SPECIAL ISSUE
THE MÉMENTOYour CPD Handbook
CONTINUING PROFESSIONAL DEVELOPMENT
TRAINING
CASE STUDIES
LE SPÉCIALISTELe magazine de La Fédération des médecins spéciaListes du Québec Vol. 16 no HS-1 | January 2014
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6vol. 16
no. HS-1LS
EDITORIAL COMMITTEEProfessional Development Office: Dr Sam J. Daniel Brigitte Vinet and Patricia WadePublic Affairs and Communications Direction: Patricia Kéroack and Nicole Pelletier
PRODUCTION Direction des Affaires publiques et des Communications
DELEGATED PUBLISHERNicole Pelletier, APR, Director, Public Affairs and Communications
RESPONSIBLE FOR PUBLICATIONSPatricia Kéroack, c.w. Communications Consultant
GRAPHIC DESIGNERDominic Armand
ENGLISH REVISIONBrigitte Vinet and Patricia Wade
TO CONTACT US
EDITORIAL CONTENT Phone: 514 350-5021Fax: 514 350-5175
ADVERTISINGFrance Cadieux, conseillèrePhone: 514 350-5274 Fax: 514 350-5175 E-Mail: [email protected]
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The mission of the Fédération des médecins spécialistes du Québec is to defend and promote the economic, professional, scientific and social interests of the medical specialists who are members of its affiliated associations.
TABLE OF CONTENTS
HISTORY- A Short History of CPD in Quebec .............................................................................................. 12
- CPD at the FMSQ: a Revealing Story .......................................................................................... 13
- Communicating Her Passion for CPD ......................................................................................... 15
GUIDELINES- Keep Your Practice at the Heart of Your Learning Program .................................................................. 16
- The CMQ’s Self-Managed CPD Plan ................................................................................................ 17
- CPD in Psychotherapy .................................................................................................................. 18
- Let’s Talk About Schedule 44! ....................................................................................................... 19
- The CQDPCM… Accomplishments in CPD for You! .............................................................................. 23
- Copyright Laws in the Digital Age ................................................................................................... 24
ORGANIZATION- The Logistics of a CPD Activity ....................................................................................................... 25
- Promoting Your CPD Activity .......................................................................................................... 27
- Getting the Media Interested in CPD ......................................................................................................... 29
Glossary ....................................................................................................................................... 8
The Mémento: A CPD Handbook... to Keep Close to You .................................................................. 9
The FMSQ’s Professional Development Office at Your Service ........................................................ 10
Foreword ..................................................................................................................................... 11
References .................................................................................................................................. 59
Continuing Professional Development
SPECIAL ISSUE
ENGLISH VERSION INTERNET ONLY
7vol. 16 no. HS-1LS
ACCREDITATION PROCESS OF ORGANIZATIONS- The Future of CPD at the RCPSC ..................................................................................................... 32
- Applying to Become an Accredited CPD Provider ............................................................................... 34
- Accreditation and the CMQ: the Past, the Present and the Future ......................................................... 36
EDUCATIONAL METHODS- Integrating the Development of CanMEDS Roles in CPD ..................................................................... 37
- Writing CPD Learning Objectives .................................................................................................... 38
- CPD at the Faculty of Medicine of McGill University ........................................................................... 39
- CPD at the Faculty of Medicine of Université Laval ............................................................................. 41
- The Faculty of Medicine’s CPASS at the Université de Montréal ........................................................... 42
- The Continuing Education Centre of the Faculty of Medicine at the Université de Sherbrooke ................... 43
- The Era of High-Definition and Three-Dimensional CPD ...................................................................... 44
- Social Networking and Clinicians ................................................................................................... 45
- Computer-Based 3-D Models in Medical Education ........................................................................... 46
- Reflecting and Acting on How the Healthcare Team Works with Patients ............................................... 47
- Training Based on Script Concordance ............................................................................................ 48
ACCREDITATION PROCESS FOR EDUCATIONAL ACTIVITIES- Accrediting Group Learning Activities ............................................................................................. 49
- Evaluating a CPD Activity .............................................................................................................. 50
- Self-approval of Educational Activities in a Hospital Setting ............................................................... 51
- Intégrer des activités d’évaluation à votre DPC................................................................................. 53
SUCCESS STORIES
- Setting Up an Academic Department .............................................................................................. 54
- Educating Tomorrow’s Physicians .................................................................................................. 55
- CPD for Nurses ........................................................................................................................... 56
- Tips for the Organization of Successful Academic Evenings ................................................................ 57
- Simulation in CPD, an Added Value ................................................................................................ 58
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La version française de ce Mémento est
disponible sur le portail fmsq.org
Training
Case Studies
8vol. 16
no. HS-1LS
GLOSSARY
CAAHC (UM) Centre d’apprentissage des attitudes et habiletés cliniques de l’Université de Montréal
CACME Committee on Accreditation of Continuing Medical Education
CÉMCQ Conseil de l’éducation médicale continue du Québec
CEU Continuing education unit
CFPC College of Family Physicians of Canada
CMA Canadian Medical Association
CME Continuing medical education*
CMPA Canadian Medical Protective Association
CMQ Collège des médecins du Québec
CMT Continuing medical training*
CPD Continuing professional development
CQDPCM Conseil québécois de développement professionnel continu des médecins
CSME (CHUSJ) Centre de simulation mère-enfant (Sainte-Justine University Hospital Centre)
CTU Continuing training unit
FMOQ Fédération des médecins omnipraticiens du Québec
FMSQ Fédération des médecins spécialistes du Québec
MFC Médecins francophones du Canada
MOC Maintenance of Certification
MSSS Ministère de la Santé et des Services sociaux du Québec
OIIQ Ordre des infirmières et infirmiers du Québec
OPQ Office des professions du Québec
PADPC Plan d’autogestion de développement professionnel continu
PDO Professional Development Office of the Fédération des médecins spécialistes du Québec
QCFP Québec College of Family Physicians
RAMQ Régie de l’assurance maladie du Québec
RCPSC Royal College of Physicians and Surgeons of Canada
Rx&D Canada’s Research-Based Pharmaceutical Companies
We opted for the use of the most common acronyms or other abbreviations, wherever possible, in order to simplify the texts of this publication. The terms they represent are given below. Please note that, in Quebec, some terms (italicized in this glossary and in the texts) remain in French as do their acronyms.
All references contained in the articles are listed together on pages 59 and 60.
REFERENCES
9vol. 16 no. HS-1LS
The Fédération des médecins spécialistes du Québec has been working for some thirty years on continuing professional development in order to integrate it within the very structure of the work performed by medical specialists. We, at the FMSQ, firmly believe that physicians must be involved in their environment and sphere of activity. What is more, we promote it and our actions are evidence of it. Medical specialists must offer the best and safest care to patients. Today, these physicians must also be involved in managing the quality of care dispensed. We need to assert what is undeniable: CPD is an integral part of the lives of medical specialists.
At the FMSQ, we have decided to help you develop good habits. Over the years, the Board of Directors has deliberately chosen to adequately finance CPD. We have negotiated fixed fees for resourcing and made CPD as accessible as possible for you, so that it can be a part of your daily lives.
We hope that this CPD Handbook, a special issue of Le Spécialiste, which we call The Mémento, follows you wherever you work... just like your RAMQ billing manual or any other book or reference tool! It also needs to be easily accessible and rapidly consultable as much by colleagues who are slow to realize we are in the age of CPD, as by colleagues who have become real “addicts” and never stop suggesting new ways of learning.
This quick reference is not a guidebook for the organizer of CPD activities, but it does cover a lot of ground. It is a colossal work that is a first at the FMSQ thanks to the collaboration of many who, like us, firmly believe in CPD. Our objective was to simplify CPD and, even more so, to help you get involved if you haven’t already. We think that if you are not yet convinced, reading this work will help you cross over to our side.
In all solidarity,
Gaétan Barrette, MD President
The MémentoA CPD Handbook to Keep Close to You
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In the name of all the members of the Professional Development Committee and the personnel of the Professional Development Office, I have the honour of introducing this CPD Handbook, a special issue of the magazine Le Spécialiste, whose aim is to meet your needs on the subject of professional development through a variety of short and informative capsules. This project is the result of teamwork: it would not have been possible without the contributions of several individuals who dedicated many hours to it.
I especially wish to highlight the unconditional support of our President, Dr Gaétan Barrette, as well as the leadership of our Vice-President, Dr Diane Francœur, who initially proposed the project, along with the support of the members of the Board of Directors. This guide is the result of the dedication and remarkable work of Mrs Brigitte Vinet and Mrs Patricia Wade of the PDO. I also wish to express our sincerest thanks to the team of Mrs Nicole Pelletier in Public Affairs and Communications for their precious contributions, especially that of Mrs Patricia Kéroack and Mr Dominic Armand, whose expertise made this project a reality. Finally, I would like to recognize the collaboration of the pioneers, the innovators and the builders of CPD who agreed to share their knowledge in the capsules contained within these pages. As a matter of fact, the FMSQ presented the Continuing Professional Development Award for 2013 to several of them.
The FMSQ as well as all the contributors to the CPD Handbook, and those who participated in the venture, hope that this publication will be able to answer several of the questions you may have and that it will inspire you to get involved in your own CPD departments. You may prove to be its next innovator!
Sam J. Daniel, MD Director
The FMSQ’s Professional Development Office at your Service
11vol. 16 no HS-1LS
FOREWORDBy Sam J. Daniel, MD
WHAT IS CPD?CPD is one of the essential components of today’s medical practice. It allows medical specialists to maintain their competencies up to date in order to proffer the best care possible to their patients by taking into account the latest probative data available.
The CQDPCM defines CPD as being: “any steps taken by a physician to acquire, maintain or develop his knowledge, skills or attitudes. Continuous professional development consists in an individual or collective action based on a need or interest, which is part of the learning cycle and aimed at improving the quality of care offered to the population.”1 CPD thus aims at acquiring knowledge, at applying it in practice, at improving performance and at evaluating results. Section 44 of the Code of Ethics of Physicians of Quebec stipulates that “A physician must practise his profession in accordance with the highest possible current medical standards; to this end, he must, in particular, develop, perfect and keep his knowledge and skills up to date.”2 For their part, Doctors Sylvia and Richard Cruess remind us that the status and privileges granted to professionals throughout the ages have been predicated on the assumption that the latter would be altruistic and moral in their daily activities.3 As a result, the social contract between medicine and the society in which we live requires that physicians be responsible for maintaining their competence by remaining the masters of their own professional development.4
The CQDPCM stipulates that a “physician must practise his profession in accordance with the highest possible current medical standards; to this end, he must, in particular, develop, perfect and keep his knowledge and skills up to date.”1 He must also comply with the Professional Code of Quebec that stipulates that a professional order’s Board of Directors can establish the continuing education activities that the members of the order must follow.5 The Collège des médecins du Québec (CMQ) has delegated this responsibility to the professional associations since they are better placed to respond to the needs of their members.
The CQDPCM is a collaborative organization that brings together the CMQ, the four universities that have a faculty of medicine, the two medical federations (FMOQ and FMSQ), the RCPSC, the CFPC, MFC, the CMPA, and Rx&D. In 2003, the CQDPCM developed the Code d’éthique des intervenants en éducation médicale continue,6 an essential tool for all organizers of CPD activities. For your information, a new code of ethics will be coming out in 2014.
CPD’S PLACE AT THE FMSQIn 1974, the FMSQ set up its Professional Development Office (PDO) in order to provide a framework for the Federation’s and its affiliated medical associations’ CPD activities, and to coordinate them. The initial mission of the PDO, which is to “[...] promote the maintenance and development of their competencies by medical specialists,”7 is a part of the overall mission of the FMSQ. Professional development is an integral part of the life of the Federation and of its affiliated associations. In addition to corresponding to the FMSQ’s mission, we find it as well in its mission and in its goals.
WHAT ROLES DOES THE PDO PLAY?The Office has assumed the roles of promoter and support. It ensures that the educational activities organized by the affiliated medical associations comply with the criteria of quality and the ethical rules of accrediting organizations. The Office also offers sessions to “train the trainer” for medical specialists who wish to organize educational activities themselves. To help those responsible for CPD to discharge their duties, the Office has developed tools and services making it easier to organize CPD activities while respecting standard, legal and ethical requirements for the organization of CPD activities in Quebec, and makes them available to teachers and organizers. For example, there are forms listing ethical and quality criteria, declaring potential conflicts of interest, applying for accredited activities, evaluating pedagogical activities, and finally tools to aid reflection and feedback. The Office compiles and publishes on the FMSQ’s Web site data concerning CPD. It also coordinates the CMQ’s accreditation visits every five years and prepares associations for the maintenance of the accreditation certificate. The Office organizes CPD monitoring activities. It takes part in the evaluation, research and development of CPD in order to ensure sustained improvement in the delivery of CPD at the FMSQ to increase the impact of these activities on the quality of care offered by medical specialists.
In closing, let us underline that CPD is in constant evolution. All the information contained in this issue is up to date. However, this information can be called upon to change over time, in order to respond to the needs of the profession, of patients and to follow technological developments. Upcoming issues of the magazine Le Spécialiste will keep you informed of all the changes that will be made to the various programs.
REFERENCES ON PAGE 59
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A Short History of CPD in QuebecIn Canada, continuing education in medicine has been in existence for more than one hundred years: indeed, there are several comments to this effect in the writings of William Osler. And yet, it’s only in the 1970s that CME started taking root in North America.
It was in 1975 in Quebec, under the impetus of the continuing medical education committee of the Collège des médecins (CMQ) that the Conseil d’ÉMC du Québec (CÉMCQ) was set up as an advisory entity bringing together the four faculties of medicine, the two medical federations (FMOQ and FMSQ) and the CMQ. In November 2005, the CÉMCQ became the Conseil québécois du développement professionnel continu des médecins (CQDPCM). With the passage of time, this organization welcomed other participants to its group: the Royal College of Physicians and Surgeons of Canada (RCPSC), the Québec College of Family Physicians (QCFP), the Canadian Medical Protective Association (CMPA) and Médecins francophones du Canada (MFC).
Since 1970, insofar as the predominant trends in continuing medical training are concerned, there are three main evolutionary periods:
1. From 1970 to 1990 - The transfer of knowledge is mainly done by experts delivering content via speeches and lectures during traditional congresses and conferences. In this type of environment, participants are essentially passive receivers of educational content.
2. From 1990 to 2000 - The availability of numerous practice guides in a multitude of clinical fields creates a structure for CPD. In addition to distributing these guides, the CPD organizers and trainers arrange for workshops based on clinical scenarios discussed by participants dispersed into small groups. In this model, participants are very active and receive clinical tools as well as constant feedback from their peers and from the content expert who is also present.
3. Since 2000 - Two major currents have been predominant in CPD: the first emphasizes self-direction of CPD by each physician, followed by a second current associated with the explosion of new technologies.
Since the start of the 21st century, within the framework of the RCPSC’s Maintenance of Certificate (MOC) program, each physician takes part in the direction of his or her own CPD. MOC thus rests on reflexive practice focused on continuous improvement and completed on a continuous basis by the participant. The MOC program includes CPD activities linked to all the transverse competencies called CanMEDS which have been implemented since 2000. On January 30th of each year, each RCPSC Fellow must update his professional CPD portfolio. This overall process is facilitated by the mainport.org platform.
In 2007, the CMQ adopted the same kind of self-directed CPD approach for specialists who are not members of the RCPSC. Here, each physician must, on June 30th of each year, update his personal approach to CPD.
As for the second current, the influx of new technologies brings us to an era where daily clinical practice can be facilitated and supported by instant research in Internet databases and by remote consultations. CPD itself is accessible remotely and in real time: virtual platforms now allow physicians to receive and complete clinical vignettes on their intelligent devices.
Since 2005, the pedagogical benefits of medical simulation have exploded. Just like airplane pilots and their crews, physicians and interdisciplinary teams can now train regularly with the help of simulators as well as via on line training platforms.
The simulation centres in faculties of medicine offer simulated patients (robotized), real patients (trained for pedagogical needs in medicine) or even patient actors (trained for various educational roles). In these centres, physicians can come to learn a new technique, to consolidate already-acquired acts or to resolve, through teamwork, clinical scenarios with a debriefing by a colleague specialist of the field.
Finally, for the last 20 years, numerous studies, research and meta-analyses have allowed us to shed light on the best practices in CPD. The latter are undeniable advantages for CPD organizers as well as for each participant. They accelerate the cascade of knowledge transfers to help the patient.
To reach these goals, we need to distinguish three key periods in the optimal sequencing of CPD: a period of dissemination of new knowledge in large groups (classic conferences and colloquia); followed by a period to facilitate the integration of the disseminated data into practice (small group workshops, clinical tools) to finally head for a period of reinforcement that will be extended over time to ensure that adjustments are adequately anchored in the practice (memos, new tools, feedback from experts).
These three phases, when they are adequately articulated, lead to optimal and safe patient care, which is the ultimate goal of any CPD plan.
By Robert L. Thivierge, MD, FRCPC
Robert L. Thivierge, a pediatrician, is an Associate Professor in the simulation centre (CAAHC) of the Faculty of Medicine at the Université de Montréal and in the Pediatrics Department at the Sainte-Justine University Hospital Centre.
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Continuing Professional Developm
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CPD at the FMSQ: a Revealing StorySome eight years after the official creation of the Fédération des médecins spécialistes du Québec, at its December 5, 1973 meeting, the Delegates’ Assembly mandated the team in place to draw up an inventory of continuing medical education programs by medical specialty and to see what was being done outside of Quebec.
The Delegates wanted a program that would meet their needs, all the more so since the government at the time had undertaken a major reform of the professional system with the creation of the Office des professions du Québec. On the basis of the work of several committees, including the Castonguay-Neveu Commission, the government modified the roles and powers of the “professional corporations” to make them exclusively responsible for the protection of the public. All other roles, such as protecting the social and economic interests of professionals, could then be taken over by union-like associations.
At the same time the Office des professions du Québec was being created, the medical professional order, under the name of the Corporation professionnelle des médecins du Québec (CPMQ), today’s Collège des médecins du Québec, was mandated to create a joint body charged with maintaining physicians’ competencies. This body, the Conseil de l’éducation médicale continue du Québec, was not universally accepted and generated more anxiety than membership: some specialized medical associations even claimed interference with their professional liberty and refused to sit in on any meeting. Medical specialists still remember
previous administrations’ attempts to seize control, which led directly to the creation of the FMSQ. Finally, the CÉMCQ’s role was redefined as an advisory one; each group or association thus retained its independence. The Collège became the accrediting organization for CME programs.
THE FMSQ ORGANISED ITSELF RAPIDLYTaking advantage of the commotion caused by the creation of the CÉMCQ, the FMSQ set up a new directorate whose role would be:
• To facilitate the implementation of a specific infrastructure for continuing medical education in each affiliated medical association;
• To research and use methods to identify CMT needs for both the medical specialist and the medical specialty itself;
• To facilitate the introduction of adult-education methods for continuing education activities;
• To guarantee the quality and measurable efficiency of CMT activities to meet the afore-mentioned objectives.
The Federation wanted its affiliated medical associations and its member physicians to retain total control of CME (while other similar organizations used the term continuing medical education, the FMSQ adopted the new term: continuing medical training). Dr Osman Gialloreto, a cardiologist working at Hôpital Santa-Cabrini, was the first director of the Office of Continuing Medical Education (OCME). His mandate was to look into the CMT of medical specialists to identify the shortcomings of current practices and to direct medical specialists to the various CMT resources available.
The Office set up the Conseil de formation médicale continue (CFMC), made up of a representative of each affiliated medical association, independently of their membership (contrary to the Delegates’ Assembly where association representation is determined by the size of its membership). A first meeting was held on May 14, 1974; the Federation reiterated that affiliated medical associations would have the mandate to organize training activities, while the FMSQ would see to the support, coordination and evaluation of training activities, as well as to monitoring their quality.
While some associations dove right into their new project, others saw it as a menace to their own vocation as a union. Apprehension in the face of any form of medical education after graduation was not limited to the affiliated medical associations who feared being reduced to local chapters of their scientific associations. Many physicians saw in it a menace to their professional freedom; some claimed to be too busy to be able to add anything at all, while others simply did not like being dictated to insofar as new lines of conduct were concerned.
By Patricia Kéroack, c.w.
Patricia Kéroack is a communications consultant and the person responsible for publications at the FMSQ’s Public Affairs and Communications Directorate.
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The OCME then met each affiliated medical association and the federative vision finally succeeded in reuniting all stakeholders. With the support of the FMSQ’s members and associations, the CFMC became the official voice of CMT for medical specialists in Quebec; the CFMC became an advisory committee within the Board of Directors of the FMSQ.
By 1980, affiliated medical associations needed to prepare to have their CMT activities validated by the CPMQ, which was charged with accrediting them. The first visit by the CPMQ took place on March 12, 1981 and, at its first try, the FMSQ and its 27 affiliated medical associations received full accreditation (for a period of four years). The Corporation recognized their compliance with established criteria for CMT. The Federation set up a program committee responsible to review the programs submitted by associations according to accreditation criteria. In fact, the Federation even invited an observer from the CPMQ to sit on the committee.
In 1985, the Federation welcomed a new Director to the Office of Continuing Medical Education: Doctor Jean Vincelette, a microbiologist at Hôpital Saint-Luc, a former representative of the FMSQ on the CÉMCQ and a close collaborator of the former director, Doctor Gialloreto. Dr Vincelette carried on the work undertaken by his predecessor with the affiliated medical associations who were to pass a second accrediting visit in 1986 and a third one in 1991.
In 1995, Dr Michel Brazeau, also a microbiologist, followed Dr Vincelette as head of the Office of Continuing Medical Education. Within a few months, he had to organize the 4th accrediting visit for the affiliated medical associations. Of the 30 associations, 21 asked for and were accredited: 13 for 5 years and 8 for 3 years. Dr Brazeau presented the Board of Directors with a new mission statement for the OFMC: to “promote the maintenance and development of medical specialists’ competency and contribute to the development of the quality of CMT and those conditions that facilitate it.” Dr Brazeau left the FMSQ in 1999 and was replaced by Dr Gilles Hudon, a radiologist working at the Montreal Heart Institute.
At this time, the Royal College of Physicians and Surgeons of Canada also launched its professional development and maintenance of competency program for its Fellows. Dr Hudon was chosen to represent Quebec physicians at the national level. From the very first meetings, a question dealing with both semantics and politics emerged: the RCPSC wanted to change the acronym for CME and suggested replacing it with PPP (perfectionnement professionnel permanent). Quebec refused this abbreviation outright as it was already widely used to mean private-public partnership.
Thus, the notion itself of continuing medical training, which had succeeded to the notion of continuing medical education, evolved to respond to the new challenges facing the profession which, in addition to dealing with knowledge, now added expertise and attitude (behaviour). From this point onwards, we referred to continuing professional development (CPD). The PDO mission statement was revised to reflect this new reality.
The years that followed showed the extent to which continuing professional development had become a requirement, even a standard. No matter which profession was involved, there were maintenance activities, knowledge refreshers and advanced workshops.
The PDO innovated by offering a workshop to train the trainer to all physicians who wanted to organize a CPD activity. The workshop would even be offered outside the offices of the FMSQ where it had been held for a number of years: a first workshop was given in Quebec City in 2009.
Since the beginning of the third millennium, the PDO multiplied its projects and accreditation visits followed one another successfully. The 100th meeting of the FMSQ’s Conseil de DPC was held on April 24, 2007 with the development of a new project: the setting up of what could become the most important continuing professional development activity in Quebec.
Thus was born the concept of the FMSQ’s Interdisciplinary Education Days (IED). The very first one took place on November 7, 2008 and attracted 233 participants. Two associations, neurology and psychiatry, organized joint educational activities. This was the start of a new era in CPD. The success of this activity continued to grow from year to year, proving that the FMSQ had seen clearly: physicians needed to stop working in isolation and start taking advantage of interdisciplinarity, as much for the benefit of their patients as for their professional practice. Within a few years, the IED have become the not-to-be-missed annual event, the largest CPD annual congress for medical specialists in Quebec. The medical associations in the rest of Canada became interested and have tried to organize similar events.
