Personality characteristics of Dutch nurse anesthetists and surgical nurses when compared to the normative Dutch population, a quantitative survey study

BACKGROUND

Working in the perioperative context is complex and challenging. The continual evaluation in this environment underscores the need for adaptability to technological advancements, and requires substantial allocation of resources for training and education. This study aimed to explore personality characteristics of nurse anesthetists and surgical nurses that are instrumental for sustainable employability in technologically advanced environment.

METHODS

Exploratory, cross-sectional survey study including nurse anesthetists and surgical nurses, both certified and in training, and a sample of the normative Dutch population. Personality characteristics were identified with the Big Five Inventory, which consisted of 60 items answered on a five-point Likert scale (strongly disagree to strongly agree).

RESULTS

Specific personality traits were found for nurse anesthetists and surgical nurses when compared to the normative Dutch population. Traits of both nurse anesthetists and surgical nurses differed significantly on all domains of the Big Five Inventory, with the largest differences found within the dimension negative emotionally.

CONCLUSIONS

This study highlights the role of specific personality traits in maintaining employability within the rapidly evolving and technologically advanced landscape of healthcare. It emphasizes the relationship between individual traits and professional excellence, being crucial educational strategies for overall improvement in healthcare.

Primary care drug therapy pharmacists in South Africa: Practice settings and conditions treated

Background

Primary Care Drug Therapy (PCDT) is a supplementary training course for South African pharmacists. The qualification affords pharmacists an expanded scope of practice to treat specific primary health care conditions.

Objective

To describe the practice settings and conditions being treated by PCDT pharmacists in South Africa, with specific focus on differences between services delivered in urban versus rural areas.

Methods

An online questionnaire survey was conducted under all PCDT trained pharmacists in 2021.

Results

Less than half (45.3%; n = 34) of the 75 respondents had received their Section 22 A(15) permit and were practicing as PCDT pharmacists. Of these respondents, only 41.2% were practicing in a rural setting. Overall, respondents indicated that ear, nose and throat conditions, and family planning, were the most often consulted conditions. Differences were, however, observed between provinces, and between urban and rural areas. Family planning, urological conditions and sexually transmitted infections were most frequently consulted in urban areas, whilst gastrointestinal conditions, and ear, nose and throat conditions, were more common in rural areas.

Conclusions

Conditions treated in the different settings in South Africa provided a unique insight into the epidemiological profile of the area, as well as the primary health care needs.

Biomedical informatics: characterization of the offer of massive open online courses

Introduction: Informatics applied to health sciences has brought cutting-edge solutions to healthcare problems. However, the number of health professionals trained in "Health Informatics" is low. Virtual education, such as massive online open courses, provide the opportunity for training in this field. Objective: To estimate the global offer of massive online open biomedical informatics courses and characterize their content. Methods: A search for massive online open courses was conducted throughout December 2021 on 25 platforms offering these courses. The search strategy included the terms "health informatics" and "biomedical informatics". The application areas of biomedical informatics, platform, institution, duration, time required per week, language, and subtitles available for each course were evaluated. Data were analyzed descriptively, reporting absolute and relative frequencies. Results; Our search strategy identified 1333 massive online open courses. Of these, only 79 were related to health informatics. Most of these courses (n = 44; 55.7%) were offered through Coursera. More than half (n = 55; 69.6%) were conducted by U.S. institutions in english (n = 76; 96.2%). Most courses focused on areas of translational bioinformatics (n = 27; 34.2%), followed by public health informatics (n = 23; 29.1%), and clinical research informatics (n = 13, 16.5%). Conclusions: We found a significant supply of massive online open courses on health informatics. These courses favor the training of more professionals worldwide, mostly addressing competencies to apply informatics in clinical practice, public health, and health research.

An evaluation of an Extension for Community Healthcare Outcomes (ECHO) intervention in cancer prevention and survivorship care

To improve cancer care in Indiana, a telementoring program using the Extension for Community Healthcare Outcomes (ECHO) model was introduced in September 2019 to promote best-practice cancer prevention, screening, and survivorship care by primary care providers (PCPs). The aim of this study was to evaluate the program’s educational outcomes in its pilot year, using Moore’s Evaluation Framework for Continuing Medical Education and focusing on the program’s impact on participants’ knowledge, confidence, and professional practice. We collected data in 22 semi-structured interviews (13 PCPs and 9 non-PCPs) and 30 anonymous one-time surveys (14 PCPs and 16 non-PCPs) from the program participants (hub and spoke site members), as well as from members of the target audience who did not participate. In the first year, average attendance at each session was 2.5 PCPs and 12 non-PCP professionals. In spite of a relatively low PCP participation, the program received very positive satisfaction scores, and participants reported improvements in knowledge, confidence, and practice. Both program participants and target audience respondents particularly valued three features of the program: its conversational format, the real-life experiences gained, and the support received from a professional interdisciplinary community. PCPs reported preferring case discussions over didactics. Our results suggest that the Cancer ECHO program has benefits over other PCP-targetted cancer control interventions and could be an effective educational means of improving cancer control capacity among PCPs and others. Further study is warranted to explain the discrepancies among study participants’ perceptions of the program’s strengths and the relatively low PCP participation before undertaking a full-scale effectiveness study.

