Vernon Curran

A review of evaluation outcomes of web-based continuing medical education

Introduction  The Internet and worldwide web have expanded opportunities for the provision of a flexible, convenient and interactive form of continuing medical education (CME). Larger numbers of doctors are accessing and using the Internet to locate and seek medical information. It has been suggested that a significant proportion of this usage is directly related to questions that arise from patient care. A variety of Internet technologies are being used to provide both asynchronous and synchronous forms of web‐based CME. Various models for designing and facilitating web‐based CME learning have also been reported. The purpose of this study was to examine the nature and characteristics of the web‐based CME evaluative outcomes reported in the peer‐reviewed literature.

Creating a Culture for Interdisciplinary Collaborative Professional Practice

Abstract The future of the health system is dependent on health professionals re-tooling the way we practice together. No longer can a multi-disciplinary model support the complex health needs of many clients nor can any one-health profession have all the knowledge needed to provide total patient-centred care. However, our current education and health systems are structured around a multidisciplinary model of practice with physicians or nurse practitioners as decision-makers and rarely are clients included in care planning. True interdisciplinary practice is defined as a partnership between a team of health professionals and a client in a participatory, collaborative and coordinated approach to shared decision-making around health issues, requires a revamping of how future health professionals are educated and how the system can accommodate shared decision-making. A client-centered collaborative professional practice model is proposed in this paper as a means for fostering and facilitating the culture for this change.

The role of medical education in the recruitment and retention of rural physicians

In many countries the sustainability of rural healthcare systems is being challenged by a shortage of rural physicians and difficulties in recruiting and retaining physicians in rural practice. There are numerous factors that influence efforts in rural physician recruitment and retention, many of which are beyond the scope of the academic medical centre and medical education. Nevertheless, there are strategies that medical schools can adopt to contribute to efforts to recruit and retain physicians in rural communities. Rural student recruitment, admissions policies, rural-oriented medical curriculum, rural practice learning experiences, faculty values and attitudes, and advanced procedural skills training are areas which the medical school has direct control of and which have been shown to influence the likelihood of medical students entering rural primary care practice. The purpose of this paper is to elaborate on some of the key strategies that have been identified in the literature.

Attitudes of health sciences faculty members towards interprofessional teamwork and education

Objectives  Faculty attitudes are believed to be a barrier to successful implementation of interprofessional education (IPE) initiatives within academic health sciences settings. The purpose of this study was to examine specific attributes of faculty members, which might relate to attitudes towards IPE and interprofessional teamwork.

Web-based continuing medical education (II): Evaluation study of computer-mediated continuing medical education

Background: Over the years, various distance learning technologies and methods have been applied to the continuing medical education needs of rural and remote physicians. They have included audio teleconferencing, slow scan imaging, correspondence study, and compressed videoconferencing. The recent emergence and growth of Internet, World Wide Web (Web), and compact disk read‐only‐memory (CD‐ROM) technologies have introduced new opportunities for providing continuing education to the rural medical practitioner. This evaluation study assessed the instructional effectiveness of a hybrid computer‐mediated courseware delivery system on dermatologic office procedures. Methods: A hybrid delivery system merges Web documents, multimedia, computer‐mediated communications, and CD‐ROMs to enable self‐paced instruction and collaborative learning. Using a modified pretest to post‐test control group study design, several evaluative criteria (participant reaction, learning achievement, self‐reported performance change, and instructional transactions) were assessed by various qualitative and quantitative data collection methods. Results: This evaluation revealed that a hybrid computer‐mediated courseware system was an effective means for increasing knowledge (p <.05) and improving self‐reported competency (p <.05) in dermatologic office procedures, and that participants were very satisfied with the self‐paced instruction and use of asynchronous computer conferencing for collaborative information sharing among colleagues.

Evaluation of the effect of a computerized training simulator (ANAKIN) on the retention of neonatal resuscitation skills.

Background: Neonatal resuscitation knowledge and skills deteriorate after initial training. Purpose: To evaluate the effectiveness of a computerized simulator system (ANAKIN) as a means for boosting neonatal resuscitation knowledge, skills, and self-reported confidence beliefs. Method: A randomized pretest-posttest control group study design involving 60 3rd-year medical students. At a 4-month, post-training interval, experimental group was exposed to ANAKIN and control group to a training video. Both groups assessed at an 8-month, post-neonatal resuscitation training interval. Results: Knowledge level for both groups decreased significantly at 4- and 8-month, post-training intervals despite booster exposure. Confidence level for both study groups increased significantly following booster exposure. However, no significant difference between study group skill levels at 8 months and no significant relation between neonatal resuscitation knowledge, confidence, or skills. Conclusion: Computerized simulator system was as effective as video for maintaining resuscitation skills of medical students, and students were very satisfied with experience of remote computer simulation training.

Academic administrators' attitudes towards interprofessional education in Canadian schools of health professional education.

