Specialists’ learning from facilitating group peer telementoring: a qualitative study

<h3>Objectives</h3> The Extension for Community Healthcare Outcomes (ECHO) is a proven model to improve specialty care for underserved communities. The IGCS uses the Project ECHO platform to connect multi-disciplinary teams across disparate regions, through virtual tumor board case discussions and didactic presentations. In the Project ECHO sessions, international pathologists provide pathology review, which is often based on limited imaging embedded in Power Point slide presentations. We present an initial review of our experience integrating pathologists into the IGCS virtual tumor boards. <h3>Methods</h3> We solicited feedback from pathologists and clinicians participating in the IGCS ECHO sessions in individual and small group settings. <h3>Results</h3> Clinicians appreciate the inclusion of pathology images and teaching in ECHO sessions with good clinical and educational value. However, challenges were noted with engagement and scheduling with in-country pathologists. Challenges noted by the consulting pathologists included: being asked to offer an opinion with limited information or images, poor quality images, lack of the final pathology report, coping with apparent diagnostic errors, lacking an established relationship with the local pathologist, and the local pathologist not always being present to discuss or explain findings. Opportunities identified include: establishing telepathology connections to facilitate case review, leveraging the IGCS Global Curriculum international mentor/local mentor/trainee model to create parallel and synergistic international and local pathologist collaborative relationships beyond ECHO sessions, further program strengthening through international exchange trips for international and local pathologists. <h3>Conclusions</h3> Inclusion of pathology experts in Project ECHO sessions is key to successful tumor boards. Addressing the above-noted challenges will strengthen the entire collaboration.

Healthcare providers (HCPs) practicing in community settings are critical to improving access to pain care, yet there are significant gaps in training opportunities designed for interprofessional learners. Project Extension for Community Healthcare Outcomes (Project ECHO®) is an established model for delivering online HCP education through virtual clinics and cultivating a community of practice. However, to our knowledge, the integration of pain core competency education into the ECHO® model has not been previously attempted. This innovation could enhance the ECHO® model while also addressing the growing calls for more accessible interprofessional pain curricula. This paper describes efforts to implement and evaluate core competency curricula within the context of Pediatric Project ECHO for Pain, one of the first pediatric-pain focused ECHO programs in the world. Needs assessments informed curricula development. The first delivered core competency model consisted of synchronous webinar-style sessions while the second model included a mixture of asynchronous (eLearning course) and synchronous (virtual clinical debrief) elements. A convenience sample of HCPs was recruited from ECHO program registrants. Participants completed baseline and follow-up surveys to assess core competency acceptability as well as impact on knowledge and self-efficacy related to managing pediatric pain. Usability of the eLearning platform (model 2 only) was also evaluated. Surveys used 5-point Likert scales to capture outcomes. A priori targets included mean scores ≥4/5 for acceptability and ≥80% of learners reporting knowledge and self-efficacy improvements. The study received local research ethics approval. The core competency was found to be highly acceptable to interprofessional learners (n = 31) across delivery models, surpassing a priori targets. Specifically, it was characterized as a worthwhile and satisfactory experience that was helpful in supporting learning. The core competency was also associated with improvements in knowledge and self-efficacy by 97% and 90% of learners, respectively. The eLearning platform was reported to have high usability with clinically realistic cases (100% of respondents) that were helpful to inform care delivery (94% of respondents). The integration of core competency learning within the Project ECHO® model was a successful approach to deliver pediatric pain education to interprofessional HCPs.

