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In this commentary, we will describe our study and report results that will be of interest to information and education professionals and researchers. Evidence-based medicine requires health professionals to keep up to date with new research-based knowledge. Canadian physicians must now participate in Continuing Medical Education (CME) activities. CME strives to improve clinician performance as well as patient health outcomes. Our study was aimed to assess whether physicians who participated in a CME program and expected health benefits for their patients following an elearning activity were more likely to have higher participation in the program in subsequent years. Weekly treatment Highlights were delivered by email to practicing family physicians across Canada, who rated them using the Information Assessment Method (IAM). The number of expected benefits for patients reported by participants during 2016 was plotted against the number of instances of participation in 2017. Results show that the number of expected benefits in 2016 was correlated with the number of IAM ratings in 2017.

Introduction: Defined as reviews of clinical aspects of a specific health problem published in peer-reviewed and non-peer-reviewed medical journals, offered without charge, continuing medical education (CME) articles form a key strategy for translating knowledge into practice. This study assessed CME articles for mention of evidence-based information on benefits and harms of available treatment and/or preventive options that are deemed essential for shared decision making (SDM) to occur in clinical practice. Methods: Articles were selected from 5 medical journals that publish CME articles and are provided free of charge to primary-care physicians of the Province of Quebec, Canada. Two individuals independently scored each article with the use of a 10-item checklist based on the International Patient Decision Aid Standards. In case of discrepancy, the item score was established by team consensus. Scores were added to produce a total article score ranging from 0 (no item present) to 10 (all items present). Results: Thirty articles (6 articles per journal) were selected. Total article scores ranged from 1 to 9, with a mean ([plus or minus] SD) of 3.1 [plus or minus] 2.0 (95% confidence interval 2.8-4.3). Health conditions and treatment options were the items most frequently discussed in the articles; next came treatment benefits. Possible harms, the use of the same denominators for benefits and harms, and methods to facilitate the communication of benefits and harms to patients were almost never described. No significant differences between journals were observed. Discussion: The CME articles evaluated did not include the evidence-based information necessary to foster SDM in clinical practice. Peer-reviewed and non-peer-reviewed medical journals should require CME articles to include this type of information. (Contains 2 tables and 1 figure.)

Introduction: The rapid increase in the use of the Internet for continuing education by physicians suggests the need to define quality criteria for accredited online modules. Methods: Continuing medical education (CME) directors from Canadian medical schools and academic researchers participated in a consensus process, Modified Nominal Group Technique, to develop agreement on the most important quality criteria to guide module development. Rankings were compared to responses to a survey of a subset of Canadian Medical Association (CMA) members. Results: A list of 17 items was developed, of which 10 were deemed by experts to be important and 7 were considered secondary. A quality module would: be needs-based; presented in a clinical format; utilize evidence-based information; permit interaction with content and experts; facilitate and attempt to document practice change; be accessible for later review; and include a robust course evaluation. There was less agreement among CMA members on criteria ranking, with consensus on ranking reached on only 12 of 17 items. In contrast to experts, members agreed that the need to assess performance change as a result of an educational experience was not important. Discussion: This project identified 10 quality criteria for accredited online CME modules that representatives of Canadian organizations involved in continuing education believe should be taken into account when developing learning products. The lack of practitioner support for documentation of change in clinical behavior may suggest that they favor traditional attendance- or completion-based CME; this finding requires further research. (Contains 1 table.)

Introduction: Considerable time and money are invested in continuing medical education (CME) for family physicians (FPs) but the effectiveness is uncertain. The participation of FPs as coordinators and teachers is not well known. The goal of this project was to describe the role of FPs in organizing and teaching CME events that are accredited for Fps. Methods: Information about accredited CME events occurring in Alberta and Nova Scotia was requested from universities, provincial chapters of the College of Family Physicians of Canada, and pharmaceutical companies. Location, coordinating site, organizing committee members, teaching faculty, and format were recorded from each event. The number and proportion of FPs involved in both organizing and teaching CME events accredited for FPs were calculated and compared. Results: A total of 314 CME events were collected, comprising a total of 1,472 hours of CME. From the CME events collected, there were 1,730 organizing committee members and 1,647 teachers. FPs constitute 59% of the organizing committees and 17% of the teachers. Significant differences in the numbers of FP planners and teachers were related to organizing group, format, location, and expected audience composition. Discussion: The accreditation requirement for FPs on organizing committees likely helps preserve a reasonable proportion of FP organizers but not teachers in FP CME. The proportions of true FP planners and teachers may actually be lower than planning documents indicate. Low level of family physician teachers in CME may be due to FPs' not selecting FP teachers, the FP teaching pool's being inadequate, or the organizing committee's being unaware of FPs who are knowledgeable in particular areas. (Contains 4 tables.)

