From death and disability to patient empowerment: an interprofessional partnership to achieve cardiovascular health in Canada

This paper proposes a paradigm shift in health care from a focus on death and disability to one on health empowerment resulting in improved cardiovascular lifestyles for all Canadians. It describes a national interprofessional initiative to achieve this new vision in the area of cardiovascular health promotion. Achieving Cardiovascular Health in Canada (ACHIC) is a partnership of health professional associations and other health advocate groups whose vision is to promote optimal cardiovascular health (including cerebrovascular health) for all Canadians through interprofessional partnership initiatives and support systems. ACHIC's objectives are to: 1) identify system barriers and supports to cardiovascular health; 2) develop strategies that will have a positive impact on the practices of health professionals/educators in the promotion of cardiovascular health; 3) develop an interprofessional national approach to support strategies to achieve cardiovascular health in Canada; and 4) support the development and delivery of consistent, evidence-based messages by health professionals/educators for promotion of cardiovascular health.     

Does requiring continuing education units for professional licensing renewal assure quality patient care?

Although most states in the United States require health care professionals to complete continuing education units (CEUs) for licensure renewal, little evidence to date has established a relationship between completing CEUs and clinical competency. Considering the high cost of health care delivery and services, it would be prudent for both managers and consumers of health care to review the costs and benefits of requiring CEUs for professional licensing renewal. This study features an extensive review of the literature to analyze the supportive as well as the opposing views of mandatory CEUs for professional license renewal. Most of the studies reviewed reported almost no relationship between participation in traditional continuing education courses and improved patient outcomes. Several recommendations evolved out of this study for improving patient outcomes following the attendance of continuing education courses.     

An Assessment of Practice Support and Continuing Medical Education Needs of Rural Pennsylvania Family Physicians

Family physicians provide the greatest proportion of care in rural communities. Yet, the number of physicians choosing family practice and rural practice has continued to decline. Undesirable aspects of rural practice, such as professional isolation and a lack of or inadequate resources, are assumed to be associated with this decline. This article reports on the practice support and continuing medical education needs of rural family physicians. A mail survey was conducted in 1993 on a purposive sample of family physicians in 39 of 67 rural-designated or urban Pennsylvania counties with low population densities. The physicians identified needs that included patient education materials and programs, community health promotion, federal regulation updates, technical assistance with computers and business management, database software and a videotape lending library, a drug hotline, and mini-fellowships on clinical skill development. A majority of respondents were willing to participate in clinical educational experiences for students and residents. Some physicians indicated a lack of interest in access to information through telecommunications, e.g., video conference referrals and consultations. Overall, findings revealed that family physicians need and are receptive to a variety of practice support and continuing education programs. A practice support program coupled with policy coordination among public and private organizations is likely to lessen complaints by rural primary care physicians.     

CPD of the future: a partnership between quality improvement and competency‐based education

Context

Many of those involved in continuing professional development (CPD) over the past 10 years have engaged in discussions about its goals and activities. Whereas in the past CPD was viewed as an education intervention directed towards the medical expert role, recent research highlights the need to expand the scope of CPD and to promote its more explicit role in improving patient care and health outcomes. Recent developments in quality improvement (QI) and competency‐based medical education (CBME), guided by appropriate theories of learning and change, can shed light on how the field might best advance. This paper describes principles of QI and CBME and how they might contribute to CPD, explores theoretical perspectives that inform such an integration and suggests a future model of CPD.

Discussion

Continuing professional development seeks to improve patient outcomes by increasing physician knowledge and skills and changing behaviours, whereas QI takes the approach of system and process change. Combining the strengths of a CPD approach with strategies known to be effective from the field of QI has the potential to harmonise the contributions of each, and thereby to lead to better patient outcomes. Similarly, competency‐based CPD is envisioned to place health needs and patient outcomes at the centre of a CPD system that will be guided by a set of competencies to enhance the quality of practice and the safety of the health system.

Conclusions

We propose that the future CPD system should adhere to the following principles: it should be grounded in the everyday workplace, integrated into the health care system, oriented to patient outcomes, guided by multiple sources of performance and outcome data, and team‐based; it should employ the principles and strategies of QI, and should be taken on as a collective responsibility by physicians, CPD provider organisations, regulators and the health system.     

