Continuing professional development:progress beyond continuing medical education

Continuing medical education(CME)is rapidly evolving into competency-based continuing professional development(CPD)and this is driving change in self-directed CPD programs undertaken by individual practitioners as well as CPD programs or frameworks offered by CPD educators.This progression is being led by many factors including the rapid change in medical knowledge and medical practitioners along with changes in patients and society,healthcare systems,regulators and the political environment.We describe our experiences primarily concerning low-resource environments,in creating the International Council of Ophthalmology(ICO)Guide to Effective CPD/CME and in developing a CPD program for the Cambodian Ophthalmological Society(COS)twinned with the Royal Australian and New Zealand College of Ophthalmologists(RANZCO).At the conclusion of the project,47(100%)Cambodian practicing ophthalmologists were registered in the CPD program and 21(45%)were actively participating in the online COS-CPD program recording.We discuss challenges in CPD,propose solutions to overcome them and recommend developing research in CPD as needed to effectively enhance educational activities with impact in public health.

Evaluation of Clinician Training in Autism Screening, Care Management, and Patient Education

Objective: The demand for pediatric developmental evaluations has far exceeded the workforce available to perform them, which creates long significant wait times for services. A year-long clinician training using the Extension for Community Healthcare Outcomes (ECHO®) model with monthly meetings was conducted and evaluated for its impact on primary care clinicians’ self-reported self-efficacy, ability to administer autism screening and counsel families, professional fulfillment, and burnout. Methods: Participants represented six community health centers and a hospital-based practice. Data collection was informed by participant feedback and the Normalization Process Theory via online surveys and focus groups/interviews. Twelve virtual monthly trainings were delivered between November 2020 and October 2021. Results: 30 clinicians participated in data collection. Matched analyses (n = 9) indicated statistically significant increase in self-rated ability to counsel families about autism (Pre-test Mean = 3.00, Post-test Mean = 3.89, p = 0.0313), manage autistic patients’ care (Pre-test Mean = 2.56, Post-test Mean = 4.11, p = 0.0078), empathy toward patients (Pre-test Mean = 2.11, Post-test Mean = 1.22, p = 0.0156) and colleagues (Pre-test Mean = 2.33, Post-test Mean = 1.22, respectively, p = 0.0391). Unmatched analysis revealed increases in participants confident about educating patients about autism (70.59%, post-test n = 12 vs. 3.33%, pre-test n = 1, p = 0.0019). Focus groups found increased confidence in using the term “autism”. Conclusion: Participants reported increases in ability and confidence to care for autistic patients, as well as empathy toward patients and colleagues. Future research should explore long-term outcomes in participants’ knowledge retention, confidence in practice, and improvements to autism evaluations and care.

A Culturally-Sensitive Model for CME Distance Learning Demonstratesa Way Forward： Kenya＇s Experience with ACME-IT （Advancing Continuing Medical Education Through Information Technology）

A distance learning Continuing Medical Education （CME） project based on live interactive presentations and a group participatory model demonstrated that important strides can be made in the quality of CME available to health care professionals in African rural settings. Implementers choose a communication model consistent with the fundamental orality of Kenyan and other sub-Saharan African countries. The project involved four hospitals and one training institution in rural Kenya. The testing of learners and focus group discussions with learners, facilitators and presenters indicated that the project＇s methodologies, that strove to be culturally and work place friendly, contributed to gains in knowledge, competencies including case management, the continuity of patient care, team work, staff morale and other issues of expressed importance to the hospital healthcare work force and hospital administrators. The learning system, known as Advancing Continuing Medical Education through Information Technology （ACME-IT）, was implemented by the Kenyan Ministry of Medical Services, EC Associates and the US-funded Aphia2 Western initiative implemented by PATH. The findings of this pilot suggests that the ACME-IT methodology that set up learning centers at the participating institutions is a promising viable alternative to the traditional and relatively expensive workshop training that characterizes much of CME in lower and middle income countries.

