Enhancing Practice Improvement by Facilitating Practitioner Interactivity: New Roles for Providers of Continuing Medical Education

Parboosingh, I. John; Reed, Virginia A.; Palmer, James C.; Bernstein, Henry H.

doi:10.1002/chp.20116

Cited by 38 publications

(52 citation statements)

References 41 publications

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“…Some studies report clinician preferences for passive training methods [36, 37], but older clinicians with established practice styles appreciate case-based simulations that promote peer interactive learning and skills uptake [38]. Older trainees such as those in continuing medical education programs (CME) may favor more active approaches compared to younger trainees.…”

Section: Discussionmentioning

confidence: 99%

How Do Clinicians Prefer Cultural Competence Training? Findings from the DSM-5 Cultural Formulation Interview Field Trial

Aggarwal

Lam²,

Castillo

et al. 2015

Acad Psychiatry

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Objective This study’s objective is to analyze training methods clinicians reported as most and least helpful during the DSM-5 Cultural Formulation Interview field trial, reasons why, and associations between demographic characteristics and method preferences. Method The authors used mixed methods to analyze interviews from 75 clinicians in five continents on their training preferences after a standardized training session and clinicians’ first administration of the Cultural Formulation Interview. Content analysis identified most and least helpful educational methods by reason. Bivariate and logistic regression analysis compared clinician characteristics to method preferences. Results Most frequently, clinicians named case-based behavioral simulations as “most helpful” and video as “least helpful” training methods. Bivariate and logistic regression models, first unadjusted and then clustered by country, found that each additional year of a clinician’s age was associated with a preference for behavioral simulations: OR=1.05 (95% CI: 1.01–1.10; p=0.025). Conclusions Most clinicians preferred active behavioral simulations in cultural competence training, and this effect was most pronounced among older clinicians. Effective training may be best accomplished through a combination of reviewing written guidelines, video demonstration, and behavioral simulations. Future work can examine the impact of clinician training satisfaction on patient symptoms and quality of life.

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Section: Discussionmentioning

confidence: 99%

How Do Clinicians Prefer Cultural Competence Training? Findings from the DSM-5 Cultural Formulation Interview Field Trial

Aggarwal

Lam²,

Castillo

et al. 2015

Acad Psychiatry

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“…This higher motivation would, in turn, lead to information-seeking and mother/baby-supportive behaviors, and take providers through pre-contemplation, contemplation, preparation, action and maintenance of the new care behaviors [21]. This is enhanced by the ‘behavioral interactivity’ considerations that lead to consideration, which suggest that change is dependent on interactions within the community of providers [34]. …”

Section: Methodsmentioning

confidence: 99%

Implementing the ten steps to successful breastfeeding in multiple hospitals serving low-wealth patients in the US: innovative research design and baseline findings

Labbok¹,

Taylor²,

Nickel

2013

Int Breastfeed J

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BackgroundThe Ten Steps to Successful Breastfeeding are maternity practices proven to support successful achievement of exclusive breastfeeding. They also are the basis for the WHO/UNICEF Baby-Friendly Hospital Initiative (BFHI). This study explores implementation of these steps in hospitals that serve predominantly low wealth populations.MethodsA quasi-experimental design with mixed methods for data collection and analysis was included within an intervention project. We compared the impact of a modified Ten Steps implementation approach to a control group. The intervention was carried out in hospitals where: 1) BFHI designation was not necessarily under consideration, and 2) the majority of the patient population was low wealth, i.e., eligible for Medicaid. Hospitals in the research aspect of this project were systematically assigned to one of two groups: Initial Intervention or Initial Control/Later Intervention. This paper includes analyses from the baseline data collection, which consisted of an eSurvey (i.e., Carolina B-KAP), Maternity Practices in Infant Nutrition and Care survey tool (mPINC), the BFHI Self-Appraisal, key informant interviews, breastfeeding data, and formatted feedback discussion.ResultsComparability was ensured by statistical and non-parametric tests of baseline characteristics of the two groups. Additional findings of interest included: 1) a universal lack of consistent breastfeeding records and statistics for regular monitoring/review, 2) widespread misinterpretation of associated terminology, 3) health care providers’ reported practices not necessarily reflective of their knowledge and attitudes, and 4) specific steps were found to be associated with hospital breastfeeding rates. A comprehensive set of facilitators and obstacles to initiation of the Ten Steps emerged, and hospital-specific practice change challenges were identified.DiscussionThis is one of the first studies to examine introduction of the Ten Steps in multiple hospitals with a control group and in hospitals that were not necessarily interested in BFHI designation, where the population served is predominantly low wealth, and with the use of a mixed methods approach. Limitations including numbers of hospitals and inability to adhere to all elements of the design are discussed.ConclusionsFor improvements in quality of care for breastfeeding dyads, innovative and site-specific intervention modification must be considered.

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“…Local clinician-led efforts that work through communities and change social norms are extremely effective, yet the most underdeveloped in healthcare 4. Communities of practice5 and quality improvement clinical communities6 are examples of local efforts that build relationships, network, learn and share, and have resulted in successful improvement efforts. Quality improvement collaboratives attempt to corral clinicians, provide a common goal and interventions to reach this goal, and network these communities to support each other in achieving this goal.…”

mentioning

confidence: 99%

Improving healthcare quality through organisational peer-to-peer assessment: lessons from the nuclear power industry

Pronovost

Hudson

2012

BMJ Qual Saf

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Healthcare has made great efforts to reduce preventable patient harm, from externally driven regulations to internally driven professionalism. Regulation has driven the majority of efforts to date, and has a necessary place in establishing accountability and minimum standards. Yet they need to be coupled with internally driven efforts. Among professional groups, internally-driven efforts that function as communities of learning and change social norms are highly effective tools to improve performance, yet these approaches are underdeveloped in healthcare. Healthcare can learn much from the nuclear power industry. The nuclear power industry formed the Institute of Nuclear Power Operators following the Three Mile Island accident to improve safety. That organization established a peer-to-peer assessment program to cross-share best practices, safety hazards, problems and actions that improved safety and operational performance. This commentary explores how a similar program could be expanded into healthcare. Healthcare needs a structured, clinician-led, industry-wide process to openly review, identify and mitigate hazards, and share best practices that ultimately improve patient safety. A healthcare version of the nuclear power program could supplement regulatory and other strategies currently used to improve quality and patient safety.

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Enhancing Practice Improvement by Facilitating Practitioner Interactivity: New Roles for Providers of Continuing Medical Education

Cited by 38 publications

References 41 publications

How Do Clinicians Prefer Cultural Competence Training? Findings from the DSM-5 Cultural Formulation Interview Field Trial

How Do Clinicians Prefer Cultural Competence Training? Findings from the DSM-5 Cultural Formulation Interview Field Trial

Implementing the ten steps to successful breastfeeding in multiple hospitals serving low-wealth patients in the US: innovative research design and baseline findings

Improving healthcare quality through organisational peer-to-peer assessment: lessons from the nuclear power industry

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