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Brookman R, Hulm Z, Hearn L, Siette J, Mathew N, Deodhar S, Cass A, Smith J, Kenny B, Liu KPY, Harris CB. Evaluation of an exercise program incorporating an international cycling competition: a multimodal intervention model for physical, psychological, and social wellbeing in residential aged care. BMC Geriatr 2024; 24:435. [PMID: 38755554 PMCID: PMC11100139 DOI: 10.1186/s12877-024-05033-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 05/02/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND The transition into residential aged care is frequently associated with a reduction in physical activity, social engagement, and emotional wellbeing. Our aim was to evaluate the impact of a 26-day international cycling competition (Road Worlds Competition for Seniors), incorporating elements of exercise, audiovisual cycling footage, social engagement, and gamification, on the physical, psychological, and social well-being of aged care residents. We aimed to use findings to inform the development of a multi-modal intervention model to maximise wellbeing for older adults. METHODS Residents (N = 32) participated in a mixed-methods single-group intervention pilot study that compared pre-and post-competition measures for the following wellbeing domains; physical, psychological, and social. In addition, interviews were conducted with residents (n = 27) and staff (n = 6) to explore their experiences. RESULTS Measures identified significant improvements across multiple wellbeing domains, including functional fitness, depression, self-efficacy, and social network sizes. Findings from the interview data indicated that the multimodal components involved in the program delivery were valued by staff and residents who enjoyed the gamification, audiovisual cycling footage, social engagement, opportunities for reminiscence, and camaraderie between peers, staff, and volunteers. CONCLUSIONS Findings highlight a constellation of benefits across physical, psychological, and social domains of wellbeing and inform a model for innovative multidimensional programs in residential aged care. The benefits for residents with varying physical and cognitive abilities support the use of creative strategies that maximise inclusion and engagement for residents.
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Affiliation(s)
- Ruth Brookman
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Zac Hulm
- Harbison, 2 Charlotte St, Burradoo, NSW, 2576, Australia
| | - Leigh Hearn
- School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Joyce Siette
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Nitish Mathew
- Harbison, 2 Charlotte St, Burradoo, NSW, 2576, Australia
| | - Saili Deodhar
- Harbison, 2 Charlotte St, Burradoo, NSW, 2576, Australia
| | - Angela Cass
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Jamilla Smith
- School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Belinda Kenny
- School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Karen P Y Liu
- School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Celia B Harris
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
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Sieplinga K, Kruger C, Goodwin E. Is it too complex? A survey of pediatric residency program's educational approach for the care of children with medical complexity. BMC MEDICAL EDUCATION 2023; 23:331. [PMID: 37170096 PMCID: PMC10174732 DOI: 10.1186/s12909-023-04324-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 05/05/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Although Entrustable Professional Activities (EPAs) regarding pediatric training in care for children with medical complexity (CMC) exist, it is unknown what US pediatric training programs provide for education related to care of CMC and whether educators perceive that pediatric residents are prepared to care for CMC upon graduation. METHODS From June, 2021 through March 2022, we surveyed US pediatric residency program delegates about practice settings, current educational offerings, perception of resident preparedness regarding care of CMC, and likelihood to implement CMC education in the future. RESULTS Response rate was 29% (56 /195). A third of responding programs (34%, n = 19) provide a specific educational CMC offering including combinations of traditional didactics (84%, n = 16), asynchronous modules/reading (63%, n = 12), experiential learning (58%, n = 11), and simulation-based didactics (26%, n = 5). The majority (93%, n = 52) of respondents agreed residents should be competent in providing primary care for CMC upon graduation and CMC should receive primary care from a resident (84%, n = 47). A total of 49% (n = 27) of respondents reported their residents are very or extremely well prepared to care for CMC after graduation. A total of 33% (n = 18) of programs reported CMC receive primary care from residents. Respondent average perception of resident preparedness was significantly higher in programs with educational offerings in five of eleven EPAs (nutrition and weight, transitions, feeding tubes, advocacy, and care coordination). The majority (78%, n = 29) of programs without educational offerings are at least somewhat likely to implement CMC curricula in the next three years. CONCLUSION Pediatric residency programs report residents should be competent in care for CMC upon graduation. Pediatric residents are exposed to a wide variety of clinical care models for CMC. The minority of responding programs have intentional CMC educational offerings. Of those programs that provide CMC education, the offerings are variable and are associated with a perception of improved preparedness to care for CMC upon graduation.
