Curriculum Innovations: Teaching Residents About Guideline Development and Cost-Conscious Care: A Mixed-Method Evaluation Study.

Abstract

Introduction and problem statement: Clinical practice guidelines (CPGs) can play a crucial role in achieving better and more cost-efficient health care. This requires training health care providers in CPG development. This study presents results of design-based research on a training program based on the learning theory of problem-based learning, following the underlying principles of active, authentic, collaborative, and blended learning.

Objectives: The CoCoCare training aims to equip neurology residents with insight in CPG development (including cost aspects) and understanding of how to apply CPGs in clinical practice.

Methods and curriculum description: The CoCoCare training consisted of 6 asynchronous e-learning modules, synchronous workshops (1 day onsite in run 1 and dispersed online sessions in run 2), and a series of online assignments mimicking the steps of CPG development. Participants could present their draft guidelines at the European Academy of Neurology conference. Between 2019 and 2021, 55 participants from 21 European member states participated in the training. A mixed-method design-based research study design was used to collect questionnaire and interview data from participants and trainers.

Results and assessment data: Participants felt that the training prepared them to participate in CPG development and that they had learned how to critically appraise a guideline and were stimulated to apply guidelines in practice. Trainers were also positive and observed an upward trend in the knowledge of the participants. Participants especially appreciated the active (assignments) and authentic learning in the practical part of the training, but the workload of the assignments in combination with clinical work was a challenge. They also enjoyed the collaborative learning in an international group of residents but asked for more interaction and support during the period dedicated to assignments.

Discussion and lessons learned: The CoCoCare training program proved to be a feasible and unique, international guideline development training with a focus on cost-efficient care. Recommendations include to arrange accreditation, ensure regular interaction between trainers and participants, review the workload of assignments, and look at possibilities to provide feedback. Future research should evaluate the impact on CPG application and participation in CPG development.