Simulation training on respectful emergency obstetric and neonatal care in north-western Madagascar: a mixed-methods evaluation of an innovative training program

BACKGROUND

The rates of maternal and neonatal deaths in Madagascar are among the highest in the world. In response to a request for additional training from obstetrical care providers at the Ambanja district hospital in north-eastern Madagascar, a partnership of institutions in Switzerland and Madagascar conducted innovative training on respectful emergency obstetric and newborn care using e-learning and simulation methodologies. The training focused on six topics: pre-eclampsia, physiological childbirth, obstetric maneuvers, postpartum hemorrhage, maternal sepsis, and newborn resuscitation. Cross-cutting themes were interprofessional communication and respectful patient care. Ten experienced trainers participated in an e-training-of-trainers course conducted by the Swiss partners. The newly-trained trainers and Swiss partners then jointly conducted the hybrid remote/in-person training for 11 obstetrical care providers in Ambanja.

METHODS

A mixed methods evaluation was conducted of the impact of the training on participants' knowledge and practices. Trainees' knowledge was tested before, immediately after, and 6 months after the training. Focus group discussions were conducted to elicit participants' opinions about the training, including the content and pedagogical methods.

RESULTS

Trainees' knowledge of the six topics was higher at 6 months (with an average of 71% correct answers) compared to before the training (62%), although it was even higher (83%) immediately after the training. During the focus group discussions, participants highlighted their positive impressions of the training, including its impact on their sense of professional effectiveness. They reported that their interprofessional relationships and focus on respectful care had improved. Simulation, which was a new methodology for the participants native to Madagascar, was appreciated for its engaging and active format, and they enjoyed the hybrid delivery of the training. Participants (including the trainers) expressed a desire for follow-up engagement, including additional training, and improved access to more equipment.

CONCLUSION

The evaluation showed improvements in trainees' knowledge and capacity to provide respectful emergency care to pregnant women and newborns across all training topics. The hybrid simulation-based training method elicited strong enthusiasm. Significant opportunity exists to expand the use of hybrid onsite/remote simulation-based training to improve obstetrical care and health outcomes for women and newborns in Madagascar and elsewhere.

Practitioners in search of an identity: A Delphi study of sport psychology professional identity

The existence of a professional identity among sport psychology practitioners (SPPs) can increase ethical and effective practice while also leading to more satisfactory careers and advancing awareness of professional roles. There is currently no consensus regarding a sport psychology professional identity (SPPI), a definition of this construct, and the factors influencing it. As such, in the present study, we sought consensus on a definition of SPPI and aimed to identify associated factors. A multinational panel of 39 SPPs from 6 different continents participated in a 3-round Delphi study. The panelists in this study, who were recruited based on their applied and scholarly experiences, constructed a shared definition of SPPI as an individual's professional self-concept concerning their sense of belonging and fit within the sport psychology profession. Further, the panelists also constructed a list of factors supporting (n = 13; e.g., knowledge and philosophy of the profession, personal meaning) and hindering (n = 10; e.g., isolation, non-traditional roles, lack of practitioner-environment fit) the development of SPPI. Professional organizations might use these results to advance professional development and training by integrating them into curricula for qualification processes. A clear understanding of what SPPI is and the factors that foster and hinder its development can support practitioners' wellbeing and practice as well as raise public awareness of what is the sport psychology profession.

Professional competences to promote healthy ageing across the lifespan: a scoping review

As societies age, the development of resources and strategies that foster healthy ageing from the beginning of life become increasingly important. Social and healthcare professionals are key agents in this process; therefore, their training needs to be in agreement with societal needs. We performed a scoping review on professional competences for social and health workers to adequately promote healthy ageing throughout life, using the framework described by Arksey and O'Malley and the Joanna Briggs Institute Guidelines. A stakeholder consultation was held in each of the participating countries, in which 79 experts took part. Results show that current literature has been excessively focused on the older age and that more attention on how to work with younger population groups is needed. Likewise, not all disciplines have equally reflected on their role before this challenge and interprofessional approaches, despite showing promise, have not been sufficiently described. Based on our results, health and social professionals working to promote healthy ageing across the lifespan will need sound competences regarding person-centred communication, professional communication, technology applications, physiological and pathophysiological aspects of ageing, social and environmental aspects, cultural diversity, programs and policies, ethics, general and basic skills, context and self-management-related skills, health promotion and disease prevention skills, educational and research skills, leadership skills, technological skills and clinical reasoning. Further research should contribute to establishing which competences are more relevant to each discipline and at what level they should be taught, as well as how they can be best implemented to effectively transform health and social care systems.

