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  • Mobile Learning and Smartphone use amongst Wessex GPs

    I have finally got around to disseminating a questionnaire to the good GPs and GPSTs of Wessex to assess the use of smartphones and their use for M-learning and CPD.  More to come but I have drafted an abstract of my findings below.

    Background and Aims

    There is an increasing use of smart phones for both under and postgraduate medical education. Despite this, uptake amongst general practitioners is poor. This survey examined the current use of smartphones for medical education amongst a cohort of Wessex GPs and GPSTs. Also explored was the use of social media for medical education.

    Method

    An online questionnaire invite was sent out via email. The questions included closed demographic questions and open free text responses. The survey population was composed of GPSTs and GPs on the Wessex PBSGL database. Responses were analysed using a grounded theory approach to identify themes.

    Results

    There were 61 respondents from 253 invitees. 98% had smartphones, 77% used smartphones for medical apps, 65% used smartphones for medical education, 69% used smartphones for social media and 20% used social media for medical education.  Thematic analysis of free text responses identified 58 nodes which were grouped into 21 minor themes in 8 categories.  These were: Accessing learning; Educational impact of online and m-learning; Educational networking; Learning involves social interaction with peers and mentor; Physical constraints of mobile devices; Signposting to guidelines and learning via the Internet; Technical challenges of online and m-learning; Work life balance

    Conclusions

    This is a snapshot of a small population but does raise some important key messages.  There is a training requirement for GPs in how to use social media for education.  GPs valued the networking between colleagues at courses and conferences.  However, most respondents recognised the future benefits of mobile learning platforms and wanted to engage more.

  • A Meta-Analysis of Continuing Medical Education Effectiveness (Mansouri and Lockyer 2007)

    Free text from here.

    In trying to justify why I think PBSGL is a good way of learning, I have done a lot of literature searching and reading about how different CME interventions can change what we do as physicians. The more recent research on PBSGL has demonstrated that Small Group Learning (SGL) is associated with several positive outcomes. For example, implementing guidelines into practice, an activity that is often associated with many difficulties (Macvicar, Cunningham et al. 2006). If only patients would do what they’re told, it would be so much easier! Clearly primary care is not about the sapiental ‘all knowing’ doctor. It is about empowering patients to make decisions. This generates uncertainties. Sharing these uncertainties in a SGL group with a trained facilitator frees up the physician to say what they think with reduced fear. I have often wanted to ask questions in a GP update lecture but am embarrassed to ask simple things about chronic disease management, something we are not always good at working for the MOD with a young population.

    I have also found lectures a mixed bag of usefulness. I write furiously in my learning journal, coming up with all sorts of ideas for audits and interventions only to reflect on them (usually just prior to my appraisal) wondering where has all that enthusiasm gone? This is why I have been such an advocate of SGL and what it can do to enhance our learning and improve patient care. Hence my review of this article for both my professional project and for general interest.

    This meta-analysis is not a new article but is a solid piece of work where the authors undertakes a literature review of CME interventions and looks at outcomes. The main type of interventions examined are active (workshops & individual training), passive (conferences and lectures) and mixed (SGL and post-course feedback). Three types of outcomes are looked at: physician knowledge, physician performance and patient outcome. There were 31 studies which actually generated 61 interventions (as some studies had multiple outcomes). The interventions were entered separately into the meta-analysis. All outcomes had positive & significant effect although the size was generally small. The data was also grouped and analysed for various types of CME. No surprises for guessing the results (summarised in table 3). Interactive SGL, case discussions, multi-faceted programmes and longitudinal workshops all had the largest effect.

    What was interesting was the small number of studies looking at patient outcomes. I decided to look in detail at one of these. Gask et al used role playing actors with videotaped consultations to look at consultation behaviour pre- and post educational intervention (Gask, Usherwood et al. 1998). The subject was depression. In what seems to be a nicely constructed but probably expensive study, ratings of the consultations with the role players were carried out in the context of assessment and management of depression. The intervention involved small group work in five 2 hour sessions. It included intensive training, review of videoed consults, role playing etc. In other words, a very intensive package and probably impractical for a busy GP nowadays.

    It would be a fair conclusion to draw that the least effective methods of delivering education (e.g lectures) are probably the most popular as they are cheaper to provide. More intensive training eg with SGL is associated with better outcomes, but with increased number of hours of intervention so the cost of delivery is probably more. I would argue that case based training can be cost effective and in the one relevant study included in this meta-analysis, physician knowledge improved considerably (Doucet, Purdy et al. 1998).

    Two other findings piqued my interest. The first was that when the assessment was done was important.  This is not surprising. If the assessment is performed 52 weeks later, the impact is likely to be less. The other finding was that mixed disciplines fared less well than single group disciplines. Details were patchy but it is something to consider if planning some interdisciplinary education. It may be that with increased specialisation and training of practice nurses, plus delegation of management to them by GPs, this effect will be less in 2016 than it was in 2007. An adjunct to this was that increased participants had a negative correlation although it is not clear if this this was related. One would expect increased numbers at passive interventions so it may be a secondary effect.

    Doucet, M., et al. (1998). “Comparison of problem-based learning and lecture format in continuing medical education on headache diagnosis and management.” MEDICAL EDUCATION-OXFORD- 32: 590-596.

    Gask, L., et al. (1998). “Evaluation of a training package in the assessment and management of depression in primary care.” Medical Education 32(2): 190-198.

    Macvicar, R., et al. (2006). “Applying evidence in practice through small group learning: a Scottish pilot of a Canadian programme.” Education for Primary Care 17(5): 465-472.

    Mansouri, M. and J. Lockyer (2007). “A meta‐analysis of continuing medical education effectiveness.” Journal of continuing education in the health professions 27(1): 6-15.