Adult learning principles and presentation pearls

Characteristics and outcomes of practice experiences in community pharmacies: A scoping review

BACKGROUND

Pharmaceutical education includes practice experiences to develop in students the competencies required to perform in community pharmacies. However, evidence on practice experiences in community pharmacies was not synthesized in a review.

OBJECTIVE

This scoping review aims to map, identify, characterize, and summarize the characteristics and outcomes of pharmacy practice experience programs in community pharmacy settings.

METHODS

A scoping review was conducted. MEDLINE (PubMed), Web of Science, Scopus, and Google Scholar were searched to identify relevant literature. Studies describing characteristics of pharmacy practice experience programs in community pharmacy settings or evaluating their outcomes were included. Studies were limited to those published from 1990 to 2024.

RESULTS

Fifty-one studies were included in the review. The papers were carried out in 19 different countries of the five continents. Most of the studies (56.9 %) included were published in the period 2016-2023. The most frequent design in the studies included was the quantitative (43.1 %), followed by mixed methods (27.5 %), and qualitative (25.5 %). There was heterogeneity across the globe in denominations of practice experiences. The findings suggested that these experiences impacted students' and preceptors' satisfaction, student's development of knowledge, skills, and attitudes, and improvements in community pharmacy.

CONCLUSIONS

These findings can inform the design and performance of practice experience programs by faculty members and preceptors, guiding them in the selection of characteristics more suitable to the context of their educational institutions and practice sites.

Teaching to Teach: A Scoping Review of Teaching Skill-Development Programs across Medical Education

OBJECTIVES

Teaching is an integral part of the day-to-day responsibilities of physicians and physicians-in-training. We provide an overview across the medical education continuum of who is being trained how to teach, the methods of delivery used, and the effectiveness of the program in improving teacher confidence and teaching skills to improve the execution of teaching training programs.

METHODS

In October 2020, the authors conducted a scoping review, systematically searching six databases (PubMed, Embase, MEDLINE, Cochrane, Cumulative Index to Nursing and Allied Health Literature, and Web of Science) for literature dating back to 2010 describing interventions aimed at teaching physicians or physicians-in-training how to teach effectively. Four authors screened the articles for inclusion based on title and key words. Four authors reviewed all of the articles selected to identify key features, including manuscript citation, study design, study institution, demographic information, course description, and efficacy, and entered the data into a Qualtrics survey. Two authors then analyzed the data extracted.

RESULTS

Of 23,409 potentially eligible studies, 163 were included. The populations studied included medical students (17%), residents (55%), fellows (13%), faculty/attendings (23%), and other (4%). The length of the training interventions ranged from half a day or less to longer than 1 year. Multiple instructional methods were used including lecture (71), observed teaching in action (71), case-based learning (34), learner feedback (24), modules (25), objective structured teaching exercises (19), essays/writing assignments (11), portfolio and/or personal teaching philosophy development (5), and tests/examinations (4). Evaluation methods varied, and efficacy was measured by an improvement in confidence in teaching abilities (61), in self-reported teaching abilities (59), objective structured teaching exercises scores (3), and an increased interest in academic medicine (33).

CONCLUSIONS

Current programs designed to teach medical students, residents, and physicians how to teach vary widely. We propose that future research is needed to advance the instruction of physicians and physicians-in-training on how to be effective clinical educators.

What do clinicians perceive as the effective implementation strategies for TREAT journal clubs? A qualitative study

BACKGROUND

Journal clubs have long been recognised as a potential tool for supporting evidence-based practice skills and culture, however they can be challenging to implement and sustain in clinical settings. While the TREAT journal club format was developed to address some of these challenges; it is unclear which strategies are most helpful in supporting ongoing sustainability. To further this enquiry, the aim of this study was to identify clinician's perspectives of the most effective implementation strategies for supporting sustainable TREAT journal club attendance, culture and satisfaction.

METHODS

Clinicians, clinician-facilitators, and research mentors were recruited from six allied health journal clubs who participated in the TREAT journal club format within a single hospital and health service. Participants were invited to attend focus groups at 10 months and 16-months following participation in their journal club. Focus group questions explored which strategies participants felt were most effective during implementation of the journal club, what outcomes they led to and what if any contextual factors influenced these outcomes. Data analysis involved an inductive and deductive approach and the formation of context- mechanism-outcome configurations drawing from elements of a realist evaluation.

RESULTS

Eighteen focus groups were conducted separately with 47 clinician participants, 12 clinician-facilitators, and 6 research mentors. Strategies reported to be the most effective related to clinical relevance and application of the topic, group participation (i.e., group prioritisation of topics, group discussion), consistency, structure (i.e., protected time, structured appraisal tool, timetabling) and mentoring. These were further synthesised within 11 context-mechanism-outcome configurations which identified contexts that influenced outcomes. For example, clinicians reported smaller and single profession journal clubs enhanced outcomes relating to attendance, culture and practice changes when implementing the strategy of discussing the article's application to practice.

CONCLUSION

Clinicians report several strategies which may enhance journal club attendance and satisfaction, EBP culture, and knowledge and skills of clinicians when implementing a TREAT journal club for up to 16-months. Findings emphasise the importance of journal club topics being identified and prioritised by clinicians as a group to maximise relevance and clinician buy-in. Strategies discussed may be useful for services to consider when implementing journal clubs, taking into consideration specific contexts.

Patients' Perceptions of Hybrid and Virtual-Only Care Models During the Cardiac Rehabilitation Patient Journey: A Qualitative Study

BACKGROUND

The COVID-19 pandemic initially led to discontinuation of the "traditional" center-based cardiac rehabilitation (CR) model. Virtual models emerged as an opportunity to deliver care, with many programs continuing to offer these models.

OBJECTIVE

The aim of this study was to explore patients' perceptions of virtual models of either hybrid (combining center-based and virtual) or virtual-only CR since the pandemic.

METHODS

Men and women who chose to participate in hybrid or virtual CR models between January 2022 and January 2023 were invited to attend 1 of 8 focus group sessions. Focus groups were conducted online until thematic saturation was reached. Transcripts were analyzed using thematic analysis.

RESULTS

Twenty-three patients (48% female; 83% attending hybrid CR) participated in the study. Analysis revealed 12 overarching themes associated with the CR patient journey: pre-CR, namely, (1) importance of endorsement from healthcare providers and (2) need for education/communication while waiting for program initiation; during CR, namely, (3) preference for class composition/structure, (4) need to enhance peer support in the virtual environment, (5) convenience and concerns with virtual sessions, (6) necessity of on-site sessions, (7) safety of the exercise prescription, (8) requirement/obligation for allied health offerings, (9) satisfaction with virtual education, and (10) use of technology to facilitate CR participation; and post-CR, namely, (11) acknowledgment of program completion and (12) need for support/education after program graduation.

CONCLUSIONS

Patients require ongoing support from time of referral to beyond CR program completion. Physical, psychosocial, nutritional, and educational supports are needed. Perceptions expressed by patients related to the program model are modifiable, and strategies to address these perceptions should be explored.

An Effective Triage Education Method for Triage Nurses: An Overview and Update

Background

Accurate decision-making in triage largely determines the amount of time required for a patient to be evaluated and treated while in the emergency department. Nursing staff worldwide have similar learning characteristics with similar working hours and common goals, despite the fact that different triage scales are used globally. The aim of this mini review is to present the different educational methods and identify the most effective for triage training of triage nurses.

Materials and Methods

We screened studies concerning triage education for nurses in Emergency Department, in databases including PubMed, CENTRAL and CINAHL. From November 12, 2023 to February 15, 2024, databases were searched for relevant literature. "Triage education" OR "triage training" AND "emergency nurses" OR "triage nurses" were the MeSH terms.

Results

There are various educational methods, including traditional, web-based, audiovisual, simulation-based, blended learning, and other specialized approaches. Almost all of the studies that are currently available demonstrate how effectively an educational intervention might improve nurses' comprehension of triage. Except for one, every study concluded that the educational intervention significantly improved nurses' triage knowledge. Comparing the included studies is challenging due to their heterogeneity, and applying the results in practice requires caution.

