Enhancing professional competency in clinical procedures using head-mounted display virtual reality - a mixed method study

BACKGROUND

The maintenance of nursing professional competency is essential to ensure patients' health outcomes. With the current shortage of nursing workforce, a novel approach is necessary to refresh clinical skills and update practice.

OBJECTIVE

This study aims to examine the effectiveness of using head-mounted display virtual reality to refresh knowledge and skills and explore nurses' perceptions towards using this technology for refresher training.

DESIGN

A pre-test post-test mixed-method experimental design was employed.

RESULTS

Participants (n = 88) were registered nurses with a diploma in nursing. The intravenous therapy and subcutaneous injection procedures were implemented using head-mounted display virtual reality. The study showed significant improvement in knowledge for the procedures, cognitive absorption, online readiness, self-directed learning, and motivation for learning. In the qualitative focus group discussions, three themes were identified using thematic analyses: enjoyable way to refresh clinical knowledge; learning outside classroom and limitations in maneuver.

CONCLUSION

Using head-mounted display virtual reality is promising in refreshing clinical skills for nurses. Training and refresher courses can explore using this novel technology, which may be a viable alternative to ensure professional competence with reduced manpower and resources used by the healthcare institution.

The development and validation of a standardised eight-station OSCE for registration of undergraduate nursing students: A Delphi study

AIM

To develop and validate a set of OSCEs for use as a nationally applicable final exam of undergraduate nursing students' clinical and professional competencies.

BACKGROUND

Tertiary recommendations for nursing registration require student achievement of a prerequisite level of both nursing knowledge and skill. Assessment of nursing skills prior to provision of nursing registration is an increasingly important focus of university nursing education. Objective Structured Clinical Examinations (OSCEs) are an appropriate tool for assessing the competencies of nursing students, but the mode and content of OSCEs varies widely. Thus, for nationally-based registration, development of a standardized set of OSCEs to determine the clinical competence of nursing students is important.

DESIGN

A modified Delphi study, informed by a systematic scoping review of relevant literature.

METHODS

A two-phase study was conducted. Initially, a scoping review was conducted to establish internationally agreed competences for graduating nursing students. These were included in an online questionnaire send to national experts to develop a validated and accepted nursing competency framework and associated implementation strategies. This was round 1 of a three-round modified Delphi study. A Content Validity Index (CVI) was calculated and thematic analysis was used to analyze the experts' opinions.

RESULTS

Details of a set of OSCEs for final exam of undergraduate nursing students were developed and validated. These OSCEs included nine competencies addressed in eight 10-minute stations.

CONCLUSION

A 'best-practice' OSCE evaluation system, designed from both international literature and the opinions of nation-wide experts was achieved. This well-designed OSCE was shown to be a reliable and valid method for assessing the clinical competence of nursing students. It reflected global procedures as well as the local conditions and Iranian expectations. The results of this study can be used by nursing schools across the country. They can also be used to model equivalent development of locally relevant OSCEs in countries around the world.

Determining the frequency of burn wound dressing for clinically competent nursing students: establishing standards based on learning curves

BACKGROUND

The primary objective of clinical practice in nursing education is to achieve mastery of clinical skills through repetitive practice. Therefore, there exists a correlation between the frequency of skill demonstration and clinical competency. This study aimed to address the following question: How many times should a nursing student perform burn wound dressing to attain clinical competency?

METHODS

This time series study was conducted on 41 junior nursing students who were selected through a census sampling method at Neyshabur School of Nursing from spring 2015 to summer 2021. The data collection tool was a researcher-made competency evaluation checklist (CEV). The competency score of each student for each skill demonstraion episode was evaluated using the Competency Evaluation Checklist (CEV) and recorded on the learning curve until a plateau was reached. SPSS16 and repeated measures analysis of variance (ANOVA) were used.

RESULTS

The mean competency score of burn wound dressing was 67.5 ± 11.0 (out of 100) during the first attempt, which increased to 95.9 ± 4.3 by the ninth attempt. The learning curve for the burn wound dressing skill reached a plateau after five attempts. Additionally, by the fifth attempt of dressing the burn wound, all students could accurately identify the depth, extent, and severity of the wound.

CONCLUSIONS

Establishing a standardized frequency for clinical skill performance and ensuring ample practice opportunities can have significant benefits in nursing education systems. These benefits include long-lasting learning, reduced costs, and improved effectiveness. As a result, nurse managers and lecturers should consider the resources available in their educational systems and strive to provide students with adequate opportunities and a supportive environment to practice their skills.

Consensus-based statements for assessing clinical competency in podiatry-related work integrated learning

BACKGROUND

The training of undergraduate and graduate-entry podiatry students in Australia and New Zealand includes practical sessions in a simulated and real-life clinical setting and Work Integrated Learning (WIL) comprising professional clinical placements. Student performance during WIL is evaluated by their Clinical Educators using clinical competency tools. Having a standardised and validated clinical assessment tool for WIL in podiatry would facilitate consistency in assessment, promote standardisation between programs, and ensure that all podiatry students are assessed against a set of criteria over the course of their clinical programs to the point of threshold clinical competency. Therefore, the aim of this study was to develop a series of consensus-based statements via Delphi technique as the first step towards developing guidelines to direct the assessment of podiatry students during WIL.

METHODS

This study used a three-round modified Delphi consensus method. A panel of 25 stakeholders was sought. Specifically, representation from each of the universities in Australia and New Zealand who provide entry level programs, Clinical Educators, podiatry student representatives, new podiatry graduates and consumers (podiatrists hiring new graduates). The survey for Round 1 aimed for consensus and consisted of five open-ended questions. Questions one to three asked respondents to nominate what they considered were the important elements that needed to be assessed for podiatry students undertaking WIL for: Clinical performance/skills, Communication and Professional behaviour, Question 4 asked respondents to identify further/other elements of importance, whilst Question 5 asked a) how these elements should be evaluated and b) how should overall competency and ability to progress within the program be determined. Round 2 and 3 aimed to gather agreement and the questions were based on the responses from previous rounds.

RESULTS

Twenty-five participants agreed to participate, 17 females (68%) and eight males (32%). The panel consisted of 10 podiatry educators (40%), nine Clinical Educators (36%), two student representatives (8%), two new podiatry graduates (8%) and two consumers (8%). From the 25 recruited participants, 21 responded to Round one, 18 to Round two and 17 in Round three. At the conclusion of the Delphi survey, 55 statements had reached consensus or agreement.

CONCLUSIONS

This Delphi study is the first of its kind for the podiatry profession to develop consensus-based statements regarding the assessment of WIL. Fifty-five statements pertinent to the assessment of WIL were identified. This is an important first step toward the development of a consistent WIL assessment tool which may be applied across entry-level podiatry programs across Australia and New Zealand.

The Relationship between Daily Spiritual Experiences and the Dimensions of Spiritual Care Competence in Nursing Students: The Dimension of Professionalization and Improvement of the Quality of Spiritual Care

Background

Daily spiritual experiences and spiritual care competence have positive health effects on patients and form an integral part of the nursing profession. This study was conducted to determine the relationship between daily spiritual experiences and the dimensions of spiritual care competence in nursing students.

Materials and Methods

This cross-sectional study was conducted on 401 nursing students in their last year of the program. The participants were selected from nursing schools in Tehran Province, Iran, in the academic year 2019-2020. The required data were extracted using a demographic information questionnaire, the Daily Spiritual Experiences Scale (DSES), and the Spiritual Care Competence Scale (SCCS). The collected data were analyzed in SPSS software at the significance level of 0.05.

Results

The mean (SD) of daily spiritual experiences and total spiritual care competence was 67.15 (16.33) and 101.77 (16.26), respectively. The personal support and patient counseling dimensions had the highest mean (SD) [22.10) 4.80)]. Among all these dimensions of spiritual care competence, only professionalization and improvement of the quality of spiritual care were predictors of the students' daily spiritual experiences (p < 0.05).

Conclusions

The professionalization dimension of spiritual care competence was identified as a predictor of daily spiritual experience in nursing students. Therefore, the researchers recommend the highlighting of this dimension in nursing programs to promote the students' spiritual care competence.

