Prediction of intern attendance at a seminar-based training programme: a behavioural intention model

The influence of psychosocial factors on the intention to incorporate complementary and integrative medicine into psychiatric clinical practices

Complementary and integrative medicine (CIM) can be of great support to individuals suffering from psychiatric conditions; however, it is still rarely incorporated into clinical practice.

OBJECTIVE

To examine the influences of psychosocial and sociodemographic factors on health-care professionals' intention to use CIM in their psychiatric clinical practice.

METHOD

One-hundred-and-five participants completed a questionnaire developed from an adapted version of Triandis' Theory of Interpersonal Behavior (TIB). Intentions to use CIM (yes or no) were analyzed using logistic regression models.

RESULTS

The multivariate model retained three main factors: affect, perceived social norms, and conditions facilitating CIM. These predicted health-care professionals' intention to use CIM with an AUC = 94.7%.

RESULTS

underlined that positive affective attitudes towards CIM, feeling that CIM was congruent with professional and institutional goals, and having sufficient skills in CIM were essential to ensuring that health-care professionals would integrate CIM into their clinical practice.

How Residents Say They Learn: A National, Multi-Specialty Survey of First- and Second-Year Residents

Relatively little is known about how, from whom, and under what conditions residents say they most effectively learn. We examined the relationships between residents' self-reported ratings of 11 different sources of learning and a number of empirical variables, using a national, random sample of postgraduate year (PGY) 1 and PGY-2 residents in the 1998-1999 training year. Residents were surveyed by mail. Completed surveys were received from 64.2% of 5616 residents contacted. The most often reported sources of learning were other residents and attending physicians. Ratings varied by specialty, level of training, and US medical graduates (USMGs) versus international medical graduates (IMGs). Factor analysis identified 3 primary modes of learning: faculty-organized, peer-oriented, and self-directed. Residents in different specialties varied in their use of these 3 sources of learning. IMG residents reported significantly less learning from peers and more self-directed learning. Increased resident duty hours were associated with a decrease in faculty-organized and self-directed learning, and an increase in peer-oriented learning.

They just don't get enough! Variable intern experience in bedside procedural skills

BACKGROUND

Medical school and resident training programmes offer different learning opportunities and outcomes. The aim of the study was to assess medical student and intern experience in common clinical procedures.

METHODS

Interns employed in a metropolitan teaching hospital from 2000 to 2004 completed a survey of experience and confidence in clinical procedures at the beginning and end of their intern year. Attendance at and the contribution to procedural confidence of a voluntary procedural skill-training programme were examined.

RESULTS

For the 314 interns, clinical experience before and during internship varied for each procedure and between year cohorts as did training programme attendance (44-84%). Student procedural confidence was predicted by pre-intern experience either on patients or by simulation (beta = 0.17, 95% confidence interval (CI) 0.02-0.21, P = 0.03) and age >30 years on commencing internship (beta = 8.44, 95%CI 3.03-14.06, P = 0.003. Adjusted R(2) = 0.08, P = 0.002). Intern procedural confidence by year's end was predicted by attendance at the training programme (beta = 0.48, 95%CI 0.34-0.62, P < 0.001), intern experience with patient procedures (beta = 0.34, 95%CI 0.21-0.47, P < 0.001) and a clear decision to enter a postgraduate training programme (beta = 0.13, 95%CI 0.04-0.22, P = 0.007, Adjusted R(2) = 0.50, P < 0.001).

CONCLUSION

Interns and students receive variable experience to carry out procedural skills on patients. This makes designing training programmes difficult as training needs vary each year. Both mandatory supervision of key skills and opportunities to supplement limited experience are needed during the intern year to ensure a uniform experience.

Emergency medicine teaching faculty perceptions about formal academic sessions: "What's in it for us?"

BACKGROUND

Little is known about factors affecting emergency physician attendance at formal academic teaching sessions or what emergency physicians believe to be the benefits derived from attending these activities.

OBJECTIVES

To determine what factors influence emergency medicine faculty attendance at formal academic rounds, what benefits they derive from attendance, and what differences in perceptions there are between full-time clinical and part-time clinical academic faculty.

METHODS

A survey was sent to all emergency physicians with academic appointments at one institution. Responses were tabulated dichotomously (yes/no) for checklist answers and analyzed using a 2-person grounded theory approach for open answers based on an a priori analysis plan. Differences between full-time and part-time faculty were compared using the chi-squared test for significance.

RESULTS

Response rate was 73.8% (48/65). Significant impediments to attendance included clinical responsibilities (75%), professional responsibilities (52.1%), personal responsibilities (33.3%), location (31.2%) and time (27.1%). Perceived benefits of attending rounds were: continuing medical education, social interaction, teaching opportunities, interaction with residents, comparing one's practice with peers, improving teaching techniques, and enjoyment of the format. There were no statistically significant differences between groups' responses.

