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Biomedical subjects

Joan Sargeant

Publications and source records attributed to Joan Sargeant.

18 recordsLinked to original sources
PubMed2006

Understanding the influence of emotions and reflection upon multi-source feedback acceptance and use.

INTRODUCTION: Receiving negative performance feedback can elicit negative emotional reactions which can interfere with feedback acceptance and use. This study investigated emotional responses of family physicians' participating in a multi-source feedback (MSF) program, sources of these emotions, and their influence upon feedback acceptance and use. METHODS: The authors interviewed 28 volunteer family physician participants in a pilot study of MSF, purposefully recruited to represent the range of scores. The study was conducted in 2003-2004 at Dalhousie University. RESULTS: Participants' emotional reactions to feedback appeared to be elicited in response to an internal comparison of their feedback with self-perceptions of performance. Those agreeing with their feedback; i.e., perceiving it as generally consistent with or higher than self-perceptions responded positively, while those disagreeing with their feedback; i.e., seeing it as generally inconsistent with or lower than self-perceptions, generally responded with distress. For the latter group, these feelings were often strong and long-lasting. Some eventually accepted their feedback and used it for change following a long period of reflection. Others did not and described an equally long reflective period but one which focused on and questioned MSF procedures rather than addressed feedback use. Participants suggested providing facilitated reflection on feedback to enhance assimilation of troubling emotions and interpretation and use of feedback. CONCLUSIONS: Negative feedback can evoke negative feelings and interfere with its acceptance. To overcome this, helpful interventions may include raising awareness of the influence of emotions, assisting recipients to focus their feedback on performance tasks, and providing facilitated reflection on feedback.

Education, Medical, Continuing↗
PubMed2006

Facilitating interpersonal interaction and learning online: linking theory and practice.

INTRODUCTION: An earlier study of physicians' perceptions of interactive online learning showed that these were shaped both by program design and quality and the quality and quantity of interpersonal interaction. We explore instructor roles in enhancing online learning through interpersonal interaction and the learning theories that inform these. METHODS: This was a qualitative study using focus groups and interviews. Using purposive sampling, 50 physicians were recruited based on their experience with interactive online CME and face-to-face CME. Qualitative thematic and interpretive analysis was used. RESULTS: Two facilitation roles appeared key: creating a comfortable learning environment and enhancing the educational value of electronic discussions. Comfort developed gradually, and specific interventions like facilitating introductions and sharing experiences in a friendly, informative manner were helpful. As in facilitating effective small-group learning, instructors' thoughtful use of techniques that facilitated constructive interaction based on learner's needs and practice demands contributed to the educational value of interpersonal interactions. DISCUSSION: Facilitators require enhanced skills to engage learners in meaningful interaction and to overcome the transactional distance of online learning. The use of learning theories, including behavioral, cognitive, social, humanistic, and constructivist, can strengthen the educational design and facilitation of online programs. Preparation for online facilitation should include instruction in the roles and techniques required and the theories that inform them.

Attitude of Health Personnel↗
PubMed2006

Learning in practice: experiences and perceptions of high-scoring physicians.

PURPOSE: To increase understanding of informal learning in practice (e.g., consulting with colleagues, reading journals) through exploring the experiences and perceptions of physicians perceived to be performing well. Objectives were to find out how physicians learned in practice and maintained their competence, and how they learned about the communication skills domain specifically. METHOD: Of 142 family physicians participating in a formal multisource feedback (360-degree) formative assessment, 25 receiving high scores were invited to participate in interviews conducted in 2003 at Dalhousie University Faculty of Medicine. Twelve responded. Interviews were 1.5 hours each, recorded, transcribed, and analyzed by the research team using accepted qualitative procedures. RESULTS: While formal learning appeared important to most, informal learning, especially through patients and colleagues, appeared to be fundamental. The physicians appeared to learn intentionally from practice and work experiences, and reflection appeared integral to learning and monitoring the impact of learning. Two findings were surprising: participants' conceptions of competence and perceptions that communication skills were innate rather than learned. CONCLUSIONS: These physicians' ways of intentional learning from practice concur with current models of informal learning. However, informal learning is largely unrecognized by formal institutions. Additionally, the physicians did not in general share notions of professional competence held by educators and others in authority. These findings suggest the need to make implicit content and learning processes more explicit. Additional research areas include exploring whether physicians across the range of performance levels demonstrate similar processes of reflective learning.