A CRUCIAL ROLESince its creation, the PDO has supported physician-members of the FMSQ in their professional development process, by showing them the benefits for their careers and for patients, by giving them practical tools, by organizing workgroups, etc. This support was motivated by a refusal to let authorities apply any form of obligation or requirement. But science has greatly evolved, as have ways of thinking; what was rejected yesterday has become desirable today. The majority of physicians have integrated continuing learning within their work. CPD has become more than a standard... it is now an ethical obligation.Since the arrival in 2013 of its new Director, Dr Sam J. Daniel, the PDO has been multiplying its development projects in line with new trends.
Within a few years, the IEDs have become the not-to-be-missed annual event, the largest CPD annual congress for medical specialists in Quebec.
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Interview by Patricia Kéroack, c.w.
Communicating her Passion for CPDShe is neither a guru nor an adult educator, nor has she ever been responsible for CPD in her medical association, and yet Diane Francœur, a gynecologist and obstetrician at Sainte-Justine University Hospital Centre and the Vice-President of the FMSQ, energetically promotes the virtues of CPD among her colleagues... to such an extent that she invites the unwilling to cast a fresh eye on what they are already doing.
DR FRANCŒUR, YOU SEEM PASSIONATE WHERE CPD IS CONCERNED. WHY IS THAT?
As our 2010-2011 advertising campaign put it, I have a passion for life (laughs). I believe that, fundamentally, CPD is as much a certainty in the life of a physician as are death and taxes for all citizens. Finishing one’s medical training does not mean not having to continue learning. Medical science evolves, techniques change, new tools, molecules or knowledge arrive. For every possible reason, in order to provide better care to my patients and to be the physician I want to be every day, I believe in CPD. My patients and I will all benefit from it.
It’s almost a profession of faith, a credo. I decided to give this unloved reality a push in the right direction. I do it almost every day by sharing my successes with my colleagues and by inspiring good reflexes in my students. At the FMSQ, I decided to put my knowledge of unionization at the service of CPD so that physicians would realize the importance of continuing to learn.
SINCE CPD HAS BECOME A STANDARD, AN ETHICAL OBLIGATION, HOW HAVE PHYSICIANS INTEGRATED RESOURCING INTO THE ORGANIZATION OF THEIR WORK?
Unfortunately, still today, not all physicians have integrated CPD into their work and they are wrong! There are some who are still unwavering CPD opponents, who don’t seem to have understood the benefits and improvement it could bring to their work or even worse, who make use of cognitive dissonance to convince themselves that it’s not mandatory. And, age is not a factor here!
Many physicians work a lot and believe it is impossible to add to their workload. The quality of medicine in Quebec is excellent; this shows that our physicians remain at the cutting edge of knowledge. All physicians take part in annual congresses and other similar meetings. They sometimes search through medical literature to find an answer to a situation in which a patient finds himself. They read certain articles they believe are interesting for their clientele or for their work, but they never fill out their forms. All of this time spent is part of CPD. All that’s needed is to learn to organize it, to record it and to bill it in order to gain all its benefits. I am convinced that all medical specialists undertake CPD and some more than they believe. Increasing awareness of CPD must be undertaken, especially for those physicians who are the most recalcitrant.
IS THE RESOURCING FEE OBTAINED BY THE FMSQ AT THE LAST NEGOTIATIONS WITH THE GOVERNMENT TO RENEW THE AGREEMENT AN INCENTIVE TO UNDERTAKE ONE’S OWN CPD?
It can be seen as an incentive, but in fact it was a question of recognizing that CPD is an integral part of being a physician, since CPD is a form of work in itself. We already know that, with the first available data on the subject, the resourcing rate is being used, but we won’t be able to evaluate its extent for each type of physician with any exactitude until later.
AT WHAT STAGE WAS CPD TEN YEARS AGO?
The face of CPD has completely changed over the last decade. It was then financed by industry, which says a lot about the offer of training and the means used to attract physicians. This doesn’t mean that the quality of the training was deficient in any way, but the financial means to provide for it were. Today, it’s a fair return of the pendulum and we now consider there is a certain virtue in CPD. On the other hand, the financial resources to organize large-scale meetings are more difficult to obtain since the modification of the ethical rules regarding contributions by industry.
AND, IN YOUR OPINION, WHERE WILL CPD BE IN TEN YEARS?
I hope that CPD will be only a click away for all physicians. CPD is already available quickly. Physicians who have five, ten or fifteen minutes between two cases can already complete an accredited activity, an exercise in simulation or a quick test on the Internet. Soon, physicians will be able to access essential knowledge with a single click: training, exercises, tests, automatic billing, addition of info for their CV and a lot more! Several online training projects are being developed, in particular at the FMSQ. Then, we will see made-to-measure tools appear to help us during surgery, cyber mentorship, for example. There will be many possibilities available to us in the future, but we need to develop automatic reflexes for CPD, and this immediately.
WHAT IS YOUR GREATEST WISH?
I would like to try to convince each CPD opponent and turn them into CPD believers! The physician who understands its functioning and who integrates it rapidly into his daily life will see there is nothing complicated there. In fact, isn’t this special issue a way of doing so? The best is still to come, that’s certain!
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The Pedagogical Principles of the Royal College’s MOC Program
Keep Your Practice at the Heart of Your Learning ProgramThe Maintenance of Certificate (MOC) program, created in the year 2000, is a guarantee of excellence in the area of continuing professional development. It provides a frame of reference to Fellows of the Royal College to guide them in their choice of educational activities.
In order to fully comprehend the three sections of the program, the Royal College offers you a reference chart. This chart will help you discover your educational needs and will guide you towards the best resources.
There are changes to the MOC requirements since January 1, 2014. Visit the Royal College’s site for more information on these changes.
BETTER LEARNING FOR BETTER CARE
Framework of Continuing Professional Development Activities
Accredited activitiesConferences, rounds, journal clubs or small-group activities that adhere to Royal College standards. Accredited group learning activities can occur face-to-face or web-based (online).
Unaccredited activitiesRounds, journal clubs or small-group activities in the process of meeting the educational and ethical standards; rural or local conferences that have no industry sponsorship.
Planned learningLearning activities initiated by the identifi cation of a need, problem, issue or goal, either at or separate from the point of care, leading to the creation of a learning plan developed independently or in collaboration with peers or mentors.
ScanningResources that physicians use to enhance their awareness of new evidence, perspectives or fi ndings that may be potentially relevant to their professional practice.
Systems learningActivities that stimulate learning through contributions to practice standards, patient safety, quality of care; curriculum development; or assessment (examination boards, peer review).
Knowledge assessmentPrograms accredited by Royal College CPD providers that provide data with feedback to individual physicians regarding their current knowledge base to enable the identifi cation of needs and the development of future learning opportunities relevant to their practice.
Performance assessmentActivities that provide data with feedback to individual physicians, groups or interprofessional health teams related to their personal or collective performance across a broad range of professional practice domains. Performance assessment activities can occur in a simulated or actual practice environment.
• Accredited rounds, journal clubs, small groups• Accredited conferences
• Unaccredited rounds, journal clubs, small groups
• Unaccredited conferences without industry support
• Fellowships• Formal courses• Personal learning projects• Traineeships
• Journal reading• Podcasts, audiotapes, videotapes• Internet searching (Medscape, UpToDate, DynaMed)• InfoPOEMs
• Practice guideline development • Quality care/patient safety committee• Curriculum development• Examination development• Peer assessment
• Accredited self-assessment programs
• Simulation• Chart audit and feedback• Multi-source feedback• Educational/administrative assessments
1 credit per hour
0.5 credits per hour (maximum of 50 credits per cycle)
100 credits per year25 credits per course2 credits per hour2 credits per hour
1 credit per article0.5 credits per activity0.5 credits per activity
0.25 credits per activity
20 credits per year 15 credits per year15 credits per year15 credits per year15 credits per year
3 credits per hour
3 credits per hour3 credits per hour3 credits per hour3 credits per hour
SECTIONS CATEGORY EXAMPLES CREDIT RATING
This table summarizes the learning sections under the new MOC framework. Activities submitted via MAINPORT are converted automatically into credits.
Sect
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1:
Gro
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2:
Self
-learn
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Sect
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© Copyright, Royal College of Physicians and Surgeons of Canada, 2009. - royalcollege.ca. Reproduction authorized by the RCPSC.
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The CMQ’s Self-Managed CPD Plan The ultimate goal of CPD programs is not the accumulation of a certain number of credits in continuing training, but the maintenance of professional competencies.
Since July 1, 2007, Quebec physicians need to choose one of the Continuing Professional Development programs. By proposing a simple and user-friendly approach to its members, the Collège allows physicians to manage their CPD plan in order to adequately meet their educational needs.
“ A physician must practise his profession in accordance with the highest possible current medical standards; to this end, he must, in particular, develop, perfect and keep his knowledge and skills up to date. ”
Code of ethics of physicians (2002), c. M-9, r. 4.1, art. 44.
Physicians must advise the Collège of their choice of CPD plan at the time they renew their annual membership. Those who were not able to do so are invited to fill out the registration form to a CPD plan and to return it as soon as possible to the Collège des médecins du Québec. You can access the Collège’s Website (cmq.org) to register your educational activities for the July 1, 2012 to June 30, 2017 period.
Once a year, the Collège asks about 3% of its members to supply proof of membership in a CPD program.
The CMQ receives numerous requests from physicians who have questions regarding the CPD plan. To this end, here are a few of the most frequent questions received and answered by the CMQ. Visit the Frequently Asked Questions section for more details: cmq.org.
1. IS THE PLAN MANDATORY? (CAN I LOSE MY RIGHT TO PRACTICE IF I DON’T HAVE A CPD PLAN?)
No, the CPD plan is not mandatory. The fact that a physician does not comply with the self-managed CPD plan from the CMQ cannot in itself have consequences for his or her right to practice nor can it serve as a basis to impose a fine as such.
On the other hand, this does not reduce the value of the plan, since it remains a pertinent tool that can help a physician manage his or her continuing education. Not following up or not taking part could serve as an indication or reveal more serious problems within the physician’s practice.
Thus, a refusal or failure by a physician to take part in some kind of continuing education activity could be used as elements of proof, among others, on the disciplinary level, during a professional inspection or even on his or her professional liability.
The CMQ considers that the absence of a CPD plan, in association with other indicators, can lead to a professional inspection visit.
2. IS THE CMQ PLAN THE ONLY ONE THAT IS RECOGNIZED?
No, the CMQ recognizes three CPD plans, thus providing for the possibility for a physician to choose the one he or she prefers or the one that best suits him or her:
- A self-managed plan such as the one from the CMQ, the PADPC from the FMOQ, or any other similar approved program;
- The RCPSC MOC program;- The competency-maintenance program
(Mainpro) from the College of Family Physicians of Canada (CFPC).
3. AM I REQUIRED TO HAVE A CPD PLAN IF I AM RETIRED, ILL, OR IF I ONLY USE MY TITLE OF PHYSICIAN OCCASIONALLY?
No. However, all physicians registered as active members, whether they practice full-time or part-time, and this, without taking their sector or activity or their chosen field into consideration, are invited to have a CPD plan.
4. HOW MANY CREDITS DOES THE CMQ REQUIRE?
The CMQ program and that of the FMOQ are based essentially on a reflexive approach, structured according to your CPD needs, while those of the CFPC and the RCPSC have additional requirements regarding the minimum number and types of credits.
Thus, the CFPC requires that those who are certified accumulate 250 credits per period of 5 years, of which a maximum of 125 M2-type credits; a minimum of 25 credits is required each year.
At the RCPSC, Fellows are required to cumulate at least 40 continuing professional development educational units each year and at least 400 units per cycle of 5 years.
CONCLUSIONRemember that the ultimate goal of the CPD plan is to contribute to maintaining professional competency as stipulated in the Code of Ethics of Physicians. The CMQ is convinced that the CPD plan helps physicians attain this goal.
By Roger Ladouceur, MD
Roger Ladouceur is the physician responsible for the CPD Plan at the Improvement of Practice Directorate at the Direction de l’amélioration de l’exercice of the Collège des médecins du Québec.
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CPD in Psychotherapy In June 2012, the Regulation respecting the psychotherapist’s permit1 came into effect. This regulation establishes the standards for delivery of a psychotherapist licence and the framework of obligations with regards to continuing education.
By virtue of Section 3 of this regula-tion and the terms and conditions of its application, the physician who practises psychotherapy is required to accu-mulate at least 90 hours of continuing education in psychotherapy over a period of five years.
This article seeks to provide answers to the most frequently asked questions raised by the implementation of this regulation, in particular to inform those members who practise psychotherapy.2 The terms and conditions for registe-ring activities are detailed in the second portion of this article.
QUESTIONS AND ANSWERS
1. WHAT IS PSYCHOTHERAPY?
The law gives a clear def init ion of psychotherapy:
The law gives a clear definition of psycho-therapy: “... psychological treatment for a mental disorder, behavioural disturbance or other problem resulting in psycholo-gical suffering or distress, and has as its purpose to foster significant changes in the client’s cognitive, emotional or behavioural functioning, his interpersonal relations, his personality or his health. Such treatment goes beyond help aimed at dealing with everyday difficulties and beyond a support or counselling role.” (Section 187.1 of the Professional Code)
2. WHAT IS NOT PSYCHOTHERAPY?
The following interventions do not, within the meaning given in the Regulation, constitute psychotherapy: accompani-ment and support at meetings, support intervention, conjugal and family inter-vention, psychological education, rehabilitation, clinical follow-up, coaching, and crisis intervention.
3. ARE PSYCHIATRISTS AFFECTED BY THIS REGULATION?
Yes, if you provide psychotherapy. The regulation is explicit in this regard:
DIVISION III
FRAMEWORK FOR CONTINUING EDUCATION REQUIREMENTS
Sec. 3. Physicians or psychologists who practise psychotherapy and holders of a psychotherapist’s permit must accumulate at least 90 hours of continuing education in psychotherapy over a 5-year period.
Physicians must choose continuing education activities from among the continuing education activities in psychotherapy adopted by the Collège des médecins du Québec.
Source: Regulation respecting the psychotherapist’s permit
4. WHO CAN USE THE TITLE OF PSYCHOTHERAPIST?
The law limits the use of the psychothe-rapist title to physicians, psychologists and holders of a psychotherapist’s permit issued by the Ordre des psychologues du Québec.
5. WHAT ARE THE CONTINUING EDUCATION OBLIGATIONS TO CONSERVE THE RIGHT TO PRACTICE PSYCHOTHERAPY?
Essentially, the regulation contains an obli-gation to complete 90 hours of continuing education specific to psychotherapy, spread over a period of 5 years.
The CMQ is responsible for ensuring compliance with the regulatory require-ments applicable to physicians practising psychotherapy. The Board of Directors adopted a resolution in 2013 defining the terms and conditions specific to these physicians.3 This resolution was amended on December 13, 2013 by the Board of Directors to include other recognized CPD activities in psychotherapy.
The resolution also determines which accredited organizations will offer CPD activities in psychotherapy as well as managing compliance with the number of continuing education hours required. These organizations are those who are members of the CQDPCM4: the QCFP; the FMOQ; the FMSQ; MFC; Université Laval ; Université de Montréal; McGill University and Université de Sherbrooke.
Activities that are also recognized include those adopted by the Ordre des psycho-logues, and group activities accredited by Canadian organizations, in particular Mainpro M1 and Mainpro C credits from the College of Family Physicians of Canada, those in Section 1 from the Royal College of Physicians and Surgeons of Canada, as well as activities accredited by an American organization, itself accredited by the American Council for Continuing Medical Education (ACCME).
6. HOW ARE PSYCHOTHERAPY CPD HOURS REGISTERED?
A physician who practises psychotherapy must register these on his annual report. He will then be subject to the applicable regulation regarding mandatory CPD hours in the field of psychotherapy and will need to declare, via the Internet tran-sactional site developed to this end and accessible since September 4, 2013, the number of hours of continuing education completed during the reference period which ends on June 30, 2017.5
Dr Roger Ladouceur is the physician-in-charge of the CPD plan at the Direction de l’amélioration de l’exercice of the Collège des médecins du Québec. Dr François Goulet is Assistant Director at the CMQ’s Direction de l’amélioration de l’exercice.
By Roger Ladouceur, MD andFrançois Goulet, MD, MA (Pedagogy, Health sciences)
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Serge Lenis is an anesthesiologist and the Director of Professional Affairs at the Fédération des médecins spécialistes du Québec.
Maintaining Competencies, Joint Committee and Others
Let’s Talk About Schedule 44!Schedule 44 (Annexe 44) of the Agreement in effect between the FMSQ and the MSSS allows medical specialists to bill certain amounts to the RAMQ when they take part in a resourcing activity. This billing concerns two very distinct types of resourcing: group resourcing, such as an annual congress, and individual resourcing.
GROUP RESOURCINGWhenever it concerns group resourcing, invoices for the time spent participating in an activity is normally sent directly to the RAMQ as long as the activity is already accredited, which means that it is given by a group recognized by one of the accrediting organizations. Depending on where the conference is held, the accre-ditor can be from Quebec, Canada, the United States or Europe. The list of accre-ditors forms an integral part of Schedule 44 (see complete list on page 22).
Congress organizers generally indicate the accreditation status of their congress in the activity program as well as the name of the accrediting organization. For most group resourcing activities that are already accredited, send your request for payment directly to the RAMQ with the appropriate documentation: payment form No. 4188, confirmation of attendance, including the number of hours of participation, and, if available, the conference program. The RAMQ then checks out that the request of payment is justified and pays the amount specified in Schedule 44 for the resourcing.
For other group resourcing that is not specifically accredited, the physician must submit a request to the Schedule 44 joint committee. The latter evaluates the resourcing to see if it meets criteria and is thus accreditable. Such a request must be sent to the FMSQ. The joint committee, which is made up of repre-sentatives of the MSSS and of the FMSQ, analyzes the request, deliberates and decides if the activity is reimbursable according to Schedule 44. The decision is sent to the RAMQ and to the requestor who must then send his request of payment to the RAMQ.
INDIVIDUAL RESOURCINGIndividual resourcing is generally a personal project for a medical specialist who wants to improve one aspect of his or her practice or who wants to develop a new aspect. The physician must submit a request to the joint committee in order to obtain approval of his activity according to Schedule 44. The request must describe the project, the goals to be reached and the name of the mentor who will supervise the training. At the end of his or her training period, the physician must obtain a letter from the mentor or supervisor of the training.
The mentor must indicate in his letter that the trainee completed the training, that the required number of hours was met and that the goals described have been reached. The request is then evaluated by the joint committee to decide if it is acceptable. If it is, the RAMQ and the trainee are so advised and the latter must send his or her request of payment to the RAMQ, along with all the asso-ciated documents.
AN ACTIVITY TO MAINTAIN COMPETENCIES DOES NOT ALWAYS INVOLVE SCHEDULE 44Certain activities give rise to credits for the maintenance of competencies, whether it is within the CMQ
Maintenance of Competency Program or the RCSPC Maintenance of Certificate Program.
It is important to understand that the fact that an activity qualifies for credits within either of these programs does not automatically mean that the activity will qualify for an amount for resourcing by virtue of Schedule 44.
It often happens that credits are awarded for activities that are not in fact resour-cing. For example, when a medical specialist is an examiner for a RCPSC exam, he or she receives credits from the College that can be allocated to his or her own maintenance of competency program. However, this activity is not resourcing in itself; therefore, he or she cannot bill this activity within the meaning of Schedule 44 for resourcing.
In the same way, giving a conference can earn credits within the framework of the Maintenance of Certificate Program, but this does not open the door to a payment by virtue of Schedule 44 for resourcing. These activities are indirectly related to the Maintenance of Competency programs at the RCPSC or at the CMQ and allow a physician to accumulate credits within the said programs. But they are not considered to be resour-cing for the purposes of Schedule 44 (the complete text – in French only - of Schedule 44 follows on pages 20 and 21).
By Serge Lenis, MD, CM, FRCPC
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ANNEXE 44 concernant l’instauration d’un programme de développement professionnel et de maintien des compétences
1. OBJETLa présente entente a pour objet la mise en place d’un programme de développement professionnel et de maintien des compétences pour les médecins spécialistes.
Ce programme prévoit l’octroi, à chaque médecin spécialiste admissible, d’un montant forfaitaire By demi-journée, pour les activités de développement professionnel et de maintien des compétences reconnues auxquelles il participe (ci-après les “ demi-journée de ressourcement ”).
2. ADMISSIBILITÉ2.1 Les mesures prévues à cette annexe s’appliquent à l’ensemble des médecins spécialistes qui ont une pratique active dans le
cadre du régime d’assurance maladie, à l’exception :
- des médecins spécialistes exerçant en région éloignée et bénéficiant des modalités de ressourcement prévues à l’Annexe 19 ;
- des médecins spécialistes rémunérés selon le mode du salariat (Annexe 16) ;
- des médecins spécialistes en anatomo-pathologie qui ont droit aux mesures de ressourcement prévues à l’Addendum 2 des services de laboratoire en établissement.
2.2 Les critères de pratique active sont déterminés périodiquement By les parties négociantes et transmis à la Régie aux fins d’application de ce programme.
3. MODALITÉS D’APPLICATION 3.1 Le médecin spécialiste bénéficie d’un maximum de quatorze (14) demi-journées de ressourcement By année civile. Les demi-
journées de ressourcement sont calculées et octroyées au crédit du médecin à raison d’une demi-journée de ressourcement pour chaque tranche de dix mille dollars (10 000 $) de gains de pratique payés By la Régie au cours de l’année civile.
3.2 Le médecin spécialiste peut utiliser ses demi-journées de ressourcement By anticipation, jusqu’à concurrence de quatorze (14) demi-journées By année civile. À la fin d’une année civile, si le médecin a utilisé, By anticipation, plus de demi-journées de ressourcement que ce à quoi il a droit en vertu de l’article 3.1, les demi-journées en excédent viennent réduire le nombre de demi-journées auquel il a droit lors de l’année subséquente.
3.3 Les demi-journées de ressourcement peuvent être utilisées tous les jours de la semaine. Le médecin qui réclame le paiement d’une demi-journée de ressourcement ne peut réclamer le paiement d’autres honoraires de la Régie au cours de la même période.
3.4 Les demi-journées de ressourcement non utilisées au cours d’une année ne peuvent être cumulées. Elles ne peuvent également faire l’objet d’une indemnisation.
3.5 Le médecin spécialiste qui participe à une activité de ressourcement reconnue doit donner un préavis d’un mois au chef de département ou de service.
3.6 Le médecin spécialiste qui participe à une activité de ressourcement reconnue a droit au paiement d’un montant forfaitaire de quatre cents dollars (400 $) By demi-journée de ressourcement.
Une activité de trois (3) heures permet l’utilisation d’une demi-journée de ressourcement. Une activité de six (6) heures permet l’utilisation de deux (2) demi-journées de ressourcement. Un maximum de 2 demi-journées est payable By jour.
3.7 Le médecin spécialiste doit, pour obtenir paiement de ce montant forfaitaire, fournir à la Régie les pièces justificatives.
Nous reproduisons ici le contenu intégral de l’Annexe 44, convenue entre le ministère de la Santé et des Services sociaux et la Fédération des médecins spécialistes du Québec le 16 décembre 2011 et modifiée le 29 juin 2012.
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4. ACTIVITÉS DE RESSOURCEMENT RECONNUES4.1 Seules les activités de développement professionnel et de maintien des compétences reconnues By les parties négociantes
peuvent donner droit aux avantages prévus au présent programme.
4.2 Sont reconnues les activités qui répondent à l’un ou l’autre des critères suivants :
I) LES ACTIVITÉS D’APPRENTISSAGE COLLECTIF AGRÉÉES
Les activités d’apprentissage collectif agréées sont des activités de développement professionnel et de maintien des compétences d’une durée minimale de 3 heures consécutives et qui sont dispensées de façon conforme aux normes d’un prestataire agréé en matière d’éducation et d’éthique.
