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12 th World Congress on Public Health Research Education and Practice April 27- May 1, 2009 Istanbul, Turkey Education Research Findings from Physicians in Canada - Implications for Practice and Public Health Outcomes Brenda Lovell Raymond Lee Why Demand for Educational Reforms?

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12th World Congress on Public Health Research Education and PracticeApril 27- May 1, 2009 Istanbul, Turkey

Education Research Findings from Physicians in Canada - Implications for Practice and Public Health Outcomes

Brenda Lovell Raymond Lee


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Why Demand for Educational Reforms?

Increased accountability, complexity, and demand for quality service delivery

Effectiveness of educational programs has been questioned, passive-teacher centered learning methodologies not leading to enhanced practice or improved health outcomes

Pressure to engage in self-assessment of knowledge and skill

Transfer of knowledge and skills to practice


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Defining Continuing Professional Development

  • Educational methods beyond didactic, concepts of self-learning and personal development, system factors

  • Practice settings, tied to experience

  • Self-reflection, interaction with patients and colleagues, community based activities

  • Combines both clinical subject matter and other issues such as practice management, broader aspects of medicine


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What is Patient Centered Health Care?

• Integration of psychological, social, physiological

aspects of illness

• Physician self-awareness, self-knowledge

• Emotional attunement

• Understanding of the whole person – context, life story

• Finding common ground with patient i.e. role of patient

and physician ( level of patient involvement in care)

• Development of trust and rapport to encourage

adherence, health promotion and healing


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Study Overview, Measures, Participants

Mixed method survey study of 278 physicians from the

province of Manitoba, Canada, data collected in 2006.

Male participants - 60% Average years in practice – 16

Specialty distribution:

family medicine 110 internal medicine 61

paediatric 30 surgical disciplines 29

residents 20 psychiatry 19

Measures

Section D of The Cross-Cultural Doctor-Patient Communication

Needs Assessment. Used a five response scale, 1- Not at all, 2- Not Very, 3- Somewhat, 4- Fairly, 5- Extremely

Participants were asked how useful they thought learning the

following topics would be in improving communication skills with

patients of different cultural and/or socioeconomic backgrounds.


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Findings from educational items

a. Your own attitudes toward different cultural and/or socio-economic backgrounds

  • Specialties with the highest means

  • Psychiatry 3.47

  • 2. Internal Med (Primary care 3.17

  • 3. Paediatrics (Primary care) 3.15

  • 4. Residents 3.10


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Findings from educational items

b. Your past experiences with people of different cultural and/or socio-economic backgrounds

  • Specialties with highest means

  • Paediatric (Primary care) 3.52

  • 2. Internal Med ( Primary care) 3.45

  • Residents 3.35

  • 4. Family Med ( Primary care) 3.26


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Findings from educational items

c. Health beliefs of people of different cultural and/or socio-economic backgrounds

  • Specialties with highest means

  • Paediatric ( Primary care) 4.11

  • 2. Residents 4.00

  • 3. Psychiatry 4.00

  • 4. Family Med (Primary care) 3.90


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Findings from educational items

d. Expectations held by persons from different cultural and/or socio-economic backgrounds about what a physician should do and how a physician should behave

  • Specialties with the highest means

  • Psychiatry 4.00

  • 2. Residents 3.95

  • 3. Family Med ( Primary care) 3.89

  • 4. Paediatric ( Primary care) 3.86


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Findings from educational items

e. Skills for working efficiently and effectively with interpreters

Specialties with highest mean

1. Psychiatry 4.22

2. Paediatrics (Primary care) 3.78

3. Internal Med (Primary care) 3.78

4. Family Med (Primary care) 3.56


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Findings from educational items

f. Patient communication and interaction skills

  • Specialties with highest mean

  • Family Med ( Primary care) 3.50

  • 2. Internal Med ( Primary care) 3.42

  • 3. Paediatrics (Primary care) 3.39

  • 4. Surgical disciplines 3.21


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Findings from educational items

Correlation between years of experience and items

Health beliefs of people of different cultural and/or socio-economic backgrounds. -.13

Expectations held by persons from different cultural and/or socio-economic backgrounds about what a physician should do and how a physician should behave. -.14

Physician gender differences

Health beliefs of people of different cultural and/or socio-economic backgrounds. ( Females more valuable )

Expectations held about what a physician should do and how a physician should behave. ( Females more valuable)


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What educational methodologies should we use?

  • • Learning portfoliosare an effective learning experience. Measure growth

  • and areas that need further development in individual medical practice.

  • • An effective assessment tool

  • • Move from a passive to active role in developing learning plan

  • Goals for portfolio:

  • - document actual learning - monitor & document progress

  • highlight achievements - enable ownership of learning

  • self assessment & reflection - transfer to practice


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Benefits and Challenges to Overcome

  • Benefits

  • Used for formative or to enhance summative assessments such as licensure exams

  • -Demonstrate level of achievement and competency in meeting standards, goals, objectives

  • Encourage peer evaluation

  • Challenges to overcome

  • Design and implementation of rubrics for scoring work

  • Institutional support, resources and time commitment


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Discussion

• Development of personalized learning by generating baseline information, address identified needs, measuring outcomes, apply to practice

• Overcome barriers that impede effective learning

  • Targeting communication skills training with specific clinical scenarios

    • Developing oneself, both professional and personal

    • Patient expectations - patients desire:

    respect (86%) knowledge and skills (64%) patient involvement in care (63%)

    • Need for public health education & decision aids


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References

1. Howard J. The emotional diary – a framework for reflective practice. Education for General Practice; 8:288-91.

2. Watling CJ, Brown JB. Education research: communication skills for neurology residents: structured teaching and reflective practice.

3. Margolis A, Alvarino F, Niski R, Fosman E, Torres J, Rios G, Petruccelli D. Continuing professional development of physicians in Uruguay: Lessons from a countrywide experience. J Cont Edu Health Prof 27(2): 81-85 2007

4. Siddiqui ZS. Continuous professional development of medical doctors in Pakistan: Practises, motivation and barriers.

5. Vanderford ML, Stein T, Sheeler R, Skochelak S. Communication challenges for experienced clinicians: Topics for an advanced communication curriculum. 2001, Health Communication (13) 3 261-84.

6. Lovell BL, Lee RT, Frank E. May I long experience the joy of healing: professional and personal wellbeing among physicians from a Canadian province. BMC Fam Pract 2009, 10:18.


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References

7. Lovell BL, Lee RT, Brotheridge CM. How communications between patient and physician affects concordance, compliance, and patient safety in a Canadian setting. Proceedings of the Health Care Systems, Ergonomics, Patient Safety International Conference, Strasbourg, France, 2008.

8. Shapiro J, Hollingshead J, Morrison E. Primary care resident, faculty, and patient views of barriers to cultural competence, and the skills needed to overcome them. Med Educ 2002; 36:749-59.

9. Wilkinson TJ, Challis M, Hobma SO, Newble DI, Parboosingh JT, Sibbald RG, Wakeford R. The use of portfolios for assessment of the competence and performance of doctors in practice. Med Educ 2002; 36:918-24.

10. Backstein D, Hutchison C, Regehr G. A needs assessment for continuing professional development in orthopedic surgery. Annals RCPSC 2002; 35(4): 219-24.

11. Oxford Textbook of Primary Medical Care, Volume 1,Princples and Concepts. Editors: Jones, Britten, Culpepper, Gass, Grol, Mant, Silagy. Oxford University Press, 2004.


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Contact Information

Brenda Lovell - email: [email protected]

Raymond Lee – email: [email protected]


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