Adult↗
PubMed2006

Evaluation of learning outcomes in Web-based continuing medical education.

BACKGROUND: There has been significant growth in use of Web-based continuing medical education (CME) by physicians. A number of evaluation and metareview studies have examined the effectiveness of Web-based CME to varying degrees. One of the main limitations of this literature has been the lack of systematic evaluation across different clinical subject matter areas using standardized Web-based CME learning formats. METHOD: One group of pretest-postest designs were used to evaluate knowledge and self-reported confidence change across multiple Web-based courses using a standardized instructional format but comprising distinct clinical subject matter. Participants also completed a participant satisfaction survey and a self-reported retrospective skill/ability change survey. RESULTS: The majority of courses evaluated demonstrated significant pre to post knowledge and confidence effect size change, as well as significant self-reported retrospective practice change. CONCLUSIONS: A Web-based CME instructional format comprising multimedia-enhanced learning tutorials supplemented by asynchronous computer-mediated conferencing for case-based discussions was found to be effective in enhancing knowledge, confidence, and self-reported practice change outcomes across a variety of clinical subject matter areas.

Attitude of Health Personnel↗
PubMed2005

Exploring family physicians' reactions to multisource feedback: perceptions of credibility and usefulness.

PURPOSE: Physician performance is comprised of several domains of professional competence. Multisource feedback (MSF) or 360-degree feedback is an approach used to assess these, particularly the humanistic and relational competencies. Research studying responses to performance assessment shows that reactions vary and can influence how performance feedback is used. Improvement does not always result, especially when feedback is perceived as negative. This small qualitative study undertook preliminary exploration of physicians' reactions to MSF, and perceptions influencing these and the acceptance and use of their feedback. METHODS: We held focus groups with 15 family physicians participating in an MSF pilot study. Qualitative analyses included content and constant comparative analyses. RESULTS: Participants agreed that the purpose of MSF assessment should be to enhance practice and generally agreed with their patients' feedback. However, responses to medical colleague and co-worker feedback ranged from positive to negative. Several participants who responded negatively did not agree with their feedback nor were inclined to use it for practice improvement. Reactions were influenced by perceptions of accuracy, credibility and usefulness of feedback. Factors shaping these perceptions included: recruiting credible reviewers, ability of reviewers to make objective assessments, use of the assessment tool and specificity of the feedback. CONCLUSION: Physicians' perceptions of the MSF process and feedback can influence how and if they use the feedback for practice improvement. These findings are important, raising the concern that feedback perceived as negative and not useful will have no or negative results, and highlight questions for further study.

Attitude of Health Personnel↗
PubMed2005

The nature of the interaction between participants and facilitators in online asynchronous continuing medical education learning environments.

BACKGROUND: MDcme.ca offers an online asynchronous continuing medical education (CME) environment for family physicians. The nature of participation in online CME using computer-mediated conferencing (CMC) discussion systems and the characteristics of interaction between participants and facilitators is not well understood. PURPOSE: To examine the association between participant and facilitator participation in online asynchronous CME learning environments. METHODS: We analyzed registration and participation data including participant and facilitator postings to an asynchronous CMC discussion system for CME programs offered through MDcme.ca using frequency counts. Pearson r correlation was used to assess the association between numbers of participants and participant postings, facilitator postings and participant postings, and the number of discussion items accessed and participant postings. RESULTS: MDcme.ca offered 25 programs to 327 registrants, of whom 180 actually participated by accessing course materials and online discussion postings. Pearson r correlations showed a significant association between the number of participants and the number of postings, the number of facilitator postings and the number of participant postings, and the mean number of discussion items accessed by participants and the overall number of participant postings. DISCUSSION: Both the number of facilitator postings and the number of discussion items accessed by participants appeared to be important determinants of the amount of interaction that will occur in asynchronous online CME. Curriculum planners and facilitators of asynchronous CME need to be aware of the importance of fostering interactive, stimulating discussions if the potential of asynchronous learning for physicians is to reach its potential in supporting higher levels of critical, reflective, practice-based learning.

