Effects of reviewing routine practices on learning outcomes in continuing education

How peer review groups support learning and wellbeing in psychiatrists

OBJECTIVE

To explore the self-reported value of Peer Review Groups (PRGs) by Australian psychiatrists, focussing on learning and wellbeing.

METHODS

A cross-sectional mixed-methods online survey of psychiatrists registered with the NSW Branch Royal Australian and New Zealand College of Psychiatrists (RANZCP) who had attended a PRG in the previous 12 months.

RESULTS

Respondents described PRG participation as supportive to their learning and to their professional wellbeing by sharing professional experiences, emotional support for the inherent stresses of practice, the provision of a space for debriefing and the amelioration of professional isolation. Difficulties or challenges in group functioning were reported rarely and included new group member selection and limitations to individual support provided by the group.

CONCLUSIONS

The PRG form of Continuing Professional Development (CPD) is unique, popular and highly valued by psychiatrists. In addition to supporting learning, PRGs provide a collegial space for processing of emotional aspects of practice that in turn supports wellbeing. Other healthcare professionals might benefit from similar self-directed, self-selected small group peer contact for CPD.

Psychiatry peer review groups in Australia: a mixed-methods exploration of structure and function

OBJECTIVES

The purpose of this study was to examine Australian psychiatrists' experience of participation in a small group learning format of continuing professional development, known as peer review groups (PRGs), with a particular emphasis on group structure and functions.

METHOD

An exploratory mixed-methods study comprising a survey (n=77) and semistructured interviews (n=6) with Australian psychiatrists participating in a PRG in the previous 12 months.

RESULTS

Qualitative findings indicate that PRGs address experiential learning through a focus on both breadth and specificity of work, as well as participants' experiences. Participants described using PRGs as a forum to manage difficult and complex work (through critiquing work, learning from one another, considering theory and guidelines, benchmarking, validating, reflecting and generalising learning) and to manage stress and well-being associated with crises, everyday stress and professional isolation. Particular structural aspects of PRGs considered essential to achieve these functions were self-selection of members, self-direction of meeting content and provision of a safe environment. These findings were convergent with the quantitative findings from scale survey data. Difficulties experienced during PRG participation are also described.

CONCLUSION

Qualitative and quantitative findings from psychiatry PRGs demonstrate how practice-based professional experience functions as both a source of learning and of collegial connection that contributes to well-being and reduction in professional stress. Study limitations and future research directions are discussed.

Self-Reflection as a Support to Evidence-Based Practice: A Grounded Theory Exploration

The purpose of this study was to explore how reflective practice is experienced by occupational therapists. Thirty participants were purposefully sampled to explore reflective practice experiences using a critical reflection inquiry model as a theoretical framework. Grounded theory using a constant comparative analysis method was used to analyze interview data. Three categories emerged: triggers to reflection, depth of reflection, and actions taken. The frequency of statements compared across survey groups showed that participants with high reflection behaviors made more critical reflections, used steps of the EBP cycle, and took actions to correct practice. Results inform practice in three ways: (1) practitioner experiences were analyzed through the complete reflective practice construct, (2) findings indicated that greater depth of reflective thinking promotes EBP use and actions taken to correct practice, and (3) narrative content analysis was found to be a credible method of assessing reflection within practice narratives, suggesting it as useful for education and promoting continuing competency.

Occupational Therapists' Implementation of Evidence-Based Practice: A Cross Sectional Survey

Evidence-based practice (EBP) implementation has been associated with quality health care outcomes, yet only a small proportion of occupational therapists implement EBP. We conducted a cross-sectional survey measuring EBP implementation, skill and knowledge, self-reflection behavior, and practice demographics to clarify implementation of EBP and factors acting as supports. A random sample of occupational therapists practicing in the U.S. was invited to participate; 578 surveys were included in the final analysis. Participants implemented EBP less than 1 time over the previous 8 weeks; EBP use was highest in those with a doctorate (p = .002) and high self-reflection behavior (p = .001); EBP use was marginally higher in those with organizational support (p = .008; p = .009), time for EBP (p = .009), and access to full text articles (p = .006). Further investigation of how reflective practice and levels of doctoral education support EBP use are recommended.

