1
|
Rafferty M, Stoff L, Smith JD, Hansen P, Briody M, Diaz C, O'Donnell L, Heinemann AW, Brown CH, Lieber RL. Promoting Evidence-Based Practice: The Influence of Novel Structural Change to Accelerate Translational Rehabilitation. Arch Phys Med Rehabil 2023; 104:1289-1299. [PMID: 36924817 PMCID: PMC10502191 DOI: 10.1016/j.apmr.2023.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 01/16/2023] [Accepted: 02/15/2023] [Indexed: 03/17/2023]
Abstract
OBJECTIVE To evaluate changes in clinicians' use of evidence-based practice (EBP), openness toward EBP, and their acceptance of organizational changes after a rehabilitation hospital transitioned to a new facility designed to accelerate clinician-researcher collaborations. DESIGN Three repeated surveys of clinicians before, 7-9 months, and 2.5 years after transition to the new facility. SETTING Inpatient rehabilitation hospital. PARTICIPANTS Physicians, nurses, therapists, and other health care professionals (n=410, 442, and 448 respondents at Times 1, 2, and 3, respectively). INTERVENTIONS Implementation of physical (architecture, design) and team-focused (champions, leaders, incentives) changes in a new model of care to promote clinician-researcher collaborations. MAIN OUTCOME MEASURES Adapted versions of the Evidence-Based Practice Questionnaire (EBPQ), the Evidence-Based Practice Attitudes Scale (EBPAS), and the Organizational Change Recipients' Beliefs Scale (OCRBS) were used. Open-ended survey questions were analyzed through exploratory content analysis. RESULTS Response rates at Times 1, 2, and 3 were 67% (n=410), 69% (n=422), and 71% (n=448), respectively. After accounting for familiarity with the model of care, there was greater reported use of EBP at Time 3 compared with Time 2 (adjusted meant2=3.51, standard error (SE)=0.05; adj. meant3=3.64, SE=0.05; P=.043). Attitudes toward EBPs were similar over time. Acceptance of the new model of care was lower at Time 2 compared with Time 1, but rebounded at Time 3 (adjusted meant1=3.44, SE=0.04; adj. meant2=3.19, SE=0.04; P<.0001; adj. meant3=3.51, SE=0.04; P<.0001). Analysis of open-ended responses suggested that clinicians' optimism for the model of care was greater over time, but continued quality improvement should focus on cultivating communication between clinicians and researchers. CONCLUSIONS Accelerating clinician-researcher collaborations in a rehabilitation setting requires sustained effort for successful implementation beyond novel physical changes. Organizations must be responsive to clinicians' changing concerns to adapt and sustain a collaborative translational medicine model and allow sufficient time, probably years, for such transitions to occur.
Collapse
Affiliation(s)
- Miriam Rafferty
- Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | | | - Justin D Smith
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City, UT
| | - Piper Hansen
- Shirley Ryan AbilityLab, Chicago, IL; Occupational Therapy Department, Rush University, Chicago, IL
| | | | - Carmen Diaz
- Northwestern University, Kellogg School of Management, Chicago, IL
| | | | - Allen W Heinemann
- Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - C Hendricks Brown
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Richard L Lieber
- Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL; Hines V.A. Medical Center, Hines, IL
| |
Collapse
|
2
|
Rafiq RB, Yount S, Jerousek S, Roth EJ, Cella D, Albert MV, Heinemann AW. Feasibility of PROMIS using computerized adaptive testing during inpatient rehabilitation. J Patient Rep Outcomes 2023; 7:44. [PMID: 37162607 PMCID: PMC10172423 DOI: 10.1186/s41687-023-00567-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/21/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND There has been an increased significance on patient-reported outcomes in clinical settings. We aimed to evaluate the feasibility of administering patient-reported outcome measures by computerized adaptive testing (CAT) using a tablet computer with rehabilitation inpatients, assess workload demands on staff, and estimate the extent to which rehabilitation inpatients have elevated T-scores on six Patient Reported Outcomes Measurement Information System® (PROMIS®) measures. METHODS Patients (N = 108) with stroke, spinal cord injury, traumatic brain injury, and other neurological disorders participated in this study. PROMIS computerized adaptive tests (CAT) were administered via a web-based platform. Summary scores were calculated for six measures: Pain Interference, Sleep Disruption, Anxiety, Depression, Illness Impact Positive, and Illness Impact Negative. We calculated the percent of patients with T-scores equivalent to 2 standard deviations or greater above the mean. RESULTS During the first phase, we collected data from 19 of 49 patients; of the remainder, 61% were not available or had cognitive or expressive language impairments. In the second phase of the study, 40 of 59 patients participated to complete the assessment. The mean PROMIS T-scores were in the low 50 s, indicating an average symptom level, but 19-31% of patients had elevated T-scores where the patients needed clinical action. CONCLUSIONS The study demonstrated that PROMIS assessment using a CAT administration during an inpatient rehabilitation setting is feasible with the presence of a research staff member to complete PROMIS assessment.