Student standardized patients versus occupational standardized patients for improving clinical competency among TCM medical students: a 3-year prospective randomized study

BACKGROUND

Standardized patient (SP) simulations are well-recognized patterns for practicing clinical skills and interactions. Our previous study showed that a simulation program using occupational SP for Traditional Chinese Medicine (OSP-TCMs) was efficient, however, a high cost and time-intensive nature have limited its use. TCM postgraduates trained as student SPs (SSP-TCMs) present a potentially cost-effective alternative. The purpose of this study was to examine and determine whether SSP simulation offered more benefits over didactic training alone for improving clinical competency among TCM medical students, and conduct a multifaceted analysis comparing SSP-TCMs and OSP-TCMs.

METHODS

This was a prospective, single-blinded, randomized controlled trial. Fourth-year TCM undergraduates were recruited as trainees from the Clinical Medical School, Chengdu University of TCM. Data were collected from September 2018 to December 2020. Trainees were randomly divided into the three following groups: traditional method training group, OSP-TCM training group, and SSP-TCM training group (1:1:1). At the end of a 10-week curriculum, trainees received a two-station examination comprising a systematic online knowledge test and an offline clinical performance examination. Post-training and post-exam questionnaires were administered to collect feedback from these trainees.

RESULTS

Students assigned to the SSP-TCM training and OSP-TCM training groups received favorable marks for the "systematic knowledge test" and "TCM clinical skills" (2018, P^a=0.018, P^b=0.042; 2019, P^a=0.01, P^b=0.033; 2020, P^a=0.035, P^b=0.039) compared to the TM trainees. Additionally, trainees in the intervention groups demonstrated a positive post-training edge in scores of "medical records" (2018, P^a=0.042, P^b=0.034; 2019, P^a=0.032, P^b=0.042; 2020, P^a=0.026, P^b=0.03) and "TCM syndrome differentiation and therapeutic regimen" (2018, P^b=0.032; 2019, P^a=0.037, P^b=0.024; 2020, P^a=0.036, P^b=0.043). For the simulation encounter assessment given by SP-TCMs, OSP-TCM trainees and SSP-TCM trainees scored higher than TM trainees (2018, P^a=0.038, P^b=0.037; 2019, P^a=0.024, P^b=0.022; 2020, P^a=0.019, P^b=0.021). For the feedback questionnaires, the students in TM group provided less positive feedback for training efficacy and test performance compared to those in the SSP-TCM and OSP-TCM groups. The trainees responded that the training effect of clinical simulations was similar between the SSP-TCM and OSP-TCM groups. SSP-TCMs were more responsive to unexpected emergencies (P^a=0.022, P^b>0.05) and more likely to encourage questioning (P^a=0.029, P^b>0.05) but tended to provide implied hints (P^c=0.015) and utilize medical jargon (P^c=0.007) as compared to OSP-TCMs.

CONCLUSION

Simulation training for SSP-TCMs and OSP-TCMs showed great benefits for enhancing clinical competency. SSP-TCM simulation was feasible, practical, and cost-effective, and may serve as an alternative method to OSP-TCM simulation.

Difficulties and innovations in teaching anatomy and physiology in nursing

AIM

This study aimed to clarify the difficulties and innovations in anatomy and physiology education from the perspective of faculty members in charge of anatomy and physiology education in Japanese nursing universities.

BACKGROUND

Many nursing students have difficulty acquiring anatomy and physiology knowledge and applying it in clinical situations; therefore, effective teaching and learning methods for anatomy and physiology must be provided in nursing education.

DESIGN

This study followed a cross-sectional observational design using a web-based self-administered questionnaire.

METHODS

A web-based self-administered open-ended survey regarding the difficulties and innovations in teaching anatomy and physiology in nursing was conducted involving nursing faculty members at universities in Japan. After inviting 280 nursing universities to participate in the survey, 37 completed questionnaires were collected and descriptively analyzed.

RESULTS

In approximately 30% of the universities, multiple professions were involved in collaboratively teaching anatomy and physiology. Furthermore, 59.5% of the universities offered a combination of didactic lectures and laboratory learning. Difficulties in teaching anatomy and physiology included the limitations of the physical teaching environment, the difficulty of teaching the importance of anatomy and physiology in nursing practice, the difficulty of adjusting educational content to learner readiness, and the difficulty of terminology and concepts specific to anatomy and physiology. Innovations used in teaching anatomy and physiology from a nursing perspective included integrating anatomy and physiology with related disciplines, encouraging students to visualize human anatomy in three dimensions, and linking anatomy and physiology to clinical nursing practice.

CONCLUSION

Despite some difficulties in teaching the subjects, faculty members have implemented effective educational methods on their own. Due to the various constraints of the learning environment, it is difficult for students to learn anatomy and physiology on campus in depth and acquire a deep understanding of its significance in clinical practice. Therefore, educational involvement that fosters students' self-directed learning skills and encourages flexible learning is expected. In addition, by collaborating with multiple disciplines to provide anatomy and physiology education, the participants of this study innovated pedagogies for teaching nursing students about the usefulness of anatomy and physiology and motivated their students. Moving forward, teachers need to relate their knowledge of anatomy and physiology to actual nursing care and clinical cases and convey the importance of deeply understanding anatomy and physiology in nursing practice to support their students' active learning.

Effects of health literacy competencies on patient-centered care among nurses

Background

This study aims to identify the relationship between health literacy competencies and patient-centered care by clinical nurses.

Methods

The participants were 180 nurses working at three university hospitals located in G City and J Province, South Korea. Self-evaluation questionnaires were used to collect data that were collected from June 1 to 30, 2021. Data were analyzed using descriptive statistics, independent t-test, one-way ANOVA, Pearson correlation coefficients, and multiple regression with SPSS 26.0.

Results

The mean of health literacy competencies was 3.19 (4 point scale) and the mean of patient-centered care was 3.48 (5 point scale). There were significant positive relationships between health literacy competencies and patient-centered care by clinical nurses (r = .50, p < .001). Factors influencing the health literacy competencies of clinical nurses were identified as education level (university) (β = .82), education level (masters) (β = .74), prior health literacy knowledge (β = .52), and health literacy competencies (β = .44). The explanatory power of this regression model was 36%, which was statistically significant (F = 17.65, p < .001).

Conclusion

Clinical nurses’ health literacy competencies should be developed to improve patient-centered care. Nursing education programs should emphasize the integration of health literacy into the nursing school curriculum.

The impact of the evaluations made by Mini-CEX on the clinical competency of nursing students

INTRODUCTION

Clinical competency is defined as one's capabilities in terms of knowledge, attitude and practice, and is a necessity for nursing practice. Evaluation is the inseparable part of the education process, without which the quality of education could not be measured. Considering the characteristics of clinical education and its impact on the clinical competency of students, as well as the importance of making precise evaluations of them using scientific, modern and efficient approaches, this study aims to investigate the impact of the evaluation made using Mini-Clinical Evaluation Exercise on the clinical competency of the nursing students of the School of Nursing and Midwifery Shahid Behesti University.

METHODS

This is a quasi-experimental study with a control group conducted on students who were taking courses "Nursing care for a sick child". The students were classified into the intervention and control groups using complete enumeration. The evaluations were made using Mini-Clinical Evaluation Exercise in the intervention group and the portfolio approach in the control group. The skills regarding patient (mother-child) education, IV therapy and medication were evaluated by checklists.

FINDINGS

The results showed that the mean score of clinical competency in the intervention group was significantly higher than that of the control group.

CONCLUSION

Considering the improvement of clinical competency in the intervention group, it is recommended to use Mini-Clinical Evaluation Exercise for the evaluation of students.

Developing a best practice framework for clinical competency education in the traditional East-Asian medicine curriculum

BACKGROUND

While clinical competency is crucial for traditional East-Asian medical education, available studies on the educational system for fostering clinical performance are scarce. This study aimed to review the educational system, curriculum, facilities, and management of current traditional East-Asian medicine in a well-established university of Korea and develop a Best Practice Framework (BPF) of clinical competency education.

