An evaluation of dental continuing professional development programs in the USA and Canada

PURPOSE

This research explores continuing professional development (CPD) requirements for dental regulatory/licensing authorities located in the USA/Canada and their preferences toward different learning and assessment strategies.

METHODS

Data were first retrieved through an environmental scan of CPD requirements posted on the websites for the 62 regulatory/licensing authorities located in the USA/Canada. Subsequently, an electronic questionnaire was distributed to the appropriate contact at each regulatory authority to capture additional data related to knowledge and preferences.

RESULTS

The environmental scan revealed that Canadian CPD programs had a significantly higher (p < 0.05) average of required CPD hours (26.67 ± 5.44) when compared to the USA (18.20 ± 4.23). For the survey component, 35 completed responses were received (response rate 56%). A total of 54% of respondents selected from a Likert scale that they "rarely" incorporate formative assessments, and 68% only "sometimes" or "often" incorporate summative assessments into their CPD programs. Additionally, 63% of respondents "never" incorporated predisposing activities, and 57% "never" incorporated reinforcing activities. It was perceived that renewal fees were insufficient to finance ongoing CPD costs (60%) and external industry sponsorships were required to sustain programs (43%). Respondents indicated that there is an insufficient number of evidence-based courses available in a variety of dental disciplines.

CONCLUSIONS

Formative and summative assessments and predisposing and reinforcing learning activities were not viewed as essential tools in CPD programs. Costs and human resources could be possible obstacles in incorporating learning activities and assessments. Future studies can build from the initial results of this study to improve the quality of learning in CPD programs.

Continuing education on child development in primary care: healthcare workers' perspectives

OBJECTIVE

To analyze the contributions of a continuing education with Primary Health Care professionals that promotes child development.

METHOD

A continuing education intervention, utilizing a qualitative approach, was conducted among healthcare workers at a Primary Health Care facility in a low-income neighborhood in the city of Recife. The intervention consisted of eight workshops conducted between July and October 2019, with the participation of fifteen healthcare workers. All data from the focus groups were recorded, transcribed, and analyzed thematically using Bronfenbrenner's bioecological model as the theoretical framework.

RESULTS

Through the continuing education intervention, healthcare professionals were able to reflect on their work processes and personal lives and propose actions to improve child development.

CONCLUSION

The study findings highlight the significant impact of such interventions in changing perceptions and professional practices related to child development. Overall, this research provides valuable insights into the effectiveness of continuing education interventions for promoting healthy child development in primary care settings.

Dentists' education, knowledge, and professional behavior concerning the diagnosis and treatment of dentin hypersensitivity: An exploration

OBJECTIVES

Dentin hypersensitivity (DH) affects patients' oral health-related quality of life, but is not always optimally treated in dental offices. The objectives were to assess dentists' DH-related education, knowledge, and professional behavior and explore relationships between education, knowledge, and behavior.

METHODS

Survey data were collected from 220 ADA members in the United States. Descriptive and correlational analyses were performed.

RESULTS

About half of the respondents agreed/strongly agreed that their dental school had educated them well about diagnosing DH in classroom-based (53.6%) and clinical settings (48.9%). Lower percentages agreed being well educated about treating DH (40.9%/37.3%). The majority self-educated themselves about DH after dental school by attending continuing education courses in person or online (60.6%/36.8%), reading articles (64.1%), or consulting with colleagues (59.6%). The majority knew that patients with DH describe their pain as stimulated (91.4%) and that recessed gingiva (89.6%), abrasion lesions (72.3%), tooth whitening (63.1%), erosion lesions (58.6%), and abfraction lesions (51.4%) are risk factors for DH. The majority diagnosed DH with patient self-reporting, confirmed by exams (81.8%), applying air blasts (53.7%), or cold-water (52.3%). They treated patients with DH often/very often with over-the-counter desensitizing agents (90%), and prescribing fluoride formulations toothpaste (82.8%) and/or potassium nitrate toothpastes (60.9%). In their offices, the majority (73.2%) educated their patients often/very often about DH and used fluoride dental varnish for treating DH (71.8%). The more recently respondents had graduated from dental school, the more positively they described their dental school education (r = 0.14; p < 0.05), the more ways to diagnose DH they used (r = 0.16; p < 0.05) and the more often they used fluoride dental varnish in their offices (r = 0.23; p < 0.001). The more dentists had educated themselves, the more methods for diagnosing DH they used (r = 0.23; p < 0.001) and the more often they used potassium oxalate products (r = 0.19; p < 0.01), Arginine/calcium products (r = 0.19; p < 0.01) and dentin bonding (r = 0.22; p < 0.001).

CONCLUSIONS

More recently graduating from dental school correlates with more positive evaluations of DH-related dental school education. The finding that most dentists engage in self-education about DH after dental school should motivate dental educators to increase education about this topic not only in dental school, but also in continuing education courses.

The systems-based practice competency: an innovative model to achieving class-wide proficiency in a pain medicine fellowship

One of the ACGME's six core competencies, systems-based practice (SBP), is difficult to interpret and developing proficiency over a one-year fellowship poses a challenge. Given the implications that successful SBP can have on pain medicine, it is especially important for fellows to focus on this competency during their training. Here, we propose a way to implement effective SBP into a pain medicine fellowship and the impact it may have within the larger health care system.

Stakeholder perspectives on co-designing a post-registration mental health nursing curriculum: A case study

INTRODUCTION

Globally, healthcare regulatory bodies require providers of academic programs to involve service users in the design and delivery of education, yet concrete and tested directions for operationalising this are lacking. Service users' involvement in education is often passive, ad-hoc and tokenistic, with limited input at the program development level.

AIM

To explore the co-design processes and outcomes of a collaborative revision of an Australian post-registration mental health nursing curriculum.

METHOD

Using qualitative case study design, the experiences and collaborative practices of five stakeholders (one mental health service user, two carers and two academics) co-designing a post-registration mental health nursing curriculum were explored.

RESULTS

Commonly identified barriers to meaningful involvement were overcome through planning and collaborative execution of the group's work. Participants reported a strong sense of successful collaboration in reviewing the curriculum, trusting relationships and mutual respect.

DISCUSSION

While it was possible to support and augment stakeholder knowledge in the context of post-registration education, co-design processes were ultimately bound by the university's relatively inflexible bureaucratic context.

IMPLICATIONS FOR PRACTICE

To ensure effective stakeholder collaboration beyond classroom teaching, mental health nurse academics must prepare service users for the role, explaining the language and practices of the tertiary health education and nursing context. As part of co-design processes, organisational mandates must be explored and negotiated, and mutual clarity regarding expectations and roles must be established. A Design Thinking approach can support meaningful engagement of stakeholders in curriculum development.

Evaluation of a Webinar to Increase Health Professionals' Knowledge about Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a severe chronic illness and patients with ME/CFS are often medically underserved in Germany and other countries. One contributing factor is health professionals' lack of knowledge about epidemiology, diagnostic criteria, and treatment of ME/CFS. Opportunities are scarce for health professionals to receive continuing medical education on ME/CFS. The current research addressed this need for further education and investigated the gain of knowledge from a webinar for German-speaking health professionals. In two studies (total sample: N = 378), participants in the intervention condition completed a knowledge test twice (before and after webinar participation). Study 2 also included a waiting-list control condition with repeated response to the knowledge test without webinar participation between measurements. Results showed that at baseline, most participants had seen patients with ME/CFS, but confidence in diagnosing and treating ME/CFS was only moderate-to-low. In the intervention condition, but not in the control condition, knowledge about ME/CFS increased between the first and the second knowledge test. These results indicate that the webinar was successful in increasing health professionals' knowledge about ME/CFS. We concluded that webinars can be a cost-efficient and effective tool in providing health professionals with large-scale continuing medical education about ME/CFS.