Attitude of Health Personnel↗
PubMed2005

Responding to rising cancer caseloads: family physician learning needs and challenges in cancer care.

BACKGROUND: In this study, we addressed physicians' learning needs and practice challenges throughout the continuum of cancer care using an interprofessional approach. METHODS: Data sources and tools included (1) 150 family physician questionnaires, (2) 11 oncologist interviews, (3) 13 focus groups with 125 health care providers, and (4) secondary sources. RESULTS: Family physicians wish to play a larger role in their cancer patients' care. Their self-reported learning needs were confirmed by other data sources. Important practice and systemic challenges to improving care exist. CONCLUSION: Decreasing cancer rates and improving cancer care are complex issues requiring educational interventions as well as organizational and communications initiatives.

Adult↗
PubMed2005

An incremental cost analysis of telehealth in Nova Scotia from a societal perspective.

We examined the costs of telehealth in Nova Scotia from a societal perspective. The clinical outcomes of telepsychiatry and teledermatology services were assumed to be similar to those for conventional face-to-face consultations. Cost information was obtained from the Nova Scotia Department of Health, the Canadian Institute for Health Information, and questionnaires to patients, physicians and telehealth coordinators. There were 215 questionnaires completed by patients, 135 by specialist physicians and eight by telehealth coordinators. Patient costs for a face-to-face consultation ranged from $240 to $1048 (all costs in Canadian dollars), whereas patient costs for telehealth were lower, from $17 to $70. However, from a societal perspective, the overall cost of providing face-to-face services was lower than for telehealth: the total costs for face-to-face services ranged from $325 to $1133, while the total costs for telehealth services ranged from $1736 to $28,084. A threshold analysis showed that, above a certain patient workload, telehealth services would be more cost-effective than face-to-face services from a societal perspective. This workload is attainable in Nova Scotia.

Costs and Cost Analysis↗
PubMed2004

Interactive on-line continuing medical education: physicians' perceptions and experiences.

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.

Attitude of Health Personnel↗
PubMed2004

Physician perceptions of the effect of telemedicine on rural retention and recruitment.

We conducted a postal survey of 140 family and community specialist physicians in a predominantly rural area which had received clinical telemedicine services and videoconferenced continuing medical education (CME) for two years. The questionnaire contained 46 items. The response rate was 47%. Most respondents (83%) reported having attended videoconferenced CME sessions and 45% reported having referred patients for teleconsultation. Physicians in more rural areas used these services more frequently. Ratings of two statements assessing the value of telemedicine in community support were significantly and positively correlated with the number of videoconferenced CME sessions attended and the number of telemedicine services used. In relation to their decision to stay in their community for at least one year, respondents rated telemedicine lower in importance than all but one of 17 other factors expected to influence physician recruitment and retention in rural communities. The influences on physician rural recruitment and retention are complex. However, telemedicine was used more frequently by the more rural physicians, and there was a relationship between higher usage and higher ratings of its value as a community support.

Adult↗
PubMed2003

Videoconferencing for practice-based small-group continuing medical education: feasibility, acceptability, effectiveness, and cost.

INTRODUCTION: Small-group, practice-based learning is an effective and well-accepted method of continuing medical education (CME). However, one limitation is that many physicians work in communities with fewer than the minimum number recommended for an effective learning group. Videoconferencing has the potential to remove this limitation. The purpose of this study was to evaluate the feasibility, acceptability, effectiveness, and cost of conducting practice-based, small-group CME learning by videoconference. METHODS: Through a videoconferencing link, 10 learners in three communities were guided through four practice-based learning modules by a trained facilitator at a fourth site. Data were collected through evaluation questionnaires, direct observation by the research team, pre- and post-knowledge tests, a focus group, and an interview. RESULTS: A total of 31 learners participated in the four modules. Videoconferencing was generally well accepted by learners. The facilitator and research team observers noted that muting microphones, video quality, audio quality, and audio lag all somewhat hindered discussion. Overall, the facilitator found moderating by videoconference only slightly more difficult than a face-to-face session. There was evidence of knowledge gain, with post-test scores being 20% higher than pretest scores (p = .006). Learners reported nine practice changes from taking the modules. At commercial rates, telecommunications costs per videoconferenced module were approximately CAN$1,200. DISCUSSION: Videoconferencing has the potential to bring the benefits of small-group, practice-based learning to many physicians; however, strict attention to videoconferencing techniques is required. Cost is also an important consideration.