Collapse
Affiliation(s)
- Riyad Bin Rafiq
- Department of Computer Science and Engineering, University of North Texas, Denton, TX, 76201, USA.
| | - Susan Yount
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Evanston, USA
| | - Sara Jerousek
- Ann & Robert H. Lurie Children's Hospital, Chicago, USA
| | - Elliot J Roth
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Evanston, USA
| | - David Cella
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Evanston, USA
| | - Mark V Albert
- Department of Computer Science and Engineering, University of North Texas, Denton, TX, 76201, USA
- Department of Biomedical Engineering, University of North Texas, Denton, USA
| | - Allen W Heinemann
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Evanston, USA
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, USA
| |
Collapse
|
3
|
Chen M, Jones CM, Bauer HE, Osakwe O, Ketheeswaran P, Baker JN, Huang IC. Barriers and Opportunities for Patient-Reported Outcome Implementation: A National Pediatrician Survey in the United States. CHILDREN 2022; 9:children9020185. [PMID: 35204906 PMCID: PMC8870373 DOI: 10.3390/children9020185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 11/16/2022]
Abstract
Purpose: To characterize pediatricians’ perceived barriers and areas of confidence in assessing patient-reported outcomes (PROs) in the U.S., and to test associations of these factors with implementing PRO assessment. Methods: Using a random sample from the members of American Medical Association, we recruited general pediatricians and pediatric subspecialists to complete a survey (July 2011 to December 2013). Perceived barriers and confidence in PRO assessment were compared by age, pediatric specialty (general pediatrics, seven subspecialties), practice settings (academic, private), and region of practice. Multivariable logistic regressions tested associations of demographic factors, barriers, and confidence factors with the implementation of PRO assessment. Findings: The survey was completed by 458 participants (response rate 48.5%); of these, 40.4%, 15.9%, 15.5%, and 8.1% were general pediatricians, cardiology, hematology/oncology, and pulmonary specialists, respectively. PRO assessment was implemented by 29.0% of the pediatricians. The top five barriers for PRO assessment included limited time/manpower (79.0%), limited training (77.4%), lengthy PRO instruments (76%), lack of meaningful cut-offs on PRO scores (75.5%), and unavailable PRO instruments (75.0%). Limited knowledge of PROs (OR 4.10; 95% CI 2.21, 7.60) and unavailability of PRO instruments (OR 1.87; 95% CI 1.01, 3.49) increased the odds of not implementing the assessment, whereas confidence in PRO assessments compatible with norms (OR 0.41; 95% CI 0.23, 0.72) and perceived benefit over clinical judgment alone (OR 0.53; 95% CI 0.31, 0.93) decreased the odds of not implementing the assessment. Interpretation: significant barriers to PRO assessment in pediatric settings suggest the need for providing training, resources, and practical guidance toward implementation. Patient or Public Contribution: healthcare service users contributed to this study by completing a survey and providing feedback about the barriers and areas of confidence in assessing PROs for pediatric populations.