Clinical practice guidelines. The Agency for Health Care Policy and Research fosters the development of evidence-based guidelines

As medical technology increases rapidly and becomes more complex, clinical practice guidelines can help healthcare providers assess current practices and integrate technological advances. Through the Agency for Health Care Policy and Research (AHCPR), the federal government has begun to facilitate the development of clinical practice guidelines. Expert or contract panels, authorized by the AHCPR, develop guidelines on specific clinical conditions. The AHCPR guideline methodology is designed to produce evidence-based guidelines that are valid, clinically applicable, and clinically flexible. Each panel spends a year or more developing the guideline, beginning with an extensive literature search and review. The panel prepares evidence tables, statistically analyzes aggregate data (where appropriate), conducts harm and benefit analyses, and prepares health policy analyses (or cost-impact studies). During this process, the panel holds an open forum to solicit comments on the guideline topic. After this public discussion, the panel prepares a final draft of the guideline. Several hundred individuals review the guideline. Some policymakers believe clinical practice guidelines can lead to better healthcare outcomes. Guidelines can provide information in a useful format for clinicians to use at the bedside or the point of decision making in patient care. Guidelines also provide information that can be used in continuing education and professional education programs.     

Determining and maintaining competence: an obligation of allied health education

In a climate of growing concern about the costs and quality of health care, there is increasing evidence that the health care system lacks effective controls to assure the continuing competence of health practitioners. The assumption that educational institutions, and specifically those that prepare allied health professionals, can meet obligations to the clinical community and the public by means of the present haphazard system of voluntary continuing education is questioned. Instead, the author suggests that schools of allied health may have to collaborate with professional organizations in identifying individual deficiencies in clinical practice and in offering remedial, continuing education programs that address these deficiencies. The rationale for the assumption of this unique responsibility for determining and maintaining clinical competence by schools of allied health is explored.     

Using problem-based learning to improve educational outcomes

As the health care industry and the occupational therapy profession experience rapid change and growth, our professional preparation and continuing education must prepare graduates and therapists for an evolving practice environment. By exploring and evaluating alternative teaching methods and their impact on educational outcomes, occupational therapy educators demonstrate their commitment to improving the quality of student education. This article proposes that the traditional educational paradigm prepared clinicians for the old health care environment, and that problem-based learning (PBL) is an educational strategy that could prepare occupational therapists for success in a new practice environment that values cost, quality, and customer satisfaction. The PBL approaches used by various international occupational therapy educators are reviewed to highlight the strategies that have been implemented to achieve educational objectives that parallel the requirements of this new practice environment. Copyright © 1996 Whurr Publishers Ltd.     

Restructuring the health workforces of the NIS countries: report of an unprecedented multinational conference

Health professionals, educators, and policy-makers in the US and the Newly Independent States met in Tashkent, Uzbekistan, and shared concerns on health workforce planning, access to care, and training. The International Conference on the Health Care Workforce for the 21st Century recognized the scope and interdependence of workforce strategies that must be employed to achieve health reform objectives in the new political system. Specific issues addressed in the conference include health workforce planning; interdisciplinary and multidisciplinary education; primary care, family medicine, and general practice; the supply of physicians; medical education; supply and role of nurses; assessing the competency of practitioners; continuing education and training; the role of professional organizations; accreditation; and international collaboration. Conclusions of the deliberations provide insight into present conditions, prospects for change and how future development assistance can most usefully be targeted.     

Framework for the strategic and business planning of the Centre – School of Public Health, Belgrade

The science and practice of the New Public Health have a key role in the promotion of people’s health and in the reform of the health system. Serbia experienced many social and economic threats to public health during the 1990s when the health infrastructure both for curative and preventive services gradually deteriorated. Existing skills and knowledge of public health professionals are insufficient in virtually all fields of public health activities. The foundation of the Centre – School of Public Health, within the Medical School of Belgrade University has been a precondition for the improvement of professional training in public health. The objectives are described as (1) education of capable experts in the field of public health, (2) improvement of knowledge in the health sciences, (3) health promotion in cooperation with local communities, (4) training of competent researchers in the field of public health and (5) improvement of the process of decision making and policy formulation. The training programme covers five key areas of education in the domain of public health: (1) public health in Europe, (2) epidemiology and biostatistics, (3) health policy and management, (4) health promotion, health education and social sciences and (5) environment and health. In the first year, 27 students were admitted for the Master of Public Health programme and more than 350 participants attended various short courses for continuing education in public health and health management based on applied learning approach. The next developmental steps focus on sustainability of the programmes for continuing education and research and a wider national and international partnership.     