Background: Repetitive transcranial magnetic stimulation (rTMS) is recommended in Canadian guidelines as a first-line treatment for major depressive disorder. With the shift towards competency-based medical education, it remains unclear how to determine when a resident is considered competent in applying knowledge of rTMS to patient care. Given inconsistencies between postgraduate training programmes with regards to training requirements, defining competencies will improve the standard of care in rTMS delivery. Objective: The goal of this study was to develop competencies for rTMS that can be implemented into a competency-based training curriculum in postgraduate training programmes. Methods: A working group drafted competencies for postgraduate psychiatry trainees. Fourteen rTMS experts from across Canada were invited to participate in the modified Delphi process. Results: Ten experts participated in all three rounds of the modified Delphi process. A total of 20 items reached a consensus. There was improvement in the Cronbach's alpha over the rounds of modified Delphi process (Cronbach's alpha increased from 0.554 to 0.824) suggesting improvement in internal consistency. The intraclass correlation coefficient (ICC) increased from 0.543 to 0.805 suggesting improved interrater agreement. Conclusions: This modified Delphi process resulted in expert consensus on competencies to be acquired during postgraduate medical education programmes where a learner is training to become competent as a consultant and/or practitioner in rTMS treatment. This is a field that still requires development, and it is expected that as more evidence emerges the competencies will be further refined. These results will help the development of other curricula in interventional psychiatry. [ABSTRACT FROM AUTHOR]

This article provides an overview of problem-based learning (PBL) in Canadian undergraduate medical education and continuing medical education (CME) programs. The CME field in Canada is described, and the major professional associations that require physicians to take annual courses and programs are noted. A brief history of PBL in undergraduate medical education is presented, along with definitions of PBL and a discussion of the strengths and weaknesses of the approach. Problem-based learning in CME has been adapted, in some cases, to suit its special circumstances; this is demonstrated by examples of how the CME departments of three universities have implemented PBL. Finally, the future of research in this field is reviewed.

Introduction: Although research in continuing medical education (CME) demonstrates positive outcomes of on-line CME programs, the effectiveness of and learners' satisfaction with interpersonal interaction in on-line CME are lower. Defined as faculty-learner or learner-learner interpersonal interaction, this study explores physicians' perceptions of and experiences in interactive on-line CME and factors influencing these. Methods: Focus groups and interviews were undertaken by three Canadian universities. Using purposive sampling, we recruited physicians based on their experiences with interactive on-line CME. Content analysis was applied first, followed by a comparative analysis to confirm themes and findings. Results: Physicians based their perceptions of interactive on-line CME by comparing it with what they know best, face-to-face CME. Although perceptions about access and technical competency remained important, two other themes emerged. The first was the capacity of on-line CME to meet individual learning preferences, which, in turn, was influenced by the quality of the program, the degree of self-pacing or self-direction, opportunity for reflection, and educational design. The second was the quality and quantity of interpersonal interaction, which was shaped by perceptions of social comfort, the educational value of interactions, and the role of the facilitator: Prior experience with on-line CME moderated perceptions. Discussion: The extent that on-line CME programs reflected characteristics of high-quality CME and individual learning preferences appeared to shape perceptions about it. It is important to incorporate the characteristics of effective CME into the design and implementation of interactive on-line programs, considering diverse learning preferences, providing faculty development for on-line facilitators, and grounding this work in learning theory.

Five teleconferences were held at 6-week intervals following a train-the-trainer workshop for continuing medical education facilitators. Participants felt more prepared to facilitate due to participation in the teleconferences. Teleconferences were an effective way to provide follow-up and reinforcement for workshop participants at a distance. (Contains 39 references.) (SK)

Responses from 112 general practitioners in Quebec who organize continuing medical education and interviews with 18 identified their skill and knowledge needs in the areas of needs assessment, adult education principles, and group leadership techniques. Their primary problems included motivating and maintaining physicians' interest in formal continuing education. (SK)

Responses from 53% of 2,300 British Columbia physicians were used to create a list of 375 educationally influential physicians. These opinion leaders will serve as resources for formal and informal continuing medical education. (SK)

Physicians in three communities (n=31) participated in four problem-based learning modules via videoconferencing. Posttest scores were 20% higher and learners reported an average of nine practice changes. Facilitators and observers reported a number of technical difficulties. Facilitators found videoconferencing slightly more difficult than face-to-face facilitation. (SK)

Background: Despite the known benefits of active learning (AL), the predominate educational format in higher education is the lecture. The reasons for slow adaptation of AL in medical education are not well understood. The purpose of this survey was to determine knowledge, usage, attitudes, and barriers to AL use in academic Continuing Medical Education (CME). Method: A 20-item questionnaire was developed and sent with a link to an online questionnaire to the Society of Academic Continuing Medical Education (SACME) listserv of ~ 350 professionals representing academic medical centers, teaching hospitals, and medical specialty societies in the United States (U.S.) and Canada. Responses were collected with SurveyMonkey® from October–November, 2019. Data were analyzed using SPSS®. Results: Responses from 146 SACME members in 91 CME units yielded a ~ 42% survey response rate. Many respondents reported their self-perceived knowledge of AL as high. Advanced training (e.g., certificate, Master of Education degree) was positively correlated with AL knowledge. AL methods were reportedly used in half of the CME activities in the majority (80%) of institutions. Higher levels of self-perceived knowledge were correlated with an increased percentage of AL-related CME activities. Commonly perceived barriers to use of AL were presenters' lack of familiarity and a need for more time-consuming preparation. Conclusions: More efforts are needed to increase innovation and incorporate evidence-based AL strategies in medical education, especially to foster learner engagement, critical thinking, and problem-solving ability. [ABSTRACT FROM AUTHOR]