Co-creating scholarship through collaborative writing in health professions education: AMEE Guide No. 143

This AMEE guide provides a robust framework and practical strategies for health professions educators to enhance their writing skills and engage in successful scholarship within a collaborative writing team. Whether scholarly output involves peer-reviewed articles, book chapters, blogs and online posts, online educational resources, collaborative writing requires more than the usual core writing skills, it requires teamwork, leadership and followership, negotiation, and conflict resolution, mentoring and more. Whilst educators can attend workshops or courses to enhance their writing skills, there may be fewer opportunities to join a community of scholars and engage in successful collaborative writing. There is very little guidance on how to find, join, position oneself and contribute to a writing group. Once individuals join a group, further questions arise as to how to contribute, when and whom to ask for help, whether their contribution is significant, and how to move from the periphery to the centre of the group. The most important question of all is how to translate disparate ideas into a shared key message and articulate it clearly. In this guide, we describe the value of working within a collaborative writing group; reflect on principles that anchor the concept of writing as a team and guide team behaviours; suggest explicit strategies to overcome challenges and promote successful writing that contributes to and advances the field; and review challenges to starting, maintaining, and completing writing tasks. We approach writing through three lenses: that of the individual writer, the writing team, and the scholarly product, the ultimate goal being meaningful contributions to the field of Health Professions Education.

Dental students' preference and perception on intraoral scanning and impression making

BACKGROUND

To investigate the preference and perception on intraoral scanning and impression making among dental students.

METHODS

Final-year dental students from the 2019 and 2020 cohorts were invited to complete an online questionnaire via Google-Form. Their preference on the intraoral-scanning/impression making techniques and their perception on these techniques including the ease of defect identification, ease of infection control, need of chairside support, ease to master the technique as a beginner, efficiency in their hands and ease to handle the scanner software (yes/no) were collected. The results were analysed using McNemar tests and binary logistic regression test. All tests were performed at significance level α = 0.05.

RESULTS

Ninety-seven students participated in this study with a response rate of 96.0 %. Eighty-one students (83.5 %) have tried intraoral scanning on peers. Fifty-three (54.6 %) students preferred intraoral-scanning and were categorized as Pro-scanning group. Forty-four (45.4 %) students either preferred impression-making (n = 21) or not sure (n = 23) were categorized as Others. More than half of students in both groups felt that intraoral-scanning is easier to identify defect, easier in infection control and require less chairside support. Higher proportion of students in the Pro-scanning group felt that intraoral-scanning requires less chairside support, easier to master as a beginner, more efficient in their hands and they can deal well with the scanner software than that in Others (P < 0.05). Regression shown that students preferred a technique that they perceived is more efficient (P = 0.000).

CONCLUSIONS

While intraoral scanning has perceived advantages, many students still prefer impression making that works more efficient to them.

Integrating webinars to enhance curriculum implementation: AMEE Guide No. 136

Webinars have been used in medical education since 2006 and are now part of the educational offerings of many organizations, including universities, societies, and industry for healthcare trainees and professionals. They are frequently used for continuing medical education (CME) and continuing professional development (CPD) for internal medicine physicians, pharmacists, nurses, and surgeons. There is very limited evidence for the positive impact of these educational events on patient care, however, there is literature that suggests they have educational value for various audiences. Based on our own extensive experience, evaluation data, and key findings over the past decade and a review of the literature, this guide proposes best practices for planning, developing, delivering and evaluating webinars as a part of your curriculum. We propose six phases with steps and questions to help achieve the key purposes of each phase.

Assessment of drug-prescribing perception and practice among dental care providers: a cross-sectional Lebanese study

Background:

Dentists play an essential role in providing high-quality dental care, taking into consideration the clinical context and concomitant medications taken by the patients.

Objective:

This study aimed to assess drug-prescribing perception and practices in addition to drug-related educational needs among Lebanese dentists; it also evaluated the need for interprofessional collaboration between dentists and pharmacists.

Methods:

An exploratory cross-sectional study using an online questionnaire targeted a sample of dentists from all Lebanese districts. Participants gave their consent by accepting to complete the survey (ethics approval reference: USJ-2016-63). The questionnaire consisted of closed-ended questions exploring: 1) drug-prescribing perception, 2) drug-prescribing practice, and 3) collaboration with pharmacists regarding their respective roles in providing appropriate counseling to patients. Two indexes were created: the first evaluated self-confidence in prescribing medications, and the second assessed dentists’ confidence in pharmacists. Logistic regressions were performed, taking each index as a dependent variable.