METHODS

The clinical competency education system in Pusan National University School of Korean Medicine was systematically described through 5 steps of governance of the educational system, competency of the graduates, educational resources, assessment strategies and tools, and gaps in the curriculum. We also reviewed the experiences in education and the points to be improved.

RESULTS

The Office of Traditional Korean Medicine Education governs the development, implementation, and evaluation of the educational curriculum for cultivating students' clinical competency. Medical students have undertaken 39 modules of clinical biomedicine and 21 of traditional medicine during the clinical clerkship courses in an affiliated hospital, Clinical Skill Practice Center, clinical research center, practice lab for medical herb, and other locations. After training, 15 modules of simulated clinical training using standardized patients, students' clinical competency are evaluated by a Clinical Performance Test using a Clinical Performance Examination (CPX) and an Objective Structured Clinical Examination (OSCE) for biomedical and traditional medical skills.

CONCLUSIONS

A clinical competency framework is required for a qualified physician of traditional East-Asian medicine. This study reviewed the current well-organized educational system of Korean traditional medicine in detail, which can be used for the BPF of competency-based clinical education. We expect the current study to be a representative reference for establishing an educational system of traditional medicine such as acupuncture and medical herbs in other countries.

Non-technical skills in surgery during the COVID-19 pandemic: An observational study

BACKGROUND

Non-technical skills are critical to surgical safety. We examined the impact of the COVID-19 pandemic on non-technical skills of operating room (OR) teams in Singapore.

MATERIALS AND METHODS

Observers rated live operations using the Oxford NOTECHS system. Pre- and post-COVID observations were captured from November 2019 to January 2020 and from January 2021 to February 2021, respectively. Scores were compared using Schuirmann's Two One-Sided Test procedure. Multivariable linear regression was used to adjust for case mix. A 10% margin of equivalence was set a priori.

RESULTS

Observers rated 159 cases: 75 pre-COVID and 84 post-COVID. There were significant differences between groups in surgical department and surgeon-reported case complexity (both P < 0.001). Total NOTECHS scores increased post-COVID on raw analysis (36.1 vs 38.0, P < 0.001) but remained within the margin of equivalence (90% CI 1.3 to 2.6, P < 0.001). Multivariable analysis demonstrated a similar increase within the margin of equivalence (2.0, 90% CI 1.3 to 2.7). Teamwork and cooperation scores increased by 1.0 post-COVID (90% CI 0.8 to 1.3); all other subcomponent scores were equivalent.

CONCLUSION

Non-technical skills before and after the peak of the COVID-19 pandemic were equivalent but not equal. A small but statistically significant improvement post-COVID was driven by an increase in teamwork and cooperation skills. These findings may reflect an improvement in team cohesion, which has been observed in teams under duress in other settings such as the military. Future work should explore the effect of the pandemic on OR culture, team cohesion, and resilience.

The impact of self-efficacy based prebriefing on nursing student clinical competency and self-efficacy in simulation: An experimental study

BACKGROUND

Prebriefing is the first phase of simulation; however, the literature does not adequately identify prebriefing standards and implementation strategies, providing little direction for simulation facilitators to conduct prebriefing in a manner that promotes student self-efficacy and clinical competency.

OBJECTIVES

The aim of this study was to examine the effects of the Self-Efficacy Prebriefing Model (SEPM) on nursing student self-efficacy and clinical competency.

DESIGN

An experimental design with group randomization was used to compare self-efficacy and clinical competency in nursing students who received prebriefing per the SEPM compared to a control group.

SETTING

The study was conducted in one public Midwestern university in the United States.

PARTICIPANTS

66 senior Bachelor of Science in Nursing students enrolled in a clinical course completed the study.

METHODS

Clinical competency and self-efficacy were examined between an experimental group that received prebriefing per the SEPM and a control group that received standard prebriefing. The relationship between self-efficacy and clinical competency was examined. Clinical competency and self-efficacy were evaluated using the Creighton Competency Evaluation Instrument and Revised Clinical and Simulation General Self-Efficacy Scale.

RESULTS

The experimental group had statistically significantly higher self-efficacy (p = .001) and clinical competency (p < .001) as compared to the control group. There was no significant relationship noted between self-efficacy and clinical competency (p = .207).

CONCLUSION

The SEPM promoted nursing student self-efficacy and clinical competency in simulation. Prebriefing has an essential role in the simulation process and in promoting student outcomes.

Use of an objective structured clinical examination (OSCE) to assess intern performance in an advanced pharmacy practice experiences (APPE) Ambulatory Care rotation

Purpose

Intern assessment during advanced pharmacy practice experiences (APPEs) are generally based upon each individual preceptor's perceptions without an objective measurement of intern understanding and performance. Therefore, we sought to determine whether a pre- and post-OSCE could be used to confirm that interns achieved the goals and objectives of the Ambulatory Care rotation. The aims of this study were to determine whether a pre-rotation OSCE can help pharmacy interns self-assess their clinical strengths and weaknesses and assess whether their knowledge and skills improved after completing a post-rotation OSCE.

Methods

Pharmacy interns undergoing APPE Ambulatory Care rotations from September 2018 to March 2020 participated in a pre- and post-rotation OSCE to assess their knowledge of various chronic disease states. Interns completed pre- and post-OSCE surveys to assess their perceptions about their knowledge and the OSCE experience.

Results

Pharmacy intern knowledge about diabetes, hypertension, dyslipidemia, and atrial fibrillation significantly improved post-OSCE compared to their pre-OSCE scores (p < 0.001). The mean post-OSCE scores for diabetes (p < 0.001), dyslipidemia (P = 0.046), anticoagulation (P = 0.006), and the overall mean post-OSCE scores (P = 0.005) were significantly higher compared to interns' pre-OSCE scores. Students believed that the post-OSCE significantly highlighted their strengths and weaknesses in skills and knowledge compared to the pre-OSCE (P = 0.008).

Conclusion

Pre- and post-APPE OSCE assessments are important tools that can provide interns and preceptors with objective evaluations of student performance. OSCEs can either be used as an alternative to perception-based assessments or integrated into existing preceptor evaluations. Furthermore, OSCEs can help preceptors identify areas that require more emphasis in their rotations.

A competency roadmap for advanced practice nursing education using PRIME-NP

BACKGROUND

Clinical competency validation is essential for nurse practitioner (NP) education and public accountability. While there has been robust discussion around what constitutes clinical competency and assessment, clear and consistent definitions and measurements remain elusive.

PURPOSE

This article describes the PRIME-NP clinical competency model that is scalable, reproducible and accurately documents NP student competency across clinical courses.

METHODS

To develop the model, work in 5 discrete domains was necessary: (a) model development, (b) assessment tool to be used in Objective Structured Clinical Exams (OSCE), (c) rubrics to accompany the OSCE exam, (d) faculty education, and (e) evaluating the model use.

FINDINGS

Faculty and student outcomes reveal that the model and assessment tool acceptability and effectiveness of the model, especially for early identification for at risk students.

CONCLUSION

The PRIME-NP offered faculty the opportunity to identify at-risk students, identify a more nuanced remediation plan, and assess student competency in simulated environments.

The predictors of nursing students' clinical competency in pre-internship objective structured clinical examination: The roles of exam anxiety and academic success

BACKGROUND

Identifying the predictors of nursing students' clinical competency in objective structured clinical examination (OSCE) is of utmost importance. Therefore, the present study was to investigate the predictive roles of exam anxiety and academic success in nursing students' clinical competency in the pre-internship OSCE.

METHODS

In this descriptive-analytical study, a total number of 102 nursing students, meeting the inclusion criteria and enrolled in the sixth semester (third year) of the graduate nursing program in Iran, were firstly selected by the census method. The pre-internship OSCE was then implemented at eight stations based on a pre-designed schedule template. The required data were also collected through a demographic-academic characteristics questionnaire and the State-Trait Anxiety Inventory to determine the exam anxiety score, the nursing program grade point average (GPA) to reflect on the levels of academic success, and the OSCE score to control clinical competency. The data analysis was also performed at the significance level of 0.05.

