Participation des médecins aux séances scientifiques planifiées

Background: Physician participation in regularly scheduled series (RSS), also known as grand rounds, was explored with a particular focus on physician perceptions about the elements that affected their engagement in RSS and the unanticipated benefits to RSS. Methods: A qualitative study using semi-structured interviews and thematic analysis examined physicians’ perception of their knowledge and educational needs and the factors that contributed to engagement in their local hospital RSS. Results: Physician engagement in RSS was affected by four major themes: Features that Affect the RSS’ Quality; Collegial Interactions; Perceived Outcomes of RSS; and Barriers to participation in RSS. Features that Affect RSS’ Quality were specific modifiable features that impacted the perceived quality of the RSS. Collegial Interactions were interactions that occurred between colleagues directly or indirectly as a result of attending RSS. Outcomes of RSS were specific outcome measures used in RSS sessions. Barriers were seen as reasons why physicians were unwilling or unable to participate in RSS. All of the elements identified within the four themes contributed to the development of physician engagement. Physicians also identified changes directly and indirectly due to RSS. Discussion: Specific features of RSS result in enhanced physician engagement. There are benefits that may not be accounted for in continuing medical education (CME) outcome study designsContexte : Nous examinons la participation des médecins aux séries de conférences planifiées (SCP) planifiées à l’avance, également connues sous le nom de séances scientifiques, plus particulièrement sous l’angle des perceptions des médecins quant aux éléments qui ont déterminé leur participation et quant aux avantages inattendus des SAR. Méthode : La perception qu'ont les médecins de leurs connaissances et de leurs besoins de formation, ainsi que des facteurs qui les ont poussés à participer aux SCP de leur hôpital sont examinés par le biais d’une étude qualitative comprenant des entretiens semi-dirigés et une analyse thématique. Résultats : Les facteurs qui déterminent la participation des médecins aux SCP se classent en quatre grands thèmes : les caractéristiques qui affectent la qualité des SCP, l’interaction entre collègues, les résultats perçus des SAR et les obstacles à leur participation aux SCP. Les premières sont des caractéristiques modifiables précises, qui influencent la qualité perçue des SCP. Les secondes sont les interactions entre collègues qui se produisent directement ou indirectement à la suite de la participation à une SCP. Les résultats des SCP sont des indicateurs de résultats précis utilisés dans les séances d’activités régulières. Sont considérés comme obstacles les raisons pour lesquelles les médecins ne voulaient pas ou ne pouvaient pas prendre part aux SCP. Tous les éléments décelés de chacun des quatre thèmes ont contribué à favoriser la participation des médecins. Les médecins ont également trouvé des changements qui sont directement ou indirectement liés aux SCP. Discussion : Certains traits spécifiques des SCP favorisent une participation accrue des médecins. Il est possible que les études de résultats du développement professionnel continu (DPC) ne tiennent pas compte de tous les avantages que les SCP procurent

Factors influencing responsiveness to feedback: on the interplay between fear, confidence, and reasoning processes

Self-appraisal has repeatedly been shown to be inadequate as a mechanism for performance improvement. This has placed greater emphasis on understanding the processes through which self-perception and external feedback interact to influence professional development. As feedback is inevitably interpreted through the lens of one’s self-perceptions it is important to understand how learners interpret, accept, and use feedback (or not) and the factors that influence those interpretations. 134 participants from 8 health professional training/continuing competence programs were recruited to participate in focus groups. Analyses were designed to (a) elicit understandings of the processes used by learners and physicians to interpret, accept and use (or not) data to inform their perceptions of their clinical performance, and (b) further understand the factors (internal and external) believed to influence interpretation of feedback. Multiple influences appear to impact upon the interpretation and uptake of feedback. These include confidence, experience, and fear of not appearing knowledgeable. Importantly, however, each could have a paradoxical effect of both increasing and decreasing receptivity. Less prevalent but nonetheless important themes suggested mechanisms through which cognitive reasoning processes might impede growth from formative feedback. Many studies have examined the effectiveness of feedback through variable interventions focused on feedback delivery. This study suggests that it is equally important to consider feedback from the perspective of how it is received. The interplay observed between fear, confidence, and reasoning processes reinforces the notion that there is no simple recipe for the delivery of effective feedback. These factors should be taken into account when trying to understand (a) why self-appraisal can be flawed, (b) why appropriate external feedback is vital (yet can be ineffective), and (c) why we may need to disentangle the goals of performance improvement from the goals of improving self-assessment

OpenLabyrinth for Learning and Teaching

Short presentation about using OpenLabyrinth virtual patient platform for learning and teaching in other areas. Although OpenLabyrinth was designed specifically for virtual patients, any algorithmic pathway or decision tree can be represented - it does not have to be clinical at all. OLab also contains many options for presenting questions and quizzes, including Situational Judgement Testing, Script Concordance Testing and other survey designs.Ye

