abstracts from cme congress 2008, vancouver, british columbia

Abstracts

Abstracts from CME Congress 2008, Vancouver,British Columbia

This feature of the Journal of Continuing Education in the Health Professions Volume 28 (Supplement 1) includesthe abstracts of research studies accepted for presentation through peer review. The abstracts were presented atCME Congress 2008 and the authors agreed to publish their accepted abstracts in this supplemental issue of thejournal.

Thirty-six abstracts compose this section. It includes needs assessment, curriculum and program design, educa-tional strategies including distance education, practice reflection, mentoring, knowledge translation, and instrumentdevelopment. These studies focus on individual learners or health teams in varying contexts and health profes-sions. A broad range of methods and interventions was used to assess knowledge gain, improved competence orbehavior change, and, less frequently, improvements in performance. The majority of studies involved practicalinterventions within the discipline, defined broadly as CME. Very few studies were designed to enhance or expandour understanding of theoretical principles or models.

I want to extend my thanks to Dr. Jocelyn Lockyer, Co-Chair of the Scientific Steering Committee for CME Con-gress 2008, for her leadership in developing and managing the initial peer review process. I am also extremelygrateful to Dr. Tanya Horsley for her dedication and expertise in managing the additional review process requiredfor publication in this supplemental issue of the journal.

Craig Campbell, MD, FRCPCCo-Chair, CME Congress 2008

Barriers to Optimal Surgical Staging for OvarianCancer in Ontario: An Analysis Using thePathman Awareness to Adherence Model

Jason E. Dodge

Introduction: Recently published studies have confirmed asignificant gap between current practice and ideal surgicalstaging for ovarian cancer by gynecologic surgeons in On-tario as defined by Canadian clinical practice guidelines(CPGs), potentially leading to suboptimal patient outcomes.This study explored context-specific barriers to optimal sur-gical practice to facilitate the future development of a suc-cessful knowledge translation (KT) strategy.

Methods: All 711 active gynecologic surgeons in Ontario weresurveyed by mail using a questionnaire that included a clin-ical case simulation and items designed to identify currentpractices as well as perceived and unperceived barriers tooptimal surgical staging for ovarian cancer using a modifiedversion of the Pathman model as an analytical framework.Both quantitative and qualitative descriptive analyses of sur-vey responses were undertaken as appropriate.

Results: A 70 percent response rate was achieved. Signifi-cant barriers to optimal surgical staging for ovarian cancer inOntario included lack of awareness of, agreement with, adop-

tion of, and adherence to the current Canadian CPGs. Lackof familiarity with the recommendations of the CPGs and per-ceived lack of relevance of the CPGs to participants’ surgicalpractice were also identified as barriers to optimal perfor-mance. Possible unperceived learning needs of gynecologicsurgeons in Ontario were also identified.

Discussion: Multiple barriers to optimal surgical staging forovarian cancer by gynecologic surgeons in Ontario have beenidentified. Future design of a KT strategy should address bar-riers at all stages of the awareness to adherence continuum,as each seems to contribute to nonoptimal surgical practicein this context.

Disclosures: The author reports none.

Jason E. Dodge, MD, MEd, FRCSC: Division of Gynecologic Oncology,Department of Obstetrics & Gynecology, University of Toronto, Toronto,Ontario, Canada.

Technology Enabled Academic Detailing:Facilitating Personalized Knowledge TranslationThrough Interprofessional Education

K. Ho, A. Nguyen, S. Jarvis-Selinger, M. Fedeles,H. Novak-Lauscher, C. Cressman, J. Fong, E. Chan

Introduction: Academic detailing provides objective,evidence-based prescribing information to physicians throughface-to-face communication with an academic detailer, usu-ally a pharmacist. Physicians practicing in nonurban locations

© 2008 The Alliance for Continuing Medical Education, the Society forAcademic Continuing Medical Education, and the Council on CME,Association for Hospital Medical Education. • Published online in WileyInterScience ~www.interscience.wiley.com!. DOI: 10.10020chp.209

JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, 28(S1):S33–S46, 2008

have infrequent or complete lack of access to academic de-tailers, who are few in number and usually clustered in urbancenters. This study examines the efficacy of technology en-abled academic detailing (TEAD) (using information technol-ogies such as conferencing via the Internet or Web-basedcommunication for academic detailing) versus face-to-faceacademic detailing (AD), and whether combining TEAD withface-to-face AD had additive effects on the management ofdiabetes.

Methods: Physicians were assigned to one of three inter-vention arms when contacted by academic detailers on dia-betes management: face-to-face AD only, TEAD only, or aTEAD/AD combination. Efficacy was measured through self-evaluation questionnaires, focus groups, and individual inter-views completed by both pharmacists and physicians.Quantitative data such as pharmacist session logs and pa-tient outcome data were collected and examined.

Results: One hundred five (105) general practitioners and12 pharmacist academic detailers participated. Both physi-cians and pharmacists welcomed AD as a useful method ofreceiving objective information through interprofessional in-teractions. TEAD sessions took significantly less time thanAD sessions (49 minutes vs. 81 minutes), while physiciansperceived no difference in utility between TEAD and AD.

Discussion: TEAD and AD are equally effective interprofes-sional interventions to help physicians acquire evidence-basedinformation. TEAD requires less time than AD and is not geo-graphically limiting. TEAD can benefit physicians practicing inrural locations who have no access to face-to-face AD.

Disclosures: Funding was provided by the Canadian Institutes of HealthResearch, Technology Enabled Knowledge Translation Investigative Cen-tre ~TEKTIC!.

H. Novak-Lauscher reports funding from the Michael Smith Foundation tosupport preparation of the manuscript.

K. Ho, Associate Dean, Continuing Professional Development and Knowl-edge Translation, Faculty of Medicine, University of British Columbia; S.Jarvis-Selinger, H. Novak-Lauscher, C. Cressman, J. Fong, and E. Chan,eHealth Strategy Office & Division of Continuing Professional Develop-ment, Faculty of Medicine, Vancouver, British Columbia, Canada; A.Nguyen, Faculty of Pharmaceutical Sciences, University of British Colum-bia, Vancouver, British Columbia, Canada; and M. Fedeles, ContinuingHealth Education, Continuing Studies, Simon Fraser University, Burnaby,British Columbia, Canada.

Acknowledgment: The authors acknowledge Ms. A. Gunasingam, for hercontributions to and participation in this project.

Academic Detailing: Improving PrescribingPractice in Australia

Judith M. Mackson, Debra Rowett, Angela Wai

Introduction: Academic detailing has been provided to Aus-tralian general practicioners (GPs) for 8 years and almost 60percent have voluntarily participated. In the last 4 years theservice has also been used in over 62 hospitals. Detailing isa component of multifaceted interventions to improve pre-scribing. Key messages addressing knowledge, attitudes, andbehaviors for improvement in prescribing are communicatedto prescribers.

Methods: The program has covered management of hyper-tension, heart failure, type 2 diabetes, dyslipidemia, asthma,

depression, chronic obstructive pulmonary disease, analge-sic use, antibiotics in primary care, and use of proton pumpinhibitors (PPIs) and community acquired pneumonia pre-senting to hospitals. The PPI program was evaluated withdrug utilization data from the national insurer, and a GP sur-vey with 2,000 GPs examined knowledge and attitudes toPPI use pre- and post-interventions. Prescribing feedback andacademic detailing on disease assessment and antibiotic ther-apy in community acquired pneumonia were undertaken in37 emergency departments.

Results: Over 11,000 GPs have participated in 16 programs.Programs have demonstrated changes in knowledge and at-titudes. The PPI program found use of the lower-strength PPIdecreased. The proportion of GPs who would step down fromomeprazole 20 mg to 10 mg after 6-month treatment in gas-troesophageal reflux disease (GERD) increased from 12 per-cent to 19 percent ( p = 0.001). The emergency departmentprogram significantly increased the use of the severity as-sessment tool and significantly increased use of appropriateantibiotic regimens ( p = 0.001).

Discussion: Drug utilization data supplemented with under-standing of prescribers’ knowledge and attitudes continues toinform the design and implementation of future NPS programs.

Disclosure: This project was funded by the National Prescribing Service~NPS! of the Australian Government, Department of Health and Ageing.

J. M. Mackson, D. Rowett, and A. Wai, National Prescribing Service, Syd-ney, Drug and Therapeutic Information Service, Daw Park.

Gauging the Impact of E-mail Alerts in GeneralPractice: A Prospective Longitudinal Study

Roland Grad, Pierre Pluye, Jay Mercer,Bernard Marlow, Marie-Eve Beauchamp,Janique Johnson-Lafleur, Sharon Wood-Dauphinee

Introduction: We conducted this study to determine the useand validity of a method to gauge the cognitive impact of e-mailalerts.

Methods: Mixed methods longitudinal study involving familyphysicians or general practitioners who rated at least fivee-mail alerts (InfoPOEMs). (1) Quantitative component: TheInformation Assessment Method was used to rate InfoPO-EMs. Ratings provided data to assess (i) use of the methodand (ii) construct validity, using principal components analy-sis (PCA). (2) Qualitative component: Content validity of eachitem of impact was assessed via thematic data analysis ofinterviews from 46 participants.