Massive open online courses: learning opportunities about global health for Latin American countries

INTRODUCTION

Massive open online courses provide the opportunity to train health professionals and researchers from Latin America in global health.

OBJETIVES

To determine the global offer of massive open online courses in global health and the characteristics of their content.

MATERIAL AND METHODS

We examined massive open online course platforms to compile the global health offerings. The search had no time restriction and was last conducted in November, 2021. The search strategy only included the descriptor “global health”. We obtained the characteristics of the courses, their content, and the global health domain covered. These data were analyzed using descriptive statistics, reporting absolute and relative frequencies.

RESULTS

Our search strategy identified 4,724 massive open online courses. Of these, only 92 were related to global health. Most of these courses (n=44; 47.8%) were offered through Coursera. More than half (n=50; 54.4%) of the MOOCs were conducted by U.S.A. institutions and in English language (n=90; 97.8%). Most courses focused on “globalization of health and healthcare” (n=24; 26.1%), followed by the domains “capacity building” (n=16; 17.4%), “global burden of disease” and “social and environmental determinants of health” (n=15; 16.3%).

CONCLUSIONS

We found a high offer of massive open online courses on global health. These courses covered the global health competencies required for health professionals.

Use of simulation for education in hospital pharmaceutical technologies: a systematic review

OBJECTIVES

Because of the inherent risks facing pharmacy technicians, and consequently also patients, initial and continuing education on hospital pharmaceutical technologies is essential. Simulation is a pedagogical tool now widely used in healthcare education. This study's objectives are to provide an overview of simulation's current place in the field of hospital pharmaceutical technology education, to classify these uses, and to discuss how simulation technologies could be better used in the future.

DATA SOURCES

Two pharmacists independently searched PubMed, Embase, and Web of Science on 21 July 2020 and included studies in English or French that used simulation as an educational tool in the field of hospital pharmaceutical technologies, whether in academic teaching or professional practice.

DATA SUMMARY

Our search criteria resulted in 6248 articles, of which 24 were assessed for eligibility and 13 included in the qualitative synthesis. Simulation in hospital pharmaceutical technology education is used in three different ways: first, as a playful pedagogical tool, with error-based simulations (cleanrooms and preparation sheets with errors), or game-based simulations (escape games, role-plays, and board games); second, as an electronic tool with virtual reality (virtual cleanrooms and serious games), or augmented reality (3D glasses); finally, to evaluate chemical contamination (fluorescein and quinine tests) and microbiological contamination (media-fill tests) during compounding to periodically requalify pharmacy technicians.

CONCLUSION

Further studies, including non-technical skills evaluations, are needed to confirm the usefulness of this innovative technique in training as efficiently as possible actual and future pharmacy professionals.

Nurses sustain manual handling risk assessment behaviours six-months after a training program to move patients safely: a pre-post study

PURPOSE

To determine if a patient manual handling training program focused on dynamic manual handling risk assessment for staff and patient safety, together with the patient's need for physical rehabilitation, can be transferred and sustained in clinical practice.

MATERIALS AND METHODS

Using a pre-post design, nurses (n = 72) from acute and rehabilitation wards participated in a 4-hour training session teaching dynamic manual handling risk assessment to safely move patients. Clinical observations audits of patient transfers were conducted prior to, and at 1-month and 6-months post training. Surveys determined experiences of training. Nurse musculoskeletal injuries and patient falls were measured 6-months after training.

RESULTS

Program patient handling skills were competently implemented 89% of the time 1-month following training and were sustained 6-months following training. There was no change in falls rates and staff injury rates were very low pre- and post-training. Training was well received and all nurses passed the competency assessment.

CONCLUSION

The patient handling training program taught nurses to better identify factors associated with risk to themselves and their patients and gave them improved skills to help patients move. Skills were incorporated safely into clinical practice and sustained at 6-months. It is uncertain whether training impacted musculoskeletal injuries.Implications for rehabilitationA dynamic manual handling risk assessment program for safely transferring and moving patients balances staff safety with the patient's need for physical rehabilitation.Nurses can be taught risk assessment skills to better identify factors associated with risk to themselves and their patients that can be translated to clinical practice.Thorough risk assessment at the point of the nurse-patient interaction can enable a patient to move at their highest level of function thus providing patients with opportunities to progress their rehabilitation at every interaction.

Understanding online self-directed learning using point of care information systems (POCIS): A plot study using a capability approach perspective

PURPOSE OF THE STUDY

Understanding self-directed learning (SDL) when using point of care information systems (POCIS) can inform educational providers of the usefulness of the system for continuing medical education (CME). Sen's capability approach can offer a unique perspective to understand SDL, which considers the extent to which individual valued learning needs can be achieved. The aim of the study was to pilot the use of a questionnaire informed by the capability approach for understanding SDL when using POCIS in the context of CME.

METHODS

A semi-structured questionnaire aligned to the capability approach (Capability Approach for SDL with POCIS Questionnaire - CA-SPQ) in the context of CME was developed and implemented with 200 users of a POCIS (BMJ Best Practice).

RESULTS

The response rate was 92 and 78% of users considered that their valued outcomes were achieved and that they could apply their new learning to practice. The questionnaire had high content, face, and construct validity.

CONCLUSION

The CA-SPQ can offer a practical instrument to provide data and useful information for understanding SDL, when using POCIS in the context of CME. It also has the potential for adaptation to other areas of medical education.

Evaluation of an intervention to promote minimally invasive dentistry (MID) in an Australian community dental agency-A pilot study

OBJECTIVES

To evaluate the impact of an intervention consisting of a 1-day continuing professional development (CPD) education programme on the International Caries Classification and Management System (ICCMS^™ ), and monthly performance feedback, and to promote minimally invasive dentistry (MID) for children aged under 12 years in an Australian community dental agency. The a priori hypotheses assumed the intervention would increase preventive services, and treatment demand was met.

METHODS

A quasi non-randomized controlled trial with convenience sampling method was adopted. Fourteen dental practitioners received the intervention. The prevalence of dental caries and gingivitis in Australian children was used to determine the treatment demand and used as the performance benchmark. Ten types of preventive and non-preventive dental services were examined. A Difference-in-Differences (DiD) of 12-month pre- (baseline) and post-intervention analysis was performed.

RESULTS

The intervention group demonstrated increases in topical fluoride application and dietary analysis and advice services. The standard care group had increases in oral prophylaxis or scale and clean, topical fluoride application and oral hygiene instructions (p-value <0.05). The DiD analysis confirmed the above findings in the intervention group, while other preventive services declined. In the intervention group, the performance benchmark for oral prophylaxis or scale and clean and oral hygiene instructions was met at baseline and post-intervention.

CONCLUSIONS

Only a few preventive services had already met the performance benchmark. The intervention was associated with varied changes to preventive and non-preventive dental services. More robust study design addressing the study limitations and validating the performance benchmark is required.