Mandibular third molar extraction: perceived surgical difficulty in relation to professional training

BACKGROUND

Establishing the level of surgical difficulty pre-operatively is an essential step in ensuring correct treatment planning. This study set out to determine whether the knowledge and experience acquired by dentists who had received different levels of training influenced, firstly, the perceived levels of difficulty of a variety of cases of mandibular third molar (MTM) extraction and, secondly, the perceived difficulty deriving from a series of factors (patient-related factors, anatomical and radiographic factors, operative factors).

METHODS

This cross-sectional, descriptive, observational study took the form of a survey. Using a visual analog scale (VAS), participants evaluated both the perceived difficulty of 30 cases of MTM extraction described by means of digital panoramic radiographs and the perceived difficulty deriving from a series of factors conditioning MTM extraction. The results underwent statistical analysis with SPSS Statistics 28.0 software. Non-parametric tests (Mann Whitney test for independent samples and the Kruskal-Wallis test) were applied.

RESULTS

A total of 389 surveys were available for analysis. Dental practioners with no surgical training saw the intervention as presenting greater difficulty. Professionals with postgraduate training in oral surgery considered patient-related factors more important than operative factors, in contrast to dentists who had not received oral surgery training.

CONCLUSIONS

Dental training has a signficant influence on the perceived difficulty of MTM extraction and also affects opinions about which factors have greater or lesser influence on surgical difficulty.

Instructors' self-efficacy, perceived benefits, and challenges in transitioning to online learning

Drawing on social cognitive theory, this study investigated instructors' online teaching self-efficacy during the sudden, COVID-19-induced transition to online teaching. The pandemic has forced instructors to shift to online teaching, arming them with valuable hands-on experience in this alternative teaching mode. This study examined instructors' online teaching self-efficacy, perceived benefits, intention to implement online teaching strategies in their future teaching, and the challenges encountered during this transition. A total of 344 instructors completed the developed and validated questionnaire. The data were analyzed using multiple linear regression modeling, using the stepwise estimation technique. The findings demonstrate that affiliated universities, the quality of online learning, and previous use of learning management systems (LMS) are significant predictors of instructors' online teaching self-efficacy. Online teaching self-efficacy, along with gender, quality of online learning, and professional training are significant predictors of the perceived benefits of online learning during emergencies. Meanwhile, the quality of online learning and professional training are significant predictors of instructors' intention to implement online teaching strategies and learning technology tools. Instructors ranked remote assessment as the most challenging factor in online teaching during emergencies, and internet access or internet speed as the first and most complicated hindrance for students in this transition. This study helps in understanding instructors' online teaching self-efficacy during the sudden transition and the positive consequences of shifting to the online mode due to the COVID-19 pandemic on the higher education field. Recommendations and implications are discussed.

The Change of Practitioner's Self-Efficacy in Triple P Professional Training: Moderating Role of Practitioner Characteristics, Country, and Delivery Mode

Two studies examined the change in self-efficacy of practitioners after attending Triple P training and the moderators that affect training outcomes. Study 1 used a large multidisciplinary sample of health, education, and welfare practitioners (N = 37,235) came from 30 countries around the world, which all participate in a Triple P professional training course during 2012-2019. This study assessed practitioners' overall self-efficacy and their consultation skills efficacy prior to training, immediately following training, and at six- to eight-weeks follow-up. Participants reported significant improvements of their overall self-efficacy and their consultation skills self-efficacy. There were significantly small differences based on practitioners' gender, disciplines, education levels, and country location. Study 2 examined the training outcomes of videoconference-based training (following the COVID-19 pandemic) compared to in-person training (N = 6867). No significant differences were found between videoconference and in-person training on any outcome measure. Implications for the global dissemination of evidence-based parenting programs as part of a comprehensive public health response to COVID-19 was discussed.

[Mapping public health training in Latin America: perspectives for training institutionsMapeamento da formação em saúde pública na América Latina: perspectivas para as instituições formadoras]

Objective

Map the public health training courses and programs offered in Latin America, and identify regional training strategies and competencies developed in health workers.