Results: During the 150-day study period, 1,007 participantssubmitted 61,493 ratings of the “cognitive impact” of InfoPO-EMs (mean=61 ratings per participant; range 5–111). “I learnedsomething new” was most frequently reported; however, In-foPOEMs also reassured participants or confirmed their cur-rent practice. The proportion of ratings of “No Impact” variedsubstantially across individual InfoPOEMs. PCA showed thatratings of “cognitive impact” supported an 8-factor solution ex-plaining 90.1 percent of total variance. Qualitative data sup-ported the content validity of 4 of 10 items and led us to refine4 other items. Interview data revealed 1 new item of impact.

Discussion: “Cognitive impact” is a multidimensional out-come that can be systematically assessed by practicing doc-

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S34 JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS—28(S1), 2008DOI: 10.1002/chp

tors in the context of an e-mail alert. Knowledge providerscan use our method to better their understanding of the im-pact of e-mail alerts. If rating e-mail alerts enhances reflec-tive learning, educational bodies can use our method todocument this activity.

Disclosure: Funded by the Canadian Institutes of Health Research. Thestudy was supported by Practice Solutions Web Services, a subsidiary ofthe Canadian Medical Association. Practice Solutions Web Services madedata collection possible through cma.ca. The College of Family Physiciansof Canada agreed to accredit this new form of education on a trial basis andfacilitated credit entry for participants.

Roland Grad, Pierre Pluye, Janique Johnson-Lafleur, Department of Fam-ily Medicine, McGill University, Montreal, PQ, Canada; Jay Mercer, Prac-tice Solutions Web Services, Montreal, PQ, Canada; Bernard Marlow,Continuing Professional Development, College of Family Physicians ofCanada, Mississauga, ON, Canada; Marie-Eve Beauchamp, Department ofEpidemiology and Biostatistics, McGill University, Montreal, PQ, Canada;Sharon Wood-Dauphinee, School of Physical and Occupational Therapy,McGill University, Montreal, PQ, Canada.

Personal Learning Projects: Examining theRelationship Between Question Structure andCommitment to Change.

Tanya Horsley, Jennifer O’Neill, Craig Campbell

Introduction: To summarize data pertaining to question typeand “quality” (components) of personal learning project itemssubmitted to the Maintenance of Certification (MOC) Pro-gram of the Royal College of Physicians and Surgeons of Can-ada and to examine the relationship between question structureand recorded stage of change. Data pertaining to questionstimuli, resources used, and time spent will be summarized.

Methods: Two investigators independently coded all itemssubmitted between January and September 2007 for ques-tion type using a validated taxonomy and quantified by kappa.The structure of clinical questions was defined by identifyingsurface cues (eg, “what,” “when”), named entities (eg, “pa-tient,” “situation”), and/or the components of PICO (Popula-tion, Intervention, Comparator, Outcome).

Results: Five hundred thirty-four (534) physicians (70 per-cent male, 96 percent Canadian) submitted 1,859 items. Themost frequent stimuli for initiating a personal learning projectwere “during the management of a patient or problem” (30percent) and “reading the literature” (27 percent). The threemost commonly recorded outcomes were “I am aware of newevidence relevant to my practice” (33 percent), “I am com-mitted to integrate this knowledge or skill into my practice”(19.3 percent), and “I am aware of a potential gap in my knowl-edge or skill” (16.9 percent). Planned literature searches (36percent) and reading articles, journals, and text (75 percent)were the most frequently indicated resources. Data pertain-ing to the relationship between question components andstage of change were also summarized.

Discussion: This research provides insights and understand-ing into the process of self-learning and practice aspects aswell as the information needs of physicians.

Disclosures: The authors report none.

Tanya Horsley, Jennifer O’Neill, Centre for Learning in Practice ~CLIP!,The Royal College of Physicians and Surgeons of Canada, Ottawa, ON,

Canada; Craig Campbell, Office of Professional Affairs, The Royal Collegeof Physicians and Surgeons of Canada, Ottawa, ON, Canada.

Pattern of Participation in Continuing MedicalEducation (CME) Activities Amongst Hong KongAnaesthetists—Getting Ready for ContinuingProfessional Development (CPD)

A. Lai, C. K. Koo, Y. F. Chow

Introduction: The purpose of the study is to evaluate thepattern of participation in Continuing Medical Education (CME)activities among Hong Kong anesthetists. The CME require-ment must be met for continuation of the fellowship of theHong Kong Academy of Medicine.

Methods: Retrospective study of computer data and the re-turn forms submitted by fellow anesthetists to the Hong KongCollege of Anaesthesiologists in the period January 1996–December 2004.

Results: In terms of per anesthetist per 6 months, the publicanesthetists gained 18.1 (mean) + 11.9 (SD) CME points viameetings, significantly more than the private anesthetists (6.7+5.3, p < 0.01) and university staff (14.7 + 11.9, p < 0.01). Theprivate anesthetists gained more points via self-study (2.6 +3.0; 0.6 + 2.8 for public anesthetists, p < 0.01; 0.3 + 1.7 foruniversity staff, p < 0.01) and participation in non-anesthesia-related events (1.7 + 4.6; 0.6 + 2.6, for public anesthetists, p <0.01; 0.4 + 2.5 for university staff, p < 0.01). The universitystaff gained more points via publication (9.4 + 9.9; 1.0 + 3.3,p < 0.01 for public anesthetists; 0.1 + 0.9, p < 0.01 for privateanaesthetists) and participation in both local and overseasmajor anesthesia events. The participation in quality assur-ance activities and workshops was infrequent.

Discussion: Three groups of anesthetists have met the min-imum requirement of gaining 90 CME points during a 3-yearcycle. However, the pattern of participation differed amongthe three groups. Changes in pattern of participation may beneeded to meet the changes in requirements set by the HongKong Academy of Medicine.


A. Lai and Y. F. Chow, Department of Anaes and OTS, Queen ElizabethHospital, Hong Kong; C. K. Koo, Department of Anesthesiology and In-tensive Care Unit ~ICU!, Tuen Mun Hospital, Hong Kong.

Evaluating the Effectiveness of the AmericanAcademy of Family Physicians’ Evidence-BasedCME Criteria

N. Davis, S. Lawrence, J. Morzinski,M. Radjenovich

Introduction: The purpose of this project was to study theperceived value and barriers to the American Academy ofFamily Physicians’ (AAFP’s) evidence-based CME credit pro-cess by CME faculty and learners. As incentive to increaseparticipation in evidence-based (EB) CME activities, AAFPawards double credit for activities with EB CME designation.

Methods: All CME faculty who applied for EB CME designa-tion for their session at the American Academy of Family Phy-sicians 2006 annual meeting were selected along with a

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JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS—28(S1), 2008 S35DOI: 10.1002/chp

random sample of equal number of CME faculty who did notapply for EB CME designation. They were surveyed to deter-mine differences in their preparation time and methods as wellas barriers to the EB CME application process. CME partici-pants were surveyed to assess perceived differences in EBCME sessions versus those without EB CME designation.

Results: The EB CME faculty had a much higher incidenceof using evidence-based sources while non-EB faculty tendedto use their own practice and expertise. Time constraints, lackof expertise, and lack of evidence were the main reasonscited for not using EB CME criteria. Participants did not rec-ognize significant differences in quality or usefulness. Theirchoice of session was based on amount of credit and speakerreputation above an evidence-based approach.

Discussion: While AAFP’s EB CME criteria have increasedawareness among CME faculty for developing evidence-based presentations, the time and expertise barriers to doc-umenting the process are significant. Because participantsuse credit amount as a selection criterion, AAFP’s double creditfor evidence-based CME seems to be an effective incentiveto promote EB CME.


N. Davis, National Institute for Quality Improvement and Education, Home-stead, Pennsylvania; S. Lawrence, J. Morzinski, and M. Radjenovich, Med-ical College of Wisconsin, Milwaukee, Wisconsin.

Prior to publication, Steven Lawrence, MD, died of lung cancer. His co-authors wish to acknowledge his significant contributions to this study.

Interprofessional Education: Educational Needsof U.S. Nurse Practitioners

M. J. Goolsby, EdD, MSN, NP-C, FAANP,J. E. Wynne, MSN, CFNP

Introduction: U.S. NPs are licensed independent providers,with CE requirements from U.S. NP certification and stateregulatory bodies. Two 2006 American Academy of NursePractitioners (AANP) surveys contribute to understanding ofNPs’ educational preferences. The 2006 AANP NP Educa-tional Needs Survey (ENS) measured CE needs of NPs ofvaried specialties, settings, and experiences, as follow-up tobaseline information from the 2006 AANP Member Survey onNPs’ CE preferences.

