An Educational Needs Assessment for Urban and Rural Primary Care Clinicians

An Educational Needs Assessment for Urban and Rural Primary Care Clinicians in Eastern Ontario: Focus on Youth Mental Health

Dr. Helen Spenser, Psychiatry, Mental Health Patient Service Unit, Children’s Hospital of Eastern Ontario

Study Rationale

Since the 1980’s, Medical Educators such as Abrahamson (1999), and Davis, et al. (1992), have introduced principles of Adult Learning and Problem Based Learning into CME. The purpose of this study was to pilot a needs assessment surveying groups of both rural and urban health care providers (rural = population served <50,000) as to preferred learning format, and perceived gaps in knowledge with respect to ability to provide comprehensive mental health care to youth.

Background

A survey done in the Mayo Clinic showed only 27% GP’s were satisfied with CE courses attended in psychiatry (Tinsley, et al. 1998). An Australian study (Veit, et al. 1996), surveyed 57 rural and urban GP’s finding 82% to have concerns about knowledge and competence to treat adolescent patients who made up 10% of their practice. Many Educational Programs for physicians are offered without assessing their learning needs.

Method

A two-page educational needs assessment questionnaire was developed following a focus group with eight academic family doctors. Six questions polled clinicians for their preferred learning format, for example, large group lecture versus live supervision by a psychiatrist. Thirteen possible topics for Continuing Education with respect to Child and Adolescent Mental Health were given using descriptive rather than a diagnostic frame.

Demographics

Ninety five health care professionals (61 urban and 34 rural; 74 physicians, 6 nurses, 3 social workers, one child care worker, and 2 others) were surveyed using multiple sources for questionnaires including: rural Grand Rounds (2), mail out to rural physicians, pediatric updates at urban university (2), and mail out to urban physicians (2).

Results

Urban physicians were significantly more likely to request educational sessions on dealing with aggressive and “wild” behaviour in youth (Z=3.54) P<.001. Rural health care providers showed a trend towards more eclectic and variable learning needs with top three choices ADHD, Mood Disorder, Learning Disability and Anxiety. Rural attendees were less likely to be physicians and more likely to request hands-on counseling skills teaching. Both Urban and Rural clinicians show a preference for small group interactive learning format.

Implications

This study reinforces the importance of evaluating the demographics and interests of both the physician and his or her patient population prior to launching an educational program. There is a clearly identified need for more education of clinicians in Adolescent Mental Health. Further study will consider adding measures for yet unperceived needs. For future studies, equal numbers of rural and urban clinicians surveyed with a larger total number would be preferable for more statistical power.

References

Abrahamson, S., Baron, J., Elstein, A., Hammond, W.P., Holzman, G.B., Marlow, B., et al. (1999). Continuing medical education for life: Eight principles, Academic Medicine, 74(12), 1288-1294.

Davis, D.A., Thomson, M.A., Oxman, A.D., Haynes, R.B. (1992). Evidence of the effectiveness of CME: A review of 50 randomized controlled trials. Journal of the American Medical Association, 268, 1111-1117.

Falloon, I.R., Ng, B., Bensemann, E., Kydd, R.R. (1996). The role of general practitioners in mental health care: A survey of needs and problems. The New Zealand Medical Journal, 109(1015), 34-36.

Hardoff, D., Tamir, A., Palti, H. (1999). Attitudes and practices of Israeli physicians toward adolescent health care: A national survey. Journal of Adolescent Health, 25(1) 35-39.

Tinsley, J.A., Shadid, G.E., Hongzhe, L., Offord, KP, Agerter, D.C. (1998). A survey of family physicians and psychiatrists: Psychotropic prescribing practices and educational needs. General Hospital Psychiatry, 20, 360-367.

Veit, F.C., Sanci, L.A., Coffey, C.M., Young D.Y., Bowes, G. (1996). Barriers to effective primary health care for adolescents. Medical Journal of Australia, 165(3), 131-133.