JCEHP Emerging Best Practices in CPD

This description is indexed by the journal search engine, please be as descriptive as possible. Metacognitive accuracy—the extent to which individuals' perceptions of their knowledge align with actual performance—is critical in clinical decision making. Overconfidence can lead to diagnostic errors, while insufficient confidence may delay decisions or prompt unnecessary testing, increasing health care costs. Although longitudinal knowledge assessments with spaced repetition have been shown to improve learning and knowledge transfer, their impact on metacognition remains underexplored. This study investigates changes in confidence under different spaced repetition strategies in a large cohort of family physicians. Data were drawn from the American Board of Family Medicine's Continuous Knowledge Self-Assessment, a longitudinal assessment administered quarterly. Participants rated their confidence on a 6-point scale after each question. In total, 16,751 physicians who completed assessments at baseline, quarter 6, and quarter 10 were included. Participants were randomized to control or intervention groups receiving repeated or clone questions at various intervals. One-sample t tests assessed confidence changes for questions initially answered incorrectly but subsequently answered correctly. Multivariate regression controls demographic factors. Confidence increased significantly for repeated questions, with moderate effect sizes in single repetition groups and large effect sizes in two-time repetition groups. Clone questions also showed gains, though smaller in magnitude. After adjusting for clinician demographics, male and younger physicians generally reported higher confidence. Spaced repetition enhances both learning and metacognitive accuracy. Two spaced repetitions yielded larger gains. These findings support incorporation of metacognitive-enhancing strategies into CME to improve clinician self-assessment and potentially reduce diagnostic error. Access the article here.

This narrative review joins an ongoing scholarly conversation about Project ECHO, a virtual educational innovation, with an aim to understand it as a technology-enabled interface that facilitates knowledge-sharing. Critical attention is paid to how dynamics of power are accounted for in the deployment of Project ECHO, and sociomaterial attention is paid to how communication technology is described. The review is relevant to those who wish to establish, understand, or further develop virtual multiprovider knowledge-sharing interfaces. Data collection followed processes set out by a narrative review methodology, a review methodology that provides a comprehensive and balanced critical analysis of the published literature. Analysis was informed by thematic analysis. Forty-five articles and one book chapter published between 2015 and 2024 were selected for inclusion. This review was contained to studies of Project ECHO in Canada. Our data set captures an implied awareness of dynamics of power and a desire to counter such dynamics. This is visible in the desire to mitigate a hierarchical differentiation between participants by using teaching and learning theories, a pedagogical design and processes of interaction that favour participation, and by using technology that allows participants to join from across vast geography. Emerging scholarly attention to how knowledge is shared and developed in Project ECHO will help develop an understanding of how technology-enabled educational innovations facilitate knowledge sharing in spaces that are imbued with complex power dynamics. Future explicit inclusion of a critical gaze and sociomaterial lens will deepen understandings of technology-enabled educational innovations.

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Introduction: Traditional evaluation models, often linear and outcome-focused, are increasingly inadequate for the complexities of modern medical education, which demands more comprehensive and nuanced assessment approaches. Methods: A standardized continuing professional development activity evaluation instrument was developed and implemented. An iterative process was performed, using a repeat Rasch analysis, to improve reliability of the evaluation instrument. Category Probability Curves and Test Information Function were generated by the Rasch analysis to refine the construction of the assessment. All educational activities completed between 2022 and 2024 were eligible for inclusion. The study incorporated a diverse range of educational activities and included multiple health care professions. Results: The pilot analysis included 250 educational activities with 26,554 individual learners completing evaluations for analysis. Initial Rasch findings demonstrated a need to remove redundancies and change from a five to four-point rating scale. The final instrument validation included 21 activities and 529 learners. Improvement was seen in reliability after modifications, with an increase in Cronbach alpha from 0.72 to 0.80. Discussion: Use of psychometrics to improve assessments can yield a more reliable and less redundant evaluation instrument. This research demonstrates a psychometrically informed, flexible evaluation tool that can inform future educational efforts and serve as a data driven metric to enhance the quality of continuing professional development programs.