Although hepatitis C virus (HCV) infection is curable, treatment of difficult to access populations (DTAP) presents unique challenges. Project ECHO (PE) (Extension for Community Healthcare Outcomes) is a telementoring programme adopted to support clinicians treating DTAP. To determine if the PE model supports primary care clinicians treating HCV and to compare cohort of PE patients with those in a tertiary liver clinic (TLC). Weekly PE group video conferences were conducted. Clinical information, laboratory indices, psychosocial elements and treatment outcomes, including sustained virological response (SVR) data were recorded in the first 100 consecutive cases and retrospectively compared to 100 consecutive patients seen at a TLC from July 2016 to April 2017. Some patient characteristics were similar between PE and TLC: gender (72% vs 75% male; P = 0.23), median age (45 vs 50; P = 0.344) and the proportion of treatment naïve patients (95.0% vs 90.9%). Treatment for HCV was commenced in 78% of the PE patients and 81% of the TLC patients; 67/68 of the TLC patients and 60/61 PE patients with virological follow up who completed treatment and attended follow up have confirmed SVR. PE patients are more likely to have ongoing substance use (44% vs 17% P < 0.001), be active intravenous drug users (32% vs 17%; P < 0.001) and polysubstance abusers (26% vs 7%; P < 0.001) and were more likely to be taking opioid substitution therapy (74% vs 20%; P < 0.001). Indigenous patients were three times more greatly represented in PE (15% vs 5%; P = 0.018). PE is an effective model to support primary healthcare providers treating HCV in DTAP with similar rates of treatment uptake and SVR compared to patients in TLC.

4051 Background: Accurate assessment of biomarkers (including HER2 and PD-L1) is integral to treatment selection in upper gastrointestinal (GI) cancers. However, challenges in integrating biomarker testing and targeted therapies are commonly reported in community settings. The Project Extension for Community Healthcare Outcomes (Project ECHO) model addresses this gap by connecting experts in tertiary care settings with rural healthcare teams. Through case-based teaching, the model builds the knowledge and skills needed to provide evidence-based, equitable care regardless of geographic location. Methods: In October 2024, 57 healthcare professionals (HCPs) from 2 US and 4 Canadian community oncology clinics participated in Project ECHO sessions. Led by an expert oncologist, each session featured interactive discussions of real-world anonymized case presentations to address key practice gaps in integrating biomarker-based therapies and coordinating multidisciplinary care for patients (pts) with upper GI cancers. Following each session, HCPs developed and implemented site-specific action plans to address gaps in care. Pre-activity and post-activity surveys measured the impact on knowledge, confidence, and competence and 90-day follow-up surveys will be collected to assess ongoing performance. Results: The top HCP-reported barriers to individualized care for pts with upper GI cancer included keeping up with the latest efficacy and safety data (44%), selecting and sequencing treatments based on individual and disease factors (40%), and limited availability/cost of biomarker testing (39%). Additionally, relatively few HCPs reported providing supportive care services for the majority of their patients, such as palliative care referrals (40%), distress screening (26%), psychosocial support (35%), and end of life counseling (19%). Following the Project ECHO sessions, HCPs demonstrated improved knowledge, competence, and confidence in biomarker testing and managing adverse events. Additionally, HCPs planned to increase patient education about disease and treatment-related side effects (65%), improve team education on biomarker testing and treatment selection (61%), establish standardized biomarker testing protocols (35%), and increase supportive care referrals (22%). Team action plans included implementing routine testing protocols, establishing a network of specialists to coordinate care, and increasing education on the use of immunotherapy. Conclusions: Project ECHO-based education improved HCP capacity to integrate biomarker-directed therapies and coordinate multidisciplinary care for patients with upper GI cancers. Full findings will detail long-term impacts on practice and inform future community-based ECHO initiatives.

