Differences in Supervision on Peer Learning Wards: A Pilot Survey of the Supervisor's Perspective

Introduction

Multiple students are placed on clinical wards simultaneously due to increasing student numbers. This has the potential to create stress for the supervisor and reduce quality of student learning. Peer learning as a pedagogical framework to supervise multiple students has been widely shown to have advantages for the students by developing teaching skills, team collaboration, and independence. However, whether peer learning impacts the characteristics of supervision and the experience of the supervisor is less understood. It is unknown whether wards that use peer learning as a pedagogical framework (peer learning wards) are any different compared to wards that do not (non-peer learning wards), from the supervisor's perspective.

Methods

We aimed to develop and pilot test a questionnaire to compare peer-learning wards and non-peer learning wards from the supervisor's perspective. We used the AMEE 7-step guide to develop questions investigating supervision, the learning environment and satisfaction. We piloted the questionnaire with 46 nurse supervisors working on inpatient hospital wards in Stockholm, Sweden. We compared answers from peer learning with non-peer learning wards. We used Orthogonal Projections to Latent Structures (OPLS) discriminant analysis to show what differed between the wards.

Results

Peer learning wards compared to non-peer learning wards had more student-centred activities, the physical space had more adaptations for students, more support available to the supervisor, and supervisors perceived greater overall satisfaction with the quality of education and with the ward as a whole. The variables that had most influence on the discrimination between the two ward types related to peer learning activities and perceptions (p=0.0034).

Conclusion

This pilot study shows that peer learning wards differ compared to non-peer learning wards regarding peer learning activities and perceptions among supervisors. Our questionnaire needs to be distributed on a larger scale to validate our findings and explore further the way in which the pedagogical framework and peer learning can affect supervision and satisfaction.

Nursing students experienced academic emotions during education - a longitudinal descriptive study from a nursing bachelor's program in Sweden

AIM

To explore nursing students' academic emotions during ongoing learning activities focusing on perceived challenge and competence.

BACKGROUND

Emotions plays an important part in learning. Positive emotions can be beneficial while negative emotions can be detrimental to educational outcomes. Optimal experiences are situations when learners simultaneously experience sufficient challenge and competence. Since various learning activities are performed in different learning environments during the nursing program, it is of interest to investigate students' ongoing emotions in the occurring contexts.

DESIGN

A longitudinal descriptive study.

METHODS

By using the Contextual Activity Sampling System, data was collected every third week on a three-year nursing program. From August 2015 to January 2020, a total of 2, 947 questionnaires were answered by 158 students. Experiences of positive and negative academic emotions were calculated for the entire program. Optimal experience was calculated for courses where high discrepancy between positive and negative experiences were identified.

RESULTS

Students self-reported academic emotions varied over time and in relation to learning activities. High ratings of negative emotions were reported during clinical practice in all semesters except the final. Students' positive academic emotions and optimal experience in clinical practice increased after having deepened their academic knowledge.

CONCLUSION

Nursing students had an increased positive experience when they themselves practice a learning activity and it appeared that they benefit from academic preparation prior to entering internship. Nursing students need an academic competence to develop their skills during training in the clinical reality. Increased collaboration between academia and clinic would be beneficial for students' clinical development.

Academic emotions and attitudes regarding interprofessional collaboration in health care activities: a prospective study among newly arrived physicians participating in a fourteen-week course

BACKGROUND

One way of facilitating entrance into the Swedish health care system, for newly arrived physicians from outside the European Union/European Economic Area, could be to set up and offer a course aimed to enhance understanding of it. This course was offered to increase insight about clinical practices, interprofessional teamwork and topics such as, Swedish health care laws, culture, and ethics. Acceptance of, and a flexible attitude towards, interprofessional teamwork are important for maintaining both the physician's professional identity and a high quality of patient care. The aim of this study was to investigate newly arrived physicians', academic emotions, experience of stress and flow during a fourteen-week course, as well as attitudes to interprofessional collaboration, both before and after.

METHOD

A prospective study was conducted, with participants asked to respond on one questionnaire every course day, by using the Contextual Activity Sampling System methodology. The participants were asked to complete a questionnaire comprising ten questions about ongoing activity and in what way they experience, e.g., collaboration, interprofessional teamwork, academic emotions, flow, and stress. Furthermore, the participants were asked to score their attitude towards interprofessional teamwork by using the interdisciplinary education perception scale both before and after the course.