Est considérée comme prestataire agréé, toute organisation évaluée comme telle By un organisme accréditeur reconnu. Sont reconnus comme organismes accréditeurs :
• Pour le Québec et le Canada : le Collège des médecins du Québec et le Collège royal des médecins et chirurgiens du Canada ;
• Pour les États-Unis d’Amérique : l’Accreditation Council for Continuing Medical Education ;
• Pour l’Union européenne : L’European Accreditation Council for Continuing Medical Education ;
• Tout autre prestataire désigné By les parties négociantes.
II) LES STAGES DE FORMATION OU DE PERFECTIONNEMENT
Les stages de formation ou de perfectionnement sont des d’activités d’une durée minimale de 3 heures consécutives, planifiées en collaboration avec un mentor ou un superviseur et qui portent sur l’acquisition de nouvelles connaissances ou compétences ou leur maintien. Ces stages d’apprentissage sont mis en place après la détermination d’un besoin ou d’un objectif, By exemple By rapport au milieu de pratique.
Un stage de formation ou de perfectionnement comporte un plan d’apprentissage élaboré individuellement ou en collaboration avec les pairs ou les mentors. Le spécialiste exerce sous la direction d’un mentor ou d’un superviseur, qui lui donne une rétroaction relative aux objectifs d’apprentissage atteints.
Tout médecin qui souhaite faire reconnaître un stage de formation ou de perfectionnement aux fins de l’application du présent programme doit transmettre une demande à cet effet aux parties négociantes au moins un mois avant le début de ce stage.
5. COMITÉ CONJOINT5.1 Les parties négociantes forment un comité conjoint aux fins de l’application du programme prévu à la présente annexe.
5.2 Le comité conjoint a pour principale fonction d’évaluer les demandes de reconnaissance de stage de formation ou de perfectionnement transmis By les médecins en vertu de l’alinéa 4.2 (ii).
De plus, le comité conjoint peut se prononcer sur toute activité de développement professionnel et de maintien des compétences prévue à l’alinéa 4.2 (i) lorsque cette implication est nécessaire afin de bien cerner si une activité satisfait ou non aux conditions prévues à cet alinéa ou lorsque cette activité est reconnue By un organisme accréditeur autre que ceux identifiés à cet alinéa.
5.3 La Régie donne suite aux avis transmis By les parties négociantes et comportant l’information nécessaire à l’application du présent programme.
6. MISE EN VIGUEUR La présente annexe entre en vigueur le 1er avril 2012. Toutefois, aux fins de l’application de l’article 3.1, on tient compte des gains de pratique du médecin à compter du 1er January 2012.
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LISTE DES ORGANISMES ACCRÉDITEURS RECONNUS ET DES PRESTATAIRES AGRÉÉS*
ORGANISME ACCRÉDITEUR PRESTATAIRES AGRÉÉS
QUÉBEC COLLÈGE DES MÉDECINS DU QUÉBEC
LA FÉDÉRATION DES MÉDECINS SPÉCIALISTES DU QUÉBEC
ASSOCIATIONS MÉDICALES AFFILIÉES
- Association des allergologues et immunologues du Québec - Association des anesthésiologistes du Québec - Association des médecins biochimistes du Québec- Association des cardiologues du Québec- Association des chirurgiens cardiovasculaires et thoraciques du Québec - Association québécoise de chirurgie- Association des chirurgiens vasculaires du Québec- Association des spécialistes en chirurgie plastique et esthétique du Québec- Association des dermatologistes du Québec- Association des médecins endocrinologues du Québec- Association des gastro-entérologues du Québec- Association des médecins généticiens du Québec- Association des médecins gériatres du Québec- Association des médecins hématologues et oncologues du Québec- Association des spécialistes en médecine interne du Québec- Association des médecins spécialistes en médecine nucléaire du Québec- Association des médecins microbiologistes infectiologues du Québec- Association des néphrologues du Québec
(Société québécoise de néphrologie)- Association de neurochirurgie du Québec- Association des neurologues du Québec- Association des obstétriciens et gynécologues du Québec- Association des médecins ophtalmologistes du Québec- Association d’orthopédie du Québec- Association d’oto-rhino-laryngologie et
de chirurgie cervico-faciale du Québec - Association des pathologistes du Québec- Association des pédiatres du Québec- Association des physiatres du Québec- Association des pneumologues de la province de Québec- Association des médecins psychiatres du Québec- Association des radiologistes du Québec
(Société canadienne française de radiologie)- Association des radio-oncologues du Québec- Association des médecins rhumatologues du Québec- Association des médecins spécialistes en santé communautaire du Québec- Association des spécialistes en médecine d’urgence du Québec- Association des urologues du Québec- Société des experts en évaluation médico-légale du Québec
LA FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
MÉDECINS FRANCOPHONES DU CANADA
LES FACULTÉS DE MÉDECINE DES UNIVERSITÉS : LAVAL, McGILL, MONTRÉAL ET SHERBROOKE
CANADA ET QUÉBEC
COLLÈGE ROYAL DES MÉDECINS ET CHIRURGIENS DU CANADA (CRMCC)
Les organismes apparaissant sur le site suivant : rcpsc.medical.org
UNION EUROPÉENNE
EUROPEAN ACCREDITATION COUNCIL FOR CONTINUING MEDICAL EDUCATION (EACCME)
Les activités organisées By l’EACCME (eaccme.eu)
Les sociétés nationales de médecins spécialistes
Les sociétés supranationales de médecins spécialistes
ÉTATS-UNIS D’AMÉRIQUE
ACCREDITATION COUNCIL FOR CONTINUING MEDICAL EDUCATION (ACCME)
Les organismes apparaissant sur le site suivant : accme.org
* Selon l’entente, est également reconnu “ tout autre prestataire désigné By les parties négociantes ”.
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The CQDPCM… Accomplishments in CPD for You!The CQDPCM is an advisory entity that is unique in Canada. Its members* meet to deliberate and collaborate on the challenges specific to CPD for physicians in Quebec. Each member retains his or her independence and acts as a spokesperson for the organization to which he or she represents.
TRACKING TRENDS IN CPDThe main challenge for CPD is to create value for our healthcare system as well as to anchor itself to the evolution of medical practice. We have seen a lot of changes over the last few years: a mandatory CPD program (requiring the maintenance of a self-managed CPD plan and its documentation); the integration of competencies in CPD; the identification of conflicts of interest among resource people; and many others. CPD is being transformed!
The future of CPD promises to be just as tumultuous, foreseeing inter and multidisciplinary team education; CPD in practice settings with longitudinal and multidimensional intervention models; the evaluation of competencies and perfor-mance; the partnership with new groups working in the fields of continuous impro-vement of care and patient safety; the use of technologies in healthcare and its applications in CPD; etc. The CQDPCM seeks to identify these innovative trends, circumscribe the challenges and discuss possible solutions. One of the methods it uses is its investment in the promotion of innovation and research in CPD.
In order to facilitate access to infor-mation, its web site contains valuable details. In addition, each year, the CQDPCM awards prizes for innovation and for research, as well as a research grant, with the aim of encouraging emerging researchers and recognizing innovative accomplishments contributing to the progress of CPD.
A CODE OF ETHICS FOR CPDA new code of ethics is in the process of approval at the CQDPCM. As was the case for the code in 20031, it will place emphasis on the quality of CPD activities and programs. New guidelines will be added such as the management of potential bias. Recognizing that any organization may have a bias because of its mission, its objectives, its members or its interests, biases will need to be identi-fied whether they are positive or negative. Commercial biases will continue to be rejected in CPD.
Organizers, resource people and parti-cipants will have to ensure they do not find themselves in situations of conflict of interest. There will be a mandatory declaration of real and potential conflicts of interest for all resource persons and a disclosure of all financial and orga-nizational affiliations. Organizers will need to prepare a process to manage conflicts of interest. Interference by any organization providing grants, no matter who they are, will need to be avoided whether this includes for example, the placement of advertising associated with a subject, a speaker or material (“tagging”). As well, the independence of resource persons will be more exten-sively highlighted and they will no longer be allowed to accept remuneration from a grant-giving organization.
The new code of ethics will be a tool adapted to the needs of today and will always support reflexive approaches by organizers, resource people and participants in order to facilitate their ethical judgement. Just like for today’s code, the CQDPCM will develop educa-tional sessions that will be available on demand.
A LETTER TO KEEP YOU INFORMED AND REFERENCE MATERIAL FOR CPDIt is difficult to keep abreast of develop-ments in CPD for all your practice areas. To make it easier for you, the CQDPCM offers tools such as the notices from L’Organisateur d’ÉMC and the Lettre du DPC, which will support you in organizing activities as well as for your own CPD.
A DIRECTORY OF ACTIVITIES Register your CPD activities in the directory through your own organization, a member of the CQDPCM, or consult the directory to find the activity that will meet your needs and that will help you plan your annual CPD.
YOUR CPD PROGRESSThe CQDPCM makes available, on demand, a training program dealing with methods of organizing CPD. Keep an eye out as well for our announcements of congresses which are an excellent opportunity to network with other organizers or to share CPD practices and knowledge. In order to guide your CPD development, the CQDPCM has developed a selection of pathways that will meet the training needs of resource people, trainers/organizers as well as that of the innovator/researcher and the manager/entrepreneur.
The CQDPCM recognizes that CPD is an essential component of profes-sional practice that evolves rapidly. Collaboration, whether it is between members of the council or of other orga-nizations in Canada and abroad, allows you to meet your educational needs and to create value for our healthcare system.
By Céline Monette
Céline Monette is Director General of Médecins francophones du Canada and former President of the Quebec Council on Physicians’ Continuing Professional Development.
* The CQDPCM is made up of the CMQ, the four universities with Faculties of Medicine, the two medical federations (FMOQ and FMSQ), the RCPSC, the QCFP, the CMPA, MFC and Rx&D.
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Copyright Laws in the Digital AgeOn June 19, 2012, the House of Commons voted in favour of Bill C-111 amending the Copyright Act. This Act allows the use of works protected by copyright for the purpose of teaching2 on condition that its use be fair. In addition, the Bill deleted references to specific technologies such as the overhead projector and now refers to all information technologies (IT) for broadcasting teaching.
The Act thus allows broadcasting courses and training over the Internet even if they contain sections protected by copyright. It allows teaching institu-tions to digitally distribute educational material protected by copyright subject to adequate compensation for copyright holders.
Unfortunately, the Act does not define the concept of fair use of works protected by copyright. A 2005 judgment on the concept of fair dealing, confirmed by the Supreme Court in 20123, proposed criteria to judge if using a work without the copyright holder’s authorisation was fair. These criteria are: the aim, the nature and the extent of use; the nature of the work; the existence or not of alternate solutions; and the effect of use on the work.
These grey zones made it difficult to understand the limits and adequately apply the sections of this law on the modernisation of copyright.
The examples that follow should clarify the implications of these changes in the Copyright Act.
CASE STUDY 1You are responsible for your depart-ment’s journal club and you want to send by e-mail a digital copy (in PDF format) of two articles taken from different periodi-cals. You have not asked for permission to distribute these articles.
Does this practice, widespread in our profession, respect the Copyright Act?
The answer is not simple, since we are dealing here with the concept of equitable use of a work, that is an article in a periodical. The Council of Ministers of Education, Canada has suggested Fair Dealing Guidelines1 for works protected by copyright in which an electronic distri-bution of material is allowed as long as it is for teaching or educational purposes. In addition, we must always quote the source, limit distribution to one copy by participant and limit the extract to a single chapter of a book (less than 20% of the book) or to a single article in a periodical.
In my opinion, and in mine only, this practice respects the concept of fair dealing as long as the distribution is limited in duration, that the number of individuals be limited (10 rather than 200 persons) and that only one copy be allowed. An appropriate way would have been to send a hyperlink to the articles thus allowing each one to download the article onto a computer.
CASE STUDY 2You have been invited to make a presen-tation during a CPD activity. You want to include your presentation with images, graphs or tables taken from articles, books or internet sites. Can you distri-bute your presentation to participants?
To begin with, you need to read the copyright (©) notice of the publication whose material you want to use. Some publishers prohibit their use even within the context of teaching, but it is usually allowed. In the latter case, you have to quote the source.
The same applies to the use of images on the Internet or in periodicals. Be careful: the rights can be different as they apply to use (during a presentation) or to broadcasting (distribution of your presentation to participants).
Distributing your presentation to parti-cipants is more problematic. In general, you have to ask permission of the copyright holder (the author or publisher). Sometimes this is free of charge, but monetary compensation can be exacted. So, how can you get out of it?
There are a few solutions. In the first place, in your presentation, replace each table, image or graph that is not royalty free with a hyperlink referring to the resource on the Internet. You thus comply with the Copyright Act. Another solution is to replace the images, graphs or tables with others that are royalty free. Several of these resources can be found on the Internet. Some examples include: Wikimedia Commons, The Commons on Flickr, Google Images with restrictions for images with authorized reuse.
There are also paying sites through which you can acquire rights for the use of images. Be careful and verify in detail the terms of purchase and the rights of use for each image.
These rules apply whether you give out a paper copy of your presentation, a digital copy (on a flash drive or on a CD) or whether you make your presentation available on an Internet site, even if the latter is password protected.
By Richard Ratelle, MD, FRCSC
Richard Ratelle, a general surgeon, is President of the CPD Committee for the Association québécoise de chirurgie.
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The Logistics of a CPD ActivityImagine the scene: you have registered for a congress which is taking place a few hundred kilometres from your home; you have already paid for your registration, not to mention lodging and transportation. Disaster! At the registration desk, you are told that your name is not on the list of participants.
From the initial planning to the holding of the activity itself, through registration and the delivery of attendance certificates, whether you were expecting 10, 100 or 1,000 persons, there is an entire logistical track you need to be familiar with to ensure the success of your activity.
To ensure it is a success, no matter the format of the event (webinar or online training, colloquium, conference call, workshop, etc.), organization and method will be your companions in arms!
PREPARING A GOOD PLAN You often repeat the same preventative advice to your patients. In the same way, the best organizers, whether they are professionals in the field or not, also dispense advice for good planning habits. Unfortunately, we never insist enough on the importance of planning and the necessity of having a long-term vision.
Start by asking yourself a few questions such as what your organization and you want to have as an event, in the short, medium and long term? Will your event be called upon to expand or to become more frequent over the years? Are you
ready to invest yourself in order to succeed (time, efforts, resources, etc.)? What kind of financing are you looking for (self-financed activities, profitable ones or completely sponsored)?
Look at what other organizations are doing; get inspiration from what they are offering, from their successes and take note of what doesn’t work. You will then have a range of ideas that will inspire you with new ones that you will be able to adapt for your own event.
FINDING THE GOOD RESOURCESYour association does not have the resources available to look after the planning of your event? Think of using the services of a specialized firm that will take on the job for you. Your local tourism office generally offers planning services. You can also call upon various specific professional services (caterers, audiovisual services, photographers, graphic artists, etc.).
Think of the long term and start compiling a notebook in which you record all the information you need for your next activities (address, contacts, telephone numbers, etc.). Of course, the workload is proportional to the type and scope of the event you want to organize.
REMINDERS FOR SUCCESSFUL LOGISTICS
PLANNING PHASE (CAN LAST SEVERAL MONTHS):
- Organization (scientific committee, organizing committee, partners, coordinating and organizing agency, volunteers, potential exhibitors);
- Distribution of tasks (establish responsibilities and schedule for all members of the organizing committee – plan for several follow-up and progress meetings);
- Budget (prepare a detailed realistic budget by adding an amount for unforeseen expenses);
- Reservations (date, locale, block of rooms, speakers, signing of contracts, accreditation requests);
- Correspondence with speakers (invitations to participate, agreements, preparatory documents, validation of training objectives, copyright agreements, biographies, resumes and photos, audiovisual permissions, professional and personal contact details, transportation, lodging, dietary restrictions, etc.);
- Coordination of requests with congress locale (space requirements, audiovisual equipment, Internet access, telephone access, videoconferencing, meals and breaks, alternatives in case of dietary restrictions, tourist and social aspects);
- Management of registrations and payments;
- Planning of promotional needs: leaflets, posters, logo, website, advertising, signage, final program;
- Communications (communications strategy, written communications tools, website, registrations: on line and others, mailings);
- Progress of the activity (master of ceremonies, audiovisual support, protocol, etc.);
- Other considerations: insurance (have your proof of insurance with you on the day of the event), mementos for speakers, promotional items, various permits, availability of parking space or transportation services, delivery of material and equipment, cloakroom, etc.
By Patricia Kéroack, c.w.
Patricia Kéroack is a communications consultant and the person responsible for publications at the FMSQ’s Public Affairs and Communications Directorate.
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Continued from page 25
A WEEK BEFORE THE EVENT:- Prepare the material needed for the
registration desk (name tags, complete lists, participant binders or kits, tax receipts, attendance certificates, prepare cheques, signature lists, etc.);
- Prepare list of emergency numbers, cell phone numbers and other information for all persons involved (persons in charge, speakers, emergency services, taxis, restaurants, nearest pharmacies, etc.);
- Prepare a box of backup supplies: notepads, pens, highlighters, scissors, erasers, Post-it notes, blank name tags and receipts, petty cash, calculator, rulers, backup cell phone, chargers, first-aid kit, spot remover for clothing, comb, tissues, nail files, X-Acto knife, markers, analgesics, needle and thread, safety pins, flashlight, tampons, etc.). Don’t skimp on this box: you’d be surprised by the types of requests that come up during a congress;
- Confirm logistics with speakers, master of ceremonies, exhibitors, photographer, etc.;
- Obtain final details from speakers (presentation, bio, statements confirming absence of conflicts of interest, etc.);
- Write speeches, presentations, etc.
THE DAY BEFORE THE EVENT:- Brief the welcome staff, confirm
delivery of all material to the congress hall and, if possible, install the signage;
- Prepare the boxes and the registration material so that everything is ready to use as soon as you arrive on site the next day;
- Install backdrops, signs and banners;
- Install coat-racks or have a cloak-room ready.
D DAY – ACTION STATIONS EVERYONE:- Be early on site: there is always
something to settle at the last minute;
- Check the signage, prepare the registration desk;
- Prepare a table for the speakers;
- Meet the persons in charge at the hotel or conference centre;
- Check on activities for spouses (if any);
- Go over the progress of the day and each activity;
- Review the set-up of each room and the material it should contain; arrange for water for the speakers;
- Distribute reminders to speakers (questions regarding organization and supplies, schedules, etc.);
- Prepare for registration: schedule sufficient personnel so that participants do not need to wait, prepare additional kits for participants;
- Check instructions for meals, breaks, cocktails and others. Give details of special diets;
- Identify a spot for a press conference or for private individual interviews.
POST EVENT:- Send thanks to speakers, sponsors,
exhibitors and other people involved;
- Immediately reserve for next year;
- Respond to the various requests received during the activity;
- Compile evaluations;
- Finalize the event’s accounts;
- Draw up the event’s balance sheet..
The worst can sometimes occur!
Being ready for any eventuality will help you keep a cool head in case of catastrophe. Each season, every locale has its lot of unpredictable conditions (winter storm, power outage, flooding, etc.), and that’s not forgetting human-begotten problems (strikes, conflicts, other catastrophes, etc.).
Remember that you cannot control every facet of your congress: therefore, have a plan B ready for each of them. For example, in 2000, when I was organizing a (large !) event on electronic
commerce, a subject that was on the lips of seemingly everyone on the planet, our star speaker had a heart attack a few hours before getting on the airplane for Montreal. Panic ensued!
Plan B was immediately put into motion: knowing the speaker had an associate, we got in touch with him and begged him to come to Montreal. The associate was able to take over brilliantly and congress participants were not short-changed (while the organizers suffered from both hot flashes and cold sweats!).
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Promoting Your CPD ActivityPromoting any activity is not limited to preparing a leaflet, a poster or a website. However, it can sometimes make a real difference between a successful activity and a flop, which is why you need to pay it attention.
As you finish planning the most important congress of your career, you imagine a full house, in view of the quality of your program and the reputation of your speakers. However, two weeks after having announced your congress, you still don’t have any registrations. You try to understand; everything seems to be there. Finally, as you near the big day, you have to bow to the inevitable, you have to cancel your congress.
If this situation seems somewhat exaggerated, in reality it is possible. P r o m o t i n g a c o n g r e s s i s a communications activity that is just as important as its planning: for it to be a guarantee of success, promoting must be a part of the content planning for your CPD activity. Here are a few ideas that could help you.
SET YOURSELF GOALSIn addition to the educational objectives you took care to write up, don’t forget that your participation goals and your budgetary goals are just as important. What is the use of wanting to demonstrate the innovations in your sector of activity if they are not accessible in day-to-day practice? Why present a European speaker if you can’t cover his travel expenses?
You have to start by establishing your participation goals and a detailed budget: how many registrations and at what price? You will then have a better idea of the kind of promotion to undertake. For example, if you want to talk of a superspecialized subject, but that at most 100 people work in this sphere and, in addition some of your colleagues will have to remain at work, it is useless to think you will attract a crowd.
However, if you offer specialized training within a more general activity, you’ll be able to attract a lot more participants than if you offer a general workshop in parallel with your specialized workshop.
Your budget will help you prioritize your communications actions. If you know your target audience, you can decide on how to reach them and at what cost. Will you choose to print a leaflet, develop a website, take out an ad in a specialized magazine, and undertake a direct mail campaign? Your budget will give you a good indication of what you can do. Generally, a percentage of registration fees need to be used to promote the event: 5%, 10%... it’s up to you to decide!
REMEMBERBefore choosing the date of your activity, take the time to check out other activities offered on the same day. Check out the calendars you normally use (medical faculties, scientific societies, associations, etc.). Once your date is set, keep an eye on other activities on the same day.
Keep up to date on what the other trainers are offering on the same day to establish whether these subjects can have an impact on your day (for example, speakers at the other conference may be potential participants in your training activity).
Try to make a list of the activities offered on the same theme over the last six months. It is important to remain on the track of new developments or, at least, to be the first to talk about your subject. Avoid “rehashing”!
KNOW YOUR AUDIENCEOnce you know what you want to transmit and to whom, you have to determine where and how to get in touch with these people. Draw up the most complete list possible of the various means of getting in touch with these people: professional orders, medical associations, unions, training institutions, working institutions, etc. It is better to use several sources, even if the information is sent more than once to the same person. Draw up a list of available broadcasting methods, advertising rates, forums and websites of interest, leaders and information relays, etc.
COMMUNICATE EFFECTIVELYPromotional communications is an art linking communications and selling. Its principle is simple: use words (the fewer the better!) that will awaken the desire to register and that will incite your target audience to buy your product: your congress. Your communication must have a call-to-action, an invitation to register for your congress.
For example, your workshop is entitled “The Ten Best Ways to Avoid EVB.” If you received an invitation with this title, would you really feel it concerned you? However, if the title was “Do you know the ten ways to avoid EVB?”, we bet you would take the time to answer the question in your head and, should you realize you don’t know them all, you would be tempted to register!
By Patricia Kéroack, c.w.
Patricia Kéroack is a communications consultant and the person responsible for publications at the FMSQ’s Public Affairs and Communications Directorate.
Promotional communications is an art linking communications and selling. It must have a call-to-action, an invitation to register for your congress.
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ADVERTISE THE EVENT. YES, BUT HOW?Your poster, your leaflets, your website are all excellent communications tools only if they are deployed adequately. If you put up your posters in the cafeteria of the hospital where only the patients go, or if you are content to place your leaflets on a secretariat desk, you have wasted your time. You have to know how to get in touch with your public wherever it is.
Preparing a promotion plan will help you reach the majority of the members of your target audience. This will also help you redress your actions, moderate or intensify your communications to reach your registration objective.
You haven’t found any group that corresponds to this type of exercise? Take two minutes and start a list of all the organizations from whom you receive information or offers, no matter what type (professional orders, faculties, societies, subscriptions, associations, etc.). The list will grow rapidly as soon as you have taken an inventory of all the means of communications available (mail, e-mail, social networks, workplace, etc.).
