Fostering Scholarship in CPD: Building a Scholarly and Outcomes - - PowerPoint PPT Presentation

Dave Davis, MD and Mary Turco, EdD AMEE MedEdWorld Webinar Thursday 5 October 2017

Fostering Scholarship in CPD:

Building a Scholarly and Outcomes Oriented Interest in Continuing Professional Development in the Health Professions

Introductions

Dave Davis MD, FCFP, FSACME Professor and Senior Director, Medical Education, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates Mary Turco, EdD, FSACME Assistant Professor, Education Outcomes Researcher and Consultant, Dartmouth-Hitchcock and Geisel School of Medicine at Dartmouth, Lebanon, NH, USA

Disclosure

We have no financial disclosures. We will mention the resources of the Society for Academic Continuing Medical Education (SACME), of which we are both

• members. We personally derive

no personal financial gain from these publications.

Agenda

• Challenge, Goal and Objectives
• Reflection: What’s your interest in scholarship?
• Scholarship Definitions
• Your Examples of Scholarship
• Stimulating Faculty Interest and Expertise
• Barriers to Scholarship and Solutions to overcome them
• Two Cases
• Resources
• Take Home Points/Future Directions
• Questions, ideas, discussion
• References

Challenge, Goal and Objectives

Challenge: While CPD (CME) is critical to understanding and effecting best

• utcomes in healthcare, relatively few faculty members embrace the research

and practical potential that it holds for improving medical education. Goal: Build a Scholarly and Outcomes Oriented Interest in Continuing Professional Development in the Health Professions Objectives: After participating in this activity, you should be able to describe and discuss:

• 1. Scholarship definitions and criteria
• 2. Reasons to stimulate faculty interest and expertise in the study,

impact and improvement in CPD at local and national levels

• 3. Case Studies on barriers and opportunities
• 4. Resources

Reflection: What’s your interest in scholarship?

Objectives

After participating in this activity, you should be able to describe and discuss:

• 1. Scholarship definitions and criteria
• 2. Reasons to stimulate faculty interest and expertise in the

study, impact and improvement in CPD scholarship at local and national levels

• 3. Case Studies on barriers and solutions
• 4. Resources

Ernest Boyer’s Scholarship Categories

1990 Discovery/Research Integration/Synthesis Application/Practice Teaching “Need … a more inclusive view of what it means to be a scholar—a recognition that knowledge is acquired through research, through synthesis, through practice, and through teaching.” 1995 Engagement “New realities with the application of new knowledge to real problems: engagement”

McNabb, J., Pawlyshyn, N. Northeastern University Online. 2014. Defining-Scholarship-with-Boyers-Four-Areas-of-Scholarship-Explored-and-the-New-Digital- Scholarship-A-Faculty-Conversation.pdf

Scholarship of Discovery/Research

Definitions

• Search for new knowledge
• Discovery of new information, models

“..the commitment to knowledge for its

• wn sake, to freedom of inquiry”

Examples

• Research projects (internally or externally funded)
• Working papers
• Peer-reviewed journal articles
• Book chapters and/or books
• Creative activity: Compositions, presentations,

performances, exhibits and projects.

Scholarship of Integration

Definitions

• Integrating knowledge from different

sources

• Presenting overview of findings
• Discovering convergence from different

disciplines

• Identifying trends

“Bringing insight to bear on original research” with “interpretive, integrative, interdisciplinary approaches.”

Examples

• Professional development workshops
• Literature reviews
• Presentations of research at conferences
• Non-academic publications that address

discipline-related concerns

• Meta-analysis - contrasting or combining

results from different studies

Scholarship of Application

Definitions

• Discovering ways to use new knowledge

and/or theory to solve real world problems “New intellectual problems can arise out of the very act of application.” “Higher education must serve the interests of the larger community”…

Examples

• Faculty consulting activities in field or industry

related to intellectual work

• Faculty support or development of community

activities in field or industry linked with academic discipline

• Faculty development and/or oversight of

practical/partnerships on behalf of University that connect students with field/industry

• Faculty development of centers for study or service

Scholarship of Teaching

Definitions

• Searching for best practices and innovations to

disseminate knowledge and develop skills, attitudes and behaviors.

