Blended learning in CME: the perception of GP trainers

Professional medical education approaches: mobilizing evidence for clinicians

Rapidly proliferating high-quality evidence supports daily decision-making in clinical practice. Continuing professional medical education links this evidence to practicing clinicians who are strongly motivated to improve the quality of their care by using the latest information. Approaches to professional education vary, and their effects depend on specific scenarios. This narrative review summarizes the main approaches for professional medical education that facilitate the mobilization of evidence for clinicians. It includes traditional learning (passive and active dissemination of educational materials, lectures, and mass media dissemination), constructivist learning (engaging in local consensus processes and education outreach visits, interfacing with local opinion leaders, conducting patient-mediated interventions, employing audit and feedback processes, and utilizing clinical decision-supporting systems), and blended learning approaches (the integration of in-person or online passive learning with active and creative learning by the learners). An optimized selection from these approaches is challenging but critical to clinicians and healthcare systems.

Twelve tips for implementing and teaching anti-racism curriculum in medical education

Racism has implicit and explicit manifestations that perpetuate disparities and negatively influence patient-centered health outcomes. Subsequently, a list of action items was provided to assist medical schools in becoming anti-racist institutions. A deep subject matter knowledge, beliefs, and reflections were a driving force for the management of medical schools or faculty members involved in undergraduate and postgraduate medical education to move forward toward inclusion of anti-racism in traditional medical curriculum or adapting existing training modules on diversity, equity, and inclusion. This paper proposes twelve practical and specific tips for implementing and teaching anti-racism in medical education. These twelve tips elaborate on the proposed actions for leaders in undergraduate and postgraduate medical education, valuable for designing future curricula and educational activities.

Ensino híbrido na formação em saúde: uma revisão sistemática

Introdução: A partir da necessidade de reestruturação das instituições de ensino em saúde devido à pandemia da COVID-19, o ensino híbrido vem se destacando como possibilidade de reorganização das atividades educativas. O objetivo deste estudo foi escrever o desenvolvimento do ensino híbrido na formação de profissionais da área da saúde. Materiais e Métodos: Revisão sistemática da literatura, baseada nas recomendações da Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A pesquisa foi desenvolvida em pares, entre julho a setembro de 2020, em quatro bases de dados eletrônicas. Os descritores foram os termos “Educação a Distância”, “Educação Superior”, “Aprendizagem”, “Saúde”, “Enfermagem”, “Medicina”, “Odontologia” e “Fisioterapia” e “Ensino híbrido”. Os artigos foram classificados conforme seu Nível de Evidência. Resultados: 49 artigos foram selecionados, entre estudos quantitativos, qualitativos e de método misto. Foram encontradas experiências do desenvolvimento do ensino híbrido nos diferentes cursos de formação na área da saúde. Observou-se aplicação do ensino híbrido segundo o modelo de Rotação, modelo à la carte e o modelo Flex. Discussão: o ensino híbrido vem ganhando destaque cada vez maior no cenário da educação acadêmica em saúde. Foi visto que, a partir dele, o aluno destaca-se em sua aprendizagem, pois é o principal gerenciador deste processo, aprendendo ativamente por diversos instrumentos educativos a partir da condução do professor. Conclusões: O êxito do ensino híbrido pode estar relacionado ao seu caráter inovador, flexível, com boa relação custo-benefício e capaz de tornar os alunos protagonistas do seu processo de ensino-aprendizagem, influenciando no desempenho acadêmico dos alunos.

Continuing professional education for general practitioners on chronic obstructive pulmonary disease: feasibility of a blended learning approach in Bangladesh

Background

Continuing medical education (CME) is essential to developing and maintaining high quality primary care. Traditionally, CME is delivered face-to-face, but due to geographical distances, and pressure of work in Bangladesh, general practitioners (GPs) are unable to relocate for several days to attend training. Using chronic obstructive pulmonary disease (COPD) as an exemplar, we aimed to assess the feasibility of blended learning (combination of face-to-face and online) for GPs, and explore trainees’ and trainers’ perspectives towards the blended learning approach.

Methods

We used a mixed-methods design. We trained 49 GPs in two groups via blended (n = 25) and traditional face-to-face approach (n = 24) and assessed their post-course knowledge and skills. The COPD Physician Practice Assessment Questionnaire (COPD-PPAQ) was administered before and one-month post-course. Verbatim transcriptions of focus group discussions with 18 course attendees and interviews with three course trainers were translated into English and analysed thematically.

