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Understanding the value added to clinical care by educational activities. Value of Education Research Group.

In an era of competition in health care delivery, those who pay for care are interested in supporting primarily those activities that add value to the clinical enterprise. The authors report on their 1998 project to develop a conceptual model for assessing the value added to clinical care by educational activities. Through interviews, nine key stakeholders in patient care identified five ways in which education might add value to clinical care: education can foster higher-quality care, improve work satisfaction of clinicians, have trainees provide direct clinical services, improve recruitment and retention of clinicians, and contribute to the future of health care. With this as a base, an expert panel of 13 clinical educators and investigators defined six perspectives from which the value of education in clinical care might be studied: the perspectives of health-care-oriented organizations, clinician-teachers, patients, education organizations, learners, and the community. The panel adapted an existing model to create the "Education Compass" to portray education's effects on clinical care, and developed a new set of definitions and research questions for each of the four major aspects of the model (clinical, functional, satisfaction, and cost). Working groups next drafted proposals to address empirically those questions, which were critiqued at a national conference on the topic of education's value in clinical care. The next step is to use the methods developed in this project to empirically assess the value added by educational activities to clinical care.

Ambulatory Care Facilities↗

Continuing education in general practice. 2. Impact of education activities.

Should continuing education for doctors be compulsory? Our study of General Practitioners in Queensland evaluated the usefulness of and preference for various types of educational activities. Lectures and consultants' letters were considered the most useful while pharmaceutical company evenings and visiting lecturers were most regularly attended. These latter activities were a useful source of medical knowledge: patient management skills were gained at weekend conferences; and procedural skills were obtained through hospital training courses.

Australia↗

Students' educational activities during clerkship.

PURPOSE: To quantify the educational activities and types of teachers that medical students had in third-year clerkships at community-based teaching hospitals. METHOD: In October-November 1992, 201 students in third-year medical clerkships at nine community-based hospitals completed a log that recorded the primary activity, site, and educator and method of education (for teaching or supervised activities) for each 15-minute interval of a 24-hour day. Each hospital offered at least three of the clerkships studied: medicine, obstetrics-gynecology (ob-gyn), pediatrics, psychiatry, and surgery. Statistical comparisons of the clerkships were done with chi-square analysis and one-way analysis of variance. RESULTS: The students received 6.5 hours a day of teaching with an instructor and committed an additional 4.9 hours to clerkship-related learning. Nearly 75% of the teaching fell to full-time faculty members and residents. In just over half of their educational activities the students participated with other learners, such as residents. The clerkships did not differ significantly in the amounts of formal teaching given; however, medicine did significantly more informal teaching, and surgery and ob-gyn did significantly more supervised practice. CONCLUSION: This preliminary study quantified medical students' educational activities in 1992 during third-year clerkships and provides baseline data describing these activities and the educators involved. Some findings may not be replicable, however, with the increasing demands of full-time faculty members in inpatient and outpatient settings and the shifting emphases in how and where residents provide instruction. Another study such as this one would help assess the effects on medical education of changes in the health care environment.

Analysis of Variance↗

Medical education and the ACGME duty hour requirements: assessing the effect of a day float system on educational activities.

BACKGROUND: In July 2003, the Accreditation Council for Graduate Medical Education (ACGME) instituted new resident work hour mandates, which are being shown to improve resident well-being and patient safety. However, there are limited data on the impact these new mandates may have on educational activities. PURPOSES: To assess the impact on educational activities of a day float system created to meet ACGME work hour mandates. METHODS: The inpatient ward coverage was changed by adding a day float team responsible for new patient admissions in the morning, with the on-call teams starting later and being responsible for new patient admissions thereafter. I surveyed the residents to assess the impact of this new system on educational activities-resident autonomy, attending teaching, conference attendance, resident teaching, self-directed learning, and ability to complete patient care responsibilities. RESULTS: There was no adverse effect of the day float system on educational activities. House staff reported increased autonomy, enhanced teaching from attending physicians, and improved ability to complete patient care responsibilities. Additionally, house staff demonstrated improved compliance with the ACGME mandates. CONCLUSIONS: The implementation of a novel day float system for the inpatient medicine ward service improved compliance with ACGME work duty requirements and did not adversely impact educational activities of the residency training program.