• Informal or formal: teaching, advising,

mentoring. “Faculty, as scholars, are also learners.” “Teaching is the highest form of understanding.” - Aristotle

Examples

• Development of new or substantially revised

courses, curricula

• Innovative teaching materials/strategies
• Publication of textbooks or teaching materials.
• Educational research projects resulting in

findings disseminated at professional conferences and/or in peer-reviewed publications

• Projects funded by external or internal grants

to support instructional activities

• Production of Instruction Videos
• Technical, procedural or practical innovations

made clinically or professionally

Scholarship of Engagement

Definition

“The scholarship of engagement means connecting the rich resources

• f the university to our most pressing

social, civic, and ethical problems, to

• ur children, to our schools, to our

teachers, to our cities.”

Ernest Boyer’s (Carnegie Foundation) address to the American Academy of Arts and Sciences (1995): https://www.jstor.org/stable/3824459?seq=16#page_scan_ta b_contents Boyer, Ernest L. The Scholarship of Engagement. Bulletin of the American Academy of Arts and Sciences. American Academy of Arts & Sciences. Vol. 49, No. 7 (Apr.,1996), pp. 18-33 URL: http://www.jstor.org/stable/3824459 Accessed: 28-09- 2017 13:50 UTC

Beyond Boyer’s Categories: Digital Scholarship

Definition

• The use of digital evidence, methods of

inquiry, research, publication and preservation to achieve scholarly and research goals.

• An open model for scholarly

communication.

Rumsey, A. “New-model scholarly communication: Road map for change.” Scholarly Communication Institute 9. July

• 2011. University of Virginia Library.

Examples

• Blogs/commentaries as communication in

virtual spaces

• Open Education Resources
• Data visualization and manipulation
• Metadata generation
• Digital publishing

Your Examples of Scholarship?

After reviewing this list, let us know, some specific examples

• f scholarship in Continuing

Professional Development happening in your

• rganization?

Are they: Discovery/Research Integration/Synthesis Application/Practice Teaching Engagement Digital

Objectives

After participating in this activity, you should be able to describe and discuss:

• 1. Scholarship definitions for CME/CPD
• 2. Reasons to stimulate faculty interest and expertise in the

study, impact and improvement in CPD scholarship at local and national levels

• 3. Case Studies on barriers and solutions
• 4. Resources

Why stimulate faculty interest and expertise?

To help them think, act, teach, learn, and act differently.

A Tale of Two Centuries

http://www.theartstory.org/artist-orozco-jose- clemente-artworks.htm

Julio Frenk, MD, MPH, PhD Jose Clemente Orozco

https://www.google.com/search?q=julio+frenk+md+photo&tbm=isch&tbo=u&source=univ&s a=X&ved=0ahUKEwjDv5- egMPWAhVS3mMKHU9UCwcQ7AkIRA&biw=1586&bih=689#imgrc=61tjGAQ- 3FBRLM:&spf=1506434089860

Flexner, Welch-Rose and Goldmark

http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(10)61854-5.pdf, page 1925

Goldmark, J. The Committee for the Study of Nursing Education. Nursing and nursing education in the United States. New York: The Rockefeller Foundation, 1923. 16 Flexner A. Medical education in the United States and Canada: a report to the Carnegie Foundation for the Advancement of Teaching. New York: The Carnegie Foundation for the Advancement of Teaching, 1910.

Welch WH, Rose W. Institute of Hygiene: a report to the General Education Board of Rockefeller Foundation. New York: The Rockefeller Foundation, 1915.

Jose Clemente Orozco: Gods of the Modern World, 1932-1934

Gods of the Modern World, Orozco

Ladd, V. “A Closer Look” (pamphlet) Hood Museum of Art, Hanover, Dartmouth College. 2013. http://hoodmuseum.dartmouth.edu/publications/closer-look-gods- modern-world-epic-american-civilization-jose-clemente-orozco

Scholarship

Add Orozco image

Faculty

Add Orozco image

Knowledge

Dissemination

Delivery of New Knowledge

Julio Frenk and International Medical Education Thought Leaders: 2010 Lancet Article

Key Points

New “infections, environmental, and behavioral risks” that “threaten [the] health security of all.”

