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Davila JA, Harada ND, Rugen KW, Gilman SC, Sansgiry S. Interprofessional Curriculum Delivery: Experience of a Primary Care Education Program. Healthcare (Basel) 2024; 12:950. [PMID: 38727507 PMCID: PMC11083181 DOI: 10.3390/healthcare12090950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/17/2024] [Accepted: 04/29/2024] [Indexed: 05/13/2024] Open
Abstract
Few post-graduate training programs offer a comprehensive curriculum that includes structured clinical experiences to teach interprofessional care. To address this need, the United States Department of Veterans Affairs, Office of Academic Affiliations funded the Centers of Excellence in Primary Care Education (CoEPCE) from 2011-2019 to provide interprofessional curricula for health profession trainees (HPTs), including physician residents, nurse practitioner residents, pharmacy residents, and psychology residents. We examined changes over time in curricular domains, system impacts, and program practices based on HPT survey data and the qualitative evaluation of narrative feedback. An annual survey was administered to participants. Indirect standardized ratios were calculated for interprofessional professional education (IPE) program domains, system impacts, and program practices. Qualitative responses were coded based on curricular domains and key program components. The study cohort included 369 HPTs. Site and profession standardized indirect ratios across all professions indicated improvements in curricular domains, system impacts, and program practices, with significant differences observed for associated health HPTs as compared to other HPTs for performance improvement. Qualitative data indicated that profession was associated with differences in perceptions of the curriculum. Although improvements occurred over time, our findings support the need for the thoughtful consideration of profession-specific identity characteristics when designing interprofessional curricula.
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Affiliation(s)
- Jessica A. Davila
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd. (MS152), Houston, TX 77030, USA;
- Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Nancy D. Harada
- Office of Academic Affiliations, Department of Veterans Affairs, 810 Vermont Ave NW, Washington, DC 20420, USA; (N.D.H.); (S.C.G.)
| | - Kathryn Wirtz Rugen
- Office of Nursing Services, Department of Veterans Affairs, 810 Vermont Ave NW, Washington, DC 20420, USA;
- College of Nursing, University of Illinois at Chicago, 845 S Damen Ave MC 802, Chicago, IL 60612, USA
| | - Stuart C. Gilman
- Office of Academic Affiliations, Department of Veterans Affairs, 810 Vermont Ave NW, Washington, DC 20420, USA; (N.D.H.); (S.C.G.)
| | - Shubhada Sansgiry
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd. (MS152), Houston, TX 77030, USA;
- Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
- Veterans Affairs South Central Mental Illness Research Education and Clinical Center, 2002 Holcombe Blvd. (MS152), Houston, TX 77030, USA
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Stoltenberg M, Leiva-Vásquez O, Pérez-Cruz PE, Daubman BR. The development of an advanced diploma program for palliative care leaders in Chile. Palliat Care Soc Pract 2023; 17:26323524231209057. [PMID: 38144972 PMCID: PMC10748680 DOI: 10.1177/26323524231209057] [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: 06/09/2023] [Accepted: 10/04/2023] [Indexed: 12/26/2023] Open
Abstract
Context The majority of people with serious health-related suffering in low- and middle-income countries lack access to palliative care (PC). Increased access to PC education is greatly needed. Objectives This paper describes the process to adapt an advanced PC training course for a Chilean context. Methods A joint team of intercultural PC educators from the US and Chile conducted a series of key informant interviews and a target audience survey to iteratively design a PC training course in Chile. Results Eight key informant interviews identified a strong need for formal PC education pathways, confirmed the five central learning domains, and helped to identify potential course sub-topics. A target audience survey of 59 PC providers from across Chile confirmed a strong desire to participate in such a course. Conclusion Our team of intercultural PC educators adapted an advanced PC course to the unique context of Chilean providers.