Methods: The 2006 Membership Survey (n = 5,308) and theENS (n = 1,412) were both conducted anonymously online.The Membership Survey included items about educationalmodalities respondents had completed, their preferred for-mats, and other issues. The ENS asked participants to selecttopics in which they had the highest interest, from a list of 240topics (120 health conditions, as well as procedures, practiceissues, professional/business topics, and therapeutics).

Results: The 2006 Membership Survey confirmed that re-spondents had participated in varied types of CE but pre-ferred face-to-face programs on clinical topics. The ENSidentified specific topics in which NPs were most interested,allowing comparisons by experience, practice setting, and clin-ical specialty.

Discussion: While much is written about newer educationalformats, NPs are adult learners who prefer live educational ac-tivities. Discussion will interpret the specified topical needs of

over 125,000 U.S. NPs and relevance for providers of pro-fessional CE, as well as ways that state and specific certify-ing CE requirements for NPs differ.


M. J. Goolsby, EdD, MSN, NP-C, FAANP, and J. E. Wynne, MSN, CFNPAmerican Academy of Nurse Practitioners, Austin, Texas.

There are more than 125,000 U.S. nurse practitioners ~NPs!, responsiblefor more than 600 million visits annually. Continuing education ~CE! pro-viders should understand the educational preferences and needs of this siz-able component of Interprofessional Education.

Critical Literacy Meets InterprofessionalEducation

B. Frank, K. Mann, J. McFetridge-Durdle,R. Martin Misener, H. Beanlands, M. Sarria

Introduction: “Seamless Care” is a 33-month project fundedby Health Canada to inform policymakers of the effective-ness of interprofessional education to promote collaborativepatient-centered practice. To help build effective interprofes-sional teams, participants (students and faculty) received train-ing on small group learning. This presentation criticallyexamines the literature on interprofessional education andsmall group learning, raising issues of social class, gender,culture, and other issues of difference.

Methods: A theoretical approach offered by critical literacy(Lewison, Seely, & Van Sluys, 2002) may assist educatorsworking in interprofessional education. A review of the lit-erature on critical literacy identified four prominent andinterrelated aspects: (1) disrupting the commonplace by prob-lematizing that which is often “taken for granted,” (2) inter-rogating multiple viewpoints, (3) focusing on the sociopoliticalissues, and (4) taking action and promoting social justicethrough praxis (Lewison et al., 2002).

Results: The challenge for interprofessional educators is todevelop the ability to examine their own pedagogical prac-tices critically and to hold an understanding of interprofes-sional learning sites, as sites that are both historical and social.

Discussion: Interprofessional education is increasingly partof both pre- and postlicensure continuing education, with dem-onstrated positive outcomes. Facilitators and teachers mustengage in interruptive/disruptive pedagogical practices if weanticipate interprofessional learning sites to benefit all stu-dents and offer the potential of best practices for the health ofpatients. Central to this argument are analysis and under-standing of issues of equity and social justice in learning sites.


B. Frank, K. Mann, J. McFetridge-Durdle, R. Martin Misener, H. Bean-lands, and M. Sarria, Dalhousie University, Halifax, Canada.

Learning Together Helps: InterprofessionalEducation in Communication Skills

J. Sargeant, T. Hill, A. Murray, A. Ritchie

Introduction: This paper describes the evaluation of acommunity-based communication skills program, involving in-terprofessional workshops to enhance health professionals’

Abstracts


communication skills, and a facilitator training workshop tobuild program sustainability within Nova Scotia.

Methods: The workshops used interactive theater, discus-sion, and content review to address essential communicationskills, delivering difficult news, and responding to anger andconflict. Evaluation of the program included pre-post ques-tionnaires, follow-up questionnaires, and focus groups withworkshop participants and facilitators. Changes in practicewere evaluated using paired t tests. Focus groups were an-alyzed using grounded theory approaches.

Results: Five hundred eighteen (518) health professionalsrepresenting 23 different professions attended the workshop;52 percent had had previous communication skills training.Participants reported statistically significant improvementsin communication immediately after and 3 months afterthe workshops. Participants were highly supportive of inter-professional learning and 98 percent agreed that the interpro-fessional format enhanced learning. A frequently reportedchange was “confidence and sense of importance as a mem-ber of the care team.” The facilitator training program wasevaluated highly and volunteer health professionals (n = 27)were confident in their ability to facilitate the workshops andfulfill their commitment to the program. In a focus group withworkshop facilitators, we learned that the main barriers toprogram sustainability were competing demands and infra-structure needs.

Discussion: The theater-based interprofessional communi-cation skills program resulted in changes in communicationspractice, and the interprofessional format contributed to learn-ing. Observing other health professionals communicate in dif-ficult situations was highly valued and increased confidencewas an important outcome. Sustainability of the program re-mains problematic.

Disclosure: Conduct of the presently reported study was supported by theLawson Foundation.

J. Sargeant and T. Hill, Office of Continuing Medical Education, DalhousieUniversity, Halifax, Nova Scotia, Canada; A. Murray, Cancer Care NovaScotia, Halifax, Canada; A. Ritchie, Irondale Ensemble Project, Halifax,Canada.

Impact of Continuing Professional Developmenton the Performance of Family Physicians—Results of a Study Involving Family Physiciansin the Province of Quebec

François Goulet, Francine Lemire

Introduction: Continuing Professional Development (CPD)is intended to impact physician performance, and hence qual-ity of patient care, positively. This study was conducted todetermine the impact of the type and duration of CPD on thequality of practice of family physicians.

Methods: Three subgroups of family physicians were se-lected from the pool of family physicians in Quebec who werepeer reviewed between 1998 and 2005: group 1, members ofthe College of Family Physicians of Canada (mandatory CPD);group 2, nonmembers of the CFPC, who declared at least 50hours CPD/year; group 3, non-CFPC members who declaredless than 10 hours CPD/year. The following variables wereanalyzed: type and number of hours of CPD, quality of med-ical records, quality of practice investigations, process of es-

tablishing diagnosis, treatment, and follow up. Chi square hasbeen used to compare the three subgroups; quality of prac-tice was evaluated by composite scoring.

Results: Factors that correlated with good quality practiceincluded affiliation with a health care institution, including asignificant portion of accredited CPD activities as part of one’sCPD portfolio. Factors that correlated negatively with qualitypractice included older age, office practice without hospitalprivileges, and relatively more informal CPD.

Discussion: This study adds to the current body of evidencethat the quality and quantity of CPD activities are positivelycorrelated with good practice.


François Goulet, MD, MA, CFPC, Collège des médecins du Québec; Fran-cine Lemire, MD, CFPC, The College of Family Physicians of Canada.

Challenges in Interviewing Physicians: AComparison of Telephone versus InternetInterviewing

P. Harper

Introduction: To compare the advantages and disadvan-tages of using two methods of interviewing physicians: tele-phone interviewing and Internet interviewing.

Methods: A qualitative study exploring barriers to tobaccointerventions offered physicians the option of completing ei-ther a 40-minute telephone interview using a semistructuredinterview guide or an Internet interviewing technique usingthe same semistructured interview guide.

Results: Preliminary results reveal that more physicians se-lected the option of Internet interviewing than selected tele-phone interviewing. While prolonging the interview process,Internet interviewing gives the physician flexibility to answerquestions at his or her convenience and allows the researcherto reflect on the answers to questions before posing the nextquestion. Answers to questions posed in the Internet formatappear, however, to be briefer than answers to questionsposed in telephone interviews.

Discussion: Internet interviews may offer researchers a vi-able alternative method for interviewing physicians. Informa-tion technologies such as e-mail and instant messaging shouldbe explored more fully as alternatives to telephone interviewing.

Disclosure: Study funded by a National Institute of Drug Abuse RuthKirschstein Postdoctoral Fellowship.

P. Harper, Office of Continuing Professional Development in Medicine andPublic Health, University of Wisconsin, Madison, Wisconsin.

Project ECHO Knowlege Networks and IterativeLearning: Evidence of ACCME Level 3, ProviderLearning and Improvement Initiative

S. Arora, S. Kalishman, D. Dion, E. Cosgrove,D. Lamba, R. Stewart

Introduction: Project ECHO, a partnership between aca-demic specialists and community providers using telemedi-cine and Internet connections, supports the comanagement

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of patients with complex diseases through iterative learningand deliberate practice based on best practice protocols. Case-based patient presentations selected by primary care provid-ers who care for rural and underserved patients underlieweekly ECHO sessions. Learning is reinforced through spe-cialists’ and providers’ longitudinal comanagement of pa-tients, and interactions among network providers who aresimultaneously learning to comanage hepatitis C patients. Ses-sions include focused didactic presentations on relevant top-ics and best practice protocols.

Methods: Three methods used to assess provider learningand improvement and patient outcomes from Project ECHOare participant observation of Project ECHO clinics, 6-monthinterval survey data from primary care providers, and hepa-titis C patient outcome data.

