Developing Internet based resources for supporting CPD and quality improvement A framework for discu

1
Developing Internet based resources for
supporting CPD and quality improvement?A
framework for discussion

• Simon de Lusignan
• Primary Care Informatics
• St. Georges Hospital Medical School

2
Overview

• Background
• Collaboration and ground-rules
• How might European Family medicine organisations
  work together?
• Operational issues
• Role of informatics Generalisable principles
• Core content Key components
• Evaluation
• How to measure what has been achieved

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Background
4
My background

• Primary Care Informatics group
• www.gpinformatics.org
• Doctors Desk http//drsdesk.sghms.ac.uk
• Primary Care National electronic Library for
  Health NeLH-PC
• www.nelh-pc.nhs.uk
• Primary Care Data Quality PCDQ
• www.pcdq.org

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Starting point

• The information retrieval systems available in
  General Practice are relatively difficult to
  access during consultations
• ..emergent technologies like NeLH offer
  opportunities
• we advocate a system whereby professional
  organisations such as RCGP might contribute to
  the process.
• Sullivan F et al. An information retrieval
  service. BJGP 1999491003-7.

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Shift towards learner-centred education

• Old think
• Passively listening to lectures
• Educator decides topic
• Read a journal or text book
• Errors should be forgotten / denied

• New think
• Actively participate in learning
• You decide the topic
• Problem solving, simulated cases
• Errors are a learning experience

Wyatt JC. Clinical Knowledge in the
Information Age London RSM, 2001
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New think is not universally accepted

• Implementation strategies preferred included
• small group
• continuing education with a specialist
  (urologist) and a general practitioner as a
  facilitator,
• lectures and patient education materials.
• Of least interest were
• Internet access,
• interactive computer systems,
• distance education modules.
• Puech M, et al. Local implementation of national
  guidelines What do
• general practitioners suggest will work? Int J
  Qual Health Care 199810(4)339-43

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Reviews of the evidence point towards certain
themes

• Our data show some evidence that interactive
  CME sessions that that enhance participant
  activity and provide the opportunity to practice
  skills can effect change in professional practice
  and, on occasion,health care outcomes.
• Based on a small number of well-conducted
  trials, didactic sessions do not appear to be
  effective in changing physician performance.
• Davis D et al. Impact of formal continuing
  medical education do continuing education
  activities change physician behavior or health
  care outcomes? JAMA 1999 Sep 1282(9)867-74

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Emerging evidence supports complex interventions

• the complex educational intervention
  exemplified the best form of knowledge
  translation (the integration of knowledge into
  practice), moving the practitioner from
• awareness of new guidelines
• to agreement with the guidelines and
• finally to adoption and adherence,
• following well-defined patterns of adoption and
  based on principles of adult learning applied to
  CME.

Davis D. Clinical practice guidelines and the
translation of knowledge the science of
continuing medical education. CMAJ 2000 163
(10 )1278-9
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The Three Workshop Themes
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Collaboration and ground-rules

• Political pressures are driving change
• In the midst of serious inquiry into the best
  ways to educate practising physicians has come
  pressure on the self-regulating bodies to monitor
  their members and assure the public that they are
  keeping up to date.
• Consequently, in addition to the ethical
  imperative to maintain knowledge and skills,
  physicians now face the threat of losing some of
  the letters after their names if they don't.

Weir E, Hoey J CMAJ's new online continuing
professional development course.
CMAJ 2002166(9)1157-8
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Collaboration and ground-rules (2)

• European Definition of GP and core competencies
• is an academic and scientific discipline with
  its own educational content, research evidence
  base and clinical activity, and a clinical
  specialty orientated to primary care. Allan J
  et al. The European Definition BJGP
  200252526-7.
• Can the same be done for CPD and quality?
• European dentists are collaborating?
• Self-assessment was followed by a visit from a
  team of international peers. Each assessment
  comprised 19 sections and was placed on the
  DentEd web site (www.dented.org)
• Shanley Dbet al. European convergence towards
  higher standards in dental education Med Educ
  2002 Feb36(2)186-92

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Operational issues Informatics

• Most countries with highly developed health
  systems are investing heavily in computer
  hardware and software in the expectation of
  higher quality for lower costs.
• Recent systematic reviews have indeed
  demonstrated the health benefits of a range of
  electronic tools, particularly in the areas of
  prevention and therapeutic monitoring.
• However, there remains a relative lack of
  published evaluations of informatics tools and
  methods.
• There are great opportunities for researchers
  interested in evaluation to fill the vacuum left
  by informaticists who are too busy writing their
  next line of code.
• Sullivan F. What is health informatics? J Health
  Serv Res Policy 20016(4)251-4

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Operational issues - Informatics (2)

• Lack of recognition of medical informatics as a
  specialty
• Many informaticians are perceived to have
  difficulty in articulating the underlying
  theories and principles
• Musen MA, van Bemmel JH. Challenges for Medical
  Informatics as an academic discipline. Methods
  Inf Med 2002411-3.
• Evidence has been summarised about what has been
  demonstrated to work.
• Mitchell E, Sullivan F. A descriptive feast but
  an evaluative famine systematic review... BMJ
  2001322(7281)279-82 http//bmj.com/cgi/content/
  full/322/7281/279/DC2

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Operational issues (2) Content

• What content and how to update?
• Of 217 drug therapy guidelines developed or
  endorsed by Canadian organizations in the period
  199498, only 15 met half or more of the
  authors' criteria for rigour in the developmental
  process, and only 7 were rated by independent
  reviewers as sound
• Time to weed the CPG garden CMAJ
  2001165(2)141, 143
• How to interact?
• A critical mass of practitioners can from a
  virtual community.
• Roberts C, Fox N. General practitioners and the
  Internet modelling a 'virtual community'.
• Fam Pract 1998 Jun15(3)211-5

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Summary
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Summary

• Look for practical, collaborative mechanisms to
  advance Internet resources for CPD and Quality
  Improvement.
• Support the development of the scientific
  principles within Informatics
• Be realistic about its limitations
• Simon de Lusignan slusigna_at_sghms.ac.uk
• www.gpinformatics.org