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Background Interest is growing in simulation-based continuing medical education courses for practicing surgeons. However, little research has explored the instruction employed during these courses. This study examines instruction practices used during an annual simulation-based continuing medical education course. Methods Audio–video data were collected from surgeon instructors (n = 12) who taught a simulated laparoscopic hernia repair continuing medical education course across 2 years. Surgeon learners (n = 58) were grouped by their self-reported laparoscopic and hernia repair experience. Instructors’ transcribed dialogue was automatically coded for 5 types of responses to the following questions: anecdotes, confirming, correcting, guidance, and what not to do. Differences in these responses were measured against the progress of the simulations and across learners with different experience levels. Postcourse interviews with instructors were conducted for additional qualitative validation. Results Performing t tests of instructor responses revealed that they were significantly more likely to answer in forms coded as anecdotes when responding to relative experts and in forms coded as what not to do when responding to novices. Linear regressions of each code against normalized progressions of each simulation revealed a significant relationship between progression through a simulation and frequency of the what not to do code for less-experienced learners. Postcourse interviews revealed that instructors continuously assess participants throughout a session and modify their teaching strategies. Conclusion Instructors significantly modified the focus of their teaching as a function both of their learners’ self-reported experience levels, their assessment of learner needs, and learner progression through the training sessions.

Background Continuing medical education is important but time-consuming for general practitioners (GPs). Current learning approaches are limited and lack the ability to engage some practitioners. Serious games are new learning approaches that use video games as engaging teaching material. They have significant advantages in terms of efficiency and dissemination. Objective The aim of this study was to create a serious game and to evaluate it in terms of effectiveness and satisfaction, comparing it with a traditional method of continuing education—article reading. Methods We produced a prototype video game called Hygie on the 5 most common reasons of consultation in general practice using 9 articles from independent evidence-based medicine journals (reviews from Prescrire and Minerva). We created 51 clinical cases. We then conducted a double-blinded randomized trial comparing the learning provided by a week of access to the game versus source articles. Participants were GPs involved as resident supervisors in 14 French university departments of family practice, recruited by email. Primary outcomes were (1) mean final knowledge score completed 3 to 5 weeks after the end of the intervention and (2) mean difference between knowledge pretest (before intervention) and posttest (3 to 5 weeks after intervention) scores, both scaled on 10 points. Secondary outcomes were transfer of knowledge learned to practice, satisfaction, and time spent playing. Results A total of 269 GPs agreed to participate in the study. Characteristics of participants were similar between learning groups. There was no difference between groups on the mean score of the final knowledge test, with scores of 4.9 (95% CI 4.6-5.2) in the Hygie group and 4.6 (95% CI 4.2-4.9) in the reading group (P=.21). There was a mean difference score between knowledge pre- and posttests, with significantly superior performance for Hygie (mean gain of 1.6 in the Hygie group and 0.9 in the reading group; P=.02), demonstrating a more efficient and persistent learning with Hygie. The rate of participants that reported to have used the knowledge they learned through the teaching material was significantly superior in the Hygie group: 77% (47/61) in the Hygie group and 53% (25/47) in the reading group; odds ratio 2.9, 95% CI 1.2-7.4. Moreover, 87% of the opinions were favorable, indicating that Hygie is of interest for updating medical knowledge. Qualitative data showed that learners enjoyed Hygie especially for its playful, interactive, and stimulating aspects. Conclusions We conclude that Hygie can diversify the offering for continuing education for GPs in an effective, pleasant, and evidence-based way. Trial Registration ClinicalTrials.gov NCT03486275; https://clinicaltrials.gov/ct2/show/NCT03486275

BACKGROUND Professional medical associations (PMAs) play a crucial role in providing accredited continuing medical education (CME) to physicians. Funding from the pharmaceutical industry may lead to biases in CME. OBJECTIVE This study examines publicly available policies on CME, adopted by Canadian PMAs as of December 2015. METHODS Policies were evaluated using an original scoring tool comprising 21 items, two questions about PMAs' general and CME funding from industry, and three enforcement measures. RESULTS We assessed 236 policies adopted by Canadian PMAs (range, 0 to 32). Medical associations received summative scores that ranged from 0% to 49.2% of the total possible points (maximum score = 63). Twenty-seven associations received an overall score of 0%. The highest mean scores were achieved in the areas of industry involvement in planning CME activities (mean: 1.1/3), presence of a review process for topics of CME activities (mean: 1.1/3), content review for balanced information (mean: 1.1/3), and responsibility of distribution of funds (mean: 1.0/3). The lowest mean scores were achieved in the areas of awards (mean: 0.0/3), industry personnel, representatives, and employees (mean: 0.1/3), distribution of industry-funded educational materials at CME activities (mean: 0.1/3), and distinction between marketing and educational materials (mean: 0.1/3). CONCLUSION These results suggest that Canadian PMAs' publicly available policies on industry involvement in CME are generally weak or non-existent; therefore, the accredited CME that is provided to Canadian physicians may be viewed as open to bias. We encourage all Canadian medical associations to strengthen their policies to avoid the potential for industry influence in CME.

