Beyond theoretical courses - A study of Swedish psychiatric residents' collegial learning through conversations in the workplace

BACKGROUND

Collegial conversations are important for sustainable learning to last beyond a course. Research on collegial conversations and peer learning in the workplace during psychiatric residency courses remains sparse, however. In this study, the aim was to explore residents' opportunities for collegial conversations during and after national courses in psychiatry.

METHODS

Residents in psychiatry completed an online survey including questions on opportunities for collegial conversations in their workplaces. Logistic regression was used for multivariate analysis and thematic content analysis was used for the open-ended answers where a theoretical framework of communities of practice was employed for the interpretation of the findings.

RESULTS

The survey was completed by 112 residents out of 725 (15,4%). The participants reported few structured forums for collegial discussion. The results of multivariate analysis suggest that more women than men feel it is advantageous to attend courses with others from the same workplace or from the same group of residents, described here as a team. The analysis of qualitative data identified how opportunities for collegial conversations differ across contexts and the type of values that are attached to team participation in residency courses.

CONCLUSIONS

This study highlights the importance of collegial conversations as a way to sustain the learning from residency courses into the workplace. By learning about residents' perceptions of collegial conversations during and after courses, teachers and directors may be more able to support residents' lifelong learning and professional development.

Sharing lessons learned from COVID-19 vaccine introductions: a global community forum for countries

To optimize the efficient introduction and deployment of COVID-19 vaccines across the globe during the COVID-19 pandemic, in April 2021 WHO launched a new process and tools for countries to rapidly review the early phase of countries' COVID-19 vaccine introduction. This methodology is called the COVID-19 vaccination intra-action review, also known as mini COVID-19 vaccine post-introduction evaluation (mini-cPIE). As of November 2022, 46 mini-cPIEs had been conducted. In collaboration with Project ECHO, WHO convened and facilitated real-time experience sharing and peer-learning among countries following their mini-cPIEs through a virtual global real-time learning forum. This five-session clinic series was attended by 736 participants from 129 countries. Based on post-session feedback surveys, when asked about the utility of the sessions, half of the participants said that sessions led them to review national guidelines and protocols or make other changes to their health systems. The post-series survey sent following the end of the clinic series showed that at least eight countries subsequently conducted a mini-cPIE after participating in the clinics, and participants from at least nine countries indicated the experience shared by peer countries on the clinic largely benefited their COVID-19 vaccine introduction and deployment. In this article, we highlight the benefits and importance of creating a global experience-sharing forum for countries to connect and share pertinent learnings in real-time during an international public health emergency. Moving forward, it is critical to foster a culture of individual and collective learning within and between countries during public health emergencies, with WHO playing an important convening role.

Exploring clinical facilitation and student learning on undergraduate nursing placements through a community of practice lens: A qualitative study

Background: High-quality clinical placement experiences are important for preparing undergraduate student nurses for practice. Clinical facilitation and support significantly impact student placement experiences and their development of skills, knowledge, and attitudes in the healthcare setting.Aim: This research aimed to explore university-employed clinical facilitators' perspectives on providing quality clinical facilitation and student learning on placement.Design: An exploratory, descriptive research design was used to examine the perspectives of n = 10 university-employed clinical facilitators working in regional New South Wales, Australia (March 2020-December 2021).Methods: Semi-structured interviews were used to explore the experiences of a purposeful sample of university-employed clinical facilitators. Data was thematically analysed using Miles et al.'s (2014) qualitative data analysis framework.Results: Five key themes were identified 1) relationships at the core of quality, 2) a culture of commitment to student learning, 3) connection to the curriculum, 4) examining the model, and 5) empowering growth and development. Clinical facilitators perceive their role as misunderstood, undervalued, and isolating and that they require further preparation and ongoing professional development to provide quality facilitation. Building rapport and relationships with staff and students was at the core of quality clinical facilitation.Conclusions: The clinical facilitator role has an important function in preparing student nurses for practice and needs further recognition and continued professional development. Education providers and healthcare organisations need to examine strategies to provide inclusive and supportive work environments, building communities of practice for clinical facilitators and stakeholders to share their experiences and knowledge, promoting individual and group learning, thus improving the student placement experience and fostering the professional identity of clinical facilitators.

