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Thomas A, Kinston R, Yardley S, McKinley RK, Lefroy J. How do medical schools influence their students' career choices? A realist evaluation. MEDICAL EDUCATION ONLINE 2024; 29:2320459. [PMID: 38404035 PMCID: PMC10898266 DOI: 10.1080/10872981.2024.2320459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 02/14/2024] [Indexed: 02/27/2024]
Abstract
INTRODUCTION The career choices of medical graduates vary widely between medical schools in the UK and elsewhere and are generally not well matched with societal needs. Research has found that experiences in medical school including formal, informal and hidden curricula are important influences. We conducted a realist evaluation of how and why these various social conditions in medical school influence career thinking. METHODS We interviewed junior doctors at the point of applying for speciality training. We selected purposively for a range of career choices. Participants were asked to describe points during their medical training when they had considered career options and how their thinking had been influenced by their context. Interview transcripts were coded for context-mechanism-outcome (CMO) configurations to test initial theories of how career decisions are made. RESULTS A total of 26 junior doctors from 12 UK medical schools participated. We found 14 recurring CMO configurations in the data which explained influences on career choice occurring during medical school. DISCUSSION Our initial theories about career decision-making were refined as follows: It involves a process of testing for fit of potential careers. This process is asymmetric with multiple experiences needed before deciding a career fits ('easing in') but sometimes only a single negative experience needed for a choice to be ruled out. Developing a preference for a speciality aligns with Person-Environment-Fit decision theories. Ruling out a potential career can however be a less thought-through process than rationality-based decision theories would suggest. Testing for fit is facilitated by longer and more authentic undergraduate placements, allocation of and successful completion of tasks, being treated as part of the team and enthusiastic role models. Informal career guidance is more influential than formal. We suggest some implications for medical school programmes.
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Affiliation(s)
| | | | - Sarah Yardley
- Marie Curie Palliative Care Research Department, University College London, London, UK
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Brust M, Gebhardt WA, Ter Hoeve N, Numans ME, Kiefte-de Jong JC. Exploring timing and delivery of lifestyle advice following an acute cardiac event hospitalization: The cardiac patient's perspective. PATIENT EDUCATION AND COUNSELING 2024; 124:108279. [PMID: 38565073 DOI: 10.1016/j.pec.2024.108279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 03/19/2024] [Accepted: 03/25/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE To explore the perspective of cardiac patients regarding the timing and manner of delivering lifestyle advice following an acute cardiac event hospitalization. METHODS Dutch cardiac patients who experienced a cardiac event hospitalization participated in a semi-structured interview (n = 14) or a cross-sectional survey study (n = 119). RESULTS Our findings indicate that cardiac patients are receptive to lifestyle advice throughout the care trajectory. Advice delivered by a cardiologist had the highest self-reported impact. Furthermore, receiving advice at multiple phases during the care trajectory was associated with a greater intention to change lifestyle (B = 0.37, CI = 0.17 - 0.57). Patients favored clear-cut, feasible, and friendly but confronting advice. Moreover, they stressed the importance of advice being aligned with their identity and beliefs about the causes of their disease. CONCLUSION The period following an acute cardiac event provides a unique opportunity to offer tailored and patient-centered lifestyle advice. This "teachable window" for lifestyle change, when used wisely, may improve health outcomes for cardiac patients. PRACTICE IMPLICATIONS Healthcare professionals should initiate lifestyle advice already during hospitalization and continue during follow-up appointments and cardiac rehabilitation. Advice should be feasible and empathy-based, as well as tailored to the patient's needs, values, and perceptions of the causes of their cardiovascular disease.
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Affiliation(s)
- Michelle Brust
- Department of Public Health and Primary Care/ Health Campus The Hague, Leiden University Medical Center, The Hague, the Netherlands.
| | - Winifred A Gebhardt
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, the Netherlands.
| | - Nienke Ter Hoeve
- Capri Cardiac Rehabilitation, Rotterdam, the Netherlands; Erasmus University Medical Centre, Department of Rehabilitation Medicine, Rotterdam, the Netherlands.
| | - Mattijs E Numans
- Department of Public Health and Primary Care/ Health Campus The Hague, Leiden University Medical Center, The Hague, the Netherlands.
| | - Jessica C Kiefte-de Jong
- Department of Public Health and Primary Care/ Health Campus The Hague, Leiden University Medical Center, The Hague, the Netherlands.
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Kerins J, Ralston K, Stirling SA, Simpson N, Tallentire VR. Training as imagined? A critical realist analysis of Scotland's internal medicine simulation programme. Adv Simul (Lond) 2024; 9:27. [PMID: 38926742 PMCID: PMC11210083 DOI: 10.1186/s41077-024-00299-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Evaluating the impact of simulation-based education (SBE) has prioritised demonstrating a causal link to improved patient outcomes. Recent calls herald a move away from looking for causation to understanding 'what else happened'. Inspired by Shorrock's varieties of human work from patient safety literature, this study draws on the concept of work-as-done versus work-as-imagined. Applying this to SBE recognises that some training impacts will be unexpected, and the realities of training will never be quite as imagined. This study takes a critical realist stance to explore the experience and consequences, intended and unintended, of the internal medicine training (IMT) simulation programme in Scotland, to better understand 'training-as-done'. METHODS Critical realism accepts that there is a reality to uncover but acknowledges that our knowledge of reality is inevitably our construction and cannot be truly objective. The IMT simulation programme involves three courses over a 3-year period: a 3-day boot camp, a skills day and a 2-day registrar-ready course. Following ethical approval, interviews were conducted with trainees who had completed all courses, as well as faculty and stakeholders both immersed in and distant from course delivery. Interviews were audio-recorded, transcribed verbatim and analysed using critical realist analysis, influenced by Shorrock's proxies for work-as-done. RESULTS Between July and December 2023, 24 interviews were conducted with ten trainees, eight faculty members and six stakeholders. Data described proxies for training-as-done within three broad categories: design, experience and impact. Proxies for training design included training-as-prescribed, training-as-desired and training-as-prioritised which compete to produce training-as-standardised. Experience included training-as-anticipated with pre-simulation anxiety and training-as-unintended with the valued opportunity for social comparison as well as a sense of identity and social cohesion. The impact reached beyond the individual trainee with faculty development and inspiration for other training ventures. CONCLUSION Our findings highlight unintended consequences of SBE such as social comparison and feeling 'valued as a trainee, valued as a person'. It sheds light on the fear of simulation, reinforcing the importance of psychological safety. A critical realist approach illuminated the 'bigger picture', revealing insights and underlying mechanisms that allow this study to present a new framework for conceptualising training evaluation.
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Affiliation(s)
- Joanne Kerins
- Scottish Centre for Simulation and Clinical Human Factors, Forth Valley Royal Hospital, Larbert, FK5 4WR, UK.
- NHS Education for Scotland, Glasgow, UK.
| | | | | | - Nicholas Simpson
- Scottish Centre for Simulation and Clinical Human Factors, Forth Valley Royal Hospital, Larbert, FK5 4WR, UK
| | - Victoria Ruth Tallentire
- Scottish Centre for Simulation and Clinical Human Factors, Forth Valley Royal Hospital, Larbert, FK5 4WR, UK
- Medical Education Directorate, NHS Lothian, Edinburgh, UK
- NHS Education for Scotland, Glasgow, UK
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Yan J, Wen Y, Liu X, Deng M, Ye B, Li T, Wang H, Jia C, Liao J, Zhang L. The effectiveness of problem-based learning and case-based learning teaching methods in clinical practical teaching in TACE treatment for hepatocellular carcinoma in China: a bayesian network meta-analysis. BMC MEDICAL EDUCATION 2024; 24:665. [PMID: 38886707 PMCID: PMC11184776 DOI: 10.1186/s12909-024-05615-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 05/29/2024] [Indexed: 06/20/2024]
Abstract
PURPOSE To investigate the effectiveness of problem-based learning (PBL) and case-based learning (CBL) teaching methods in clinical practical teaching in transarterial chemoembolization (TACE) treatment in China. MATERIALS AND METHODS A comprehensive search of PubMed, the Chinese National Knowledge Infrastructure (CNKI) database, the Weipu database and the Wanfang database up to June 2023 was performed to collect studies that evaluate the effectiveness of problem-based learning and case-based learning teaching methods in clinical practical teaching in TACE treatment in China. Statistical analysis was performed by R software (4.2.1) calling JAGS software (4.3.1) in a Bayesian framework using the Markov chain-Monte Carlo method for direct and indirect comparisons. The R packages "gemtc", "rjags", "openxlsx", and "ggplot2" were used for statistical analysis and data output. RESULTS Finally, 7 studies (five RCTs and two observational studies) were included in the meta-analysis. The combination of PBL and CBL showed more effectiveness in clinical thinking capacity, clinical practice capacity, knowledge understanding degree, literature reading ability, method satisfaction degree, learning efficiency, learning interest, practical skills examination scores and theoretical knowledge examination scores. CONCLUSIONS Network meta-analysis revealed that the application of PBL combined with the CBL teaching mode in the teaching of liver cancer intervention therapy significantly improves the teaching effect and significantly improves the theoretical and surgical operations, meeting the requirements of clinical education.
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Affiliation(s)
- Jingxin Yan
- West China Hospital, Sichuan University, Chengdu, China
| | - Yonghao Wen
- Department of Hepatopancreatobiliary Surgery, Affiliated Hospital of Qinghai University, Xining, China
- Department of Postgraduate, Qinghai University, Xining, China
| | - Xinlian Liu
- Department of Pathology and Pathophysiology, Chengdu Medical College, Chengdu, China
| | - Manjun Deng
- Department of Hepatopancreatobiliary Surgery, Affiliated Hospital of Qinghai University, Xining, China
- Department of Postgraduate, Qinghai University, Xining, China
| | - Bin Ye
- Department of General Surgery, Rongxian People's Hospital, Zigong, China
| | - Ting Li
- Department of Orthopedics, Sichuan Provincial People's Hospital, Chengdu, China
| | - Huanwei Wang
- Department of Ultrasonography, Hainan General Hospital/Hainan Affiliated Hospital of Hainan Medical University, Haikou, 570100, China
| | - Cui Jia
- Department of Pathology and Pathophysiology, Chengdu Medical College, Chengdu, China
| | - Jinsong Liao
- Department of Anesthesiology, Affiliated Hospital of Chengdu University, Chengdu University, Chengdu, China.
| | - Lushun Zhang
- Department of Pathology and Pathophysiology, Chengdu Medical College, Chengdu, China.
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Tate K, Penconek T, Booth A, Harvey G, Flynn R, Lalleman P, Wolbers I, Hoben M, Estabrooks CA, Cummings GG. Contextually appropriate nurse staffing models: a realist review protocol. BMJ Open 2024; 14:e082883. [PMID: 38719308 PMCID: PMC11086385 DOI: 10.1136/bmjopen-2023-082883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/08/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION Decisions about nurse staffing models are a concern for health systems globally due to workforce retention and well-being challenges. Nurse staffing models range from all Registered Nurse workforce to a mix of differentially educated nurses and aides (regulated and unregulated), such as Licensed Practical or Vocational Nurses and Health Care Aides. Systematic reviews have examined relationships between specific nurse staffing models and client, staff and health system outcomes (eg, mortality, adverse events, retention, healthcare costs), with inconclusive or contradictory results. No evidence has been synthesised and consolidated on how, why and under what contexts certain staffing models produce different outcomes. We aim to describe how we will (1) conduct a realist review to determine how nurse staffing models produce different client, staff and health system outcomes, in which contexts and through what mechanisms and (2) coproduce recommendations with decision-makers to guide future research and implementation of nurse staffing models. METHODS AND ANALYSIS Using an integrated knowledge translation approach with researchers and decision-makers as partners, we are conducting a three-phase realist review. In this protocol, we report on the final two phases of this realist review. We will use Citation tracking, tracing Lead authors, identifying Unpublished materials, Google Scholar searching, Theory tracking, ancestry searching for Early examples, and follow-up of Related projects (CLUSTER) searching, specifically designed for realist searches as the review progresses. We will search empirical evidence to test identified programme theories and engage stakeholders to contextualise findings, finalise programme theories document our search processes as per established realist review methods. ETHICS AND DISSEMINATION Ethical approval for this study was provided by the Health Research Ethics Board of the University of Alberta (Study ID Pro00100425). We will disseminate the findings through peer-reviewed publications, national and international conference presentations, regional briefing sessions, webinars and lay summary.
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Affiliation(s)
- Kaitlyn Tate
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Tatiana Penconek
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Andrew Booth
- School of Medicine and Population Health, University of Sheffield, Sheffield, South Yorkshire, UK
| | - Gillian Harvey
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Rachel Flynn
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | | | - Inge Wolbers
- University of Applied Sciences Utrecht, Utrecht, Netherlands
| | - Matthias Hoben
- School of Health Policy and Management, York University, Toronto, Ontario, Canada
| | - Carole A Estabrooks
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Greta G Cummings
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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Montiel C, Mishara BL. A qualitative study of factors involved in the helping behaviors of suicide prevention gatekeepers. DEATH STUDIES 2024; 48:522-532. [PMID: 37603417 DOI: 10.1080/07481187.2023.2246018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
This study explores the factors involved in the capacity of newly trained suicide prevention gatekeepers to engage in the identification and support of people at risk of suicide. In-depth telephone interviews were conducted with 18 gatekeepers from various settings who had participated in a larger quantitative study of the impact of gatekeeper training. Conventional content analysis was performed on the data collected. Participants said that gatekeeper training provided key information and legitimized their role. Previous experience with suicidal friends and family members motivated their involvement and helped them to engage with at-risk individuals. Support available from the setting, including attitudes toward suicide, resources for referrals and promotion of the gatekeeper activities, were instrumental in gatekeepers' ability to fulfill their role. Gatekeeper programs may benefit from adopting a comprehensive approach to gatekeeper helping behaviors by attending to their contextual influences, and the effects of gatekeepers' personal experiences.
