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Health complaints in individual visiting primary health care: population-based national electronic health records of Iran. BMC Health Serv Res 2022; 22:502. [PMID: 35421968 PMCID: PMC9008379 DOI: 10.1186/s12913-022-07880-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 03/31/2022] [Indexed: 11/21/2022] Open
Abstract
Background The mission of medical schools is a sustainable commitment to orient education, research, and services based on the priorities and expectations of society. The most common complaints of patients from comprehensive health service centers (CHSCs) based on the data from electronic health records were assessed in order to determine primary health care (PHC) priorities for the educational planning of medical students in Iran. Methods A population-based national study was designed to assess clinical complaints of patients in all age groups who were referred to CHSCs at least once to be visited by physicians. All the data in the census were extracted from electronic health records in PHC system during 2015–2020, classified by the International Classification of Primary Care 2nd edition (ICPC-2e-English), and statistically analyzed. The total number of complaints that were recorded in the system was 17,430,139. Results 59% of the referring patients were women. The highest number of referrals was related to the age group of 18–59 years (56.9%), while the lowest belonged to the elderly people (13.3%). In all age and sex groups, the first ten complaints of patients with three top priorities in each category included process (follow-up, consultation, and results exam), digestive (toothache and gum complaint, abdominal pain, and diarrhea), respiratory (cough, sore throat, and runny nose), general (fever, pain, and weakness and fatigue), musculoskeletal (back pain, leg complaint, and knee injuries), endocrine and nutritional (weight gain, Feeding problem, and weight loss), cardiovascular (hypertension, palpitations, and Postural hypotension), neurological (headache, dizziness, and paralysis), sexual dysfunction (vaginal complaint, discharge, and irregular menstruation), and dermatological (pruritus, rash, and inflammation) problems. Conclusion High priorities in referring to PHC had a key role in assessing the country's health needs. Since this study was in line with the national pattern of complaints and patients' profile, the present findings can be helpful to amend policy-making, educational planning and curricula development in medical schools. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07880-z.
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Cordovani L, Wong A, Monteiro S. Maintenance of certification for practicing physicians: a review of current challenges and considerations. CANADIAN MEDICAL EDUCATION JOURNAL 2020; 11:e70-e80. [PMID: 32215145 PMCID: PMC7082474 DOI: 10.36834/cmej.53065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Maintenance of certification (MOC) has become increasingly important in medicine to ensure maintenance of competence throughout a physician's career. This paper reviews current issues and challenges associated with MOC in medicine, including how to define medical competencies for practicing physicians, assessment, and how best to support physicians' lifelong learning in a continuous and self-motivated way. We explore how the combination of self-monitoring, regular feedback, and peer support could improve self-assessment. Effective MOC programs are learner-driven, focused on every day practice, and incorporate educational principles. We discuss the importance of MOC to the physicians' actual practice to improve acceptability. We review the benefits of tailored programs as well as decentralization of MOC programs to better characterize the physician's practice. Lastly, we discuss the value of simulation-based medical education in MOC programs. Simulation-based education could be used to practice uncommon complications, life-threatening scenarios, non-technical skills improvement, and become proficient with new technology. As learners find simulation experiences educationally valuable, clinically relevant, and positive, simulation could be a way of increasing physicians' participation in MOC programs.