Collapse
Affiliation(s)
- Ming Chen
- College of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA;
| | - Conor M. Jones
- Weill Medical College, Cornell University, New York, NY 10021, USA;
| | - Hailey E. Bauer
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA;
| | | | | | - Justin N. Baker
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA;
| | - I-Chan Huang
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA;
- Correspondence: ; Tel.: +1-901-595-8369
| |
Collapse
|
4
|
Burton SV, Valenta AL, Starren J, Abraham J, Nelson T, Kochendorfer K, Hughes A, Harris B, Boyd A. Examining perspectives on the adoption and use of computer-based patient-reported outcomes among clinicians and health professionals: a Q methodology study. J Am Med Inform Assoc 2022; 29:443-452. [PMID: 34871423 PMCID: PMC8800531 DOI: 10.1093/jamia/ocab257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/02/2021] [Accepted: 11/17/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To determine factors that influence the adoption and use of patient-reported outcomes (PROs) in the electronic health record (EHR) among users. MATERIALS AND METHODS Q methodology, supported by focus groups, semistructured interviews, and a review of the literature was used for data collection about opinions on PROs in the EHR. An iterative thematic analysis resulted in 49 statements that study participants sorted, from most unimportant to most important, under the following condition of instruction: "What issues are most important or most unimportant to you when you think about the adoption and use of patient-reported outcomes within the electronic health record in routine clinical care?" Using purposive sampling, 50 participants were recruited to rank and sort the 49 statements online, using HTMLQ software. Principal component analysis and Varimax rotation were used for data analysis using the PQMethod software. RESULTS Participants were mostly physicians (24%) or physician/researchers (20%). Eight factors were identified. Factors included the ability of PROs in the EHR to enable: efficient and reliable use; care process improvement and accountability; effective and better symptom assessment; patient involvement for care quality; actionable and practical clinical decisions; graphical review and interpretation of results; use for holistic care planning to reflect patients' needs; and seamless use for all users. DISCUSSION The success of PROs in the EHR in clinical settings is not dependent on a "one size fits all" strategy, demonstrated by the diversity of viewpoints identified in this study. A sociotechnical approach for implementing PROs in the EHR may help improve its success and sustainability. CONCLUSIONS PROs in the EHR are most important to users when the technology is used to improve patient outcomes. Future research must focus on the impact of embedding this EHR functionality on care processes.
Collapse
Affiliation(s)
- Shirley V Burton
- Department of Biomedical and Health Information Sciences, University of Illinois Chicago, Chicago, Illinois, USA
| | - Annette L Valenta
- Department of Biomedical and Health Information Sciences, University of Illinois Chicago, Chicago, Illinois, USA
| | - Justin Starren
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois, USA
| | - Joanna Abraham
- Department of Anesthesiology and Institute for Informatics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Therese Nelson
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois, USA
| | - Karl Kochendorfer
- Department of Clinical Family Medicine, University of Illinois Chicago, Chicago, Illinois, USA
| | - Ashley Hughes
- Department of Biomedical and Health Information Sciences, University of Illinois Chicago, Chicago, Illinois, USA
| | - Bhrandon Harris
- Department of Family Medicine, University of Illinois Chicago, Chicago, Illinois, USA
| | - Andrew Boyd
- Department of Biomedical and Health Information Sciences, University of Illinois Chicago, Chicago, Illinois, USA
| |
Collapse
|
5
|
Tulsky DS, Kisala PA. Overview of the Spinal Cord Injury-Functional Index (SCI-FI): Structure and Recent Advances. Arch Phys Med Rehabil 2021; 103:185-190. [PMID: 34756875 DOI: 10.1016/j.apmr.2021.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 11/02/2022]
Abstract
The Spinal Cord Injury - Functional Index is a system of patient reported outcomes (PRO) measures of functional activities developed specifically with and for individuals with spinal cord injury (SCI). The SCI-FI was designed to overcome limitations in measurement of the full range of activities and breadth of content of physical functioning commonly used in SCI research. Generic measurement tools of physical function (i.e., those focused on the general population) tend to overemphasize mobility and do not contain enough items at the lower end of the functional range (e.g., appropriate for individuals with tetraplegia). The SCI-FI consists of nine item response theory (IRT)-calibrated item banks that represent relevant and meaningful item content for individuals with SCI, span a wide range of functional abilities, and subdivide physical functioning into important subdomains, including basic mobility, self-care, and fine motor function. Since the original publication of the SCI-FI in 2012, there have been significant advances in and publications on the reliability and psychometric properties of the measures. The manuscripts presented in this special section clarify the SCI-FI structure and present new research on the SCI-FI measurement system.