Conclusion

The majority of studies reported that educational interventions effectively increased nurses' triage knowledge. Blended learning in conjunction with refresher courses enhanced triage-related knowledge and decision-making; however, additional research is required to ascertain whether this approach is superior to the others and whether these improvements will last.

Factors associated with attendance at a pharmacist-led group diabetes self-management education class and impact on health outcomes

Background

Group education has demonstrated benefits among people with diabetes, including reduced A1C and improved self-monitoring practices. Despite this, attendance rates are low for a variety of reasons, including lack of understanding of potential benefits among patients.

Objectives

The pharmacist-led diabetes self-management education program at a community hospital has low attendance. This project assesses characteristics associated with attendance and compares outcomes among attendees and non-attendees.

Methods

Retrospective data was collected between July 2022 and December 2023. Variables included: age, sex, class attendance, pre- and ≥ 90-day post-class A1C, pre- and post-class BMI, attending pharmacist-led clinic prior to scheduled class, social determinants of health screening survey responses, and diagnosis of depression or anxiety.

Results

103 patients were identified. 53 % attended at least one class out of a series of four. Attendance at the pharmacist-led diabetes clinic (70 % among attendees versus 30 % among non-attendees, p < 0.001) was associated with attendance. Age, gender, concurrent mental health diagnoses (depression and anxiety), and SDOH related needs were not associated with attendance. Baseline A1C was similar for attendees and non-attendees (9.6 vs. 9.7 %, respectively). Post-class A1C was 7.4 % for attendees of at least one class and 8 % for non-attendees. Patients who attended all four classes achieved a mean A1C <7 %.

Discussion

There are many factors that lead to lack of engagement with group education for diabetes. Referral to group education by a pharmacist who has established rapport with the patient and can speak to specific details about benefits of the classes may improve attendance at diabetes group education.

Training of Peer Coaches to Assist Individuals with Knee Osteoarthritis Prepare and Recover From Total Knee Replacement

OBJECTIVE

The objective of this study is to outline the training of peer coaches in the Moving Well intervention, which was designed to reduce anxiety, depression, and pain catastrophizing in patients before and after total knee replacement (TKR).

METHODS

Selected peer coaches had a history of knee osteoarthritis (KOA), a TKR of 12 months or more before training, and were 60 or older. Training was primarily conducted virtually, with a later addition of one in-person session. Training centered on developing skills in motivational interviewing (MoI), encompassing techniques like open-ended questions, affirmations, reflective listening, and summarization. It also covered the MoI processes of engagement, focus, evocation, and planning. Coaches were required to discuss at least 90% of session-specific topics, which were monitored using checklists for each certification, and to complete individual MoI training, which was not graded. The evaluation of peer coach training involved surveys and a focus group.

RESULTS

Three women and two men, averaging 75 years in age, completed the peer coach training for the Moving Well intervention. An in-person training session was added to address technology and MoI skill concerns, greatly enhancing their grasp of MoI skills and their ability to guide others through the program effectively. Peer coaches stressed the importance of live feedback, in-person training, and incorporating personal experiences into the program content during their training.

CONCLUSION

To effectively train older adults as peer coaches for the Moving Well intervention, flexibility in learning formats, personalized guidance, peer support, and regular evaluations were essential in building the necessary MoI competencies to guide research participants in the program.

Training providers to implement heart failure shared medical appointments: A qualitative evaluation

Shared medical appointments (SMA) help patients learn skills to self-manage chronic medical conditions. While this model of care delivery is thought to improve access to care with an efficient use of healthcare providers' time, many healthcare teams struggle to implement this healthcare model. Guidance and training resources on the implementation of SMAs is expected to improve adoption, implementation and sustainability of SMAs. Our evaluation team collaborated with the HF SMA trainer to complete a developmental formative evaluation of a two-day training program with a goal of adapting the training program and to better suit the needs and resources of healthcare teams interested in implementing HF-SMAs. Our evaluation team interviewed members of healthcare teams participating during each stage of training: pre-training, post-training, and post-implementation. The evaluation team also observed training sessions and reviewed minutes from debrief and training team meetings. Qualitative data collected from interviews, observations and document reviews were analyzed using matrix analysis with a focus on identifying potential adaptations to improve the HF-SMA training program. Data summaries were presented by the evaluation team to the training team for consideration. Training program participants found the training comprehensive, useful, and helpful; they highlighted how the trainers were experienced SMA providers who shared lessons learned. While participants found the training to be useful, opportunities for improvement, success of the virtual format and identified six adaptations: 1) the two-day training was reduced to short online modules, 2) curriculum was adapted to fit local site's needs, 3) added periodic one-on-one coaching, 4) shifted training to focus on skills and knowledge needed for each team member requirements, 5) adapted curriculum provides for more team building during premeeting assignments, and 6) training had more information included. We offer/present an improved model for a HF-SMA training program. Future studies, potentially using comparative designs to measure success and sustainability are needed.

Sepsis Education and Successful Implementation of a Sepsis Recognition and Management Workflow in an Inpatient Pediatric Hematologic Oncologic Unit

Sepsis is a leading cause of morbidity, mortality, and healthcare utilization for children worldwide. Forty-nine percent of pediatric sepsis patients have an underlying condition rendering them more susceptible to infection. One in six severe sepsis patients has an underlying neoplastic disease and has a 30% higher risk of death compared to other severe sepsis patients. Consequently, focus on pediatric sepsis management is paramount. In a 42-bed pediatric hematology-oncology unit, a Sepsis Algorithm was implemented aimed to improve nurses' ability to recognize, manage, and treat suspected and early sepsis and septic shock over a 4-year period. This algorithm consisted of various elements including ongoing educational offerings, quality improvement methodologies, and sepsis prevention interventions. The sepsis workflow provided targeted care guidelines and aligned interventions previously proven to improve patient outcomes. Pre- and posttests were administered with each educational offering to monitor effectiveness. Nurses demonstrated higher levels of understanding of sepsis recognition and prevention efforts following educational activities. Consequently, a 10.7% Sepsis Algorithm compliance and a 24.7% antibiotic administration within 1 hr compliance improvement was realized. Utilization of the Sepsis Algorithm contributed to maintaining a mortality rate of zero related to sepsis and/or septic shock while patients were in the hematology-oncology unit. Bedside nurses' sepsis management knowledge improved. The Sepsis Algorithm implementation was successful and improved patient outcomes.

Designing and Implementing the Psychiatrist-led Personalized Mentorship Programs: The Role and Impact of Live Consultation-driven Training Methods

Background

Clinical training in traditional medical education often needs more translational value, especially for in-service MBBS doctors working in primary health centers (PHCs), who provide first-line treatment for psychiatric disorders. To address this gap, a psychiatrist-led personalized mentorship program incorporating three live consultation-driven training (CDT) methods was developed to integrate psychiatric care into PHCs.

Methods

The authors designed and implemented a personalized mentorship program using three CDT methods tailored for in-service MBBS doctors. The CDT methods were applied through live consultations to facilitate real-time, real-life learning and integration of psychiatric care into primary health settings. Data from published articles and manuals on CDT methods were collected, focusing on their descriptions, effectiveness, principles, and advantages over traditional classroom training.

Results

Data indicate the effectiveness of the CDT methods to translate to real-life skills (translational quotient). The personalized mentorship program showed promising results in enhancing the confidence and competence of MBBS doctors in managing psychiatric disorders in PHCs. The CDT methods were found to be superior to traditional classroom training in terms of practical applicability and real-time learning.

Conclusion

The psychiatrist-led personalized mentorship program with CDT methods demonstrates the potential for significant improvements in the training of in-service MBBS doctors, facilitating the integration of psychiatric care into PHCs. These methods offer a practical and effective approach to bridging the gap in clinical training and can be replicated among medical students and residents across various medical and surgical specialties. Further research and longitudinal studies are recommended to validate these preliminary findings and explore the program's broader applicability.