Results

A total of 137 dentists completed the survey (59% females; mean age: 42.17; SD: 13.78 years). The majority had a fair to good perceived knowledge in pharmacology and therapeutics (80.3%), only 30.7% reported to be sufficiently equipped to prescribe safely. Dentists exhibited particularly low perceived knowledge about prescribing in elderly patients, dosing, medication use in pregnancy, drug interactions, and adverse reactions. Dentists specialized in periodontics had the lowest odds of having self-confidence in prescribing drugs (aOR=0.25; p<0.001). Also, 64.3% declared that they routinely check a reference source before prescribing, and 78% relied on pharmaceutical companies and medical representatives to get information on medications. While 61% declared that pharmacists should provide oral care counseling, only half of them encouraged their patients to talk to their pharmacists about their medications. Only 15% considered that patients are getting enough counseling from the pharmacist, with a global confidence index below the median value, suggesting the need for more collaboration, especially with periodontists who exhibited the lowest confidence in pharmacists (aOR=0.45).

Conclusions

Lebanese dentists reported some lack of knowledge and confidence in prescribing practices. Education, training, and close collaboration between pharmacists and dentists are essential to overcome these problems and avoid potential harm to patients.

Strategy required: "Maintenance of certification for European radiologists"

Maintenance of certification (MOC) is thought to be an important tool in assessing and controlling quality of medical professionals. Considerations on the heterogeneity of implementation throughout various National Radiology Associations are described. Testocracy is warned for. The urge for defining strategical steps from a central institute is discussed.

Frequency of Early Refills for Opioids in the United States

OBJECTIVE

Refilling an opioid prescription early is an important risk factor of prescription opioid abuse and misuse; we aimed to understand the scope of this behavior. This study was conducted to quantify the prevalence and distribution of early refills among patients prescribed opioids.

METHODS

We conducted a retrospective cohort study utilizing dispensed prescription records. Patients filling one or more prescription opioids were identified and followed for one year. Early refills were defined as having a second prescription filled ≥15% early relative to the days' supply of the previous prescription for the same opioid (according to the National Drug Code [NDC]). The distribution of the number of early refills and patient characteristics were assessed.

RESULTS

A total of 60.6 million patients met the study criteria; 28.8% had two or more opioid prescriptions for the same opioid during follow-up. Less than 3% of all patients receiving an opioid had an early refill. Approximately 10% of those with two or more opioid prescriptions for the same drug had an early refill. For patients with multiple fills (N = 1.5 million with extended-release long-acting [ER/LA] opioids; N = 17.1 million with immediate-release short-acting [IR/SA] opioids), early refills were more common among patients with an ER/LA opioid (18.5%) compared with an IR/SA opioid (8.7%). Three-quarters of patients with an early refill had only one (70.9% and 78.4% for ER/LA and IR/SA, respectively).

CONCLUSION

Refilling an opioid prescription with the same opioid early is an infrequent behavior within all opioid users, but more common in ER/LA users. Patients who refilled early tended to do so just once.

Maintenance of certification for radiologists: an overview of European countries

Background

It is currently unclear whether the continuing medical education (CME) requirements for radiologists to keep up their certification are equal across Europe, which would be desirable for uniform cross-border quality of radiology and because of the fundamental principle of free movement of workers in the European Union. This study aimed to determine the maintenance of certification requirements for radiologists in different European countries.

Methods

National radiological societies of European countries and/or their delegates as listed on the European Society of Radiology website were contacted to inquire about the maintenance of licensure requirements for radiologists in their country. Data were analysed using descriptive statistics.

Results

Forty-six European countries were contacted. Response rate was 80%. Twenty-two of 36 responding countries (59%) reported mandatory requirements to maintain a radiologist’s license to practise. The median license period was 5 years (range 1–7). The median required number of CME points per year was 40 (range 8–58, interquartile range 30). Eight countries reported additional requirements, including practising clinical radiology, attending quality meeting/clinical audit, and attending additional courses (such as radiation safety training and advanced medical training course). Fifteen of 37 responding countries (41%) did not report mandatory requirements.

Conclusions

There is considerable heterogeneity across European countries regarding the maintenance of certification requirements for radiologists. More homogeneity is desired for uniform quality assurance and professional mobility of radiologists across Europe. The data from our overview may be used to establish a benchmark for national societies who issue maintenance of licensure requirements for radiologists.

FDA collaboration to improve safe use of fluoroquinolone antibiotics: an ex post facto matched control study of targeted short-form messaging and online education served to high prescribers

Objective:

This ex post facto matched control study was conducted to evaluate the effect of targeted short-form messages or continuing medical education (CME) on fluoroquinolone prescribing among high prescribers.

Methods:

A total of 11,774 Medscape healthcare provider (HCP) members prescribing high volumes of fluoroquinolones were randomized into three segments to receive one of three unique targeted short-form messages, each delivered via email, web alerts, and mobile alerts. Some HCPs receiving targeted short-form messages also participated in CME on fluoroquinolone prescribing. A fourth segment of HCPs participated in CME only. Test HCPs were matched to third-party-provider prescriber data to identify control HCPs. We used prescriber data to determine new prescription volume; percentage (%) of HCPs with reduced prescribing; new prescription volume for acute bacterial sinusitis (ABS), uncomplicated urinary tract infection (uUTI), and acute bacterial exacerbations of chronic bronchitis in those with chronic obstructive pulmonary disease (ABECB-COPD). Open rates for emailed targeted short-form messages were also measured.