Physician engagement in regularly scheduled rounds

Background: Physician participation in regularly scheduled series (RSS), also known as grand rounds, was explored with a particular focus on physician perceptions about the elements that affected their engagement in RSS and the unanticipated benefits to RSS.Methods: A qualitative study using semi-structured interviews and thematic analysis examined physicians’ perception of their knowledge and educational needs and the factors that contributed to engagement in their local hospital RSS.Results: Physician engagement in RSS was affected by four major themes: Features that Affect the RSS’ Quality; Collegial Interactions; Perceived Outcomes of RSS; and Barriers to participation in RSS. Features that Affect RSS’ Quality were specific modifiable features that impacted the perceived quality of the RSS. Collegial Interactions were interactions that occurred between colleagues directly or indirectly as a result of attending RSS. Outcomes of RSS were specific outcome measures used in RSS sessions. Barriers were seen as reasons why physicians were unwilling or unable to participate in RSS. All of the elements identified within the four themes contributed to the development of physician engagement. Physicians also identified changes directly and indirectly due to RSS.Discussion: Specific features of RSS result in enhanced physician engagement. There are benefits that may not be accounted for in continuing medical education (CME) outcome study designs.Contexte : Nous examinons la participation des médecins aux séries de conférences planifiées (SCP) planifiées à l’avance, également connues sous le nom de séances scientifiques, plus particulièrement sous l’angle des perceptions des médecins quant aux éléments qui ont déterminé leur participation et quant aux avantages inattendus des SAR.Méthode : La perception qu'ont les médecins de leurs connaissances et de leurs besoins de formation, ainsi que des facteurs qui les ont poussés à participer aux SCP de leur hôpital sont examinés par le biais d’une étude qualitative comprenant des entretiens semi-dirigés et une analyse thématique.Résultats : Les facteurs qui déterminent la participation des médecins aux SCP se classent en quatre grands thèmes : les caractéristiques qui affectent la qualité des SCP, l’interaction entre collègues, les résultats perçus des SAR et les obstacles à leur participation aux SCP. Les premières sont des caractéristiques modifiables précises, qui influencent la qualité perçue des SCP. Les secondes sont les interactions entre collègues qui se produisent directement ou indirectement à la suite de la participation à une SCP. Les résultats des SCP sont des indicateurs de résultats précis utilisés dans les séances d’activités régulières. Sont considérés comme obstacles les raisons pour lesquelles les médecins ne voulaient pas ou ne pouvaient pas prendre part aux SCP. Tous les éléments décelés de chacun des quatre thèmes ont contribué à favoriser la participation des médecins. Les médecins ont également trouvé des changements qui sont directement ou indirectement liés aux SCP.Discussion : Certains traits spécifiques des SCP favorisent une participation accrue des médecins. Il est possible que les études de résultats du développement professionnel continu (DPC) ne tiennent pas compte de tous les avantages que les SCP procurent

A knowledge translation project, combining webinars, virtual patients and asynchronous discussion around clinical practice guidelines on chronic pain.

An important strategy for improving population health is to use what we learn from medical research in our patient care. One approach to this is using the highest quality medical research to make recommendations and guide healthcare providers in deciding how to diagnose and treat their patients. These recommendations form the basis of healthcare tools that are called clinical practice guidelines. Theme four focused on strategies for increasing the uptake of clinical practice guidelines on low back pain and headache into community-based care. Theme four researchers collaborated with guideline developers in Alberta at the Institute of Health Economics and an organization called Towards Optimize Practice (TOP) that is sponsored by the Alberta Medical Association and the Alberta Ministry of Health (Alberta Health and Wellness). The research team first looked at what is already been known about uptake of guideline recommendations for chronic pain. This process involved going back to original research from around the world. Research librarians and scientists found 19 scientific papers that are relevant. Taken together, these studies indicated that the best approach to improving uptake of chronic pain guidelines into community care is to present them to care providers in special interactive educational settings where they are able to discuss the recommendations approaches with the educators. Theme four then went on to test this approach in the study of using an interactive educational workshop focused on the low back pain guideline. The study was conducted in collaboration with researchers from the University of Calgary and the University of Alberta. The workshop presenters were an expert team of physicians, physiotherapists, nurses and psychologists that traveled to the offices of the community healthcare providers. This study showed that the providers’ knowledge of low back pain increased after the workshop. When the medical records were examined, the researchers were unable to detect changes in how care was provided. This was a small study involving 24 providers. The researchers concluded that a larger study may confirm the increase in provider knowledge and detect changes in care. An important advance in healthcare is the use of computerized medical records. Computerization also provides an opportunity for healthcare providers to access relevant health information during their time with the patient. Theme four researchers collaborated with the Department of Family Medicine that McMaster University to develop a tool to help community caregivers use the recommendations from clinical practice guidelines while they are in the office with patients. This tool called the McMaster Pain Assistant has undergone successful usability testing and is now being tested in the community to see if using the tool leads to increases in knowledge and decisions that reflect the guideline. Rural physicians face important challenges in accessing medical education. In the past they would have to leave their practices and travel to a distant site to learn. Theme four researchers collaborated with the Department of Continuing Medical Education at the University of Calgary to explore a distance learning approach using Internet-based webinars and “virtual patients” that are designed to teach about the guidelines and how it might affect their care. This preliminary study demonstrated that rural physicians appreciated being able to access high quality medical education where they can interact with experts without having to travel. They found the sessions and the virtual patients highly engaging and realistic. Only small changes were shown in management of the virtual patients through the case series. Detailed analysis of practice patterns showed participants to be very conformant with clinical practice guideline recommendations.CIHRYe

How do clinicians use implementation tools to apply breast cancer screening guidelines to practice?

