Professional competence in physical therapy

Defining, assessing, and measuring ongoing or continuing professional competence in physical therapy has been receiving more attention, perhaps due in part to the increasing reality of direct access (e.g., examination and treatment of patients without referral), increased professional autonomy, and the transition to the doctor of physical therapy as the entry-level degree. The purpose of this paper is to review recent initiatives related to competence beyond initial licensure and give examples of the multidimensional nature of assessing continuing professional competency in physical therapy.

Guidelines for resident training in veterinary clinical pathology. II. Hematology

BACKGROUND

The Education Committee of the American Society for Veterinary Clinical Pathology (ASVCP) identified a need for improved structure and guidance in training residents in clinical pathology. To begin to meet this need, guidelines for training in clinical chemistry were published in 2003.

OBJECTIVE

The goal of this report is to define learning objectives and competencies in hematology, including coagulation and immunohematology.

METHODS

These guidelines were developed and written with the input of ASVCP Education Committee members and peer experts.

RESULTS

The primary objectives of training in hematology are: 1) to accrue a thorough, extensive, and relevant knowledge base of the types, principles, and properties of hematology tests and concepts of pathophysiology in animals; 2) to develop abilities to reason, think critically, communicate effectively, and exercise judgment in hematologic data interpretation and investigative problem-solving; and 3) to acquire technical and statistical skills important in hematology and laboratory operations. We also provide options and ideas for training activities and identify hematology resources useful for clinical pathology faculty and staff, training program coordinators, and residents.

CONCLUSIONS

The guidelines define expected competencies that will help ensure proficiency, leadership, and the advancement of knowledge in veterinary hematology and provide a useful framework for didactic and clinical activities in resident-training programs. The learning objectives can readily be adapted to institutional and individual needs, interests, goals, and resources.

Writing Multiple-Choice Questions for Continuing Medical Education Activities and Self-Assessment Modules

The multiple-choice question (MCQ) is the most commonly used type of test item in radiologic graduate medical and continuing medical education examinations. Now that radiologists are participating in the maintenance of certification process, there is an increased need for self-assessment modules that include MCQs and persons with test item-writing skills to develop such modules. Although principles of effective test item writing have been documented, violations of these principles are common in medical education. Guidelines for test construction are related to development of educational objectives, defining levels of learning for each objective, and writing effective MCQs that test that learning. Educational objectives should be written in observable, behavioral terms that allow for an accurate assessment of whether the learner has achieved the objectives. Learning occurs at many levels, from simple recall to problem solving. The educational objectives and the MCQs that accompany them should target all levels of learning appropriate for the given content. Characteristics of effective MCQs can be described in terms of the overall item, the stem, and the options. Flawed MCQs interfere with accurate and meaningful interpretation of test scores and negatively affect student pass rates. Therefore, to develop reliable and valid tests, items must be constructed that are free of such flaws. The article provides an overview of established guidelines for writing effective MCQs, a discussion of writing appropriate educational objectives and MCQs that match those objectives, and a brief review of item analysis.

Legal and Regulatory Education and Training Needs in the Healthcare Industry

As in any other industry, laws and regulations significantly impact the functioning of the healthcare industry. Some laws, such as those relating to malpractice and social insurance systems, affect the manner in which the industry operates. Other laws, such as those regulating antitrust and employment practices, affect the organization and the environment in which the industry operates. It is increasingly important that practitioners and managers be cognizant of this complex and dynamic legal minefield. This study examined healthcare managers and executives' knowledge of 9 key issues in the legal and regulatory environment of the healthcare industry. Specifically, the study focused on knowledge concerning tort and contract liability, insurance law, labor and employment regulation, criminal and ethical responsibility, antitrust regulation, the law governing business associations and recent developments. Findings suggest that the levels of knowledge required to manage legal and regulatory issues are much greater than the existing levels of knowledge.

The summit on healing: honoring diversity, finding common ground

The issue of languaging became an important point of discussion because the lack of definitions makes it difficult to objectively explore phenomena that occur during healing work. There were many more questions raised than answered. The opportunity to share in this dialogue created an increased awareness of and respect for the complexities of this work and the healers that devote their lives to it.

Physician specialization and the quality of care for human immunodeficiency virus infection

BACKGROUND

There is debate over the types of physicians who should treat patients with complex chronic medical conditions such as human immunodeficiency virus (HIV) infection. We sought to assess the relationship between specialty training and expertise and the quality of care delivered to patients with HIV infection.

METHODS

We selected random samples of HIV-infected patients receiving care at 64 Ryan White CARE (Comprehensive AIDS Resources Emergency) Act-funded clinics throughout the country and their primary HIV physicians for an observational cohort study in which quality-of-care measures were assessed by medical record review.