Interprofessional education is an approach to educating and training students and practitioners from different health professions to work in a collaborative manner in providing client and/or patient-centred care. The introduction and successful implementation of this educational approach is dependent on a variety of factors, including the attitudes of students, faculty, senior academic administrators (e.g., deans and directors) and practitioners. The purpose of this study was to examine attitudes towards interprofessional teamwork and interprofessional education amongst academic administrators of post-secondary health professional education programs in Canada. A web-based questionnaire in English and French was distributed via e-mail messaging during January 2004 to academic administrators in Canada representing medicine, nursing, pharmacy, social work, occupational therapy and physiotherapy post-secondary educational programs. Responses were sought on attitudes towards interprofessional teamwork and interprofessional education, as well as opinions regarding barriers to interprofessional education and subject areas that lend themselves to interprofessional education. In general, academic administrators responding to the survey hold overall positive attitudes towards interprofessional teamwork and interprofessional education practices, and the results indicate there were no significant differences between professions in relation to these attitudinal perspectives. The main barriers to interprofessional education were problems with scheduling/calendar, rigid curriculum, turf battles and lack of perceived value. The main pre-clinical subject areas which respondents believed would lend themselves to interprofessional education included community health/prevention, ethics, communications, critical appraisal, and epidemiology. The results of this study suggest that a favourable perception of both interprofessional teamwork and interprofessional education exists amongst academic administrators of Canadian health professional education programs. If this is the case, the post-secondary system in Canada is primed for the introduction of interprofessional education initiatives which support the development of client and patient-centred collaborative practice competencies.

Evaluation of learning outcomes in Web-based continuing medical education.

Background There has been significant growth in use of Web-based continuing medical education (CME) by physicians. A number of evaluation and metareview studies have examined the effectiveness of Web-based CME to varying degrees. One of the main limitations of this literature has been the lack of systematic evaluation across different clinical subject matter areas using standardized Web-based CME learning formats. Method One group of pretest–postest designs were used to evaluate knowledge and self-reported confidence change across multiple Web-based courses using a standardized instructional format but comprising distinct clinical subject matter. Participants also completed a participant satisfaction survey and a self-reported retrospective skill/ability change survey. Results The majority of courses evaluated demonstrated significant pre to post knowledge and confidence effect size change, as well as significant self-reported retrospective practice change. Conclusions A Web-based CME instructional format comprising multimedia-enhanced learning tutorials supplemented by asynchronous computer-mediated conferencing for case-based discussions was found to be effective in enhancing knowledge, confidence, and self-reported practice change outcomes across a variety of clinical subject matter areas.

Advances in Rural Medical Education in Three Countries: Canada, the United States and Australia

INTRODUCTION This article documents a number of rural medical education initiatives in Australia, Canada and the United States. A typology is created reflecting the centrality the rural mandate and characterizing different features of each schools program. Interviews with school officials are drawn on to reflect the challenges these schools face. METHOD Seven schools noted for their rural programs were selected from the three countries and interviews were conducted with senior officials. The interview data was supplemented by published material on the schools. RESULTS The Typology: Three kinds of school are distinguished: Mixed Urban/Rural Schools (University of Washington, US, the University of British Columbia, Canada, and Flinders University, Australia); DeFacto Rural Schools (University of New Mexico, US and Memorial University, Canada) and Stand Alone Rural Schools (James Cook University, Australia and the Northern Ontario School of Medicine, Canada). The Pipeline Approach: All of the schools adopted in varying degrees a pipeline approach to meeting the need for rural doctors focusing on: (a) early recruitment; (b) admissions; (c) locating clinical education in rural settings; (d) rural health focus to curriculum; and (e) support for rural practice. CONCLUSION The analysis does not strongly favor one model over others, although the Stand-Alone Rural schools had more opportunities to adopt innovative curricula reflecting rural health issues and to foster positive views of rural practice. Government funding targeting rural health needs will remain critical in the development of all these programs.

Student satisfaction and perceptions of small group process in case-based interprofessional learning

Background: The small group, case-based learning approach is believed to be a useful strategy for facilitating interprofessional learning and interaction factors are said to have a significant effect on student interest, learning and satisfaction with such approaches. Aim: The purpose of our study was twofold: assess students’ satisfaction with a blended approach to interprofessional learning which combined computer-mediated and face-to-face, case-based learning; and examine the relationship between student satisfaction and perceptions of the collaborative learning process. Method: We introduced six interprofessional learning modules to approximately 520 undergraduate health professional students from medicine (61), nursing (351), pharmacy (20), and social work (89). All students were invited to complete an evaluation survey which assessed student satisfaction with the interprofessional learning experience and students’ perceptions of the small group learning process. Results: Students’ satisfaction with interprofessional education was related to professional background. Students from across professions reported greater satisfaction with face-to-face, case-based learning when compared with other learning methods. A more positive perception of face-to-face, case-based learning was related to greater satisfaction with interprofessional learning. Conclusions: The findings support the case-based method in facilitating interprofessional learning and highlight the importance of effective facilitation of small-group collaborative learning to enhance student satisfaction with interprofessional learning experiences.