Make up a l ist of the groups, organizations, and leaders who can talk about your congress (websites, discussion groups, departments, medical faculties, etc.). Ask them to publish your invitation or to distribute it to their members. Take note that you cannot purchase mailing lists; you have to mandate a third party who will see to protecting the confidentiality of people’s identity.
Register your activity with pertinent calendars, whether they are on websites or in printed communication tools (CPD activities, faculties, professional orders, hospitals, organizations, CMDPs, departments within institutions, resident and student rooms, associations, etc.).
Take note that too much communications is just as bad as too little. Learn to dose. Once people have received your invitation, let a few days pass before starting to remind them (a reminder per week containing an invitation is the maximum recommended). Vary your texts, inform people of changes and new items: “Already 400 colleagues have registered, you’re the only one missing...” or “Since workshop XYZ is so popular, a second session will be given during the afternoon...” or “Did you know...”.
Offer something for registering: a discount for registering early, for a group signing up together, for a spouse, etc.
Use viral marketing: encourage people who receive your e-mail message to share it with interested acquaintances. For each sponsored registration, you could offer a discount, a promotional item, an autographed book, etc.
USE SOCIAL MEDIA Facebook, Twitter, Google+ and the other new media are a good way of promoting your event... on the condition that you put in the time required. Do take note however that your audience is smaller (people have to be subscribers), and it will be up to you to work to increase it and thus reach your target audience... if it uses these media.
If you put together a Facebook page, make sure you maintain the interest of your subscribers by adding new material on a regular basis.
Create a Facebook event and regularly send out invitations. This functionality allows you to invite friends to your activity. Those who respond will be sorted into three categories: I’ll take part, I won’t take part and Maybe. To people who have answered they will participate, send out invitations for them to officially register until it is done. As well continue to invite the undecided. It’s an excellent way of increasing your circle of acquaintances on Facebook.
Use Twitter to make yourself known. Your subscribers could become an important communication channel if they reissue your tweets. But be careful: Twitter is limited to a maximum of 140 characters, including spaces. Be brief... and inviting!
REWARDING STRATEGIESBy putting in some effort, your training activity could become an essential one. Your activity has to distinguish itself among all the others: it has to offer “more.” Participants like to live a real “client experience”: the one that is talked about, that we are waiting for, months in advance! Your satisfied clients will become your best ambassadors: they’ll be the first to transmit your e-mail invitation.
Promotion is an unavoidable element if you want a certain success, or even a guaranteed success, with
your activity. You have to invest the energy and time needed to communicate adequately.
LOOK TO THE FUTURELearn to take advantage of the activity taking place as a tribune to announce the date of your next event, to pre-register people or even to attract them thanks to your next theme, if you know it in advance. Satisfied participants have a tendency to come back and to become your ambassadors
to their own public. In marketing communications, retention is just as important as acquisition.
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Getting the Media Interested in CPD You are organizing a CPD event in Quebec and are in charge of the media (or of communications). You think your event is news, that the public would be interested in learning that physicians are really concerned with maintaining their knowledge and their competencies (in spite of their workload) and that they invest both their time and money to do so. This is true, except that...
The competition is fierce in the world of news and the media have an embarrassment of choices. You need several ingredients to get a headline for your event, including a good dose of perseverance and a certain dose of luck. But there’s no reason not to try! Your communications slant: show that patients are the first to benefit when medical specialists take part in CPD activities like the event you are organizing.
HOW DO YOU GO ABOUT IT?To start with, your media offensive requires that you, as the person responsible for the media, be available and easily reachable to answer calls from the media. You need to take this into consideration in parallel with your professional obligations.
First off, know that a press conference is the least attractive venue to privilege, at least in large urban centres. If this option still attracts you, ask yourselves the questions a journalist would not avoid asking: Will your event bring in one or more speakers of international renown? Will you be revealing an innovative discovery or make an important announcement?
It would probably be better to choose to write press releases with the W5 technique (Who, What, When, Where, Why) and dispatch them in the following order (two before and one after the event):
• Some 5 or 6 weeks ahead of the event, announce the event, the subjects dealt with, the objectives (as a benefit to patients), the speakers (with photographs), etc.
• Then, 2 or 3 weeks ahead, refer to the first press release and add details (and more photographs), the stakes for patients, the number of participants, their geographical origins, etc.
• In the days that follow, report on the success of the event, give examples of “benefits” for patients, quote the speakers, the participants, the organizers (and, yes, provide more photographs).
Of course, you will have compiled a list of the media in your city or region including their complete coordinates. Your press releases will be addressed to the news or news desk editors.
And don’t forget the convergence made possible by social media! Each time you publish a press release, write up some short messages in the form of “Did you know...?” and systematically redirect your subscribers to the event’s website. From the moment when you start trying to interest journalists and reporters in your event, they must be able to easily find ALL the pertinent and, I insist, up-to-date information.
If you think your event is of interest to the media, it’s probably because you have already read, heard or seen reports on similar activities. Journalists and reporters from the media in your city or region may be assigned to professional affairs, training, health or even events. This is where things become interesting, because compared to a general offensive, you could increase your chances of media coverage with a personalized approach.
Target the specialized journalists, reporters, editorialists in order to contact them personally. You could begin with an e-mail, followed by a telephone call, and an invitation to attend the event, in all or in part. You could also organize an interview with the speaker or the president of the event. This interview can take place before the event if required.
A few days before the event, in spite of everything else that remains to be done, the organizing committee must take the time to identify the more “prominent” media stakes and to prepare for them.
Your capacity to convince could make the difference. You need to be a facilitator, to know your field and to talk about it in clear language (for the non-initiated). By definition, you are not afraid of the media. That goes without saying you will answer... make no mistake!
D DAYIf you have decided to interest the media in your event, it is because you will accept their presence on the day in question.
Your efforts don’t seem to be bearing fruit up to the day before the event? At the venue, you may be surprised to see the arrival of a journalist (or several) with whom you have not had any previous contacts. One of your press releases may have hit the mark and, with current events helping, this journalist will have found the time to come and see what was happening. This journalist will be “colder” and you will have very little time (with the activity already unfolding) to interest him or her in the strong points of the activity.
With the program in hand, ask what it is that interests the journalist, know where to find the spokesperson (beeper!!!). Go over the strong points of the day, have attendance numbers on hand (number of medical specialists, regions represented, specialties, etc.); check if one of the main speakers is quickly available for an interview; be ready to rapidly organize a “photo op”; ensure that a participant (beeper!!!) is willing to explain why this training is useful for his or her practice. Remember your communications slant!
A HUNDRED TIMES ON THE DRAWING BOARD If, this time, your communications efforts did not succeed in attracting the media interest you hoped for, tell yourself you have planted a seed and you will be harvesting sooner or later. And, you’ll be proud of your achievement!
By Nicole Pelletier, APR
Nicole Pelletier is the Director of Public Affairs and Communications at the FMSQ.
CONTINUING PROFESSIONAL DEVELOPMENTAT THE FMSQ IS...
THE PROFESSIONAL DEVELOPMENT OFFICEA directorate entirely dedicated to maintaining the competence of medical specialists in Quebec.
The Office aims to contribute to the constant improvement of healthcare quality for Quebeckers by promoting the continuing development of medical specialists and by offering support to organizers of CPD activities.
THE PORTAL
fmsq.orgThe centralized area that groups together an abundance of resources necessary for your continuing professional development: hyperlinks, models, templates, guides, tools, forms, etc.
TRAINING ACCREDITATIONDid you know that the FMSQ can provide accreditations (in Sections 1 and 3) for training delivered by its affiliated medical associations?
INTERDISCIPLINARY EDUCATION Since 2008, the FMSQ’s Interdisciplinary Education Days have brought together, in one place, physicians from several specialties to discuss, exchange, learn and integrate new developments in their medical practices. Over the years, this event has become the largest annual congress of medical specialists in Quebec.
TRAIN THE TRAINERSYou think you’ve got the stuff to be a good trainer? If you do, Workshop F-201 is the first step you can take in this direction. Offered twice a year by the FMSQ, this workshop will give you the appropriate tools to better understand learning cycles, how to evaluate needs, how to adequately formulate learning objectives, pedagogical methods and more.
RÉUNION SCIENTIFIQUEFormation des formateurs F-201
Atelier interactif organisé par l’Office de développement professionnel de la FMSQ
LES 4 PHASES DU CYCLE DES APPRENTISSAGES
Le vendredi 13 septembre 2013Fédération des médecins spécialistes du Québec
Salle Raymond-Robillard 20e étage, tour Est
2, Complexe Desjardins, Montréal H5B 1G8
Population cibleCet atelier s’adresse à tous les médecins spécialistes intéressés par l’organisation d’activités de développement professionnel continu admissibles à des crédits de formation.
Description de l’activitéAu cours de l’activité, le participant sera appelé à développer une activité éducative pour les membres de son association. À partir des besoins identifiés, il devra élaborer des objectifs mesurables et choisir le format approprié.
L’activité comportera des exposés théoriques, du travail en petits groupes et un partage en grand groupe.
L’atelier comprend 4 modules :
1. L’identification des besoins ;
2. La formulation des objectifs ;
3. Le choix des méthodes éducatives ;
4. L’évaluation.
CoûtsCette activité est gratuite pour les membres de la FMSQ. Nous vous demandons cependant de nous faire parvenir un chèque de 250 $ à l’ordre de la FMSQ, chèque qui vous sera rendu lorsque vous vous présenterez à la table d’accueil. Votre chèque sera toutefois encaissé si vous omettez de vous présenter à l’activité ou si vous annulez votre participation après le 6 septembre 2013.
ObjectifsÀ la fin de cet atelier interactif, le participant sera en mesure de :
• Choisir les méthodes les plus appropriées pour identifier les besoins d’apprentissage de la population cible ;
• Rédiger des objectifs d’apprentissage indiquant clairement à la population cible ce à quoi elle peut s’attendre en s’inscrivant à l’activité ;
• Définir les méthodes d’apprentissage appropriées pour l’activité à organiser ;
• Construire et juger un questionnaire d’évaluation pour mesurer l’impact de l’activité sur la pratique du médecin.
Crédits de formationL’Office de développement professionnel (ODP) de la Fédération des médecins spécialistes du Québec est pleinement agréé à titre de prestataire de développement professionnel continu (DPC) par le Collège royal des médecins et chirurgiens du Canada (CRMCC) et par le Collège des médecins du Québec (CMQ).
L’ODP approuve cette activité comme étant une formation collective agréée au sens que lui donne la section 1 du programme de Maintien du certificat du CRMCC.
L’Office de développement professionnel reconnaît 1 crédit de la section 1 par heure de participation, pour un total de 6,5 crédits pour l’activité globale. Une participation à cette activité donne droit à une attestation de présence.
Les participants doivent réclamer un nombre d’heures conforme à la durée de leur participation.
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The Future of Continuing Medical EducationOver the past two decades, we have witnessed the evolution of a cultural shift in how Continuing Professional Development (CPD) has been conceptualized. The old model, what we called Continuing Medical Education (CME), was frequently based on ‘intensive short courses’ or ‘updates’, which focused primarily on knowledge dissemination and transfer.
In this model, experts used lectures to prov ide perspect i ves and recommendations on the current ‘scientif ic evidence’ to passive participants.1 These short intensive courses were frequently organized in locations at a certain distance from a physician’s usual work place, perpetuating the idea that CME was something you ‘left practice to do’. The old model of CME did not adequately recognize the importance of a physician’s practice as an impetus for self-learning, reflection, and question-asking stimulated by interactions with patients, peers, and health professionals.2-4
The old model of CME frequently underestimated the challenges and barriers physicians faced in attempting to implement expert opinions into their clinical practice. Even with these limitations, the research literature established that this approach to learning by physicians could have small but important impacts on changing physician behaviours and patient outcomes.5-7 Despite these outcomes, increasing concerns about the lack of physician adherence to established practice standards,8 significant gaps in the quality and safety of health care provided to patients.9 and the limitations of physician self-assessment abilities10 demanded a change in culture.
THE COMPETENCY-BASED MODEL OF CPDThe cultural shift focused on the development of a new competency-based model that expected the profession to not only commit to being lifelong learners throughout their
professional careers but to demonstrate how participation in learning activities produced quantifiable improvements in their competence and performance in both providing exemplary health care to patients11 and continuously improving the quality and safety of the healthcare systems in which they work.12
This new model of CPD embraces the importance of learning across a broad range of domains that reflect ‘good medical practice’.13 Rather than seeing competence as a static set of attributes, the new competency-based model views competence as a dynamic process in which physicians continuously use their practice experience to “progress in competence” towards the attainment of expertise across all aspects of the practice of medicine (clinical, administration, education and research).11 Competency-based CPD embraces the intentional integration of multiple learning strategies, including formative assessments of
knowledge, skills and performance, to enhance learning and change among individuals, groups or interprofessional healthcare teams.
COMPETENCY-BASED CPD: IMPLICATIONS FOR PHYSICIANSThe new model of competency-based CPD will have multiple implications for physicians. Here are a few of the ‘future realities’.
The new model of competency-based CPD will promote a shift in the:
1. PHYSICAL SETTING OF LEARNING FROM THE CLASSROOM TO THE WORKPLACE.
The learning and practice settings will increasingly merge to ensure learning is addressing the actual needs of each physician and enabling the physician to integrate the new evidence into his or her practice. The workplace will not only be the stimulus for self-learning but will facilitate assessment
of performance as well as learning among peers and interprofessional healthcare teams.
2. CONTENT OF LEARNING FROM THE MEDICAL EXPERT ROLE TO ALL CANMEDS ROLES
Physician learning will remain focused on the rapidly expanding knowledge base they are responsible for in their practice. However, physician learning will also include the full range of competencies across the CanMEDS Roles.14
By Craig Campbell, MD, FRCPC
Craig Campbell is a medical specialist in Internal Medicine, Associate Professor of Medicine, University of Ottawa and Director of Continuing Professional Development (Office of Specialty Education) at the Royal College of Physicians and Surgeons of Canada.
Copyright © 2009. Le Collège royal des médecins et chirurgiens du Canada. http://rcpsc.medical.org/canmeds. Reproduction authorized by the RCPSC.
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3. PROCESS OF LEARNING FROM READING JOURNALS AND ATTENDING CONFERENCES TO ACCESSING EVIDENCE INSTANTLY USING APPLICATIONS ACCESSIBLE ON TABLETS AND SMART PHONES.
The professional of the future will be able to leverage multiple technological tools to access, appraise and apply evidence accessible through the Internet.15
4. ACQUISITION OF COMPETENCIES FOR EFFECTIVE LIFELONG LEARNING.
These competencies inc lude the abilities:
- ➢ to develop continuous learning reflexes;
- ➢ to create and use a profile of the problems, issues and procedures performed in order to develop a practice-specific learning strategy;
- ➢ to scan the i r env i ronment, systematically and effectively, for new and relevant innovations in development, for new evidence that has been reviewed and approved by the profession and for practices that should be discontinued because they have been found to be ineffective or potentially harmful;
- ➢ to formulate questions and translate them into learning activities;
- ➢ and to use processes and tools to assess performance and receive feedback on areas of practice that should be improved.16
COMPETENCY-BASED CPD: IMPLICATIONS FOR CPD PROVIDER ORGANIZATIONSThe new model of competency-based CPD will also have multiple implications for CPD provider organizations who are seeking to develop strategies and tools to support learning by individual physicians and interprofesional healthcare teams.
Here are a few of the ‘future realities’ for CPD provider organizations.
The new model of competency-based CPD will promote a shift in:
• TARGET AUDIENCES
The primary target audience of most learning activities will be individual physicians. If CPD intends to enhance the quality and safety of care, there will be a need to focus on the entire healthcare team who collectively pool their knowledge and expertise in caring for patients.17
• TRADITIONAL NEEDS ASSESSMENT STRATEGIES
A competency-based CPD model will require CPD provider organizations to develop learning activities using data sources that define gaps in the competence or performance of physicians and in the health status of patients or communities. Relying exclusively on surveys and focus groups to identify topics or issues defined by the profession will be inadequate to address the entire range of practice needs. CPD provider organizations must ‘start with the end in mind and work backwards’18 rather than hoping physicians will be able to effectively translate new learning into practice. This expectation will challenge CPD provider organizations to identify and access sources of performance data and translate these into needs that facilitate the development of learning activities.
• LEARNING ACTIVITIES
Reliance on lectures, workshops and other interactive learning strategies will need to be balanced with opportunities for learners to demonstrate they have acquired the knowledge, skills, or abilities the educational session intended for them to learn. Formative assessment strategies using role-playing in educational sessions, direct observation with standardized patients, and on-line simulation will need to be considered. All of these options will require that physicians receive feedback to identify learning needs of the future.19
Finally, CPD provider organizations will be expected to supply strategies and tools to physicians so that they can establish new goals or plans for practice to reinforce learning after their return to practice as well as tools for them to assess performance in practice.20
• EVALUATION OF LEARNING FOR PRACTICE
Evaluation strategies in the future will balance self-declarations of learning with assessments that define what knowledge, skills or competencies were acquired, how learning was applied in practice and how changes in behaviour impacted patient care and outcomes. The development and implementation of a broad range of evaluation strategies will be required to support a more comprehensive evaluation of the effectiveness of learning, knowledge, skills, attitudes and competencies of physicians.18
CONCLUSIONA new v is ion of cont inu ing professional development for physicians has emerged over the past two decades. The evolution towards a competency-based model of CPD will require physicians to use formal and informal learning as well as assessments to continuously enhance their practice. The new model has significant implications for learners, CPD planners and the health system as a whole to ensure learning is linked to measureable enhancements of competence, performance, as well as the quality and safety of the care physicians provide to patients as individual practitioners and as members of integrated healthcare teams.
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Raising the Bar for Your Physician Organization
Applying to Become an Accredited Provider of CPDMedical knowledge is exploding. The practice of medicine is becoming increasingly complex and is constantly changing. There is increasing emphasis on accountability to the public. As a result, a formalized process of Continuing Professional Development (CPD) for physicians has become mandatory.
For medical specialists, this process is supported by the Royal College of Physicians and Surgeons of Canada (RCPSC) Maintenance of Certification (MOC) Program which in turn is supported by organizations such as university offices of CPD and national specialty societies.
These organizations can apply to the Royal College to become accredited providers of CPD. They in turn are then able to accredit educational activities under Group Learning, Section 1, and Assessment, Section 3, so that these activities may be used for credit in the RCPSC MOC Program.
The Royal College’s CPD Accreditation Section provides a lot of support to organizations proceeding through the accreditation process, making it significantly less onerous and time-consuming than expected through personal consultation and provision of templates for required documents related to accreditation.1
The accreditation process involves completion of an application form that provides documentary evidence that the organization has the necessary elements in place to develop CPD activities and to assess CPD activities developed by other physician organizations to ensure adherence to the highest educational and ethical standards. The application process also includes teleconferences to provide organizations with the opportunity to comment verbally on their application and reviewers to clarify items in the application.
In order for an organization to be accredited, it needs to demonstrate the following:
• A mission statement that includes CPD and an appropriate target audience that includes specialist physicians;
• An annual budget with sufficient financial resources allocated to CPD;
• An administrative infrastructure to support the CPD program;
• An organized documentation system that includes minutes of meetings, policies and procedures, and other documents as required. Documents must be regularly updated in order to remain current;
• A CPD committee with educational expertise that is representative of the target audience;
• Documentation to show that, in the organization’s CPD activities, the educational cycle of needs assessment, objective development, delivery and evaluation is complete;
• Documentation of adherence to ethical standards;
• Documentation of policies, procedures and application forms for accrediting Section 1 and Section 3 events developed by other physician organizations.
EDUCATIONAL STANDARDS
A. NEEDS ASSESSMENT
There must be a process to assess the perceived and unperceived educational needs of the target audience. Perceived needs are those of which the target audience is aware. These may be determined through surveys or focus groups within the target audience. Unperceived needs are those of which the target audience is not aware and that can be revealed using external sources of data such as practice audits.
By Laurette Geldenhuys, MD, FFPATH, MMed, FRCPC, FIAC, MAEd
Laurette Geldenhuys is an Anatomical Pathologist at the QE II Health Sciences Centre in Halifax and Professor, Department of Pathology, Dalhousie University and a Royal College educator in CPD for Nova Scotia.
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B. DEVELOPMENT OF LEARNING OBJECTIVES
Needs are translated by the CPD committee or planning committee into learning objectives including objectives for the educational event and session-specific objectives, the latter usually in collaboration with presenters. Objectives must be written from the learner’s perspective. The Royal College provides guidelines on writing learning objectives.2
Organizational CPD goals and objectives must be included in a document that must be shared with all members of the CPD and planning committees, as well as presenters. Objectives for an educational event and for each session must be included in the event program and the latter must also be included by the presenter at the beginning of his or her presentation.
C. DELIVERY
i. Interactive LearningIn order to enhance learning, a variety of learning formats are encouraged, particularly interactive ones, and at least 25% of a session’s duration must involve interactions such as a question and discussion period.
ii. CanMEDs RolesThe spectrum of educational activities should address all CanMEDs roles, not only the medical expert role.
D. EVALUATION
The organization’s CPD program must be evaluated by the use of tools such as membership surveys. Evaluation of educational events and sessions must also be performed.
Evaluation of individual sessions must include questions on:
• Whether the objectives were met;
• Whether at least 25% of the presentation’s duration was interactive;
• Whether bias was detected;
• How participants will change their practice as a result of what they learnt in the session;
• What further learning they intend to pursue;
• Additional questions on the quality of the presentation, AV equipment, venue, and suggestions for future presentations may also be helpful.
The results of the evaluation must be shared with the presenter and with the planning committee in order to assess needs for future educational events as well as to identify and manage bias.
ETHICAL STANDARDSThe ethical standards ensure that the educational activities address the needs of physicians, that the organization designing the program is not influenced by external forces, and that the content is balanced and scientifically rigorous.
The CMA Policy, Guidel ines for Physicians in Interactions with Industry3 or the Quebec Code of Ethics for Parties Involved in Continuing Medical Education, must thus be adhered to in all aspects of CPD.4
• The organization must have policies and procedures on sponsorship and reimbursement of presenters that adhere to these standards. They must also be reflected in written communications with sponsors.
• Grants must be paid to the organization, who will handle reimbursement to presenters and other expenses.
• Participants cannot be reimbursed.
• Sponsors can be acknowledged as a group in the program, but not associated with any single session in an event, i.e. tagging.
• The planning committee and presenters must complete a Declaration of Conflict of Interest Form and the details must be published in the program. Presenters must also include these details at the beginning of their presentation.
• The planning committee may not include industry representatives and must maintain complete control of the educational content.
• Evaluation forms must contain a question about bias and any indication of bias must be identified and managed by the planning committee.
• Unaccredited educational events sponsored by industry cannot occur at the same time as accredited events and cannot be advertised in the program.
ACCREDITATION OF ACTIVITIES DEVELOPED BY OTHER PHYSICIAN ORGANIZATIONSThe o rgan iza t ion app l y ing to become an accredited provider must demonstrate that it has policies, procedures and application forms for accrediting Section 1 and Section 3 events developed by other physician organizations, and must keep a record of these activities. It may choose to accredit these or not. A fee set by the accrediting organization can be charged for review and accreditation of activities and programs and this is a possible revenue stream for organizations. Being an accredited provider avoids the expense and effort of applying for accreditation of its educational activities for other organizations.
CONCLUSIONThere are great benefits to your national physician organization, and its members, of becoming a Royal College accredited provider of CPD, and with the support of the Royal College CPD Unit the accreditation process is a very positive experience. It is an opportunity for your organization to become part of a community of practice where it can learn and evolve.5
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Accreditation and the CMQ: the Past, the Present and the FutureHistory reminds us that, since its constitution, the Collège des médecins et chirurgiens de la province de Québec (today the CMQ), founded by the Lower Canada government in 1847, was responsible for issuing licenses to practice and thus had the obligation of guaranteeing the professional competence of physicians.
