Interdisciplinary medical, nursing, and administrator education in practice: the Johns Hopkins experience

Demanded interdisciplinary subjects for integration in medical education program from the point of view of graduated medical physicians and senior medical students: a nationwide mixed qualitative-quantitative study from Iran

INTRODUCTION

This study aimed to detect interdisciplinary subjects for integration into the medical education program of Iran.

METHODS

A qualitative-quantitative method was used. Firstly, interdisciplinary subjects demanded by medical graduates and senior medical students were defined by qualitative study. In the second stage, questionnaire was developed which based on the findings of qualitative stage, experts' opinion and reviewing of the national general guide of professional ethics for medical practitioners. Questionnaire consisted of demographic, occupational and thirteen interdisciplinary items. These items consisted of social determinants of health, social and economic consequences of disease, social prescribing, physicians' social responsibility, role of gender, racial, ethnic, social and economic issues in approach to patients, role of logic and mathematics in clinical decision-making, philosophy of medicine, maintaining work-life balance, self-anger management, national laws of medicine, religious law in medical practice, health system structure, and teamwork principles. Level and importance of knowledge and self-assessed educational needs were asked about each item. In the third stage, a national online survey was conducted. SPSS 25 was used for statistics.

RESULTS

By content analysis of data in qualitative stage, 36 sub-themes and 7 themes were extracted. In the quantitative part, 3580 subjects from 41 medical universities across Iran participated in this study. 2896 (80.9%) were medical graduates and 684 (19.1%) were senior medical students. Overall, knowledge about interdisciplinary items was low to intermediate, while high to very high knowledge ranged from maximally 38.7% about socioeconomic consequences of disease to minimally 17.2% about social prescribing. Participants gave the most importance to the having knowledge about self-anger management (88.3%), maintaining work-life balance (87.2%) and social determinants of health (85.8%), respectively. However, national laws of medicine (77.6%), maintaining work-life balance (75.4%) and self-anger management (74%) were the first top three educational demands by participants.

CONCLUSION

This study revealed a low to moderate level of knowledge about interdisciplinary topics among both graduated medical physicians and senior medical students. These groups showed a strong demand and tendency to know and to be educated about these topics. These findings underscore the urgency for educational reforms to meet the interdisciplinary needs of medical professionals in Iran.

Quality improvement in the implementation science paradigm in professional programs: scoping review

OBJECTIVE

To map knowledge regarding Quality Improvement in the implementation science paradigm in graduate nursing education in professional programs.

METHOD

This is a scoping review, conducted from October to December 2021, following the assumptions established by the Joanna Briggs Institute and the PRISMA-ScR protocol.

RESULTS

18 studies were selected. Being, 7 articles (38.8%) about the implementation strategies and development of Quality Improvement projects for graduate nursing students. The included studies emphasize Quality Improvement as a methodological strategy capable of capturing a problem in practice, to be solved without losing scientific rigor, and emphasize the importance of obtaining Quality Improvement skills in professional programs.

CONCLUSION

Implementation science and Quality Improvement projects advance professional programs to improve and develop quality health care.

Challenges facing healthcare leadership in attaining accreditation of teaching hospitals

PURPOSE

This paper aims to examine the challenges faced by health-care leadership in teaching hospitals in attaining accreditation for their institutions.

DESIGN/METHODOLOGY/APPROACH

This paper is based on a study of current literature on health-care leadership, hospital accreditation and quality of patient care and identifies the challenges facing health-care leadership in attaining accreditation for teaching hospitals.

FINDINGS

Based on a review and analysis of literature, infrastructure, finance, legal support, workforce recruitment and training, documentation and technology are identified as challenges faced by health-care leadership in teaching hospitals. The key challenges facing health-care leadership with respect to medical education and clinical research are found to be integration of education into hospital operations, compliance with all regulatory and professional requirements and adequacy of resources in executing research programs.

ORIGINALITY/VALUE

This study draws the attention of health-care leadership in teaching hospitals on the challenges they face in obtaining accreditation for their institutions so that they may develop appropriate strategies to overcome them.

Midwifery Professional Relationships: Collaboration Across the Novice-to-Expert Continuum

This article describes the types of helpful and supportive interactions or communication strategies that characterize the collaborative relationships in which a midwife can engage across the novice-to-expert continuum of professional development. Similarities and distinctions are drawn between the various terms describing types of collaboration and discussed with respect to the added value that each relationship can have for the individual and for the health care team. A conceptual depiction of the essential components of effective teamwork or collaboration is presented. Emphasis is placed on the dynamic nature of the process of developing and sustaining these relationships across the midwife’s professional lifetime.

Results of an effort to integrate quality and safety into medical and nursing school curricula and foster joint learning

Improvements in health care are slow, in part because doctors and nurses lack skills in quality improvement, patient safety, and interprofessional teamwork. This article reports on the Retooling for Quality and Safety initiative of the Josiah Macy Jr. Foundation and the Institute for Healthcare Improvement, which sought to integrate improvement and patient safety into medical and nursing school curricula. In one academic year, 2009-10, the initiative supported new learning activities (87 percent of which were interprofessional, involving both medical and nursing students) in classrooms, simulation centers, and clinical care settings that involved 1,374 student encounters at six universities. The work generated insights-described in this article-into which learning goals require interprofessional education; how to create clinically based improvement learning for all students; and how to demonstrate the effects on students' behavior, organizational practice, and benefits to patients. A commonly encountered limiting factor for the programs was the lack of a critical mass of clinically based faculty members who were ready to teach about the improvement of care. What's more, the paucity of robust evaluation strategies for such programs suggests a future research agenda that deserves to be funded.