Where do Peer Review Groups fit in the international Continuing Professional Development literature?

OBJECTIVES

To describe what is reported in the Continuing Professional Development (CPD) literature on small group learning formats in medicine, including the Royal Australian and New Zealand College of Psychiatrists (RANZCP) CPD Peer Review Groups (PRGs).

METHOD

A literature review of international peer-reviewed publications in relation to the use of small group learning formats for CPD in medicine.

RESULTS

Small groups are commonly used as a learning format in medical CPD, primarily in general practice, but are little researched. Such groups take differing forms and they are valued by participants for a range of purposes, having effects on professionalism, clinical performance and doctors' wellbeing.

CONCLUSION

We believe that the contribution of these groups to medical CPD should be further explored. To this end, this review forms the first part of a research project focussing on the RANZCP PRG model used by Australian and New Zealand psychiatrists.

Reflections From the Rearview Mirror: Internal Medicine Physicians' Reactions to Clinical Feedback After Transitions of Responsibility

PURPOSE

Learning from practice is important for continuous improvement of practice. Yet little is known about how physicians assimilate clinical feedback and use it to refine their diagnostic approaches. This study described physicians' reactions to learning that their provisional diagnosis was either consistent or inconsistent with the subsequent diagnosis, identified emotional responses to those findings, and explored potential consequences for future practices.

METHOD

In 2016-2017, 22 internal medicine hospitalist and resident physicians at Oregon Health & Science University completed semistructured interviews. Critical incident prompts elicited cases of patient care transitions before the diagnosis was known. Interview questions explored participants' subsequent follow-up. Matrix analysis of case elements, emotional reactions, and perceived practice changes was used to compare patterns of responses between cases of confirming versus disconfirming clinical feedback.

RESULTS

Participants described 51 cases. When clinical feedback confirmed provisional diagnoses (17 cases), participants recalled positive emotions, judged their performance as sufficient, and generally reinforced current approaches. When clinical feedback was disconfirming (34 cases), participants' emotional reactions were mostly negative, frequently tempered with rationalizations, and often associated with perceptions of having made a mistake. Perceived changes in practice mostly involved nonspecific strategies such as "trusting my intuition" and "broadening the differential," although some described case-specific strategies that could be applied in similar contexts in the future.

CONCLUSIONS

Internists' experiences with posttransition clinical feedback are emotionally charged. Internists' reflections on clinical feedback experiences suggest they are primed to adapt practices for the future, although the usefulness of those adaptations for improving practice is less clear.

Instruments to measure the ability to self-reflect: A systematic review of evidence from workplace and educational settings including health care

INTRODUCTION

Self-reflection has become recognised as a core skill in dental education, although the ability to self-reflect is valued and measured within several professions. This review appraises the evidence for instruments available to measure the self-reflective ability of adults studying or working within any setting, not just health care.

MATERIALS AND METHODS

A systematic review was conducted of 20 electronic databases (including Medline, ERIC, CINAHL and Business Source Complete) from 1975 to 2017, supplemented by citation searches. Data were extracted from each study and the studies graded against quality indicators by at least two independent reviewers, using a coding sheet. Reviewers completed a utility analysis of the assessment instruments described within included studies, appraising their reported reliability, validity, educational impact, acceptability and cost.

RESULTS

A total of 131 studies met the inclusion criteria. Eighteen were judged to provide higher quality evidence for the review and three broad types of instrument were identified, namely: rubrics (or scoring guides), self-reported scales and observed behaviour.

CONCLUSIONS

Three types of instrument were identified to assess the ability to self-reflect. It was not possible to recommend a single most effective instrument due to under reporting of the criteria necessary for a full utility analysis of each. The use of more than one instrument may therefore be appropriate dependent on the acceptability to the faculty, assessor, student and cost. Future research should report on the utility of assessment instruments and provide guidance on what constitutes thresholds of acceptable or unacceptable ability to self-reflect, and how this should be managed.