Methods

An internet search was conducted to identify public health training courses and programs offered by Latin American institutions. The following data were collected: name, country, and province/state of the training institution; course name; type of institution; educational level; modality; accreditation; year first offered; periodicity; and contact information. The programs and curricula on offer were analyzed by training level using descriptive content analysis, and the main competencies developed were identified.

Results

The mapping identified 2 296 public health training opportunities in all Latin American subregions, distributed across 29 of the Region's 33 countries; these were fairly heterogeneous, both conceptually and programmatically, with uneven geographical distribution within and between countries. In the analysis of curricula and programmatic contents, a need for greater linkage with essential public health functions was detected.

Conclusion

It is necessary to adapt the competencies and skills developed by the courses and programs to the demands of users of the regional health services, programs, and systems in order to achieve programs aimed at tackling the socio-environmental determinants of health and the production and reproduction of inequalities.

The study of virtual reality influence on the process of professional training of miners

Virtual reality technologies are actively applied for the organization of professional training in various industries, as well as in distance learning. However, numerous studies show the presence of a large number of negative factors that limit the effectiveness of using these technologies (united by the concept of "cybersickness"). The study, identification and reduction in the influence of these negative factors will increase the immersiveness and quality of the professional training process. Within the framework of this study, several hypotheses have been put forward regarding the negative and positive impact of VR technologies on the process of professional training, the coal and mining industry has been chosen as the subject area. Thus, the problem of effective training of miners for activities in regular and emergency situations is considered, in the latter case, VR technologies would allow forming the necessary set of skills and knowledge about actions in emergency situations. To confirm the declared hypotheses, an experimental group of 30 people was formed, corresponding to the trained miners by age characteristics. Based on the analysis, a list of quantitative and qualitative metrics for evaluating interaction with virtual reality was formed, the software of virtual scenes for two tasks (moving simple objects and a set of exercises in a virtual mine) was developed. The experimental group repeatedly performed these exercises, which allowed us to analyze the dynamics of changes in the average values of quantitative and qualitative metrics. The data obtained were processed by statistical tests (Shapiro-Wilk, Kruskal-Wallis, Mann-Whitney), which allowed us to assess the impact of the selected configurations (with and without VR) and the number of attempts on the selected metrics. The obtained results partially or completely confirmed the declared hypotheses and allowed us to form a list of recommendations for the organization of high-quality professional training using virtual reality technologies.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10055-022-00687-7.

Faculty Success Initiative: An Innovative Approach to Professional Faculty Onboarding and Development

Higher education institutions have been increasingly dependent on adjunct faculty to provide instruction at undergraduate and graduate levels. At professional schools, most faculty begin teaching graduate courses with limited to no formal training or teaching experience as industry expertise is the primary requirement for employment. Despite the availability of ample pedagogical resources to advance teaching, these faculty require additional support during their induction into academia. This paper describes the design and operationalization of the New York University Faculty Success Initiative (FSI), an innovative, semi-structured, faculty-centered onboarding and professional development program that provides quality, longer term preparation to new faculty throughout their first semester of instruction to increase their teaching effectiveness and their sense of connection to their academic unit. An analysis of multiple qualitative and quantitative data sources indicates that FSI led to an increase in teaching effectiveness and played a significant role in transitioning professional faculty from practitioners to educators.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s41686-022-00069-x.

Educational guidance for functional visual diversity in Nicaragua. Design and evaluation of a teacher-training program

The article exposes the process of design and implementation of a training program for teachers that teach people with Visual Functional Diversity (VFD), taking into account their needs both in training and in the provision of resources in Nicaragua. To verify the effectiveness of the program, a quasi-experimental design was carried out with a non-equivalent pretest and posttest control group. The experimental group received training while the control group did not receive training. The evaluation of the results obtained after the application of the program was carried out through two instruments: an efficacy questionnaire and a satisfaction questionnaire. The results showed significant differences between the experimental and control group after the application of the program (Z = -4,383; p = 0.000) in favor of the experimental group. It is confirmed that the program is effective in training teachers on inclusive education for the visually impaired as the teachers who took part in the training program significantly increased their knowledge in that issue.

Empathy in medical students of Córdoba, Argentina

INTRODUCTION

Physicians' empathy is an advantage for a better patient care and resolution of disease, and is considered a relevant part of professional training.

OBJECTIVE

To measure the level of empathy and its components in medical students of the city of Córdoba, Argentina.

