Healthcare lecturers' perceptions of spirituality in education

AIM

The aim of this research was to identify healthcare teaching staff's understanding of spirituality, how their understanding may shape teaching practice and how this may contribute to the documented issues around incorporating spirituality into patient assessment and care.

METHOD

A mixed-method, small-scale explorative online survey was used.

FINDINGS

Several perceptions and practices were identified that led to a better understanding of the obstacles to teaching in this area. Suggestions were made about how to shape teaching spirituality to improve patients' experience and ensure spirituality is integrated more fully into assessment and care.

CONCLUSION

This study brought a better understanding of obstacles to integrating spirituality into teaching for healthcare lecturers and offered some ideas on how to best address these obstacles.

Coming From Behind: A Historical Perspective on Black Education and Attainment

In our current reliance on "hard data," achievement test scores are used incorrectly and without warrant as the ultimate mark of educational progress. While it is true that a gap continues to exist, educational history shows that, overall, both Black and White students have participated steadily in increasing numbers in the educational system, whether the measure is the number of students attending school, the increasing length of the school years, literacy rates, or in the actual level of educational attainment over a period of more than 100 years. The data examined in historical perspective show that the American education system, through thick and thin, has served its students well. Those data also show that change comes slowly, in increments of just a few percent a decade. Expectations of rapid change are totally unreasonable when viewed against the historical data. In addition, the historical data show that the Black population has made progress more rapidly over time than the White population. As a result of more rapid progress, although there is still a gap between White and Black, the gap has narrowed considerably. We suggest the gap reflects history and culture. The small increments per decade argue that cultures change slowly and persist over time. We will discuss the history of Black education to suggest some reasons for the gap. The history will help us assess today's achievement gap and help us to understand how far our public education system has brought us.

[Excessive loads on schoolchild: analysis of the hygienist]

In the article there are presented the arguments of the hygienist in favor of the improvement the of pedagogical technologies inthe school for the maintenance of children's health. Recommendations expressed in this article are based on modern data of current domestic research and observations of domestic scientists hygienists, as well as on the analysis of the opinions of parents and teachers of the school.

Using standardized videos to validate a measure of handoff quality: the handoff mini-clinical examination exercise

BACKGROUND

The most recent iteration of the Accreditation Council for Graduate Medical Education duty-hour regulations includes language mandating handoff education for trainees and assessments of handoff quality by residency training programs. However, there is a lack of validated tools for the assessment of handoff quality and for use in trainee education.

METHODS

Faculty at 2 sites (University of Chicago and Yale University) were recruited to participate in a workshop on handoff education. Video-based scenarios were developed to represent varying levels of performance in the domains of communication, professionalism, and setting. Videos were shown in a random order, and faculty were instructed to use the Handoff Mini-Clinical Examination Exercise (CEX), a paper-based instrument with qualitative anchors defining each level of performance, to rate the handoffs.

RESULTS

Forty-seven faculty members (14 at site 1; 33 at site 2) participated in the validation workshops, providing a total of 172 observations (of a possible 191 [96%]). Reliability testing revealed a Cronbach α of 0.81 and Kendall coefficient of concordance of 0.59 (>0.6 = high reliability). Faculty were able to reliably distinguish the different levels of performance in each domain in a statistically significant fashion (ie, unsatisfactory professionalism mean 2.42 vs satisfactory professionalism 4.81 vs superior professionalism 6.01, P < 0.001 trend test). Two-way analysis of variance revealed no evidence of rater bias.

CONCLUSIONS

Using standardized video-based scenarios highlighting differing levels of performance, we were able to demonstrate evidence that the Handoff Mini-CEX can draw reliable and valid conclusions regarding handoff performance. Future work to validate the tool in clinical settings is warranted.