Metrics and management: Two unresolved problems on the pathway to health care-associated infection elimination

Surveillance and management of health care-associated infections (HAIs) has traditionally relied on analyses of outcome data to elucidate trends in HAI incidence, discover host or treatment risk factors, and facilitate comparisons of HAI rates within and among licensed providers or facilities. This paper explores residual gaps and shortcomings associated with outcome reporting and possible sources of bias that may invalidate intra- and interfacility comparisons. As an alternative to outcome surveillance and reporting, real-time process monitoring and control is proposed. To address the need for uncompromising conformity with preventive measures, the concepts of social entropy, authority, responsibility, and accountability are explored and linked to process control at the bedside.

Professional formation: extending medicine's lineage of service into the next century

In his 1910 report on medical education, Flexner emphasized the importance of competency in basic sciences. Less widely recognized is that he also emphasized the necessity of liberal education. On the Flexner Report's 100th anniversary, medicine is challenged to realize Flexner's full vision for medical education to ensure that physicians are prepared to lead lives of compassion and service as well as to perform with technical proficiency. To meet the complex medical and social challenges of the next century, medical educators must continue to promote cognitive expertise while concurrently supporting "professional formation"-the moral and professional development of students, their ability to stay true to their personal service values and the core values of the profession, and the integration of their individual maturation with growth in clinical competency. The goal of professional formation is to anchor students to foundational principles while helping them navigate the inevitable moral conflicts in medical practice. The consequences of inadequate support for professional formation are profound, impacting individual learners, patients, the profession, and society at large. Among the many successful professional formation projects nationally, two long-standing programs are described in modest detail to identify common elements that might guide future developments elsewhere. Key elements include experiential and reflective processes, use of personal narratives, integration of self and expertise, and candid discussion within a safe community of learners. Committing to professional formation within medical education will require transformation of formal and informal curricula and will necessitate a rebalancing of attention and financial support within schools of medicine.

Creating champions for health care quality and safety

Patient safety and quality of care are public concerns that demand personal responsibility at all levels of the health care organization. Senior residents in our graduate medical education program took responsibility for a capstone quality improvement project designed to transform them into champions for health care quality. Residents (n = 26) participated alone or in pairs in a 1-month faculty-mentored rotation at the Veterans Administration Hospital during the 2007-2008 academic year. They completed a Web-based curriculum, identified a quality-of-care issue, applied Plan-Do-Study-Act cycles, authored a report, and engaged colleagues in their innovations during a department-wide presentation. Results indicated that residents demonstrated significantly enhanced knowledge and attitudes about patient safety and quality improvement and provided consistently positive faculty and rotation evaluations. In addition, residents generated 20 quality improvement project proposals with a 50% rate of hospital-wide implementation, leading to meaningful changes in the systems that affect patient care.

House calls and the ACGME competencies

BACKGROUND

The Accreditation Council for Graduate Medical Education (ACGME) "core competencies" (patient care, medical knowledge, interpersonal and communication skills, practice-based learning, and systems-based practice) are challenging to achieve in today's complex, high-acuity, hospital-based setting. House calls provide unique clinical exposure to opportunities for learning the ACGME competencies in a single integrated experience. We review the medical literature on the educational value of house calls and describe a pilot questionnaire of housestaff perceptions of the value of house calls in addressing all of the competencies.

DESCRIPTION

Focused literature review and questionnaire.

EVALUATION

A substantial body of literature supports our hypothesis that house calls expose residents to all of the ACGME competency domains. Residents actively engaged in house call training perceive that their experiences allow them to fulfill all of the ACGME competencies.

CONCLUSION

House calls provide an ideal and highly valued opportunity for internal medicine residents to learn the ACGME competencies.

Preparing professional staff to care for cancer survivors

INTRODUCTION

Oncology health care professionals frequently lack the background to implement needed survivorship activities and follow-up care. The purpose of this project is to assist providers in the clarification and initiation of potentially durable changes in survivorship care by developing a health professional curriculum, recruiting participants, implementing the course, conducting course evaluation and following participants' defined goals over time.

MATERIALS AND METHODS

The curriculum was developed based on recommendations from the Institute of Medicine Report-From Cancer Patient to Cancer Survivor--Lost in Transition. Three concepts were used to structure the course: cancer survivorship quality of life, changing practice via performance improvement, and principles of adult education. Expert faculty designed and implemented the curriculum and teaching methods using adult learning principles and an interactive approach. Competitively-selected, two-person interdisciplinary teams for the first course (July 12-15, 2006, Pasadena, California) were selected based on stated interests, three projected goals, and letters of commitment from administrators.

RESULTS

Participants represented 52 cancer care settings from 28 states. Teams included Nurses (48.1%), Social Workers (20.7%), Physicians (18.8%), Directors/Administrators (6.6%), Psychologists (2.8%), and others (3%). The institutional barriers identified by teams were lack of survivorship knowledge (94 %), financial constraints (61%), lack of administrative support (6%), and staff philosophy that excluded survivorship (15%). Evaluation of content from the first course was consistently positive.

CONCLUSIONS

Dissemination of survivorship education for health care professionals stimulates participants to define and begin to implement goals for improving survivors' care.

IMPLICATIONS FOR CANCER SURVIVORS

A training program such as the one described provides professional knowledge regarding survivorship that has the potential to facilitate change in the health care that cancer survivors receive thus ideally improving long term health and well being.