A New Educational Framework to Improve Lifelong Learning for Cardiologists

The future of education in Preventive Cardiology: a statement of the European Association of Preventive Cardiology of the European Society of Cardiology

In recent years, major advances in our understanding of risk factors implicated in the development of cardiovascular disease (CVD), in available tools for early detection of CVD, and in effective interventions to prevent subclinical or clinically manifest disease, have led to an increasing appreciation of prevention as a major pillar of cardiovascular (CV) medicine. Preventive Cardiology has evolved into a dynamic sub-speciality focused on the promotion of CV health through all stages of life, and on the management of individuals at risk of developing CVD or experiencing recurrent CV events, through interdisciplinary care in different settings. As the level of knowledge, specialized skills, experience, and committed attitudes related to CV prevention has exceeded core cardiology training, the European Association of Preventive Cardiology (EAPC) has placed major emphasis on continuous education and training of physicians and allied professionals involved in CV prevention, with the aim of setting standards for practice and improving quality of care. The EAPC recognizes the need for a comprehensive educational offer across different levels of training (from core cardiology to sub-speciality to expert training) as well as the need for interdisciplinary approaches that will promote synergies among allied professionals involved in CV prevention. This statement by the EAPC aims to highlight current gaps and unmet needs and to describe the framework to help standardize, structure, and deliver comprehensive, up-to-date, interactive, and high-quality education using a combination of traditional and novel educational tools. The document aims to form the basis for ongoing refinements of the EAPC educational offer, with the ultimate goal of ensuring that new evidence in the field will translate to better CV practice and improved outcomes for our patients.

Adult congenital heart disease training in Europe: current status, disparities and potential solutions

OBJECTIVES

This study aimed to determine the status of training of adult congenital heart disease (ACHD) cardiologists in Europe.

METHODS

A questionnaire was sent to ACHD cardiologists from 34 European countries.

RESULTS

Representatives from 31 of 34 countries (91%) responded. ACHD cardiology was recognised by the respective ministry of Health in two countries (7%) as a subspecialty. Two countries (7%) have formally recognised ACHD training programmes, 15 (48%) have informal (neither accredited nor certified) training and 14 (45%) have very limited or no programme. Twenty-five countries (81%) described training ACHD doctors 'on the job'. The median number of ACHD centres per country was 4 (range 0-28), median number of ACHD surgical centres was 3 (0-26) and the median number of ACHD training centres was 2 (range 0-28). An established exit examination in ACHD was conducted in only one country (3%) and formal certification provided by two countries (7%). ACHD cardiologist number versus gross domestic product Pearson correlation coefficient=0.789 (p<0.001).

CONCLUSION

Formal or accredited training in ACHD is rare among European countries. Many countries have very limited or no training and resort to 'train people on the job'. Few countries provide either an exit examination or certification. Efforts to harmonise training and establish standards in exit examination and certification may improve training and consequently promote the alignment of high-quality patient care.

Health sciences lifelong learning and professional development in the era of artificial intelligence

INTRODUCTION

In the field of healthcare, lifelong learning is considered a quality indicator due to its potential to enhance healthcare services and the knowledge and skills of healthcare professionals. The purpose of this research is to investigate and document the attitudes and behavior of healthcare professionals from different healthcare institutions toward lifelong learning using artificial intelligence.

THE STUDY ACHIEVES TWO OBJECTIVES

Identifying healthcare professionals' interest in formal lifelong learning and determining how they engage in lifelong learning. Additionally, this study aims to develop a dynamic web platform with several key features including an introduction page, navigation menu, document download form, document table, and download, delete, and resume buttons.

METHODOLOGY

The study was conducted from 07/04/2022 to 19/05/2022 and involved a sample of 114 healthcare professionals from various locations in Morocco. A questionnaire comprising three sections (personal information, lifelong learning for personal development, and lifelong learning for professional development) was used as the research instrument.

RESULTS

The average age of the participants was 43 years, and 76.8% had more than 11 years of experience in the field. The results indicate a correlation between professional development and lifelong learning among healthcare professionals. The two most important factors driving lifelong learning were identified as the advancement of the healthcare profession and the need to elevate the quality of care. Also, this research objective is to develop a dynamic online platform featuring an introduction page, navigation menu, document download form, document table, and download, delete, and resume buttons.

