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Introduction: There are numerous examples of care gaps that could be reduced through enhanced knowledge exchange and practice collaboration between medical specialist physicians. In this paper, we report preliminary results on using speed-dating sessions (SDSs) to stimulate the development of continuing interdisciplinary education (CIDE) activities. Methods: In 2007, a 35-minute SDS was carried out during a 2-hour faculty development workshop to provide continuing medical education (CME) directors of Quebec's 35 medical specialist associations with a formal opportunity to quickly share clinical issues and goals. A post-workshop survey was used to assess participants' satisfaction and whether they had met new colleagues, learned about interdisciplinary issues, and discovered opportunities for collaboration. CME accreditation files were audited to assess the occurrence of CIDE activities in the year prior and the 2 years that followed the workshop. CME directors were called to assess whether the development of these activities was directly attributable to their participation in the SDS. Results: CME directors of 26 specialist physician associations attended the faculty development workshop. The vast majority of survey respondents ( n = 18/20) were satisfied with the SDS and believed that this method was a stimulating and efficient way to meet new colleagues, quickly share clinical issues and goals, learn about unexpected but important interdisciplinary issues, and identify opportunities for CIDE collaboration. Sixty percent (12/20) reported having identified at least 1 opportunity for collaboration that was worth pursuing in the near future, and 19% of attending CME directors (5/26) developed a CIDE activity within 2 years, as compared with none in the previous year and for the 9 nonparticipating associations. Discussion: Results suggest that SDSs enhanced networking, knowledge exchange, and collaboration in continuing education among CME providers who participated in a faculty development activity on CIDE. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To analyze physician-assessed asthma control and care compared with current guidelines criteria, in a cohort of patients from a high(HMR) vs. low asthma-related morbidity region(LMR), as determined by a large-scale populational survey(asthma cartography). DESIGN: Analysis of questionnaires provided by 47 primary care physicians and asthmatic patients(HMR: 74; LMR: 73). RESULTS: Asthma control was often suboptimal in both regions. In both regions, asthma control, the pattern of prescriptions for asthma, patient compliance, and referral for asthma education were similar; 32% of patients had been referred for asthma education, whereas 65% wanted to know more about their asthma. CONCLUSIONS: Results of regional/local cohort studies differ from those of a“population cartography,” the former probably more likely reflecting individual medical practices of physicians interested in taking part in such studies. [ABSTRACT FROM AUTHOR]

Asthma management is not always optimal, and deficiencies such as inadequate treatment and insufficient patient education are often reported. Towards Excellence in Asthma Management (TEAM) is a four-phase disease management program of the Quebec Asthma Education Network (QAEN), to be carried out over a 5-year period. The program aims to achieve a continuous improvement of asthma management by caregivers and patients. The first phase, completed in January 2000, consisted of determining the actual level of asthma-associated morbidity and mortality in various Quebec regions. The second phase, which began in September 1999, included three parts: 1. Definition of the burden of asthma, taking into account the socioeconomic consequences of the disease and the quality of life of the patients 2. Comparison of current medical practices with the Canadian Asthma Consensus Guidelines for adult and pediatric populations 3. Evaluation of the level of compliance with medical treatment and with the environmental changes recommended to asthmatic patients. This phase is carried out via a cohort study of physicians, mainly general practitioners and pediatricians, generating a patient cohort study, in addition to substudies evaluating specific aspects of asthma care. Once the care gap is identified, it will be possible to define, apply, and evaluate a series of interventions for physicians, other health professionals, and patients. The interventions will be particularly targeted at regions where asthma incidence and morbidity are higher. We hope that this model of disease management will progressively reduce the burden associated with asthma, and potentially other chronic diseases, and will result in the more effective use of health services. [ABSTRACT FROM AUTHOR]