Results:

Targeted short-form messages and CME each resulted in significant new prescription volume reduction versus control. Combining targeted short-form messages with CME yielded the greatest percentage of test HCPs with reduced prescribing (80.1%) versus controls (76.2%; p<0.0001). New prescription volume decreased significantly for uUTI and ABS following exposure to targeted short-form messages, CME, or both. Targeted short-form messages containing comparative prescribing information with or without clinical context were opened at slightly higher rates (10.8% and 10.6%, respectively) than targeted short-form messages containing clinical context alone (9.1%).

Conclusions:

Targeted short-form messages and CME, alone and in combination, are associated with reduced oral fluoroquinolone prescribing among high prescribers.

Mandatory continuing education for pharmacists in a developing country: assessment of a three-year cycle

Background:

In Lebanon, mandatory continuing education (CE) for pharmacists was implemented in January 2014.

Objective:

The objectives of this study are to assess 1) the overall adherence to the mandatory CE program, 2) pharmacists’ preferences related to CE, and 3) barriers to adherence to CE.

Methods:

By the end of October 2017, an evaluation of pharmacists’ participation in the mandatory CE program was conducted using electronic reports available in the Learning Management System (LMS). Descriptive results were presented as frequencies and percentages. In addition, a cross-sectional survey was conducted among pharmacists to better understand their preferences and barriers to their participation to the CE program. Finally, a focus group was organized with pharmacists who did not start their CE.

Results:

Out of all registered pharmacists in Lebanon, 68.30% started their CE and 25.6% already achieved their required credits. Among pharmacists enrolled in the CE system, the majority (69%) used the online courses at least once. Moreover, CE enrolment was similar among old and young pharmacists except for those newly registered. The majority of pharmacists preferred clinical and pharmacological topics, followed by preventive medicine and transferable skills. Barriers to engaging in CE were mainly work and family obligations, lack of interest, lack of time, and difficulties in commuting and technology use.

Conclusion:

Although results of the present study are similar to those in developing countries, the resistance to change is higher. The Lebanese Pharmacists Association [Ordre des Pharmaciens du Liban] should develop strategies to motivate and enroll more pharmacists in the CE system, based on the barriers and preferences cited in the results, while continuing to offer high quality and cost-favorable CE programs to Lebanese pharmacists.

Cost-Effectiveness of Digital Wound Care Education in a Healthcare Organization

Advantages of digitalization are understood, but implementation to healthcare is slow. Cost savings and quality improvements are needed in healthcare. Continuous education of healthcare professionals is essential for quality, and digital education (DE) enables that cost-efficiently. The aim was to evaluate the cost-effectiveness of a DE for wound care by comparing it to lecture education (LE). DE enabled a slightly better learning outcome than LE. However, combination resulted in superior outcome. DE provided best cost-effectiveness.

A training program incorporating a diabetes tool to facilitate delivery of quality diabetes care by community pharmacists in Malaysia and Australia

Objectives:

To assess a clinical training program on management of Type 2 Diabetes Mellitus (T2DM) incorporating a diabetes tool, the Simpler™ tool. Subsequently pharmacists’ experience utilising the tool to deliver structured, consistent, evidence-based T2DM care was explored.

Methods:

Full-time non-credentialed diabetes pharmacists providing diabetes medication management services in community settings were purposively recruited. Participants had either face-to-face or online training on diabetes management using the tool which took about two hours and 20 minutes to complete. Their diabetes management knowledge was assessed pre- and post-training using quantitative methodology. They were then required to apply the tool in daily practice for one month. Feedback on both the training sessions and tool utilisation were obtained through semi-structured interviews and analysed using a qualitative approach.

Results:

Twelve pharmacists participated: Six from Australia and six from Malaysia. Before attending the training session, their median test score was 6.5/27, IQR 1.4 (1st marker) and 5.3/27, IQR 2.0 (2nd marker). After training, the scores doubled to 14.3/27, IQR 4.5 (1st marker) and 11.3/27, IQR 3.1 (2nd marker), showing significant improvements (p=0.002). Interview data identified perceived effectiveness factor through use of the tool. Participants found the content relevant, structured, concise and easy to understand; enabled comprehensive medication reviews; focused on achieving glycaemic improvement; facilitated documentation processes and pharmacists’ role in T2DM management; and as a specific aid for diabetes management. Barriers included lack of accessibility to patients’ laboratory data in Australia.

Conclusions:

The targeted training improved pharmacists’ knowledge on diabetes management and supported the Simpler™ tool use in practice as a structured and beneficial method to deliver evidence-based T2DM care.

Attitudes of Lebanese pharmacists towards online and live continuing education sessions

Background:

Continuing education (CE) is an internationally recommended approach as a lifelong learning model for pharmacists, enabling them to maintain the necessary knowledge, skills and ethical attitudes so as to remain current and competent in their practice.