Many of the world’s 8B people are “trapped in the in health conditions of a century earlier.”

Systemic reasons exist why the education of health professionals has not kept pace with the world’s health challenges:

• 1. Mismatch of competencies to patient and

population needs

• 2. Persistent gender stratification of professional

status

• 3. Predominant hospital orientation at the expense
• f primary care
• 4. Weak leadership to improve health system

performance

http://www.thelancet.com/pdfs/journals/lancet/PIIS0140- 6736(10)61854-5.pdf

Julio Frenk and International Medical Education Thought Leaders: 2010 Lancet Article

Key Points

Called for a redesign of health professions education across the continuum, including CME/CPD, is required to match the work of Flexner (Medicine), Welch-Rose (Public Health), and Goldmark (Nursing) in the early 20th Century Demanded a “new century of transformative professional education” to create a more “equitable better performing health system…with consequent benefits for patients and populations everywhere in our interdependent world.”

Frenk J, Chen L, Bhutta ZA, et al. Health professionals for a new century: Transforming education to strengthen health systems in an interdependent world. Lancet. 2010; 376(9756):1923-1958. Flexner A, Pritchet H, Henry S. Medical education in the united states and canada bulletin number four (the flexner report). New York (NY): The Carnegie Foundation for the Advancement of Teaching. 1910. Welch WH, Rose W. Institute of hygiene: A report to the general education board of rockefeller foundation. New York: The Rockefeller Foundation. 1915. Goldmark, J. Committee for the Study of Nursing Education, Nursing and nursing education in the united states: Report of the committee for the study of nursing. New York: The Rockefeller Foundation, 1923. 16

http://www.thelancet.com/pdfs/journals/lancet/PIIS0140- 6736(10)61854-5.pdf

Objectives

After participating in this activity, you should be able to describe and discuss:

• 1. Scholarship definitions for CME/CPD
• 2. Reasons to stimulate faculty interest and expertise in the

study, impact and improvement in CPD scholarship at local and national levels

• 3. Case Studies on barriers and solutions
• 4. Resources

Two Cases: Barriers & Solutions

• Dr Chavez is a 32 year old

nephrologist interested in preventing end-stage renal

• disease. He has coordinated

several courses over the past 5 years in ESRD, but shows no interest in carrying his interests to generate research or approach scholarship in this area.

• Is he a lost cause?
• The CPD team at your institution

is very efficient, generates many courses, is interested in new techniques such as social media. You’ve tried to get them interested in a journal club (with pizza, last week) but many are not interested.

• What can you think of to

stimulate their interest?

We’re busy enough!! Barriers and (some) solutions

We’re busy enough!

Barriers and enablers in CPD scholarship

The Barriers

NO TIME!!

I have no research training in this area

But…my field is cardiovascular disease prevention, oral surgery, left big toe disease! There’s educational research??? Who knew??

Eight steps to change

Kotter’s change management tips

Seven steps to developing a scholarly approach to CPD

• 1. Personalize the argument to your audience: what’s in it for them?

Why undertake scholarship?

• 2. Disseminate the argument to a larger audience
• 3. Create a burning platform, a sense of urgency
• 4. Plan/strategize for scholarship
• 5. Think of success metrics
• 6. Create/mobilize resources
• 7. Go for an easy win

Think Differently?

Think Differently

Adopt a new perspective WHAT’s OUT: Objectivist Myth of Knowing: one expert imparts knowledge to amateurs who have little or no knowledge (Palmer) WHAT’s IN: The Community of Truth: a community of knowers and learners co-produce learning and knowledge (Palmer) Collaboration across disciplines, professions and the continuum of learning Collective Competence of individual in teams Patients as partners in the co-production

• f knowledge and care. (Batalden)

Mateo Romero, Praying for Rain

https://www.google.com/search?biw=1920&bih=1047&tbm=isch&sa=1&q=Mateo+Romero+art&oq=Mateo+Romero+art&gs_l=psy- ab.12..0.35286.42650.0.44625.16.16.0.0.0.0.148.2217.0j16.16.0.dummy_maps_web_fallback...0...1.1.64.psy- ab..0.16.2207...0i67k1j0i24k1j0i30k1.0.qCtEfNJZbQU#imgrc=8nBzI4gxp9SvtM:&spf=1506620234221 Palmer, P. The Courage to Teach: Exploring the inner landscape of a teacher’s life) Batalden, P. Foreword in Continuing Professional Development in Medicine and Healthcare: Better Education, Better Patient Outcomes. Rayburn, WF, Turco, MT, Davis DA. Eds. Philadelphia: Wolters Kluwer

• Lippincott. 2018: xiv.