The use of abstract paintings and narratives to foster reflective capacity in medical educators: a multinational faculty development workshop

Reflective capacity is integral to core healthcare professional practice competencies. Reflection plays a central role in teacher education as reflecting on teaching behaviours with critical analysis can potentially improve teaching practice. The humanities including narrative and the visual arts can serve as a valuable tool for fostering reflection. We conducted a multinational faculty development workshop aiming to enhance reflective capacity in medical educators by using a combination of abstract paintings and narratives. Twenty-three family physicians or physicians-in-training from 10 countries participated in the workshop. Qualitative assessment of the workshop showed that the combined use of art and narrative was well received and perceived as contributing to the reflective exercise. Participants generally felt that viewing abstract paintings had facilitated a valuable mood transformation and prepared them emotionally for the reflective writing. Our analysis found that the following themes emerged from participants' responses: (1) narratives from different countries are similar; (2) the use of art helped access feelings; (3) viewing abstract paintings facilitated next steps; (4) writing reflective narratives promoted examination of educational challenges, compassion for self and other, and building an action plan; and (5) sharing of narrative was helpful for fostering active listening and appreciating multiple perspectives. Future research might include comparing outcomes for a group participating in arts-narrative-based workshops with those of a control group using only reflective narrative or in combination with figurative art, and implementing a combination of qualitative and quantitative methods of assessment.

MicroResearch: finding sustainable local health solutions in East Africa through small local research studies

Background: Sub-Saharan African countries have urged grassroots input to improve research capacity. In East Africa, MicroResearch is fostering local ability to find sustainable solutions for community health problems. At 5 years, the following reports its progress.

Methods: The MicroResearch program had three integrated components: (1) 2-week training workshops; (2) small proposal development with international peer review followed by project funding, implementation, knowledge translation; (3) coaching from experienced researchers. Evaluation included standardized questions after completion of the workshops, 2013 online survey of recent workshop participants and discussions at two East Africa MicroResearch Forums in 2013.

Results: Between 2008 and 2013, 15 workshops were conducted at 5 East Africa sites with 391 participants. Of the 29 projects funded by MicroResearch, 7 have been completed; of which 6 led to changes in local health policy/practice. MicroResearch training stimulated 13 other funded research projects; of which 8 were external to MicroResearch. Over 90% of participants rated the workshops as excellent with 20% spontaneously noting that MicroResearch changed how they worked. The survey highlighted three local research needs: mentors, skills and funding – each addressed by MicroResearch. On-line MicroResearch and alumni networks, two knowledge translation partnerships and an East Africa Leaders Consortium arose from the MicroResearch Forums.

Conclusion: MicroResearch helped build local capacity for community-directed interdisciplinary health research.

Development of a National Consensus for Tactical Emergency Medical Support (TEMS) Training Programs--Operators and Medical Providers

INTRODUCTION

Tactical teams are at high risk of sustaining injuries. Caring for these casualties in the field involves unique requirements beyond what is provided by traditional civilian emergency medical services (EMS) systems. Despite this need, the training objectives and competencies are not uniformly agreed to or taught.

METHODS

An expert panel was convened that included members from the Departments of Defense, Homeland Security, Justice, and Health and Human Services, as well as federal, state, and local law-enforcement officers who were recruited through requests to stakeholder agencies and open invitations to individuals involved in Tactical Emergency Medical Services (TEMS) or its oversight. Two face-to-face meetings took place. Using a modified Delphi technique, previously published TEMS competencies were reviewed and updated.

RESULTS

The original 17 competency domains were modified and the most significant changes were the addition of Tactical Emergency Casualty Care (TECC), Tactical Familiarization, Legal Aspects of TEMS, and Mass Casualty Triage to the competency domains. Additionally, enabling and terminal learning objectives were developed for each competency domain.

CONCLUSION

This project has developed a minimum set of medical competencies and learning objectives for both tactical medical providers and operators. This work should serve as a platform for ensuring minimum knowledge among providers, which will serve enhance team interoperability and improve the health and safety of tactical teams and the public.

Commitment to change and assessment of confidence: tools to inform the design and evaluation of interprofessional education

INTRODUCTION

This study examines use of the commitment-to-change model (CTC) and explores the role of confidence in evaluating change associated with participation in an interprofessional education (IPE) symposium. Participants included students, faculty, and practitioners in the health professions.

METHODS

Satisfaction with the symposium and levels of commitment and confidence in implementing a change were assessed with a post-questionnaire and a follow-up questionnaire distributed 60 days later. Participants who reported changed behavior were compared with those who did not make a change. Independent sample t-tests determined whether there were differences between groups in their average level of commitment and/or confidence immediately following the symposium and at follow-up.