RESULTS

The total sample comprised 27 qualified physicians, from outside the European Union/European Economic Area. In the interdisciplinary education perception scale category, "perception of actual cooperation¨, the participants had significantly higher scores after the course. Flow and academic emotions were felt mostly during own periods of study, seminars, and lectures. The academic emotions were apathy, anxiety, and boredom. The most frequently experienced academic emotion was apathy. Course participants rated stress highest in connection with the examination.

CONCLUSION

The results show that the course had a positive impact on the participants perception of actual cooperation. It appears that participating in this kind of course was a positive experience for the participants, since they mostly experienced high levels of flow. Collaborating with others was experienced as positive, with participants reporting a high degree of flow in activities during collaboration.

The impact of learning styles on attitudes to interprofessional learning among nursing students: a longitudinal mixed methods study

BACKGROUND

A functional interprofessional teamwork improves collaborative patient-centred care. Participation in interprofessional education promotes cooperation after graduation. Individuals tend to use different approaches to learning depending on their individual preferences. The purpose of this study was to explore nursing students' experiences of professional development with a focus on the relationship between attitudes to interprofessional learning and learning styles.

METHODS

A longitudinal parallel mixed-methods design. The study was carried out at a Swedish three-year nursing program from August 2015 to January 2020. On enrolment, thirty-four students self-assessed their attitudes to interprofessional learning according to the Readiness for Interprofessional Learning Scale, and their learning style according to Kolbs' Learning Style Inventory. In the final semester the students participated in an interview focusing on their experiences and perceptions of teamwork and they self-assessed their attitudes to interprofessional learning again.

RESULTS

Our findings indicated that 64.7% had a predominantly concrete learning style and 35.3% had a predominantly reflective learning style. No significant relationship with internal consistency reliability was identified among the participants between attitudes to interprofessional learning and learning styles. The content analysis resulted in four main categories: Amazing when it's functional; Deepened insight of care; Increased quality of care; Understanding own profession which were summarized in the theme: Well-functioning teams improve patients' outcome and working environment.

CONCLUSION

The students' attitudes to interprofessional learning were positive and it was considered as an opportunity to participate in interprofessional cooperation during internship. Transformative learning is a useful strategy in fostering interprofessional relationships due to the interdependence of various professions in interprofessional teams. When students are guided to use reflection to develop new perspectives and meaning structures, they acquire emotional and rational skills beneficial for interprofessional cooperation.

Size matters - redefining sex differences among patients with transthyretin amyloid cardiomyopathy – have we been wrong all along?

Background

Transthyretin amyloid cardiomyopathy (ATTR-CM) is most often diagnosed in men (1–5). The few available studies suggest affected women have a more favourable cardiac phenotype (5–8), but remain unclear regarding differences in outcomes.

Objectives and methods

To characterise sex differences among consecutive patients with non-hereditary and two prevalent forms of hereditary ATTR-CM diagnosed over a 20-year period at our specialist centre through analysis of deep phenotyping at presentation, changes on serial echocardiography and overall prognosis.

Results

In total, 1732 patients were studied, comprising: 1095 with wild-type (wt)ATTR-CM; 206 with T60A-hATTR-CM; and 431 with V122I-hATTR-CM. Female prevalence was greater in T60A-hATTR-CM (29.6%) and V122I-hATTR-CM (27.8%) compared to wtATTR-CM (6%). At presentation, females were 3.3 years older than males (81.9 vs 77.8 years for wtATTR-CM; 68.7 vs 65.1 years for T60A-hATTR-CM; 77.1 vs 74.9 years for V122I-hATTR-CM). At diagnosis, non-indexed measures of wall thickness were significantly greater in males (interventricular septum in diastole (IVSd) of 17.13mm in males & 16.15mm in females; p<0.001). When indexed for body surface area (BSA), we observed that the mean indexed IVSd was fairly constant in males throughout the study period, but in females, had a tendency to decrease over the same study period. Furthermore, BSA significantly influenced measures of disease severity. When indexed for BSA, overall structural and functional phenotype was similar between sexes; the few observed significant differences including indexed IVSd (9.62mm/m2 in females & 8.88mm/m2 in males; p<0.001), indexed left ventricular (LV) end-diastolic volume (35.07ml/m2 in females & 41.05ml/m2 in males; p<0.001) and indexed LV end-systolic volume (17.95ml/m2 in females & 21.74ml/m2 in males; p<0.001) suggested a mildly worse phenotype in females. No significant differences were observed in disease progression on serial echocardiography and mortality across the overall population (p=0.459) and when divided by genotype (p=0.730 for wtATTR-CM; p=0.161 for T60A-hATTR-CM; p=0.056 for V122I-hATTR-CM).