CONCLUSIONS

According to the findings, healthcare professionals consider lifelong learning an ongoing and continuous process essential to their work.

Flipped learning as an educational model in a cardiology residency program

INTRODUCTION

Flipped learning (FL) is a model which allows students to adjust their study rhythm by taking advantage of class time to apply their knowledge. Although FL meets many of the needs of the traditional lecture-based model and the exclusively virtual model, its effectiveness in medical residency programs has not been thoroughly studied. Our study evaluates the efficacy of an FL model in a cardiology residency program based on the satisfaction and academic performance of the participants.

METHOD

A prospective, observational, and descriptive study was conducted at Ignacio Chávez National Institute of Cardiology in Mexico City to evaluate the satisfaction and effectiveness of an FL model for acquiring competencies in electrocardiographic diagnosis among thirty-one first-year cardiology residents. The Advanced Electrocardiography Workshop and a virtual classroom were designed for the intervention. Four teachers taught the workshop and video classes, and ten medical specialists from the participants' areas of work performed evaluations of practical skills before and after the intervention.

RESULTS

75% of the participants rated the intervention as very favorable compared to the traditional and virtual models. The main advantages offered by the FL model were identified. An improvement of high statistical significance was observed in participants' academic performance after the intervention (P value < 0.001).

CONCLUSION

The FL model has a high degree of acceptance among participants and teachers. Our study shows an improvement in academic performance after the intervention. Considering that the FL model is flexible and reproducible in other areas of medicine, it represents an excellent educational alternative that meets current needs.

Paediatric and adult congenital cardiology education and training in Europe

BACKGROUND

Limited data exist on training of European paediatric and adult congenital cardiologists.

METHODS

A structured and approved questionnaire was circulated to national delegates of Association for European Paediatric and Congenital Cardiology in 33 European countries.

RESULTS

Delegates from 30 countries (91%) responded. Paediatric cardiology was not recognised as a distinct speciality by the respective ministry of Health in seven countries (23%). Twenty countries (67%) have formally accredited paediatric cardiology training programmes, seven (23%) have substantial informal (not accredited or certified) training, and three (10%) have very limited or no programme. Twenty-two countries have a curriculum. Twelve countries have a national training director. There was one paediatric cardiology centre per 2.66 million population (range 0.87-9.64 million), one cardiac surgical centre per 4.73 million population (range 1.63-10.72 million), and one training centre per 4.29 million population (range 1.63-10.72 million population). The median number of paediatric cardiology fellows per training programme was 4 (range 1-17), and duration of training was 3 years (range 2-5 years). An exit examination in paediatric cardiology was conducted in 16 countries (53%) and certification provided by 20 countries (67%). Paediatric cardiologist number is affected by gross domestic product (R² = 0.41).

CONCLUSION

Training varies markedly across European countries. Although formal fellowship programmes exist in many countries, several countries have informal training or no training. Only a minority of countries provide both exit examination and certification. Harmonisation of training and standardisation of exit examination and certification could reduce variation in training thereby promoting high-quality care by European congenital cardiologists.

The Utility and Educational Impact of a Virtual Webinar to Deliver an International Undergraduate Cardiovascular Conference

Introduction

Conferences are an important avenue for dissemination of knowledge, research and provide networking opportunities for career development. The COVID-19 pandemic has prompted adoption of virtual platforms for delivery of these conferences. The aim of the study was to determine the utility and educational impact of a student-led virtual webinar to deliver an undergraduate cardiovascular conference compared to a traditional in-person conference.

Methods

We conducted a two-day virtual conference using the Zoom platform in June 2021. The conference consisted of cardiology subspecialty lectures, and workshops were conducted by a junior doctor, senior cardiology trainees and consultants. The conference also outlaid a virtual poster hall and oral presentation session while networking opportunities were encouraged using breakout rooms and poster hall chat function. A 38-item self-administered online questionnaire was designed and disseminated at the end of the conference to all attending delegates. All data analysis and data visualisation strategies were conducted on R statistical programming.