Teach and

Learn

Differently?

Teach and Learn Differently

Teaching

Time re-conceptualized Interdisciplinary, inter- professional students Theory- and evidence-based Psychologically safe Technology enhanced

Learning

Co-Learning: faculty/teachers and students/residents together In-practice in workplace not in classrooms.

https://www.google.com/search?q=famous+african+art+paintings&tbm=isch&tbs=rimg:Cdr0MXZtb8N2IjhXPoMBqgZvA yfprWiLYOkq14IE2YYddZenf9SqwYK4H8uXDNFs31f3UrU9XxU7mENjSt5KsOBRkCoSCVc-gwGqBm8DEUZdVzrKg_1-nKhIJJ- mtaItg6SoRPt4dhLb5uEAqEgnXggTZhh11lxG1ytpL- P7y8CoSCad_11KrBgrgfEY3zDQVraRvWKhIJy5cM0WzfV_1cRGD5FwicRuS4qEglStT1fFTuYQxHlFwl- vV57TioSCWNK3kqw4FGQEaYbElstLHdy&tbo=u&sa=X&ved=0ahUKEwi24bO0vMjWAhWThRoKHdLzDWEQ9C8IHA&biw=1 920&bih=1047&dpr=1#imgrc=Vz6DAaoGbwMQOM:&spf=1506622033265

Act Differently?

Act Differently

Proceed with caution but make progress in spite of known and unknown threats

Sweat the Big Stuff… Create a moral imperative that involves patient outcomes Change the Culture: deconstruct strict hierarchies related to gender, race and economic status Improve the Leadership: of self, team, organization and system; teach leadership across the health professions education continuum and professions…in IP teams

https://www.google.com/imgres?imgurl=https://upload.wikimedia.org/wikipedia/en/7/74/PicassoGuernica.jpg&imgrefurl=https://en.wikipedia.org/ wiki/Guernica_(Picasso)&h=283&w=631&tbnid=HMnm9cztiGO_sM:&tbnh=89&tbnw=200&usg=__4Ayj_psQMXhmCl0q1y5ZBB5eK3k=&vet=10ahU KEwjG_Z2OrcjWAhWIq1QKHcJLAsAQ_B0IowEwFQ..i&docid=Myq7sRx9EgmH7M&itg=1&sa=X&ved=0ahUKEwjG_Z2OrcjWAhWIq1QKHcJLAsAQ_B0I

• wEwFQ&ei=PSrNWYbrGIjX0gLCl4mADA

Guernica, Picasso

Act Differently

Sweat the Small Stuff…

Move beyond basic evaluation to assessment Incent all Scholarship: teaching, research, integration, dissemination, engagement, digital/electronic Invest in education outcomes researchers and their research Disseminate all learnings

Act Differently

Take care of yourself?

Support Professional Identity Formation: Reflection and clarification of professional identity essential over lifetime of practice Promote Self-Care: critical to promote wellness and joy and to avoid dyscompetence Encourage Life Long Learning

Solutions: Davis and Rayburn

Four Pillars

Health system and CPD enterprise must acknowledge the importance of each other and work together conscientiously Profound re-imagination of what it means to be a faculty member Re-engineer (or abandon) current tools of CME/CPD External pressures – CME Clinical Learning Environment Reviews?