This study is to introduce an effective and systematic accreditation and evaluation system of continuing medical education (CME) and continuing professional development (CPD) in Korea, suitable for the future development, and based on the review of the characteristics of well-recognized systems implemented in western countries such as the US and Canada. CME and CPD comprise programs that expand the clinical knowledge and skills required of physicians as well as educational activities aiming to maintain, develop, and increase knowledge, specialized skills, or performance standards for provision of better medical services. These include not only self-directed activities but also official activities, such as leadership activities, professional development, and evaluation of the practitioner's level of knowledge and competence. Recently, continuing education for doctors has emphasized CPD, centered around learners, in a departure from CME, centered around educators. Each CME/CPD program in the US and Canada has unique features. However, they share common features of self-directed learning, competency-based education, and evaluation. Although there are remain problems, the Continuing Medical Education Accreditation and Evaluation Council of the Korean Medical Association, as a unique accreditation authority for CME, is currently developing a new CME/CPD system, which would constitute an idealistic onesystem for Korean physicians oriented toward future development, designed to fulfill standards equivalent to that of the Accreditation Council for Continuing Medical Education or any other internationally well-recognized organization. [ABSTRACT FROM AUTHOR]

A continuing medical education course on the physician-patient relationship used on such topics as patient-centered interviews. A majority of 406 respondents (including 205 in a follow-up survey) were using what they learned in practice. Additional workshops on issues of intimacy and difficult relationships were developed. (SK)

Two rural and two urban sites in Nova Scotia received continuing medical education via interactive videoconferencing. Although limited bandwidth and video and sound quality were concerns, 72% of 46 participants felt it was as effective as face-to-face instruction and appreciated not having to travel or lose work time. (SK)

This paper presents a review and comparison of qualitative improvements in the organization, needs assessment, educational methodology, evaluation, and research in continuing medical education in the United States and Canada. Accreditation, medical schools, medical societies and specialty boards, and health care systems and continuing medical education are discussed. (Author/MLW)

Supplemental Digital Content is Available in the Text. COVID-19 precipitated many CPD providers to develop new technology competencies to create effective online CPD. This study aims to improve our understanding of CPD providers' comfort level, supports, perceived advantages/disadvantages, and issues in technology-enhanced CPD delivery during COVID-19. A survey was distributed to CPD providers at the University of Toronto and members of the Society for Academic Continuing Medical Education and analyzed using descriptive statistics. Of the 111 respondents, 81% felt very to somewhat confident to provide online CPD, but less than half reported IT, financial, or faculty development supports. The top reported advantage to online CPD delivery was reaching a new demographic; top disadvantages included videoconferencing fatigue, social isolation, and competing priorities. There was interest in using less frequently used educational technology such as online collaboration tools, virtual patients, and augmented/virtual reality. COVID-19 precipitated an increased comfort level in using synchronous technologies to provide CPD, giving the CPD community an increased cultural acceptance and skill level to build on. As we move beyond the pandemic, it will be important to consider ongoing faculty development, particularly toward asynchronous and HyFlex delivery methods to continue expand CPD reach and negate negative online experiences such as videoconferencing fatigue, social isolation, and online distractions. [ABSTRACT FROM AUTHOR]

The Geriatric Psychiatry Fellowship Subspecialty survey aimed to identify key motivating factors associated with choosing geriatric psychiatry as a career, and to assess training satisfaction among geriatric psychiatry fellows/residents in Canada and the United States. American and Canadian geriatric psychiatry program directors were asked to distribute an online survey to their fellows. Descriptive statistics for quantitative items and Mann-Whitney U tests were performed to assess for differences by country of training. Thirty-one geriatric psychiatry fellows completed the survey. The most important motivating factors for pursuing a career in geriatric psychiatry were found to be "working with patients and families", "working in an interdisciplinary environment", and "intellectual stimulation". Fellows' overall training satisfaction was high, with American fellows more satisfied than Canadian residents (p = .047) on average, especially with regard to biomedical aspects of training (p = .01). [ABSTRACT FROM AUTHOR]