Systematic review of the stability of antimicrobial agents in elastomeric devices for outpatient parenteral antimicrobial therapy services based on NHS Yellow Cover Document standards

BACKGROUND

In order to use aseptically prepared elastomeric infusers, outpatient parenteral antimicrobial therapy (OPAT) services require extended stability data for antimicrobial agents to assign a product shelf-life. In the UK, the relevant standards for stability testing and shelf-life assignment are published in 'A Standard Protocol for Deriving and Assessment of Stability-Part 1 (Aseptic Preparations-Small Molecules), commonly called the Yellow Covered Document (YCD). A previous systematic review published in 2017 failed to identify data on the stability of antimicrobials in elastomeric devices for OPAT services that met YCD requirements in force at the time. The aim of this review was to update that search, following a subsequent change to YCD requirements in 2017 and 2019 and expand that dataset to identify progress made in providing assurance about the stability of antimicrobial agents for OPAT services.

METHODS

Searches were undertaken for papers relating to extended stability of antimicrobials. Citations were included when antimicrobial shelf-life was assessed using a stability-indicating method and considered a period of storage, either refrigerated or at room temperature, followed by in-use testing at a temperature at or above 32°C.

RESULTS

Of 267 initial citations, six met the inclusion criteria and underwent full text review for data extraction. Included antimicrobials were cefazolin, ceftazidime, piperacillin/tazobactam, flucloxacillin and ceftolozane/tazobactam. Of these, only flucloxacillin and piperacillin demonstrated YCD compliant stability over the 24-hour infusion period while cefazolin, ceftazidime and ceftolozane/tazobactam could be infused over 12-hour period.

CONCLUSIONS

Contrary to the position found in 2017 review, high-quality data are now available to support the use of a number of antimicrobial agents in extended infusion in elastomeric devices for OPAT services. There is a need to expand the dataset, as well as developing international consensus on the ideal parameters for stability assessment of such infusions in elastomeric devices.

A virtual research showcase and judging platform created from a patchwork of workplace applications

Background

Despite the challenges the COVID-19 pandemic placed on libraries' existing workflows and operations, many librarians developed and debuted new services that addressed novel needs that emerged during the pandemic. This report describes how two electronic resource librarians at regional hospitals within a healthcare corporation used exhibition platforms to showcase resident research in an online format as a complement to in-person resident research programming.

Case Presentation

Over the course of the pandemic, two exhibition platform variants were implemented, one year apart. This case report describes how each platform was developed. The first online event was conducted using a virtual exhibit platform to minimize in-person contact. The second online event, held the following year, blended a traditional live event with virtual elements using the online exhibit platform. To ensure completion of tasks, project management techniques were adopted throughout the event planning process.

Conclusions

The pandemic created opportunities for hospitals to explore transforming meetings from primarily live and onsite into hybrid and fully virtual events. While many corporate hospitals have transitioned back to primarily in-person programming, newly adopted online practices such as online judging platforms and automation of continuing medical education tasks will likely remain. As in-person restrictions within healthcare settings are lifted or eased at uneven rates, organizations may continue to explore the value of in-person meetings versus the video conference experience of the same meeting.

Effectiveness of Digital Flipped Learning Evidence-Based Practice on Nurses' Knowledge, Attitude, and Practice: A Quasi-Experimental Trial

Background: Evidence-based care has become critical in raising the quality of medical facilities. The implementation of evidence-based practice helps medical practitioners make better clinical decisions. Objective: The objective of this study was to investigate whether the innovative flipped teaching model could be as effective as the conventional teaching model in terms of knowledge, attitude, and practice and to confirm the continuous effect. Design: A quasi-experimental design using the flipped and conventional learning groups concurrently with repeat measurements was used. Setting: The setting was a 475-bed regional teaching hospital in Taiwan, from March to July 2020. Participants: The study included 114 licensed nurses who had worked longer than three months, with 57 participants each in two groups. Methods: The participants were assigned to two groups using a block randomization method. All participants completed questionnaires related to knowledge, attitude, and practice of EBP at four-time points: pre-test (T0) and immediately after intervention (T1), at month 1 (T2), and at month 3 (T3). Analysis of repeated generalized estimating equations was used. Results: The flipped and conventional learning groups had significant differences in knowledge, attitude, and practice at the T0 and T1 (p < 0.05). The flipped group was higher than the conventional group at T3 in the knowledge score (p = 0.001) and lower than the conventional group at T2 in the attitude score (p = 0.010). There were no significant differences between the two groups’ practice scores at different time points. There were no significantly different score changes for knowledge, attitude, and practice (p > 0.05). The interaction term only at T3 vs. T0 in the knowledge score was slightly different (p = 0.049) in primary outcome. Conclusion: The intervention methods of both groups were effective. Flipped learning is more flexible and has more time for discussion, which nurses favor. Under the policy promoted in the hospital, EBP combined with the nursing advancement system was standardized, and conventional learning also improved the learning effect.

Use of the CPD-REACTION Questionnaire to Evaluate Continuing Professional Development Activities for Health Professionals: Systematic Review

BACKGROUND

Continuing professional development (CPD) is essential for physicians to maintain and enhance their knowledge, competence, skills, and performance. Web-based CPD plays an essential role. However, validated theory-informed measures of their impact are lacking. The CPD-REACTION questionnaire is a validated theory-informed tool that evaluates the impact of CPD activities on clinicians' behavioral intentions.

OBJECTIVE

We aimed to review the use of the CPD-REACTION questionnaire, which measures the impact of CPD activities on health professionals' intentions to change clinical behavior. We examined CPD activity characteristics, ranges of intention, mean scores, score distributions, and psychometric properties.

METHODS

We conducted a systematic review informed by the Cochrane review methodology. We searched 8 databases from January 1, 2014, to April 20, 2021. Gray literature was identified using Google Scholar and Research Gate. Eligibility criteria included all health care professionals, any study design, and participants' completion of the CPD-REACTION questionnaire either before, after, or before and after a CPD activity. Study selection, data extraction, and study quality evaluation were independently performed by 2 reviewers. We extracted data on characteristics of studies, the CPD activity (eg, targeted clinical behavior and format), and CPD-REACTION use. We used the Mixed Methods Appraisal Tool to evaluate the methodological quality of the studies. Data extracted were analyzed using descriptive statistics and the Student t test (2-tailed) for bivariate analysis. The results are presented as a narrative synthesis reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.

RESULTS

Overall, 65 citations were eligible and referred to 52 primary studies. The number of primary studies reporting the use of CPD-REACTION has increased continuously since 2014 from 1 to 16 publications per year (2021). It is available in English, French, Spanish, and Dutch. Most of the studies were conducted in Canada (30/52, 58%). Furthermore, 40 different clinical behaviors were identified. The most common CPD format was e-learning (34/52, 65%). The original version of the CPD-REACTION questionnaire was used in 31 of 52 studies, and an adapted version in 18 of 52 studies. In addition, 31% (16/52) of the studies measured both the pre- and postintervention scores. In 22 studies, CPD providers were university-based. Most studies targeted interprofessional groups of health professionals (31/52, 60%).

CONCLUSIONS

The use of CPD-REACTION has increased rapidly and across a wide range of clinical behaviors and formats, including a web-based format. Further research should investigate the most effective way to adapt the CPD-REACTION questionnaire to a variety of clinical behaviors and contexts.

TRIAL REGISTRATION

PROSPERO CRD42018116492; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=116492.