Today, the CMQ is responsible for making sure that the programs developed by the faculties of medicine meet the criteria established for professional training. Accreditation is the method used by the CMQ to guarantee that the training of residents is recognized and thus allow them to have access to medical practice examinations.
Accreditation is a process of periodic and integrated institutional introspection and external examination based on pre-established standards. Accreditation aims at ensuring training criteria are respected as much at the level of faculties of medicine as of CPD units, faculty units and organizations involved in specialized medicine, such as the FMSQ. This process also allows the development of cooperation with members in order to ensure the regular update of knowledge and of training standards for existing and emerging specialties. Since 1974, the Comité des études médicales et de l’agrément (CÉMA) at the Collège des médecins performs the accreditation of organizations that offer continuing medical education activities.
Accreditat ion standards were designed in line with an essential reality. Continuing medical education or continuing professional development departments are unique, since they are an integral part of each of the professional medical associations. They have the responsibility of meeting their members’ needs. In fact, the diversity of CÉMA members and observers ensures the respect of this “continuum” of training and acquisition of knowledge between the stages of student, resident and practicing physician. The quality of this life-long continuing training is the cornerstone of a self-regulated profession and contributes to the quality of care associated with our social contract.
This accreditation process could easily never evolve, but such is not the case. Our sharing of accreditation criteria with Canadian organizations such as the Committee on Accreditation of Continuing Medical Education, the Royal College of Physicians and Surgeons of Canada as well as the College of Family Physicians of Canada is a guarantee of uniformity in this search for high-quality continuing training.
Within the context of the national and international discussions regarding the recertification of specialists and the almost-daily addition of new knowledge, the accreditation process remains, more than ever, an essential tool. All the associations we met during these accreditation visits have a positive attitude with regards to CÉMA’s observations and recommendations. It is always remarkable to observe the dynamic attitude of CPD contributors. Reaching an exemplary degree of conformity may seem exceptional, but, with each accreditation, we can see the desire to
meet this objective for all the standards within the framework of continuously improving quality.
The principal mandate of the Collège des médecins du Québec is to ensure the public’s protection by various means, in particular via access to quality medicine. Accreditation is a precious tool, effective and indispensable to maintain the excellence of medical training and practice.
This process should allow for the adequate integration of the four major CPD accreditation criteria:
• Respond to the needs of society;
• Offer a variety of activities meeting the perceived and unperceived needs of physicians;
• Present a methodical approach for the planning and implementation of these activities;
• Develop an organizational structure designed to fulfill its mission and reach its objectives.
By Anne-Marie MacLellan, MD, C.M., CSPQ, FRCPC
Anne-Marie MacLellan, a pediatrician, is Director of the Medical Education Division and Assistant Secretary at the Collège des médecins du Québec.
Within the context of the national and international discussions regarding the recertification of specialists and the almost-daily addition of new knowledge, the accreditation process remains, more than ever, an essential tool.
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Much More Than an Expert…
Integrating the Development of CanMEDS Roles in CPDMedical expertise has been the cornerstone of our training: most often, it is the only CanMEDS role within the CPD of medical specialists. If he wants to effectively take charge of his patients, the medical specialist must be much more than an expert in his discipline.
He must be able to communicate and cooperate efficiently, be a good manager, promote health, be able to evaluate scientific advances as well as transmit them... all of this, in a professional fashion. How can we integrate these roles in our CPD activities?
As an individual, it is good to familiarize oneself with the meaning of each of the CanMEDS roles. An evaluation of our strengths and weaknesses at the level of each role allows us to better choose the development activities in which we should participate. Thus, reflecting on our practice, analyzing critical incidents, discussing with colleagues or with our department head can guide us to the areas that need greater attention on our part.
Measuring our performance thanks to direct evaluation (observation) by our peers or via certain tools (for example: surveying our colleagues, our personnel, other healthcare professionals and even our patients) can allow us to draw a realistic picture. Finally, reading articles or studies about physicians (such as articles from the CMPA or studies on the physician-patient relationship) can also help us become aware of certain gaps that we must fill.
Once our needs have been identified, we must develop a CPD plan that takes them into account. The choice of activities will depend on several factors: cost, travel, time, preference for individual or group activities, etc.
On the individual level, there is a lot of literature on the various roles, including on cooperation, communication and management. Reading articles as well as taking part in discussions with colleagues on these subjects can also be tools that will allow us to learn the theoretical concepts and integrate practical advice in order to modify our own behaviour (Section 2 credits). Insofar as group activities are concerned, several professional associations offer specialized training in certain areas. For example, each year, there is a Canadian conference on medical leadership (management) and another one on medical education (erudition). Some other associations, including those at the provincial level, can also offer training activities on these roles within the context of an annual congress or of other more specific training activities.
You are perhaps a member of a CPD committee and you are asking yourself how to offer relevant activities responding to the needs of your colleagues where CanMEDS roles are concerned. Conferences (Section 1) with an expert in one of the aspects of the roles can be a way of transmitting more theoretical knowledge or to share ways of doing so.
We must not forget to have a sufficient period of interaction (more than 25% of the time) in order to make the training more active. Implementing workshops with demonstrations of certain skills in the presence of real or simulated collaborators (patients, nurses, and other physicians) can allow the identification of needs in certain individuals and fulfill them.
Learning is more often translated into practice when individuals are involved and active during activities, which is what interactive workshops allow. For example, a workshop with feedback on how to give bad news allows us to have an activity that is both within Section 1 (knowledge and skills developed in groups) and in Section 3 (the part on professional evaluation and reflection). Implementing Objective Structured
Clinical Evaluation (OSCE) with an evaluation of several components of CanMEDS roles is a way of having a Section 3 activity that allows participants to evaluate their competencies. Finally, setting up mentoring between members with a good knowledge of continuing professional development and others needing advice for the implementation of their CPD allows
the CPD committee of an association to fulfill its role at the individual level.
All that is needed is a deeper look at the CanMEDS roles to notice their importance in our daily practice. In such a case, why not grant them an equally important role within our continuing professional development? After all, it’s easy!
By Frédéric Bernier, MD, MHA, FRCPC
Frédéric Bernier, an endocrinologist, is an Assistant Professor of Medicine at the Université de Sherbrooke and a CPD Educator at the Royal College of Physicians and Surgeons of Canada. is also Vice-President of the CPD Committee at the Association des médecins endocrinologues du Québec.
An evaluation of our strengths and weaknesses at the level of each role allows us to better choose the development activities in which we should participate.
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Writing CPD Learning ObjectivesAfter having clearly identified educational needs, whether they are perceived, unperceived, standardized or institutional, it is important to restate them as objectives or learning competencies.
An objective is the observable behaviour demonstrated by the learner at the end of his or her training period. This behaviour can be classified as cognitive (knowledge), psychomotor (skills) or affective (attitudes).1
A competency is a complex expertise resulting from the integration, mobilization and organization of a set of efficiently-used capabilities, skills and knowledge.2
The objective or the competency is thus the result we wish to obtain from the participant at the end of the learning period. There is no mention of the content nor of the theme of the activity.
Learning objectives play an essential role in the planning and organization of any continuing professional development activity:
• They contribute to the creation of a main theme which is used to develop a coherent and logical CPD program;
• They help define a more specific mandate for key persons (moderators, speakers, etc.);
• In the promotion of the activity, they allow organizers to cleary definine the desired learning outcomes and educational methods used. ;
• They contribute to the activity’s evaluation by validating with participants the extent to which they have reached or consolidated the various objectives or learning competencies.3
In CPD, educational objectives are often integrated and associated with competencies. It is therefore useless
in CPD to reduce each par t of knowledge, each action or attitude into a smaller denominator.
For example, in the following objective: “The participant prescribes the appropriate medicine in the right dosage and at the right frequency,” it is useless to divide the objective or the competency into smaller portions of knowledge or actions: “The participant will be able to prescribe xylocaine® (lidocaine), in the right dosage and at the right frequency.” Since we are dealing with complex competencies the objectives will have to reflect complex knowledge.
Objectives have to be clearly written in order for participants to understand the teaching method promoted by the organizers.
Thus, in the initial example, the organizer could add the teaching method used to attain the objective as follows: “Based on a fictional case, with an ECG graph from a cardiorespiratory resuscitation, the participant prescribes the administration of the appropriate medication at the right dosage and at the correct frequency.”
Learning objectives must be expressed from the learner’s point of view. The action verb chosen must express an action, a competency or an observable behaviour. Tables of action verbs are available on the CQDPCM web site in the CME Vade-Mecum.1
An objective must have five, or often six, essential qualities (SMART-E):1. Specific: precise and unequivocal;2. Measurable or observable;3. Acceptable: totally pertinent for
the learner;4. Realistic or feasible;
5. Time-bound: the objective must be attainable within the time assigned to it;
6. Evaluate.1
Just like professional’s tasks, objectives and competencies can be divided into three domains:• Cognitive: knowing about
– knowledge;• Psychomotor: knowing how to do –
actions, capabilities;• Affective: knowing how to be
– attitudes..
Certain complex competencies thus involve several areas as is the case in a professional practice. In CPD, it is essential that each of these areas be clearly defined according to the competency or objective aimed at.
It is essential for any CPD organizer to set objectives within the overall CanMEDS competencies, not only medical expertise. Objectives dealing with professionalism, interprofess iona l co l laborat ion, communications, management, erudition and health promotion will need to propose personalized teaching methods and assessment processes. Professional practice requires actions, complex attitudes as well as judgment that goes beyond simple knowledge.
In addition, each of these areas is divided into three levels of difficulty.4 The lowest level is for the novice and the highest for the experienced professional.
The pertinence of an activity’s content depends on recognized needs. Its application to the participant will depend on high quality written objectives or learning competencies
By François Goulet, MD, MA(Health Sciences Pedagogy)
François Goulet is Assistant Director of the Practice Enhancement Division at the Collège des médecins du Québec.
CPD ACTIVITIES
Level Cognitive Domain Psychomotor Domain Affective Domain
1 Can remember facts Can reproduce an action Can demonstrate receptivity
2 Can interpret data Can control actions somewhat effectively Can respond on an emotional level
3 Can find a solution to a problem Can act automatically with a high degree of effectiveness Can empathize with an emotion
Adapted from Educational Handbook for Health Personnel – WHO. Offset Publication No 35 – Geneva, 1981, p140. This table illustrates the various areas covered by objectives as well as the corresponding levels of difficulty. In CPD, objectives must aim at the highest level of competency.
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Ivan Rohan is Vice-Dean of the McGill Continuing Health Professional Education Office (CHPE).
CPD at McGill’s Faculty of MedicineThe McGi l l Cont inu ing Hea l th Profess iona l Educat ion Of f ice (CHPE), Faculty of Medicine, is a self-sustained unit, independent from Faculty Development. CHPE provides educational services, notably in the areas of accreditation, programming, e-learning and consulting.
ACCREDITATIONCHPE is fully accredited by the Committee on Accreditation of Canadian Medical Education (CACME), to sponsor continuing medical education for physicians and other health care professionals. CME accreditation ensures participants that accredited activities in which they enroll meet high educational standards. To support Program Directors and Organizers we offer the following services:
• Assistance with the accreditation process, ensuring that courses meet CME criteria for accreditation
• Provision of supporting material templates and documentation
EDUCATIONAL CONSULTINGCHPE acknowledges the importance of applying best practices in course design, development, delivery and measurement. Our Educational Consultant ensures that important health issues and learning best practices are identified, analyzed and addressed in program design and delivery to promote improved health outcomes.
RESEARCHCHPE is involved in research initiatives designed to enhance professional education in the health care field, promoting excellence in healthcare and lifelong learning. Studies are driven by knowledge translation and outcomes education frameworks. Our CHPE Office values partnership with other universities, government agencies and other accrediting bodies.
INTERACTIVITYOur mission is to promote excellence in healthcare and optimize patient care. To this end, our interactive courses are designed to provide the most up to date information and strategies for physicians and other health care professionals. The Wednesday e-Learning Series (WELS) is directed at distant learners on Wednesday from 12:00 PM to 1:00 PM Participants attend interactive sessions individually or in groups. WELS is archived on the CHPE website, allowing participants to access past presentations asynchronously.
MedPoint is an Accredited Conference Report Series (Mainpro-M1 and MOC Sect 2 Scanning) to keep abreast of the latest information in a wide range of therapeutic areas. Target audience include: primary care physicians, specialists and other healthcare professionals. You can easily apply and receive attestation for your credits online.
Oncology for Practicing Physicians Course is an accredited (Mainpro-M1 and MOC-Section 2) comprehensive interactive, online course targeting family physicians, medical specialists, trainees, medical students and other healthcare professionals. It provides f lexible asynchronous access from a variety of electronic devices. Evidence-based content (17 modules) authored by McGill faculties with opportunities to interact with oncology experts. Available November 2013 (Phase I) and Spring 2014 (Phase II).
AUDIOVISUAL AND WEB CASTING Exceptional audiovisual service is our continuous commitment. Our high-quality attention to detail ensures the image projection and audio quality of your meeting come together flawlessly. Our audiovisual professionals offer full-service audiovisual that can be tailored to the needs of your meeting.Our audiovisual / web casting services enable small groups to collaborate in a highly interactive online environment. Video conferencing and web casting services can be used to facilitate live events and/or to record events and make them available to your audience on demand.
ARCHIVED CONFERENCESMissed a conference? Archived presentations allow interested participants to view past video conferences at their own convenience. Easy access makes this tool appealing. Visit our archived page and choose from over 1,200 hours of educational content. New presentations are added weekly to enrich and expand our archived content.
Also available: hosting your educational content on our web site. Record your accredited event and share your program with other physicians by archiving the content on our web site.
WORKSHOPS AND CONFERENCESCHPE can provide support in delivering outstanding workshops. As an accreditation provider, we ensure that the CPD accreditation criteria’s are met. Our services include: workshop design, facilitation, evaluation design, needs assessment, printing of the handouts and other documents for distribution, collating participant packages, preparation of sign in sheet, catering, onsite Course Director assistance: greeting and providing instructions to participants.
THURSDAY EVENING LEARNING SERIES (TELS)
This consists of a weekly series every Thursday from 6:30 PM to 8:30 PM delivered to an audience of physicians and other healthcare professionals. Participants have the option to attend live or via webinar. TELS is archived on the CHPE website, allowing participants to access past presentations asynchronously.
MCGILL CME CRUISE
A yearly accredited conference targeting family physicians, specialists and other healthcare professionals. Not sponsored by pharmaceutical industry and delivered by McGill faculties. The curriculum (16 – 25 hrs) covers relevant, evidence-based topics driven by needs assessment. A follow-up self-reported measure enhances reflective learning and measures reported impact on practice.
By Ivan Rohan, MD
À LA FAC DE MÉDECINE DE L’UNIVERSITÉ LAVAL
LA COMPÉTENCEEST PANDÉMIQUE
www.fmed.ulaval.ca/dp
Formation qui répond à vos besoinsDestinée aux médecins de famille et aux médecins spécialistes
Modalités d’apprentissage variées :en présentiel : conférences, symposiums, ateliers, colloques, journées de formation, simulation
en ligne : club de lecture, modules d’autoapprentissage, rendez-vous Web pour les médecins de famille
Soutien pédagogique individuel ou en groupe pour nos cliniciens enseignants
Pour mieux vous servirInscription et paiement en ligneDossier personnaliséFormation accréditée
Découvrez notre o�re de développement professionnelcontinu et de développementpédagogique
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CPD at the Faculty of Medicine of Université LavalThe Continuing Professional Development Section (CPDS) of the Faculty of Medicine of Université Laval is one of the five sections making up the Vice-Deanship for Pedagogy and Continuing professional development (VDPCPD) whose mission is to contribute to the development, promotion and support of pedagogy applied to the health sciences.
The five sections work together on the development and implementation of CPD projects.
The VDPCPD covers the following areas of expertise:
LEARNING VIA SIMULATION At Centre Apprentiss, we reproduce the reality of the workplace. Students and professionals in continuing professional development, remotely or on site, thus familiarize themselves with the most recent technologies and accumulate several hours of practice.
The Centre has more than thirty learning labs, some of which are equipped with advanced interactive mannequins that react to the treatments and medications administered to them. The techniques that are used in the lab allow classes to be given in real time, within the pavilion and in healthcare facilities.
PEDAGOGICAL DEVELOPMENT Activities to develop pedagogical competencies respond to basic and advanced training needs at the teaching and consultation levels, support for pedagogical innovation and support for pedagogical research.
The activities are aimed at clinical teachers; at supervisors in all clinical environments, in laboratories and in other workplaces; at lecturers; at teachers; at small group at all educational levels; as well as at professors and researchers performing teaching functions.
EVALUATIONExpertise in this area is offered to programs and teachers within the Faculty as well as to external organizations in the field of health. Services are made up of consultations in evaluating learning and competencies (for example, psychometric analysis, evaluation methods), organizing performance examinations (for example, objective structured clinical examination, structured oral exams), evaluating training programs (for example, follow-up during implementation of new programs, test measurement analysis), training on evaluating learning outcomes for teachers within the Faculty’s network, and training on evaluating competencies.
RESEARCH IN HEALTH SCIENCES EDUCATION In addition to developing and carrying out research projects, this area of expertise includes services in the development and leadership of research activities in health sciences education (for example, the Échanges du VDPDPC, presentations at the Faculty’s Annual Teaching Day); in consultation for research projects in health sciences education; in mentoring young researchers; in support for publications and presentations at conferences on health sciences education; and in the promotion of health sciences education.
THE CONTINUING PROFESSIONAL DEVELOPMENT SECTOR By supporting various organizations, the CPDS offers several services such as the evaluation of training needs (for example, studies of the needs of participants), planning training programs and their
evaluation (for example, training days, symposiums), accrediting activities in continuing medical education, logistical support for implementing successful tra in ing activ i t ies ( for example, registration, welcome, reserving space and audiovisual equipment, preparing pedagogical material, etc.), and distance training activities (developing, implementing and delivering). We are currently redesigning our website to make it more user-friendly and more efficient in terms of offering on line services.
The CPDS also wishes to contribute to the development of evidence in continuing education; this is the goal for its involvement with various joint research projects. With the aim of remaining up to date on the most recent developments in continuing education, it monitors scientific advances as they apply to maintaining competencies.
The VDPCPD’s CPDS is concerned with responding to the evolving needs of professionals in practice. It offers several training programs using new technologies, including online training programs and videoconferencing, in addition to classroom training.
ACCREDITATION The VDPCPD is fully accredited by the Collège des médecins du Québec, by the Accreditation Committee of the Association of Faculties of Medicine of Canada (AFMC), by the Accreditation Council for Continuing Medical Education (ACCME) in the United States. It is authorized to offer to the Faculty’s healthcare professionals training activities to maintain their competencies.
By Louise Côté, MD, FRCPC
Louise Côté is Director of the Continuing Professional Development Section at the Vice-deanship for Medical Pedagogy in the Faculty of Medicine of Université Laval.
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The Faculty of Medicine’s CPASS at the Université de MontréalThe Centre de pédagogie appliquée aux sciences de la santé (CPASS) of the Faculty of Medicine at the Université de Montréal is a part of the Vice-deanship for the Continuing Development of Professional Competencies, which covers the organization of CPD activities as well as the development of pedagogy and innovation in CPD.
THE CONCEPT OF CPD AT THE UNIVERSITÉ DE MONTRÉALCPD is the process through which professionals actively search for the best ways to improve their own practice. Their choices for professional development will be made according to their needs and their own field of practice taking into account not only the maintenance and development of competencies linked to clinical expertise, but also those that are needed to fulfill all the roles defined by the CanMEDS framework.
LEADERS IN PEDAGOGY AND THE COMPETENCY-BASED APPROACHOne significant project of the Vice-deanship is the Leaders in pedagogy and the competency-based approach (CBA). Leaders are teachers trained to accompany pedagogical committees and clinicians who work with residents and trainees in transforming training programs into CBA. The objective is to train healthcare professionals to respond to patient expectations throughout the roles they perform. Their attachments to various departments and their close relationships with those who are responsible for CPD within these departments make of them a significant and facilitating resource for teachers and programs.
THE COLLABORATION AND PATIENT PARTNERSHIP DIRECTORATE The Programme Par tenaires de soins (PPS), under the banner of the Collaboration and patient partnership directorate of the CPASS, has developed an approach to continuously improve the care partnership. PPS experts accompany
care teams so that they question their collaborative practices through a reflexive approach and transform their practice by integrating the vision of a partnership with patients and their families. People involved in the field of health recognize that patients have abilities to care for themselves and have acquired knowledge through their experience of illness. Patients are supported by a team of caregivers to progressively develop their self-care competencies and autonomy and thus make informed decisions about their health.
SCRIPT CONCORDANCE TEST: TO EVALUATE ONE’S PRACTICE AND REFLECT UPON ITThe CPASS and its collaborators have developed an online training platform for script concordance tests. Participants are presented with authentic cases described in a few lines. The clinician “deduces”, based on the overall knowledge linked to each hypothesis that is known as a disease script, that such a clinical sign should be present or absent then checks whether clinical data reinforces or minimizes the options present, or whether it requires generating new ones, more consistent with the facts of the case. This CPD tool allows practitioners to inventory their learning needs by evaluating their practice and by stimulating reflexivity.
PROGRAMMING ACTIVITIES FOR LARGE GROUPSThe CPASS is also mandated to develop and implement CPD activities and tools to support clinical practice and decision-making by physicians and healthcare professionals working within its care network (Université de Montréal RUIS) and, more extensively, within the overall healthcare system in Quebec, and this, by reason of social responsibility.
GRANTING EDUCATIONAL CREDITSThe Vice-deanship validates and educational training credits that meet strict criteria both on the pedagogical level and on the ethical level. It trains CPD
organizers and supports them in their role: adult pedagogy for professionals in practice, CPD program accreditation, maintenance of competence including the competency-based approach, support for self-managed CPD through reflexive practice.
ONLINE TRAININGThe ABCdaire is an online training program whose objective is to allow the healthcare professional to develop a systematic and individualized approach for the periodic examination of children aged 0 to 5 years. It proposes a series of tools developed by the CPD department of the CPASS to support the scientific approach put forward by the program.
THE INFORMATION BULLETINLe Bulletin du CPASS is a quarterly publication whose aim is to inform the community about innovative projects underway and on current issues in CPD and in pedagogy.
EVALUATIONThe Vice-deanship especially cares about the evaluation of its activities as much for their impact on professional practice as for the pedagogical impact of its innovations. The development of evaluation tools centered on the competency-based approach and the development of learning opportunities are examples of the importance of reflexivity that places the learner at the center of his or her professional development.
SIMULATIONThis pedagogical method allows one to acquire knowledge, but especially to master the clinical or therapeutic acts, via a technology using virtual reality, simulated patients or computerized mannequins. Simulation is extremely interesting for the training of interdisciplinary teams. The activities of the Centre de pédagogie appliquée aux sciences de la santé, the pedagogical tools as well as all the details of our services are available on the CPASS website: cpass.umontreal.ca.
By Andrée Boucher, MD, FRCPC
Andrée Boucher, an endocrinologist, is Vice-Dean for the Continuing Development of Professional Competencies, and Director of the Faculty of Medicine’s CPASS at the Université de Montréal. She is also President of the CQDPCM.
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The Continuing Education Centre of the Faculty of Medicine at the Université de SherbrookeThe mission of the Continuing Education Centre of the Faculty of Medicine and Health Sciences at the Université de Sherbrooke is to contribute to the maintenance and development of practicing healthcare professionals’ knowledge and competencies, with the ultimate aim of taking part in improving the quality of care offered to the population.
This mission is deployed along three major objectives which are:
• To dispense, in response to the needs of its clientele, accredited or credited educational activities, regularly updated, and meeting the highest standards in the area of the pedagogy of competency development;
• To support healthcare professionals in formulating their educational needs in line with the characteristics and determining health factors of the population they serve;
• To promote innovation and research in continuing professional development, by emphasizing the evaluation of the effects of educational interventions on practices.
