Using ACGME General Surgery Milestones to Define the Competent Foundational Surgical Resident

OBJECTIVE

In transitioning to competency-based surgical training, the need to clearly define competency is paramount. The purpose of this study is to define the well-prepared foundational resident using the ACGME General Surgery Milestones as our conceptual framework.

DESIGN

Participants reflected on their expectations of a well-prepared resident at the end of PGY1, then assigned milestone levels reflecting this level of competence for General Surgery Milestones 1.0 and 2.0. Subcompetency scores were averaged among residents and faculty. The level of the well-prepared foundational resident was determined based on the highest level within one standard deviation of faculty, resident, and total group averages.

SETTING

This took place during a dedicated education retreat at a single, large academic general surgery residency program.

PARTICIPANTS

Key faculty stakeholders and a representative sample of residents (PGY 1-5) within our institution participated.

RESULTS

Eight faculty and five residents completed Milestones 1.0 and 2.0 scoring. Mean scores between faculty and residents were compared. For 1.0, mean scores for Practice-Based Learning and Improvement 3 (PBLI 3) and Interpersonal Communication Skills 3 (ICS 3) were discernably lower for residents than for faculty (PBLI 3 1.3 (0.3) v 0.9 (0.2), p = 0.01; ICS3 1.6 (0.6) v 1.1 (1), p = 0.01). Scores of 2.0 were comparable across all subcompetency domains. With this broad agreement, Milestone-based competency standards were determined. Descriptive narratives of the KSAs were created for each subcompetency, combining the determined Milestones 1.0 and 2.0 levels.

CONCLUSIONS

We were able to clearly define the competent foundational resident using the ACGME Milestones as a conceptual framework. These Milestone levels reflect the culture and expectations in our department, providing a foundation upon which to build a program of assessment. This methodology can be readily replicated in other programs to reflect specific expectations of the program within the larger ACGME frameworks of competency.

Driving factors of community pharmacist weight management service: A structural equation modeling approach

BACKGROUND

Even though the effectiveness of community pharmacists in helping customers to reduce weight has been evident, few pharmacists provided weight management services (WMS). To drive community pharmacist WMS provision, factors affecting their intention and WMS provision were important to be investigated.

OBJECTIVE

The present study aimed to explore relationships among pharmacist authority, perceived customer obstruction, WMS performance support, obstacles, and facilitators with intention to provide WMS and WMS rovision using structural equation modeling (WMS.

METHOD

Self-administered questionnaires were utilized to collect data from 302 Thai community pharmacists from December 2022 to March 2023. Structural equation modeling (SEM) was used to explore the influencing factors on pharmacist WMS intention and WMS provision.

RESULTS

Pharmacist authority (r = 0.35), WMS performance support (r = 0.24), and facilitators (r = 0.22) were significantly correlated with community pharmacist WMS provision. Pharmacist authority (r = 0.50), facilitators (r = 0.46), and WMS performance support (r = 0.42) were significantly correlated with community pharmacist intention to provide WMS e structural equation model (SEM), pharmacist authority (β = 0.34) and intention (β = 0.16) significantly influenced WMS provision (R2 = 0.20). Authority (β = 0.49) and WMS performance support (β = 0.28) significantly influenced pharmacist intention to WMS (R2 = 0.42). The model from empirical data indicated a good fit with the hypothetical model (p-value = 0.000, Comparatively Fit Index = 0.9, and Tucker-Lewis Index = 0.878).

CONCLUSION

Pharmacist authority had direct effects with both their intention to provide WMS and WMS provision. WMS performance support had a direct effect on intention to provide WMS and an indirect effect on WMS provision. Facilitators also had significant correlations with intention to provide WMS and WMS provision.

Core sepsis-related competencies for medical students: an international consensus by Delphi technique

BACKGROUND

Sepsis is a life-threatening condition which may arise from infection in any organ system and requires early recognition and management. Healthcare professionals working in any specialty may need to manage patients with sepsis. Educating medical students about this condition may be an effective way to ensure all future doctors have sufficient ability to diagnose and treat septic patients. However, there is currently no consensus on what competencies medical students should achieve regarding sepsis recognition and treatment. This study aims to outline what sepsis-related competencies medical students should achieve by the end of their medical student training in both high or upper-middle incomes countries/regions and in low or lower-middle income countries/regions.

METHODS

Two separate panels from high or upper-middle income and low or lower-middle income countries/regions participated in a Delphi method to suggest and rank sepsis competencies for medical students. Each panel consisted of 13-18 key stakeholders of medical education and doctors in specialties where sepsis is a common problem (both specialists and trainees). Panelists came from all continents, except Antarctica.

