Browsing by Author "Davis, David A"

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Clinical Performance Improvement in Diabetes: Adapting a Proven Model in Dubai
(2019) Davis, David A
Abstract: The Dubai Performance Improvement (P.I.) project in Diabetes (Dubai-PID) will replicate the 6-phase process used in the European Performance Improvement in Diabetes Demonstration project (EPIDD), an initiative deployed in the region of Cantabria, Spain. Dubai-PID will aim to improve clinical practice of primary care teams treating and managing Type 2 Diabetes (T2D) patients in Dubai. The project will begin with the formation of a Triple Helix collaborative between a private P.I. organisation (AXDEV), academia (Mohammed Bin Rashid University), and industry and local governmental health authorities. Phase 1 will include the development of a collaborative agreement, defining the roles and responsibilities of each organisation, ensuring a common understanding of the project. In Phase 2, potential practice challenges will be identified from a literature review. In Phase 3, a consultation group of local healthcare providers (HCP) and decision-makers will prioritise the locally relevant challenges, which will be further validated during semi-structured interviews with HCPs. Confirmed challenges will inform case-based educational interventions designed and deployed in selected Dubai clinics during Phase 4. The ethics-approved evaluation (Phase 5)will include online surveys and qualitative interviews with learners, clinic administrators and T2D patients. The initiative will also include a dissemination plan (Phase 6), to ensure sharing of lessons learned to the professional educator and healthcare provider communities. This case will use the results and learnings from EPIDD to inform each phase, to ensure success of the initiative.
Data and Lifelong Learning Protocol: Understanding Cultural Barriers and Facilitators to Using Clinical Performance Data to Support Continuing Professional Development.
(2018-10) Davis, David A
Abstract: Continuing professional development (CPD) can support delivery of high-quality care, but may not be optimized until we can understand cultural barriers and facilitators, especially as innovations emerge. Lifelong learning (LLL), linked with quality improvement, competence, and professionalism, is a core competency in medical education. The purpose of this study is to examine cultural factors (individual, organizational, and systemic) that influence CPD and specifically the use of clinical data to inform LLL and CPD activities. This mixed-method study will examine the perceptions of two learner groups (psychiatrists and general surgeons) in three phases: (1) a survey to understand the relationship between data-informed learning and orientation to LLL; (2) semistructured interviews using purposive and maximum variation sampling techniques to identify individual-, organizational-, and system-level barriers and facilitators to engaging in data-informed LLL to support practice change; and (3) a document analysis of legislation, policies, and procedures related to the access and the use of clinical data for performance improvement in CPD. We obtained research ethics approval from the University Health Network in Toronto, Ontario, Canada. By exploring two distinct learner groups, we will identify contextual features that may inform what educators should consider when conceptualizing and designing CPD activities and what initial actions need to be taken before CPD activities can be optimized. This study will lead to the development of a framework reflective of barriers and facilitators that can be implemented when planning to use data in CPD activities to support data adoption for LLL.
Examining Associations Between Physician Data Utilization for Practice Improvement and Lifelong Learning
(2019) Davis, David A
Introduction: Practice data can inform the selection of educational strategies; however, it is not widely used, even when available. This study’s purpose was to determine factors that influence physician engagement with practice data to advance competence and drive practice change. Methods: A practice-based, pan-Canadian survey was administered to three physician subspecialties: psychiatrists (Psy), radiation oncologists (RO), and general surgeons (GS). The survey was distributed through national specialty society membership lists. The survey assessed factors that influence the use of data for practice improvement and orientation to lifelong learning, using the Jefferson Scale of Physician Lifelong Learning (JeffSPLL). Linear regression was used to model the relationship between the outcome variable frequency of data use and independent predictors of continuous learning to improving practice. Results: A total of 305 practicing physicians (Psy = 203, RO = 53, GS = 49) participated in this study. Most respondents used data for practice improvement (n = 177, 61.7%; Psy = 115, 40.1%; RO = 35; 12.2%; GS = 27, 9.4%) and had high orientation to lifelong learning (JeffSPLL mean scores: Psy = 47.4; RO = 43.5; GS = 45.1; Max = 56). Linear regression analysis identified significant predictors of data use in practice being: frequency of assessing learning needs, helpfulness of data to improve practice, and frequency to develop learning plans. Together, these predictors explained 42.9% of the variance in physicians’ orientation toward integrating accessible data into practice (R2 = 0.426, P < .001). Discussion: This study demonstrates an association between practice data use and perceived data utility, reflection on learning needs and learning plan development. Implications for this work include process development for data-informed action planning for practice improvement for physicians.