Current State of Affairs with Regard to Continuing Medical Education for Technicians in Radiology in Francophone West Africa

Background: This study aimed to determine the level of continuing medical education (CME) of medical imaging technicians in French-speaking West Africa. Materials and methods: This opinion survey was administered to radiology technicians in French-speaking West Africa from 1st June to 31st October 2020, i.e. over a period of 5 months concerning their level of CME and their need for CME. Results: Out of 100 technicians, 69% were men. The mean age was 40 years, with extremes ranging from age 23 to age 57. The majority of technicians (64%) worked in the public sector and 78% had work experience of less than 11 years. Most technicians were holders of a Bachelor’s degree (73%). The types of CMEs they knew were congresses, seminars, and modular training in 46% of the cases. The most available CMEs were seminars (63%). All technicians agreed on the need for CME and 96% said it had an impact on the delivery of radiology services. Technicians who had received CME at least once represented 61%. For 90% of technicians, the specific CME sought was management in radiology (33.33%) and radiation protection (25.81%). Conclusion: The need for CME is increasingly indisputable to radiology technicians in French-speaking West Africa;however, it remains a luxury for them, due to its scarcity and its high cost.

Interpretation of proposed measures for continuing nursing education

1 Introduction With the development of modern medicine,the growth of the social demand for nursing,and the gradual improvement of the concept and connotation of lifelong nursing education,continuing nursing education(CNE),as a key form of lifelong nursing education,has received wide attention and played an important role worldwide.CNE is a kind of lifelong education of nursing science on the basis of continuing

Building towards Expertise in CME （Continuous Medical Education）： Suggestions for a New Paradigm

To build towards expertise, one has to accept to modify his way of practicing, including： （1） a need to reflect on and about the action; （2） a continuous concern about our competence to practice; （3） tireless effort to combine metacognition and mental practice in a trans-disciplinary approach; （4） adding research with neuroscience, understanding neuroplasticity, modulation and artificial intelligence. Usual practice actually does not include a continuous concern for CME （continued medical education） and is intermittent at best. This new paradigm constitutes the basis of our approach. Expertise starting in 2015 is described as an asymptotic curve unable to be obtained with usual practice and intermittent education. We suggest a new way of conceiving CME combining practice, reflection on action and in-situ simulation laboratory near work. We are describing TEE （technology-enhanced education） coupled with certain neuro-enhancers to achieve a break in the asymptotic curve of expertise. This is in reality a new conception of CME in medicine.

Cross-sectional study of the educational background and trauma knowledge of trainees in the “China trauma care training” program

Background:Since the trauma knowledge of trauma providers correlates with the outcomes of injured patients,this study aims to assess the socio-demographic characteristics and levels of trauma knowledge of trainees in the China trauma care training(CTCT)program in addition to their post-course test results to provide support for the development of trauma care training programs and trauma systems in China.Methods:A cross-sectional study was conducted by collecting demographic information,hospital-related information and trauma knowledge of the trainees from 19 regions in China.All participants were assessed by questionnaires collecting the socio-demographic data,the trauma care knowledge levels and the information of the hospitals.Results:There were 955 males(78.9%)and 256 females(21.1%)enrolled.Among them,854 were physicians(70.5%),357 were registered nurses(29.5%).In addition,64 of them also played an administrative role in the hospitals(5.3%).The score of the trainees who were members of the emergency department staff(72.59±14.13)was the highest among the scores of all the personnel surveyed,followed by those of the trainees from the intensive care unit(ICU)(71.17±12.72),trauma surgery department(67.26±13.81),orthopedics department(70.36±14.48),general surgery department(69.91±14.79)and other departments(69.93±16.91),P=0.031.The score of the professors(73.09±15.05)was higher than those of the associate professors(72.40±14.71),lecturers(70.07±14.25)and teaching assistants(67.58±15.16),P<0.0001.The score of the individuals who attended experts’trauma lectures(72.22±14.45)was higher than that of individuals who did not attend the lectures(69.33±15.17),P=0.001.The mean scores before and after the training were 71.02±14.82 and 84.24±13.77,respectively,P<0.001.The mean score of trauma knowledge after the training of trainees from different provinces and with different educational backgrounds was higher than that before the training,with a statistically significant difference(P<0.05).Conclusions:The level of trauma knowledge of trauma care providers was associated with their department,professional position and previous participation in related academic conferences.Trauma care experience and participation in academic lectures and training program including CTCT may effectively improve individuals’level of trauma knowledge.

