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Robert Guzman October 10, 2013 ENC 1102 Ms. Leslie Wolcott Annotated Bibliography on Continuing Medical Education In my research I included articles which shed light on what necessary improvements and measures the medical field has to partake in to continue medical education. Continuing medical education in todays world and contemporary age has become very difficult because there are more obstacles and challenges that oppose the progress made in the medical field than ever before. Some obstacles include old teaching methods, old curriculums and old technologies. In my research I included articles which addresses those types of problems, but there are challenges which involve more than just the learning environment that medical practitioners and students partake in that are standing in the way of progress. Such challenges include the medical students and practitioners own self efficacy and their ability to set goals adequately to fulfill them as efficient as possible, because learning medicine requires a large amount of responsibility from the person learning it as well. Collaboration also needs to take place within the medical field to continue education because we live in a world where we are constantly been given new information to process every day that would just be impossible to manage without cooperation within the medical field. There are also disparities within the health departments that make it increasingly difficult to teach education such as differences in gender and ethnicity. Teaching and continuing medical education has proved to be increasingly difficult because the society and

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the world we live in are evolving at such a fast pace that the medical field needs to keep up with the progress. My annotated bibliographies include: CURTIS, MICHAEL T., DEBORAH DIAZGRANADOS, and MOSHE FELDMAN. "Judicious Use Of Simulation Technology In Continuing Medical Education." Journal Of Continuing Education In The Health Professions 32.4 (2012): 255-260. Academic Search Premier. Web. 11 Oct. 2013. In this scholarly journal, Michael T Curtis a Research Scientist at the University of Central Florida Institute for Simulation and Training and a part of the team performance laboratory along with Deborah Diazgranados and Moshe Feldman Assistant Professors at the Virginia Commonwealth University, School of Medicine test their hypothesis and position that simulation-based training is quickly becoming a vital source of experiential learning to continue medical education. This article uses a cross section of stimulation training domains for determining the appropriate levels of fidelity, and it creates guidelines for creating an optimal balance of skill practice and realism for efficient training outcomes. With the use of stimulation training and fidelity learning outcomes will be optimized. After defining fidelity, 3 dimensions of fidelity, drawn from the human factors literature, are discussed in terms of their relevance to medical simulation. This article is of relevance to my research because it focuses mainly on how fidelity alongside stimulation training can be a good combination for continuing medical education in the medicine field. REED, VIRGINIA A., KAREN E. SCHIFFERDECKER, and MARY G. TURCO. "Motivating Learning And Assessing Outcomes In Continuing Medical Education Using A Personal

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Learning Plan." Journal Of Continuing Education In The Health Professions 32.4 (2012): 287-294. Academic Search Premier. Web. 11 Oct. 2013. In this scholarly Journal author Reed a. Virginia a Research Associate Professor of Community and Family Medicine and Psychological and Brain Sciences, Geisel School of Medicine at Dartmouth College and Director for Center for Program Design & Evaluation at Dartmouth. Karen E. Schifferdecker Research Assistant Professor of Community & Family Medicine, Geisel School of Medicine at Dartmouth, and Director of Office of Community-Based Education and Research. Mary G. Turco Assistant Professor of Medicine, Geisel School of Medicine at Dartmouth, Director of the Center for Continuing Education in the Health Professions and of Continuing Medical Education at Dartmouth-Hitchcock Medical Center. They all take the position that strategies to influence and promote behavior change among medical students can alter and optimize the outcomes in learning medicine. The article implies using the SMART approach in a personal learning plan designed to motivate and asses CME learning. The goal of this study was to explore the relationship between SMART goals developed after attending a CME conference and subsequent provider behavior change, using the PLP as a tool. The article makes claims that the participants that completed their goals used the SMART approach as opposed to the ones that were not close at all in completing theirs because they didnt use the SMART approach. This article is relevant to my research because it takes into consideration how important self-development is in learning medicine in todays world. SEAGULL, F. JACOB. "Human Factors Tools For Improving Simulation Activities In Continuing Medical Education." Journal Of Continuing Education In The Health Professions 32.4 (2012): 261-268. Academic Search Premier. Web. 11 Oct. 2013.