Background: Professional Identity formation is the process by which learners internalize a profession's values, behaviors, and perceptions. With respect to physicians, this occurs at multiple levels of medical education, including the undergraduate, graduate, and continuing medical education stages. Professional identity formation likely starts even earlier, during the undergraduate pre-medical years but, to date, no known scoping or systematic review has been conducted on this topic. The objective of this scoping review is to systematically map the literature on professional identity formation among undergraduate pre-medical students. Methods: This review protocol has been designed following the Arksey and O'Malley framework. We will search MEDLINE, CINAHL, Embase, and Scopus, as well as relevant grey literature, conference proceedings, and citations of selected articles. Inclusion criteria are articles (1) written in the English language, (2) involving undergraduate pre-medical students in the USA and Canada, and (3) containing original data about professional identity formation. Two independent reviewers will evaluate the titles, abstracts, and full articles for eligibility. A third reviewer will help resolve any disputes. Once the full text of articles are obtained, data will be abstracted using a standardized form. A narrative summary of findings will then be conducted, as well as a consultation exercise with university pre-medical students, pre-med advisors, and first-year medical students. Discussion: By conducting this scoping review, we expect to gain a better understanding of how the experiences of undergraduate pre-medical students impact their professional identity formation. These findings will help to identify gaps in the literature, to better characterize professional identity formation in the specific context of the undergraduate pre-medical track, and to outline potential approaches to facilitate professional identity formation among undergraduate pre-medical students. Systematic review registration: The protocol is registered with the Open Science Framework (htps://osf.io/nfzxc). [ABSTRACT FROM AUTHOR]

The article presents a study involving comparative analysis of the perceived continuing medical education (CME) needs of a group of rural and urban family physicians in Canada. It comprises Canadian family physicians who became Certificant members of the College of Family Physicians in 2001. Result shows that there is greater proportion of rural respondents reported to have higher CME needs in emergency medicine.

Background: Obtaining speakers for various continuing medical education (CME) programs can be a challenging and sometimes frustrating process. Purpose: The goal of this study was to quantify the difficulty in recruiting speakers for CME. Methods: A retrospective review of planning documents from three CME programs for family physicians was conducted. Descriptive analysis and analysis of variance testing was performed on the data collected. Results: In all three programs, obtaining speakers has become more difficult over the past 3 years with 1.75 [standard deviation (SD) = 1.46] to 2.32 (SD = 1.85) mean requests. Finding speakers for rural programs is more challenging than local CME sessions with 2.11 (SD = 1.78) compared with 1.68 (SD = 1.12) mean requests, respectively. University faculty represent 45.7% of CME speakers. Conclusions: This is the first study to document the increasing difficulty of recruiting speakers for CME. This significant difficulty in speaker recruitment has several implications for the CME offices and physician learners. [ABSTRACT FROM AUTHOR]

Background: Transgender people encounter significant barriers when seeking timely, high-quality healthcare, resulting in unmet medical needs with increased rates of diabetes, asthma, chronic obstructive pulmonary disease, and HIV. The paucity of postgraduate medical education to invest in standardization of transgender health training sustains these barriers, leaving physicians feeling unprepared and averse to provide transgender health care. Closing this education gap and improving transgender healthcare necessitates the development of consensus-built transgender health objectives of training (THOOT), particularly in Adult Endocrinology and Metabolism Residency programs. Methods: We conducted a two-round modified-Delphi process involving a nationally representative panel of experts, including Adult Endocrinology and Metabolism program directors, physician content experts, residents, and transgender community members, to identify THOOT for inclusion in Canadian Endocrinology and Metabolism Residency programs. Participants used a 5-point Likert scale to assess THOOT importance for curricular inclusion, with opportunities for written feedback. Data was collected through Qualtrics and analyzed after each round. Findings: In the first Delphi round, panelists reviewed and rated 81 literature extracted THOOT, achieving consensus on all objectives. Following panelists' feedback, 5 THOOT were added, 9 removed, 34 consolidated into 12 objectives, and 47 were rephrased or retained. In the second Delphi round, panelists assessed 55 THOOT. Consensus was established for 8 THOOT. Program directors' post-Delphi feedback further consolidated objectives to arrive at 4 THOOT for curriculum inclusion. Conclusions: To our knowledge, this is the first time a consensus-based approach has been used to establish THOOT for any subspecialty postgraduate medicine program across Canada or the United States. Our results lay the foundation towards health equity and social justice in transgender health medical education, offering a blueprint for future innovations. [ABSTRACT FROM AUTHOR]

Purpose: Learning is optimised when postgraduate trainees engage in clinical tasks in their zone of proximal development (ZPD). However, workplace learning environments impose additional non‐learning goals and additional tasks that may lead to trainees engaging in tasks that do not fall within their ZPD. We do not fully understand how trainees select clinical tasks in the workplace learning environment. If we knew the goals and factors they consider when selecting a task, we could better equip trainees with strategies to select tasks that maximise learning. We explored how postgraduate trainees select clinical tasks using echocardiography interpretation as a model. Methods: Canadian General Cardiology residents and Echocardiography fellows were invited to participate in semi‐structured interviews. Aligning with a theory‐informed study, two independent researchers used a deductive, directed content analysis approach to identify codes and themes. Results: Eleven trainees from seven Canadian universities participated (PGY4 = 4, PGY5 = 3, PGY6 = 1 and echocardiography fellows = 3). Goals included learning content, fulfilling assessment criteria and contributing to clinical demands. Trainees switched between goals throughout the day, as it was too effortful for them to engage in tasks within their ZPD at all times. When trainees had sufficient mental effort available, they selected higher complexity tasks that could advance learning content. When available mental effort was low, trainees selected less complex tasks that fulfilled numerically based assessment goals or contributed to clinical demands. Trainees predominantly used perceived complexity of the echocardiogram as a factor to select tasks to achieve their desired goals. Conclusion: Postgraduate trainees select tasks within their ZPD that enable them to maximise learning when they perceive to have sufficient mental effort available and workplace affordances are adequate. These findings can inform individual and systemic strategies to maximise learning when selecting tasks. Furthering understanding of workplace‐based learning, Blissett et al. demonstrate how trainees take on low complexity tasks to allow mental effort to recharge, thus facilitating maximal engagement with tasks within their Zone of Proximal Development. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The article reports on drug promotion related to continuing medical education (CME). It argues that sponsorship of the pharmaceutical industry in CME programs does not compromise the quality of medical research since quality measures are being implemented. It also discusses the College of Family Physicians of Canada (CFPC) and its process of accrediting CME programs.