Contexte/problématique : Le savoir est devenu une source importante de création de richesse Les soins médicaux sont basés sur le savoir, et leur amélioration, sur un transfert efficace des connaissances, car les compétences des professionnels sont déterminantes pour les résultats du système de santé. Buts de l'atelier : Dans cet atelier, nous proposons aux leaders et aux gestionnaires de la formation continue (FC) de mettre en place un modèle de centre de création de valeur (CCV) comme mode de fonctionnement pour leur bureau de FC Ce modèle facilite le développement de plans stratégiques axés sur une amélioration de la contribution d'un bureau de FC au transfert des connaissances, basé sur les besoins du système de santé et de la société Les participants visualiseront comment ils peuvent transformer une organisation axée sur la dispensation d'activités éducatives ou la génération de profits en une organisation tournée vers les compétences et l'amélioration des résultats du système de santé. Les CCV soutiennent de manière plus efficace les professionnels dans leur recherche de maintien et d'amélioration de leur performance et intègrent la FC dans un système qui crée de la valeur pour la société Objectifs : 1) Décrire et expliquer les concepts suivants : retour sur la valeur (ROV); le système de santé et les valeurs; flux de création de valeur; chaîne de création de valeur; 2) Identifier la contribution de leur bureau de FC à la création de valeur pour le système de santé; 3) Visualiser comment la gestion, la contribution et la capacité de leur bureau de FC pourraient être améliorées afin d'accroître leur contribution au système de santé; 4) Expliquer les avantages de transférer d'un centre de profit à un centre de création de valeur Méthodes : Présentation magistrale, discussion en petits groupes et en plénière. [ABSTRACT FROM AUTHOR]

Reflection is the mechanism by which we contemplate and try to understand relatively complex and sometimes troubling ideas for which there is no obvious solution. Reflection allows us to transform current ideas and experiences into new knowledge and action. Personal experiences and organizational feedback can trigger reflection, whereas a lack of time, available colleagues, and social networks detract from the ability professionals have to reflect. Educational programs can encourage reflection through the judicious use of case-based discussion, formal and informal needs assessments, and commitment to change exercises. Learning journals and personal learning projects are self-directed methods that facilitate reflection. In the workplace, critical incident techniques and debriefing of cases provide opportunities for thoughtful inquiry. Additional study is needed to understand how and why reflection works to transform surface learning into deep learning and change in practice; how reflection enhances the integration of reading, collegial interchange, and classroom discussion into practice; and how technology can enhance reflection. [ABSTRACT FROM AUTHOR]

Experts estimate that the prevalence of antibiotics use exceeds the prevalence of bacterial acute respiratory infections (ARIs). To develop, adapt and validate DECISION+ and estimate its impact on the decision of family physicians (FPs) and their patients on whether to use antibiotics for ARIs. Two-arm parallel clustered pilot randomized controlled trial. Four family medicine groups were randomized to immediate DECISION+ participation (the experimental group) or delayed DECISION+ participation (the control group). Thirty-three FPs and 459 patients participated. DECISION+ is a multiple-component, continuing professional development program in shared decision making that addresses the use of antibiotics for ARIs. Throughout the pilot trial, DECISION+ was adapted in response to participant feedback. After the consultation, patients and FPs independently self-reported the decision (immediate use, delayed use, or no use of antibiotics) and its quality. Agreement between their decisional conflict was assessed. Two weeks later, patients assessed their decisional regret and health status. Compared to the control group, the experimental group reduced its immediate use of antibiotics (49 vs. 33% absolute difference = 16%; P = 0.08). Decisional conflict agreement was stronger in the experimental group (absolute difference of Pearson's r = 0.26; P = 0.06). Decisional regret and perceptions of the quality of the decision and of health status in the two groups were similar. DECISION+ was developed successfully and appears to reduce the use of antibiotics for ARIs without affecting patients' outcomes. A larger trial is needed to confirm this observation. [ABSTRACT FROM AUTHOR]