National opportunities for health promotion: the Canadian experience

Health promotion is a fundamental strategy to address the majorissues which confront health systems in developed and developingcountries alike. Chief amongst these issues are unhealthy environments,health inequities and non-communicable diseases. The infrastructuresfor health promotion include mechan isms for development andimplementation of health policy; policies and programs supportiveof community involvement in health promotion programs; reorientationof the health care system towards prevention; and research.Consensus building among key stakeholders from the public andprivate sectors is at the core of the policy development process.A New Perspective for the Health of Canadians (1974) and theWHO Ottawa Charter for Health Promotion (1987) have guided healthpromotion policy and program development at both the nationaland provincial levels, in Canada, a number of initiatives haveplaced into pra ctice the policy frameworks, among them: HealthyCommunities, the Canadian Heart Health initiative, integrationofpreven lion into clinical practice, and structures to supportresearch in health promotion.     

The accountability of clinical education: its definition and assessment

BACKGROUND: Medical education is not exempt from increasing societal expectations of accountability. Competition for financial resources requires medical educators to demonstrate cost-effective educational practice; health care practitioners, the products of medical education programmes, must meet increasing standards of professionalism; the culture of evidence-based medicine demands an evaluation of the effect educational programmes have on health care and service delivery. Educators cannot demonstrate that graduates possess the required attributes, or that their programmes have the desired impact on health care without appropriate assessment tools and measures of outcome. OBJECTIVE: To determine to what extent currently available assessment approaches can measure potentially relevant medical education outcomes addressing practitioner performance, health care delivery and population health, in order to highlight areas in need of research and development. METHODS: Illustrative publications about desirable professional behaviour were synthesized to obtain examples of required competencies and health outcomes. A MEDLINE search for available assessment tools and measures of health outcome was performed. RESULTS: There are extensive tools for assessing clinical skills and knowledge. Some work has been done on the use of professional judgement for assessing professional behaviours; scholarship; and multiprofessional team working; but much more is needed. Very little literature exists on assessing group attributes of professionals, such as clinical governance, evidence-based practice and workforce allocation, and even less on examining individual patient or population health indices. CONCLUSIONS: The challenge facing medical educators is to develop new tools, many of which will rely on professional judgement, for assessing these broader competencies and outcomes.     

Process guides for nutrition care in community health

The process of nutrition care is central to the clinical management of the public health client. However, this care is not often provided by the public health nurse. Thus, process guides that describe the techniques and strategies for providing nutrition care are important components of continuing education for those health professionals. This article presents one format for the development and presentation of such guides. Procedures for implementing the guides in public health practice are also described.     

The relevance of the alliance for CME competencies for planning, organizing, and sustaining an interorganizational educational collaborative

The heightened demand for accountability, access, and quality performance from health care professionals has resulted in linkages between continuing education (CE), performance improvement (PI), and outcomes. CE health professionals must also expand their skills and abilities to design, implement, and measure CE activities consistent with these new expectations. In addition to administrative and meeting-planning activities, new competencies associated with educational consultation and performance coaching are needed. This article utilizes the Alliance competencies as the framework for discussion of the competencies of CE professionals and applies it to the unique setting of a collaborative. The CS2day initiative serves as an example of the application of these competencies in this environment. The framework of the Alliance competencies can serve as a guide and a tool for self-assessment, work design, and professional development at individual, organization, and systems levels. Continual reassessment of the Alliance competencies for CE in the health professions will be critical to the continued effectiveness of CE that is linked to performance improvement and outcomes for the CE professional and the health care professionals we serve. A collaborative can provide one option for meeting these new expectations for professional development for CE professionals and the creation of effective educational initiatives.     