Digital health technologies have reshaped continuing professional development (CPD) in healthcare. However, learning in digitally mediated programs is often assumed rather than explicitly designed and assessed. Project ECHO® (Extension for Community Healthcare Outcomes), a globally implemented telementoring model, expands access to specialized expertise through videoconferencing-based, case-oriented learning. While prior literature has documented program reach, implementation, and clinical outcomes, comparatively less attention has been paid to the interactional mechanisms through which learning unfolds within ECHO sessions. This article conceptualizes Project ECHO as a structured learning environment and proposes a theoretically grounded framework for examining and assessing learning processes in digital CPD. Using situated learning, communities of practice, and cognitive apprenticeship as analytical lenses, this conceptual analysis examines participation structures, distributed expertise, facilitation practices, and case-based dialogue in ECHO sessions. Principles of constructive alignment inform a process-oriented assessment approach aligned with CPD evaluation models such as Moore's framework. This article develops a theory-informed framework that conceptualizes Project ECHO as a structured learning architecture for digital continuing professional development. The framework identifies how participation, distributed expertise, facilitation, and case-based dialogue support learning processes during ECHO sessions. It also proposes process-oriented indicators to make learning dynamics more visible alongside outcome-based evaluation approaches. By foregrounding learning processes, this analysis offers a conceptual foundation to strengthening pedagogical alignment, faculty development, and assessment design in ECHO programs. The framework contributes to digital CPD scholarship by clarifying how learning develops within telementoring environments and by guiding future research and program refinement. More specifically, the article contributes a process-oriented evaluation perspective that helps make learning quality more visible within telementoring environments, thereby complementing dominant outcome-focused CPD models.

This review aimed to identify the impact of the ECHO® model on monitoring people diagnosed with diabetes mellitus. It followed the Joanna Briggs Institute and the PRISMA-ScR Checklist. The search was conducted in the Cochrane Library, Embase, Virtual Health Library, PubMed/MEDLINE, Scopus, and Web of Science databases. The strategy included the descriptors "Diabetes mellitus," "Diabetes Melito," "Diabetes," "Diabetes Melito," "Model ECHO," "Project ECHO," and "Extension for Community Healthcare Outcomes." Two independent reviewers selected the studies using the Rayyan-Intelligent Systematic Review management software. Nine of the 151 studies initially identified were selected, and one study was identified through gray literature. The ten studies were published in English between 2012 and 2022. Improvements were found in the professionals' knowledge and self-confidence, besides decreased glycated hemoglobin levels, hospital admissions, and hospitalization costs among people with diabetes. The conclusion is that the ECHO® Model positively impacted the monitoring of people with diabetes mellitus, especially in vulnerable communities.

This review aimed to identify the impact of the ECHO® model on monitoring people diagnosed with diabetes mellitus. It followed the Joanna Briggs Institute and the PRISMA-ScR Checklist. The search was conducted in the Cochrane Library, Embase, Virtual Health Library, PubMed/MEDLINE, Scopus, and Web of Science databases. The strategy included the descriptors “Diabetes mellitus,” “Diabetes Melito,” “Diabetes,” “Diabetes Melito,” “Model ECHO,” “Project ECHO,” and “Extension for Community Healthcare Outcomes.” Two independent reviewers selected the studies using the Rayyan-Intelligent Systematic Review management software. Nine of the 151 studies initially identified were selected, and one study was identified through gray literature. The ten studies were published in English between 2012 and 2022. Improvements were found in the professionals’ knowledge and self-confidence, besides decreased glycated hemoglobin levels, hospital admissions, and hospitalization costs among people with diabetes. The conclusion is that the ECHO® Model positively impacted the monitoring of people with diabetes mellitus, especially in vulnerable communities.

