John Toews

Changing physicians' practices: the effect of individual feedback.

OBJECTIVE To determine whether physicians who received feedback from six peers, six referring/referral physicians, six co-workers, and 25 patients about 55 aspects of their medical practices (e.g., able to reach doctor by phone after office hours) would make changes to their practices based on that feedback. METHOD In an earlier study, 308 physicians were given feedback about 106 aspects of their practices in the form of mean Likert-scale ratings that (1) the peers made on 26 aspects; (2) the referring/referral physicians made on 23 aspects; (3) the co-workers made on 17 aspects; and (4) the patients made on 40 aspects. Three months later 255 of these physicians responded when asked to indicate whether they had contemplated or initiated changes, or whether no change had been necessary, regarding 31 practice aspects, each of which was a summary of one or more of 55 of the original 106 aspects on which they had received ratings. These 55 were considered the aspects most amenable to change over a short period. The physicians were also asked about the educational interventions that they felt would help them make changes. Multivariate analysis of variance was used to see whether the types of changes reported for the specific aspects of practice were associated with the feedback ratings received for those aspects. RESULTS An examination of the responses showed that 83% of the 255 physicians reported having contemplated a change, and 66% reported having initiated a change for at least one aspect of practice. Changes were contemplated most frequently for aspects of practice associated with clinical skills and resource use. Changes were initiated most frequently for aspects of practice associated with communication with patients and support of patients. Physicians who contemplated or initiated changes had lower (i.e., more negative) mean ratings than did physicians who reported that no change was necessary, which suggests that the physicians did use their feedback ratings to decide about changes, although their qualitative comments indicated other sources as well. Printed material was chosen most often as a method of receiving continuing medical education related to making changes in the practice areas examined.

Clinical Implications of Research on Religion, Spirituality, and Mental Health

The relation between religion and (or) spirituality (RS), and mental health has shown generally positive associations; however, it is a complex and often emotion-laden field of study. We attempt to examine potential mechanisms that have been proposed as mediators for the RS and mental health relation. We also examine more philosophical areas including patient and physician opinions about inclusion of RS in patient care, and ethical issues that may arise. We review suggested guidelines for sensitive patient inquiry, and opportunities and challenges for education of psychiatrists and trainees. We also study practical ways to incorporate psychospiritual interventions into patient treatment, with specific reference to more common spiritual issues such as forgiveness, gratitude, and altruism.

Feasibility and psychometric properties of using peers, consulting physicians, co-workers, and patients to assess physicians

No abstract available.

Standardized patients as a measure of change in the ability of family physicians to detect and manage alcohol abuse.

No abstract available.

Twelve tips for effective short course design.

Short courses are commonly used by physicians to stay up-to-date and acquire new skills for practice. Unfortunately, many short courses are not designed to maximize their impact on practice as they fail to acknowledge how people learn and change. Designers of effective short course planning should pay attention to writing outcomes based objectives; conducting needs assessments; determining the optimal content, resources, speakers and format; preparing ancillary materials (handouts and pre- and post-course assessments); and preparing speakers and evaluation. This paper discusses how each of the components of the curriculum design can be used to enhance the learning experience and obtain the desired course outcomes.

Distance Education for Physicians: Adaptation of a Canadian Experience to Uruguay

Introduction: The production of online high‐quality continuing professional development is a complex process that demands familiarity with effective program and content design. Collaboration and sharing across nations would appear to be a reasonable way to improve quality, increase access, and reduce costs. Methods: In this case report, the process of adapting and modifying a course to improve the management of Alzheimers disease developed for the Canadian context for use in Uruguay is described. Results: Both quantitative and qualitative data on the process are shown. The original course was developed by the University of Calgary in the 1990s, and taught initially face to face and later online. The adaptation included using a distance education system developed and widely used in Uruguay, called eviDoctor. Discussion: The key aspects of transforming this course from one country to another with different resources, health care systems, culture, and language are analyzed. Problems encountered are described, as well as their possible solutions.