Objectives:

The objective of this study is to 1) describe factors associated with taking different types of CE courses among pharmacists in Lebanon, and 2) assess the correlation between types of CE activity and the attitude of Lebanese pharmacists (motivation and value) and their computer literacy.

Methods:

This is a cross-sectional observational study conducted between February and May 2017, using a random sample of Lebanese pharmacists from all districts of Lebanon. All pharmacists were eligible to participate; the sample consisted of those who agreed to complete the questionnaire. The questionnaire includes questions about computer literacy, motivation and value about CE, in addition to sociodemographic characteristics of pharmacists.

Results:

Out of the 750 questionnaires distributed, 628 (83.73%) were filled out and returned to be analyzed. The mean age of the participants was 39.04 (SD 10.57) years, 66.9% of them were females, and 41.1% of them had a bachelor degree in pharmacy and worked in Mount Lebanon. Among the 628 respondents, 567 (90.3%) have earned at least one CE credit. Of those, 5.4% took mainly online courses, 15.4% took mainly live courses and the remaining took both types of CE. Higher motivation (aOR=1.05; CI 0.994-1.109) and higher value (aOR=1.076; CI 0.968-1.197) were associated with higher odds of taking live CE courses. Higher motivation (aOR=1.07; 95%CI 0.994-1.152) was associated with higher odds of taking online CE courses. Higher motivation (aOR=1.059; 95%CI 1.006-1.114) and higher general confidence with computer use (aOR=1.058; 95%CI 1.012-1.106) were significantly associated with higher odds of taking both types of CE courses.

Conclusions:

A high percentage of Lebanese pharmacists enrolled in the CE system, mainly driven by motivation and value of CE, in addition to a higher general confidence in computer use. Further efforts should be exerted by the Lebanese Order of Pharmacists to motivate pharmacists and help them improve their computer literacy, which is expected to improve not only enrollment in CE activities, but also the completion of their CE requirements.

National Trends in Prescription Opioid Risk Mitigation Practices: Implications for Prescriber Education

OBJECTIVES

To assess national trends in selected prescription opioid risk mitigation practices and associations with prescriber type, state-specific opioid overdose severity, and required pain education.

METHODS

Analysis of the national SCOPE of Pain registrants' baseline self-report of five safer opioid prescribing practices over three years (March 2013-Februrary 2016).

RESULTS

Of 6,889 registrants for SCOPE of Pain, 70-94% reported performing each of five opioid risk mitigation practices for "most or all" patients, with 49% doing so for all five practices. Only 28% performed all five practices for "all" patients prescribed opioids. There were few differences among three yearly cohorts. Advanced practice nurses reported performing practices for "all" patients more often than physicians or physician assistants. Clinicians from states with high opioid overdose rates reported significantly higher implementation of most practices, compared with clinicians from states with low rates.

CONCLUSIONS

Prescribers report low levels of employing five opioid risk mitigation practices for all patients prescribed opioids before attending a safer opioid prescribing training.

POLICY IMPLICATIONS

Safer opioid prescribing education should transition from knowledge acquisition toward universal implementation of opioid risk mitigation practices.

Nurse and physician reflections on the application of a quality standards training program to reduce maternal mortality

OBJECTIVE

High rates of maternal mortality persist in Low and Middle Income countries, despite increasing rates of facility-based births, suggesting a need to focus on quality of maternity care. The purpose of the current study was to evaluate provider perspectives on the implementation of material taught during an evidence-based medical education session aimed at reducing common causes of maternal death in government hospitals in India.

DESIGN

Several months after the training, labor room nurses and physicians from twenty-two hospitals participated in semi-structured focus group discussions.

SETTING

Training sessions were held in an off-site location in each of fourteen districts across Kerala, India.

PARTICIPANTS

Nurses and physicians working in labor and delivery wards within government hospitals.

INTERVENTION

Participants were trained on evidence-based practices to treat and prevent common causes of maternal death. Training was a combination of lecture and hands-on practice, conducted over a single working day in a classroom setting.

MEASUREMENTS AND FINDINGS

Main items of discussion were challenges to implementing material taught in the training session and identification of successful strategies to adopt the recommended standards of care. Primary barriers to implementation of quality standards were provider unwillingness to apply new techniques, inadequate infrastructure, challenges with staffing capacity and lack of required materials and equipment. Facilitators to implementing standards of care included staff motivation, supportive leadership and co-training of nurses and doctors.

KEY CONCLUSIONS

In international settings, clinical uptake of evidence-based material taught in a classroom format may differ by physician attitude and may be moderated by external factors such as infrastructure quality and equipment availability. In some circumstances, highly motivated staff may overcome external barriers through effort and persistence.

IMPLICATIONS FOR PRACTICE

Continuing medical education aimed to improve utilization of evidence-based maternity care in low- and middle-income countries may have limited effect without complementary support from hospital administration and provision of adequate infrastructure, equipment and materials to support evidence-based practice.

