RETRACTED: Attitudes of midwives towards perinatal bereavement in Hong Kong

OBJECTIVE

to explore attitudes towards perinatal bereavement care among midwives working in Hong Kong through examination of relationships between attitudes towards bereavement support, need for bereavement education and appropriate hospital policy.

DESIGN

a descriptive correlational survey.

SETTING

the obstetric and gynaecology units at two hospitals.

INSTRUMENT

a structured self-report questionnaire on attitudes towards perinatal bereavement support; required support and education needs for midwives on bereavement care.

PARTICIPANTS

154 out of 202 midwives (76.2% response rate) working at the two units.

FINDINGS

two-step cluster analysis yielded two clusters. Cluster 1 consisted of 91 (59.1%) midwives and cluster 2 consisted of 63 (40.9%) midwives. Cluster 2 midwives were younger, had less obstetric and gynaecology experience, junior ranking and less post-qualification education than cluster 1 midwives. Cluster 1 midwives had additional personal grieving experiences and experience of caring for grieving parents. Attitudes towards bereavement care were positively correlated with educational needs (r(s)=0.55, p< 0.001) and hospital policy support (r(s)=0.50, p< 0.001).

CONCLUSIONS

Hong Kong midwives require increased bereavement care knowledge and experience, improved communication skills, and greater hospital and team member support. Findings may be used to improve support of midwives, to ensure sensitive bereavement care in perinatal settings and to reflect training needs in the midwifery education curricula. Study findings highlight the universality of grief for a lost baby, irrespective of cultural differences in approaching emotional topics. This study may help midwives internationally to gain a broader perspective in this area.

Educating advanced midwife practitioners: a collaborative venture

AIM

To describe the collaborative development of an MSc course preparing Ireland's first advanced midwife practitioners.

BACKGROUND

Ireland has 55 advanced nurse practitioner posts, but, as yet, no advanced midwife practitioners.

METHODS

A consultative, collaborative process involving 38 midwives across Ireland generated the philosophy, aims and content of the course.

RESULTS

Participants stated that candidates should be committed to the conceptual uniqueness of midwifery; the advanced midwife practitioner role should be clearly defined and supported by the candidate's sponsors; programme content should emphasize normal midwifery, be practice led, and encourage reflective, evidence-based, women-centred care.

CONCLUSION

The collaborative process used to develop this programme ensures that it will meet individual students' needs, thus enhancing the education of Ireland's first advanced midwife practitioners. IMPLICATIONS FOR MIDWIFERY MANAGEMENT: The emphasis on normality rather than specialization is a message that could be assimilated by managers in other countries to the benefit of childbearing women across the world.

The impact of assessing simulated bad news consultations on medical students' stress response and communication performance

Seventy second-year medical students volunteered to participate in a study with the aim of evaluating the impact of the assessment of simulated bad news consultations on their physiological and psychological stress and communication performance. Measurements were taken of salivary cortisol, systolic and diastolic blood pressure, heart rate, state anxiety and global stress using a Visual Analogue Scale. The subjects were asked to take three salivary cortisol samples on the assessment day as well as on a quiet control day, and to take all other measures 5 min before and 10 min after conducting the bad news consultation. Consultations were videotaped and analyzed using the information-giving subscale of the Amsterdam Attitude and Communication Scale (AACS), the Roter Interaction Analysis System (RIAS), and the additional non-verbal measures, smiling, nodding and patient-directed gaze. MANOVA repeated measurements were used to test the difference between the cortisol measurements taken on the assessment and the control day. Linear regression analysis was used to determine the association between physiological and psychological stress measures and the students' communication performance. The analyses were restricted to the sample of 57 students who had complete data records. In anticipation of the communication assessment, cortisol levels remained elevated, indicating a heightened anticipatory stress response. After the assessment, the students' systolic blood pressure, heart rate, globally assessed stress level and state anxiety diminished. Pre-consultation stress did not appear to be related to the quality of the students' communication performance. Non-verbal communication could be predicted by pre-consultation physiological stress levels in the sense that patient-directed gaze occurred more often the higher the students' systolic blood pressure and heart rate. Post-consultation heart rate remained higher the more often the students had looked at the patient and the more information they had provided. However, the heart rate appeared to diminish the more often the students had reassured the patient. These findings suggest that in evaluating students' communication performance there is a need to take their stress levels into account.

Virtues-based advice for beginning medical students

OBJECTIVE

The goals of this article are to present a framework, based on John Gregory's (1724-1773) concept of professionalism, for advising beginning medical students about what is important to training and to the practice of medicine.

METHOD

The author presents Gregory's concept of professionalism with an emphasis on the related virtues. Members of the editorial board of Academic Psychiatry were also surveyed for their advice for beginning students.