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Affiliation(s)
- Mark Stoltenberg
- Division of Palliative Care and Geriatrics, Massachusetts General Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
| | - Ofelia Leiva-Vásquez
- Sección Medicina Paliativa - Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pedro E. Pérez-Cruz
- Sección Medicina Paliativa - Escuela de Medicina, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, Of 523, Santiago 8330077, Chile
| | - Bethany-Rose Daubman
- Division of Palliative Care and Geriatrics, Massachusetts General Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
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Grün FC, Heibges M, Westfal V, Feufel MA. "You Never Get a Second Chance": First Impressions of Physicians Depend on Their Body Posture and Gender. Front Psychol 2022; 13:836157. [PMID: 35386902 PMCID: PMC8978719 DOI: 10.3389/fpsyg.2022.836157] [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: 12/15/2021] [Accepted: 02/11/2022] [Indexed: 11/13/2022] Open
Abstract
A first impression matters, in particular when encounters are brief as in most doctor-patient interactions. In this study, we investigate how physicians’ body postures impact patients’ first impressions of them and extend previous research by exploring posture effects on the perception of all roles of a physician – not just single aspects such as scholarly expertise or empathy. In an online survey, 167 participants ranked photographs of 4 physicians (2 female, 2 male) in 4 postures (2 open, 2 closed). The results show that male physicians were rated more positively when assuming open rather than closed postures with respect to all professional physician roles. Female physicians in open postures were rated similarly positive for items related to medical competence, but they tended to be rated less favorably with respect to social skills (such as the ability to communicate with and relate to the patient). These findings extend what is known about the effects of physicians’ body postures on the first impressions patients form to judge physicians’ medical versus social competencies. We discuss practical implications and the need for more research on interaction effects of body postures and physician gender on first impressions.
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Affiliation(s)
- Felix C Grün
- Department of Psychology and Ergonomics (IPA), Division of Ergonomics, Technische Universität Berlin, Berlin, Germany
| | - Maren Heibges
- Department of Psychology and Ergonomics (IPA), Division of Ergonomics, Technische Universität Berlin, Berlin, Germany
| | - Viola Westfal
- Department of Psychology and Ergonomics (IPA), Division of Ergonomics, Technische Universität Berlin, Berlin, Germany
| | - Markus A Feufel
- Department of Psychology and Ergonomics (IPA), Division of Ergonomics, Technische Universität Berlin, Berlin, Germany
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Daubman BR, Stoltenberg M, Spence D, Krakauer EL, Farrell S, Traeger L, Thomas R, Bromfield B, Sharpe N, Toppin PJ, Paul T, Schachter AB, Shields AE. Implementing Palliative Care Training in the Caribbean: Development and Assessment of a Basic Palliative Care Training Course in Jamaica. J Pain Symptom Manage 2021; 62:1145-1153. [PMID: 34146660 DOI: 10.1016/j.jpainsymman.2021.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/14/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
CONTEXT The majority of people in need of palliative care (PC) in low- and middle-income countries lack access to it and suffer unnecessarily as a consequence. This unmet need is due, in part, to the lack of trained PC providers. OBJECTIVES This study aims to assess the effects of regional training in PC for doctors, nurses, and pharmacists in the Caribbean through assessment of participant satisfaction, anticipated course impact on participants' clinical practice, barriers to changing practice, and perceived course impact on achievement of key PC milestones. METHODS We created and taught a course in basic PC for clinicians from the Caribbean region and collected and analyzed postcourse quantitative and qualitative data on satisfaction and expected impact. RESULTS Eighty-three clinicians from five Caribbean countries participated in this workshop. Thirty participants completed the post-course survey. One hundred percent of these participants ranked the quality of the course as "very high quality" or "high quality." The majority of participants anticipated changing their practice as a result of this course. Several barriers were reported, including lack of formal PC training in participants' home countries. Results of participants' retrospective pre- and postcourse self-assessment for achievement of key PC milestones showed a statistically significant mean increase of at least one point on the seven-point Likert scale for each milestone. CONCLUSION Overall satisfaction with the course was high, and self-assessed competency in PC improved. These data suggest that an intensive training over several days is an effective format for increasing providers' perceived efficacy in delivering PC.