Management of Adult Growth Hormone Deficiency at Peking Union Medical College Hospital:A Survey among Physicians

Objective To evaluate physicians' attitude and knowledge about the management of adult growth hormone deficiency(AGHD) at Peking Union Medical College Hospital and impact factors associated with better decision-making.Methods A 21-question anonymous survey was distributed and collected at Peking Union Medical College Hospital,a major teaching hospital in Chinese Academy of Medical Sciences.Data of physicians' educational background,clinical training,patient workload per year and continuing medical education in AGHD were collected.Factors associated with appropriate answers were further analyzed by multivariate regression models.Results One hundred and eighteen internal medicine residents,endocrine fellows,attending physicians and visiting physicians responded to the survey.Among them,44.9% thought that AGHD patients should accept recombinant human growth hormone replacement therapy.Moreover,56.8% selected insulin tolerance test and growth hormone-releasing hormone-arginine test for the diagnosis of AGHD.Logistic regression analysis of physician demographic data,educational background,and work experience found no consistent independent factors associated with better decision-making,other than continued medical education,that were associated with treatment choice.Conclusions The physicians' reported management of AGHD in this major academic healthcare center in Beijing was inconsistent with current evidence.High quality continued medical education is required to improve Chinese physician management of AGHD.

A comparison of ophthalmic education in China and America

Training qualified ophthalmic professional is crucial for any eye care system worldwide.Education of modern western Ophthalmology in China started late but develops rapidly.This review focused on ophthalmic education in China and US,describing details of the programs and analyzing the differences.This summary may provide useful information for practitioners of medical education from both countries and help improve the present training designs.

The Impact of a Real-Life Inflammatory Bowel Disease Education Course for Brazilian Physicians from the Perspective of Its Participants

Background: Physicians must acquire the necessary skills to provide Inflammatory Bowel Disease (IBD) patients with state-of-the-art clinical care, aiming to improve patient’s quality of life and disease outcomes. Purpose: To describe the queries and experiences of doctors enrolled in an IBD education course and to evaluate the impact of the course. Methods: A retrospective study included 100 physicians, of which 78 attended the course. A questionnaire was applied evaluating how the course had an impact on their IBD-knowledge. The 20-hour-course consisted of practical “real-life” activities and theoretical discussions. Results: The majority of doctors’ expertise was in gastroenterology (53%) and coloproctology (44%). A significant portion had no experience with biological therapy for ulcerative colitis (19.4%) or Crohn’s disease (5.05%). The main topics doctors wanted to discuss were biological therapy (93%), new drugs (74%) and differential diagnosis (64%). A considerable number of physicians did not feel confident at prescribing biological therapy before the course (44.4%), a percentage that decreased to 8.5% after the course (p < 0.0001). The impact of the course was considered high (grades 9 and 10) by most of the participants (78.2%). Discussion: The ideal course should have a practical and theoretical component, as well as the support of an experienced multidisciplinary team. A real-life practical-theoretical IBD course proved a success at increasing IBD knowledge.

Process evaluation of E-learning in continuing medical education:evidence from the China-Gates Foundation Tuberculosis Control Program

Background:E-learning is a growing phenomenon which provides a unique opportunity to address the challenges in continuing medical education(CME).The China-Gates Foundation Tuberculosis(TB)Control Program implemented online training forTB health workers in three provinces of China.We aim to evaluate the implementation of E-learning CME programs,analyse the barriers and facilitators during the implementation process,and to provide policy recommendations.

The effectiveness of E-learning in continuing medical education for tuberculosis health workers: a quasi-experiment from China

Background:Given the context of rapid technological cha nge and COIVD-19 pan demies,E-lear ning may provide a unique opportunity for addressing the challenges in traditional face-to-face continuing medical education(CME).However,the effectiveness of E-learning in CME interventions remains unclear.This study aims to evaluate whether E-learning training program can improve TB health personnel's knowledge and behaviour in China.