Background Addressing low HPV vaccination coverage will require U.S. health care providers to improve their recommendation practices and vaccine delivery systems. Because readily available continuing medical education (CME) could be an important tool for supporting providers in this process, we sought to assess the content of web-based CME activities related to HPV vaccination. Methods We conducted a content analysis of web-based CME activities about HPV vaccination available to U.S. primary care providers in May-September 2016. Using search engines, educational clearinghouses, and our professional networks, we identified 15 activities eligible for study inclusion. Through a process of open coding, we identified 45 commonly occurring messages in the CME activities, which we organized into five topic areas: delivering recommendations for HPV vaccination, addressing common parent concerns, implementing office-based strategies to increase HPV vaccination coverage, HPV epidemiology, and guidelines for HPV vaccine administration and safety. Using a standardized abstraction form, two coders then independently assessed which of the 45 messages each CME activity included. Results CME activities varied in the amount of content they delivered, with inclusion of the 45 messages ranging from 17% to 86%. Across activities, the most commonly included messages were related to guidelines for HPV vaccine administration and safety. For example, all activities (100%) specified that routine administration is recommended for ages 11 and 12. Most activities (73%) also noted that provider recommendations are highly influential. Fewer activities modeled examples of effective recommendations (47%), gave specific approaches to addressing common parent concerns (47%), or included guidance on office-based strategies to increase coverage (40%). Conclusions Given that many existing CME activities lack substantive content on how to change provider practice, future activities should focus on the practical application of interpersonal and organizational approaches for improving HPV vaccine delivery in the clinical setting.

Kristen K Hicks,Peter S Murano Texas A&M University, Department of Nutrition and Food Science, College Station, TX, USA Objective: The purpose of this research study was to determine whether a 1-hour online continuing medical education (CME) course focused on nutrition for type 2 diabetes would result in a gain in nutrition knowledge by practicing physicians. Methods: A practicing physician and dietitian collaborated to develop an online CME course (both webinar and self-study versions) on type 2 diabetes. This 1-hour accredited course was launched through the state-level medical association’s education library, available to all physicians. Results: Physicians (n=43) registered for the course, and of those, 31 completed the course in its entirety. A gain in knowledge was found when comparing pre- versus post-test scores related to the online nutrition CME (P

Objective To evaluate the effect of state continuing medical education (CME) requirements on physician clinical knowledge. Data Sources Secondary data for 19,563 general internists who took the Internal Medicine Maintenance of Certification (MOC) examination between 2006 and 2013. Study Design We took advantage of a natural experiment resulting from variations in CME requirements across states over time and applied a difference-in-differences methodology to measure associations between changes in CME requirements and physician clinical knowledge. We measured changes in clinical knowledge by comparing initial and MOC examination performance 10 years apart. We constructed difference-in-differences estimates by regressing examination performance changes against physician demographics, county and year fixed effects, trend–state indicators, and state CME change indicators. Data Collection Physician data were compiled by the American Board of Internal Medicine. State CME policies were compiled from American Medical Association reports. Principal Findings More rigorous CME credit-hour requirements (mostly implementing a new requirement) were associated with an increase in examination performance equivalent to a shift in examination score from the 50th to 54th percentile. Conclusions Among physicians required to engage in a summative assessment of their clinical knowledge, CME requirements were associated with an improvement in physician clinical knowledge.

Introduction Active learning and sequencing have been described as effective techniques for improving educational conferences. However, few departmental continuing medical education/graduate medical education (CME/GME) conferences, such as Grand Rounds (GR), have adopted these techniques. The purpose of this study was to describe the development, implementation, and evaluation of Friday Forum (FF), a weekly CME/GME conference that incorporated active learning and sequencing techniques into a new educational offering, complementary to GR, within a medium-sized academic pediatrics department. Methods Implemented in 2013, FF was designed to address 5 medically relevant themes in a sequential, rotating, interactive format, and included: (1) clinical reasoning, (2) evidence-based medicine, (3) morbidity & mortality, (4) research in progress, and (5) ethics. In 2018, at the conclusion of its fifth year, a survey and focus groups of faculty, residents, and fellows explored the relative value of FF compared with the departmental GR. Results Survey response rates for residents/fellows and faculty were 37/76 (48.7%) and 57/112 (50.9%), respectively. FF was rated highly for helping participants develop rapport with colleagues, exposing participants to interactive strategies for large-group teaching and value for time spent. GR was rated highly for helping participants learn about academic endeavors outside the department and emerging challenges in pediatrics. Qualitatively, two key themes emerged for FF: desire for interaction (community building) and topical variety. Discussion Using active learning and sequencing techniques, we implemented a novel CME/GME conference that enhanced our learning community by integrating the education of faculty and trainees, and achieved complementary objectives to GR.

Recent studies have documented that diet quality in the US is poor and linked to higher rates of cardiovascular disease (CVD), other non-communicable diseases, and total mortality. As a result, nutrition counseling in clinical practice is an evidence-based strategy endorsed by numerous stakeholders. However, medical nutrition education (MNE) in the US has been inadequate, and physician knowledge, competencies, and practices related to diet counseling have been documented to be insufficient. National scientific meetings and conferences offer opportunities to translate new scientific evidence, guidelines, and competencies to clinicians in attendance and to publicize this evidence widely. This review assessed the adequacy of, and trends in, nutrition education provided at recent major US scientific meetings that offer continuing medical education (CME), with a focus on CVD-related conferences. The authors found no reviews that have assessed the scope and type of nutrition-related educational programming at major conferences. We therefore investigated nutrition-related programming at CVD-related CME conferences in the US from 2013 to 2018. National scientific CVD-related conferences in the USA have offered variable amounts of programming related to practical applications of nutrition science. We did not observe an increase in nutrition-related offerings, despite the increase in diet-related diseases and the growing evidence base for the role of nutrition in the prevention and management of chronic disease. Increasing nutrition-related CME programming at national scientific meetings can lead to greater translation of nutrition evidence to patients by healthcare providers and improved health outcomes in the population.

