Effective feedback for maintenance of competence: From data delivery to trusting dialogues

Canadian Medical Association Journal (Impact Factor: 5.96). 03/2013; 185(6). DOI: 10.1503/cmaj.121772
Source: PubMed
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    • "The extent to which practice changes occur following provision of MSF will be influenced by the acceptability of information perceived to be negative [25] and the manner in which positive motivation is encouraged [26]. The current study provides descriptive evidence for the value of supplementary assessment, conversation and individualised guidance for flagged physicians in the PAR program. "
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    ABSTRACT: Licensed physicians in Alberta are required to participate in the Physician Achievement Review (PAR) program every 5 years, comprising multi-source feedback questionnaires with confidential feedback, and practice visits for a minority of physicians. We wished to identify and classify issues requiring change or improvement from the family practice visits, and the responses to advice. Retrospective analysis of narrative practice visit reports data using a mixed methods design to study records of visits to 51 family physicians and general practitioners who participated in PAR during the period 2010 to 2011, and whose ratings in one or more major assessment domains were significantly lower than their peer group. Reports from visits to the practices of family physicians and general practitioners confirmed opportunities for change and improvement, with two main groupings -- practice environment and physician performance. For 40/51 physicians (78%) suggested actions were discussed with physicians and changes were confirmed. Areas of particular concern included problems arising from practice isolation and diagnostic conclusions being reached with incomplete clinical evidence. This study provides additional evidence for the construct validity of a regulatory authority educational program in which multi-source performance feedback identifies areas for practice quality improvement, and change is encouraged by supplementary contact for selected physicians.
    BMC Medical Education 09/2013; 13(1):121. DOI:10.1186/1472-6920-13-121 · 1.22 Impact Factor
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    ABSTRACT: The Royal College of Physicians and Surgeons of Canada, in 2001, implemented a mandatory maintenance of certification (MOC) program that is required for fellows to maintain membership and fellowship. Participation in the MOC program is one of the recognized pathways approved by provincial medical regulatory authorities in Canada by which specialists can demonstrate their commitment to continued competent performance in practice. This article traces the historical beginnings of the MOC program, highlighting the educational foundation and scientific evidence that influenced its philosophy, goals, and strategic priorities. The MOC program has evolved into a complex system of continuing professional development to facilitate and enable a "cultural shift'' in how we conceptualize and support the continuing professional development (CPD) of specialists. The MOC program is an educational strategy that supports a learning culture where specialists are able to design, implement and document their accomplishments from multiple learning activities to build evidence-informed practices. In the future, the MOC Program must evolve from assisting fellows to use effective educational resources "for credit" to enable fellows, leveraging a competency-based CPD model, to demonstrate their capacity to continuously improve practice. This will require innovative methods to capture learning and practice improvements in real time, integrate learning during the delivery of health care, expand automation of reporting strategies, and facilitate new sociocultural methods of emergent learning and practice change. Collectively, these directions will require a research agenda that will generate evidence for how transformative cultural change in continuing professional education of the profession can be realized.
    Journal of Continuing Education in the Health Professions 09/2013; 33(S1):S36-S47. DOI:10.1002/chp.21205 · 1.36 Impact Factor
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    ABSTRACT: Recently, more is being learned about the linkages among assessment, feedback, and continued learning and professional development. The purpose of this article is to explore these linkages and to understand how assessment and feedback can guide professional development and related practice change. It includes a brief review of conceptual models that guide learning and practice change in general, related to both formally structured continuing professional development (CPD) sessions and to self-directed individual activities, and draws on these to inform learning and change from assessment and feedback. However, evidence and theory show that using assessment and feedback for learning and change are not naturally intuitive activities. We propose a 4-phase facilitated reflective process for enabling engagement with assessment data and feedback and using it for learning and change, and explore the varied personal and contextual factors which are influential and require consideration. We end with practical implications and suggestions.
    Journal of Continuing Education in the Health Professions 09/2013; 33(S1):S54-S62. DOI:10.1002/chp.21202 · 1.36 Impact Factor
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