase the overall feasibility and sustainability.

Examining Associations Between Physician Data Utilization for Practice Improvement and Lifelong Learning Introduction: Practice data can inform the selection of educational strategies; however, it is not widely used, even when available. This study's purpose was to determine factors that influence physician engagement with practice data to advance competence and drive practice change. Methods: A practice-based, pan-Canadian survey was administered to three physician subspecialties: psychiatrists (Psy), radiation oncologists (RO), and general surgeons (GS). The survey was distributed through national specialty society membership lists. The survey assessed factors that influence the use of data for practice improvement and orientation to lifelong learning, using the Jefferson Scale of Physician Lifelong Learning (JeffSPLL). Linear regression was used to model the relationship between the outcome variable frequency of data use and independent predictors of continuous learning to improving practice. Results: A total of 305 practicing physicians (Psy = 203, RO = 53, GS = 49) participated in this study. Most respondents used data for practice improvement (n = 177, 61.7%; Psy = 115, 40.1%; RO = 35; 12.2%; GS = 27, 9.4%) and had high orientation to lifelong learning (JeffSPLL mean scores: Psy = 47.4; RO = 43.5; GS = 45.1; Max = 56). Linear regression analysis identified significant predictors of data use in practice being: frequency of assessing learning needs, helpfulness of data to improve practice, and frequency to develop learning plans. Together, these predictors explained 42.9% of the variance in physicians' orientation toward integrating accessible data into practice (R2 = 0.426, P < .001). Discussion: This study demonstrates an association between practice data use and perceived data utility, reflection on learning needs and learning plan development. Implications for this work include process development for data-informed action planning for practice improvement for physicians.

Leadership Gender Disparity Within Research-Intensive Medical Schools: A Transcontinental Thematic Analysis Background: The underrepresentation of women in senior leadership positions of academic medicine continues to prevail despite the ongoing efforts to advance gender parity. Our aim was to compare the extent of gender imbalance in the leadership of the top 100 medical schools and to critically analyze the contributing factors through a comprehensive theoretical framework. Methods: We adopted the theoretical framework of the Systems and Career Influences Model. The leadership was classified into four tiers of leadership hierarchy. Variables of interest included gender, h-index, number of documents published, total number of citations, and number of years in active research. A total of 2448 (77.59%) men and 707 (22.41%) women met the inclusion criteria. Results: Male majority was found in all regions with a significant difference in all levels of leadership (chi square = 91.66; P value = .001). Women had a lower mean h-index across all positions in all regions, and when we adjusted for number of years invested, M Index for women was still significantly lower than men (T test = 6.52; P value = .02). Discussion: Organizational and individual influences are transcontinental within the top 100 medical school leadership hierarchy. Those factors were critically assessed through in-depth analysis of the Systems and Career Influences Model. Evidence-driven actionable recommendations to remedy those influences were outlined.

Continuing Professional Development Engagement—A UK-based Concept Analysis Introduction: Although much literature exists regarding the operationalization of the term engagement, this relates specifically to work/employee engagement and user, consumer, and scholarly engagement. There is no clear understanding of the term Continuing Professional Development (CPD) engagement for allied health professionals and Nurses and Midwives in the UK, although it is becoming a frequently used term. This raises the challenge of creating measures of the impact of CPD engagement. This concept analysis therefore sought to operationalize the term CPD engagement. Methods: A theoretical concept analysis was undertaken, as part of a Professional Doctorate, using Walker and Avant's Concept Analysis Framework. Literature was accessed via OVID, PubMed, CINAHL, ERIC, ABI INFO, and PsychINFO using search terms engagement, work/employee, user, consumer, scholarly engagement, CPD, and life-long learning. Results: Defining attributes for CPD engagement included criteria based around the terms such as self-initiated, voluntary, applied, recorded, evaluated and shared, and continuation of learning beyond the initial activity. Antecedents focused around drive and availability of resources including time, money, and support. Discussion: There are potentially many positive consequences of CPD engagement, such as job satisfaction, employee retention, and quality of service provision, that may be more easily investigated and measured against the attributes defined from this study, which indicates that CPD engagement is characterized by the following five criteria: (1) self-initiated; (2) rewarded (either intrinsically or extrinsically); (3) applied in practice; (4) recorded, evaluated, and shared with others; and finally (5) continues beyond the initial learning activity.

Along the Axes of Difference: Setting Scholarship and Practice Agendas for Faculty Development Abstract: The rise of academic clinical education programs underlines the growing influence of faculty development on how health care is taught and therefore practiced. Research to date has outlined the rapid rise of these postgraduate qualifications and their impact on their graduates' professional identities. Given the scale and nature of the change, it is worth considering these programs from a broader perspective. “Axes of difference” are invoked to chart the tensions and intersections between various social identities that form distinctive features of clinical education. Six axes are described: patients–clinicians, trainees–trainers, classrooms–clinics, uniprofessional–interprofessional, local–global, and teachers–clinicians. These reveal a range of complexities about faculty development, which can inform both practice and scholarship agendas.

Development of a Framework to Describe Functions and Practice of Community Health Workers Abstract: There is evidence to support the effectiveness of community health workers (CHWs), as they practice in a wide range of health care settings; yet, the perceived value of CHWs suffers from a lack of uniform credentialing and from a dearth of billing and payment structures to recognize their individual work. In turn, credentialing and billing for the work of CHWs is hampered by widely variable regulation, conflicting job titles and position descriptions, and general confusion about CHW identity, sometimes complicated by service boundaries that overlap with those of other health care and social service occupations. This article presents evidence from a rapid review of the CHW literature from 2003 to 2018. It includes clinical trials, meta-analyses, and policy reports summarizing more than 200 CHW interventions intended to improve patient health status or care delivery. The evidence is used to identify CHW roles, responsibilities, behaviors, and competencies. Four categories of CHW practice are developed from the evidence: peer CHW, general CHW, clinical CHW, and health navigator. A framework is proposed to recognize unique CHW roles, promote and further integrate varied levels of CHW function into health care–related organizations, and to inform decisions regarding certification, education, and payment for CHW services in the United States.

Making the Learning Continuum a Reality: The Critical Role of a Graduate Medical Education–Continuing Medical Education Partnership Abstract: A true continuum of learning in physician education, envisioned as the seamless integration of undergraduate, graduate, and continuing medical education that results in lifelong learning, has yet to be realized. Rapid clinical change, evolving systems of health care, and a shift to competency-based training make the continuum and lifelong learning even more critical. Because they function independently, the efforts of Graduate Medical Education (GME) and Continuing Medical Education (CME) have fallen short of the integrated ideal. The complementary threads of accreditation requirements, expertise, resources, and scholarly activities provide an opportunity for GME and CME to operate in a more integrated and coordinated fashion. Our local GME–CME partnership model demonstrates that these complimentary threads can be tied together to effectively facilitate lifelong learning and promote an integrated learning continuum.

Use of Active Learning and Sequencing in a Weekly Continuing Medical Education/Graduate Medical Education Conference: Erratum. No abstract available