Assessing the perceptions of pharmacists working in Lebanese hospitals on the continuing education preferences

BACKGROUND

Continuing education (CE) is an international tool that requires lifelong active participation in learning activities allowing the pharmacist to stay a major player among others. In 2014 the CE program was introduced to the pharmacists licensed in Lebanon as a mandatory requirement for re-licensure. In the absence of guidelines regarding the quality and quantity of CE programs, behavioral resistance to precipitate in the CE programs might be encountered among the pharmacists.

OBJECTIVE

The objective of this study is to assess the perceptions of pharmacists working in Lebanese hospitals on the continuing education preferences. The advantage of this program is to collect information that would help the Order of Pharmacy in Lebanon to upgrade the CE program in a way that is more acceptable and convenient for the pharmacists.

METHODS

A cross-sectional study was carried out in 2016, using a proportionate random sample of Lebanese hospital pharmacies from all governorates in Lebanon. A structured questionnaire was distributed to all hospital pharmacies in Lebanon. Descriptive statistics were calculated for all study variables. This includes the mean and standard deviation for continuous measures, counts and percentages for categorical variables.

RESULTS

A total of 107 (53.5%) participants completed the questionnaires. The majority of participants were from Beirut and Mount Lebanon. The percentage of participants working at private hospitals was (68.2%).The majority of participants who completed the questionnaire (86.2%) agreed that continuing education programs affects their way of practice and increases their knowledge. Their preferred CE types to be used in the future were the computer based ones (60.6%), interactive workshops (45.5%) and printed materials (44.9%). Their considerations for selecting the CE type is based on their interest in the topic (80.6%), the ease of access to print or online material (77.2%), or the convenience of being offered during an event (67.1%). Participants noted that barriers to attend live CEs were mainly work responsibilities (76%), travel distance (65.6%), family commitments (48.4%) and scheduling (40.6%).

CONCLUSIONS

Lebanese hospital pharmacists are highly committed to CE. They consider it a practical tool for career development and advancement.

Attitudes towards continuous professional development: a study of pharmacists in Lebanon

Objective:

To investigate the views and assess motivation, attitudes of pharmacists in Lebanon towards mandatory continuous education (CE), its transition to Continuous Professional Development (CPD), and identify barriers to participation in CPD.

Methods:

A cross-sectional observational study, conducted between February and May 2017, enrolled 591 pharmacists. The questionnaire used in this study was developed after an extensive literature review and based on previous similar studies in different countries.

Results:

Half of the pharmacists who completed the questionnaire agreed that all the factors that were mentioned in the questionnaire motivated completing CPD, whereas 55.4% felt confident that CPD meets their needs. 78.4% felt confident in their abilities to assess what they have learned. 71.6% felt confident in their abilities to assess what additional CPD activity may be necessary. The majority of the pharmacists agreed that accessibility of group learning activities (location/distance) (69.6%), job restrictions (76.3%) and lack of time (80.6%) were the most essential barriers against participation in CPD. Motivation was significantly and positively correlated with attitude (r= 0.718), but negatively correlated with barriers (r= -0.243). Attitude was significantly and negatively correlated with barriers (r= -0.120).

Conclusion:

Our findings contribute to informing the forward pathway for the profession. Attitude and motivation to CPD were positive in this study. Accessibility of group learning activities due to distance and location, job restrictions and lack of time were the major barriers to participation in CPD. Potential solutions can be sought to address these issues.

Ongoing nursing training influence on the completion of electronic pressure ulcer records

INTRODUCTION

Pressure ulcer (PU) care in nursing at the Hospital Clínico Universitario de Valladolid (HCUV) in Spain includes basic care and its registration through the electronic GACELA Care tool. To assess and evaluate the nursing intervention in PU evolution, a training programme was carried out to unify criteria on PU assessment, treatment, evaluation and monitoring.

OBJECTIVE

To assess the influence of training on the completion of PU records in the GACELA Care application, and identify the level of satisfaction of the nurses after its use.

MATERIALS AND METHODS

A quasi-experimental prospective study consisting of a specific training programme assessed pre- and post-training was carried out on the records of PU documentation at the HCUV. The PU records included in the study were collected using the electronic nursing healthcare management computer tool GACELA Care and belonged to patients admitted for >48h, excluding venous, arterial and stage I PUs. The pre-training sample consisted of 65 records collected between 1 April and 30 June 2014, and there were 57 post-training records, completed from 1 January to 31 March 2015. The training programme consisted of thirty-minute theoretical and practice training sessions. The study variables were ulcer type, location, stage, length and diameter, perilesional skin, cure type, products used and cure frequency, in addition to the number of actions taken in the records in correlation to the days of hospitalisation. To identify the nurses' opinions, a satisfaction survey about the management platform of ongoing Castilla y León training was administered.

RESULTS

The variations from the pre- to the post-training PU-sample completion rates were the following: from 23% to 40% for PU diameter, from 11% to 38% for PU length and from 57% to 79% for perilesional skin condition records. There was also a significant increase in the number of form updates after the training activity. The nurses' level of satisfaction with the training activity showed a positive outcome, with an average score of 8.84 over 10.