RESULTS

At post-symposium, attendees were satisfied with content and format. Sixty-eight percent said they would make a change in profession related activities. At 60 days, 53% indicated they had implemented a change. In comparison to those who reported no change, those who made a change reported higher levels of commitment and higher levels of confidence. Logistic regression suggested that the combination of commitment and confidence did not predict implementation in this sample; however, confidence had a higher odds ratio for predicting success than did commitment.

DISCUSSION

Confidence should be studied further in relation to commitment as a predictor of behavioral change associated with participation in an IPE symposium. Evaluators and instructional designers should consider use of follow-up support activities to improve learners' confidence and likelihood of successful behavior change in the workplace.

Recognition of health informatics in Australian standard classifications for research, occupation and education

Work on building a strong research base, a skilled workforce and an accredited learning and development system in Australian Health Informatics is not mature. This paper aims to explore how such work is supported at a fundamental level, that is, within formal systems for identifying fields of research, occupation and education in Australia. The researchers examined the treatment of Health Informatics and related terms in a range of relevant Australian standards. We found that Health Informatics has somewhat inappropriate recognition in the formal systems defining research in Australia, a tenuous presence in those describing education, and none in those describing occupations. We argue that our findings provide the evidence base for decisive action to benefit not only individuals but also the wider Australian community.

Further considerations of evaluation competencies in Taiwan

A list of evaluator competencies (Stevahn, King, Ghere, & Minnema, 2005) was adapted to fit the Taiwanese context by Lee, Altschuld, & Lee (2012). It was studied as to how it generalized to a large sample in Taiwan. Likert and Fuzzy surveys with needs assessment formats (importance and competence) were mailed via random assignment to two groups of participants. The questions for the study were: do the modified competencies relate country-wide to Taiwan, did the investigation uncover training needs for evaluators, and were there convergent rating patterns across the two forms of the instrument? The results supported a fit of the modified competencies to the context and convergent validity was observed but strong competency needs were not apparent. Reasons for the findings and implications for future research are discussed.

Challenges for nursing education in Angola: the perception of nurse leaders affiliated with professional education institutions

BACKGROUND

Angola is one of the African countries with the highest morbidity and mortality rates and a devastating lack of human resources for health, including nursing. The World Health Organization stimulates and takes technical cooperation initiatives for human resource education and training in health and education, with a view to the development of countries in the region. The aim in this study was to identify how nurses affiliated with nursing education institutions perceive the challenges nursing education is facing in Angola.

METHODS

After consulting the National Directory of Human Resources in Angola, the nurse leaders affiliated with professional nursing education institutions in Angola were invited to participate in the study by email. Data were collected in February 2009 through the focus group technique. The group of participants was focused on the central question: what are the challenges faced for nursing education in your country? To register and understand the information, besides the use of a recorder, the reporters elaborated an interpretative report. Data were coded using content analysis.

RESULTS

Fourteen nurses participated in the meeting, most of whom were affiliated with technical nursing education institutions. It was verified that the nurse leaders at technical and higher nursing education institutions in Angola face many challenges, mainly related to the lack of infrastructure, absence of trained human resources,bureaucratic problems to regularize the schools and lack of material resources. On the opposite, the solutions they present are predominantly centered on the valuation of nursing professionals, which implies cultural and attitude changes.

CONCLUSIONS

Public health education policies need to be established in Angola, including action guidelines that permit effective nursing activities. Professional education institutions need further regularizations and nurses need to be acknowledged as key elements for the qualitative enhancement of health services in the country.

Promoting professionalism via a video-based educational workshop for academic hospitalists and housestaff

BACKGROUND

Unprofessional behavior can compromise care and detract from the hospital learning environment. Discrepancy between professional behaviors formally taught and what is witnessed has become increasingly evident.

METHODS

With funding from the American Board of Internal Medicine Foundation, a workshop was developed to address unprofessional behaviors related to inpatient care previously identified in a multi-institution survey. The aims were to utilize video-based education to illustrate unprofessional behaviors, how faculty play a role in promoting such behaviors, and facilitate reflection regarding motivation for and prevention of these behaviors. Hospitalists and housestaff at 3 Chicago-area academic hospitals and 1 community teaching affiliate participated. Videos were debriefed, identifying barriers to professional behavior and improvement strategies. A postworkshop survey assessed beliefs on behaviors and intent to change practice.

