title: A method for developing standardised interactive education for complex clinical guidelines.
abstract: BACKGROUND
  Although systematic use of the Perinatal Society of Australia and New Zealand internationally endorsed Clinical Practice Guideline for Perinatal Mortality (PSANZ-CPG) improves health outcomes, implementation is inadequate. Its complexity is a feature known to be associated with non-compliance. Interactive education is effective as a guideline implementation strategy, but lacks an agreed definition. SCORPIO is an educational framework containing interactive and didactic teaching, but has not previously been used to implement guidelines. Our aim was to transform the PSANZ-CPG into an education workshop to develop quality standardised interactive education acceptable to participants for learning skills in collaborative interprofessional care.
  
  
  METHODS
  The workshop was developed using the construct of an educational framework (SCORPIO), the PSANZ-CPG, a transformation process and tutor training. After a pilot workshop with key target and stakeholder groups, modifications were made to this and subsequent workshops based on multisource written observations from interprofessional participants, tutors and an independent educator. This participatory action research process was used to monitor acceptability and educational standards. Standardised interactive education was defined as the attainment of content and teaching standards. Quantitative analysis of positive expressed as a percentage of total feedback was used to derive a total quality score.
  
  
  RESULTS
  Eight workshops were held with 181 participants and 15 different tutors. Five versions resulted from the action research methodology. Thematic analysis of multisource observations identified eight recurring education themes or quality domains used for standardisation. The two content domains were curriculum and alignment with the guideline and the six teaching domains; overload, timing, didacticism, relevance, reproducibility and participant engagement. Engagement was the most challenging theme to resolve. Tutors identified all themes for revision whilst participants identified a number of teaching but no content themes. From version 1 to 5, a significant increasing trend in total quality score was obtained; participants: 55%, p=0.0001; educator: 42%, p=0.0004; tutor peers: 57%, p=0.0001.
  
  
  CONCLUSIONS
  Complex clinical guidelines can be developed into a workshop acceptable to interprofessional participants. Eight quality domains provide a framework to standardise interactive teaching for complex clinical guidelines. Tutor peer review is important for content validity. This methodology may be useful for other guideline implementation.
authors.affiliation: Maternal-Fetal Medicine Unit, John Hunter Hospital, Lookout Road, New Lambton, NSW, 2305, Australia. janet@drjanetvaughan.com.au
authors.forename: Janet I
authors.initials: JI
authors.lastname: Vaughan
authors.forename: Heather E
authors.initials: HE
authors.lastname: Jeffery
authors.forename: Camille
authors.initials: C
authors.lastname: Raynes-Greenow
authors.forename: Adrienne
authors.initials: A
authors.lastname: Gordon
authors.forename: Jane
authors.initials: J
authors.lastname: Hirst
authors.forename: David A
authors.initials: DA
authors.lastname: Hill
authors.forename: Susan
authors.initials: S
authors.lastname: Arbuckle
mesh_terms: D001315:Australia; D003194:Computer-Assisted Instruction; D003299:Cooperative Behavior; D003479:Curriculum / Q000592:standards; D004493:Education / Q000458:organization & administration; D004502:Education, Medical, Continuing / Q000458:organization & administration* / Q000592:standards*; D004503:Education, Medical, Graduate / Q000458:organization & administration* / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D007231:Infant, Newborn; D033183:Interdisciplinary Communication; D008297:Male; D009520:New Zealand; D018743:Perinatal Care / Q000458:organization & administration* / Q000592:standards*; D054238:Perinatal Mortality; D010500:Perinatology / Q000193:education*; D010865:Pilot Projects; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D018794:Problem-Based Learning / Q000458:organization & administration* / Q000592:standards*; D012955:Societies, Medical