Poster
# 5
Poster |
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6th Internet World Congress for Biomedical Sciences |
G. Reid(1), J.D. Denstedt(2), S. Das(3), R. deVere White(4), G. Brock(5), C. Evans(6), G. McLorie(7), J. Parker(8)
(1)(5)Lawson Research Institute - London. Canada
(2)University of Western Ontario - London. Canada
(3)(4)(6)University of California, Davis School of Medicine - Sacramento. United States
(7)University of Toronto - Toronto. Canada
(8)Axia Health - Calgary. Canada
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[Health Informatics] |
[Urology] |
Given that the number of papers published annually in the biomedical sciences is now approaching two million (26), means whereby health care professionals can best keep abreast of and integrate new knowledge into clinical practice are much studied. Indeed, the Research and Development Resource Base in Continuing Medical Education (RDRB/CME), maintained by McMaster University and University of Toronto, Canada, now contains over 8000 references to the literature of continuing health professional education (27,28).
Further, estimates of primary care practitioners who are not aware of, or do not use, new research and evidence relating to current practice range from 20% to 50% (29). Similarly, the level of current knowledge with relevance to clinical practice is known to decrease with number of years in practice (30,31,32,33). Yet, most medical professionals are highly motivated to maintain knowledge currency as personal standards of achievement and need to validate both knowledge base and practices are most often cited as the primary reasons for participating in continuing medical education programs (34).
The sheer volume of new knowledge published annually in the biomedical sciences, the growing interest in how best to maintain a professional knowledge base and practice standard and the challenges posed for health care professionals to remain current during the course of practice, all point to the need for ongoing knowledge and skill development to ensure both currency and relevance of care provided within an ever-changing health care environment (35).
Specialty certification for health care professionals and, specifically, physicians, has been documented as early as 1300 where Venetian licensed practitioners were required to attend annual refresher courses in anatomy (36). More recently, the need for systematic CME was first addressed by the American Medical Association in 1955 which, after much trial and error, led to the formation of the Accreditation Council for Continuing Medical Education (ACCME) (37,38,39,40,41,42).
Outside the United States, CME is receiving greater attention within many national and international organizations including the World Health Organization, European Union of Medical Specialists, World Federation for Medical Education, European Academy of Medical Training, the Royal Australasian College of Physicians, the Royal College of Physicians and Surgeons of Canada and others thereby making the quality and impact of CME on clinical performance and patient care issues of international interest and priority. Specifically, there appears to be growing agreement that clear accreditation guidelines, policies on ethical delivery of CME and determining and promoting competencies of CME providers are important requirements to establish professional and international standards of clinical competence and practice (43,44,45,46,47,48,49).
Yet, despite this growing attention and recognition of need to provide career-long learning opportunities to health care professionals, how best to design, implement and evaluate such programs remain incompletely understood (50,51,52,53,54,55).
Two fundamentally different approaches to continuing education, commonly utilized across a wide variety of continuing medical education programs, lie at the heart of this uncertainty: teacher-centered approach to learning and student-centered approach to learning (56). The teacher-centered approach to learning emphasizes the teacher and what is taught and involves conventional or "surface" strategies of teaching including lecturing and recall-based examinations. In contrast, student-centered learning emphasizes the learner as an active participant and what is learned by encouraging a "deep" approach to learning (57,58).
In the case of teacher-centered learning, such traditional styles of expert led teaching remain the cornerstone of continuing medical education (50,59). Yet, exclusive reliance on these methods to maintain knowledge currency and competent clinical practice has proven ineffective in achieving meaningful or permanent change in practice behaviors (60,61).
For example, Davis and colleagues (51,52,60,62) published a series of reports wherein the literature concerning effectiveness of different types of educational interventions in improving health professional performance and health outcomes was evaluated.
While the number of studies which satisfied the authors’ criteria for inclusion was relatively small, when used as the primary method of continuing medical education, "dissemination-only" strategies, such as formally planned conferences or review of education materials, including clinical guidelines, demonstrated little or no change in health professional behavior and had no discernable effects on health outcome of patients. The authors conclude that teacher-centered means of continuing medical education, involving formal conferences or review of education materials, effect little meaningful impact on professional practice, a conclusion shared by others (50,63,64,65,66,67,68,69).