Successful treatment of Verona integron-encoded metallo-β-lactamase-producing Klebsiella pneumoniae infection using the combination of ceftazidime/avibactam and aztreonam

The case of a female who had an accident that caused an open fracture is reported. During hospitalisation, Verona integron-encoded metallo-β-lactamase (VIM)-producing Klebsiella pneumoniae was isolated. Antimicrobial susceptibility testing revealed resistance to β-lactam antibiotics, quinolones, trimethoprim/sulfamethoxazole, and susceptibility to tigecycline, colistin, fosfomycin and aminoglycosides. Synergistic activity of ceftazidime-avibactam and aztreonam was proved in vitro and a combined therapy with tigecycline was started. Combination with aminoglycosides was ruled out as it was not described in the literature and also in order to avoid side effects. Colistin was rejected because of its nephrotoxicity profile. The antibiotic treatment was assessed by a multidisciplinary team with a pharmacist who closely monitored adverse effects and interactions with other drugs. The total duration of this combination was 25 days, without any adverse events reported. Fourteen weeks after the accident the patient was discharged. After 2 months of follow-up neither relapses nor reinfections have been reported.

Levofloxacin induced bullous fixed drug eruption: a rare case report

A 42-year-old male patient visited the outpatient department for follow-up with a history of respiratory tract infection and diabetes mellitus. His main symptom was peeling of his epidermal layer of skin, and bullous fixed drug eruption on the lower and upper limbs and bank region of the body. Following assessment, the patient was prescribed levothyroxine, hydroxychloroquine, levofloxacin, and a combination of sulfamethoxazole-trimethoprim. On assessing causality of the adverse drug reaction (ADR), different ADR assessment scales such as the WHO-UMC Scale, Naranjo Scale, and Hartwig's Severity Assessment Scale were used, and the ADR was found by these scales to be 'likely', 'moderate', and 'probable', respectively. It was found that ADRs such as bullous fixed drug eruptions are not fatal but can cause patient anxiety and a reduced quality of life. This case report will help physicians and clinicians to become aware and vigilant about the ADR caused by levofloxacin, facilitating its early detection and management.

Mini-Residencies to Improve Care for Women Veterans: A Decade of Re-Educating Veterans Health Administration Primary Care Providers

Background: Many primary care providers (PCPs) in the Veterans Health Administration need updated clinical training in women's health. The objective was to design, implement, and evaluate a training program to increase participants' comfort with and provision of care to women Veterans, and foster practice changes in women's health care at their local institutions. Methods: The Women's Health Mini-Residency was developed as a multi-day training program, based on principles of adult learning, wherein knowledge gleaned through didactic presentations was solidified during small-group case study discussions and further enhanced by hands-on training and creation of a facility-specific action plan to improve women Veterans' care. Pre, post, and 6-month surveys assessed attendees' comfort with and provision of care to women. The 6-month survey also queried changes in practice, promulgation of program content, and action plan progress. Results: From 2008 to 2019, 2912 PCPs attended 26 programs. A total of 2423 (83.2%) completed pretraining and 2324 (79.3%) completed post-training surveys. The 6-month survey was sent to the 645 attendees from the first 14 programs; 297 (46.1%) responded. Comparison of pre-post responses indicated significant gains in comfort managing all 19 content areas. Six-month data showed some degradation, but comfort remained significantly improved from baseline. At 6 months, participants also reported increases in providing care to women, including performing more breast and pelvic examinations, dissemination of program content to colleagues, and progress on action plans. Conclusions: This interactive program appears to have been successful in improving PCPs' comfort in providing care for women Veterans and empowering them to implement institutional change.

65

BACKGROUND

Large discrepancies exist between standards of healthcare provision in high-income (HICs) and low and middle-income countries (LMICs). The root cause is often financial, resulting in poor infrastructure and under-resourced education and healthcare systems. Continuing professional education (CPE) programmes improve staff knowledge, skills, retention, and practice, but remain costly and rare in low-resource settings. One potential solution involves healthcare education collaborations between institutions in HICs and LMICs to provide culturally appropriate CPE in LMICs. To be effective, educational partnerships must address the challenges arising from differences in cultural norms, language, available technology and organisational structures within collaborating countries.

METHODS

Seven databases and other sources were systematically searched on 7 July 2020 for relevant studies. Citations, abstracts, and studies were screened and consensus was reached on which to include within the review. 54 studies were assessed regarding the type of educational programme involved, the nature of HIC/LMIC collaboration and quality of the study design.

RESULTS

Studies varied greatly regarding the types and numbers of healthcare professionals involved, pedagogical and delivery methods, and the ways in which collaboration was undertaken. Barriers and enablers of collaboration were identified and discussed. The key findings were: 1. The methodological quality of reporting in the studies was generally poor. 2. The way in which HIC/LMIC healthcare education collaboration is undertaken varies according to many factors, including what is to be delivered, the learner group, the context, and the resources available. 3. Western bias was a major barrier. 4. The key to developing successful collaborations was the quality, nature, and duration of the relationships between those involved.

CONCLUSION

This review provides insights into factors that underpin successful HIC/LMIC healthcare CPE collaborations and outlines inequities and quality issues in reporting.

Medical education in Italy: Challenges and opportunities

Italy is a country of 60 million citizens with a high life expectancy, an increasing prevalence of chronic multi-morbidity and a public healthcare system. There are 61 medical schools and more than one thousand postgraduate programs for 50 different specialisations. In this article, we describe the Italian medical educational system and its most recent evolution towards a process of internationalization, alongside pedagogical and cultural changes. The main challenges are in the process of students' selection, which is still only based on the assessment of basic knowledge, and in the reform of the post-graduate education, which lacks an official, formal definition of the learning outcomes and the aligned methods of assessment. The opportunities come from the increasing awareness of the importance of faculty development programs. The pandemic itself acted as a catalyst of innovation, pushing toward more student-centered teaching-learning activities. Finally, an increase in international collaborations in medical education research could be effective to foster the development of medical education in the country.

Ontario dentists' ease to discuss sensitive health issues with their patients: A cross-sectional study

OBJECTIVES

With consistent calls for a more integrated approach to improve the healthcare system's effectiveness, the scope of practice for dentists has expanded; dentists are now seen to positively intervene to address several sensitive health issues among their patients. However, it is not clear how comfortable dentists feel in doing so. This study endeavored to assess self-perceived ease of dentists to discuss various sensitive health issues and if their socio-demographics influence their ease.

METHODS

A self-administered online survey was sent to Ontario dentists (n = 9975) to assess their self-perceived ease in discussing five sensitive health issues with their patients: eating disorders, substance abuse, sexually transmitted infections (STIs), sexual behaviors, and physical abuse. Ordinal logistic regressions were performed along with descriptive analyses.

RESULTS

The response rate was 9.3%. Over 50% of participants indicated difficulty discussing STIs, sexual behaviors and physical abuse. Younger dentists, female practitioners, dentists practicing in private settings, and those practicing in rural areas perceived more difficulty to discuss all five health issues. Place of training was also a significant predictor: internationally trained dentists perceived it easier to discuss eating disorders, substance abuse, and physical abuse while Canadian trained were more at ease to discuss STIs and sexual behaviors.

CONCLUSION

This exploratory study identified that a large proportion of dentists are not comfortable discussing sensitive health issue with their patients. There are numerous opportunities for intervention in Canadian dental curriculums, continuing education programs, and communication practices to support dentists' discussions with patients about these important health concerns.

