title: Training health care professionals for 21st-century practice: a systematic review of educational interventions on chronic care.
abstract: OBJECTIVE
  To systematically review the evidence for high-quality and effective educational strategies to train health care professionals across the education continuum on chronic disease care.
  
  
  METHODS
  A search of English-language publications and conference proceedings was performed in November 2013 and updated in April 2014. Studies that evaluated a newly developed curriculum targeting chronic disease care with learner outcomes were included. Two primary reviewers and one adjudicating reviewer evaluated the studies and assessed their quality using the validated Medical Education Research Study Quality Instrument (MERSQI). Studies were also mapped onto elements of Wagner's chronic care model (CCM) to evaluate their use of established evidence-based models for chronic care delivery. Miller's classification of clinical competence was used to assess the quality of learner achievements for each educational intervention.
  
  
  RESULTS
  A total of 672 articles were found for this review. Twenty-two met criteria for data extraction. The majority of studies were of moderate quality according to MERSQI scoring. Only three studies reported both learner and patient outcomes. The highest-quality studies incorporated more elements of Wagner's CCM and showed high-level learner competence according to Miller's classification. Successful interventions redesigned health care delivery systems to include team-based care, emphasized training of health care professionals on patient self-management, and included learner-based quality improvement initiatives.
  
  
  CONCLUSIONS
  The growing number of children and adults with chronic disease necessitates improved educational interventions for health care professionals that involve evidence-based models for restructuring chronic care delivery, aim for high-level learner behavioral outcomes, and evolve through quality improvement initiatives.
authors.affiliation: J.F. Bogetz is postdoctoral fellow and clinical instructor, Division of General Pediatrics, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California. C.E. Rassbach is associate residency program director, pediatric hospitalist, and clinical assistant professor, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California. S. Bereknyei is a research scholar, Stanford Center for Medical Education Research and Innovation (SCeMERI), Stanford University School of Medicine, Palo Alto, California. F.S. Mendoza is professor of pediatrics and chief, Division of General Pediatrics, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California. L.M. Sanders is associate professor of pediatrics, Division of General Pediatrics, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California. C.H. Braddock III is professor of medicine and vice dean for education, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California.
authors.forename: Jori F
authors.initials: JF
authors.lastname: Bogetz
authors.forename: Caroline E
authors.initials: CE
authors.lastname: Rassbach
authors.forename: Sylvia
authors.initials: S
authors.lastname: Bereknyei
authors.forename: Fernando S
authors.initials: FS
authors.lastname: Mendoza
authors.forename: Lee M
authors.initials: LM
authors.lastname: Sanders
authors.forename: Clarence H
authors.initials: CH
authors.lastname: Braddock
mesh_terms: D002908:Chronic Disease / Q000628:therapy*; D003479:Curriculum; D004501:Education, Medical / Q000592:standards*; D019317:Evidence-Based Medicine / Q000193:education*; D006801:Humans; D017145:Models, Educational; D058996:Quality Improvement