Transfusion Medicine Rotations for Pathology Residents: Structure, Resources, and Milestones

CONTEXT.—

Transfusion medicine can be a challenging subject to teach to pathology residents while also ensuring that all the Accreditation Council for Graduate Medical Education's (ACGME's) milestones are met.

OBJECTIVE.—

To explore how one major academic residency program has structured its transfusion medicine rotation.

DESIGN.—

The residents on the pathology rotation have very defined roles for their day-to-day responsibilities. Many new resources have been developed during the past 3 years to improve the residents' educational experience on their transfusion medicine rotation. A daily patient list is used to direct the residents' educational and service responsibilities. They also have numerous resources to help with independent study and reading during their rotation.

RESULTS.—

The implementation of several new resources has greatly improved the residents' educational experience and has improved the overall evaluation of the rotation by the residents. Many of the ACGME milestones can be met by the structure of this rotation.

CONCLUSIONS.—

With the proper structure and resources, transfusion medicine can be effectively taught to all pathology residents while also meeting the ACGME milestones requirements.

Breaking chains of tobacco: empowering African American churches in West Virginia for a healthier future

Across West Virginia, tobacco use continues to be a significant public health challenge. Specifically, tobacco use is linked to high poverty across the state and disproportionately affects African Americans. A faith-based tobacco prevention network was formed to address these concerns and increase education and cessation. The West Virginia African American Tobacco Prevention Network (WVAATPN) was formed in 2021 and since then has expanded its reach across the state, involving 22 congregations. The Network's model includes annual training for lay leaders on various tobacco-related topics, tailored educational curriculum for congregations, and collaboration with national experts to enhance program efficacy. The Network has run educational and cessation workshops and promoted events such as No Menthol Sunday. Workshops have yielded positive outcomes among participants, including increased awareness of tobacco marketing tactics, higher cessation rates, and improved understanding of the health impacts of tobacco. The WVAATPN continues to expand its reach and effectiveness by advocating for policy change, enhancing community engagement, and fostering partnerships to combat tobacco-related disparities in West Virginia's African American communities.

Community Pharmacist-Centered training program improves confidence in delivering epilepsy care

RATIONALE

Incorporating pharmacists into interdisciplinary healthcare teams can improve patient outcomes across disease states; however, there is little evidence describing pharmacists' contributions to epilepsy care. Previous research from our group revealed that community pharmacists are well positioned to serve as patient advocates, monitor medications, and provide education for people living with epilepsy. However, pharmacists would like to receive additional training in epilepsy management. Advanced training in neurology is not a practical approach for community pharmacists who engage daily with patients having a variety of conditions and medications.

OBJECTIVE

To develop and evaluate a flexible, community pharmacist-centered training program to improve both confidence and competence in delivering epilepsy care.

METHODS

The training program consisted of five 1-hour, self-paced online modules and two 90-minute synchronous virtual sessions. Topics included the classification of the epilepsies, comorbid conditions, antiseizure medicine (ASM) therapy, special populations (pregnancy, people of childbearing potential, older adults), seizure emergencies, and sudden unexpected death in epilepsy (SUDEP), as well as social determinants of health. The training program was delivered over 6 weeks to pharmacists located at two community pharmacies in Washington State. Learning was assessed using a pre- and post-training questionnaire containing questions that evaluated knowledge and confidence in the training material.

RESULTS

The training program did not significantly change pharmacists' mastery of the material. However, the pharmacists' confidence in delivering the material significantly improved in 14 of the 16 areas that were evaluated. Pharmacists' mastery and confidence were strongest in areas around ASM management, SUDEP and seizure emergencies, people of child-bearing potential and older adults with epilepsy, and comorbidities, whereas social health disparities in epilepsy care remained an area that required further training.

CONCLUSION

Our findings support the idea that community pharmacists are well positioned with the knowledge to play an important role in epilepsy care. However, dedicated training tailored to community pharmacists' needs may improve their confidence in providing such care.

The Development of Leadership Communities of Practice: Utilizing the ADKAR Framework

This paper introduces the concept of leadership communities of practice (COP) as a strategy to enhance succession planning and leadership development within the Canadian healthcare context. Drawing upon Prosci's ADKAR methodology as a foundational change management framework, this paper explores the adaptation of COP, originally developed by Lave and Wenger in 1991, to foster collaborative learning. While COP have a long history in business and education sectors, their formal integration into healthcare, specifically leadership development is relatively recent. This paper highlights the necessity of a robust change management approach to effectively introduce COP as a mechanism to enhance leadership development in healthcare settings, highlighting their potential to facilitate knowledge exchange and support social learning among healthcare leaders.

Meaningful connections: An education program to enhance resident-certified nursing assistant relationships

Close relationships between nursing home residents and Certified Nursing Assistants (CNAs) result in positive outcomes for both residents and staff, including increased well-being for residents. However, many resident-CNA relationships remain superficial, are focused primarily on physical care, and interpersonal skill training for CNAs is sparse. The purpose of this study was to develop an education program to foster CNAs' interpersonal skills and relationship development. We conducted a literature review on CNA interpersonal skill training and disseminated a survey to CNAs to inform the education program. Literature review findings revealed that CNAs value their relationships with residents and desire more interpersonal training, but this training is often limited. The survey, which was disseminated via social media and facility contact referrals, asked responding CNAs (n = 73) to evaluate their perceptions of empowerment, interpersonal skill competency, and learning preferences. We found that most CNAs feel confident in their interpersonal skills, but they lack training in boundary-setting and bereavement support. About one-third of respondents did not feel that their work was valued or their strengths recognized by their supervisors. Most respondents reported that they valued visual (85%), experiential (91%) learning. The final program, Meaningful Connections, includes nine modules covering topics such as person-centered caregiving, empathy, emotional intelligence, and boundary-setting. One supplementary module provides potential adaptations to the curriculum to customize the needs of each participant group. The results of this project suggest a need for more CNA relationship training and support, especially in the areas of boundary-setting and bereavement.

The effectiveness of psychiatric genetic counseling training: An analysis of 13 international workshops

Studies have consistently shown that psychiatric genetic counseling (pGC) helps people with psychiatric conditions by increasing empowerment and self-efficacy, and addressing emotions like guilt. Yet, it is not routinely provided. Genetic counselors and trainees express low confidence in their ability to provide meaningful pGC, especially in the absence of adequate training. Therefore, to address this gap a "Psychiatric Genetic Counseling for Genetic Counselors" (PG4GC) workshop was developed and delivered to 13 groups of participants (primarily qualified genetic counselors and trainees) between 2015 and 2023 (10 workshops were delivered in-person, and three virtually). Participants completed quantitative questionnaires both before and after completing the workshop to assess their comfort, knowledge, behavior, and feeling of being equipped to provide pGC. In total, 232 individuals completed the pre-workshop questionnaire and 154 completed the post-workshop questionnaire. Participants felt more comfortable, knowledgeable, and equipped to provide pGC, and reported being more likely to address psychiatric concerns after the workshop, regardless of whether they were trainees or practicing professionals and whether they completed the workshop in-person or virtually. This study suggests that the PG4GC workshop is an effective educational tool in pGC training that may aid in broader implementation of the service.