Project ECHOTM (Extension for Community Healthcare Outcomes) is a hub-spoke telehealth outreach model that democratizes specialty knowledge to reduce disparities and improve health outcomes. Limited access to endocrinologists forces many primary care providers (PCPs) to manage patients with type 1 diabetes (T1D) without specialty support. As such, Stanford and the University of Florida partnered to develop and pilot “ECHO T1D”, a teleECHOTM clinic focused on T1D in California (CA) and Florida (FL), respectively. Our goal was to demonstrate the feasibility of ECHO T1D and improve PCPs’ abilities to manage patients with T1D. Primary care spokes were recruited targeting Federally Qualified Health Centers (FQHCs) where vulnerable T1D patient populations more likely rely on PCPs for care. In CA, 11 spokes enrolled with 37 clinics serving ∼900 patients with T1D who do not receive routine specialty T1D care. In FL, 12 spokes enrolled with 67 clinics serving ∼1,000 patients with T1D. Multidisciplinary hub team specialists were recruited and a 6-month curriculum was developed. Weekly 1-hour teleECHO sessions consisting of didactic presentations and case reviews were offered for 27 sessions. Weekly engagement of the 70 participating PCPs (69% in CA) ranged from 0 to 27 (mean 14) sessions and 65 completed both baseline and exit surveys. Baseline data demonstrated low confidence in providing T1D care, especially related to diabetes technology. Pre/post surveys demonstrated statistically significant improvements in provider confidence in T1D management and knowledge (p=0.02). PCPs who attended ≥ 50% sessions had the largest improvements. Over 90% of PCPs reported changes in medical practice (e.g., insulin and pump adjustments) and 95% would recommend the program to colleagues. The ECHO model can be applied to T1D to improve PCPs’ ability to manage patients with T1D. Future directions include evaluating influence on patient level outcomes and applying the model to insulin-requiring T2D patients. Disclosure N. Cuttriss: None. C. Anez-Zabala: None. L.G. Baer: None. S.L. Filipp: None. M. Basina: None. M.J. Gurka: None. L. Figg: None. M.J. Haller: Advisory Panel; Self; SAB Biotherapeutics, Inc. K.K. Hood: Research Support; Self; Dexcom, Inc. Speaker’s Bureau; Self; LifeScan, Inc., MedIQ. X. Roque: None. R. Lal: Consultant; Self; Abbott, Biolinq. S.C. Westen: None. D.M. Maahs: Advisory Panel; Self; Eli Lilly and Company, Insulet Corporation, Medtronic, Novo Nordisk A/S. Consultant; Self; Abbott, Sanofi. Research Support; Self; Bigfoot Biomedical, Dexcom, Inc., Roche Diabetes Care, Tandem Diabetes Care. M. Town: Other Relationship; Self; Insulet Corporation. C. Wang: None. J.J. Wong: None. K. Yabut: None. A.F. Walker: None. Funding The Leona M. and Harry B. Helmsley Charitable Trust

Department of Anesthesiology, University of Rochester Medical Center, Strong Memorial Hospital, Rochester, New York. peter_bailey@urmc.rochester.eduThis issue of Anesthesiology contains the first of what is to be a monthly, article-based continuing medical education (CME) program. Some readers might question whether another CME program or product is needed.Numerous factors are forcing clinicians to evaluate how they obtain CME credits and specialties to assess their CME activities. Travel to CME meetings takes individuals away from family and work. In addition, travel to CME meetings with family can make serious learning a challenge. Of note, the Accreditation Council of Continuing Medical Education has increased its scrutiny of CME programs and the participation of individuals. The American Board of Anesthesiology, and indeed all 24 medical specialties which comprise the American Board of Medical Specialties, is moving toward a certification model based on “maintenance of certification” and “life-long learning and self-assessment.”1Assessment of professional competence is also being developed on several fronts.2Although performance is different from CME, surely they are linked. All these factors and more have contributed to the changing landscape of CME.The American Society of Anesthesiologists and the American Board of Anesthesiology convened a Strategic Planning Committee in the fall of 2003 to assess current American Society of Anesthesiologists CME programs and determine the need, if any, for the development of additional CME products. Starting a CME program in Anesthesiology was enthusiastically endorsed.Each month, one article will be chosen to be the focus of the journal-based CME program which, when successfully completed, will award participants up to 1 h of Category 1 CME credit toward the Accreditation Council of Continuing Medical Education’s Physician Recognition Award. Readers may wonder about the value of 1 h of CME credit. However, if an individual successfully completes the new program every month, the number of CME credits obtained in a year will equal approximately one-half of the annual requirement for Category 1 credits (25) and more than one-third of the credits that are needed annually as defined by the American Board of Anesthesiology for maintenance of certification (35).1We hope the ease with which CME credits can be obtained through this new program, as well as the value of its content, will be appealing to American Society of Anesthesiologists members and other qualified individuals.It is our intent to make the process of obtaining journal-based CME credits straightforward and beneficial. There will undoubtedly be some growing pains. However, with constructive criticism from participants, I am confident that Anesthesiology’s new CME program will be educational and convenient and will allow practitioners to obtain clinically valuable information in one more manner. What’s more, the cost is very modest: American Society of Anesthesiologists members pay only $10.00 per test or $60.00 for the full year; the fee for nonmembers is $15.00 per test or $90.00 for the year.For further information, please see the CME section starting on page 249 of this issue or visit the CME Web site at www.asahq.org/journal-cme. The Web site has a feedback link where participants can comment on the Journal’s new CME activity.So follow the instructions, and let us know what you think and how the program can be improved!

