Enhancing General Practitioners Participation in a Virtual Community - - PDF document

Enhancing General Practitioners Participation in a Virtual Community of Practice for Continuing Medical Education: an Exploratory Study

Abdulaziz MURADa,1, Reeva LEDERMAN a, Rachelle BOSUA a, Shanton CHANG a and John D. WARKb,c

a School of Computing and Information Systems, The University of Melbourne b Department of Medicine (Royal Melbourne Hospital), The University of Melbourne c Head, Bone & Mineral Medicine, The Royal Melbourne Hospital

• Abstract. As sources of medical information grow online, Virtual Communities of

Practice (VCoPs) have evolved into a potential tool that allows General Practitioners (GPs) to interact through the sharing of their experience and

• knowledge. However, literature reports that GPs are reluctant to participate in

VCoPs especially for their continuing medical education (CME). Currently, no study has explored the design and structural aspects of VCoPs that may lead to enhancing GPs’ participation in such online communities. Hence, this paper explores how GPs envisage the use of a VCoP for their CME and how to enhance their participation by conducting an exploratory qualitative study of two focus groups with 10 GPs in each group, accompanied by a specialist and a nurse. Our empirical findings identified two key contributions: i) seven themes that need to be incorporated in the VCoP to enable and support GP’s CME through the use of a VCoP; ii) three recommendations to take into consideration for researchers when evaluating VCoPs for CME.

• Keywords. Virtual Communities of Practice, General Practitioners, Continuing

Medical Education, Design Considerations

Introduction General practice is fundamental for an efficient and effective health system as general practitioners (GPs) are in many communities the primary source of care to individuals and families [1]. Hence, GPs are required to continuously advance their medical education to keep expanding medical knowledge and improve their clinical practice [2]. However, due to the unique nature of their work, GPs face a range of barriers in terms

• f the learning processes associated with continuing medical education (CME) [3] as

they are under constant time pressures due to their work structure and environment, with both factors often cited as an impediment to face-to-face professional development [4]. GPs have recognized online sources as potential support structures for CME if fulfilled within the context of a group of professionals [3]. Any group of GPs can

1 Corresponding Author: Abdulaziz Murad; E-mail: amurad@student.unimelb.edu.au.

become a Virtual Community of Practice (VCoP) to share knowledge and learn more from each other about specific practices [5]. However, GPs have shown an unwillingness to use VCoPs for their CME [3] and even when used, VCoPs suffer high rates of attrition, making them unsustainable for long periods of time [5]. In our previous work [6] we have identified from the literature, a set of four design and one human role consideration to be taken into account when designing a health practitioner VCoP that is focused on sustained learning and knowledge sharing. The four design considerations are subdivided into individual and group design considerations due to the nature of designing a VCoP i.e.: Rich Profile Information (Individual), Platform Navigation (Individual), a Diverse Community (Group), and a Rich Contextual Content (Group). Hence, we postulate that: enhancing GPs’ participation in a VCoP for CME needs to take into account these two individual and two group design considerations and the moderation of human roles to sustain the learning and knowledge-sharing process [6]. By sustained learning we mean keeping participants of a VCoP engaged to contribute to discussions in order to enhance practitioners’ participation [7]. The aims of this paper are two-fold: i) to explore preferred modes and models of VCoP use by GPs for CME and ii) to examine how GPs’ participation in a VCoP can be enhanced to support their CME. Our goal is to test our proposed design considerations which can be incorporated into the design of a VCoP for GPs’ CME to mitigate the previously mentioned barriers and motivate GPs to sustaining participation in VCoPs for CME.

• 1. Method

We adopted a qualitative research methodology [8] to test our four design and human role considerations with real users of enhancing GPs participation in using a VCoP for their CME. After obtaining Human Research Ethics approval, we organised and gathered data from two focus groups of 10 GPs each with the presence of a bone health specialist and a nurse in each focus group. The bone health specialist and nurse were included to understand what issues may arise when developing a CME VCoP for GPs and recognising if there is a need to include other health practitioners in the VCoP for enhancing the GPs’ CME experience. Each focus group lasted 30 minutes with the researcher asking eight open ended questions to assess each of the four design and human role consideration identified in our initial study [6]. Questions involved: i) asking GPs about their use of the internet for medical education; ii) if GPs were/are involved in online communities for learning; iii) incentives and opportunities to join an online community; iv) finally, any suggestions

• n what is needed to keep GPs interested for continuous involvement in a VCoP for
• CME. Following data collection, we employed a thematic content analysis approach to

identify recurring themes that offer rich and compelling insights in understanding and explaining the value of our five design elements for CME in a VCoP [9]. All audio recorded data were transcribed, integrated with our notes and validated by a GP chair and the bone health specialist involved in the two focus groups. Furthermore, a questionnaire with the same questions that were discussed in both focus groups sessions was also sent out to GPs (e.g. n=20) from the same focus groups to answer in their own free time in the event they felt reluctant in answering in the group session. Four written questionnaires were received from participants across the two groups.

