Abstract: Introduction: There are guidelines for referral to medical and/or surgical weight loss interventions (MSWLI) in Ontario; however, only about one-third of eligible patients in our region are being referred for consideration of MSWLI.
Methods: A planning committee, including a registered dietician, psychiatrist, endocrinologist, bariatric surgeon, family physician, and educationalists, developed an interdisciplinary continuing professional development (CPD) program focused on practical approaches to the management of patients living with obesity. The Kirkpatrick model was used to evaluate the educational outcomes of the CPD program specifically focusing on Level-2, -3, and -4 outcomes based on self-reported questionnaire and health administrative data.
Results: Eighteen primary care providers from the CPD program agreed to participate in this study, and 16 primary care providers (89%) completed the postintervention questionnaire and granted us access to their MSWLI referral data; 94% of study participants reported changes to their knowledge, comfort, and confidence (Level 2), as well as expected change in their future behaviour (Level 3) following the CPD program. However, there was no change in Kirkpatrick Level-4 outcomes, despite more than 90% of participants indicating that they will be making changes to their practice after the program.
Discussion: The CPD program in our study was overwhelmingly well received and participants reported knowledge (Level 2) and behavioural (Level 3) changes following participation; however, there was no detectable change in their clinical practice (Level 4). The methodology described in our proof-of-concept study can be modified and adopted to evaluate Level-4 outcomes in other studies of effectiveness of CPD interventions.
Competing Interests: Disclosures: The authors would like to disclose that the evaluated CPD program received an unstructured educational grant from Medtronic Canada. The grant was overseen by an independent scientific planning committee including the authors of this grant and was peer reviewed by independent members of the health care community. The authors declare no conflict of interest.
(Copyright © 2022 The Alliance for Continuing Education in the Health Professions, the Association for Hospital Medical Education, and the Society for Academic Continuing Medical Education.)
References: Barber D, Morkem R, Dalgarno N, et al. Patients eligible and referred for bariatric surgery in southeastern Ontario. Can Fam Physician. 2021;67:E31–E40.
Zevin B, Dalgarno N, Martin M, et al. Barriers to accessing weight-loss interventions for patients with class II or III obesity in primary care: a qualitative study. CMAJ Open. 2019;7:E738–E744.
Campbell-Scherer DL, Asselin J, Osunlana AM, et al. Changing provider behaviour to increase nurse visits for obesity in family practice: the 5As Team randomized controlled trial. CMAJ Open. 2019;7:E371–E378.
Velazquez A, Robinson KJH, Frederick JL, et al. Development and outcomes of an immersive obesity summit workshop for medical resident and fellow education. Clin Obes. 2019;9:e12315.
Mastrocola MR, Roque SS, Benning LV, et al. Obesity education in medical schools, residencies, and fellowships throughout the world: a systematic review. Int J Obes (Lond). 2020;44:269–279.
Schuster RJ, Tasosa J, Terwoord NA. Translational research—implementation of NHLBI obesity guidelines in a primary care community setting: the physician obesity awareness project. J Nutr Heal Aging. 2008;12:764–769.
Allen LM, Palermo C, Armstrong E, et al. Categorising the broad impacts of continuing professional development: a scoping review. Med Educ. 2019;53:1087–1099.
Steinert Y, Mann K, Anderson B, et al. A systematic review of faculty development initiatives designed to enhance teaching effectiveness: a 10-year update: BEME guide no. 40. Med Teach. 2016;38:769–786.
Kirkpatrick D, Kirkpatrick J. Evaluating Training Programs: The Four Levels. 3rd ed. Oakland, CA: Berrett‐Koehler Publishers; 2006.
Mansouri M, Lockyer J. A meta-analysis of continuing medical education effectiveness. J Contin Educ Health Prof. 2007;27:6–15.
Zevin B, Martin M, Dalgarno N, et al. Survey of perceptions and educational needs of primary care providers regarding management of patients with class II and III obesity in Ontario, Canada. BMC Fam Pract. 2021;22:14.
Zevin B, Sivapalan N, Chan L, et al. Factors influencing primary care providers' referral for bariatric surgery: a systematic review. Can Fam Physician. 2019;68:e107–e117.
Campbell C, Sisler J. Supporting Learning and Continuous Practice Improvement for Physicians in Canada: A New Way Forward. 2019. Available at: https://www.fmec-cpd.ca/wp-content/uploads/2019/08/FMEC-CPD_Synthesized_EN_WEB.pdf . Accessed March 22, 2021.
Forsetlund L, Bjørndal A, Rashidian A, et al. Continuing education meetings and workshops: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2009;2:CD003030.
Marinopoulos SS, Dorman T, Ratanawongsa N, et al. Effectiveness of continuing medical education. Evid Rep Technol Assess (Full Rep). 2007;149:1–69.
Grol R, Grimshaw J. From best evidence to best practice: effective implementation of change in patients' care. Lancet. 2003;362:1225–1230.
Lavoie KL, Rash JA, Campbell TS. Changing provider behavior in the context of chronic disease management: focus on clinical inertia. Annu Rev Pharmacol Toxicol. 2017;57:263–283.
Wallace S, May SA. Assessing and enhancing quality through outcomes-based continuing professional development (CPD): a review of current practice. Vet Rec. 2016;179:515.
Sargeant J, Armson H, Chesluk B, et al. The processes and dimensions of informed self-assessment: a conceptual model. Acad Med. 2010;85:1212–1220.
Cerveno R, Gaines J. The impact of CME on physician performance and patient health outcomes: an updated synthesis of systematic reviews. J Cont Educ Health Prof. 2015;35:131–138.
Shen N, Yufe S, Saadatfard O, et al. Rebooting Kirkpatrick: integrating information system theory into the evaluation of web-based continuing professional development interventions for interprofessional education. J Contin Educ Health Prof. 2017;37:137–146.
Légaré F, Freitas A, Turcotte S, et al. Responsiveness of a simple tool for assessing change in behavioral intention after continuing professional development activities. PLoS One. 2017;12:1–13.
Sargeant J, Wong BM, Campbell CM. CPD of the future: a partnership between quality improvement and competency-based education. Med Educ. 2018;52:125–135.
Moreau KA. Has the new Kirkpatrick generation built a better hammer for our evaluation toolbox? Med Teach. 2017;39:999–1001.
Frye AW, Hemmer PA. Program evaluation models and related theories: AMEE guide no. 67. Med Teach. 2012;34:e288–e299.
Moehead A, DeSouza K, Walsh K, et al. A web-based dementia education program and its application to an australian web-based dementia care competency and training network: integrative systematic review. J Med Internet Res. 2020;22:1–12.
Davis DA, Mazmanian PE, Fordis M, et al. Accuracy of physician self-assessment compared with observed measures of competence: a systematic review. JAMA. 2006;296:1094–1102.
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