Extension of community healthcare outcomes in Parkinson disease (Parkinson ECHO): A feasibility study

Background: Globalisation, newly discovered diseases, and technological improvements have been noted to have significantly altered the healthcare system in recent years, which is continuously affecting healthcare outcomes. These adjustments necessitate standard care from medical specialists, who must be highly motivated to collaborate as a team. Aim: To assess and compare the attitudes of postgraduate medical and nursing students towards inter-professional learning. Study design: Comparative cross-sectional study. Methodology: Purposive sampling approach and a comparative cross-sectional study design were used to study postgraduate medical and nursing students from the University of Health Sciences and the University of Lahore. One hundred twenty (120) of the three hundred and twelve (312) postgraduate medical and nursing students who were contacted for data collection completed the survey. The 19 items of the RIPL, or Readiness to Inter-professional Learning Scale, were used to collect the data. In order to analyze the data, SPSS 23 was used. Results: Ages of study participants ranged from 21 to 52, with a mean of 32.4 +/- 6.4. 62 (51.7%) and 58(48.3%) of the 120 people were from the University of Health Sciences, Lahore, respectively. The mean readiness score on the Inter-professional Learning Scale, with a range of 42 to 86, was 72.4 6.97 overall. In the categories of duty and responsibility and teamwork and collaboration, there was no appreciable difference between postgraduate medical and nursing students' mean attitudes scores. Practical Implication: IPL as a pedagogical tool because it gives the concepts of collaborative practice, as represented by the IPL idea, a framework. Students must always be prepared to participate in inter-professional learning if IPL is to be successfully promoted, as doing so will expand their knowledge, skills, and understanding of responsibilities of healthcare professionals. Conclusion: It was concluded that early adoption of inter-professional learning programmes at the beginning of professional training and the provision of a suitable learning environment for healthcare learners will promote collaboration and cooperation in clinical settings, which may also improve patient and family satisfaction. Keywords: Inter-professional Learning, Post-graduate Nurses, Knowledge and Attitude.

The literature on participation in priority-setting has three key gaps: it focuses on techniques for obtaining public input into priority-setting that are consultative mechanisms and do not involve the public directly in decision-making; it focuses primarily on the public's role in priority-setting, not on all potential participants; and the range of roles that various participants play in a group making priority decisions has not been described. To begin addressing these gaps, we interviewed individuals who participated on two priority-setting committees to identify key insights from participants about participation. A qualitative study consisting of interviews with decision-makers, including patients and members of the public. Members of the public can contribute directly to important aspects of priority-setting. The participants described six specific priority-setting roles: committee chair, administrator, medical specialist, medical generalist, public representative and patient representative. They also described the contributions of each role to priority-setting. Using the insights from decision-makers, we have described lessons related to direct involvement of members of the public and patients in priority-setting, and have identified six roles and the contributions of each role.