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Affiliation(s)
- Corentin Montiel
- Centre for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, Montréal, Canada
| | - Brian L Mishara
- Centre for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, Montréal, Canada
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Fitzmaurice Y, Beeke S, Isaksen J, Cunningham U, Jagoe C, Shé ÉN, McMenamin R. Communication partner training for student health and social care professionals engaging with people with stroke acquired communication difficulties: A protocol for a realist review. HRB Open Res 2024; 6:60. [PMID: 38384971 PMCID: PMC10879762 DOI: 10.12688/hrbopenres.13783.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 02/23/2024] Open
Abstract
Background Stroke acquired communication impairments impede effective communication. Consequently, in stroke care, communicative interactions can be challenging for both patients and staff and can predispose patients to increased risk of preventable adverse events. Communication partner training (CPT) can mitigate such negative outcomes by optimising communicative interactions. Providing CPT to student health and social care professionals (SH&SCPs) has the potential to enhance their clinical expertise and experiences and enhance the future clinical care of patients with stroke acquired communication impairments. This research aims to expand our understanding of how CPT is operationalised for SH&SCPs in higher education institutions and determine: what works; for whom; in what contexts; how and why? Methods This review is Phase 1 of a research project employing a realist approach with public and patient involvement (PPI). It incorporates five iterative steps: 1.) Clarifying the scope; 2.) Searching for evidence; 3.) Selecting and appraising evidence; 4.) Data extraction; 5.) Synthesising data and developing a middle range theory explaining how CPT is expected to work for SH&SCPs. An advisory panel, including PPI advisors, content advisors, student advisors, realist advisors and educationalist advisor has been set up to consult throughout the review and collaboratively agree the middle range theory. Discussion While there is an evolving evidence base for CPT, including stroke specific CPT for SH&SCPs, it is acknowledged that there are challenges to its implementation in complex real-world settings. In combining empirical evidence with theoretical understanding, realist review permits synthesis of data from diverse sources and goes beyond determining efficacy to explore generative causation and solutions for real world practice. A middle range realist programme theory that coherently explains how CPT is expected to work when teaching SH&SCPs to communicate with people with stroke acquired communication impairments will provide educators with new insights into CPT development and implementation in their higher education institutions.
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Affiliation(s)
- Yvonne Fitzmaurice
- School of Health Sciences, University of Galway, Galway, H91 TK33, Ireland
| | - Suzanne Beeke
- Division of Psychology and Language Sciences, University College London, London, England, WC1E 6BT, UK
| | - Jytte Isaksen
- Department of Language, Culture, History and Communication, University of Souhern Denmark, Odense, Denmark
| | - Una Cunningham
- Mater Misericordiae University Hospital, Dublin, D07 R2WY, Ireland
| | - Caroline Jagoe
- School of Linguistics, Speech and Communication Sciences, The University of Dublin Trinity College, Dublin, Leinster, D02 PN40, Ireland
- Speech Pathology and Audiology, School of Human and Communication Development, University of Witwatersrand, Johannesburg, South Africa
| | - Éidín Ní Shé
- Graduate School of Healthcare Management, RCSI University of Medicine and Health Sciences, Dublin, D02 YN77, Ireland
| | - Ruth McMenamin
- School of Health Sciences, University of Galway, Galway, H91 TK33, Ireland
- PPI Ignite Network @ University of Galway, University of Galway, Galway, H91 TK33, Ireland
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van Oorschot F, Brouwers M, Muris J, Veen M, Timmerman A, Dulmen SV. How does guided group reflection work to support professional identity formation in postgraduate medical education: A scoping review. MEDICAL TEACHER 2024:1-11. [PMID: 38626746 DOI: 10.1080/0142159x.2024.2339409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 04/02/2024] [Indexed: 04/18/2024]
Abstract
PURPOSE In postgraduate medical education, guided group reflection is often applied to support professional identity formation. However, little is known about how guided group reflection is shaped and how it works. Our scoping review synthesizes existing evidence about various approaches for guided group reflection, their aims, components and potential working mechanisms. METHODS We conducted a scoping review using JBI (Joanna Briggs Institute) guidelines for conducting scoping reviews. We searched PubMed, PsycINFO, EMBASE and ERIC databases for all research articles published in English or Dutch in an iterative team approach. The articles were extracted and summarized quantitatively and qualitatively. RESULTS We included 71 papers (45 primary research papers and 26 non-empirical papers including program descriptions, theoretical concepts and personal experiences). We identified a diversity of approaches for guided group reflection (e.g. Balint groups, supervised collaborative reflection and exchange of experiences), applied in a variety of didactic formats and aims. We distilled potential working mechanisms relating to engagement in reflection, group learning and the supervisor's role. CONCLUSIONS There are significant knowledge gaps about the aims and underlying mechanisms of guided group reflection. Future systematic research on these topics is needed to understand the effectiveness of educational methods, that can help facilitate learning conditions to best shape professional identity formation (PIF) in educational curricula.
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Affiliation(s)
- Frederieke van Oorschot
- Department of Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands
| | - Marianne Brouwers
- Department of Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands
| | - Jean Muris
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Mario Veen
- Department of General Practice, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Angelique Timmerman
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Sandra van Dulmen
- Department of Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands
- Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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Myezwa H, Nixon S, Potterton J, Ajidahun AT, Cameron C, Konje M, Omoroh F, Chiluba BC, Chisoso T, Solomon P. Evaluation of a knowledge translation intervention for HIV and rehabilitation advocacy in physiotherapy in three sub-Saharan African countries. Disabil Rehabil 2024; 46:1220-1229. [PMID: 36970783 DOI: 10.1080/09638288.2023.2188265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 03/02/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE To evaluate a knowledge translation intervention to determine knowledge, attitudes and self-efficacy related to HIV and rehabilitation advocacy in physiotherapy students. METHODS A pre and post-test study was conducted at three physiotherapy-training programs in Sub Saharan Africa - the University of the Witwatersrand (Wits), the University of Zambia (UNZA) and Kenya Medical Technical College (KMTC). For each site, the knowledge, attitude and self-efficacy of physiotherapy students were tested pre- and post-intervention using a standardized questionnaire. RESULTS Students' knowledge improved with regard to being able to describe the challenges faced by their patients, knowing what resources are available and understanding their role as an advocate. In terms of self-efficacy, they felt more confident clinically, as well as being a resource person to colleagues and an advocate for their patients. This study highlights the need to contextualize knowledge translation interventions to meet the unique needs of individual academic sites. Students who have clinical experience working with people living with HIV are more likely to embrace their role as advocates in the area of HIV and rehabilitation.Implications for RehabilitationThe knowledge translation process used in this study gives a concrete example of how to use research evidence on HIV knowledge in rehabilitation applied within the advocacy process.Applying the principles of advocacy translates to understanding the management of HIV practically.Clinical experience in managing people living with HIV strengthens knowledge and improves the attitude of physiotherapy studentsPhysiotherapy students need guidance in realizing their potential as advocates for holistic rehabilitation care for people living with HIV.
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Affiliation(s)
- Hellen Myezwa
- Department of Physiotherapy, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephanie Nixon
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Joanne Potterton
- Department of Physiotherapy, University of the Witwatersrand, Johannesburg, South Africa
| | - Adedayo Tunde Ajidahun
- Department of Physiotherapy, University of the Witwatersrand, Johannesburg, South Africa
| | - Cathy Cameron
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Moses Konje
- Department of Physiotherapy, Kenya Medical Training College, Nairobi, Kenya
| | - Florence Omoroh
- Department of Physiotherapy, Kenya Medical Training College, Nairobi, Kenya
| | | | - Theresa Chisoso
- Department of Physiotherapy, University of Zambia, Lusaka, Zambia
| | - Patricia Solomon
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
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Kinston R, Gay S, McKinley RK, Sam S, Yardley S, Lefroy J. How well do UK assistantships equip medical students for graduate practice? Think EPAs. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024; 29:173-198. [PMID: 37347459 DOI: 10.1007/s10459-023-10249-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 05/28/2023] [Indexed: 06/23/2023]
Abstract
The goal of better medical student preparation for clinical practice drives curricular initiatives worldwide. Learning theory underpins Entrustable Professional Activities (EPAs) as a means of safe transition to independent practice. Regulators mandate senior assistantships to improve practice readiness. It is important to know whether meaningful EPAs occur in assistantships, and with what impact. Final year students at one UK medical school kept learning logs and audio-diaries for six one-week periods during a year-long assistantship. Further data were also obtained through interviewing participants when students and after three months as junior doctors. This was combined with data from new doctors from 17 other UK schools. Realist methods explored what worked for whom and why. 32 medical students and 70 junior doctors participated. All assistantship students reported engaging with EPAs but gaps in the types of EPAs undertaken exist, with level of entrustment and frequency of access depending on the context. Engagement is enhanced by integration into the team and shared understanding of what constitutes legitimate activities. Improving the shared understanding between student and supervisor of what constitutes important assistantship activity may result in an increase in the amount and/or quality of EPAs achieved.
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Affiliation(s)
- Ruth Kinston
- School of Medicine, Keele University, Clinical Education Centre, University Hospital of North Midlands, Newcastle Road, Staffordshire, ST4 6QG, UK.
| | - Simon Gay
- University of Leicester School of Medicine, Leicester, UK
- Keele University School of Medicine, Keele, UK
| | | | - Sreya Sam
- Keele University School of Medicine, Keele, UK
| | - Sarah Yardley
- Marie Curie Palliative Care Research Department, University College London, London, UK
- Central & North West London NHS Foundation Trust, London, UK
| | - Janet Lefroy
- School of Medicine and Faculty Lead for the Health Professionals Education Research Theme, Keele University, Keele, UK
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Morris C, McDonald J, Officer TN, Fa'asalele Tanuvasa A, Smiler K, Parore N, Dunn P, McKinlay E, Kennedy J, McBride-Henry K, Cumming J. A realist evaluation of the development of extended pharmacist roles and services in community pharmacies. Res Social Adm Pharm 2024; 20:321-334. [PMID: 38065764 DOI: 10.1016/j.sapharm.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 11/14/2023] [Accepted: 11/14/2023] [Indexed: 02/18/2024]
Abstract
BACKGROUND Internationally, community pharmacy models of care have been moving away from a focus on dispensing to extended, clinically-focused roles for pharmacists. OBJECTIVES To identify how community pharmacy strategies were being implemented in Aotearoa New Zealand; how changes were expected to influence health and health system outcomes; what extended services were being delivered; the responses of pharmacists, other health professionals and consumers to these developments; and the contexts and mechanisms supporting the successful implementation of new community pharmacy services. METHODS A realist evaluation methodology was employed, to explore a complex policy intervention. Realist evaluation explores the contexts (C) within which initiatives are introduced and identifies the mechanisms (M) triggered by different contexts to produce outcomes (O). Realist evaluation processes iteratively develop, test, and refine CMO configurations. In this study, initial programme theories were developed through key government and professional policy documents, then refined through key informant interviews, a survey and interviews with pharmacists and intern (pre-registration) pharmacists, and finally, 10 case studies of diverse community pharmacies. RESULTS Four intermediate health service outcomes were identified: development of extended community pharmacist services; consumers using extended community pharmacist services; more integrated, collaborative primary health care services; and a fit-for-purpose community pharmacy workforce. Enabling and constraining contexts are detailed for each outcome, along with the mechanisms that they trigger (or inhibit). CONCLUSIONS There are wide-ranging and disparate levers to support the further development of extended community pharmacy services. These include aligning funding with desired services, undergraduate educators and professional leaders setting expectations for the pharmacists' role in practice, and the availability of sufficient funding and time for both specific extended service accreditation and broader postgraduate training. However, no simple "fix" can be universally applied internationally, nor even in pharmacies within a single jurisdiction, to facilitate service development.
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Affiliation(s)
- Caroline Morris
- Department of Primary Health Care & General Practice, University of Otago, Wellington, PO Box 7343, Newtown, Wellington, 6242, New Zealand.
| | - Janet McDonald
- Te Hikuwai Rangahau Hauora, Health Services Research Centre, Te Herenga Waka-Victoria University of Wellington, PO Box 600, Wellington, 6140, New Zealand.
| | - Tara Nikki Officer
- Te Hikuwai Rangahau Hauora, Health Services Research Centre, Te Herenga Waka-Victoria University of Wellington, PO Box 600, Wellington, 6140, New Zealand.
| | - Ausaga Fa'asalele Tanuvasa
- Te Hikuwai Rangahau Hauora, Health Services Research Centre, Te Herenga Waka-Victoria University of Wellington, PO Box 600, Wellington, 6140, New Zealand.
| | - Kirsten Smiler
- Te Hikuwai Rangahau Hauora, Health Services Research Centre, Te Herenga Waka-Victoria University of Wellington, PO Box 600, Wellington, 6140, New Zealand.
| | - Nora Parore
- Te Hikuwai Rangahau Hauora, Health Services Research Centre, Te Herenga Waka-Victoria University of Wellington, PO Box 600, Wellington, 6140, New Zealand.
| | - Phoebe Dunn
- Te Hikuwai Rangahau Hauora, Health Services Research Centre, Te Herenga Waka-Victoria University of Wellington, PO Box 600, Wellington, 6140, New Zealand.
| | - Eileen McKinlay
- Department of Primary Health Care & General Practice, University of Otago, Wellington, PO Box 7343, Newtown, Wellington, 6242, New Zealand.
| | - Jonathan Kennedy
- Department of Primary Health Care & General Practice, University of Otago, Wellington, PO Box 7343, Newtown, Wellington, 6242, New Zealand.
| | - Karen McBride-Henry
- Te Hikuwai Rangahau Hauora, Health Services Research Centre, Te Herenga Waka-Victoria University of Wellington, PO Box 600, Wellington, 6140, New Zealand.
| | - Jacqueline Cumming
- Te Hikuwai Rangahau Hauora, Health Services Research Centre, Te Herenga Waka-Victoria University of Wellington, PO Box 600, Wellington, 6140, New Zealand.
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Watermeyer J, Nattrass R, Beukes J, Madonsela S, Scott M. Considerations for paediatric student-led telepractice in speech-language therapy: A pilot observational study from South Africa. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2024; 59:665-677. [PMID: 37772704 DOI: 10.1111/1460-6984.12958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 09/04/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND COVID-19 necessitated emergency telepractice for student-led speech-language therapy clinical practicals in training institutions, with limited preparation and evidence-based guidelines. Beyond the pandemic, practitioners and university training sites are likely to continue to offer telepractice necessitating thorough preparation for telepractice services underpinned by a comprehensive understanding of the complexities involved in online therapy. AIMS Adopting realist evaluation principles, our aim in this paper was to explore broadly what works and does not work in a set of student-led telepractice sessions in a diverse, resource-limited context. The broader goal of this project was to provide evidence-based support to enhance the efficiency and success of telepractice sessions in student clinical training contexts. METHODS & PROCEDURES We used qualitative observational methods with reflexive thematic analysis to analyse 28 video recordings and 61 observation notes of student-led paediatric telepractice sessions from a South African university clinic as part of a pilot study. OUTCOMES & RESULTS We identified four overarching considerations for student-led telepractice: (1) additional, specific preparation is required, (2) with greater management of technology and adaptation of tasks, especially during times of poor connectivity; (3) telepractice relies heavily on caregiver input and collaboration; and (4) promoting engagement online, holding a client's attention, building rapport and offering reinforcement are critical skills that are complicated by the lack of face-to-face contact. CONCLUSIONS & IMPLICATIONS Our findings indicate that telepractice pedagogy needs to be explicitly taught and students require practical assistance as they learn how to use this service delivery approach effectively. There are some aspects peculiar to telepractice that require unique consideration and planning, especially in contexts where service providers and users may be unfamiliar with this form of service provision. The findings of this pilot study can be used by clinical educators and student clinicians to enhance clinical training opportunities involving telepractice. WHAT THIS PAPER ADDS What is already known on this subject Many speech-language therapy (SLT) student clinicians had to transition quickly to telepractice service provision during COVID-19 with limited existing guidelines and support, especially in contexts where teletherapy is typically non-existent or difficult to access. Although there is some literature available on experiences of telepractice, there is very little evidence-based research which explores the mechanics of such sessions in real-time and which offers practical support to student clinicians and clinical educators engaging in this mode of service delivery. What this study adds This pilot study examined video-recorded, student-led, paediatric, speech-language teletherapy sessions to understand challenges and considerations involved in using telepractice as a clinical training tool. Findings show that additional preparation for telepractice sessions is required, particularly in contexts of poor digital literacy; students must learn to manage technology, especially when connectivity poses a challenge, and adapt therapy tasks for online work with clients; telepractice relies heavily on caregiver input and collaboration, more so than in in-person consultations, and this relationship requires careful management; and promoting engagement online, holding a client's attention, building rapport and offering reinforcement are critical yet challenging skills in telepractice. What are the potential or actual clinical implications of this work? Our findings highlight a need to teach telepractice pedagogy explicitly and support students practically in learning how to provide therapy effectively via this mode of service delivery. Observational methods for studying practices in recorded telepractice sessions can be used as part of a reflective approach to clinical training. Using already available data allowed us to unpack the 'messy reality' of clinical training using telepractice.