Advancing the Science of Mentorship: Future Directions for Sustainable Implementation and Evaluation of Mentorship Education for the Clinical and Translational Science Workforce

The Advancing the Science of Mentorship: Future Directions for Sustainable Implementation and Evaluation of Mentorship Education for the Clinical and Translational Science Workforce conference was held in Madison, Wisconsin, in April 2023. The conference provided an engaging and scholarly forum for clinical and translational researchers from diverse backgrounds and career stages (including leaders at Clinical and Translational Science Award (CTSA) hubs and affiliated institutions) with a professional interest and commitment to improving and diversifying workforce development and fostering a climate of inclusive excellence through best practices in mentorship. Outcomes from the conference include an online resource and a new Community of Practice.

Creation of a National Emergency Medicine Medical Education Journal Club

Background There are a relatively limited number of emergency medicine (EM) medical education (MedEd) fellowships with few trainees at each program, creating barriers to local collaboration and networking. While best practices for developing MedEd journal clubs exist, there has not been an established national EM MedEd journal club. To address this need, we created a national journal club, the Council of Residency Directors (CORD) MedEd Journal Club (MEJC), to facilitate collaboration and networking opportunities by providing a synchronous online journal club. Objectives Our primary objective was to create a network for collaboration across geographical barriers to form a virtual community of practice (CoP) around the shared domain of evidence-based MedEd. Our secondary objective was to improve MedEd fellows' knowledge, skills, and attitudes surrounding MedEd research. Tertiary objectives included (1) broadening fellow exposure to key topics within MedEd, (2) describing how to develop scholarly work within MedEd, and (3) filling a perceived need for building a national MedEd virtual CoP. Curricular design The concept and objectives of the CORD MEJC were introduced to fellows and fellowship directors through a national listserv in March of 2022. Fellows volunteered to lead virtual sessions via Zoom on a monthly basis. Session fellow leaders independently chose the topics and were asked to submit two to three journal club articles discussing the topic at least two weeks in advance of each session. No topics were repeated throughout the academic year.  Impact/effectiveness Our quality improvement survey results indicated that the CORD MEJC is meeting its primary and secondary objectives. Survey results will be utilized as part of a continuous quality improvement initiative to enhance our program structure and curricula for the 2023-2024 academic year.

Transfer of Knowledge on Pneumoconiosis Care Among Rural-Based Members of a Digital Community of Practice: Cross-Sectional Study

BACKGROUND

Given the re-emergence of coal workers' pneumoconiosis in Appalachia and Mountain West United States, there is a tremendous need to train rural professionals in its multidisciplinary management. Since 2016, the Miners' Wellness TeleECHO (Extension for Community Health Outcomes) Program held by the University of New Mexico, Albuquerque, and Miners' Colfax Medical Center, Raton, New Mexico, provides structured longitudinal multidisciplinary telementoring to diverse professionals taking care of miners by creating a digital community of practice. Program sessions emphasize active learning through discussion, rather than didactic training. Professional stakeholder groups include respiratory therapists, home health professionals, benefits counselors, lawyers or attorneys, clinicians, and others. Rural-urban differences in knowledge transfer in such a community of practice, however, remain unknown.

OBJECTIVE

We aim to evaluate the role of the rurality of the patient or client base in the transfer of knowledge to professionals caring for miners using the digital community of practice approach.

METHODS

This is a cross-sectional study of 70 professionals participating in the Miners' Wellness TeleECHO Program between 2018 and 2019. Drawing insights from social network analysis, we examined the association between the rurality of participants' patient or client base and their self-reported receipt of knowledge. Our focal independent variable was the respondent's self-reported percentage of patients or clients who reside in rural areas. We measured knowledge transfer sources by asking participants if they received knowledge regarding the care of miners during and outside of TeleECHO sessions from each of the other participants. Our dependent variables included the number of knowledge sources, number of cross-stakeholder knowledge sources, number of same stakeholder knowledge sources, and range and heterogeneity of knowledge sources.

