The Journal oJConfinrring Edirrarion in fhe Healfh ProJessions, Volume 8 . pp. 55-61 Printed in lhc USA. All rights reserved.

Allied Health

0894-1912/88 S3.00t .00 Copyright 0 1988 The Alliance for Continuing Medical Education and

the Society of Medical College Directors of Continuing Medical Education

Assessing Continuing Education Needs of Five Allied Health Professions

in Rural California

SHARON ROBERTS Kern Area Health Education Center and Department of Clinical Sciences California State University, Bakersfield 9001 Stockdale Highway Bakersfield, California 9331 1-1099

JACK SCOTT Kern Area Health Education Center Department of Clinical Sciences California State University, Bakersfield 9001 Stockdale Highway Bakersfield, California 933 1 1 - 1099

Abstract Meeting the needs of rural health care professionals for continuing education remains a challenge for health planners. An assessment of these needs is the focus of this survey of rural practitioners. A continuing education needs survey of jive allied health professions in an agricultural region of California was conducted. Variables selected related to professional education and retention and included paramedics, physical therapists, pharmacists, clinical psychologists, and medical technologists. Results indicated a strong need for high quality, moderate cost, locally offered continuing education seminars. Access to professional literature searches was also regarded as important. Several of the selected health profession groups were concerned about maintaining licensure; most intended to remain in their professions for at least six to ten years. These survey jindings clearly suggest a need for centrally coordinated continuing education opportunities for allied health personnel in rural service delivery areas.

Introduction

Analysis of continuing education competence and accessibility in rural commu- nities has been examined by numerous investigators. Sultz, Sawner, and Sherwin have concluded that “surveys of community-based clinicians that are conducted to determine their desires with respect to continuing education reflect interests rather than competence deficiencies.”’ This is usually borne out in survey results

55

56 Needs of Allied Health Professions

which indicate subject matter interests based upon current popular topics rather than clinical assessment criteria, which are more competence-based measure- ments.

A more determinant means of assessing needs is suggested by Ehrmeyer who contends that a variety of means can be utilized in identifying continuing education needs. What one should know (criterion referenced) and what one would like to know (popular topics) can be assessed from professional organiza- tions and literature, subject matter experts, proficiency testing programs, and job analysis or audits.* These methods, when coupled with participant interests, can form the basis for relevant or appropriate programs.

Conine assessed the views of allied health professionals concerning their preferences for continuing education. Results indicated an overwhelming (98%) need for CE. Moreover, the more clinical fields (e.g., medical technology) favored even greater preference for CE needs3 An apparent strong demand for maintain- ing competencies remain a priority for health professionals. Those in rural areas thus have an added conflict in accessing CE opportunities.

Other investigators have alluded to the difficulties in providing programs to rural professionals. Smorynski and Parochka contend that employer-provided benefits for health professionals participating in continuing education courses are not equally shared among all allied health professionals. They are not generally available to any allied health professionals. They had found medical technologists receiving education fee reimbursements to a far greater extent than other health personnel. They also point to the constraints placed upon rural health profession- als who must travel great distances in order to attend continuing education credit courses in urban academic centers. This is often at considerable cost to the health professional and/or their employer considering work-hour adjustments, travel cost, and worker replacements, if any.4 The difficulty for rural professionals in attending education programs is likewise reported by Gray. The requirements for relicensure pose difficulties in accessibility to such programs. Such alternate resources as: satellite television programming, self-assessment instruments, com- puter-based instruction, and correspondence courses are all expensive

The Kern Area Health Education Center (AHEC), a nonprofit health profes- sion training agency in Bakersfield, California, sought to assess the long-range professional education needs for allied health personnel in a large agricultural area in central California. There are approximately 500,000 (1985) persons residing in the county of Kern. The dispersal of residents in an 8,000-square mile area presents difficulty in attaining health services. Bakersfield is the major population center (240,000). Located in the western portion of the county, access to medical education seminars is most difficult. To mitigate the problem, a goal was set to design convenient, yet clinical, relevant programs. Additional assessments of professional longevity, clinical and nonclinical issues were likewise analyzed in order to retain professionals in rural communities.