Inpatient vs. Outpatient: A Systematic Review of Information Needs throughout the Heart Failure Patient Journey

The objective of this systematic review was to identify and describe information needs for individuals with heart failure (HF) throughout their patient journey. Six databases were searched (APA PsycINFO, CINAHL Ultimate, Embase, Emcare Nursing, Medline ALL, and Web of Science Core Collection) from inception to February 2023. Search strategies were developed utilizing the PICO framework. Potential studies of any methodological design were considered for inclusion through a snowball hand search. Data from the included articles were extracted by a reviewer, and the extraction accuracy was independently cross-checked by another author. Quality appraisal was assessed using the Mixed-Methods Appraisal Tool. A narrative synthesis was used to analyze all the outcomes according to the Synthesis Without Meta-analysis reporting guidelines. Twenty-five studies (15 quantitative and 10 qualitative) were included. Socioeconomic, cultural, and demographic factors influencing information needs were considered. The top three information needs for outpatients included general HF information, signs and symptoms and disease management strategies. For inpatients, medications, risk factors, and general HF were reported as the top needs. These divergent needs emphasize the importance of tailored education at different stages. Additionally, the review identified gaps in global representation, with limited studies from Africa and South America, underscoring the need for inclusive research. The findings caution against overgeneralization due to varied reporting methods. Practical implications call for culturally sensitive interventions to address nuanced HF patients' needs, while future research must prioritize standardized reporting, consider diverse patient journey timepoints, and minimize biases for enhanced reliability and applicability.

Employment of Small-Group Discussions to Ensure the Effective Delivery of Medical Education

The changing landscape of medical education has made small-group discussions crucial components. These sessions, including problem-based learning (PBL), case-based learning (CBL), and team-based learning (TBL), revolutionize learning by fostering active participation, critical thinking, and practical skills application. They bridge theory with practice, preparing future healthcare professionals for the dynamic challenges of modern healthcare. Despite their transformative potential, there are challenges in faculty preparation, resource allocation, and effective evaluation. The best practices include aligning discussions with curriculum goals, skilled facilitation, promoting active participation, and robust assessment strategies. Looking ahead, adapting to emerging health trends, ongoing research, and evolving healthcare demands will ensure the continued relevance and effectiveness of small-group discussions, shaping competent and adaptable healthcare providers equipped for the ever-evolving healthcare landscape.

Which virtual education methods do e‑students prefer? Design and validation of Virtual Education Preferences Questionnaire (VEPQ)

BACKGROUND

With the prevalence of new technologies and evolving student learning styles, virtual teaching methods have become increasingly popular. As a result, more and more students are opting to learn online. However, one common concern is that they may feel disconnected from their teachers, leading to feelings of loneliness and doubts about the quality of education they are receiving. To address this issue, a study was conducted to gather data on students' preferences for virtual education and to validate a tool for measuring students' preferences for virtual education.

METHODS

The research was conducted in a mixed method with a quantitative-qualitative sequence. A virtual education preferences questionnaire (VEPQ) for students with a total of 17 items was created and validated as part of the qualitative component by looking at the theoretical underpinnings and experts' opinions in the focus group. The scale of the six-point Likert questionnaire was from very high to very low. To validate the tool and determine preferences, exploratory factor analysis was used. A total of 155 samples answered the questions and the data were analyzed using SPSS-24 software.

RESULTS

A total of 155 complete questionnaires were returned; among them, 110 (71%) were filled out by women, 73 (47.1%) by respondents between the ages of 36 and 45, 107 (69%) were already employed in paramedical fields, and 48 (31%) were enrolled in a medical school. The opinions of ten experts were used to confirm the face validity of the questionnaire. With CVI = 0.924 and CVR = 0.805, content validity was verified. Using the internal consistency method of the questions with a Cronbach's alpha coefficient of R = 0.824, the validity of the entire questionnaire was confirmed. Exploratory factor analysis revealed that a total of five components-self-directed projects (29.58%), e-content (13.00%), online presentation (10.97%), face-to-face interactions (9.12%), and text interactions (7.11%) had the highest load, with a total of 69.77% of the structure explaining virtual education preferences. The factor analysis test and the suitability of the sample are both confirmed by the value of KMO = 0.721 and the significance of Pvalue < 0.001.

CONCLUSION

It appears that the highly valid tool developed can be used to ascertain the educational preferences of students. Also, the high factor load of self-directed educational methods and e-content shows that independence and flexibility in time and place are more important for students.

Exploring basic science knowledge retention within a cohort of undergraduate medical students in the United Kingdom: A longitudinal study

BACKGROUND

Clinical reasoning is reliant on students having acquired a strong foundation in the basic sciences. However, there remains uncertainty regarding whether medical students are maintaining this knowledge over the span of their degrees. Therefore, this project aimed to assess long-term retention of basic science knowledge within a cohort of students from an undergraduate medical school in the United Kingdom (UK).

METHODS

This longitudinal study followed a cohort of students, from their first to final year. In their final year, participants sat a bespoke formative basic science knowledge assessment that utilised 46 single-best-answer questions. To examine for long-term attainment differences, these scores were compared with those achieved in first-year assessments.

RESULTS

Of the eligible students, 40% partook in the study (n = 22). Comparing assessment scores highlighted an enhancement in overall basic science knowledge between first and final year (p < 0.01). Although most basic science domains remained unchanged between both time points, anatomy and physiology scores increased (p = 0.03 and p = 0.02, respectively), whereas biochemistry scores were the only ones to decrease (p = 0.02).

DISCUSSION

This project provides insight into how well students are retaining the basic sciences during their studies. Underperforming science domains were identified, alongside pedagogical explanations for their individual shortcomings; for instance, students' perceived relevance of a domain is seen as a driver for its retention. Subsequently, a group of recommendations were derived to reinforce the most affected domains. The inclusion of more questions on the underperforming sciences, in clinically focussed assessments, is one such suggestion.

"The most culturally safe training I've ever had": the co-design of a culturally safe Managing hepatitis B training course with and for the Aboriginal health workforce of the Northern Territory of Australia

BACKGROUND

The Aboriginal health workforce provide responsive, culturally safe health care. We aimed to co-design a culturally safe course with and for the Aboriginal health workforce. We describe the factors which led to the successful co-design, delivery, and evaluation of the "Managing hepatitis B" course for the Aboriginal health workforce.

METHODS

A Participatory Action Research approach was used, involving ongoing consultation to iteratively co-design and then develop course content, materials, and evaluation tools. An Aboriginal and Torres Strait Islander research and teaching team received education in chronic hepatitis B and teaching methodologies. Pilot courses were held, in remote communities of the Northern Territory, using two-way learning and teach-back methods to further develop the course and assess acceptability and learnings. Data collection involved focus group discussions, in-class observations, reflective analysis, and use of co-designed and assessed evaluation tools.

RESULTS

Twenty-six participants attended the pilot courses. Aboriginal and Torres Strait Islander facilitators delivered a high proportion of the course. Evaluations demonstrated high course acceptability, cultural safety, and learnings. Key elements contributing to success and acceptability were acknowledging, respecting, and integrating cultural differences into education, delivering messaging and key concepts through an Aboriginal and Torres Strait Islander lens, using culturally appropriate approaches to learning including storytelling and visual teaching methodologies. Evaluation of culturally safe frameworks and findings from the co-design process led to the creation of a conceptual framework, underpinned by meeting people's basic needs, and offering a safe and comfortable environment to enable productive learning with attention to the following: sustenance, financial security, cultural obligations, and gender and kinship relationships.

CONCLUSIONS

Co-designed education for the Aboriginal health workforce must embed principles of cultural safety and meaningful community consultation to enable an increase in knowledge and empowerment. The findings of this research can be used to guide the design of future health education for First Nations health professionals and to other non-dominant cultures. The course model has been successfully transferred to other health issues in the Northern Territory.

Effect of a Coaching Intervention to Improve Cardiologist Communication: A Randomized Clinical Trial

Importance

Communication between cardiologists and patients can significantly affect patient comprehension, adherence, and satisfaction. To our knowledge, a coaching intervention to improve cardiologist communication has not been tested.

Objective

To evaluate the effect of a communication coaching intervention to teach evidence-based communication skills to cardiologists.

Design, Setting, and Participants

This 2-arm randomized clinical trial was performed at outpatient cardiology clinics at an academic medical center and affiliated community clinics, and from February 2019 through March 2020 recruited 40 cardiologists and audio recorded 161 patients in the preintervention phase and 240 in the postintervention phase. Data analysis was performed from March 2022 to January 2023.