CONCLUSIONS

Emergency physicians in our study attend formal teaching sessions infrequently, suggesting that the perceived benefits do not outweigh impediments to attendance. The single main impediment, competing responsibilities, is difficult to modify for emergency physicians. Strategies to increase faculty attendance should focus on enhancing the main perceived benefits: continuing medical education, social interaction and educational development. Faculty learn from themselves and from residents during formal teaching sessions.

Class half-empty? Pre-registration house officer attendance at weekly teaching sessions: implications for delivering the new Foundation Programme curriculum

This study aimed to explore patterns of attendance at classroom-based, taught education programmes for pre-registration house officers (PRHOs) and to identify reasons for non-attendance, and to consider implications for Foundation Programme curriculum delivery and suggest strategies for improving delivery. We analysed registers of attendance for education sessions for 3 local teaching hospitals in the Leicestershire, Northamptonshire and Rutland (LNR) Healthcare Workforce Deanery, along with PRHO exit questionnaire returns (from 2001 to 2005). Despite a trend for attendance to fall slightly over the course of a rotation, attendance rates have, in general, remained relatively stable at around two-thirds. However, during most 4-month posts, a fifth or more of PRHOs missed half or more of all sessions. Two types of barrier to attendance were identified: 'routine barriers', which relate to hospital working patterns, and 'contextual barriers', which refer to the particularities of each hospital post. There was no evidence that doctors' motivation and commitment towards the education programme is a main determinant of attendance. Contextual barriers to attendance, such as pressure being placed on PRHOs to remain on the ward, can be addressed. However, routine barriers to attendance, including on-call working patterns and annual leave, render it impossible to avoid significant numbers of education sessions being missed by PRHOs in each post during a rotation. En bloc teaching of basic generic skills prior to the start of the rotation plus greater use of online learning resources are examples of ways in which reliance on in-post, classroom-based programmes can be reduced.

Factors affecting the intention of providers to deliver more effective continuing medical education to general practitioners: a pilot study

BACKGROUND

Despite the importance of continuing medical education (CME) for GPs, there has been little research into how providers decide what types of CME to deliver to GPs. This study aimed to identify factors affecting the intention of providers to provide more effective types of CME; and to design a survey instrument which can be used to test the applicability of Triandis' model of social behaviour to the provision of CME to general practitioners.

METHODS

This was a cross-sectional study on a convenience sample of 11 Australian providers of CME for interviews and a random sample of 25 providers for the pilot test. Open-ended interviews structured on Triandis' theory were performed with key informants who provide CME to GPs. These were used to develop a pilot survey instrument to measure the factors affecting intention, resulting in a revised instrument for use in further research.

RESULTS

There was a broad range of factors affecting providers' intention to deliver more effective forms of CME identified, and these were classifiable in a manner which was consistent with Triandis' model. Key factors affecting providers' intention were the attitude toward CME within organisations and the time and extra work involved.

CONCLUSIONS

We identified a range of potential factors influencing the intention of providers to provide more effective forms of CME, in all categories of Triandis model. Those interested in increasing the choice of more effective CME activities available to GPs may need to broaden the methods used in working with providers to influence them to use more effective CME techniques. The interview material and questionnaire analysis of the pilot survey support the use of Triandis model. Further research is needed to validate Triandis'model for the intention to deliver more effective forms of CME. Such research will inform future strategies aimed at increasing the amount and choice of effective CME activities available for GPs.

An adaptation of the theory of interpersonal behaviour to the study of telemedicine adoption by physicians

Physicians' acceptance of telemedicine constitutes a prerequisite for its diffusion on a national scale. Based upon the Theory of Interpersonal Behavior, this study was aimed at assessing the predictors of physicians' intention to use telemedicine in their clinical practice. All of the physicians involved in the RQTE, the extended provincial telemedicine network of Quebec (Canada) were mailed a questionnaire to identify the psychosocial determinants of their intention to adopt telemedicine. Confirmatory factor analysis (CFA) was performed to assess the measurement model and structural equation modelling (SEM) was applied to test the theoretical model. The adapted theoretical model explained 81% (P<0.001) of variance in physicians' intention to use telehealth. The main predictors of intentions were a composite normative factor, comprising personal as well as social norms (beta=1.08; P<0.001) and self identity (beta=-0.33; P<0.001). Thus, physicians who perceived professional and social responsibilities regarding adoption of telehealth in their clinical practice had stronger intention to use this technology. However, it is likely that personal identity had a suppression effect in the regression equation, indicating that physicians' intention to use telemedicine was better predicted if their self-perception as telemedicine users was considered. These results have several implications at the theoretical and practical levels that are discussed in this paper.