Implementing a Virtual Community of Practice for Family Physician Training: A Mixed-Methods Case Study

Background

GP training in Australia can be professionally isolating, with trainees spread across large geographic areas, leading to problems with rural workforce retention. Virtual communities of practice (VCoPs) may provide a way of improving knowledge sharing and thus reducing professional isolation.

Objective

The goal of our study was to review the usefulness of a 7-step framework for implementing a VCoP for general practitioner (GP) training and then evaluated the usefulness of the resulting VCoP in facilitating knowledge sharing and reducing professional isolation.

Methods

The case was set in an Australian general practice training region involving 55 first-term trainees (GPT1s), from January to July 2012. ConnectGPR was a secure, online community site that included standard community options such as discussion forums, blogs, newsletter broadcasts, webchats, and photo sharing. A mixed-methods case study methodology was used. Results are presented and interpreted for each step of the VCoP 7-step framework and then in terms of the outcomes of knowledge sharing and overcoming isolation.

Results

Step 1, Facilitation: Regular, personal facilitation by a group of GP trainers with a co-ordinating facilitator was an important factor in the success of ConnectGPR. Step 2, Champion and Support: Leadership and stakeholder engagement were vital. Further benefits are possible if the site is recognized as contributing to training time. Step 3, Clear Goals: Clear goals of facilitating knowledge sharing and improving connectedness helped to keep the site discussions focused. Step 4, A Broad Church: The ConnectGPR community was too narrow, focusing only on first-term trainees (GPT1s). Ideally there should be more involvement of senior trainees, trainers, and specialists. Step 5, A Supportive Environment: Facilitators maintained community standards and encouraged participation. Step 6, Measurement Benchmarking and Feedback: Site activity was primarily driven by centrally generated newsletter feedback. Viewing comments by other participants helped users benchmark their own knowledge, particularly around applying guidelines. Step 7, Technology and Community: All the community tools were useful, but chat was limited and users suggested webinars in future. A larger user base and more training may also be helpful. Time is a common barrier. Trust can be built online, which may have benefit for trainees that cannot attend face-to-face workshops. Knowledge sharing and isolation outcomes: 28/34 (82%) of the eligible GPT1s enrolled on ConnectGPR. Trainees shared knowledge through online chat, forums, and shared photos. In terms of knowledge needs, GPT1s rated their need for cardiovascular knowledge more highly than supervisors. Isolation was a common theme among interview respondents, and ConnectGPR users felt more supported in their general practice (13/14, 92.9%).

Conclusions

The 7-step framework for implementation of an online community was useful. Overcoming isolation and improving connectedness through an online knowledge sharing community shows promise in GP training. Time and technology are barriers that may be overcome by training, technology, and valuable content. In a VCoP, trust can be built online. This has implications for course delivery, particularly in regional areas. VCoPs may also have a specific role assisting overseas trained doctors to interpret their medical knowledge in a new context.     

How Can Research Keep Up With eHealth? Ten Strategies for Increasing the Timeliness and Usefulness of eHealth Research

Background

eHealth interventions appear and change so quickly that they challenge the way we conduct research. By the time a randomized trial of a new intervention is published, technological improvements and clinical discoveries may make the intervention dated and unappealing. This and the spate of health-related apps and websites may lead consumers, patients, and caregivers to use interventions that lack evidence of efficacy.

Objective

This paper aims to offer strategies for increasing the speed and usefulness of eHealth research.

Methods

The paper describes two types of strategies based on the authors’ own research and the research literature: those that improve the efficiency of eHealth research, and those that improve its quality.

Results

Efficiency strategies include: (1) think small: conduct small studies that can target discrete but significant questions and thereby speed knowledge acquisition; (2) use efficient designs: use such methods as fractional-factorial and quasi-experimental designs and surrogate endpoints, and experimentally modify and evaluate interventions and delivery systems already in use; (3) study universals: focus on timeless behavioral, psychological, and cognitive principles and systems; (4) anticipate the next big thing: listen to voices outside normal practice and connect different perspectives for new insights; (5) improve information delivery systems: researchers should apply their communications expertise to enhance inter-researcher communication, which could synergistically accelerate progress and capitalize upon the availability of “big data”; and (6) develop models, including mediators and moderators: valid models are remarkably generative, and tests of moderation and mediation should elucidate boundary conditions of effects and treatment mechanisms. Quality strategies include: (1) continuous quality improvement: researchers need to borrow engineering practices such as the continuous enhancement of interventions to incorporate clinical and technological progress; (2) help consumers identify quality: consumers, clinicians, and others all need to easily identify quality, suggesting the need to efficiently and publicly index intervention quality; (3) reduce the costs of care: concern with health care costs can drive intervention adoption and use and lead to novel intervention effects (eg, reduced falls in the elderly); and (4) deeply understand users: a rigorous evaluation of the consumer’s needs is a key starting point for intervention development.

Conclusions

The challenges of distinguishing and distributing scientifically validated interventions are formidable. The strategies described are meant to spur discussion and further thinking, which are important, given the potential of eHealth interventions to help patients and families.     

eHealth Literacy Interventions for Older Adults: A Systematic Review of the Literature

Background

eHealth resources offer new opportunities for older adults to access health information online, connect with others with shared health interests, and manage their health. However, older adults often lack sufficient eHealth literacy to maximize their benefit from these resources.

Objective

This review evaluates the research design, methods, and findings of eHealth literacy interventions for older adults.

Methods

A systematic review of peer-reviewed research articles from 28 databases in 9 fields was carried out in January 2013. Four rounds of screening of articles in these databases resulted in a final sample of 23 articles.