RESULTS

We studied 5247 patients linked to 177 physicians who responded to a survey. Fifty-eight percent of the physicians were general medicine physicians ("generalists") and 42% were infectious diseases specialists. Sixty-three percent of the generalists (37% overall) considered themselves expert in HIV care. In hierarchical logistic regression models that controlled for patient characteristics, infectious diseases physicians and expert generalists had similar performance. In contrast, nonexpert generalists delivered lower quality care. More than 80% of the appropriate patients being cared for by infectious diseases physicians and expert generalists were receiving highly active antiretroviral therapy, compared with 73% of appropriate patients of nonexpert generalists (P<.001). Physicians with fewer than 20 patients with active HIV had fewer appropriate patients on highly active antiretroviral therapy (73% vs 82% of physicians with >/=20 such patients, P = .04) and saw patients less frequently.

CONCLUSION

These findings extend previous work by examining a range of quality-of-care measures and suggest that generalists with appropriate experience and expertise in HIV care can provide high-quality care to patients with this complex chronic illness.

Cultural competence: a systematic review of health care provider educational interventions

OBJECTIVE

We sought to synthesize the findings of studies evaluating interventions to improve the cultural competence of health professionals.

DESIGN

This was a systematic literature review and analysis.

METHODS

We performed electronic and hand searches from 1980 through June 2003 to identify studies that evaluated interventions designed to improve the cultural competence of health professionals. We abstracted and synthesized data from studies that had both a before- and an after-intervention evaluation or had a control group for comparison and graded the strength of the evidence as excellent, good, fair, or poor using predetermined criteria.

MAIN OUTCOME MEASURES

We sought evidence of the effectiveness and costs of cultural competence training of health professionals.

RESULTS

Thirty-four studies were included in our review. There is excellent evidence that cultural competence training improves the knowledge of health professionals (17 of 19 studies demonstrated a beneficial effect), and good evidence that cultural competence training improves the attitudes and skills of health professionals (21 of 25 studies evaluating attitudes demonstrated a beneficial effect and 14 of 14 studies evaluating skills demonstrated a beneficial effect). There is good evidence that cultural competence training impacts patient satisfaction (3 of 3 studies demonstrated a beneficial effect), poor evidence that cultural competence training impacts patient adherence (although the one study designed to do this demonstrated a beneficial effect), and no studies that have evaluated patient health status outcomes. There is poor evidence to determine the costs of cultural competence training (5 studies included incomplete estimates of costs).

CONCLUSIONS

Cultural competence training shows promise as a strategy for improving the knowledge, attitudes, and skills of health professionals. However, evidence that it improves patient adherence to therapy, health outcomes, and equity of services across racial and ethnic groups is lacking. Future research should focus on these outcomes and should determine which teaching methods and content are most effective.

Assessment of Risks Related to Medicine Dispensing by Nonprofessionals in Colombia: Clinical Case Simulations

BACKGROUND:

Appropriate dispensing is one of the steps for rational drug use, so it is generally advised that the dispenser should have relevant and updated knowledge, skills, and attitudes.

OBJECTIVE:

To assess pharmacies and nonprofessional employees' (NEs) skills and knowledge, as well as their response to several specific case simulations in Bogotá, Colombia.

METHODS:

A descriptive cross-sectional study was performed on a random sample of 371 pharmacies in Bogotá. Information from each pharmacy was obtained using 2 approaches: (1) direct interview to collect data on organizational aspects of the store and characteristics of NEs, and (2) simulation (both by direct interview and by telephone) to assess dispensing responses in 6 simulated clinical cases.

RESULTS:

More than half of the simulated clinical situations resulted in inappropriate dispensing (direct simulations 57%; telephone simulations 55%). The proportion of correct answers to theoretical questions regarding a specific therapeutic problem during interviews was higher than the response when a simulation presented that same case and a dispensing act was expected. The educational background of the NEs included in the study points to a specific problem: two-thirds of the individuals selling medicines had completed only secondary-level education and only 2% of the sample had a pharmacist as technical director. Continuing education courses were either directly organized by drug manufacturers (one-third of the courses attended by pharmacists) or sponsored by them (more than an additional one-third).

CONCLUSIONS:

NEs should be considered part of the therapeutic chain and, if appropriately updated or instructed, could play a very important role in the always difficult promotion of rational drug use. Public health institutions and universities should be more actively involved in the provision of independent, unbiased, and essential information on common therapeutic problems, safety concerns, and new drug prescription restrictions.

