Parboosingh I John, Reed Virginia A, Caldwell Palmer James, Bernstein Henry H
University of Calgary.
J Contin Educ Health Prof. 2011 Spring;31(2):122-7. doi: 10.1002/chp.20116.
Research into networking and interactivity among practitioners is providing new information that has the potential to enhance the effectiveness of practice improvement initiatives. This commentary reviews the evidence that practitioner interactivity can facilitate emergent learning and behavior change that lead to practice improvements. Insights from learning theories provide a framework for understanding emergent learning as the product of interactions between individuals in trusted relationships, such as occurs in communities of practice. This framework helps explain why some groups respond more favorably to improvement initiatives than others. Failure to take advantage of practitioner interactivity may explain in part the disappointingly low mean rates of practice improvement reported in studies of the effectiveness of practice improvement projects. Examples of improvement models in primary care settings that explicitly use relationship building and facilitation techniques to enhance practitioner interactivity are provided. Ingredients of a curriculum to teach relationship building in communities of practice and facilitation skills to enhance learning in small group education sessions are explored. Sufficient evidence exists to support the roles of relationships and interactivity in practice improvement initiatives such that we recommend the development of training programs to teach these skills to CME providers.
对从业者之间的网络和互动性的研究正在提供新信息，这些信息有可能提高实践改进举措的有效性。本评论回顾了相关证据，即从业者的互动性能够促进产生导致实践改进的新兴学习和行为改变。学习理论的见解提供了一个框架，用于将新兴学习理解为处于可信赖关系中的个体之间互动的产物，比如在实践社区中发生的互动。这个框架有助于解释为什么有些群体对改进举措的反应比其他群体更积极。未能利用从业者的互动性可能部分解释了在实践改进项目有效性研究中所报告的令人失望的低平均实践改进率。文中提供了初级保健环境中明确使用建立关系和促进技巧来增强从业者互动性的改进模型示例。探讨了在实践社区中教授建立关系以及在小组教育课程中教授促进学习技巧的课程要素。有充分证据支持关系和互动性在实践改进举措中的作用，因此我们建议开发培训项目，向继续医学教育提供者传授这些技能。
