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«A thesis Presented to The Faculty of Education University of Ottawa In partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy ...»

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Exploring learning experiences and outcomes among cardiologists participating in a web

conference workshop series.

A thesis

Presented to

The Faculty of Education

University of Ottawa

In partial Fulfillment

of the Requirements for the Degree of

Doctor of Philosophy

by

Carolyn E. Pullen

October 9th, 2012

© Carolyn Pullen, Ottawa, Canada, 2012

EXPLORING PRACTICE CHANGE

Abstract

Opportunities for supporting physician continuing professional development (CPD) may exist through careful instructional design and creative use of information and communication technology. The overarching goal of this study was to explore the learning experiences and outcomes of cardiologists participating in a web conference (“webinar”) series to understand the factors that can support webinars in being an appealing and satisfying CPD medium for these learners. Acknowledging that a pedagogically-based framework for program design is a cornerstone of effective CPD (Hutchinson & Estabrooks, 2009; Inan & Lowther, 2007; Casimiro, MacDonald, Thompson, & Stodel, 2009), this study used the W(e)Learn Framework (MacDonald, Stodel, Thompson, & Casimiro, 2009) as a process guide and quality standard for program design, development and delivery.

Cardiologists voluntarily participated in an educational webinar series in which they shared their observations and experiences. Informed by the results of a systematic review of physician eLearning design preferences, this dissertation serves as a mechanism to learn about how webinars can be implemented to support learning and practice change within a population of highly specialized physician learners. Methodological approaches included a systematic review of literature examining physician preferences for eLearning design, a case study of webinar implementation, and interviews with cardiologists who participated in the webinars.

The findings of the systematic review, the case study and the interviews aligned to characterize key considerations in webinar implementation. Webinar designers must carefully determine program structures, content, and media to create a satisfying learning experience. Cardiologists ii

EXPLORING PRACTICE CHANGE

seek a webinar experience that responds to their professional reality of competing priorities, complex patients, and ambiguous clinical questions. They seek a mix of evidence-based, authentic and challenging content, delivered by credible content experts. The study found that purposefully designed webinars can be a satisfying learning experience for cardiologists with the potential to influence changes in knowledge and practice. The use of an instructional design framework may structure and enrich webinar implementation; this dissertation encourages their use.

–  –  –

When I set out to pursue a doctoral degree, I envisioned a primarily solo journey, advancing month by month by way of my own initiative. Looking back, I now know a PhD is anything but an independent endeavor. Like an exploratory river trip, by the time the expedition was underway, many had joined my company to variously follow and lead through an amazing wilderness that, at every turn, presented curiosities, challenges, and small victories. The degree is my reward, but, for me, the magic was fully in the people and the path we traveled together.

At my side from the start was my thesis advisor, Dr. Colla MacDonald. Her enthusiasm, boundless energy, and creative input were invaluable to me. I am grateful for her advice, support and wonderful sense of humour. Drs. Ian Graham, Ruth Kane and Angus McMurtry formed my thesis advisory committee. They challenged my thinking and pushed me as a researcher. Their depth of knowledge and input at key stages strengthened my study and this thesis. The compassion they showed at critical points is a testament to their exceptional mentorship. The external examiner, Dr. Joan Sargeant, likewise contributed highly constructive feedback that expanded the breadth of my inquiry and enhanced my thesis in many ways. It was a pleasure to work with and learn from these talented researchers.

I was fortunate to have a wonderful group of colleagues, now friends, to work with to build and deliver the Heart Failure program. Marie Josée Martin, Jody McCombe, and Drs. Bob McKelvie, Justin Ezekowitz and Jonathan Howlett were tireless and endlessly good natured.

They invested countless hours in this journey and I am thankful for their inquisitiveness and dedication that kept them engaged from the first team meeting to the final interview.

–  –  –

Many extended family and friends encouraged me and helped maintain my momentum. I am indebted to Jean Woo, in particular. Jean’s friendship, Tiger Mother qualities and generosity with her time and knowledge made all the difference as I entered the home stretch.

My family was my rock-solid foundation. My ever-supportive parents lent helping hands on many occasions in many ways. Their unflagging belief in the capabilities of their children is among their most endearing qualities. My sister in law, more like sister, Dr. Kristen Hayes, was a pillar of support. She is deeply wise, whip smart, endlessly kind. We had many after-dinner, running, and riverside coaching sessions that helped me understand, navigate, and prepare, ensuring I arrived strong at the finish. I can’t thank her enough. My sons Ben and James were my inspiration and conscripted supporters. Only 5 and 7 when I started, they didn’t realize what I was signing them up for. They fully accepted my decision to pursue a PhD, never begrudged my absences, and always gave hugs when I arrived back home. They cheered me as I went, especially when Thai take-out marked the milestones. It is a great joy to me to see that this experience helped embed the principle of lifelong learning as a natural element of our family culture. I look forward to unconditionally supporting them in achieving their goals, they way they did for me.





Above all, I thank my husband, Jim. For six of the busiest years of our lives, he goodnaturedly shouldered the cooking and coaching load (though I’m not the only one glad about that!), allowing me to vanish for hours. He innately understood that I needed to do this and never questioned. I know no one more considerate and patient. He suggested superb, non PhD-related reading to keep my horizons wide, and diplomatically explained, more than a few times, that “whom” is the object of the verb. I am greatly blessed to have him in my life. Above all others, I owe my success to him.