Simulators have been widely adopted to help surgical trainees learn procedural rules and acquire basic psychomotor skills, and research indicates that this learning transfers to clinical practice. However, few studies have explored the use of simulators to help more advanced learners improve their understanding of operative practices. To model how surgeons with different levels of experience use procedural simulators, we conducted a quantitative ethnographic analysis of small-group conversations in a continuing medical education short course on laparoscopic hernia repair. Our research shows that surgeons who had less experience with laparoscopic surgery tended to use the simulators to learn and rehearse the basic procedures, while more experienced surgeons used the simulators as a platform for exploring a range of hernia presentations and operative approaches based on their experiences. Thus simple, inexpensive simulators may be effective with both novice and more experienced learners.

Electronic learning has changed the continuing medical education (CME) methods. For the first time, we aim to design, install, and launch an electronic CME (e-CME) system at our university, to integrate it with our National Continuing Medical Education Center of the Ministry of Health, to determine its effects on the midwives’ knowledge and problem-solving skills in postpartum hemorrhage (PPH), and their satisfaction with the electronic content and attitude toward the e-CME method. First, we designed and installed the learning management system (LMS) and integrated it with the national system. In the second phase, by the census, we applied it to 32 midwives through a quasiexperimental with a single-group pretest-posttest design. So, midwives used the electronic system in all five sessions and completed the research tools such as PPH knowledge, skills in solving problems, satisfaction with the content, and attitude toward e-CME before and after these sessions. Data were analyzed using the SPSS-16 software by the paired t-test, Wilcoxon, Friedman’s, and Pearson’s tests with a 95% confidence level. The levels of midwives’ PPH knowledge and problem-solving skills were both significantly improved ( p < 0.05 ). The total attitudes toward using e-learning CME for most participants were positive both before and after the intervention. After the intervention, there was a high satisfaction level (4.04 ± 0.16) with the electronic content among participating midwives. The positive results and successful use of e-learning by midwives lead to the achievement of the university’s mission of continuing medical education.

Conferences serve an essential means of learning and staying up to date in all aspects of medicine. Reproductive endocrinology and infertility is a young and constantly evolving field. The Midwest Reproductive Symposium International (MRSi) is a yearly conference held in Chicago, IL, and is one of the most intimate yet influential conferences in the fertility world. This conference is geared towards all professions and roles in the fertility world such as physicians, geneticists, nurses, allied health professionals, basic scientists, mental health professionals, business administration professionals, reproductive endocrinology and infertility fellows, and obstetrics and gynecology residents alike. The goal of MRSi is to continue to understand this revolutionary field in order to improve patient outcomes while staying up to date with the latest technology.

Background Continuing education aims at assisting physicians to maintain competency and expose them to emerging issues in their field. Over the last decade, approaches to the delivery of educational content have changed dramatically as medical education at all levels is now benefitting from the use of web-based content and applications for mobile devices. The aim of the present study is to investigate through a randomized trial the effectiveness of a smart phone application to increase public health service physicians’ (PHS physicians) knowledge regarding pediatric oral health care. Method Five of all seven DHCs (District Health Center) in Tehran, which were under the supervision of Tehran University of Medical Sciences and Iran University of Medical Sciences, were selected for our study. Physicians of one DHC had participated in a pilot study. All PHS physicians in the other four centers were invited to the current study on a voluntary basis (n = 107). They completed a self-administered questionnaire regarding their knowledge, attitudes, practice in pediatric dentistry, and background. PHS physicians were assigned randomly to intervention and control groups; those in the intervention group, received a newly designed evidence-based smartphone application, and those in the control group received a booklet, a CME seminar, and a pamphlet. A post-intervention survey was administered 4 months later and t-test and repeated measures ANCOVA (Analysis of Covariance) were performed to measure the difference in the PHS physicians’ knowledge, attitude and practice. Results In both groups, the mean knowledge scores were significantly higher (p-Value Conclusion In the light of the limitations of the present study, smart phone applications could improve knowledge, attitude and practice in physicians although this method was not superior to the conventional method of CME. Trial registration Our clinical trial had been registered in Iranian Registry of Clinical Trials (registration code: IRCT2016091029765N1).

Background Teaching Hospital Anuradhapura[THA] is the largest tertiary care hospital in Anuradhapura district(1100000 population, area 7179 km² with 82 health institutions). I held presidency of Anuradhapura Clinical Society(ACS),which is the leading clinical academic society in Northcentral Province and led the council(two secretaries, two treasurers and 46 council members) in 2018/2019. Main objective of ACS is to organise CMEs for healthcare professionals in the district(92 specialists & 357 doctors). Poor participation was evident especially from peripheries. Lack of awareness about CMEs, logistical difficulties to travel, difficulties in getting time-off were identifiable causes. Aims Improve participation of healthcare professionals of the Province in CMEs at THA. Methods Repeated discussions with the council members, administrators and medical officers covering all institutions were used to get ideas and feedback. Multiple interventions were implemented such as, innovative methods to increase awareness of CMEs(internet based social media, posting information flyers, phone reminders), supporting to get time-off, pre-arranged transportation for peripheral doctors, engaging target group in organising(giving ownership) and methods to attract participants. Involvement of eminent speakers, use of accessible and attractive external venues, organising events for other staff were done. Results Number of CMEs organised increased from 18 to 29(2018/19). Mean number of participants for an event increased from 62 to 91. Participation of doctors from peripheries and THA increased. Participation of peripheral doctors increased by 19.2 fold compared to 2017/18.378 other health professionals participated (54.7% from peripheries). Conclusions In comparison to 2017/18, participation and enthusiasm among health professionals about CMEs increased. Perseverance and innovation with maximum membership involvement, teamwork and multisectoral collaboration contributed to success.