Conclusion

This study of a well-characterized large cohort of ATTR-CM patients, contrary to previous dogmas, did not demonstrate overall differences between sexes in either clinical phenotype, when indexed, or with respect to disease progression and prognosis. The analysis highlighted the deficiencies in using non-indexed values which can not only lead to the inaccurate perception of a milder clinical phenotype in women compared to men, but has been shown to result in female patients presenting at an older age and with a worse phenotype compared to men. These findings indicate the need for revision of existing clinical guidelines regarding awareness and diagnosis of ATTR-CM in women, and modification of clinical trials which currently use single non-indexed threshold for wall thickness as key inclusion criterion.

Funding Acknowledgement

Type of funding sources: Foundation.

Cardiac transplantation in transthyretin amyloid cardiomyopathy: outcomes from three decades of tertiary centre experience

Background

Transthyretin cardiac amyloidosis (ATTR-CM) is a progressive and fatal cardiomyopathy. Treatment options in patients with advanced heart failure are limited to cardiac transplantation (CT). Despite small case series demonstrating comparable outcomes with CT between patients with ATTR-CM and non-amyloid cardiomyopathies, ATTR-CM is considered to be an absolute contraindication to CT in some centres. This is in part due to a perceived risk of amyloid recurrence in the cardiac allograft. We report outcomes of patients with ATTR-CM assessed at our centre whom underwent CT over the past thirty years.

Methods

We retrospectively evaluated all ATTR-CM patients assessed at the UK National Amyloidosis Centre between 1990 and 2020 who underwent CT. Pre-transplantation disease and patient characteristics were determined and outcomes were compared with our large cohort of non-transplanted ATTR-CM patients. Censor date was 11th January 2022.

Results

Eleven (9 male, 2 female) patients with ATTR-CM underwent CT including 8 with wild-type ATTR-CM and 3 with variant ATTR-CM (ATTRv). Median age at CT was 60.3 years and median follow up post-CT was 65.7 months. Median (range) NT-proBNP concentration pre-transplant was 4478ng/L (1057–8778ng/L), median (range) left ventricular ejection fraction (LVEF) was 39% (27–56%) and mean (IQR) interventricular septal (IVSD) was 18 mm (15.9–20.1 mm). 8 patients were NYHA functional class III, the 3 remaining patients were class II.

One, three, and five-year survival was 100%, 89% and 86%, respectively and the longest surviving patient was censored >19 years post CT. Survival is at least comparable to UK and US CT outcome registry data for all non-amyloid patients undergoing CT. No patients had recurrence of amyloid in the cardiac allograft as assessed by endomyocardial biopsy and/or Tc-DPD scintigraphy. Two patients were commenced on Patisiran for amyloid polyneuropathy at 211 and 5 months post-CT. Graft rejection requiring treatment was observed in 2 patients, and successfully treated with intravenous steroids. Renal impairment was common, with 6 patients being left with chronic kidney disease.

Three patients died, including one with ATTRv-CM from complications of leptomeningeal amyloidosis. Survival among the cohort of patients who underwent CT was significantly longer than UK patients with ATTR-CM generally (P≤0.006), regardless of NAC ATTR disease stage and including those diagnosed under 65 years of age (P=0.028). (Figure 1) All surviving patients were NYHA functional class I at time of censor.

Conclusion

Our data indicates that cardiac transplantation is well tolerated, restores functional capacity, and prolongs survival in ATTR-CM with little risk of recurrence of amyloid in the cardiac allograft. We believe that our data argues strongly for ATTR-CM to be routinely included in the list of indications for cardiac transplantation.

Funding Acknowledgement

Type of funding sources: None.

Extracellular volume fraction by computed tomography predicts long-term prognosis among patients with cardiac amyloidosis

Objective

This study sought to investigate the association of extracellular volume fraction by computed tomography (ECVCT), myocardial remodeling and mortality in patients with systemic amyloidosis.

Background

Light chain (AL) and transthyretin (ATTR) amyloid fibrils are deposited in the extracellular space of the myocardium, resulting in heart failure and premature mortality. Extracellular expansion can be quantified by CT, offering a rapid and cost-effective alternative to cardiovascular magnetic resonance (CMR), especially among patients with cardiac devices or on renal dialysis.