Davis, DA, Rayburn, WF Introduction: Integrating Continuing Professional Development into with Health System Change in Continuing Professional Development in Medicine and Health Care: Better Education, Better Patient Outcomes. Rayburn, WF, Turco, MG, and Davis DA. (Eds.) Philadelphia, PA, Wolters Kluwer. 2018: xxv-xxx

Solutions: Wiljer Practical Considerations

• Build scholarship pathways
• Identify system problems
• Establish appropriate partnerships
• Co-create solutions
• Identify Scholarship Opportunities
• Framing the question
• Understanding the needs
• Contextualizing the work
• Building frameworks
• Evaluation vs Research
• Creating a moral imperative
• Moving beyond basic evaluation
• Disseminate all learnings

Mode-Gakuen Spiral Towers: Nagoya, Japan

Wiljer, D. Muses of Scholarship in CPD. (presentation) SACME 40th Annual Meeting. Scottsdale, AZ. 2017. 05.17.2017. https://www.google.com/search?biw=1920&bih=1047&tbm=isch&sa=1&q=great+architecture+photo+japan&oq=great+architecture+photo+japan&gs_l=psy- ab.12...85097.86334.0.88339.6.6.0.0.0.0.124.550.0j5.5.0.dummy_maps_web_fallback...0...1.1.64.psy- ab..1.0.0....0.qjHH9s6jNPo#imgrc=JPuK6XmDHgjImM:&spf=1506626244706

Olson: Nurture Scholarly CPD Practitioners

Scholarly practitioner Someone who mediates between professional practice and the universe of scholarly, scientific, and academic knowledge and discourse. Someone who sees practice as part of the larger enterprise of knowledge generation and critical reflection To the extent that this practical knowledge can be more systematically produced, captured, and disseminated (i.e., made more scholarly) practitioners can accelerate the value that CME/CPD can contribute to health care. Mediate – “two-way street”: drawing from and contributing to the “knowing” base of CME/CPD.

Olson CA. On the Need for Scholarly Practitioners in CPD. JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, 31(3):137–139, 2011.

Objectives

After participating in this activity, you should be able to describe and discuss:

• 1. Scholarship definitions for CME/CPD
• 2. Reasons to stimulate faculty interest and expertise in the

study, impact and improvement in CPD scholarship at local and national levels

• 3. Case Studies on barriers and solutions
• 4. Resources

46

Resources

Addresses how to provide better education to produce better clinical practice and improved health care outcomes

EDITORS William Rayburn MD, MBA David A. Davis, MD Mary G. Turco, EdD

Resources

Research Chapter Appendix with Research Resources

Williams, BW, Welindt D, Olson, CA, Educational Research: Relevant Data bases, Web Sites, Organizations, Funding Sources, Certificate Programs, Books and Articles (Appendix C) in Continuing Professional Development in Medicine and Health Care: Better Education, Better Patient Outcomes. Rayburn, WF , Turco, MG, and Davis DA. (Eds.) Philadelphia, PA, Wolters Kluwer. 2018: 413-432. Olson, CA, Williams, BW. Principles of Effective Research in Continuing Professional Development in the Health Professions in Continuing Professional Development in Medicine and Health Care: Better Education, Better Patient

• Outcomes. Rayburn, WF

, Turco, MG, and Davis DA. (Eds.) Philadelphia, PA, Wolters Kluwer. 2018: 363-384.

THE JOURNAL of CONTINUING EDUCATION in the HEALTH PROFESSIONS (JCEHP)

Resources

Take Home Points

• It’s time to help faculty

build a scholarly and

• utcomes oriented interest

in CPD scholarship/research

• Enable all forms of

scholarship: Discovery, Integration, Application, Teaching, Engagement and Digital

• Articulate reasons and

imperatives

• Stimulate faculty to engage

in a profound re- imagination of what it means to be a faculty member - to think, teach, learn, and act differently

• Address barriers and

provide solutions with awareness of pillars and practical considerations

• Enable practitioners too
• Provide resources

Future Directions: Better Education, Better Patient Outcomes

Mateo Romero, The Next Evolution

https://www.google.com/search?q=mateo+romero+artist+artwork&tbm=isch&tbo=u&source= univ&sa=X&ved=0ahUKEwiG_pGZ4MjWAhUBwmMKHTLBD1oQ7AkIQA&biw=1920&bih=1047#i mgrc=xtG9CAkiuLfLTM:&spf=1506631634669

Questions, Ideas and Discussion

Appreciation

• Don Moore, PhD
• Vivian Ladd
• Curtis Olson, PhD
• David Wiljer, PhD
• Betsy Williams, PhD
• Dillon Welindt
• Joseph McNabb, PhD
• Nancy Pawlyshyn, PhD

Contact Information

Dave Davis drdavedavis@gmail.com dave.davis@mbru.ac.ae Mary Turco Mary.G.Turco@hitchcock.org Mary.G.Turco@dartmouth.edu

• Batalden, P. Foreword in Continuing Professional Development in Medicine and Healthcare: Better Education, Better Patient Outcomes. Rayburn, WF, Turco, MT,

Davis DA. Eds. Philadelphia: Wolters Kluwer Lippincott. 2018: xiv.