Interventions

Half of the cardiologists were randomized to receive a coaching intervention that involved three 1:1 sessions, 2 of which included feedback on their audio-recorded encounters. Communication coaches taught 5 skills derived from motivational interviewing: (1) sitting down and making eye contact with all in the room, (2) open-ended questions, (3) reflective statements, (4) empathic statements, and (5) "What questions do you have?"

Main Outcomes and Measures

Coders unaware of study arm coded these behaviors in the preintervention and postintervention audio-recorded encounters (objective communication). Patients completed a survey after the visit to report perceptions of communication quality (subjective communication).

Results

Analysis included 40 cardiologists (mean [SD] age, 47 [9] years; 7 female and 33 male) and 240 patients in the postintervention phase (mean [SD] age, 58 [15] years; 122 female, 118 male). When controlling for preintervention behaviors, cardiologists in the intervention vs control arm were more likely to make empathic statements (intervention: 52 of 117 [44%] vs control: 31 of 113 [27%]; P = .05); to ask, "What questions do you have?" (26 of 117 [22%] vs 6 of 113 [5%]; P = .002); and to respond with empathy when patients expressed negative emotions (mean ratio of empathic responses to empathic opportunities, 0.50 vs 0.20; P = .004). These effects did not vary based on patient or cardiologist race or sex. We found no arm differences for open-ended questions or reflective statements and were unable to assess differences in patient ratings due to ceiling effects.

Conclusions and Relevance

In this randomized clinical trial, a communication coaching intervention improved 2 key communication behaviors: expressing empathy and eliciting questions. Empathic communication is a harder-level skill that may improve the patient experience and information comprehension. Future work should explore how best to assess the effect of communication coaching on patient perceptions of care and clinical outcomes and determine its effectiveness in larger, more diverse samples of cardiologists.

Trial Registration

ClinicalTrials.gov Identifier: NCT03464110.

Ophthalmology Residency in the United States: The Case for a National Curriculum

To identify strategies for effective curriculum development and implementation in United States (US) ophthalmology residency training programs. A literature review was conducted for all English-language PubMed/Medline articles relating to ophthalmology residency education or curriculum/curricula. Despite ACGME-defined program requirements outlining curricular goals for US ophthalmology residency training programs, there is no comprehensive, national curriculum with detailed plans for instruction of necessary topics within the 36-month residency training period. Several articles identify a need for detailed curricula on various topics, propose ideas on how residency programs could create curricula, and explore ways of assessing resident competence. There is a paucity of literature evaluating how ophthalmology residents best learn various ophthalmology topics. We need to develop an intentional, comprehensive, and timely national curriculum for ophthalmology residency programs in the US, with detailed plans on how to meet curricular objectives and consideration of the most effective teaching strategies for different ophthalmology concepts.

Creation and evaluation of a participatory child abuse and neglect workshop for medical students

BACKGROUND

Since child abuse and neglect (CAN) is prevalent worldwide, medical students should acquire basic knowledge, skills, and confidence in identifying and addressing CAN. Although significant educational efforts have been previously described, none has focused on using participatory methods to teach medical students CAN.

PURPOSE

To: 1) develop a participatory educational workshop in CAN for medical students, 2) gather, train, and establish a peer-to-peer teaching group, and 3) assess the effectiveness of the workshop in gain of knowledge and improvement of self-confidence for participants.

METHODS

A two-hour workshop was created with role-playing, the use of mannikins and peer-to-peer teaching. A 15-item knowledge and a 9-item self-confidence questionnaire were used before, right after, and six months after each workshop.

RESULTS

Nine workshops in two academic pediatric departments with a total attendance of 300 6th year medical students were conducted. For the 69 students who completed the questionnaires at all three times, there were statistically significant gains in knowledge right after (p < .001) and six months after (p < .0001) the workshops. Similarly, self-confidence increased right after (p < .0001) and six months after (p < .001) the workshops. Self-selection bias testing indicated that these 69 students who completed all three questionnaires were representative of those who completed the pre-testing and the testing right after.

CONCLUSIONS

We successfully established a peer-to-peer teaching group to conduct nine participatory workshops that improved the participants' knowledge and self-confidence in CAN. This feasible and novel active learning approach may help address inadequacies in medical curricula.

Readers Theatre as an arts-based approach to education: A scoping review on experiences of adult learners and educators

BACKGROUND

Arts-based educational methodologies have been implemented in nursing and other health disciplines to promote person-centered approaches to care. Readers Theatre has been applied as a tool to promote compassionate and holistic approaches to care. Readers Theatre is a form of drama that requires participants to read aloud a scripted narrative to the audience.

OBJECTIVES

To examine the extant literature on experiences of adult learners and educators in utilizing Readers Theatre, and its potential suitability for nurse education. The review question was: "What are the learning experiences of adult students and the teaching experiences of educators in the uptake of Readers Theatre?"

DESIGN AND DATA SOURCES

Scoping review guidelines proposed by Arksey and O'Malley were adopted. Academic databases searches were carried out in ProQuest, JSTOR, Scholars Portal, EBSCO, Web of Science, PubMed, Expanded Academic ASAP, and Scopus.

REVIEW METHODS

The search and keyword strategy was developed by two reviewers and approved by the lead author, and a librarian. All titles and abstracts were individually examined by the two reviewers with discrepancies discussed and resolved by both parties. Data were extracted for thematic analysis.

RESULTS

A total of 31 studies were selected for the final sample. Four themes were identified within the scoping review relevant to Readers Theatre teaching-learning experiences: 1) principles and characteristics; 2) awareness, understanding, caring and empathy; 3) cross-disciplinary collaboration, interdisciplinary education, and knowledge dissemination; and 4) promoting students' skills.

CONCLUSIONS

Readers Theatre has the potential to be utilized within a nursing curriculum, and particularly in theory and substantive class-based courses, through active group learning, in the application phase of knowledge acquisition.

Virtual integration of patient education in radiotherapy (VIPER)

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Videoconferencing allows for face-to-face interactions and visual aids for patient education.

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Patients were highly satisfied with videoconferencing for virtual patient education.

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Radiation Therapists reported videoconferencing and in-person patient education were comparable.

Purpose

Pre-radiotherapy patient education led by Radiation Therapists (RTT) has been shown to improve patients’ distress and overall experiences. In an effort to offer a remote delivery method while allowing for visual learning and face-to-face communication, this pilot project evaluated the feasibility and acceptability of using virtual videoconferencing for patient education.

Methods

This prospective pilot study integrated virtual patient education into standard care. This workflow consisted of a one-on-one, 45-minute tele-education session with an RTT on the day prior to CT-simulation. For this study, patients were offered the option to complete the session using web-based videoconferencing if they had the capability for it. Feasibility was evaluated as the proportion of patients who agreed to and completed virtual education. To evaluate acceptability, patients and RTTs were then emailed post-intervention surveys evaluating their satisfaction with virtual patient education.

Results

Over three months 106 of 139 patients (76%) approached consented to virtual education. The median (range) age was 65 (27–93), 69% were male and most had genitourinary (38%) or head-and-neck (29%) cancers. Ninety patients (85%) completed virtual education as planned, with incompletions due to scheduling (8) or patient technical issues (7), or treatment cancellation (1). Sixty-eight patients completed surveys, with the vast majority agreeing virtual education was clear (94%) and helped them prepare (100%), they were comfortable with the technology (96%) and they were satisfied overall (99%). Twelve RTTs responded, suggesting overall that virtual education was higher quality though less feasible than tele-education, and comparable to in-person education.

Conclusion

Offering individual, RTT-led virtual education using videoconferencing to patients pre-radiotherapy was feasible and acceptable in this pilot study, and is therefore being recommended as an option for all our patients. Future work will directly compare the effectiveness of in-person versus virtual education, and incorporate individual patient needs and preferences.