Investigating the Relationship Between Resilience, Stress-Coping Strategies, and Learning Approaches to Predict Academic Performance in Undergraduate Medical Students: Protocol for a Proof-of-Concept Study
(2019) Alsheikh-Ali, Alawi; Akhras, Aya; Hassan Khamis, Amar; ; Davis, David A
Background: The evolution of an undergraduate medical student into an adept physician is perpetual, demanding, and stressful. Several studies have indicated medical students have a higher predominance of mental health problems than other student groups of the same age, where medical education acts as a stressor and may lead to unfavorable consequences such as depression, burnout, somatic complaints, decrease in empathy, dismal thoughts about quitting medical school, self harm and suicidal ideation, and poor academic performance. It is imperative to determine the association between important psychoeducational variables and academic performance in the context of medical education to comprehend the response to academic stress. Objective: The aim of this proof-of-concept study is to determine the relationship between resilience, learning approaches, and stress-coping strategies and how they can collectively predict achievement in undergraduate medical students. The following research questions will be addressed: What is the correlation between the psychoeducational variables resilience, learning approaches, and stress-coping strategies? Can academic performance of undergraduate medical students be predicted through the construction of linear relationships between defined variables employing the principles of empirical modeling? Methods: Study population will consist of 234 students registered for the MBBS (Bachelor of Medicine, Bachelor of Surgery) at Mohammed Bin Rashid University of Medicine and Health Sciences distributed over 4 cohorts. Newly registered MBBS students will be excluded from the study. Various psychoeducational variables will be assessed using prevalidated questionnaires. For learning approaches assessment, the Approaches and Study Skills Inventory for Students questionnaire will be employed. Resilience and stress-coping strategies will be evaluated using the Wagnild-Young resilience scale and a coping strategies scale derived from Holahan and Moos’s Coping Strategies Scale, respectively. Independent variables (resilience, stress-coping strategies, and learning approaches) will be calculated. Scores will be tested for normality by using the Shapiro-Wilk test. An interitem correlational matrix of the dependent and independent variables to test pairwise correlation will be formed using Pearson bivariate correlation coefficients. Regression models will be used to answer our questions with type II analyses of variance in tests involving multiple predictors. Regression analyses will be checked for homogeneity of variance (Levine test) and normality of residuals and multicollinearity (variance inflation factor). Statistical significance will be set at 5% (alpha=.05). Effect sizes will be estimated with 95% CIs. Results: Psychoeducational instruments in the form of validated questionnaire have been identified in relation to the objectives. These questionnaires have been formatted for integration into Google forms such that they can be electronically distributed to the consenting participants. We submitted the proposal to MBRU institutional review board (IRB) for which exemption has been awarded (application ID: MBRU-IRB-2019-013). There is no funding in place for this study and no anticipated start date. Total duration of the proposed research is 12 months.
The medical school without walls: Reflections on the future of medical education
(2018) Davis, David A
Introduction: Poems, medical schools and the future of medical education: “Something there is,” Robert Frost said, “that does not love a wall” (Frost 1949). The American poet was providing a lesson: human beings try to build walls; nature attempts to tear them down. Medical educators build walls too: impermeable boundaries between undergraduate and postgraduate education; barriers between health professions; silos created by distinguishing classrooms (and learning) from clinical settings and care; faculties of medicine with no meaningful presence in continuing professional development (CPD). In this commentary, the subject of walls, or the need to tear them down, has been inspired by this question: “If you were made dean of a brand new medical school, with unlimited resources, what would you create?” I feel privileged to write a response to the question, much as I feel privileged to have worked in medical education for nearly five decades, as learner and teacher, fan and critic. In particular, I’m guided by my perspective from the end of the educational continuum: CPD allows a window on the quality, training, experience and outcomes of the educational mills that produce clinicians. It’s led to the creation, in my mind, of an imaginary future school, the medical school without walls. The reasoning that links the concept of walls, the future of medical education, and the question will become clear, hopefully, by the commentary’s conclusion.
A novel 6D-approach to radically transform undergraduate medical education: preliminary reflections from MBRU
(2018-12) Banerjee, Yajnavalka; Azar, Aida J; Tuffnell, Christopher; Bayoumi, Riad; Davis, David A
Background: Designers of undergraduate medical education (UME) need to address the exponentially expanding volume and variability of scientific knowledge, where by didactic teaching techniques need to be augmented by innovative student - centric pedagogical strategies and implementation of milieus, where information, communication and technology-enabled tools are seamlessly integrated, and lifelong information gathering, assimilation, integration and implementation is the ultimate goal. In UME, the basic sciences provide a solid scaffold allowing students to develop their personal critical decisional framework as well as define the understanding of normal human physiology, pivotal for the identification, categorization and management of pathophysiology. However, most medical schools confine themselves to“stagnant curricula”, with the implementation of traditional “teacher centered” pedagogical techniques in the dissemination of the courses pertaining to basic sciences in UME. Method: To tackle the above paucity, we present a novel“6D-Approach”for the dissemination of concepts in basic sciences through mentored journal-clubs. The approach is informed by a teaching principle derived from Constructivism. The technique in which the 6D-approach can be implemented in UME, is shown using an example from a first-year course of Molecular Biology and Principles of Genetics at our medical school. A reflection on the impact of 6D-Approach for students as well as instructors is also presented. Result: The 6D-approach was positively received by the students and the formal feedback for the course: Molecular Biology and Principles of Genetics, where the approach was repeatedly employed, indicated that students expressed satisfaction with the teaching strategies employed in the course, with ~ 89% of the students in the cohort strongly agreeing with the highest grading score “extremely satisfied”. Further, the approach through the use of mentored journal clubs encourages retention of knowledge, critical thinking, metacognition, collaboration and leadership skills in addition to self-evaluation and peer feedback. Conclusion: Hence, through the 6D-Approach, our attempt is to initiate, advance and facilitate critical thinking,problem-solving and self-learning in UME, demonstrated by graduating accomplished, competent and safe medical practitioners.