RESULTS

Respondents, on average, identified 4.46 (SD 3.16) unique knowledge sources within the community, with a greater number of cross-stakeholder knowledge sources (2.80) than same stakeholder knowledge sources (1.72). The mean knowledge source range was 2.50 (SD 1.29), indicating that, on average, respondents received knowledge sources from roughly half of the 5 stakeholder groups. Finally, the mean heterogeneity of knowledge sources, which can range between 0 and 0.80, was near the midpoint of the scale at 0.44 (SD 0.30). Multivariable analyses revealed that as the rurality of patient or client bases increased, participants reported more knowledge sources overall, more knowledge sources from outside of their stakeholder groups, a higher knowledge source range, and greater heterogeneity of knowledge sources (P<.05 for all comparisons).

CONCLUSIONS

Our findings suggest that participants who serve rural areas especially benefit from knowledge transfer within the TeleECHO community of practice. Additionally, the knowledge they receive comes from diverse information sources, emphasizing its multidisciplinary nature. Our results underscore the capacity of the TeleECHO model to leverage technology to promote rural health equity for miners.

Evolution of a self-renewing, participant-centered workshop series in BMB assessment

We present as a case study the evolution of a series of participant-centered workshops designed to meet a need in the life sciences education community-the incorporation of best practices in the assessment of student learning. Initially, the ICABL (Inclusive Community for the Assessment of Biochemistry and Molecular Biology/BMB Learning) project arose from a grass-roots effort to develop material for a national exam in biochemistry and molecular biology. ICABL has since evolved into a community of practice in which participants themselves-through extensive peer review and reflection-become integral stakeholders in the workshops. To examine this evolution, this case study begins with a pilot workshop supported by seed funding and thoughtful programmatic assessment, the results of which informed evidence-based changes that, in turn, led to an improved experience for the community. Using participant response data, the case study also reveals critical features for successful workshops, including participant-centered activities and the value of frequent peer review of participants' products. Furthermore, we outline a train-the-trainer model for creating a self-renewing community by bringing new perspectives and voices into an existing core leadership team. This case study, then, offers a blueprint for building a thriving, evolving community of practice that not only serves the needs of individual scientist-educators as they seek to enhance student learning, but also provides a pathway for elevating members to positions of leadership.

The Trial Innovation Network Liaison Team: building a national clinical and translational community of practice

In 2016, the National Center for Advancing Translational Science launched the Trial Innovation Network (TIN) to address barriers to efficient and informative multicenter trials. The TIN provides a national platform, working in partnership with 60+ Clinical and Translational Science Award (CTSA) hubs across the country to support the design and conduct of successful multicenter trials. A dedicated Hub Liaison Team (HLT) was established within each CTSA to facilitate connection between the hubs and the newly launched Trial and Recruitment Innovation Centers. Each HLT serves as an expert intermediary, connecting CTSA Hub investigators with TIN support, and connecting TIN research teams with potential multicenter trial site investigators. The cross-consortium Liaison Team network was developed during the first TIN funding cycle, and it is now a mature national network at the cutting edge of team science in clinical and translational research. The CTSA-based HLT structures and the external network structure have been developed in collaborative and iterative ways, with methods for shared learning and continuous process improvement. In this paper, we review the structure, function, and development of the Liaison Team network, discuss lessons learned during the first TIN funding cycle, and outline a path toward further network maturity.