What do the undergraduate medical students think of their educational environment

Context: Assessment of medical education is important to identify the deficiencies in medical educational environment. Dundee Ready Education Environment Measure (DREEM) is a pre-validated inventory tool that helps to assess and thereby address those deficiencies. Aims: To know about the student’s perception regarding the education environment at Rajendra Institute of Medical sciences (RIMS), Ranchi. Methods and Material: This cross-sectional study was conducted amongst the undergraduate medical students of 2017, 2018 and 2019 batch studying at RIMS, Ranchi; between the periods of January 2020 to March 2020. Statistical analysis used: Means (with standard deviations) were used to describe sample variables. Mann Whitney U test was used to compare the individual as well as the subscale and overall scores with gender and the Kruskal Wallis H test was used to compare the subscale and overall sores with the batch to which respondent belonged to. Results: Out of a total 450 students, 291 submitted the Google forms representing an overall response ratio of 65%. Most number of responses was submitted by undergraduates from 2019 batch (93%). 

Teaching Parents Read, Ask, Answer, Prompt Strategies via Telepractice: Effects on Parent Strategy Use and Child Communication

PURPOSE

This study aimed to explore the feasibility of a telepractice communication partner intervention for children who use augmentative and alternative communication (AAC) and their parents.

METHOD

Five children (aged 3;4-12;9 [years;months]) with severe expressive communication impairments who use AAC and their parents enrolled in a randomized, multiple-probe design across participants. A speech-language pathologist taught parents to use a least-to-most prompting procedure, Read, Ask, Answer, Prompt (RAAP), during book reading with their children. Parent instruction was provided through telepractice during an initial 60-min workshop and five advanced practice sessions (M = 28.41 min). The primary outcome was parents' correct use of RAAP, measured by the percentage of turns parents applied the strategies correctly. Child communication turns were a secondary, exploratory outcome.

RESULTS

There was a functional relation (intervention effect) between the RAAP instruction and parents' correct use of RAAP. All parents showed a large, immediate increase in the level of RAAP use with a stable, accelerating (therapeutic) trend to criterion after the intervention was applied. Increases in child communication turns were inconsistent. One child increased his communication turns. Four children demonstrated noneffects; their intervention responses overlapped with their baseline performance.

CONCLUSIONS

Telepractice RAAP strategy instruction is a promising service delivery for communication partner training and AAC interventions. Future research should examine alternate observation and data collection and ways to limit communication partner instruction barriers.

The impact of a "Psychiatric Genetics for Genetic Counselors" workshop on genetic counselor attendees: An exploratory study

Genetic counseling is the process of supporting patients' and families' adaptation to genetic information. Psychiatric genetic counseling has been proven to be effective in improving empowerment, self-efficacy, and knowledge even in the absence of genetic testing. Despite this, only one specialist psychiatric genetic counseling clinic currently exists. In order to engage genetic counselors in providing psychiatric genetic counseling, a 2-day workshop: "Psychiatric Genetic Counseling for Genetic Counselors", was developed and implemented aimed at empowering genetic counselors to feel confident and competent in this practice domain. The aim of the study was to qualitatively explore the impact of the workshop. Semistructured interviews were carried out with 12 genetic counselors who attended the workshop between 2015 and 2018. Thematic analysis revealed that the workshop empowered all participants to feel comfortable and confident offering psychiatric genetic counseling to patients. Participants also reflected how the workshop highlighted the stigma associated with mental illnesses and offered support in normalizing these conditions. Overall, this study presents that the "Psychiatric Genetic Counseling for Genetic Counselors" workshop fulfilled its proposed aims and outcomes.

An e-learning pediatric cardiology curriculum for Pediatric Postgraduate trainees in Rwanda: implementation and evaluation

BACKGROUND

Access to pediatric sub-specialty training is a critical unmet need in many resource-limited settings. In Rwanda, only two pediatric cardiologists are responsible for the country's clinical care of a population of 12 million, along with the medical education of all pediatric trainees. To strengthen physician training opportunities, we developed an e-learning curriculum in pediatric cardiology. This curriculum aimed to "flip the classroom", allowing residents to learn key pediatric cardiology concepts digitally before an in-person session with the specialist, thus efficiently utilizing the specialist for additional case based and bedside teaching.

METHODS

We surveyed Rwandan and US faculty and residents using a modified Delphi approach to identify key topics in pediatric cardiology. Lead authors from Rwanda and the USA collaborated with OPENPediatrics™, a free digital knowledge-sharing platform, to produce ten core topics presented in structured videos spanning 4.5 h. A mixed methods evaluation was completed with Rwandan pediatric residents, including surveys assessing knowledge, utilization, and satisfaction. Qualitative analysis of structured interviews was conducted using NVivo.

RESULTS

Among the 43 residents who participated in the OPENPediatrics™ cardiology curriculum, 33 (77%) completed the curriculum assessment. Residents reported using the curriculum for a median of 8 h. Thirty-eight (88%) reported viewing the curriculum on their personal or hospital computer via pre-downloaded materials on a USB flash drive, with another seven (16%) reporting viewing it online. Twenty-seven residents viewed the course during core lecture time (63%). Commonly reported barriers to utilization included lack of time (70%), access to internet (40%) and language (24%). Scores on knowledge assessment improved from 66.2% to 76.7% upon completion of the curriculum (p < 0.001) across all levels of training, with most significant improvement in scores for PGY-1 and PGY-2 residents. Residents reported high satisfaction with the visuals, engaging presentation, and organization of the curriculum. Residents opined the need for expanded training material in cardiac electrocardiogram and echocardiogram and requested for slower narration by foreign presenters.

CONCLUSION

Video-based e-learning via OPENPediatrics™ in a resource-limited setting was effective in improving resident's knowledge in pediatric cardiology with high levels of utilization and satisfaction. Expanding access to digital curriculums for other pediatric sub-specialties may be both an effective and efficient strategy for improving training in settings with limited access to subspecialist faculty.

Certificate Course in Occupational Safety and Health: A Capacity Building Program for Primary Care Physicians based on Adult Learning Model

Context

The need for physicians qualified in the field of occupational safety and health (OSH) is growing with the growth of manufacturing and service sectors where maximum number of work-related morbidity and mortality occur.

Aims

This article aims to assess the effectiveness and feasibility of the certificate course in occupational safety and health for training and capacity building of primary care physicians in OSH.

Methods and Material

Guideline for reporting evidence-based practice educational interventions and teaching (GREET) was used for describing educational interventions. The outcome was assessed by comparing the mean scores. t test with P < 0.005 was considered a level of significance.

Results

The result showed significant improvement in the cumulative pre- and post-test scores after each module. The certificate course is suitable for adult learning as there was no intergroup difference in knowledge after the program. Consistent with the findings, the improvement scores indicate that training has made a difference in the knowledge and learning of the trained physicians.

Conclusions

This customized training intervention has high potential for scaling up while optimally addressing the scarcity of trained physicians in the OSH in high population density settings like India where a high number of vulnerable workforces work in the informal economy.

Evaluation of an online course for prevention of unwanted sexual behaviour in residential aged care services-A pilot study

BACKGROUND

Residential aged care services (RACS) staff have substantial gaps in knowledge to prevent and manage unwanted sexual behaviour (USB) in RACS.

OBJECTIVES

This study aimed to explore the feasibility of a pilot online course (intervention) addressing USB in RACS.

METHOD

Development of a self-guided e-learning educational course was based on existing research, national and international approaches to human rights approaches to sexual assault and underwent internal and external peer review. An anonymous, online, cross-sectional survey was conducted post-intervention completion. RAC-Communiqué subscribers were recruited via an e-invitation. English speaking enrolled or registered nurses, employed in an Australian RACS, were eligible. From the 167 participants who expressed interest to enrol, 129 were eligible and 45 returned completed consent forms. Fifteen survey items regarding perceived competence and intervention satisfaction were analysed.

