Anesthesia nurses' self-perceived roles, competencies, and attitudes toward patient safety culture

AIM

This study aimed to explore anesthesia nurses' (ANs) perceptions of roles, competencies, and attitudes towards patient safety culture, along with predictive factors for patient safety culture.

INTRODUCTION

The 2021 guidelines from the International Council of Nurses aim to ensure global access to safe surgical and anesthesia care by 2030. However, in Taiwan, the roles and competencies of ANs are still evolving. Many have a limited understanding, posing potential risks to patient safety.

METHODS

A cross-sectional study was conducted, involving ANs from five hospitals within a healthcare foundation. ANs' self-perceived roles and competencies were assessed using a structured questionnaire based on the CanMEDS framework from the International Federation of Nurse Anesthetists. Additionally, data were collected using the Chinese version of the Safety Attitudes Questionnaire. Reporting followed the STROBE guideline.

RESULTS

Among 200 ANs, a consensus emerged favored all roles and competencies, with positive attitudes toward patient safety culture. Remarkably, self-perceived competencies, working in regional hospitals, and working in medical centers significantly predicted ANs' attitude toward patient safety culture.

DISCUSSION

The study results can assist ANs in gaining a deeper understanding of their roles and competencies. Considering predictive factors, strengthening ANs' competencies may contribute to enhancing patient safety culture.

CONCLUSION AND IMPLICATION FOR NURSING AND HEALTH POLICY

Our results informed nursing leaders and policymakers in Taiwan and other countries regarding ANs' perceptions of roles and competencies. Nurse managers could consider the specific factors influencing ANs' attitudes toward patient safety culture and make great efforts to develop strategies aimed at enhancing their competencies.

Community Health Nursing Education in Austria-The Need for Competences in Planning, Management and Collaboration: A Problem-Centered Qualitative Study

(1) Background: The Austrian health care system is extremely fragmented. Primary care is mainly provided by self-employed GPs. Other health professionals are rarely integrated into primary care. But, according to the political plans of the Austrian government, a system of community nurses and community health nurses should be implemented and several pilot projects have already been started. (2) Objective: The present study explores the skills and competences needed in the planning, management and collaboration for the change in the system and gives recommendations for community health nurse education in Austria. (3) Methodology: Fifteen qualitative, problem-centered interviews were conducted with experts in the field of community health nursing and analyzed using qualitative content analysis. (4) Results: The skills and competences often and widely mentioned are interprofessional collaboration, cooperation with other actors, systems thinking, project and change management, and basic management skills, including strategic planning, communication, accounting and finance. Areas such as health planning and lobbying are also highlighted. The main competences are broken down into subcompetences, making it possible to create a detailed competence grid. Competences in planning, management and collaboration are particularly important in the initial stages of the first implementation of a community health nursing system. (5) Conclusions: Skills and competences in these areas occupy a central position. A multilayered breakdown of these competences is required in order to create a targeted requirements profile. Due to the small-scale fragmentation of the Austrian health care system, collaboration and coordination are more difficult and costly, but all the more important. The aforementioned skills and competences represent an essential expansion of nursing education in Austria.

Nurse Manager Span of Control in Hospital Settings: An Integrative Review

BACKGROUND

Nurse managers face great challenges in responding to organizational demands. There exists a general mismatch between managerial span of control and the demands of the job post, which can lead to overburdening and attrition. The aim of this review was to identify the effects of the nurse manager span of control on hospital organizations.

METHODS

An integrative literature review was carried out on nurse manager span of control using the Medline, Embase and Web of Science databases.

RESULTS

21 articles were included. Our findings indicate that the span of control of nursing managers influences outcomes in inpatients, professionals, nurse managers, and the organization.

CONCLUSIONS

The span of control of each nurse manager must be assessed and adjusted to each case. An appropriate span of control will lead to improved outcomes for stakeholders and the organization as a whole.

IMPLICATIONS FOR NURSING MANAGEMENT

Tools must be developed and implemented to measure and evaluate the span of control of nurse managers. This study was not registered.

Digital health care and data work: Who are the data professionals?

BACKGROUND

This article reports on a study that investigated data professionals in health care. The topic is interesting and relevant because of the ongoing trend towards digitisation of the healthcare domain and efforts for it to become data driven, which entail a wide variety of work with data.

OBJECTIVE

Despite an interest in data science and more broadly in data work, we know surprisingly little about the people who work with data in healthcare. Therefore, we investigated data work at a large national healthcare data organisation in Denmark.

METHOD

An explorative mixed method approach combining a non-probability technique for design of an open survey with a target population of 300+ and 11 semi-structured interviews, was applied.

RESULTS

We report findings relevant to educational background, work identity, work tasks, and how staff acquired competences and knowledge, as well as what these attributes comprised. We found recurring themes of healthcare knowledge, data analytical skills, and information technology, reflected in education, competences and knowledge. However, there was considerable variation within and beyond those themes, and indeed most competences were learned "on the job" rather than as part of formal education.

CONCLUSION

Becoming a professional working with data in health care can be the result of different career paths. The most recurring work identity was that of "data analyst"; however, a wide variety of responses indicated that a stable data worker identity has not yet developed.

IMPLICATIONS

The findings present implications for educational policy makers and healthcare managers.

The challenge of education for sustainability in higher education: key themes and competences within the University of the Basque Country

Introduction

One of the major challenges for higher education institutions in the last decade has been (and will continue to be) the integration of sustainability into their curricula and the development of sustainability competences in students. Education for Sustainability (ES) can help prepare students to meet the challenges of making societies more sustainable. However, as a first step toward this goal, teachers need to incorporate ES into their teaching. In this regard, this research aimed to analyze if members of the teaching staff have started this integration and, if so, which sustainability-related topics have been introduced and which skills do they consider contribute to the development of future graduates.

Methods

A questionnaire was administered to teaching staff at the University of the Basque Country in 2022. A total of 403 teachers completed the questionnaire, expressing their perceptions through open-ended questions.

Results

In general terms teachers incorporate ES into their teaching (71.22%). However, they do this mainly within the framework of two general themes: "Environmental awareness and energy" - most used by teachers of experimental sciences and engineering - and "Social commitment," most used by teachers of social sciences and those who are familiar with the UN 2030 Agenda for Sustainable Development. Regarding the key competences that ES provides for future graduates, those most frequently mentioned were "training of professionals committed to society" and "critical thinking and ethics." These competences were particularly notable in the discourse of teachers who were aware of the 2030 Agenda and who use active methodologies in their classrooms. Finally, the opinion that sustainability has little to do with their teaching (28.78%) was notably expressed by teachers less familiar with the 2030 Agenda.

Discussion

Thus, it can be concluded that, aside from knowledge of the 2030 Agenda, factors such as the sustainability policy of the institution, area of teaching expertise, and the use of active methodologies all play a significant role in determining whether competences for sustainable development are integrated into higher education teaching.

