Leslie Rourke

A framework for enhancing continuing medical education for rural physicians: A summary of the literature

Background: Recruitment and retention of rural physicians is vital for rural health care. A key deterrent to rural practice has been identified as professional isolation and access to continuing medical education/continuing professional development (CME/CPD). Aims: The purpose of this article is to review and synthesize key themes from the literature related to CME/CPD and rural physicians to facilitate CME/CPD planning. Methods: A search of the peer-reviewed English language literature and a review of relevant grey literature (e.g., reports, conference proceedings) was conducted. Results: There is robust evidence demonstrating that the CME/CPD needs of rural physicians are unique. Promising practices in regional CME/CPD outreach and advanced procedural skills training and other up-skilling areas have been reported. Distance learning initiatives have been particularly helpful in increasing access to CME/CPD. The quality of evidence supporting the overall effect of these different strategies on recruitment and retention is variable. Conclusion: Supporting the professional careers of rural physicians requires the provision of integrated educational programs that focus on specific information and skills. Future research should examine the linkage between enhanced CME/CPD access and its effect on factors related to retention of physicians in rural communities. A proposed framework is described to aid in developing CME/CPD for rural practitioners.

The Rourke Baby Record Infant/Child Maintenance Guide: do doctors use it, do they find it useful, and does using it improve their well-baby visit records?

BackgroundThe Rourke Baby Record (RBR) – http://www.rourkebabyrecord.ca – is a freely available evidence-based structured form for child health surveillance from zero to five years. Family physicians/general practitioners (FP/GPs) doing office based well-baby care in three Ontario Canada cities (London, Ottawa, and Toronto) were randomly sampled to study the prevalence and utility of the RBR and documentation of well-baby visits.MethodsDatabase with telephone confirmation was conducted to assess the prevalence of use of the RBR.Study Part 1: Questionnaire mailed to a random sample of 100 RBR users. Outcome measures were utility of, helpfulness of, and suggestions for the RBR. Descriptive analysis was employed.Study Part 2: Retrospective chart review of well-baby visits by 38 FP/GPs using student t-tests and factor analysis. Outcome measures were well-baby visit documentation of growth, nutrition, safety issues, developmental milestones, physical examination, and overall comprehensiveness.ResultsThe RBR was used by 78.5% (402/512) of successfully contacted FP/GPs who did well-baby care in these 3 cities.Study Part 1: Questionnaire respondents (N = 41/100) used the RBR in several ways, and found it most helpful for assessing healthy child development, charting/recording the visits, managing time effectively, addressing parent concerns, identifying health problems, and identifying high risk situations. The RBR was seen to be least helpful as a tool for managing or for referring identified health problems.Study Part 2: Charts from a total of 1,378 well-baby visits on 176 children were audited. Well-baby care provided by the 20 FP/GPs who used the RBR compared to that by the 18 non-users was statistically more likely to include documentation of type of feeding (p = 0.023), discussion of safety issues (p < 0.001), assessment of development (p = 0.001), and overall comprehensiveness (p < 0.001). Well-baby care provided by the RBR users compared to that by the non-users was not more likely to include documentation of measurement of growth (p = 0.097), or physical examination (p = 0.828).ConclusionThe RBR was widely used by FP/GPs in these settings. RBR users found it helpful for many purposes, and had a consistently high rate of documentation of many aspects of well-baby care. The Rourke Baby Record has become a de facto gold standard clinical practice tool in knowledge translation for pediatric preventive medicine and health surveillance for primary care pediatric providers.

Connecting the Dots: An Ecological Lens to Preventive Measures for Adverse Childhood Experiences

ABSTRACT Adversity in early childhood may have a profound impact on physical and mental health as well as general well-being later in life. Despite increasing research evidence on the lifelong impact of adverse experiences, one of the key questions that motivated this research was how to translate this knowledge into preventive measures. This article presents data from an exploratory study aimed to explore strategies and effective practices to prevent adverse experiences in early childhood. An ecological framework organized participants’ suggested actions, highlighting the importance of proactive, multifaceted approaches and interventions that connect the child to the background environment where adversity takes place.