RESULTS

The linear regression model, in which the exam anxiety, the nursing program GPA, and the demographic-academic characteristics variables had been imported, could explain 33.52% of the variance of the nursing students' clinical competency in the pre-internship OSCE (R² = 0.616). Of the variables concerned, only the nursing program GPA could be a significant predictor of the nursing students' clinical competency scores in the OSCE, so that 0.8 points were added to the clinical competency scores in the OSCE as the nursing program GPA increased by one unit (p = 0.000, β = 0.717), but no significant relationship was observed between exam anxiety and clinical competency in the pre-internship OSCE among the nursing students.

CONCLUSIONS

The results of this study endorsed the use of the OSCE in assessing the nursing students' clinical competency and implementing learning strategies to strengthen the levels of academic success in such individuals.

The Impact of a Structured Virtual Reality Simulation Training Curriculum for Novice Endoscopists

Background

Current evidence supports the use of virtual reality (VR) simulation-based training for novice endoscopists. However, there is still a need for a standardized induction programme which ensures sufficient preparation, with knowledge and basic skills, before their approach to patient-based training. We designed a structured progressive programme in upper endoscopy and colonoscopy and aimed to determine its impact on cognitive and technical performance.

Methods

Prospective, multicentre study, focused on "Endoscopy I, 2018," a course with a theoretical and a hands-on module (20 h) in the GI Mentor II®. Gastroenterology residents of the 1st year were enrolled. A pre-test and test were applied to evaluate the cognitive component, and a pre-training and post-training esophagogastroduodenoscopy (EGD) and colonoscopy VR cases were used to evaluate the technical component. The hands-on training included psychomotor exercises (Navigation I, Endobubble I), 4 EGD, and 4 colonoscopy VR cases. The metrics applied for technical skills evaluation were time to reach the second portion of duodenum (D2)/cecum (seconds), efficiency of screening (%), and time the patient was in pain (%).

Results

Twenty-three participants were included, majority female (67%), 26 ± 0.7 years old. Comparing the pre-test versus test, the cognitive score significantly improved (11/15 vs. 14/15; p < 0.001). Considering the technical assessment after training: in EGD, the time to D2 was significantly lower (193 vs. 63 s; p < 0.001), and the efficiency of screening significantly better (64 vs. 91%; p < 0.001); in colonoscopy, the time to reach the cecum was significantly lower (599 vs. 294 s; p = 0.001), the time the patient was in pain was significantly lower (27 vs. 10%; p = 0.005), and the efficiency of screening had a tendency towards improvement (50 vs. 68%; p = 0.062).

Conclusion

The proposed training curriculum in basic endoscopy for novices is aligned with international recommendations and demonstrated a significant impact on cognitive and technical skills learning achievements.

ACGME Case Log Reminder Does Not Improve Resident Accuracy in Logging Cases

To assess competency of residents prior to graduation, the Accreditation Council for Graduate Medical Education (ACGME) maintains a case log system, where residents self-report cases they perform. This mechanism results in underreporting of resident involvement in patient care. To determine if an intraoperative case log reminder would increase the frequency of ACGME case logging amongst anesthesiology residents. An intraoperative ACGME case log reminder was implemented on March 13, 2019. The authors collected data for all 53 PGY2-4 anesthesiology residents at the authors' institution from July 14, 2018 to July 16, 2019 from the electronic medical record and ACGME system to calculate the proportion of cases logged and the "lag time" between case occurrence and logging. Data was analyzed for all residents, classes, and individuals. A total of 16,342 anesthetics were performed, and a total of 11,713 cases were logged. The reminder did not improve overall logging rates. Case-logging rates amongst PGY2 residents remained unchanged and declined for PGY3 and PGY4 residents. The lag time between case occurrence and logging increased. An automatic reminder did not improve logging frequency. This may be because residents are unable to log cases intraoperatively in many instances, or they may not feel as though they have participated enough in a case to log it. Additionally, senior residents may log cases less frequently once they have met required case minimums. An automatic case-logging system that transmits resident information directly to the ACGME may be the best way to increase logging accuracy.

An investigation of the predictive validity of selection tools on performance in physiotherapy training in Australia

OBJECTIVES

Despite a large body of research on selection in medical education, very little is conducted in other health professions. This study investigated the predictive validity of multiple selection tools on academic and clinical performance outcomes of undergraduate physiotherapy students.

DESIGN

A retrospective observational study.

SETTING

Undergraduate physiotherapy program in Australia.

PARTICIPANTS

497 undergraduate physiotherapy students across seven entry cohorts. Including students directly from secondary school (n=381) and with prior tertiary study (n=116).

MAIN OUTCOME MEASURES

Academic performance as measured by written examinations. Clinical performance, measured by Objective Structured Clinical Examinations (OSCEs) during on-campus units and the Assessment of Physiotherapy Practice (APP) for off-campus clinical placements. Predictor variables included selection tools (academic achievement, interview, aptitude test) and demographic variables (age, gender).

RESULTS

Selection interview was a positive predictor of OSCEs and final year clinical performance in direct school leaver participants. Academic achievement scores from selection positively predicted written examinations scores.

CONCLUSION

Clinical and academic performance were predicted by tools measuring different domains at selection. Assessing broadly across academic and non-academic domains at selection can be valuable in identifying applicants who will be able to meet the range of outcomes for course completion and subsequent registration in the physiotherapy profession.

A study of the role and educational needs of ophthalmic specialist nurses

AIMS

To explore the current roles, responsibilities and educational needs of ophthalmic specialist nurses (OSNs) in the UK.

METHOD

A survey of 73 OSNs ranging from band 4 to band 8 was undertaken in May 2018.

FINDINGS

73% of OSNs undertake more than one active role, with 59% involved in nurse-led clinics; 63% felt formal learning resources were limited, with 63% reporting training opportunities and 21% reporting time as major barriers to further training. More than 38% emphasised hands-on clinic-based teaching had a greater impact on their educational needs. Some 64% were assessed on their skills annually and 59% felt confident with their skill set.

CONCLUSION

The Ophthalmic Common Clinical Competency Framework provides a curriculum and assessment tools for OSNs to use as a structure to maintain clinical skills and knowledge. Eye departments should use this as guidance to target learning needs and improve standards of care to meet the changing needs of society.

Challenges of objective structured clinical examination in undergraduate nursing curriculum: Experiences of faculties and students

BACKGROUND

Assessment of clinical competence of nursing students is necessary to ensure safe practice and the realization of professional clinical standards. An Objective Structured Clinical Examination (OSCE) is commonly used internationally in nursing education programs to assess clinical competence, but is a new process in Iranian nursing curricula.

OBJECTIVE

The aim of this study was to explore and describe challenges associated with OSCE implementation based on the experiences of faculty members and nursing students, with the objective of further improving the assessment of clinical competence in nursing education.

DESIGN

This study used a qualitative approach that included thematic analysis of the transcribed interviews.

SETTING

Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences (TBZMED), Tabriz, Iran.

PARTICIPANTS

Purposive sampling was used to select eighteen faculty members and fifteen students from those interested. These participants represent a reasonable cross-section of those who had participated in the OSCE.

METHODS

A pre-developed interview guide was used to inform semi-structured in-depth interviews. These were recorded and analyzed using the 6-phase thematic analysis method as described by Braun and Clarke (2013). Themes were independently verified.

RESULTS

Challenges identified by participants around OSCEs as part of undergraduate nursing education were extracted from the interview data. Two main themes were evident from the data: 1) shortcomings in executive and technical infrastructure, 2) shortcomings in educational infrastructure. These themes reflected both student and faculty experiences. These also aligned with themes that commonly emerge in related literature.

CONCLUSION

The study findings illustrate several key challenges associated with organizing and implementing OSCEs and so provides unique insights into the development of strategies to implementing and promoting OSCEs in nursing education. We recommend that managers and authorities in nursing education focus on these challenges and explore processes to successfully introduce this exam for assessment of nursing student capacity.

Designing a comprehensive clinical competency test for operating room technology student: Using Delphi technique and CIPP model evaluation

BACKGROUND

The ultimate goal in educating medical students is to train skilled workforce who by obtaining the required knowledge of the discipline, personal and professional skills, and attitudes to enter the national health-care system. This study was conducted with the goal of designing a comprehensive clinical competency test of operating room technology student using the Delphi technique, and then, the clinical skills of the operating room technology students of the paramedical school were assessed using the CIPP evaluation model.