RESULTS

The panels reached consensus on 38 essential sepsis competencies in low or lower-middle income countries/regions and 33 in high or upper-middle incomes countries/regions. These include competencies such as definition of sepsis and septic shock and urgency of antibiotic treatment. In the low or lower-middle income countries/regions group, consensus was also achieved for competencies ranked as very important, and was achieved in 4/5 competencies rated as moderately important. In the high or upper-middle incomes countries/regions group, consensus was achieved in 41/57 competencies rated as very important but only 6/11 competencies rated as moderately important.

CONCLUSION

Medical schools should consider developing curricula to address essential competencies, as a minimum, but also consider addressing competencies rated as very or moderately important.

Nurses' competency on electrocardiography interpretation in adult emergency room: Addis Ababa, Ethiopia, 2021. Multicenter cross-sectional study

AIM

This study aimed to assess the proficiency of nurses in interpreting electrocardiogram within the adult emergency units of Addis Ababa, Ethiopia, during the year 2021.

METHODS

This institutional-based descriptive, cross-sectional study involved 175 nurses from five randomly selected hospitals' adult emergency units. Semi-structured, self-administered questionnaires were used for data collection. Data were entered into Epi-Data and analyzed using SPSS version 26. Fisher's exact test identified statistical significance between dependent and independent variables at a p-value < 0.05.

RESULTS

Out of 203 respondents, 175 participated actively, yielding a response rate of 86.2%. Among these nurses, 159 (90.9%) were deemed not competent (scoring < 65%), with a mean score of 6.82 ± 3.65 SD.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution was included in this study.

CONCLUSION

The overall competency level in electrocardiogram interpretation among nurses is significantly poor. This indicates that most nurses in the emergency units are unable to accurately interpret ECG monitoring, potentially leading to the failure to recognize signs of arrhythmias, electrolyte disturbances, and other cardiac abnormalities. Consequently, this may result in inappropriate patient care and increased mortality rates. Education and training were identified as key factors in enhancing their competency.

OSABSS: An authentic examination for assessing basic surgical skills in surgical residents

Objectives

This study aimed to develop and validate the OSABSS (Objective Structured Assessment of Basic Surgical Skills), a modified Objective Structured Clinical Examination (OSCE), to assess basic surgical skills in residents.

Design

A developmental study conducted in two phases. Basic skills were identified through literature review and gap analysis. The OSABSS was then designed as a modified OSCE.

Setting

This study took place at Alborz University of Medical Sciences in Iran.

Interventions

The OSABSS was created using Harden's OSCE (Objective Structured Clinical Examination) methodology. Scenarios, checklists, and station configurations were developed through expert panels. The exam was piloted and implemented with residents as participants and faculty as evaluators.

Participants

32 surgical residents in gynecology, general surgery, orthopedics, and neurosurgery participated. 22 faculty members were evaluators.

Primary and secondary outcome measures

The primary outcome was OSABSS exam scores. Secondary outcomes were written exam scores, and national residency entrance ranks.

Main results

The mean OSABSS score was 16.59 ± 0.19 across all stations. Criterion validity was demonstrated through correlations between OSABSS scores, written scores and entrance ranks. Reliability was high, with a Cronbach's alpha of 0.87. No significant inter-rater score differences were found.

Conclusions

The rigorous OSABSS development process produced an exam demonstrating strong validity and reliability for assessing basic surgical skills. The comprehensive station variety evaluates diverse technical and non-technical competencies. Further research should expand participant samples across surgical disciplines.

Developing a competency model for Chinese general practitioners: a mixed-methods study

BACKGROUND

The Chinese government has formulated a series of policies and strengthened training of general practitioners (GPs) to support their role as "gatekeepers" of residents' health. This study aimed to explore the core competencies of Chinese GPs and develop a competency framework in line with China's actual conditions, which can provide a more scientific basis for the education, training, and evaluation of GPs.

METHODS

Literature analysis and behaviour event interviews were conducted to build the competency dictionary and the initial version of the competency model. Two rounds of Delphi were performed to gain consensus on the final model. The questionnaire survey was carried out in 10 provinces (municipalities, autonomous regions) of China, and GPs were invited to score the importance of each competency item. The total sample was randomly divided into two groups. One group was for exploratory factor analysis (EFA), and the other was for confirmatory factor analysis (CFA) to examine the scale's reliability and validity.

RESULTS

The dictionary of general practitioners' competency including 107 competency items was constructed. After two rounds of Delphi, a consensus was reached on 60 competencies in 6 domains. A total of 1917 valid questionnaires were obtained in the nationwide survey. The average importance score of all second-level indicators is 4.53 ± 0.45. The Cronbach's α coefficient is 0.984. The results of the five factors extracted by EFA showing the 68.16% cumulative explained variance variation is considered to be consistent with the six dimensions obtained by Delphi after thorough discussion. The model fitness indexes obtained by CFA were acceptable (χ2/df = 4.909, CFI = 0.869, NFI = 0.841, RMSEA = 0.065). The values of the composite reliability (CR) of the six dimensions were all greater than 0.7 (0.943, 0.927, 0.937, 0.927, 0.943, 0.950), and the average of variance extracted (AVE) were all greater than 0.5 (0.562, 0.613, 0.649, 0.563, 0.626, 0.635). The results showed that the model has good reliability and validity.