Results

Eight-hundred and forty students from 55 countries attended the event. Four hundred and ninety participants (58.5% response rate, 55.9% female) completed the questionnaire. Factors such as weekend conference (84.9%), student-led or organised (84.1%), environmental/sustainable (82.3%), appropriate level for me (81.5%) and comfort to present (80.8%) were deemed to be at least equal to traditional in-person conference. The conference also increased participants' interest, their core cardiology knowledge and improved their critical analysis and basic echocardiography skills [median 4 (IQR 3-5) for all parameters]. Overall, participants also found it easy to use the virtual platform [median 5 (IQR 5-5)] and easier to ask questions compared to in-person conferences [median 5 (IQR 4-5) vs median 4 (IQR 3-5), p < 0.001].

Conclusion

Our virtual conference provided opportunities to students that the COVID-19 pandemic would have otherwise affected; however, its utility and educational impact will need to be assessed within its individual context of delivery.

Evaluation of a Novel Cardiology Undergraduate Medical Education Curriculum

Introduction

Cardiology is a complex discipline that requires mastery of key principles and the ability to apply them in varied clinical scenarios, which may be challenging to teach in the traditional lecture-based format. The purpose of this educational intervention was to evaluate the effect of a flipped classroom model on knowledge base and attitudes towards high-yield cardiology concepts in third and fourth-year medical students at our institution.

Methods

An invitation to this optional course was sent to third and fourth-year medical students at the Icahn School of Medicine at Mount Sinai. Interested students were sent a document providing optional pre-course self-directed educational materials designed to take one hour to review. The materials included videos, graphics, and short sections of articles related to heart failure (HF), acute coronary syndrome (ACS), and tachyarrhythmias (TA). Students were then scheduled for a thirty-minute small-group session with a clinician, during which they reviewed the diagnosis and management of HF, ACS, and TA on an online video conference platform. Anonymous pre- and post-course assessments to measure knowledge and confidence were collected.

Results

Twenty-one students completed the pre-course assessment, and 19 students completed the post-course assessment. Seventy-nine percent of the students reported completion of at least half of the self-directed pre-work. The average score on the knowledge assessment rose from 42% to 71% after the course (p<0.001). After the course, 18 (95%) felt comfortable contributing to the management of a case of HF, 16 (84%) a case of ACS, and 13 (68%) a case of TA.

Conclusion

Knowledge assessment scores and learner self-confidence with the management of HF, ACS, and TA rose significantly after undergraduate medical education students completed this flipped classroom training. This exploratory study showed that the flipped classroom model with small group sessions can be a well-received model for medical student cardiology education among a self-motivated group of learners, though further analysis with a larger learner cohort is needed.

Continuing Education Courses for Orthopedic and Sports Physical Therapists in the United States Often Lack Supporting Evidence: A Review of Available Intervention Courses

OBJECTIVE

The purpose of this study was to characterize the extent to which orthopedic and sports-related continuing education course descriptions approved for physical therapists in the United States taught interventions supported by evidence.

METHODS

A review was conducted of courses available on CEU Locker from January through December 2020, estimated to represent most courses nationally available to physical therapists. This review focused specifically on courses teaching interventions for musculoskeletal conditions in adults. Specifically, courses for orthopedic and sports populations were identified. All course information was extracted, including the intervention name, course description, and target audience. Finally, clinical practice guidelines (CPGs) and systematic reviews with at least moderate-level evidence published through May 1, 2021, were searched to determine if treatments were recommended or not recommended, or if no evidence existed.

RESULTS

The review identified 2406 available courses extracted from the database. After excluding courses that did not meet inclusion criteria, duplicates, and those with incomplete or inadequate information, the final number was 319. Most courses (52.7%, n = 168) taught interventions not supported by a CPG or systematic review. Approximately one-third of courses (34.2%, n = 109) taught interventions that were recommended by a CPG. Many courses were targeted to multiple disciplines (38.9%, n = 124), whereas 89 (27.9%) were specifically for physical therapists, physical therapist assistants, or both. The specific target was unclear for 106 (33.2%) courses. Courses usually focused on multiple body regions, and exercise was the most included intervention. Soft-skill courses were the most supported by evidence (82.9%, n = 29), whereas those teaching modalities were the least supported (30.5%, n = 29).