Similar results were reported by Lomas and colleagues who investigated the impact of newly published guidelines on the trial of labor and frequency of vaginal delivery in women with previous cesarean section (70). When used as the sole method of education, or in combination with clinical performance audit, independent review of these newly published guidelines had no impact on either trial of labor or vaginal delivery rates. However, when used in combination with other more creative approaches to continuing education, including reinforcement provided by an opinion leader in obstetrics, rates of both labor trial and vaginal delivery were significantly higher, 46% and 85%, respectively, while duration of hospital stay was significantly lower. Similar results have been reported by several others (71,72,73).
Reasons cited as to why teacher-centered learning appears to be ineffective are varied and none has been sufficiently studied to be conclusive (56). Such teaching methods may reduce learners to passive listeners, of whom little preparation or participation is required in evaluating individual clinical competence or performance (74).
Most teacher-centered activities are designed for large groups and, as such, cannot identify or address individual learning needs and provide limited, if any, opportunity for individual engagement and feedback. Furthermore, knowledge gained through such venues is recall-based, which may not be accurately or completely remembered in patient care situations (75).
Donen (35) argues that such conventional or surface approaches to continued learning frequently mandate only attendance as evidence of participating in a continuing medical education event. Providing only evidence of attendance offers no guarantee of meaningful and permanent changes in attitude, motivation or current practice patterns. Further, such programs are not typically developed following principles of adult learning and, as such, may be interpreted as punitive by health care professionals who are, in the main, strongly motivated to engage in student-centered learning activities.
Finally, specific education strategies utilized in teacher-centered venues frequently involve heavy workloads, provide excessive amounts of course material, offer little opportunity to either choose or explore subjects in depth, involve means of evaluation which frequently provoke anxiety and reward only recall of factual information (56).
Yet, teacher-centered strategies, including formally planned conferences and reading materials, do provide effective venues for health care professionals to keep abreast of new developments in health care and should not be completely dismissed as inadequate methods of imparting up-to-date information (42). This is particularly true when the objectives of such events and venues are clearly defined and communicated to attendees and participants (76).
In contrast to teacher-centered approaches to learning, there is growing consensus that continuing medical education venues grounded in principles of both adult and student-centered learning may lead to greater and more permanent changes in clinical knowledge and performance (56,77,78,79,80).
Adult and student-centered approaches to learning are the educational strategies most likely to produce health professionals prepared for life-long learning and able to meet the ever changing needs and demands of the health care setting. Such approaches foster "deep" learning and provide a context in which students are highly motivated, actively take part in learning and explore and navigate through a well structured knowledge base. Further, adult and student-centered approaches to learning appear most effective when learning is experience-based wherein new knowledge and understanding are easily integrated into both personal and professional contexts of a learner (81).
The table below summarizes key elements of both adult and student-centered learning (Adapted from 56, 82, 83):
Table 4. Key Elements of Adult and Student-centered Learning
| Strategy | Key Elements |
| Student-centered Learning | The student initiates the following:
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| Adult Learning | The student is motivated by learning which:
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Several formats for adult and student-centered learning have been developed including both "problem-based learning" and "guided discovery learning". Problem-based learning is receiving considerable attention in the education and medical literature and is generally understood to mean a strategy whereby students identify clinical situations which require explanation and new knowledge. Understanding of underlying principles and concepts is gained through small group, collaborative, problem solving (56).
Some 10% of medical schools world-wide have adopted problem-based learning curriculums and recent evidence suggests that problem-based learning offers an effective alternative to more conventional means of learning by enhancing motivation to learn, improving knowledge recall and facilitating integration of new knowledge and learning into clinical practice (84,85,86,87,88).
Guided discovery learning combines both teacher-centered and student-centered approaches to learning which enable both discovery and exploration of knowledge, while making the learner responsible for mastery of understanding (89). Study guides are typically used to facilitate and guide student directed learning by establishing specific learning objectives, providing appropriate learning resources and enabling students to evaluate understanding of new knowledge (56).
While enthusiasm for student-centered strategies for continuing medical education is growing, research which clearly establishes these methods as preferential to teacher-centered means of learning is lacking and several authors suggest that, in addition to the need for further research, a combination of teacher-centered and student-centered approaches will likely prove most effective (56,90,91,92).
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[Urology] |