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A qualitative study exploring how nurses adapt to electronic health records is submitted to a journal. The reviewers agree the topic is timely and the interviews are rich, but the article is returned with a request for major revisions. Why? The research questions are vague, the sampling strategy is unclear, and the analytic process is summarized in a single sentence. The rejection note concludes: "Important work, but insufficiently rigorous." Qualitative research offers the field of continuing education in the health professions an opportunity to gain a rich understanding of the culture, context, and perspectives of study participants. This methodology allows for an in-depth investigation of study participants, highlighting "their points of view and experiences … illustrated with their own words … to deepen our understanding of individual variation." However, qualitative research articles are challenged when aspects of the methodology and analysis are not robust, resulting in resubmissions for authors. Common issues in writing qualitative research include the lack of an explicit argument, insufficient interpretation of findings, lack of theoretical foundations, and a clear explication of the data collection and analysis. This editorial outlines common weaknesses in qualitative articles submitted to JCEHP that elicit reviewer criticism and provide strategies for addressing them. This editorial is organized around the major sections of a research article—introduction, methodology, results, discussion, limitations, and conclusion to provide explicit guidance for authors intending to submit to JCEHP. When submitting a qualitative article for consideration in JCEHP, authors should align the components of the article with EQUATOR guidelines and address the following issues outlined in this editorial guide.

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The underpinnings of adult learning theory are foundational to continuing medical education (CME). Several widely studied learning theories are relevant to medical providers including deliberate practice, situated learning theory and community of practice, social cognitive theory and self-determination, adaptive expertise, and experiential learning theory. The Accreditation Council for Continuing Medical Education recognizes 11 types of CME activities each integrating these learning theories to some degree. Provider preferences are shaped by accessibility, cost, flexibility, and opportunities for networking leaving many balancing the convenience of online programs with the value of in-person interactions. The degree to which learning theories are integrated within CME activities is widely understudied despite their interwoven relationship and association to provider preferences. This analysis aims to (1) evaluate the degree various CME models integrate learning theory; (2) identify theory-led strengths and limitations of CME models; and (3) extrapolate themes for CME planners to strengthen theory integration. The three most common types of CME activities are enduring material (ie, web-based courses, web-based courses with simulation), live courses (ie, conferences, webinars, simulations), and regular scheduled series (ie, Project Extension for Community Healthcare Outcomes, speaker series). Integration of learning theory across 7 CME models was evaluated through a content analysis using a trichotomous classification system (fully integrated, partially integrated, or no integration). Results varied, with Project Extension for Community Healthcare Outcomes and live simulations having the highest degree of theory integration. A thematic analysis identified five themes for improving theory integration including feedback mechanisms, structured self-reflection, adaptability to promote autonomy, repeat exposure to complex skills, and practice of humility.

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Introduction: Respiratory therapists (RTs) must apply competencies to address the health care needs of the public. Although all competencies are deemed essential, scholarly practice requires that professionals critically assess their practices, integrate evidence-based literature, and enhance the care they deliver to patients. Though scholarly practice is also associated with professional empowerment, role satisfaction, and improved patient care, it is rarely measured. The purpose of this study was to develop, pilot, and generate preliminary validity evidence of a tool designed to measure scholarly practice among RTs. Methods: We used DeVellis' nine-step scale development process and exploratory factor analysis to develop the tool. The results of a scoping review and qualitative study were used to generate an item pool and pilot test it with 81 RTs across Canada. The refined tool was tested on a larger sample (n = 832) and analyzed using exploratory factor analysis. Results: Using principal axis factoring with Promax rotation, we retained 18 items across 4 factors, explaining 56.7% of the variance in the data: (Factor 1) professional development and credibility, (Factor 2) elements supporting scholarly practice, (Factor 3) the perceived impact of scholarly activities on practice, and (Factor 4) scholarly practitioner identity and ability. Internal consistency of the final 18-item scale was suitable overall. Discussion: Our results provide preliminary evidence for a scholarly practice tool that can encourage self-reflection and/or foster peer-based reflection. Using the tool with other health care professionals and conducting confirmatory factor analysis could generate additional validity evidence.