Indigenous Voices in Psychedelic Therapy: Experiential Learnings from a Community-Based Group Psychedelic Therapy Program

Novel and traditional psychedelic medicines are attracting interest as potential treatments of mental illness. Before psychedelic therapies can be made available in culturally safe and effective ways to diverse peoples, the field must grapple with the complex legacies of colonialism and ongoing clashes between biomedical and Indigenous Ways of Knowing. This article presents results of a pilot program offering group-based therapy augmented by three sessions of ketamine at a psychedelic dose, for a group of Indigenous participants. This unique project was undertaken in partnership between Roots to Thrive and the Snuneymuxw First Nation to assess this approach's effectiveness and safety for Indigenous peoples. Thematic analysis of qualitative interviews and anonymous feedback received throughout the program from eight participants and two Elders provided rich information on participant motivations, perceived barriers, appreciated and beneficial aspects of the program, and the psychedelic experiences, as well as important directions for further improvement. In addition to challenges, participants attributed significant benefits to the program while highlighting the importance of the involvement of Indigenous team members, the incorporation of traditional approaches to healing, and the cultivation of open and authentic relationships between group participants and facilitators. We discuss important lessons learned and the essential work of reconciliation in, and beyond, psychedelic therapies.

HIV in MOTION: a community of practice on physical rehabilitation for and by people living with HIV and their allies

Background

This paper describes the design, implementation, and evaluation of a community of practice (CoP), HIV in MOTION (HIM), to advance physical activity rehabilitation interventions with adults living with HIV, clinicians, researchers, and representatives from community-based organizations. We attracted a diverse audience of geographically dispersed people living with HIV, clinicians, exercise personnel, and trainees to eight HIM community of practice events that featured the clinical, research, and lived experience of people living with HIV. HIV in MOTION had (a) a domain related to physical rehabilitation, exercise, and social participation for people living with HIV; (b) a community of diverse individuals; and (c) a practice, that is, a series of sustained interactions online and offline, synchronous, and asynchronous. Our team included six diverse people living with HIV, two coordinators, and three academic researchers who planned, prepared, implemented, and evaluated each online session. To evaluate the HIV in MOTION CoP, we employed an evaluation framework composed of five criteria: Goals and Scope, Context and Structure, Process and Activities, Outcomes, and Impact. We collected quantitative and qualitative evaluative data using online evaluation, audiovisual archiving, and participant observations during the debriefing with all members of our team.

Results

We widened the Goals and Scope of the HIV in MOTION CoP to include the HIV narrative of lived experiences, including autopathography, and participant storytelling. In matters of Context and Structure, we received explicit satisfaction with our governance and leadership. Also, being flexible to fit online formats was a productive strategy that made the HIV in MOTION CoP sessions agile and amenable to audiovisual archiving. Our indicators of success in Process, Activities, and Outcomes included participant retention online, elicited verbal interventions and comments in the chat room, and a rate of three repeat visits online. The indicators of success of Impact were the presence of voluntary and unscripted autopathography, the patient storytelling and how it reportedly caused changes in the participants, and the "legitimate peripheral participation" of emerging research and clinical students. In conclusion, we recommend our form of CoP for mixing the knowledge of diverse persons in this area. However, we recommend considering budget and burnout as serious challenges to sustainability.

Shared Reading as a Community of Practice for Overcoming the Generation Gap and Improving Psychological Safety in Rural Family Medicine Education: A Grounded-Theory Approach

Background A community of practice (CoP) is essential for continuous professional development in family medicine. A CoP in medical education comprises a group of individuals who share common interests and learn and share knowledge, skills, and attitudes. The generation gap between teachers and learners can influence their effective collaboration in family medicine education. To address this issue, shared reading, which involves group discussions on medical texts, effectively promotes intergenerational learning within a CoP. Shared reading is particularly beneficial in rural contexts, where medical resources are scarce, and the generation gap between teachers and learners is wide. This study examines how shared reading facilitates learning and practice among family medicine trainees in rural areas. Methods This qualitative study utilized a grounded-theory approach. It involved the participation of eight family medicine residents, five junior residents, and seven medical students from Unnan City Hospital, Japan, in shared reading sessions between August 2022 and March 2023. Semi-structured interviews were conducted with all participants after the sessions. Results Data analysis using the grounded-theory approach yielded three themes: facilitating learning and motivation, respectful collaboration with teachers, and developing a relationship that fosters psychological safety. First, through shared reading, the participants had opportunities to learn about medical issues and engage in continual dialogues with colleagues and teachers. Second, the participants felt motivated to apply their newly acquired knowledge at work and collaborate with teachers. Third, they acquired self-regulated learning skills by adapting their motivations to their interests and experiences. Increased interaction between participants and teachers during the sessions helped mitigate the generation gap and enhanced psychological safety. Conclusions Shared reading effectively promotes continuous learning and motivates medical learners to apply their knowledge and collaborate with teachers. It facilitates the development of self-regulated learning skills, helps mitigate the generation gap, and enhances psychological safety among educators and learners in rural medical education.