• 2. Findings

Seven themes were derived from the responses to the focus group interview and the questionnaires submitted by participants, highlighting the issues of most concern to GPs in using a VCoP for CME. 2.1. Perception of Low Trust and Risk Taking A perceived risk was acknowledged when receiving knowledge from peers online where said knowledge would be an issue to GP’s diagnosing a particular case due to not fully trusting the information source. As a consequence, GPs indicated their preference was to transfer the responsibility of diagnosis to an expert in the field to lower their own responsibility of making a final diagnosis. Furthermore, a suggestion

• f verifying qualifications of participating GPs would help in building trust from

receiving knowledge from peers online: “One of the biggest problem … is that people [GPs] worry about all sorts of things as if they put their case and get some advice on from an internet based versions [online sources], Somehow I don’t know why that [online advice] is more risky than if you refer to… an expert because of full responsibility…The [online VCoP] participants need to be health professionals and there need to be [methods of] verification of [their] qualifications.” - GP2 2.2. Permission to Share Patient Information GPs felt reluctant when wanting to share patient information online with other GPs because they need patient’s permission to do so due to privacy concerns and taking full responsibility in conveying any diagnostic information: “It takes full responsibility [to share patient information] we don’t have the permission of the patients of course, I’m just a bit phased down about this” - GP3 2.3. The Need for Timed Responses A GP mentioned that there needs to be timely responses to clinically-relevant discussions to sustain participation in using a VCoP for CME: “The topics and discussion need to be timely so if clinical problems are raised the professional seeking advice can use it for his/her practice within maybe a few days.” - GP2 2.4. Searching Relevant Websites for Information GPs mentioned that there should be a Website that highlights content from other Websites for their learning of specific medical knowledge: “google information, going to what I believe to be reliable Websites eg better health, dermnet, CDC, subscription sites e.g. therapeutic guidelines, access hospital websites, access patient information for handouts, information form RACGP, Medical indemnity…” – GP2 “There has to be a website [one Website portal] that tells us what’s happening [content] on other websites.” - GP7

2.5. Difference in Individual Learning Styles GPs mentioned that their learning is usually enhanced through face-to-face discussions with other GPs or via emails. However, the specialist mentioned that their learning was enhanced through evidence-based case study discussions: “Most people learn by discussion” - GP1 (Male) “We have 1400 registrars and would like to ask for their advice; all of them have good work.” – GP3 “Email colleagues for professional communication, sharing articles etc.” – GP2 “I learned most of my medicine from cases” - Specialist A GP used a Website focused on practice and not necessarily clinical outcomes. The Website helped him/her attain (extend) his/her knowledge about quality improvement of medical practice. In this regard s/he found regular Webinars useful: “…it might be worth [to], look at [Website…run by the Provider] that has 100 odd

• GPs. They gather data every month, and have regular webinars about a whole variety
• f quality improvement activities which has been going on for five years, but not so

much about clinical outcomes more about quality improvement of the practice.” - GP6 2.6. Lack of Communication between GPs and Specialists Communication between specialists and GPs is currently an issue: “The interaction with hospital specialists…one of the problems comes back to that ancient issue of communication……and not knowing……so in that situation you tend to take a very conservative stance if I don’t know anything you do I assume you do nothing which is not true but it’s sort of a protective reflex.” - Specialist This sparked the nurse involved to share her experience as well: “There is a specialist in a study that I did said ‘I have been sending letters to GPs, every time I see a patient, in the 6, 7, 10 years that I’ve been a specialist in cancer I have never received a letter back.’ … they hear nothing back from general practice so we don’t know what’s happening.” – Nurse 2.7. The Need for Diversity and Interactivity in an Online Learning Environment A GP mentioned that the addition of specialists in a VCoP was an important incentive to join an online social network. In addition, different generations of GPs would also complement diversity and interactivity in a VCoP to share learning experiences between senior GPs and GP trainees: “It would be great to also add something in about the communication between specialists and GPs and be involved in the discussion - GP 10 “That [diversity in the VCoP] is really good as well ... cause the different generations and different people here are more experienced and are prepared to take it