Background. Home environmental exposures may aggravate asthma. Few population-based studies have investigated the relationship between asthma control in children and home environmental exposures. Objective: Identify home environmental exposures associated with poor control of asthma among asthmatic children less than 12 years of age in Montreal (Quebec, Canada). Methods. This cross-sectional population-based study used data from a respiratory health survey of Montreal children aged 6 months to 12 years conducted in 2006 ( n = 7980). Asthma control was assessed ( n = 980) using an adaptation of the Canadian asthma consensus report clinical parameters. Using log-binomial regression models, prevalence ratios (PRs) with 95% confidence intervals (95% CIs) were estimated to explore the relationship between inadequate control of asthma and environmental home exposures, including allergens, irritants, mold, and dampness indicators. Subjects with acceptable asthma control were compared with those with inadequate disease control. Results. Of 980 children with active asthma in the year prior to the survey, 36% met at least one of the five criteria as to poor control of their disease. The population's characteristics found to be related with a lack of asthma control were younger age, history of parental atopy, low maternal education level, foreign-born mothers, and tenant occupancy. After adjustments, children living along high-traffic density streets (PR, 1.35; 95% CI, 1.00-1.81) and those with their bedroom or residence at the basement level (PR, 1.30; 95% CI, 1.01-1.66) were found to be at increased risk of poor asthma control. Conclusions. Suboptimal asthma control appears to be mostly associated with traffic, along with mold and moisture conditions, the latter being a more frequent exposure and therefore having a greater public health impact. [ABSTRACT FROM AUTHOR]

The greatest resource for improving interprofessional learning and practice is the knowledge, wisdom, and energy of professionals who adapt to challenging situations in their everyday work. We call collective capability the ability of a group of professionals to balance two interdependent levels of organization of practice: what professionals know and what they do collectively over time. Organizing what professionals know links the relational value - caring for patients - to the knowledge value of practice. Organizing what professionals do includes human and organizational factors that facilitate collective work and learning: technical skills for care delivery, institutional support, and a complex mix of emotional, ethical and moral factors involved in social decision-making. Performance gaps can result from a lack of an integrated knowledge framework or from a disembodied knowledge that is not anchored in practice. Opportunities for continuous learning can be seized by documenting the source of the performance gap, and providing the relevant resources to establish the balance between the organization of knowledge and the organization of work. [ABSTRACT FROM AUTHOR]

CURATA is a multifaceted continuing medical education (CME) intervention, developed with input from 12 healthcare organizations to address the gap between current and recommended osteoarthritis (OA) treatment of general practitioners in Québec, Canada. Focusing on appropriate prescription of non-steroidal anti-inflammatory drugs, including cyclooxygenase-2 selective inhibitors (coxibs), the intervention comprised small-group, case-based workshops modelled after the Script Concordance test, and a decision tool reflecting current evidence-based clinical practice guidelines. A self-reported questionnaire measured knowledge of recommended OA treatment on an eight-point scale. Participants ( n = 381) showed a mean 10.1% improvement in questionnaire score immediately following the workshop (15.2% improvement relative to mean pre-workshop score). Knowledge was maintained for three months post-workshop. [ABSTRACT FROM AUTHOR]

Introduction: Written action plans (WAPs) are instructions that enable asthmatics to manage their condition appropriately and are recommended by current asthma clinical practice guidelines (CPGs). However, general practitioners (GPs) rarely draft WAPs for their patients. An interactive, case-based workshop for asthma, combined with an objective structured clinical examination (OSCE), was developed to increase GPs' knowledge and use of WAPs in Quebec. Methods: The study compared 24 GPs receiving an OSCE preworkshop and 12 months post-workshop (group I) with 16 GPs receiving an OSCE preworkshop and at 6 and 12 months post-workshop (group 2). Participants received no feedback on their OSCE performance. During the workshop, which presented a preformatted tool to aid drafting of the WAPs, all 40 GPs worked individually and in small groups to answer questions on a hypothetical clinical case and then discussed the responses with a facilitator and an asthma specialist. Results: Only group 2 GPs showed a significant improvement in knowledge of WAPs 12 months post-workshop (p = .01). The likelihood of prescribing WAPs to patients increased in group 2 to a degree approaching statistical significance (p = .070), and there was a borderline nonsignificant trend for prescribing practice to improve more among group 2 GPs than among group 1 GPs (p =. 052). There was also a nonsignificant trend for 6-month OSCE to increase attendance at the 12-month OSCE. Discussion: An interactive workshop employing a preformatted WAP tool and a reinforcing OSCE at 6 months yielded improved knowledge of WAPs at 1 year. Although originally developed as a form of evaluation, the OSCE appears to have formative value even when correction is not provided and may increase the effectiveness of continuing medical education interventions to enhance CPG implementation. [ABSTRACT FROM AUTHOR]