Urgent Need of Continuing Medical Education:The Key for Patient Awareness of Labor Epidural Analgesia-A Survey of Chinese Perinatal Care Providers

Objective:This survey was designed to understand the misconceptions about labor epidurals.Methods:This voluntary and anonymous online survey on wenjuan.com was conducted from September 1st,2015 to January 1st,2016 via mainly WeChat groups dedicated to perinatal healthcare providers in China.The questionnaire included items inquiring the knowledge and opinions about labor epidural analgesia related to maternal complications,baby safety,and effect on laboring.Incomplete surveys were excluded from the data analysis.The data was presented as percentages and a Chi-square test or Fisher's exact test,as appreciate,was used to quantitatively compare the results.Results:A total of 1412 respondents completed surveys with 42.9%(606/1412)of them being anesthesiologists,35.1%(495/1412)being obstetricians,11.8%(167/1412)being midwives,3.7%(52/1412)being labor and delivery nurses,and 6.5%(92/1412)being hospital administrators and unspecified.The study revealed a lack of knowledge in labor pain control.Although 82.4%(1164/1412)of respondents were familiar with labor epidural analgesia,8.9%(126/1412)did not know how it works,and 1.1%(15/1412)never heard it in a multiple-choice question.The three main groups(anesthesiologists,obstetricians,and midwives/labor and delivery nurses)were chosen for comparisons.Opinions among these three groups concerning five questions in the three main concerns were evaluated using a statistical significance of P<0.05.Conclusion:The results in our survey indicated an urgent need of continuing medical education to multidisciplinary specialties to improve evidence-based medical practices as these misconceptions have existed for over 10 years in the medical professionals.Lack of public awareness fueled by misconceptions related to labor epidural analgesia may be associated with a lack of professional knowledge.Correct knowledge in professionals needs to be disseminated to the public in order to dispel possible misconceptions and rumors about labor epidural analgesia.This would not only enhance patient understanding of their care but also improve maternal,fetal,and neonatal outcomes.

因材施教——耳鼻咽喉科教学中的几点体会

耳鼻咽喉头颈外科作为医学科学的二级学科,在临床理论课教学和临床实践教学中均占有相当数量的学时;在基础教育和继续教育中占有重要地位。本文就如何根据不同医学教育阶段,不同的学生类型,设计不同的教学侧重点,激发学生对耳鼻咽喉科学习的兴趣,提高学习效率,谈几点想法。

耳鸣学术研讨班互动式教学效果的评价

为了提高耳鸣学术研讨班的教学效果和培训质量,我们在耳鸣学术研讨班中应用师生互动式、兴趣互动式、问题互动式和多媒体互动式教学模式,比较培训前后,学员回答耳鸣试卷的得分情况,对教学效果进行评价。7期227位学员,培训前耳鸣试卷得分39～73,平均47;培训后得分83～100,平均97;培训前后差异有统计学意义(t=32.456,P=0.00001)。99.12%学员接受了耳鸣可治的观念,93.95%接受了耳鸣必须先找病因的观点,100%同意不再轻易下神经性耳鸣的诊断,90.75%认可适应和习惯是耳鸣对症治疗的重要目的,94.25%掌握了耳鸣习服疗法的适应证和禁忌证,100%认为耳鸣与心理问题密切地相关。耳鸣学术研讨班能够改变学员对耳鸣的错误认识,互动式教学有助于提高耳鸣学术研讨班培训质量。

Teaching through social media

Timely and widely available,social media(SM)platforms and tools offer new and exciting learning opportunities in medical education.Despite scarce,we sought for a body of consistent evidence allowing us to substantially approach the concept of SM and how physicians as learners and medical educators can use SM based-education to benefit their clinical practice and their patients’outcomes.We correlate education theories with the progression of world-wide web phases and how this influences the process of teaching and learning.We mention some examples of SM tools already in use in healthcare education.Potential advantages and effectiveness SM in medical education,as well as limitations of SM and pre-requisites for its use are discussed.Our concluding remarks underline the good practices in effectively utilizing SM in healthcare education.