Methods

Patients with confirmed systemic amyloidosis and varying degrees of cardiac involvement underwent ECG-gated cardiac CT. ECVCT was analysed in the inter-ventricular septum. All patients also underwent clinical assessment, ECG, echocardiography, serum amyloid protein component (SAP) and/or technetium-99m (99mTc) 3,3-diphosphono-1,2-propanodicarboxylic acid scintigraphy. ECVCT was compared across different extents of cardiac infiltration (ATTR Perugini Grade / AL Mayo Class) and evaluated for its association with myocardial remodelling and all-cause mortality.

Results

72 patients were studied (AL n=35, ATTR n=37; age 67 (59–76) years, 71% males). Mean septal ECVCT was 42.7±13.1% and 55.8±10.9% in AL and ATTR, respectively, and correlated with indexed left ventricular (LV) mass (r=0.426, p<0.001), LV ejection fraction [LVEF, (r=0.460, p<0.001)], NT-proBNP (r=0.563, p<0.001) and hsTnT (r=0.546, p=0.02). ECVCT increased with cardiac amyloid involvement in both AL and ATTR (Figure 1). Over a mean follow-up of 5.3±2.4 years, 40 deaths occurred (AL 14 [35%]; ATTR 26 [65%]). ECVCT was independently associated with all-cause mortality in ATTR (not AL) after adjustment for age and IV septal wall thickness (HR: 1.046, 95% CI: 1.003–1.090, p=0.037).

Conclusion

Cardiac amyloid burden quantified by ECVCT is associated with adverse cardiac remodelling as well as all-cause mortality among ATTR amyloid patients. ECVCT may address the need for better identification and risk stratification of amyloid patients, using a widely-accessible imaging modality (Figure 2).

Funding Acknowledgement

Type of funding sources: None.

Progression, regression and redefining the treatment response – cardiac magnetic resonance with T1 and extracellular volume mapping in cardiac light-chain amyloidosis

Background

The presence and severity of cardiac involvement in AL amyloidosis is the main driver of prognosis [1]; patients with symptomatic heart failure frequently die within 6 months [1] but median survival has nearly doubled over the past decade, mainly due to significant improvements in chemotherapy. The haematological response to chemotherapy is principally evaluated with serial measurements of serum-free light-chains (FLC) [2]. The cardiac response to chemotherapy is assessed through changes in serum concentrations of brain natriuretic peptides (including NT-proBNP) and echocardiographic parameters [3–5]. Neither are able to directly measure cardiac amyloid burden. Cardiovascular magnetic resonance (CMR) with extra-cellular volume (ECV) mapping can measure the extent cardiac amyloid infiltration [6].

Aims

We investigated the ability of CMR to: 1) measure changes in response to chemotherapy; 2) assess the correlation between haematological response (HMR) and changes in cardiac amyloid; 3) assess the association between changes in cardiac amyloid and prognosis over and above existing predictors.

Methods

In total, 176 patients with cardiac light-chain amyloidosis treated with chemotherapy were assessed with FLC, NT-proBNP and CMR with ECV mapping at baseline (before chemotherapy), 6-months, 12-months & 24-months after commencing chemotherapy. Haematological response was categorized by reductions in FLC as: complete response (CR), very good partial response (VGPR), partial response (PR) or no response (NR). CMR response was categorized by changes in ECV as: progression (≥0.05 increase), stable (<0.05 change) or regression (≥0.05 decrease).

Results

A progressive increase in patients achieving either CR or VGPR was observed at each time point (61% of patients at 6-months, 71% at 12-months and 80% at 24-months). At 6-months, CMR regression was observed in 3% (all had either CR or VGPR) and progression in 32% (61% had either PR or NR; 39% had either CR or VGPR). At 1-year, CMR regression was observed in 22% (all had either CR or VGPR); progression in 22% (63% had either PR or NR; 37% had either CR or VGPR). At 2-years, CMR regression was observed in 38% (all had CR/VGPR); progression in 14% (80% had either PR or NR; 20% had either CR or VGPR). During follow-up (40±15 months), 36 (25%) patients died. CMR response at 6-months predicted death (progression HR 3.821; 95% CI 1.950–7.487; p<0.001) and remained independently associated with prognosis after adjusting for haematological response, NT-proBNP and longitudinal strain on echocardiography (p<0.01).

Conclusions

CMR demonstrates that cardiac amyloid deposits frequently regress following chemotherapy, but only in patients who achieve CR or VGPR, highlighting the need for deep haematological response. Changes in amyloid burden (ECV) predict outcomes after adjusting for known predictors, showing the crucial role of CMR in redefining treatment response.

Funding Acknowledgement

Type of funding sources: Foundation.

