Involving patients and their carers in educating and training practitioners

Reliability and validity of Urdu PARENTS for assessing non-technical skills of paediatric residents in a teaching hospital in Pakistan

PURPOSE

The primary objective of our study is twofold. First, we assessed nontechnical skills (NTSs), such as the cognitive, social, and personal skills of postgraduate residents (PGRs), from paediatric caregivers' perspectives in a paediatric emergency department (PED) of a tertiary care hospital. Second, we evaluated the reliability and validity of the 'Parents' Assessment of Residents Enacting Non-Technical Skills' (PARENTS) instrument in its Urdu-translated version, ensuring its applicability and accuracy in the Pakistani context.

MATERIALS AND METHODS

This mixed-method study used an instrument translation and validation design. We translated an existing instrument, PARENTS, into Urdu, the national language of Pakistan, and administered it to paediatric caregivers in the PED of a tertiary care hospital. We collected data from 471 paediatric caregivers and coded them for analysis in AMOS and SPSS.

RESULTS

The Urdu-translated version of the PARENTS demonstrated reliability and internal validity in our study. The findings from the assessment revealed that paediatric caregivers expressed satisfaction with the knowledge and skill of residents. However, there was comparatively lower satisfaction regarding the residents' display of patience or empathy towards the children under their care.

CONCLUSION

The study findings support the validity and reliability of the PARENTS as an effective instrument for assessing the NTS of PGRs from the perspective of paediatric caregivers. With its demonstrated efficacy, medical educators can utilize PARENTS to pinpoint specific areas that require attention regarding the NTS of PGRs, thus facilitating targeted interventions for enhanced patient care outcomes.

The impact of expert by experience involvement in teaching in a DClinPsych programme; for trainees and experts by experience

INTRODUCTION

There is a growing acknowledgement of the value of creating partnerships between those delivering and those accessing health services. Less is known about this in the context of clinical psychology doctoral training programmes. This study explores the models of involvement of experts by experience (EbEs) in teaching on a DClinPsych course in England; the impact of this both for EbEs and trainee clinical psychologists and whether improvements are required to better meet their needs.

METHODS

An audit of current involvement was conducted by reviewing course records. Two survey questionnaires designed around commonly used frameworks of participation and reflective learning were completed by EbEs and trainees. Thematic Analysis was used to evaluate the written feedback from the surveys.

RESULTS

Records of current EbE involvement were found to be lacking in detail and sometimes missing. Key themes extrapolated from the surveys highlighted the importance of EbE involvement in supporting the wellbeing of EbEs and the learning experiences of trainees.

CONCLUSIONS

Recommendations with regard to the processes for future involvement of EbEs in teaching are put forward.

PATIENT OR PUBLIC CONTRIBUTION

A carer of a service user was consulted about the design of the participant information sheet, consent form and the survey questionnaire which was sent to the EbEs. A trainee clinical psychologist was also consulted to provide a trainee perspective on the above forms and the survey questionnaire that was sent to trainees. Further to this, the first author's supervisor identifies as a user of physical and mental health services and provided continued supervision and support regarding the direction of the study including the research questions, design, methodology and interpretation of results.

Patient references in the 2005 and 2015 CanMEDS frameworks

Background

Patient involvement in postgraduate medical education (PGME) can help residents improve their communication, professionalism, and collaboration. The CanMEDS Framework defines such competencies for physicians and informs teaching and assessment activities in PGME. However, it is unclear how patients are referenced in the CanMEDS Framework and if these references encourage the active involvement of patients in PGME. To inform how patients are referenced in the revisions of the CanMEDS Framework, scheduled for publication in 2025, our aim was to determine how patients are referenced in each the 2005 and 2015 CanMEDS Frameworks.

Methods

We used document analysis to examine how the term 'patient(s)' is referenced in the 2005 and 2015 CanMEDS Frameworks.