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In this article Jacob F. Seagull Assistant Professor in the Department of Medical Education, University of Michigan Medical School takes the position that human factors a discipline drawn upon when there is the need to train people to perform complex, high-stakes tasks and effectively asses their performance could prove to be useful in enhancing CME. The article demonstrates how human factors has developed specialized techniques that have been effective in overcoming complex tasks in work settings such as aviation, process control and the military. This article is relevant to my research because it shows how human factors alongside simulation in health care could improve training in medical education. Sergio Islas-Andrade, et al. "Promoting Networks Between Evidence-Based Medicine And Values-Based Medicine In Continuing Medical Education." BMC Medicine 11.1 (2013): 1-17. Academic Search Premier. Web. 19 Oct. 2013. According to the credited authors from the infant hospital of Mexico there is an urgent need to promote medical education that strengthens the relationship between the two paradigms of value based medicine and evidence based medicine. By determining the values relevant to everyday medical activities the work they fulfil work is designed to establish the foundations for a continuing medical education program aimed at encouraging the dialogue between evidence based medicine and value based medicine. According to the authors a concurrent triangulation design of mixed methods strategies to analyze both quantitative and qualitative data was used to empirically explore the axiology in the clinical practice of Mexican healthcare professionals. The methods include a quasi-experimental, observational, comparative, prospective and qualitative study that was conducted by analyzing through a concurrent triangulation strategy the correlation between healthcare personnel patient relationship, healthcare personnel's life history, and ethical judgments regarding dilemmas that arise in daily clinical practice. The health care

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personnel that were participating in the CME intervention in clinical ethics had improved highorder values which were openness to change and self-transcendence which are essential in medicine. The article is relevant to my research because it takes into account different aspects and factors from health care personnels lives which include not just their work place but also their life history and the relationships with their patients to promote medical education. Gopal, K. S. Santhan, and Mary Varghese. "Evidence Based Medicine: Why should we be practicing it all the time?." Indian Journal of Ophthalmology May 2013: 193+. Academic Search Premier. Web. 19 Oct. 2013. The authors Santhan K.S. Gopal from Kamala Nethralaya and Mary Varghese from the department of Ophthalmology at St. John's Medical College, Bangalore, India take the position that evidence based medicine should be practiced all the time. The authors focus on the benefits of evidence-based medicine in better decision-making for a patient centered medical care. The authors discuss various ways of gathering evidence for practicing evidence based medicine which include consulting colleagues, uploading scientific problem data on websites and through medical education programs. The authors state that medical literature is the best method of gathering evidence as it allows easy collection of all levels of evidence. While the authors are taking the position that the practice of evidence based medicine is vital to the field, they are not comparing and contrasting evidence based medicine as opposed to other ways of learning medicine such as value based medicine. This article is relevant to my topic because it reveals the importance of evidence based medicine in the field of medicine and why it is crucial to continue it.

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Irene W. Y. Ma, et al. "Feasibility Of Scenario-Based Simulation Training Versus Traditional Workshops In Continuing Medical Education: A Randomized Controlled Trial." Medical Education Online 18.(2013): 1-7. Academic Search Premier. Web. 19 Oct. 2013. The credited authors from the provincial simulation program of the University of Calgary take the position that although simulation-based training is increasingly used for medical education, its benefits and efforts in continuing medical education are less encouraged. This study seeks to evaluate the feasibility of incorporating simulation-based training into a CME conference and compare its effectiveness with the traditional workshop in improving knowledge and selfreported confidence. The methods in this study include randomizing a group of 27 participants to either a simulation-based workshop or a traditional case-based workshop. According to the article Post-training, knowledge assessment score neither did increase significantly in the traditional group nor did significantly decrease in the simulation group. Suggesting that some of the effects of the training with simulation may be short lived. This article is relevant to my research because it tests how the traditional way of teaching and looking at medicine can be modified with modern methods of teaching to help continue the education of medicine. Howa Yeung, et al. "Prioritizing Health Disparities In Medical Education To Improve Care." Annals Of The New York Academy Of Sciences 1287.1 (2013): 17-30. Academic Search Premier. Web. 20 Oct. 2013. According to the credited authors from the Universities of New Mexico, Puerto Rico, New York, California, Mount Sinai School of Medicine, Massachusetts General Hospital, Harvard Medical School, Brigham and Women's Hospital significant disparities remain in health, health quality, and access to health care within the United States despite yearly advances in life-saving and preventive medicine, as well as strategic approaches by governmental and social agencies and