CONCLUSION

A competency model for GPs suited to China has been developed, which may offer guidance for future training and medical licensing examinations of GPs.

Barriers and future improvements of workplace-based learning in Korean medicine clinical clerkship: perspectives of graduates

BACKGROUND

Workplace-based learning (WPBL) has emerged as an essential practice in healthcare education. However, WPBL is rarely implemented in Korean medicine (KM) due to the passive attitude of teachers and possible violation of medical laws that limit the participation of trainees in medical treatment. In this study, we implemented WPBL in the clinical clerkship of Acupuncture and Moxibustion Medicine at a single College of KM and explored the barriers and future improvements of WPBL.

METHODS

The WPBL was implemented from January to July 2019. During the clerkship, each senior student was assigned an inpatient at the university hospital. WPBL was conducted as follows: patient presentation by the supervisor, interaction with the patient at the bedside, preparation of medical records, oral case presentation, and discussion with feedback. The student performed a physical examination and review of systems as a clinical task. In addition, six doctors of KM who are currently practicing after three years of WPBL were interviewed in September 2022 to investigate the real-world effects and unmet needs of WPBL in their workplaces.

RESULTS

Two major themes identified from the interview were: "the experience of novice doctors of KM with KM practice" and "Current state of KM clinical education." The five subcategories were: "Clinical competency priorities vary according to the KM workplace," "Difficulties faced by doctors of KM immediately after graduation," "WPBL experience of the interviewees," "Necessary but difficult to implement real patient learning," and "Unmet needs for clinical clerkship in KM."

CONCLUSION

It is essential to consider the unique characteristics of KM practice and the duties required in various workplaces for successful WPBL. We anticipate our study to be a starting point for improving the WPBL and addressing the unmet needs in KM clinical education.

Qualified fitness trainers practice scientifically based judgement in prescribing exercise programs

Fitness trainers are widely in demand by both commercial fitness centres and individual people. They serve members in one-to-one personal training (PT) or group training (GX) in commercial fitness centres. However, the services provided by fitness trainers have not been consistent across the industry. This service inconsistency has led to an increased doubt about professionalism in conducting safe and correct exercise for the public. No studies have evaluated how fitness trainers make decisions when they curate exercise programs for members. This research utilized a qualitative semi-structured interview method to collect data from 16 fitness trainers in Greater Kuala Lumpur, Malaysia. Inverview data was verbatim transcribed and analyzed using a theory-driven analysis. The study investigated fitness training professional decision-making processes when they design and precribe fitness execise programming to clients. Using Cognitive Continuum Theory (CCT) as a lens to explore the decision-making processes revealed a dichotomy of decision-making processes for curating personal training and group training. Feedback mechanism in the implementation of personal training was proven to be more personalized than group training. There are four themes in decision-making processed discovered to be impreative characteristics for fitness trainers. The application of CCT allowed further understanding of the implementation of exercise programs for PT and GX training when fitness trainers modified exercise programs.

Perceptions of spirituality and predictors of competence in spiritual care among nursing students in five middle eastern countries: A cross-sectional survey

BACKGROUND

Spiritual Care is integral to holistic nursing; however, it often remains underprovided due to a lack of education.

OBJECTIVE

This study examined perceptions of spirituality and predictors of competence in spiritual care among nursing students in Middle Eastern countries.

DESIGN

A cross-sectional survey was used.

PARTICIPANT/SETTING

Nursing students (n = 785) from five universities in Middle Eastern countries were included.

METHODS

Participants completed the Spiritual Care-Giving Scale-Arabic and Spiritual Care Competency Scale. Multiple linear regression analysis was used to identify the predictors of perceived competence in spiritual care.

RESULTS

Nursing students showed positive attitudes towards spirituality, with a mean score of 5.1 (SD = 0.60) on the Spiritual Care-Giving Scale-Arabic. However, their perceived competence in providing spiritual care was low to moderate with a mean score of 79.0 (SD = 32.0) on the Spiritual Care Competency Scale. The bivariate analysis indicated significant relationships between students' spiritual care competence and gender, previous exposure to spirituality education, willingness to undergo spirituality training, and total spirituality score. Finally, significant predictors of higher competence included regular admission status, prior spiritual education, willingness to undergo spiritual care training, and higher personal spirituality scores.

CONCLUSION

Nursing students in the Middle East have positive attitudes towards spirituality, but low to moderate competence in providing spiritual care. The influence of personal spirituality on competence underscores the importance of fostering a supportive environment for students to reflect on their beliefs. Comprehensive curriculum revisions and training programs, along with the recognition of the impact of personal spirituality, are essential to prepare future nurses for holistic people's care.