RESULTS

Forty-four (53%) faculty and 244 (68%) residents (postgraduate year 1 and greater) participated. The workshop was well received, with 89% reporting it "useful and effective." Two-thirds expressed intent to change behavior. Most (86%) believed videos were realistic and effective. Those who perceived videos as "very realistic" were more likely to report intent to change behavior (93% vs 53%, P = 0.01).

CONCLUSIONS

Video-based education is a feasible way to promote reflection and address unprofessional behaviors among providers and may positively impact the learning environment.

IMPACT OF CLINICAL OFFICER ANAESTHETIST TRAINING PROGRAMME AT THE KENYA MEDICAL TRAINING COLLEGE, NAKURU, ON TRAINEE SATISFACTION, QUALITY OF PRACTICE, AND CADRE SHORTFALL ALLEVIATION

OBJECTIVE

To determine the impact of Clinical Officer (C.O) Anaesthetist Training programme at Kenya Medical Training College (KMTC) Nakuru, on Trainee satisfaction, quality of practice and cadre shortfall alleviation.

DESIGN

Cross-sectional descriptive study.

SETTING

Kenya Medical Training College, Nakuru.

SUBJECTS

All thirty one Clinical Officer Anaesthetist graduates from KMTC Nakuru, since the training programme started 8 years ago.

RESULTS

Twenty nine of the 31 C.O Anaesthetist graduates responded. Twenty six of the 29 respondents (89.7%) passed in the final qualifying examination in the first sitting. Twenty one (72.4%) are working in Public health facilities. All graduates are distributed in 16 out of the 47 counties in Kenya. Twenty six (89.7%) are satisfied with the training. Their average working week is 54 hours, with a median of 45 working hours a week. They recommend an improvement in peripheral nerve blocks and epidural training in the 2005 curriculum.

CONCLUSION

C.O Anaesthetist training in KMTC Nakuru over the last eight years has produced self reported satisfied, adequately trained graduates and has had an impact in alleviating shortage of this cadre in Kenya. Improvement in peripheral nerve blocks and epidural training is needed.

Using generalized additive modeling to empirically identify thresholds within the ITERS in relation to toddlers' cognitive development

Research linking high-quality child care programs and children's cognitive development has contributed to the growing popularity of child care quality benchmarking efforts such as quality rating and improvement systems (QRIS). Consequently, there has been an increased interest in and a need for approaches to identifying thresholds, or cutpoints, in the child care quality measures used in these benchmarking efforts that differentiate between different levels of children's cognitive functioning. To date, research has provided little guidance to policymakers as to where these thresholds should be set. Using the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B) data set, this study explores the use of generalized additive modeling (GAM) as a method of identifying thresholds on the Infant/Toddler Environment Rating Scale (ITERS) in relation to toddlers' performance on the Mental Development subscale of the Bayley Scales of Infant Development (the Bayley Mental Development Scale Short Form-Research Edition, or BMDSF-R). The present findings suggest that simple linear models do not always correctly depict the relationships between ITERS scores and BMDSF-R scores and that GAM-derived thresholds were more effective at differentiating among children's performance levels on the BMDSF-R. Additionally, the present findings suggest that there is a minimum threshold on the ITERS that must be exceeded before significant improvements in children's cognitive development can be expected. There may also be a ceiling threshold on the ITERS, such that beyond a certain level, only marginal increases in children's BMDSF-R scores are observed.

Nursing student attitudes toward and preferences for working with older adults

A growing aging population will require nurses who prefer to work with older adults. Schools of nursing have used several strategies to improve students' attitudes, and encourage preferences for working with older adults. However, research on these strategies is inconsistent, with some programs improving students' attitudes whereas others have no effect. More recent studies have found that although attitudes have improved, working with older adults is generally the least preferred area of nursing. The purpose of this longitudinal mixed methods study is to describe and explain student nurse attitudes and preference changes over time. Eighty undergraduate nursing students were surveyed over 2 years. Students' attitudes and preference for working with older adults improved over time. However, their preference to work in nursing homes was consistently ranked last among the 10 choices for work preferences. In focus groups, students reported that the gerontological course dispelled myths about caring for older adults, and that clinical placement played a major role in influencing student work preferences.