An in-person multidisciplinary continuing medical education (CME) program was designed to address previously identified knowledge gaps regarding quality indicators of care in kidney cancer. The objective of this study was to develop a CME program and determine if the program was effective for improving participant knowledge. CME programs for clinicians were delivered by local experts (uro-oncologist and medical oncologist) in four Canadian cities. Participants completed knowledge assessment tests pre-CME, immediately post-CME, and 3-month post-CME. Test questions were related to topics covered in the CME program including prognostic factors for advanced disease, surgery for advanced disease, indications for hereditary screening, systemic therapy, and management of small renal masses. Fifty-two participants attended the CME program and completed the pre- and immediate post-CME tests. Participants attended in Ottawa (14; 27%), Toronto (13; 25%), Québec City (18; 35%), and Montréal (7; 13%) and were staff urologists (21; 40%), staff medical oncologists (9; 17%), fellows (5; 10%), residents (16; 31%), and oncology nurses (1; 2%). The mean pre-CME test score was 61% and the mean post-CME test score was 70% (p = 0.003). Twenty-one participants (40%) completed the 3-month post-CME test. Of those that completed the post-test, scores remained 10% higher than the pre-test (p value 0.01). Variability in test scores was observed across sites and between French and English test versions. Urologists had the largest specialty-specific increase in knowledge at 13.8% (SD 24.2, p value 0.02). The kidney cancer CME program was moderately effective in improving provider knowledge regarding quality indicators of kidney cancer care. These findings support continued use of this CME program at other sites.

Introduction: Physicians are often challenged with accessing relevant up-to-date arthritis information to enable the delivery of optimal care. An online continuing medical education programme to disseminate arthritis clinical practice guidelines (CPGs) was developed to address this issue. Methods: Online learning modules were developed for osteoarthritis (OA) and rheumatoid arthritis (RA) using published CPGs adapted for primary care (best practices), input from subject matter experts and a needs assessment. The programme was piloted in two rural/remote areas of Canada. Knowledge of best practice guidelines was measured before, immediately after completion of the modules and at 3-month follow-up by assigning one point for each appropriate best practice applied to a hypothetical case scenario. Points were then summed into a total best practice score. Results: Participants represented various professions in primary care, including family physicians, physiotherapists, occupational therapists and nurses (n = 89) and demonstrated significant improvements in total best practice scores immediately following completion of the modules (OA pre = 2.8/10, post = 3.8/10, P < 0.01; RA pre = 3.9/12, post = 4.6/12, P < 0.01). The response rate at 3 months was too small for analysis. Conclusions: With knowledge gained from the online modules, participants were able to apply a greater number of best practices to OA and RA hypothetical case scenarios. The online programme has demonstrated that it can provide some of the information rural/remote primary care providers need to deliver optimal care; however, further research is needed to determine whether these results translate into changes in practice. [ABSTRACT FROM AUTHOR]

Introduction: Referrals between generalists and specialists are a central component of the health care system and necessitate effective communication between the involved providers. Despite the high prevalence of patient referrals and their crucial role in continuity and quality of care, the medical literature demonstrates that generalists may receive little or no information about the care their patients received and little information about the appropriateness of the referral or recommendations for follow-up care. General practitioners (GPs) prefer teaching that is directly related to their clinical work rather than traditional continuing education such as formal lectures. The purpose of this review is to assess the role of referral reply letters in the continuing education of GPs. Methods: A comprehensive literature search was conducted to November 2001 using MEDLINE, EMBASE, the Cochrane Library, and the Research and Development Resource Base developed by Continuing Education, Faculty of Medicine, University of Toronto, to identify studies that examined the use of referral letters for the transfer of information from specialists to referring physicians. Data on methodology, unit of analysis, main outcome measures, and results were extracted. Results: Of 1,250 articles retrieved, 9 met the eligibility criteria. Three of these analyzed the content of referral reply letters and 6 described the results of surveys of general and specialty physicians. Discussion: Little educational content is currently included in letters from specialists to referring GPs. GPs are receptive to the use of referral replies as sources of learning. [ABSTRACT FROM AUTHOR]

Describes a project for assessing the content and format appropriate for the continuing education needs of practicing physicians, carried out by the Department of Bioethics and the Office of Continuing Education of Dalhousie University in Halifax, Nova Scotia. Method used for teaching medical ethics; Lack of systematic approach to the identification and analysis of ethical issues in medicine.