Recredentialing in the allied health professions

Credentialing of allied health professionals is used to assure the public that they are receiving care from competent individuals, and recredentialing is a means to demonstrate continuing competence. There is considerable variability in the requirements that allied health professions have for recredentialing. Of the 16 national credentials representing 14 allied health professions that were included in this study, 50% had no continuing education (CE) or retesting requirement in order to maintain the credential. The remaining 50% required CE in amounts ranging from 10 to 50 hours per year, with a mean of 18.5 hours. One credential requires both CE and retesting. A review of the literature reveals that CE requirements are not linked to improved patient outcomes, and evidence linking retesting to improved outcomes is lacking. Therefore, even though there is external pressure to implement recredentialing requirements for the allied health professions, care needs to be taken to assure that the tools used to ensure continued competence are valid and reliable.     

The need to incorporate health information technology into physicians' education and professional development

Nationwide, as physicians and health care systems adopt electronic health records, health information technology is becoming integral to the practice of medicine. But current medical education and professional development curricula do not systematically prepare physicians to use electronic health records and the data these systems collect. We detail how training in meaningful use of electronic health records could be incorporated into physician training, from medical school, through licensure and board certification, to continuing medical education and the maintenance of licensure and board certification. We identify six near-term opportunities for professional organizations to accelerate the integration of health information technology into their requirements.     

Developing and implementing an effective framework for collaboration: the experience of the CS2day collaborative

Organizations from varied sectors have pursued collaboration to better fulfill their missions, facilitate decision making, solve more complex problems, and respond more rapidly to a changing environment. While these benefits are evident through the products and services provided, few organizations evaluate the factors that contribute to the success or failure of the collaboration itself. The CS2day Collaborative was formed by 9 separate organizations with a common goal of increasing smoking quit rates through health care professional education. To better understand the factors that influence successful collaboration, the authors applied criteria established by the Wilder Foundation to the functioning of this health care education collaborative. Factors analyzed include the influence of the environment, membership, process and structure, communication, purpose, and resources. Factors relevant to continuing medical education/continuing professional development (CME/CPD) including accreditation, conflict of interest resolution and management, guideline dissemination, continuous assessment and interprofessional education influenced the collaborative structure. Specific examples provided illustrate how diverse organizations can work together effectively to address a public health need. While the CS2day Collaborative was not formed with prior knowledge of these factors, they provide a useful framework for examining how this collaborative was developed and has operated.     

Does continuing medical education improve the quality of medical care? A look at the evidence.

Although continuing education has a long tradition within the medical profession, mandated continuing medical education is of very recent origin. The conceptual framework used to justify continuing medical education is that it exposes physicians to new knowledge, changes physician behavior, and favorably alters patient outcomes. Considerable evidence exists that physician knowledge can be increased, and that behavior can be changed, but there is very little to show an effect on patient outcomes. The effectiveness of continuing medical education is further clouded by such issues as consumerism, licensure politics, and professional standards review organization legislation. Family physicians should have a role in determining the outcome of the continuing medical education debate, as participants, as policy-setters, and as informed critics.     

Can public health and medicine partner in the public interest?

The dominant issues for health and health care today can be effectively engaged only if public health and medicine work together as better partners. Yet historical, professional, organizational, operational, and financial barriers exist to closer relationships. Fostering the necessary collaboration will require changes for both public health and medicine in leadership styles, professional education, practice incentives, accountability measures, and financing structures.     

Curriculum revision: product innovation for quality outcomes

The education of any professional discipline rests on a curricular foundation that reflects the discipline's theory and knowledge bases, practice patterns, and unique skills. In addition, professional health care education must respond to and reflect changes in technology, societal definitions of health and wellness, and broad social issues such as access to care, health care funding, and changing patient demographics. These issues are interwoven with efforts to also provide high-quality education with positive learning outcomes. In this article, the authors describe a school of nursing's efforts to revise its curriculum to reflect a professional shift in focus to community-based nursing practice and the goals of the federal health goals outlined in Healthy People 2010. The revision also served as the starting point for a change in the process through which the college will seek accreditation in the future; this process-Academic Quality Improvement Program-requires institutions of higher learning to use a continuous quality model as its base.