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groups. The factors and determinants of these disparities include baseline health status, race and ethnicity, culture, gender identity and expression, socioeconomic status, region or geography, gender and age. According to the article in order to renew the commitment of the medical community to address health disparities, particularly at the medical school level, we must remind ourselves of the roles of doctors and medical schools as the gatekeepers and the value setters for medicine. Meaning that within these roles are responsibilities toward the social mission of working to eliminate health disparities. It will require a lot of effort and partnerships with communities as well as with academic centers to actively develop and to implement diversity and inclusion strategies. This article is relevant to my research because it tries to shed light on the disparities within the medical field that may stand in the way of continuing medical education. Fred, Herbert L. "Medical Education on the Brink." Texas Heart Institute Journal June 2012: 322+. Academic Search Premier. Web. 20 Oct. 2013. Fred Herbert from the department of internal medicine at the University of Texas Health Science Center at Houston takes the position that medical education is on the brink. Based on his fifty years of bedside teaching and sixty years of involvement in medical education he states that medical education has gone through some changes that have slowed its progress. According to him medical education has evolved from patient-centered to laboratory-centered, and to a physician-centered pedagogy way of teaching. He offers his insight that there is a need to update the curriculum of medical schools and post-graduate training programs in order to continue this transformation without slowing down the progress of continuing medical education. Society has been evolving as a whole that medical education has not caught up with it many of todays medical graduates are not adequately prepared to meet contemporary expectations and responsibilities.(Fred Herbert) The medical field and its personnel need to put forth the effort to

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boost the creativity and energy to make medical education relevant to our evolving health care system. This article is relevant to my research because it demonstrates how the times have changed and the educational system of medicine has not evolved with the current time period humanity lives on. Steven J. Durning, et al. "Development And Initial Validation Of A Survey To Assess Students' Self-Efficacy In Medical School." Military Medicine (2012): 31-37. Academic Search Premier. Web. 20 Oct. 2013. According to the authors from the Uniformed Services University of the Health Sciences, Bethesda self-efficacy is a very important concept in the world of medicine. According to the article self-efficacy is a personal belief in one's capability to successfully execute the behaviors necessary to attain designated types of performances. The purpose of the study is to develop a survey for measuring students' medical skills in self-efficacy and to collect reliability and validity evidence. A secondary purpose is to explore differences in students' self-efficacy from year one of medical school to year four. Self-efficacy does increase from the students year one to their year four showing the level of dedication students put forth once they start advancing to higher levels of difficulty within the medical school. This article does bring a lot of relevance to my research because it shows just how it important self-improvement is in the field of medicine. Melissa Spence, et al. "Bridging The Gap: Innovative Approaches To Continuing Education In Rural, Remote, And Isolated First Nation Communities." Seminars In Dialysis 26.2 (2013): 164-168. Academic Search Premier. Web. 20 Oct. 2013. According to the credited authors from Saint Elizabeth First Nations, Inuit and Mtis Program, Winnipeg and Manitoba delivering affordable and accessible continuing education for healthcare

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providers in rural, remote, and isolated first Nation communities is challenging due to barriers such as geography, isolation, costs, and staff shortages. According to the article access to education, communication, and support is essential for achieving and maintaining a skilled healthcare workforce. The authors propose that in order to make access to medical education easier the innovative use of technology, such as on-line courses and webinars, will be needed to continue medical education for healthcare providers in these settings. A study is performed demonstrating how a national health care organization has partnered with healthcare providers in these communities to support care at the local level through various technology-based knowledge exchange activities. This article is very important to my research because it reveals just how multiple barriers can stand in the way of continuing medical education in todays world. Joshua Quinones, et al. "The Utility Of Simulation In Medical Education: What Is The Evidence?." Mount Sinai Journal Of Medicine 76.4 (2009): 330-343. Academic Search Premier. Web. 20 Oct. 2013. According to the authors from Mount Sinai Medical Center, the institute for medical simulation and advanced learning, Health and Hospitals Corporation from New York and the Keck School of Medicine at the University of Southern California, Los Angeles, California medical schools and residencies are currently facing a shift in their teaching paradigm. According to the article The increasing amount of medical information and research makes it difficult for medical education to stay current in its curriculum. A reasonable cause for this occurrence is that patients have become increasingly concerned that students and residents are practicing on them, clinical medicine is becoming focused more on patient safety and quality than on bedside teaching and education as a result. Educators have tried to face this challenge by restructuring the curricula. Nonetheless, a gap still exists between the classroom and the clinical environment.

