Each year, four winners are selected from among the many abstract and poster submissions during the Annual Meeting. Their work is presented here in acknowledgement of the extraordinary achievement of these SACME authors. Congratulations!
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Commitment to change (CTC) and actual practice change after a continuing medical education (CME) intervention
Authors: Sharisse Arnold Rehring, MD, John Steiner, MD, MPH and Mathew Daley, MD
Institution: Colorado Permanente Medical Group
Problem/Intervention - Evidence linking commitments to change (CTC) to actual practice change is limited, yet a widespread practice is to utilize CTC on evaluations as a means to assess CME outcomes. Commitments to change are intended to promote learner reflection, serve as a proxy for actual behavior change and even motivate learners to implement the intended change in practice. CTC usually depends on self-report. They are often used to measure effectiveness of CME since actual practice changes are difficult to measure in most settings due to inadequate access to clinical data, logistical challenges in measuring the content of educational interventions and lack of organizational incentives to invest resources in evaluation. Important questions remain about whether CTC accurately translates into performance change.
In an intervention that combined live CME with changes to the electronic health record to promote judicious antibiotic use for children with urinary tract infections (UTIs), we evaluated CTC and subsequent prescribing behavior in Kaiser Permanente Colorado, an integrated health care system. CTC was assessed immediately after the session using closed-ended questions about session learning objectives and open-ended questions to elicit specific practice changes. Perceived barriers to implementing recommended changes were also assessed.
Methods - The components of the CME intervention used to study CTC on pediatric UTIs included a live, case-based 2-hour educational session with randomized flipped classroom. All participants were offered individualized and peer-comparison antibiotic prescribing data. Spaced repetition emails with online knowledge assessments were disseminated along with “take home points” after the CME activity. Local clinical practice guidelines were published within the Clinical Library, which is available within the electronic health record (EHR) on the same day as the CME activity. New condition-specific order sets within the EHR addressing antibiotic prescribing in pediatric UTIs were developed and became available to family medicine and pediatric clinicians on the day of the CME activity.
Results - Among 179 participants, 80 (45%) completed post-session evaluations and treated one or more child with a UTI in the subsequent 17 months (856 UTIs total). In closed-ended responses to session learning objectives, 45 clinicians (56%) committed to changing practice for antibiotic choice and duration, while 37 (46%) committed to implementing guidelines. When asked open-ended questions to identify specific practice changes, 32 (40%) committed to antibiotic choice change and 29 (36%) committed to treatment duration change. Participants who made specific CTC statements had greater improvement in antibiotic choice (relative rate ratio [RRR] 1.56, 95% CI 1.16, 2.09) and duration (RRR 1.59, 95% CI 1.05, 2.41) than participants who did not make specific commitments. Few perceived barriers affected subsequent prescribing.
Key lessons learned for CME/CPD practice - The key lessons learned included the following:
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- Commitment to changing specific clinical behaviors after a CME activity were significantly associated with sustained changes in prescribing for children with UTIs. At the end of the CME, some attendees were ready to change, made a commitment, and sustained the intended prescribing practices without ongoing audit and feedback. This is unique in the behavior change literature around antibiotic prescribing.
- Commitment to change in open-ended response evaluations of CME interventions may be associated with change in practice; and open-ended responses may be a better indicator of change in practice than responses to closed-ended evaluation questions.
- CME participants who self-identify as unlikely to make a change in practice may benefit from alternate educational interventions and strategies. Further studies on how to design educational interventions while maintaining the confidential integrity of the evaluation process are needed.
- Perceived barriers did not adversely impact the likelihood of practice change. Clinicians are not always able to predict whether perceived barriers will impact actual practice.
- This was a well-designed CME that met all the criteria defined in the literature for CME effectiveness. Further research is needed to replicate this finding.
Accelerating the appropriate adoption of AI in healthcare through building new knowledge, skills, and capacities in the Canadian healthcare professions
Authors: Mohammad Salhia, HBSc, MEd, Rebecca Charow MSc, Tharshini Jeyakumar MHI, Azra Dhalla MBA, Caitlin Gillan Med, Dalia Al-Mouaswas BHS, Elham Dolatabadi PhD, Ethan Jackson PhD, Jane Mattson MLT, Jacqueline Waldorf EMBA, Manal Siddiqui MBA, Sarah Younus MPH, Wanda Peteanu MHSc, Walter Tavares PhD, and David Wiljer, PhD
Institution: University of Toronto
Problem/Intervention. There is a lack of capacity in healthcare systems to optimize the use of artificial intelligence (AI) to improve patient care, despite calls for AI integration as part of the National Academy of Medicine’s Quintuple Aim model. The proposed program will be designed to transform the mindset, skillset and toolsets of health care providers and organizational leaders across Canada.
Methods - To prepare a health care organization, its staff, its partners, learners, and its other stakeholders to have the knowledge skills and attitudes to harness AI tools effectively, a concurrent, multi-stepped approach is suggested to accelerate the rate of organizational change across Canada and ensure that AI not only automates but also enhances and optimizes health care delivery. This project consists of developing four education programs: basic AI awareness; two certificate-based programs to educate health care providers and leaders about AI; and a mentoring and coaching innovation hub.