Introduction The purpose of this study is to assess whether annual refresher session offerings match the needs of physicians by coding and comparing session syllabi to physician questions collected electronically at the point of care. Methods Thirteen syllabi from annual refresher continuing medical education (CME) events offered to family physicians in Canada were collected and their session titles and descriptions entered into a database. Titles and descriptions were coded using the International Classification for Primary Care version 2 (ICPC-2). Titles and descriptions were further coded depending on whether the sessions involved a drug treatment/medication component. Syllabi content was compared to previously determined questions asked by physicians at the point of care. Results Of the original 701 session titles, 625 (89.2%) were suitable for analysis. CME sessions focused on musculoskeletal, digestive, skin, urologic, and general categories were underrepresented in comparison to point-of-care questions. The reverse was true for the psychological/mental health category. Discussion Differences between questions asked by physicians at the point of care and the content of contemporaneous CME refresher courses can be analyzed to identify gaps in CME offerings. This knowledge could be used to develop CME curricula and highlight areas of need for inclusion in refresher courses. [ABSTRACT FROM AUTHOR]

Introduction: Severe acute respiratory syndrome (SARS) struck Toronto in the spring of 2003, causing many deaths, serious morbidity, forced quarantine of thousands of individuals, and the closure of all provincial hospitals for several weeks. Given the direction by public health authorities to cancel or postpone all continuing medical education (CME) courses, including those sponsored by the University of Toronto Faculty of Medicine, SARS has had a profound effect on the delivery of CME in Toronto and beyond. Method: Case study design using existing documents and self-report. Results: The immediate, specific response of the University of Toronto CME program to SARS is described for the period from March 2003 to September 2003. Discussion: During major outbreaks of infectious disease, continuing education providers should maintain regular contact with public health authorities and learners, enact a rational process for postponing or canceling courses, and implement a disaster plan flexible enough to ensure the delivery of education using technological advances. [ABSTRACT FROM AUTHOR]

Background: Transgender individuals are discriminated against in health care environments and consistently experience poorer health outcomes than their cisgender counterparts. Enhancing physician training in transgender‐specific health is critical to closing the transgender health gap. Methods: We conducted a scoping review to identify transgender health training objectives in Internal Medicine and Internal Medicine Subspecialty residency programmes in Canada and the United States. A systematic search was conducted from 1946 to 15 February 2022. Studies were eligible for inclusion if they were written in English, included transgender training objectives, and were aimed at resident physicians in Internal Medicine or Internal Medicine Subspecialty training programmes in Canada or the United States. Findings: We found 4048 papers, of which 11 were included for analysis. Transgender health training objectives were synthesised into five themes, including (1) terminology, physiology, and gender presentation, (2) gender‐affirming care and communication, (3) hormonal and surgical management, (4) routine health management and maintenance, and (5) equity, diversity, and inclusion in clinical care. The majority of objectives pertained to equity, diversity, and inclusion in clinical care, namely, respectful communication and non‐judgemental care of transgender patients. Discussion Our findings provide a comprehensive overview of published transgender health objectives in Canada and the United States and highlight existing gaps in postgraduate medical education for Internal Medicine and Subspecialty programmes. Conclusions: We argue a need for standardisation of transgender‐related residency training and suggest that postgraduate Internal Medicine programmes can utilise this review as a framework to begin enhancing transgender health education for their residents. [ABSTRACT FROM AUTHOR]

The article reports on drug promotion related to continuing medical education (CME). It discusses that CME programs in Canada and the U.S. are sponsored by drug companies which influence the agenda of medical research. The article argues that CME programs should remain independent of commercial influences to safeguard the quality of studies in medicine.

Purpose: The authors investigated the impact of the use of an efficient multiple-choice question (MCQ) test-enhanced learning (TEL) intervention for continuing professional development (CPD) on knowledge retention as well as self-reported learning behaviors., Method: The authors conducted a randomized controlled trial comparing knowledge retention among learners who registered for an annual CPD conference at the University of Toronto in April 2016. Participants were randomized to receive an online preworkshop stand-alone MCQ test (no feedback) and a postworkshop MCQ test (with feedback) after a 14-day delay. Controls received no pre-/posttesting. The primary outcome measure was performance on a clinical vignette-based retention and application test delivered to all participants four weeks post conference. Secondary outcomes included self-reported changes in learning behavior, satisfaction, and efficiency of TEL., Results: Three hundred eight physicians from across Canada registered for the four-day conference; 186 physicians consented to participate in the study and were randomized to receive TEL or to the control group in 1 of 15 workshops, with 126 providing complete data. A random-effects meta-analysis demonstrated a pooled effect size indicating moderate effect of TEL (Hedges g of 0.46; 95% CI: 0.26-0.67). The majority of respondents (65%) reported improved CPD learning resulting from pretesting., Conclusions: Testing for learning can be leveraged to efficiently and effectively improve outcomes for CPD. Testing remains an underused education intervention in CPD, and the use of formative assessment to enhance professional development should be a key target for research.