Results: Providers are learning about the screening, man-agement, and treatment of hepatitis C virus (HCV) patientsincluding the pharmacologic, behavioral health, and supportaspects they need. Observations of Project ECHO clinics pro-vide evidence that support providers’ engagement in iterativelearning and deliberate practice centered on case-based pa-tient care. Outcomes for patients with similar hepatitis C geno-type treated by primary care providers are equivalent to thoseof patients treated by academic health center specialists. Ac-cess to care for hepatitis C patients in rural and underservedcommunities has increased.

Discussion: ECHO integrates CME into the providers’ work,addresses barriers to change, and engages stakeholders. To-gether these approaches create a robust and dynamic learn-ing environment that fully addresses Level 3 ACCME criteria.

Disclosure: S. Arora reports support from the US Agency for Health CareResearch and Quality and the New Mexico legislature for conducting thepresently reported study and preparation of the manuscript.

S. Arora, S. Kalishman, D. Dion, and E. Cosgrove, University of NewMexico School of Medicine; D Lamba, Federally Qualified Rural HealthCenter, Clovis, New Mexico; R. Stewart, Department of Health, Las Cruces,New Mexico.

Family Physicians Involvement in the Planningand Delivery of CME for Their Peers

Doug Klein, G. Michael Allan, Donna Manca,Joan Sargeant, Carly Barnett

Introduction: The goal of this project was to describe therole of family physicians in organizing and teaching CMEevents that are accredited for family physicians. Large differ-ences were observed between family physicians on organiz-ing committees (50 percent) and family physician teachers(18 percent). Considerable time and money is invested in Con-tinuing Medical Education (CME) for family physicians, butits effectiveness is uncertain. The effectiveness of the role offamily physicians as coordinators and/or teachers of CME isunknown. The goal of this project was to describe the role offamily physicians in organizing and teaching CME events thatare accredited for family physicians.

Methods: Information about accredited CME events occur-ring in Alberta and Nova Scotia was requested from univer-sities, provincial chapters of the College of Family Physiciansof Canada (CFPC), and pharmaceutical companies. The rel-evant information from each event was recorded, includinglocation, coordinating site, format, planning members, and

teaching faculty. The number and proportion of family prac-titioners involved in both organizing and teaching CME eventswere calculated.

Results: A total of 314 CME events were collected, compris-ing a total of 1,472 hours of CME including 2,041 plannersand 1,915 teachers. Large differences were observed be-tween the proportion of family physicians on organizing com-mittees (50 percent) compared with teachers (18 percent).Higher levels of family physician teachers were associatedwith both the type and the format of the CME event as well asits location.

Discussion: It is important that we determine who is drivingCME, since in some cases, CME driven by nonfamily physi-cians may bias physicians’ behaviors in a negative mannerby supporting the sponsors’ or lecturers’ views, as is evidentin industry driven CME. This study demonstrated that familyphysicians on planning committees fail to select a similar pro-portion of their family physician colleagues as teachers.

Disclosure: This project was conducted with unrestricted funding receivedfrom the College of Family Physicians of Canada.

Doug Klein, University of Alberta; G. Michael Allan, University of Al-berta; Donna Manca, University of Alberta; Joan Sargeant, Dalhousie Uni-versity; Carly Barnett, University of Alberta.

How Do CME Speakers Use Research Results toSupport Therapeutic Recommendations? AQuantitative and Qualitative Study

R. Handfield-Jones, M. Allen, T. Hill, M. Fleming,D. Sinclair, T. Elmslie

Introduction: Studies indicate that physicians are more likelyto interpret therapy as effective and make changes to theirpractice when data using relative rather than absolute termsare presented. This study will determine the way researchfindings are presented to family physicians (FPs) at CMEevents and will evaluate the statistical knowledge of theCME speakers and FPs attending CME events.

Methods: Data were collected from two regional family med-icine review courses. A total of 30 randomly selected presen-tations involving therapy were analyzed, using (1) videotapesof speakers’ presentations to determine how they link thera-peutic recommendations to research data and (2) speakers’PowerPoint files to determine their emphasis on presentingrelative versus absolute terms. Speakers’ and FPs’ under-standing of research data was evaluated using a statisticalknowledge questionnaire. Finally, focus groups were con-ducted to explore FPs’ preferences for the types of researchdata used to support therapeutic recommendations.

Results: Preliminary findings indicate that FPs have a low tomoderate understanding of statistics. FPs indicated that theywant recommendations to be supported with research, yetfew speakers linked therapeutic recommendations to researchdata. Furthermore, very few speakers presented data in rel-ative or absolute terms. FPs want short review courses onstatistics and recommend that CME providers develop guide-lines to encourage speakers’ consistency in presenting re-search data.

Discussion: We believe that findings will generate recom-mendations for how providers and speakers might incorpo-rate research findings into CME programs and presentations.

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This could lead to more effective evidence-based teaching inCME, undergraduate, and residency programs.

Disclosure: Funding provided by the Drug Evaluation Alliance of NovaScotia and the Royal College of Physicians and Surgeons of Canada.

R. Handfield-Jones, Continuing Medical Education, University of Ottawa,Ottawa, Ontario, Canada; M. Allen, T. Hill, M. Fleming, and D. Sinclair,Continuing Medical Education, Dalhousie University, Halifax, Nova Sco-tia, Canada; T. Elmslie, Foundation for Medical Practice Education, Ham-ilton, Ontario, Canada.

Integrating Health Care Communities of Practice:The Case of Uruguay

A. Séror

Introduction: The objective of this study is to identify theconfiguration of Web-based virtual infrastructures in the pub-lic and private sectors supporting communities of practice as-sociated with the National Health Care System of Uruguay.Special attention is focused on continuing medical education(CME) as well as knowledge management for evidence-based medical practice in the current context of system reform.

Methods: Qualitative case research methods offer a flexibleapproach to the understanding of large and complex healthservice delivery systems embedded within their extended so-cial context. The National Health Care System of Uruguay isa unique interorganizational network valuable to scientific studyas a critical case, particularly for in-depth analysis of the in-tegration of public and private subsystems in the regional LatinAmerican tradition of social medicine.

Results: This study reveals a unique pattern of linkage amongvirtual infrastructures of national and regional health care in-stitutions. These include the Ministry of Public Health, theMedical Syndicate of Uruguay, and the National University,as well as small private enterprises such as EviMed. Largeregional institutions such as the Brazilian-led Virtual HealthLibrary and the Pan American Health Organization also con-tribute significant resources to support Uruguayan commu-nities of practice.

Discussion: Both public and private sector institutions offercontinuing medical education and resources for evidence-based practice in a unique social network of physicians andother health care providers. The pattern of linkage shows bothregional and national integration as well as emergence of spe-cialized medical infrastructures such as the Oncology Na-tional Network.


A. Séror, MBA, PhD eResearch Collaboratory, Quebec City, Quebec, Canada.

Creating Communities of Practice forInterprofessional Collaboration: The ehpicLeadership Project

D. Kwan, K. Leslie, S. Lieff, S. Reeves, E. Egan-Lee,E. Hollenberg, D. Dematteo, I. Silver, I. Oandasan

Introduction: The purpose of this project was to build lead-ership capacity in interprofessional collaboration (IPC) withinUniversity of Toronto’s academic teaching community.

Methods: Interprofessional teams from the university’s 13affiliated teaching hospitals took part in a three-phase pro-gram: Phase 1 was a 3-day course about the principles ofIPC. Utilizing a change-enabling framework, teams devel-oped an idea for an IPC project in their organization. DuringPhase 2, teams tested the viability of their ideas by identify-ing additional needs and challenges. Phase 3 addressed spe-cific challenges in the implementation of an IPC project intheir hospital. Experts in the areas of organizational changeand IPC provided on-site consultation to the teams.

Results: A pre-post methodology design using mixed meth-ods was used. Data were gathered from program leaders,facilitators, and attendees. Results indicated that the pro-gram had been successful in enhancing attendee IPC skillsand had provided increased opportunities for interorganiza-tional collaboration, dialogue, and learning through bringingtogether hospitals to share ideas and resources.

Discussion: With the support and buy-in of hospital leader-ship, an integrated series of workshops, combined with indi-vidual consultation and support, can stimulate significantinterest and activity in IPC in hospital settings.


D. Kwan, Department of Family and Community Medicine; K. Leslie, S.Lieff, S. Reeves, E. Egan-Lee, E. Hollenberg, D. Dematteo, and I. Silver,Centre for Faculty Development; I. Oandasan, Department of Family andCommunity Medicine and Office for Interprofessional Education, Univer-sity of Toronto, Ontario, Canada.

Validation of a Communications Skills Audit ToolUsing the College of Family Physicians ofCanada (CFPC) Simulated Office OralExamination (SOO)

F. Lemire, C. Brailovsky

Introduction: The Medical Council of Canada (MCC) hasdeveloped a reliable tool to assess the doctor-patient com-munication skills of physicians. This assessment tool hasnot been validated against any other validated national as-sessment tool. Questions asked: (1) How does the evalu-ation of a physician’s performance using the MCC toolcompare to the assessment of communication skills of thesame physician on the SOOs of the Certification Examina-tion of the CFPC? (2) What is the degree of congruence inperformance between the MCC tool and the SOOs for eachphysician?