The target clientele is mainly that of the healthcare professions for which the Faculty dispenses education, by granting a priority to those professionals who are involved in the Université de
Sherbrooke RUIS. For the members of this teaching network, who contribute to the clinical training of physicians, nurses, physiotherapists and occupational therapists, particular attention is paid to their continuing professional development needs including clinical and pedagogical competencies.
COLLOQUIAAnnually, 14 colloquia are offered by the Centre. We favour as much as possible themes that distinguish themselves from what other continuing education suppliers’ offer. Particular care is given as much to the organization as to the planning of these colloquia, thus obtaining a high degree of satisfaction on the part of participants.
TELECONFERENCESFor more than 30 years, a program of lunchtime teleconferences is offered and reaches healthcare professionals in their workplace. The program, having become very popular over time, presents a total of 14 one-hour teleconferences every two weeks from September to May. Registration is on an annual basis, at the start of the teleconference series.
RESUSCITATION AND INTENSIVE CARE TRAINING WORKSHOPSThe Centre is recognized for its large selection of workshops in resuscitation and in intensive care: cardiorespiratory resuscitation (ACLS); resuscitation of multitrauma victims (ATLS); pediatric resusc i tat ion ( PALS ) ; neonata l resuscitation (NRP); intensive care (FCCS); and traumatology for nurses (TNCC). The Centre’s reputation is such that it normally sells out these workshops a year in advance.
ULTRASOUND WORKSHOPSThe Centre offers to clinicians who are not radiologists practical workshops on the use of ultrasound: “Ultrasound in the Emergency Room,” a two-day course; “Échographie guidée en situation de choc,” a one-day course; as well as a
course on the musculoskeletal system with international experts, spread over six weekends.
WORKSHOPS WITHIN CLINICAL ENVIRONMENTS AND MENTORSHIPSThe Centre also offers a refresher workshop on CPR for physicians who work solely in an office. A workshop on the care of wounds began last October and can be given several times during the year. Individual mentorships are also offered. These are individual apprenticeships in a specific field of activity that can last from a few days to a few months. Group mentorships have also been added to our list of activities.
GRADUATE-LEVEL MICROPROGRAMSThe Centre offers eight graduate microprograms with credits, five of which are in healthcare (International Health, Pain Management, Clinical Ethics, End-of-Life Care, Prevention and Control of Infections) and three in healthcare information technologies (Healthcare IT, Healthcare IT Standards, and Implementing Electronic Health Records). Participants obtain 1 credit for 15 hours in class and 30 hours of self-leaning.
ACCREDITATIONThe Continuing Education Centre of the Faculty of Medicine and Health Sciences at the Université de Sherbrooke is fully accredited by the CMQ and by the Committee on Accreditation of Canadian Medical Schools to offer continuing development activities to healthcare professionals. The certificates it issues are recognized by the professional orders.
For help regarding the process of accrediting an activity, or for any other information regarding our activities as a whole, you can look up the Continuing Education Centre’s website at: usherbrooke.ca/cfc.
By Bernard Martineau, MD, FCMFC, MA
Bernard Martineau is the Academic Director of the Continuing Education Centre of the Faculty of Medicine and Health Sciences at the Université de Sherbrooke.
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Simulation in CPD
The Era of High-Definition and Three-Dimensional CPD While continuing education used to rest primarily on the classical format of lectures, the increasingly-recognized importance of exchanges in small groups during workshops has led continuing professional development programs towards better clinical use of knowledge acquired by participants.
During the first decade of this century, the very rapid development of simulation technology – with the availability of low and high-definition devices (particularly in the form of sophisticated mannequins which reproduce human physiology in an astonishing manner) – has led faculties of medicine and their associated hospital centers to integrate this technology into their training programs.
Simulation centres have become select environments (a kind of virtual hospital) where all learners can repeat - technical gestures as much as they wish, interact alone or in teams during various situations from the simplest to the more complex, and then reflect in the presence of a feedback expert (a debriefing). This is how learners can develop and maintain their competencies which will afterwards be translated into clinical actions (performance).
These simulation-based training environments are also offered to practicing physicians for individual activities in order to acquire a technique, a precise act or even to solve clinical vignettes in a particular field. They can also be used for the training of interdisciplinary or interprofessional teams in order to promote a better collaborative approach. In both cases, feedback is immediate.
When planning their own CPD, medical specialists have access to complementary tools to the more traditional ones like conferences (first-dimension tools) or interactive workshops (second-dimension tools); they can
now also use third-dimension tools (simulation). In addition, this takes place in a warm and welcoming climate that promotes rich exchanges in the presence of experts, but especially in a protected environment, as much for the professional who is experimenting as for the future patient.
In this sense, the world of aviation has been using, for more than twenty years, repetitive practice sessions in flight simulators in addition to the formal didactic method of teaching. This technique is used as much for training pilots as for the maintenance of their certification. It is also used with all crew members for specific situations. The aim of using these simulators is optimal flying that ensures the safety of passengers. Consequently, much of the experience gained by using simulation in the aviation field can be extrapolated for the medical field including team cohesion and the management, in real time, of situations that could generate incidents or errors. Just like in aviation, the ultimate aim in medicine is the same as in aviation: ensure optimal care in a safe environment for patients.
Training in simulation centres is not limited to the use and manipulation of sophisticated devices. Programs are offered in different formats to adapt to the learning needs of participants no matter their level in the medical curriculum. Whether it involves role-playing, the contribution of standardized patients,
of real patients, of virtual patients (online) or of specific-task trainers, we cannot minimize the importance of the human resources that -enhance the technical aspects of this pedagogical method.
With the changes made to the Royal College’s MOC program, which now requires obtaining 25 credits per five-year cycle (see the details of these changes on page 53), the use of simulation in hospital centres and in pedagogical settings directly concerns clinical performance, provides immediate feedback, and thus becomes part of an environment where reflective practice is assumed.
Welcome to the age of third-dimension CPD (3D-CPD), that of simulation (HD-CPD): it will no doubt enrich our annual congresses and our concurrent sessions with each of our respective medical associations.
By Robert L. Thivierge, MD, FRCPC
Robert L. Thivierge, a pediatrician, is an Associate Professor in the simulation centre (CAAHC) of the Faculty of Medicine at the Université de Montréal and in the Pediatrics Department at the Sainte-Justine University Hospital Centre.
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Social Networking and Clinician Educators The use of social networking tools is becoming increasingly common in medical education and among physicians, residents, and students1,2. These tools have created new ways for physicians to learn and to communicate, thus contr ibuting to their social accountability and health advocacy roles in today’s digital world. What follows is a short practical guide to the most popular social networking tools and their possible use by clinician educators.
FACEBOOKWith one billion active users, Facebook is the most popular of online social networking services.3
Although mostly used for private and personal connections, Facebook has two interesting tools for clinician educators: “Page” and “Group”.
“Page”: Facebook users can create public pages, allowing “Fans” to “Like” or “Subscribe” to the page’s posts and updates, which can be done without becoming Facebook “friends” with other users. A page allows physicians to post information about a course, a disease, or an event, for example, for page fans. It also allows them to poll and question their page’s audience. A page further provides rich statistical analysis that is useful for tracking who is in the audience.
“Group”: A Facebook group can be created at three levels: “Open” (public), “Closed” (seen by the public but open only to members), and “Secret” (seen only by members). A group allows members to post and to discuss content such as links, articles, media, questions, and documents, and it allows other group members to “Comment” on these items.
LINKEDINLinkedIn is a “Professional Facebook” that allows people in professional occupations to network. LinkedIn reports having more than 225 million users in more than 200 countries.3 It’s an effective way to showcase one’s curriculum vitae (CV) in the digital world.
Much like Facebook, LinkedIn also supports the formation of a “Group.” Most of the largest groups are employment-related; a wide range of topics are covered mainly on professional and career issues, and 128,000 groups currently exist for both academic and corporate alumni.3
GOOGLE+Google+, a social networking and identity service, is the second-largest social networking site in the world after Facebook, with a total of 500 million registered users. Google has described Google+ as a “social layer” that enhances many of its online properties, unlike conventional social networks that are generally accessed through a single website.3
Google+ allows users to add one another to “Circles,” which enables users to organize people in groups for sharing updates. “Hangouts” is a Skype-like platform that allows group video chat (with a maximum of 10). This is a helpful way for educators to bring together people from different sites for a meeting, ground rounds, etc. A new addition is a “Hangouts on Air” feature, which allows for a live broadcast to be made to a large population. This can be used to get a message or announcement out to the public while allowing the public to comment live and to ask questions.
TWITTERTwitter is an online social networking and microblogging service that enables users to send and to read “Tweets”, which are text messages limited to 140 characters. About 100,000 “Tweets” are generated per minute, so being able to filter them is an important task. One way is to use a hashtag (#). A hashtag is used as a keyword marker in the Twitter world. A list of the most healthcare-relevant #s (e.g., diseases, conferences, etc.) can be found at Symplur’s4 site.
YOUTUBEYouTube is a video-sharing website on which users can upload, view, and share videos.3
This platform provides a great visual for physicians to showcase content such as an introduction to a disease, an introduction to a procedure, educational talks, and clinical skill videos for learners, including medical students, medical residents, patients, and other physicians.
BLOGSA blog is a discussion or informational site published on the Internet and consisting of discrete entries (“posts”). Recently “multi-author blogs” (MABs) have evolved, with posts written by large numbers of authors and professionally edited.6 One of the most famous physician MABs is KevinMD blog, with more than 1,000 author contributors (doctors, nurses, medical students, policy experts, and patients).5
A WORD OF CAUTIONThe ethical and legal risks of online medical conversations must always be kept in mind. Physicians should always follow any policies that the hospital and/or university they are associated with have established on such matters. If such policies do not exist, several provincial and national bodies have developed these types of guidelines.
The CMA social media guidelines6 indicate a few key issues that should always be taken into consideration, including patient conf idential i ty and professionalism.
The guidelines also include four rules of engagement when using social media that every physician should respect:
1) Understand the technology and your audience;2) Be transparent;3) Respect others; and4) Focus your own areas of expertise.
I hope this short guide about social networking tools and their use in medicine has been both educational and inspirational. Remember: there’s no privacy online. Be vigilant... always.
By Alireza Jalali, MD
Ali Jalali is Professor of Anatomy, Distinguished Teacher and Teaching Chair at the Clinical and functional anatomy Division of the Faculty of Medicine of the University of Ottawa.
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W. Robert J. Funnell is Associate Professor of Biomedical Engineering and Otolaryngology and Associate Member of Obstetrics & Gynecology and Electrical Engineering at McGill University.
Computer-Based 3-D Models in Medical EducationComputer-based three-dimensional (3-D) models can be used at many levels of medical education, from undergraduate medicine (e.g., knowledge of anatomy) to residency (e.g., surgical skills) and clinical practice (e.g., surgical planning capabilities). Here we briefly discuss two of these objectives with the use of 3-D models in Continuing Medical Training.
KNOWLEDGE OF ANATOMYTeaching and learning anatomy have traditionally been done with 2-D illustrations, videos and cadavers. The limitations of 2-D media for conveying complex 3-D relationships are obvious. Cadavers are good for conveying 3-D relationships but there are problems with this learning method: it is expensive; small nerves and vessels are difficult to see; some structures, such as the middle and inner ear, cannot be accessed easily; colours and textures are unrealistic; and anatomical variations are limited and uncontrolled. Computer-based 3-D models cannot and should not replace cadavers, but they can address some of these problems.
Since our early efforts in this area,1 there have been tremendous advances in consumer computer hardware and in the speed of network access, which has made it much easier to deliver high-quality 3-D interaction to users. This delivery has also been facilitated by the development of Web standards, from the then-relatively-new VRML standard we used in 1998 to the recently developed WebGL standard we are exploring at present.
Although the delivery of 3-D models is easier now, the creation of good 3-D anatomical models still requires a great deal of expertise and time. We have been developing our own open-source software for this purpose2 and our National Sciences and Engineering Research Council (NSERC) funded research is aimed at making the task easier.
Our goal is to facilitate the creation of open-source models delivered via open-source software without requiring the user to install any special software.3 Given the effort required to develop 3-D models, a key issue is the evaluation of their pedagogical effectiveness. We demonstrated a statistically significant advantage in using highly interactive models to learn 3-D relationships.4, 5 Some researchers continue to report negative results but this may be because they are asking the wrong questions: 3-D models are more useful for learning complex spatial relationships than for simply learning the names of anatomical structures, and a high degree of interactivity is central to the successful use of 3-D models.
SURGICAL SIMULATIONIt is increasingly accepted that surgical residents should be able to learn and practise on simulators before operating on real patients. Simulators could also be used for ongoing maintenance and evaluation of technical skills. This is analogous to what is done for commercial pilots and interest in the development of surgical simulators by flight-simulator manufacturers is no coincidence.
Haptics, or the use of computer-generated force feedback, which may be useful for learning anatomy, is essential for surgical simulation.6 One of the limiting factors is the cost of haptic devices that are good enough for this application.
There are currently devices on the market for a few hundred dollars that are clearly not good enough and others for tens of thousands of dollars that are probably too expensive in most contexts. There are devices costing a few thousand dollars that may be good enough and may be inexpensive enough. The level of acceptability on both counts depends to some extent on the goals of the simulation.
The current state of the technology does not yet provide an ideal device but many groups are working on improved designs. Much work is also being done on new computer algorithms for providing fast but realistic visual and force feedback, such as our work on dynamic deformations.7 The evaluation of surgical simulators is even more important than the evaluation of models for teaching anatomy.
By W. Robert J. Funnell, PhD, ing.
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Une nouvelle forme d’activité de DPC
Reflecting and Acting on How the Healthcare Team Works with PatientsAs a physician, are you a member of a team made up of healthcare and social services professionals working in primary care or in specialized care? Are you concerned that each team member should optimally contribute to patient care in order to increase access to services, ensure quality healthcare and patient safety, and obtain increased compliance to treatment by patients? Would you like to become involved in a new form of CPD?
The program Partenaires de soins (PPS), under the authority of the Collaboration et Partenariat patient Collaboration and patient partnership directorate of the CPASS at the Université de Montréal Faculty of medicine, has developed an approach of continuous improvement to partnership in care. In 2013-2014, PPS experts accompanied 26 teams from 16 institutions belonging to the Université de Montréal RUIS so that they could re-examine their collaborative practices through a reflexive approach and transform their way of doing things, by integrating the vision of partnership with patients and their relatives. In this approach, the patient is a full member of the healthcare team. Healthcare stakeholders recognize that patients have the ability for self-care and have knowledge acquired through their experience of their illness (experiential knowledge).
The needs, hopes and life plans of the patient influence the interventions chosen and the patient is an essential participant. He is (Patients are) supported by team members to progressively develop (their) healthcare competencies and autonomy, and thus make informed decisions regarding his or her health.
A continuous improvement committee (CIC) from the Partenariat de soins et de services is set up within a clinical team. The CIC includes the following people: a clinical manager; a physician; a clinical co-manager or not; one or two key stakeholders recognized by their peers as playing a significant role in the team member interrelationships; one or two patients or close resources, previously chosen by the team in line with certain predefined criteria, trained and supported by patient coaches from the PPS; a leader of collaboration in an institution (LCI) trained and coached by CPASS to become the CIC moderator chosen among clinicians, clinical advisors or institution managers. The LCIs from the institutions within the Université de Montréal RUIS interact through a virtual community of practice promoting exchanges and sharing of tools.
The CIC members go through the following steps, meeting four times for an hour and a half, over a cycle of three to four months:
1st Meeting: Distribution of the team’s diagnostic balance sheet with regards to collaborative practices in partnership with the patient to initiate reflection. The team`s balance sheet is based on answers to questionnaires filled out in tandem by the medical and administrative management; on observations from clinical case discussions meetings, in particular those to develop the interdisciplinary patient intervention (IPI) plan; or on data produced by a multisource evaluation tool. The balance sheet is made up of three dimensions: i) team and organization structures; ii) team dynamics; iii) team results (indicators in place).
2nd Meeting: Choosing a priority for improvement and formulating a plan of action. The CIC members analyze the team’s balance sheet, review the experiences of the resource patients and identify the strengths and elements to consolidate at the level of the care and services partnership. Afterwards, they develop a plan of action to be implemented in the short term (maximum of 3 to 4 months), which includes an objective (SMART), various ways to transform the team, allocating tasks to each member, including the resource patient, a calendar and precise deliverables.
3rd and 4th Meetings: Implementing the transformation activities and evaluating results obtained. The transformational activities can take various forms: developing educational content for patients; creating management tools that promote the partnership (process of welcoming patients into a clinical department); team educational activities, including workshops and demonstration videos on how to lead an IPI meeting with the patient, and its functions; surveys of patients to increase knowledge of their points of view, etc. Evaluating how the CIC objective was met is done mid-way to perform a course correction (if needed) and at the end of the cycle. The participation of physicians in the CIC is essential.
This approach to continuing improvement of the care partnership allows the team to be taken as it stands, respecting its specificities and bringing it, step by step, through short continuing improvement cycles, to transform its practices. This approach is considered a continuing professional development activity and may be credited for physicians and professionals who take part in it.
By Paule Lebel, MD, MSc, CSPQ, FRCPC,Vincent Dumez, Patient, MSc andHélène Essiembre, PhD*
* Paule Lebel, a specialist in community medicine, is Co-Director of the Collaboration et Partenariat patient directorate of the Centre de pédagogie appliquée aux sciences de la santé (CPASS) of the Université de Montréal Faculty of Medicine, in addition to being medical consultant for the Direction de la santé publique of the Montreal ASSS and Co-President of the Comité sur les pratiques collaboratives et la formation interprofessionnelle for the Université de Montréal RUIS.
Vincent Dumez is Co-Director of the Collaboration et Partenariat patient directorate of the CPASS.
Hélène Essiembre is a psychologist specializing in work and organizations, head of the Programme partenaires de soins section of the CPASS.
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To Evaluate One’s Practice and Reflect Upon It
Training Based on Script Concordance Testing At the end of numerous research projects, it is currently recognized that clinicians reason by very rapidly generating hypotheses or options, which guide and orient the diagnostic approach or case management.
These options appear to be based on environmental factors and indicators found in patients which orient data collection. The clinician “deduces”, from the overall knowledge linked to each hypothesis which we call illness script, what clinical sign should be present or absent and checks to see if the clinical data reinforces or minimizes the current options or if they force us to generate new ones, more consistent with the situational data. This way of dealing with data implies that clinicians permanently interpret the information and generate micro judgments regarding the consequences of this information with regards to the hypothesis.
Uncertainty characterizes medical practice. Physicians often have to make decisions within a framework of uncertainty because the data available on the clinical situation is incomplete or because patients do not correspond exactly to the inclusion criteria of studies that gave birth to the clinical guidelines or best practice.
The existence of these micro judgments within a context of uncertainty has given birth to an innovative method of training that places participants in a simulated clinical situation, asks them to judge the significance of the data and compares their responses to those of a panel of subject-matter experts. It then becomes possible to have participants undertake tasks that bring them to reflect on their professional practice all the while receiving immediate feedback. The method takes its name, “script concordance test” (see illustration), from the fact that it implies a comparison between participant scripts and those of the experts.
The Centre de pédagogie appliquée en sciences de la santé (CPASS) at the Université de Montréal, in association with collaborators, has developed an online platform which presents participants within authentic cases described in a few lines, with or without images, sounds, or complementary examination data. Each case carries uncertainty by design and generates 4 or 5 questions regarding the diagnosis or case management of the patient. Experts make up a reference panel. They write up answers which they judge to be the best adapted to the case along with a short justification of their responses with, if needed, one or two documentary sources. When participants respond, they immediately discover how many
experts answered the way they did, or differently, which justifications they gave, and, if necessary, they can consult the complementary sources.
This method, based on case studies, thus brings participants to reflect on the real stakes of medical practice while receiving immediate and multisource feedback. These principles were described in a recent issue of the Journal of Continuing Education in the Health Professions1, which presented the use, in continuing development, of the concept of script concordance, which had been the subject of numerous publications on evaluation listed on the website of cpass.umontreal.ca.
By Bernard Charlin, MD, FRCS, PhD
Bernard Charlin, an ORL, is a professor in the Department of Surgery and a researcher at the Centre de pédagogie appliquée aux sciences de la santé (CPASS) of the Faculty of Medicine at the Université de Montréal.
INTERACTIONS IN CPD BASED ON SCRIPT CONCORDANCE TEST
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Script concordance test: format
Case
An option
Interactivity
Reflexivity on cases from practice
Participant’s responseAccess to expert
responses
Feedback1 - Concordance with experts
2 - Experts’ justification3 - Complementary resources
A datumFive-point
Likert scale
-2 Much less probable; 0 No more nor less; 2 A lot more probable
If you were thinking of… And then you find The effect of this new data on the option is
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Accrediting Group Learning ActivitiesOrganizing a congress or a CPD activity requires a lot of planning in order to offer quality activities and programs to meet the needs of your members.
One very important part of your planning process is accreditation. Here are the steps that must be followed by anyone responsible for developing CPD activities in order to obtain an accreditation for the learning activity under Section 1 of the MOC program at the RCPSC.
IDENTIFY THE SCIENTIFIC COMMITTEE The scientific committee responsible for the organization of an activity must be representative of the various groups of physicians and other healthcare professionals described as the target audience. The committee’s identification must appear in the activity’s program.
IDENTIFY THE TARGET AUDIENCEThe scientific committee must decide to whom the learning activity is destined in order to develop and to meet the audience’s needs. The target audience for a CPD activity must also be clearly indicated in the program.
IDENTIFY NEEDSA needs analysis must be performed by the scientif ic committee. The chosen activity must meet previously-documented educational needs for the target audience.
DEVELOP LEARNING OBJECTIVESSpecific learning objectives must be defined in line with the previously-established needs. It is important to always use action verbs in formulating objectives so that they describe what participants will be able to accomplish after the activity (e.g. at the end of this activity, the participant will be able to...).
The verbs to “learn”, “understand”, and “know” are to be avoided as they can give rise to conflicting interpretations. Tables of action verbs are offered on the website of the CQDPCM.
Finally, in order to clearly communicate to participants the knowledge and skills they will develop by the end of the activity, learning objectives must be included in the activity’s program and must be sent to participants beforehand.
CHOOSE APPROPRIATE METHODS OF LEARNINGWhile preparing your program, make sure you indicate which educational methods will be used (conference, symposium, round table, colloquium, etc.) in order to allow participants to choose the workshops that best correspond to their learning style.
During CPD activities, a minimum of 25% of the time must be interactive in nature (question and answer sessions, case discussions, quizzes, practical exercises, etc.). The audience must be able to contribute actively to their learning.
THE PROCESS OF EVALUATIONParticipants must evaluate the activity at the end of the meeting. They must be able to express themselves on different aspects of the activity and the organization such as pertinence of content, efficiency of resource persons, respect of objectives, appearance of commercial bias, time allocated to interactivity, whether objectives were met as well as their impact on their practice. Finally, the evaluation must allow participants to add written comments (form).
All CPD activities must respect the code of ethics of the CQDPCM as well as the guidelines of the RCPSC and the CMA. A CPD activity, in order to be compliant, must meet all the ethical considerations of these organizations.
The scient i f ic commit tee must guarantee the transparency of financial management and the disclosure of financial contributions by its partners.
Any contribution, including those emanat ing f rom a commerc ia l source, must be given in the form of an educational grant, payable to the association responsible for the activity and usable without any conditions other than the holding of the activity, meaning for the sole purpose of the financed event. In order to ensure transparency, the financial contribution of any organization must be highlighted in the program and on any other material used for the activity (except for the participants’ nametags). Finally, all grant-giving organizations must be thanked on the last page of the program using the same size and style of font (typographical elements).
Potential conflicts of interest must be fully identified while developing the activity and included in the request for accreditation.
The physician responsible for organizing the activity for an affiliated medical association must ensure that all members of the scientific committee as well as the resource persons for the learning activity (speakers, moderators, presenters, etc.) fill out the form on disclosure of potential conflicts of interest.