METHODS

This was an exploratory, cross-sectional study. The Jefferson Scale of Physician Empathy was administered, in its Spanish version for health sciences students (version S), validated in Mexico and Chile, and culturally adapted to Argentina based on experts' opinion. A two-factor analysis of variance (model III) was used to assess mean differences between sexes and school years, and the interaction between these factors.

RESULTS

306/497 students from first through fifth year assessed in November 2016. The sample was stratified by school year and sex. Significant differences were observed in overall empathy and in compassionate care in both factors. These differences increased over the years (higher among fifth year students and lower among first year ones), and women showed higher values than men in terms of empathy and compassionate care.

CONCLUSION

Overall empathy, and the compassionate care component specifically, increased from first through fifth year (and were higher among women compared to men), which evidenced the progressive development of the affective component of empathy. The percentage of development of overall empathy and the cognitive components showed little progression.

[Flexible programs and advanced training for rheumatological patient education]

In two research projects, rheumatological patient education programmes were updated. The first step was to develop an expert consented framework for all rheumatological patient education programmes. From this, curricula and working materials for rheumatoid arthritis (RA) and axial spondyloarthritis (AS) were derived and two exemplary patient education manuals developed. A randomized controlled trail was designed for the five-hour RA basic education program. Finally, existing train-the-trainer training courses were adapted for these patient education programmes.

[West Africa Ebola outbreak - immediate and hands-on formation: the pre-deployment training program for frontline aid workers of the German Red Cross, other aid organizations, and the German Armed Forces, Wuerzburg, Germany 2014/15]

BACKGROUND

In September 2014, the German government mandated the German Red Cross (GRC) and the German Armed Forces to support the international efforts to stop the epidemic of Ebola virus disease (EVD) in West-Africa. The GRC requested specific training from the Medical Mission Institute Wuerzburg (MI).

OBJECTIVES

We describe and discuss the development, strategy, results, and evaluation of the program to formulate conclusions and recommendations for similar emergencies.

METHODS

On 26 September 2014, it was agreed to establish a two-day training program to prepare Ebola aid workers for the treatment of EVD patients and infection protection in Ebola treatment centers (ETC) in the epidemic area. Course evaluation was based on protocoled discussions with participants and standardized questionnaires.

RESULTS

The training started on 6 October 2014. By 24 February 2015, 214 trainees participated in 14 courses. Of 96 GRC staff deployed to West Africa, 90 (94%) participated in the training. Course content included containment strategy in filovirus outbreaks and practical exercises for standardized procedures in personal protective equipment (PPE). The average trainer-trainee ratio in PPE exercises was 1:3. "Excellent" or "good" ratings were received on 93% of the evaluations.

CONCLUSION

Rapid implementation was possible by teaching a harmonized, and field-approved concept for infection protection and treatment. Realistic simulated scenarios and field-experienced trainers allowed transfer of knowledge as well as reassurance. Additional recommendations are further conversion of the training into a permanent program and, in the case of a crisis, interlocking of training with operational planning to allow rapid escalation and adaptation. Also, the concepts for training and interventions should be harmonized and developed further for additional challenges like airborne transmission and application of intensive-care medicine.

The Training Experiences of Behavior Analysts: Compassionate Care and Therapeutic Relationships with Caregivers

Successfully working with families of children with autism requires technical behavior-analytic skills and critical interpersonal relationship-building skills. Taylor, LeBlanc, and Nosik (2018) suggested that many Board Certified Behavior Analysts might have been trained in graduate programs that focus primarily on conceptual and technical skills with little coverage of skills related to building therapeutic relationships. The current paper provides the results of an online survey of the precredential and postcredential training experiences of behavior analysts. The majority of behavior analysts surveyed indicated that they received no explicit didactic training or reading assignments on relationship-building skills in their graduate coursework in behavior analysis. Approximately half indicated that their practical experience supervisor provided guidance and mentoring on these skills. The majority of behavior analysts indicated that it is very important or extremely important that professional training programs develop formal training in this area.

Peritoneal Carcinomatosis Diagnosis and Treatment in China: Focusing on Training and Collaboration

Cancer has become the number one killer. The most difficult part of cancer treatment is the treatment of metastasis, particularly the peritoneal metastasis, generally referred to as peritoneal carcinomatosis (PC). Internationally, the integrated treatment strategy of cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) has been developed to be the standard treatment for PC. Although the development in this field has been relatively slow, as a result of the hard work put in over the last 20 years, there has been outstanding progress and gratifying achievements in both the diagnosis and treatment of PC in China. Our center (Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University) focuses on the research in diagnostic methods for PC, CRS+HIPEC, and management of perioperative adverse events. Based on these, "Chinese expert consensus on cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal malignancies" is developed. Our center that is the pioneering center for this treatment in China has accumulated a wealth of experiences and achievements with more than 1000 cases of CRS+HIPEC. Additionally, our center establishes a nationwide professional training program to promote and standardize the practice of CRS+HIPEC gradually.