Methods: Family physician volunteers aiming to sit the spring2007 sitting of the Certification Examination in Family Medi-cine were invited to participate and agreed to allow at least20 patients to rate their own experience. Physicians and pa-tients are asked to complete an evaluation of the same itemsfor the same encounter.

Results: (1) The MCC tool is reliable and factor analysis con-firms the internal validity of the instrument. (2) Patient ques-tionnaires correlate well with examiner’s evaluation in theSOOs. (3) Physicians’ autoevaluation does not correlate wellwith patients’ evaluations or with examiner’s evaluation in theSOOS.

Discussion: We confirm the validity of the MCC tool throughtriangulation with the SOO, a nationally validated tool.

Abstracts


Disclosure: Background research for this project was funded by an un-restricted grant from the Medical Council of Canada.

F. Lemire, College of Family Physicians of Canada, Mississauga, Ontario,Canada; C. Brailovsky, Faculty of Medicine, Laval University, Quebec City,Quebec, Canada.

Multiphased Evaluation of a Community-BasedProgram Targeting Alzheimer’s Disease RiskFactors.

S. Murray, R. Friedland, K. Cytryn

Introduction: Optimal health care is provided within acommunity health care system. This study evaluated the ef-fectiveness of a national community health literacy programbased on community representatives and the communityhealth care system, targeting African Americans’ knowledgeand understanding of risk factors and lifestyle behaviors re-lated to Alzheimer’s disease (AD).

Methods: This program was initiated at six sites and con-sisted of three components: community meetings, lunch andlearns, and teenager-parent/grandparent surveys. Represen-tatives drawn from the community carried out each compo-nent. The multiphased IRB-approved evaluation employed atime series design triangulated from multiple perspectives,providing a view of the broader community system. (1) Com-munity participants (n = 300) filled out a self-report question-naire assessing their knowledge, attitudes, and behaviorsrelated to risk factors of AD. (2) Community speakers com-pleted a questionnaire assessing their expectations and per-ceptions of the impact of the programs they gave. (3) Programdesigners were provided with an observation grid, evaluatingprogram delivery and perceptions of reception and impact onparticipants.

Results: Triangulated results of patient outcomes in changesin knowledge, attitudes, and health-related behaviors are re-ported. Impact on community networks and communicationwith community health care providers around AD is identified.Program strengths and weaknesses in achieving patient out-comes are identified.

Discussion: This program design opened dialogue be-tween community members and their health care providers.This multiphased evaluation process identified the role ofeach contributor, including the participants and their fami-lies, as well as the community health care system. The eval-uation highlights the importance of considering the entirehealth care system when providing educational interventions.

Disclosure: Conduct of the presently reported study and its evaluation arefunded by a grant from Pfizer and Boehringer Ingelheim.

S. Murray and K. Cytryn, AXDEV Group; R. Friedland, Department ofNeurology, Case Western Reserve University, Cleveland, Ohio.

Continuing Education and ProfessionalDevelopment of Physicians in Uruguay, aCollaborative Work in Progress

A. Margolis, F. Alvariño, R. Niski, E. Fosman,A. M. Ginés

Introduction: Uruguay is a small country located in theSouthern Cone of South America. There are over 13,000

physicians (for a population of 3.3 million). The health caresector is divided equally into public providers and privatenot-for-profit prepaid insurers and providers. This presenta-tion describes the advancement of continuing professionaldevelopment (CPD) for physicians in Uruguay and explainsthe motivations for a CPD system, the role of the faculty ofmedicine and the other stakeholders, the strategic goals,and current results, including strengths and weaknesses. Fora complete description, please see Journal of ContinuingEducation in the Health Professions. 2007;27(2):81–85.

Methods: Descriptive study.

Results: The work had three strategic objectives: (1) initiatea CPD accreditation program, (2) train physician leadersin CPD, and (3) promote the creation of a national system forCPD. The accreditation program currently has 34 accreditedinstitutions. Over a 10-year period, 150 physician leaders fromdifferent regions of the country had been trained in concep-tual and methodological issues of CPD. Legislation is ex-pected to be introduced into parliament for coordinating CPDefforts at a national level.

Discussion: The construction of a national system forCPD requires a long-term commitment of the main stake-holders, since it is a process of cultural change, involv-ing both leaders and practicing physicians, which willcontinue even as deans, secretaries of health, and presi-dents of medical organizations change. This long-term pro-cess needs clear goals, in order to avoid becoming abureaucratic system. Interdisciplinary and international col-laboration are essential in order to develop this new areaof knowledge.


A. Margolis, F. Alvariño, R. Niski, E. Fosman, and A. M. Ginés, Escuelade Graduados, Facultad de Medicina, Universidad de la República, Uruguay.

The Role of Physician Leader in ImprovingClinical Practice: A Comparative Case Study ofTwo Successful Initiatives

T. R. Tooman, C. A. Olson, L. L. Bakken

Introduction: The purpose of this study was to explore theactions and roles of physician leaders in a successful behav-ioral change process.

Methods: Using Engel’s (1997) Soft Knowledge Systemstheory as a conceptual framework, a comparative case studywas conducted of two hospitals in the United States. A snow-ball sampling technique was used to identify 30 key “actors”in the change process. Face-to-face and telephone inter-views were then conducted to determine the identity, actions,and role of the key leader. Transcripts were analyzed usingan open coding method to reveal the primary roles and ac-tions of the physician leader.

Results: As a key member of a health care team, a physicianleader functioned as a vital communicator, change advocate,and liaison to clinical peers. The physician recognized an op-portunity to improve patient care and organized a multidisci-plinary team to create and execute a solution.

Conclusions: Physicians serve a critical role in executing asuccessful change process to improve patient care.

Abstracts


Disclosure: Conduct of the presently reported study and preparation of themanuscript were supported by Wyeth Pharmaceuticals.

T. R. Tooman, MS, C. A. Olson, PhD, and L. L. Bakken, PhD, Office ofContinuing Professional Development and Department of Medicine, Schoolof Medicine and Public Health, University of Wisconsin, Madison, Mad-ison, Wisconsin.

Translating Educational Scholarship: CanMonthly Classes and Computer Time Lead toSuccessful Educational Project Implementation?

Savithiri Ratnapalan

Methods: The objective of the study was to assess the im-pact of a continuing education course in leading to successfuleducational project implementations. A full-year interprofes-sional continuing education course was developed consistingof half-day monthly seminars. Each class consisted of 2 hoursin class teaching followed by 2 hours of practice in the com-puter laboratory. The class size was limited to 12 partici-pants. Needs assessment surveys at the beginning of thecourse and student evaluations and midterm and final progressreports were analyzed.

Results: Seven staff physicians, three clinical fellows, onenurse educator, and a research assistant enrolled in thecourse. Initial needs assessment surveys indicated that mostpeople could type with two or more fingers, had adequatecomputer skill, had no statistical knowledge, and had limitedliterature searching skills. The mean speaker evaluation forthe lectures was 4.5 on a scoring scheme of 1–5 in which 1was poor and 5 was outstanding. More than 80 percent of theparticipants had a complete proposal for an educational projectwritten by midterm. Nine participants applied for externalgrants, and two of them received external funding for theirprojects. Four participants completed phase 1 of their projectby the end of the class.

Discussion: At the end of a monthly course consisting oflectures and hands-on practice, 80 percent of the class wrotean educational proposal and 33 percent completed an edu-cational research project. Ensuring protected time for thecourse (4 hours per month) may have improved class atten-dance and faculty productivity.


Savithiri Ratnapalan, MBBS, MEd, The Hospital for Sick Children, Uni-versity of Toronto, Canada.

Evaluation of National Specialty SocietyAccreditation Criteria as a Needs Assessment forCE/CPD Activities

J. Cossette, C. Campbell, R. Sibbald

Introduction: We conducted a retrospective analysis of thedegree of adherence by continuing professional develop-ment (CPD) organizations recognized by the Royal Collegeof Physicians and Surgeons of Canada to the accreditationstandards established for these organizations. The purposeof the review was to assess, identify, and determine strat-egies to address gaps in organizational performance.

Methods: The accreditation system is based on eight stan-dards relating to organizational infrastructure, resourcespolicies and procedures (standards 1–4), and educationalplanning processes, including needs assessments, learningobjectives, educational methodologies, and evaluation (stan-dards 5–8). Each standard and substandard is judged usingfour levels of adherence: nonadherence, partial adherence,adherence, and exemplary adherence. An Excel spread-sheet was used to analyze the cumulative results of orga-nizational reviews completed since 2004. Revisions to theaccreditation standards over time resulted in three ver-sions: 17 organizations were assessed with Version 1 (15substandards); 11 organizations with Version 2 (15 substan-dards), and 3 organizations with Version 3 (19 substandards).Overall, 31 organizations were assessed on a total of 477substandards.