Viewing faculty development through an organizational lens: Sharing lessons learned

INTRODUCTION

Faculty Development (FD) plays a key role in supporting education, especially during times of change. The effectiveness of FD often depends upon organizational factors, indicating a need for a deeper appreciation of the role of institutional context. How do organizational factors constrain or enhance the capacity of faculty developers to fulfil their mandates?

METHODS

Using survey research methodology, data from a survey of FD leaders at Canadian medical schools were analyzed using Bolman and Deal's four frames: Symbolic, Political, Structural, and Human Resource (HR).

RESULTS

In the Symbolic frame, FD leaders reported lack of identity as a FD unit, which was seen as a constraining factor. Within the Political frame, developing visibility was seen as an enhancing factor, though it did not always ensure being valued. In the Structural frame, expanding scope of practice was seen as an enhancing factor, though it could also be a constraining factor if not accompanied by increased resources. In the HR frame, a sense of instability due to changing leadership and uncertainty about human resources was seen as a constraining factor.

CONCLUSION

While broadening the mandate of FD can generally be considered as positive, it is imperative that it is appropriately resourced and accompanied by recognition of FD as a valued contributor to the educational mission.

Twelve tips for developing a global community of scholars in health professions education

Scholarship in Health Professions Education is not just original research, it also includes study of educational processes, and application of new knowledge to practice. The pathways to successful scholarship are not always clear to novice educators. In this article, we describe strategies to establish a Community of Scholars (CoS), where more experienced and senior members guide junior members in scholarship to advance the field. Drawing on Lave and Wenger's concepts of Communities of Practice (CoP), we describe twelve practical tips, which include generation of a shared vision, formation of a global community of scholars, engagement in scholarly initiatives, and development of a professional identity, categorised under three major steps: establish, grow, and sustain the community. The tips embrace inclusivity for diverse cultural contexts which further provide opportunities for Health Professions Educators, interested in forming communities of practice, to work on scholarly outputs and add value to the professional arena.

Impact of pharmacist-led interventions in improving adherence to glaucoma medications in the geriatric population

OBJECTIVES

Geriatric patients can be non-adherent to ophthalmic glaucoma medications because of complex eye drops instillation techniques and forgetfulness, so pharmacists can play their part in improving the clinical outcomes of patients by acting as care providers. The purpose of the current study was to implement various pharmacist-led interventions to improve adherence to glaucoma medications and to evaluate the outcomes of interventions in the geriatric population.

METHODS

The Morisky Green Levine (MGL) adherence scale was used for analysis because it measures the extent of non-adherence and analyses the reasons for it. The interview-based sessions were conducted with control and interventional groups followed by educational interventions, including techniques for eye drop instillation, graphical images, precautionary measures, and individual patient counselling for the interventional group. Patients were asked to complete the adherence scale after the conclusion of every follow-up session for a duration of 6 months.

RESULTS

After 6 months of pharmacist-led interventions, a significant shift was found in the interventional group from low to high adherence according to MGL scale evaluation. Moreover, the number of patients in the interventional group whose intraocular pressure was in the safe range significantly increased and follow-up sessions significantly improved the patient's knowledge about glaucoma.

CONCLUSION

The results of this pharmacist-led educational interventional study showed it was effective in improving adherence to glaucoma medications in the geriatric patients, who showed better adherence scores and improved intraocular pressure.

Effect of a pharmacist-led educational intervention on clinical outcomes: a randomised controlled study in patients with hypertension, type 2 diabetes and hypercholesterolaemia

OBJECTIVES

In recent years, hospital pharmacists have gained more importance in the clinical support of patients. However, most of the studies evaluating the impact of clinical pharmacy have only studied patients' adherence or satisfaction. The aim of this study was to evaluate the direct clinical outcomes of a pharmacist-led educational intervention in patients with chronic disease.

METHODS

We conducted a randomised, controlled, parallel, physician-blinded study in a day hospital and a consultation unit of a French teaching hospital over a 1-year period. Patients with hypertension, type 2 diabetes or hypercholesterolaemia who did not reach their therapeutic goals despite drug therapy were eligible. Patients in the intervention group received an intervention from a hospital pharmacist who provided patient education on pathology and drug management. The primary outcome was the proportion of patients reaching their therapeutic goals for blood pressure, glycated haemoglobin level or low-density lipoprotein cholesterol level at the 3-month follow-up consultation.

RESULTS

From January to December 2015, 89 patients were included and 73 completed the study. In the intervention group, 61.7% (21/34) of the patients reached their therapeutic goals compared with 33.3% (13/39) in the control group (p=0.015). The intervention was significantly more effective in polypharmacy patients (60.0% (12/20) vs 16.7% (4/24); p=0.005), in those aged >60 years (57.9% (11/19) vs 26.1% (6/23); p=0.037) and in patients with a high education level (68.8% (11/16) vs 29.4% (5/17); p=0.024).

CONCLUSION

A single pharmacist-led educational intervention has a clinical impact, doubling the proportion of patients reaching their therapeutic goals at 3 months, especially in polypharmacy patients and those aged >60 years. This study confirms the value of clinical involvement of hospital pharmacists in patient care in a consultation unit and day hospital.

Clinical pharmacists' services, role and acceptance: a national Swedish survey

AIM

Describe, and between regions, compare the services provided, and the pharmacists' perceptions of their role and its importance.

METHOD

Online survey involving active clinical pharmacists in Sweden.

RESULT

The survey was completed by 118 pharmacists (66%), half of whom had at least 1 year's formal training in clinical pharmacy, and work experience in excess of 5 years. Admission medication reconciliation and medication review are provided in most regions and often on a daily basis. The most important services were: making suggestions to physicians regarding drug changes, medication review, medication reconciliation, and patient communication. On a five-point Likert-scale (where 1 = negative and 5 = positive) very few respondents scored less than 4 on the role, acceptance and skills questions.

DISCUSSION

Our study confirms the strong position of clinical pharmacy and clinical pharmacists in Sweden. There were some differences regarding the services provided between regions but clinical pharmacists' patient-centred work in the clinical setting as part of the care team is well established, accepted and important. Respondents believed they could take on additional responsibilities for prescription changes without the need for further education.

CONCLUSION

Patient-centred clinical pharmacy work in a clinical setting as part of the care team is well established, accepted and important.

Professional development training preferences of occupational therapists working with older adults in Australia: A discrete choice experiment

INTRODUCTION

Members of the public expect occupational therapists to provide evidence-based practice. Participation in professional development activities is essential to update knowledge and acquire skills to enable delivery of evidence-based assessment and intervention. Therapists commonly choose to participate in professional development through attending training workshops. Little is known about occupational therapists' preference of how continuing professional development training programmes should be designed and delivered.

METHODS

An online quantitative survey of occupational therapists working with older people in Australia, conducted June to September 2018, incorporated a discrete choice experiment to elicit and estimate preferences for professional development training when acquiring skills in delivering an evidence-based intervention. A series of questions asked participants to choose one of two options for training, each differing in terms of attributes (level of recognition, mode of learning, follow-up post-training and cost to establish willingness to pay). Statistical analyses were conducted according to recommended practice in the field of choice-modelling.

RESULTS

A total of 108 responses were received from occupational therapists practicing around Australia. Therapists reported a strong preference for receiving post-training support to implement their new skills in practice and would be willing to pay an additional A$200 for training that included this option. They also highly regarded achieving 'certification' in their new skill (willing to pay an additional A$100) and having the opportunity to become a 'Master Trainer' in the future (willing to pay an additional A$200).