Educational outreach visits to improve knee osteoarthritis management in primary care

BACKGROUND

Knee osteoarthritis is a common problem, but often underdiagnosed and undertreated in primary care as compared to evidence-based guidelines. Educational outreach visits are an effective strategy to improve guideline adherence, but its contribution to knee osteoarthritis management is largely unknown. The aim of this study was to evaluate the overall effectiveness of educational outreach visits on process quality indicators for knee osteoarthritis management, more specifically on the referral for physical therapy.

METHODS

An educational intervention study, non-randomized and controlled, was designed for general practitioners (GPs) in Belgium. During four months, 426 GPs were visited by academic detailers and allocated to the intervention group. The control group was selected from GPs not visited by academic detailers during the study period. Six months post-intervention, both groups received a questionnaire with two case-vignettes to measure the effectiveness of the educational outreach. Outcomes were assessed with a Belgian set of quality indicators for knee osteoarthritis management and focused on the number of prescriptions for appropriate physical therapy (i.e. muscle strengthening, aerobic, functional or range of motion exercises) and the adherence to eight additional quality indicators related to knee osteoarthritis management. For the analysis, multivariable logistic regression models were used and Generalized Estimating Equations to handle the correlation between the multiple results per GP.

RESULTS

The intervention group showed a tendency to prescribe more frequently at least one appropriate physical therapy for a case (43.8%), compared to the control group (31.3%, p = 0.057). Muscle strengthening exercises were the most frequently prescribed therapy with 37.0% in the intervention versus 26.9% in the control group. The adherence to the other quality indicators showed no significant difference between the intervention and control group and varied between 8.9 and 100% in the intervention group.

CONCLUSIONS

This intervention did not alter significantly the adherence to quality indicators and in particular the probability of prescribing physical therapy. To change general practitioners' prescription behavior, more extensive or combined interventional approaches seem warranted.

Managing the link and strengthening transition from child to adult mental health Care in Europe (MILESTONE): background, rationale and methodology

BACKGROUND

Transition from distinct Child and Adolescent Mental Health (CAMHS) to Adult Mental Health Services (AMHS) is beset with multitude of problems affecting continuity of care for young people with mental health needs. Transition-related discontinuity of care is a major health, socioeconomic and societal challenge globally. The overall aim of the Managing the Link and Strengthening Transition from Child to Adult Mental Health Care in Europe (MILESTONE) project (2014-19) is to improve transition from CAMHS to AMHS in diverse healthcare settings across Europe. MILESTONE focuses on current service provision in Europe, new transition-related measures, long term outcomes of young people leaving CAMHS, improving transitional care through 'managed transition', ethics of transitioning and the training of health care professionals.

METHODS

Data will be collected via systematic literature reviews, pan-European surveys, and focus groups with service providers, users and carers, and members of youth advocacy and mental health advocacy groups. A prospective cohort study will be conducted with a nested cluster randomised controlled trial in eight European Union (EU) countries (Belgium, Croatia, France, Germany, Ireland, Italy, Netherlands, UK) involving over 1000 CAMHS users, their carers, and clinicians.

DISCUSSION

Improving transitional care can facilitate not only recovery but also mental health promotion and mental illness prevention for young people. MILESTONE will provide evidence of the organisational structures and processes influencing transition at the service interface across differing healthcare models in Europe and longitudinal outcomes for young people leaving CAMHS, solutions for improving transitional care in a cost-effective manner, training modules for clinicians, and commissioning and policy guidelines for service providers and policy makers.

TRIAL REGISTRATION

"MILESTONE study" registration: ISRCTN ISRCTN83240263 Registered 23 July 2015; ClinicalTrials.gov NCT03013595 Registered 6 January 2017.

A pilot study to determine the effect of radiographer training on radiostereometric analysis imaging technique

INTRODUCTION

Producing x-ray images for radiostereometric analysis (RSA) is a demanding technique. Suboptimal examinations result in a high percentage of exposure repetition. The aim of this pilot study was to use an experiential training approach to sharpen the skills of radiographers in acquiring images of an optimal quality.