Abstract Background Implementation tools (iTools) may enhance uptake of guidelines. However, little evidence exists on their use by primary care clinicians. This study explored which iTools clinicians used and how often; how satisfied clinicians were with the tools; whether tool use was associated with practice changes; and identified mediators for practice change(s) related to breast cancer screening (BCS). Methods Canadian primary care providers who are members of the Practice-Based Small Group Learning Program (n = 1464) were invited to participate in this mixed methods study. An educational module was discussed in a small group learning context, and data collection included an on-line survey, practice reflection tools (PRTs), and interviews. The module included both the Canadian Task Force on Preventive Health Care revised guideline on BCS and iTools for clinician and/or patient use. After discussing the module and at 3 months, participants completed PRTs identifying their planned practice change(s) and documenting implementation outcome(s). Use of the iTools was explored via online survey and individual interviews. Results Seventy participants agreed to participate. Of these, 48 participated in the online survey, 43 completed PRTs and 14 were interviewed. Most survey participants (77%) reported using at least one of seven tools available for implementing BCS guideline. Of these (78%) reported using more than one tool. Almost all participants used tools for clinicians (92%) and 62% also used tools for patients. As more tools were used, more practice changes were reported on the survey and PRTs. Interviews provided additional findings. Once information from an iTool was internalized, there was no further need for the tool. Participants did not use tools (23%) due to disagreements with the BCS guideline, patients’ expectations, and/or experiences with diagnosis of breast cancer. Conclusion This study found that clinicians use tools to implement practice changes related to BCS guideline. Tools developed for clinicians were used to understand and consolidate the recommendations before tools to be used with patients were employed to promote decision-making. Mediating factors that impacted tool use confirmed previous research. Finally, use of some iTools decreased over time because information was internalized

How do physicians behave when they participate in audit and feedback activities in a group with their peers?

Abstract Background Audit and feedback interventions may be strengthened using social interaction. With this in mind, the Calgary office of the Alberta Physician Learning Program developed a process for audit and group feedback for physician groups. As a part of a larger project to develop a practical approach to the design and implementation of audit and group feedback projects, we explored patterns of physician behavior during facilitated audit and group feedback sessions. Methods Six audit and group feedback sessions were recorded, transcribed, and analyzed thematically to derive a conceptual model of physicians’ behaviors during audit and group feedback sessions. Results A predictable cycle of behaviors emerged from audit and group feedback sessions. This cycle would repeat with discussion of each new data element: reacting to the data, questioning and understanding the data, justifying and contextualizing, sharing and reflecting on the data and relevant guidelines, and planning for change. “Change cues” that emerged within groups reliably pivoted the discussion towards action planning. Conclusions In audit and group feedback sessions, physicians display a predictable series of behaviors as they move towards commitment to change. Establishing the meaning and credibility of the data is a necessary precursor to reflection. Group reflection leads to “change cues” triggered by group members, which stimulate action planning

The Calgary Audit and Feedback Framework: a practical, evidence-informed approach for the design and implementation of socially constructed learning interventions using audit and group feedback

Abstract Background Audit and feedback interventions may be strengthened using social interaction. The Calgary office of the Alberta Physician Learning Program (CPLP) developed a process for audit and group feedback for physicians. This paper extends previous work in which we developed a conceptual model of physician responses to audit and group feedback based on a qualitative analysis of six audit and group feedback sessions. The present study explored the mediating factors for successfully engaging physician groups in change planning through audit and group feedback. Methods To understand why some groups were more interactive than others, we completed a comparative case analysis of the six audit and group feedback projects from the prior study. We used framework analysis to build the case studies, triangulated our observations across data sources to validate findings, compared the case studies for similarities and differences that influenced social interaction (mediating factors), and thematically categorized mediating factors into an organizing framework. Results Mediating factors for socially interactive AGFS were a pre-existing relationship between the program team and the physician group, projects addressing important, actionable questions, easily interpretable data visualization in the reports, and facilitation of the groups that included reflective questioning. When these factors were in place (cases 1, 2A, 3), the audit and group feedback sessions were dynamic, with physicians sharing and comparing practices, and raising change cues (such as declaring commitments to de-prescribing, planning educational interventions, and improving documentation). In cases 2C–D, the mediating factors were less well established and in these cases, the sessions showed little physician reflection or change planning. We organized the mediating factors into a framework linking the factors for successful sessions to the conceptual model of physician behaviors which these mediating factors drive. Conclusions We propose the Calgary Audit and Feedback Framework as a practical tool to help foster socially constructed learning in audit and group feedback sessions. Ensuring that the four factors, relationship, question choice, data visualization, and facilitation, are considered for design and implementation of audit and group feedback will help physicians move from reactions to their data towards planning for change

Legislative Documents

Also, variously referred to as: House bills; House documents; House legislative documents; legislative documents; General Court documents