CONCLUSION

Fewer than one-half of courses that focused on management of musculoskeletal disorders taught interventions supported by a CPG or systematic review, and course descriptions often misrepresented the current state of evidence. Courses required for licensure renewal might not be meeting the intended goal of keeping clinicians current with new and emerging research.

IMPACT

Relatively few continuing education courses on orthopedic and sports-related physical therapist interventions are based on evidence provided by CPGs or systematic reviews, and some continuing education options required for physical therapists to meet annual licensure renewal requirements might not be keeping therapists current with the latest evidence. This study provides data that can facilitate candid dialog within the profession about potential solutions.

Medical education and training within congenital cardiology: current global status and future directions in a post COVID-19 world

Despite enormous strides in our field with respect to patient care, there has been surprisingly limited dialogue on how to train and educate the next generation of congenital cardiologists. This paper reviews the current status of training and evolving developments in medical education pertinent to congenital cardiology. The adoption of competency-based medical education has been lauded as a robust framework for contemporary medical education over the last two decades. However, inconsistencies in frameworks across different jurisdictions remain, and bridging gaps between competency frameworks and clinical practice has proved challenging. Entrustable professional activities have been proposed as a solution, but integration of such activities into busy clinical cardiology practices will present its own challenges. Consequently, this pivot towards a more structured approach to medical education necessitates the widespread availability of appropriately trained medical educationalists, a development that will better inform curriculum development, instructional design, and assessment. Differentiation between superficial and deep learning, the vital role of rich formative feedback and coaching, should guide our trainees to become self-regulated learners, capable of critical reasoning yet retaining an awareness of uncertainty and ambiguity. Furthermore, disruptive innovations such as "technology enhanced learning" may be leveraged to improve education, especially for trainees from low- and middle-income countries. Each of these initiatives will require resources, widespread advocacy and raised awareness, and publication of supporting data, and so it is especially gratifying that Cardiology in the Young has fostered a progressive approach, agreeing to publish one or two articles in each journal issue in this domain.

Do Flipped Learning and Adaptive Instruction Improve Student Learning Outcome? A Case Study of a Computer Programming Course in Taiwan

Flipped learning could improve the learning effectiveness of students. However, some studies have pointed out the limitations related to flipped classrooms because the content of the flipped course does not vary according to the needs of the students. On the other hand, adaptive teaching, which customizes the learning mode according to the individual needs of students, can make up for some of the shortcomings of flipped teaching. This study combines adaptive teaching with flipped teaching and applies it to face-to-face classroom activities. The purpose of this research is to explore whether the implementation of flipping and adaptive learning in a computer programming course can improve the learning effectiveness of students. The experimental subjects of this study are the sophomore students in the Department of Information Management. The flipped classroom with adaptive instruction has been realized in the limited course time. This study uses questionnaires to collect pre- and post-test data on the "learning motivation" of students. The learning effectiveness was evaluated based on the students' previous programming course (C language) and the semester scores of this course. Research results show that the post-test "learning motivation" has improved overall compared with the pre-test, and the learning effect is significant. The results of this research not only prove the effectiveness of modern teaching theories in programming courses but also lay the foundation for future teaching design.

Cardiovascular Medical Education During the Coronavirus Disease 2019 Pandemic: Challenges, Adaptations, and Considerations for the Future

The coronavirus disease 2019 (COVID-19) pandemic has greatly impacted graduate medical education for cardiovascular fellows in training. During the initial case surge in the US in early 2020, most training programs reformatted didactic curricula, redeployed fellows in training to non-cardiac services or furloughed fellows in training on non-essential services, reimagined procedural training in light of decreased case volumes, and balanced issues regarding trainee wellbeing and safety with occupational COVID-19 exposure risk. In this article, the authors review the educational challenges posed by the COVID-19 pandemic, and discuss opportunities to incorporate technological and curricular innovations spurred by the pandemic into cardiovascular fellowship training in the future.