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Affiliation(s)
- Jennifer Watermeyer
- Health Communication Research Unit, School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Rhona Nattrass
- Health Communication Research Unit, School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Johanna Beukes
- Health Communication Research Unit, School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Sonto Madonsela
- Health Communication Research Unit, School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Megan Scott
- Health Communication Research Unit, School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
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Komasawa N, Yokohira M. Survey on Medical Students' Attitudes Toward Medical Practice Just Before Clinical Clerkship in Japan. Cureus 2024; 16:e52899. [PMID: 38406098 PMCID: PMC10891475 DOI: 10.7759/cureus.52899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2024] [Indexed: 02/27/2024] Open
Abstract
INTRODUCTION The present study examined the confidence in essential medical practices during clinical clerkship (CC) and performance in preparing education for medical students who are just starting CC at our university. METHODS We conducted a survey using questionnaires with 105 fourth-year medical students just before starting CC. This questionnaire analysis consists of the confidence in objective structured clinical examination (OSCE) and computer-based testing (CBT) performance toward essential medical practice recommended in the "Report on Medical Practice during Clinical Clerkship" by the Japanese Ministry of Health, Labor, and Welfare and medical safety for CC. RESULTS The response rate was 67.6% (71/105). As for the performance in each OSCE theme, the confidence in basic clinical technique was significantly smaller compared to chest or abdominal examination, medical interview, and emergency response (p<0.05 each). Medical interviews showed stronger confidence compared to gynecological, breast, or rectal examinations and prostate palpitation among medical examinations (p<0.05 each). In the basic technique during CC, skin disinfection showed stronger confidence compared to other techniques (p<0.05 each). On surgical technique during CC, surgical hand washing and gown technique significantly showed stronger confidence compared to skin suture, suture removal, bleeding control, and surgical assistant (p<0.05 each). CONCLUSION Our results suggest that medical students just before CC have less confidence in invasive medical practice during CC. As medical practice by student doctors becomes public, further systematic basic skill training both before and during CC is warranted.
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Affiliation(s)
- Nobuyasu Komasawa
- Community Medicine Education Promotion Office, Faculty of Medicine, Kagawa University, Takamatsu, JPN
| | - Masanao Yokohira
- Department of Medical Education, Faculty of Medicine, Kagawa University, Takamatsu, JPN
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Derbyshire J, Porteous D, Corder K, Foggo B, Steven A. Investigating the processes and influences involved in the transformational journeys of Registered Nurse Degree Apprentices: A realist informed qualitative study. Nurse Educ Pract 2024; 74:103834. [PMID: 38039711 DOI: 10.1016/j.nepr.2023.103834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/17/2023] [Accepted: 11/01/2023] [Indexed: 12/03/2023]
Abstract
AIM This study aimed to investigate students' learning journeys across the duration of a new registered nurse degree apprenticeship programme and to develop an understanding of the contextual factors, mechanisms and outcomes involved. BACKGROUND Registered nurses are the largest group of healthcare workers globally, but shortages exist. To encourage existing UK healthcare employees into nursing, national investment was made into Registered Nurse Degree Apprenticeships. In 2018 a UK health service organisation and a university collaboration led to development of a nursing degree apprenticeship programme. Research into these novel undergraduate programmes in nursing is lacking, with scarce evidence or understanding of processes and experiences involved in such programmes. DESIGN AND METHODS An exploratory qualitative design informed by realistic evaluation was employed. Three sequential semi-structured interviews were conducted with an entire cohort (n=8) across the 18-month programme (24 interviews). Focused interviews were also undertaken with practice assessors (n=8) involved in the apprentices' journey. Initial thematic analysis was followed by application of Realist Evaluation principles and a temporal lens to move beyond qualitative description. RESULTS Analysis identified four interrelated temporal themes, each comprising contextual factors, mechanisms and outcomes acting to inhibit or facilitate transition across the apprenticeship journey: (1) Starting out (Latent Ambition, enhanced motivation and expectations): programme availability and conditions enabled enactment of ambitions to become qualified nurses, preconceived assumptions regarding roles influenced expectations. (2) Initial stages (Identity dissonance, transition to academia, becoming a student nurse) related to changing identity and re-conceptualisation of their role to student nurse, alongside transitioning into higher education. (3) Travelling through (Being an apprentice, social capital, self-efficacy and confidence) facilitated confident integration into placements, although over confidence could be risky. Academic struggles prompted some episodes of emotional dissonance. (4) Moving beyond to become registered nurses (Confidence, empowerment and loyalty in the transition to becoming a nurse) saw apprentices transform, with revised understandings of nursing, increased empowerment and self-efficacy. All expressed gratitude and loyalty for the apprenticeship opportunity, with all securing jobs in their employing organisation. CONCLUSION This study is one of the first of its kind, providing detailed insight into processes experienced by students over the duration of a novel apprenticeship programme. Analysis identified several factors that facilitated and inhibited progress in participants' 'learning journeys', mapping context, mechanism, outcome configurations which came into play at various stages. These were influential in successful completion of the programme by all apprentices, resulting in the development of competent Registered Nurses.
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Affiliation(s)
- Julie Derbyshire
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne NE7 7XA, UK.
| | - Debbie Porteous
- Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne NE7 7XA, UK
| | - Karen Corder
- Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne NE7 7XA, UK
| | - Barbara Foggo
- Health Education England, working across the North East and North Cumbria, Trust Headquarters, Queen Elizabeth Hospital, Queen Elizabeth Avenue, Sheriff Hill, Gateshead NE9 6SX, UK
| | - Alison Steven
- Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne NE7 7XA, UK
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Patocka C, Pandya A, Brennan E, Lacroix L, Anderson I, Ganshorn H, Hall AK. The Impact of Just-in-Time Simulation Training for Healthcare Professionals on Learning and Performance Outcomes: A Systematic Review. Simul Healthc 2024; 19:S32-S40. [PMID: 38240616 DOI: 10.1097/sih.0000000000000764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
ABSTRACT Although just-in-time training (JIT) is increasingly used in simulation-based health professions education, its impact on learning, performance, and patient outcomes remains uncertain. The aim of this study was to determine whether JIT simulation training leads to improved learning and performance outcomes. We included randomized or nonrandomized interventional studies assessing the impact of JIT simulation training (training conducted in temporal or spatial proximity to performance) on learning outcomes among health professionals (trainees or practitioners). Of 4077 citations screened, 28 studies were eligible for inclusion. Just-in-time training simulation training has been evaluated for a variety of medical, resuscitation, and surgical procedures. Most JIT simulation training occurred immediately before procedures and lasted between 5 and 30 minutes. Despite the very low certainty of evidence, this systematic review suggests JIT simulation training can improve learning and performance outcomes, in particular time to complete skills. There remains limited data on better patient outcomes and collateral educational effects.
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Affiliation(s)
- Catherine Patocka
- From the Department of Emergency Medicine (C.P., A.P.), University of Calgary Cumming School of Medicine, Calgary, Canada; Department of Emergency Medicine (E.B.), Queen's University, Kingston, Canada ; Department of Emergency Medicine (L.L., A.K.H.), University of Ottawa, Ottawa, Canada; Department of Pediatric Emergency Medicine (I.A.), Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH; Royal College of Physicians and Surgeons of Canada (A.K.H.), Ottawa, Canada ; Libraries and Cultural Resources (H.G.), University of Calgary, Calgary, Canada
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Eriksen S, Dahler AM, Øye C. The informal way to success or failure? Findings from a comparative case study on video consultation training and implementation in two Danish hospitals. BMC Health Serv Res 2023; 23:1135. [PMID: 37865741 PMCID: PMC10590501 DOI: 10.1186/s12913-023-10163-w] [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: 11/01/2022] [Accepted: 10/12/2023] [Indexed: 10/23/2023] Open
Abstract
BACKGROUND This study evaluated an attempt to implement video consultations through a novel education intervention in telehealth training and implementation in two middle-sized hospitals in Denmark. Three units tested the education intervention along with a regional decision to strengthen multidisciplinary and cross-sectoral collaboration through technology to improve service delivery by making the process more coherent and saving time and resources. This study aims to identify what contextual factors enable workplace learning, skills acquisition, and utilization of new digital skills to use and routinize video consultations in workplace practice. METHODS This qualitative case study draws on the principles of the realist evaluation framework using cross-case comparisons to test and refine program theories by exploring the complex and dynamic interaction among context, mechanism, and outcome. The methods in this study include participant observations, document analysis, semi-structured individual interviews, and focus groups. We performed an interpretive cross-case analysis, which explored the context-mechanism-outcome relationship using the guiding question, "What works, for whom, under what circumstances, and why?". RESULTS Two broad mechanisms appeared to enable skills acquisition and routinization of video consultations: informal workplace learning and adjusting video consultations to professional judgment. The three units had different approaches to the implementation and training and, as such, had different outcomes. First, the skills acquired in the units differed; therefore, how and with whom they used video consultations varied. Second, video consultation use was more likely to be adjusted to workflows if unit managers were responsive to staff's professional judgments regarding patients, as was evident in all three units. CONCLUSION Our study shows that a formal training course alone is insufficient to provide healthcare professionals with the skills needed to use video consultations in workplace practice. Informal workplace learning with support on the spot and continuous follow-up seems to equip healthcare professionals with the skills to use video consultations. Video consultations are more likely to be used confidently if novel workflows are adjusted to health care professionals' knowledge, skills, and judgment and their concerns regarding patient soundness.
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Affiliation(s)
- Susanne Eriksen
- Faculty of Health and Social Science, Western Norway University of Applied Sciences, Bjørnsonsgate 45, 5528, Haugesund, Norway.
| | - Anne Marie Dahler
- Centre for Applied Welfare Research, UCL University College, Niels Bohrs Allé 1, 5230, Odense M, Denmark
| | - Christine Øye
- Faculty of Health and Social Science, Western Norway University of Applied Sciences, Klingenbergvegen 4, 5414, Stord, Norway
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Lu M, Barlow J, Meinck F, Neelakantan L. Unpacking School-Based Child Sexual Abuse Prevention Programs: A Realist Review. TRAUMA, VIOLENCE & ABUSE 2023; 24:2067-2081. [PMID: 35544032 PMCID: PMC10486164 DOI: 10.1177/15248380221082153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background: Existing efforts to understand school-based child sexual abuse (CSA) prevention programs mainly focus on the effectiveness of these programs in increasing participants' CSA knowledge and self-protective skills. There are currently no reviews addressing the underpinning pathways leading to these outcomes. In order to increase our understanding about the underpinning causal and contextual factors and inform the further development of school-based CSA prevention programs, a realist review was conducted to synthesize existing evidence from a broad range of data. Methods: An iterative search of electronic databases and grey literature was conducted, supplemented with citation tracking to locate relevant literature. For quantitative evidence, we considered evaluation studies that focused on students aged 5-18 years, who were enrolled in primary or secondary schools; for other types/formats of studies/documents, no population restrictions were applied. We included school-based CSA prevention programs that focused on improving knowledge of CSA or self-protective skills. Outcomes of interest included knowledge of CSA or self-protective skills. We did not apply methodological filters in terms of the types of studies to be included. Thematic content analysis was conducted to synthesize data. Results: Sixty-two studies were included. Five themes and five overarching Context-Strategy-Mechanism-Outcome configurations (CSMOs) that contributed to the success of school-based CSA interventions were identified, including tailoring programs to participants' cognitive developmental levels, repeated exposure of key concepts and skills, utilization of interactive delivery methods and positive feedback, delivery of positive information and application of the 'train-the-trainer' model. Implications: Findings from this realist review provide insights into the underlying program theory of school-based CSA prevention programs, which can aid in the development and implementation of these programs in the future.
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Affiliation(s)
- Mengyao Lu
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Jane Barlow
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Franziska Meinck
- School of Social and Political Sciences, University of Edinburgh, Edinburgh, UK
- Optentia, Faculty of Health Sciences, North-West University, Vanderbijlpark, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Tate K, Bailey S, Deschenes S, Grabusic C, Cummings GG. Factors Influencing Older Persons' Transitions to Facility-Based Care Settings: A Scoping Review. THE GERONTOLOGIST 2023; 63:1211-1227. [PMID: 35793531 DOI: 10.1093/geront/gnac091] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Older adults (≥65 years) are living longer with complex health needs and wish to remain at home as their care needs change. We aimed to determine which factors influence older persons' transitions from home living to facility-based care (FBC) settings such as long-term care facilities or assisted living. RESEARCH DESIGN AND METHODS Through a scoping review of 7 databases, we considered all academic literature examining factors influencing transitions from home living to FBC. Only English articles were reviewed. Based on the Meleis' Health Transition (MHT) model, we categorized findings into: (a) transition conditions; (b) patterns of response; and (c) health services and interventions. RESULTS We included 204 unique studies. Age, cognitive/functional impairments, and caregiver burden were the most consistent risk factors for older persons' transitions to FBC. Caregiver burden was the only consistent risk factor in both quantitative and qualitative literature. Other factors around health service use or nonmedical factors were examined in a small number of studies, or demonstrated mixed or nonsignificant results. Key research gaps relate to transitions to intermediate levels of FBC, research in public health systems, and research employing qualitative and interventional methods. DISCUSSION AND IMPLICATIONS We expanded the MHT model to capture informal caregivers and their critical role in transitions from home to FBC settings. More research is needed to address practical needs of clients and caregivers while at home, and self-directed care funding models could be expanded. Theory-driven interventional research focusing on caregivers and successful hospital discharge is critically needed.