To receive CME/MOC credit for this activity, please go to: http://acgjournalcme.gi.org/Article Title: Current Status of Endoscopic Resection of Gastric Subepithelial Tumors.

Background Several disasters over the past decade have highlighted the need for strong acute-care systems in Haiti. As part of a multifaceted approach to improving national acute-care training, the Research and Education consortium for Acute Care in Haiti (REACH) launched the inaugural Haiti Acute and Emergency Care Conference (HAECC). # Methods REACH is a Haitian-led, multinational collaboration based out of Saint Luc Hospital in Port-au-Prince. The first HAECC was held in April, 2017. Pre- and post-course evaluation consisted of subjective and objective components. Differences between pre- and post-responses were determined using McNemar's test of paired proportions. # Results 57 participants from 21 hospitals in five Haitian departments were included. The majority (37/58, 63.8%) were physicians. Most (33/57, 57.9%) had no prior training in acute or emergency care, but 8/57 (14.0%) had taken ATLS/ACLS, 11/57 (19.3%) had taken a formal course not internationally recognized, and only 1/57 (1.8%) had completed acute care specialty training. 43.7% (25/57) reported routine access to point-of-care ultrasound. Following course completion, participants felt significantly more comfortable managing basic emergency conditions (up to 25/57, 43.9% increase, *P*\

To receive CME/MOC credit for this activity, please go to: http://acgjournalcme.gi.org/Article Title: Diagnosis and Treatment of Rumination Syndrome: A Critical Review.

To receive CME/MOC credit for this activity, please go to: http://acgjournalcme.gi.org/Article Title: Opportunities to Prevent Alcoholic Liver Cirrhosis in High-Risk Populations: A Systematic Review and Meta-Analysis.

To receive CME/MOC credit for this activity, please go to: http://acgjournalcme.gi.org/Article Title: Influence of Dietary Restriction on Irritable Bowel Syndrome.

Background The Mobile Continuing Medical Education Project (mCME V.2.0) was a randomized controlled trial designed to test the efficacy of a text messaging (short message service [SMS])-based distance learning program in Vietnam that included daily quiz questions, links to readings and online courses, and performance feedback. The trial resulted in significant increases in self-study behaviors and higher examination scores for intervention versus control participants. Objective The objective of this mixed-methods study was to conduct qualitative and quantitative investigations to understand participants' views of the intervention. We also developed an explanatory framework for future trial replication. Methods At the endline examination, all intervention participants completed a survey on their perspectives of mCME and self-study behaviors. We convened focus group discussions to assess their experiences with the intervention and attitudes toward continuing medical education. Results A total of 48 HIV specialists in the intervention group completed the endline survey, and 30 participated in the focus group discussions. Survey and focus group data suggested that most clinicians liked the daily quizzes, citing them as convenient mechanisms to convey information in a relevant manner. A total of 43 of the 48 (90%) participants reported that the daily quizzes provided motivation to study for continuing medical education purposes. Additionally, 83% (40/48) of intervention participants expressed that they were better prepared to care for patients with HIV in their communities, compared with 67% (32/48) at baseline. Participation in the online coursework component was low (only 32/48, 67% of intervention participants ever accessed the courses), but most of those who did participate thought the lectures were engaging (26/32, 81%) and relevant (29/32, 91%). Focus group discussions revealed that various factors influenced the clinicians' decision to engage in higher learning, or "lateral learning," including the participant's availability to study, professional relevance of the topic area, and feedback. These variables serve as modifying factors that fit within an adapted version of the health belief model, which can explain behavior change in this context. Conclusions Qualitative and quantitative endline data suggested that mCME V.2.0 was highly acceptable. Participant behaviors during the trial fit within the health belief model and can explain the intervention's impact on improving self-study behaviors. The mCME platform is an evidence-based approach with the potential for adoption at a national scale as a method for promoting continuing medical education. Trial registration ClinicalTrials.gov NCT02381743; https://clinicaltrials.gov/ct2/show/NCT02381743.

Background: Despite the magnitude and impact of co-occurring physical and substance use disorders (SUDs) and evidence of effectiveness of integrated care, the training for management of comorbidities has been neglected. Our objective was to examine the effectiveness of 1-day continuing medical education (CME) in this area on participants' perceived and objective knowledge and skills. Materials and Methods: It was a cross-sectional study of CMEs conducted in a tertiary care center with a pre-post assessment design. Assessment included rating perceived knowledge and skill on a five-point scale and objective multiple-choice questions. Subjective feedback on qualitative aspects of the CME was taken. Out of total 154 participants, 69 completed pre-post assignments that included interactive lectures through multimodal presentations and problem-based learning. Pre-post comparisons were done by paired t-test and Wilcoxon signed-rank test. Results: Pre-CME assessment showed low mean scores (4.04 [1.75]) in objective (assessment to be added) and limited perceived knowledge and ability. However, objective knowledge assessment showed a significant improvement (P < 0.001) after the CME. Perceived knowledge and skills showed a significant positive (P < 0.001, all comparisons) change in all the four (CME-1) and seven (CME-2) domains assessed. CME was perceived to be excellent in terms of the practical value of material (60.3%), able to meet its stated objectives (60.3%), quality of instructions (58.8%), and organization of material (60.3%). Conclusion: CME is a viable option for training of psychiatrists to address the unmet need for treating co-occurring physical and SUDs. Future studies with experimental designs should determine the effectiveness of the components of CMEs.