MATERIALS AND METHODS

The present study was conducted in the University of Medical Sciences to evaluate clinical skills with Delphi technique and CIPP evaluation model. This was a mixed methods study. Purposive sampling method was employed in the qualitative stage, and a census was conducted in the quantitative part. A comprehensive clinical competency test was designed in this research using the Delphi technique and was conducted with 18 students. Then, clinical skills evaluation was performed by descriptive-analytical statistical tests and evaluator's observation using the CIPP model.

RESULTS

The comprehensive clinical competencies test of the surgical technology students was designed in four sections: content, evaluation method, test conditions, and the criteria for passing the comprehensive test. The results in the implementation stage showed that the operating room technology students had a range of excellent to weak performances in exhibiting basic skills at different levels.

CONCLUSIONS

The results of the present study showed that the comprehensive test, designed based on the Delphi technique of experts, and using the CIPP model can be a good criterion for the evaluation of the operating room technology students before entering the clerkship.

Academic evaluation, management and satisfaction of clinical practicums among undergraduate students: software CliPrAS@UB

AIM/OBJECTIVE

To determine the development of competency acquisition, the satisfaction of the agents involved and recording incidents with a digital platform CliPrAS @UB on the Clinical Placements I and II courses in the second and third years of the Bachelor's Degree in Nursing.

BACKGROUND

The teaching of clinical practice subjects requires an analysis of the competence evolution, a management structure and an analysis of the satisfaction of the agents involved in the subject.

DESIGN

Prospective, analytical, observational cohort study.

METHODS

The study was carried out in a public university center in Barcelona with 387 students distributed in nine centers of the network of Health Institutions.

RESULTS

An increase of 2.32 points was observed in the competence dimensions of Professional Practice and with a reduction in the average score in the skills of care provision, therapeutic communication and professional development of more than 0.08 points. Regarding the seminars, a reduction of the average global score of 0.58 points was observed.

CONCLUSIONS

The use of the CliPrAS @ UB computer platform has improved the implementation of the mandatory documents, the recording of incidents and the overall satisfaction of the students.

Differences in clinical knowledge levels between residents in two post-graduate rotation programmes in Japan

BACKGROUND

In Japan, between 2010 and 2020, there were two post-graduate training curricula for post-graduate medical education, as follows: comprehensive rotation programmes (CRPs), which require rotation in at least seven clinical departments; and limited rotation programmes (LRPs), which require rotation in fewer clinical departments. The curriculum that should be used for standardized Japanese post-graduate training has long been debated. Multiple studies show that post-graduate trainees who trained with CRPs were more satisfied and confident and gained more clinical experience than those who trained with LRPs. However, a comparison of objective measurements of the clinical knowledge of Japanese post-graduate trainees has not been reported. The aim of this study is to objectively measure and compare the clinical knowledge of trainees in CRPs and LRPs using a component of the Professional and Linguistic Assessment Board test (PLAB test).

METHODS

A nationwide cross-sectional study was conducted in February and March 2020. Post-graduate trainees who graduated from medical school were voluntarily recruited from general hospitals in Japan. To objectively measure the trainees' basic clinical knowledge, the PLAB test was adapted from the UK. The cut-off point was set at 63%, as recommended by the UK General Medical Council. A statistical analysis was conducted to determine whether post-graduate programme differences contributed to the trainees' test scores.

RESULTS

Twenty-two facilities volunteered to participate after recruitment, and 97 trainees from 19 facilities participated in the study. Thirty-one participants (32%) were in a CRP, and 66 participants (68%) were in an LRP. According to multiple logistic regression, the adjusted odds ratio of CRP trainees being in the high-scoring group was 5.16 (95% CI: 1.28-20.73, p<0.05). Mean differences in the scores in paediatrics, mental health and neurology were statistically higher among CRP trainees than LRP trainees.

CONCLUSION

Post-graduate trainees who were in a CRP had better basic clinical competence knowledge (PLAB test) scores and performed better when tested in a wider range of subspecialties. Not only exam performance but also clinical performance and the longitudinal trend of trainees' competency in post-graduate medical training should be evaluated in future studies.

Interpersonal skills mediate the relationship between communicative and clinical competencies among nursing students: A descriptive study

BACKGROUND

The development of clinical competency reduces nursing students' stress and turnover intention and improves their clinical practice satisfaction and academic performance. Still, many nursing supervisors feel that new graduate nurses have inadequate communicative and clinical competencies, and no prior study has analyzed the mediating effect of interpersonal skills in the relationship between these two variables.

OBJECTIVES

To examine the factors that affect nursing students' clinical competency, including the mediating effect of interpersonal skills, and to identify/determine interventions that promote it and improve students' clinical performance.

DESIGN

This study employed a cross-sectional, descriptive correlational design.

SETTING

Four departments of nursing in Jeollabuk-do, South Korea.

PARTICIPANTS

Participants (N = 222; mean age = 22.7 years; 75.2% women) were students enrolled in the third and fourth year of nursing.

METHODS

From February 5-28, 2018, we collected data through self-reported questionnaires; these asked about participants' demographic characteristics and measured their communicative competency, interpersonal skills, and clinical competency. The relationships among the variables were identified using Pearson's correlation coefficient. We also used the Sobel test and a three-step multiple regression analysis to verify the mediating effects of interpersonal skills.

RESULTS

Students who were female, in their fourth year, satisfied with their major, and satisfied with their clinical practice had higher clinical competency scores than their counterparts. Interpersonal skills completely mediated the effects of communicative competency on clinical competency (explanatory power = 53.8%).

CONCLUSIONS

The results suggest the need for a program that improves nursing students' social relationship skills and diminishes their anxiety. In particular, students in the third and fourth years need a continuous/intensified curriculum that fosters their communicative competencies, such as listening to patients' needs and establishing effective interpersonal relationships with peers/superiors. Longitudinal studies are warranted to identify differences in communicative/clinical competencies among nursing students in different academic years.

Nursing fundamentals - supporting clinical competency online during the COVID-19 pandemic

During the Spring of 2020, due to the COVID-19 pandemic, many schools of nursing were challenged to change their educational delivery methods from a face-to-face to an online format. This article discusses educational strategies utilized to support clinical competency using an online format for a fundamentals of nursing clinical course. Discussions of regulatory considerations, faculty planning, and teaching pedagogy utilized during this transition are presented. The authors also discuss future implications and suggestions for attaining learning objectives for a clinical course using an online format.

Developing a New Set of ACGME Milestones for Child Neurology Residency

BACKGROUND

The Educational Milestones developed by the Accreditation Council for Graduate Medical Education (ACGME) are a construct used to evaluate the development of core competencies during residency and fellowship training. The milestones were developed to create a framework for professional development during graduate medical education. The first iteration of milestones for the child neurology residency was implemented in 2015. In the years that followed, the ACGME received and reviewed feedback about the milestones and set out to revise them.

METHODS

A committee was assembled to review the original milestones and develop a new set of milestones. The group was also encouraged to not only consider the child neurology residency graduate of today but also the graduate of tomorrow, taking into account growing fields such as genetics and technology.

RESULTS

A diverse group of 12 individuals, including 10 child neurologists (all of whom were current or previous program directors or associate program directors), one child neurology resident, and one non-physician program coordinator, were recruited from programs of varying size across the country.

CONCLUSIONS

The committee developed a revision to the child neurology milestones. All changes made were with a focus on how the milestones can be useful to trainees, program directors, and clinical competency committee members. Implementation and further feedback should help guide future revisions. These changes should help trainees, clinical competency committee members, and program directors find more meaning from their use.