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Affiliation(s)
- Kaitlyn Tate
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Stephanie Bailey
- Continuing Care Branch, Alberta Health, Edmonton, Alberta, Canada
| | - Sadie Deschenes
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Carmen Grabusic
- Continuing Care Branch, Alberta Health, Edmonton, Alberta, Canada
| | - Greta G Cummings
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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Molitor V, Busse TS, Giehl C, Lauer R, Otte IC, Vollmar HC, Thürmann P, Holle B, Palm R. How and why educational interventions work to increase knowledge of delirium among healthcare professionals in nursing homes: a protocol for a realist review. BMJ Open 2023; 13:e072591. [PMID: 37495388 PMCID: PMC10373687 DOI: 10.1136/bmjopen-2023-072591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Delirium is a neuropathological condition that impairs cognitive performance, attention and consciousness and can be potentially life-threatening. Nursing home residents are particularly vulnerable to developing delirium, but research thus far tends to focus on the acute hospital setting. Healthcare professionals (HCPs) working in nursing homes seem to be little aware of delirium. To improve healthcare for affected or at-risk individuals, increasing knowledge among HCPs is highly relevant. Using the realist review method helps to understand how and why an educational intervention for HCPs on delirium in nursing homes works. METHODS AND ANALYSIS In accordance with the Realist And Meta-narrative Evidence Syntheses: Evolving Standards publication standards for realist syntheses, the review process will include the following five steps: (1) search strategy and literature review; (2) study selection and assessment; (3) data extraction; (4) data synthesis and (5) development of an initial programme theory. The literature search will be conducted in the databases Medline (PubMed), CINAHL (Ebsco), Scopus, Web of Science, GeroLit and Carelit. Additional focuses are on snowballing techniques, hand research and grey literature. Studies of any design will be included to develop the initial programme theory. The literature will be selected by two researchers independently. In addition, the experiences of HCPs from nursing homes will be reflected in group discussions. To this end, Context-Mechanism-Outcome configurations (CMOcs) will be established to develop an initial programme theory. ETHICS AND DISSEMINATION The results will be disseminated within the scientific community. For this purpose, presentations at scientific conferences as well as publications in peer-reviewed journals are scheduled. In the next step, the CMOcs could serve for the development of a complex educational intervention to increase the knowledge of HCPs on delirium in nursing homes. REGISTRATION DETAILS This protocol has been registered at Open Science Framework (https://doi.org/10.17605/OSF.IO/HTFU4).
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Affiliation(s)
- Vincent Molitor
- Faculty of Health, School of Nursing Science, Witten/ Herdecke University, Witten, Germany
| | - Theresa Sophie Busse
- Institute of General Practice and Family Medicine (AM RUB), Faculty of Medicine, Ruhr University Bochum, Bochum, Germany
| | - Chantal Giehl
- Institute of General Practice and Family Medicine (AM RUB), Faculty of Medicine, Ruhr University Bochum, Bochum, Germany
| | - Romy Lauer
- Institute of General Practice and Family Medicine (AM RUB), Faculty of Medicine, Ruhr University Bochum, Bochum, Germany
| | - Ina Carola Otte
- Institute of General Practice and Family Medicine (AM RUB), Faculty of Medicine, Ruhr University Bochum, Bochum, Germany
| | - Horst Christian Vollmar
- Institute of General Practice and Family Medicine (AM RUB), Faculty of Medicine, Ruhr University Bochum, Bochum, Germany
| | - Petra Thürmann
- Faculty of Health, School of Medicine, Chair of Clinical Pharmacology, Witten/Herdecke University, Witten, Germany
- Philipp Klee-Institute of Clinical Pharmacology, Helios University Hospital Wuppertal, Wuppertal, Germany
| | - Bernhard Holle
- Faculty of Health, School of Nursing Science, Witten/ Herdecke University, Witten, Germany
- Deutsches Zentrum fur Neurodegenerative Erkrankungen Standort Witten, Witten, Germany
| | - Rebecca Palm
- Faculty of Health, School of Nursing Science, Witten/ Herdecke University, Witten, Germany
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Janssen M, Fluit CRMG, Lubbers RR, Cornelissen SA, de Graaf J, Scherpbier ND. Learning collaboration at the primary-secondary care interface: a dual-method study to define design principles for interventions in postgraduate training programmes. BMC MEDICAL EDUCATION 2023; 23:308. [PMID: 37138295 PMCID: PMC10158135 DOI: 10.1186/s12909-023-04254-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 04/12/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Collaboration between primary and secondary care (PSCC) is important to provide patient-centered care. Postgraduate training programmes should provide training to learn PSCC. With a design based research (DBR) approach design principles can be formulated for designing effective interventions in specific contexts. The aim of this study is to determine design principles for interventions aimed to learn PSCC in postgraduate training programmes. METHODS DBR is characterised by multi-method studies. We started with a literature review on learning collaboration between healthcare professionals from different disciplines within the same profession (intraprofessional) to extract preliminary design principles. These were used to inform and feed group discussions among stakeholders: trainees, supervisors and educationalists in primary and secondary care. Discussions were audiotaped, transcribed and analysed using thematic analysis to formulate design principles. RESULTS Eight articles were included in the review. We identified four preliminary principles to consider in the design of interventions: participatory design, work process involvement, personalised education and role models. We conducted three group discussions with in total eighteen participants. We formulated three design principles specific for learning PSCC in postgraduate training programmes: (1) The importance of interaction, being able to engage in a learning dialogue. (2) Facilitate that the learning dialogue concerns collaboration. (3) Create a workplace that facilitates engagement in a learning dialogue. In the last design principle we distinguished five subcategories: intervention emphasises the urge for PSCC and is based on daily practice, the presence of role models, the work context creates time for learning PSCC, learning PSCC is formalised in curricula and the presence of a safe learning environment. CONCLUSION This article describes design principles for interventions in postgraduate training programmes with the aim to learn PSCC. Interaction is key in learning PSCC. This interaction should concern collaborative issues. Furthermore, it is essential to include the workplace in the intervention and make adjacent changes in the workplace when implementing interventions. The knowledge gathered in this study can be used to design interventions for learning PSCC. Evaluation of these interventions is needed to acquire more knowledge and adjust design principles when necessary.
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Affiliation(s)
- Marijn Janssen
- Department of Internal Medicine Nijmegen, Radboud University Medical Center, Geert Grooteplein Zuid 10, PO box 9101, postal route 463, Nijmegen, 6500 HB, The Netherlands.
| | - Cornelia R M G Fluit
- Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Roel R Lubbers
- Department of Internal Medicine Nijmegen, Radboud University Medical Center, Geert Grooteplein Zuid 10, PO box 9101, postal route 463, Nijmegen, 6500 HB, The Netherlands
- Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sylvia A Cornelissen
- Department of Internal Medicine Nijmegen, Radboud University Medical Center, Geert Grooteplein Zuid 10, PO box 9101, postal route 463, Nijmegen, 6500 HB, The Netherlands
- Department Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jacqueline de Graaf
- Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nynke D Scherpbier
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, Groningen, The Netherlands
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Tanzi S, Martucci G. Doing palliative care research on hematologic cancer patients: A realist synthesis of literature and experts’ opinion on what works, for whom and in what circumstances. Front Oncol 2023; 13:991791. [PMID: 37051541 PMCID: PMC10083487 DOI: 10.3389/fonc.2023.991791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 03/13/2023] [Indexed: 03/29/2023] Open
Abstract
BackgroundResearch in PC (Palliative Care) is frequently challenging for patient’s frailty, study design, professional misconceptions, and so on. Little is known about specificity in PC research on Hematologic cancer patients, who have distinct characteristics that might influence the enrollment process.AimsWhat works, how and for whom, in increasing enrollment in studies in PC on patients with hematologic malignancies?MethodsRealist review: a qualitative review whose goal is to identify and explain the interaction between Contexts, Mechanisms, and Outcomes (CMOs). The theory was informed by a narrative, theory-based literature research, including an initialsystematic research, and the addition of papers suggested by experts of the field. We also used 7 interviews with experts in PC about patients with hematologic malignancies research and our own experience from a PC pilot study on patients with hematologic malignancies to refine the initial theory.ResultsIn our initial theory we hypothesize that: - Access to palliative care could be beneficial to hematologic patients, even in early stages - Hematologists tend to under-use palliative care services in general, due to unpredictable disease trajectories and cultural barriers. - These factors may negatively impact the patients’ enrollment in PC researchWe included secondary literature as narrative reviews, if they presented interesting propositions useful for our theoretical construction. 23 papers met our inclusion criteria.We also searched for relevant CMOs impacting referral in palliative care, and we selected a list of CMOs that could be relevant also in hematology. We accordingly theorized a group of interventions that could increase the enrollment in PC research and presented them using “social exchange theory” (SET) as a theoretical framework.Prominent researchers in PC in hematologic malignancies were interviewed on their opinion on our results, and additional CMOs.ConclusionsBefore conducting research in PC on patients with hematologic malignancies, it’s probably advisable to assess: - The perception of the different actors (physicians, nurses, other professionals involved), in particular the hematologists, in terms of pros and cons of referral to PC and enrollment in PC trials - The existing relationship between PC and the Hematology departmentAccordingly, it’s possible to tailor different interventions on the various actors and choose a model of trial to increase the perception of benefits from PC and, consequently, enrollment.
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Affiliation(s)
- Silvia Tanzi
- Palliative Care Unit, Azienda USL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Gianfranco Martucci
- Palliative Care Local Program, Local Health Unit of Modena, Modena, Italy
- *Correspondence: Gianfranco Martucci,
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22
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Mausz J, Donnelly EA. Violence Against Paramedics: Protocol for Evaluating 2 Years of Reports Through a Novel, Point-of-Event Reporting Process. JMIR Res Protoc 2023; 12:e37636. [PMID: 36928257 PMCID: PMC10131719 DOI: 10.2196/37636] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 12/05/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Violence against paramedics has been described as a serious public health problem with the potential for significant physical and psychological harm, but the organizational culture within the profession encourages paramedics to consider violence as just "part of the job." Therefore, most incidents of violence are never formally documented. This limits the ability of researchers and policy makers to develop strategies that mitigate the risk and enhance paramedic safety. OBJECTIVE Following the development and implementation of a novel, point-of-event violence reporting process in February 2021, our objectives are to (1) estimate the prevalence of violence and generate a descriptive profile for incidents of reported violence; (2) identify potentially high-risk service calls based on characteristics of calls that are generally known to the responding paramedics at the point of dispatch; and (3) explore underpinning themes, including intolerance based on gender, race, and sexual orientation, that contribute to incidents of violence. METHODS Our work is situated in a single paramedic service in Ontario, Canada. Using a convergent parallel mixed methods approach, we will retrospectively review 2 years of quantitative and qualitative data gathered from the External Violence Incident Report (EVIR) system from February 1 2021 through February 28, 2023. The EVIR is a point-of-event reporting mechanism embedded in the electronic patient care record (ePCR) developed through an extensive stakeholder engagement process. When completing an ePCR, paramedics are prompted to file an EVIR if they experienced violence on the call. Our methods include using descriptive statistics to estimate the prevalence of violence and describe the characteristics of reported incidents (Objective 1), logistic regression modeling to identify high-risk service calls (Objective 2), and qualitative content analysis of incident report narratives to identify underpinning themes that contribute to violence (Objective 3). RESULTS As of January 1, 2023, 377 paramedics-approximately 1 in 5 active-duty paramedics in the service-have filed a total of 975 violence reports. Early analysis suggests 40% of reports involved a physical assault on the reporting paramedic. Our team is continuing to collect data with more fulsome analyses beginning in March 2023. Our findings will provide much-needed epidemiological data on the prevalence of violence against paramedics in a single paramedic service, its contributing themes, and potential risk factors. CONCLUSIONS Our findings will contribute to a growing body of literature demonstrating that violence against paramedics is a complex problem that requires a nuanced understanding of its scope, risk factors, and contributing circumstances. Collectively, our research will inform larger, multisite prospective studies already in the planning stage and inform organizational strategies to mitigate the risk of harm from violence. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/37636.
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Affiliation(s)
- Justin Mausz
- Peel Regional Paramedic Services, Brampton, ON, Canada
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23
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Cousins S, McKechnie R, Jackman P, Middleton G, Rasekaba T, Blackberry I. Interventions to Increase Physical Activity in Community-Dwelling Older Adults in Regional and Rural Areas: A Realist Synthesis Review Protocol. Methods Protoc 2023; 6:mps6020029. [PMID: 36961049 PMCID: PMC10037574 DOI: 10.3390/mps6020029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 03/14/2023] Open
Abstract
The importance of physical activity (PA) for the health and wellbeing of older adults is well documented, yet many older adults are insufficiently active. This issue is more salient in regional and rural areas, where evidence of the most critical components of interventions that explain PA participation and maintenance in older populations is sparse. This realist review will (1) systematically identify and synthesise literature on PA interventions in community-dwelling older adults in regional and rural areas, and (2) explore how and why those interventions increase PA in that population. Using a realist synthesis framework and the behaviour change wheel (BCW), context-mechanism-outcome (C-M-O) patterns of PA interventions for older adults in regional and rural areas will be synthesised. Thematic analysis will be employed to compare, contrast, and refine emerging C-M-O patterns to understand how contextual factors trigger mechanisms that influence regional and rural community-dwelling older adults' participation in PA interventions. This realist review will be the first to adopt a BCW analysis and a realist synthesis framework to explore PA interventions in community-dwelling older adults in regional and rural areas. This review will provide recommendations for evidence-based interventions to improve PA participation and adherence by revealing the important mechanisms apparent in this context. Systematic review registration: (PROSPERO CRD42023402499).
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Affiliation(s)
- Stephen Cousins
- John Richards Centre for Rural Ageing Research, La Trobe University, Albury-Wodonga Campus, Wodonga, VIC 3689, Australia
| | - Rebecca McKechnie
- John Richards Centre for Rural Ageing Research, La Trobe University, Albury-Wodonga Campus, Wodonga, VIC 3689, Australia
| | - Patricia Jackman
- School of Sport and Exercise Science, University of Lincoln, Lincoln LN6 7TS, UK
| | - Geoff Middleton
- School of Sport and Exercise Science, University of Lincoln, Lincoln LN6 7TS, UK
| | - Tshepo Rasekaba
- John Richards Centre for Rural Ageing Research, La Trobe University, Albury-Wodonga Campus, Wodonga, VIC 3689, Australia
| | - Irene Blackberry
- John Richards Centre for Rural Ageing Research, La Trobe University, Albury-Wodonga Campus, Wodonga, VIC 3689, Australia
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24
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Maddock B, Dārziņš P, Kent F. Realist review of interprofessional education for health care students: What works for whom and why. J Interprof Care 2023; 37:173-186. [PMID: 35403557 DOI: 10.1080/13561820.2022.2039105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Interprofessional education (IPE) programs, are complex, logistically challenging, and can be expensive to deliver, but these matters are offset by the perceived benefits of IPE. There is little clarity regarding how IPE contributes to the desirable development of collaborative practitioners. To guide educators in the design of IPE programs there is a need to understand the elements that promote optimal learning. A realist review was conducted to identify the mechanisms and resources that contribute to IPE outcomes. Four databases were searched until April 2020 for empirical studies describing mandatory IPE for pre-registration medical, nursing and other health professional students. Twelve articles met the inclusion criteria. Two novel learning design elements were identified; interdependence, where there is a need for genuine contribution of skills and knowledge from the professions learning together to successfully complete tasks, and embodiment, where through being immersed in an authentic scenario, learners feel what it is like to work in their professions. Other observations supported previous research findings such as the importance of skilled facilitators to promote interaction and reflection. Interprofessional interventions incorporating these specific learning design features seem likely to enhance the impact of IPE, thus making the best use of limited institutional resources and student time.