Improving the Management of Patients with Schizophrenia in Primary Care: Assessing Learning Needs as a First Step

Objective: To assess family physician learning needs related to the care of patients with schizophrenia. Methods: Questionnaires were mailed to all family physicians and general practitioners practising in southern Alberta. Physicians were asked to indicate the number of patients with schizophrenia cared for, their interest in improving the care they provided, their preferred learning methods, and the content they wished to learn. Results: A total of 539 surveys were returned for a return rate of 43.8%. Over half of the physicians (53.5%) indicated that they saw 1 to 2 patients with schizophrenia each month. Almost half (48.5%) indicated they were somewhat or very interested in increasing the care provided. Primary learning needs included increasing their knowledge of psychopharmacologic agents and monitoring and adjusting medications. Lectures and half-day workshops were the preferred learning methods. Conclusion: Our study was helpful in identifying the types of education that physicians wanted as well as the duration of the programming prior to the development of teaching interventions.

Use of focus groups from different disciplines to identify clinical management and educational issues

Background: Focus groups of physicians have been used as a needs assessment technique to plan continuing medical education; however, rarely have the views of other health professionals been sought to complement such data. Purpose: The purpose of this research was to determine the feasibility of using focus groups from different disciplines to identify management and educational issues related to patients with chronic daily headache. Description: Focus groups of family physicians, pharmacists, allied health professionals, and patients discussed difficulties with diagnosis and treatment, helpful resources and possible continuing medical education. Evaluation: We found recruitment of focus groups difficult. However, once established, focus groups of professionals were helpful in identifying physician educational and clinical management issues and enhancing physician data. Physician and patient groups identified diagnostic difficulties and all groups described treatment problems, referral difficulties, and th...

A Spirituality Teaching Program for Depression: A Randomized Controlled Trial

Objective: This randomized controlled trial assessed the efficacy of a Spirituality Teaching Program to treat unipolar major depression. Method: A randomized controlled, assessor blinded trial design was used. A total of 84 individuals aged 18 years or older with unipolar major depression of mild to moderate severity were recruited in Calgary, Canada and randomized to two study arms: 1) Spirituality Teaching Program Group (8 week, home-based Spirituality Teaching Program); and 2) Waitlist Control Group (no intervention followed by Spirituality Teaching Program starting at week 9). Outcome measures (depression severity, response rate, remission rate) were assessed at baseline, 8, 16, and 24 weeks using the Hamilton Depression Rating Scale (HAM-D). Results: The two trial groups were similar in their demographic and disease characteristics at baseline. At the 8-week point, the change in depression severity was significantly different between the two groups (change in HAM-D score: 8.5 for the Spirituality Group and 2.3 for the Waitlist Control Group, p < 0.001). The Spirituality Teaching Program Group had significantly higher response (36% vs. 4.4%, p < 0.001) and remission rates (31% vs. 4.4%, p < 0.001) than the Waitlist Control Group. The benefits remained throughout the observation period for the Spirituality Teaching Program Group participants with response rates of 56.4% at 16 weeks and 58.9% at 24 weeks. Conclusion: The Spirituality Program significantly reduced depression severity and increased response and remission rates. This non-drug treatment program should be investigated further as a treatment option for depression.

Physician educational needs in osteoporosis: An approach to needs assessment

&NA; The objective of this paper was to determine the current learning needs and pre‐ferred learning methods of family physicians in the management of osteoporosis. Three methods of needs assessment—a literature review, focus groups, and a questionnaire—were used over a 12‐month period. The three methods identiled different learning issues but were comple‐mentary. Triangulation of information from different types of needs assessment is an important way of ensuring that a needs assessment is current and valid for a local population. Our study showed that learning needs evolve over time. Both focus groups and the survey indicated that the needs identified by the international literature were dated. The focus groups were useful in identifying the content to be examined. The survey determined the relative importance of the concerns identified and the preferred formt at for the content.