METHODS

A controlled trial using action research strategy was used. The study entailed a two phased approach. Radiographers were purposefully recruited and trained to perform the required investigations. Each phase included 12 examinations of a total knee arthroplasty phantom followed by 10 patient examinations. The quality of all x-ray images performed during the two phases was characterized by measuring the number of visible beads, the center position of the prosthesis (CP) compared to the center of calibration field (CCF). The number of re-exposures used to obtain a usable image during patient examinations was also recorded.

RESULTS

The radiographers undergoing the training resulted in a significant improvement in the quality of images produced and visualization of the beads. That is, the ability to move the CP on average 36.1 mm closer to the CCF (p < 0.001), the number of visible beads increased by 3.1 (p < 0.001) and radiographers needed 2.1-2.9 exposures less to obtain RSA images of sufficient qualities during patient examinations in phase 2 (p < 0.001).

CONCLUSION

This study illustrates the value of experiential method of teaching and learning with minimal compromise on patient safety but a significant contribution in terms of establishing quality of RSA images.

Have You Ever Googled a Patient or Been Friended by a Patient? Social Media Intersects the Practice of Genetic Counseling

Patients and healthcare providers are becoming increasingly connected via social media, bringing new opportunities and challenges. Direct connection can occur between patients and providers using online tools such as Facebook and LinkedIn. In addition, providers can gather information about patients using a search engine such as Google, referred to as patient-targeted Googling (PTG). An online 54-item survey was used to gain information on (1) how and to what extent genetic counseling students and genetic counselors connect directly with patients via social media sites, and (2) gather information on providers using PTG. Four hundred genetic counseling students and genetic counselors participated in the survey. The majority of respondents (88.9%; n = 344/387) find it is never or rarely acceptable to interact with current patients via social media sites; however, 27.7% (n = 110/397) have visited a patient's social media site. Gathering information for patient care was the most commonly reported reason (76.8%; n = 43/56). Thirty-three percent (n = 130/394) have considered searching online or actually searched online for information about a patient. Curiosity was the most common reason (92.7%; n = 114/123); although, respondents also used PTG to obtain contact information and to prepare for patient sessions. Our study supports the need for development and dissemination of professional guidelines to serve as a valuable resource for practicing genetic counselors and genetic counseling training programs.

Design and evaluation of learning strategies for a group of radiographers in radiostereometric analysis (RSA)

INTRODUCTION

The purpose of this study was to design and evaluate a radiostereometric analysis (RSA) program aimed at radiographers in order to increase their cognitive and practical skills, thereby increasing image quality and minimizing exposure repetition.

METHODS AND MATERIALS

Twenty radiographers were randomized into two identically sized study groups. Training consisted of a theoretical and practical workshop using a phantom. Tests were performed to compare the effect of training to nontraining, and the effect of time duration on the maintenance of RSA skills. The effect of training was measured by a written test and three defined parameters influencing image quality.

RESULTS

Group A reduced significantly (p < 0.001) by 31.3 mm (21-31%) the distance between the centrum of the prosthesis (CP) and the centrum of the calibration field (CCF) and increased the number of beads (NB) visible by 3.6 (out of 18). A further significant reduction of 5.1 mm (p = 0.023), 1.0 bead more (p < 0.001) and a 2.1 (p = 0.022) point better rotation of the prosthesis (RP) was registered two months later. Group B was tested twice without training and no significant improvement was registered. One month after training group B had experienced overall significant improvement on a par with group A.

CONCLUSION

It is realistic to implement an RSA X-ray training program where radiographers significantly improve their theoretical and practical skills in centering the CP closer to the CCF, NB and RP. A duration of up to two months after training does not influence the quality of participants' performance.

Case Method in COPD education for primary care physicians: study protocol for a cluster randomised controlled trial

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a common cause of morbidity and mortality worldwide. It is often undiagnosed and insufficiently managed. Effective forms of continuing medical education (CME) for primary care physicians (PCPs) are necessary to ensure the implementation of guidelines in clinical practice and, thus, improve patients' health.