Method

A two-page survey of 352 allied health professionals was conducted. The professions included in the survey were paramedics, physical therapists, pharma- cists, clinical psychologists, and medical technologists. Subjects were chosen

Sharon Roberts and Jack Scott 57

from mailing lists or from state licensure lists and were selected using a table of random numbers. A response rate of 24% (n = 76) was obtained and distributed among the subjects as indicated in the frequency distribution on Table 1.

The three major areas assessed by the survey included: (1) the availability, cost, and quality of available continuing education; (2) the greatest clinical and nonclinical issues; and (3) length of professional career. Additional data regarding other health professions training resource needs and major health care concerns for Kern County were solicited. It was anticipated that these areas would provide sufficient information upon which to base further study.

Results

Paramedics

Paramedics revealed several factors related to their educational needs, profes- sional perceptions, and concerns about medical issues. They had strong concerns about job “burn-out” and lack of professional advancement in their field. They expressed strong concerns about having adequate field-training experiences and rated the need for CE (continuing education) to maintain their licenses as very high. They were undecided in their perception of the quality of locally available CE lectures and programs. Further, they would much prefer to attend CE programs if held locally as opposed to traveling outside the area even though their employer does not compensate them for their attendance. Their views of nonclinical issues were centered mainly on the topic of “job-stress/burn-out” while clinical issues were primarily involved with cardio-vascular disease, haz- ardous material handling, and with the administration of drugs. Paramedics saw the most pressing CE resource needs as being quality, locally-held seminars. Finally, they planned upon staying in their profession either one to five years or indefinitely.

Physical Therapists

Physical therapists were selected for study to represent an emerging trend towards rehabilitation services in the health care delivery system. Despite their

Table 1 Frequency Distribution of Allied Health Respondents

Number in Percent Number Number Percent Kern Co. Sampled Selected Responding Responding

Paramedics 50 67% I00 17 17%

Pharmacists 200 25% 50 16 32% Clinical Psychologists 40 100% 40 10 25% Medical Technologists 150 100% I50 24 16%

TOTALS 552 52% 352 76 24%

Physical Therapists 12 100% 12 9 75%

58 Needs of Allied Health Professions

small numbers, it was felt that an assessment of their educational needs would provide a more balanced appraisal in the spectrum of health occupations. As shown in Table 1, a 75% response rate out of the total population demonstrates a very highly representative sample. Physical therapists rated the need to have CE programs to maintain licensure/registration as very high. Their perception of the locally available CE programs was generally of low quality. Yet they, like all those who responded, would much prefer to attend local CE programs. Their employer provides no such educational programs. They felt that increased physician control of patient referrals was the greatest nonclinical issue they faced. Most wished to remain in their chosen profession indefinitely. Finally, therapists requested educational seminars as the great CE resource needed in the community.

Pharmacists

Pharmacists, like physical therapists, also rated the need for CE to retain licensure as very high. Most of the 50 selected pharmacists were community- based (as opposed to hospital-based practitioners). Again, a preference for attending local CE programs was cited. They too received no employer-sponsored educational programs. Pharmacists rated knowledge of antibiotic drugs and patient education as their most important clinical issues. The single greatest nonclinical issue expressed was pharmaceutical dispensing by physicians. Most planned on remaining in the profession six to ten years or indefinitely. Finally, as did each professional category, the greatest CE resource needed was educational seminars. The fact that more community-based pharmacists were selected is because their access to CE programs is less.

Clinical Psychologists

Continuing education is not needed by clinical psychologists to maintain licen- sure. This is reflected in the relatively low response obtained from our sample (n = 40). Their motivations in needing CE are thus lessened. Psychologists indicated the needs for CE for relicensure as high, as compared to very high for their fellow allied health professionals. They prefer locally held CE courses even though they felt the quality of those provided was low. Unlike other professionals tested, they had employer-sponsored CE programs provided for them. However, it is worth noting that unlike the other allied health personnel surveyed, clinical psycholo- gists are generally self-employed as private practitioners. Most sought hospital staff privileges as their most important nonclinical issue and stated that they would remain in their profession indefinitely. Finally, educational seminars were the greatest CE resource need. Of note, is the inclusion of current medical literature searches as a high resource need.