Results

Forty GPs completed the course (Blended: 19; Traditional: 21). The knowledge and skills post course, and the improvement in self-reported adherence to COPD guidelines was similar in both groups. Most participants preferred blended learning as it was more convenient than taking time out of their busy work life, and for many the online learning optimised the benefits of the subsequent face-to-face sessions. Suggested improvements included online interactivity with tutors, improved user friendliness of the e-learning platform, and timing face-to-face classes over weekends to avoid time-out of practice.

Conclusions

Quality improvement requires a multifaceted approach, but adequate knowledge and skills are core components. Blended learning is feasible and, with a few caveats, is an acceptable option to GPs in Bangladesh. This is timely, given that online learning with limited face-to-face contact is likely to become the norm in the on-going COVID-19 pandemic.

"Acquired brain injury and return to work": the feasibility of a training program for insurance physicians

Purpose: To study the feasibility (limited efficacy, acceptability, and implementation) of a training program for insurance physicians.Methods: Limited efficacy was evaluated over time (T0-T2) by conducting knowledge question tests using realistic case scenarios, analyzed by non-parametric Friedman and Wilcoxon signed-rank tests. Acceptability was evaluated by asking participants to agree or disagree with statements; for example, the knowledge was "relevant," "useful," or "appropriate." Answers were analyzed using descriptive statistics. Open-ended questions were used to ask participants what, in their opinion, were the facilitators of and barriers to implementing the knowledge taught. Their answers were coded and categorized.Results: Fifty-one IPs participated in the study. Concerning limited efficacy: the median values of the knowledge scores increased significantly over time and between time points from 16 (T0) to 21 (T1) and 32 (T2), p < 0.00. Concerning acceptability: 46 of 47 respondents perceived the training program to be "relevant," "useful," and "appropriate"; 44 respondents intended to use it in practice. Concerning implementation: participants reported "training" and "utility" as examples of facilitators and "lack of time," for example, as a barrier.Conclusion and implications: The feasibility (limited efficacy, acceptability, implementation) of the training program is demonstrated; the training program can be applied in practice.Implications for rehabilitationThe "acquired brain injury and return to work" training programme can be applied in postgraduate teaching and continuing medical education for insurance physicians.Interactive teaching methods including realistic case scenarios with a link to practice are recommended to provide insurance physicians the opportunity to learn to apply and discuss new knowledge and effectively improve insurance physicians' knowledge.Implementation of a training programme for insurance physicians can be facilitated if a brief summary of the imparted knowledge is available.Barriers, such as "other occupational healthcare and paramedical professionals being unfamiliar with the imparted knowledge" need to be addressed when implementing the "acquired brain injury and return to work" training programme.

Perceptions toward a pilot project on blended learning in Malaysian family medicine postgraduate training: a qualitative study

BACKGROUND

Blended learning (BL) is a learning innovation that applies the concept of face-to-face learning and online learning. However, examples of these innovations are still limited in the teaching of postgraduate education within the field of family medicine. Malaysian postgraduate clinical training, is an in-service training experience and face-to-face teaching with the faculty members can be challenging. Given this, we took the opportunity to apply BL in their training. This study provides an exploration of the perceptions of the educators and students toward the implementation of BL.

METHODS

A qualitative approach was employed using focus group discussions (FGD) and in-depth interviews (IDI) at an academic centre that trains family physicians. Twelve trainees, all of whom were in their hospital specialty's rotations and five faculty members were purposively selected. Three FGDs among the trainees, one FGD and two IDIs among the faculty members were conducted using a semi-structured topic guide. Data were collected through audio-recorded interviews, transcribed verbatim and checked for accuracy. A thematic approach was used to analyse the data.

RESULTS

There were four main themes that emerged from the analysis. Both educators and trainees bill the perspective that BL encouraged continuity in learning. They agreed that BL bridges the gap in student-teacher interactions. Although educators perceived that BL is in concordance with trainees learning style, trainees felt differently about this. Some educators and trainees perceived BL to be an extra burden in teaching and learning.

CONCLUSION

This study highlights a mix positive and negative perceptions of BL by educators and trainees. BL were perceived positively for continuity in learning and student-teacher interaction. However, educator and learner have mismatched perception of learning style. BL was also perceived to cause extra burden to both educators and learners. Integrating BL to a traditional learning curriculum is still a challenge. By knowing the strengths of BL in this setting, family medicine trainees in Malaysia can use it to enhance their current learning experience. Future study can investigate different pedagogical designs that suit family medicine trainees and educators in promoting independent learning in postgraduate training.

Development and evaluation of a blended educational programme for general practitioners' trainers to stimulate proactive HIV testing

Background

In the Netherlands, a substantial proportion of newly diagnosed HIV patients present late for care, therefore, we investigated the effectiveness of a blended educational programme for trainers of GPs designed to stimulate proactive HIV testing.