METHODS

In this study, we will measure the effects of CME by Case Method and compare them against those of traditional lectures and no CME at all through an unblinded, cluster randomised controlled trial (CRCT). Thirty-three primary health care centres (PHCCs) in Stockholm, Sweden, with a total of 180 PCPs will be involved. Twenty-two primary PHCCs, will be cluster-randomised into: an intervention group who will receive CME by Case Method (n = 11) and a control group who will receive traditional lectures (n = 11). The remaining PHCCs (n = 11) will be a reference group and will receive no CME. From the intervention and control groups, 460 randomly selected patients with COPD in GOLD stages 2 and 3 will participate, while no patients will be recruited from the reference group. For the patients, smoking status, actual treatment and urgent visits to a health provider due to airway problems will be registered. For the PCPs, professional competence (i.e. knowledge and management skills) in COPD, will be measured using a questionnaire based on current guidelines and guideline implementation problems in clinical practice which has previously been described by the authors. Data will be collected at baseline and at follow-up, which will be after 1.5 years for the patients, and 1 year for the PCPs. Statistical methods for individual-level and cluster-level analyses will be used.

DISCUSSION

COPD is considered a particularly complex clinical challenge involving managing multimorbidity, symptom adaptation, and lifestyle problematisation. Case Method in CME for PCPs may contribute to a better understanding of the impact of COPD on patients' lives and, thus, improve their management of it. The present study is expected to contribute scientific knowledge about indicators for an effective CME in COPD that is tailor-made to primary care physicians.

TRIAL REGISTRATION

ClinicalTrials.gov, identifier: NCT02213809 . Registered on 10 August 2014. Protocol version: Issue date: May 2014.

[Stalking of psychiatrists and psychotherapists : Results of an online survey]

BACKGROUND

Currently, there are clear indications that due to their exposed occupational position psychiatrists and psychotherapists are at a higher risk than the general public to become the victim of stalking by patients.

OBJECTIVES

This study investigated the frequency of stalking and its psychosocial impact among psychiatrists and psychotherapists in the Federal Republic of Germany.

METHODS

Analysis of an online survey among members of the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) from 23 September 2015 until 22 October 2015.

RESULTS

Of the respondents 26.5% reported having been the victim of stalking. In more than a third of the reported cases the stalking was described as severely or very severely debilitating. The majority of the perpetrators suffered from psychotic or personality disorders. Male victims were significantly more frequently stalked by a female perpetrator. Approximately 1 in 10 stalking victims continued the treatment of the perpetrator. The majority of the stalking victims did not obtain substantial support from their employer.

CONSLUSION

The phenomenon of stalking within therapeutic relationships needs to be incorporated into the medical and psychotherapeutic professional training, e. g. by implementing specialized training courses and the systematic integration of this topic into clinical supervision. The institutional dealing with stalking by patients needs to optimized, e. g. by promptly transferring treatment of patients who stalk to other professionals and, where required, providing assistance in reporting stalking incidents to the police.

Children and disabilities: what we call them, think and feel about them

Disability is a problem that affects more and more children and adolescents. But in the course of our graduate and postgraduate education, we have received practically no training in this regard. A pediatrician is the primary care physician of every child and adolescent, and the above-mentioned lack of training becomes a hurdle in the care provided to children with disabilities. Our idea of diversity is clearly determined by our culture and the social and family environment where we grew up, and is highly influenced by our human and extracurricular development rather than by our medical training. Every course involved in professional training should include a subject on disability. As pediatricians, we should reflect on how we see children with disabilities.

Medical physics in radiotherapy: The importance of preserving clinical responsibilities and expanding the profession's role in research, education, and quality control

Medical physicists have long had an integral role in radiotherapy. In recent decades, medical physicists have slowly but surely stepped back from direct clinical responsibilities in planning radiotherapy treatments while medical dosimetrists have assumed more responsibility. In this article, I argue against this gradual withdrawal from routine therapy planning. It is essential that physicists be involved, at least to some extent, in treatment planning and clinical dosimetry for each and every patient; otherwise, physicists can no longer be considered clinical specialists. More importantly, this withdrawal could negatively impact treatment quality and patient safety. Medical physicists must have a sound understanding of human anatomy and physiology in order to be competent partners to radiation oncologists. In addition, they must possess a thorough knowledge of the physics of radiation as it interacts with body tissues, and also understand the limitations of the algorithms used in radiotherapy. Medical physicists should also take the lead in evaluating emerging challenges in quality and safety of radiotherapy. In this sense, the input of physicists in clinical audits and risk assessment is crucial. The way forward is to proactively take the necessary steps to maintain and advance our important role in clinical medicine.