Impact of Coaching on the Development of Personal and Social Competences among Secondary School Students

In this study, the impact of school coaching in Spain on the dimensions that comprise the effective personality construct and the development of those dimensions among secondary school students is analyzed. Differences relating to the variables of gender, course year/age, and the state/private sector of each educational center are specified. A longitudinal study employing a quasi-experimental methodology was conducted with a sample of 310 students in attendance at 6 educational centers within the Community of Madrid, Spain; the study cohort comprised 156 (50.3%) male students and 154 (49.7%) female students. The effective personality questionnaire in secondary education was used for the pre- and post-intervention evaluations, as well as to conduct an open survey once the program had ended. The students who attended the six-session intervention expressed high degrees of satisfaction. Despite the brevity of each session (45-60 min), a slight non-significant improvement was observed in the experimental group relative to the control group in the dimensions that were studied (p > 0.05). Regarding gender, the program worked better with male rather than with female students. It was also more effective within state-aided than in state schools.

Autonomous competences and quality of professional life of paediatric nurses in primary care, their relationship and associated factors: A cross-sectional study

AIMS AND OBJECTIVES

To identify the autonomous competences and quality of professional life of paediatric nurses in primary care, their relationship and possible associated factors.

BACKGROUND

The autonomous competences of paediatric nurses vary among healthcare providers in Catalonia, Spain. Autonomy is related to quality of professional life, but little is known about autonomous competences and other factors contributing to paediatric nurses' quality of professional life.

DESIGN

A cross-sectional study following the STROBE statement.

METHODS

Data from 206 paediatric primary care nurses were analysed. A self-administered survey consisting of an ad hoc questionnaire and a validated instrument to measure quality of professional life (QPL-35 questionnaire) was conducted. Descriptive, bivariate and general multivariate regression analyses were used to identify the relationship between autonomous competences and quality of professional life, and its predicting factors.

RESULTS

47.6% nurses reported a medium level of autonomous competences, 46.6% a high level, and 5.8% a low level. Quality of professional life was medium-high for the domains perception of managerial support and global perception of workload and for the item disconnect from work after work shift, and very high and high values for the domain intrinsic motivation and for the item quality of work life, respectively. Autonomous competences and perceived autonomy were factors associated with quality of professional life. Other associated factors were academic background, specific training and being a paediatric nurse specialist.

CONCLUSIONS

Paediatric nurses in primary care have a medium-high level of autonomous competences and they perceive a high level of autonomy. Autonomous competences and level of perceived autonomy are predictors of quality of professional life.

RELEVANCE TO CLINICAL PRACTICE

Enhancing paediatric nurses' autonomous competences and academic background, receiving specific training and being paediatric nurse specialists might improve their quality of professional life, healthcare quality and outcomes for the child population.

Teachers' Professional Development and Intelligent Ways of Coping with It: A Systematic Review in Elementary and Middle School Education

This research addresses teacher training at different generational stages, with the aim of analysing the training actions developed by school teachers and the intentionality of linking them to their professional development, in order to offer a broad perspective of the paradigm of smart schools, allowing for the adjustment of the quality of training to real demands. To this end, a systematic review of articles published between 2012 and 2022 in the main databases (WoS, Scopus, Eric, Dialnet, and Google Scholar) was carried out. After applying the inclusion criteria, 56 articles were selected and analysed following the PRISMA 2020 statement. The findings showed the interest and importance of initial, continuous, and lifelong learning among teachers as a driver of professional development. The results also showed that research is mostly focused on novice teachers and qualitative methodologies predominate, although this is limited to certain countries and specialised publications. However, generational differences were observed. While younger teachers are more highly trained in ICT, older teachers have a higher level of competence at a processual and relational level in the classroom. In conclusion, it should be noted that teacher training linked to professional development has an impact on school improvement, especially if it is carried out from an intergenerational collaborative perspective, and the acquisition of new skills.

Competence and Attitude of Family Physicians towards Sexuality Regarding Their Sexual Orientation, Age, or Having a Partner-Survey Study and Validation

BACKGROUND

The main objective of this study was to assess different aspects of family physicians (sex, age, sexual orientation, or having a partner) regarding their competencies, attitudes, and procedures towards their patients' sexuality. We also sought to develop a valid questionnaire to perform this task.

METHODS

A cross-sectional study was performed among family and community medicine physicians in southeast Spain.

RESULTS

A total of 259 family physicians participated. Overall, 69.9% were women, 80.7% were heterosexual, 80.7% had a partner, and 50.6% had not received specific sexology training. Homosexual physicians showed a slightly more positive attitude toward sexuality. Training in sexuality established differences in competencies and procedures, but no differences were found in the attitude regarding whether the physicians had a partner or their training. While younger ages were correlated with a more positive attitude, the global score was positively correlated with the age of the professionals.

CONCLUSIONS

Competences, attitudes, and knowledge of procedures do not depend on whether the professional has a partner, but there may be slight differences regarding attitude when considering the sexual orientation of the physicians. The attitude toward sexuality may not depend on previous training. Albeit younger family physicians have a more positive attitude, all providers become more involved with sexuality as they gain professional experience.

Development and Assessment of Professional Competences among Polish Nursing Students during a 3-Year Education Cycle Trying

The essence of the profile of nursing professional competences are basic behavioral characteristics, as well as mastering practical skills. The aim of this study was determination of the development of professional competences of perceiving a patient by first-, second-and third-year students of licentiate nursing study. The study was of a longitudinal character, and lasted for 3 years. The research instrument used was the Ascent to Competence Scale, and traditional assessment of students’ knowledge and skills. A statistically significant relationship was observed between the average grade in practical education from all three years, and competences in student–teacher relationship. Higher grades in theoretical education were accompanied by lower results obtained by students in the area of nursing competences. The respondents’ opinions concerning the development of knowledge and professional skills were relatively high among first-year students, which may be related with a sharp increase in nursing knowledge, whereas third-year students considered it important to perceive a considerable development of professional competences. The results of this study can help in the design of education programs meeting quality standards, and alignment with students and population health needs, which is adequate to the assumptions of the WHO Global Strategic Directions for Nursing and Midwifery 2021–2025.

Nursing Students' Views of the Content of Palliative Care in Undergraduate Education and their Self-assessed Palliative Care Competence-A Nationwide Cross-sectional Study

BACKGROUND

The importance of integrating palliative care (PC) education into undergraduate nursing studies has been recognized. Still, there is considerable variation in the PC education of nurses.

OBJECTIVE

To study the nursing students' views of the PC contents during the nursing education; students' self-assessed levels of PC competence; and whether prior education or work experience influence these views.

METHODS

A cross-sectional study. Data were collected using a questionnaire which was tested for its content and construct validity and internal consistency. The sample consisted of final-year undergraduate nursing students (n = 1331) from Finland.

RESULTS

The response rate was 94%. Of the students, 94.4% considered PC education to be quite or very useful, but only 51.9% reported the achieved PC teaching as quite or very good. Teaching on mental symptoms, existential issues and multicultural aspects were considered incomplete. Over half of the students wanted more education on pharmacological- and non-pharmacological pain management. Students with previous education assessed their PC competence as quite or very good more often than other students (70.1% vs. 54%, P < .001), and more often felt that these competencies are relevant to their profession (72.2% vs. 57.6%, P < .001).

CONCLUSION

PC was considered as a useful subject, still only about half of the students reported the received PC education and their competence on PC as sufficient. Previous education or experience may enhance PC competence highlighting the need for divergent teaching. The results identify development needs for the contents of PC education in undergraduate nursing studies.