To receive CME/MOC credit for this activity, please go to: http://acgjournalcme.gi.org/ Article Title: Participant‐Related Risk Factors for False‐Positive and False‐Negative Fecal Immunochemical Tests in Colorectal Cancer Screening: Systematic Review and Meta‐Analysis

This article discusses the steps the practical implementation of the system of continuing medical education in «forensic examination». The role of the Association of forensic experts in the organization of continuing medical education for members of the community. The analysis of types and forms of continuing education cycle. The procedure of accreditation of training activities, analyzed the possibility of accumulation of credits over a certain period.

Context Palliative care (PC) physicians are vulnerable for burnout given the nature of practice. The burnout frequency may be variable and reported between 24% and 38% across different countries. Objective The main objective of our study was to determine the frequency of burnout among PC physicians participating in PC continuing medical education course. Methods A survey including the Maslach Burnout Inventory—General along with 41 custom questions were administered to determine the frequency of burnout among physicians attending the 2018 Hospice and Palliative Medicine Board review course. Results Of 110 physicians, 91 (83%) completed the survey. The median age was 48 years with 65% being females, 81% married, 46% in community practice, 38% in practice for 6–15 years. PC was practiced ≥50% of the time by 62%, and 76% were doing clinical work. About 73 (80%) reported that PC is appreciated at their work, 58 (64%) reported insurance to be a burden, and 58 (64%) reported that the electronic medical record was a burden. About 82 (90%) felt optimistic about continuing PC in future. Maslach Burnout Inventory results suggest that 35 (38%) participants reported at least one symptom of burnout. Only being single/separated showed trend toward significance with burnout (P = 0.056). Conclusion Burnout among PC physicians who attended a board review course was 38%. Being single/separated showed trend toward association with burnout. Physicians who choose to attend continuing medical education may have unique motivating characteristics allowing them to better cope with stress and avoid burnout.

Background Dementia is the second leading cause of death in Australia. Over half of patients with dementia are undiagnosed in primary care. This paper describes the development, implementation and initial evaluation of the first national continuing medical education program on the timely diagnosis and management of dementia in general practice in Australia. Methods Continuing medical education workshops were developed and run in 16 urban and rural locations across Australia (12 were delivered as small group workshops, four as large groups), and via online modules. Two train-the-trainer workshops were held. The target audience was general practitioners, however, international medical graduates, GP registrars, other doctors, primary care nurses and other health professionals were also welcome. Self-complete questionnaires were used for the evaluation. Results Of 1236 people (GPs, other doctors, nurses and other health professionals) who participated in the program, 609 completed the full program (small group workshops (282), large group workshops (75), online modules (252)); and 627 elected to undertake one or more individual submodules (large group workshops (444), online program (183)). Of those who completed the full program as a small group workshop, 14 undertook the additional Train-the-trainer program. 76% of participants felt that their learning needs were entirely met and 78% felt the program was entirely relevant to their practice. Conclusion Continuing medical education programs are an effective method to deliver education to GPs. A combination of face-to-face and online delivery modes increases reach to primary care providers. Train-the-trainer sessions and online continuing medical education programs promote long-term delivery sustainability. Further research is required to determine the long-term knowledge translation effects of the program.

The development of medical technology has largely enhanced physicians’ professional responsibilities. Besides, the emergence of consumer rights, patients’ awakening of human right awareness, and the intervention of insurance have healthcare quality and physicians’ professional abilities gradually become the focus of health policies. The importance of continuing medical education is therefore highlighted. With nonequivalent pretest posttest control group design, two hospitals in Hubei Province are studied. One is proceeded continuing medical education, while the other maintains the original situation without continuing medical education. The experimental study is preceded for half a year. The research results show that 1.continuing medical education would affect job stress, 2.continuing medical education would influence sleep quality, 3.job stress presents significantly negative effects on sleeping time in sleep quality, and 4.job stress shows remarkably negative effects on quality level in sleep quality. According to the results, suggestions are proposed, expecting to enhance healthcare staff’s physiological and psychological health, promote job safety and performance, reduce medical incidents, and enhance healthcare service quality.

Continuing medical education (CME) and work-shops go a long way to update and refresh medical education of the medical practitioners and help them to stay updated about latest advances in the medical field which helps them to impart latest and better treatment to the patients. This article aims at reporting the evaluation of the effectiveness of the learning in terms of knowledge gained immediately after the workshop and to objectively quantify the knowledge gain from the CME program. Pre- and post-CME survey of knowledge by the way of multiple choice question questionnaire was used to assess the efficacy of the CME and the learning gain of the participants. 42 participants were included in the assessment of the gain in knowledge after the CME. An increase of 17.9% in the scores of the participants was seen at the end of the CME, with a learning gain of 38%. Educational activity like CME can improve the knowledge base of the intended participants. Further research is required to evaluate if education delivered in a short workshop of this nature is retained for any length of time and if it results in any change in practice that affects health outcomes.