Love the way you're teaching us': A purpose-developed clinical communication workshop for first year midwifery students

Preparing students for communication in clinical healthcare settings can be challenging, particularly given it may be the first time they have considered how and why they communicate. The challenge is to find an effective process for the development of clinical communication skills in a highly content-driven curriculum. The objective of this study was to empower first-year midwifery students to reflect on their experiences of communication to inform and expand their clinical communication by drawing on two distinct disciplines - midwifery and linguistics. This paper reports on the findings of a study that examined the implementation of innovative, preparatory workshops for first-year midwifery students. Data from quantitative and qualitative surveys were collected pre- and post-workshop, and post-clinical placement, and analysed using linguistic mapping and thematic analysis. Perceptible shifts in self-evaluation of competence were noted post the workshop and clinical placement. Students developed and used metalanguage appropriately to describe and evaluate communication while demonstrating increased awareness of the complexity of professional communication. They were able to find a balance between the vital technical information, and the interpersonal aspects of communication. This impacted positively on their perception of women as partners.

Effectiveness of implementation of "mental health nursing students' clinical competency model" on academic performance of nursing students

Background: Clinical nursing competence in mental health is one of the most important topics in theoretical and practical nursing training with many factors affecting it. The purpose of this study is to determine the impact of the implementation of the "mental health nursing students' clinical competence model" on nursing students' academic performance. Methods: This study is a semi experimental following one group of student nurses. "mental health nursing students' clinical competence model" for undergraduate nursing student's education was applied. The study population included 50 nursing students, who were studying from fifth semester to seventh semester and selected through census sampling. During the seventh semester after the completion of theoretical and practical courses in mental health nursing, re-evaluation was conducted and the scores before and after the implementation of the clinical competence model were compared. Results: Rate of clinical competency before the intervention, was estimated at the level of non-mastered; and after intervention was at the level of mastered, demonstrating a significant difference (p<0.001). Areas of clinical competency scores before and after the intervention were compared which showed significant difference in all the areas except the mental competency areas (p<0.05). Conclusions: The implementation of the "mental health nursing students' clinical competence model" and appropriate planning for achievement of mental health nursing specialized competency can ensure the achievement of clinical competency by nursing students.

Effectiveness of implementation of "mental health nursing students' clinical competency model" on academic performance of nursing students

Background: Clinical nursing competence in mental health is one of the most important topics in theoretical and practical nursing training with many factors affecting it. The purpose of this study is to determine the impact of the implementation of the "mental health nursing students' clinical competence model" on nursing students' academic performance. Methods: This study is a semi experimental following one group of student nurses. "mental health nursing students' clinical competence model" for undergraduate nursing student's education was applied. The study population included 50 nursing students, who were studying from fifth semester to seventh semester and selected through census sampling. During the seventh semester after the completion of theoretical and practical courses in mental health nursing, re-evaluation was conducted and the scores before and after the implementation of the clinical competence model were compared. Results: Rate of clinical competency before the intervention, was estimated at the level of non-mastered; and after intervention was at the level of mastered, demonstrating a significant difference (p<0.001). Areas of clinical competency scores before and after the intervention were compared which showed significant difference in all the areas except the mental competency areas (p<0.05). Conclusions: The implementation of the "mental health nursing students' clinical competence model" and appropriate planning for achievement of mental health nursing specialized competency can ensure the achievement of clinical competency by nursing students.

Validation of time to task performance assessment method in simulation: A comparative design study

BACKGROUND

There is a lack of objective and valid measures for assessing nursing clinical competence which could adversely impact patient safety. Therefore, we evaluated an objective assessment of clinical competence, Time to Task (ability to perform specific, critical nursing care activities within 5 min), and compared it to two subjective measures, (Lasater Clinical Judgement Rubric [LCJR] and common "pass/fail" assessment).

DESIGN/METHODS

Using a prospective, "Known Groups" (Expert vs. Novice nurses) comparative design, Expert nurses (ICU nurses with >5 years of ICU experience) and Novice nurses (senior prelicensure nursing students) participated individually in a simulation of a patient in decompensated heart failure. Fourteen nursing instructors or preceptors, blinded to group assignment, reviewed 28 simulation videos (15 Expert and 13 Novice) and scored them using the LCJR and pass/fail assessments. Time to Task assessment was scored based on time thresholds for specific nursing actions prospectively set by an expert clinical panel. Statistical analysis consisted of Medians Test and sensitivity and specificity analyses.

RESULTS

The LCJR total score was significantly different between Experts and Novices (p < 0.01) and revealed adequate sensitivity (ability to correctly identify "Expert" nurses; 0.72) but had a low specificity (ability to correctly identify "Novice" nurses; 0.40). For the subjective measure 'pass/fail', sensitivity was high (0.90) but specificity was low (0.47). The Time to Task measure had statistical significance between Expert and Novice groups (p < 0.01) and sensitivity (0.80) and specificity (0.85) were good.

CONCLUSION

Commonly used subjective measures of clinical nursing competence have difficulties with achieving acceptable specificity. However, an objective measure, Time to Task, had good sensitivity and specificity in differentiating between groups. While more than one assessment instrument should be used to determine nurse competency, an objective measure, such as Time to Task, warrants further study.

Grace Under Pressure: Leadership in Emergency Medicine

Physicians in general, including emergency physicians (EPs), are trained in the diagnostic, therapeutic, and administrative aspects of patient care but not so much in the theoretical and practical aspects of assuming and delivery of leadership. EPs are always taught to focus on their performance, to excel and achieve, to be accountable for their own clinical decisions, and to appreciate feedback and peer-to-peer review. Currently, if there are some semblances of formal or semi-formal leadership instruction, the organized theoretical curriculum often does not formally include very structured and planned departmental leadership and management elements. Leadership is a process for a person (“the leader”) to lead, influence, and engage a group or organization to accomplish their objectives and mission. To do this, the leader must understand a variety of issues of working, interacting, and integrating with people, the environment and both, the intrinsic and extrinsic factors, and elements that have an impact on the industry or area he/she is leading in. Leadership in emergency medicine (EM) is even more challenging, with its unique focus, issues, and trajectory, moving into the new century, with new considerations. No single strategy is sufficient to ace EM leadership and no single specific leadership model is complete. This paper shares some current views on medical/EM leadership. The author shares her views and some suggested proposals for more formal and structured leadership, implementation, and succession to help nurture and groom Eps who will become leaders in EM in the near future.

Using reusable learning objects (RLOs) in wound care education: Undergraduate student nurse's evaluation of their learning gain

BACKGROUND

Both nationally and internationally concerns have been expressed over the adequacy of preparation of undergraduate nurses for the clinical skill of wound care. This project describes the educational evaluation of a series of Reusable Learning Objects (RLOs) as a blended learning approach to facilitate undergraduate nursing students learning of wound care for competence development. Constructivism Learning Theory and Cognitive Theory of Multimedia Learning informed the design of the RLOs, promoting active learner approaches. Clinically based case studies and visual data from two large university teaching hospitals provided the authentic learning materials required. Interactive exercises and formative feedback were incorporated into the educational resource.

METHODS

Evaluation of student perceived learning gains in terms of knowledge, ability and attitudes were measured using a quantitative pre and posttest Wound Care Competency Outcomes Questionnaire. The RLO CETL Questionnaire was used to identify perceived learning enablers. Statistical and deductive thematic analyses inform the findings.

RESULTS

Students (n=192) reported that their ability to meet the competency outcomes for wound care had increased significantly after engaging with the RLOs. Students rated the RLOs highly across all categories of perceived usefulness, impact, access and integration.

CONCLUSION

These findings provide evidence that the use of RLOs for both knowledge-based and performance-based learning is effective. RLOs when designed using clinically real case scenarios reflect the true complexities of wound care and offer innovative interventions in nursing curricula.

Pilot Investigation into the Use of an Anthropomorphic Breast Sonography Phantom as a Training and Assessment Tool

A device for the training and quantitative assessment of the competency of trainee radiologists in the technically challenging area of breast sonography was developed and evaluated. Currently, suitable commercially available devices are lacking, and there is a growing realization that the reliance on direct exposure to patients for learning may not represent best practice from either the trainees' or patients' perspective. Three devices (PI, PII and PIII) were designed to produce very realistic sonographic images of breast morphology with a range of embedded pathologies. The pilot evaluation used a case study research design to evaluate the role of the anthropomorphic breast sonography training device in training and assessment in a clinical environment. Through the case study, it was possible to evaluate the process and relationships when using this type of training intervention for a small group of radiology resident trainees. The investigation involved a baseline assessment of trainees' (n = 4) ability to detect and characterize all lesions in PI, followed by a 4-wk training period on PII and a post-training assessment using PIII. The evaluation revealed an improvement of 30% ± 8% in the trainee's performance from pre- to post-training. It was expected that the performance of the trainees would improve as the training phantom described in this study aligns with the learning theory of constructivism and fits the ideal specifications of a medical training device in terms of its realism and facilitation of self-directed learning and deliberate practice of the trainees. The device provides a useful platform upon which training and assessment can be facilitated.