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Affiliation(s)
- Kira Sieplinga
- Michigan State University College of Human Medicine, 15 Michigan St NE, Grand Rapids, MI, 49503, USA.
- Department of Pediatrics, Spectrum Health Helen DeVos Children's Hospital, 100 Michigan St NE MC 188, OME Suite Office #A624, Grand Rapids, MI, 49503, USA.
| | - Christopher Kruger
- Department of Pediatrics, University of Michigan C.S. Mott Children's Hospital, 1540 E Hospital Dr, Ann Arbor, MI, 48109, USA
| | - Emily Goodwin
- Division of General Academic Pediatrics, Children's Mercy Kansas City, University of Missouri Kansas City School of Medicine; University of Kansas School of Medicine, 2401 Gillham Rd, Kansas City, MO, 64108, USA
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Priorities and Progress in Complex Care Education. Acad Pediatr 2022; 23:562-563. [PMID: 36442835 DOI: 10.1016/j.acap.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/22/2022] [Accepted: 11/19/2022] [Indexed: 11/26/2022]
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Perez JM, Schainker E, Castro Summers M, Huth K. Partnering to develop a curriculum in post-acute care of children with medical complexity. MEDICAL EDUCATION 2022; 56:1125-1126. [PMID: 35989451 DOI: 10.1111/medu.14907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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Murphy Salem S, Chase B, Newman LR, Cohen AP, Cheston C, Huth K. Perspectives on Complex Care Training in a Large Academic Pediatric Training Program. Acad Pediatr 2022; 22:867-872. [PMID: 35306188 DOI: 10.1016/j.acap.2022.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 01/23/2022] [Accepted: 03/14/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To identify gaps and opportunities in complex care training for pediatric residents. METHODS Residents in an academic pediatric residency program were surveyed about: training experiences in complex care; self-entrustment in key clinical activities in complex care; educational strategies that would increase preparedness; and recommendations for curriculum development. We used descriptive statistics for quantitative data and content analysis for free-text responses. RESULTS Of the 160 residents surveyed, 110 (69%) participated. Most participants reported prior clinical exposure to children with medical complexity (CMC; 106, 96%) during both inpatient (82, 75%) and outpatient (88, 80%) clinical rotations. Mean self-entrustment was at or below "somewhat confident" for all clinical activities in complex care, for residents in all postgraduate years. Clinical activities with highest reported self-entrustment included evaluating aspiration into the airway, nutritional issues, care coordination, and evaluating pain. Lowest self-entrustment was reported for facilitating transition to adult care, managing medical technologies, and safety/emergency planning. In terms of educational strategies, participants recommended inpatient encounters with an expert preceptor teaching about evaluating aspiration, pain/irritability and dysmotility (>50%); discussions with patients/families for advocacy, difficult discussions, and transition to adult care (>40%); and hands-on practice for medical technology care (>40%). CONCLUSIONS Pediatric residents report limited self-entrustment in performing key clinical activities in complex care, including for residents at the end of their last postgraduate year. Future curriculum development should prioritize direct observation of clinical encounters with CMC by expert preceptors, partnership with patients and families of CMC, and hands-on simulation.
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Affiliation(s)
- Sinead Murphy Salem
- Department of Pediatrics (S Murphy Salem, B Chase, and Kathleen Huth), Boston Children's Hospital, Boston, Mass; Department of Pediatrics (S Murphy Salem, B Chase, and C Cheston), Boston Medical Center, Boston, Mass.
