Update on Continuing Professional Development KT Initiatives

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

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

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

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

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

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

8. CPD Practice - Designing, providing, evaluating CPD interventions • N = 1 • N = small group • N= large group/ population • Academic detailing • Performance feedback & coaching • Foundation for Medical Practice Education, Practice-Based Small Groups • Workshops • Conferences (with interaction) • Webinairs (e.g., H1N1, 2009) • EBM websites (with interaction)

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

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

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

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

13. JCEHP 2011: 31(4) • INNOVATIONSUsing problem-based case studies to learn about knowledge translation interventions: An inside perspective • FORUM Tailoring interventions: Examining the evidence and identifying gapsReflections on knowledge brokering within a multidisciplinary research team

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

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

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

17. Planning Committee • Michael Allen, MD MSc(c) Dalhousie University • Francine Borduas, MD Université Laval • France Légaré, MD PhD Université Laval • Jocelyn Lockyer, PhD MHA University of Calgary • Ian Graham, PhD Vice-President KT, CIHR • Jeremy Grimshaw, MBChB PhD Ottawa University • Tanya Hill, MSc Dalhousie University • Francesca Luconi, PhD McGill University • Joan Sargeant, PhD Dalhousie University • Ivan Silver, MD MEd University of Toronto • Ingrid Sketris, PharmD MPA Dalhousie University • Sharon Straus, MD MSc University of Toronto • Heather Stenerson, MEd University of Saskatchewan

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

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

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

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

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

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

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

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

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

27. France CPD-KT initiatives and activities

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

41. Thank you!