Creating a consumer-driven global community of practice to support action within environmental design with people living with dementia: assistive technology challenges and opportunities

The environment, and assistive technologies as part of this, can play an important role in supporting the participation and wellbeing of people living with dementia. If not considered, environments can be overwhelming and disempowering. Disability approaches including environmental considerations and assistive technology were often not offered routinely with people living with dementia. Concerned by this, dementia advocates aimed to create change in this area. The Environmental Design-Special Interest Group (ED-SiG) of Dementia Alliance International was developed as an international consumer-driven community of practice bringing together people with different relevant expertise including living experience (people living with dementia, care partners), architecture and design, occupational therapy, rehabilitation and care provision. This practice opinion piece provides an overview of dementia, the need for collaborative practices within practice with people living with dementia, and the considerations of assistive technology, environmental design and the global context. The reflection provides insights into this international community of practice, with personal reflections of members with living experience of dementia, and benefits and opportunities in considering environmental design and assistive technology from the perspectives of members. This work demonstrates and advocates collaborations that centre the perspectives and expertise of people living with dementia.

A Community of Practice on Environmental Design for Long-Term Care Residents with Dementia

The use of communities of practice (CoP) to support the application of knowledge in improved geriatric care practice is not widely understood. This case study's aim was to gain a deeper understanding of the knowledge-to-action (KTA) processes of a CoP focused on environmental design, to improve how persons with dementia find their way around in long-term care (LTC) homes. Qualitative data were collected (key informant interviews, observations, and document review), and analysed using emergent coding. CoP members contributed extensive knowledge to the KTA process characterized by the following themes: team dynamics, employing a structured process, technology use, varied forms of knowledge, and a clear initiative. The study's CoP effectively synthesized and translated knowledge into practical tools to inform changes in practice, programs, and policy on dementia care. More research is needed on how to involve patients and caregivers in the KTA processes, and to ensure that practical application of knowledge has financial and policy support.

A Pilot Study Comparing a Community of Practice Program with and without Concurrent Ketamine-Assisted Therapy

The prevalence of depression, anxiety, and post-traumatic stress disorder (PTSD) has increased among healthcare providers, while the effectiveness of conventional treatments remains limited. Ketamine-assisted therapy offers a promising alternative; however, few have integrated ketamine with a group-based therapeutic modality. We report a retrospective, secondary analysis of a 12-week pilot of a Community of Practice (CoP) oriented group therapy program with optional, adjunct ketamine for depression, anxiety, and PTSD in a sample of 57 healthcare providers. All participants moved through the treatment as one group, with 38 electing to also receive three adjunct ketamine sessions in addition to the weekly CoP. Symptoms were assessed at baseline and pilot completion with the PHQ-9 for depression, GAD-7 for anxiety, and PCL-5 for PTSD. We observed significant reductions in the mean change among all participants, suggesting that benefit was derived from the CoP component, with or without ketamine as an adjunct. PHQ-9 scores decreased by 6.79 (95% CI: 5.09-8.49, p < .001), GAD-7 scores decreased by 5.57 (CI: 4.12-7.00, p < .001), and PCL-5 scores decreased by 14.83 (CI: 10.27-19.38, p < .001). Reductions were larger, but statistically nonsignificant, among those receiving ketamine. Further research is required to assess the impact of ketamine as an adjunct in group-based therapies.

Evolving Project ECHO: delivery of pediatric pain core competency learning for interprofessional healthcare providers

Introduction

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.

Methods

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.

Results

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).

Conclusion

The integration of core competency learning within the Project ECHO® model was a successful approach to deliver pediatric pain education to interprofessional HCPs.

