Promoting Public Health >>Promoting Public Health among Health Professionals Training in Methodology and Documentation

TRAINING IN METHODOLOGY AND DOCUMENTATION

Background.

The means traditionally used by doctors to keep up to date in their fields, such as attending congresses or subscribing to medical journals, are no longer adequate in a world in which the sheer volume of offerings undermines their usefulness. There are more than 30,000 medical journals; the 4,000 best publish more than 400,000 articles a year, and only 15% of them apply a sufficiently rigorous and systematic methodology to guarantee the reliability of their results.

Doctors feel the need to keep up to date and they try to do so, but few are familiar with the modern computer techniques that are indispensable in handling such a volume of information. Similarly, most physicians do not know how to filter the information quickly according to its scientific quality in order to select reliable articles that really should be studied.

Finally, the pressure of work and attending patients often leaves the physician without the time he or she needs to be able to review hundreds of thousands of articles each year in order to find those referring to his or her specialization, to evaluate their scientific quality in order to discard those whose results could be counter productive because they were developed with a scientifically incorrect methodology, and finally, to study carefully those selected.

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Objective.

The objective of this project is to provide health care professionals with the minimum necessary skills in order to:

1. Have access to those scientific articles published each year in the most important medical journals around the world and to select those of interest according to topic.

2. Evaluate quickly the methodological quality of these articles in order to select and study only that information that has been scientifically validated and is reliable.

By reaching all the information and selecting the studies or articles that are relevant and reliable, the medical professional can update his or her knowledge with less effort and expense.

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Description.

The Foundation decided to limit its goals in this field for the following reasons:

1. Target population. It was not realistic to assume that all practicing physicians were interested in methodology and documentation. While they are indispensable in order to reach a minimum degree of autonomy in the process of keeping up with one's profession, many doctors prefer to delegate this task to certain publications or to their representative bodies. This program was directed specifically at those professionals who, without wishing to cease being essentially practicing physicians, wanted to acquire the minimal methodological skills to maintain their medical practice up to date.

2. Teaching and the availability of courses. The Kovacs Foundation is essentially research-oriented. This project was especially appropriate at a time in which the only available courses in research methodology and medical documentation were very specialized, as they were directed at those who wanted to dedicate themselves professionally to research. Therefore, they did not reach the body of professionals dedicated to providing health care. Thus, the Kovacs Foundation designed this program, assuming the role of catalyst in order to encourage the development of courses of this kind. However, the Foundation did not intend to offer the course indefinitely or to compete with other public or private teaching institutions as soon as they recognized the need the Foundation had sought to cover.

3. Geographic setting and exact resource. The cost was to be assumed in part by the Kovacs Foundation so that its price would not be a limiting factor. Nevertheless, it was not acceptable to take Foundation resources away from research in order to finance this project, so its application was limited to those geographic settings where there were entities willing to co-finance the project along with the Kovacs Foundation.

The Kovacs Foundation decided to organize a pilot program for the doctors of the Balearic Islands. It consisted of seminars that did not seek to transform the participants into research experts, but rather to provide the minimum, indispensable information needed in order to keep their practice up to date.

The Kovacs Foundation took the necessary measures to make the seminars attractive and useful for the doctors. To make them attractive, the Foundation:

1. Selected the topics in terms of the doctors' priority interest. A questionnaire was sent to all of the doctors in the region asking which of the following subjects interested them (see adjoining table):