Access and success with less: improving productivity in broad-access postsecondary institutions

Achieving national goals for increased college completion in a time of scarce resources will require the postsecondary institutions that enroll the majority of undergraduates--community colleges and less-selective public universities--to graduate more students at a lower cost. Davis Jenkins and Olga Rodriguez examine research on how these "broad-access" institutions can do so without sacrificing access or quality. Research indicates that the strategies broad-access institutions have relied on in the past to cut costs--using part-time instructors and increasing student-faculty ratios--may in fact reduce productivity and efficiency. The limited evidence available suggests that some of the most popular strategies for improving student success are not cost-effective. New strategies to cut costs and improve college success are therefore imperative. Some believe that redesigning courses to make use of instructional technologies will lead to better outcomes at lower cost, although the evidence is mixed. Recently, a growing number of institutions are going beyond redesigning courses and instead changing the way they organize programs and supports along the student's "pathway" through college. These efforts are promising, but their effects on cost per completion are not yet certain. Meager funding has so far hampered efforts by policy makers to fund colleges based on outcomes rather than how many students they enroll, but some states are beginning to increase the share of appropriations tied to outcomes. Jenkins and Rodriquez argue that as policy makers push colleges to lower the cost per graduate, they must avoid providing incentives to lower academic standards. They encourage policy makers to capitalize on recent research on the economic value of postsecondary education to measure quality, and urge colleges and universities to redouble efforts to define learning outcomes and measure student mastery.

Non-formal educator use of evaluation results

Increasing demands for accountability in educational programming have resulted in increasing calls for program evaluation in educational organizations. Many organizations include conducting program evaluations as part of the job responsibilities of program staff. Cooperative Extension is a complex organization offering non-formal educational programs through land grant universities. Many Extension services require non-formal educational program evaluations be conducted by field-based Extension educators. Evaluation research has focused primarily on the efforts of professional, external evaluators. The work of program staff with many responsibilities including program evaluation has received little attention. This study examined how field based Extension educators (i.e. program staff) in four Extension services use the results of evaluations of programs that they have conducted themselves. Four types of evaluation use are measured and explored; instrumental use, conceptual use, persuasive use and process use. Results indicate that there are few programmatic changes as a result of evaluation findings among the non-formal educators surveyed in this study. Extension educators tend to use evaluation results to persuade others about the value of their programs and learn from the evaluation process. Evaluation use is driven by accountability measures with very little program improvement use as measured in this study. Practical implications include delineating accountability and program improvement tasks within complex organizations in order to align evaluation efforts and to improve the results of both. There is some evidence that evaluation capacity building efforts may be increasing instrumental use by educators evaluating their own programs.

The Physicians' Competence in Substance Abuse Test (P-CSAT): a multidimensional educational measurement tool for substance abuse training programs

BACKGROUND

Efforts to enhance physician substance abuse (SA) management skills lack tools to assess skills and training effectiveness. We sought to develop an easily administered survey to assess SA fact-based skills and clinical decision-making.

METHODS

We prepared 60 fact-based items dealing with SA knowledge, attitudes, and behaviors (KAB) and 53 script concordance test (SCT) items assessing SA decision-making. We used expert review and standard psychometric criteria to eliminate discordant or non-contributory survey items. We tested 92 draft items in 117 physicians, including 13 with additional SA training (trained), and 17 recognized SA experts. We assessed final survey internal consistency with Cronbach's alpha and differences in scores between experts, trained physicians, and physicians without SA training (novices) with the Kruskal-Wallis test.

RESULTS

Following refinement, the draft survey was reduced to 30 KAB and 33 SCT items. Alpha was 0.901 for the final 63-item survey and 0.887 and 0.797 for the KAB and SCT subscales, respectively. Novices, trained physicians, and experts scored means of 196, 213, and 261 respectively out of 315 possible points on the final survey. The KAB and SCT subscale results showed similar patterns. Score differences for the overall survey and its subscales were highly significant (p<0.001).

CONCLUSIONS

This survey, which we have named the Physicians' Competence in Substance Abuse Test (P-CSAT) and placed in the public domain, meets baseline criteria for reliability and validity. Future studies should determine the extent to which the P-CSAT provides consistent results in other practitioner populations and responds to SA educational efforts.