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Affiliation(s)
| | - Pēteris Dārziņš
- Faculty of Medicine, Nursing and Health Sciences, Melbourne, Australia
| | - Fiona Kent
- Faculty of Medicine, Nursing and Health Sciences, Melbourne, Australia
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25
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Hudon C, Kessler R. Integrating case management for patients with complex needs in the ground practice: the importance of context in evaluative designs. Health Res Policy Syst 2023; 21:9. [PMID: 36694260 PMCID: PMC9873218 DOI: 10.1186/s12961-023-00960-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 01/09/2023] [Indexed: 01/26/2023] Open
Abstract
Responding to complex needs calls for integrating care across providers, settings and sectors. Among models to improve integrated care, case management demonstrates a good evidence base of facilitating the appropriate delivery of healthcare services. Since case management is a complex, multi component intervention, with its component parts interacting in a non-linear manner, effectiveness is largely influenced by the context in which the intervention is implemented. This paper discusses how to respond to implementation challenges to evaluating complex interventions for patients with complex needs. Building on the example of case management, we suggest that documenting innovation effectiveness remains important, but that evaluation needs to include theory-based and systems perspectives. We also suggest that implementation science needs to be part of intervention design while engaging stakeholders to define the most relevant research questions and implementation effectiveness, to optimize successful implementation and sustainability.
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Affiliation(s)
- Catherine Hudon
- grid.86715.3d0000 0000 9064 6198Department of Family and Emergency Medicine, Université de Sherbrooke, Pavillon Z7-local 3007, 3001, 12eAvenue Nord, Sherbrooke, QC J1H 5N4 Canada
| | - Rodger Kessler
- grid.430503.10000 0001 0703 675XDepartment of Family Medicine, University of Colorado School of Medecine, Aurora, CO United States of America
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26
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Grimes TC, Guinan EM. Interprofessional education focused on medication safety: a systematic review. J Interprof Care 2023; 37:131-149. [PMID: 35050843 DOI: 10.1080/13561820.2021.2015301] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Safe medication use necessitates interprofessional working, with calls to enhance interprofessional education (IPE) focusing on medication safety (MS) in healthcare professional (HCP) curricula. Little is known about the design, delivery or evaluation of such activities. This systematic literature review describes MS-focused IPE activities in pre-qualification HCP programmes. MedLine, EMBASE, CINAHL and ERIC were searched, relevant studies identified and data extracted. The McGill Mixed Methods Appraisal Tool was employed. The 3P (presage-process-product) theory structured deductive analysis. Thirty-one studies were included, reporting on 30 activities, mostly undertaken in North America or United Kingdom. Presage/Design: Most reported activities involved pharmacy, nursing, medical or physician assistant students learning with one or more other HCP group. Few studies matched student groups' skills or experiences. Few studies reported theoretical underpinnings. Process/Delivery: Multiple pedagogical approaches were employed, mostly social construction, and low- and high-fidelity simulation-based learning. Few studies reported learning outcomes or summative assessment, more reported formative assessment. Product/evaluation: Outcomes measured were learners' opinions, satisfaction or attitudes toward interprofessional working and findings were generally positive. Few studies reported on student development or outcomes specific to medication safety. Lack of integration of qualitative/quantitative components of mixed methods studies and limited outcome measurements' validity or reliability weakened study quality. MS-focused IPE for pre-qualification HCPs is well received by students. Design of future activities could be enhanced by employing theory and ensuring matching of students' and groups' skills, professional identity and learner attributes to enhance learning in an interprofessional setting. Future delivery should embed MS-focused IPE into the standard curricula to optimize constructive alignment, learner engagement, quality and drive development. The required skillset in pre-qualification HCP programmes to facilitate future safe medication practice, together with the associated learning outcomes and assessment approaches, should be defined. The quality of scholarly studies examining these activities needs improvement.
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Affiliation(s)
- T C Grimes
- School of Pharmacy and Pharmaceutical Sciences, Panoz Institute, Trinity College Dublin, Dublin 2, Ireland
| | - E M Guinan
- School of Medicine, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Ireland
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27
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Lauzier-Jobin F, Brunson L, Olson B. Introduction to the special issue on critical realism. JOURNAL OF COMMUNITY PSYCHOLOGY 2022. [PMID: 36573800 DOI: 10.1002/jcop.22981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 11/28/2022] [Indexed: 02/17/2024]
Abstract
This special issue explores how philosophy of science matters for both research and social action in community psychology. It explores the complex issue of what might be appropriate philosophical bases for community psychology theory, research, and practice. In particular, it focuses on critical realism, a relatively new approach to the philosophy of science. In this introductory article, we start by discussing the importance of philosophy of science for community psychologists. We then situate our subject by exploring the history of paradigms in community psychology. We next offer a brief description of critical realism by describing its assumptions on ontology (nature of the world), epistemology (theory of knowledge), axiology (theory of values), and methodology (theory of action).
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Affiliation(s)
| | - Liesette Brunson
- Département de psychologie, Université du Québec à Montréal, Montréal, Quebec, Canada
| | - Brad Olson
- Department of Psychology, National Lewis University, Chicago, Illinois, USA
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28
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Newington L, Alexander CM, Kirby P, Saggu RK, Wells M. Reflections on contributing to health research: A qualitative interview study with research participants and patient advisors. PLoS One 2022; 17:e0279354. [PMID: 36534681 PMCID: PMC9762575 DOI: 10.1371/journal.pone.0279354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES The aims of this study were to explore individuals' experiences of contributing to health research and to identify the types of impact that are perceived as important by participants or patient and public advisors. Specifically, research led by NMAHPP clinicians (Nursing, Midwifery, Allied health professions, Healthcare science, Psychology and Pharmacy). METHODS Semi-structured one-to-one interviews were conducted with health research participants and patient or public advisors. Interviewees were recruited from five UK sites and via social media. Interview transcripts were analysed using Thematic Analysis to identify key themes and areas of disagreement. RESULTS Twenty-one interviews were completed, and four main themes were identified. The first, optimising research experiences, included personal reflections and broader recommendations to improve participant experiences. The second, connecting health research with healthcare, described research as key for the continued development of healthcare, but illustrated that communication between research teams, participants, and clinicians could be improved. The third theme explored the personal impacts of contributing to research, with interviewees recalling common positive experiences. The final theme discussed capturing research impacts. Interviewees highlighted potential priorities for different stakeholders, but emphasised that financial impacts should not be the sole factor. CONCLUSION Individuals who were involved in NMAHPP health research recalled positive experiences and reported good relationships with their research teams. They felt that their contributions were valued. Suggested strategies to optimise the research experience focused on simplifying documentation, clear signposting of the research activities involved, and feedback on the research findings. Routine sharing of relevant research data with clinicians was also recommended. Personal impacts included a deeper understanding of their health condition or health more broadly, and increased confidence interacting with healthcare and other professionals. These findings will be used to inform development of a framework to capture the impact of NMAHPP research.
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Affiliation(s)
- Lisa Newington
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
- Therapies, Imperial College Healthcare NHS Trust, London, United Kingdom
- * E-mail:
| | - Caroline M. Alexander
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
- Therapies, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Pippa Kirby
- Therapies, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Rhia K. Saggu
- Therapies, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Mary Wells
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
- Nursing Directorate, Imperial College Healthcare NHS Trust, London, United Kingdom
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29
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Reith-Hall E. The teaching and learning of communication skills for social work students: a realist synthesis protocol. Syst Rev 2022; 11:266. [PMID: 36503510 PMCID: PMC9743560 DOI: 10.1186/s13643-022-02125-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 11/08/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Good interpersonal communication is the cornerstone of social work practice, enhancing the outcomes of people in receipt of its services. Social workers' communication skills are often identified as an area of concern. Communication skills can be developed and refined through training or education. The teaching and learning of communication skills is firmly embedded in many social work qualifying courses; however, considerable heterogeneity exists regarding such complex interventions and the theoretical underpinnings of which have not been made explicit. Realist synthesis can help explain how, why, for whom and in what circumstances an intervention might work, which is an important first step for helping educators to tailor courses to meet the needs of different learner groups and, where applicable, the employing agencies and government departments who fund them. METHODS Realist synthesis is an interpretive, theory-driven and explanatory approach that aims to explain the interplay between the context, mechanisms and outcomes of interventions. This realist synthesis seeks to understand and explain to what extent, how, why, for whom and in what circumstances complex educational interventions aimed at teaching communication skills to social work students produces its effects. A five-step process will be followed iteratively. In step 1, the initial programme theory will be developed. Step 2 will involve searching for evidence. In step 3, selection and appraisal will take place. Step 4 requires data to be extracted and organised, and in step 5, data will be analysed and synthesised. DISCUSSION The teaching and learning of communication skills in social work education is under theorised. The findings from this realist synthesis aim to help policymakers and educators make informed decisions about the design and delivery of complex educational interventions aimed at improving the communication skills of social work students. The realist synthesis will be conducted and reported in accordance with the RAMESES guidelines and standards. SYSTEMATIC REVIEW REGISTRATION The review is registered with the Open Science Framework. https://doi.org/10.17605/OSF.IO/BYHC7.
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Affiliation(s)
- Emma Reith-Hall
- Department of Social Work and Social Care, School of Social Policy, Muirhead Tower, Edgbaston, Birmingham, England.
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30
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Azevedo S, Guede-Fernández F, von Hafe F, Dias P, Lopes I, Cardoso N, Coelho P, Santos J, Fragata J, Vital C, Semedo H, Gualdino A, Londral A. Scaling-up digital follow-up care services: collaborative development and implementation of Remote Patient Monitoring pilot initiatives to increase access to follow-up care. Front Digit Health 2022; 4:1006447. [PMID: 36569802 PMCID: PMC9768029 DOI: 10.3389/fdgth.2022.1006447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022] Open
Abstract
Background COVID-19 increased the demand for Remote Patient Monitoring (RPM) services as a rapid solution for safe patient follow-up in a lockdown context. Time and resource constraints resulted in unplanned scaled-up RPM pilot initiatives posing risks to the access and quality of care. Scalability and rapid implementation of RPM services require social change and active collaboration between stakeholders. Therefore, a participatory action research (PAR) approach is needed to support the collaborative development of the technological component while simultaneously implementing and evaluating the RPM service through critical action-reflection cycles. Objective This study aims to demonstrate how PAR can be used to guide the scalability design of RPM pilot initiatives and the implementation of RPM-based follow-up services. Methods Using a case study strategy, we described the PAR team's (nurses, physicians, developers, and researchers) activities within and across the four phases of the research process (problem definition, planning, action, and reflection). Team meetings were analyzed through content analysis and descriptive statistics. The PAR team selected ex-ante pilot initiatives to reflect upon features feedback and participatory level assessment. Pilot initiatives were investigated using semi-structured interviews transcribed and coded into themes following the principles of grounded theory and pilot meetings minutes and reports through content analysis. The PAR team used the MoSCoW prioritization method to define the set of features and descriptive statistics to reflect on the performance of the PAR approach. Results The approach involved two action-reflection cycles. From the 15 features identified, the team classified 11 as must-haves in the scaled-up version. The participation was similar among researchers (52.9%), developers (47.5%), and physicians (46.7%), who focused on suggesting and planning actions. Nurses with the lowest participation (5.8%) focused on knowledge sharing and generation. The top three meeting outcomes were: improved research and development system (35.0%), socio-technical-economic constraints characterization (25.2%), and understanding of end-user technology utilization (22.0%). Conclusion The scalability and implementation of RPM services must consider contextual factors, such as individuals' and organizations' interests and needs. The PAR approach supports simultaneously designing, developing, testing, and evaluating the RPM technological features, in a real-world context, with the participation of healthcare professionals, developers, and researchers.
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Affiliation(s)
- Salomé Azevedo
- Value for Health CoLAB, Lisbon, Portugal,Comprehensive Health Research Center, Nova Medical School, Nova University of Lisbon, Lisbon, Portugal,CEG-IST, Instituto Superior Técnico, University of Lisbon, Lisbon, Portugal
| | - Federico Guede-Fernández
- Value for Health CoLAB, Lisbon, Portugal,LIBPhys (Laboratory for Instrumentation, Biomedical Engineering and Radiation Physics), NOVA School of Science and Technology, Campus de Caparica, Caparica, Portugal
| | - Francisco von Hafe
- Value for Health CoLAB, Lisbon, Portugal,Comprehensive Health Research Center, Nova Medical School, Nova University of Lisbon, Lisbon, Portugal
| | - Pedro Dias
- Value for Health CoLAB, Lisbon, Portugal,Comprehensive Health Research Center, Nova Medical School, Nova University of Lisbon, Lisbon, Portugal
| | - Inês Lopes
- Fraunhofer Portugal AICOS, Porto, Portugal
| | | | - Pedro Coelho
- Comprehensive Health Research Center, Nova Medical School, Nova University of Lisbon, Lisbon, Portugal,Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Jorge Santos
- Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - José Fragata
- Comprehensive Health Research Center, Nova Medical School, Nova University of Lisbon, Lisbon, Portugal,Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Clara Vital
- Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Helena Semedo
- Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Ana Gualdino
- Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Ana Londral
- Value for Health CoLAB, Lisbon, Portugal,Comprehensive Health Research Center, Nova Medical School, Nova University of Lisbon, Lisbon, Portugal,Correspondence: Ana Londral
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31
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Gillespie H, Reid H, Conn R, Dornan T. Pre-prescribing: Creating a zone of proximal development where medical students can safely fail. MEDICAL TEACHER 2022; 44:1385-1391. [PMID: 35820063 DOI: 10.1080/0142159x.2022.2098100] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Prescribing is a common task, often performed by junior clinicians, with potential for significant harm. Despite this, it is common for medical students to qualify having only prescribed in simulated scenarios or assessments. We implemented an alternative: students were given pens with purple ink, which permitted them to write prescriptions for real patients. We set out to understand how this intervention, pre-prescribing, created a zone of proximal development (ZPD) for learners. METHODS An anonymous, mixed methods, evaluation questionnaire was distributed to all final-year medical students at one university in the United Kingdom. Analysis was guided by Experience Based Learning theory. RESULTS Two hundred and eighteen students made 386 free-text comments. Most participants reported that pre- helped them become capable doctors (Strongly Agree n = 96, 45%; Agree: n = 110, 50%). Pre-prescribing created a ZPD in which participants could use the tools of practice in authentic contexts under conditions that made it safe to fail. CONCLUSIONS This research shows how a theoretically informed intervention can create conditions to enhance learning. It encourages educators to identify aspects of routine practice that could be delegated, or co-performed, by learners. With appropriate support, educators can create 'safe-fails' which allow learners to participate safely in authentic, risky, and indeterminate situations they will be expected to navigate as newly qualified clinicians.