Electronic modes of continuing medical education (eCME) can provide an appropriate and scalable way of updating the knowledge and skills of general practitioners (GPs). To optimize the adoption of eCME and develop efficient and cost-effective eCME programs, factors explaining GPs' intention to use eCME must first be elucidated.Using the Theory of Planned Behavior as a framework, we developed a questionnaire and administered it to GPs in seven CME seminars in Isfahan, Iran, in 2014. Three domains of GPs' intention to use eCME were measured: attitudes, perceived behavioral control, and subjective norms. We used linear and logistic regression to identify the main predictors of intention and behavior.GPs who had high score in perceived behavioral control and a more positive attitude toward e-learning had a higher intention to adopt it for CME. In contrast, subjective norms (eg, social pressures to use eCME) were not a predictor. Attitude toward usefulness of eCME was the main predictor of being an actual eCME user.Perceived behavioral control and attitude constitute the main predictors of the intention to use eCME. Establishing discussions forums and strengthening organizational support for eCME through an increased awareness among clinical superiors and CME managers would be expected to increase GPs' intention to use eCME.

INTRODUCTION: As the health consequences of climate change (CC) will likely become more manifest in the future, family physicians have to be knowledgeable about these impacts and the ways in which they can affect their patients. The main aim of this study was to propose a competency framework and questionnaire used to conduct a needs analysis to identify and prioritize family physicians' real educational needs regarding the health impacts of CC. METHODS: A mixed method combining a qualitative interview and a quantitative online questionnaire was used (n = 24 physicians). The interview assessed key beliefs related to participating in an online continuing medical education (eCME) activity on the health impacts of climate change, and the perception of the key factors or conditions required to ensure the family physicians' satisfaction with this eCME activity. The questionnaire assessed the current and desired levels of competency on five general training themes: general knowledge about CC; heat-related illnesses; CC, extreme weather events and modification of vector-borne and zoonotic diseases; CC, extreme weather events and modification of water-borne diseases; and mental health impacts of natural disasters. RESULTS: Results revealed the need for improved medical education on climate change and health. Results also add to the literature by showing that a 3-hour eCME activity covering these topics would be useful and would allow family physicians to use this knowledge in their daily practice, notably through prevention and counseling. DISCUSSION: Introducing a CME needs assessment framework and a generic instrument that reflects family physicians' needs regarding the health impacts of CC has the added advantage of standardizing the assessmentprocedure.

Introduction This study provided physicians with continuing medical education (CME) related to type 2 diabetes and evaluated the effect on patient health outcomes. Methods Physicians participated in multi-platform CME (live and online programs) and completed a 25 item questionnaire for patient baseline (3-months pre-CME activity) and follow-up visits (≥6-months post-CME activity). Changes in physician knowledge and patient health outcomes were evaluated. Results 34 physicians completed both phases of the CME curricula and submitted data for 264 patients. Significant improvements were observed in physician knowledge after the live (p

Introduction: Continuing Medical Education (CME) has been considered as a lifelong commitment for doctors to provide the optimal care for patients. Despite a long history of creating CME programs, outcomes are far from ideal. The present qualitative study aims to clarify the barriers affecting effectiveness of the CME programs in Iran based on the experiences of general practitioners. Methods: Sixteen general practitioners were recruited to participate in in-depth interviews and field observations concerning experiences with CME. The study was performed using a qualitative content analysis method. The codes, categories and themes were explored through an inductive process in which the researchers moved from specific to general. Results: The participants’ experiences identified a number of barriers, particularly insufficient interaction with the instructors; additional problems included the teachers’ use of an undifferentiated approach; unreal and abstract CME; and ignorance of the diverse reasons to participate in CME. Conclusion: Based on the study results, there are multiple barriers to effective implementation of CME in Iran. The key barriers include insufficient interaction between the trainees and providers, which must be considered by other stakeholders and program designers. Such interactions would facilitate improved program design, invite more specific tailoring of the education to the participants, allow for more effective educational methods and set the stage for outcome evaluation from the learners actually applying their new knowledge in practice. Replication of these findings with another sample would improve confidence in these recommendations, but these findings are broadly consistent with findings in the educational literature on improving the efficacy of CME.

Article Title: Hypercontractile Esophagus From Pathophysiology to Management: Proceedings of the PISA Symposium.

The medical profession has seen significant advancement in the availability of a variety of educational activities, across a range of formats and processes, to help physicians remain current and improve professional performance. The objectivity and quality of continuing medical education (CME) activities has been enhanced by the credit recognition systems of the American Academy of Family Physicians (AAFP), the American Medical Association (AMA), and the American Osteopathic Association (AOA). These credit systems also provide a metric for tracking compliance with a variety of regulatory requirements such as state medical licensure, hospital staff privileges, and health insurance plan participation, and are increasingly used as criteria for voluntarily obtaining and maintaining specialty certification and fulfilling requirements for membership in medical specialty societies. This article reviews the history of CME, the research that supports its value, and the opportunities that exist to address its challenges. It also explains how the Federation of State Medical Boards (FSMB) Maintenance of Licensure (MOL) framework incorporates and builds upon the research involving the effectiveness of CME for physician learning and improvement. Special focus is given to the CME credit systems and their features, the synergies among them, and the way in which various learning formats that can be certified for CME credit are aligned with the three recommended components of MOL.

The article considers vocational and pedagogic position reflection as an important component of medical vocational continuing education of doctors. According to the general hypothesis of the study, a special program for training vocational and pedagogic position reflection can contribute positively to medical caregivers’ vocational performance in treating patients, who experience troubles with medical compliance and adaptation to the disease. The key methods of the study include a literature survey and theoretical elaboration of the concept of the vocational and pedagogic position of a doctor reflection, meanwhile, the empirical research is based on formative pilot experiment, preceded and followed by testing medical learners’ personal reflexivity readinesses (by using Karpov’s questionnaire). The medical caregiver’s ‘reflective ability’ (Bogin) was considered as a source of doctors’ professionalization. Reflexivity was regarded as a key component of doctors’ preparedness to show empathy and to provide proper pedagogic support for hemodialysis patients, receiving audio-therapy. The results of the study show significant positive dynamics in learners’ cognitive sphere and critical thinking development, a high level of performance in role-played solving educational training healthcare cases, meanwhile personal reflexivity measurements have shown no statistically significant differences after training (according to Student’s t-test). The latter experimentation result testifies the personal nature of the reflexivity feature.

