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Allen LM, Balmer D, Varpio L. Physicians' lifelong learning journeys: A narrative analysis of continuing professional development struggles. MEDICAL EDUCATION 2024. [PMID: 38605442 DOI: 10.1111/medu.15375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 01/18/2024] [Accepted: 02/14/2024] [Indexed: 04/13/2024]
Abstract
INTRODUCTION Despite tenacious efforts of continuing professional development (CPD) developers and educators, physician engagement in CPD is fraught with challenges. Research suggests that these educational interventions and the maintenance of professional competence systems that mandate them are often seen as impractical, decontextualized and check-box activities by participants. This study explores physicians' learning post graduate medical education (GME) training across their CPD journey to understand how they (a) conceive of themselves as learners and (b) engage in lifelong learning across the course of their professional careers. METHODS Using narrative inquiry and holistic narrative analysis situated within a social constructivist orientation, we carried out individual interviews with physicians from across a large children's hospital network including academic hospitals, community hospitals and primary care practices. Timelines and story arcs were used to support the narrative analysis's re-storying. RESULTS Twelve physicians from six different sub-specialties were interviewed. We identified three noteworthy challenges as particularly salient across participants' re-storied narratives: (i) train-on-a-track to treading water, (ii) learning takes a backseat, and (iii) learning through foraging or hunting and gathering. Participants described significant change when transitioning from GME to CPD learning. While participants identified as learners, they described the disorienting impact of losing GME's formal supports and structures. They articulated that patient care trumped learning as their top priority. They lamented having limited insight into their learning needs (e.g. little feedback data) and so resorted to engaging in CPD activities that were readily at hand-but not necessarily relevant-and to finding learning resources that might not be formally recognised for CPD credit. CONCLUSIONS Physicians' learning journeys post-GME are challenging, and the systems created to support that learning are ill equipped to meet the needs of physicians transitioning from GME to CPD. To encourage meaningful learning, the complex interplay of factors impeding CPD engagement should inform future innovations.
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Affiliation(s)
- Louise M Allen
- Department of Medical Education, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Dorene Balmer
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Lara Varpio
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Rottman BM, Caddick ZA, Nokes-Malach TJ, Fraundorf SH. Cognitive perspectives on maintaining physicians' medical expertise: I. Reimagining Maintenance of Certification to promote lifelong learning. Cogn Res Princ Implic 2023; 8:46. [PMID: 37486508 PMCID: PMC10366070 DOI: 10.1186/s41235-023-00496-9] [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: 03/01/2022] [Accepted: 06/20/2023] [Indexed: 07/25/2023] Open
Abstract
Until recently, physicians in the USA who were board-certified in a specialty needed to take a summative test every 6-10 years. However, the 24 Member Boards of the American Board of Medical Specialties are in the process of switching toward much more frequent assessments, which we refer to as longitudinal assessment. The goal of longitudinal assessments is to provide formative feedback to physicians to help them learn content they do not know as well as serve an evaluation for board certification. We present five articles collectively covering the science behind this change, the likely outcomes, and some open questions. This initial article introduces the context behind this change. This article also discusses various forms of lifelong learning opportunities that can help physicians stay current, including longitudinal assessment, and the pros and cons of each.
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Affiliation(s)
- Benjamin M Rottman
- Learning Research and Development Center, University of Pittsburgh, 3420 Forbes Ave., Pittsburgh, PA, 15260, USA
- Department of Psychology, University of Pittsburgh, Pittsburgh, USA
| | - Zachary A Caddick
- Learning Research and Development Center, University of Pittsburgh, 3420 Forbes Ave., Pittsburgh, PA, 15260, USA
- Department of Psychology, University of Pittsburgh, Pittsburgh, USA
| | - Timothy J Nokes-Malach
- Learning Research and Development Center, University of Pittsburgh, 3420 Forbes Ave., Pittsburgh, PA, 15260, USA
- Department of Psychology, University of Pittsburgh, Pittsburgh, USA
| | - Scott H Fraundorf
- Learning Research and Development Center, University of Pittsburgh, 3420 Forbes Ave., Pittsburgh, PA, 15260, USA.
- Department of Psychology, University of Pittsburgh, Pittsburgh, USA.
