CME providers' experiences and practices in Pakistan: a case study.

BACKGROUND: Pakistan has made numerous attempts to establish and implement a national mandatory CME program which currently do not exist. The purpose of this study is to explore the views of major CME providers in order to identify possible strengths and weaknesses in the current program, and offer evidence-based recommendations to help further enhance the national CME program in Pakistan. METHODS: An exploratory study design using a case study approach through in depth interviews was conducted to examine CME providers' experiences and perceptions. The study was conducted in Pakistan between August and November 2019 with CME providers from Sindh, Punjab, the North-West Frontier Province, and the Federal Capital Territory. Thirty-six providers recognised by the Pakistan Medical and Dental Council who were involved in providing CME activities at the national level and whose contact information was publicly available on their websites, were selected for the study. Of the 36 providers invited, 22 participated in this study. RESULTS: The results generated several organising themes grouped into three major themes: (1) CME current practices, (2) CME past experiences, and (3) Future developments. CONCLUSION: Participants recommended needs-based educational activities for physicians, a well-structured central regulatory CME body collaborating with existing providers, involving experienced providers for rural CME, accrediting diverse local providers, limiting commercial entities' role, and implementing CME with proper preparation and a phased approach.

AMEE Faculty Development Committee internship: A collage of social learning experiences.

An internship with the Association for Medical Education in Europe (AMEE) Faculty Development (FacDev) Committee has proven to be a useful approach to engaging and supporting emerging faculty developers through social learning and communities of practice. An essential aspect of this internship process is to expand the membership of the faculty development team, fostering the individual and collective capabilities required to navigate the complexity of implementing AMEE faculty development goals.

Introducing General Education in the Medical Sciences: A Call to Action.

Null.

The Status Quo of Continuing Medical Education in South-East Asia and Eastern Mediterranean Regions: A Scoping Review of 33 Countries.

INTRODUCTION: Continuing medical education is a process of continuous learning to maintain physicians' competence and professional performance. Efforts to make continuing medical education (CME) programs mandatory in the South-East Asia Region by linking credits to the renewal of registration have met with mixed success. However, there are no recent reviews on the CME status in regions with a large number of developing countries. This review aims to map the practices and regulation of the CME activities in the South-East Asia and Eastern Mediterranean regions. METHODS: A scoping review was undertaken using a modified Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. A search was conducted within PubMed, Embase, Web of Science, Scopus databases, and national medical and health council websites. RESULTS: Evidence on the provision of CME is available for all but seven of the 33 countries in both regions. Fourteen countries of varying income levels have implemented mandatory CME linked to the renewal of registration. They have statutory bodies governing CME and allocating credits, with most requiring a large number of hourly based activities for the renewal of registration and evidence of a wide range of local providers. CONCLUSIONS: Financial resources, a thorough organizational structure and standards, and a wide range of local CME providers seem to promote the implementation of mandatory CME in most of these countries.

Performance improvement CME for quality: challenges inherent to the process.

PURPOSE: The purpose of this paper is to discuss the perspective debates upon the real-time challenges for a three-staged Performance Improvement Continuing Medical Education (PI-CME) model, an innovative and potential approach for future CME, to inform providers to think, prepare and to act proactively. DESIGN/METHODOLOGY/APPROACH: In this discussion, the challenges associated for adopting the American Medical Association's three-staged PI-CME model are reported. FINDINGS: Not many institutions in USA are using a three-staged performance improvement model and then customizing it to their own healthcare context for the specific targeted audience. They integrate traditional CME methods with performance and quality initiatives, and linking with CME credits. PRACTICAL IMPLICATIONS: Overall the US health system is interested in a structured PI-CME model with the potential to improve physicians practicing behaviors. ORIGINALITY/VALUE: Knowing the dearth of evidence for applying this structured performance improvement methodology into the design of CME activities, and the lack of clarity on challenges inherent to the process that learners and providers encounter. This paper establishes all-important first step to render the set of challenges for a three-staged PI-CME model.

Expanded Outcomes Framework for Effective CME - The Way Forward for Pakistan.

Continuing Medical Education (CME) providers recognize the importance to plan educational activities that focus to improving and assessing knowledge, competency and performance outcomes rather than on attendance and satisfaction. This perspective proposes using an expanded outcomes framework for planning and assessing CME. The expanded outcomes framework supports backward planning, that starts with the population health outcomes (level 7) and moves backward, to providing continuing education for physicians that may result in improved outcomes. We the authors recognize the complexity of this framework, the recently evolved CME system in Pakistan, and the limited resources; and therefore, we suggest that planning and assessment should begin at level 3, physician knowledge. Thus, be mindful of the end and the scope of this framework that is associated and leads toward the improvement of population health outcomes.