Ankle fracture surgery performed by orthopaedic residents without supervision has comparable outcomes to surgery performed by fellowship trained orthopaedic surgeons

BACKGROUND

Unstable fractures often necessitate open reduction and internal fixation (ORIF), which generally yield favourable outcomes. However, the impact of surgical trainee autonomy on healthcare quality in these procedures remains uncertain. We hypothesized that surgery performed solely by residents, without supervision or participation of an attending surgeon, can provide similar outcomes to surgery performed by trauma or foot and ankle fellowship-trained orthopaedic surgeons.

METHODS

A single-center cohort of an academic level-1 trauma center was retrospectively reviewed for all ankle ORIF between 2015 and 2019. Data were compared between surgery performed solely by post-graduate-year 4 to 6 residents, and surgery performed by trauma or foot and ankle fellowship-trained surgeons. Demographics, surgical parameters, preoperative and postoperative radiographs, and primary (mortality, complications, and revision surgery) and secondary outcome variables were collected and analyzed. Univariate analysis was performed to evaluate outcomes.

RESULTS

A total of 460 ankle fractures were included in the study. Nonoperative cases and cases operated by senior orthopaedic surgeons who are not trauma or foot and ankle fellowship-trained orthopaedic surgeons were excluded. The average follow-up time was 58.4 months (SD ± 12.5). Univariate analysis of outcomes demonstrated no significant difference between residents and attendings in complications and reoperations rate (p = 0.690, p = 0.388). Sub-analysis by fracture pattern (Lauge-Hansen classification) and the number of malleoli involved and fixated demonstrated similar outcomes. surgery time was significantly longer in the resident group (p < 0.001).

CONCLUSION

The current study demonstrates that ankle fracture surgery can be performed by trained orthopaedic surgery residents, with similar results and complication rates as surgery performed by fellowship-trained attendings. These findings provide valuable insights into surgical autonomy in residency and its role in modern clinical training and surgical education.

LEVEL OF EVIDENCE

Level III - retrospective cohort study.

The burden and management competency of cardiomyopathies in China: a nationwide survey study

Background

The public health burden of cardiomyopathies and competency in their management by health agencies in China are not well understood.

Methods

This study adopted a multi-stage sampling method for hospital selection. In the first stage, nationwide tertiary hospital recruitment was performed. As a result, 88 hospitals with the consent of the director of cardiology and access to an established electronic medical records system, were recruited. In the second stage, we sampled 66 hospitals within each geographic-economic stratification through a random sampling process. Data on (1) the outpatient and inpatient visits for cardiomyopathies between 2017 and 2021 and (2) the competency in the management of patients with cardiomyopathies, were collected. The competency of a hospital to provide cardiomyopathy care was evaluated using a specifically devised scale.

Findings

The outpatient and inpatient visits for cardiomyopathies increased between 2017 and 2021 by 38.6% and 33.0%, respectively. Most hospitals had basic facilities for cardiomyopathy assessment. However, access to more complex procedures was limited, and the integrated management pathway needs improvement. Only 4 (6.1%) of the 66 participating hospitals met the criteria for being designated as a comprehensive cardiomyopathy center, and only 29 (43.9%) could be classified as a primary cardiomyopathy center. There were significant variations in competency between hospitals with different administrative and economic levels.

Interpretation

The health burden of cardiomyopathies has increased significantly between 2017 and 2021 in China. Although most tertiary hospitals in China can offer basic cardiomyopathy care, more advanced facilities are not yet universally available. Moreover, inconsistencies in the management of cardiomyopathies across hospitals due to differing administrative and economic levels warrants a review of the nation allocation of medical resources.

Funding

This work was supported by the Chinese Academy of Medical Sciences (CAMS) Innovation Fund for Medical Sciences (2023-I2M-1-001) and the National High Level Hospital Clinical Research Funding (2022-GSP-GG-17).

Case mapping of geriatrics: Looking beyond age in skills laboratories

BACKGROUND AND PURPOSE

Development of competencies related to care of older adults is necessary in pharmacy education. Skills laboratories as an essential part of the curriculum represent an important setting to teach geriatrics. The purpose of this research was to describe geriatrics cases in skills/simulation activities of an undergraduate pharmacy program.

EDUCATIONAL ACTIVITY AND SETTING

A retrospective review of one academic year of skills laboratories from the pharmacy program at the Faculty of Pharmacy of University of Montreal was performed. Sessions including cases aged ≥65 years were selected. Content was extracted for characteristics relating to the patient, health, medications, and care context. A framework including geriatric considerations such as geriatric syndromes, frailty status, and potentially inappropriate medications was developed for data collection.

