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12th World Congress on Public Health Research Education and

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12th World Congress on Public Health Research Education and Powered By Docstoc
					        12th 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?
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
   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
       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
       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.
         Findings from educational items

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


Specialties with the highest means
1. Psychiatry                     3.47
2. Internal Med (Primary care     3.17
3. Paediatrics (Primary care)     3.15
4. Residents                      3.10
            Findings from educational items

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

Specialties with highest means
1. Paediatric (Primary care)       3.52
2. Internal Med ( Primary care)    3.45
3. Residents                       3.35
4. Family Med ( Primary care)       3.26
            Findings from educational items

c. Health beliefs of people of different cultural
  and/or socio-economic backgrounds
   Specialties with highest means
   1. Paediatric ( Primary care)              4.11
   2. Residents                               4.00
   3. Psychiatry                               4.00
   4. Family Med (Primary care)                3.90
          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
1. Psychiatry                     4.00
2. Residents                      3.95
3. Family Med ( Primary care)     3.89
4. Paediatric   ( Primary care)   3.86
            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
           Findings from educational items

f. Patient communication and interaction skills

 Specialties with highest mean
1. Family Med ( Primary care)       3.50
2. Internal Med ( Primary care)     3.42
3. Paediatrics (Primary care)       3.39
4. Surgical disciplines             3.21
           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)
   What educational methodologies should we use?

• Learning portfolios are 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
           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
                         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
                            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.
                               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.
                Contact Information



Brenda Lovell - email:   brendaleelovell@gmail.com


Raymond Lee – email:     raylee@cc.umanitoba.ca

				
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