Enhancing practice improvement by facilitating practitioner interactivity: new roles for providers of continuing medical education.

Research into networking and interactivity among practitioners is providing new information that has the potential to enhance the effectiveness of practice improvement initiatives. This commentary reviews the evidence that practitioner interactivity can facilitate emergent learning and behavior change that lead to practice improvements. Insights from learning theories provide a framework for understanding emergent learning as the product of interactions between individuals in trusted relationships, such as occurs in communities of practice.

Participating in a Community of Learners enhances resident perceptions of learning in an e-mentoring program: proof of concept.

Background: Community learning and e-mentoring, learning methods used in higher education, are not used to any extent in residency education. Yet both have the potential to enhance resident learning and, in the case of community learning, introduce residents to basic lifelong learning skills. We set out to determine whether residents participating in an Internet based e-mentoring program would, with appropriate facilitation, form a community of learners (CoL) and hold regular community meetings.

Communities of practice: creating opportunities to enhance quality of care and safe practices.

A Communities of Practice (CoPs) approach was used to enhance interprofessional practice in seven clinical sites across Alberta. Participating staff were free to decide the area of practice to focus on and the actions to be implemented. All practice changes implemented by the CoPs related to either improving communications (e.

Linking assessment to learning: a new route to quality assurance in medical practice.

Background: If continuing professional development is to work and be sensible, an understanding of clinical practice is needed, based on the daily experiences of doctors within the multiple factors that determine the nature and quality of practice. Moreover, there must be a way to link performance and assessment to ensure that ongoing learning and continuing competence are, in reality, connected. Current understanding of learning no longer holds that a doctor enters practice thoroughly trained with a lifetime's storehouse of knowledge.

Development of a computerized telecommunication system for in-training evaluation of residents in a laparoscopic educational program.

Objective: To describe our initial experience with a computerized telecommunication system, termed the interactive voice-response system, to record resident performance of laparoscopic surgery.

Methods: After completing a laparoscopic procedure, the surgeon and resident telephone a toll-free number independently and respond to three prerecorded statements using a Likert scale of 1 to 5. The caller then is asked to describe the resident's response to critical incidents or elements of surprise that arose during the surgery.

Adoption of innovations by Canadian radiologists.

The purpose of this study was to determine the factors that help or hinder the adoption of new procedures and practices by Canadian radiologists. Canadian radiologists were asked, by means of a mail survey, for information about innovations in practice adopted during the previous 2 years or planned for the next 2 years. Surveys were sent to the 1077 practising radiologists registered in the Canadian Association of Radiologists as of Sept.

Physicians Innovation Awareness Program: helping radiologists learn about innovations.

The Physicians Innovation Awareness Program (PIAP) was designed to study the strategies of Canadian radiologists implementing innovations into their practices and to use the information to design an educational program to help radiologists learn about innovations. Canadian radiologists were asked, by means of a mail survey, for information about innovations in practice adopted in the previous 2 years and planned for the next 2 years. Surveys were sent to the 1077 practising radiologists registered in the Canadian Association of Radiologists (CAR) as of Sept.

The Maintenance of Competence (MOCOMP) Program: motivating specialists to appraise the quality of their continuing medical education activities.

The goal of the Maintenance of Competence (MOCOMP) Pilot Project is to develop a comprehensive CME strategy that will motivate specialists to continuously update their clinical practice. In its 1st year the pilot program has taken several significant steps. A credit system has been implemented to facilitate recognition of CME of the highest educational quality and to encourage specialists to compare their CME efforts with those of their colleagues.

Responses to non-emergency questions in rural medicine: their usefulness to practice decisions.

This study reports the nature of non-emergency, day-to-day practice-related questions which arose in rural practice and were phoned in to a medical information system (MIS). The usefulness of these questions, and their responses, to clinical decision-making is outlined. Sixty-seven practitioners from 10 rural communities enrolled in the project.

A randomized controlled trial of early amniotomy.

OBJECTIVE-To determine if a policy of early amniotomy resulted in a reduction in mean labour duration when compared to a policy of conservation of the membranes. DESIGN-A single-centre randomized controlled trial. SETTING-A tertiary care teaching hospital in Alberta, Canada.

A medical information networking system between practitioners and academia.

This paper reports on a one-year experience with an information networking system (MIS) between 47 rural practitioners and an academic center. Physicians were invited to phone in non-emergency clinical questions specific to daily practice needs to a telephone answering service located in the medical school library. Two-hundred-forty questions triggered by patient visits, colleagues, local rounds, allied health or local professionals, and on-site administrative meetings were forwarded to the MIS.

Practice-generated questions: a method of formulating true learning needs of family physicians.

The importance of identifying true learning needs prior to planning and conducting educational programs is well documented. In this study a collection of 579 clinical questions forwarded by 87 family physicians in southern Alberta was reviewed and analysed to determine if the questions would cluster and, therefore, be useful as sources for planning continuing medical education (CME) conferences and newsletters. The nature of submitted questions was also examined to determine if particular groups of physicians, as identified by socio-demographic characteristics, significanly differed by type of questions submitted.

Teleconferencing cme programs to rural physicians: the university of calgary teleconference program.

Continuing medical education (CME) provides practising family physicians with the cornerstone of maintenance and improvement of skills. In rural areas the problems of isolation and distance are a barrier to continuing medical education. Provision of CME programs by audio-teleconferencing is an attempt to overcome these problems.

Nurses' perceptions of inter- and intra-professional relationships: an analysis of support from nursing and physician colleagues in rural hospitals.

Nurses employed in ten rural hospitals in Canada completed questionnaires designed to examine their perceptions of the strength of the professional relationship which existed among nurses and between nurses and physicians. Four questions addressed the availability of nursing education programs and the attendance of nurses and physicians at such programs. Seven questions examined the nurses' perception of physician interest in nursing education and the encouragement received from their nursing colleagues to participate in learning activities and medical management decision making.

Case studies in electronic fetal heart rate monitoring.

Subtle changes in the characteristics of the fetal heart rate are currently used to assess the condition of the fetus in late pregnancy and during labour. The authors present three case studies of fetal heart rate monitoring.

The role of standardized risk assessment in the provision of prenatal care.

Errors in the provision of prenatal care are more likely to be the result of mental saturation than of inadequacies in the physician's fund of knowledge. To eliminate medical errors the physician should commit more time to the processing of clinical data. There are, however, limits to the physician's ability to handle large amounts of information in a busy clinic.

A conjoint medical/nursing diabetes education program: impact on care in a rural community.

This paper describes the planning, teaching format, and evaluation of an interdisciplinary education program in diabetes mellitus for physicians and nurses in a rural Canadian community. Most participants preferred the conjoint teaching format to the unidisciplinary didactic programs traditionally offered. An evaluation, by chart review, of the management of diabetic patients cared for before and at 3, 6, and 12 months after the teaching program revealed significant changes in the referral practices of both the home care nurses and the physicians.