A Unified Theoretical Framework of Learning Theories to Inform and Guide Public Health Continuing Medical Education Research and Practice.

ABSTRACT: Continuing medical education (CME) emerged at the start of the 20th century as a means of maintaining clinical competence among health care practitioners. However, evidence indicates that CME is often poorly developed and inappropriately used. Consequently, there has been increasing interest in the literature in evaluating wider contexts at play in CME development and delivery. In this article, the authors present a unified theoretical framework, grounded in learning theories, to explore the role of contextual factors in public health CME for health care practitioners. Discussion with pedagogical experts together with a narrative review of learning theories within medical and social science literature informed the framework's development. The need to consider sociocultural theories of learning within medical education restricted suitable theories to those that recognized contexts beyond the individual learner; adopted a systems approach to evaluate interactions between contexts and learner; and considered learning as more than mere acquisition of knowledge. Through a process of rigorous critical analysis, two theoretical models emerged as contextually appropriate: Biggs principle of constructive alignment and Bronfenbrenner bioecological model of human development. Biggs principle offers theoretical clarity surrounding interactive factors that encourage lifelong learning, whereas the Bronfenbrenner model expands on these factor's roles across multiple system levels. The authors explore how unification into a single framework complements each model while elaborating on its fundamental and practical applications. The unified theoretical framework presented in this article addresses the limitations of isolated frameworks and allows for the exploration of the applicability of wider learning theories in CME research.

Healthcare accessibility in the rural plains (terai) of Nepal: physical factors and associated attitudes of the local population.

BACKGROUND: While access to healthcare has been a focus of international development, populations around the world continue to lack proper access to care. Identifying at-risk demographic groups can help advance efforts both regionally and internationally. There are only a small number of studies that previously have assessed physical barriers and attitudes in Nepal. METHODS: This study assessed the factors and attitudes associated with healthcare accessibility in a rural population outside of Lumbini, Nepal. This descriptive cross-sectional study used a volunteer-sampling approach to collect 585 questionnaire responses from the area formerly known as the Madhuwani Village Development Committee. RESULTS: The study found that the population was more likely to access private care than public, and reported longer times to access a hospital than the national average. Across almost all findings, those with lower than a secondary education had significantly larger barriers, lower satisfaction and higher reported difficulty in accessing healthcare. Females were shown to have significantly larger transportation barriers in accessing care and lower satisfaction compared with males. CONCLUSIONS: Results identify women and the less-educated as having larger barriers to accessing healthcare. Further research should focus on how inequities in access affect health outcomes among these identified vulnerable groups.