The perceived global impact of the COVID-19 pandemic on doctors' medical and surgical training: An international survey

INTRODUCTION

The COVID-19 pandemic has resulted in a significant burden on healthcare systems causing disruption to the medical and surgical training of doctors globally.

AIMS AND OBJECTIVES

This is the first international survey assessing the perceived impact of the COVID-19 pandemic on the training of doctors of all grades and specialties.

METHODS

An online global survey was disseminated using Survey Monkey® between 4th August 2020 and 17th November 2020. A global network of collaborators facilitated participant recruitment. Data were collated anonymously with informed consent and analysed using univariate and adjusted multivariable analyses.

RESULTS

Seven hundred and forty-three doctors of median age 27 (IQR: 25-30) were included with the majority (56.8%, n = 422) being male. Two-thirds of doctors were in a training post (66.5%, n = 494), 52.9% (n = 393) in a surgical specialty and 53.0% (n = 394) in low- and middle-income countries. Sixty-nine point two percent (n = 514) reported an overall perceived negative impact of the COVID-19 pandemic on their training. A significant decline was noted amongst non-virtual teaching methods such as face-to-face lectures, tutorials, ward-based teaching, theatre sessions, conferences, simulation sessions and morbidity and mortality meetings (P ≤ .05). Low or middle-income country doctors' training was associated with perceived inadequate supervision while performing invasive procedures under general, local or regional anaesthetic. (P ≤ .05).

CONCLUSION

In addition to the detrimental impact of the COVID-19 pandemic on healthcare infrastructure, this international survey reports a widespread perceived overall negative impact on medical and surgical doctors' training globally. Ongoing adaptation and innovation will be required to enhance the approach to doctors' training and learning in order to ultimately improve patient care.

COVID-19 and the Digitalisation of Cardiovascular Training and Education-A Review of Guiding Themes for Equitable and Effective Post-graduate Telelearning

The coronavirus disease-2019 (COVID-19) pandemic has had an unprecedented impact leading to novel adaptations in post-graduate medical education for cardiovascular and general internal medicine. Whilst the results of initial community COVID-19 vaccination are awaited, continuation of multimodality teaching and training that incorporates telelearning will have enduring benefit to post-graduate education and will place educational establishments in good stead to nimbly respond in future pandemic-related public health emergencies. With the rise in innovative virtual learning solutions, medical educators will have to leverage technology to develop electronic educational materials and virtual courses that facilitate adult learning. Technology-enabled virtual learning is thus a timely progression of hybrid classroom initiatives that are already adopted to varying degrees, with a need for faculty to serve as subject matter experts, to host and moderate online discussions, and to provide feedback and overall mentorship. As an extension from existing efforts, simulation-based teaching (SBT) and learning and the use of mixed reality technology should also form a greater core in the cardiovascular medicine curriculum. We highlight five foundational themes for building a successful e-learning model in cardiovascular and general post-graduate medical training: (1) digital solutions and associated infrastructure; (2) equity in access; (3) participant engagement; (4) diversity and inclusion; and (5) patient confidentiality and governance framework. With digitalisation impacting our everyday lives and now how we teach and train in medicine, these five guiding principles provide a cognitive scaffold for careful consideration of the required ecosystem in which cardiovascular and general post-graduate medical education can effectively operate. With due consideration of various e-learning options and associated infrastructure needs; and adoption of strategies for participant engagement under sound and just governance, virtual training in medicine can be effective, inclusive and equitable through the COVID-19 era and beyond.

Implementation of a virtual international cardiology curriculum to address the deficit of cardiovascular education in Haiti: a pilot study

BACKGROUND

Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality worldwide, conferring a disparate burden on low-income and middle-income countries (LMICs). Haiti represents a resource-constrained setting, limited by a paucity of resources and trained cardiovascular professionals equipped to address the increasing burden of CVD.

OBJECTIVE

Here, we describe the creation of a comprehensive cardiology curriculum delivered through a virtual classroom. The curriculum was created to augment cardiovascular education in LMICs such as Haiti.