Collapse
Affiliation(s)
- David S Tulsky
- Center for Health Assessment Research and Translation (CHART), University of Delaware, Newark, DE; Departments of Physical Therapy and Psychological and Brain Sciences, University of Delaware, Newark, DE.
| | - Pamela A Kisala
- Center for Health Assessment Research and Translation (CHART), University of Delaware, Newark, DE
| |
Collapse
|
6
|
The Canadian Occupational Performance Measure (COPM) as Routine Practice in Community-Based Rehabilitation: A Retrospective Chart Review. Arch Rehabil Res Clin Transl 2021; 3:100134. [PMID: 34589685 PMCID: PMC8463439 DOI: 10.1016/j.arrct.2021.100134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Objective To investigate whether patients experienced improved functional outcomes as a result of their admission to rehabilitation and to identify whether the service provided effective, patient-centered and goal-directed rehabilitation. Design Retrospective chart review of admission and discharge data from patients accessing the service between 2011 and 2019. Setting Community-based interdisciplinary rehabilitation service. Participants Consecutive patients (N=612) admitted to the service. Interventions Routine care delivered with a median duration of 181 days and an interquartile range of 120-261 days. Main Outcome Measures The Canadian Occupational Performance Measure (COPM) administered on admission and discharge and an improvement ≥2 in the COPM subscales of performance and satisfaction. Results Of 612 participants, 96% had the COPM administered at admission (baseline) and 68% again at discharge. Performance and satisfaction were measured in 584 patients at admission, 406 at discharge, and 404 at both time points. For performance, 243 patients (60%) experienced an improvement (≥2), with an average of 2.2 points. For satisfaction, 268 patients (66%) experienced an improvement (≥2), with an average of 2.8 points. Factors influencing outcomes, differed. For each 10 year increase in patient age, the average improvement in satisfaction was 0.26 points lower (95% confidence interval, 0.07-0.45) after adjusting for sex, duration, completion, and health condition. Conclusions Irrespective of patient-related factors and regardless of age, sex, health condition, or discharge plan, the majority of patients reported a positive functional outcome in COPM Performance and satisfaction as a result of time spent in the community-based rehabilitation service. This service provided equitable care and patient-centered, goal-focused, and outcome-based therapy that enabled patients to improve their functional capacity.
Collapse
|
7
|
Implementation of an Acute Care COPD Exacerbation Patient Mobilization Tool. A Mixed-Methods Study. ATS Sch 2021; 2:249-264. [PMID: 34409419 PMCID: PMC8362741 DOI: 10.34197/ats-scholar.2020-0129oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 02/10/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Improving the mobility of hospitalized patients with
an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a
priority of care. AECOPD-Mob is a clinical decision-making tool for physical
therapists, especially those who are newly graduated or are new to caring
for patients with AECOPDs in acute care settings. Although this tool has
been available for several years, dissemination via publication is not
sufficient to implement it in clinical practice. Objective: The primary objective of this study was to develop,
implement, and evaluate different formats of AECOPD-Mob in an acute care
setting. Methods: We used a mixed-methods, convergent parallel design. In
addition to the paper format of AECOPD-Mob, we developed a smartphone app, a
web-based learner module, and an in-service learning session. Newly
graduated physical therapists (PTs) or PTs new to the practice area were
recruited from urban acute care hospitals. Participants used the different
formats for 3 weeks and then completed the Post-Study System Usability
Questionnaire. User data were retrieved for the learning module.
Participants participated in focus groups at 3 weeks and 3 months. Results: Eighteen (72% of eligible PTs, 100% female, 94%
graduated within 3 yr) PTs participated. Post-Study System Usability
Questionnaire scores for the learning module and smartphone indicated that
participants were satisfied with these formats (median score 2.0 on
1–7 Likert Scale for both technology formats, lower scores indicating
greater satisfaction). However, the participants reported in the focus group
that the paper format was preferred over other formats. Concerns with the
smartphone app included infection control and the perception of lack of
professionalism when using a smartphone during clinical practice. The
learning module and in-service were considered helpful as an introduction
but not as an ongoing support. The paper format was seen as the most
efficient way to access the necessary information and to facilitate
communication between other members of the care team about the importance of
mobility for hospitalized patients with AECOPDs. Conclusion: Newly graduated PTs strongly preferred the paper
format of the AECOPD-Mob tool in the acute care setting. Future research
will focus on knowledge translation strategies for other health
disciplines.