Results

Several 2005 and 2015 CanMEDS Roles include patients in the descriptions but do not reference them in the competencies. Others do not reference patients in the descriptions or competencies, potentially detracting from the importance of involving patients. As it stands, the 2015 Health Advocate is the only Role that describes and references patients working with physicians as partners in care, facilitating potential opportunities for patient involvement in PGME.

Conclusion

There are inconsistencies in how patients are described and referenced as potential partners in PGME throughout past and present CanMEDS Frameworks. Understanding these inconsistencies can inform the revision of CanMEDS that is scheduled for publication in 2025.

To Connect and Educate: Why Families Engage in Family-Professional Partnership Training Experiences

Successful family-professional partnerships (FPP) have been shown to positively impact both satisfaction with care and health outcomes for children with disabilities and their families. Many healthcare training programs have recognized the benefit of FPP training and often include learning experiences that feature families as teachers or mentors. However, most research on FPP training has focused on professionals' experiences, and not on families' experience in the roles of mentors and experts. The Leadership Education in Neurodevelopmental and Related Disabilities (LEND) program is a graduate-level interdisciplinary training program with sites across the country. LEND programs train future healthcare and service professionals in the disability field and often utilize a Family Mentor Experience (FME) as one aspect of their training. This study used qualitative interviews to examine the experiences of eight family mentors who worked with trainees in one LEND program. Overall, the family mentors expressed positive views regarding the FME, describing how it allowed them to connect with trainees, other families, and community resources, as well as educating trainees. Family mentors also identified several facilitators and barriers to participation. Study findings provide information on the FFP's impact on family mentors and guidance on how programs can support sustainable, effective FPP experiences.

An exploration of nursing students' and clinical instructors' perceptions of patient and parent involvement in the assessment of nursing students during pediatric clinical placements: A qualitative study

AIM

Clinical instructors are typically the sole assessors of nursing students completing their pediatric clinical placement in Canadian children's hospitals, as per their educational institution's assessment criteria and learning objectives. The purpose of this study was to explore nursing students' and clinical instructors' perceptions of and experiences with involving pediatric patients and parents in assessing nursing students during their pediatric clinical placement.

DESIGN

We conducted a qualitative descriptive study.

METHODS

We completed semi-structured interviews with fourth-year nursing students and pediatric clinical instructors from a University located in a city in central-eastern Canada. We used qualitative content analysis to analyze the data.

RESULTS

We found that students and instructors perceived patient and parent involvement in the assessment of nursing students' clinical practice as beneficial for patients, parents, students and instructors. Students and instructors believed patients and parents could contribute to assessing students' communication and therapeutic relationship skills. However, we identified potential challenges including patients' and parents' lack of knowledge regarding nursing skills, as well as added stress for students and parents.

CONCLUSION

Future studies should focus on ways of overcoming these challenges before implementing this novel assessment process.

Patients and carers as teachers in psychiatric education: a literature review and discussion

INTRODUCTION

The direct involvement of patients and carers in psychiatric education is driven by policy in the United Kingdom and Ireland. The benefits of this involvement are well known, however, it is important to consider the ethical aspects. This paper suggests how further research could explore and potentially mitigate adverse outcomes.

METHOD

A literature search evaluating the role of patients and carer involvement in psychiatric education was undertaken to summarise existing evidence relating to the following: methods of involvement, evidence of usefulness, patient's/carer's views and learners' views.

RESULTS

The Medline search produced 231 articles of which 31 were included in the literature review based on the key themes addressed in the paper.

DISCUSSION/CONCLUSION

The available evidence is generally positive regarding the use of patients and carers in psychiatric education. However, available research is varied in approach and outcome with little information on the ethical consequences. More research is required to inform policies on teaching regarding potential adverse effects of service user involvement.

The Involvement of Adolescents With Chronic Health Conditions in Medical Education: An Exploratory Qualitative Study

OBJECTIVES

In this study, we explored the involvement of adolescents with chronic health conditions in medical education. We focused specifically on adolescents' desired level of involvement in the education of medical students and residents, strategies for involving them in it, and topics on which they would feel comfortable educating these learners.