Clinical Skills Performed By Iranian Emergency Nurses: Perceived Competency Levels and Attitudes Toward Expanding Professional Roles

INTRODUCTION

Emergency nurses play an important role in the care of critically ill and injured patients, and their competency to perform clinical skills is vital to safe and effective patient care. The aim of this study was to evaluate the frequency of clinical skills performed and perceived competency levels among Iranian emergency nurses. In addition, attitudes toward expanding the professional roles of Iranian emergency nurses were also assessed.

METHODS

In this descriptive correlational study, 319 emergency nurses from 30 hospitals in northwest Iran participated. Data were collected using a self-report questionnaire. Descriptive statistics and Pearson's correlation coefficient were used to present the findings.

RESULTS

Overall competency of the emergency nurses was 73.31 ± 14.2, indicating a good level of perceived competence. The clinical skills most frequently performed were in the domains of organizational and workload competencies (3.43 ± 0.76), diagnostic function (3.25 ± 0.82), and the helping role (3.17 ± 0.83). A higher level of perceived competence was found for skills within these domains. Less frequently, participants performed skills within the domains of effective management of rapidly changing situations (2.70 ± 0.94) and administering and monitoring therapeutic interventions (2.60 ± 0.97); a lower perceived level of competence was noted for these clinical skills. There was a significant correlation between frequency of performing clinical skills and perceived competency level (r = 0.651, P < .001). Participants had positive attitudes toward expanding their professional roles (2.13 ± 0.92), with 81.5% agreeing it would improve their job satisfaction.

DISCUSSION

Higher perceived competency levels were significantly associated with more frequent performance of clinical skills. This has implications for nurse managers and educators who may consider offering more frequent experiential and educational opportunities to emergency nurses. Expansion of nurses' roles could also result in increased experience in clinical skills and higher levels of competency. Research is needed to investigate nurses' clinical competence using direct and observed measures.

Development and psychometric properties rating scale of "clinical competency evaluation in mental health nurses": Exploratory factor analysis

Introduction

Evaluation of clinical competency in nurses has a distinct importance in healthcare due to its significant impact on improving the quality of patient care and creation of opportunities for professional promotion. This is a psychometric study for development of the “Clinical Competency of Mental Health Nursing”(CCMHN) rating scale.

Methods

In this methodological research that was conducted in 2015, in Tehran, Iran, the main items were developed after literature review and the validity and reliability of the tool were identified. The face, content (content validity ratio and content validity index) and construct validities were calculated. For face and content validity, experts’ comments were used. Exploratory factor analysis was used to determine the construct validity. The reliability of scale was determined by the internal consistency and inter-rater correlation. The collected data were analyzed by SPSS version 16, using descriptive statistical analysis.

Results

A scale with 45 items in two parts including Emotional/Moral and Specific Care competencies was developed. Content validity ratio and content validity index were 0.88, 0.97 respectively. Exploratory factor analysis indicated two factors: The first factor with 23.93 eigenvalue and second factor with eigenvalue 2.58. Cronbach’s alpha coefficient for determination of internal consistency was 0.98 and the ICC for confirmation inter-rater correlation was 0.98.

Conclusion

A scale with 45 items and two areas was developed with appropriate validity and reliability. This scale can be used to assess the clinical competency in nursing students and mental health nurses.

North Korean refugee doctors' preliminary examination scores

PURPOSE

Although there have been studies emphasizing the re-education of North Korean (NK) doctors for post-unification of the Korean Peninsula, study on the content and scope of such re-education has yet to be conducted. Researchers intended to set the content and scope of re-education by a comparative analysis for the scores of the preliminary examination, which is comparable to the Korean Medical Licensing Examination (KMLE).

METHODS

The scores of the first and second preliminary exams were analyzed by subject using the Wilcoxon signed rank test. The passing status of the group of NK doctors for KMLE in recent 3 years were investigated. The multiple-choice-question (MCQ) items of which difficulty indexes of NK doctors were lower than those of South Korean (SK) medical students by two times of the standard deviation of the scores of SK medical students were selected to investigate the relevant reasons.

RESULTS

The average scores of nearly all subjects were improved in the second exam compared with the first exam. The passing rate of the group of NK doctors was 75%. The number of MCQ items of which difficulty indexes of NK doctors were lower than those of SK medical students was 51 (6.38%). NK doctors' lack of understandings for Diagnostic Techniques and Procedures, Therapeutics, Prenatal Care, and Managed Care Programs was suggested as the possible reason.

CONCLUSION

The education of integrated courses focusing on Diagnostic Techniques and Procedures and Therapeutics, and apprenticeship-style training for clinical practice of core subjects are needed. Special lectures on the Preventive Medicine are likely to be required also.

Exploring examiner judgement of professional competence in rater based assessment

Exercise physiology courses have transitioned to competency based, forcing Universities to rethink assessment to ensure students are competent to practice. This study built on earlier research to explore rater cognition, capturing factors that contribute to assessor decision making about students' competency. The aims were to determine the source of variation in the examination process and document the factors impacting on examiner judgment. Examiner judgement was explored from both a quantitative and qualitative perspective. Twenty-three examiners viewed three video encounters of student performance on an OSCE. Once rated, analysis of variance was performed to determine where the variance was attributed. A semi-structured interview drew out the examiners reasoning behind their ratings. Results highlighted variability of the process of observation, judgement and rating, with each examiner viewing student performance from different lenses. However, at a global level, analysis of variance indicated that the examiner had a minimal impact on the variance, with the majority of variance explained by the student performance on task. One anomaly noted was in the assessment of technical competency, whereby the examiner had a large impact on the rating, linked to assessing according to curriculum content. The thought processes behind judgement were diverse and if the qualitative results had been used in isolation, may have led to the researchers drawing conclusions that the examined performances would have yielded widely different ratings. However, as a cohort, the examiners were able to distinguish good and poor levels of competency with the majority of student competency linked to the varying ability of the student.

The relationship between nurses' clinical competence and burnout in neonatal intensive care units

Background:

Nurses’ clinical competency plays an important role in the care of preterm infants. On the other hand, burnout is one of the most important factors in reducing the nurses’ efficiency. With regard to the importance of the role of nurses, and the vulnerability of the infants, the purpose of this study was to investigate the relationship between nurses’ burnout and clinical competency in NICUs.

Materials and Methods:

The descriptive cross-sectional study was conducted with the participation of 86 nurses working in the NICUs of hospitals in Isfahan, Iran. Census sampling method was used in the NICUs of educational hospitals in 2014. Data were collected by a questionnaire including demographic characteristics, Patricia clinical competency, and Maslach burnout scales. Data were analyzed by the statistical tests of independent t-test and Pearson correlations test with the significance level of α < 0.05.

Results:

Six dimensions of clinical competency and three dimensions of nurses’ burnout were assessed at three levels (weak, moderate, and strong levels). Statistical tests showed that clinical competency was at a moderate level in all fields. Of the dimensions of nurses’ burnout, emotional exhaustion was moderate, depersonalization was weak, and personal performance was strong. The results showed that nurses’ burnout and clinical competency in the NICUs were at a moderate level and had a significant negative relationship (r = −0.322, P = 0.003).

Conclusions:

Results showed that burnout had a negative relationship with competency. Therefore, managers are suggested to improve nurses’ competency and diminish their job burnout through better and more applicable planning.

Ultrasound clinical progress monitoring: Who, where and how?

