KeyLIME Session 196:
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Jeong et.al., Barriers and Facilitators to Self-Directed Learning in Continuing Professional Development for Physicians in Canada: A Scoping Review Acad Med. 2018 Jul;93(7):1079-1084.
Reviewer: Linda Snell (@LindaSMedEd)
‘CPD is composed of diverse educational and developmental activities that address multiple aspects of physician competencies’: in Canada, as for UGME and PGME, CanMEDS 2015 is the competency framework.
Maintenance of competence largely addressed through self-assessment and engagement in CPD, primarily by self-directed learning (SDL). Defined as ‘activities planned to address specific needs, enhance awareness of new evidence potentially relevant to practice or enhance the quality of multiple systems.’ SDL has become a regulatory requirement for CPD in Canada as elsewhere.
Thus developers of accredited CPD programs must incorporate SDL initiatives into their activities.
In CPD, does SDL actually ‘work’? It depends … on internal factors (of the learner), external sources, the learning environment, culture and context. Strategies have been proposed to address all these.
However there is no review of the literature that systematically identifies the barriers and facilitators to implementing and engaging in SDL in CPD [in Canada or elsewhere]. This would be important for designing successful CPD activities, integrating CanMEDS competencies, and the authors say might result in practice changes.
“To perform a scoping review ‘exploring the barriers and facilitators that influence physicians’ engagement in, and SDL developers’ design and implementation of, SDL programs in CPD in Canada.”
Key Points on Method
The purpose of conducting a scoping review is to ‘identify knowledge gaps, to inform research agendas, and to identify implications for policy and decision making within a multidisciplinary field where different types of study designs can be found; to investigate complex and multidisciplinary topics where evidence is still emerging.’
6 steps (Arksey et al 2005 … although I like A Thomas et al 2017):
- Identify research question: “What are the barriers and facilitators to SDL in CPD in Canada?”
- Identify relevant studies: appropriate data bases, 2005-15, key words SDL, physicians, CPD, Canadian setting.
- Study selection: >1300 articles: >900 after title and abstract review; 90 after full text review + 9 from reference search; second review to be relevant to research question left 17 articles addressing barriers/facilitators (B/F) of SDL in CPD for physicians in Canada.
- Chart data; and
- Collate, summarize, and report the results; two steps:
- standard content analysis
- used the Theoretical Domains Framework (TDF)* to identify the specific behavioral factors that may act as barriers and facilitators in implementing and engaging in SDL programs in CPD.* Framework used in implementation science with 12 domains that synthesize constructs drawing on psychological theories associated with clinical behavior change. Has been validated as a method for identifying B/F to behavior change in health professionals, to develop interventions. It has not been used as a framework to direct coding.
- Consult with an expert panel: used the research team [rather than consumer and/or stakeholders].
About half were empirical research, rest reviews; various research methods; most published in JCEHP. Inductive categories: levels where barriers/facilitators perceived to occur: individual, program, technological, environmental, and workplace/ organizational. Individual barriers and program facilitators coded in most Deductive categories using TDF domains coded 318 times: Barriers were coded 133 times (41.8%), and facilitators were coded 185 times (58.2%).
Most codes were in the environmental context and resources domain (27.0% – both B/F), social influences (23.0% – more F), beliefs about consequences (8.8% – more f), and behavioral regulation (6.9%).
Barriers = time constraints, limited access to tools/programs, competing demands/ interests, cost, technological problems, and lack of faculty with expertise and experience in team training.
Facilitators = included teamwork/collaborative work/interactivity/networking; helpful facilitators, experts, and presenters; managerial and peer enthusiasm/ recommendation from college; peer-to peer training; and administrative and organizational support for SDL.
>90% articles addressed B/F for physicians, few for designers
The authors ‘identified five categories of barriers and facilitators in the literature and four key TDF domains (environmental context and resources, social influences, beliefs about consequences, and behavioral regulation) where most factors related to behavior change of physicians and SDL developers… There was a significant gap in the literature about factors that may contribute to SDL developers’ capacity to design and implement SDL programs in CPD.’
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