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Affiliation(s)
- Bethany-Rose Daubman
- Division of Palliative Care and Geriatrics, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Jamaica Cancer Care and Research Institute, Kingston, Jamaica.
| | - Mark Stoltenberg
- Division of Palliative Care and Geriatrics, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Jamaica Cancer Care and Research Institute, Kingston, Jamaica
| | - Dingle Spence
- Jamaica Cancer Care and Research Institute, Kingston, Jamaica; Hope Institute Hospital, Kingston, Jamaica
| | - Eric L Krakauer
- Division of Palliative Care and Geriatrics, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Jamaica Cancer Care and Research Institute, Kingston, Jamaica
| | - Susan Farrell
- Harvard Medical School, Boston, MA, USA; Office of Continuing and Professional Development, Massachusetts General Hospital Institute of Health Professions, Boston, MA, USA
| | - Lara Traeger
- Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston MA, USA
| | - Robert Thomas
- Jamaica Cancer Care and Research Institute, Kingston, Jamaica; Harvard/Massachusetts General Hospital Center on Genomics, Vulnerable Populations and Health Disparities, Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Brittany Bromfield
- Jamaica Cancer Care and Research Institute, Kingston, Jamaica; Harvard/Massachusetts General Hospital Center on Genomics, Vulnerable Populations and Health Disparities, Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA, USA
| | | | - Patrick Jason Toppin
- University of the West Indies, Mona, Section of Anaesthesia and Intensive Care, Mona, Jamaica
| | - Tomlin Paul
- Jamaica Cancer Care and Research Institute, Kingston, Jamaica; The Faculty of Medical Sciences, The University of the West Indies (Mona), Kingston, Jamaica
| | - Anna Boonin Schachter
- Jamaica Cancer Care and Research Institute, Kingston, Jamaica; Harvard/Massachusetts General Hospital Center on Genomics, Vulnerable Populations and Health Disparities, Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Alexandra E Shields
- Harvard Medical School, Boston, MA, USA; Jamaica Cancer Care and Research Institute, Kingston, Jamaica; Harvard/Massachusetts General Hospital Center on Genomics, Vulnerable Populations and Health Disparities, Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA, USA; The Faculty of Medical Sciences, The University of the West Indies (Mona), Kingston, Jamaica
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Padley J, Boyd S, Jones A, Walters L. Transitioning from university to postgraduate medical training: A narrative review of work readiness of medical graduates. Health Sci Rep 2021; 4:e270. [PMID: 33855193 PMCID: PMC8025846 DOI: 10.1002/hsr2.270] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/16/2021] [Accepted: 03/04/2021] [Indexed: 01/01/2023] Open
Abstract
CONTEXT Work readiness is often described in terms of the clinical competence medical graduates bring to day 1 of internship. Despite being increasingly viewed as a key graduate outcome, work readiness has remained poorly defined. OBJECTIVE This narrative review draws on the international literature to explore how different research methods provide differing insight into what constitutes work readiness of medical graduates. From this, we explored contributory factors and developed a conceptual framework to better understand work readiness. METHODS Databases were searched using the terms including "ready," "readiness," "preparedness," "medical graduates," "intern," and "junior doctor." Information was summarized using a textual description template that included information on study setting, participants, methodologies, limitations, and key result areas (including measures/themes and study conclusions). Consensus discussions between authors led to the naming and understanding of the key themes. RESULTS Seventy studies were included in the review. Study participants included final-year medical students (n = 20), junior doctors early in internship (n = 24), and junior doctors late in internship or postgraduate year 2 and above (n = 23). Most studies explored work readiness through the retrospective self-report of the students and/or junior doctor participants. Quantitative research methods elaborated on key skills-based competencies, whereas qualitative research methods provided insight into key contextual and individual characteristics that contributed to preparedness. CONCLUSIONS Different research methods provided insight into competencies, as well as individual and contextual aspects, associated with preparedness for practice. The transition from university to clinical practice is significant and requires personal capability and confidence, as well as a supportive training context. Enabling students to engage authentically in clinical environments enhanced preparedness by promoting understanding of role and responsibility. Individual resilience is important, but contextual factors, including provision of adequate support and feedback, can enhance or subtract from feeling prepared. We propose a novel conceptual framework for better understanding work readiness.