CONCLUSION

The training activity improved PU record completion significantly and was deemed positive by the nurses, mainly for its applicability in clinical practice.

Are burnout prevention programs for hospital physicians needed?

INTRODUCTION

Burnout, whether as a brief episode or more protracted, affects all aspects of a physician's life. Given the critical role of physicians in society, efforts to monitor, preserve, and enhance physician health are beneficial also to their patients. We investigated the patterns of burnout in physicians.

METHODOLOGY

Maslach Burnout Inventory (MBI), in the General Survey version, was handed out to interested physicians of a Canadian general hospital in a Grand Rounds lecture on "well-being of physicians." They were to complete the MBI on an anonymous basis. Fifty-five adequately completed questionnaires were received.

RESULTS

Our physicians obtained significantly higher (p<0.01) average score on Emotional Exhaustion subscale of MBI (14.0, SD=7.5) and on the Cynicism subscale of the MBI than average scores from combined 9 occupational samples listed in Maslach's manual: our physicians reported more intense emotional depletion and endorsed more items suggestive of cynicism. However, their average Professional Efficacy score (27.6, SD=6.3) did not significantly differ from Maslach's combined average for this subscale. The physicians' Professional Efficacy scores were not significantly related to those of Emotional Exhaustion and of Cynicism (Pearson coefficients, p>0.05).

CONCLUSIONS

This suggests that improving professional medical skills (and thus a sense of efficiency) alone cannot prevent physicians from burnout. An implementation of other preventive strategies such as those based on mindfulness or on cognitive behaviour therapy (CBT) is necessary.

Organisation of workplace learning: a case study of paediatric residents' and consultants' beliefs and practices

Several studies have examined how doctors learn in the workplace, but research is needed linking workplace learning with the organisation of doctors' daily work. This study examined residents' and consultants' attitudes and beliefs regarding workplace learning and contextual and organisational factors influencing the organisation and planning of medical specialist training. An explorative case study in three paediatric departments in Denmark including 9 days of field observations and focus group interviews with 9 consultants responsible for medical education and 16 residents. The study aimed to identify factors in work organisation facilitating and hindering residents' learning. Data were coded through an iterative process guided by thematic analysis. Findings illustrate three main themes: (1) Learning beliefs about patient care and apprenticeship learning as inseparable in medical practice. Beliefs about training and patient care expressed in terms of training versus production caused a potential conflict. (2) Learning context. Continuity over time in tasks and care for patients is important, but continuity is challenged by the organisation of daily work routines. (3) Organisational culture and regulations were found to be encouraging as well inhibiting to a successful organisation of the work in regards to learning. Our findings stress the importance of consultants' and residents' beliefs about workplace learning as these agents handle the potential conflict between patient care and training of health professionals. The structuring of daily work tasks is a key factor in workplace learning as is an understanding of underlying relations and organisational culture in the clinical departments.

Assessment of Texan pharmacists' attitudes, behaviors, and preferences related to continuing pharmacy education

BACKGROUND

Whether the available Continuing Education (CE) programs meet pharmacists' continuously increasing needs and preferences is open to question.

OBJECTIVES

to investigate pharmacists' perceptions and attitudes concerning available CE programs, evaluate the pharmacists' choices with regard to selecting among different CE programs, and investigate the factors that are associated with preference to utilize online CE programs.

METHOD

A 17-question survey was developed and mailed to a random sample of 600 Texan pharmacists. In addition to collecting basic demographic information, the survey investigated pharmacists' choices with regard to delivery and content of CE programs, motivations to participation in CE programs, and pharmacists' preferences for future CE programs.

RESULTS

A total of 161 pharmacists completed the survey and mailed back their responses. Excluding the 75 undeliverable surveys, the response rate was 31%. Approximately 83% of respondents found that currently available CE programs met their educational needs. The most important factors influencing pharmacists' choices with regard to CE programs were the scope programs, the location where programs are held, and the cost associated with enrolling in such programs. Online CE was the most preferred mode of CE among participants. The factors that were associated with pharmacists' preferences to complete 50% or more of required CE through online programs were previous use of online CE programs, preference to limit the duration of CE programs to 1 or 2 hour-long, and perceived ability to find adequate CE programs among currently available CE programs.

CONCLUSION

The findings suggest modalities for CE programs providers on how to improve CE programs in the future in order to meet the preferences of local pharmacists.

Creating a journal club competition improves paediatric nurses' participation and engagement

BACKGROUND

To improve journal club participation, innovative approaches are required but few have been described. It was unknown if adding an element of competition, to an established journal club, would increase nurses' participation.

OBJECTIVE

To explore the impact on attendance and participation in a hospital-wide nursing journal club through the introduction of an element of competition.

DESIGN

A descriptive exploratory study.

SETTING AND PARTICIPANTS

An Australian specialist tertiary paediatric hospital with over 1600 nurses.