FINDINGS

In total, 210 patient cases were extracted. Older adults (≥ 65 years) were represented in 51 cases (24%), with 8 cases (4%) aged ≥80 years. Geriatric syndromes were documented in 8%, functional status in 10%, and mobility in 12% of the cases. The median number of comorbidities and medications were 4 and 7, respectively. Regarding polypharmacy, only 10 cases had >10 medications, and none had >15 medications. Potentially inappropriate medications were found in 47% (n = 24) of the cases but were addressed in only 14% (n = 7) cases.

SUMMARY

This mapping of skills laboratories highlights gaps in geriatrics content. Inclusion of the oldest patients and geriatrics issues were incorporated in a minority of cases and lacked many characteristics essential for geriatrics care.

Criteria to evaluate graduate nurse proficiencies in obtaining a health history and perform physical assessment in simulation-based education: A narrative review

BACKGROUND

Simulation is a technique being used increasingly in healthcare education which offers opportunities to evaluate nursing proficiencies. The use of valid and reliable instruments is recognised as the foundation for a robust assessment, however competency-based health assessment courses for graduate nurses can consequently become reductionist in measuring proficiencies.

OBJECTIVE

The specific review question was: In simulation-based education, what are the criteria that evaluate graduate nursing student's competence in obtaining a health history and performance of patient assessment?

METHODS

Eleven studies were included in the review. Papers were critically appraised with The Joanna Briggs Institute quasi-experimental studies checklist. Bloom's taxonomy was used to structure this narrative review.

RESULTS

Seven papers evaluated cognition through questionnaires and two papers used a Likert-scale to determine self-perceived knowledge. Six papers evaluated psychomotor skills with a behavioural checklist. Diversity of application was factored into the studies when testing affective skills. Three papers used Likert-scales to evaluate preparedness, six papers used Likert-scales to evaluate self-confidence and one used a Likert-scale to evaluate autonomy. Three papers used a checklist to evaluate professionalism. Four papers used faculty member/ standardised patient feedback.

CONCLUSION

Reductionist evaluation instruments create a barrier when evaluating competency. The limited validity and reliability of assessment instruments in simulation, as well as the lack of standardisation of affective skills assessment, presents a challenge in simulation research. Affective skills encompass attitudes, behaviours and communication abilities, which pose a significant challenge for standardised assessments due to their subjective nature. This review of the simulation literature highlights a lack of robustness in the evaluation of the affective domain. This paper proposes that simulation assessment instruments should include the standardisation of affective domain proficiencies such as: adaptation to patients' cognitive function, ability to interpret and synthesise relevant information, ability to demonstrate clinical judgement, readiness to act, recognition of professional limitations and faculty/standardised-simulated patient feedback. The incorporation of the affective domain in standardised assessment instruments is important to ensure comprehensive assessment of simulation particularly in the development of health history and physical assessment proficiencies. Attention to all of the domains in Blooms taxonomy during simulation assessment has the potential to better prepare professionals for the patient care setting.

Persons with mental disorders and assisted dying practices in Spain: In response to Ramos et al

Ramos et al. paper offers a narrative review of Spanish Organic Law 3/2021, which regulates euthanasia, focusing on its application to individuals with mental disorders. Ramos et al. examine the application of legal prerequisites from an ethical-legal perspective to ascertain the conditions under which psychiatric euthanasia might be considered legitimate and compliant with legal stipulations. Nevertheless, it is apparent that the core ethical inquiries linked to this matter have not been exhaustively investigated. The criteria laid out are, in our assessment, still open to further debate and broader deliberation. Our article emphasizes the need for a comprehensive ethical and legal debate in Spain regarding psychiatric euthanasia. Competency assessment is central to the legislation, but there are concerns about the validity of assessment tools and the subjective nature of interviews. Furthermore, defining irreversible suffering in mental health contexts poses challenges. The article advocates for a deeper understanding of the needs of individuals with mental disorders before considering euthanasia and emphasizes the importance of comprehensive care and psychosocial interventions in reducing the desire for euthanasia. Ultimately, it underscores the ethical complexities of euthanasia in mental health and the necessity of prioritizing comprehensive care in addressing these complexities.

Nursing students' and faculty's experiences of first medication administration: A phenomenological inquiry

BACKGROUND

Learning medication administration is essential for nursing students, but the first time can be stressful and shape their clinical development. Previous research primarily focused on student knowledge and technical aspects.

PURPOSE

This phenomenological study helped explore the lived experiences of nursing students and faculty during student's first medication administration in the clinical setting to gain a deeper understanding of their thoughts, feelings, and perspectives.

METHOD

Semi-structured interviews were conducted with female student and faculty informants (N = 12). Using a phenomenological study, data were analyzed using van Manen's hermeneutic six-step research activity method.

RESULTS

Five overarching themes were found: administrating medication, (un)preparedness for complexities in the clinical environment, transformative experience, overcoming fears, and reaping the rewards.