Collapse
|
8
|
Heinemann AW, Nitsch KP, Gracz K, Ehrlich-Jones L, Engel E, Wilson M, Zale C, Graham ID. Implementing Patient-Reported Outcome Measures in Inpatient Rehabilitation: Challenges and Solutions. Arch Phys Med Rehabil 2021; 103:S67-S77. [PMID: 34144004 DOI: 10.1016/j.apmr.2021.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 05/10/2021] [Accepted: 05/17/2021] [Indexed: 11/02/2022]
Abstract
A project with the goal of implementing electronic health record (EHR) - based patient-reported outcome measures (PROMs) into a large inpatient spinal cord injury (SCI) rehabilitation program took twice as long as expected. This report details the lessons learned from the barriers, successes, and unexpected issues that arose during this prolonged, but now successful project. The goals of this implementation project were to (1) identify barriers and supports to the use of PROMs; (2) develop an implementation strategy to incorporate the use of PROMs into inpatient rehabilitation; and (3) implement the strategy and evaluate its effects on team communication. In brief, we conducted an initial pilot phase outside of the EHR and used our findings to guide procedural and EHR incorporation during a demonstration phase. We encountered multiple barriers. Procedural issues were significant: even though grant funding covered the cost of writing the code for integration of the PROMs into the EHR, our institution's competing priorities slowed progress. Institutional inertia was reflected in the reluctance of some clinical staff members to assume new duties that would take away from direct patient care responsibilities. Therefore, we needed to obtain additional staffing. Detailed planning upfront, guided by changes when necessary, cooperation and interaction with our institution's Information Systems department, and identification of key players and implementation champions proved essential to our success. We now have an up-and-running system and are sharing our experience, observations, and recommendations to assist other healthcare organizations incorporate PROMs into their EHRs.
Collapse
Affiliation(s)
- Allen W Heinemann
- Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine and Director, Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab.
| | - Kristian P Nitsch
- Department of Psychology, Shepherd Pathways, Shepherd Center, Atlanta, GA
| | | | - Linda Ehrlich-Jones
- Research Associate Professor, Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, and Associate Director, Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab
| | - Edeth Engel
- Project Coordinator, Shirley Ryan AbilityLab
| | - Meghan Wilson
- Clinical Assistant Professor, Department of Physical Medicine and Rehabilitation, University of Arkansas for Medical Sciences College of Medicine
| | - Colleen Zale
- Occupational/Physical Therapist, Shirley Ryan AbilityLab
| | - Ian D Graham
- FRSC Professor, School of Epidemiology and Public Health, University of Ottawa, and Senior Scientist, Clinical Epidemiology Program, Ottawa Hospital Research Institute
| |
Collapse
|
9
|
Kisala PA, Victorson D, Nandakumar R, Shermeyer A, Fyffe D, Heinemann AW, Dyson-Hudson TA, Tulsky DS. Applying a Bookmarking Approach to Setting Clinically Relevant Interpretive Standards for the Spinal Cord Injury: Functional Index/Capacity Basic Mobility and Self-Care Item Bank Scores. Arch Phys Med Rehabil 2020; 103:224-236. [DOI: 10.1016/j.apmr.2020.08.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 08/03/2020] [Accepted: 08/05/2020] [Indexed: 11/16/2022]
|
10
|
Kitto S. Pursuing the Mission of JCEHP. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2019; 39:75. [PMID: 31149949 DOI: 10.1097/ceh.0000000000000256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Simon Kitto
- Dr. Kitto: Professor, Department of Innovation in Medical Education, Director of Research, Office of Continuing Professional Development, University of Ottawa, Ottawa, Canada, Assistant Professor, Department of Surgery, University of Toronto, Toronto, Canada, and Editor-in-Chief, Journal of Continuing Education in the Health Professions
| |
Collapse
|