Shaping the future-ready doctor: a first-aid kit to address a gap in medical education.
(2020) Otaki, Farah; Naidoo, Nerissa; Heialy, Saba Al; John-Baptiste, Anne-Marie; Davis, David A; Senok, Abiola
To the Editor: With the advent of Industry 4.0 (i.e., the fourth industrial revolution) came a paradigm shift built on core work-related skills that further dictated the emergence of a "new" world, with diverse professional disruptors and innovators at the forefront. In an effort to address this new paradigm, recommendations in higher education for the "creation of more practical and applied curricula" and for enhancing "relationships between higher education institutions, employers, and other partners . . ." have been proposed. To create a level playing field for global healthcare sectors of the future, Morrison outlined the diverse roles a future-ready doctor will be expected to uphold. Thus, medical education has to evolve to mold a holistic future-ready doctor who can treat and continuously innovate. To this end, medical schools are challenged to amalgamate basic medical sciences with clinical sciences seamlessly and to adapt their curricula to yield millennial physicians who are able to respond to and act on cur-rent and emerging trends in healthcare. In addition to building on Flexner's legacy to ensure progressive pedagogical approaches, innovative means to incorporate the active components of human presence, comparable to that of core work-related attributes (i.e., heart - values, head - knowledge, mind - qualities, and hands - skills), need to be developed. However, it is undeniable that traditional classroom instruction alone cannot produce these characteristics of the future-ready doctor. (Continued)
“Systems-Integrated CME”: The Implementation and Outcomes Imperative for Continuing Medical Education in the Learning Health Care Enterprise
(2021) Davis, David A
Introduction: Health care delivery has evolved from a variably connected collective of individually owned proprietorships and independent hospitals to an environment in which physicians increasingly contract with or are employed by health care enterprises. While continuing medical education (CME) that is focused on the dissemination and maintenance of medical knowledge and the development of skills plays a critical role in helping physicians keep up to date, the authors of this manuscript believe the structure and delivery of CME have not suffi ciently evolved to be broadly viewed by health enterprise leaders as a strategic or integral asset to improving health care delivery. Therefore, an evolution and a reconceptualization of the structure and function of CME are necessary to enable collaboration between leaders and improvement experts in health care enterprises and CME. In this paper, the authors describe models that better refl ect a more eff ective role of CME within learning health care delivery enterprises and the implications of such models for these enterprises and the CME profession.
Translating evidence into practice: Lessons for CPD
(2018) Davis, David A
Background: Failure to translate best evidence into practice often generates inappropriate, unsafe, and costly healthcare.The continuing professional development (CPD) of physicians and other health professionals represents a widely underutilized strategy to improve both clinician performance and healthcare quality and safety. The evidence: Despite the clear evidence of the potential impact of CPD based in learning theory and science, some CPD providers, health systems, and clinicians themselves implement less-than-effective effective learning strategies. This phenomenon is the product of several factors: within health systems, a lack of recognition of the importance of ongoing, system-linked professional education; among CPD providers, an adherence to old but easy-to-deliver “one-and-done” methods CPD; and even among clinicians themselves, choosing less engaging learning activities, uninformed by objective performance data. Recommendation: Suggestions to improve this lack of translation of best evidence into practice fall into four groups.Academic medical institutions, employers and educators need to embrace principles and practices of self-directed learning; health systems must share responsibility for the physician learning and the performance data and feedback on which such learning is best-based; physician specialty societies and licensing boards must undertake meaningful re-licensure and re-certification processes; and CPD planners must seek out partnerships with health system leadership and quality improvement managers as they create engaging, integrated, and impactful CPD activities.
What Do We Need to Protect, at All Costs, During the 21st Century? Reflections From a Curated, Interactive Co-Created Intellectual Jazz Performance
(2016) Davis, David A
Abstract: The question that forms the title of this article, “What do we need to protect, at all costs, during the 21st century?,” speaks to the sizable changes in health care systems and settings that surround the continuing professional development (CPD) provider, and the need to establish a core set of principles and practices as the field moves forward from both theoretical and practical aspects. It also provided the focus for one of the five keynote lectures presented during the 2016 World Congress on Continuing Professional Development. As the planners of this keynote session, we sought to evoke answers to the question, not from the speaker, but from the audience itself, a process enabled by a highly engaging presentation style and powered by interactive digital technologies. Further, we believed that the session would not directly lead to suggestions to improve the theory and practice of CPD, but rather to create the biopsychosocial context—a sort of platform—on which such discussions can occur.