Running head: SECTIONS Model Medical Grand Rounds
Use of SECTIONS model to examine Medical Grand Rounds Tim Bulger Athabasca University
SECTIONS Model Medical Grand Rounds
Introduction Health professionals, such as physicians and nurses, in Alberta are required by provincial legislation, the Health Professions act, to maintain their continuing competence (Province of Alberta, 2010). One means of doing so is to participate in accredited continuing medical education (CME) events such as rounds. Rounds are lectures on specific medical topics delivered at large urban hospitals. The University of Alberta Department of Medicine delivers weekly Grand Rounds on a range of topics relevant to providing care to adults. Health professionals in rural and remote communities cannot easily access Medical Grand Rounds. This is the first of three papers which will examine the potential to use technology to make Medical Grand Rounds available to health professionals. This paper will use the SECTIONS model, as defined by Bates & Poole (2003), to identify the opportunity of using distance education technology to make Medical Grand Rounds available to an audience beyond the University of Alberta campus. The second paper will identify and examine specific technology which could be used to deliver these rounds. The final paper will propose specifics regarding how Medical Grand Rounds could be delivered using technology and provide details such as costs and implications to the instructors and administrators.
Description of the Course Continuing medical education (CME) is a generic term used to describe the process of providing ongoing post-graduate education to health professionals, primarily physicians. The intention of CME is to formalize the maintenance of, and improvement in, the practice of health professionals to deliver patient care. Professional governing bodies, such as The Royal College of Physicians and Surgeons Canada, require their members to demonstrate continuous learning in order to maintain membership (Royal College of Physicians and Surgeons Canada, 2009). In
SECTIONS Model Medical Grand Rounds Alberta health professionals are required by legislation to maintain their professional competence (Province of Alberta, 2010). Physicians practicing in Alberta can participate in CME events provided by the two medical schools, University of Alberta and University of Calgary, and medical programs of Alberta Health Services, the provincial health board. Medical Grand Rounds provided by the University of Alberta, Department of Medicine are multi-disciplinary lectures regarding the diagnosis and treatment of diseases experienced by adults. Medical Grand Rounds are delivered weekly throughout the school year (September to June) and involve a lecture followed by questions and discussion. Each lecture is delivered by a different lecturer though over the course of time a lecturer may present at Medical Grand Rounds on more than one occasion. These lectures are held in a classroom at the Walter MacKenzie Center which is the teaching hospital located on the University of Alberta campus. Approximately 50 physicians, primarily Department of Medicine clinical and research faculty, attend the live lecture. The following section identifies the potential audience that could be reached by using distance education technology to deliver these lectures.
Who are the Students The principle audience, i.e., the students, who will be targeted to receive Medical Grand Rounds via distance education technology are physicians in Alberta working outside of Edmonton who cannot access live Medical Grand Rounds. But all health professionals working in Alberta are required to demonstrate that they are completing ongoing competence training. Presently there are just over 2,100 physicians in rural communities (College of Physicians & Surgeons of Alberta, 2012). The largest group of health professionals are nurses. In 2008, there were 32,800 nurses working in Alberta, approximately 10,000 of these nurses work outside of Edmonton and Calgary (Canadian Institute of Health Information, 2010). The potential audience
SECTIONS Model Medical Grand Rounds for Medical Grand Rounds is very large. However, health professionals in rural and remote communities face a range of barriers to access Medical Grand Rounds. These barriers include having time required to travel, inability to take time away from clinical practice, and associated costs of lost work (Curran, Fleet, & Kirby, 2006; Penz, D'Arcy, & Stewart, 2007). Distance education technology, such live videoconference broadcast or recording for access from a web based video archive, could provide an opportunity to increase the potential for target audience to access Medical Grand Rounds.