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Affiliation(s)
- Ligia Cordovani
- 1Department of Health Research Methods, Evidence and Impact, McMaster University, Ontario, Canada
| | - Anne Wong
- 2Department of Anesthesia, McMaster University, Ontario, Canada
| | - Sandra Monteiro
- 3Department of Health Research Methods, Evidence and Impact, McMaster University, Ontario, Canada
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Lee L, Hillier LM, Patel T, Weston WW. A Decade of Dementia Care Training: Learning Needs of Primary Care Clinicians. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2020; 40:131-140. [PMID: 32175933 DOI: 10.1097/ceh.0000000000000288] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Limited knowledge of dementia among health professionals is a well-documented barrier to optimal care. This study examined the self-perceived challenges with dementia care and learning needs among primary care clinicians and assessed whether these were associated with years of practice and perceived preparedness for dementia care. METHODS Participants were multi-disciplinary clinicians attending a 5-day team-based dementia education program and physicians attending a similar condensed continuing medical education workshop. Pre-education, they completed an online survey in which they rated (5-point scales): interest in learning about various dementia-related topics, perceived challenges with various dementia-related practice activities and preparedness for dementia care, provided additional dementia-related topics of interest, number of years in clinical practice, and discipline. RESULTS Thirteen hundred surveys were completed across both education programs. Mean ratings of preparedness for dementia care across all respondents reflected that they felt somewhat prepared for dementia care. Challenge ratings varied from low to very challenging and mean ratings reflected a high level of interest in learning more about all of the dementia-related topics; significant differences between disciplines in these ratings were identified. In most cases, perceived challenges and learning needs were not correlated with number of years in clinical practice, but in some cases lower ratings of preparedness for dementia care were associated with higher ratings of the challenges of dementia care. DISCUSSION Clinicians perceived that their formal education had not prepared them well for managing dementia and desired more knowledge in all topic areas, regardless of years in practice. Implications for education are discussed.
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Affiliation(s)
- Linda Lee
- Dr. Lee: Lead Physician, MINT Memory Clinic, Centre for Family Medicine Family Health Team, Kitchener, Ontario, Canada, Associate Professor, Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada, and Schlegel Research Chair in Primary Care for Elders, Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada. Ms. Hillier: Research Affiliate, Geriatric Education and Research in Aging Sciences (GERAS) Centre, Hamilton, Ontario, Canada. Dr. Patel: Pharmacist, MINT Memory Clinic, Centre for Family Medicine Family Health Team, Kitchener, Ontario, Canada, and Assistant Clinical Professor, School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada, and Assistant Clinical Professor, Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada. Dr. Weston: Professor Emeritus, Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Armson H, Perrier L, Roder S, Shommu NS, Wakefield J, Shaw E, Zahorka S, Elmslie T, Lofft M. Assessing Unperceived Learning Needs in Continuing Medical Education for Primary Care Physicians: A Scoping Review. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2020; 40:257-267. [PMID: 33284177 DOI: 10.1097/ceh.0000000000000300] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
INTRODUCTION Assessing needs before developing continuing medical education/continuing professional development (CME/CPD) programs is a crucial step in the education process. A previous systematic literature review described a lack of objective evaluation for learning needs assessments in primary care physicians. This scoping review updates the literature on uses of objective evaluations to assess physicians' unperceived learning needs in CME/CPD. Identifying and understanding these approaches can inform the development of educational programs that are relevant to clinical practice and patient care. The study objectives were to (1) scope the literature since the last systematic review published in 1999; (2) conduct a comprehensive search for studies and reports that explore innovative tools and approaches to identify physicians' unperceived learning needs; (3) summarize, compare, and classify the identified approaches; and (4) map any gaps in the literature to identify future areas of research. METHODS A scoping review was used to "map" the literature on current knowledge regarding approaches to unperceived needs assessment using conceptual frameworks for planning and assessing CME/CPD activities. RESULTS Two prominent gaps were identified: (1) performance-based assessment strategies are highly recommended in nonresearch articles yet have low levels of implementation in published studies and (2) analysis of secondary data through patient input or environmental scanning is emphasized in grey literature implementation strategies more so than in peer-reviewed theoretical and research articles. DISCUSSION Future evaluations should continue to incorporate multiple strategies and focus on making unperceived needs assessments actionable by describing strategies for resource management.
