Continuing professional development of occupational medicine practitioners: a needs assessment

Needs assessment: towards a more responsive Canadian Society of Nephrology Annual General Meeting (CSN AGM) program

Background

A critical feature of any continuing medical education (CME) program is the inclusion of a needs assessment for its target audience. This assessment must identify both perceived and unperceived needs, so as to best capture the entire spectrum of learning opportunities for the group.

Objective

We describe the process developed by the Canadian Society of Nephrology (CSN) to enhance the educational effectiveness of its Annual General Meeting program.

Design

The design of this study is the analysis of a survey questionnaire and of the Canadian Organ Replacement Registry (CORR) database.

Participants

We surveyed members of the CSN and analyzed patient data from CORR aggregated by center.

Measurements

We tabulated votes in the survey by topic. We assessed the extent to which centers achieved CSN guideline targets on the clinical management of patients on dialysis.

Methods

Perceived needs: a CSN panel constructed a list of topics, which was amplified by the inclusion of topics based on members’ text responses to open-ended questions during previous iterations of this process. CSN members specified their top five choices, using an online survey instrument. Unperceived needs: an expert panel determined achievable thresholds for a number of quality metrics associated with dialysis. The quality metrics were identified from CSN guidelines. Using patient data in the CORR database, we generated center-specific performance estimates for each quality metric and constructed ratios comparing the performance of each center with the achievable threshold. We triangulated the results of the two assessments.

Results

The response rate for the perceived needs assessment survey was 16 %. This assessment identified “Primary and Secondary Glomerulonephritis” as the non-dialysis topics and “Infectious Complications of Dialysis Access” and “Volume Status and Hypertension on Dialysis” as the dialysis topics with the highest perceived learning needs. In the unperceived needs assessment, “Vascular Access Type” and “Vascular Access Monitoring” were identified as having the highest learning needs. Triangulation identified “Vascular Access Type” and “Vascular Access Monitoring” as high needs topics.

Limitations

Perceived needs assessment: Some topics were much more general than others, which could have led to over-selection. The response rate of 16 % limits the robustness of generalization to the membership as a whole or to all meeting attendees.

Unperceived needs assessment: The assessment was limited by the data that CORR actually collects; many aspects of general nephrology practice, including glomerulonephritis, are not covered. The level of evidence underlying the various guidelines was variable, and in some cases, poor. A validated approach to data analysis in this area is lacking.

Conclusions

To our knowledge, this is the first published example of a needs assessment for a nephrology CME event that considers both the perceived and unperceived needs of the membership. The results of this exercise are currently being used to assist in the development of a more responsive CME program.

Specialist competencies in occupational medicine: appraisal of the peer-reviewed literature

BACKGROUND

A re-assessment of competencies and therefore learning outcomes for higher specialist training in occupational medicine (OM) is being undertaken. Although peer-reviewed literature on the subject exists, it is limited and needs appraisal.

AIMS

To search, and critically appraise the peer-reviewed literature on specialist competencies in OM.

METHODS

Systematic search of a range of databases of peer-reviewed literature, followed by criterion based appraisal and categorization of the findings.

RESULTS

Two hundred and thirty five papers were found of which only 20 were left after application of the grading and exclusion criteria. These addressed competencies from four perspectives: peer consensus, client, educational and legal.

CONCLUSIONS

Limited evidence can be obtained from the peer-reviewed literature on specialist competencies in OM. However, it suggests the main paradigms for deriving these competencies as well as indicating gaps and the manner in which these might be filled.

Dermatologist and family practitioner practice patterns for occupational contact dermatitis

Medical practitioners have a role in the recognition of occupational contact dermatitis. The longer the duration of symptoms before diagnosis, the poorer the outcome. Our objective was to understand practice patterns, barriers and needs for early diagnosis of occupational contact dermatitis. A survey to obtain information on practice patterns was developed based on the literature and interviews with dermatologists and family practitioners. The survey was sent to all dermatologists and a random sample of 600 family practitioners in Ontario. Fifty-seven per cent of dermatologists and 9% of family practitioners report seeing more than 20 patients per year with occupational contact dermatitis. The majority of practitioners report taking a workplace exposure history. Barriers to taking a workplace exposure history include time constraints and lack of knowledge. Reasons for referral to specialists include a lack of expertise, testing facilities and knowledge about workers' compensation, time constraints and inadequate reimbursement, whereas lack of access to specialists is a barrier for referral. Although most practitioners identify a need for further education, a low volume of patients and time constraints are key barriers to continuing education. Opportunities are identified to improve educational initiatives and health services delivery for occupational contact dermatitis, tailored to each practitioner group.

Required competencies of occupational physicians: a Delphi survey of UK customers

BACKGROUND

Occupational physicians can contribute to good management in healthy enterprises. The requirement to take into account the needs of the customers when planning occupational health services is well established.

AIMS

To establish the priorities of UK employers, employees, and their representatives regarding the competencies they require from occupational physicians; to explore the reasons for variations of the priorities in different groups; and to make recommendations for occupational medicine training curricula in consideration of these findings.

METHODS

This study involved a Delphi survey of employers and employees from public and private organisations of varying business sizes, and health and safety specialists as well as trade union representatives throughout the UK. It was conducted in two rounds by a combination of computer assisted telephone interview (CATI) and postal survey techniques, using a questionnaire based on the list of competencies described by UK and European medical training bodies.

RESULTS

There was broad consensus about the required competencies of occupational physicians among the respondent subgroups. All the competencies in which occupational physicians are trained were considered important by the customers. In the order of decreasing importance, the competencies were: Law and Ethics, Occupational Hazards, Disability and Fitness for Work, Communication, Environmental Exposures, Research Methods, Health Promotion, and Management.

CONCLUSION

The priorities of customers differed from previously published occupational physicians' priorities. Existing training programmes for occupational physicians should be regularly reviewed and where necessary, modified to ensure that the emphasis of training meets customer requirements.