RESULTS

There are four fundamental virtues that originated from Greogory's concept of professionalism: integrity, compassion, self-effacement, and self-sacrifice. Medical students should actively cultivate these virtues in order to promote excellence in every clinical encounter.

CONCLUSIONS

These four fundamental virtues together obligate medical students to learn and practice in accordance with the principles of evidence-based medicine and to protect and promote the interests of patients.

Peer-assisted learning in the acquisition of clinical skills: a supplementary approach to musculoskeletal system training

BACKGROUND

This study evaluates whether peer-assisted learning (PAL) can be used to improve students' clinical examination skills.

METHODS

Four year 4 students trained in PAL techniques and musculoskeletal (MSS) examination used the Gait, Arms, Legs and Spine (GALS) system in a five-week student selected module. These students then recruited and trained 28 second-year trainees. Trainees were evaluated using pre/post confidence questionnaires (100 mm visual analogue scale), a course experience questionnaire (five-point Likert scales) and end-of-year objective structured clinical examination (OSCE) scores.

RESULTS

Baseline data from the experimental group were no different from a separate control group, but after training a statistically significant difference in confidence levels was observed in all parts of GALS, <38 to >73 (p < 0.0001). Course experience questionnaires demonstrated benefits in all parameters including communication skills and group work with all students recommending PAL training. In end-of-year OSCE 93% of PAL-trained students passed the MSS examination station compared with 67% for those participating in the standard curriculum alone (p < 0.0001). Examination results for other clinical skill stations showed no difference in performance between the two groups.

CONCLUSIONS

This study shows that PAL is a useful adjunct to MSS training, and could be incorporated into medical curricula to enhance clinical skills.

Using Structured Academic Controversy With Nursing Students

Nurse educators use a variety of strategies to foster critical thinking in undergraduate and graduate students. Structured academic controversy, although used by other disciplines, offers a novel approach for nurse educators. The author describes structured academic controversy and its use in a graduate course in gerontological nursing. The article also presents a rubric developed to grade the structured academic controversy assignment.

Use of case-based exams as an instructional teaching tool to teach clinical reasoning

BACKGROUND

It is a very well-known fact that examinations drive learning to a great extent. The examination program is actually the 'hidden curriculum' for the students. In order to improve teaching and learning one option is to strategically use of exams.

AIMS

This report of the strategic use of an innovative assessment tool in clinical problem solving domain, presents the design, format, content, students' results and evaluation of one year test results of instructive case-based exams for 6th year medical students.

METHOD

Using a hybrid form of the OSCE, PMP and KFE formats, we developed a case-based stationary exam. Students were treated as advanced beginners in medical career and forced to an inquiry to use their clinical knowledge in the cases. Case discussions and question-answer sessions followed the exams. Six exams were held in 2000-2001 and 382 students participated in the study. One or two problems were used for each exam and the mean duration was 27 minutes for 7-11 stations. 17-19 observers contributed to each exam. Exams were evaluated by questionnaire based feedbacks of the students and oral feedbacks of the staff members.

RESULTS

The exams were well received and rated 'fair' by the students and the format was found highly 'relevant for learning' while the content was 'instructive' and 'not difficult'. The total non-satisfactory performance rate was 2.36%. Students asked to take a similar test weekly. Although it was labor intensive, staff members appreciated the collaborative working process.

CONCLUSIONS

Instructive case-based exams and the following case discussions seemed a high potential and motivating teaching tool in the clinical problem solving domain for 6th year students.

The association between patient shortage and patient satisfaction with general practitioners

OBJECTIVE

The aim of the study was to explore whether or not the influx of patients to a GP's practice is associated with satisfaction with the GP.

DESIGN

Persons in the Norwegian Living Condition Survey answered a questionnaire on satisfaction with their GP. The data on satisfaction were merged with registered information on the GPs and the GPs' patient lists from the National Insurance Administration, with registered information on the sample's sociodemographic background, and on their resident municipality from Statistics Norway.

SETTING

A representative sample of 2326 persons answered the questionnaire. This constituted persons in the survey who had visited their GP during the last six months.

MAIN OUTCOME MEASURE

Satisfaction with the GP's interpersonal skills, the GP's medical skills, the GP's use of time, general accessibility to the GP, and the GP's role as a gatekeeper.

RESULTS

Persons listed with a GP who experience patient shortage were less satisfied than others along four dimensions of satisfaction: the GP's interpersonal skills, the GP's medical skills, the GP's referral practices, and the consultation lengths the GP offered. The GP's age and gender, characteristics of the patient, and characteristics of the organization of primary care had minor influence.

CONCLUSION

Whether or not a GP experiences patient shortage is associated with patient satisfaction. Whether or not the lower patient satisfaction is a result of patient shortage or vice versa is not known.

