In order to practise efficiently and provide the best possible care to patients, physicians need to participate in CME and practice-improvement learning opportunities that are both practical and meaningful to them and their patients. Content must be clinically relevant, effect positive change in how physicians practise, and improve patient health outcomes.

Traditionally doctors have participated in CME that delivers instructional objectives and uses specific learning resources.[1] This teaching style requires learners to participate in formal activities and its effectiveness is measured using set criteria.

In recent years the medical practice landscape has shifted significantly: patients are moving toward taking more responsibility for their own health, and the use of EMRs has become widespread. To accommodate this evolution and influence further positive change, physicians are seeking new CME opportunities that allow them to participate in the learning process by defining and identifying content that is meaningful to their practices.

In response to physicians’ requests for innovative learning opportunities, the Practice Support Program (PSP) has introduced a new model of support: small-group learning sessions. This group education model accommodates natural learning styles[1] and focuses on facilitation of learning. Each local division of family practice works with its PSP regional support team coordinator to identify topics that reflect the local quality improvement needs.

Physicians are offered choices about what content is featured, and they are encouraged to identify the information they need based on opportunity, interest, or perceived gaps in care. Depending on the chosen content and facilitation methods, small-group learning sessions have been approved for Mainpro-C accreditation on a basis of one credit per hour.

Evidence shows that interactive sessions, either one-on-one or in a small group, are more likely to result in sustained practice change.[2] Teaching, mentoring, and coaching can be tailored to a small number of learners more easily than to larger groups, and cooperative, problem-based group learning emphasizes effective communication and interactive teamwork. Tailored with this evidence in mind, PSP learning session activities are self-directed 
and focus on physician-identified practice needs.

Small-group learning sessions provide an opportunity for doctors to discuss issues and innovations and to observe practices and procedures before adopting related changes.[2] While participating in small-group learning sessions physicians can: 
•   Explore and customize learnings.
•   Plan for practice changes based on content.
•   Discuss how to embed these changes into their practice workflow and to help enrich provider satisfaction.
•   Test group learning content in a practice environment.
•   Collect aggregated data and share information through a model of supporting reflective learning to ensure the improvements being implemented are sustainable and shared in supporting the physician’s clinic or practice.

After a session doctors can receive in-office support from a physician, MOA peer mentor, or PSP staff (regional support team coordinator). Regional support teams help guide doctors to use new knowledge and skills in their future activities. With coaching, regional support teams aim to: 
•   Support physicians in determining ways to embed practice change into clinical workflows.
•   Illuminate the value in the active, action-based learning experience.
•   Share successes and challenges and transfer knowledge to other physicians as appropriate.

With a goal of supporting sustainable practice changes and improvements, PSP will collect and evaluate aggregated data about the sessions (e.g., themes in topics, learnings, and outcomes) and share successes and experiences.

During July and August, 16 family physicians, 1 nurse, and 16 MOAs participated in four small-group learning sessions across the province, with more sessions planned for the fall. Topics included Med Access upgrade to maternity care, Profile EMR basics, EMR messaging and tasks, entering discrete data into an EMR, and more. The group sessions have been EMR related but small-group learning sessions are not limited to EMRs. It is anticipated that these sessions will evolve to include more emphasis on using the data in the EMR to inform practice improvement in specific clinical care areas.

To support a commitment for change, funding for small group learning sessions is available through regional support teams, and physicians can receive sessional payments for participating in the reflective continuous learning process. For more information on small-group learning sessions or other PSP services visit www.pspbc.ca [10]. 
—Bruce Hobson, MD
Practice Support Program

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This article is the opinion of the GPSC and has not been peer reviewed by the BCMJ Editorial Board.

References

1.    Fox RD, Bennett NL. Learning and change: Implications for continuing medical education. BMJ 1998;316:466-468.
2.    Kalaian SA, Kasim RM. Synthesizing the effectiveness of small-group learning in STEM classes using multilevel meta-analysis methods. Presented at the Annual Meeting of the Mid-Western Educational Research Association, St. Louis, MO, 14 October 2009.