RESULTS

The intervention addressed content pertaining to staffs' legal and regulatory requirements, managing incidents and awareness of key services. Thirty-eight of 45 eligible participants responded (84.4%). Participants reported they would recommend the intervention to a colleague (n = 36, 97.3%). Participants self-reported (i) advanced learning post-completion; (ii) raised awareness (n = 29, 78.4%) (iii) prompted current practice reflection (n = 35, 94.6%) and (iv) prompted improving USB workplace management (n = 34, 91.9%). Results are subjected to social desirability bias.

CONCLUSIONS

The intervention was relevant, engaging and practical. The findings contribute to a more comprehensive understanding of the specific training topics relevant and useful to RACS staff.

IMPLICATION FOR PRACTICE

E-learning tools could be an effective teaching method for USB in RACS. The intervention may be a useful tool to encourage staff to reflect and change current practice.

A health-based coaching program for diabetes self-management (DSM) practice: A sequential exploratory mixed-method approach

BACKGROUND

Diabetes self-management (DSM) is crucial for glycemic control among type-2 diabetic (T2D) people.

METHOD

This was a sequential exploratory mixed-method approach to assess whether a health-based coaching program designed to fit the unmet needs of T2D was the best intervention for improving DSM practice. Twenty-eight participants from different backgrounds were involved in phase 1 (Qualitative study) to explore DSM knowledge and practice, any difficulties obstructing such knowledge and practice, and the feasibility of implementing an intervention program nationwide. Sixty patients were recruited for phase 2 (Quasi-experimental study). A health-based coaching program, constructed to fit the unmet needs from phase 1 was implemented among thirty patients in an experimental group. By comparison, 30 patients in the control group received their usual care. Diabetes and DSM knowledge, DSM practice, and health outcomes were measured and compared between the two groups at baseline and after the 12th week of the intervention.

RESULTS

The following problems were found: (1) a low perception of susceptibility to and severity of illness, (2) inadequate DSM knowledge and skills, (3) a lack of motivation to perform DSM practice, and (4) social exclusion and feelings of embarrassment. After the implementation of the program among the experimental group, all the variables improved relative to baseline and to the control group.

CONCLUSION

A health-based coaching program can improve DSM knowledge and practice and health outcomes. A nationwide program is recommended to promote DSM practice among Indonesian communities.

Lessons from the field: delivering trachoma mass drug administration safely in a COVID-19 context

The first coronavirus disease 2019 (COVID-19) interim guidance released by the World Health Organization recommended suspension of non-urgent community health interventions, including mass drug administration (MDA) for neglected tropical diseases. However, with no end in sight for the COVID-19 pandemic, it was crucial to find ways to restart MDA while testing measures to reduce the risk of COVID-19 transmission between health workers, volunteers and communities. Consequently, guidelines were developed for delivering MDA safely in a COVID-19 context and the training and implementation were assessed through an observation checklist. The study also gathered data on the feasibility of using the MDA platform to disseminate COVID-19 health education. The results suggest that delivering MDA safely in a COVID-19 context is possible but revealed significant challenges in using the MDA platform for COVID-19 education.

Exploring a novel approach to surgery clerkship didactics during the COVID-19 pandemic: A qualitative study

Background

The COVID-19 pandemic brings unforeseen challenges in medical education. The current study aims to: 1) describe third-year medical students’ experiences with the novel Shelf-Exam-Type Question Didactics (SET QD) before (in-person) and during (virtual) COVID-19.

Methods

In this qualitative study using grounded theory, we conducted purposive sampling and used 23 in-depth semi-structured interviews. Audio recordings were transcribed verbatim and the Atlas.Ti software was used to manage the thematic analysis.

Results

There are three themes and eight subthemes that emerged: 1) The SET QD Framework (sub-themes: questions as learning opportunities; interleaving; notable clinical scenarios; team learning; accountability). 2) Experienced Educator (subtheme: transformational teaching). 3) Virtual Accessibility (sub-themes: alleviating time constraints, and mitigating life-stressors).

Conclusions

Medical students regarded SET QD as impactful for shelf exam preparation, clinical preparation, and long-term retention of the material. This novel virtual didactic method may be used in non-surgical clerkships as well.

Strengthening healthcare providers' capacity for safe abortion and post-abortion care services in humanitarian settings: lessons learned from the clinical outreach refresher training model (S-CORT) in Uganda, Nigeria, and the Democratic Republic of Congo

Background

Fragile and crisis-affected countries account for most maternal deaths worldwide, with unsafe abortion being one of its leading causes. This case study aims to describe the Clinical Outreach Refresher Training strategy for sexual and reproductive health (S-CORT) designed to update health providers’ competencies on uterine evacuation using both medications and manual vacuum aspiration. The paper also explores stakeholders’ experiences, recommendations for improvement, and lessons learned.

Methods

Using mixed methods, we evaluated three training workshops that piloted the uterine evacuation module in 2019 in humanitarian contexts of Uganda, Nigeria, and the Democratic Republic of Congo.

Results

Results from the workshops converged to suggest that the module contributed to increasing participants’ theoretical knowledge and possibly technical and counseling skills. Equally noteworthy were their confidence building and positive attitudinal changes promoting a rights-based, fearless, non-judgmental, and non-discriminatory approach toward clients. Participants valued the hands-on, humanistic, and competency-based training methodology, although most regretted the short training duration and lack of practice on real clients. Recommendations to improve the capacity development continuum of uterine evacuation included recruiting the appropriate health cadres for the training; sharing printed pre-reading materials to all participants; sustaining the availability of medication and supplies to offer services to clients after the training; and helping staff through supportive supervision visits to accelerate skills transfer from training to clinic settings.

Conclusions

When the lack of skilled human resources is a barrier to lifesaving uterine evacuation services in humanitarian settings, the S-CORT strategy could offer a rapid hands-on refresher training opportunity for service providers needing an update in knowledge and skills. Such a capacity-building approach could be useful in humanitarian and fragile settings as well as in development settings with limited resources as part of an overall effort to strengthen other building blocks of the health system.

Positive Side Effects: The Perceived Health and Psychosocial Benefits of Delivering an HIV Self-Management Program for Peer Educators Living With HIV

Although there is evidence that peer-led HIV treatment interventions are effective in improving health outcomes of people living with HIV (PLWH), few studies have assessed the health and psychosocial benefits of being a peer living with HIV. Qualitative interviews were conducted with nine PLWH who were peers of an HIV self-management intervention, to examine how this experience was perceived to impact their health behaviors, social support, and professional development. Peers reported improved HIV self-management and reduced health risk behaviors, which were attributed to increased self-efficacy and the desire to be a role model for participants. Peers described the experience as an opportunity to expand social networks and develop professional skills that could be leveraged for future employment. Our findings suggested that the benefits of being a peer could be enhanced in trainings and supervision by linking the importance of health-promoting behaviors to being a role model for other PLWH.

Heart to Heart Cards: A Novel, Culturally Tailored, Community-Based Advance Care Planning Tool for Chinese Americans

CONTEXT

A paucity of literature describes the growing Chinese American community's end-of-life (EOL) priorities and preferences.

OBJECTIVE

Develop a culturally-tailored advance care planning (ACP) tool to understand the EOL preferences of this underserved minority group.

METHODS

Informed by the Cultural Appropriateness Theory, the Chinese American Coalition for Compassionate Care (CACCC) developed Heart to Heart (HTH) Cards using a 3-step approach. First, CACCC created and refined a list of bilingual, culturally relevant EOL issues. Next, CACCC organized the EOL issues into a card deck. Finally, CACCC developed a unique playstyle of the cards-the HTH Café. From 2014-2019, CACCC recruited Chinese American volunteers and participants for HTH Cafés. Following each Café, participants completed an anonymous survey describing their sociodemographics, top 3 cards, and café evaluation.