Corporate solutions to caseload management -- an evaluation

This paper describes an evaluation of a change in health visiting service delivery from GP caseload management to corporate caseload working, in one inner city health centre located in a deprived area of Glasgow. The aim of the study was to identify if moving to corporate caseload working provides the reported benefits cited in the limited literature available. A purposive sample consisting of ten health visitors, one GP, one manager and three clients volunteered to participate in this mixed methods evaluation study. Data were collected by means of a stress questionnaire, public health nursing diary, focus groups and semi-structured interviews. Findings show that immediate improvements were seen in team working, staff communication, sharing practice, enhanced clinical reflection and standards of documentation. However, corporate caseload working did not appear to reduce staff stress levels, increase public health nursing activity or improve quality of client service. Further research conducted over a longer time period with a full staffing complement is needed to validate these findings.

[Achieving an educative strategy in undergraduate medical interns with respect to patients with diabetes]

OBJECTIVE

To estimate the achievement of an educative strategy that promoted participation of the development of the clinical aptitude of undergraduate medical students with regard to patients with diabetes.

MATERIALS AND METHODS

We conducted a quasi-experimental study with two groups of undergraduate medical students. We validated an instrument to explore clinical attitude concerning diabetes mellitus (ACDIME) with 30 items for each of six indicators. The instrument was applied at two general hospitals, before and after carrying out the educative strategies. In the experimental group, we conducted an educative strategy that promotes participation in developing clinical aptitude, while the customary strategy was developed in the control group.

RESULTS

ACDIME consistency was 0.80. Both study groups were similar before the educative strategies (p = 0.165). Statistically significant differences existed after the strategies in all indicators were evaluated, in favor of the experimental group. The tendency to change, with a criterion of 50% or more, was only statistically significant in the experimental group (p < 0.0001).

CONCLUSIONS

The ACDIME instrument is valid and reliable. The educative strategy that promoted participation is clearly superior to the customary strategy with regard to achievement.

Human Patient Simulation

The use of human patient simulation as a teaching methodology for nursing students has become popular. Using human patient simulation effectively demands paying careful attention to the details of the simulation, debriefing, and evaluation processes. Our experience in designing simulation experiences and evaluating student behaviors confirms the resource-intensive nature of human patient simulation and the need for clear, measurable objectives. When used properly, human patient simulation offers a unique opportunity to teach nursing students important patient safety principles.

Using Improvisational Theater to Teach Genetics Concepts

For 40 years, nursing leaders have called for more genetics content in the undergraduate nursing curriculum, but incorporating the essentials of the growing body of genetics knowledge into crowded nursing curricula remains a struggle. This case report describes an innovative strategy for assessing genetics content in a curriculum while providing a stimulating learning opportunity for students. Results suggest that using improvisational theater for teaching genetic concepts is an effective strategy and is well accepted by students.

A need assessment study of occupational health curriculum for Thai medical students

OBJECTIVE

To assess and develop an appropriate occupational health curriculum for Thai medical students.

MATERIAL AND METHOD

An assessment of existing occupational health curriculum in 12 Thai medical schools, questionnaire survey of occupational medicine experts, questionnaire survey of physicians practiced in industries and primary care hospitals in Pathumthani province, and questionnaire survey and public comments of medical education administration, academician, occupational physician, and medical students were performed

RESULTS

An appropriate occupational health curriculum for Thai medical students included 1) knowledge of occupational health hazards and their illnesses, occupational health hazard evaluation and control, clinical features and investigation of occupational disease, principles of occupational safety, emergency treatment of occupational injury, and principles of health promotion, education, and behavioral modification; 2) experience of occupational health and safety surveillance and occupational disease differential diagnosis; and 3) competence in occupational disease diagnosis, taking clinical history and examination, advise on provision of first aid facilities, physical hazards recognition and control, work related and environmental related disease differential diagnosis, performing a risk assessment, and risk communication.

CONCLUSION

The present study evaluated an occupational health curriculum needed for Thai medical students. Necessary topics for curriculum were developed. However, a future study of learning methods for each topic is needed.

The knowledge and attitudes of the primary care physicians on developmental dysplasia of the hip

OBJECTIVE

For the prevention and early diagnosis of developmental dysplasia of the hip (DDH), a detailed clinical screening of the newborn performed by a primary care (PC) physician is recommended as a standard practice throughout the most western countries. We aimed to determine the knowledge and attitudes of the PC physicians towards DDH, and to develop further educational and training programs, according to the results obtained from the study.

METHODS

The study was a pre- and post- test with a cross-sectional design. In winter of 2005, the participants included 102 PC physicians from 20 primary health care centers in Kahramanmaras, Turkey. A structured questionnaire was prepared consisting of 28 statements on medical, practical, and traditional knowledge and attitudes concerning DDH.