CONCLUSION

First-time medication experiences are greater than an exercise in skill proficiency and may be improved if faculty provides more structured learning experiences and take sufficient time for student preparation in relating medication knowledge to the skill, technology usage, and supporting students' attitudes toward nurse-patient interactions. These are essential aspects of the medication administration learning process as nursing programs shift toward competency-based education. Clinical faculty also need support in their role as educators and to be facilitated to find this time, considering their multiple responsibilities.

Association of self-efficacy and faculty support on students' readiness for practice

BACKGROUND

The nursing shortage is apparent again after nearly five decades of having a stable workforce. One novel development is that new Registered Nurses (RNs) are exiting their careers too early. Many of them leave the profession for multiple reasons such as burnout and family obligations, yet one reason has emerged - lack of readiness for practice, that also drives the RNs to leave the profession.

PURPOSE

The purpose of this study was twofold - (1) to investigate the relationship between students' characteristics, their Generalized Self-Efficacy (GSE), Perceived Faculty Support (PFS), the Assessment Technologies, Inc. (ATI) Comprehensive Predictor RN Exam scores and their self-report of readiness for practice and (2) to examine which variables best explains the students' readiness for practice.

METHODS

A cross-sectional descriptive correlational research design with convenience sampling was utilized. Descriptive statistics were obtained to investigate the students' socio-demographic data. The Pearson r and multiple regression were used to analyze the relationships and influence between dependent variables Casey-Fink Readiness for Practice scale (CFRPS) and independent variables, students' characteristics, GSE, PFS, and ATI scores.

RESULTS

One hundred forty-three (143) out of 416 students in five baccalaureate schools from the western region of the United States participated in the survey. Findings showed GSE and PFS had significant positive correlations with students' readiness for practice. Further, factors of CFRPS in learning strategies, problem-solving, resourcefulness, and team player are best explained by GSE and PFS, accounting for 91 % of the variance.

CONCLUSION

Students' GSE and PFS can contribute to their readiness for practice. Nurse educators must employ strategies that will bolster students' preparedness by improving their sense of self-efficacy and showing them the utmost faculty support.

Building a Competency Framework to Integrate Inter-disciplinary Precision Medicine Capabilities into the Medical Technology and Pharmaceutical Industry

INTRODUCTION

Integration of precision medicine (PM) competencies across the Medical Technology and Pharmaceutical industry is critical to enable industry professionals to understand and develop the skills needed to navigate the opportunities arising from rapid scientific and technological innovation in PM. Our objective was to identify the key competency domains required by industry professionals to enable them to upskill themselves in PM-related aspects of their roles.

METHODS

A desktop research review of current literature, curriculum, and healthcare trends identified a core set of domains and subdomains related to PM competencies that were consistent across multiple disciplines and competency frameworks. A survey was used to confirm the applicability of these domains to the cross-functional and multi-disciplinary work practices of industry professionals. Companies were requested to trial the domains to determine their relevance in practice and feedback was obtained.

RESULTS

Four PM-relevant domains were identified from the literature review: medical science and technology; translational and clinical application; governance and regulation and professional practice. Survey results refined these domains, and case studies within companies confirmed the potential for this framework to be used as an adjunct to current role specific competency frameworks to provide a specific focus on needed PM capabilities.

CONCLUSION

The framework was well accepted by local industry as a supplement to role specific competency frameworks to provide a structure on how to integrate new and evolving technologies into their current workforce development planning and build a continuous learning and cross-disciplinary mindset.

Do income-welfare satisfaction and competency enhance work engagement among Chinese nursing home caregivers? --A moderated mediating effect based on professional identity

Due to China's aging population, there is a high demand for elderly care that is further exacerbated by the shortage of well-trained caregivers and high turnover rates in nursing homes, urgently requiring enhanced work engagement of caregivers. This study used structural equation modeling based on the survey data of Chinese caregivers in nursing homes to explore the association among income-welfare satisfaction, competency, professional identity, family support and work engagement. Findings indicated that (1) income-welfare satisfaction, competency, and professional identity all enhanced caregivers' work engagement, with professional identity being stronger. (2) Professional identity partially mediated the effects of income-welfare satisfaction and competency on work engagement, with higher values and shares of competency. (3) When family support was high, the positive effect of income-welfare satisfaction on professional identity was significant, and the mediating role of professional identity between income-welfare satisfaction and work engagement was moderated by family support.

Development of nursing handoff competency scale: a methodological study

BACKGROUND

Nursing handoff competency is the ability of the nurse performing the handoff to select and interpret the necessary information for patient care and to convey it efficiently to the nurse accepting the handoff. Nursing handoff is an important nursing task that ensures nursing care continuity, quality and patient safety. This study aimed to develop a scale to measure nursing handoff competency and verify its validity and reliability.

METHODS

This study adopted a methodological design. A research process included three phases: (1) scale development (literature review and interviews); (2) scale validation (validity and reliability); (3) standard setting. Data were collected from 496 clinical nurses currently working in hospital wards, intensive care units, and emergency rooms, and who independently perform a handoff in South Korea.