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Kozikowski A, Morton-Rias D, Puckett K, Jeffery C, Mauldin S, Goodman J. The association of physician assistant/associate demographic and practice characteristics with perceptions of value of certification. BMC MEDICAL EDUCATION 2023; 23:228. [PMID: 37041511 PMCID: PMC10088160 DOI: 10.1186/s12909-023-04215-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 03/30/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND To determine physician assistant/associate (PA) perceptions of the value of certification and explore how they vary across demographic and practice characteristics. METHODS We conducted a cross-sectional online survey between March and April 2020 with PAs participating in the longitudinal pilot program for recertification administered by the National Commission on Certification of Physician Assistants (NCCPA). The survey was distributed to 18,147 PAs, of which 10,965 participated (60.4% response rate). In addition to descriptive statistics, chi-square tests were conducted on demographics and specialty to examine if perceptions of value of certification (1 global and 10 items measuring specific domains) were associated with a particular PA profile. A series of fully adjusted multivariate logistic regressions were performed, exploring the relationship between PA characteristics and the value of certification items. RESULTS Most PAs strongly agreed/agreed that certification helps with fulfilling licensure requirements (9,578/10,893; 87.9%), helps with updating medical knowledge (9,372/10,897; 86.0%), and provides objective evidence of continued competence (8,875/10,902; 81.4%). The items receiving the lowest percentage of responses for strongly agreeing/agreeing were for certification providing no value (1,925/10,887; 17.7%), helping with professional liability insurance (5,076/10,889; 46.6%), and competing with other providers for clinical positions (5,661/10,905; 51.9%). Age 55 and older and practicing in dermatology and psychiatry were among the strongest predictors of less favorable views. PAs from underrepresented in medicine (URiM) backgrounds had more positive perceptions. CONCLUSIONS Overall, the findings indicate that PAs value certification; however, perceptions varied by demographics and specialties. PAs who were younger, from URiM backgrounds, and practicing in primary care specialties had among the most favorable perspectives. Continued feedback monitoring is critical in ensuring certification is relevant and meaningful in supporting PAs across demographics and specialties. Measuring PA perceptions of the value of certification is essential to understanding how to support the PA profession's current and future credentialing needs and those who license and hire PAs.
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Affiliation(s)
- Andrzej Kozikowski
- National Commission on Certification of Physician Assistants, 12000 Findley Road, Suite 100, Johns Creek, GA 30097 USA
| | - Dawn Morton-Rias
- National Commission on Certification of Physician Assistants, 12000 Findley Road, Suite 100, Johns Creek, GA 30097 USA
| | - Kasey Puckett
- National Commission on Certification of Physician Assistants, 12000 Findley Road, Suite 100, Johns Creek, GA 30097 USA
| | - Colette Jeffery
- National Commission on Certification of Physician Assistants, 12000 Findley Road, Suite 100, Johns Creek, GA 30097 USA
| | - Sheila Mauldin
- National Commission on Certification of Physician Assistants, 12000 Findley Road, Suite 100, Johns Creek, GA 30097 USA
| | - Joshua Goodman
- National Commission on Certification of Physician Assistants, 12000 Findley Road, Suite 100, Johns Creek, GA 30097 USA
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Bucalon B, Whitelock-Wainwright E, Williams C, Conley J, Veysey M, Kay J, Shaw T. Thought Leader Perspectives on the Benefits, Barriers, and Enablers for Routinely Collected Electronic Health Data to Support Professional Development: Qualitative Study. J Med Internet Res 2023; 25:e40685. [PMID: 36795463 PMCID: PMC9982719 DOI: 10.2196/40685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 12/22/2022] [Accepted: 01/20/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Hospitals routinely collect large amounts of administrative data such as length of stay, 28-day readmissions, and hospital-acquired complications; yet, these data are underused for continuing professional development (CPD). First, these clinical indicators are rarely reviewed outside of existing quality and safety reporting. Second, many medical specialists view their CPD requirements as time-consuming, having minimal impact on practice change and improving patient outcomes. There is an opportunity to build new user interfaces based on these data, designed to support individual and group reflection. Data-informed reflective practice has the potential to generate new insights about performance, bridging the gap between CPD and clinical practice. OBJECTIVE This study aims to understand why routinely collected administrative data have not yet become widely used to support reflective practice and lifelong learning. METHODS We conducted semistructured interviews (N=19) with thought leaders from a range of backgrounds, including clinicians, surgeons, chief medical officers, information and communications technology professionals, informaticians, researchers, and leaders from related industries. Interviews were thematically analyzed by 2 independent coders. RESULTS Respondents identified visibility of outcomes, peer comparison, group reflective discussions, and practice change as potential benefits. The key barriers included legacy technology, distrust with data quality, privacy, data misinterpretation, and team culture. Respondents suggested recruiting local champions for co-design, presenting data for understanding rather than information, coaching by specialty group leaders, and timely reflection linked to CPD as enablers to successful implementation. CONCLUSIONS Overall, there was consensus among thought leaders, bringing together insights from diverse backgrounds and medical jurisdictions. We found that clinicians are interested in repurposing administrative data for professional development despite concerns with underlying data quality, privacy, legacy technology, and visual presentation. They prefer group reflection led by supportive specialty group leaders, rather than individual reflection. Our findings provide novel insights into the specific benefits, barriers, and benefits of potential reflective practice interfaces based on these data sets. They can inform the design of new models of in-hospital reflection linked to the annual CPD planning-recording-reflection cycle.