Attitude of Health Personnel↗
PubMed2003

Videoconferenced grand rounds: needs assessment for community specialists.

INTRODUCTION: Grand rounds are a traditional means of continuing education for specialist physicians. The purpose of this study was to determine the need for and feasibility of interactive videoconferenced grand rounds between an academic health center and community specialists practicing in the three provinces served by the health center. METHODS: Using questionnaires, we studied two populations: the academic center's clinical department and division heads and community specialists in three provinces. RESULTS: We received 27 of 34 (79%) questionnaires from department heads. Nine reported that they already videoconferenced their rounds, 12 expressed a willingness to do so, and 4 responded that they may be interested. Fourteen departments responded that they were willing to include community specialists in planning and presenting. Using a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree), respondents rated the statement "Regional specialists would benefit from videoconferenced grand rounds" as 4.2. The return rate from community specialists was 333 of 876 (38%), of which 274 indicated that they would attend videoconferenced rounds, 42 said "maybe," and 9 said "no." Using the same 5-point scale, respondents rated both the following statements as 3.8: "Videoconferenced grand rounds would benefit me" and "These rounds would help me keep in touch with my colleagues." One hundred and two (31%) indicated that they would help plan rounds from the academic center. DISCUSSION: This study demonstrated the willingness on the part of one academic center to videoconference grand rounds to community specialists and interest from community specialists in participating. It raises logistical and educational issues, including scheduling and how to effectively include community physicians in needs assessment and planning. As requirements for specialists to participate in accredited learning activities become more rigorous, videoconferencing grand rounds may be one way to increase access to important learning activities.

Academic Medical Centers↗
PubMed2002

Helping family physicians improve their cardiac auscultation skills with an interactive CD-ROM.

INTRODUCTION: There have been few studies of the cardiac auscultation skills of residents and family physicians. This study assessed a group of family physicians' cardiac auscultation skills and use of a computerized self-instructional program to improve these skills. METHODS: Forty-two volunteer family physicians participated in an initial assessment of cardiac auscultation skills using test recordings of 12 common heart sounds. They were provided with a CD-ROM instructional program and were asked to devote 15 hours of self-study to the program and to return in 9 months for reassessment. RESULTS: The 42 family physicians in the initial assessment identified 39% of the heart sounds. Twenty-one returned for reassessment and showed significant improvement. Their initial mean score was 4.3 of 12 (35%), and their final mean score was 8.0 of 12 (67%). They found the CD-ROM program to be a valuable resource. The feature most liked was the unlimited opportunity to review sounds, cases, and tutorials. Most frequent problems related to computer access or skills. Eleven respondents reported using the program to resolve patient problems in their clinical practices. DISCUSSION: The cardiac auscultation skills of a group of volunteer family physicians showed low initial scores that improved significantly after self-study with a CD-ROM instructional program. The program was a valuable self-instructional aid, and physicians used it as a resource in clinical practice. However, only 50% of the initial group completed the self-study and returned for final assessment. Providing more support and assistance in the initial phase, especially with computer use, may enable completion of similar computerized self-study programs.

CD-ROM↗
PubMed2002

Implementing a communication skills programme in medical school: needs assessment and programme change.