Trends and Innovations of Simulation for Twenty First Century Medical Education

In the last two decades there has been an enormous growth in the use of clinical simulation. This teaching-learning methodology is currently the main tool used in the training of healthcare professionals. Clinical simulation is in tune with new paradigms in education and is consistent with educational theories that support the use of experiential learning. It promotes the development of psychomotor skills and strengthens executive functions. This pedagogical approach can be applied in many healthcare topics and is particularly relevant in the context of restricted access to clinical settings. This is particularly relevant considering the current crisis caused by the COVID-19 pandemic, or when trying to reduce the frequency of accidents attributed to errors in clinical practice. This mini-review provides an overview of the current literature on healthcare simulation methods, as well as prospects for education and public health benefits. A literature search was conducted in order to find the most current trends and state of the art in medical education simulation. Presently, there are many areas of application for this methodology and new areas are constantly being explored. It is concluded that medical education simulation has a solid theoretical basis and wide application in the training of health professionals at present. In addition, it is consolidated as an unavoidable methodology both in undergraduate curricula and in continuing medical education. A promising scenario for medical education simulation is envisaged in the future, hand in hand with the development of technological advances.

[Selected personality dimensions and occupational burnout in the group of professional and volunteer firefighters]

BACKGROUND

The purpose of this research was to examine the relationships between selected personality dimensions and occupational burnout among professional and volunteer firefighters. Difficult conditions are the cause of loss of not only health but also life. Such working conditions may cause occupational burnout consisting of employee's exhaustion.

MATERIAL AND METHODS

The group under examination consisted of 164 firefighters, including 76 volunteers aged 19-61 years (M = 32.49, SD = 9.21) and 88 professional firefighters aged 20-49 years (M = 33.85, SD = 10.05). This research employed the Maslach Burnout Inventory and Gough and Heilburn's Adjective Check List along with the Personality and Axiological Model (MOA) (competences, relations, autonomy).

RESULTS

The results of the conducted research indicate differences between the examined groups of firefighters in personality dimensions (Ord: t = -2.739, p = 0.006; Mls: t = -2.159, p = 0.032; competences t = -2.390, p = 0.017). The research also enabled assessing the correlations with occupational burnout. The greatest relationship with occupational burnout in the group of volunteer firefighters concerns succorance (Suc) and total occupational burnout, and the greatest relationship with occupational burnout in the group of professional firefighters pertains to the competence dimension from the MOA model.

CONCLUSIONS

The results of the conducted research should be related to the cognitive aspect (the application of the new MOA model in this professional group) and attention should be paid to the personality differences between the groups of volunteer and professional firefighters. The application value for more effective work of psychologists with this professional group is also important in terms of the results obtained. Med Pr. 2021;72(5).

Evaluation of primary care services in Hungary: a comprehensive description of provision, professional competences, cooperation, financing, and infrastructure, based on the findings of the Hungarian-arm of the QUALICOPC study

BACKGROUND

Primary health care provision in terms of quality, equity, and costs are different by countries. The Quality and Costs of Primary Care (QUALICOPC) study evaluated these domains and parameters in 35 countries, using uniformized method with validated questionnaires filled out by family physicians/general practitioners (GPs).This paper aims to provide data of the Hungarian-arm of the QUALICOPC study and to give an overview about the recent Hungarian primary care (PC) system.

METHODS

The questionnaires were completed in 222 Hungarian GP practices, delivered by fieldworkers, in a geographically representative distribution. Descriptive analysis was performed on the data.

FINDINGS

Financing is based mostly on capitation, with additional compensatory elements and minor financial incentives. The gate-keeping function is weak. The communication between GPs and specialists is often insufficient. The number of available devices and equipment are appropriate. Single-handed practices are predominant. Appointment instead of queuing is a new option and is becoming more popular, mainly among better-educated and urban patients. GPs are involved in the management of almost all chronic condition of all generations. Despite the burden of administrative tasks, half of the GPs estimate their job as still interesting, burn-out symptoms were rarely found. Among the evaluated process indicators, access, continuity, comprehensiveness, and coordination were rated as satisfactory, together with equity among health outcome indicators. Financing is insufficient; therefore, many GPs are involved in additional income-generating activities. The old age of the GPs and the lack of the younger GPs generation contributes to a shortage in manpower. Cooperation and communication between different levels of health care provision should be improved, focusing better on community orientation and on preventive services. Financing needs continuous improvement and appropriate incentives should be implemented. There is a need for specific PC-oriented guidelines to define properly the tasks and competences of GPs.

Nursing Students' Knowledge of Patient Safety and Development of Competences Over their Academic Years: Findings from a Longitudinal Study

Introduction

Future nurses should possess the knowledge and competences necessary to ensure patient safety. However, little evidence is available on the way in which students learn patient safety-related principles over time. This study explored the progress of a cohort of Italian undergraduate nursing students as they acquired patient safety knowledge and competences from time of enrolment to graduation.

Methods

A longitudinal study carried out between 2015 and 2018 enrolled a cohort of 90 nursing students from two Italian Bachelor of Nursing Science Degree Courses at the Udine University, Italy. The students were followed-up on an annual basis and data collection was performed three times: at the end of the 1st, 2nd and 3rd years. The validated Italian version of the Professional Education in Patient Safety Survey tool was used to collect data.

Results

At the end of the 1st year, students reported an average 4.19 out of 5 patient safety knowledge acquired in classrooms (CI 95%, 4.11-4.28), which was stable at the end of the 2nd (4.16; CI 95%, 4.06-4.26) and 3rd years (4.26; CI 95%, 4.16-4.32) and no statistical differences emerged over the years. With regard to the competences acquired in clinical settings, at the end of the 1st year the students reported an average 4.28 out of 5 (CI 95%, 4.20-4.37), which decreased significantly at the end of the 2nd year (4.15; CI 95%, 4.07-4.23; p=0.02) and increased at the end of the 3rd year (4.37; CI 95%, 4.27-4.47; p<0.01).

Conclusions

Nursing students' competences in patient safety issues increases over time, while their knowledge remains stable. Students are more vulnerable at the end of the 1st year, when they seem to be overconfident about patient-safety issues.

Palliative Nursing Competencies Required for Different Levels of Palliative Care Provision: A Qualitative Analysis of Health Care Professionals' Perspectives

Background: Nurses must possess adequate competencies to provide high-quality palliative care. Earlier statements have described certain competencies that are relevant for palliative care, yet only limited empirical research has focused on the perspective of health care professionals to clarify which competencies are required for different levels of palliative care provision. Objective: The aim was to describe the required palliative nursing competencies of registered nurses aligned to different levels of palliative care provision, from the perspectives of multiprofessional groups. Design: A qualitative study design. Setting/Subjects: A purposive sample of professionals, working in different levels of palliative care across various settings in Finland, was used to gain information about the aim of the study (n = 222). Measurements: Content analysis was applied to describe the competencies of registered nurses. Results: Competencies relevant to basic palliative care were categorized under 17 main categories, which included a total of 75 subcategories. "Competence in managing the most common symptoms" was the main category that contained the largest number of reduced expressions (f = 75). An analysis of specialist palliative care data yielded 10 main categories, including 49 subcategories, with "Competence in maintaining expertise and taking care of own well-being at work" containing the most reduced expressions. Conclusion: The study provided new knowledge; more specifically, competencies related to encounters and maintaining hope were described as palliative care nursing competences. The results can be used to ensure that palliative nursing education focuses on the competences that are necessary in practice.