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Affiliation(s)
- Hannah Gillespie
- Centre for Medical Education, Queen's University Belfast, Northern Ireland, United Kingdom
- School of Health Professions Education, Maastricht University, The Netherlands
| | - Helen Reid
- Centre for Medical Education, Queen's University Belfast, Northern Ireland, United Kingdom
| | - Richard Conn
- Centre for Medical Education, Queen's University Belfast, Northern Ireland, United Kingdom
| | - Tim Dornan
- Centre for Medical Education, Queen's University Belfast, Northern Ireland, United Kingdom
- School of Health Professions Education, Maastricht University, The Netherlands
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32
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Li SA, Chen R, Tong XC, Wong AK, Chan TM. Learning while leading: a realist evaluation of an academic leadership programme. BMJ LEADER 2022; 6:263-270. [PMID: 36794608 DOI: 10.1136/leader-2021-000508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 10/27/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Many academic health centres and universities have implemented leadership development programmes; however, their potential impact in different contexts in healthcare remains unknown. We assessed the impact of an academic leadership development programme on the self-reported leadership activities of faculty leaders in their respective work contexts. METHODS Ten faculty leaders who participated in a 10-month leadership development programme between 2017 and 2020 were interviewed. The realist evaluation approach was used to guide deductive content analysis, allowing concepts related to what works for whom, why and when to emerge from the data. RESULTS Faculty leaders benefited in different ways depending on the organisational context (eg, culture) in which they reside and their individual contexts (eg, personal aspirations as a leader). Faculty leaders who have minimal mentorship in their leadership role gained an increased sense of community and belongingness with peer leaders and received validation in their personal leadership approach from the programme. Faculty leaders with accessible mentors were more likely than their peers to apply the knowledge they learnt to their work settings. Prolonged engagement among faculty leaders in the 10-month programme fostered continuity of learning and peer support that extended beyond programme completion. CONCLUSIONS This academic leadership programme included participation of faculty leaders in different contexts, resulted in varying impacts on participants' learning outcomes, leader self-efficacy and application of acquired knowledge. Faculty administrators should look for programmes with a multitude of learning interfaces to extract knowledge, hone leadership skills and build networks.
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Affiliation(s)
- Shelly-Anne Li
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Ruth Chen
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.,Office of Continuing Professional Development, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,Academic Leadership Program, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - X Catherine Tong
- Office of Continuing Professional Development, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.,Department of Family Medicine, Waterloo Regional Campus, McMaster University, Waterloo, ON, Canada
| | - Anne K Wong
- Academic Leadership Program, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.,Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Teresa M Chan
- Office of Continuing Professional Development, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada .,Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.,Division of Education & Innovation, Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
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Bylund CL, Vasquez TS, Peterson EB, Ansell M, Bylund KC, Ditton-Phare P, Hines A, Manna R, Singh Ospina N, Wells R, Rosenbaum ME. Effect of Experiential Communication Skills Education on Graduate Medical Education Trainees' Communication Behaviors: A Systematic Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1854-1866. [PMID: 35857395 PMCID: PMC9712157 DOI: 10.1097/acm.0000000000004883] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE A better understanding of how communication skills education impacts trainees' communication skills is important for continual improvement in graduate medical education (GME). Guided by the Kirkpatrick Model, this review focused on studies that measured communication skills in either simulated or clinical settings. The aim of this systematic review was to examine the effect of experiential communication skills education on GME trainees' communication behaviors. METHOD Five databases were searched for studies published between 2001 and 2021 using terms representing the concepts of medical trainees, communication, training, and skills and/or behaviors. Included studies had an intervention design, focused only on GME trainees as learners, used experiential methods, and had an outcome measure of communication skills behavior that was assessed by a simulated or standardized patient (SP), patient, family member, or outside observer. Studies were examined for differences in outcomes based on study design; simulated versus clinical evaluation setting; outside observer versus SP, patient, or family member evaluator; and length of training. RESULTS Seventy-seven studies were ultimately included. Overall, 54 (70%) studies reported some positive findings (i.e., change in behavior). There were 44 (57%) single-group pre-post studies, 13 (17%) nonrandomized control studies, and 20 (26%) randomized control studies. Positive findings were frequent in single-group designs (80%) and were likely in nonrandomized (62%) and randomized (55%) control trials. Positive findings were likely in studies evaluating communication behavior in simulated (67%) and clinical (78%) settings as well as in studies with outside observer (63%) and SP, patient, and family member (64%) evaluators. CONCLUSIONS This review demonstrates strong support that experiential communication skills education can impact GME trainees' communication behaviors. Marked heterogeneity in communication trainings and evaluation measures, even among subgroups, did not allow for meta-analysis or comparative efficacy evaluation of different studies. Future studies would benefit from homogeneity in curricular and evaluation measures.
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Affiliation(s)
- Carma L Bylund
- C.L. Bylund is professor, Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida
| | - Taylor S Vasquez
- T.S. Vasquez is a doctoral student, Department of Public Relations, College of Journalism and Communications, University of Florida, Gainesville, Florida
| | - Emily B Peterson
- E.B. Peterson is senior research analyst, University of Southern California, Los Angeles, California
| | - Margaret Ansell
- M. Ansell is associate university librarian and associate chair, Health Science Center Libraries, University of Florida, Gainesville, Florida
| | - Kevin C Bylund
- K.C. Bylund is associate professor, Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York
| | - Philippa Ditton-Phare
- P. Ditton-Phare is medical education support officer (psychiatry), Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - April Hines
- A. Hines is journalism and mass communications librarian, George A. Smathers Libraries, University of Florida, Gainesville, Florida
| | - Ruth Manna
- R. Manna is associate director, Patient Experience Partnerships, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Naykky Singh Ospina
- N. Singh Ospina is associate professor, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida
| | - Robert Wells
- R. Wells is science writer, Office of Research, University of Central Florida, Orlando, Florida
| | - Marcy E Rosenbaum
- M.E. Rosenbaum is professor, Department of Family Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
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Greene L, Aryankhesal A, Megson M, Blake J, Wong G, Briscoe S, Hilton A, Killett A, Reeve J, Allan L, Ballard C, Broomfield N, van Horik J, Khondoker M, Lazar A, Litherland R, Livingston G, Maidment I, Medina-Lara A, Rook G, Scott S, Shepstone L, Fox C. Understanding primary care diagnosis and management of sleep disturbance for people with dementia or mild cognitive impairment: a realist review protocol. BMJ Open 2022; 12:e067424. [PMID: 36400725 PMCID: PMC9676996 DOI: 10.1136/bmjopen-2022-067424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION The increasingly ageing population is associated with greater numbers of people living with dementia (PLwD) and mild cognitive impairment (MCI). There are an estimated 55 million PLwD and approximately 6% of people over 60 years of age are living with MCI, with the figure rising to 25% for those aged between 80 and 84 years. Sleep disturbances are common for this population, but there is currently no standardised approach within UK primary care to manage this. Coined as a 'wicked design problem', sleep disturbances in this population are complex, with interventions supporting best management in context. METHODS AND ANALYSIS The aim of this realist review is to deepen our understanding of what is considered 'sleep disturbance' in PLwD or MCI within primary care. Specifically, we endeavour to better understand how sleep disturbance is assessed, diagnosed and managed. To co-produce this protocol and review, we have recruited a stakeholder group comprising individuals with lived experience of dementia or MCI, primary healthcare staff and sleep experts. This review will be conducted in line with Pawson's five stages including the development of our initial programme theory, literature searches and the refinement of theory. The Realist and Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) quality and reporting standards will also be followed. The realist review will be an iterative process and our initial realist programme theory will be tested and refined in response to our data searches and stakeholder discussions. ETHICS AND DISSEMINATION Ethical approval is not required for this review. We will follow the RAMESES standards to ensure we produce a complete and transparent report. Our final programme theory will help us to devise a tailored sleep management tool for primary healthcare professionals, PLwD and their carers. Our dissemination strategy will include lay summaries via email and our research website, peer-reviewed publications and social media posts. PROSPERO REGISTRATION NUMBER CRD42022304679.
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Affiliation(s)
- Leanne Greene
- Clinical Trails Unit, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Aidin Aryankhesal
- Faculty of Medicine and Health Sciences, School of Health Sciences, University of East Anglia, Norwich, UK
| | - Molly Megson
- Academy of Primary Care, Hull York Medical School, University of Hull, Hull, UK
| | - Jessica Blake
- Faculty of Medicine and Health Sciences, School of Health Sciences, University of East Anglia, Norwich, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK
| | - Simon Briscoe
- Clinical Trails Unit, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Andrea Hilton
- Faculty of Health Sciences, School of Paramedical PeriOperative and Advanced Practice, University of Hull, Hull, UK
| | - Anne Killett
- Faculty of Medicine and Health Sciences, School of Health Sciences, University of East Anglia, Norwich, UK
| | - Joanne Reeve
- Academy of Primary Care, Hull York Medical School, University of Hull, Hull, UK
| | - Louise Allan
- Clinical Trails Unit, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Clive Ballard
- Clinical Trails Unit, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Niall Broomfield
- Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Jayden van Horik
- Clinical Trails Unit, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Mizanur Khondoker
- Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Alpar Lazar
- Faculty of Medicine and Health Sciences, School of Health Sciences, University of East Anglia, Norwich, UK
| | | | - Gill Livingston
- Faculty of Brain Sciences, Division of Psychiatry, University College London, London, UK
| | - Ian Maidment
- College of Health and Life Sciences, Aston Pharmacy School, Aston University, Birmingham, UK
| | - Antonieta Medina-Lara
- Clinical Trails Unit, University of Exeter Medical School, University of Exeter, Exeter, UK
| | | | - Sion Scott
- College of Life Sciences, School of Allied Health Professions, University of Leicester, Leicester, UK
| | - Lee Shepstone
- Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Chris Fox
- Clinical Trails Unit, University of Exeter Medical School, University of Exeter, Exeter, UK
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Pelletier J, Bergeron D, Rouleau G, Guillaumie L. Nurses' clinical practices reducing the impact of HIV-related stigmatisation in non-HIV-specialised healthcare settings: a protocol for a realist synthesis. BMJ Open 2022; 12:e062569. [PMID: 36385029 PMCID: PMC9670922 DOI: 10.1136/bmjopen-2022-062569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Despite tremendous progress in care, people living with HIV (PLHIV) continue to experience HIV-related stigmatisation by nurses in non-HIV-specialised healthcare settings. This has consequences for the health of PLHIV and the spread of the virus. In the province of Quebec (Canada), only four interventions aimed at reducing the impact of HIV-related stigmatisation by nurses have been implemented since the beginning of the HIV pandemic. While mentoring and persuasion could be promising strategies, expression of fears of HIV could have deleterious effects on nurses' attitudes towards PLHIV. In literature reviews on stigma reduction interventions, the contextual elements in which these interventions have been implemented is not considered. In order to develop new interventions, we need to understand how the mechanisms (M) by which interventions (I) interact with contexts (C) produce their outcomes (O). METHODS AND ANALYSIS Realist synthesis (RS) was selected to formulate a programme theory that will rely on CIMO configuration to describe (1) nursing practices that may influence stigmatisation experiences by PLHIV in non-HIV-specialised healthcare settings, and (2) interventions that may promote the adoption of such practices by nurses. The RS will draw on the steps recommended by Pawson: clarify the scope of the review; search for evidence; appraise primary studies and extract data; synthesise evidence and draw conclusions. To allow an acute interpretation of the disparities between HIV-related stigmatisation experiences depending on people's serological status, an initial version of the programme theory will be formulated from data gathered from scientific and grey literature, and then consolidated through realist interviews with various stakeholders (PLHIV, nurses, community workers and researchers). ETHICS AND DISSEMINATION Ethical approval for realist interviews will be sought following the initial programme theory design. We intend to share the final programme theory with intervention developers via scientific publications and recommendations to community organisations that counter HIV-related stigmatisation.
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Affiliation(s)
- Jérôme Pelletier
- Department of Health Sciences, Université du Québec à Rimouski, Rimouski, Quebec, Canada
- Faculty of Nursing Sciences, Université Laval, Quebec, Quebec, Canada
| | - Dave Bergeron
- Department of Health Sciences, Université du Québec à Rimouski, Rimouski, Quebec, Canada
| | - Geneviève Rouleau
- Women's College Hospital, Toronto, Ontario, Canada
- Research Chair in Innovative Nursing Practices, Centre de recherche du CHUM, Montréal, Quebec, Canada
| | - Laurence Guillaumie
- Faculty of Nursing Sciences, Université Laval, Quebec, Quebec, Canada
- Centre de recherche du CHU de Québec-Université Laval, Quebec, Quebec, Canada
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Sukhera J, Knaak S. A realist review of interventions to dismantle mental health and substance use related structural stigma in healthcare settings. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Haruta J, Takayashiki A, Ozone S, Maeno T, Maeno T. How do medical students learn about SDH in the community? A qualitative study with a realist approach. MEDICAL TEACHER 2022; 44:1165-1172. [PMID: 35583394 DOI: 10.1080/0142159x.2022.2072282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The need to learn social determinants of health (SDH) is increasing in disparate societies, but educational interventions are complex and learning mechanisms are unclear. Therefore, this study used a realist approach to identify SDH learning patterns, namely context (C), mechanism (M), and outcomes (O) in communities. METHODS A 4-week clinical practice program was conducted for 5th- and 6th-year medical students in Japan. The program included SDH lectures and group activities to explore cases linked to SDH in the community. The medical students' structural reflection reports for learning SDH were thematically analyzed through CMO perspectives. RESULTS First, medical students anticipated the concept of SDH and participated in a community in which a social model was central. They then transformed their perspective through observational learning and explanations from role models. Second, medical students' confrontation of contradictions in the medical model triggered integrated explanations of solid facts. Third, conceptual understanding of SDH was deepened through comparison and verbalization of concrete experiences in multiple regions. Fourth, empathy for lay people was fostered by participating from a non-authoritative position, which differed from that in medical settings. CONCLUSION Medical students can learn about the connections between society and medicine through four types of SDH learning patterns.