Results: The majority of CPD organizations were offeringprograms using appropriate educational processes. Thirty (30)substandards (6.3 percent) were deemed exemplary; 280(58.7 percent) were deemed adherent; 148 (31 percent) weredeemed partially adherent; 15 (3.1 percent) were deemednonadherent; and 4 (0.84 percent) were not applicable. Ad-herence to the substandard “evaluation of overall CPD pro-gram” was the most difficult to achieve (23 societies)

Discussion: Several educational process gaps common tomany organizations were identified, facilitating the creation ofeducation opportunities, tools, and reflective strategies to en-hance adherence.


J. Cossette and C. Campbell, Royal College of Physicians and Surgeons ofCanada, Ottawa, Ontario, Canada; R. Sibbald, University of Toronto, To-ronto, Ontario, Canada.

Physician’s Perceptions of Continuing MedicalEducation in a Private Teaching Hospital

Sandra Oliver, Rebecca Wiatrek, Shane Lewis,Eugene Terry, J. Scott Thomas, Mohsen Shabahang

Introduction: Mandatory continuing medical education (CME)is criticized for not demonstrating substantial impact on phy-sicians’ medical practice. This study explored physicians’ viewsabout their CME experiences and their perceptions of the im-pact of CME on clinical practice.

Methods: The study was conducted in the Southwest at asmall health science center. A 20-item questionnaire was sentto 500 physicians; 247 (49.4 percent) physicians responded.Most respondents (151/61 percent) practiced in clinics; 27percent (67) were hospital based; 5 percent worked in am-bulatory care or research laboratories. All primary fields ofmedicine and 38 subspecialties were represented. Physi-cians were not concerned about the State Medical Board li-censure requirement for CME. Many respondents (32 percent)did not know the minimal CME requirement. However, 233(96 percent) received more than the minimal CME require-ment for the past 2 years. The main motivating factor behindseeking CME was to develop or increase knowledge, skills,and professional performance. In addition to obtaining morethan the required CME, 207 (88 percent) of the physiciansregularly read up to four journals a month.

Abstracts


Results: Local and national conferences were the most at-tended CME activity (237/97 percent) and 164 (87 percent)respondents believed them to be the most likely CME activityto impact professional practice. At a conference 221 (90 per-cent) of the respondents attended 50 percent or more of themeeting.

Discussion: In summary, improvement of medical practice isthe driving force for physicians to attend CME activities. At-tending conferences is the preferred choice of CME activityand is believed to have the most impact on professionalcompetence.


Sandra Oliver, PhD; Rebecca Wiatrek, MD; Shane Lewis, MD; EugeneTerry, MD; J. Scott Thomas, MD; Mohsen Shabahang, MD, PhD, TexasA&M0Scott & White, Temple, Texas.

Acknowledgment: The authors would like to acknowledge the contribu-tions of Dr. Mitra Jafari.

Investigating the Relationship BetweenSelf-Directed Learning Activities and theCanMEDS Roles

Tanya Horsley, Jennifer O’Neill, Craig Campbell

Introduction: Studies in continuing education have been fo-cused on the classification of clinical questions generated byphysicians. To date, there is little evidence examining ques-tions generated by physicians linked to CanMEDS compe-tencies. The purpose of our study was to determine the typeand frequency of questions linked to various CanMEDS rolessubmitted by specialists to the Maintenance of Certification(MOC) Program of the Royal College of Physicians and Sur-geons of Canada. We summarized question stimuli, resourcesused, level of commitment to change, and time spent learn-ing for each item.

Methods: Two investigators independently coded all itemssubmitted (January–September 18, 2007) to the MOC sys-tem. The frequency and demographic data of items werecalculated using SPSS 15.0. Each item was then also inde-pendently coded by two investigators using the CanMEDSframework definitions for medical expert, communicator,collaborator, manager, health advocate, scholar, and profes-sional and quantified using the kappa statistic. Coding agree-ment was then compared to the self-recorded outcomes ofphysicians.

Results: Five hundred thirty-four (534) physicians (70 per-cent male, 96 percent Canadian) submitted 1,859 items. Ofall personal learning project items submitted, 584 (31.4 per-cent) were indicated by physicians as being relevant to oneor more CanMEDS roles. The majority of items indicated byphysicians as relevant were “Medical expert” (51.4 percent)followed by “Professional” (28 percent) and “Scholar” (22 per-cent). The least frequent role was identified as “Manager” (3percent).

Discussion: Increasing our understanding of the learning ac-tivities physicians engage in, specifically with relation toCanMEDS roles, provides insights into the scope of self-learning linked to a broader competency framework.


Tanya Horsley, Jennifer O’Neill, Centre for Learning in Practice ~CLIP!,The Royal College of Physicians and Surgeons of Canada, Ottawa, ON,Canada; Craig Campbell, Office of Professional Affairs, The Royal Collegeof Physicians and Surgeons of Canada, Ottawa, ON, Canada.

Multisource Feedback: A Retrospective Analysisof the College of Physicians and Surgeons ofAlberta—Physician Achievement ReviewInstruments

Jocelyn Lockyer, Claudio Violato, Herta Fidler

Introduction: The College of Physicians and Surgeons ofAlberta (CPSA) has a multisource feedback program with feed-back from patients, coworkers, and medical colleagues aboutperformance related to communication, collegiality, profes-sionalism, and clinical skill. Instruments have been devel-oped and tested for general practice, medical and surgicalspecialties, anesthesiology, emergency medicine, and inves-tigational medicine. This study examines the instruments forevidence of reliability and validity and provides recommen-dations for improvement.

Methods: Published and unpublished data for each of theinstruments by group of respondents were examined.

Results: Patient instruments have 11–44 items with a phy-sician mean response rate of 17.71 to 24.6 of 25. Mean scoresrange from 4.5 to 4.7. The instruments have 2–7 factors ac-counting for 63–80 percent of the variance. Internal consis-tency reliability ranges from a = .93 to .99 and G-studiesindicate that the generalizability co-efficient (Ep2) ranges from.64 to .78. Coworker instruments have 17–22 items with amean physician response rate 7.2–7.8 of 8. The mean scoreson all surveys were 4.5. The instruments show a 2–3 factorsolution accounting for 56–70 percent of the variance. Inter-nal consistency reliability ranges from a = .90 to .97 and theEp2 ranges from .56 to .87. Medical colleague instrumentshave 26–38 items with a mean physician response rate of6.9–7.8 of 8. Mean scores range from 4.3 to 4.5. The instru-ments provide a 3–4 factor solution accounting for 60–75 per-cent of the variance. The internal consistency reliability rangesfrom a = .95 to .98 and the Ep2 ranges from .64 to .84.

Discussion: The instruments provide evidence for validityand reliability. Modification of some of the instruments mayfurther improve psychometric quality.

Disclosure: Conduct of the present study was supported by the College ofPhysicians and Surgeons of Alberta.

Jocelyn Lockyer, Claudio Violato, and Herta Fidler, University of Calgary.

Distance Education for Physicians: Adaptation ofa Canadian Experience to Uruguay

L. Llambí, A. Margolis, J. Toews, J. Dapueto,E. Esteves, E.Martínez, T. Forster,A. López Arredondo, J. Lockyer

Introduction: The production of online high-quality continu-ing professional development is a complex process that de-mands familiarity with effective program and content design.Collaboration and sharing across nations would appear to bea reasonable way to improve quality, increase access, andreduce costs. When the educational program originates in one

Abstracts


language but requires adaptation into a second language, lo-cal clinical, computer, and translator expertise is required.

Methods: In this case report, the process of adapting andmodifying a course to improve the management of Alzhei-mer’s disease developed for the Canadian context, for use inUruguay, is described. The original course was developed bythe University of Calgary; the adaptation included using a dis-tance education system developed by EviMed (www.evimed.net) and widely used in Uruguay. Through EviMed, blendedcontinuing medical education (CME) programs, which maycombine distance education and traditional on-site activities,are developed. It includes a weekly electronic newsletter, read-ing materials for physicians and their patients, as well ase-rounds.

Results: Both quantitative and qualitative data on the pro-cess are reported in Llambí L, et al. Distance education forphysicians: Adaptation of a Canadian experience to Uruguay.Journal of Continuing Education in the Health Professions,2008;28(2):79–85. Nearly two of every three physicians readsome or all of the reading materials but only 7.8 percent par-ticipated actively in the e-round.

Discussion: It will be important in the future to ensure par-ticipants actively engage in the CME event, as CME studieshave shown that better learning outcomes and participant sat-isfaction result from higher interaction and involvement in on-line activities. Meaningful international collaboration in CMEneeds to take into account differences such as culture, healthcare systems, clinical practice, language, CME accreditationsystems, and technological and economic development.

Disclosures: Conduct of the present reported study and preparation of themanuscript were supported by EviMed.

L. Llambí,1,2 A. Margolis,1,2 J. Toews,3 J. Dapueto,1,2 E. Esteves,1

E.Martínez,4 T. Forster,1 A. López Arredondo,1,5 J. Lockyer3

1Evimed, Uruguay; 2Facultad de Medicina, Universidad de la República,Uruguay; 3Faculty of Medicine, University of Calgary, Canada; 4Facultadde Ciencias de la Comunicación, Universidad de la República, Uruguay;5Facultad de Ingeniería, Universidad de la República, Uruguay.