Workforce challenges in digital health implementation: How are clinical psychology training programmes developing digital competences?

Objectives

Digital practice in psychological services is a rapidly expanding and innovative area which is supporting continuation of clinical provision during the COVID-19 pandemic. Training the workforce to deliver safe and effective online psychological provision is key to service success and relies on accurate mapping of competences and current training needs. This paper discusses the initial stage for developing the first digital mental health competence framework for applied psychology in the UK. It reports on the digital training currently provided nationally and barriers/facilitators to acquiring these competencies.

Methods

Eighteen of the thirty UK Clinical Psychology Doctoral training programmes completed a 16-item survey. This mapped current digital health teaching and skills acquisition for trainee Clinical Psychologists throughout their 3-year pre-registration training. Furthermore, potential barriers and facilitators to developing these digital skills for both trainee and qualified Clinical Psychologists were investigated.

Results

The quantitative analysis highlighted the majority of respondents viewed developing digital mental health competencies with importance, but were not integrating this into teaching or clinical placements activity. The qualitative, inductive content analysis revealed seven key themes influencing the development of digital mental health skills, with the majority of respondents identifying with two themes; the need for practice guidelines (50% of respondents) and opportunities for digital mental health experience.

Conclusions

The findings suggest the need for a greater focus on developing the digital health knowledge, skills, and confidence across trainee and qualified Clinical Psychologists. Strategic analysis indicated the need to develop a framework for digital mental health competences across the curriculum and placement experience. Easily accessible learning packages may support the implementation of training nationally.

Home-Care Workers' Representations of Their Role and Competences: A Diaphanous Profession

Because of the gradual aging of the population, hospital facilities for socio-sanitary care of the elderly are quite scarce relative to the very high number of elderly people present in the country. This has pushed a high number of families to privately hire home-care workers. The scientific literature gives a picture of the psycho-physical risks that this type of profession is exposed to; however, there is still a need for a more systemic reflection with regard to representations about their role and competences. The aim of the present study is to outline the representations of the role and the skills it requires from home-care workers’ point of view. We reconstructed how home-care workers perceive and define the profession, and understand the necessary skills required from their point of view. Our results show that the professional profile of home-care workers still remains poorly defined and that professionals themselves struggle to find value and recognition, and to articulate what the skill set they develop is formed of.

Comparison of the Informed Health Choices Key Concepts Framework to other frameworks relevant to teaching and learning how to think critically about health claims and choices: a systematic review

Background: The Informed Health Choices (IHC) Key Concepts are principles for evaluating the trustworthiness of claims about treatment effects. The Key Concepts provide a framework for developing learning-resources to help people use the concepts when treatment claims are made, and when they make health choices.

Objective: To compare the framework provided by the IHC Key Concepts to other frameworks intended to promote critical thinking about treatment (intervention) claims and choices.

Methods: We identified relevant frameworks from reviews of frameworks, searching Google Scholar, citation searches, and contact with key informants. We included frameworks intended to provide a structure for teaching or learning to think critically about the basis for claims, evidence used to support claims, or informed choices. For a framework to be included, there had to be a description of its purpose; a list of concepts, competences, or dispositions; and definitions of key terms. We made independent assessments of framework eligibility and extracted data for each included framework using standardised forms.

Results: Twenty-two frameworks met our inclusion criteria. The purpose of the IHC Framework is similar to that of two frameworks for critical thinking and somewhat similar to that of a framework for evidence-based practice. Those frameworks have broader scopes than the IHC Framework. An important limitation of broad frameworks is that they do not provide an adequate basis (concepts) for deciding which claims to believe and what to do. There was at most some overlap between the concepts, competences, and dispositions in each of the 22 included frameworks and those in the IHC Framework.

Conclusions: The IHC Key Concepts Framework appears to be unique.  Our review has shown how it and other frameworks can be improved by taking account of the ways in which other related frameworks have been developed, evaluated, and made useful.

The development of a consensus-based spiritual care education standard for undergraduate nursing and midwifery students: An educational mixed methods study

AIMS

The aim of this study was to develop a consensus-based Spiritual Care Education Standard for undergraduate N/M students to use in undergraduate programmes.

DESIGN

Mixed methods were used consisting of qualitative and quantitative methods based on the principles of Delphi research.

METHODS

The sample consisted of a total of 58 (N = 58) participants from 21 European countries. Data collection was conducted from June 2017 - February 2019 and took place in facilitated iterative action learning cycles and online surveys. Data were analysed by descriptive statistics and qualitative analysis. Consensus was stated by >90% agreement.

RESULTS

The process resulted in an EPICC Spiritual Care Education Standard consisting of the following four spiritual care competences: Intrapersonal spirituality, Interpersonal spirituality, Spiritual care: assessment and planning, Spiritual care: intervention and evaluation. For every competence, learning outcomes were described in knowledge, skills and attitudes.

CONCLUSION

This Standard guides N/M spiritual care education, student assessment and research. It can be the starting point for discussing spiritual care competences in other healthcare professions. Follow-up research should focus on implementation of the standard and on assessment of students' spiritual competence.

IMPACT

The Standard guides curriculum and programme development. The Standard guides students in performing their learning process. The Standard provides a frame of reference for policy making and follow-up research.

Analysis of teaching methods in anaesthesia in the undergraduate curriculum of four veterinary universities

OBJECTIVE

To design a holistic audit tool to assess the effectiveness of anaesthesia teaching strategies, and thereby to study veterinary undergraduate teaching methods in different geographical areas.

STUDY DESIGN

Qualitative study using interviews of university staff and students to identify common themes and differences in teaching veterinary anaesthesia.

METHODS

An audit was performed using an audit tool in four veterinary universities (École Nationale Vétérinaire d'Alfort, France; Royal Veterinary College, UK; University of Buenos Aires, Argentina; and Alma mater studiorum - Università di Bologna, Italy). First, an open-question interview of anaesthesia head of service (60-90 minutes) identified the pedagogical strategies in order to conceive a subsequent semi-directive interview formulated as a SWOT analysis (Strength/Weaknesses/Opportunity/Threats). Second, the SWOT reflection was conducted by a second staff member and focussed on: 1) general organization; 2) topics for pre-rotation teaching; 3) teaching methods for clinical rotation; and 4) assessment methods. Qualitative analysis of the interview responses was performed with semi-structured interviews. Finally, the students evaluated their teaching through a students' questionnaire generated from the output of both interviews.

RESULTS

A group of nine lecturers and 106 students participated in the study at four different sites. Preclinical teaching ranged from 13 to 24 hours (median 15 hours). Clinical teaching ranged from 4 to 80 hours (median 60 hours). Overall, all faculties perceived time as a limitation and attempted to design strategies to achieve the curriculum expectations and optimize teaching using more time-efficient exercises. Large animal anaesthesia teaching was found to be a common area of weakness. Internal feedback was delivered to each university, whereas generalized results were shared globally.

CONCLUSIONS

This preliminary study proved the generalizability of the protocol used. Recruiting a larger pool of universities would help to identify and promote efficient teaching strategies and innovations for training competent new graduates in an ever-expanding curriculum.