METHODS

In 2013, 12 hospital wards/departments were randomly assigned a month each to present journal club. Nurses were supported to evaluate an article according to a published framework. A predetermined rubric guided marking. Post competition, all hospital nurses received an anonymous online survey invitation. Demographic, Likert scale and qualitative data were collected. Questions elicited attitudes and perceived barriers or facilitators to participation in the journal club.

RESULTS

Compared to 2012, there was a statistically significant increase in journal club attendance (2013 median=20.5 [IQR=18.2, 27.7] vs. 2012 median=9 [IQR=6.5, 12.5], Mann-Whitney U test, p<0.01). Full online survey responses were received from 289/1674 (response rate 17.3%) of sent invitations (Non-Attendees n=224, Attendees n=65 (including 18 presenters). Overall, Attendees reported journal club had a positive impact on their professional engagement. Presenters rated the journal club format highly as it developed skills and increased their confidence in journal club presentation. Emergent themes were time and location, engagement, topics and content.

CONCLUSION

A competition format can increase nurses' journal club attendance and participation. Further work is required to establish applicability of this format to other settings.

Family medicine 360°: Global exchanges in family medicine

Objective:

The global world of the 21^st century has created communities and cultures that are interconnected, thanks to the development both in the field of transportation and technology. In this global intercultural community, future physicians, and even more so future general practitioners (GPs)/family physicians (FPs), need to be clinically competent and culturally sensitive and flexible in order to adapt to different social settings while delivering holistic care in multiethnic teams and environments with professionalism. As such, exchange programs are exceptional opportunities for international collaboration and the development of personal and professional competencies of these health care professionals.

Materials and Methods:

This article presents a review of the literature on the value of exchanges as well as the results of exchange programs with educational content that are aimed at junior GPs/FPs.

Results:

Exchange programs have been growing in popularity, especially among junior GPs/FPs. Since its launch in 2013, The “Family Medicine 360° (FM360°) program has been receiving up to 163 inquires till date, promoting global cooperation among the World Organization of family Doctors (WONCA)'s Young Doctors’ Movementd (YDMs).

Conclusions:

By participating in an exchange program, future GPs/FPs are given the chance to experience intercultural communication and peer collaboration. They also develop personal and professional skills and thus, actively contribute to the growth and development of primary care all over the world.

Increasing research capacity in the chiropractic profession: A case study and evaluation of an innovative research program in Norway

OBJECTIVE

The subject of research methods is not commonly covered in continuing professional development (CPD) courses in spite of its emphasis in undergraduate education. This initiative aimed to develop postgraduate research competency and recruit chiropractors to musculoskeletal research.

METHODS

The program was delivered as a university-based program with 20 credits over seven contact weekends covering topics of evidence-based practice, research methods, statistics, ethics, resources, and funding. Students were assessed through assignments showing competency in critical literature review, case report writing, and production of a research protocol as the final assessment. Non-student participation for CPD points was possible. A student evaluation survey was completed after the end of the academic year.

RESULTS

There were 26 participants: 16 as students handing in assignments, 10 as non-student participants for up to 94 CPD points. Three submitted a final protocol and two registered at a university PhD program. A network of research clinics was established for data collection for future multicenter studies.

CONCLUSIONS

The program was well received by the participants and gave them the tools and resources to perform research. The two-level attendance system afforded a basis for setting up a network of research clinics with a fundamental understanding of optimal data collection. This initiative has shown that research skills can be revisited through CPD programs as part of evidence-based lifelong learning.

Impact of educational intervention on the pattern and incidence of potential drug-drug interactions in Nepal

OBJECTIVE

To study the impact of educational intervention on the pattern and incidence of potential drug-drug interactions (DDIs).

METHOD

All patients admitted to Internal Medicine wards of Manipal Teaching Hospital during the study period were included. Patient details were collected using a patient profile form and the datum from the filled forms was analyzed using Micromedex electronic database. An intervention was carried out through a presentation during clinical meeting and personal discussion. The target groups for the intervention included doctors and the nurses.

RESULTS

Altogether 435 patients during preintervention and 445 during postintervention were studied. The incidence of potential DDIs was 53% (preintervention) and 41% (postintervention) [chi-square =11.27, p=0.001]. The average number of drugs per patient was 8.53 (pre-intervention) and 7.32 (post-intervention) [t=3.493, p=0.001]. Sixty-four percent of the potential DDIs were of 'Moderate' type and 58% had a 'Delayed' onset in both the phases. Seventy percent of the potential DDIs during the pre-intervention phase and 61% during post-intervention phase had a 'Good' documentation status. Pharmacokinetic mechanism accounted for 45% of the potential DDIs during preintervention and 36% in the post-intervention phase. Cardiovascular drugs accounted for 36% of the potential DDIs during pre-intervention and 33.2% during post-intervention phase. Furosemide was the high risk drug responsible for DDIs in both phases. The most common potential DDIs observed were between amlodipine and atenolol (4.82%) (preintervention) and frusemide and aspirin (5.20%) (postintervention).

CONCLUSION

There was an association between potential DDIs and age, sex, and polypharmacy.