DISCUSSION

This study generates new knowledge about aspects of a professional development training programme that occupational therapists' value and aspects that they are willing to compromise on when acquiring new skills that they intend to use in their practice. These findings can influence the training programme design utilised by those working in implementation research and providers of continuing professional development for health professionals.

The evaluation of an e-learning prescribing course for general practice

Prescribed medication may lead to significant morbidity or mortality as a result of these medications causing adverse events, or because of a prescribing error. E-learning is a common tool used in supporting training in prescribing. This paper describes the development of an e-learning course and the subsequent evaluation undertaken by the users with the aim of obtaining an effective e-learning course for prescribing. The e-learning course was developed by general practitioners and pharmacists and focussed on the principles of good prescribing, examined the common reasons for prescribing errors, and was evaluated using self-reported quantitative and qualitative measures. Scores significantly increased on an assessment given before and after the course. The majority of respondents reported that the e-learning course had a positive impact on prescribing knowledge, skills and attitudes, with medication reviews the top area where a change in prescribing practice was reported. Over 90% of the respondents agreed that the e-learning course was easy to use and a useful part of their continuing professional education. This study shows that clinicians recognise the on-going need for training in prescribing, but the lack of training is one of the factors contributing to errors, which suggests that more education is needed, not just for GPs in training, but for qualified GPs as well.

Identifying Training Needs and Active Information Opportunities in Primary Care Through the Analysis of Drug Information Requests

INTRODUCTION

Drug information (DI) services should work toward efficiency by identifying knowledge gaps and actively creating resources to address those needs. The aim was to identify training needs and active information opportunities in primary care by analyzing DI requests and to calculate labor cost associated with DI requests addressable with training or active information.

METHODS

DI requests received in 2016 and 2017 by ambulatory care pharmacists were independently classified by 2 authors into: training (i.e., delivery of content meant to be retained as knowledge and used when needed); active information (i.e., resources created preemptively and consulted when needed); or passive information (i.e., not addressable with training or active information). Inter-rater reliability was calculated using Cohen's Kappa. Median time spent by category and across practice settings/professional types was compared using bivariate analysis. Thematic analysis categorized specific training and active DI requests and labor costs were calculated.

RESULTS

Of 2,041 DI requests, 330 (16.2%) were classified as training, 454 (22.2%) active information, and 1257 (61.6%) passive information (kappa = 0.769). Median (IQR) time to resolve requests was 5 (2-10) mins for training, 5 (3-11) active information, and 10 (4-15) passive information. Pharmacists spent 132.1 hrs = $8,956.98 answering questions addressable with training or active information. Areas warranting training or active information included: controlled substances, immunizations, patient assistance programs, policy/regulations, medication preparation/administration, storage/stability, disposal, availability/ordering medications, and patient-related resources.

CONCLUSION

Several opportunities for training and active information were identified. Despite the single-institution nature, the method described can serve as an example for other institutions.

An update on developments in medical education in response to the COVID-19 pandemic: A BEME scoping review: BEME Guide No. 64

BACKGROUND

COVID-19 has fundamentally altered how education is delivered. Gordon et al. previously conducted a review of medical education developments in response to COVID-19; however, the field has rapidly evolved in the ensuing months. This scoping review aims to map the extent, range and nature of subsequent developments, summarizing the expanding evidence base and identifying areas for future research.

METHODS

The authors followed the five stages of a scoping review outlined by Arskey and O'Malley. Four online databases and MedEdPublish were searched. Two authors independently screened titles, abstracts and full texts. Included articles described developments in medical education deployed in response to COVID-19 and reported outcomes. Data extraction was completed by two authors and synthesized into a variety of maps and charts.

RESULTS

One hundred twenty-seven articles were included: 104 were from North America, Asia and Europe; 51 were undergraduate, 41 graduate, 22 continuing medical education, and 13 mixed; 35 were implemented by universities, 75 by academic hospitals, and 17 by organizations or collaborations. The focus of developments included pivoting to online learning (n = 58), simulation (n = 24), assessment (n = 11), well-being (n = 8), telehealth (n = 5), clinical service reconfigurations (n = 4), interviews (n = 4), service provision (n = 2), faculty development (n = 2) and other (n = 9). The most common Kirkpatrick outcome reported was Level 1, however, a number of studies reported 2a or 2b. A few described Levels 3, 4a, 4b or other outcomes (e.g. quality improvement).

CONCLUSIONS

This scoping review mapped the available literature on developments in medical education in response to COVID-19, summarizing developments and outcomes to serve as a guide for future work. The review highlighted areas of relative strength, as well as several gaps. Numerous articles have been written about remote learning and simulation and these areas are ripe for full systematic reviews. Telehealth, interviews and faculty development were lacking and need urgent attention.

Factors Included in T1DM Continuing Education for Korean School Nurses: A Systematic Review

(1) Background: The aim of this systematic review was to identify key factors for inclusion in continuing education for Korean school nurses to improve their competence in managing students with type 1 diabetes mellitus (T1DM). (2) Methods: This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. (3) Results: Twelve studies were included in this systematic literature review. The factors identified for inclusion in continuing education on Type 1 diabetes mellitus included 6 competencies. These were strengthening competence in managing students with Type 1 diabetes mellitus, facilitating networking with experts and peers, the perspective of the school nurse as a leader, use of a type 1 diabetes mellitus-specific evidence-based standardized approach of care, supporting self-management to promote healthy learners, and communication and collaboration between key stakeholders. Identified barriers to accessing continuing education on type 1 diabetes mellitus were work demands, difficulty taking time off during the school year, and limited support from administrators. (4) Conclusions: Based on the findings of this study, online or e-learning continuing education on type 1 diabetes mellitus must be developed for school nurses who manage students with this condition.

The RightSTEPS initiative: Continuing education impact on clinicians' optimal medical therapy practices for chronic heart failure

PURPOSE

Despite the existence of expert recommendations that can improve morbidity and mortality, reduce the need for hospitalization or readmission, and enhance quality of life in patients with heart failure (HF), many patients do not receive optimal medical therapy (OMT). The goal of this initiative, titled RightSTEPS, was to help physicians take the right steps to apply-evidence-based HF management strategies in clinical practice.

METHODS

Using the PRECEDE-PROCEED Model aimed at improving the clinical behavior of the learner, the instructional design featured 23 online and live face-to-face activities offering up to 16 credit hours of CME/CNE credit. These activities were delivered sequentially in three phases: predisposing, enabling and reinforcing. The lessons provided concise, pragmatic, stepwise management strategies aimed at empowering clinicians to prescribe evidence-based, guideline-directed OMT for patients with HF.

RESULTS

The predisposing and reinforcing online activities within the initiative reached a total of 71,510 learners with 23,902 successfully completed activities and post-tests; the enabling face-to-face activities reached a total audience of 763 clinicians. This initiative resulted in a statistically significant (p < 0.0001) increase in knowledge and competence related to HF OMT among the clinician learners. Furthermore, follow-up surveys indicated a commitment from learners to implement these guideline-directed strategies in their clinical practice.

CONCLUSIONS

This initiative demonstrated that the design of the RightSTEPS curriculum, using the Precede-Proceed model with sequentially-delivered, blended learning, provides a methodological framework to help learners translate knowledge into improvements in clinical behavior with the potential to improve patient health outcomes.