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In health care, cost-effectiveness analysis evaluates changes in health outcomes as a function of costs. The cost-effectiveness of continuing professional development for health care providers has not been historically well characterized despite substantial investment. This literature review identified publications considering the costs and cost-effectiveness of accredited continuing medical education activities. Searches were conducted for English language records in PubMed and the gray literature using a 10-year lookback period from March 10, 2023. Search terms included concepts related to continuing medical education, cost, effect, and utilization. One reviewer conducted title/abstract screening, full-text review, and data extraction, with direction and adjudication of search and screening concepts provided by the lead advisor. Publications were categorized as related to costs of an educational intervention (Concept 1) and/or the impact of education on health care costs (Concept 2). Results were summarized using descriptive statistics. A total of 668 database records were screened, 125 (19%) underwent full-text review, and 25 of 125 (20%) were accepted; 7 of 351 (2%) gray literature sources were accepted for a total of 32 included records. The most common reason for rejection was not being an accredited activity. Of the 32 records, 27 (84%) were related to Concept 1 only, 3 (9%) to Concept 2 only, and 2 (6%) to both Concepts 1 and 2. Approximately half (n = 19, 59%) mentioned costs without supporting data. These findings show that considerations of cost and cost-effectiveness are rare in the accredited continuing medical education literature, which may limit how the value of continuing medical education is characterized.

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Open-ended feedback from learners offers valuable insights for adapting continuing health education to their needs; however, this feedback is burdensome to analyze with qualitative methods. Natural language processing offers a potential solution, but it is unclear which methods provide useful insights. We evaluated natural language processing methods for analyzing open-ended feedback from CPD training at a psychiatric hospital. The data set consisted of survey responses from staff participants, which included two text responses on how participants intended to use the training ("intent to use"; n = 480) and other information they wished to share ("open-ended feedback"; n = 291). We analyzed "intent-to-use" responses with topic modeling, "open-ended feedback" with sentiment analysis, and both responses with (LLM)–based clustering. We examined outputs of each approach to determine their value for deriving insights about the training. Our results indicated that because the "intent-to-use" responses were short and lacked diversity, topic modeling was not useful in differentiating content between the topics. For "open-ended feedback," sentiment scores did not accurately reflect the valence of responses. The LLM-based clustering approach generated meaningful clusters characterized by semantically similar words for both responses. LLMs may be a useful approach for deriving insights from learner feedback because they capture context, making them capable of distinguishing between responses that use similar words to convey different topics. Future directions involve exploring other methods involving LLMs, or examining how these methods fare on other data sets or types of learner feedback.

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Although the Continuing Professional Development (CPD) field has rapidly expanded in scope, breadth, and depth, there is a gap in how we understand CPD leadership and the role of the leader. Previous scholarship indicates that there is neither an agreed on set of competencies for CPD leadership roles nor a distinct pathway towards those roles. This study is aimed at answering the following question: How is leadership described or defined in CPD and what are the contextual issues that are and/or should be shaping its evolution? Seventeen interviews were conducted. There were multiple components identified that were important to CPD leadership, such as being visionary, or having strong collaboration skills with some components, such as adaptability and flexibility appearing more unique to the CPD context. The role of CPD leadership and the pathway to CPD leadership remain highly variable. Attaining a CPD leadership position predominantly involves some degree of "serendipity." While CPD leaders may fundamentally need basic and common leadership skills, an essential attribute of the CPD leader is to effectively respond to the context and the unique needs of the health system. We recommend better articulating and valuing the role of the CPD leader within the health system.

Despite intensive attempts to create scholarship equity at academic medical centers, clinician educators continue to face a challenging professional promotion environment that puts them at risk for burnout, stalled career advancement, and abandonment of academic medicine altogether. Coaching, which has a wealth of supportive evidence from outside of medicine, is distinguished by (1) being driven by the agentic coachee that is inherently capable, creative, and resourceful, (2) not requiring the coach and coachee to have shared content expertise, and (3) not being centered around transfer of expertise from the more knowledgeable or experienced party to the recipient. Initial evidence from within medicine indicates that coaching reduces burnout and improves learner self-reflection, teaching effectiveness, goal setting, reflective capacity, professional identity formation, career planning, and development of adaptive expertise. In this article, faculty coaching is presented as a powerful means to help clinician educators overcome the myriad challenges to professional advancement and career fulfillment. The current evidence in support of coaching—both within and outside of medicine—is reviewed. Finally, a conceptual model is provided, as are guidelines demonstrating specific roles, behaviors, and responsibilities for faculty coaches and coachee.