METHODS

We used a community-based participatory research approach and qualitative one-on-one semistructured interviews. Adolescents (ages 13-18) with chronic health conditions lasting >3 months who were admitted on inpatient wards and were well enough to participate in an interview were eligible. Two investigators analyzed the interview transcripts to identify common categories across the interview data.

RESULTS

A total of 17 adolescents participated. Data analysis revealed that adolescents want to be regularly involved in medical education, compensated in some way for their time and effort, and receive support and oversight in their activities. Adolescents discussed the following 5 strategies for involving them in the education of medical students and residents: face-to-face presentations, shadowing and mentoring, videos, handouts and books, and assessment feedback. Adolescents want to educate learners on their experiences and coping strategies as well as on how to interact and develop rapport with adolescents.

CONCLUSIONS

The adolescents with chronic health conditions who participated in this study want to be actively involved in medical education and can provide innovative insights and strategies for doing so. However, future researchers need to explore the benefits and limitations of such involvement.

'Can the patient speak?': postcolonialism and patient involvement in undergraduate and postgraduate medical education

CONTEXT

Patients are increasingly being engaged in providing feedback and consultation to health care institutions, and in the training of health care professionals. Such involvement has the potential to disrupt traditional doctor-patient power dynamics in significant ways that have not been theorised in the medical literature. Critical theories can help us understand how power flows when patients are engaged in the training of medical students.

METHODS

This paper applies postcolonial theory to the involvement of patients in the development and delivery of medical education. First, I review and summarise the literature around patient involvement in medical education. Subsequently, I highlight how postcolonial frameworks have been applied to medical education more broadly, extrapolating from the literature to apply a postcolonial lens to the area of patient engagement in medical education.

CONCLUSION

Concepts from postcolonial theory can help medical educators think differently about how patients can be engaged in the medical education project in ways that are meaningful and non-tokenistic. Specifically, the positioning of the patient as 'subaltern' can provide channels of resistance against traditional power asymmetries. This has curricular and methodological implications for medical education research in the area of patient engagement.

The development of the PARENTS: a tool for parents to assess residents' non-technical skills in pediatric emergency departments

BACKGROUND

Parents can assess residents' non-technical skills (NTS) in pediatric emergency departments (EDs). There are no assessment tools, with validity evidence, for parental use in pediatric EDs. The purpose of this study was to develop the Parents' Assessment of Residents Enacting Non-Technical Skills (PARENTS) educational assessment tool and collect three sources of validity evidence (i.e., content, response process, internal structure) for it.

METHODS

We established content evidence for the PARENTS through interviews with physician-educators and residents, focus groups with parents, a literature review, and a modified nominal group technique with experts. We collected response process evidence through cognitive interviews with parents. To examine the internal structure evidence, we administered the PARENTS and performed exploratory factor analysis.

RESULTS

Initially, a 20-item PARENTS was developed. Cognitive interviews led to the removal of one closed-ended item, the addition of resident photographs, and wording/formatting changes. Thirty-seven residents and 434 parents participated in the administration of the resulting 19-item PARENTS. Following factor analysis, a one-factor model prevailed.

CONCLUSIONS

The study presents initial validity evidence for the PARENTS. It also highlights strategies for potentially: (a) involving parents in the assessment of residents, (b) improving the assessment of NTS in pediatric EDs, and

A qualitative exploration of which resident skills parents in pediatric emergency departments can assess

BACKGROUND

Residents must strive for excellence in their nontechnical skills (NTS). However, NTS have not traditionally been well-assessed in pediatric emergency departments (EDs). One underutilized assessment strategy is to have parents assess the residents caring for their children. Prior to involving parents in resident assessment, it is essential to identify which NTS parents in pediatric EDs can assess.

AIM

To explore which resident NTS parents in pediatric EDs can assess.