• Boyer, E. (Carnegie Foundation) address to the American Academy of Arts and Sciences (1995):

https://www.jstor.org/stable/3824459?seq=16#page_scan_tab_contents

• Boyer, E. The Scholarship of Engagement. Bulletin of the American Academy of Arts and Sciences, American Academy of Arts & Sciences. Vol. 49, No. 7

(Apr.,1996), pp. 18-33: http://www.jstor.org/stable/3824459. Accessed: 28-09-2017 13:50 UTC

• Davis, DA, Rayburn, WF Introduction: Integrating Continuing Professional Development into with Health System Change in Continuing Professional Development in

Medicine and Health Care: Better Education, Better Patient Outcomes. Rayburn, WF, Turco, MG, and Davis DA. (Eds.) Philadelphia, PA, Wolters Kluwer. 2018: xxv- xxx.

• Flexner A, Pritchet H, Henry S. Medical education in the united states and canada bulletin number four (the flexner report). New York (NY): The Carnegie

Foundation for the Advancement of Teaching. 1910.

• Frenk J, Chen L, Bhutta ZA, et al. Health professionals for a new century: Transforming education to strengthen health systems in an interdependent world.
• Lancet. 2010; 376(9756):1923-1958.
• Goldmark, J. Committee for the Study of Nursing Education, Goldmark JC. Nursing and nursing education in the united states: Report of the committee for the

study of nursing e

• Kotter, JP Leading Change: Why Transformation Efforts Fail Harvard Business Review Classics India: Harvard Business School Publishing .2010.
• Ladd, V. “A Closer Look” (pamphlet) Hood Museum of Art, Hanover, Dartmouth College. 2013. http://hoodmuseum.dartmouth.edu/publications/closer-look-gods-

modern-world-epic-american-civilization-jose-clemente-orozco

• McNabb, J, Pawlyshyn, N. Defining-Scholarship-with-Boyers-Four-Areas-of-Scholarship-Explored-and-the-New-Digital-Scholarship-A-Faculty-Conversation.pdf.

Northeastern University Online. Accessed 2014.

• Moore, D. Scholarly Practitioners in CPD. (presentation) SACME 40th Annual Meeting. Scottsdale, AZ. 2017. 05.17.2017.
• Olson CA. On the Need for Scholarly Practitioners in CPD. JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, 31(3):137–139, 2011.
• Olson, CA, Williams, BW. Principles of Effective Research in Continuing Professional Development in the Health Professions in Continuing Professional Development

in Medicine and Health Care: Better Education, Better Patient Outcomes. Rayburn, WF, Turco, MG, and Davis DA. (Eds.) Philadelphia, PA, Wolters Kluwer. 2018: 363-384.

• Rayburn, WF, Turco, MG, and Davis DA. Continuing Professional Development in Medicine and Health Care: Better Education, Better Patient Outcomes.

Philadelphia, PA, Wolters Kluwer. 2018.

• Welch WH, Rose W. Institute of hygiene: A report to the general education board of Rockefeller Foundation. New York: The Rockefeller Foundation. 1915.
• Wiljer, D. Muses of Scholarship in CPD. (presentation) SACME 40th Annual Meeting. Scottsdale, AZ. 2017. 05.17.2017.
• Williams, BW, Welindt D, Olson, CA, Educational Research: Relevant Data bases, Web Sites, Organizations, Funding Sources, Certificate Programs, Books and

Articles (Appendix C) in Continuing Professional Development in Medicine and Health Care: Better Education, Better Patient Outcomes. Rayburn, WF, Turco, MG, and Davis DA. (Eds.) Philadelphia, PA, Wolters Kluwer. 2018: 413-432.

References and Resources