RESULTS

The 54 HTH Cards were organized into 4 suits (spiritual, physical, financial/legal, and social). Each card displayed a culturally-tailored EOL issue in English and Chinese. Playstyles included one-on-one and group formats (ie. HTH Café). CACCC volunteers conducted 316 HTH Cafés for 2,267 Chinese American adults. Most participants were female (61.6%), between 18-50 years old (56.7%), lived in California (80.2%) and born in Asia (74.3%). The top priority (25.5%) was "If I'm going to die anyway, I don't want to be kept alive by machines." Participants thought the session was pleasant (99.5%) and expressed intent to complete advance directives (86.5%).

CONCLUSION

HTH Cards represents the first, theory-driven, culturally-tailored ACP tool for Chinese Americans. More research is needed to establish its impact on ACP conversations and outcomes.

Exploring Students' Perceptions of the Educational Environment in a Caribbean Veterinary School: A Cross-Sectional Study

Educational environment has a significant impact on students' learning and academic achievement. The aim of this article was to explore the perception of veterinary school students' regarding their educational environment at the University of the West Indies. In this cross-sectional study, the Dundee Ready Education Environment Measure (DREEM) was administered to veterinary undergraduate students from year 2 to year 5. The DREEM questionnaire consists of 50 items with five subscales: students' perceptions of learning, students' perceptions of teachers, students' academic self-perceptions, students' perceptions of atmosphere, and students' social self-perceptions. Each item was scored on a 5-point Likert scale ranging from strongly disagree (0) to strongly agree (4). The Cronbach's alpha for the overall DREEM score was 0.92, and for the five subscales, it ranged from 0.66 to 0.83. A total of 99 students responded (response rate: 86%). The students' overall DREEM mean score was 106.59 out of the global mean score of 200, indicating that students' perception of the educational environment was generally more positive than negative. In the five DREEM subscales, students were found to have a more positive perception of learning (55.15%); students' perception of teachers was generally positive (61.41%); and their perception of academic atmosphere was also positive (57.75%). Conversely, students' academic self-perception (51.41%) and social self-perception (42.61%) trended negatively. The findings suggest that improvement is needed in significant areas in the veterinary school, including curriculum review, faculty development, provision of sports and cultural facilities, stress management, and academic support systems.

Thriving in the future: intentional followership development

Purpose

The purpose of this paper is to highlight the significance of the role of followership by raising self-awareness of those in organisational hierarchies through the followership intelligence activity. As practitioners, we intentionally spotlight the importance of followership learning and link followership development to the future needs of a thriving organisation through the facilitation of our activity.

Design/methodology/approach

This paper outlines the proposed followership intelligence activity (FIA), which includes a progression of questions, group discussions and linkages to adult learning principles, experiential learning and followership theory.

Findings

Feedback from authors’ workshops and general observations indicate that once “learning” leaders understand the importance of followership and identify as both followers and leaders, they begin to build and promote work environments open to conversations about the behaviours and skills of exemplary followers.

Practical implications

People cannot change behaviour that they do not notice. However, when leaders begin to identify as both leaders and followers, their openness to learning, developing (self and others) and having followership conversations increases, which promotes both personal awareness and growth. As leaders model and create conversations about exemplary followership skills, they can promote and inspire these behaviours in others within the organisation.

Originality/value

The intention of embedding the FIA into our leadership development programme is to legitimise, honour and promote life-long learning of both leadership and followership. Both roles are vital for a thriving workplace, and they need to be performed with strength, accountability and pride.

Family Functional-based Coaching Program on Healthy Behavior for Glycemic Control among Indonesian Communities: A Quasi-experimental Study

OBJECTIVES

This study sought to examine the impact of a family functional-based coaching program on improving the perceived family functioning practice and clinical outcomes among patients with glycemic uncontrolled type 2 diabetes mellitus (T2DM) in the Indonesian community.

METHODS

We applied a quasi-experimental study, pretest, and posttest design with a non-equivalent control group. Sixty pairs of T2DM patient-caretaker dyads were recruited and assigned to either an intervention or control group. The Family Function Questionnaire (FFQ) was used to assess the perception of family functioning practices by T2DM patients of their caretakers to support their diabetes self-management. The clinical outcomes were measured using clinical outcome devices and laboratory tests. These measurements were conducted and compared at a baseline and 12 weeks after completing the program.

RESULTS

Patients who received the family functional-based coaching program saw significant improvement in perception of family function practice, compared to the control group who received usual care. The findings also showed a positive decline glycated hemoglobin and total cholesterol levels after receiving the 12-week program. However, no significant difference was found in body mass index.

CONCLUSIONS

It can be concluded that a family functional-based coaching program is feasible to implement among uncontrolled T2DM in a large scale study.

Strategies to Increase Peer Support Specialists' Capacity to Use Digital Technology in the Era of COVID-19: Pre-Post Study

BACKGROUND

Prior to the outbreak of coronavirus disease (COVID-19), telemental health to support mental health services was primarily designed for individuals with professional clinical degrees, such as psychologists, psychiatrists, registered nurses, and licensed clinical social workers. For the first the time in history, peer support specialists are offering Medicaid-reimbursable telemental health services during the COVID-19 crisis; however, little effort has been made to train peer support specialists on telehealth practice and delivery.

OBJECTIVE

The aim of this study was to explore the impact of the Digital Peer Support Certification on peer support specialists' capacity to use digital peer support technology.

METHODS

The Digital Peer Support Certification was co-produced with peer support specialists and included an education and simulation training session, synchronous and asynchronous support services, and audit and feedback. Participants included 9 certified peer support specialists between the ages of 25 and 54 years (mean 39 years) who were employed as peer support specialists for 1 to 11 years (mean 4.25 years) and had access to a work-funded smartphone device and data plan. A pre-post design was implemented to examine the impact of the Digital Peer Support Certification on peer support specialists' capacity to use technology over a 3-month timeframe. Data were collected at baseline, 1 month, 2 months, and 3 months.

RESULTS

Overall, an upward trend in peer support specialists' capacity to offer digital peer support occurred during the 3-month certification period.

CONCLUSIONS

The Digital Peer Support Certification shows promising evidence of increasing the capacity of peer support specialists to use specific digital peer support technology features. Our findings also highlighted that this capacity was less likely to increase with training alone and that a combinational knowledge translation approach that includes both training and management will be more successful.

Evaluation of a Training Program to Improve Organizational Capacity for Health Systems Analytics

OBJECTIVE

The Leadership in Analytics and Data Science (LEADS) course was evaluated for effectiveness. LEADS was a 6-month program for working biomedical and health informatics (BMHI) professionals designed to improve analytics skills, knowledge of enterprise applications, data stewardship, and to foster an analytics community of practice through lectures, hands-on skill building workshops, networking events, and small group projects.

METHODS

The effectiveness of the LEADS course was evaluated using the Kirkpatrick Model by assessing pre- and postcourse knowledge, analytics capabilities, goals, practice, class lecture reaction, and change in the size of participant professional networks. Differences in pre- and postcourse responses were analyzed with a Wilcoxon signed rank test to determine significance, and effect sizes were computed using a z-statistic.

RESULTS

Twenty-nine students completed the course with 96% of respondents reporting that they were "very" or "extremely" likely to recommend the course. Participants reported improvement in several analytics capabilities including Epic data warehousing (p = 0.017), institutional review board policy (p = 0.005), and data stewardship (p = 0.007). Changes in practice patterns mirrored those in self-reported capability. On average, the participant professional network doubled.

CONCLUSION

LEADS was the first course targeted to working BMHI professional at a large academic medical center to have a formal effectiveness evaluation be published in the literature. The course achieved the goals of expansion of BMHI knowledge, skills, and professional networks. The LEADS course provides a template for continuing education of working BMHI professionals.

Mobilizing Education to Nurses at the Bedside

After a survey revealed practice gaps in central venous catheter care, one organization was challenged to identify a novel approach to educate nurses. Through a search for evidence, a project workgroup discovered an existing but beneficial teaching method, using a mobile cart to deliver meaningful education at the point of care. Successful outcomes and sustained practice change were realized.