Ease of Use and Cost Medical Grand Rounds are delivered as weekly lectures to a live audience at the Walter MacKenzie Centre in Edmonton. The lectures typically include powerpoint slides to illustrate aspects of the lecture. This format is very familiar to both the students and the lecturer. Introducing technology to enable health professionals in rural and remote communities to participate in the lectures could increase the complexity for the lecturers and participants. Planning for what technology could be put in place will have to reflect the impact on lecturers and remote participants. The revolving nature of Medical Grand Rounds lecturers creates a much more complicated environment for training the teaching staff. It also makes it difficult for the lecturer to become familiar with new technology as they may only use it once every year or two. Ideally the technology being used will be transparent to the lecturer. The nature of the target audience also presents a challenge. Rural health professionals are very busy with their patients and office obligations so have little opportunity to participate in education events which require them to leave their office. Fortunately computer use among physicians is high (Martin, 2001). In addition, rural Alberta has good availability of the internet, a 2007 survey found that 70% of
SECTIONS Model Medical Grand Rounds rural Canadians are internet users (McKeown & Veenhof, 2009). This could allow remote health professionals the opportunity to access the events during less busy times of the day, or at home. Medical Grand Rounds are delivered free of cost. Future analysis would have to determine the capital and ongoing costs of using distance education technology to deliver these lectures. This analysis will also identify benefits associated with rural health professionals being able to receive Medical Grand Rounds.
Teaching and Learning The format of the Medical Grand Rounds is a didactic lecture where an expert instructor, typically a physician, provides a 30 to 40 minute talk then takes questions from the audience. Concrete information in the form of text on powerpoint slides is augmented with narration and multimedia (photos, graphs, short videos). The multimedia nature of these lectures indicates that the distance technology used will have to accommodate, at a minimum, video transmission (Bates & Pooley, 2003. p.96). There is no student assessment associated with Medical Grand Rounds so the technology put in place would not require this. However there is a need to register participation to enable participants to receive a credit for the total time spent participating in CME. Credit is given in the form of a certificate provided by the Department of Medicine twice per year. Therefore the distance education technology will be required to have some form of registration for remote participants.
Interactivity In the current lecture format of Medical Grand Rounds time is reserved to allow participating health professionals to ask questions of the speaker. In addition, the live format likely creates a social format which includes the opportunity for learner-to-learner interaction. Creating social opportunities for remote participants of Medical Grand Rounds will be
SECTIONS Model Medical Grand Rounds challenging, especially if synchronous interaction with the presenter is desired. However asynchronous interaction may be feasible and could allow for interaction amongst health professionals in various rural communities. Further investigation could include recruiting health professionals in remote communities to gain their input on how to incorporate distance education technology into the delivery of Medical Grand Rounds.
Organizational Issues The mandate of the Department of Medicine is to train physicians, support medical research, and provide clinical services to the public. Medical Grand Rounds provide a learning forum for physicians and a place for researchers to present and discuss their work. The Department of Medicine is open to explore the use of technology to deliver rounds to remote health professionals. A challenge of implementing technology is the fact that the Department has to work with a range of partners such as Alberta Health Services (AHS). AHS is the provincial health board which is responsible for the delivery of most health services in Alberta communities. Most physicians in Alberta practice within AHS facilities. The implementation of distance education technology to deliver Medical Grand Rounds could be complicated if the installation of new equipment at AHS facilities is required or if existing resources are going to be used in new ways, such as installing new software on computers. Future planning will have to identify internal and external partners who need to be involved to ensure the success of implementing distance education technology.
Novelty & Speed The typical means of delivering medical rounds, classroom lectures, is far from novel. Using technology to increase the audience to include health professionals in remote communities represents an innovation which may attract the interest of the Department of Medicine and other
SECTIONS Model Medical Grand Rounds partners to make such a change. The speed of developing content for Medical Grand Rounds remains the same whether technology is used or not. The content is created by each speaker therefore the work is distributed among a group of people. The topic areas can change year to year according to comments from the audience, who are asked in the evaluation questionnaire to identify areas of interest for future presentations.
Conclusion Health professionals in Alberta are required by provincial legislation, the Health Professions act, to maintain their continuing competence. CME accredited lecture series such as the geriatric grand rounds are a means of accessing professional development. Health professionals in rural and remote communities cannot easily accessing CME rounds. This paper has used the SECTIONS model to describe how applying distance education technology could enable rural health professionals to more easily access Medical Grand Rounds. Distance technology such as live videoconference broadcast or recording the lectures for online access could provide a means of increasing access to these rounds. Further investigation will undertake detailed examination of specific technologies.
SECTIONS Model Medical Grand Rounds
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