Traveling by winding roads or highways: Stability of medical students' specialty preferences over time

INTRODUCTION

Medical students switch career preferences during medical school and likely distinguish themselves in stability of preference over time. The purpose of our study was to gain insight in career paths stability of medical students.

METHOD

The authors conducted a longitudinal, four sessions interview study with medical students with three intervals over a three and a half-year period. From all 24 participants the first and second career preferences were documented, analyzed and we calculated a stability score, to interpret career preference stability.

RESULTS

Three different pathways were found: a 'winding road' with low stability (0-7 points); a 'country road' with medium stability (8-14 points); and a 'highway' with high stability (15-22 points).

CONCLUSION

This study provides a longitudinal view of how the stability of career preference, including the first and second career preference, evolves over time. While we only studied a small sample, the characterization may hold when larger samples are studied.

Perfectionism as a mediator of psychological distress: Implications for addressing underlying vulnerabilities to the mental health of medical students

OBJECTIVE

Medical students have personalities that are often shown to be perfectionistic. Perfectionism can manifest as maladaptive and lead to psychological distress. This study examined the mediating role of perfectionism on the association between personality trait profiles and levels of psychological distress.

METHODS

First-year medical students completed a questionnaire containing measures of personality, perfectionism (Concern over Mistakes: CoM), stress, anxiety and depression. Latent profile analysis classified students based on their personality traits and identified a profile vulnerable to psychological distress. Structural equation models examined the mediation effects of perfectionism on the relationship between the vulnerable personality profile and distress.

RESULTS

The sample totalled 376 (84% response). The vulnerable personality profile was highest in Harm Avoidance, lowest in Self-Directedness, and significantly correlated with the highest Perfectionism-CoM. High Perfectionism-CoM was associated with the highest levels of stress, anxiety and depression. Perfectionism-CoM was a significant mediator for the relationship between personality and higher levels of psychological distress.

CONCLUSION

Certain personality profiles are predisposed to psychological distress such as anxiety, stress and depression. Perfectionism, as a mediator between personality and psychological distress, may be a target strategy to help increase students' self-acceptance, and self-awareness of their perfectionistic tendencies and lower their vulnerability to poor mental health.

Continuing education in biochemistry and molecular biology in industry: A parallel session at the IUBMB/PSBMB 2019 "Harnessing Interdisciplinary Education in Biochemistry and Molecular Biology" conference

Science requires that we are always current with research, techniques, and tools but what are the best approaches for continuing education? The presenters in this session described a range of approaches used in universities, government bodies, and industry.

Assessment of the effectiveness of a pharmacist approach for improving disease-specific knowledge and treatment in patients with chronic obstructive pulmonary disease

OBJECTIVE

Adequate knowledge is essential for the appropriate management of chronic conditions such as chronic obstructive pulmonary disease (COPD). However, some patients may not be able either to comprehend or obtain adequate information. This study aims to assess the effectiveness of the clinical pharmacist approach to refining disease-specific knowledge in patients with COPD treated in a tertiary care hospital.

METHODS

A prospective observational longitudinal study was carried out in adult COPD patients for 9 months in the tertiary care hospital of Pune. At the time of enrolment, disease-specific knowledge of patients with COPD was assessed using the Bristol COPD Knowledge Questionnaire (BCKQ). After the assessment, patients were educated, counselled verbally and provided with a validated COPD information leaflet. The patients' knowledge was reassessed 1 month and 3 months after enrolment. Pre and post scores of BCKQ were compared by ANOVA followed by Tukey's post hoc test. The difference in the proportions was calculated using the χ² test.

RESULTS

Of 75 patients, the majority were men (53.33%), aged >60 years (72%), employed (62.67%) and had obtained secondary education (37.33%). The mean baseline BCKQ overall score of the patients was 25.87, which increased after education to 42.43 on the first visit (1 month) and to 45.62 on the second visit (3 months) (p<0.0001). At baseline, the topics 'vaccination', 'inhaled steroids' and 'antibiotics' returned the lowest mean scores of 0.37, 0.38 and 0.60, which were increased to 2.30, 2.70 and 2.72, respectively, after follow-up.

CONCLUSION

The knowledge of patients with COPD about the disease and its treatment was poor at the time of enrolment. Proper counselling and education provided by the clinical pharmacist helped to improve the patients' knowledge about COPD and its treatment.

Taking stock of what is known about faculty development in competency-based medical education: A scoping review paper

Purpose: The primary objective was to inventory what is currently known about faculty development (FD) for competency-based medical educations (CBME) and identify gaps in the literature.Methods: A scoping review methodology was employed. Inclusion criteria for article selection were established with two reviewers completing a full-text analysis. Quality checks were included, along with iterative consultation on data collection and consensus decision making via a grounded theory approach.Results: The review identified 19 articles published between 2009 and 2018. Most articles (N = 15) offered suggestions as to what should happen with FD in CBME, but few (N = 4) adopted an experimental design. Six main themes were identified with three main features of FD noted across themes: (1) The importance of direct and timely feedback to faculty members on their teaching and assessment skills. (2) The role of establishing shared mental models for CBME curricula. (3) That FD is thought of longitudinally, not as a one-time bolus.Conclusion: This work illustrates that there is limited, high quality research in FD for CBME. Future FD activities should consider employing a longitudinal and multi-modal program format that includes feedback for the faculty participants on their teaching and assessments skills, including the development of faculty coaching skills.

How we make choices and sacrifices in medical education during the COVID-19 pandemic

In this commentary, we highlight some of the pressing choices and sacrifices we must make in medical education during the COVID-19 pandemic.

Teaching, reflecting, and learning: The value of an intercalated medical education programme

Objectives: Teaching programmes within medicine focus primarily on pathways of a shorter length with little regard to teaching lasting longer than a month. This study is different from other studies as it examines the benefits of a nine month-long medical education degree programme and its impact beyond graduation. This study set out to explore the impact of a medical education intercalated degree programme for its graduates and their careers.Methods: A small scale, exploratory qualitative case study was conducted with 10 graduates of an intercalated degree programme.Results: The findings highlight the longer term value of an intercalated degree programme with particular emphasis on academic and personal skills; research and teaching skills; independence and confidence; its impact on future practice and the notion that 'student as teacher' programmes are a valuable asset to medical education as a whole. Participants advocated more teaching opportunities as a core longitudinal teaching component in preparation for the teaching responsibilities in their working lives.Conclusions: The programme enables the development of a range of academic and personal skills, with particular emphasis on research and teaching skills, independence and confidence.

12-hr shifts in nursing: Do they remove unproductive time and information loss or do they reduce education and discussion opportunities for nurses? A cross-sectional study in 12 European countries

Aims and objectives

To examine the association between registered nurses' (referred to as “nurses” for brevity) shifts of 12 hr or more and presence of continuing educational programmes; ability to discuss patient care with other nurses; assignments that foster continuity of care; and patient care information being lost during handovers.

Background

The introduction of long shifts (i.e., shifts of 12 hr or more) remains controversial. While there are claims of efficiency, studies have shown long shifts to be associated with adverse effects on quality of care. Efficiency claims are predicated on the assumption that long shifts reduce overlaps between shifts; these overlaps are believed to be unproductive and dangerous. However, there are potentially valuable educational and communication activities that occur during these overlaps.

Design

Cross‐sectional survey of 31,627 nurses within 487 hospitals in 12 European countries.

Methods

The associations were measured through generalised linear mixed models. The study methods were compliant with the STROBE checklist.