Interprofessional Education of NutritionClinicians: The Education Outcome of a LiveCME Course

J. S. Scolapio, J. K. DiBaise, W. F. Schwenk,M. E. Macke, R. Burdette

Introduction: The aim of this prospective study was to as-sess participants’ nutrition knowledge and practice behaviorsbefore and after completing a live continuing medical educa-tion (CME) course.

Methods: The course was designed for practicing nutritionclinicians of all disciplines. Twenty-five faculty from the UnitedStates participated. Electronic surveys were sent to the first100 registered participants before and after the course. Thecurriculum consisted of 16 hours of live education. The cur-riculum was revised when the precourse surveys identified a“gap” in medical knowledge or practice behavior. Knowledgechange was assessed by a 15-question survey (survey 2)given before and 1 week after the course. Change in practicebehavior was assessed by a 10-question survey (survey 3)administered 2 months after the course.

Results: Dietitians were the predominant discipline attend-ing the course. Forty-eight percent indicated they write totalparental nutrition (TPN) orders and 51 percent write total en-teral nutrition (TEN) orders; of these 62 percent indicated theyare comfortable writing TPN orders and 81 percent comfort-able writing TEN orders. Twenty-six percent stated they werecertified in nutrition support. Seventy-eight percent of the par-ticipants responded to survey 2; the median correct responserates were 51 percent before and 76 percent after the course.Seventy percent responded to survey 3; the median positiveclinical practice behavior change was 69 percent.

Discussion: To the best of our knowledge, this is the first re-port documenting improved knowledge and nutrition practicebehavior following a live CME nutrition course. Electronic pre-course surveys were a useful tool to identify the educationalneeds of the real-time learner and to assess learner outcome.


J. S. Scolapio, J. K. DiBaise, W. F. Schwenk, M. E. Macke, and R. Burdette,Mayo Clinic School of Continuing Medical Education.

Building Neurology Capacity in the DevelopingWorld Through Innovative CME: A Case Study ofthe World Federation of Neurology CME Initiative

Abi Sriharan, Theodore Munsat

Introduction: What leadership roles can transnational med-ical professional societies play in addressing lifelong learningneeds of health professionals in the emerging world? TheWorld Federation of Neurology (WFN) provides neurologicaleducation programs in countries with unmet neurological train-ing needs, in an effort to improve the knowledge and skills ofneurologists. Currently the WFN program offers continuingmedical education (CME) programs in over 36 countries. TheWFN’s experience provides a unique study to exemplify howglobal stakeholders collaborate with each other to deliver CMEand to improve the quality of health care services.

Methods: A multistage program evaluation was undertakento explore the WFN CME, in an effort to understand the pro-gram process and to understand the success factors and thechallenges of delivering global CME. The program evaluationwas conducted between June 2005 and March 2006, usingmultiple data collection tools to achieve data triangulation.

Results: The study results reveal that global CME programscould be designed effectively with minimal costs, when re-sources are shared to prevent duplication of tasks. Further,the study showed that educational materials developed in onecountry could be adapted effectively across borders. In coun-tries where there is a huge demand for evidence-based CMEprograms, strategically planned CME programs triggersystems-level outcomes. Effective global CME programs re-quire strong local commitment and leadership to sustain theimplementation and impact.

Discussion: Transnational societies through their membersocieties have the opportunity to address continuing educa-tional and professional development needs of health profes-sionals in low- and middle-income countries.


Abi Sriharan, Doctoral Student, University of Oxford; Theodore Munsat,MD, Chair, Education Committee, World Federation of Neurology.

Abstracts


Interprofessional Education for the Managementof Chronic Noncancer Pain—Call for ProfferedPapers, Symposia, Workshops, and Poster

M. Allen, B. Zwicker, M. Chiarot, T. Hill

Introduction: Managing chronic noncancer pain (CNCP) is achallenging clinical problem, particularly when recommendedmedications have the potential for abuse. The purpose of thisstudy was to evaluate an interprofessional CNCP program forphysicians, dentists, and pharmacists working in the CapeBreton District Health Authority, where the incidence of opioidabuse was of concern.

Methods: A 2.5-hour CNCP program of interactive case-based discussion was developed on the basis of the resultsof a needs assessment with physicians, dentists, pharma-cists, and patients. The program was evaluated using a pro-gram evaluation questionnaire, pre-post self-efficacyquestionnaires, pre-post prescribing practices, and two inter-professional focus groups.

Results: Overall evaluation of the program was high (4.3/5.0). Physicians (n = 13) rated some domains higher thandentists (n = 15) and pharmacists (n = 26), including contentapplicable to practice, adequate time for discussion, and ac-quisition of new knowledge. Postprogram self-efficacy in-creased for asking a patient starting opioids to sign amanagement agreement and asking the Prescription Moni-toring Program for help monitoring patients. We could notevaluate postprogram opioid prescribing as a result of a lackof consent. One-year follow-up through focus groups re-vealed increased interprofessional communication for phar-macists and the need for more frequent and informalinterprofessional learning.

Discussion: The CNCP program was an effective way toeducate physicians, dentists, and pharmacists to improve treat-ment of their patients with chronic pain. Overall, participantsreported increased self-efficacy in one or more areas, al-though pharmacists had the greatest increase in interprofes-sional communication. The initial program has been revisedand is currently offered to health professionals throughoutNova Scotia.

Disclosure: Funding was provided by the Health Canada Drug Strategy Com-munity Initiatives Fund and the Drug Evaluation Alliance of Nova Scotia.

M. Allen and T. Hill, Office of Continuing Medical Education, DalhousieUniversity, Halifax, Nova Scotia, Canada; B. Zwicker, Nova Scotia Col-lege of Pharmacists, Halifax, Nova Scotia, Canada; M. Chiarot, Oral andMaxillofacial Surgery, Scotia Surgery, Dartmouth, Nova Scotia, Canada.

Clinical Performance Improvement for AtrialFibrillation: “Moving the Needle” Towards BestPractices

B. Bellande, K. Canova, A. M. Smith, J. Sibley

Introduction: Clinical performance measures, practice guide-lines, and consensus statements have been developed to pro-vide evidence-based processes for best practices inprevention, diagnosis, and management of disease state(s).These tools promulgate excellent clinical practices for as-sessing medical knowledge, practice performance improve-ment, and clinical competence. The purpose of this study isto use best practice tools and benchmarks to identify, mea-sure, and report practice performance improvement by car-

diologists and electrophysiologists for selected progressindicators (PIs) in the treatment of patients with atrial fibrilla-tion. The hypothesis of the study is that with effective edu-cational interventions, adoption of best practices by clinicianswould be improved from the current reality (thresholds) toideal performance (targets).

Methods: Using a variety of best practice resources, PIs wereselected from each of four areas: anticoagulation (4 PIs),rhythm management/ablation (4 PIs), cardioversion (6 PIs),and ablation (3 PIs). For each of the 17 PIs, data were col-lected by means of pre- and posttests administered for eacheducation intervention. For each PI and for each of the twotarget audiences, data were identified for (1) Threshold(current performance), (2) Benchmarks (generally acceptedperformance), and (3) Target (ideal performance). These cat-egories provide a perspective of how to “move the needle” onclinical performance from the current reality to evidence-based best practices.

Results: For all learners, except electrophysiologists, the av-erage performance gap was reduced, as evidenced by theincrease in the number of questions answered correctly frompre- to posttest. The hypothesis of this study was proven cor-rect for cardiologists by the data collected and analyzed.

Discussion: Effective educational interventions can improvephysician performance as evidenced by pre- and postmea-surement of performance metrics based on critical perfor-mance indicators of clinical guidelines and performancemeasures.


B. Bellande, President, CME Enterprise, Carmel, Indiana; K. Canova, VicePresident for Education, Heart Rhythm Society, Washington, DC; A. M.Smith, Owner of Lifelong Learning Service, Silver Springs, Maryland; J.Sibley, Owner of Corporate Resources, Gaithersburg, Maryland.

Facing Suicide: Training Physicians to UseSystems

A. Gagnon, G. Beauchamp

Introduction: This award-winning workshop has been dis-seminated in Quebec through regional teams of trainers. Theseteams included a general practitioner, a psychiatrist as anexpert in suicide, and a community worker trained to dealwith suicidal crisis. It was offered to hundreds of general prac-titioners and supported by the Ministère de la Santé et desServices Sociaux du Québec.

Methods: The training-the-trainer sessions will be explainedand detailed, as well as the workshop’s educational choices.Different quantitative and qualitative evaluations are analyzed.

Results: The feedback indicated how general practitioners(GPs) became more at ease and able to intervene more aptly.They learned how to select emergency referrals more appro-priately and to use community resources and especially fam-ily members. However, the content of the workshop had to bereframed for each local reality and practice. Even the selec-tion of the training teams became a challenge and often ini-tiated the development of some coherent appropriate localclinical strategies and patient-centered care.