Social workers' educational needs in end-of-life care

A survey of 391 health care social workers assessed educational content and skills needed for competence in practice with those facing the end of life. Content perceived as most needed included psychological and social needs of patients and families; psychosocial interventions to ameliorate distress; and the influence of dying on family dynamics. Assessing complex needs of patients/families; communication of psychosocial needs of patient/family to team members; facilitation of effective family and team communication; and provision of crisis intervention were the skills perceived to be required for competence in end-of-life care practice. Results of these data can be used to develop model end-of-life care curricula for continuing education programs and to identify content for possible inclusion in social work programs.

An evolution of experts: MEDLINE in the library school

QUESTION

What is the real value that medical librarians bring to the health care environment? How have library science educators, frequently former practitioners themselves, responded to the challenge of expert searching?

METHODS

In this paper, I give an historical introduction to the landscape of medical information retrieval through the development of MEDLINE. I then look at the evolution of training in online searching and its place in the context of library school education and particularly the effect of generalist education on future specialists. Finally, I acknowledge the new role of the informationist as another assertion of our professional expertise.

CONCLUSIONS

The three interdependent subsystems of our professional machine-our schools, our association, and our professional peers- must all respond to this challenge by asserting our expertise in our curricula, in our continuing education, and in our dialogues with each other. Only by acknowledging the interaction of these subsystems will real and positive changes be effected to benefit our profession and our constituencies.

Survey of administration of medicines to pupils in primary schools within the London area

OBJECTIVE

To examine the policy, administration, and supervision of medicine administration in primary schools within the Greater London area (GLA).

DESIGN

A prospective survey using postal questionnaires sent to 172 randomly selected primary schools within the GLA.

PARTICIPANTS

Head teachers of primary schools.

RESULTS

Some 65% of head teachers replied. Less than 50% of responding head teachers had actually read the national guidelines Supporting Pupils with Medical Needs and only 30% of respondents were aware of other members of staff who had read the document. A total of 95% of respondents followed a policy/procedure in caring for the medical needs of pupils. Over 80% of respondents had staff handling the pupils' medical needs, staff handling access to stored medicines, and prior arrangements for staff training. However, it is worrying that a quarter of the schools did not keep a written record of medicines given to children in schools. The majority of staff with responsibility for medicine administration in schools are support staff. The most encouraging findings were that for the majority of schools with children using the EpiPen and rectal diazepam, there were trained staff to administer these medicines.

CONCLUSIONS

The majority of schools had a policy in place to deal with medicine administration, although further work should be conducted to analyse the content of such policies. It is very important that training is directed at staff responsible for medicine administration and not just at teachers. Most schools were willing to administer rectal diazepam and EpiPen treatment in an emergency.

Interpretation of trauma radiographs by radiographers and nurses in the UK: a comparative study

The purpose of this study was to identify the number of hospitals employing nurses and radiographers formally to undertake radiographic interpretation of trauma images and to compare the education undertaken by these professionals and any limitations imposed. A cross-sectional questionnaire survey of nurse and radiographer managers responsible for Accident and Emergency services within National Health Service hospitals in the UK was undertaken in January 2002. A total of 526 questionnaires were distributed. Response rates of 75.3% (n=198/263) and 69.2% (n=182/263) were received from radiographer and nurse managers, respectively. 96 nurse managers (52.7%, n=96/182) indicated that nurses within their departments were formally interpreting radiographs as part of their extended role whereas only 68 radiography managers (34.3%, n=68/198) indicated that radiographers were undertaking this role. Education to support radiographic interpretation varied markedly with 92.6% (n=63/68) of radiographers having undertaken a postgraduate qualification in image interpretation. In contrast, nurse education at all levels was more generic to the nursing role. The range of examinations which nurses and radiographers were permitted to interpret also varied markedly. Radiographic interpretation is undertaken by both nurses and radiographers. However, there is interprofessional and intraprofessional inconsistency in the range of examinations they are permitted to interpret and the level of education provided to support this role. Consequently, it can be surmised that national variation in service delivery and quality exists and a review of current service delivery strategies is recommended.

An evaluation of provider educational needs in geriatric care

Providers of geriatric care in Arkansas were surveyed to determine the desire for more information on their specialty as well as opportunities for further training. Those in the nursing profession were most interested in further training, and the major area of interest for all providers was in cognitive decline and mental health information. Specifically, information was sought in the areas of dementia, depression, and memory loss. It is recommended that improvement in geriatric care in the future should focus on nursing education and on raising the level of knowledge and academic prestige in the treatment of elderly patients, especially in the mental health areas.