Results

When nurses worked shifts of 12 hr or more, they were less likely to report having continuing educational programmes; and time to discuss patient care with other nurses, compared to nurses working 8 hr or less. Nurses working shifts of 12 hr or more were less likely to report assignments that foster continuity of care, albeit the association was not significant. Similarly, working long shifts was associated with reports of patient care information being lost during handovers, although association was not significant.

Conclusion

Working shifts of 12 hr or more is associated with reduced educational activities and fewer opportunities to discuss patient care, with potential negative consequences for safe and effective care.

Relevance to clinical practice

Implementation of long shifts should be questioned, as reduced opportunity to discuss care or participate in educational activities may jeopardise the quality and safety of care for patients.

Systematic review of the clinical effectiveness for long-term follow-up of total hip arthroplasty

Objectives: Total hip arthroplasty (THA) is highly successful but national registries indicate that average age has lowered and that younger patients are at higher risk of revision. Long-term follow-up of THA was historically recommended to identify aseptically failing THA, minimising the risks associated with extensive changes, but follow-up services are now in decline. A systematic review was conducted to search for evidence of the clinical or cost-effectiveness of hip arthroplasty surveillance.

Methods: The study was registered with PROSPERO International Prospective Register of Systematic Reviews and conducted according to PRISMA guidelines; databases included MEDLINE and Embase, and all studies were quality assessed. Original studies (2005 to 2017) reporting follow-up of adults with THA in situ >5 years were included. Researchers extracted quantitative and qualitative data from each study.

Results: For eligibility, 4,137 studies were screened: 114 studies were included in the final analysis, representing 22 countries worldwide. Data extracted included study endpoint, patient detail, loss to follow-up, revisions, scores and radiographic analysis. Six themes were derived from inductive content analysis of text: support for long-term follow-up, subgroups requiring follow-up, effect of materials/techniques on THA survival, effect of design, indicators for revision, review process. Main findings—follow-up was specifically recommended to monitor change (eg asymptomatic loosening), when outcomes of joint construct are unknown, and for specific patient subgroups. Outcome scores alone are not enough, and radiographic review should be included.

Conclusion: There were no studies directly evaluating the clinical effectiveness of the long-term follow-up of THA but expert opinions from a range of international authors advocated its use for defined subgroups to provide patient-centred care. In the absence of higher level evidence, these opinions, in conjunction with emerging outputs from the national joint registries, should be used to inform services for long-term follow-up of THA.

Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use:

https://youtu.be/lAKW3hQGyJQ

Implementation of a pharmacogenomics education program for pharmacists

PURPOSE

The development, implementation, and evaluation of a pharmacogenomics education program for pharmacists in a large, integrated multicampus health system are described.

SUMMARY

Pharmacogenomics has been described as tailoring medications to each patient's unique genetic sequence with the goals of minimizing harmful effects and optimizing therapeutic effects. Pharmacists are uniquely trained to lead the implementation of pharmacogenomics in clinical care. After assessment of pharmacists' comfort with pharmacogenomics, different approaches were explored to develop, pilot test, and disseminate pharmacogenomics education across a multicampus academic medical center. Limited success with large-audience, single-lecture didactic education led to development and delivery of targeted, competency-based online modules using the institution's academic virtual learning environment and course management system. Implementation steps included (1) collaboration with the Mayo Clinic Center for Individualized Medicine to create an interprofessional development team and project charter, (2) galvanizing pharmacy leadership support across multiple campuses, (3) development of competency-based interactive modules, and (4) assessment of the quality of and learner satisfaction with the modules. Significant improvements in competency scores were observed with each module and across the multiple campuses. Satisfaction with the education program was assessed at the end of a 4-module series.

CONCLUSION

A pharmacogenomics educational program targeting pharmacists was developed through interprofessional collaboration and provided a novel opportunity to construct an educational infrastructure to support enterprise health-system campuses with limited educational resources.

Survey of Australasian geriatricians' satisfaction with, and preferences for, continuing professional development

BACKGROUND

Continuing professional development (CPD) is an obligation for all Australasian geriatricians; however, there are no systematic data regarding Australian and New Zealand geriatricians' satisfaction with, and preferences for, CPD.

AIMS

To inform understanding of Australasian geriatricians' satisfaction with, and preferences for, CPD.

METHODS

An electronic survey to collect data relating to demographics, current CPD activities, preferred CPD activities and perceived major barriers to CPD was distributed to 706 geriatricians in Australia and New Zealand.

RESULTS

Two hundred and thirteen (30%) responses were received. Respondents commonly reported CPD through participation in conferences (n = 205 (96%)) and research/educational activity (n = 146 (70%)). Most respondents agreed that the annual scientific meeting (n = 168 (79%)) and state-based meetings (n = 135 (63%)) are valuable for their CPD. Respondents perceived their professional (n = 155 (73%)) and non-professional (n = 21 (57%)) commitments as the major barriers to quality CPD. Respondents supported additional electronic CPD resources being made available, improved integration of assessment in CPD activities and flexible methods of CPD participation to meet the diverse needs of geriatricians.

CONCLUSIONS

Respondents perceived the face-to-face CPD opportunities currently available to them as valuable for their CPD but seek additional, flexible products to enable CPD participation based on individual needs and preferences.

Ageing doctors

Doctors are neither more nor less susceptible than the general population to the effects of ageing. The relevance of deterioration with age depends on the nature of the work undertaken. Reduced muscle strength and visual and auditory deterioration can compromise clinical ability. Accumulation of chronic disease further reduces capacity. Cognitive decline is of particular importance, as good medical care requires considerable cognitive function. Patient safety is paramount, yet older doctors are an important part of the medical workforce and their value should be recognised. Changes in patient case mix, work place support systems and individual adjustments can assist safe practice. Deterioration in health should be acknowledged and requires proactive management. Current methods of ensuring competence are inadequate for supporting ageing doctors. A new initiative is recommended comprising collaboration between regulators, colleges and employing institutions to support the ageing doctor in providing safe and effective practice.

A Qualitative Evaluation of an Online Expert-Facilitated Course on Tobacco Dependence Treatment

Qualitative evaluations of courses prove difficult due to low response rates. Online courses may permit the analysis of qualitative feedback provided by health care providers (HCPs) during and after the course is completed. This study describes the use of qualitative methods for an online continuing medical education (CME) course through the analysis of HCP feedback for the purpose of quality improvement. We used formative and summative feedback from HCPs about their self-reported experiences of completing an online expert-facilitated course on tobacco dependence treatment (the Training Enhancement in Applied Cessation Counselling and Health [TEACH] Project). Phenomenological, inductive, and deductive approaches were applied to develop themes. QSR NVivo 11 was used to analyze the themes derived from free-text comments and responses to open-ended questions. A total of 277 out of 287 participants (96.5%) completed the course evaluations and provided 690 comments focused on how to improve the program. Five themes emerged from the formative evaluations: overall quality, content, delivery method, support, and time. The majority of comments (22.6%) in the formative evaluation expressed satisfaction with overall course quality. Suggestions for improvement were mostly for course content and delivery method (20.4% and 17.8%, respectively). Five themes emerged from the summative evaluation: feedback related to learning objectives, interprofessional collaboration, future topics of relevance, overall modifications, and overall satisfaction. Comments on course content, website function, timing, and support were the identified areas for improvement. This study provides a model to evaluate the effectiveness of online educational interventions. Significantly, this constructive approach to evaluation allows CME providers to take rapid corrective action.