Medical Technologists

Medical technologists had the lowest response rate (16%). This may partly be because CE is not required for relicensure. Again, convenient locally held CE offerings were preferred and their employer did not provide educational programs. The advent of increased technology (equipment and procedures) and blood

Sharon Roberts and Jack Scott 59

banking were considered the greatest clinical issues. Nonclinical concerns were mostly in improved management skills. Med techs exhibited the greatest variabil- ity in terms of interest in remaining in their profession. A common division of one to five years, six to ten years, and an indefinite period were characterized by this allied health category. As did their fellow respondents, med techs indicated a high need for seminars as the greatest CE resource need in the target area.

Discussion This survey response indicated a strong need for CE programs to be held in Bakersfield (which has approximately 50% of the area’s 500,000 population). Existing CE course offerings, though convenient, were generally regarded as of inferior quality.

Identifying clinical and nonclinical interests (lecture topics) proved to be quite variable. But overall, preventive care and technological advancements were frequently mentioned. Typical respondents sought to remain in their profession indefinitely. However, med techs and paramedics were somewhat divided as to their short term (one to five year) job prospects or career commitments (indefi- nitely). Perhaps the high rate of technological advances, lack of professional advancement or stress may play a role. Uniformity was well-expressed in the need for seminars as the main educational method. A broad interest in computerized literature search capabilities and availability of a central videotape library was likewise shown by all respondents.

The data provide a basis for local CE planners to design and market seminars which are of moderate cost, high quality (or at least higher than previously provided), involve technologic and preventive topics, and most of all, are offered locally. This investigation indicates a desire for local allied health professionals to remain current in their professional knowledge not only because CE credits are needed for professional relicensure but also for personal growth. Further empha- sis should be placed upon central coordination of locally offered low-cost educational conferences for allied health professionals.

Acknowledgment Supported at least in part by Cooperative Agreement DHHS 5 V76 PE 0053-07 with Division of Medicine, Bureau of Health Manpower, Health Resources Administration, Department of Health and Human Services.

References

I . Sultz HA, Sawner KA, Sherwin FS. Determining and maintaining competence: An

2. Ehrmeyer SS. Continuing education: A practical programming model for new planners.

3. Conine TA. Should continuing education be required? Views of allied health profes-

4. Smorynski HW, Parochka J. Providing continuing education opportunities in the allied

5. Gray MS. Recertification and relicensure in the allied health professions. J Allied Health

obligation of allied health education. J Allied Health 1984; 13:272-279.

J Allied Health 1980; 9:276-282.

sionals. J Allied Health, Fall 1977; 6:34-39.

health professions. J Allied Health 1979; 8:47-54.

1984; 13~27-30.

Appendix Health Profession Assessment Plan

Thank you for taking the time to complete and return this brief summary of health profession training needs. The Kern Area Health Education Center (AHEC) will remain a major provider of educational programs with your cooperation. These survey results will allow us to better serve your professional needs. Your responses are strictly confidential. We appreciate your participation. Please complete and return this survey.

1. Physician practicing in (community)

2. My needs for Continuing Education (CE) to maintain my licensekertification and specializing in

are: Very High High Undecided Low Very Low

Completely For the most part

Minimally Not at all

3. To what extent are your CE needs being met:

P a r t i a l l y

4. I regard the quality of CE program lecturers/faculty available in Bakersfield as:

Very High High Undecided Low Very Low

Bakersfield Area Los Angeles Area Elsewhere in California Out of State

six-hour CE program (select one):

5 . I prefer to attend CE programs in my field in (location):

6. I would be willing to pay the registration fee checked below for a local

$30 $45 $60 $75 $90

60

61

7. Most of my CE credits are through seminars/courses provided by my place of employment:

Yes No

Yes No

8. 1 would prefer to attend CE programs with persons of my same profession:

9. I see the three greatest clinical issues needed in my profession as:

10. 1 see the three greatest nonclinical issues in my profession as:

1 1 . 1 plan on staying in my present health profession career for another: 1-5 years 6-10 years Indefinitely Undecided

12. What health profession training resources do we need in Kern County ( e g , video/library presentations, literature searches, seminars)?

13. What major health care concerns do you foresee in Kern County’s future?

14. What patient education needs do you foresee in your practice?