Changes in Pharmacists' Perceptions After a Training in Opioid Misuse and Accidental Overdose Prevention

INTRODUCTION

Continuing education is needed for health professionals to take an active role in reversing the opioid crisis. This report describes the results of training to promote behavioral change by altering pharmacists' perceptions toward opioid misuse through the provision of content-related education.

METHODS

A free 3-hour opioid misuse and overdose prevention training program was developed and delivered to 43 community pharmacists. The training consisted of five modules addressing the disease of addiction, risks associated with opioids and accidental overdose, the role of naloxone, opioid dispensing and consultation pearls, and effective ways to communicate with patients about opioids. A paired analysis was performed from a 12-item survey delivered before and after the training program to assess changes in pharmacists' perception.

RESULTS

Five items showed a statistically significant (P < .05) change in perceptions after the training. Significant changes were reported for opioid addiction being outside the control of the affected person, the role of family history in prescription drug abuse, the value of counseling to support patients at risk of prescription opioid abuse, the value of screening tools, and the importance of viewing things from the patient's perspective. Correlation analysis identified that pharmacists' views on their role in the fight against the opioid epidemic and their agreement in the value to screen for opioid misuse were most closely related to the desire for behavioral change.

DISCUSSION

A training program influenced pharmacists' attitudes and perceptions about targeted behaviors and associated with the value of screening for opioid misuse or overdose risk and counseling patients about the benefits and risks of opioids.

Personal Commitment Statements: Encouraging the Clinical Application of Continuing Professional Development Events for Health Practitioners in Low- and Middle-Income Countries

INTRODUCTION

Statements of commitment to change are commonly used to evaluate continuing medical education. However, this approach is new to evaluating the continuing professional development (CPD) of other health care practitioners such as audiology, speech-language therapy, occupational therapy, and physiotherapy in low- and middle-income countries. This study explored the use of Personal Commitment (to change) Statements (PCSs) as an evaluation tool of continuing education for health professionals in low- and middle-income countries, and its impact on the integration of new knowledge and skills with previous knowledge and clinical practice.

METHODS

PCSs were used in a case study conducted at a 1-day interprofessional CPD event held for health practitioners in South Africa. A qualitative thematic analysis was made of these PCSs, and results were synthesized into main themes.

RESULTS

Thirty-two participants turned in a PCS at the end of the CPD event with a total of 71 text statements. Three main domains were identified: (1) applying new knowledge in practice (61.97%); (2) increasing training-related content knowledge (21.12%); and (3) sharing information, skill, and resources (16.9%).

DISCUSSION

This study demonstrated that personal commitment statements can be used to describe the outcomes of CPD events for audiologists, speech-language, occupational, and physiotherapists. Participants engaged in reflection generated by the personal commitment statement, which contained no guiding statements, yet elicited responses showing that participants were more aware of the assessment tools and how they could use them in practice. Further study is warranted into the process and the role of follow-up regarding health practitioners' commitment to change in clinical practice.

New Approaches to Continuing Medical Education: a QStream (spaced education) Program for Research Translation in Ovarian Cancer

Continuing medical education (CME) is challenging and often has limited impact on clinician behavior or patient outcomes. This study examined the impact of an online Qstream education program on senior clinicians to determine its utility for increasing clinician knowledge about the latest guidelines regarding genetic assessment and consideration of genetic testing for women with particular types of ovarian, fallopian tube and primary peritoneal cancer. Participants were recruited into a pilot study that involved responding to case-based scenarios at spaced and repeated intervals. At the completion of the program, semi-structured interviews were conducted to ascertain the impact on their knowledge and referral behavior. Findings from interviews were subject to thematic analysis that involved the identification of categories and themes. Twenty-one participants commenced the program, seventeen completed and twelve participated in semi-structured interviews. Thematic analysis yielded several themes including knowledge change, curriculum and format and changes in referral patterns. A majority of participants (n = 10) agreed the program had helped update their knowledge about referring women, and eight agreed they would now change their referral patterns. The use of QStream as an approach to CME has significant advantages when working with busy clinicians. QStream has a well accepted format and most participants indicated it is very appropriate for disseminating updates to clinical guidelines and protocols. It is important to supplement CME programs with other implementation techniques, such as audit and feedback as multifaceted approaches are more likely to result in behavior change.