Beyond the classroom, 'pro-active teaching methods--a must for today's CPD movement'.

Non-traditional teaching approaches are not recent innovations in the field of continuing medical and professional development; however, there is a lack of employing such methods in our context. The reasons could include lack of awareness, recognition and overlapping and adoption of these approaches, peculiarly academic detailing, by the pharmaceuticals. Nevertheless these methods have proven to be useful in changing physicians' behaviour and attitudes towards patient care and health safety. Moreover, it guides, promotes and derives the self-directedness of the physicians to acquire current knowledge, skills and generic attributes that are required for lifelong learning.

Task-based learning versus problem-oriented lecture in neurology continuing medical education.

OBJECTIVE: To determine whether general practitioners learned better with task-based learning or problem-oriented lecture in a Continuing Medical Education (CME) set-up. STUDY DESIGN: Quasi-experimental study. PLACE AND DURATION OF STUDY: The Aga Khan University, Karachi campus, from April to June 2012. METHODOLOGY: Fifty-nine physicians were given a choice to opt for either Task-based Learning (TBL) or Problem Oriented Lecture (PBL) in a continuing medical education set-up about headaches. The TBL group had 30 participants divided into 10 small groups, and were assigned case-based tasks. The lecture group had 29 participants. Both groups were given a pre and a post-test. Pre/post assessment was done using one-best MCQs. The reliability coefficient of scores for both the groups was estimated through Cronbach's alpha. An item analysis for difficulty and discriminatory indices was calculated for both the groups. Paired t-test was used to determine the difference between pre- and post-test scores of both groups. Independent t-test was used to compare the impact of the two teaching methods in terms of learning through scores produced by MCQ test. RESULTS: Cronbach's alpha was 0.672 for the lecture group and 0.881 for TBL group. Item analysis for difficulty (p) and discriminatory indexes (d) was obtained for both groups. The results for the lecture group showed pre-test (p) = 42% vs. post-test (p) = 43%; pre- test (d) = 0.60 vs. post-test (d) = 0.40. The TBL group showed pre -test (p) = 48% vs. post-test (p) = 70%; pre-test (d) = 0.69 vs. post-test (d) = 0.73. Lecture group pre-/post-test mean scores were (8.52 ± 2.95 vs. 12.41 ± 2.65; p < 0.001), where TBL group showed (9.70 ± 3.65 vs. 14 ± 3.99; p < 0.001). Independent t-test exhibited an insignificant difference at baseline (lecture 8.52 ± 2.95 vs. TBL 9.70 ± 3.65; p = 0.177). The post-scores were not statistically different lecture 12.41 ± 2.65 vs. TBL 14 ± 3.99; p = 0.07). CONCLUSION: Both delivery methods were found to be equally effective, showing statistically insignificant differences. However, TBL groups' post-test higher mean scores and radical increase in the post-test difficulty index demonstrated improved learning through TBL delivery and calls for further exploration of longitudinal studies in the context of CME.

Evaluating neurology CME in two educational methods using Patton's utilization focused model.

BACKGROUND: Generally in continuing education medical education (CME) the most time is consumed for in the planning and preparation of the event. This planning and preparation, however, needs recognition through an evaluative process. The purpose of this study was to evaluate neurology CME in two educational methods, lecture vs task-based learning, using Patton's utilisation focused model. METHODS: This was an observational, cross-sectional inquiry. The questionnaire evaluated the educational elements such as learning objectives met, content covered, presentations at the level of understanding, level of interaction, knowledge gained, time management, queries responded, organisation, quality of learning material and overall grading of the educational event. General Practitioners were the key participants in this evaluation and consisted of 60 self-selected physicians distributed equally in both the TBL and lecture groups. Patton's utilization focused model was used to produce findings for effective decision making. The data were analysed using Mann-Whitney U test to know the value of the learning method that satisfied the most participants. RESULTS: A total of 58 evaluations were returned, 29 from the TBL group and 29 from the lecture. The analysis of the elements showed higher mean ranks for TBL method ranging between 32.2 and 38.4 versus lecture (20.6-26.8). Most of the elements assessed were statistically significant (p > 0.05), except time management (p = 0.22). However, elements as 'objectives of the activity met' (p = 0.07), 'overall grading of the event' (p = 0.06) and 'presentations at the level of understanding' (p = 0.06) were at border line. Of the 29 respondents in the TBL group, 75% rated all the elements of the program above very good. In the lecture group, 22 (75%) respondents out of 29 rated almost half of the elements above very good. CONCLUSION: Majority of respondents in the TBL group rated all program elements as exceptional compared to the lecture group in which only half of the elements were rated above very good. Task-based learning method made the most impact on participants' satisfaction.