–  –  –

Abstract

Acknowledgements

Table of Contents

CHAPTER 1

Healthcare Context

Research Problem

Literature Review

Continuing Professional Development

Information and Communication Technologies and ELearning

Learning Theories

Research Design and Methodology

Study Setting and Context

Study Intervention: A Webinar Series for Cardiologists

Research Questions

Researcher Philosophical Assumptions

Methods

Study Population and Recruitment

Data Collection Methods

Data Analysis

Ethical Considerations

Trustworthiness

Structure of Dissertation

Conclusion

Contribution to the Field of Education

References

CHAPTER 2 (Article 1)

Introduction

Methods

Search Strategy and Selection Criteria

Quality Assessment

Data Extraction and Analysis

Results

Structure

Content

Media

Service

Discussion

Physician Preferences for ELearning Design

Suggested Refinements to the W(e)Learn Framework

vi

EXPLORING PRACTICE CHANGE

Limitations

Conclusion

References

Figure 2

Appendix A: Search strategy

Appendix B: Quality assessment of included studies

Appendix C: Characteristics of included studies

Appendix D: Findings from all included studies

CHAPTER 3 (Article 2)

Theoretical Background

Constructivist Learning Theory

The W(e)Learn Framework for Online Education

Methods

Data Collection

Data Analysis

Results

How Needs Assessment Results Influenced Webinar Design and Delivery................ 130  Results from Feedback Surveys

Ongoing Improvements to Webinar Implementation

Individual Learners versus a Learning Community

Use of the Asynchronous Webinar Recordings

Discussion

Use of a Design Framework

The Role of the Design Team

Outcomes of the Webinar Series

The Learning Environment: Learning Communities and Real-time Engagement....... 143  Asynchronous Resources

Limitations

Conclusion

References

Appendix A: Flow diagram of webinar series participants………………………………...155 Appendix B: Demographic and learning needs assessment survey results………..…..…156 Appendix C: Webinar program outline and summary of observations and changes....... 160  Appendix D: Sample case content for a CCS heart failure webinar

Appendix E: Summary of webinar participation data

Appendix F: Feedback survey data from webinars 1-4

CHAPTER 4 (Article 3)

Study Background

Methods

Study Design

Participants and Recruitment

Interview Design

Data Analysis

vii

EXPLORING PRACTICE CHANGE

Findings

Study Question 1

Study Question 2

Discussion

Content

Structure

Webinar Technology

Webinar Outcomes

Limitations

Conclusion

References

Figure 1: Comparison of demographics…………………………………………………201 Appendix A: Semi-structured interview questions

CHAPTER 5

Summary of Results

Integration of Results

Learning Experiences

Important Factors in Webinar Design, Development and Delivery

The Use of an Instructional Design Framework

Implications

Implications for Webinar Design for Cardiologists

Implications for Designers of CPD for Physicians

Implications for Supporting Practice Change

Implications for Future Research

Contribution to CPD Research

Limitations

Research Design Biases

Researcher Bias

Strengths

Personal Reflection………………………………………………………………………….... 230 Conclusion

References

APPENDICES Appendix A: ELearning frameworks and guidelines

Appendix B: The W(e)Learn Framework

Appendix C: Demographic and educational needs survey

Appendix D: Heart failure webinar feedback form

Appendix E: Letter of informed consent to the participants

Appendix F: Letter to the Canadian Cardiovascular Society administration

–  –  –

This chapter describes the foundation for this study which explores the learning experiences and outcomes among cardiologists participating in a web conference workshop series. The chapter begins with an overview of the current landscape in healthcare as it relates to knowledge-to-practice gaps, a role for continuing professional development (CPD) in closing this gap, and the potential for eLearning 1 as a medium for delivering CPD.

The description of the healthcare context is followed by a presentation of the research problem, and an in-depth review of the literature. The literature review addresses CPD, information and communication technology (ICT), and constructivist learning theory, to provide the necessary foundation for studying cardiologists’ learning experiences in and outcomes from a webinar-based CPD program. The study’s conceptual framework is then presented to illustrate the relationship between the theories and constructs upon which this study is grounded. The research questions are then specified, followed by presentation of the research design and methods. To assist readers in navigating this body of work, the chapter concludes with an outline of how this article-based dissertation is organized.

–  –  –

The speed and magnitude at which the research base in medicine is expanding has created a compounding challenge for physicians in keeping informed about evidence-based changes to best practices (Grimshaw et al., 2004; Lenfant, 2003). A landmark 2003 study on the quality of

–  –  –

healthcare in the United States found gaps between current research and practice resulting in patients receiving recommended care less than 55% of the time (McGlynn et al., 2003). Other researchers have similarly shown that patient care is frequently inconsistent with best practice guidelines; some interventions are not only unnecessary, but contraindicated (Cochrane et al., 2007; Grol, 2001; Lang, Wyer, & Haynes, 2007). In response to these findings, concerned individuals and groups have suggested that strengthening the tools and techniques for continuing professional development (CPD) for physicians may contribute to reducing the knowledge-to practice-gap (Bloom, 2005; Bordage, Carlin, & Mazmanian, 2009; Marinopoulos et al., 2007).

Continuing professional development is a career-long activity which enables physicians to keep current with best practices in the broad spectrum of skills and knowledge required in the practice of medicine (Peck, McCall, McLaren, & Rotem, 2000). Its purpose is to support ongoing development of professional competencies by keeping physicians abreast of the latest advances in patient care, helping them accept or reject new practices, and convincing them to discontinue less effective practices (Bordage et al., 2009). Fostering changes in attitude and knowledge through CPD has been identified as one mechanism to support physicians in moving research evidence into clinical practice (Hutchinson & Estabrooks, 2009).



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