Digitized Industrial Work: Requirements, Opportunities, and Problems of Competence Development

German companies have been affected by a new wave of digitalization during the past years, and this has led to responses both in the way production is organized and in the goals of the German industrial policy. The coordinated response is widely referred to as "Industry 4.0" and is intended to support German industries in the increasingly fierce competition for global leadership in manufacturing. Simultaneously, a social science debate about changes in work and in employee training began and continues to this day. Far-reaching predictions of fundamental change circulate, especially concerning the organization of work and worker competence requirements. Other issues include also the needs and opportunities of firm-based competence development at work as well as the role and the uses of digital media. In recent years, more empirical studies have become available for clarifying open questions, and this paper presents three main results from one such study based on case investigations in 10 German industrial firms. First, digitalization does not change industrial production work radically. There is no general trend of upskilling, downgrading, or reskilling. A moderate trend favoring upgrading is observable, however. Thus, traditional workforce competences are not becoming "obsolete." Rather, in the context of automation, they are being complemented by other skills including new technical qualifications in information technology as well as the ability to take a more theoretical approach to problem-solving in process optimization. Second, our results confirm more cautious assessments of the need for accelerated continuing vocational training. They also make it clear that the potential for increased learning opportunities in digital work and for the increased use of digital media in continuing vocational training has been overestimated. Learning opportunities seem to decrease rather than increase with digital work. Moreover, the use of digital media in continuing vocational training is limited due to organizational, financial, and cultural constraints and due to the lack of knowledge about the effectiveness of digital learning environments. Third, a number of organizational measures are needed to manage change. One measure would be to integrate new skill requirements into a binding institutional curriculum for education and training. Another measure would be to make on-the-job learning opportunities a central aspect of how work is organized.

Developing the culture of ethics in population health intervention research in Canada

Population health intervention research (PHIR) is a particular field of health research that aims to generate knowledge that contributes to the sustainable improvement of population health by enabling the implementation of cross-sectoral solutions adapted to social realities. Despite the ethical issues that necessarily raise its social agenda, the ethics of PHIR is still not very formalized. Unresolved ethical challenges may limit its focus on health equity. This contribution aims to highlight some of these issues and calls on researchers to develop a culture of ethics in PHIR. Three complementary ways are proposed: to build an ethical concept specific to this field, to promote a shared space for critical reflection on PHIR ethics, and to develop the ethical competence in PHIR for which a preliminary framework is proposed.

The Challenge of Greening Religious Schools by Improving the Environmental Competencies of Teachers

Even though sacred scriptures emphasize the key role that Creation and respect for living creatures play in all religions, the so-called religious schools seem to show little interest in putting this sacred mandate into effect. To shed light on this subject, this work investigates the role of teachers in the process, focusing on their environmental competencies. Our hypotheses are tested through a structural equation model on a sample of 214 biology and religion teachers from 118 Catholic schools in Spain who voluntary participated in a survey. The research findings confirm that it is crucial that environmental competencies are developed in teachers to enable the greening of schools. Theoretical and practical implications for defining the job training of teachers in religious schools are drawn from the study.

The Odyssey of Integration: Is Management its Achilles' Heel?

Introduction

The importance of management to the implementation of integrated care is recognised in evidence and practice. Despite this recognition, there is a lack of clarity about what 'good' management of integrated care looks like, if the competences are different to management for 'traditional' care, and how such competences can be acquired.

Theory and methods

This exploratory study is based on qualitative interviews with participants with extensive experience of implementing integrated care in senior professional, research, administrative and/or policy roles. It conceptualises management as working at 'strategic' and 'operational' levels.

Results

Management of integrated care was seen to require an ability to create networks across professions and organisations, to be comfortable with distributing responsibilities, and to thoroughly understand the wider system. Competences to support these new ways of working included an understanding of how to implement people-centredness, to have courage to challenge the status quo, and to demonstrate humility to learn from others. Structured development opportunities for managers were lacking, but seen as vital for the sustainability of change.

Discussion and conclusion

Management for integrated care remains an underdeveloped concept and practice. A first formulation of the competences necessary was achieved, but more work is urgently required to understand how to better prepare and support managers to achieve necessary changes in practice and culture.

The Saudi Medical Licensure Examination-Clinical Skills (SMLE-CS): A Call for Implementation

The Saudi Commission for Heath Specialties (SCFHS) was founded in 1992 to nationally regulate healthcare-related practices and accreditation. Specifically, SCFHS is the official organization that principally oversees the postgraduate residency training programs (RTPs). A crucial aim of SCFHS is to warrant that medical graduates, prior to their enrollment into RTPs as first-year resident physicians, have national minimum entry standards of learning competencies to practice safe and effective healthcare. Generally, there are three primary domains of learning competencies that should be assessed, namely: theoretical clinical knowledge, practical clinical skills and professional attitudes. SCFHS primarily evaluates the theoretical clinical knowledge of applicants through the administration of the Saudi Medical Licensure Examination (SMLE) and we call on SCFHS to rename the conventional SMLE to SMLE-Clinical Knowledge (CK), or shortly abbreviated as SMLE-CK. On the other hand, to date, there is no examination administered by the SCFHS that assesses the applicants' competencies of practical clinical skills and professional attitudes prior to admission to RTPs. Herein, we call on SCFHS to formally incorporate a mandatory national practical licensure examination. The suggested name is the SMLE-Clinical Skills (CS), or shortly abbreviated as SMLE-CS. The purpose, structure, content, rationale, potential counteractive views and future research directions regarding the SMLE-CS are presented. This proposal is not limited to Saudi Arabia only, and it may be contemplated by the other countries, too.

Postdoctoral nursing researcher career: A scoping review of required competences

Aim

The aim of this review was to identify and summarize the required competences of nursing PhD students and postdoctoral researchers to pursue a successful researcher career and to compare these competences with the existing competence frameworks.

Design

Scoping review.

Methods

PubMed, CINAHL, SocIndex, PsycInfo, Eric, EMBASE, Academic Search Premier and Scopus databases were searched from January 1990-December 2018. The guidelines of PRISMA Extension for Scoping Reviews and the scoping review framework by Arksey and O'Malley (2005, International Journal of Social Research Methodology, 8, 19) were applied.

Results

Forty-four studies were reviewed comprising 15 competence domains. Competences corroborated the competences defined in the competence frameworks. However, the qualitative and descriptive research designs rendered a modest level of evidence and generalizability.

Evidence-Based Genetic Education of Non-Genetic-Expert Physicians: Experiences Over Three Decades in Amsterdam

To study and improve the competences of health-care workers in the domain of genetics, attention needs to be paid to attitudes, activities, knowledge, and changes in performance. Three decades of research on genetic education for non-genetic-experts in Amsterdam are summarized, including both local and international collaborative efforts. Evidence shows that assessment of learners’ needs and the definition of competences have driven slow but gradual improvement in genetics competence among non-geneticists. Attitudes and behavior are mainly influenced by face-to-face training. eLearning modules can serve to increase knowledge in a large number of participants in a rapidly changing field. Materials developed for accredited courses will sometimes be used for reference or just in time learning. Taking a theoretically informed evaluation approach, it has been possible to demonstrate satisfaction, improved knowledge, and self-reported behavioral change, although measuring effects on health-care practice and population health remains challenging. A flexible approach is needed to serve learners’ needs in a field with many upcoming challenges.