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Affiliation(s)
- Heather Armson
- Dr. Armson: Assistant Dean, Continuing Medical Education and Professional Development and Professor, Department of Family Medicine, University of Calgary; Research Director, The Foundation for Medical Practice Education, McMaster University. Dr. Perrier: Research Data Management Librarian, University of Toronto Libraries, University of Toronto. Dr. Roder: Research Program Coordinator, The Foundation for Medical Practice Education, McMaster University. Dr. Shommu: Research Coordinator, Department of Medicine, Cumming School of Medicine, University of Calgary. Dr. Wakefield: Professor Emeritus, Department of Family Medicine, McMaster University; Senior Editor, Module Development, The Foundation for Medical Practice Education, McMaster University. Dr. Shaw: Professor; Associate Chair of Education, Department of Family Medicine; Director, Module Development, The Foundation for Medical Practice Education, McMaster University. Ms. Zahorka: Education Coordinator, The Foundation for Medical Practice Education, McMaster University. Dr. Elmslie: Professor Emeritus, Department of Family Medicine, University of Ottawa; Executive Director, The Foundation for Medical Practice Education, McMaster University. Ms. Lofft: Research Assistant, The Foundation for Medical Practice Education, McMaster University
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Murad A, Hyde N, Chang S, Lederman R, Bosua R, Pirotta M, Audehm R, Yates CJ, Briggs AM, Gorelik A, Chiang C, Wark JD. Quantifying Use of a Health Virtual Community of Practice for General Practitioners' Continuing Professional Development: A Novel Methodology and Pilot Evaluation. J Med Internet Res 2019; 21:e14545. [PMID: 31774401 PMCID: PMC6906624 DOI: 10.2196/14545] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 09/18/2019] [Accepted: 09/24/2019] [Indexed: 12/31/2022] Open
Abstract
Background Health care practitioners (HPs), in particular general practitioners (GPs), are increasingly adopting Web-based social media platforms for continuing professional development (CPD). As GPs are restricted by time, distance, and demanding workloads, a health virtual community of practice (HVCoP) is an ideal solution to replace face-to-face CPD with Web-based CPD. However, barriers such as time and work schedules may limit participation in an HVCoP. Furthermore, it is difficult to gauge whether GPs engage actively or passively in HVCoP knowledge-acquisition for Web-based CPD, as GPs’ competencies are usually measured with pre- and posttests. Objective This study investigated a method for measuring the engagement features needed for an HVCoP (the Community Fracture Capture [CFC] Learning Hub) for learning and knowledge sharing among GPs for their CPD activity. Methods A prototype CFC Learning Hub was developed using an Igloo Web-based social media software platform and involved a convenience sample of GPs interested in bone health topics. This Hub, a secure Web-based community site, included 2 key components: an online discussion forum and a knowledge repository (the Knowledge Hub). The discussion forum contained anonymized case studies (contributed by GP participants) and topical discussions (topics that were not case studies). Using 2 complementary tools (Google Analytics and Igloo Statistical Tool), we characterized individual participating GPs’ engagement with the Hub. We measured the GP participants’ behavior by quantifying the number of online sessions of the participants, activities undertaken within these online sessions, written posts made per learning topic, and their time spent per topic. We calculated time spent in both active and passive engagement for each topic. Results Seven GPs participated in the CFC Learning Hub HVCoP from September to November 2017. The complementary tools successfully captured the GP participants’ engagement in the Hub. GPs were more active in topics in the discussion forum that had direct clinical application as opposed to didactic, evidence-based discussion topics (ie, topical discussions). From our knowledge hub, About Osteoporosis and Prevention were the most engaging topics, whereas shared decision making was the least active topic. Conclusions We showcased a novel complementary analysis method that allowed us to quantify the CFC Learning Hub’s usage data into (1) sessions, (2) activities, (3) active or passive time spent, and (4) posts made to evaluate the potential engagement features needed for an HVCoP focused on GP participants’ CPD process. Our design and evaluation methods for ongoing use and engagement in this Hub may be useful to evaluate future learning and knowledge-sharing projects for GPs and may allow for extension to other HPs’ environments. However, owing to the limited number of GP participants in this study, we suggest that further research with a larger cohort should be performed to validate and extend these findings.