Methods

GP trainers at the Academic Medical Center in Amsterdam were invited to participate in a two days training programme incorporating evidence-based practice guidelines and multiple teaching strategies, including interactive lectures, discussion groups, e-learning and quality improvement targets. The GP trainers completed questionnaires before and after the programme to evaluate the effect of the programme. We also used six-monthly cumulative laboratory data from 2010 to 2015 to compare the participating GPs’ HIV tests to the general trend in testing among non-participating GPs.

Results

150 GP trainers attended the first session, and 74 completed the questionnaires for both sessions. GPs median score on achieving their quality improvement targets was high and the quality of the programme highly appreciated. Between 2010 and 2013, the mean annual number of laboratory-documented HIV tests decreased by 9.1% in the 624 GPs in the control group, and by 13.0% for 11 GPs in the intervention group. After the programme, the annual decreases were 2.3% and 1.8%, respectively. Before the programme, the GPs in the intervention group had 50% more laboratory-documented HIV tests than GPs in the control group. After the programme, GPs in the intervention group had twice as many laboratory-documented HIV tests as the controls.

Conclusions

We provided a detailed description of a programme based on educational and clinical evidence. We could not retrieve laboratory-documented HIV testing data for the majority of GPs in both the intervention and control groups. Therefore, the limited results should be interpreted with caution as our findings may not be representative of all participants. The blended educational programme appears to have stabilized – at a higher level – the initially stronger downward trend in testing for 11 GPs undergoing the intervention, indicating that the programme may have had an impact on their HIV testing behaviour.

Electronic supplementary material

The online version of this article (10.1186/s12875-018-0723-8) contains supplementary material, which is available to authorized users.

An E-Learning Module to Improve Nongenetic Health Professionals' Assessment of Colorectal Cancer Genetic Risk: Feasibility Study

BACKGROUND

Nongenetic health providers may lack the relevant knowledge, experience, and communication skills to adequately detect familial colorectal cancer (CRC), despite a positive attitude toward the assessment of history of cancer in a family. Specific training may enable them to more optimally refer patients to genetic counseling.

OBJECTIVE

The aim of this study was to develop an e-learning module for gastroenterologists and surgeons (in training) aimed at improving attitudes, knowledge, and comprehension of communication skills, and to assess the feasibility of the e-learning module for continued medical education of these specialists.

METHODS

A focus group helped to inform the development of a training framework. The e-learning module was then developed, followed by a feasibility test among a group of surgeons-in-training (3rd- and 4th-year residents) and then among gastroenterologists, using pre- and posttest questionnaires.

RESULTS

A total of 124 surgeons-in-training and 14 gastroenterologists participated. The e-learning was positively received (7.5 on a scale of 1 to 10). Between pre- and posttest, attitude increased significantly on 6 out of the 10 items. Mean test score showed that knowledge and comprehension of communication skills improved significantly from 49% to 72% correct at pretest to 67% to 87% correct at posttest.

CONCLUSIONS

This study shows the feasibility of a problem-based e-learning module to help surgeons-in-training and gastroenterologists in recognizing a hereditary predisposition in patients with CRC. The e-learning led to improvements in attitude toward the assessment of cancer family history, knowledge on criteria for referral to genetic counseling for CRC, and comprehension of communication skills.

Implementation and Evaluation of a Blended Learning Course on Tuberculosis for Front-Line Health Care Professionals

OBJECTIVES

To implement and evaluate the effectiveness of a 10-module blended learning course on tuberculosis diagnosis for Ethiopian health care professionals.

METHODS

This implementation science research was conducted within the routine in-service training for health care professionals in Ethiopia. A combined web-based and face-to-face acid-fast bacilli microscopy course was designed and its applicability studied after 6 weeks of enrollment of 108 medical laboratory professionals. A survey was conducted to capture participants' feedback on the course.

RESULTS

Of 108 participants enrolled, 81 attended and 73 (90%) completed the course; 72 (94%) had no experience taking online courses. Mean percentages of quizzes, assignments/exercises, and hands-on scores were 88%, 70%, and 95%, respectively. No significant differences were found in scores between participants from public, private, and nongovernmental health facilities ( P = .386) or between higher and lower level facilities ( P = .533). Participants' overall satisfaction with the course was 88%.

CONCLUSIONS

Blended learning was an effective pedagogic approach for this category of professionals because of the crucial need for hands-on training for practicing and translating knowledge into skills. This approach also had the advantages of keeping the costs of the entire course low and reaching a greater number of participants, all without significant disruption of work schedules.