Update on Continuing Professional Development KT Initiatives Joan

Update on Continuing Professional Development KT Initiatives Joan Sargeant Ph. D & France Légaré MD, Ph. D Dalhousie University, Halifax Université Laval, Quebec KT Canada Jan 12, 2012

Objectives CPD-KT session 1. Describe CPD and its context, and organization in Canada – 1. Practice 2. Research 2. Review CPD-KT initiatives of past 2 years in association with KT Canada 3. Review 1 -2 ongoing projects 4. Discuss challenges in collaboration and ways for CPD-KT to move ahead

1. Describe CPD and its context, and compare with KT in Canada ■ Schizophrenic – CME? ? Or CPD? ? ■ CME (traditional term) ● “putting on educational programs that will help physicians keep up to date” (Rosof, Felch 1992) ● Now realize that it takes much more than “programs” and much more than just “keeping up to date” (knowledge only)

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CPD (Continuing Professional Development) ■ CPD refers to an array of educational activities that health professionals undertake to maintain, develop and enhance the ● ● Knowledge Skills Performance and Relationships they require to improve individual and population health (Davis, Barnes, Fox 2003)

Physician roles (RCPSC Can. MEDs & Can. MEDs-FM CFPC) ■ ■ ■ ■ Medical expert Professional Communicator Collaborator Scholar Manager Health advocate ■ CPD addresses enhancing each role, not just the medical expert

Physician roles (RCPSC Can. MEDs & Can. MEDs-FM ) ■ Practice – Can. MEDS Roles Conflicts of interest ● Medical expert Communication skills Teamsdecision-making / IP learning ▪ Professional Shared Health technology assessment ▪ Communicator Life-long learning, self. Quality assurance and improvement ▪ Collaborator assessment, Critical appraisal / EBM Patient safety ▪ Scholar Health policy / Public health ▪ Manager ▪ Health advocate 7

CPD Practice - Designing, providing, evaluating CPD interventions ■ N=1 ■ Academic detailing ■ Performance feedback & coaching ■ N = small group ■ Foundation for Medical Practice Education, Practice-Based Small Groups ■ Workshops ■ N= large group/ population ■ Conferences (with interaction) ■ Webinairs (e. g. , H 1 N 1, 2009) ■ EBM websites (with interaction)

EBM Websites with interaction; e. g. ■ UBC CPD website: “This Changed my Practice” ● www. thischangedmypractice. com ● ‘We’ve asked our team of contributing physicians which clinical trials or practice tips have truly impacted their practice. Whether it’s a trial which changed their current treatment of a problem, or new data that made them question something they did before, we’ve asked our team of local key opinion leaders to share some of the things that were truly practice-changing. Think of it as sitting down with a trusted colleague and asking them: “what new information changed your practice in the last year? ” ‘

CPD and Knowledge-to-Action Framework 10 Graham et el JCEHP 2006

Goal of CPD Research ■ Optimize putting evidence into practice ■ Optimize ● More effective outcomes ● More efficient (easier, cheaper) ● Increase understanding ■ Evidence ● ● ● Clinical evidence Educational evidence Behavioural Social Not just what works but how and why it works 11

Journal of Continuing Education in the Health Professions - vol 31(4) fall 2011 ■ ORIGINAL RESEARCH, e. g. ● Identifying primary care skills and competencies in opioid risk management ● Physician preferences for accredited online continuing medical education ■ LITERATURE REVIEW ● Identifying the educationally influential physician: A systematic review of approaches ● Physician self-audit: A scoping review ■

JCEHP 2011: 31(4) ■ INNOVATIONS Using problem-based case studies to learn about knowledge translation interventions: An inside perspective ■ FORUM Tailoring interventions: Examining the evidence and identifying gaps Reflections on knowledge brokering within a multidisciplinary research team

Organization of academic CPD in Canada ■ Located at each of our 17 medical schools (UGME, PGME, CME/ CPD) ■ Nationally accredited ■ AFMC (Association of Faculties of Medicine of Canada) ■ All members of AFMC Standing Committee of Continuing Professional Development ■ Meet annually face-to-face, bi-monthly by TC ■ All units provide CPD, most conduct research ■ Research funds limited ■ Professional associations, clinical dept’s also provide accredited CPD