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Affiliation(s)
- Abdulaziz Murad
- School of Computing and Information Systems, University of Melbourne, Melbourne, Australia
| | | | - Shanton Chang
- School of Computing and Information Systems, University of Melbourne, Melbourne, Australia
| | - Reeva Lederman
- School of Computing and Information Systems, University of Melbourne, Melbourne, Australia
| | - Rachelle Bosua
- School of Computing and Information Systems, University of Melbourne, Melbourne, Australia.,Open University of the Netherlands, Heerlen, Netherlands
| | - Marie Pirotta
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Ralph Audehm
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Christopher J Yates
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia.,Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, Australia.,Bone and Mineral Medicine, Royal Melbourne Hospital, Melbourne, Australia
| | - Andrew M Briggs
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Alexandra Gorelik
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia.,School of Behavioral and Health Science, Australian Catholic University, Melbourne, Australia
| | - Cherie Chiang
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia.,Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, Australia.,Bone and Mineral Medicine, Royal Melbourne Hospital, Melbourne, Australia.,Department of Pathology, Royal Melbourne Hospital, Melbourne, Australia
| | - John D Wark
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia.,Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, Australia.,Bone and Mineral Medicine, Royal Melbourne Hospital, Melbourne, Australia
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Shah MD, Goyal V, Singh V, Lele J. Preferences and attitudes of physicians in India towards continuing medical education. J Eur CME 2018; 6:1332940. [PMID: 29644133 PMCID: PMC5843049 DOI: 10.1080/21614083.2017.1332940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 05/17/2017] [Indexed: 11/14/2022] Open
Abstract
Introduction: Physicians in India display an enthusiasm for continuing medical education (CME), however a proper system for facilitation and organisation of CME activities is yet to evolve in the country. Methods: A questionnaire-based survey was conducted among 751 physicians from eight medical specialties across India and the data retrieved was analysed at individual physician and collective specialty-specific levels. Results: The surveyed physicians considered case presentations (73%), live speaker programmes (70%) and round-table meetings/focus group meetings (70%) as the most effective CME activities. They preferred a duration of <2 h for CME activities such as webcasts (89%) and lectures (86%). Most of them considered scientific agenda (78%) and stature of speakers (77%) as the most important determinants of the quality of a CME event. Most physicians wanted topics such as disease guidelines (88%) and new drugs/devices/interventions (86%) for discussion in CME activities. Medical associations (87%) were the most desirable organisations for holding the CME activities and face-to-face modules appealed to majority of the physicians (64%). Conclusions: This study indicates that Indian physicians prefer live, interactive, short, specialty-specific educational sessions for CME activities, delivered by Indian experts and organised by medical associations at domestic destinations.
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Affiliation(s)
- Manan D Shah
- Medical Affairs, Janssen India, Johnson & Johnson Pvt. Ltd, Mumbai, India
| | - Vishal Goyal
- Medical Affairs, Janssen India, Johnson & Johnson Pvt. Ltd, Mumbai, India
| | - Vikram Singh
- Medical Affairs, Janssen India, Johnson & Johnson Pvt. Ltd, Mumbai, India
| | - Jayesh Lele
- Indian Medical Association, Mumbai, Maharashtra, India
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Archibald D, Liddy C, Lochnan HA, Hendry PJ, Keely EJ. Using Clinical Questions Asked by Primary Care Providers Through eConsults to Inform Continuing Professional Development. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2018; 38:41-48. [PMID: 29351133 DOI: 10.1097/ceh.0000000000000187] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
INTRODUCTION Continuing professional development (CPD) offerings should address the educational needs of health care providers. Innovative programs, such as electronic consultations (eConsults), provide unique educational opportunities for practice-based needs assessment. The purpose of this study is to assess whether CPD offerings match the needs of physicians by coding and comparing session content to clinical questions asked through eConsults. METHODS This study analyzes questions asked by primary care providers between July 2011 and January 2015 using a service that allows specialists to provide consultation over a secure web-based server. The content of these questions was compared with the CPD courses offered in the area in which these primary care providers are practicing over a similar period (2012-2014). The clinical questions were categorized by the content area. The percentage of questions asked about each content area was calculated for each of the 12 specialties consulted. CPD course offerings were categorized using the same list of content areas. Percentage of minutes dedicated to each content area was calculated for each specialty. The percentage of questions asked and the percentage of CPD course minutes for each content area were compared. RESULTS There were numerous congruencies and discrepancies between the proportion of questions asked about a given content area and the CPD minutes dedicated to it. DISCUSSION Traditional needs assessment may underestimate the need to address topics that are frequently the subject of eConsults. Planners should recognize eConsult questions as a valuable source of practice-associated challenges that can identify professional development needs of physicians.