Evaluation of curriculum to improve health professionals' ability to manage age-related driving impairments

As our elderly population increases in proportion with respect to the rest of society, age-related driving impairments are increasing in importance as a public health concern. In this context, health professionals play an important role in identifying impaired drivers. This situation is complicated for two reasons: discussion of driving cessation is a sensitive topic for both health professionals and the elderly, and physicians have limited familiarity with the current American Medical Association (AMA) screening guidelines or mandated reporting laws. To assess curriculum that trains health professionals to increase their awareness, screening, management, and reporting of age-related driving impairments. Between 2009 and September 2011, 47 trainings were delivered to 1202 health professionals. The majority of trainings were seminars or lectures lasting 1h; all were conducted in southern California. The training curriculum was divided into four sections: introduction and background; screening and interpretation; managing outcomes and reporting; and referrals and resources. Videos addressed broaching the topic with patients and counseling on driving cessation. The curriculum was delivered by physicians with the support of public health-trained program staff. Pre- and post-testing was done with 641 of the participants; the majority were physicians. Post-training, participants' confidence in ability to screen increased to 72% and intent to screen increased to 55%. Fully 92% stated they had developed a better understanding of California's mandated reporting laws. Similarly, 92% said they had developed a better understanding of the medical conditions and medications that may impair older adults' ability to drive safely. Furthermore, 91% said mandated-reporting laws helped protect the safety of patients and others, and 59% said it was easier to discuss and justify driving cessation with patients. In-person training of health professionals on age-related driving impairments was well received and resulted in increased self-reported knowledge, confidence to screen, and intent to screen. Physicians were supportive of mandatory reporting laws.

Effects of Palliative Care Training Program on Knowledge, Attitudes, Beliefs and Experiences Among Student Physiotherapists: A Preliminary Quasi-experimental Study

Background:

Physiotherapists play an inherent role in the multidisciplinary palliative care team. Existing knowledge, attitudes, beliefs and experiences influence their team participation in palliative care.

Aims:

The objective of this study was to assess the changes in knowledge, attitudes, beliefs and experiences among student physiotherapists who attended a palliative care training program.

Settings and Design:

Preliminary quasi-experimental study design, conducted at an academic institution.

Materials and Methods:

Fifty-two student physiotherapists of either gender (12 male, 40 female) of age (20.51±1.78 years) who attended a palliative care training program which comprised lectures and case examples of six-hours duration participated in this study. The study was performed after getting institutional approval and obtaining participants’ written informed consent. The lecture content comprised WHO definition of palliative care, spiritual aspects of life, death and healing, principles, levels and models of palliative care, and role of physiotherapists in a palliative care team. The physical therapy in palliative care-knowledge, attitudes, beliefs and experiences scale (PTiPC-KABE Scale)- modified from palliative care attitudes scale were used for assessing the participants before and after the program.

Statistical Analysis:

Paired t-test and Wilcoxon signed rank test at 95% confidence interval using SPSS 11.5 for Windows.

Results:

Statistically significant differences (P<0.05) were noted for all four subscales- knowledge (7.84±4.61 points), attitudes (9.46±8.06 points), beliefs (4.88±3.29 points) and experiences (15.8±11.28 points) out of a total score of 104 points.

Conclusions:

The focus-group training program produced a significant positive change about palliative care in knowledge, attitudes, beliefs and experiences among student physiotherapists.

Clinical informatics board certification: history, current status, and predicted impact on the clinical informatics workforce

Within health and health care, medical informatics and its subspecialties of biomedical, clinical, and public health informatics have emerged as a new discipline with increasing demands for its own work force. Knowledge and skills in medical informatics are widely acknowledged as crucial to future success in patient care, research relating to biomedicine, clinical care, and public health, as well as health policy design. The maturity of the domain and the demand on expertise necessitate standardized training and certification of professionals. The American Medical Informatics Association (AMIA) embarked on a major effort to create professional level education and certification for physicians of various professions and specialties in informatics. This article focuses on the AMIA effort in the professional structure of medical specialization, e.g., the American Board of Medical Specialties (ABMS) and the related Accreditation Council for Graduate Medical Education (ACGME). This report summarizes the current progress to create a recognized sub-certificate of competence in Clinical Informatics and discusses likely near term (three to five year) implications on training, certification, and work force with an emphasis on clinical applied informatics.