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Affiliation(s)
- James Padley
- Discipline of Rural and Remote Health, College of Medicine & Public HealthFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Sarah Boyd
- Discipline of Rural and Remote Health, College of Medicine & Public HealthFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Alison Jones
- College of Medicine & Public HealthFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Lucie Walters
- Discipline of Rural and Remote Health, College of Medicine & Public HealthFlinders UniversityBedford ParkSouth AustraliaAustralia
- Adelaide Rural Clinical SchoolUniversity of AdelaideAdelaideSouth AustraliaAustralia
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Kalafatis N, Sommerville TE, Gopalan PD. Do South African anaesthesiology graduates consider themselves fit for purpose? A longitudinal study. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2021. [DOI: 10.36303/sajaa.2021.27.3.2479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- N Kalafatis
- Department of Anaesthesiology and Critical Care, Nelson R Mandela School of Medicine, University of KwaZulu-Natal,
South Africa
| | - TE Sommerville
- Department of Anaesthesiology and Critical Care, Nelson R Mandela School of Medicine, University of KwaZulu-Natal,
South Africa
| | - PD Gopalan
- Department of Anaesthesiology and Critical Care, Nelson R Mandela School of Medicine, University of KwaZulu-Natal,
South Africa
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Ahmed O, Walsh TN. Surgical Trainee Experience with Open Cholecystectomy and the Dunning-Kruger Effect. JOURNAL OF SURGICAL EDUCATION 2020; 77:1076-1081. [PMID: 32362558 DOI: 10.1016/j.jsurg.2020.03.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/27/2020] [Accepted: 03/29/2020] [Indexed: 05/05/2023]
Abstract
BACKGROUND Laparoscopic cholecystectomy has become the standard approach to gallbladder surgery, but open cholecystectomy retains a role in complex cases. AIMS The aim of this study was to evaluate exposure of senior trainees in general surgery to open cholecystectomy and their experience and confidence in independent performance. METHODS General surgical trainees on a higher surgical training programme from surgical training years 5 (ST 5) to 8 (ST8) were invited to partake in an online anonymous survey. Data pertaining to case numbers, whether supervised or independently performed and level of comfort were collated and analyzed. RESULTS Twenty-six of 40 trainees responded (65%). Twenty-one (81%) had performed over 40 laparoscopic cholecystectomies with their trainer either scrubbed or un-scrubbed in theatre. As to open cholecystectomy experience, 12 trainees had assisted in 5 or fewer cases and only 3 assisted in over 20; 17 (65%) had performed 2 or fewer cases whilst assisted by their trainer while 24 of 26 trainees (92%) had no independent experience of open cholecystectomy. However, 16 felt they would be "somewhat comfortable" and 2 reported feeling "very comfortable" while only 8 reported they were "not comfortable" converting to open cholecystectomy. CONCLUSIONS This study confirms a steep decline in training opportunities in open cholecystectomy, but also raises concern about a Dunning-Kruger effect as, despite this lack of experience, the majority felt "somewhat comfortable" or "very comfortable" in converting to open surgery. Trainees need first to be familiar with safer alternatives to conversion. Surgical trainers need to consider the assessment of confidence as well as competence as an endpoint of trainee evaluation.
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Affiliation(s)
- Ola Ahmed
- Department of General and Upper Gastrointestinal Surgery, Connolly Hospital, Blanchardstown, Dublin, Ireland
| | - Thomas Noel Walsh
- Department of General and Upper Gastrointestinal Surgery, Connolly Hospital, Blanchardstown, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland.
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