• n themselves…if it’s too hard this sums[summary of experienced knowledge] it all the

way.” – GP4

• 3. Discussion

This paper presents our preliminary findings in exploring design considerations GPs’ require in using a VCoP for CME. In addition, our study identifies seven necessary themes for consideration when designing VCoPs to sustain GPs participation throughout the cycle for their CME: perception of low trust and risk taking; permission to share patient information; the need for timed responses; searching relevant websites for information; differences in individual learning styles, lack of communication between GPs and specialists; and the need for diversity and interactivity in an online learning environment. There are limited studies that have investigated GP participation in a VCoP for CME [4][7], where only one current study [10] looked at GP trainees using a VCoP to help them in their professional isolation and knowledge sharing. Furthermore, this exploratory study is unique as it's the only study known at this time that involved a group of senior GPs to gather data about their perceived VCoP use for

• CME. Considering the seven themes identified, there are three key recommendations

that need to be considered for designing and sustaining a VCoP for GPs’ CME and can be used for researchers in evaluating their current and future VCoPs. 3.1. Increasing Trust and Methods for Sharing Patient Information GPs agreed when using VCoPs, there was an issue with trusting online participants in receiving any knowledge unless participants provided qualifications that could justify their outlook/experience on a certain topic lowering their perceived risk of VCoPs. Furthermore, the notion of low trust can be mitigated if GPs and facilitators first meet face-to-face pre-implementation of the VCoP to build and increase trust for the CME process [11]. Another issue is the online sharing of patient information and GPs reluctance to do so due to the potential risk of others recognising the identity of a patient based on his/her special diagnosis. This notion can be mitigated by: i) anonymising patient information and ensuring that facilitators act as gatekeepers to preserve the privacy of patient information, such as providing a template to enter patient information prior to submitting this information to the VCoP; ii) relying on GPs to trust one another on not conveying any recognisable information outside the VCoP which needs to be continuously advocated by facilitators and participants. 3.2. Assisting in Time Management GPs lack of time to be engaged in online learning and knowledge sharing had always been a recurring issue [4][7][10]. GPs expressed a need for rapid and timely feedback by VCoP facilitators when seeking advice on topics and when discussing relevant clinical practice problems they face on a daily base. Furthermore, GPs mentioned that there is a need for a single Website portal that consolidates and provides an entry to

• ther Websites which also summarises the value of and content provided by other

useful websites for CME, thus, incentivising GPs in saving time in searching for information.

3.3. Effortless Communication between Participants GPs learn more from discussions with each other either face-to-face or through the exchange of emails. This can be an incentive in VCoPs where a gathering of GPs can be an opportunity to exchange experiences easily in diagnosis, treatment, etc., due to GPs having no hierarchical boundaries unlike for example nurses [12]. Grouping specialists and GPs in the same VCoP environment helps in bridging the communication disparity between the two groups of health practitioners as it is an

• pportunity to build a network of connections and assist GPs in benchmarking their
• wn knowledge [10]. Furthermore, senior GPs showed some interest in having

specialists and other GPs (i.e. GP trainees and more senior experienced GPs) as part of the online community to enrich their CME experience. A limitation of this paper was that the two focus groups were conducted only with senior GPs that meet quarterly in Melbourne, Australia. Furthermore, both focus groups

• f GPs had a keen interest in exploring new online learning activities and opportunities

as a few mentioned their involvement in the “GPS Down Under” group on Facebook, some drew on Webinars for their learning, while others accessed the RACGP Website for information. However, one of the key outcomes of this study was a need to have a consolidation of these types of mechanisms to foster GPs CME.

• 4. Conclusion and Future Work

VCoPs have much potential in assisting GPs in their CME. However, no current study has yet explored how GPs wish to use a VCoP for CME. In particular, no study specifically explored the design consideration that could enhance and sustain participation in, learning and knowledge sharing in a VCoP for CME. Hence, our findings identified seven themes that GPs need in supporting their use of VCoP, which is an important contribution for VCoP designers. In addition, we proposed three recommendations that can be used to evaluate researchers current VCoPs for CME. Researchers have the opportunity to adopt VCoPs for GPs’ CME because of the learning and knowledge sharing potential that warrants attention in transforming VCoPs into a successful resource for GPs’ CME. The seven themes identified will be incorporated in our future VCoP prototype to enhance and sustain GPs participation for CME as one out of five evaluation methods which will be reported in future studies. References

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