Discussion: To be efficient in primary-care settings, trainingmodels have to become highly adaptive to fit the communi-ty’s needs and focus on systems’ interfaces. However, the

Abstracts


different professionals would appreciate having more oppor-tunities to be trained to work and to find solutions together.This also requires administrative support. Future programssuch as those developed by the CCMH are to be encour-aged, but changes in the university academic curriculum arealso necessary to enhance effective collaboration.


A. Gagnon, Centre Hospitalier Pierre-Janet, Gatineau, PQ, Canada, andUniversity of Ottawa, Ottawa, ON, Canada; G. Beauchamp, Cégep del’Outaouais, Gatineau, PQ, Quebec, Canada.

Successful Implementation of AntimicrobialResistance Practice Guidelines: A Cross-CaseStudy of Three Hospitals

C. A. Olson, T. R. Tooman, A.-S. Loose,G. Lindeman, C. Alvarado

Introduction: To describe how health care professionals andtheir organizations translate information about best practicesfor preventing antimicrobial resistance (AR) into usable prac-tical knowledge and make changes in clinical practice.

Methods: Three cases were selected using specific criteriaand reviewed by a panel of experts in AR. Data werecollected using interviews, document analysis, and directobservation. Soft Knowledge Systems Theory (Engel, PGH[1997]. The Social Organization of Innovation: A Focus onStakeholder Interaction. Amsterdam, the Netherlands, KITPress) was used as a conceptual framework to generate re-search questions and guide initial coding of data. Analyseswere done first within-case and then across-cases.

Results: Despite significant differences in setting, goals, andimplemented practices, there were common elements, includ-ing (1) the pivotal role of knowledge and information, (2) theuse of performance data to establish the need for changeand monitor progress, (3) the importance of actors’ practicalknowledge, (4) the use of scientific evidence to give validityto proposed changes, (5) the involvement of physician andpeer champions, (6) the reliance on personal and profes-sional networks to achieve change, and (7) the adaptation ofnew practices to fit the context.

Discussion: Our findings suggest that successful change inpractice aimed at reducing antimicrobial resistance in the hos-pital setting resembles less a simple dissemination of re-search findings or practice guidelines than a complex socialprocess in which health care professionals are both usersand producers of multiple forms of knowledge.

Disclosure: This project was supported by an unrestricted educational grantfrom Wyeth Pharmaceuticals.

C. A. Olson, T. R. Tooman, A.-S. Loose, G. Lindeman, and C. Alvarado,University of Wisconsin, Madison, Madison, Wisconsin.

Assessment of a Practice Reflection Tool ThatIncludes Commitment to Change Statements

H. Armson, S. Kinzie, S. Roder, T. Elmslie,J. Wakefield

Introduction: A practice reflection tool (PRT) was developedas part of a practice-based small group (PBSG) learning pro-

gram. The tool encourages family physicians to reflect on theapplication of new knowledge to their clinical practices and todocument the outcome of their learning session in the form ofcommitment-to-change (CTC) statements. This study is as-sessing whether the PRT enhanced the development of CTCstatements and captured the proposed practice changes. TheCTC statements will also be examined to assess whether acognitive hierarchy of increasingly complex, higher-level prac-tice changes can be developed.

Methods: The initial study consists of an individual PRT com-pleted by participants in PBSG sessions immediately and 3months later. Semistructured interviews followed to verify theself-reported data on the PRT and to explore the process ofimplementing planned changes in practice. Both the PRT andthe interviews were assessed using a grounded theory ap-proach to identify emerging themes and concepts.

Results: Pilot work identified the role of the PRT in relatingeducational material to practice and in exploring practice im-plementation strategies. The initial analysis suggests that thePRT captures most proposed practice changes. The first phaseof the project has resulted in a hierarchy of practice changesthat will now be explored with a broader population.

Discussion: Assessment of the PRT demonstrated the abil-ity of the tool to capture proposed practice changes. The ini-tial categorization of the CTC statements will underpin furtherdevelopment of a tool to assess the complexity of the pro-posed practice changes.

Disclosure: This project is supported by the Manning Award of the Societyof Academic Continuing Medical Education.

H. Armson,1,2 S. Kinzie,2,3 S. Roder,2 T. Elmslie,2,4 and J. Wakefield2,3

1Department of Family Medicine, University of Calgary; 2The Foundationfor Medical Practice Education; 3Department of Family Medicine, McMas-ter University; and 4Department of Family Medicine, University of Ottawa.

Video-Conferenced City-Wide Medical GrandRounds (VC-CWMGRs): A Vehicle for AchievingStrategic Priorities in an Academic Departmentof Medicine (DOM)?

G. Bandiera, M. Bell, A. Russell

Introduction: To compare the evaluation of traditional med-ical grand rounds (TMGRs) and video-conferenced city-widemedical grand rounds (VC-CWMGRs) and to evaluate theextent to which VC-CWMGRs advanced the strategic priori-ties of the University of Toronto’s Department of Medicine.

Methods: (1) A quantitative summary of evaluation formsfor the 2005–2006, 2006–2007, and 2007–2008 academicyears from the DOM TMGRs and VC-CWMGRs was per-formed. (2) VC-CWMGR Evaluation Survey—992 full- andpart-time faculty were invited to complete a Web-basedsurvey, which evaluated awareness of VC-CWMGRs, syn-chronous and asynchronous webcasting, and archiving;attendance; satisfaction; technology; and advancing DOMstrategic priorities. (3) A comparison of scores on the DOMstandard evaluation form was performed for VC-CWMGRand TMGRs. Data collection procedures: Survey Monkey wasused to collect VC-CWMGRs survey data. Quantitative analy-sis of the TMGRs and VC-CWMGRs evaluation data setwas performed using descriptive statistics.

Abstracts


Results: Overall evaluation scores were similar for VC andTMGRs. Evaluation data for individual VC-CWMGRs did notdiffer when comparing local versus visiting speaker, theme oftalk, or attendance. There was a trend for higher ratingsat the host site. A total of 503/992 (50.7 percent) facultycompleted the survey. Enhancement of 4 of 10 strategic pri-orities via VC-CWMGR was reported.

Discussion: Medical grand rounds may serve a new pur-pose in academic teaching centers as a vehicle for fulfilling adepartment’s mission. At the University of Toronto, VC-CWMGRs are a valued service and have advanced strategicpriorities, including enriching our teaching programs, provid-ing greater cross-departmental contact, and facilitating unifi-cation of the Department of Medicine.


G. Bandiera, St. Michael’s Hospital, Toronto, ON, Canada, and Universityof Toronto, Toronto, ON, Canada; M. Bell, Sunnybrook Health SciencesCentre, Toronto ON, Canada, and University of Toronto, Toronto, ON, Can-ada; A. Russell, LKSKI Research Training Centre, St. Michael’s Hospital,Toronto, ON, Canada, and Office of Continuing Education and Profes-sional Development, University of Toronto, Toronto, ON, Canada.

A Perfect Storm: A Didactic CME Activity ThatMade a Difference in Physicians’ Learning andPractice

M. Wang, M. B. Shershneva, G. C. Lindeman,C. C. Gibson, J. Savoy

Introduction: A longitudinal evaluation was conducted to as-sess the impact of a 75-minute didactic continuing medicaleducation (CME) activity for primary care physicians on com-

municating the risks and benefits of treatments for meno-pausal symptoms to patients.

Methods: Qualitative and quantitative data were collectedfrom 41 physicians over 15 months using pre- and posteventinterviews and a postevent survey (35 participants completedall phases of the evaluation). These data were complementedby direct observations of the activity. A 360-degree evalua-tion of eight participants was conducted to corroborate re-ported practice change. Six evaluation nonparticipantinterviews were performed to assess the impact of the eval-uation process.

Results: All evaluation participants reported one or more learn-ing outcomes postevent and most reported commitments topractice change (an average of 2.5 commitments). By thetime of 9 months, 85.7 percent (30 of 35) participants imple-mented one or more of the commitments. The 360-degreesurveys, collected from patients, peers, and health care teammembers of eight physicians, supported physicians’ claims ofpractice change. Secondary evaluation suggests that the eval-uation process itself accounted for some but not all of theobserved outcomes.

Discussion: A relatively short practice-oriented didactic CMEcan result in learning and practice change. Conditions thatfacilitate change may include (1) identifying clinical topics ofhigh relevance to the target audience, (2) conducting system-atic program planning to address knowledge and practice gaps,(3) developing practice-oriented content with sound instruc-tional design, and (4) implementing the program as planned.

Disclosure: Conduct of the present study and preparation of the manuscriptwere supported by Wyeth Pharmaceuticals.

M. Wang, M. B. Shershneva, G. C. Lindeman, C. C. Gibson, and J. Savoy,University of Wisconsin, Madison, Madison, Wisconsin.

Abstracts


abstracts from cme congress 2008, vancouver, british columbia

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