METHODS

An exploratory qualitative study design was used. It included interviews with faculty members involved in the supervision and assessment of residents in a pediatric ED and residents who had experience working in a pediatric ED, as well as focus groups with parents who had visited a pediatric ED at least twice in the past year.

RESULTS

Participants in this study suggested that parents, if provided with the opportunity, can assess residents' communication skills, comfort in a pediatric setting, adaptability, and collaboration.

CONCLUSIONS

This study demystifies how parents can become involved in the assessment of residents' NTS. The findings will inform the development of assessment strategies and could be used to develop assessment instruments that enable parents to become actively involved in the assessment of residents in pediatric EDs.

Pathway to mental health recovery: a qualitative and quantitative study on the needs of Chinese psychiatric inpatients

BACKGROUND

Exploration of the information and participation needs of psychiatric inpatients is an important step for the implementation of recovery-oriented mental health service. The objective of this study was to explore the information and participation needs of Chinese psychiatric inpatients in the largest psychiatric hospital in Hong Kong.

METHODS

The study was divided into two parts. In the first part, eight focus groups with patients, patients' relatives and healthcare professionals were held to identify 22 items of information needs and 16 items of participation needs of Chinese psychiatric inpatients. Basing on the items identified in the first part of the study, a questionnaire was developed to survey on the importance of the different information and participation needs in the second part of the study. Participants were asked to rate in rank order their perceived importance of the items in the questionnaire survey.

RESULTS

A hundred and eighty three Chinese psychiatric inpatients completed the questionnaire and the majority of them suffered from schizophrenia (68.3 %). For information needs, the top three needs rated by patients as the most important in descending order were: "Information on the classifications of mental illnesses, signs and symptoms and factors contributing to relapse", "Information on the criteria and arrangements for discharge", and "Information on the importance of psychiatric drug taking and its side effects". For participation needs, the top three needs rated by patients as the most important in descending order were: "Enquiring about personal needs and arrangements", "Keeping in touch with the outside world", and "Learning and practising self-management".

CONCLUSIONS

This study reveals that Chinese psychiatric inpatients are concerned about information on their mental illness and its treatments as well as the criteria for discharge. On the other hand, patients are concerned about their personal needs, their self-management, as well as their keeping in touch with the outside world during their hospitalisation. Moreover, patients with different socio-demographic and clinical characteristics have different information and participation needs. The results of the present study serve as a reference for designing guidelines, strategies, and programmes to meet the information needs and participation needs of psychiatric inpatients in Hong Kong.

Pediatric caregiver involvement in the assessment of physicians

BACKGROUND

Given the growth and benefits of consumerist and family-centred approaches to pediatric health care, there is a need to involve pediatric caregivers in the assessment of their children's physicians.

DISCUSSION

We present interconnected questions that are important to address in order to facilitate pediatric caregiver involvement in the assessment of their children's physicians. Pediatric caregivers can be valuable assessors of physicians' non-technical skills. It is important to conduct additional research on caregiver involvement in assessment activities and create a reflective discourse on this topic. To ensure that pediatric caregivers' assessments of physicians are formally recognized and advantageous, it is important to understand: (a) what pediatric caregivers can assess; (b) what assessment tools exist for pediatric caregivers;

Paid carers' experiences of caring for mechanically ventilated children at home: implications for services and training

UK survival rates for long-term mechanically ventilated children have increased and paid carers are trained to care for them at home, however there is limited literature on carers' training needs and experience of sharing care. Using a qualitative abductive design, we purposively sampled experienced carers to generate data via diaries, semi-structured interviews, and researcher reflexive notes. Research ethics approval was granted from NHS and University committees. Five analytical themes emerged - Parent as expert; Role definition tensions; Training and Continuing Learning Needs; Mixed Emotions; Support Mechanisms highlighting the challenges of working in family homes for carers and their associated learning needs. Further work on preparing carers to share feelings with parents, using burnout prevention techniques, and building confidence is suggested. Carers highlight the lack of clinical supervision during their night-working hours. One solution may be to provide access to registered nurse support when working out-of-office hours.