2. Review CPD-KT initiatives of past 2 years in association with KT Canada, and 2 -3 activities ■ Joan and France ■ Initiatives: ● 2009: CPD leaders and KT researchers meeting in Québec city ● 2010: CPD leaders and KT researchers meeting in Halifax ● Outcomes of meetings/ activities

Moving Research Forward: a Collaboration of National CME/CPD and KT Researchers (CIHR meeting grant) Halifax NS , June 5, 6 2010

Planning Committee ■ ■ ■ ■ Michael Allen, MD MSc(c) Dalhousie University Francine Borduas, MD Université Laval France Légaré, MD Ph. D Université Laval Jocelyn Lockyer, Ph. D MHA University of Calgary Ian Graham, Ph. D Vice-President KT, CIHR Jeremy Grimshaw, MBCh. B Ph. D Ottawa University Tanya Hill, MSc Dalhousie University Francesca Luconi, Ph. D Mc. Gill University Joan Sargeant, Ph. D Dalhousie University Ivan Silver, MD MEd University of Toronto Ingrid Sketris, Pharm. D MPA Dalhousie University Sharon Straus, MD MSc University of Toronto Heather Stenerson, MEd University of Saskatchewan

Goal: build capacity for CME-KT researcher exchange and collaboration ■ Objectives: ● provide opportunity for networking across CME-KT research communities ● identify current trends and future directions in CME and KT research, where they fit in the KTA cycle, and perspectives which inform them ● identify common and unique interests, approaches, skills ● develop a shared research agenda and working groups to address them

Outcomes 1. Identified similarities and differences between the two groups; shared views of how KT & CPD can fit together. 2. Series of CPD-KT publications 3. Research grants – new and support for existing work

Dimensions for comparing our difference and similarities… ■ Activities: Service vs research ■ Core foundations – ● Systematic reviews, evidence synthesis ● Conceptual approach, theoretical perspectives ■ ■ Questions of research interest Approaches to changing behaviour Research methodologies and methods Infrastructure to support, expertise required

Publications: JCEHP 2011; 31(3) ■ JCEHP editor attended Halifax meeting 1. Sargeant J, Borduas F, Sales A, Klein D, Lynn B, Stenerson H. CPD and KT: Models used and opportunities for synergy. 2. Curran J, Grimshaw J, Hayden J, Campbell B. Knowledge translation research: The science of moving research into policy and practice 3. Légaré F, Borduas F, Mac. Leod T, Sketris I, Campbell B, Jacques A. Partnerships for knowledge translation and exchange in the context of continuing professional development

Activities/ Research ■ Dalhousie CME (Michael Allen) ● Katie program – knowledge translation program with Dalhousie Continuing Pharmacy Education ● Appraise, Apply, Interact ● CIHR funding ● www. katie. dal. ca ● Academic detailing (CIHR national study) 22

Research ■ Improving Patient Outcomes: Mapping practice boundaries and intersections between the domains of Continuing Education, Knowledge Translation, Patient Safety and Quality Improvement (funded by AFMC National CPD research Fund) ● Simon Kitto, Mary Bell, Scott Reeves, Joan Sargeant, Edward Etchells, Ivan Silver ● Qualitative study: interpretive and critical discourse analysis 23

Addition of KT researcher to existing “educators” team Performance feedback to inform self-assessment and guide practice improvement: Developing and testing a feedback facilitation model Joan Sargeant, Heather Armson, Jamie Brehaut, Erik Driessen, Eric Holmboe, Jocelyn Lockyer, Karen Mann, Ivan Silver

Goal ■ Develop and test a model ● For providing facilitated feedback on formal physician performance, ● To enhance feedback acceptance ● To inform self-assessment and self-monitoring ● Guide performance improvement 25

Research Frameworks & Methodology ■ Realist evaluation (Pawson, Tilley 1997) ● Studies the context and its interaction with the intervention as well as the intervention itself ● Goal: to understand how the various components of the feedback intervention work and how they interact with context, people ■ Methods – mixed qualitative ● video-recording of feedback sessions, reflective review of videos, interviews, focus groups, synthesis

France CPD-KT initiatives and activities

4. Discuss challenges in collaboration and ways for CPD-KT to move ahead ■ Challenges ● Different cultures, training, skills, world views… ● Access to research funds, study populations… ■ Opportunities for… ● More collaborative meetings? ● More collaborative research? ■ What do you see as challenges and opportunities?

Thank you!