Accreditation↗

Occupational therapy practitioners' perceptions of the impact of continuing education activities on continuing competency.

OBJECTIVE: The purpose of this exploratory study was to evaluate Florida-licensed occupational therapy practitioners' perceptions of the impact of various continuing education activities on their continuing competency. METHOD: A self-report mail survey was used to evaluate occupational therapy practitioners' perceptions of various continuing education activities in three domains: (a) learning, (b) application, and (c) results. The respondents' perceptions of the impact of specific continuing education activities were compared. RESULTS: As rated by the respondents, formal programs 1 or more days in length had a significantly greater impact than most informal continuing education activities. On-the-job training (in the domain of application) and being mentored had a significantly greater impact than formal educational programs less than 3 hr in length. CONCLUSION: Informal continuing education activities, in some cases, are perceived to have as effective an impact on continuing competency of occupational therapy practitioners as formal continuing education activities.

Attitude of Health Personnel↗

A formal audit of continuing medical education activity for license renewal.

Formal audits of the continuing medical education activities of physicians licensed in Michigan were undertaken to assess compliance with a law mandating participation in 150 hours of continuing medical education each 3 years. A random sample of all physicians renewing their licenses in 1987 and 1988 were asked to provide documentation of their continuing medical education activities. The average physician participated in 175 hours of category I approved activities; 53.1% of the hours were obtained in a different state, and only 27.6% were obtained in the home community. A total of 13.7% (132/967) of the physicians were initially unable to document 150 hours of credit. Documentation deficiencies and addition errors were found on 72.5% of forms. If formal audits of compliance with legislation are to be undertaken, early notification of the participants and specific instructions for compliance are needed. Because of problems with documentation, only category I approved activities, with exclusions for trainees, should be used to assess compliance.

Adult↗

[Factors associated with the participation of pregnant women in maternal education activities at a health center].

OBJECTIVE: To determine the factors associated with participation in Maternal Education activities offered to pregnant women monitored at a Health Centre. DESIGN: A descriptive, transversal study. SETTING: Urban Health Centre. Population group with a medium to high social and economic level. PARTICIPANTS: A total of 107 pregnant women monitored at the Health Centre, whose probable delivery date was between 1.1.95 and 30.12.95. MEASUREMENTS AND RESULTS: The variables analysed were social and demographic, the presence of clinical and/or social risk, wanted pregnancy or not, week of attendance for clinical controls, referrals and health conduct during pregnancy (tobacco dependency). The profile of the pregnant women not receiving maternal education at our Health Centre was: average age 30; 86% married; 73% working outside the home; with an average of 1.4 children; 60.8% with medium to low educational level. The factors linked to not receiving maternal education were: leaving the programme (73.9% against 24%) and number of children (1.39 against 0.360). CONCLUSIONS: Women with more children and who stop attending for check-ups take less part in Maternal Education activities at our Health Centre.

Adult↗

Theory-based health education activities for third to sixth grade children.

Eight educational activities based on social learning and social support theories were used as part of a comprehensive cardiovascular risk reduction program for families with children in the third to sixth grades. These activities focused on providing the children with skills in recognizing high-salt and high-saturated fat foods, preparing such foods, resisting pressures to each such foods, increasing aerobic activity and providing support to peers and family in attempting such changes. Data analyses revealed significantly greater decreases in high-salt and high-saturated, fat food consumption and perceived increases in aerobic activity, in the experimental than the control group. The participative, enjoyment and inexpensive aspects of these activities are emphasized to encourage their use in school health programs.

Cardiovascular Diseases↗