Background: Implementation of the new competency-based post-graduate medical education curriculum has renewed the push by medical regulatory bodies in Canada to strongly advocate and/or mandate continuous quality improvement (cQI) for all physicians. Electronic anesthesia information management systems contain vast amounts of information yet it is unclear how this information could be used to promote cQI for practicing anesthesiologists. The aim of this study was to create a refined list of meaningful anesthesia quality indicators to assist anesthesiologists in the process of continuous self-assessment and feedback of their practice. Methods: An initial list of quality indicators was created though a literature search. A modified-Delphi (mDelphi) method was used to rank these indicators and achieve consensus on those indicators considered to be most relevant. Fourteen anesthesiologists representing different regions across Canada participated in the panel. Results: The initial list contained 132 items and through 3 rounds of mDelphi the panelists selected 56 items from the list that they believed to be top priority. In the fourth round, a subset of 20 of these indicators were ranked as highest priority. The list included items related to process, structure and outcome. Conclusion: This ranked list of anesthesia quality indicators from this modified Delphi study could aid clinicians in their individual practice assessments for continuous quality improvement mandated by Canadian medical regulatory bodies. Feasibility and usability of these quality indicators, and the significance of process versus outcome measures in assessment, are areas of future research. [ABSTRACT FROM AUTHOR]

The article presents a survey conducted to determine the latest trends in continuing medical education among obstetrician-gynecologists in connection to their maintenance of certification scheme. The survey was conducted among physician members of the American College of Obstetricians and Gynecologists in the U.S., Canada and Puerto Rico. The maintenance of certification program is a four-part scheme mandated by the American Board of Obstetricians and Gynecologists for board recertification.

Background: Hospital trauma teams consist of a diverse spectrum of health care professionals who work together to deliver quality care. Although the qualities of a well-performing trauma team are often believed to be self-evident, there is little objective information about the most desirable personal and professional characteristics associated with quality trauma care. The aim of this study was to determine the traits and characteristics deemed of greatest value for a trauma team leader and a trauma team member in the adult trauma care setting.Methods: Semistructured interviews were conducted with trauma team leaders and trauma team members at a tertiary Canadian trauma centre. Standard qualitative research methodology was used. Interviews were recorded, transcribed and analyzed via an inductive analysis approach.Results: Thematic saturation was achieved after 5 interviews, and 6 further interviews were conducted to ensure that a breadth of trauma care disciplines were included. Six attributes were identified to be of greatest value for trauma team leaders: communication, role clarity, experience, anticipation, management and decisiveness. Four attributes were identified to be of greatest value for trauma team members: engagement, efficiency, experience and collaboration. We further characterized the language defining the ranking of performance for each of these attributes.Conclusion: Results of this qualitative study involving an experienced and diverse spectrum of trauma team practitioners provide insight into the characteristics that are critical to establishing a “good” trauma team. These findings can be used to inform future determinations of the quality of trauma teams, the education of trauma practitioners and continuing medical education training and assessment tools. [ABSTRACT FROM AUTHOR]

Social medicine and health advocacy curricula are known to be uncommon in postgraduate medical education. As justice movements work to unveil the systemic barriers experienced by sexual and gender minority (SGM) populations, it is imperative that the emergency medicine (EM) community progress in its efforts to provide equitable, accessible, and competent care for these vulnerable groups. Given the paucity of literature on this subject in the context of EM in Canada, this commentary borrows evidence from other specialties across North America. Trainees across specialties and of all stages are caring for an increasing number of SGM patients. Lack of education at all levels of training is identified as a significant barrier to adequately caring for these populations, thereby precipitating significant health disparities. Cultural competency is often mistakenly attributed to a willingness to treat rather than the provision of quality care. However, positive attitudes do not necessarily correlate with trainee knowledge. Barriers to creating and implementing culturally competent curricula are plentiful, yet facilitating policies and resources are rare. While international bodies continuously publish position statements and calls to action, concrete change is seldom made. The scarcity of SGM curricula can be attributed to the universal absence of formal acknowledgment of SGM health as a required competency by accreditation boards and professional membership associations. This commentary synthesizes hand-picked literature in an attempt to inform healthcare professionals on their journey toward developing culturally competent postgraduate medical education. By thematically organizing evidence into a stepwise approach, the goal of this article is to borrow ideas across medical and surgical specialties to inform the creation of recommendations and make a case for an SGM curriculum for EM programs in Canada. [ABSTRACT FROM AUTHOR]