BackgroundSince the time of Web 2.0, more and more consumers have used online doctor reviews to rate their doctors or to look for a doctor. This phenomenon has received health care researchers’ attention worldwide, and many studies have been conducted on online doctor reviews in the United States and Europe. But no study has yet been done in China. Also, in China, without a mature primary care physician recommendation system, more and more Chinese consumers seek online doctor reviews to look for a good doctor for their health care concerns.ObjectiveThis study sought to examine the online doctor review practice in China, including addressing the following questions: (1) How many doctors and specialty areas are available for online review? (2) How many online reviews are there on those doctors? (3) What specialty area doctors are more likely to be reviewed or receive more reviews? (4) Are those reviews positive or negative?MethodsThis study explores an empirical dataset from Good Doctor website, haodf.com—the earliest and largest online doctor review and online health care community website in China—from 2006 to 2014, to examine the stated research questions by using descriptive statistics, binary logistic regression, and multivariate linear regression.ResultsThe dataset from the Good Doctor website contained 314,624 doctors across China and among them, 112,873 doctors received 731,543 quantitative reviews and 772,979 qualitative reviews as of April 11, 2014. On average, 37% of the doctors had been reviewed on the Good Doctor website. Gynecology-obstetrics-pediatrics doctors were most likely to be reviewed, with an odds ratio (OR) of 1.497 (95% CI 1.461-1.535), and internal medicine doctors were less likely to be reviewed, with an OR of 0.94 (95% CI 0.921-0.960), relative to the combined small specialty areas. Both traditional Chinese medicine doctors and surgeons were more likely to be reviewed than the combined small specialty areas, with an OR of 1.483 (95% CI 1.442-1.525) and an OR of 1.366 (95% CI 1.337-1.395), respectively. Quantitatively, traditional Chinese medicine doctors (P<.001) and gynecology-obstetrics-pediatrics doctors (P<.001) received more reviews than the combined small specialty areas. But internal medicine doctors received fewer reviews than the combined small specialty areas (P<.001). Also, the majority of quantitative reviews were positive—about 88% were positive for the doctors' treatment effect measure and 91% were positive for the bedside manner measure. This was the case for the four major specialty areas, which had the most number of doctors—internal medicine, gynecology-obstetrics-pediatrics, surgery, and traditional Chinese medicine.ConclusionsLike consumers in the United States and Europe, Chinese consumers have started to use online doctor reviews. Similar to previous research on other countries’ online doctor reviews, the online reviews in China covered almost every medical specialty, and most of the reviews were positive even though all of the reviewing procedures and the final available information were anonymous. The average number of reviews per rated doctor received in this dataset was 6, which was higher than that for doctors in the United States or Germany, probably because this dataset covered a longer time period than did the US or German dataset. But this number is still very small compared to any doctor’s real patient population, and it cannot represent the reality of that population. Also, since all the data used for analysis were from one single website, the data might be biased and might not be a representative national sample of China.

Nursing Programs Could Sharpen LTC Focus

Immunization among patients with inflammatory bowel disease (IBD) is suboptimal. We sought to characterize attitudes of US primary care professionals (PCPs) towards immunization practices for patients with IBD. Using a web-based opt-in panel of PCPs (DocStyles survey, spring 2021, cross-sectional study), we assessed likelihood of PCPs' recommending influenza, pneumococcal disease, herpes zoster, and human papilloma virus vaccinations for IBD patients by PCP characteristics and availability of clinical tools. Reasons for unlikelihood of recommending vaccines and approaches to improve vaccine recommendation were examined. Among 1503 PCPs, 64% recommended all vaccines. Herpes zoster vaccine was most likely to be recommended (89.8%) and pneumococcal vaccine was least likely (74.0%). Clinical tools including decision support based on electronic health records (EHRs; 48.9%) and staff tracking of patients' vaccine needs (36.3%) were significantly associated with likelihood of recommending vaccines (P < .001). A greater likelihood of vaccine recommendation was observed for pediatricians vs other medical specialties, group outpatient clinic vs other worksites, and seeing >50 patients/week (P < .05). One-third of PCPs were unlikely to recommend ≥1 vaccine, and the top reason reported was unfamiliarity with vaccine guidelines for patients with IBD (48.0%). A review of guidelines or continued medical education (63.0%) and decision support from EHRs (51.2%) were the most frequently selected approaches identified to improve certainty of vaccine recommendation. There is room for improvement of vaccination recommendations by PCPs. Promoting continuing education and use of clinical tools may help support PCP immunization practices for patients with IBD.