The uncut jade: differing views of the potential of expert users on staff training and rehabilitation programmes for service users in Hong Kong

BACKGROUND

Service user participation in direct service provision and evaluation has been developing in the western world in the past 20 years. However, this recovery-based care model is relatively new in Asia.

AIM

To understand the views and perceptions of the service users and of psychiatric nurses about the recruitment of peer specialists in a regional psychiatric unit in Hong Kong.

METHOD

A qualitative study using probe questions to understand the above issues in the form of focus group discussion. A total of 13 psychiatric nurses and 16 mental health service users were recruited from a regional psychiatric unit for the study.

RESULTS

Content analysis based loosely on grounded theory has identified several important themes. While service users are generally enthusiastic about the potential contribution of peer specialists in a service setting, they are much concerned about rejection and discrimination by the psychiatric staff. Psychiatric nurses are also sceptical about the involvement of peer specialists in the delivery of service, although for an entirely different set of reasons. In view of the divergent views of the service users and the psychiatric nurses, a second round of focus group discussion was conducted seven months later to understand whether the themes distilled were consistent with their views expressed in the first round of focus group discussion.

CONCLUSION

It is encouraging is that, for those psychiatric nurses who worked with volunteer service users in the pilot scheme of 'expert user participation', there was a change in view towards positive acceptance about peer specialist involvement in service delivery. The study provides some insight into the potential obstacles to and opportunities in the implementation of peer specialist services in routine psychiatric services in Hong Kong.

Involvement of inpatient mental health clients in the practical training and assessment of mental health nursing students: Can it benefit clients and students?

Even though the central position of the client has been recognized in psychiatric nursing education, the client is seldom formally involved in the feedback provided to students during practical training. This research paper focuses on three questions: (1) What conditions support the gathering of meaningful client feedback to enhance the student's learning process and client's wellbeing? (2) Does the use of the practical model for client feedback lead to positive experiences, and if so, under what conditions? (3) To what extent is a client's feedback on the student's work performance, consistent with feedback from the mentor (nurse from the ward), the teacher and the student? Based on a literature review, participatory observation and contacts with experts, a practical model was developed to elicit client feedback. Using this model in two psychiatric inpatient services, clients were actively and formally involved in providing feedback to four, final year psychiatric nursing students. Clients, nurses, teachers and students were interviewed and data were analysed using a qualitative explorative research approach. Analyses revealed that client feedback becomes meaningful in a safe environment created by the psychiatric nurse. Client feedback generates a learning effect for the student and supports the student's recognition of the value and vulnerability of the psychiatric client.

Improving transitions for young people who move from child and adolescent mental health services to mental health services for adults: lessons from research and young people's and practitioners' experiences

PURPOSE OF REVIEW

The importance of ensuring robust arrangements for young people's transitions from specialist child and adolescent mental health services to specialist mental health services for adults is well documented in the international literature. Nonetheless, according to young people, there remains great variation in the quality of services in respect of their transitions. Furthermore, the problems that we report are by no means confined to single continents. This review examines recent literature and explores the themes that emerge from it with a view to finding solutions.

RECENT FINDINGS

Our findings from the literature suggest a clear strategic direction to improve the quality of the care of young people who need to move from specialist child and adolescent mental health services to specialist mental health services for adults. Our examination of the literature identifies a number of themes that have been recognized by practitioners and we have used them to define a model of care and aspects of good practice. We think they should be included within all evidence-based policies, protocols and care pathways for young people. There is little literature available that documents the personal experiences of young people in transition and their families, but consistent themes emerge from what is available.

SUMMARY

There are a number of topics that require active consideration when preparing young people for transition between services. Despite the limited volume of research, and particularly that which has directly involved young people and families, we know from anecdote, experience and local audit and research that improvements in service design and practice are required. These matters inform the solutions that we suggest. We see as pivotal involving young people directly in planning their own care and setting quality standards for healthcare and other services.

