Enhancing General Practitioners Participation in a Virtual Community of Practice for Continuing Medical Education: an Exploratory Study Abdulaziz MURAD a,1 , Reeva LEDERMAN a , Rachelle BOSUA a , Shanton CHANG a and John D. WARK b,c a School of Computing and Information Systems, The University of Melbourne b Department of Medicine (Royal Melbourne Hospital), The University of Melbourne c Head, Bone & Mineral Medicine, The Royal Melbourne Hospital Abstract. As sources of medical information grow online, Virtual Communities of Practice (VCoPs) have evolved into a potential tool that allows General Practitioners (GPs) to interact through the sharing of their experience and knowledge. However, literature reports that GPs are reluctant to participate in VCoPs especially for their continuing medical education (CME). Currently, no study has explored the design and structural aspects of VCoPs that may lead to enhancing GPs’ participation in such online communities . Hence, this paper explores how GPs envisage the use of a VCoP for their CME and how to enhance their participation by conducting an exploratory qualitative study of two focus groups with 10 GPs in each group, accompanied by a specialist and a nurse. Our empirical findings identified two key contributions: i) seven themes that need to be incorporated in the VCoP to enable and support GP’s CME through the use of a VCoP; ii) three recommendations to take into consideration for researchers when evaluating VCoPs for CME. Keywords. Virtual Communities of Practice, General Practitioners, Continuing Medical Education, Design Considerations Introduction General practice is fundamental for an efficient and effective health system as general practitioners (GPs) are in many communities the primary source of care to individuals and families [1]. Hence, GPs are required to continuously advance their medical education to keep expanding medical knowledge and improve their clinical practice [2]. However, due to the unique nature of their work, GPs face a range of barriers in terms of the learning processes associated with continuing medical education (CME) [3] as they are under constant time pressures due to their work structure and environment, with both factors often cited as an impediment to face-to-face professional development [4]. GPs have recognized online sources as potential support structures for CME if fulfilled within the context of a group of professionals [3]. Any group of GPs can 1 Corresponding Author: Abdulaziz Murad; E-mail: amurad@student.unimelb.edu.au.
become a Virtual Community of Practice (VCoP) to share knowledge and learn more from each other about specific practices [5]. However, GPs have shown an unwillingness to use VCoPs for their CME [3] and even when used, VCoPs suffer high rates of attrition, making them unsustainable for long periods of time [5]. In our previous work [6] we have identified from the literature, a set of four design and one human role consideration to be taken into account when designing a health practitioner VCoP that is focused on sustained learning and knowledge sharing. The four design considerations are subdivided into individual and group design considerations due to the nature of designing a VCoP i.e.: Rich Profile Information (Individual), Platform Navigation (Individual), a Diverse Community (Group), and a Rich Contextual Content (Group). Hence, we postulate that: enhancing GPs’ participation in a VCoP for CME needs to take into account these two individual and two group design considerations and the moderation of human roles to sustain the learning and knowledge-sharing process [6]. By sustained learning we mean keeping participants of a VCoP engaged to contribute to discussions in order to enhance practitioners’ participation [7]. The aims of this paper are two-fold: i) to explore preferred modes and models of VCoP use by GPs for CME and ii) to examine how GPs’ participation in a VCoP can be enhanced to support their CME. Our goal is to test our proposed design considerations which can be incorporated into the design of a VCoP for GPs’ CME to mitigate the previous ly mentioned barriers and motivate GPs to sustaining participation in VCoPs for CME. 1. Method We adopted a qualitative research methodology [8] to test our four design and human role considerations with real users of enhancing GPs participation in using a VCoP for their CME. After obtaining Human Research Ethics approval, we organised and gathered data from two focus groups of 10 GPs each with the presence of a bone health specialist and a nurse in each focus group. The bone health specialist and nurse were included to understand what issues may arise when developing a CME VCoP for GPs and recognising if there is a need to include other health practitioners in the VCoP for enhancing the GPs’ CME experience. Each focus group lasted 30 minutes with the researcher asking eight open ended questions to assess each of the four design and human role consideration identified in our initial study [6]. Questions involved: i) asking GPs about their use of the internet for medical education; ii) if GPs were/are involved in online communities for learning; iii) incentives and opportunities to join an online community; iv) finally, any suggestions on what is needed to keep GPs interested for continuous involvement in a VCoP for CME. Following data collection, we employed a thematic content analysis approach to identify recurring themes that offer rich and compelling insights in understanding and explaining the value of our five design elements for CME in a VCoP [9]. All audio recorded data were transcribed, integrated with our notes and validated by a GP chair and the bone health specialist involved in the two focus groups. Furthermore, a questionnaire with the same questions that were discussed in both focus groups sessions was also sent out to GPs (e.g. n=20) from the same focus groups to answer in their own free time in the event they felt reluctant in answering in the group session. Four written questionnaires were received from participants across the two groups.
2. Findings Seven themes were derived from the responses to the focus group interview and the questionnaires submitted by participants, highlighting the issues of most concern to GPs in using a VCoP for CME. 2.1. Perception of Low Trust and Risk Taking A perceived risk was acknowledged when receiving knowledge from peers online where said knowledge would be an issue to GP’s diagnosing a particular case due to not fully trusting the information source. As a consequence, GPs indicated their preference was to transfer the responsibility of diagnosis to an expert in the field to lower their own responsibility of making a final diagnosis. Furthermore, a suggestion of verifying qualifications of participating GPs would help in building trust from receiving knowledge from peers online: “One of the biggest problem … is that people [GPs] worry about all sorts of things as if they put their case and get some advice on from an internet based versions [online sources], S omehow I don’t know why that [online advice] is more risky than if you refer to… an expert because of full responsibility … The [online VCoP] participants need to be health professionals and there need to be [methods of] verification of [their] qualifications. ” - GP2 2.2. Permission to Share Patient Information GPs felt reluctant when wanting to share patient information online with other GPs because they need patient’s permission to do so due to privacy concerns and taking full responsibility in conveying any diagnostic information: “It takes full responsibil ity [to share patient information] we don’t have the permission of the patients of course, I’m just a bit phased down about this” - GP3 2.3. The Need for Timed Responses A GP mentioned that there needs to be timely responses to clinically-relevant discussions to sustain participation in using a VCoP for CME: “The topics and discussion need to be timely so if clinical problems are raised the professional seeking advice can use it for his/her practice within maybe a few days.” - GP2 2.4. Searching Relevant Websites for Information GPs mentioned that there should be a Website that highlights content from other Websites for their learning of specific medical knowledge: “google information, going to what I believe to be reliable Websites eg better health, dermnet, CDC, subscription sites e.g. therapeutic guidelines, access hospital websites, access patient information for handouts, information form RACGP, Medical indemnity…” – GP2 “There has to be a website [one Website portal] that tells us what ’ s happening [content] o n other websites.” - GP7
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