How does self-efficacy affect performance of learner?

All types of attribution based on which learners make their judgement (i.e., self efficacy), about academic success or failure or about a specific task usually affect their performance and their capabilities to deal with different realities. It is perhaps the most distinctive capability of self-reflection. Many of the cognitive theorists have defined it as a meta-cognitive capability. This judgement influence learners choose what to do, how much effort to be invested in the activity, how long to carry the phase of disappointment, and whether to approach the task anxiously or with assurance.

Three-level quality assessment of a dental hospital using EFQM.

PURPOSE: This article aims to measure quality by applying the European Foundation for Quality Management (EFQM) excellence model at three different participation levels, in a Karachi teaching university dental hospital. DESIGN/METHODOLOGY/APPROACH: The case study assessed the eight EFQM model excellence concepts as benchmarks for providing quality services: results orientation; customer focus; leadership and constancy of purpose; management by processes and facts; people development and involvement; continuous learning, innovation and improvement; partnership development; and corporate social responsibility. This study was conducted at Hamdard University Dental Hospital (HUDH), located in Karachi - part of the largest privately-owned university in Pakistan. Data were collected through in-depth interviews with internal stakeholders at three levels (management, faculty and student). FINDINGS: Continuous learning, innovation and improvement; partnership development; and corporate social responsibility were satisfactorily represented. RESEARCH LIMITATIONS/IMPLICATIONS: The EFQM assessment was limited to a single university dental hospital, hence findings cannot be generalized. ORIGINALITY/VALUE: The article highlights that it is envisaged that this exercise will bring about a positive change in attitude and will stimulate institute staff to kick start the self assessment process and implement measures leading to better quality practices, thus establishing a continuous quality improvement cycle.

Content audit of drug advertisements in Pakistan.

A sample of 120 drug advertisements was drawn by nonprobability convenience sampling from among the stalls of 50 pharmaceutical companies participating in an exhibition in Karachi, Pakistan. 23 belonging to the NSAID drug group were selected and evaluated on whether they met guidelines for ethical advertisements as laid down in the Drugs Act, 1976. Only 5 out of the 23 advertisements met at least 14 out of 16 criteria for ethical advertisements as given in the Drugs Act, 1976.

Continuing medical education and pharmaceutical industry.

Continuing medical education providers' (academia) and industrial relationship is drawing attention all over the world. To date, there are no national commercial support guidelines available in Pakistan to properly regulate cooperation between the two distinct entities. However, the fact is that the future of all continuing medical education depends on pharmaceutical support and the providers are heavily dependent on the pharmaceutical industry to remain in action. It should always be remembered that medical education and profession is regarded as a moral of enterprise based on a blind faith between the physician and the patient. The funding support by the industry should not bind or influence physician's prescription for any reason. To be trusted, medicine must be free of all such dependency; it should be accountable only to the society it serves and to its own professional standards.

Oral hygiene KAP assessment and DMFT scoring among children aged 11-12 years in an urban school of Karachi.

OBJECTIVE: To assess the oral hygiene knowledge, attitude and practices among school children and evaluate their DMFT (Decayed/Missing/Filled Teeth) scores. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: A private school of Karachi from March to April 2008. METHODOLOGY: Convenient sample comprising 300 students of grade 6 within the age group of 11-12 years was selected. A knowledge, attitude and practices survey questionnaire based on quantitative indicators was filled by the students. Clinical examination was done for DMFT. Data analysis was done by using SPSS version 11. Associations were assessed using chi-square test and a p-value of < 0.001 was considered significant. RESULTS: There were 160 males and 140 females in the target group. The mean DMFT was found to be 1.27. The children had satisfactory knowledge of oral health's effect on general health and the problems associated with poor dental hygiene. However, 50.3% children did not have positive attitude towards importance of a dentist's role in maintaining their dental health. Only a few students (11.3%) had familiarity with dental floss. A statistically significant association was found between frequency of brushing and children's knowledge of the problems related to irregular tooth brushing (p < 0.001). CONCLUSION: The attitude of school children towards dental health and dental service utilization is determined by certain social and cultural factors. The mean DMFT of 1.27 showed that there must have been some poor oral practices that are contributing towards a higher mean.