Health Training Needs at Primary Care Level Health Facilities in Rural Western Uganda

Introduction: Continual education is recognized worldwide as a tool for the professional development of health care practitioners. It is however effective when the training targets the appropriate needs of the target beneficiaries. This study was therefore aimed at identifying priority training needs of Primary Care Level health professionals in rural Western Uganda. Methods: This was a descriptive cross-sectional survey among 35 rural community health facilities represented by their managers in rural Western Uganda. Participants were invited to Mbarara University of Science and Technology and responded to a self-administered questionnaire and also participated in qualitative group discussions guided by Facilitators from the Community Based Education and Research Services unit within the Community Health Department of Mbarara University of Science and Technology. Priority health training needs were determined based on the computed weighted scores. Results: The majority of managers of rural primary care level health facilities were medical officers by the level of training (51.43%) and male by gender (68.57%). Priority health training needs identified were child health and maternal health with total weighted scores of 12.0 and 10.9 respectively. Qualitatively, emerging themes included;leadership and management, and supervisory roles during student field attachments. Conclusion: Priority health training needs at rural Primary Care level health facilities were child health, maternal health, leadership and management, and supervisory skills. There is dire need to train rural primary care level, health professionals. In-service training based on identified needs should be offered by MUST in partnership with regional stakeholders. This is likely to enhance the quality of services provided by rural primary care level health facilities.

Virtual reality simulator for training urologists on transurethral prostatectomy

Background A virtual reality simulator provides a novel training model for improving surgical skills in a variety of fields. They can simulate a variety of surgical scenarios to improve the overall skills required for endoscopic operations, and also record the operative process of trainees in real-time and allow for objective evaluation. At present, some simulators for transurethral resection of the prostate （TURP） are available. The utility of virtual reality simulators in training of transurethral prostatectomy was investigated. Methods Thirty-eight urologists were randomly selected to take part in a simulation based training of TURP using the TURPSimTM system. Pre and post-training global rate scale （GRS） scores and objective parameters recorded by the simulator were assessed. Then, questionnaires were filled out. Results Compared with baseline levels, the GRS scores of trainees increased （18.0±4.0 vs. 12.4±4.2, P 〈0.001）, while the rate of capsule resection （26.3%±0.6% vs. 21.2%±0.4%, P 〈0.001）, amount of blood loss （（125.8±86.3） ml vs. （83.7±41.6） ml, P 〈0.001）, external sphincter injury （3.6±2.9 vs. 2.0±2.0, P 〈0.001 ） decreased significantly after training. Most trainees were satisfied with the simulator based training and believed that the simulator accurately mimicked actual surgical procedures and could help improve their surgical skills. Conclusions As a new method of training on transurethral prostatectomy skills, training of TURP using a virtual simulator can help urologists improve their surgical skills and safety. Therefore, the application of the TURPSimTM system in education and training of urologic surgery is warranted.

Evaluation of 3-day smoking cessation training course for doctors from 38 cities in China

Background The World Health Organization＇s ＂Framework Convention on Tobacco Control＂ came into effect in China in 2006. Since then, a series of tobacco control measures has been undertaken, including the first step to establish a coordinated network of stop-smoking clinics in Chinese hospitals. Training for stop-smoking specialists has been traditionally provided via printed materials. This study evaluated the outcomes of the first two intensive 3-day courses in smoking cessation in China run in collaboration with experts who provide training to UK Specialist Stop Smoking Service. Methods Eighty-four doctors from 38 cities in China responsible for stop-smoking treatment in 20 provinces and four autonomous regions participated in the training courses. Participants＇ knowledge competencies and self-efficacy were assessed before and after the authentication training. Results The training significantly improved participants＇ knowledge, skills and self-efficacy across different domains. Forty-eight participants were finally certified as ＂smoking cessation specialist＂. Conclusions The UK model of face-to-face training was acceptable and effective in China. A relatively brief intensive training program can generate significant improvements in skills, knowledge, and readiness to engage in smoking cessation activities.