Evaluation of transplant procurement management courses: an educational project as a tool for the optimization of transplant coordination

Undergraduate Education in Transplantation

INTRODUCTION

Training in the transplants of organs, tissues, and cells as a therapeutic modality of multiple pathologies is essential in undergraduate education. The medical aspects typical of the theme are associated with ethical, legal, religious, and philosophical concerns, giving a holistic view of the process. We present a teaching model of the donation-transplant process with 15 years of experience.

METHODS

The subject of Organ, Tissue, and Cell Transplants began its activities in 2008. It is an elective, annual subject included in the last year of the medical career. Since its inception, it has established a continuous teaching methodology with a global approach to the donation and transplantation process.

RESULTS

During the last 15 years and until the moment of the presentation, 1057 students have registered for the subject, 80.6% (852) completed the requirements of approval of the course, 79.9% of the students presented for the final evaluation (681), and 96.4% (654) of the students passed the final assessment. The average final grade calculated was equal to 6.53 ± 2.9 points out of 10; 205 students (19.4%) still need to comply with the final evaluative instance.

CONCLUSION

The available literature has different training modalities, but none resembles the model presented. It is concluded that, during these 15 years, the pedagogic expectations in the training of human resources have been exceeded.

Development and Evaluation of a Training Program for Organ Procurement Coordinators Using Standardized Patient Methodology

OBJECTIVES

The low rate of consent by next of kin of donor-eligible patients is a major limiting factor in organ transplant. Educating health care professionals about their role may lead to measurable improvements in the process. Our aim was to describe the developmental steps of a communication skills training program for health care professionals using standardized patients and to evaluate the results.

MATERIALS AND METHODS

We developed a rubric and 5 cases for standardized family interviews. The 20 participants interviewed standardized families at the beginning and at the end of the training course, with interviews followed by debriefing sessions. Participants also provided feedback before and after the course. The performance of each participant was assessed by his or her peers using the rubric. We calculated the generalizability coefficient to measure the reliability of the rubric and used the Wilcoxon signed rank test to compare achievement among participants. Statistical analyses were performed with SPSS software (SPSS: An IBM Company, version 17.0, IBM Corporation, Armonk, NY, USA).

RESULTS

All participants received higher scores in their second interview, including novice participants who expressed great discomfort during their first interview. The participants rated the scenarios and the standardized patients as very representative of real-life situations, with feedback forms showing that the interviews, the video recording sessions, and the debriefing sessions contributed to their learning.

CONCLUSIONS

Our program was designed to meet the current expectations and implications in the field of donor consent from next of kin. Results showed that our training program developed using standardized patient methodology was effective in obtaining the communication skills needed for family interviews during the consent process. The rubric developed during the study was a valid and reliable assessment tool that could be used in further educational activities. The participants showed significant improvements in communication skills.

Tissue banking training courses: Polish experience

Personnel directly involved in the donation, procurement, testing, processing, preservation, storage and distribution of human tissues and cells should be appropriately qualified and provided with timely and relevant training according to EU directives. In the time of new tissue and cells regulations implementation such a training system existed in Poland only at a local level. The first training programme outlines for various groups of health professionals engaged in tissue banking practice was created in co-operation with the Institute for LifeLong Learning at University of Barcelona in 2006. This initial training courses were financially supported by EU Transition Facility Programme 2004. Then, starting from 2006, based on previous experience, system of advanced training courses was created. This training programme was financially supported by the National Programme for the Development of Transplantation Medicine 2006–2009—POLGRAFT financed by Polish Ministry of Health. During 2006 and 2007 first set of tissue banking initial training courses were provided according to TF 2004 project. Over 200 pathologists, forensic medicine specialists and other medical doctors responsible for donor screening and classification, medical directors of tissue establishments, technical staff; tissue graft users: orthopaedic surgeons, neurosurgeons, cardiosurgeons and ophthalmologists were trained. Between 2006 and 2009 there were organized 8 advanced tissue banking training courses according to POLGRAFT programme. There were organized both theoretical and practical courses on various aspects of tissue for over 350 persons. We present our experience in organisation of international and national tissue banking training courses.