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Affiliation(s)
- Douglas Archibald
- Dr. Archibald: Assistant Professor, CT Lamont Primary Health Care Research Centre, Department of Family Medicine, University of Ottawa; Bruyère Research Institute, Ottawa, Ontario, Canada. Dr. Liddy: Associate Professor, CT Lamont Primary Health Care Research Centre, Department of Family Medicine, University of Ottawa; Bruyère Research Institute, Ottawa, Ontario, Canada. Dr. Lochnan: Associate Professor, Department of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. Dr. Hendry: Professor, Department of Surgery, University of Ottawa; University of Ottawa Heart Institute, Ottawa, Ontario, Canada. Dr. Keely: Professor, Department of Medicine, University of Ottawa; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Zuchowski JL, Hamilton AB, Washington DL, Gomez AG, Veet L, Cordasco KM. Drivers of Continuing Education Learning Preferences for Veterans Affairs Women's Health Primary Care Providers. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2017; 37:168-172. [PMID: 28817394 DOI: 10.1097/ceh.0000000000000164] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Documented gaps in health professionals' training in women's health are a special concern for continuing education (CE). In the Veterans Affairs (VA) health care system, women veterans are a numerical minority, preferably assigned to designated women's health primary care providers (DWHPs). DWHPs need to maintain their knowledge and skills in women's health topics, in addition to general internal medicine topics. We explored drivers of VA DWHPs' learning preferences for women's health topics-ie, factors which influence greater and lesser learning interest. METHODS We conducted semistructured telephone interviews with DWHPs across six VA health care systems. Interviews were audio recorded, transcribed, and coded in ATLAS.ti. We synthesized results by grouping relevant coded sections of text to form emergent themes. RESULTS Among the 31 DWHPs interviewed, reported drivers of learning interests among women's health topics were (1) high frequency of clinical incidence of particular issues; (2) perceived appropriateness of particular issues for management in primary care settings; and (3) perceived appropriateness of particular issues for partial management in primary care. Lower interest in particular women's health topics was associated with (1) perceived existing competency or recent training in an issue and (2) perceived need for specialty care management of an issue. DISCUSSION Understanding drivers of DWHPs' CE learning priorities lays a foundation for developing CE programming that will be of interest to women's health primary care providers. Attention to drivers of learning interests may have applicability beyond women's health, suggesting a general approach for CE programming that prioritizes high-volume topics within the practice scope of target providers.
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Affiliation(s)
- Jessica L Zuchowski
- Dr. Zuchowski: VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Sepulveda, CA. Dr. Hamilton: VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Sepulveda, CA, and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA. Drs. Washington and Cordasco: VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Sepulveda, CA; Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA, and Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA. Dr. Gomez: Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA, and Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA. Dr. Veet: VA Women's Health Services, Office of Patient Care Services, Veterans Health Administration, Washington, DC, and Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA
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Olson CA. In this issue and a comment on the contradictions of the preface. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2015; 35:1-2. [PMID: 25799966 DOI: 10.1002/chp.21261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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