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Affiliation(s)
- Bernard Bucalon
- Human Centred Technology Research Cluster, School of Computer Science, The University of Sydney, Sydney, Australia
| | - Emma Whitelock-Wainwright
- Centre for Learning Analytics, Faculty of Information Technology, Monash University, Melbourne, Australia
| | | | | | - Martin Veysey
- Division of Medicine, Royal Darwin Hospital, Tiwi, Australia
| | - Judy Kay
- Human Centred Technology Research Cluster, School of Computer Science, The University of Sydney, Sydney, Australia
| | - Tim Shaw
- Research in Implementation Science and e-Health Group, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Toews H, Pearce J, Tavares W. Recasting Assessment in Continuing Professional Development as a Person-Focused Activity. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023; 43:S35-S40. [PMID: 38054490 DOI: 10.1097/ceh.0000000000000538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
ABSTRACT In this article, we examine assessment as conceptualized and enacted in continuing professional development (CPD). Assessment is pervasive throughout the life of an individual health professional, serving many different purposes compounded by varied and unique contexts, each with their own drivers and consequences, usually casting the person as the object of assessment. Assessment is often assumed as an included part in CPD development conceptualization. Research on assessment in CPD is often focused on systems, utility, and quality instead of intentionally examining the link between assessment and the person. We present an alternative view of assessment in CPD as person-centered, practice-informed, situated and bound by capability, and enacted in social and material contexts. With this lens of assessment as an inherently personal experience, we introduce the concept of subjectification, as described by educationalist Gert Biesta. We propose that subjectification may be a fruitful way of examining assessment in a CPD context. Although the CPD community, researchers, and educators consider this further, we offer some early implications of adopting a subjectification lens on the design and enactment of assessment in CPD.
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Affiliation(s)
- Helen Toews
- Toews: Registered Dietitian, The Wilson Centre, University of Toronto, Toronto, Ontario, Canada. Dr. Pearce: Principal Research Fellow, Specialist and Professional Assessment, Tertiary Education, Australian Council for Educational, Research, Camberwell, Australia. Dr. Tavares: Scientist|Assistant Professor, Department of Health and Society, The Wilson Centre, Department of Medicine, University of Toronto, Scarborough, Ontario, Canada
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Pizzuti C, Palmieri C, Shaw T. Using eHealth Data to Inform CPD for Medical Practitioners: A Scoping Review with a Consultation Exercise with International Experts. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023; 43:S47-S58. [PMID: 38054492 DOI: 10.1097/ceh.0000000000000534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
INTRODUCTION eHealth data analytics is widely used in health care research. However, there is limited knowledge on the role of eHealth data analysis to inform continuing professional development (CPD). The aim of this study was to collate available research evidence on the use of eHealth data for the development of CPD programs and plans for medical practitioners. METHODS A scoping review was conducted using the six-stage Arksey and O'Malley Framework. A consultation exercise (stage 6) was performed with 15 international experts in the fields of learning and practice analytics to deepen the insights. RESULTS Scoping review. The literature searches identified 9876 articles published from January 2010 to May 2022. After screening and full-text review, a total of nine articles were deemed relevant for inclusion. The results provide varied-and at times partial or diverging-answers to the scoping review research questions. Consultation exercise. Research rigor, field of investigation, and developing the field were the three themes emerged from analysis. Participants validated the scoping review methodology and confirmed its results. Moreover, they provided a meta-analysis of the literature, a description of the current CPD ecosystem, and clear indications of what is and should be next for the field. DISCUSSION This study shows that there is no formal or well-established correlation between eHealth data and CPD planning and programming. Overall findings fill a gap in the literature and provide a basis for further investigation. More foundational work, multidisciplinary collaborations, and stakeholders' engagement are necessary to advance the use of eHealth data analysis for CPD purposes.
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Affiliation(s)
- Carol Pizzuti
- Ms. Pizzuti: Industry PhD Candidate, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia; and Senior Research Officer, Professional Practice, The Royal Australasian College of Physicians, Sydney, Australia. Dr. Palmieri: Head of Member Learning and Development, Professional Practice, The Royal Australasian College of Physicians, Sydney, Australia; and Faculty of Arts and Social Sciences, The University of Sydney, Camperdown, Australia. Dr. Shaw: Professor of Digital Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
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Monrad SU. Perceptions and emotions about learning and assessment: Why should we care? MEDICAL EDUCATION 2022; 56:354-356. [PMID: 35106802 DOI: 10.1111/medu.14739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 01/19/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Seetha U Monrad
- Departments of Internal Medicine and Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
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