Results

Findings indicated a significant gap in the literature for eHealth literacy interventions evaluating health outcomes as the outcome of interest, a lack of theory-based interventions, and few studies applied high-quality research design.

Conclusions

Our findings emphasize the need for researchers to develop and assess theory-based interventions applying high-quality research design in eHealth literacy interventions targeting the older population.     

Quality assessment of data discrimination using self-organizing maps

MotivationOne of the important aspects of the data classification problem lies in making the most appropriate selection of features. The set of variables should be small and, at the same time, should provide reliable discrimination of the classes. The method for the discriminating power evaluation that enables a comparison between different sets of variables will be useful in the search for the set of variables.ResultsA new approach to feature selection is presented. Two methods of evaluation of the data discriminating power of a feature set are suggested. Both of the methods implement self-organizing maps (SOMs) and the newly introduced exponents of the degree of data clusterization on the SOM. The first method is based on the comparison of intraclass and interclass distances on the map. Another method concerns the evaluation of the relative number of best matching unit’s (BMUs) nearest neighbors of the same class. Both methods make it possible to evaluate the discriminating power of a feature set in cases when this set provides nonlinear discrimination of the classes.AvailabilityCurrent algorithms in program code can be downloaded for free at http://mekler.narod.ru/Science/Articles_support.html, as well as the supporting data files.     

便携式甲醛测定仪测定方法及其应用

目的：了解便携式甲醛测定仪使用方法及在现场检测中的应用,掌握气体的体积浓度与质量浓度的数据换算。方法使用理研FP-30型甲醛测定仪对空气中的甲醛含量进行检测。结果对14个办公场所进行了监测,甲醛最高浓度大于1.23mg/m3,42.9%(6/14)办公场所的超过国家限值0.08 mg/m3的标准。相对偏见差为17.5%,在平行双样分析相对偏差允许值范围内。结论理研FP-30型甲醛测定仪体积小便于携带、操作简单、检测过程时间短,结果相对稳定,适用于空气中甲醛的现场检测工作。     

提高儿科门诊护理服务质量的体会

随着医学模式的转变,现代护理学的发展,护理的功能已从单纯的护理转向护理、预防、康复和保健等综合性护理。护士的职能在扩大,健康教育已经成为护理工作的一项重要内容。我院近年来,使用科学的护理程序,在儿科门诊开展有效的护理健康教育,使患儿及家属在就诊及治疗、护理过程中掌握相关疾病的防治知识,改变不良的卫生习惯,提高了自我保健意识。在实施过程中,提高了护理人员的自身素质,改善了服务态度,从而提高了儿科门诊护理服务质量。     

Clinical competence in developmental‐behavioural paediatrics: Raising the bar

For our specialist paediatric workforce to be suitably equipped to deal with current childhood morbidity, a high level of competence in developmental‐behavioural paediatrics (DBP) is necessary. New models of training and assessment are required to meet this challenge. An evolution of training in DBP, built around the centrepiece of competency‐based medical education, is proposed. Summative assessment based upon entrustable professional activities, and a menu of formative workplace‐based assessments specific to the DBP context are key components. A pilot project to develop and implement these changes is recommended.     

Legislative Advocacy: Evaluation of a Grand Rounds Intervention for Pediatricians

ObjectiveTo evaluate the impact of a Grand Rounds Action Alert (GRAA) intervention on the behaviors, knowledge, and attitudes of pediatric grand rounds (GR) attendees; and to assess its acceptability.MethodsA cross-sectional, quasi-experimental study was performed at a freestanding children's hospital. GRAA on child health legislative topics were presented in the first 2 minutes of the pediatric GR session as well as posted outside. Each session included an action item, such as writing/signing letters to elected officials or informational sheets with legislator contact information. Main outcome measures included self-reported behavior, advocacy knowledge, attitudes, and acceptability.ResultsOne year after GRAA implementation, GR attendees with high exposure to the intervention were more likely to have written/signed a letter to a legislator compared to those with low/no exposure (60% vs 35%, P = .016). Those with high exposure were also more knowledgeable regarding financing of health care for low-income children (20% vs 5%, P = .027). Attitudes toward advocacy at baseline were positive: respondents agreed it is important to remain informed about (98%) and advocate for (94%) legislation favorable to children's health. Implementing this program was challenging, but the intervention was accepted favorably: 93% of respondents agreed that GRAA should continue.ConclusionsGRAA facilitated participation in legislative advocacy behaviors while improving self-perceived knowledge of legislative issues relating to children's health. They were well received in a large tertiary children's hospital.     

Tobacco use and smoking cessation among third‐year dental students in southern Brazil

The aim of the present cross‐sectional study was to assess tobacco use and smoking cessation among third‐year dental students in southern Brazil. The Global Health Professions Student Survey questionnaire was used in eight dental schools in Rio Grande do Sul state, Brazil. Of the 663 eligible students, 576 (87%) participated. The prevalence of current smoking was 19.1% [95% confidence interval (CI): 12.9–25.3%], and 61.6% (95% CI: 54.9–68.3%) of students reported having smoked at least once in their lifetime. The prevalence of dental students who had smoked ≥100 cigarettes in their lifetime was 17.1% (95% CI: 12.5–21.7%). Being frequently exposed to other smokers at home or in other places (second‐hand smoke) increased the likelihood of current smoking by two‐ to threefold. Approximately 6.1% (95% CI: 3.5–8.7%) of the students reported that they currently wanted to stop smoking and 7.5% (95% CI: 5.3–9.6%) had tried to stop smoking in the last year. Friends and family were the most frequent sources of help or counselling, and only a limited proportion of students received help from health professionals. Tobacco use and exposure to second‐hand smoking is widespread among dental students in southern Brazil. Smoking‐cessation initiatives targeting health care students are urgently needed.