INTRODUCTION: Communication skills training (CST) in medicine, once considered a minor subject, is now ranked a core clinical skill. To assess the state of formal and informal CST at Dalhousie Medical School a needs assessment was undertaken in 1997 with the goal of using these findings to plan and implement a new communication skills curriculum. OBJECTIVES: This article briefly describes the relevant findings of the needs assessment, the subsequent development of an integrated cross curriculum CST programme, and early programme evaluation results. METHOD: Surveys were completed by undergraduates at the end of pre-clinical (n=65), and clinical phases (n=82), residents (n=54), and faculty (n=117). Results revealed learners' and faculty's appreciation of the importance of CST, learners' assessment of training weaknesses in the delivery of CST, learners' weakness in higher order patient--doctor communication skills, and faculty weakness in assessing learners' communication skills competency. The results also indicated that CST was generally not being addressed either formally or informally in clinical medical education. RESULTS: The paper describes and discusses the subsequent implementation (beginning in 1998) of CST into the medical school curriculum. There is a description of programme development and evaluation at the pre-clinical, clerkship and postgraduate levels, a description and discussion of faculty development, and discussion of the importance of financial and administrative support for the programme. CONCLUSION: Programme evaluation results at all levels are positive.

Clinical Competence↗
PubMed2002

Videoconferencing for continuing medical education: from pilot project to sustained programme.

Videoconferencing has been used to provide distance education for medical students, physicians and other health-care professionals, such as nurses, physiotherapists and pharmacists. The Dalhousie University Office of Continuing Medical Education (CME) has used videoconferencing for CME since a pilot project with four sites in 1995-6. Since that pilot project, videoconferencing activity has steadily increased; in the year 1999-2000, a total of 64 videoconferences were provided for 1059 learners in 37 sites. Videoconferencing has been well accepted by faculty staff and by learners, as it enables them to provide and receive CME without travelling long distances. The key components of the development of the videoconferencing programme include planning, scheduling, faculty support, technical support and evaluation. Evaluation enables the effect of videoconferencing on other CME activities, and costs, to be measured.

Attitude of Health Personnel↗
PubMed2002

Evaluation of videoconferenced grand rounds.

We evaluated various aspects of grand rounds videoconferenced from a tertiary care hospital to a regional hospital in Nova Scotia. During a five-month study period, 29 rounds were broadcast (19 in medicine and 10 in cardiology). The total recorded attendance at the remote site was 103, comprising 70 specialists, nine family physicians and 24 other health-care professionals. We received 55 evaluations, a response rate of 53%. On a five-point Likert scale (on which higher scores indicated better quality), mean ratings by remote-site participants of the technical quality of the videoconference were 3.0-3.5, with the lowest ratings being for ability to hear the discussion (3.0) and to see visual aids (3.1). Mean ratings for content, presentation, discussion and educational value were 3.8 or higher. Of the 49 physicians who presented the rounds, we received evaluations from 41, a response rate of 84%. The presenters rated all aspects of the videoconference and interaction with remote sites at 3.8 or lower. The lowest ratings were for ability to see the remote sites (3.0) and the usefulness of the discussion (3.4). We received 278 evaluations from participants at the presenting site, an estimated response rate of about 55%. The results indicated no adverse opinions of the effect of videoconferencing (mean scores 3.1-3.3). The estimated costs of videoconferencing one grand round to one site and four sites were C dollars 723 and C dollars 1515, respectively. The study confirmed that videoconferenced rounds can provide satisfactory continuing medical education to community specialists, which is an especially important consideration as maintenance of certification becomes mandatory.

Attitude of Health Personnel↗
PubMed2002

Videoconferenced continuing medical education in Nova Scotia.

Videoconferencing has been used for continuing medical education (CME) in Nova Scotia since a pilot project to four communities in 1995. The Nova Scotia Telehealth Network was developed after the pilot project. Using the network, the videoconferenced CME programme expanded over the next few years until in, 2000-1, 66 programmes were broadcast to 38 sites. During the expansion of the programme, we improved video quality and developed efficient methods of: scheduling and planning the content of the videoconferences; training faculty presenters in videoconferencing techniques; and evaluation. We consider this programme represents a success. However, several aspects could be improved. Faculty members still need encouragement to make visual aids legible by videoconference and to provide handouts. Also, there has been little upgrading of equipment over the past four years and some reduction in the reliability of connections.

Education, Distance↗