Author: Brian S McGowan, PhD

Objectives There are various interventions for guideline implementation in clinical practice, but the effects of these interventions are generally unclear. We conducted a systematic review to identify effective methods of implementing clinical research findings and clinical guidelines to change physician practice patterns, in surgical and general practice. Study Design Systematic review of reviews. Methods We searched electronic databases (MEDLINE, EMBASE, and PubMed) for systematic reviews published in English that evaluated the effectiveness of different implementation methods. Two reviewers independently assessed eligibility for inclusion and methodological quality, and extracted relevant data. Results Fourteen reviews covering a wide range of interventions were identified. The intervention methods used include: audit and feedback, computerized decision support systems, continuing medical education, financial incentives, local opinion leaders, marketing, passive dissemination of information, patient-mediated interventions, reminders, and multifaceted interventions. Active approaches, such as academic detailing, led to greater effects than traditional passive approaches. According to the findings of 3 reviews, 71% of studies included in these reviews showed positive change in physician behavior when exposed to active educational methods and multifaceted interventions. Conclusions Active forms of continuing medical education and multifaceted interventions were found to be the most effective methods for implementing guidelines into general practice. Additionally, active approaches to changing physician performance were shown to improve practice to a greater extent than traditional passive methods. Further primary research is necessary to evaluate the effectiveness of these methods in a surgical setting.

via Changing physician behavior: what works? – PubMed – NCBI.

It is a significant challenge for any medical education program to provide adequate training in medical knowledge. It can be just as daunting to include appropriate opportunity to learn about and manage the emotional impact of illness experiences, the healing process, and provider-patient relationships. While there may be only a few basic changes to the core of medical knowledge, advances in medical practice regularly have an impact on the nature of patient care. Life-long learning is essential to maintain one’s competence. However, everything doctors and other medical professionals learn about relationships with patients during their training is relevant for the rest of their career. One primary source of this learning are reflective practices. However, there is no guide or description of or comparison among the distinguishing characteristics of reflective processes. In addition, there are no criteria for the selection or integration of reflective processes in medical training or beyond. This article proposes understanding reflection as a complex, three-level process and identifies dimensions which differentiate a variety of reflective process activities. The discussion includes considerations for selecting which activities might be usefully incorporated in education curricula, and identifies conditions of medical training cultures that will support successful integration.

via A guide to introducing and integrating reflective practices in medical education. – PubMed – NCBI.

BACKGROUND:
Journal club has become a signature pedagogy in postgraduate medical education. In this article, social learning theory, through the lens of “communities of practice” (CoP), is applied to elucidate the process of learning in journal club.
MATERIALS AND METHODS:
The study is a case study of a surgical journal club. Video recordings of 2 journal club sessions were followed by semistructured audio-recorded interviews with a sample of journal club participants. Thematic content analysis was performed, mapping data to themes arising based on the key tenets of CoP.
RESULTS:
Features of the 4 tenets of CoP learning (community, meaning, identity, and practice) were identified in both the video recordings of journal club and the participant interviews. A shared enterprise and common sense of purpose (community) was seen throughout the video recordings, but feelings of belonging to the community were much stronger for senior members (consultants/attending staff and senior trainees) compared with junior members (junior trainees and students). Experiences and perspectives were more commonly exchanged between senior trainees and consultants, with junior trainees not partaking in discussions, an example of newcomers beginning at the periphery. The main impediment to learning was found with low senior member attendance at journal club, thus limiting access to narratives of senior experience of practice and feedback.
CONCLUSIONS:
In attempting to improve journal club design for learning, ensuring the participation of senior community members and thus access to narratives of experience along with active engagement of junior members to allow them develop their own meaning should be incorporated into the journal club design.

via Surgical journal club as a community of practice: a case study. – PubMed – NCBI.