METHODS

Over one academic year (May 2019-2020), International Cardiology Curriculum Accessible by Remote Distance Learning-Haiti consisted of biweekly, live-streamed, synchronous didactic lectures, seminars and case presentations broadcasted to 16 internal medicine (IM) residents at Hôpital Universitaire de Mirebalais, one of only four IM training programmes in Haiti. The virtual classroom was created using commercially available videoconferencing and data-sharing platforms. Prelecture and postlecture surveys and an end of the year survey were administered to assess the impact of the curriculum.

RESULTS

Participant performance analysis revealed that 80% of the curriculum demonstrated a positive trend in knowledge acquisition postintervention. Based on the end of the year evaluation, 94% of participants reported that the curriculum was educational and relevant to medical practice in Haiti and 100% reported that the curriculum was good to excellent. Additionally, the curriculum was cited as an effective means of maintaining trainee education during the COVID-19 pandemic.

CONCLUSION

This international medical education pilot study demonstrates the feasibility of augmenting cardiology education in LMICs by creating a virtual curriculum made possible by local partnerships, internet access and technology.

Education interventions for health professionals on falls prevention in health care settings: a 10-year scoping review

BACKGROUND

Falls in hospitals are a major risk to patient safety. Health professional education has the potential to be an important aspect of falls prevention interventions. This scoping review was designed to investigate the extent of falls prevention education interventions available for health professionals, and to determine the quality of reporting.

METHOD

A five stage scoping review process was followed based on Arksey and O'Malley's framework and refined by the Joanna Briggs Institute Methodology for JBI Scoping Reviews. Five online databases identified papers published from January 2008 until May 2019. Papers were independently screened by two reviewers, and data extracted and analysed using a quality reporting framework.

RESULTS

Thirty-nine publications were included. Interventions included formal methods of educational delivery (for example, didactic lectures, video presentations), interactive learning activities, experiential learning, supported learning such as coaching, and written learning material. Few studies employed comprehensive education design principles. None used a reporting framework to plan, evaluate, and document the outcomes of educational interventions.

CONCLUSIONS

Although health professional education is recognised as important for falls prevention, no uniform education design principles have been utilised in research published to date, despite commonly reported program objectives. Standardised reporting of education programs has the potential to improve the quality of clinical practice and allow studies to be compared and evaluated for effectiveness across healthcare settings.

Training in interventional pulmonology: What we have learned and a way forward

IP encompasses a complex list of procedures requiring knowledge, technical skills and competence. Modern, learner-centric educational philosophies and an explosion of multidimensional educational tools including manikins, simulators, online resources, social media and formal programs can foster learning in IP, promoting professionalism and a culture of lifelong learning. This paper provides background and guidance to a structured, multidimensional and learner-centric strategy for medical procedural education. Focusing on our experience in IP, we describe how competency-based measures, simulation technology and various teaching modalities contribute to a more uniform learning environment in which patients do not suffer the burdens of procedure-related training.

Reinvigorating Continuing Medical Education: Meeting the Challenges of the Digital Age

Clinicians in today's health care environment face an overwhelming quantity of knowledge that requires continued education and lifelong learning. However, traditional continuing medical education (CME) courses cannot meet these educational needs, particularly given the proliferation of knowledge and increasing demands on clinicians' time and resources. CME courses that previously offered only in-person, face-to-face education must evolve in a learner-centric manner founded on principles of adult learning theory to remain relevant in the current era. In this article, we describe the transition of the Mayo Clinic Cardiovascular Review for Cardiology Boards and Recertification (CVBR) from a traditional course with only live content to a course integrating live, online, and enduring materials. This evolution has required leveraging technology to maximize learner engagement, offering faculty development to ensure content alignment with learner needs, and strong leadership dedicated to providing learners an unparalleled educational experience. Despite stagnation in growth of the traditional live course, these changes have increased the overall reach of the Mayo Clinic CVBR. Learners engaging with digital content have demonstrated larger increases in knowledge with less educational time commitment. Courses seeking to implement similar changes must develop formal learning objectives focused on learner needs, build an online presence that includes an assessment of learner knowledge, enlist a cohort of dedicated faculty who teach based on principles of adult learning theory, and perpetually refresh educational content based on learner feedback and performance. Following these principles will allow traditional CME courses to thrive despite learners' resource constraints and alternative means to access information.