   -	Seminars Offered
   -	Access to Biomedical Information
   -	Analysis of Health Data by Means of the SPSS I Program.
   -	Analysis of Health Data by Means of the SPSS II Program.
   -	Analysis of Health Data by Means of the SPSS III Program.
   -	Application of the Internet in the Health Sciences.
   -	Basic Concepts of Epidemiology
   -	Basic Concepts of Statistics.
   -	Email and the World Wide Web
   -	Creation and Management of Personal Bibliographic Databases by Means of the Reference Manager.
   -	Research Design
   -	Clinical Trials and Studies of the Effectiveness of Treatments
   -	Advanced Statistics (I): Multivariant Analysis. Multiple regression.
   -	Advanced Statistics (II): Multivariant Analysis. Logistical regression
   -	Advanced Statistics (III): Survival Analysis. Cox regression.
   -	Efficacy and Effectiveness Studies. Clinical Decision-making.
   -	Evaluation of Diagnostic Procedures
   -	Evaluation of Health Technology
   -	Introduction to Windows 95/98
   -	Introduction and Use of PowerPoint Presentations
   -	Critical Reading of Clinical Trials
   -	Finding Articles on Medline
   -	Advanced Use of Windows 95/98
   -	Methodology of Scientific Communication
   -	Teaching Methodology
   -	Workshop on Internet

   
   

2. It offered doctors the possibility of adding subjects that interested them that had not figured in the list of proposals.

3. It insisted on the practical and brief nature of the seminars. Most were fewer than 10 class-hours. The concept was to transmit the necessary skills and knowledge in a practical manner and to organize other more specialized and equally brief seminars for those who wished to study a given subject in greater depth.

4. It organized the seminars around the students; the calendar and schedule of each one was fixed in terms of the preferences of those registered to attend. Moreover, the Foundation and Sa Nostra-Caixa de Balears Savings Bank financed the project so that the price paid by the student for each seminar represented approximately 20% of its cost.

To ensure that the seminars were useful, the Foundation:

1. Hired experts to teach them, who in addition to having great theoretical knowledge also, because of their work, put the concepts they taught into practice each day.

2. Included the collaboration of clinical advisers. Chosen from among the most prestigious practicing physicians in the region, these advisers defined the most current and controversial topics in their respective fields of specialization. These topics were then used as examples to find studies and to evaluate their scientific quality during the seminars.

So that the Foundation could evaluate its own efforts, all of the participants in each of the seminars filled out an anonymous evaluation at the end of the seminar. In it, on a scale of 0 to 10, they rated its organization, the infrastructure used, the available media, the teachers, the program content and its practical applicability. Their suggestions were also solicited in order to improve future editions of the seminar that each student had attended

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Along with the Kovacs Foundation, the following have participated in this project.

La Conselleria de Sanitat i Consum del Govern de les Illes Balears, (The Department of Health and Consumer Rights of the Autonomous Government of the Balearic Islands), the University of the Balearic Islands, INSALUD of Baleares, The Academy of Medical Sciences of Baleares and the Illustrious Official College of Physicians of Baleares.

The program was co-funded by the Kovacs Foundation, Sa Nostra-Caixa de Balears Savings Bank, and the Office of the President of the Autonomous Government of the Balearic Islands.

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Status.

The project was a success, both in terms of the number of students and their evaluations of the seminars. The number of registrations corresponded to approximately 15% of all of the doctors in the Balearic Islands.

Given the success of its first edition in 1996, the seminars were extended to other health professionals in addition to doctors: pharmacologists, veterinarians, psychologists, nurses and physiotherapists.

On a scale of 0 to 10, in which 10 represented the best score possible, the average points given to each aspect of the seminars held between September 1996 and January of 2000 were the following: Organization: 8.58, Infrastructure: 8.11, Media: 8.63, Teachers: 9.09, Program content: 8.87, Applicability: 8.20.

The main problem found among some of the doctors was the time limitation imposed by professional commitments. While the seminars were scheduled on the days and hours chosen by the professionals, some of those registered could not be physically present for the entire seminar.

For that reason, in 1998, this project was transformed into a video-training project in systems of actualization in the Health Sciences. A mechanism for this "tele-education" was established that permitted the health professionals to receive the necessary training without having to attend the seminars in person.

Registration for and completion of the courses could be made on-line. Also, because not all doctors have access to the Internet, it was also possible to send all course documentation by standard mail. The teacher of each course could also be contacted by means of E-mail or fax.

In the year 2000, the Foundation acknowledged the success already achieved with this project and the fact that in the five years since the seminars began, this kind of training for doctors was now being offered more widely. Considering that its proposed goals had been met, the project was concluded.