Do All Roads Lead to Full Participation? Examining Trajectories of Clinical Educators in Graduate Medical Education through Situated Learning Theory

Phenomenon: As new faculty members begin their careers in Graduate Medical Education, each begins a journey of Professional Identity Formation from the periphery of their educational communities. The trajectories traveled vary widely, and full participation in a given educational community is not assured. While some medical school and post-graduate training programs may nurture Professional Identity Formation, there is scant support for faculty. To date, the trajectories that Graduate Medical Education faculty travel, what may derail inbound trajectories, and what tools Graduate Medical Education faculty use to navigate these trajectories have not been explicitly described. We explore these three questions here. Approach: Communities of Practice, a component of Situated Learning Theory, serves as a helpful framework to explore trajectories of educator identity development among Graduate Medical Educators. We used a inductive and deductive approach to Thematic Analysis, with Situated Learning Theory as our interpretive frame. Semi-structured interviews of faculty members of GME programs matriculating into a Health Professions Education Program were conducted, focusing on participants' lived experiences in medical education and how these experiences shaped their Professional Identity Formation. Findings: Participants noted peripheral, inbound, boundary, and outbound trajectories, but not an insider trajectory. Trajectory derailment was attributed to competing demands, imposter syndrome and gendered marginality. Modes of belonging were critical tools participants used to shape PIF, not only engagement with educator roles but disengagement with other roles; imagination of future roles with the support of mentors; and fluid alignment with multiple mutually reinforcing identities. Participants identified boundary objects like resumes and formal roles that helped them negotiate across Community of Practice boundaries. Insights: Despite a desire for full participation, some clinical educators remain marginal, struggling along a peripheral trajectory. Further research exploring this struggle and potential interventions to strengthen modes of belonging and boundary objects is critical to create equitable access to the inbound trajectory for all of our colleagues, leaving the choice of trajectories up to them.

Preprint Peer Review Enhances Undergraduate Biology Students' Disciplinary Literacy and Sense of Belonging in STEM

Education about scientific publishing and manuscript peer review is not universally provided in undergraduate science courses. Since peer review is integral to the scientific process and central to the identity of a scientist, we envision a paradigm shift where teaching peer review becomes integral to undergraduate science education. We hypothesize that teaching undergraduates how to peer review scientific manuscripts may facilitate their development of scientific literacy and identity formation. To this end, we developed a constructivist, service-learning curriculum for biology undergraduates to learn about the mechanisms of peer review using preprints and then to write and publish their own peer reviews of preprints as a way to authentically join the scientific community of practice. The curriculum was implemented as a semester-long intervention in one class and, in another class, as an embedded module intervention. Students' scientific literacy and peer review ability were assessed using quantitative methods. Student's perceptions of their scientific literacy and identity were assessed using thematic analysis of students' reflective writing. Here, we present data on the improvement in the peer review ability of undergraduates in both classes and data on the curriculum's interrelated impact on students' development of scientific literacy, identity, and belonging in peer and professional discourse spaces. These data suggest that undergraduates can and should be trained in peer review to foster the interrelated development of their scientific literacy, scientific identity, and sense of belonging in science.

COPUS-TA: An "Entry-Level" Peer Observation Tool to Support Teaching Assistant Professional Pedagogical Development

When coordinating teams of teaching assistants (TAs) in our courses, it can be time and resource prohibitive to provide mentorship for individual professional development of their teaching. Peer observation of teaching is a useful and effective approach for professional development and for forming a community of practice that TAs can engage in. However, structured peer observation can require substantial training - which may make it infeasible for large teams of TAs with variable teaching expertise and limited contract hours. This article describes the development of an observation protocol, adapted for the TA context, from the Classroom Observation Protocol for Undergraduate STEM (COPUS; by Smith et al. 2013). We have used this successfully, with very minimal training (15-min discussion plus one practice observation). I include the modified form (COPUS-TA) for practical and immediate use in supporting the development of TAs' teaching skills.

