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Continuous Professional Competence (CPC) for Irish paramedics and advanced paramedics: a national study

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      Abstract

      Background

      Internationally, continuing professional competence (CPC) is an increasingly important issue for all health professionals. With the imminent introduction of a CPC framework for paramedics and advanced paramedics (APs) in Ireland, this paper aims to identify factors that will inform the implementation of this CPC framework by seeking stakeholder input into the development of a CPC model for use by the regulatory body. Our secondary objective is to determine the attitudes of registrants towards CPC and what they consider as optimal educational outcomes and activities, for the purposes of CPC.

      Methods

      All paramedics and APs registered in Ireland (n = 1816) were invited by email to complete an anonymous on-line survey. The study instrument was designed based on CPD questionnaires used by other healthcare professions. Quantitative and qualitative analyses were performed.

      Results

      The overall response rate was 43% (n = 789), with 82% of APs and 38% of paramedics participating. Eighty-nine per cent agreed that registration was of personal importance; 74% agreed that evidence of CPC should be maintained and 39% believed that persistent failure to meet CPC requirements should mandate denial of registration. From a pre-determined list of activities, respondents indicated practical training scenarios (94%), cardiac re-certification (92%), e-learning supplemented by related practice (90%) and training with simulation manikins (88%) were most relevant, while e-learning alone (36%), project work (27%) and reading journal articles (24%) were least relevant.

      Conclusions

      Irish Paramedics and APs are supportive of CPC linked with their professional development and registration. Blended learning, involving evidence of patient contact, team-based learning and practical skills are preferred CPC activities.

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      Most cited references 17

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      Impact of formal continuing medical education: do conferences, workshops, rounds, and other traditional continuing education activities change physician behavior or health care outcomes?

      Although physicians report spending a considerable amount of time in continuing medical education (CME) activities, studies have shown a sizable difference between real and ideal performance, suggesting a lack of effect of formal CME. To review, collate, and interpret the effect of formal CME interventions on physician performance and health care outcomes. Sources included searches of the complete Research and Development Resource Base in Continuing Medical Education and the Specialised Register of the Cochrane Effective Practice and Organisation of Care Group, supplemented by searches of MEDLINE from 1993 to January 1999. Studies were included in the analyses if they were randomized controlled trials of formal didactic and/or interactive CME interventions (conferences, courses, rounds, meetings, symposia, lectures, and other formats) in which at least 50% of the participants were practicing physicians. Fourteen of 64 studies identified met these criteria and were included in the analyses. Articles were reviewed independently by 3 of the authors. Determinations were made about the nature of the CME intervention (didactic, interactive, or mixed), its occurrence as a 1-time or sequenced event, and other information about its educational content and format. Two of 3 reviewers independently applied all inclusion/exclusion criteria. Data were then subjected to meta-analytic techniques. The 14 studies generated 17 interventions fitting our criteria. Nine generated positive changes in professional practice, and 3 of 4 interventions altered health care outcomes in 1 or more measures. In 7 studies, sufficient data were available for effect sizes to be calculated; overall, no significant effect of these educational methods was detected (standardized effect size, 0.34; 95% confidence interval [CI], -0.22 to 0.97). However, interactive and mixed educational sessions were associated with a significant effect on practice (standardized effect size, 0.67; 95% CI, 0.01-1.45). Our data show some evidence that interactive CME sessions that enhance participant activity and provide the opportunity to practice skills can effect change in professional practice and, on occasion, health care outcomes. Based on a small number of well-conducted trials, didactic sessions do not appear to be effective in changing physician performance.
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        A meta-analysis of continuing medical education effectiveness.

        We undertook a meta-analysis of the Continuing Medical Education (CME) outcome literature to examine the effect of moderator variables on physician knowledge, performance, and patient outcomes. A literature search of MEDLINE and ERIC was conducted for randomized controlled trials and experimental design studies of CME outcomes in which physicians were a major group. CME moderator variables included the types of intervention, the types and number of participants, time, and the number of intervention sessions held over time. Thirty-one studies met the eligibility criteria, generating 61 interventions. The overall sample-size weighted effect size for all 61 interventions was r = 0.28 (0.18). The analysis of CME moderator variables showed that active and mixed methods had medium effect sizes (r = 0.33 [0.33], r = 0.33 [0.26], respectively), and passive methods had a small effect size (r = 0.20 [0.16], confidence interval 0.15, 0.26). There was a positive correlation between the effect size and the length of the interventions (r = 0.33) and between multiple interventions over time (r = 0.36). There was a negative correlation between the effect size and programs that involved multiple disciplines (r = -0.18) and the number of participants (r = -0.13). The correlation between the effect size and the length of time for outcome assessment was negative (r = -0.31). The meta-analysis suggests that the effect size of CME on physician knowledge is a medium one; however, the effect size is small for physician performance and patient outcome. The examination of moderator variables shows there is a larger effect size when the interventions are interactive, use multiple methods, and are designed for a small group of physicians from a single discipline.
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          Iron Deposition and Ferritin Heavy Chain (Fth) Localization in Rodent Teeth

          Background An iron rich layer on the labial surface is characteristic of the enamel of rodent incisors. In order to address a role for iron content in continuously growing incisors during odontogenesis, we studied iron deposition patterns in enamel and dentine using Perls’ blue staining and ferritin heavy chain (Fth) immunolocalization. Fth expression is regulated by iron level; therefore its localization can be used as a sensitive indicator for iron deposition. Results Sagittal sections of 4-week old rat incisors showed a gradual increase in iron level in the enamel organ from secretory to maturation stages. In addition, iron was detected in ameloblasts of erupting third molars of 4-week old rats, suggesting iron plays a role in both incisor and molar development. In odontoblasts, the presence of iron was demonstrated, and this is consistent with iron’s role in collagen synthesis. Using postnatal 3-, 6-, 9-day old mice, the spatial and temporal expression of Fth in tooth development again indicated the presence of iron in mature ameloblasts and odontoblasts. Conclusions While these data do not explain what functional role iron has in tooth formation, it does highlight a significant molecular activity associated with the formation of the rodent dentition.
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            Author and article information

            Affiliations
            [1 ]Graduate Entry Medical School and Centre for Interventions in Infection, Inflammation & Immunity (4i) University of Limerick, Limerick, Ireland
            [2 ]Health Services Executive, National Ambulance Service College, Dublin, Ireland
            Contributors
            Journal
            BMC Med Educ
            BMC Med Educ
            BMC Medical Education
            BioMed Central
            1472-6920
            2014
            2 March 2014
            : 14
            : 41
            24580830 3943403 1472-6920-14-41 10.1186/1472-6920-14-41
            Copyright © 2014 Knox et al.; licensee BioMed Central Ltd.

            This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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            Research Article

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