Objective: To assess the readiness of the Canadian otolaryngology community for an on-line continuing medical education (CME) program. Methods: Data were obtained through surveys mailed to members of the Canadian Society of Otolaryngology-Head and Neck Surgery. Results: Two hundred and eight of 321 (65%) surveys were returned. Seventy-six percent of the respondents indicated that they would be interested in participating in an on-line CMF, course. A greater proportion of younger otolaryngologists and those with community-based practices were interested in participating. A greater number of those with an academic practice were found to have convenient access to the Internet, the ability to post images on-line, and encountered cases they felt worthy of discussion and were willing to instruct/facilitate future on-line CMF. Ninety-three percent of respondents described having easy access to the Internet, but only 32% said that they have the equipment necessary to post computed tomographic scans/audiograms on-line. Twenty-three percent had previous computer-based CME experience. Sinusitis and related topics were of greatest interest, with hearing loss/ear surgery and oncology following respectively. Conclusions: The data suggest that on-line CME would be welcomed and are feasible in the Canadian otolaryngology community. [ABSTRACT FROM AUTHOR]

This study examined the effect of the Driving and Dementia Toolkit on physician knowledge and confidence gained and the anticipated change in patient assessment and evaluated the extent to which physicians found the material to be useful. Before receiving the driving toolkit, 301 randomly selected primary care physicians received a copy of the pretest questionnaire; 145 responded and met the eligibility criteria. This group was then sent the toolkit, a satisfaction a survey, and a posttest questionnaire. Physicians were faxed the questionnaires (with up to three reminders) and telephoned if necessary. Changes in pre- and posttest results were analyzed using the McNemar test and Wilcoxon signed rank test nonparametric procedures included in SPSS, Version 10.0, and paired-samples t test. Pre- and posttest data were available and could be matched for 86 physicians (59.3%) response. Knowledge and confidence increased significantly (P ≤.05) for most of the toolkit content questions. There was also a clear intent on the part of study participants to begin including additional pertinent questions in the patient/caregivers interview when assessing a patient's fitness to drive. On a scale from 1 (low) to 10 (high), overall satisfaction with the toolkit rated an average of 8.4. Use of the toolkit resulted in a clear improvement in physicians' reported knowledge of and confidence in dealing with dementia and driving. Future applications of similar innovative continuing education models can be used for other areas such as disclosure of dementia diagnosis, capacity assessments, or end-of life issues. [ABSTRACT FROM AUTHOR]

Several letters to the editor are presented in response to the article "The need for an Institute of Continuing Health Education," by Paul Hébert in the 2008 issue.

Part I. Evaluates Internet-based continuing medical education (CME), using a hybrid Web instructional delivery system at the Memorial University of Newfoundland's Telemedicine Center in Saint John's. Instructional benefits of Internet-based education; Model for the development of the hybrid system; Efficiency of computer-mediated CME.

Background: Implementing competency-based medical education (CBME) in post-graduate medical education (PGME) is a complex process that requires multiple systemic changes in a complex system that is simultaneously engaged in multiple initiatives. These initiatives often compete for attention during the implementation of CBME and produce unintended and unanticipated consequences. Understanding the impact of this context is necessary for evaluating the effectiveness of CBME. The purpose of the study was to identify factors, such as contexts and processes, that contribute to the implementation of CBME. Methods: We conducted a realist evaluation using data collected from 15 programs through focus groups with residents (2 groups, n = 16) and faculty (one group, n = 8), and semi-structured interviews with program directors (n = 18), and program administrators (n = 12) from 2018 to 2021. Data were analyzed using a template analysis based on a coding framework that was developed from a sample of transcripts, the context-mechanism-outcomes framework for realist evaluations, and the core components of CBME. Results: The findings demonstrate that simultaneous initiatives in the academic health sciences system creates a key context for CBME implementation – rivalries for attention – and specifically, the introduction of curricular management systems (CMS) concurrent to, but separate from, the implementation of CBME. This context influenced participants' participation, communication, and adaptation during CBME implementation, which led to change fatigue and unmet expectations for the collection and use of assessment data. Conclusions: Rival initiatives, such as the concurrent implementation of a new CMS, can have an impact on how programs implement CBME and greatly affect the outcomes of CBME. Mitigating the effects of rivals for attention with flexibility, clear communication, and training can facilitate effective implementation of CBME. [ABSTRACT FROM AUTHOR]

Background: Arts-based activities' roles in medical education is to challenge students to cultivate clinical skills using ART (aesthetics, reflection, time). ART activities offer opportunities for students to cultivate creative dimensions of their clinical skills and to reflect on their responses to uncertainty and ambiguity. Faculty, however, are challenged to structure these learning activities in diverse, sometimes unfamiliar, health care settings. Methods: This study explored preclerkship medical students' responses to participating in ART activities presented in the common medical educational format of an objective structured clinical exam (OSCE). Activities included interpreting fine art (eg, images and poetry) and drawing a simulated patient. The discussion section transcript and student sketchbooks were analyzed to identify themes related to participating in the study. Results: Use of arts-based activities elicited behaviors similar to those observed in students' responses to formal summative OSCEs, although students also wrestled with challenges and expressed their subjective impressions. Conclusions: This study offers an arts-based tool set capable of being delivered within the familiar medical education setting and established structure of the OSCE. [ABSTRACT FROM AUTHOR]