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Many students feel that they are inadequately trained in history taking, physical examination, diagnosis, and management. Medical simulation has been proposed as a technique to bridge this educational gap. This article reviews the evidence for the usage of simulation in medical education. This article is relevant to my research because it shows evidence on just how useful simulation training can be and it helps give support to my previous article: Judicious Use of Simulation Technology in Continuing Medical Education. Price, David. "Continuing Medical Education, Quality Improvement, And Organizational Change: Implications Of Recent Theories For Twenty-First-Century CME." Medical Teacher 27.3 (2005): 259-268. Academic Search Premier. Web. 20 Oct. 2013. According to David Price from the Colorado Permanente Medical Group, Denver, USA the American Board of Medical Specialties now requires physicians to participate in systems-based practice and practice-based learning and improvement activities as part of maintenance of specialty board certification. In todays age healthcare providers and systems are being asked to measure and improve the quality of care delivered to their patients. It might seem like a burden but these changing paradigms provide opportunities for continuing medical education to become more aligned with health system goals and help prepare clinicians to practice in this new environment.(David Price) This article sheds light on how medical education can play a role in helping organizations improve. This article is relevant to my research because it demonstrates that medical education cannot continue without improvement in quality in medical organizations. Gluck, Jeannine Cyr. "The Contribution Of Hospital Library Services To Continuing Medical Education." Journal Of Continuing Education In The Health Professions 24.2 (2004): 119-123. Academic Search Premier. Web. 20 Oct. 2013.

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According to Jeannine Gluck the director of the Medical Library from the Eastern Connecticut Health Network in Manchester much of the literature relating to continuing medical education programs lack the effectiveness of traditional lecture-based format, the most often used method of presentation in hospitals. There is a confusion between what is learned and what is done in the actual medical field a gap exists between the content taught in lectures and the application of that knowledge in actual patient care. (Jeannine Gluck) This article demonstrates how the services of the medical librarian, already employed in most hospitals, can help lessen this problem. Libraries help to support quality improvement efforts. This article is of relevance of my research because it points out three functions which are: library services, continuing medical education, and quality improvement, which are interdependent. Schifferdecker, Karen E., and Virginia A. Reed. "Using Mixed Methods Research In Medical Education: Basic Guidelines For Researchers." Medical Education 43.7 (2009): 637-644. Academic Search Premier. Web. 20 Oct. 2013 In this scholarly journal, Karen Schifferdecker and Virginia Reed take the position that mixed methods deserve an increased presence and recognition in medical education research. Mixed methods research can be defined as the collection, analysis and integration of both qualitative and quantitative data in a single study.(Schifferdecker & Reed) The purpose of this article is to provide an overview of mixed methods research, research design models relevant for medical education research, examples of each research design model in medical education research, and basic guidelines for medical education researchers interested in mixed methods research. This article is relevant to my paper because it demonstrates how mixed methods proves to be useful in increasing integrity and the applicability of findings when studying new or complex initiatives and interactions in medical education research and continuing medical education.

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Curtis A. Olson, et al. "Learning To Collaborate: A Case Study Of Performance Improvement CME." Journal Of Continuing Education In The Health Professions 28.3 (2008): 140147. Academic Search Premier. Web. 20 Oct. 2013. In this scholarly article, the credited authors from the University of Wisconsin School of Medicine and Public Health take the position that collaboration in the field of medicine is vital if the education of medicine is to continue. The authors talk about how Performance Improvement Continuing Medical Education (PI CME) is a mechanism for joining quality improvement (QI) in health care to continuing medical education (CME) systems together. The observational study performed in this article describes how an academic institution and a community-based primary care practice collaborated to enhance patient care in the area of hypertension. According to the article the value of shared goals and agreement on the process among the participants, planners, and others involved improved greatly due to collaboration. This article is relevant to my research because it shows just how important collaboration is in the field of medicine.