Evaluation of Organ Procurement in an Area Under the Influence of a Training Program

INTRODUCTION

The procurement of organs was evaluated in an area of 1,450,000 inhabitants. This area provides two international programs and two training courses for transplant coordinators. One of them deals with the entire process of donation and transplantation, and the other is a monographic course about family consent and donation request. One transplantation coordinator manages the area.

METHODS

The results of the last 6 years have been analyzed concerning the procurement of organ donors (related to brain death [BD] donors, exitus at the hospital, and the intensive care unit [ICU]); loss in the process, such as medically unsuitable; problem detection; and family refusals.

RESULTS

During the past 6 years the donor potential increased from 1.67% to 4.06%. The BD by exitus in the ICU increased from 7% to 14.01% (the average in Spain 12.2%); the cases of BD in ICU beds increased from 0.5% to 1.31% (average in Spain 0.8%). The loss for medical exclusion criteria decreased from 27% to 20% and in family refusals from 19.7% to 13.6%. The efficiency of the process in percentage of actual donations by BD increased from 52.4% to 65.3% (average in Spain 49%). The actual donors per million population (PMP) increased from 37 PMP to 59 PMP. The average number of organs obtained from donors increased from 3.1 to 3.6, and the transplants increased from 2.7 to 3.04 per donor. The average waiting period for a renal transplant was reduced from 365 days to 199 days.

CONCLUSION

The training of coordinators and the net system of regional coordinator, area coordinator, and hospital coordinator improved our donation rate.

Asclepiad's cock: a patient-physician association is a useful tool for educational programs in nephrology, dialysis, and transplantation

BACKGROUND

The negative impact of the mass media, the lack of information, and the request for in-depth knowledge are the basis for the present need for educational programs on transplantation, brain death, and chronic kidney diseases end-stage renal disease; (ESRD). The aim of the present article was to critically review the activities performed by Il Gallo di Esculapio, a nonprofit association, in the education on the different phases of ESRD. The associates are physicians and patients, and the activities are integrated institutionally.

METHODS

This report is a narrative review of the material produced and performed by Il Gallo di Esculapio ONLUS in 1996-2004.

RESULTS

The two main activities developed were book writing and an educational program. Eight books for patient education were written on different aspects of dialysis, transplantation, and ESRD. Most were designed as theses of the Medical School. Cooperation with patients was important in all cases and fundamental for the collection of interviews.

EDUCATION

A 4-hour educational program on transplantation started in 2000-2001 (1 high school was involved). The checklist originally included only transplantation and organ donation, but progressively gave space also to dialysis, ESRD, and social health care problems. In 2003-2004 the program involved 67 high schools. The association coordinated progressive patient involvement.

CONCLUSION

Small, nonprofit patient-physician associations linked with the University allow enrolling resources for educational activities to often-neglected parts of the medical profession.

Making a movie on kidney transplantation: A medical school graduation thesis to explain kidney transplantation from students to students

The aim of this study was to report on the production and the opinions of a video movie on transplantation and organ donation. The video was developed by a medical school student with the help of the students and teachers of a high school for applied arts. For this task, the making of the video was included in the high school program of the participating class. The students were tutored by their photography teacher. The video movie lasts about 50 minutes. Each "scene" lasts no more than 5 minutes, to avoid reducing the attention level. The choice of a nonmedical frame helped to have some moments to digest the technical information and to stress the importance of the patient-physician relationship. The video was employed as a part of small-group lessons in the nephrology course. A semistructured anonymous questionnaire gathered the opinion of 65 students at the end of the lessons. Student satisfaction was high; the median score was the highest (8, range 6 to 10) for the lesson based upon the movie, as compared with the conventional ones on chronic kidney disease or dialysis (7, range 5 to 10). As far as the authors know, this is the first experiment of a multimedia approach, dedicated to medical and nonmedical targets, developed as a graduation thesis in an Italian Medical School. In conclusion, the positive opinions of the students, who highly appreciated the peer-developed message, may suggest implementing such nonconventional educational approaches to support human resources and enthusiasm for kidney transplantation among the new generations.