A systematic review of the international published literature relating to quality of institutional care for people with longer term mental health problems

BACKGROUND

A proportion of people with mental health problems require longer term care in a psychiatric or social care institution. However, there are no internationally agreed quality standards for institutional care and no method to assess common care standards across countries. We aimed to identify the key components of institutional care for people with longer term mental health problems and the effectiveness of these components.

METHODS

We undertook a systematic review of the literature using comprehensive search terms in 11 electronic databases and identified 12,182 titles. We viewed 550 abstracts, reviewed 223 papers and included 110 of these. A "critical interpretative synthesis" of the evidence was used to identify domains of institutional care that are key to service users' recovery.

RESULTS

We identified eight domains of institutional care that were key to service users' recovery: living conditions; interventions for schizophrenia; physical health; restraint and seclusion; staff training and support; therapeutic relationship; autonomy and service user involvement; and clinical governance. Evidence was strongest for specific interventions for the treatment of schizophrenia (family psychoeducation, cognitive behavioural therapy (CBT) and vocational rehabilitation).

CONCLUSION

Institutions should, ideally, be community based, operate a flexible regime, maintain a low density of residents and maximise residents' privacy. For service users with a diagnosis of schizophrenia, specific interventions (CBT, family interventions involving psychoeducation, and supported employment) should be provided through integrated programmes. Restraint and seclusion should be avoided wherever possible and staff should have adequate training in de-escalation techniques. Regular staff supervision should be provided and this should support service user involvement in decision making and positive therapeutic relationships between staff and service users. There should be clear lines of clinical governance that ensure adherence to evidence-based guidelines and attention should be paid to service users' physical health through regular screening.

Incorporating the experiences of youth with traumatic injury into the training of health professionals

Youth violence and related injury continue to be a serious public health problem and are identified as a major priority on the national health care agenda. Despite recommendations by numerous professional organizations to enhance healthcare professionals' roles in youth violence prevention efforts, there has been little documentation of effective training. To address this gap, the University of California, San Diego Department of Pediatrics (UCSD) partnered with San Diego-based Sharp HealthCare's Institute for Injury & Violence Prevention Think First San Diego in a novel program. As part of a panel that highlighted violence as a public health problem and a physician's responsibility in youth violence prevention, youth disabled by violence told fourth year medical students about opportunities for direct intervention in the lives of victims and perpetrators. The personal stories these young people tell of the effect of violence on individuals is a valuable training tool and a powerful way of humanizing the situation. Their participation also highlights physicians' opportunities for intervention and responsibility in directly addressing adolescents at risk.

Service user perspectives about their roles in undergraduate medical training about mental health

BACKGROUND

Current policy states that 'service users and carers should be involved in planning, providing and evaluating training for all health care professionals. We wished to explore service users' views regarding undergraduate psychiatry.

AIMS

We aimed to explore user perspectives on the specific role of service users in the delivery of teaching psychiatry.

METHOD

The study design was qualitative and used focus groups. The study took place in a community context with one focus group in Leeds, Leicester, Lincoln and Nottingham. Four focus groups were run with a total of 28 participants (16 women and 12 men, all white). No exclusion criteria were applied. The lead of each group were contacted and they then recruited volunteers from their membership.

RESULTS

The key findings were that participants felt that service users could play important roles in contextualising the part mental health plays in people's lives; dispel myths and fantasies about mental health; offer positive aspects of mental health to counterbalance the media; illustrate diversity within mental health and hope and recovery. Participants also identified the potential challenges to their participation including vulnerabilities especially at critical points in people's illnesses; perceived credibility - lack of support from some involved in academic roles; lack of appropriate training and support and issues of power and lack of genuine partnership in the planning and delivery of teaching. They were favourable about the development of guidelines as long as they involved a range of perspectives.

CONCLUSIONS

Service users present a range of ways in which they could be involved to enhance the educational experience of medical students in psychiatry.