Participants will be informed of these potential sources of conflicts of interest with the grant-giving organizations through an inscription in the proceedings and the disclosure of these conflicts (or absence thereof) will be made by the presenter at the beginning of the presentation (verbal disclosure and visual disclosure with slides).
An activity that respects all of the above criteria is judged to meet the accreditation standards of quality established by the CMQ and the RCPSC. As an accrediting organization, the FMSQ is authorized to issue a notice of compliance thus allowing participants to register their credits on the RCPSC’s MAINPORT portal or in the CMQ’s self-managed plan.
By Brigitte Vinet
Brigitte Vinet is an Assistant to the Director at the FMSQ’s Office of Continuing Professional Development.
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Evaluating a CPD ActivityEvaluating a CPD activity, the step that is often unrecognized by organizers, is an essential one that leads to ensuring that learning objectives have been met.1 It allows you to establish the value of the activity (cost/benefit) as well as its impact on medical practice.2,3
A good evaluation allows participants and organizers to develop ways of reflecting on future needs in CPD. For collaborators ( resource people, speakers and members of the scientific committee), an evaluation makes immediate feedback possible, allowing them to improve their next presentation.
To develop an evaluation formula that will meet your future CPD needs, you need to be well prepared. Here are a few steps to follow:
1. Set the evaluation’s objectives;2. Plan the collection of data;3. Collect the data;4. Analyse the data;5. Interpret the data;6. Ensure there is a follow-up to the
evaluation.3
SET THE EVALUATION’S OBJECTIVESBefore formulating these objectives, you need to determine exactly what you want to evaluate. You need to make sure you evaluate both the process of your activity and your participants’ learning.1
To make sure you comply with the accreditation standards of the RCPSC Section 1 activities, your participants must be able to express the ir opinions on:
• The pertinence of the content;• The effectiveness of resource people;• Whether objectives were met;• The appearance of commercial or
other bias;• What they have learnt and its impact
on their practice;• The time allocated for interactivity;• The presence of a section where they
can add their written comments.
To comply with the accreditation standards of Section 3 activities, the evaluation will also need to include a more in-depth assessment of participants’ learning. Here are a few tools that can help you:
• Pre- and post-testing;• Immediate feedback as in the case
of simulations;• A tool to help reflection allowing
the participant to identify his or her strengths, weaknesses as well as perceived and unperceived educational needs.
PLAN THE COLLECTION OF DATAThis step must be done at the very beginning when you are planning your activity. If you want your activity to be accredited, you need to build your evaluation form in line with the accreditation criteria as specified. Data collection can be done on a traditional form (paper) or on an automated one (such as SurveyMonkey®).
The FMSQ has developed a generic evaluation form that you can use upon payment of an administration fee.
COLLECT THE DATACollecting data from your evaluation can be done at various moments during your activity. Everything depends on the objectives you have set for the evaluation. To measure participant satisfaction, knowledge, competencies as well as intention to modify their practice, you should have the evaluation completed immediately after your activity. If you want to measure the acquisition of new knowledge or competencies, pre- and post-testing as well as an evaluation during the activity is the better approach.
Finally, if you choose to measure retention and application of knowledge, a pre-activity evaluation followed by evaluations after 3, 6 and 12 months will allow you to better reach your objectives.3 Tools such as clinical observation, chart audits as well as knowledge testing will then be useful.1
ANALYSE THE DATAThe method you use to analyse the data will depend on the format of your evaluation. The same applies for any scientific undertaking and the extent of the analysis is proportional to the results expected. The analysis can be done manually if traditional forms are used or automatically if you have access to a technology. The FMSQ forms are analysed electronically. Results are compiled by our team and are then sent back to the association who organized the activity.
INTERPRET THE DATA AND ENSURE THERE IS FOLLOW-UPAfter analysing the results, the organizers should get together and discuss achievements as well as elements to be improved. This meeting and discussion can be used to celebrate successful activities and explore ways of improving the organization of future ones.3
Speakers should also receive results of their evaluation to provide them with feedback for their own process of continuing development. An evaluation that is not followed up on is a useless one.
A well-planned and well executed process of evaluation will allow you to establish the cost/benefit ratio of your activity and thus invest your human and financial resources in the best activities.
By Patricia Wade, MN, CPN (C).
Patricia Wade is a consultant in research and development in the Professional Development Office of the FMSQ.
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Self-approval of Educational Activities in a Hospital SettingCPD activities in a clinical setting, such as grand rounds, are an important component of all learning plans.1 The Royal College offers you a self-approval process that allows you to obtain Section 1 credits within the framework of the pedagogical options of the MOC Program.
A SIMPLE SIX-STEP RECIPE
1. CREATING A PLANNING COMMITTEE THAT REPRESENTS THE TARGET AUDIENCE
To begin, a planning committee must be implemented to see to the organization of educational activities and to maintaining the appropriate registers and files. This committee must respect certain standards. It must report to the head of the department or service, the director of professional services or their equivalent in order to guarantee an educational content that respects the mandate of the institution where the committee is established. It must maintain an attendance record and supply a certificate of attendance to participants. This confirmation must also repeat the RCPSC’s statement regarding accreditation.
2. EVALUATING THE TRAINING NEEDS OF THE TARGET AUDIENCE WHETHER PERCEIVED OR NOT
The scientific committee must prepare educational activities according to the needs of the target audience. In fact, the members of the committee must represent the target audience in order to make sure that the objectives and contents of CPD activities are pertinent and that this is reflected in the scope of the events planned by the committee.
It must also implement a needs evaluation strategy in order to establish the target audience’s educational needs, perceived or not. The committee will set objectives for the activities in order to ensure the subjects chosen are appropriate for the target audience.
By Sam J. Daniel, MD, FRCSC
Sam J. Daniel, an ORL, is the Director of the Professional Development Office of the FMSQ.
Respect of Ethical Principles
The planning committee must make sure that the self-approved educational sessions remain free from the influence of persons with commercial interests and that the content of each activity is free of any commercial bias.
The activities must respect the standards of the Conseil québécois de développement professionnel continu des médecins (cemcq.qc.ca). They must also comply with the Canadian Medical Association`s guidelines for physicians in interactions with industry.
Any financial support from the pharmaceutical industry must be allocated in the form of an educational grant
Participants must be informed of any conflict of interest linked to each series of educational sessions or self-approved individual activities before the start of the presentation.
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The activities include journal clubs, grand rounds and small group sessions. It doesn’t matter if your hospital is a university health centre or not, if your practice setting is in a large city or in a remote region, you can take advantage of the self-approval process.
The process is available to all medical specialists who use the MOC Program and is completely free of charge.
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Continued from page 51
A few examples of useful sources for the evaluation of the perceived or unperceived needs of the target audience are listed below. At the level of perceived needs, surveys, requests from the target audience, questionnaires and the results of previous years’ evaluations could also prove useful. Insofar as unperceived needs are concerned, the self-assessment tests, chart audits, patient comments, performance assessments, hospital data on quality assurance, provincial databases, as well as reports of incidents could be very useful to the planning committee.
3. PREPARING PERIODIC EDUCATIONAL ACTIVITIES IN LINE WITH THE NEEDS OF THE TARGET AUDIENCE
A series of periodic activities (a minimum of four per year) must be planned and announced in advance. The promotional material must include the following statement regarding accreditation from the RCPSC: “The [rounds’ or journal club’s name] is a self-approved group learning activity (Section 1) as defined by the Maintenance of Certification program of The Royal College of Physicians and Surgeons of Canada.”
The training objectives of these professional development activities must be communicated in advance to the target audience.
4. USING DIVERSIFIED LEARNING STRATEGIES: A MINIMUM OF 25% OF THE DURATION OF AN ACTIVITY MUST BE INTERACTIVE
At least 25% of the duration of an activity must be interactive. A diversity of learning strategies is essential and the pedagogical methods must be appropriate to the learning objectives established for each activity. For example, certain subjects are better suited to conferences, others to debates or group discussions.
5. EVALUATING EDUCATIONAL ACTIVITIES
Participants must evaluate the individual educational activities to determine if they adequately meet their needs. An evaluation template is available for you in the CPD section of the FMSQ’s internet portal.
Insofar as the planning committee is concerned, it must also implement strategies to evaluate its program as a whole. This can be done by way of questionnaires, group discussions, etc. An evaluation of the educational sessions as a whole must take place preferably every year or, at a minimum, every two years.
6. RESPECTING ETHICAL GUIDELINES THROUGHOUT THE PROCESS
The planning committee must ensure that self-approved educational sessions are free from the influence of organizations or persons with commercial interests and that the content of each activity is free of commercial bias.
The activities must meet the standards of the CQDPCM (cemcq.qc.ca). They must also comply with the CMA`s guidelines for physicians in interactions with industry. Any financial support from the pharmaceutical industry must be allocated as if it were an educational grant.
Participants must be informed of any conflict of interests associated with each series of educational sessions or with self-approved individual activities before the start of the presentation.
COMPLETING THE PROCESS Having followed this process, all you need to do is download and fill out a self-approval form, available in English and in French on the RCPSC website in the CPD section. There is a link on the Federation’s internet portal. Once the form has been signed and sent to the RCPSC, participants in the self-approved educational sessions can start claiming their credits under section 1 of the MOC Program. The planning committee must retain a copy of this form in its files.
The PDO team at the FMSQ remains at your service to support you in all your self-approval undertakings.
REMINDER OF THE SIX STEPS
1 Create a planning committee representative of the target audience.
2 Evaluate the target audience’s perceived and unperceived educational needs.
3Prepare periodic educational activities (at least quarterly) according to the target audience’s needs. These activities, along with their learning objectives, should be planned and announced in advance.
4 Use diversified learning activities: at least 25% of the duration of an activity must be interactive.
5 Evaluate the educational activities.
6 Respect ethical guidelines throughout the process.
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Integrating Assessment Activities into Your CPDResearch in CPD has c lea r l y demonstrated that the capacity of medical specialists to accurately assess their own knowledge, competencies and performance, without external indicators, is limited. It also shows that assessment strategies made up of data accompanied by feedback are more likely to modify performance and improve patient outcomes than do other forms of continuing professional development. It is in part for this reason that the RCPSC now requires that each Fellow, with a new cycle of the MOC program starting on or after January 1, 2014, obtain at least 25 credits in Section 3 within the five-year cycle. Moreover, the assessment of competencies in practice is an expectation that is becoming increasingly important as much for regulatory authorities as for the population.
Assessment activities offer medical specialists a process that allows them to receive data and feedback to better identify the areas in which they need improvement and to establish appropriate learning plans. These can be classified as either knowledge assessment or performance assessment. As the weighting is established at three credits per hour, this amounts to approximately eight and a half hours of assessment during a five-year cycle.
KNOWLEDGE ASSESSMENTAccording to your specialty, several accredited self-assessment activities have been designed to meet established pedagogical and ethical standards. These must assess the candidate and provide feedback with an explanation based on evidence. A list of all accredited self-assessment programs can be found on the RCPSC website in Section 3 of MAINPORT. If you cannot find the self-assessment program in which you are participating, write to the RCPSC. If the College judges it to be eligible, it will be added to MAINPORT.
PERFORMANCE ASSESSMENTAssessing performance can take place in a simulated environment or in a physician’s actual practice environment (individual performance assessment), in a group (performance assessment of several specialists), or even in an interprofessional medical team (collective performance assessment).
CONCRETE EXAMPLESYour Federation’s PDO is now accredited for Section 3 activities and these are admissible for resourcing on the same basis as are Section 1 activities. During their annual congress, several associations began integrating Section 3 activities that give rise to three credits per hour of participation. For example, a workshop where participants are evaluated on their performance with regards to a procedure or a technique; or a workshop with a standardized patient; or a simulation of clinical scenarios.
The RCPSC and the CMPA are among the organizations that offer several accredited self-assessment programs free of charge. The RCPSC’s bioethics modules are accessible on their website and, because they deal with ethics in the medical field, they are useful for all specialists.
The time you spend examining your annual learning self-assessments or the assessments done by your department head qualify as hours dedicated to examining your data, reflecting upon it and collecting comments from your peers. This includes the assessments you receive over the course of the year from teaching medical students, residents or physicians in professional practice, within an official framework of continuing medical education.
There are several per formance a s s e s s m e n t p ro g ra m s , 3 6 0° assessment, or any other type of assessment approach in the workplace related to the profession’s fields of practice, including communication, and leadership or management abilities. One example of these programs, that is becoming increasingly important in Quebec, is that of the patient-partner allowing the latter to provide feedback in order to improve various aspects of a practice. The hours you dedicate to examining your data and to reflecting upon it are included under Section 3.
Section 1: Group learning activities
Section 2: Self-learning activities
Section 3: Assessment
Do you write articles for scientific journals where submissions are reviewed by a committee of peers? The time you spend studying the comments received from your peers gives rise to three credits per hour under Section 3.
Do you submit your practice to chart audits or other forms of professional practice assessment based on performance? Take note that, on this level, there are established markers such as the minimum of ten charts with at least three different assessment measurements. These activities also give rise to credits under Section 3.
In conclusion, the possibilities of integrating assessment activities to your continuing professional development are abundant. These activities have the greatest potential of a direct impact on your practice.
By Sam J. Daniel, MD, FRCSC
Sam J. Daniel, an ORL, is the Director of the Office of Professional Development at the FMSQ.
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A Real-Life Experience at McGill
Setting Up an Academic DepartmentSetting up a university department leads to the creation of an academic structure that promotes continuing professional development, research and innovation. This was my vision and my hope when I founded the Department of Pediatric Surgery at McGill University.
In fact, pediatric surgeons of all disci-plines dedicate their career and the maintenance of their competencies to the surgical treatment of young children suffering from particular conditions, often unique to this age group. Apart from the congenital nature of the health problems encountered, the patient’s corporeal habitat differs from that of an adult: the problems as well as the potential compli-cations faced by pediatric surgeons largely depend on it. In addition, these considerations are often similar (up to a certain point) between the different pediatric surgical specialties. For example, endoscopic surgery, whether it involves neuro-endoscopy, laparos-copy, bronchoscopy, thoracoscopy or cystoscopy, presents similar challenges to surgeons from different specialties who perform it.
Pediatric surgeons regularly have CPD activities that are different from those of surgeons for adults. These medical specialists often work within international pediatric associations where they have exchanges with colleagues who, like them, concentrate their efforts on the treatment of children.
It goes without saying therefore that pedagogical activities, academic meetings and mortality and morbidity rounds for surgeons working with children are adapted to the practice of these professionals. It therefore seemed logical to create a department of pediatric surgery that is separate from adult surgery departments.
The same thing applies in the area of research. There have been important advances in neuro-imagery, with the introduction of operative magnetic resonance techniques; in minimally-invasive surgery; in fetal surgery; in treatments for blindness derived from molecular biology; in therapies to counter ototoxicity; and in distraction osteoge-nesis, to name but a few.
It was important that this CPD envi-ronment, with its distinct identity, be highlighted in a context that is different from that of adult specialties. The creation of the Department allowed for much more direct communication with the Faculty of Medicine, thus making possible a better coordination of the orientation of these two groups.
HOW IT WAS ALL DONE…McGill University’s Department of Pediatric Surgery was created in November 2011. From the start, it set up an academic structure allowing for advances in education, research and CPD. An executive committee made up of division directors for the ten disciplines involved meet on a monthly basis.
Before the creation of the Department, we had already established a structure of academic meetings and of morbidity rounds on a monthly basis and had a program of visiting professors. We also had an advanced research program in ophthalmology, in orthopædic surgery, in ORL, in head and neck surgery, and in neuro-imagery with the arrival, in Quebec, of the very first operative magnetic resonance equipment in 2009.
To this, we added a day dedicated to pediatric research which normally takes place at the end of the academic year and during which residents and clinical monitors present their research projects.
Finally, over the years, the Department also created research chairs.
AFTER TWO YEARS…During its first two years of existence, our Department has developed various projects. Thus, we have created two retreats for professionals: one, in April 2012, focusing on our academic role; and the other in April 2013, dealing with research.
We have also created five associate director positions for the Department: operative care; quality of the act and humanitarian missions; education; research and transition; and develop-ment. Finally, we set up a departmental promotion committee.
Thus, by setting up an academic department, we have already reached our goal of creating an environment feasible to professional development in the various fields of pediatric surgery at McGill University.
By Jean-Pierre Farmer, MD, FRCSC
Jean-Pierre Farmer, a neurosurgeon, is Surgeon-in-Chief at the Montreal Children’s Hospital, Head of the Department of Pediatric Surgery at the McGill University Health Centre, a professor in neurosurgery, pediatric surgery, oncology and surgery, and the holder of the Dorothy Williams Chair at McGill University.
The creation of the Department allowed for much more direct communication with the Faculty of Medicine thus making possible a better coordination of the orientation of these two groups.
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Educating Tomorrow’s PhysiciansChanging the culture to integrate Continuing Professional Development (CPD) into the residency curriculum is very challenging. McGill University’s Faculty of Medicine has been involved in two pivotal projects whose goals are to develop the physicians of tomorrow.
The first project is the Future of Medical Education Project: Postgraduate (FMEC-PG) and the other is the International Medical Graduate (IMG) Evaluation and Orientation Center.
THE FUTURE OF MEDICAL EDUCATION PROJECT: POSTGRADUATE (FMEC-PG)The FMEC-PG Project careful ly reviewed current Canadian residency training programs and found that our traditional time-based approach had significant gaps. In collaboration with the Associate Deans of the Universities of Toronto and British Columbia, I was involved with both the Environmental Scan and the Liaison and Engagement Consulting (LEC) Group. The LEC group visited Quebec’s four medical schools as well as Dalhousie and Memorial to determine each faculty’s opinions on postgraduate medical training in Canada and its future. After several rounds of consultations, problems were mainly identified in the areas of competency and assessment skills.
Presently, medical residents journey through their five years of training with minimal direct observation or on the job assessments. They are promoted from one year to the next with minimal objective assessments. Although they receive some form of in-training evaluations, these evaluations are of ten subjective and rarely based on achievement of specialty-specific milestones.
Based on these analyses, the FMEC-PG project developed several recommendations. The two most important were to: first, transition to competency-based curricula and, second, institute objective summative assessments to accurately verify the achievement of specific competencies.
These recommendations have the potential to revolutionize resident training programs with the incorporation of milestones and the development of novel assessment tools such as portfolios. In addition, the project leaders noted that residents would need more support in order to facilitate their transition from residency to professional practice.
In current residency programs, residents spend a lot of time and energy studying for end-of-training examinations and miss out on the most important last few months of training. By moving the certification examination to the penultimate year and carefully instilling a culture of continuing professional development, the competent graduating physician will remain competent in practice. In addition, they will be able to begin their professional practice with the confidence that comes from working independently. These changes will be gradual and it is hoped that by 2017, the majority will be implemented.
INTERNATIONAL MEDICAL GRADUATE (IMG) ORIENTATION AND EVALUATION CENTERMcGill’s Faculty of Medicine submitted a proposal to the Ministère de la Santé et des Services Sociaux (MSSS) and the Ministère de l’Éducation to develop IMG centers in its faculty. The proposal was later adopted by the Echave Commission as part of its recommendations for improving the integration of IMGs in the workforce.
Every year, Quebec welcomes foreign medical graduates. The purpose of the IMG program is to offer a 3- to 4-month evaluation in order to facilitate their entry into training programs. The evaluation programs were developed in partnership with St. Mary’s and Verdun Hospitals. As Associate Dean at McGill’s Faculty of Medicine, I participated in the organization of the sites as well as in naming the members of the Education Committee which developed the educational content and evaluation system. To date, this program has evaluated over 30 foreign graduates, with 17 accepted into residency. These international graduates would not have been able to enter medical practice in Quebec without this program.
CONCLUSIONCurrent training programs have undergone few changes since the days of Dr William Osler and it is clear that improvements must be made so that residency education can enter the 21st century. The public expects that we graduate competent physicians committed to lifelong learning. Although we have been measuring competency implicitly for over 100 years, it is imperative that we implement explicit measures that will benefit both society and our young trainees.
My goal, for these past seven years has been to improve the education and training of tomorrow’s physicians. I believe that, through these projects, the education of residents and foreign medical graduates has significantly improved and, in the final analysis, is benefiting the population of Quebec.
By Sarkis Meterissian, MD, FRCSC
Sarkis Meterissian, an oncology surgeon, is Professor of Surgery and Oncology and Associate Dean, Post-Graduate Medical Education and Professional Affairs at the McGill University.
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CPD for NursesCPD for healthcare professionals is an essential component of the practice. It is as much an ethical obligation for nurses1 as it is for physicians.3
Nurses have the same responsibility to provide healthcare both competently and safely. The nursing profession is in constant evolution and it would be impossible for initial training programs to fully prepare clinicians for all the professional situations which could present themselves during the course of a career. To ensure they maintain their competency up to date and conti-nually improve their knowledge of the latest evidence, nurses must develop a culture of continuing education.
This is why, in January 2012, the OIIQ adopted a professional standard of conti-nuing education. This standard applies to all nurses, whether they work in the public or private sectors, full-time or part-time. It is part of the OIIQ’s mandate to protect the public and to ensure the competency of its members.
CPD AND THE OIIQThe OIIQ defines continuing education as being “a permanent process that is both active and sustained in which nurses undertake to acquire, by way of learning activities throughout their entire profes-sional lives, new knowledge that will allow them to develop their competencies and to offer quality care and services to the popu-lation.”2 Contrary to the RCPSC five-year learning cycles, the OIIQ chose to develop a one-year cycle. CPD activities are calcu-lated in hours rather than in credits.
The professional standard includes three items applicable to nurses. Nurses must:
1. Take part in a minimum of 20 hours of continuing education, at least 7 of which must be accredited.
2. Annually declare the total number of continuing education activity hours they have followed and, among these, those that were accredited.
3. Keep an annual register of continuing education activities. The register must be kept for five years.
Just like the RCPSC, the OIIQ has developed certain tools to support nurses in their professional development.
ACCREDITED AND NON-ACCREDITED HOURSContinuing education hours are divided into two categories: accredited hours and non-accredited ones. Accredited hours must represent a minimum of seven hours of the annual cycle, though there is no maximum. Nurses could complete their total cycle with accredited activities, but could not do so with non-accredited ones. Education activities in which nurses take part must be pertinent to their practice and allow them to update their compe-tencies in nursing care or in transverse areas that are essential to the profession.
Non-accredited activities can be compared to RCPSC MOC activities such as:
• Education activities organized by an employer in a clinical setting;
• Activities offered by a group, a professional association or an expert;
• Reading professional and scientific articles, participating in a journal club;
• Preparing a presentation to be given in the context of a conference;
• Writing and publishing articles or texts pertinent to nursing care.
Eligible accredited activities must also meet one of the following two criteria:
• Be a continuing education activity developed by the OIIQ, the organization responsible for issuing standards for the nursing profession;
• Be an education activity recognized by organizations authorized to issue a certification, for example, education credits (with a view to obtaining a certificate or diploma), continuing education credits, CME units, CTUs or CEUs.4
University courses after initial training as well as accredited activities offered by accredited medical CPD providers are admissible as accredited hours of education, if they are pertinent to the nurse’s practice.
To facil itate access to continuing education, the OIIQ regularly issues on-line education on its learning platform Mistral. Quebec nurses can access a directory of various training proposed by the order as well as by other organizations.
DECLARING EDUCATION HOURS AND MAINTAINING A REGISTER Each year, at the time of registering on the roll, nurses must indicate the number of hours dedicated to CPD. In the future, the order intends to implement follow-up and support measures in order to ensure these standards are respected.
DID YOU KNOW THAT...Just like physicians and nurses, pharma-cists, dentists, licenced practical nurses, respiratory therapists, physiotherapists as well as occupational therapists also have standards relative to CPD. For more information on CPD standards applicable to each profession, consult the Web site of the professional order involved or that of the Office des professions du Québec (opq.gouv.qc.ca).
By Patricia Wade, MN, CPN (C)
Patricia Wade is a consultant in research and development in the Professional Development Office of the FMSQ.