The roadmap for allergology in Europe: The subspecialty of allergology as "stop-over" on the way to a full specialty. An EAACI position statement

The vision of European Academy of Allergy and Clinical Immunology (EAACI) and the Union of European Medical Specialists Section and Board on allergology is to promote and to establish a full specialty of allergology in all European countries. In many European countries, a full specialty does not exist. In those countries, organ-based (sub)specialists or paediatricians and internists with an expertise in allergology may deliver allergy care. There are no generally accepted requirements for the training of subspecialists available. To fill the gap between the need and availability of experienced and accredited physicians who can deliver optimal care to the allergic patients, the EAACI Specialty Committee proposes the minimal requirements for training and certification of subspecialists in allergology. This paper describes the required theoretical knowledge, skills, competences and training facilities (staff and institution). The subspecialist as described in this paper should ideally show the necessary competence in providing good quality care to patients in an environment lacking those full specialists in allergology or tertiary care paediatric subspecialists in allergy.

How could the topic patient safety be embedded in the curriculum? A recommendation by the Committee for Patient Safety and Error Management of the GMA

The topic of patient safety is of fundamental interest for the health care sector. In view of the realisation of the National Competence-Based Learning Objectives Catalogue for Undergraduate Medical Education (NKLM) this topic now has to be prepared for medical education. For a disciplinary and content-related orientation the GMA Committee developed the Learning Objectives Catalogue Patient Safety for Undergraduate Medical Education (GMA-LZK). To ensure an optimal implementation of the GMA-LZK we recommend a longitudinal embedding into the existing curriculum. This position paper supports the implementation of the GMA-LZK and is aimed at everyone who wants to establish teaching courses on the topic patient safety and embed them in the curriculum. In light of this, we will initially describe the key features for a structured analysis of the current situation. Based on three best-practice-examples, as seen in the faculties of Freiburg, Bonn and Munich, different approaches to the implementation of the GMA-LZK will be illustrated. Lastly, we will outline the methodical requirements regarding the curriculum development as well as the disciplinary and methodical competences that the lecturers will have to hold or develop to fulfil the requirements.

[The All-Russian forensic medicine Olympiad 'The moves toward professional skills' and its role in the overall educational process]

This article is published on the occasion of the 2^nd All-Russian forensic medicine student Olympiad. The Olympiad has been held during three years in succession and attracts attention of the students from different Universities of the Russian Federation and the former Soviet republics. The Olympiad is considered to be a highly efficient form of the intellectual leisure activities of the students; moreover, it facilitates formation of motivation for the self-education and the acquisition of the professional skills and competences envisaged by the state standards for higher education that have not yet been incorporated into the program of modern medical education adopted in the Russian Federation.

The Changing Role of Health Care Professionals in Nursing Homes: A Systematic Literature Review of a Decade of Change

Although the role of health care professionals is known to have changed over the last years, few formal efforts have been made to examine this change through means of a scientific review. Therefore, the goal of this paper was to investigate the changing role of health care professionals in nursing homes, as well as the conditions that make this change possible. A systematic review of health care literature published in the last decade (2007-2017) was utilized to address these goals. Our findings suggest that although health care in nursing homes is shifting from task-oriented care to relation-oriented care (e.g., through an increased focus on patient dignity), various obstacles (e.g., negative self-image, work pressure, and a lack of developmental opportunities), needs (e.g., shared values, personal development, personal empowerment, team development, and demonstrating expertise), and competences (e.g., communication skills, attentiveness, negotiation skills, flexibility, teamwork, expertise, and coaching and leadership skills) still need to be addressed in order to successfully facilitate this change. As such, this paper provides various implications for health care research, health care institutions, practitioners, HR professionals and managers, and occupational health research.

[Skills lab training in veterinary medicine. Effective preparation for clinical work at the small animal clinic of the University for Veterinary Medicine Hannover, Foundation]

OBJECTIVE

During five and a half years of studying veterinary medicine, students should in addition to theoretical knowledge acquire sufficient practical skills. Considering animal welfare and ethical aspects, opportunities for hands-on learning on living animals are limited because of the high annual number of students. The first German veterinary clinical-skills lab, established in 2013 at the University for Veterinary Medicine Hannover, Foundation (TiHo), offers opportunities for all students to learn, train and repeat clinical skills on simulators and models as frequently as they would like, until they feel sufficiently confident to transfer these skills to living animals. This study describes the establishment of clinical-skills lab training within the students' practical education, using the example of the small-animal clinic of the TiHo.

MATERIAL AND METHODS

Two groups of students were compared: without skills lab training (control group K) and with skills lab training (intervention group I). At the end of both the training and a subsequent 10-week clinical rotation in different sections of the clinic, an objective structured clinical examination (OSCE) was performed, testing the students' practical skills at 15 stations. An additional multiple-choice test was performed before and after the clinical rotation to evaluate the increased theoretical knowledge.

RESULTS

Students of group I achieved significantly (p ≤ 0.05) better results in eight of the 15 tested skills. The multiple-choice test revealed a significant (p ≤ 0.05) gain of theoretical knowledge in both groups without any differences between the groups. Students displayed a high degree of acceptance of the skills lab training.

CONCLUSION

Using simulators and models in veterinary education is an efficient teaching concept, and should be used continually and integrated in the curriculum.

Knowledge vs. Action: Discrepancies in University Students' Knowledge about and Self-Reported Use of Self-Regulated Learning Strategies

University students are supposed to be autonomous learners, able to adapt to an educational environment significantly less guided than school. Entering higher education poses a challenge of self-regulation, in which beginning students are often not prepared with self-regulation strategies needed. Since there are many studies assessing self-regulated learning (SRL) via classical self-reports, we know a lot about how students generally self-assess their SRL strategies. However, SRL and performance do not always correlate highly in these studies. The aim of the present study is to determine whether there are discrepancies between students' knowledge about SRL and their action in applying adequate SRL strategies in relevant learning situations. We also want to know whether such discrepancies generalize across domains and what the reasons for discrepancies are. The situation-specific Self-Regulated Learning Questionnaire for Action and Knowledge (SRL-QuAK) was used in a sample of 408 psychology and economic sciences students. Descriptive data analysis was conducted to determine potential discrepancies between SRL knowledge and action and differences between the study domains in an explorative way. The reasons for not using SRL-strategies were derived via qualitative content analysis. The results showed that although students had quite advanced knowledge of SRL strategies, they did not put this knowledge into action. This dissonance between SRL knowledge and action was found in both domains. In terms of reasons, students stated that they (a) lacked the time to use SRL strategies, (b) would not benefit from SRL strategies in the given situation, (c) would not be able to put the strategies to use effectively or (d) found it too arduous to use SRL strategies. The implications of these results will be discussed, e.g., the consequences for measures to overcome students' dissonance between knowledge and action and therefore to promote academic performance and well-being.