RESULTS

The final scale comprises a self-reported 4-points Ilert scale with 25 items based on four factors: knowledge on handoff methods, identification of patient information, judgment and transfer of nursing situation, and "formation of supportive relationships. Construct validity, criterion-related validity, and discrimination validities were verified and the fitness of the scale revealed good results in confirmatory factor analysis. The Cronbach's α of the whole tool was.912 and the cut-off score for satisfied/unsatisfied was.72.

CONCLUSIONS

The developed scale can evaluate the nurse's handoff competencies and determine whether training is necessary. The measurement results of the scale can be used to select training subjects and compose the contents of the education program.

Effectiveness of a Brief Point of Care Ultrasound Course at a National Nephrology Conference

The rising demand for point of care ultrasound (POCUS) instruction during nephrology fellowship has been limited due to a shortage of trained faculty and courses designed specifically for nephrologists. A hands-on POCUS pre-course was organized during the April 2023 National Kidney Foundation (NKF) Spring Clinical Meeting to address this challenge. The course consisted of pre-recorded lectures and a 4-hour hands-on workshop guided by multidisciplinary POCUS experts. The anonymous post-course survey received responses from 25 out of 39 participants, yielding a 64.1% response rate. On a scale of 0-10, confidence levels for acquiring kidney images rose from 2.6 + 2.3 (mean + SD) pre-workshop to 7.8 + 1.5 post-workshop (p<0.001). Similarly, a remarkable improvement in confidence for acquiring lung and cardiac images was seen as scores increased from 1.8 + 2.4 to 7.7 + 1.5 (p<0.001) and from 1.5 + 2.2 to 7.2 + 1.3 (p<0.001), respectively. Additionally, respondents reported a substantial improvement in their confidence to interpret kidney, lung, and cardiac POCUS images, with scores increasing from 4.5 + 2.2 to 7.7 + 1.1 (p<0.001), 2.3 + 2.4 to 7.6 + 1.5 (p<0.001), and 2 + 2 to 7.3 + 1.5 (p<0.001), respectively. Barriers to implementing POCUS use at institutions included a perceived lack of trained faculty, limited protected time for faculty, and insufficient support from division leadership. The NKF POCUS pre-course successfully improved participants' confidence in acquiring and interpreting basic POCUS images.

Role of simulation-based training and assessment to improve brachytherapy competency among radiation oncology residents

Simulation is a technique used in healthcare to replicate clinical scenarios and improve patient safety, efficacy, and efficiency. Simulation-based medical education facilitates training and assessment in healthcare without increasing risk to patients, supported by ample evidence from surgical/procedural specialties. Simulation in radiation oncology has been leveraged to an extent, with successful examples of both screen-based and hands-on simulators that have improved confidence and performance in trainees. In the current era, evidence substantiates a significant deficit in brachytherapy procedure education, with radiation oncology residents reporting low confidence in this procedural skill, largely attributable to insufficient caseloads at some centers. Simulation-based medical education can facilitate structured training and competency-based assessment in brachytherapy skills. This review discusses existing advances and future directions in brachytherapy simulation, using examples from simulation in surgical specialties.

The effect of core competencies of university students on employment and first year salary level based on school activity log

Deciding on a career and securing employment at an ideal company represent significant challenges for students. Employment is not only a personal achievement but also a measure of success for universities and governments. To transform students into competitive applicants, various activities are provided by universities, governments, and companies. These activities may leave students either excited about the prospects or overwhelmed by the experience. The aim of this study is to explore the relationship between college experiences and post-graduation employment through an analysis of a five-year activity log. Specifically, students' diverse activities were categorized into six core competencies: skill reinforcement, leadership and teamwork, globalization, organizational commitment, job exploration, and autonomous implementation. We used logistic regression to examine how these competencies relate to employment status, and ANOVA analysis to assess their impact on initial salaries. The findings reveal that while competencies in skill improvement, job exploration, and organizational commitment were not statistically significant, those in leadership and teamwork, globalization, and autonomous implementation were crucial for securing employment. Additionally, globalization, job exploration, and autonomous implementation competencies influenced annual salary levels. Furthermore, a comparison of students completing either a single major or a convergent major revealed that job exploration competency significantly impacts the annual salary level.

Computer-aided quality assessment of endoscopist competence during colonoscopy: A systematic review

BACKGROUND AND AIMS

Endoscopists' competence can vary widely, as shown in the variation in adenoma detection rate (ADR). Computer-aided quality assessment (CAQ) can automatically assess performance during individual procedures. This review aims to identify and describe different CAQ systems for colonoscopy.

METHODS

A systematic review of the literature was done using MEDLINE, EMBASE, and SCOPUS based on three blocks of terms according to the inclusion criteria: Colonoscopy, Competence assessment, and Automatic evaluation. Articles were systematically reviewed by two reviewers, first by abstract and then in full text. The methodological quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI).