Prior to assessment of final ultrasound clinical competency it is important to monitor clinical progress, provide high quality feedback and encourage skills development. The role of the supervisor, mentor and assessor are fundamental to the on-going progress monitoring of ultrasound trainees. This article forms the second part of a larger project which was to elicit ultrasound practitioners' opinions on how progress should be monitored, where and by whom. An on-line questionnaire was used to gain opinions from ultrasound practitioners. Totally, 116 responses were received from professionals with an interest in ultrasound assessment. Results suggested that experienced, qualified ultrasound practitioners should undertake the role of supervisor and assessor, having been prepared for that role by the training centre. Formative monitoring should take place both within the clinical department and possibly the training centre, using a range of methods. Following completion of the training, practitioners should have a preceptorship period to consolidate their knowledge and skills for 3 to 6 months or until further competencies have been demonstrated. Formative progress monitoring should be a recognised part of ultrasound training. Essentially, staff undertaking supervision and assessor roles should be supported and trained to ensure a high quality, consistent learning experience for ultrasound trainees. Additionally, they should provide appropriate feedback to the trainee and education centre.

Development of clinical competence assessment tool for novice physical and occupational therapists-a mixed Delphi study

[Purpose] The aim of this study was to clarify essential abilities of novice physical and occupational therapists for independent execution of their duties and to develop a clinical competence assessment tool. [Subjects] Forty-five experienced therapists participated in this study. [Methods] A two-phase mixed-methods design was used. First, semi structured interviews were conducted on 15 experienced therapists to create a comprehensive list of essential abilities that novice therapists need. Second, 30 experienced therapists participated in a two-round Delphi study to select items for the assessment tool being developed. [Results] Fifty-five items were extracted and classified into three categories: basic attitudes, therapeutic skills, and clinical practice-related thoughts. [Conclusion] Present results suggest that not only knowledge of execution of therapy-related duties and therapeutic skills is essential in novice therapist, but also appropriate abilities in social adjustment, self-management, and self-education. The newly developed tool might be useful for postgraduate education in clinical practice.

Relation between spiritual intelligence and clinical competency of nurses in Iran

Background:

Clinical competency is one of the most important requirements in nursing profession, based on which nurses are assessed. To obtain an effective and improved form of clinical competency, several factors are observed and monitored by the health educational systems. Among these observed factors, spiritual intelligence is considered as one of the most significant factors in nurses’ success and efficacy. In this study, it is aimed to determine the spiritual intelligence status and its relationship with clinical competency.

Materials and Methods:

The descriptive–correlational research was carried out on 250 nurses in Mashhad educational hospitals, selected by multi-stage sampling. Demographic, clinical competency, and spiritual intelligence questionnaires were used for data collection and 212 questionnaires were analyzed.

Results:

About 53.3% of nurses obtained above average scores in spiritual intelligence. Clinical competency was evaluated by both self-evaluation and head nurse evaluation methods. Most nurses (53.8%) were having good level of clinical competency based on self-evaluation, 48.2% were at average level based on head nurse evaluation, and 53.3% were at average level based on overall score. A significant correlation was found between spiritual intelligence and clinical competency.

Conclusions:

In this study, the positive significant correlation between nurses’ spiritual intelligence and their clinical competency is investigated. Because of the positive effects of spiritual intelligence on nurses’ clinical competency and quality of care, it is recommended to develop nurses’ spiritual intelligence during their education and by way of continuous medical education.

Clinical Competency of 1-Year Trained Vision Technicians in Andhra Pradesh, India

PURPOSE

To assess clinical competency of 1-year trained vision technicians (VTs) in detecting and referring causes of visual impairment in India.

METHODS

Eye examination results and management plans for 328 patients examined by 24 VTs in 24 vision centers of LV Prasad Eye Institute in Andhra Pradesh were compared with those of a standard optometrist who examined the same patients. Eye examinations included retinoscopy and subjective refraction, slit lamp examination, applanation tonometry and undilated direct ophthalmoscopy. Data were analyzed for level of concordance in retinoscopy, spectacle prescription, disease detection and referral.

RESULTS

VTs demonstrated moderate to good levels of agreement in refraction, disease detection and referral. Sensitivity and specificity for ocular pathology identification were 77.4% (95% confidence interval, CI, 69.4-84.2%) and 86.6% (95% CI 81.1-91.1%), respectively. The highest sensitivity was demonstrated in detecting significant cataract (91.5%) and refractive error (83.0%). VT spectacle prescriptions were accurate 76% of the time for mean spherical equivalent and 65% of the time for astigmatism. VT sensitivity in detecting posterior segment abnormalities was low (18.5%) resulting in failure to detect retinal conditions such as diabetic retinopathy and maculopathy. Despite lack of recognition of the specific pathology, referral decisions were correct in 78.4% of cases.

CONCLUSION

VTs in India competently detect and manage or refer the two most common causes of visual impairment; uncorrected refractive error and cataract. Over two-thirds of patients received accurate and appropriate services from VTs, suggesting that they are a useful and competent cadre for rural and remote eye care.

Reliability of clinical competency evaluation list for novice physical and occupational therapists requiring assistance

[Purpose] This study examined the reliability of a clinical ability evaluation table developed in a previous study with the aim of clarifying the abilities necessary for therapists to independently implement their duties. [Subjects and Methods] Forty-eight physical therapists with less than 2 years of clinical experience were targeted for evaluation, 48 main supervisors, and 48 sub-supervisors, 144 in total, were studied. [Results] The total score was lower when the evaluation was conducted by the target therapists themselves than when it was conducted by the main or sub-supervisors. Regarding the reliability of the total scores for the entire scale and each category, values representing the intra-rater reliability were higher when the evaluation was conducted by the target therapists or main supervisors, while there were marked differences between high and low values for each item. Regarding the inter-rater reliability, both the total scores for the entire scale and each category, as well as values for each item, were low. [Conclusion] Values representing the intra-rater reliability of the study table were low, indicating the necessity of further improvement.

Summative clinical competency assessment: A survey of ultrasound practitioners' views

Clinical competency and the assessment of core skills is a crucial element of any programme leading to an award with a clinical skills component. This has become a more prominent feature of current reports on quality health care provision. This project aimed to determine ultrasound practitioners' opinions about how best to assess clinical competency. An on-line questionnaire was sent to contacts from the Consortium for the Accreditation of Sonographic Education and details distributed at the British Medical Ultrasound Society conference in 2011. One hundred and sixteen responses were received from a range of clinical staff with an interest in ultrasound assessment. The majority of respondents suggested that competency assessments should take place in the clinical departments with or without an element of assessment at the education centre. Moderation was an important area highlighted by respondents, with 84% of respondents suggesting that two assessors were required and 66% of those stating some element of external moderation should be included. The findings suggest that respondents' preference is for some clinical competency assessments to take place on routine lists within the clinical department, assessed by two people one of which would be an external assessor. In view of recent reports relating to training and assessment of health care professionals, the ultrasound profession needs to begin the debate about how best to assess clinical competence and ensure appropriate first post-competency of anyone undertaking ultrasound examinations.

A core competency model for Chinese baccalaureate nursing graduates: a descriptive correlational study in Beijing

BACKGROUND

A review of the literature showed that the core competencies needed by newly graduated Chinese nurses were not as of yet undocumented.

OBJECTIVE

To develop a psychometrically sound instrument for identifying and measuring the core competencies needed by Chinese nursing baccalaureate graduates.

DESIGN

Descriptive correlational and multicentre study.

SETTING

Seven major tertiary teaching hospitals and three major medical universities in Beijing.

PARTICIPANTS

790 subjects, including patients, nursing faculty members, doctors and nurses.

METHOD

A reliable and valid self-report instrument, consisting of 58 items, was developed using multiple methods. It was then distributed to 790 subjects to measure nursing competency in a broader Chinese context. The psychometric characteristics of reliability and validity were supported by descriptive and inferential analyses.

RESULTS

The final instrument consists of six dimensions with 47 items. The content validity index was 0.90. The overall scale reliability was 0.97 with dimensions range from 0.87 to 0.94. Six domains of core competencies were identified: professionalism; direct care; support and communication; application of professional knowledge; personal traits; and critical thinking and innovation.

CONCLUSION

The findings of this study provide valuable evidence for a psychometrically sound measurement tool, as well as for competency-based nursing curriculum reform.