| | - Brenna Chase
- Department of Pediatrics (S Murphy Salem, B Chase, and Kathleen Huth), Boston Children's Hospital, Boston, Mass; Department of Pediatrics (S Murphy Salem, B Chase, and C Cheston), Boston Medical Center, Boston, Mass
| | - Lori R Newman
- Department of Education (LR Newman), Boston Children's Hospital, Boston, Mass
| | - Amy P Cohen
- Department of Health Policy and Management (AP Cohen), Harvard Chan School of Public Health, Boston, Mass
| | - Christine Cheston
- Department of Pediatrics (S Murphy Salem, B Chase, and C Cheston), Boston Medical Center, Boston, Mass
| | - Kathleen Huth
- Department of Pediatrics (S Murphy Salem, B Chase, and Kathleen Huth), Boston Children's Hospital, Boston, Mass
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Abstract
OBJECTIVES Children with severe chronic illness are a prevalent, impactful, vulnerable group in PICUs, whose needs are insufficiently met by transitory care models and a narrow focus on acute care needs. Thus, we sought to provide a concise synthetic review of published literature relevant to them and a compilation of strategies to address their distinctive needs. DATA SOURCES English language articles were identified in MEDLINE using a variety of phrases related to children with chronic conditions, prolonged admissions, resource utilization, mortality, morbidity, continuity of care, palliative care, and other critical care topics. Bibliographies were also reviewed. STUDY SELECTION Original articles, review articles, and commentaries were considered. DATA EXTRACTION Data from relevant articles were reviewed, summarized, and integrated into a narrative synthetic review. DATA SYNTHESIS Children with serious chronic conditions are a heterogeneous group who are growing in numbers and complexity, partly due to successes of critical care. Because of their prevalence, prolonged stays, readmissions, and other resource use, they disproportionately impact PICUs. Often more than other patients, critical illness can substantially negatively affect these children and their families, physically and psychosocially. Critical care approaches narrowly focused on acute care and transitory/rotating care models exacerbate these problems and contribute to ineffective communication and information sharing, impaired relationships, subpar and untimely decision-making, patient/family dissatisfaction, and moral distress in providers. Strategies to mitigate these effects and address these patients' distinctive needs include improving continuity and communication, primary and secondary palliative care, and involvement of families. However, there are limited outcome data for most of these strategies and little consensus on which outcomes should be measured. CONCLUSIONS The future of pediatric critical care medicine is intertwined with that of children with serious chronic illness. More concerted efforts are needed to address their distinctive needs and study the effectiveness of strategies to do so.
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Shi CR, Newman LR, Kassamali B, Burgin S. Maintaining patient involvement in dermatology education during the COVID-19 pandemic: Challenges and solutions. J Am Acad Dermatol 2021; 86:e217-e218. [PMID: 34929218 PMCID: PMC8677625 DOI: 10.1016/j.jaad.2021.11.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/28/2021] [Accepted: 11/29/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Connie R Shi
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Lori R Newman
- Harvard Medical School, Boston, Massachusetts, USA; Department of Education, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Bina Kassamali
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Susan Burgin
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
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Tenney-Soeiro R, Sieplinga K. Teaching about children with medical complexity: A blueprint for curriculum design. Curr Probl Pediatr Adolesc Health Care 2021; 51:101129. [PMID: 35086780 DOI: 10.1016/j.cppeds.2021.101129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Children with medical complexity make up a small portion of the pediatric population but utilize a large percentage of health care time and spending. The medical needs of children with medical complexity are highly variable and the education of healthcare providers in the care of these children has taken on more significance. Designing curricula and educational innovations related to the care of children with medical complexity can be challenging. Familiarity with the sociocultural theory, the zone of proximal development, Kolb's experiential learning model, and the educational resources that already exist allow for more ease in developing a curriculum that fits the needs of learners who may have a wide range of exposure to children with medical complexity. Flipped classroom models, simulations, asynchronous modules, and home and community experiences are all useful learning modalities to provide a varied and important curriculum. Taking advantage of the knowledge and skills of the many different members of the multi-disciplinary team caring for children with medical complexity is an important educational strategy that provides benefits to the learners and can enhance interprofessional education.
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Affiliation(s)
- Rebecca Tenney-Soeiro
- Associate Professor of Pediatrics, Perelman School of Medicine at University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, PA, United States.
| | - Kira Sieplinga
- Assistant Professor Pediatrics, Program Director Pediatric Residency Spectrum Health, Helen DeVos Children's Hospital, Michigan State University College of Human Medicine, Grand Rapids, MI, United States
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