Continuing Medical Education, Continuing Professional Development, and Knowledge Translation: Improving Care of Older Patients by Practicing Physicians

Abstract

Many community-based internists and family physicians lack familiarity with geriatrics knowledge and best practices, but they face overwhelming fiscal and time barriers to expanding their skills and improving their behavior in the care of older people. Traditional lecture-and-slide-show continuing medical education (CME) programs have been shown to be relatively ineffective in changing this target group's practice. The challenge for geriatrics educators, then, is to devise CME programs that are highly accessible to practicing physicians, that will have an immediate and significant effect on practitioners' behavior, and that are financially viable. Studies of CME have shown that the most effective programs for knowledge translation in these circumstances involve what is known as active-mode learning, which relies on interactive, targeted, and multifaceted techniques. A systematic literature review, supplemented by structured interviews, was performed to inventory active-mode learning techniques for geriatrics knowledge and skills in the United States. Thirteen published articles met the criteria, and leaders of 28 active-mode CME programs were interviewed. This systematic review indicates that there is a substantial experience in geriatrics training for community-based physicians, much of which is unpublished and incompletely evaluated. It appears that the most effective methods to change behaviors involved multiple educational efforts such as written materials or toolkits combined with feedback and strong communication channels between instructors and learners.

Advancing geriatrics education: An efficient faculty development program for academic hospitalists increases geriatric teaching

“…First, using hospitalist peers and local geriatricians likely increased trust in the educational curricula and allowed for strong communication channels between instructors. 25,26 Second, coteaching allowed for hospitalist mentorship. Hospitalists acknowledged their coleaders as mentors and several hospitalists subsequently engaged in new geriatric projects.…”

“…Use of multiple educational techniques yields greater knowledge and behavioral change as compared to a single method, such as lecture alone. 24,25,30,31 Finally, sessions were sequenced over a year, rather than clustered in short, intensive activity. Sequenced, or ''learn-work-learn'' opportunities allow education to be translated to practice and reinforced.…”

Kollegiale Visitationen als Methode Reflexiver Professioneller Entwicklung

“…Eine Überblicksstudie über Programme, die auf Verhaltensänderungen in eng umrissenen Bereichen abzielten, zeigte, dass kleine Lerngruppen und Praxisbesuche der Instruktoren förderlich sind. Auch die Erhebung von Bedürfnissen der Lernenden vorab und methodische Vielfalt sind Bedingungen für verhaltenswirksame Fortbildung (Thomas et al 2006). Diese Bedingungen, besonders die Einbeziehung der Praxis und der informelle Austausch sind in der Methode der Visitation gegeben.…”

Education to Improve Dementia Care:

“…Research on CME indicates that the most effective methods to change behaviors involve multiple educational strategies including written materials or toolkits. 22 The purpose of this study was to examine the impact of this workshop to provide primary care clinicians with a structured clinical reasoning approach to dementia diagnosis and brain map tool on self-perceived changes in knowledge, confidence, and ability to assess and manage memory problems and on self-reported application of learning to clinical practice.…”

“…18 The seven-step clinical reasoning model ( Figure 1) and brain map 19 provide clinicians with a structured approach to assessment. The process includes consideration of conditions that might present with cognitive symptoms, such as delirium or depression, as well as screening for reversible causes consistent with Canadian consensus guidelines 22,23 and consideration of medication adverse effects. If these are excluded, the next step is the differentiation of dementia, mild cognitive impairment, and subjective cognitive impairment.…”