Developing an intervention to improve the quality of childcare centers in resource-poor urban settings: a mixed methods study in Nairobi, Kenya

Background

Globally, 350 million under-5s do not have adequate childcare. This may damage their health and development and undermine societal and economic development. Rapid urbanization is changing patterns of work, social structures, and gender norms. Parents, mainly mothers, work long hours for insecure daily wages. To respond to increasing demand, childcare centers have sprung up in informal settlements. However, there is currently little or no support to ensure they provide safe, nurturing care accessible to low-income families. Here, we present the process of co-designing an intervention, delivered by local government community health teams to improve the quality of childcare centers and ultimately the health and development of under-5 children in informal settlements in Kenya.

Methods

This mixed methods study started with a rapid mapping of the location and basic characteristics of all childcare centers in two informal settlements in Nairobi. Qualitative interviews were conducted with parents and grandparents (n = 44), childcare providers, and community health teams (n = 44). A series of 7 co-design workshops with representatives from government and non-governmental organizations (NGOs), community health teams, and childcare providers were held to design the intervention. Questionnaires to assess the knowledge, attitudes, and practices of community health volunteers (n = 22) and childcare center providers (n = 66) were conducted.

Results

In total, 129 childcare centers were identified -55 in Korogocho and 77 in Viwandani. School-based providers dominated in Korogocho (73%) while home-based centers were prevalent in Viwandani (53%). All centers reported minimal support from any organization (19% supported) and this was particularly low among home-based (9%) and center-based (14%) providers. Home-based center providers were the least likely to be trained in early childhood development (20%), hence the co-designed intervention focused on supporting these centers. All co-design stakeholders agreed that with further training, community health volunteers were well placed to support these informal centers. Findings showed that given the context of informal settlements, support for strengthening management within the centers in addition to the core domains of WHO's Nurturing Care Framework was required as a key component of the intervention.

Conclusion

Implementing a co-design process embedded within existing community health systems and drawing on the lived experiences of childcare providers and parents in informal settlements facilitated the development of an intervention with the potential for scalability and sustainability. Such interventions are urgently needed as the number of home-based and small center-based informal childcare centers is growing rapidly to meet the demand; yet, they receive little support to improve quality and are largely unregulated. Childcare providers, and government and community health teams were able to co-design an intervention delivered within current public community health structures to support centers in improving nurturing care. Further research on the effectiveness and sustainability of support to private and informal childcare centers in the context of low-income urban neighborhoods is needed.

Creating and Activating an Implementation Community to Drive HPV Vaccine Uptake in Texas: The Role of an NCI-Designated Cancer Center

The University of Texas MD Anderson Cancer Center, a comprehensive cancer center designated by the National Cancer Institute (NCI), defines its service population area as the State of Texas (29.1 M), the second most populous state in the country and the state with the greatest number of uninsured residents in the United States. Consistent with a novel and formal commitment to prevention as part of its core mission, alongside clear opportunities in Texas to drive vaccine uptake, MD Anderson assembled a transdisciplinary team to develop an institutional Framework to increase adolescent HPV vaccination and reduce HPV-related cancer burden. The Framework was developed and activated through a four-phase approach aligned with the NCI Cancer Center Support Grant Community Outreach and Engagement component. MD Anderson identified collaborators through data-driven outreach and constructed a portfolio of collaborative multi-sector initiatives through review processes designed to assess readiness, impact and sustainability. The result is an implementation community of 78 institutions collaboratively implementing 12 initiatives within a shared measurement framework impacting 18 counties. This paper describes a structured and rigorous process to set up the implementation of a multi-year investment in evidence-based strategies to increase HPV vaccination that solves challenges preventing implementation of recommended strategies and to encourage similar initiative replication.