Curriculum Mapping of the Master's Program in Pharmacy in Slovenia with the PHAR-QA Competency Framework

This article presents the results of mapping the Slovenian pharmacy curriculum to evaluate the adequacy of the recently developed and validated European Pharmacy Competences Framework (EPCF). The mapping was carried out and evaluated progressively by seven members of the teaching staff at the University of Ljubljana's Faculty of Pharmacy. Consensus was achieved by using a two-round modified Delphi technique to evaluate the coverage of competences in the current curriculum. The preliminary results of the curriculum mapping showed that all of the competences as defined by the EPCF are covered in Ljubljana's academic program. However, because most EPCF competences cover healthcare-oriented pharmacy practice, a lack of competences was observed for the drug development and production perspectives. Both of these perspectives are important because a pharmacist is (or should be) responsible for the entire process, from the development and production of medicines to pharmaceutical care in contact with patients. Nevertheless, Ljubljana's graduates are employed in both of these pharmaceutical professions in comparable proportions. The Delphi study revealed that the majority of differences in scoring arise from different perspectives on the pharmacy profession (e.g., community, hospital, industrial, etc.). Nevertheless, it can be concluded that curriculum mapping using the EPCF is very useful for evaluating and recognizing weak and strong points of the curriculum. However, the competences of the framework should address various fields of the pharmacist's profession in a more balanced way.

The Production of the PHAR-QA Competence Framework

This article describes the background and methodology of the PHAR-QA (Quality Assurance in European Pharmacy Education and Training) project that produced a competence framework for pharmacy education and practice in the EU. In order to produce a harmonized competence framework that could be accepted within the EU situation, we developed a two-stage Delphi process centred on two expert panels. A small panel of academics produced the competence framework that was then validated by the rankings of a large panel consisting of representatives of the EU pharmacy community. The main aspects of this process are developed in this article.

A Comparison of Competences for Healthcare Professions in Europe

In Europe and elsewhere, there is increasing interest in competence-based education (CBE) and training for professional practice in healthcare. This review presents competences for pharmacy practice in Europe and compares them with those for medicine and dentistry. Comparisons amongst competence frameworks were made by matching the European Directive for Professional Qualifications in sectoral professions such as healthcare (EU directive) with the frameworks of competences elaborated by European consortia in pharmacy (PHAR-QA), medicine (MEDINE), and dentistry (ADEE). The results show that the recommendations of the EU directive for all three professions are similar. There is also widespread similarity in the formulation of competences for all healthcare professions. Furthermore, for medicine and pharmacy, the rankings by practitioners of the vast majority of competences are similar. These results lay the foundations for the design of more interdisciplinary educational programs for healthcare professionals, and for the development of team-based care.

Harmonisation of Dental Education in Europe - a survey about 15 years after visitation of dental schools participating in the DentEd project

INTRODUCTION

The DentEd Thematic Networks (TNP) were funded from the EU to converge and harmonise the dental curricula. Forty-four dental schools participated in this visitation process between 1998 and 2002. The aim of the survey was to evaluate the implementation of the Dented outcomes in the curricula and if the concept of core competences are integrated in the curriculum.

MATERIAL AND METHOD

In October 2012, questionnaires were sent out to all dental schools participated in the visitation process of Dented and Dented evolves. The main question blocs were as follows: structure of the curriculum and facilities, education of students, content and quality of education, assessment, research, European involvement and value of visit for the school.

RESULTS

Twenty-five dental schools (57%) answered to the questionnaire. The responder represented 20 European countries of 22, whose schools were involved (91%). The self-assessment report was stimulating the continuation of curriculum improvement. Most of them acknowledge that major competences are essential outcome for the graduated dentist. Twelve schools (58%) rated the value of the DentEd visit with strong positive influence.

DISCUSSION

The visits showed strengths, weaknesses and threats. Three-quarter of all schools implemented the European Credit Transfer System (ECTS). But most of them did not realize the unit of ECTS with modules among the Bologna process.

CONCLUSION

The self-assessment report was a core issue for the continuation of curriculum improvement. The challenge for the ongoing curriculum improvement is the implementation of the module system among the Bologna recommendations.

Implementation process of all periodontal competences and assessments as proposed in the 2010 European consensus meeting into the existing local undergraduate curriculum

AIM

To report on our implementation process within the existing local curriculum of all periodontal competences and assessments as proposed in the 2010 European consensus meeting.

MATERIAL AND METHOD

In 2011, a workshop for all teaching staff at the Department of Periodontology, ACTA, an education and assessment blueprint, was developed to test for missing education and assessment of European competences, divided into seven domains. This was repeated in 2013. An oral evaluation of the staff followed both meetings.

RESULTS

It appeared that eight of 58 (14%) European competences were not taught, and 21 (35%) competences were not assessed. After evaluation of the results on the actual curriculum and the assessment programme, shared decisions were made about how to teach and assess the missing competences within the local periodontal educational programme. The second workshop in 2013 revealed still 8 (14%) competences were not taught and 8 (14%) competences were not assessed. Staff appreciated the used method of validation; it gave insight and an overview of the curriculum. The existence of the European consensus report for undergraduate periodontal education, based on seven domains, has been instrumental and essential.

CONCLUSION

The development of a blueprint from the education programme and concomitant assessment methods in periodontology by participating teaching staff gives a validation and appreciation of the curriculum and will improve the quality of education and assessment. It is advised that for quality control of the curriculum, dental schools could do this exercise for all their specialties if European consensus reports exist.

The Second Round of the PHAR-QA Survey of Competences for Pharmacy Practice

This paper presents the results of the second European Delphi round on the ranking of competences for pharmacy practice and compares these data to those of the first round already published. A comparison of the numbers of respondents, distribution by age group, country of residence, etc., shows that whilst the student population of respondents changed from Round 1 to 2, the populations of the professional groups (community, hospital and industrial pharmacists, pharmacists in other occupations and academics) were more stable. Results are given for the consensus of ranking and the scores of ranking of 50 competences for pharmacy practice. This two-stage, large-scale Delphi process harmonized and validated the Quality Assurance in European Pharmacy Education and Training (PHAR-QA) framework and ensured the adoption by the pharmacy profession of a framework proposed by the academic pharmacy community. The process of evaluation and validation of ranking of competences by the pharmacy profession is now complete, and the PHAR-QA consortium will now put forward a definitive PHAR-QA framework of competences for pharmacy practice.

How Do European Pharmacy Students Rank Competences for Practice?

European students (n = 370), academics (n = 241) and community pharmacists (n = 258) ranked 13 clusters of 68 personal and patient care competences for pharmacy practice. The results show that ranking profiles for all three groups as a rule were similar. This was especially true of the comparison between students and community pharmacists concerning patient care competences suggesting that students have a good idea of their future profession. A comparison of first and fifth (final) year students shows more awareness of patient care competences in the final year students. Differences do exist, however, between students and community pharmacists. Students—like academics—ranked competences concerned with industrial pharmacy and the quality aspects of preparing drugs, as well as scientific fundamentals of pharmacy practice, well above the rankings of community pharmacists. There were no substantial differences amongst rankings of students from different countries although some countries have more “medicinal” courses than others. This is to our knowledge the first paper to look at how, within a healthcare sectoral profession such as pharmacy, the views on the relative importance of different competences for practice of those educating the future professionals and their students, are compared to the views of working professionals.

Achieved competences in temporomandibular disorders/orofacial pain: a comparison between two dental schools in Europe

AIMS

The aim was to study achieved competences in temporomandibular disorders (TMD)/orofacial pain (OP) at two universities by comparing student's knowledge and understanding, satisfaction with their education and confidence in their clinical competences of TMD/OP.