OBJECTIVE: Because there have been no published formal reviews on teaching of firearm safety, we set out to systematically locate and review the literature on curricula that educated physicians and other health care providers, residents across specialties, and medical students on how to counsel on firearm safety. METHODS: We searched for all papers with outcomes that described firearm safety training programs for healthcare providers and trainees. Studies were identified through PubMed, Scopus, Google Scholar, PsychInfo, EMBASE, and MedEdPortal databases and electronically searched using combinations of words from general topic areas of firearms, learners, and education. RESULTS: We found four programs that met inclusion criteria. These targeted a narrow range of learners including medical students, pediatric residents, practicing pediatricians, and nurse practitioners. Teaching methods included lectures, case-based learning, group discussions, and audiotape training. There were two randomized controlled trials, one cohort design, and one posttest design. One of the randomized controlled trials was an office-based high quality multisite national study, although the focus of teaching was not on firearm safety alone. All studies used different outcomes, and only one study validated the outcome measures. There were no studies targeting psychiatrists or psychiatry residents. CONCLUSION: These results underscore a priority for developing firearm safety education programs in undergraduate, graduate, and continuing medical education settings. Language: en

Most physicians who work in the United Nations Relief and Works Agency (UNRWA) infant and child health programme in Jordan are general practitioners with no postgraduate training in paediatrics. Furthermore, in resource-poor or remote settings, the ability to deliver live continuing medical education (CME) is often limited. A questionnaire exploring the resources available for accessing CME, preferences for types of CME, current sources of CME and topics of interest in the field of paediatric care was sent to all 92 physicians practising in UNRWA clinics in Jordan. Of the 89 respondents 80% had attended live medical lectures for CME and 70% CME meetings. Despite most physicians having access to the Internet only 52.8% were interested in Internet-based courses for accessing CME. There was a statistically significant relationship between year of graduation from medical school and preference for Internet-based CME. Implications for CME participation and paediatric CME topics are discussed.احتياجات أطباء الأونروا في الأردن وما يفضلونه بخصوص التعليم الطبي المستمر في مجال طب الأطفال.أروى عبد الحق ناصر، علي خضر، ليث ناصر، اشتيوي آبو زايد، أكيهيرو سيتا.إن معظم الأطباء الذين يعملون في برنامج صحة الرضع والأطفال التابع لوكالة الأمم المتحدة لغوث وتشغيل اللاجئن (الأونروا) في الأردن هم ممارسون عامون لم يدرَّبوا بعد التخرج عى طب الأطفال. وعاوة عى ذلك فإن القدرة عى تقديم تعليم طبي مستمر مباشر - في الأماكن شحيحة الموارد أو في المناطق النائية - غالباً ما تكون محدودة. فقد أُرسل لجميع الأطباء ال 92 الذين يمارسون العمل في عيادات الأونروا في الأردن استبيان لاستقصاء الموارد المتاحة والمصادر الحالية للتعليم الطبي المستمر، واستكشاف ما يفضلونه من أناط التعليم الطبي المستمر، والوقوف عى الموضوعات ذات الاهتام في مجال الرعاية الطبية للأطفال. فذكر % 80 من المجيبن ال 89 أنهم حروا محاضرات طبية مباشرة للتعليم الطبي المستمر، كا ذكر % 70 أنهم حروا اجتماعات للتعليم الطبي المستمر. وعى الرغم من أن معظم الأطباء تتوافر لديهم إمكانية الوصول إلى الإنترنت فإن % 52.8 منهم فقط كان مهتاً بدورات شبكة الإنترنت للحصول عى التعليم الطبي المستمر. وكانت هناك علاقة ذات دلالة إحصائية بن سنة التخرج من كلية الطب وبن تفضيل التعليم الطبي المستمر عن طريق شبكة الإنترنت. إن الآثار المترتبة عى المشاركة في التعليم الطبي المستمر ومواضيع التعليم الطبي المستمر في مجال طب الأطفال هي قيد المناقشة.Besoins et préférences en matière de formation médicale continue en pédiatrie des médecins exerçant en Jordanie de l’Office de secours et de travaux des Nations Unies pour les réfugiés de Palestine dans le Proche-Orient.La plupart des médecins qui travaillent pour le programme de santé du nourisson et de l’enfant en Jordanie à l’Office de secours et de travaux des Nations Unis pour les réfugiés de Palestine dans le Proche-Orient (UNRWA) sont des médecins généralistes sans spécialisation en pédiatrie. Par ailleurs, dans un contexte de ressources limitées ou dans des zones isolées, la capacité à dispenser une formation médicale continue (FMC) est souvent limitée. Un questionnaire étudiant les ressources disponibles qui permettent d’accéder à la formation médicale continue, les types de formation préférés, les sources actuelles de formation médicale continue et les sujets d’intérêt dans le domaine des soins pédiatriques a été envoyé à l’ensemble des 92 médecins exerçant dans des cliniques de l’UNRWA en Jordanie. Sur un total de 89 répondants, 80 % avaient assisté en personne à des conférences médicales dans le cadre de la formation médicale continue et 70 % à des réunions de formation médicale continue. Si la plupart des médecins avaient accès à l'Internet, seuls 52,8 % étaient intéressés par des cours en ligne permettant d’accéder à la formation médicale continue. Il existait une relation statistiquement significative entre l’année de fin d’études en faculté de médecine et la préférence pour une formation médicale continue sur l'Internet. Les implications pour une participation à la formation médicale continue et les sujets de formation médicale continue en pédiatrie sont en cours de discussion.