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Affiliation(s)
- Junji Haruta
- Medical Education Center, School of Medicine, Keio University, Tokyo, Japan
- Department of Primary Care and Medical Education, Faculty of Medicine, University of Tsukuba, Japan
| | - Ayumi Takayashiki
- Department of Primary Care and Medical Education, Faculty of Medicine, University of Tsukuba, Japan
| | - Sachiko Ozone
- Department of Primary Care and Medical Education, Faculty of Medicine, University of Tsukuba, Japan
- Department of Family Medicine, General Practice and Community Health, Faculty of Medicine, University of Tsukuba, Japan
| | - Takami Maeno
- Department of Primary Care and Medical Education, Faculty of Medicine, University of Tsukuba, Japan
| | - Tetsuhiro Maeno
- Department of Primary Care and Medical Education, Faculty of Medicine, University of Tsukuba, Japan
- Department of Family Medicine, General Practice and Community Health, Faculty of Medicine, University of Tsukuba, Japan
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Wood B, Bohonis H, Ross B, Cameron E. Comparing and using prominent social accountability frameworks in medical education: moving from theory to implementation in Northern Ontario, Canada. CANADIAN MEDICAL EDUCATION JOURNAL 2022; 13:45-68. [PMID: 36310909 PMCID: PMC9588193 DOI: 10.36834/cmej.73051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Social accountability in medical education is conceptualized as a responsibility to respond to the needs of local populations and demonstrate impact of these activities. The objective of this study was to rigorously examine and compare social accountability theories, models, and frameworks to identify a theory-informed structure to understand and evaluate the impacts of medical education in Northern Ontario. METHODS Using a narrative review methodology, prominent social accountability theories, models, and frameworks were identified. The research team extracted important constructs and relationships from the selected frameworks. The Theory Comparison and Selection Tool was used to compare the frameworks for fit and relevance. RESULTS Eleven theories, models, and frameworks were identified for in-depth analysis and comparison. Two realist frameworks that considered community relationships in medical education and social accountability in health services received the highest scores. Frameworks focused on learning health systems, evaluating institutional social accountability, and implementing evidence-based practices also scored highly. CONCLUSION We used a systematic theory selection process to describe and compare social accountability constructs and frameworks to inform the development of a social accountability impact framework for the Northern Ontario School of Medicine. The research team examined important constructs, relationships, and outcomes, to select a framework that fits the aims of a specific project. Additional engagement will help determine how to combine, adapt, and implement framework components to use in a Northern Ontario framework.
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Affiliation(s)
- Brianne Wood
- Medical Education Research Lab in the North (MERLIN), Northern Ontario School of Medicine, Ontario, Canada
| | - Hafsa Bohonis
- Medical Education Research Lab in the North (MERLIN), Northern Ontario School of Medicine, Ontario, Canada
| | - Brian Ross
- Northern Ontario School of Medicine, Ontario, Canada
| | - Erin Cameron
- Medical Education Research Lab in the North (MERLIN), Northern Ontario School of Medicine, Ontario, Canada
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Rachul C, Collins B, Chan MK, Srinivasan G, Hamilton J. Rivalries for attention: insights from a realist evaluation of a postgraduate competency-based medical education implementation in Canada. BMC MEDICAL EDUCATION 2022; 22:583. [PMID: 35906632 PMCID: PMC9336173 DOI: 10.1186/s12909-022-03661-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 07/22/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Implementing competency-based medical education (CBME) in post-graduate medical education (PGME) is a complex process that requires multiple systemic changes in a complex system that is simultaneously engaged in multiple initiatives. These initiatives often compete for attention during the implementation of CBME and produce unintended and unanticipated consequences. Understanding the impact of this context is necessary for evaluating the effectiveness of CBME. The purpose of the study was to identify factors, such as contexts and processes, that contribute to the implementation of CBME. METHODS We conducted a realist evaluation using data collected from 15 programs through focus groups with residents (2 groups, n = 16) and faculty (one group, n = 8), and semi-structured interviews with program directors (n = 18), and program administrators (n = 12) from 2018 to 2021. Data were analyzed using a template analysis based on a coding framework that was developed from a sample of transcripts, the context-mechanism-outcomes framework for realist evaluations, and the core components of CBME. RESULTS The findings demonstrate that simultaneous initiatives in the academic health sciences system creates a key context for CBME implementation - rivalries for attention - and specifically, the introduction of curricular management systems (CMS) concurrent to, but separate from, the implementation of CBME. This context influenced participants' participation, communication, and adaptation during CBME implementation, which led to change fatigue and unmet expectations for the collection and use of assessment data. CONCLUSIONS Rival initiatives, such as the concurrent implementation of a new CMS, can have an impact on how programs implement CBME and greatly affect the outcomes of CBME. Mitigating the effects of rivals for attention with flexibility, clear communication, and training can facilitate effective implementation of CBME.
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Affiliation(s)
- Christen Rachul
- Office of Innovation and Scholarship in Medical Education, Max Rady College of Medicine, University of Manitoba, S204, Medical Services Building, 750 Bannatyne Ave, Winnipeg, MB, R3E 0W2, Canada.
- Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada.
| | - Benjamin Collins
- Department of Anthropology, University of Manitoba, Winnipeg, Canada
| | - Ming-Ka Chan
- Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Ganesh Srinivasan
- Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Joanne Hamilton
- Office of Innovation and Scholarship in Medical Education, Max Rady College of Medicine, University of Manitoba, S204, Medical Services Building, 750 Bannatyne Ave, Winnipeg, MB, R3E 0W2, Canada
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Mosedale A, Hendrie D, Geelhoed E, Zurynski Y, Robinson S. Realist evaluation of the impact of the research translation process on health system sustainability: a study protocol. BMJ Open 2022; 12:e045172. [PMID: 35697458 PMCID: PMC9196166 DOI: 10.1136/bmjopen-2020-045172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Sustainability at a system level relates to the capacity of the system to be able to service the ongoing health needs of the population. It is a multifaceted concept encompassing both the affordability and efficiency of a system and the system's ability to adapt and change.To address issues that currently threaten health system sustainability, healthcare leaders, policy makers, clinicians and researchers are searching for solutions to ensure the delivery of safe, value-based care into the future. The timely translation of research evidence into sustainable interventions that can be adopted into the health system is one way of bolstering the sustainability of the system as a whole. We present a protocol for the realist evaluation of a research translation funding programme to understand how the research translation process contributes to health system sustainability and value-based healthcare. METHODS AND ANALYSIS Underpinned by the realist evaluation framework, we will: (1) Develop the Initial Program Theory (IPT) of the research translation process; (2) Test the program theory through case study analysis; and (3) Refine and consolidate the theory through stakeholder consultation. The evaluation uses a case example of a research translation programme, chosen for its representation of a microcosm of the broader health system and the heterogeneity of service improvement activities taking place within it. Across the three phases, analysis of data from documents about the research translation program and interviews and focus groups with stakeholders and program users will draw on the context (C), mechanism (M), outcome (O) formula that is core to realist evaluation. In addition, system dynamic methods will capture the feedback loops and complex relationships among the IPT and context-mechanism-outcome configurations. This approach to evaluation of a research translation funding programme may be adapted to similar programmes operating in other settings. ETHICS AND DISSEMINATION Curtin University Human Research Ethics Committee, Western Australia, approved this study (approval number: HRE2020-0464). Results will be published in scientific journals, and communicated to respondents and relevant partners.
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Affiliation(s)
- Abby Mosedale
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Delia Hendrie
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Elizabeth Geelhoed
- School of Allied Health, University of Western Australia, Perth, Western Australia, Australia
| | - Yvonne Zurynski
- Australian Institute of Health Innnovation, Macquarie University, Sydney, New South Wales, Australia
| | - Suzanne Robinson
- School of Population Health, Curtin University, Perth, Western Australia, Australia
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Hosseini S, Yilmaz Y, Shah K, Gottlieb M, Stehman CR, Hall AK, Chan TM. Program evaluation: An educator's portal into academic scholarship. AEM EDUCATION AND TRAINING 2022; 6:S43-S51. [PMID: 35783081 PMCID: PMC9222891 DOI: 10.1002/aet2.10745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 06/15/2023]
Abstract
Program evaluation is an "essential responsibility" but is often not seen as a scholarly pursuit. While Boyer expanded what qualifies as educational scholarship, many still need to engage in processes that are rigorous and of a requisite academic standard to be labelled as scholarly. Many medical educators may feel that scholarly program evaluation is a daunting task due to the competing interests of curricular change, remediation, and clinical care. This paper explores how educators can take their questions around outcomes and efficacy of our programs and efficiently engage in education scholarship. The authors outline how educators can examine whether training programs have a desired impact and outcomes, and then how they might leverage this process into education scholarship.
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Affiliation(s)
- Shera Hosseini
- Faculty of Health SciencesMcMaster Institute for Research on AgingMcMaster Education Research, Innovation, and TheoryMcMaster UniversityHamiltonOntarioCanada
| | - Yusuf Yilmaz
- McMaster Education Research, Innovation and Theory (MERIT) Program & Office of Continuing Professional DevelopmentFaculty of Health SciencesMcMaster UniversityHamiltonOntarioCanada
- Department of Medical EducationFaculty of MedicineEge UniversityIzmirTurkey
| | - Kaushal Shah
- Department of Emergency MedicineWeill Cornell Medical SchoolNew YorkNew YorkUSA
| | - Michael Gottlieb
- Department of Emergency MedicineRush University Medical CenterChicagoIllinoisUSA
| | - Christine R. Stehman
- Department of Emergency MedicineUniversity of Illinois College of Medicine ‐ Peoria/OSF HealthcarePeoriaIllinoisUSA
| | - Andrew K. Hall
- Department of Emergency MedicineUniversity of OttawaOttawaOntarioCanada
- Royal College of Physicians and Surgeons of CanadaOttawaOntarioCanada
| | - Teresa M. Chan
- Faculty of Health SciencesMcMaster UniversityHamiltonOntarioCanada
- Division of Emergency MedicineDepartment of MedicineMcMaster UniversityHamiltonOntarioCanada
- McMaster Program for Education Research, Innovation, and Theory (MERIT)McMaster UniversityHamiltonOntarioCanada
- Department of Health Research Methodology, Impact, and EvidenceMcMaster UniversityHamiltonOntarioCanada
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Martin RA, Nunnerley JL, Young T, Hall A, Snell DL, Hackney JJ, Bourke JA, Derrett S, Dunn JA. Vocational wayfinding following spinal cord injury: In what contexts, how and why does early intervention vocational rehabilitation work? JOURNAL OF VOCATIONAL REHABILITATION 2022. [DOI: 10.3233/jvr-221189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Early intervention vocational rehabilitation (EIVR) is used to optimize return to work (RTW) outcomes for people following spinal cord injury (SCI). However, theoretical clarity is required about how EIVR works, for whom and under what circumstances. OBJECTIVE: To develop a theoretical understanding of how people respond to EIVR following SCI and the contexts in which mechanisms of intervention effect are likely to be activated. METHODS: Realist research methods were used to analyze interviews with 30 participants who had received EIVR following SCI. RESULTS: We conceptualized the reporting of our analyses using a travel metaphor, encapsulating the types and degree of wayfinding support participants required to think about, plan and action their vocational aspirations. Developing, maintaining and enacting hope, supporting self-identity and vocational identity, and focusing on environmental context adaptations required to enact vocational aspirations, appear to be critical mechanisms of intervention effect within EIVR. CONCLUSIONS: Various contexts and mechanisms of EIVR contribute to successful negotiation, achievement and sustainability of RTW outcomes for people following SCI. These theoretical understandings can refine EIVR service provision within SCI rehabilitation and inform how EIVR can improve RTW outcomes for people with acquired neurological conditions in other rehabilitation contexts.
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Affiliation(s)
- Rachelle A. Martin
- Burwood Academy Trust, Christchurch, New Zealand
- Department of Medicine, University of Otago Wellington, Wellington South, New Zealand
| | - Joanne L. Nunnerley
- Burwood Academy Trust, Christchurch, New Zealand
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | | | - Andrew Hall
- New Zealand Spinal Trust, Christchurch, New Zealand
| | - Deborah L. Snell
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | | | - John A. Bourke
- Burwood Academy Trust, Christchurch, New Zealand
- Menzies Health Institute, Griffith University, QL, Australia
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Sarah Derrett
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Jennifer A. Dunn
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
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Bansal A, Greenley S, Mitchell C, Park S, Shearn K, Reeve J. Optimising planned medical education strategies to develop learners' person-centredness: A realist review. MEDICAL EDUCATION 2022; 56:489-503. [PMID: 34842290 PMCID: PMC9306905 DOI: 10.1111/medu.14707] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/17/2021] [Accepted: 11/22/2021] [Indexed: 05/31/2023]
Abstract
CONTEXT Person-centeredness is a stated aim for medical education; however, studies suggest this is not being achieved. There is a gap in our understanding of how, why and in what circumstances medical education interventions that aim to develop person-centredness are successful. METHODS A realist review was conducted with a search of Medline, Embase, HMIC and ERIC databases and the grey literature using the terms 'medical education' and 'person-centred' and related synonyms. Studies that involved a planned educational intervention in medical education with data on outcomes related to person-centredness were included. The analysis focused on how and why different educational strategies interact with biomedical learner perspectives to trigger mechanisms that may or may not lead to a change in perspective towards person-centredness. RESULTS Sixty-one papers representing fifty-three interventions were included in the final synthesis. Nine context-intervention-mechanism-outcome configuration (CIMOc) statements generated from the data synthesis make up our refined programme theory. Where educational interventions focused on communication skills learning or experiences without person-centred theory, learners experienced dissonance with their biomedical perspective which they resolved by minimising the importance of the learning, resulting in perspective endurance. Where educational interventions applied person-centred theory to meaningful experiences and included support for sense making, learners understood the relevance of person-centeredness and felt able to process their responses to learning, resulting in perspective transformation towards person-centredness. CONCLUSION Our findings offer explanations as to why communication skills-based interventions may be insufficient to develop learners' person-centredness. Integrating experiential person-centred learning with theory on why person-centredness matters to clinical practice and enabling learners to make sense of their responses to learning, may support perspective transformation towards person-centredness. Our findings offer programme and policymakers testable theory to inform the development of medical education strategies that aim to support person-centredness.