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Tips for the Organization of Successful Academic EveningsThe academic evenings of the Faculty of Medicine’s Oto-rhino-laryngology program at the Université de Montréal have existed since the end of the 1990s and, over this period, their popularity has steadily increased (see table). Over the course of a university year, 18 evenings are thus organized to cover cutting edge subjects; they are divided into Journal Clubs, scientific sessions also called “Grand Rounds,” and conferences. For some years now, these evenings are also broadcast by videoconferencing to all regions in Quebec as well as to two centres in New Brunswick.
During Journal Clubs, before an article is presented, two multiple choice questions are submitted to participants to stimulate their attention and promote the memorization of information. These questions can also encourage participants to develop a personal learning project, which can be attributed to Section 2 of the Royal College MOC. The speaker must have developed a critique of the article and analyzed the quality of the methodology used as well as the relevance of the conclusions reached by the authors. He must also have chosen with which CanMEDS competence the article is associated with. The articles chosen cover all areas of ORL, including ethics and medical pedagogy. Very often, the choice falls on controversial or innovative subjects which inspire some very good discussions between participants. The comments of professors present in the audience are also very beneficial due to their experience and their expertise.
During Grand Rounds, cases are usually presented under the supervision of a staff by residents who, very quickly, become expert speakers and masters of the audiovisual.
The subjects of these Grand Rounds are not revealed in advance, as we prefer that participants reflect on the clinical approach in order to develop, during the presentation, a differential diagnosis, an investigative process and an interpretation of the data in order to establish a final diagnosis. A review of the literature is then performed on the subject matter. This approach has the merit of simulating as closely as possible the reality of a patient who has come to consult us. It is also well suited to teaching residents and externs who sit in on our evenings and who are invited to analyze the clinical data as well as that produced by medical imagery and to formulate a differential diagnosis.
Finally, over the course of a year, we invite three or four local, national or international speakers to share the results of their research, new discoveries or experience with innovative surgical techniques. All speakers receive feedback in the form of a summary of the evaluations of their presentation.
All of these activities benefit from a relaxed and informal atmosphere, in one of the CHU Sainte-Justine’s amphitheatres. They take place in the early evening to allow as many physicians as possible to participate. However, many of them arrived without having had the time to eat. As Cato the Elder said, “Hungry belly has no ears.” We therefore found sponsors who would provide meals, served one hour before the start of presentations. These moments of relaxation promote cordial exchanges between participants and help set an atmosphere that encourages learning.
Finally, we added a personal touch in the form of a musical quiz at the start of the
evening, immediately before the presentations. We noticed that this quiz helped capture the attention of all participants. It’s a habit to which our participants are attached and which has become one of the expected features of our evenings.
Throughout all these years, my experience as the person responsible for the academic evenings has been very enriching and gratifying. Even if this form of learning is not considered as conducive to modifying medical practice, it should still not be underestimated. A well-known surgeon admitted to me that the idea for a new revolutionary technique for tympanoplasty came to him after the presentation of an article during one of our academic evenings.
The success of an academic evening can be summarized in three points: a good messenger, a stimulating message promoting participation and a pleasant atmosphere where people can have a positive experience.
As the French sociologist, Michel Tardy, said: “Education does not consist of force-feeding students, but rather of making them hungry.”
By Pierre Arcand, MD, FRCSC
Pierre Arcand, an ORL, is the head of the ORL Department at the Sainte-Justine University Hospital Centre, an Assistant Clinical Professor and the person responsible for the ORL program’s academic evenings at the Université de Montréal Faculty of Medicine.
Année Présences ORL Présences ORL et étudiants Présences totales
1997-1998 13,21998-1999 13,2 23,31999-2000 19,3 27,9 332000-2001 27,9 39,4 46,12001-2002 29,6 40,6 47,82002-2003 21,8 32,3 45,42003-2004 26,8 37 45,42004-2005 28 37,6 43,92005-2006 27,1 39 462006-2007 27,5 40,4 45,62007-2008 34,8 49 542008-2009 33 48 54,72009-2010 36,8 55,8 61,32010-2011 35,1 54 57,3 Moins de représentants2011-2012 38,7 51,2 54,4 Moins de représentants et externes2012-2013 37 53,6 56,7 Moins de représentants
-
10
15
20
25
30
35
40
Médecins ORL - Grand Rounds
0
10
20
30
40
50
60
Médecins ORL et étudiants - Grand Rounds
30
40
50
60
Assistance totale - Grand Rounds
20
30
40
50
60
Assistance totale - Journal Club
Année Présences ORL Présences ORL et étudiants Présences totales
1997-1998 13,21998-1999 13,2 23,31999-2000 19,3 27,9 332000-2001 27,9 39,4 46,12001-2002 29,6 40,6 47,82002-2003 21,8 32,3 45,42003-2004 26,8 37 45,42004-2005 28 37,6 43,92005-2006 27,1 39 462006-2007 27,5 40,4 45,62007-2008 34,8 49 542008-2009 33 48 54,72009-2010 36,8 55,8 61,32010-2011 35,1 54 57,3 Moins de représentants2011-2012 38,7 51,2 54,4 Moins de représentants et externes2012-2013 37 53,6 56,7 Moins de représentants
-
10
15
20
25
30
35
40
Médecins ORL - Grand Rounds
0
10
20
30
40
50
60
Médecins ORL et étudiants - Grand Rounds
30
40
50
60
Assistance totale - Grand Rounds
20
30
40
50
60
Assistance totale - Journal Club
Total Attendance - Grand Rounds
Total Attendance - Journal Club
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The experience at the Centre de simulation mère-enfant (CSME), CHU Sainte-Justine
Simulation in CPD, an Added Value“Clinical experience alone
does not guarantee the acquisition of clinical competence”,
Issemberg and McGaghie 20131
Reducing medical errors is a priority since the publication of “To Err is Human” in 1999.2 The expectations of society with regards to patient safety and the obligation of safely providing training centered on the learner have introduced a new medical teaching model based on simulation.
This pedagogical method allows one to acquire knowledge, but also to master clinical or therapeutic acts via a technology using virtual reality, simulated patients or computerized mannequins. Simulation is defined as a faithful and realistic representation of a complex environment where situations can be reproduced.3 Its use provides control on the educational environment while diminishing the risks associated with live patients.
Simulations can be created to reproduce a whole system, to target precise skills on simulators of specific tasks or to generate complex scenarios that assemble conditions requiring cognitive aptitudes which materialize in overall performances. Technological advances allow for the creation of realistic environments that improve our capacity to reproduce everyday clinical tasks and increase the opportunities for experiential teaching and learning.4 The aviation and nuclear industries have been using simulation for many decades. It is used for the training and evaluation of students in medicine (pre- and post-graduates) as well as all other healthcare professionals, but it is still little used in the field of continuing professional development.
And yet, it is a pedagogical tool that provides CPD with new emphasis on the acquisition and maintenance of skills and knowledge, on the integration of a new technique in a well-established practice or in a recertification. Simulation is extremely interesting for training interdisciplinary teams. When errors occur in medicine (as in aviation), communication failures are often the cause. This can occur at the level of coordination, especially in assigning roles to dif ferent team members. Medical errors often occur in complex crisis situations.
Managing resources in crisis situations is defined as a “management system that uses all available resources (equipment, protocols, and personnel) in an optimal fashion, to maximize safety and the effectiveness of the work.”5 As a concrete example, recently, at the CHU Sainte-Justine, the rapid mobilization of care teams allowed a mother to survive grave complications at 48 hours post-partum. This clinical success happened shortly after training by simulation on the protocol for massive hemorrhaging.6 This resuscitation called upon extraordinary interdisciplinary efforts and high levels of confidence between team members.
Complex clinical situations due to a massive hemorrhage or any other critical problem are rare, but they can happen. Clear communications, the appropriate attribution of roles and adequate management of available treatments are all essential components in a successful resuscitation.
It has been shown that simulation is good for the acquisition and maintenance of clinical skills that are rarely needed. This pedagogical method allows previously acquired theoretical notions to be applied in a clinical environment, improves the level of confidence and promotes long-term retention.7 Simulation consolidates the capacity to work within a team in crisis situations by developing communication skills, the role of the leader and that of other team members.8
Four massive hemorrhages have been simulated at the CHU Sainte-Justine CSME in order to evaluate the clinical work of an interdisciplinary team: two in obstetrics and two in pediatric traumatology. Four teams (nurses, respiratory therapists, staff members and physicians) attached to obstetrics, anesthetics, intensive care, pediatric emergency and hematology departments were recruited. Each case was followed by a feedback session led by expert facilitators in pedagogy applied to simulation and coming from each discipline. Participants were able to express the feelings they experienced during the simulation. The facilitators then explored the cause of the gap in performance between the actions observed and those wished for by the team.
This project transformed the teaching offered to the professionals in our institution. The acquisitions of increased knowledge on the subject of massive hemorrhaging, the application of the protocol as well as the teaching of teamwork were part of the objectives. This pilot project demonstrated an improvement in the application of a protocol and in the needed skills for the management of crisis situations within an interdisciplinary team.6
Simulation is an area of increasing interest for CPD. There is growing evidence regarding its potential benefits as a training tool. Nevertheless, the ill-informed adoption of this technology can result in the creation of inefficient programs and even generate insecurity. CPD trainers must define and understand the learning objectives of their target audience, as well as the time and budget constraints. Simulation must be integrated into hospital activities and implemented within a program to be effective and sustainable as a long-term investment.7
By Andrée Sansregret, MD, MA Ed, FRCSC
Andrée Sansregret, an obstetrician and gynecologist at the Sainte-Justine University Hospital Centre, is Assistant Clinical Professor, the Academic Co-Director of the CHU Sainte-Justine CSME and is responsible for training by simulation in obstetrics and gynecology at the Université de Montréal CAAHC. The author wishes to thank Dr Arielle Lévy, a pediatrician and Academic Co-Director of the CSME.
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REFERENCES
PAGE 11FOREWORD
1. Conseil québécois de développement professionnel continu des médecins. Développement professionnel continu. Available in French at cemcq.qc.ca. [Viewed on November 13, 2013].
2. Quebec. Code of ethics of physicians, RRQ 1981, c M-9, r 4. Quebec : Éditeur officiel du Québec, 2002.
3. Cruess RS, Cruess SR, Johnston SE. Renewing professionalism : an opportunity for medicine. Acad Med 1999;74:878-84.
4. Cruess SR, Cruess RS. Professionalism : a contract between medicine and society. CMAJ 2000;163:668-9.
5. Quebec. Professional Code, CQLR c. C-26, s. 94. Quebec : Éditeur officiel du Québec.
6. Conseil québécois de développement professionnel continu des médecins. Code d’éthique des intervenants en éducation médicale continue. Available in French at cemcq.qc.ca [Viewed on November 3, 2013].
7. Fédération des médecins spécialistes du Québec. Mission en regard de l’organisation de la formation médicale continue de la FMSQ : résolution CA-95-1804, art. 1.1. Montréal : FMSQ, 11 octobre 1995.
PAGE 18
CPD IN PSYCHOTHERAPY
1. Quebec. Regulation respecting the psychotherapist’s permit, CQLR c. C-26, r. 222.1. Quebec : Éditeur officiel du Québec. Available at publicationsduquebec.gouv.qc.ca.
2. Trudeau JB, Goulet F. L’exercice de la psychothérapie par le médecin. Le Collège 2012;52(3):27.
3. Collège des médecins du Québec. Modalités relatives à la formation continue en psychothérapie. Montréal : CMQ. Available in French at cmq.org.
4. Conseil québécois de développement professionnel continu des médecins. Organismes membres. Available in French at cemcq.qc.ca.
5. Available in French in the secure section of the CMQ website at cmq.org.
PAGE 23
THE CQDPCM… ACCOMPLISHMENTS IN CPD FOR YOU!
1. Conseil québécois de développement professionnel continu des médecins. Code d’éthique des intervenants en éducation médicale continue. Montréal : CQDPCM, 2003. Available in French at cemcq.qc.ca. [Viewed on October 23, 2013].
General references:
- Lo B, Ott C. What is the enemy in CME, conflicts of interest or bias? JAMA 2013;310(10):1019-20.
- Monette C. Developing an instrument to measure bias in CME. Résumé de l’étude. La Lettre du DPC 2008;17(2).
- Olson CA. Twenty predictions for the future of CPD : implications of the shift from the update model to improving clinical practice. Journal of Continuing Education in the Health Professions 2012;32(3):151-2.
PAGE 24
COPYRIGHT LAWS IN THE DIGITAL AGE
1. Canada. Copyright Act R.S.C., 1985, c. C-42. Available at laws-lois.justice.gc.ca/eng/acts/C-42/.
2. Industry Canada. What the Copyright Modernization Act Means for Teachers and Students. Available at ic.gc.ca.
3. Alberta (Education) v. Canadian Copyright Licensing Agency (Access Copyright), 2012 CSC 37. Available at scc.lexum.org.
4. The Council of Ministers of Education, Canada. Fair Dealing Guidelines. Available at cmec.ca.
PAGE 32
THE FUTURE OF CPD AT THE RCPSC
1. Davis D, O’Brien MA, Freemantle N, Wolf FM, Mazmanian P, Taylor-Vaisey A. Impact of formal continuing medical education : do conferences workshops and other traditional continuing education activities change physician behavior or health outcomes? JAMA 1999;282:867-74.
2. Embell M. Information at the point of care. Answering clinical questions. J Am Board Fam Pract 1999;12(3):225-35.
3. Barrie AR, Ward AM. Questioning behavior in general practice : a pragmatic study. BMJ 1997;315(7121):1512-5.
4. Campbell C, Parboosingh J, Gondocz T, Klein L. Use of a diary to record physician self-directed learning activities. JCEHP 1995;15:209-16.
5. Mansouri M, Lockyer J. A metaanalysis of continuing medical education effectiveness. JCEHP 2007;27(1):6-15.
6. Marinopoulos SS, Dorman T, Ratanawongsa N, Wilson LM, Ashar BH, Magaziner JL, et al. Effectiveness of continuing medical education. Evid Rep Technol Assess (Full Rep) 2007 Jan;(149):1-69.
7. Forsetlund L, Bjorndal A, Rashidian A, Jamtvedt G, O’Brien MA, Wolf FM, et al. Continuing education meetings and workshops : effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews 2009;(2). Art. No. DOI : 10.1002/14651858. CD003030.pub2.
8. McGlynn EA, Asch SM, Adams J, Keesey J, Hicks J, DeCristofaro A, Kerr EA. The quality of health care delivered to adults in the United States. NEJM 2003;348:2635-45.
9. Grol R, Baker R, Moss F. Quality improvement research : understanding the science of change in health care. Qual Saf Health Care 2002;11(2):110-1.
10. Davis DA, Mazmanian PE, Fordis M, Van Harrison R, Thorpe KE, Perrier L. Accuracy of physician self-assessment compared with observed measures of competence. A systematic review. JAMA 2006 ;296(9):1094-102.
11. Campbell C, Silver I, Sherbino J, Ten Cate O, Holmboe ES. Competency-based continuing professional development. Medical Teacher 2010 ;32:657-62.
12. Batalden P, Davidoff F. What is “quality improvement” and how can it transform health care? Qual Saf Health Care 2007;16(1):2-3.
13. General Medical Council (UK) Good medical practice. 2010. Available at gmc-uk.org [Viewed on November 15, 2013].
14. Royal College of Physicians and Surgeons of Canada. The CanMEDS framework. Available at royalcollege.ca. [Viewed on November 15, 2013].
15. Coppus SF, Emparanza JI, Hadley J, Kulier R, Weinbrenner S, Arvantis TN, et al. A clinically integrated curriculum in evidence-based medicine for just-in-time learning through on-the-job-training : the EU-EBM project. BMC Med Educ 2007 ;7:46.
16. Parboosingh J, Campbell C, Sliver I, Horsley T, Richardson D, Dath D, et al. Pursuing excellence in practice. A CanMEDS scholar program on lifelong learning. Ottawa : Royal College of Physicians and Surgeons of Canada, 2008.
17. Bower P, Campbell S, Bojke C, Sibbald B. Team structure, team climate and the quality of care in primary care : an observational study. Qual Safety Health Care 2003 ;12(4):273-9.
18. Moore DR, Green JS, Gallis HA. Achieving desired results and improved outcomes. Integrating planning and assessment throughout learning activities. JCEHP 2009;29(1):1-15.
19. Sargeant J, Mann KV, van der Vleuten CP, Metsemakers JF. Reflection : a link between receiving and using assessment feedback. Adv in Health Sci Edu August 2009;14(3):399-410.
Note: Complete hyperlinks are available on the Internet version of this magazine at fmsq.org
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APPLYING TO BECOME AN ACCREDITED CPD PROVIDER
1. Royal College of Physicians and Surgeons of Canada. CPD accreditation. Available at royalcollege.ca.
2. Royal College of Physicians and Surgeons of Canada. Learning Objectives. Available at royalcollege.ca.
3. Canadian Medical Association. Guidelines for physicians in interactions with industry. Ottawa : CMA, 2007. Available at cma.ca.
4. Conseil québécois de développement professionnel continu des médecins. Code d’éthique des intervenants en éducation médicale continue. Montréal : CQDPCM, 2003. Available in French at cemcq.qc.ca.
5. Kopelow M, Campbell G. The benefits of accrediting institutions and organizations as providers of continuing professional education. Journal of European CME 2013;2:10-4.
PAGE 38
WRITING CPD LEARNING OBJECTIVES
1. Conseil de l’éducation médicale continue du Québec. Vade-Mecum en éducation médicale continue. 2e éd. Montréal : CEMCQ, 1998.
2. Lasnier F. Réussir la formation par compétences. Montréal : Guérin, 2000.
3. Vincelette J. Des objectifs pour éclairer le sens d’une activité d’EMC : réponse au Dr Ajour. L’organisateur d’EMC 1995;8(4):4-6.
4. Guilbert JJ. Educational Handbook for Health Personnel – Revised Ed. Geneva, Switzerland : World Health Organization, 1981.
PAGE 44
SOCIAL NETWORKING AND CLINICIANS
1. Chretien K, Kind T. Social media and clinical care : ethical, professional and social implications. JAMA 2013 ;127(1):1413–21.
2. Jalali A, Wood T. Tweeting during conferences : educational or just another distraction? Medical Education 2013 ;47(11):1129–30.
3. Wikipedia (assorted searches). Available at wikipedia.org . [Viewed on October 18, 2013].
4. Symplur. The healthcare hashtag project. Available at symplur. com [Viewed on October 18, 2013].
5. KevinMD.com : social media’s leading physician voice. Available at kevinmd.com/blog [Viewed on October 18, 2013].
6. Canadian Medical Association. Social media and Canadian physicians - issues and rules of engagement. Available at cma.ca [Viewed on October 18, 2013].
PAGE 46
COMPUTER-BASED 3-D MODELS IN MEDICAL EDUCATION
1. Warrick PA, Funnell WRJ. A VRML-based anatomical visualization tool for medical education. IEEE Trans Inf Technol Biomed1998 ;2(2):55–61.
2. AudiLab. Fie: Fabrication d’imagerie extraordinaire. Available at audilab.bme.mcgill.ca.
3. A preliminary implementation is available at http://audilab.bme.mcgill.ca/~funnell/~davis3d/.
4. Nicholson DT, Chalk C, Funnell WRJ, Daniel SJ. Can virtual reality improve anatomy education? A randomised controlled study of a computer-generated three-dimensional anatomical ear model. Med Educ 2006;40(11):1081–7.
5. Nicholson DT, Chalk C, Funnell WRJ, Daniel SJ. The evidence for virtual reality. Med Educ 2008;42(2):224.
6. Sedaghat Y. Combined static-dynamic deformations with haptic rendering (M. Sc. thesis). Montreal : McGill University, 2011.
7. Delorme, S., Laroche, D., DiRaddo, R., & Del Maestro, R. F. (2012). NeuroTouch: A physics-based virtual simulator for cranial microneurosurgery training. Neurosurgery, 71, ons32–ons42
PAGE 47
REFLECTING AND ACTING ON HOW THE HEALTHCARE TEAM WORKS WITH PATIENTS
For more information, see:
- The May 20113 issue of the Bulletin du CPASS (cpass.umontreal.ca)
- The Twitter feed (twitter.com/patients_udm)
PAGE 48
TRAINING BASED ON SCRIPT CONCORDANCE
1. Hornos E, Pleguezuelos E, Brailovsky C, Harillo L, Dory V, Charlin B. The practicum script concordance test : an online continuing professional development format to foster reflection on clinical practice. J of Continuing Education in the Health Professions 2013 ;33(1):59-66.
PAGE 49
ACCREDITING GROUP LEARNING ACTIVITIES
- Conseil québécois de développement professionnel continu des médecins. La rédaction d’objectifs rendus facile. Available in French at cemcq.qc.ca. [Viewed on October 23, 2013].
- Conseil québécois de développement professionnel continu des médecins. Critères de qualité d’une activité de DPC. Available in French at cemcq.qc.ca. [Viewed on October 23, 2013].
- Royal College of Physicians and Surgeons of Canada. Royal College Accreditation Standards for Accredited CPD Provider Organizations. Available at royalcollege.ca. [Viewed on October 23, 2013].
PAGE 50
EVALUATING A CPD ACTIVITY
1. Conseil québécois de développement professionnel continu des médecins. Vade-Mecum en éducation médicale continue. Québec : CQDPCM, n.d.
2. Davis D, Barnes BE, Fox R. The continuing professional development of physicians. Atlanta : AMA press; 2003.
3. L’évaluation dans Les 4 cycles d’apprentissage. FMSQ : F-201 : La formation des formateurs. Atelier. Québec, mai 2013.
PAGE 51
SELF-APPROVAL OF EDUCATIONAL ACTIVITIES IN A HOSPITAL SETTING
1. Goulet F. Pourquoi un plan d’autogestion du développement professionnel continu des médecins? Le Collège 2007;XLVII(1):8-9.
- Royal College of Physicians and Surgeons of Canada. Self-approval activities. Available at royalcollege.ca.
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CPD FOR NURSES
1. Ouellet J, Maillé M, Durand S, Thibault C. Vers une culture de formation continue pour la profession infirmière au Québec - document d’orientation. Montréal : Ordre des infirmières et infirmiers du Québec, 2011.
2. Ibid. p.8.
3. Collège de médecins du Québec. Code de déontologie des médecins. Québec : CMQ, 2010.
4. Ouellet J, Maillé M, Durand S, Thibault C. Vers une culture de formation continue pour la profession infirmière au Québec - norme professionnelle. Québec : Ordre des infirmières et infirmiers du Québec, 2011.
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SIMULATION IN CPD, AN ADDED VALUE
1. Motola I, Devine LA, Chung HS, Sullivan JE, Issenberg SB. Simulation in healthcare education : a best evidence practical guide. AMEE guide no. 82. Medical teacher 2013 ;35(10):e1511-30.
2. Kohn LT, Corrigan JM, Donaldson MS. To err is human. Washington, DC : National Academy Press, 1999.
3. Gaba DM. The future vision of simulation in health care. Quality & safety in health care. 2004;13(Suppl 1):i2-10.
4. Curtis MT, DiazGranados D, Feldman M. Judicious use of simulation technology in continuing medical education. The Journal of continuing education in the health professions 2012;32(4):255-60.
5. Gaba DM. Crisis resource management and teamwork training in anaesthesia. Br J Anaesth 2010;105(1):3-6.
6. Lévy A, Pettersen G, Gauvin F, Sansregret A. Projet pilote. Évaluation de l’application d’un protocole d’hémorragie massive via la simulation en équipes interdisciplinaires. Oral accepté au SimSummit Vancouver 2013.
7. Boet S, et al. Complex procedural skills are retained for a minimum of 1 yr after a single high-fidelity simulation training session. Br J Anaesth 2011;107(4):533-9.
8. Haller G, et al. Effect of crew resource management training in a multidisciplinary obstetrical setting. Int J Qual Health Care 2008;20(4):254-63.
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