Diabetes in School Health (DiSH): Telementoring Collaboration Between Pediatric Diabetes Specialists and School Nurses to Improve Care of Children With Diabetes

Rates of diabetes in youth are rising and more than 1 million children have diabetes. School nurses are central to a school-aged child's diabetes care and they must make important moment-to-moment decisions requiring understanding of and comfort with diabetes care and technology. The rapid changes in diabetes care and technology make ongoing education essential, yet access to up-to-date and practical education is limited for many school nurses. Integrating needs data and stakeholders' input, this group developed Diabetes in School Health (DiSH) to address this gap. We adapted a well-established, innovative, and easily-accessible telementoring educational model, Project ECHO, to create a collaborative learning community. In the first year, 9 diabetes experts and >150 school nurses joined live DiSH sessions. DiSH has been well-received by the school community and next steps include expansion of DiSH to other states and study of impact of DiSH on health disparities.

Learning to make a difference for chILD: Value creation through network collaboration and team science

Addressing the recognized challenges and inequalities in providing high quality healthcare for rare diseases such as children's interstitial lung disease (chILD) requires collaboration across institutional, geographical, discipline, and system boundaries. The Children's Interstitial Lung Disease Respiratory Network of Australia and New Zealand (chILDRANZ) is an example of a clinical network that brings together multidisciplinary health professionals for collaboration, peer learning, and advocacy with the goal of improving the diagnosis and management of this group of rare and ultra-rare conditions. This narrative review explores the multifaceted benefits arising from social learning spaces within rare disease clinical networks by applying the value creation framework. The operation of the chILDRANZ network is used as an example across the framework to highlight how value is generated, realized, and transferred within such collaborative clinical and research networks. The community of practice formed in the chILDRANZ multidisciplinary meetings provides a strong example of social learning that engages with the uncertainty inherent in rare disease diagnosis and management and pays attention to generate new knowledge and best practice to make a difference for children and families living with chILD. This review underscores international calls for further investment in, and support of, collaborative clinical networks and virtual centers of excellence for rare disease.

Addressing Complex Social Problems Using the Lens of Family Violence: Valuable Learning from the First Year of an Interdisciplinary Community of Practice

It is imperative that universities continue to explore innovations that support staff and student learning and pursue their mission to promote social responsibility and community service. Communities of Practice have been used to facilitate innovation and regenerate teaching and learning in tertiary contexts, including interdisciplinary collaborations around complex problems. This study describes the challenges and achievements of the first year of an interdisciplinary Community of Practice which aimed to create innovative approaches to teaching and learning about family and domestic violence, a complex social issue, inherently gendered, which receives little attention across the University discipline areas, despite the centrality of this issue in much of the future work of University graduates within a range of professional areas. We interviewed engaged members to explore the value gained from their first year of involvement in the Community of Practice. This initiative brought members substantial value while recognising the need for long-term engagement and commitment from the senior University leadership to embed innovation. A key lesson was that developing an innovative curriculum to address critical and ongoing social and public health issues requires much more senior leadership, responsibilities shared across faculty, and commitment of dedicated resources and staff time. The findings provide valuable learning for other Communities of Practice attempting to engage with complex problems and create innovative interdisciplinary approaches to teaching, learning, and research.

Collective case formulation in situations of violent radicalization: A critical perspective in training

Case formulation is used in clinical training to weave together theoretical perspectives and support a shared plan of action. Although a cornerstone of clinical practice, critical social theorists have highlighted the risks of depoliticizing political struggles and of reifying and fixing subjects when using psychopathology and case formulation to address situations of injustice. In the field of violent radicalization, this risk is increased by the extreme affects evoked by terror in practitioners and in societies. This article explores the challenges of training clinicians in the field of violent radicalization. It does so by analyzing a Community of Practice (CoP) that was developed to support practitioners involved in this domain of practice in Quebec, Canada. Four focus groups with CoP participants and participant observation of nine CoP meetings were conducted. Thematic and narrative analyses were used to explore the training potential of the CoP and to identify the discursive processes and group dynamics associated with this modality. Results indicate that the diversity of professional perspectives and social positionalities in the group plays a central role in helping participants become aware of their biases and in developing more complex understandings of cases and of their social embedding. Results also suggest that the collective holding of risk is key to preserve practitioners' investment in patients involved with violent radicalization. The sensitive issue of partnership between health and social services and security agencies is also addressed. Results suggest that CoPs with strong leadership allow for experiential training to enhance clinical and critical thinking.