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Affiliation(s)
- Aarti Bansal
- Academy of Primary Care, Hull York Medical SchoolUniversity of HullHullUK
| | - Sarah Greenley
- Institute of Clinical and Applied Health ResearchUniversity of HullHullUK
| | - Caroline Mitchell
- Academic Unit of Medical EducationSam Fox House, Northern General HospitalSheffieldUK
| | - Sophie Park
- Research Department of Primary Care and Population HealthUniversity College LondonLondonUK
| | - Katie Shearn
- Health and Wellbeing Research Institute – Postgraduate Research CentreSheffield Hallam UniversitySheffieldUK
| | - Joanne Reeve
- Academy of Primary Care, Hull York Medical SchoolUniversity of HullHullUK
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Kinley E, Skene I, Steed E, Pinnock H, McClatchey K. Delivery of supported self-management in remote asthma reviews: A systematic rapid realist review. Health Expect 2022; 25:1200-1214. [PMID: 35411670 PMCID: PMC9327809 DOI: 10.1111/hex.13441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 01/07/2022] [Accepted: 01/09/2022] [Indexed: 11/29/2022] Open
Abstract
Background The COVID‐19 pandemic forced health care systems globally to adapt quickly to remote modes of health care delivery, including for routine asthma reviews. A core component of asthma care is supporting self‐management, a guideline‐recommended intervention that reduces the risk of acute attacks, and improves asthma control and quality of life. Objective We aimed to explore context and mechanisms for the outcomes of clinical effectiveness, acceptability and safety of supported self‐management delivery within remote asthma consultations. Design The review followed standard methodology for rapid realist reviews. An External Reference Group (ERG) provided expert advice and guidance throughout the study. We systematically searched four electronic databases and, with ERG advice, selected 18 papers that explored self‐management delivery during routine asthma reviews. Setting, Participants and Intervention Health care professional delivery of supported self‐management for asthma patients during remote (specifically including telephone and video) consultations. Main Outcome Measures Data were extracted using Context‐Mechanism‐Outcome (C‐M‐O) configurations and synthesised into overarching themes using the PRISMS taxonomy of supported self‐management as a framework to structure the findings. Results The review findings identified how support for self‐management delivered remotely was acceptable (often more acceptable than in‐person consultations), and was a safe and effective alternative to face‐to‐face reviews. In addition, remote delivery of supported self‐management was associated with; increased patient convenience, improved access to and attendance at remote reviews, and offered continuity of care. Discussion Remote delivery of supported self‐management for asthma was generally found to be clinically effective, acceptable, and safe with the added advantage of increasing accessibility. Remote reviews could provide the core content of an asthma review, including remote completion of asthma action plans. Conclusion Our findings support the option of remote delivery of routine asthma care for those who have this preference, and offer healthcare professionals guidance on embedding supported self‐management into remote asthma reviews. Patient and Public Contribution Patient and public contribution was provided by a representative of the Asthma UK Centre for Applied Research (AUKCAR) patient and public involvement (PPI) group. The PPI representative reviewed the findings, and feedback and comments were considered. This lead to further interpretations of the data which were included in the final manuscript.
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Affiliation(s)
- Emma Kinley
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, Scotland
| | - Imogen Skene
- Asthma UK Centre for Applied Research, Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University London, London, England
| | - Elizabeth Steed
- Asthma UK Centre for Applied Research, Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University London, London, England
| | - Hilary Pinnock
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, Scotland
| | - Kirstie McClatchey
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, Scotland
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Harrison M, Alberti H. How does the introduction of a new year three GP curriculum affect future commitment to teach? An evaluation using a realist approach. EDUCATION FOR PRIMARY CARE 2022; 33:92-101. [PMID: 35343398 DOI: 10.1080/14739879.2021.1974952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In western countries, there is a trend towards increasing amounts of undergraduate medical education being delivered in General Practice (GP). However, many medical schools report difficulties with the recruitment and retainment of GP clinical teachers. Newcastle University recently introduced a new year three GP curriculum, involving an increased quantity of community-based teaching and changes to the responsibilities of GP clinical teachers. We sought to explore and explain how this curricular change affects the future teaching commitment of year three GP clinical teachers. We adopted a realist approach. We firstly developed a candidate theory of how the new curriculum may affect future teaching commitment. Data collection and analysis then involved interviews of 10 GP teachers to refine this theory and produce a final Programme Theory. The results suggest that different teachers are affected in different ways, influenced by practice and individual contexts. Some parts of the new curriculum tend to reduce future teaching commitment, whereas other aspects tend to increase commitment. Mechanisms include changes to autonomy and sense of value. The results allow medical schools to better understand how GP teacher retention can be facilitated during curricular change. We make numerous recommendations, including advocating a team-based approach to teaching, paying attention to teacher autonomy, and considering patient contact in relation to generalist, primary care-orientated medicine as a core component of GP teaching.
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Affiliation(s)
- Michael Harrison
- School of Medical Education, Faculty of Medical Sciences, Newcastle University Newcastle upon Tyne UK
| | - Hugh Alberti
- School of Medical Education, Faculty of Medical Sciences, Newcastle University Newcastle upon Tyne UK
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Hammond SP, Duddy C, Mickleburgh E, Hiller R, Neil E, Williams K, Rodgers L, Wilson J, Wong G. Improving the mental health and mental health support available to adolescents with social care-experience via low-intensity life story work: a realist review protocol. BMJ Open 2022; 12:e058424. [PMID: 35264370 PMCID: PMC8915363 DOI: 10.1136/bmjopen-2021-058424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Adolescents are the fastest growing group entering social care and are most at risk of mental ill-health. Life Story Work (LSW) is an existing transdiagnostic intervention thought to improve the well-being and mental health of children and adolescents under the care of a local authority by assisting the processing of trauma. Yet LSW is poorly evidenced, lacks standardisation and focuses on younger children. LSW is also high-intensity, relying on specialist input over several months. Adolescent-focused low-intensity-LSW is a promising alternative. However, there is poor evidence on how LSW, let alone low-intensity-LSW should be delivered to adolescents. We aim to identify why, how, in what contexts, for whom and to what extent low-intensity-LSW interventions can be delivered to adolescents with care-experience. METHODS AND ANALYSIS Undertaking a realist review, we will: (1) develop an initial programme theory (PrT) of adolescent-focused low-intensity-LSW by consulting with two key expert panels (care-experienced and professional stakeholders), and by searching the literature to identify existing relevant theories; (2) undertake a comprehensive literature search to identify secondary data to develop and refine our emerging PrT. Searches will be run between 12/2021-06/2022 in databases including MEDLINE, PsycINFO, ASSIA and relevant sources of grey literature; (3) select, extract and organise data; (4) synthesise evidence using a realist logic of analysis and undertake further iterative data searching and consultation with our expert panels; (5) write up and share the refined PrT with our expert panels for their final comments. From this process guidance will be developed to help improve the delivery of LSW to support the mental health needs of adolescents with care-experience. ETHICS AND DISSEMINATION Ethical approval is not required. Dissemination will include input from expert panels. We will develop academic, practice and youth focused outputs targeting adolescents, their carers, social, healthcare, and educational professionals, academics, and policymakers. PROSPERO REGISTRATION NUMBER CRD42021279816.
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Affiliation(s)
- Simon P Hammond
- School of Education and Lifelong Learning, University of East Anglia, Norwich, UK
- Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Claire Duddy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Rachel Hiller
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Elsbeth Neil
- School of Social Work, University of East Anglia, Norwich, UK
| | | | | | - Jon Wilson
- Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Rees CE, Nguyen VNB, Ottrey E, Davis C, Pope K, Lee S, Waller S, Palermo C. The effectiveness of extended-duration supervision training for nurses and allied health professionals: A realist evaluation. NURSE EDUCATION TODAY 2022; 110:105225. [PMID: 35344840 DOI: 10.1016/j.nedt.2021.105225] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 10/06/2021] [Accepted: 11/12/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Training helps maintain high-quality supervision and its associated benefits (e.g. reduced burnout, improved care). While studies have previously evaluated extended-duration supervision training programmes, none have treated these as complex interventions so have not employed realist approaches. OBJECTIVES Building on a previous realist synthesis, this evaluation tests and develops programme theory for extended-duration supervision training to answer the question: to what extent does the supervision training programme work, for whom, under what circumstances and why? DESIGN We conducted a realist evaluation of a novel state-wide Victorian 3-month supervision training programme including one or two 3.5-h workshops followed by weekly reflexive longitudinal audio diaries (LADs) for up to 12 weeks. METHODS Realist evaluation data comprised 25 entrance interviews with nurses and allied health professionals, 176 LADs (and 29 written diaries), and 23 exit interviews. We employed team-based realist analysis to identify context-mechanism-outcome configurations (CMOCs) to test and develop programme theory. RESULTS We refined four recurring CMOCs from the realist synthesis programme theory, found insufficient evidence for two, and established five new recurring CMOCs. We identified multiple positive outcomes from our extended-duration supervision training programme (e.g. improved supervisor practices) through various mechanisms relating to pedagogy (e.g. weekly reflexivity), supervisors (e.g. engagement), and workplaces (e.g. enabling supervision cultures). Some negative outcomes were reported (e.g. decreased engagement) through various mechanisms (e.g. suboptimal training design). Such mechanisms were thought to come about by diverse contexts including supervisors (e.g. inexperienced/experienced), professions (nursing/allied health), and organisations (supervision-enabled/non-enabled cultures). CONCLUSIONS Our findings extend the realist synthesis programme theory by highlighting various contexts triggering outcome-generating mechanisms. Programme outcomes are maximised through ongoing supervisor reflexivity paying attention to facilitator-supervisor relationships, as well as protected time for supervisors to translate learning into practice.
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Affiliation(s)
- Charlotte E Rees
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia; Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, VIC, Australia.
| | - Van N B Nguyen
- Monash Nursing & Midwifery, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, VIC, Australia
| | - Ella Ottrey
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, VIC, Australia
| | - Corinne Davis
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, VIC, Australia; Department of Nutrition, Dietetics and Food, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Kirsty Pope
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, VIC, Australia; Department of Occupational Therapy, Faculty of Medicine, Nursing & Health Sciences, Monash University, Frankston, VIC, Australia
| | - Sarah Lee
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, VIC, Australia
| | - Susan Waller
- School of Rural Health, Faculty of Medicine, Nursing & Health Sciences, Monash University, Bendigo, VIC, Australia; Department of Medical Education, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Claire Palermo
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, VIC, Australia; Department of Nutrition, Dietetics and Food, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
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Enhancing human aspects of care with young people with muscular dystrophy: An evaluation of a participatory qualitative study with clinicians. PLoS One 2022; 17:e0263956. [PMID: 35213591 PMCID: PMC8880938 DOI: 10.1371/journal.pone.0263956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/31/2022] [Indexed: 11/19/2022] Open
Abstract
Purpose
This paper evaluates a study which aimed to enhance clinical care of young people with Duchenne or Becker muscular dystrophy (MD) and their families in two Canadian neuromuscular clinics. We report on how/why the study changed clinical practices in relation to the ‘human’ (e.g., emotional, social, existential, cultural) dimensions of living with MD.
Materials and methods
The intervention involved regular dialogical exchanges with clinicians across the two sites, during which direct observations of the clinics’ care practices were discussed and changes were planned. We drew from realist evaluation approaches to assess changes in clinical care associated with the intervention. Data sources included dialogical exchanges; clinic observations; interviews with clients, families and clinicians; and team analysis sessions.
Results
Our evaluation suggests the clinical teams shifted their thinking and practices towards greater consideration of human aspects of living with MD including: more routinely attending to emotional, social and experiential dimensions of living with MD; reconceptualisation of risk; and considerations of affective aspects of clinical care. Not all clinicians changed their thinking and practices in the same ways, or to the same extent, and there were differences between the sites. These differences were likely due to numerous factors, including varying levels of clinician comfort with examining and shifting their own practices, and differing formal and informal clinic routines at each site.
Conclusions
Overall, this intervention was able to shift clinic practices, and could feasibly be adapted across rehabilitation settings.
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Fullerton PD, Sarkar M, Haque S, McKenzie W. Culture and understanding the role of feedback for health professions students: realist synthesis protocol. BMJ Open 2022; 12:e049462. [PMID: 35190412 PMCID: PMC8860032 DOI: 10.1136/bmjopen-2021-049462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Clinical education has moved to a 'competency-based' model with an emphasis on workplace-based learning and assessment which, in turn, depends on feedback to be effective. Further, the understanding of feedback has changed from information about a performance directed to the learner performing the task, to a dialogue, which enables the learner to act and develop.In health professional education, feedback is a complex interaction between trainee, supervisor and the healthcare system. Most published research on feedback in health professional education originates in Europe and North America. Our interest is on the impact of Culture on this process, particularly in the context of Asian cultures.The (scientific) realist approach of Pawson and Tilley provides a means to examine complex interventions in social situations, and thus is an appropriate lens to use for this study. This is a protocol for a realist synthesis which asks how, why and in what circumstances do Asian Cultures influence health professional trainees to seek, respond to and use feedback given in the clinical environment, if at all. METHODS AND ANALYSIS An initial search was performed to help define the scope of the review question and develop our initial programme theory. The formal electronic search was carried out in February 2020 and included: CINAHL, ERIC, Medline and PsycInfo, and repeated in October 2020. Retrieved articles were imported into Covidence for screening and data extraction, after which components of the Context-Mechanisms-Outcomes configurations will be sought to refine the initial programme theory. ETHICS AND DISSEMINATION As this study is a literature review, ethics approval is not required.The findings will be documented in line with the RAMESES (Realist And MEta-narrative Evidence Syntheses: Evolving Standards) publications standards for Realist syntheses, and we plan to disseminate the findings by means of a peer-reviewed journal article and conference presentation(s).
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Affiliation(s)
- Paul Douglas Fullerton
- Clinical School Johor Bahru, Monash University Malaysia, Johor Bahru, Johor, Malaysia
- Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Mahbub Sarkar
- Monash Centre for Scholarship in Health Education, Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Shamsul Haque
- Department of Psychology, Jeffrey Cheah School of Medicine and Health Science, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Wendy McKenzie
- Office of Deputy Dean, Education, Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
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Durling P, Henni J, Mrozowich D, Rankin J, Barlow A, Grimminck R. A Mixed-Methods Realist Analysis of an Interdisciplinary Simulation Intervention for Psychiatry Residents. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2022; 46:95-105. [PMID: 34613598 PMCID: PMC8493779 DOI: 10.1007/s40596-021-01524-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 08/10/2021] [Indexed: 05/30/2023]
Abstract
OBJECTIVES Simulation research in postgraduate psychiatry remains limited, with minimal studies on interdisciplinary involvement and mechanisms of change. To address these gaps, the authors implemented a mixed-methods realist analysis of an interdisciplinary simulation intervention administered to psychiatry residents. METHODS The University of Calgary implemented a simulation intervention for psychiatry residents. Eight junior residents participated in or observed 4 scenarios and eighteen senior residents participated in or observed 8 scenarios. Scenarios lasted 15 minutes with a pre-simulation orientation and post-scenario debrief. Most scenarios involved interdisciplinary staff. Scenarios included agitated and suicidal patients; treatment-related emergencies; and challenging conversations. All residents completed pre- and post-simulation surveys reporting confidence levels. Changes in confidence were analyzed using paired t tests and differences between junior and senior residents' confidence using ANOVA. Eleven residents participated in 2 focus groups. Transcripts were analyzed using a constant comparative model to identify contexts, mechanisms, outcomes, and the relationship between these realist categories. Key themes were extracted using generic theme analysis. RESULTS Aggregated survey data demonstrated statistically significant improvements in self-reported confidence for 7 of 8 proposed scenarios, with variations in confidence outcomes between junior and senior residents. Four themes emerged: (1) How Simulations Facilitate Learning, (2) The Role of Pre-simulation Instructions, (3) Factors Facilitating Confidence, (4) Positive Effects of Interdisciplinary Involvement. CONCLUSIONS This study identifies possible mechanisms for residents' self-reported improvements in learning and confidence, which may help programs tailor interventions. Furthermore, this study suggests there may be benefits to interdisciplinary simulations, with self-reported outcomes of improved collaboration and safety planning.
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