RESULTS

12,575 studies were identified, 6,831 remained after removal of duplicates, and 6,806 did not pass the eligibility criteria and were excluded, leaving thirteen studies for final analysis. Five categories of CAQ systems were identified: Withdrawal speedometer (seven studies), Scope movement analysis (three studies), Effective withdrawal time (one study), Fold examination quality (one study), and Visual gaze pattern (one study). The withdrawal speedometer was the only CAQ system that tested its feedback by examining changes in ADR. Three studies observed an improvement in ADR, and two studies did not. The methodological quality of the studies was high (mean MERSQI 15.2 points, maximum 18 points).

CONCLUSIONS

Thirteen studies developed or tested CAQ systems, most frequently by correlating it to ADR. Only five studies tested feedback by implementing the CAQ system. A meta-analysis was impossible due to the heterogeneous study designs, and more studies are warranted.

Effect of evidence-based nursing practices training programme on the competency of nurses caring for mechanically ventilated patients: a randomised controlled trial

BACKGROUND

Evidence-Based Practice (EBP) has been recognised worldwide as a standardised approach for enhancing the quality of healthcare and patient outcomes. Nurses play a significant role in integrating EBP, especially in Intensive Care Unit (ICU). Consequently, this study aims to examine the effect of an adapted evidence-based nursing practices training programme on the competency level of nurses caring for mechanically ventilated patients.

METHODS

A prospective open-label parallel 1:1 randomised controlled trial was conducted on 80 nurses caring for ICU patients at the National Hepatology and Tropical Medicine Research Institute, Egypt. The trial was carried out between November 2022 and February 2023 under the registration number NCT05721664. The enrolled nurses were randomly divided into intervention and control groups. The intervention group received the evidence-based nursing practice training programme (EBNPTP) in accordance with the Johns Hopkins EBP conceptional model, whereas the control group received traditional in-service education. Four assessments (one pre- and three post-assessments) were conducted to evaluate nurses' competency level over time using the adapted evidence-based nursing competency assessment checklist. The primary endpoint was an increase the competency levels among nurses caring for mechanically ventilated patients.

RESULTS

The current study results revealed statistically significant differences between intervention and control groups in relation to their level of competency across the three post-assessments, with (p <.001). The study also demonstrated that the nurses' competency level continued to decline significantly over time, with (p <.001). Additionally, a significant correlation was found between the nurses' pre-assessment and educational level, acting as independent variables (predictors), and the third endpoint assessment (p <.01), indicated by multiple linear regression.

CONCLUSION

The EBP training programme demonstrated a significant increase in the nurses' level of competency compared with traditional in-service education. This suggests that by training the nurses in various settings with the essential skills and knowledge for EBP, their competency level can be enhanced, leading to the delivery of effective care and improving patient outcomes. However, the long-term sustainability of the EBP adoptions was insufficient; further studies are needed to investigate the factors that affect the durability of EBP adoption.

TRIAL REGISTRATION

The study was registered with Clinical Trials.gov (Registration # NCT05721664) on 10/02/2023.

Assessment of Basic Thoracic Ultrasound Skills in Immersive Virtual Reality: Gathering Validity Evidence

OBJECTIVE

Operator skills are essential for thoracic ultrasound (TUS) to ensure diagnostic accuracy. Immersive virtual reality (IVR) has shown potential within medical education but never for assessment of TUS skills. This study was aimed at developing an IVR test for assessing TUS skills, gathering validity evidence and establishing a pass/fail score.

METHODS

An expert panel developed a test based on the TUS protocol by the European Respiratory Society (ERS), including a tutorial and two clinical cases (pleural effusion and interstitial syndrome), using an IVR platform (VitaSim, Odense, Denmark). Four anterior, four lateral and six posterior zones were available for examination and decision of diagnosis. Each correct examination equaled one point. The contrasting groups' method was used to set a pass/fail score.

RESULTS

Data were collected during the 2022 ERS Congress. We included 13 novices (N, experience: 0 TUS), 22 intermediates (I, 1-50 TUS) and 11 experienced clinicians (E, >50 TUS). Cronbach's α was 0.86. The total mean point scores in case 1 (C1) were (N) 5.0 ± 2.7, (I) 7.3 ± 2.4 and (E) 8.7 ± 1.3, and the scores in case 2 (C2) were (N) 4.5 ± 1.8, (I) 6.7 ± 2.3 and (E) 8.5 ± 2.1. Significant differences were found between N and I for C1 (p = 0.007) and C2 (p = 0.02), I and E for C1 (p = 0.04) and C2 (p = 0.019) and N and E for C1 (p < 0.001) and C2 (p < 0.001). The pass/fail score was 7 points in each case.

CONCLUSION

We established an IVR test that can distinguish between operators with different TUS skills. This enables a standardized, objective and evidence-based approach to assessment of TUS skills.