Purpose: Due to the shortage in the healthcare workforce, insufficient qualifications, a lack of infrastructure and limited resources in Mongolia, it is not always possible for healthcare workers in rural areas who wish to attend continuous training and retraining courses to do so. However, in order to provide high-quality care, the demand for distance learning and the upgrading of knowledge and practice of many medical topics (especially related to morbidity and mortality) are necessary for the rural population. This study aimed to assess the needs of e-learning medical education, of graduates in Mongolia.Methods: A cross-sectional research design was implemented. We collected data from 1,221 healthcare professionals (nursing professionals, physicians, midwives, and feldshers) who were randomly selected from 69 government hospitals in Mongolia. Data were collected using self-assessment questionnaires which captured the needs assessment in a survey for online continuous medical education in Mongolia. Data were analyzed using descriptive statistics and Kruskal-Wallis statistical test.Results: Ninety percent of the respondents reported that they plan on attending online continuous medical education with the most preferred specialty area being emergency medicine. Results using the Kruskal-Wallis statistical technique suggested the preferred specialty area, educational content, appropriate time schedule, available devices, and tools were statistically significant and were different between the nursing professionals, physicians, midwives, and feldshers (p

ObjectivesThis study investigates the learning outcomes for peer reviewers participating in a manuscript review continuing medical education (CME) process. CME from serving as a peer reviewer is one of the many benefits of serving as a reviewer.DesignThis is a descriptive study retrospectively analysing learning outcomes self-reported by peer reviewers from 2013 to 2017 using a CME assessment framework.Setting, participants and primary outcome measuresParticipant data are from 1985 peer reviewers who completed 2413 manuscript reviews over 32 medical journals from 2013 to 2017 and completed the CME process after their prepublication manuscript review. 417 reviewer responses were practice behaviour change(s) that were studied in depth using an assessment framework on changes in knowledge, competence and performance.ResultsThe results show positive learning outcomes reported by reviewers at the knowledge, competence and performance behaviour levels as a result of reviewing manuscripts. Higher levels of learning outcomes are more frequently achieved when reviewers consult multiple sources when conducting reviews. Reviewer demographics, such as gender or years of experience, did not have a significant association to learning outcomes.ConclusionsManuscript Review CME is an effective way that learning within the peer reviewer process can occur and helps reviewers gain knowledge, improve competence and make changes to their professional practice at all stages of their careers. Journal publishers should emphasise and support reviewers through offering CME to reviewers and encourage consultation of multiple sources when conducting reviews, which is an added benefit and resource to help professionals continue their development.

Background Inadequate attention has been given to ensuring ongoing training to improve knowledge, skills and capacity of primary health care providers in low- and middle-income countries. The Hanoi Medical University, Vietnam is providing training sessions for physicians working in commune health stations (CHSs) in three mountainous, remote northern provinces in 2019. This article aims to assess these physicians’ knowledge of correct medical responses to emergencies in order to assess their training needs. Methods We conducted a cross-sectional study amongst doctors posted to CHSs located in 3 mountainous remote provinces of northern Vietnam. We used a self-administered questionnaire that comprised questions on common medical emergencies, maternal and child care, and non-communicable disease management. We performed Chi-square tests to assess the statistical significance of differences in the mean proportions of correct answers for each health care question category, and for differences in mean proportions of correct answers by doctor characteristics. Results In total 302 doctors were recruited to the study. More than half of the sample answered 30–50% of the questions correctly, followed by around a third who answered 50–70% correctly. Less than 2% of doctors answered more than 70% correct responses to the entire question set. There were statistically significant differences between question categories, with cardiovascular care questions answered correctly significantly less often than any of the categories (p Conclusion The findings reported here show that the doctors who participated in the study have relatively low knowledge on common emergencies, particularly to answer cardiovascular care questions. The results also support the need for continuing medical education to improve doctors’ knowledge, who are mostly practicing in resource limited remote settings.

Background After the fall of the Soviet Union in 1991, the existing process of Continuing Medical Education (CME) was decimated. The Fund for Armenian Relief (FAR) was able to leverage competitive educational fellowship programmes in existence, and harness new knowledge gained by returning fellows thus amplifying the impact on education and patient care in the regions of the republic of Armenia. Aims This manuscript describes a replicable novel amplification programme using a “train the trainer” model for CME in the republic of Armenia. We sought to identify challenges specific to physicians from the regions, and to examine the strengths of the CME programme that can serve as a model for programme development and improvement in countries facing similar challenges. Methods The manuscript details a descriptive and mixed method study that includes in-depth interviews and focus group discussions from 2015–2016. Conceptual content analysis was used to identify major themes from the transcripts. Results Challenges facing regional physicians in post-Soviet counties in transition, exemplified by Armenia, are profound. Exploration of themes related to perceived barriers to care in the regions included, physicians’ personal financial constraints, lack of up-to-date knowledge and equipment, lack of confidence, fear of criticism and of making incorrect diagnoses. Conclusions The FAR/CME programme presents an innovative way to amplify the knowledge of Armenian physicians upon their return from educational programme participation abroad in order to address challenges facing regional physicians.