RESULTS

There was a significant difference between the pre-test (71.47 +/- 9.92) and post-test scores (78.85 +/- 12.86) of participants (p=0.000). Of the participants, 83 (81.4%) before, and 93 (91.2%) after the lecture, thought that DDH is a preventable disease. Prior to the lecture, only 27.5% of the physicians were aware of the wrong traditional attitudes that are considered as risk factors for DDH.

CONCLUSION

The knowledge and attitudes of PC physicians on DDH needs to be improved by providing continuous education programmes.

What are the occlusal outcomes for unilateral cleft lip and palate patients? A national project in the UK

AIM

This national project assessed the orthodontic outcome for unilateral cleft lip and palate (UCLP) patients in the UK.

METHOD

Six consecutively treated fixed appliance cases where orthognathic surgery was not undertaken were assessed using the peer assessment rating (PAR) index on orthodontic study models. These cases were submitted by NHS consultant orthodontists undertaking treatment on patients with cleft lip and/or palate.

SETTING

UK NHS consultant-led hospital service.

RESULTS

The mean reduction in PAR score was 69% + or - 22. The mean start PAR score was 41 + or - 11. The mean end of treatment PAR was 12 + or - 9. The proportion of cases where the score was worse or no different was 7.5%.

CONCLUSION

The mean percentage PAR reduction compares well with other national projects looking at outcome from patients treated in the hospital service. The mean PAR reduction could be used as a benchmark for outcome in UCLP orthodontic treatments in future audit projects and the annual consultant appraisal process.

Perceptions of surgical specialists in general surgery, orthopaedic surgery, urology and gynaecology on teaching endoscopic surgery in The Netherlands

BACKGROUND

Specific training in endoscopic skills and procedures has become a necessity for profession with embedded endoscopic techniques in their surgical palette. Previous research indicates endoscopic skills training to be inadequate, both from subjective (resident interviews) and objective (skills measurement) viewpoint. Surprisingly, possible shortcomings in endoscopic resident education have never been measured from the perspective of those individuals responsible for resident training, e.g. the program directors. Therefore, a nation-wide survey was conducted to inventory current endoscopic training initiatives and its possible shortcomings among all program directors of the surgical specialties in the Netherlands.

METHODS

Program directors for general surgery, orthopaedic surgery, gynaecology and urology were surveyed using a validated 25-item questionnaire.

RESULTS

A total of 113 program directors responded (79%). The respective response percentages were 73.6% for general surgeons, 75% for orthopaedic surgeon, 90.9% for urologists and 68.2% for gynaecologists. According to the findings, 35% of general surgeons were concerned about whether residents are properly skilled endoscopically upon completion of training. Among the respondents, 34.6% were unaware of endoscopic training initiatives. The general and orthopaedic surgeons who were aware of these initiatives estimated the number of training hours to be satisfactory, whereas the urologists and gynaecologists estimated training time to be unsatisfactory. Type and duration of endoscopic skill training appears to be heterogeneous, both within and between the specialties. Program directors all perceive virtual reality simulation to be a highly effective training method, and a multimodality training approach to be key. Respondents agree that endoscopic skills education should ideally be coordinated according to national consensus and guidelines.

CONCLUSIONS

A delicate balance exists between training hours and clinical working hours during residency. Primarily, a re-allocation of available training hours, aimed at core-endoscopic basic and advanced procedures, tailored to the needs of the resident and his or her phase of training is in place. The professions need to define which basic and advanced endoscopic procedures are to be trained, by whom, and by what outcome standards. According to the majority of program directors, virtual reality (VR) training needs to be integrated in procedural endoscopic training courses.

Cultural competence in health care and its implications for pharmacy. Part 1. Overview of key concepts in multicultural health care

Pharmacists are caring for more individuals of diverse age, gender, race, ethnicity, socioeconomic status, religion, sexual orientation, and health beliefs than in previous decades. Not all residents of the United States equally experience long life spans and good health. Health disparities in various cultures have been documented. One critical aspect of reducing health disparities is moving health care providers, staff, administrators, and practices toward increased cultural competence and proficiency. Effective delivery of culturally and linguistically appropriate service in cross-cultural settings is identified as cultural competence. Culture is a dynamic process, with people moving in and out of various cultures throughout their lives. The failure to understand and respect individuals and their cultures could impede pharmaceutical care. Incongruent beliefs and expectations between the patient and pharmacist could lead to misunderstandings, confusion, and ultimately to drug misadventures. Models and frameworks have been developed that provide descriptions of the process by which individuals, practice settings, and organizations can become culturally competent and proficient. This article, the first in a five-part series, presents an overview of issues related to cultural competence in health care with an emphasis on the pharmacy profession. Also provided are definitions for cultural competence and related terms, a brief overview of health disparities and challenges to the common morality, and a discussion of models and frameworks that describe pathways to cultural competence and proficiency.