Results - Framed by the Knowledge-to-Action framework, we are currently in the knowledge creation stage to inform the curricula for each deliverable. An environmental scan and a scoping review were conducted to understand the current state of artificial intelligence education programs as reported in academic literature. The environmental scan identified 13 AI accredited programs specific to health professionals where 4 were from the US, 4 from the UK, 3 from Canada, and 2 from Asian countries. The most common curriculum topics across the environmental scan and scoping review included AI fundamentals, AI in healthcare, ethics, data science, and challenges and opportunities of AI. There is a need for nationwide education standards, competency-based frameworks, and evaluation approaches.
Key lessons learned for CME/CPD practice - In order to participate in the shaping of AI practices, healthcare professionals must have the competencies and capabilities to implement and shape the future of their discipline and practices for advancing high-quality care within the digital ecosystem.
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BEST EARLY INVESTIGATOR
Leading and influencing change in continuing professional development: A work in progress
Authors: Morag Paton, MEd, Suzan Schneeweiss, MD, MEd, FRCPC, Jane Tipping, MADEd, Marta Guzik-Eldridge, BA, Rowland, PhD, Walter Tavares, PhD,
David Wiljer, PhD. With special acknowledgement of Kaitlin Fuller, MLIS.
Institution: University of Toronto
Problem/Intervention - CPD remains underappreciated in the landscape and not well integrated into leadership structures (Vinas et al., 2020) in practice. While leading effective CPD requires competence across multiple domains, there is no requirement for CPD leaders to have completed professional development themselves (FMEC-CPD, 2019) and limited understanding of what educational leadership means or what it does in health organizations (Onyura 2019).
Methods - This study, presented as a work in progress at SACME 2021, has two main components. The first is an evaluation project of an existing CPD leadership program: Leading and Influencing Change in CPD (LAIC) which is in its fourth iteration and its first fully online delivery after substantial revision in content and format. We will use multiple data points including participant data, evaluations, assignments, and commitment to change statements evaluate the program based on levels 1-5 of Moore’s Framework (2009).
The second component is to describe what CPD (physician) leadership means, its competencies, and impact on practice change. This goal will be explored through a qualitative narrative study, first by conducting a scoping review of literature and complementing this, through interviews of CPD leaders and LAIC participants to better understand their lived experiences with leadership in CPD. We will use thematic template analysis (Brooks et al. 2015) to organize interview data.
Results - Early reflections from LAIC’s leaders on the transition to the online program indicate positive experiences with the integration of learning material, and improved involvement of and access to international CPD experts. Challenges include building a sense of community and balancing content delivery and interactivity.
Following Arksey and O’Malley’s methodology (2015) we piloted our search strategy with 5% of the 656 references (n=33) identified in MEDLINE. Title and abstract screening by two reviewers indicated that 33% (n=11) would be suitable to move forward to full text review.
Key lessons learned for CME/CPD Practice - At this early stage, we recommend working with a librarian to determine scoping review search strategies. We anticipate that this study will harness valuable data for new and developing CPD leadership programs and contribute to the growing literature about leadership in CPD.
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Educating correctional officers to better meet the mental health needs of inmates
Authors: Shaheen A. Darani, MD, FRCPC, Kiran Patel, MBBS, FRCPC, Laura Hayos, OT, Tanya Connors, MSW, Faisal Islam, PhD, Anika Saiva, HBSc., MPH, Sandy Simpson, MBBS, FRCPC
Institution: University of Toronto
Problem/Intervention - In Canada, there has been an increase in the rate of incarceration of individuals with mental health diagnoses. Over-representation of individuals with psychiatric diagnoses in correctional settings is well-established. Front-line officers play a central role in dealing with the mental health struggles of inmates. Nonetheless, the training that officers receive is often considered less than adequate.
Methods - A needs assessment was undertaken among officers at the Toronto South Detention Centre (TSDC) in Toronto, Canada. In response to needs identified, a one-day course was delivered to officers (n = 57) at the TSDC and Vanier Centre for Women (n = 41). The curriculum included mental health awareness; assessment of risk; communicating with inmates in distress; and self-care. Live simulations provided the opportunity for participants to identify signs of mental illness, assess risk, and respond strategically to de-escalate situations. Participants’ knowledge and confidence in their ability to identify and assist individuals with these problems was established using pre and post measures. Participant satisfaction was also measured via a survey. A three-month follow-up administration was used to determine maintenance of training gains. Focus groups at nine months were conducted to understand participants’ needs, learning, and impact of training.
Results - The results were promising, with 92% and 88% of participants at TSDC and Vanier Centre for Women respectively expressing satisfaction and 62% and 68% at TSDC and Vanier Centre for Women respectively stating they intended to change practices. Analyses of change in knowledge and confidence scores pre to post-training showed statistically significant improvement in all areas measured. Three-month follow-up at TSDC showed 75% of respondents have applied what they learned from the training to a “moderate or great extent”. Focus group themes showed improved attitudes and ability to identify behaviors related to inmate mental health struggles and interest in further training to support officers’ mental health. This study shows that training informed by officer learning needs can help them better meet the mental health needs of inmates. Training can improve attitudes toward inmates presenting with mental health issues.
Key lessons learned for CME/CPD practice - This study can guide the creation and delivery of future training programs. Training that is interactive and provides skills practice can have sustained impact on practice. Further training should integrate self-care to support officers' mental health. These findings could contribute toward best practice guidelines for future inmate mental health training programs.
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