METHODS

The study was conducted in collaboration between Malmö University, Sweden—which uses problem-based learning—and the University of Naples Federico II, Italy—which uses traditional educational methods. Final-semester dental students responded to a self-report questionnaire regarding their knowledge and understanding, interpretation of cases histories, clinical experience, satisfaction and confidence in clinical examination, management and treatment evaluation.

RESULTS

No significant difference was found between the students regarding knowledge and understanding. Eighty-seven per cent of the Malmö students and 96% of the Naples students met the criterion on achieved competence. Malmö students had a higher per cent of correct diagnoses than Naples students in the interpretation of case histories. Overall, Malmö students reported most clinical experience and higher confidence than Naple students.

CONCLUSIONS

The main findings were that students from Malmö and Naples were, similar in knowledge and understanding of TMD/OP and in satisfaction with their clinical competences. However, Malmö students perceived more confidence in clinical management of patients with TMD/OP. This may reflect that, besides the theoretical part of the programme, a sufficient level of clinical exposure to patients with TMD/OP is essential to gain competences in TMD/OP.

Disastrous events and political failures

Response to the Ebola crisis (ongoing event) has been less than efficient. It has been monitored less than adequately by the international community and has been coordinated poorly in the USA. The event is used as a platform to examine deficiencies in public health infrastructure, the limits of its political and financial support, and how political outcomes can be affected. The need to tease out the political determinants implicit in policy failure and disaster management is argued in this Editorial. Failures mentioned include in the Balkans and in Greece with ongoing austerity. Comments on the real heroes of Ebola on the ground in Africa and the need for a charismatic role for political leaders in public health are also included.

Leadership Competences in Slovenian Health Care

Background

Leadership competences play an important role for the success of effective leadership. The purpose of this study was to examine leadership competences of managers in the healthcare sector in Slovenia.

Methods

Data were collected in 2008. The research included 265 employees in healthcare and 267 business managers. Respondents assessed their level of 16 leadership relevant competences on a 7-point Likert-type scale.

Results

Test of differences between competences and leader position of health care professionals yielded statistically significant differences between leader and non-leader positions. Leaders gave strongest emphasis to interpersonal and informational competences, while regarding decision making competences, the differences between leaders and other employees are not that significant. When comparing competences of healthcare managers with those of business managers, results show that healthcare managers tend to give weaker emphasis to competences related to all three managerial roles than business managers.

Conclusions

The study showed that in Slovenian health care, leaders distinguish themselves from other employees in some leadership competences. In addition, all three dimensions of leadership competences significantly distinguished the group of healthcare managers from the business managers, which indicates a serious lag in leadership competences among leaders in Slovenian healthcare.

A qualitative study on barriers in the prevention of anaemia during pregnancy in public health centres: perceptions of Indonesian nurse-midwives

BACKGROUND

Anemia in pregnancy remains a major problem in Indonesia over the past decade. Early detection of anaemia in pregnancy is one of the components which is unsuccessfully implemented by nurse-midwives. This study aims to explore nurse-midwives' experiences in managing pregnant women with anaemia in Public Health Centres.

METHODS

We conducted a qualitative study with semi-structured face to face interviews from November 2011 to February 2012 with 23 nurse-midwives in five districts in Yogyakarta Special Province. Data analysis was thematic, using the constant comparison method, making comparison between participants and supported by ATLAS.ti software.

RESULTS

Twelve nurse-midwives included in the interviews had less than or equal to 10 years' working experience (junior nurse-midwives) and 11 nurse-midwives had more than 10 years' working experience (senior nurse-midwives) in Public Health Centres. The senior nurse-midwives mostly worked as coordinators in Public Health Centres. Three main themes emerged: 1) the lack of competence and clinical skill; 2) cultural beliefs and low participation of family in antenatal care programme; 3) insufficient facilities and skilled support staff in Public Health Centres. The nurse-midwives realized that they need to improve their communication and clinical skills to manage pregnant women with anaemia. The husband and family involvement in antenatal care was constrained by the strength of cultural beliefs and lack of health information. Moreover, unfavourable work environment of the Public Health Centres made it difficult to apply antenatal care the pregnant womens' need.

CONCLUSIONS

The availability of facilities and skilled staffs in Public Health Centre as well as pregnant women's husbands or family members contribute to the success of managing anaemia in pregnancy. Nurse-midwives and pregnant women need to be empowered to achieve the optimum result of anaemia management. We recommend a more comprehensive approach in managing pregnant women with anaemia, which synergizes the available resources and empowers nurse-midwives and pregnant women.

Whither the elephant?: the continuing development of clinical leadership in the UK National Health Services

The paper revisits the theme of clinical leadership in UK countries, following an earlier (2009) review. It examines the competency-based approach; considers the emerging voices of clinical leaders; explores the results of evaluation research studies; identifies learning from intra-UK and international comparisons and considers the issue of leader development versus leadership development. It concludes that there is little conceptual clarity; that there continues to be a major disconnect between clinicians and managers; that different approaches to developing clinical leaders are emerging in different parts of the UK and that the major challenge remains to develop leadership, rather than leaders.

Education for public health in Europe and its global outreach

INTRODUCTION

At the present time, higher education institutions dealing with education for public health in Europe and beyond are faced with a complex and comprehensive task of responding to global health challenges.

REVIEW

Literature reviews in public health and global health and exploration of internet presentations of regional and global organisations dealing with education for public health were the main methods employed in the work presented in this paper. Higher academic institutions are searching for appropriate strategies in competences-based education, which will increase the global attractiveness of their academic programmes and courses for continuous professional development. Academic professionals are taking advantage of blended learning and new web technologies. In Europe and beyond they are opening up debates about the scope of public health and global health. Nevertheless, global health is bringing revitalisation of public health education, which is recognised as one of the core components by many other academic institutions involved in global health work. More than ever, higher academic institutions for public health are recognising the importance of institutional partnerships with various organisations and efficient modes of cooperation in regional and global networks. Networking in a global setting is bringing new opportunities, but also opening debates about global harmonisation of competence-based education to achieve functional knowledge, increase mobility of public health professionals, better employability and affordable performance.

CONCLUSIONS

As public health opportunities and threats are increasingly global, higher education institutions in Europe and in other regions have to look beyond national boundaries and participate in networks for education, research and practice.

Essential facets of competence that enable trust in medical graduates: a ranking study among physician educators in two countries

One way to operationalize the assessment of trainees in a competency-based context is to determine whether they can be entrusted with critical activities. To determine which facets of competence (FOCs) are most informative for such decisions, we performed a Delphi study among Dutch educators. In the current study, the resulting list of facets of competence was evaluated among experienced Dutch and German clinical educators to determine which facets appear most relevant and to evaluate the agreement among experts in different countries as a support for their external validity. Eight Dutch and eight German experts scored each FOC on a five-point scale for relevance. A rank-order comparison showed that there was almost full agreement about the top 10 FOCs, among which 'Scientific and empirical grounded method of working', 'Knowing and maintaining own personal bounds and possibilities', 'Active professional development', 'Teamwork and collegiality', 'Active listening to patients', and 'Verbal communication with colleagues and supervisors'. We conclude that these facets of competence may be used in a training for educators who need to make entrustment decisions about trainees.