Undergraduate nursing students' experiences of becoming a professional nurse: a longitudinal study

Background

During education it is essential for nursing students to develop professionalism in nursing. Nurses are placed in situations based on trust, and it is crucial that their patients have confidence in them to provide professional and safe care. A key period in nursing students’ development of a professionalism occurs during training when students gain knowledge and skills that separate nurses as professional healthcare workers from laypeople. The purpose of this study was to investigate nursing students’ experiences of professional competence development during education.

Methods

A longitudinal study was carried out using qualitative content analysis with a manifest inductive approach. Thirty-four students enrolled in a Swedish three-year nursing program, from August 2015 to January 2017 were interviewed on four occasions.

Results

The results revealed that students’ professional role developed gradually. The students’ started their education with dreams and a naive understanding of the profession, but their understanding of the complexity of the nursing profession gradually evolved. Students became theoretically equipped at the university and developed clinical skills through practice. Students’ focus went from mastering medical technology to a more holistic approach. Before graduating, students felt ready but not fully trained.

Conclusions

Our findings indicate a discrepancy between the content of the theoretical education and the clinical settings since students identified a lack of evidence-based practice. A solid theoretical education before entering clinical training offered students possibilities for reflecting on evidence-based practice and the clinical settings. The realization that there is always potential for professional improvement can be interpreted as an emerging awareness, and development of professionalism. It is clear that students could benefit from increased collaborative work between clinical supervisors and faculty staff at the university.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-022-01002-0.

What about the supervisor? Clinical supervisors' role in student nurses' peer learning: A phenomenographic study

INTRODUCTION

Peer learning is increasingly used for healthcare students in the clinical setting. However, as peer learning between students involves students taking a teaching role, it is unclear what the supervisor's role then becomes. It is vital to determine the role of the supervisor in student peer learning to ensure high quality learning and patient safety.

METHODS

Semi-structured interviews were performed with 15 student nurse supervisors (nurses and assistant nurses) from two hospital wards that practice peer learning to investigate the different ways clinical supervisors view their role in students' peer learning. Transcribed data were coded and analysed using a phenomenographic approach.

RESULTS

Four hierarchical levels of the supervisor's understanding of their role in students' peer learning were identified: the teacher; the facilitator; the stimulator; and the team player. These categories represent an increasingly inclusive view of which people present on the ward play a role in enabling effective peer learning.

CONCLUSIONS

The various understandings of supervisor roles have implications for how supervision of peer learning could be implemented in the future.

Dual use of instruments for assessing nursing students professional- and clinical competence

BACKGROUND

Changes in demographics and the development of health systems have a direct impact on patients' nursing needs and nurses' ability to meet them. Modern and forward-looking nursing education programmes that will help nursing students to develop their professional competence require useful tools for assessment and self-reflection that can be combined in theoretical and clinical education.

OBJECTIVES

To investigate the associations between the Nurse Professional Competence Scale - Short Form (NPC-SF), and the tool Assessment of Clinical Education (AssCE) tool, and to assess the graduating students´ professional competence based on their self-assessment.

DESIGN

A cross-sectional descriptive study design was used.

PARTICIPANTS AND SETTINGS

A total of 151 nursing students at a Swedish university college completed the NPC-SF and the AssCE (response rate 77%).

METHODS

In their final weeks of the nursing programme, students were invited to respond to two questionnaires: the NPC Scale - Short Form (35 items) and the AssCE tool (21 items).

RESULT

There are significant correlations between the nursing students' responses to the NPC-SF competence areas and the AssCE areas (r = 0.19-0.57). Students score in the NPC-SF were highest in Value-based Nursing Care and lowest in Development, Leadership and Organization of Nursing Care, and in the AssCE areas student scores were highest in Examination and treatment and Professional Approach and lowest in Management and Cooperation.

CONCLUSION

The NPC-SF and AssCE are valid and reliable instruments, showing a high level of correlation. Results imply that dual use could strengthen student-centred theoretical and clinical learning as well as professional competence development. Additional research is needed to assess student's competence development during the nursing program.

Atrial strain in cardiacATTR amyloidosis from pathophysiology to prognosis: is it time to rethink our approach to disease?

Background

Left atrial (LA) involvement in cardiac ATTR amyloidosis (ATTR-CM) has never being explored. The aim of the study is to characterize the spectrum of changes in LA structure in ATTR-CM, the functional consequences on LA mechanics and the association with mortality.

Methods

We studied 936 patients with ATTR-CM who underwent prospective protocolized evaluations comprising ECG, full echocardiographic assessment, 6MWT, blood biomarkers sampling and survival assessment between 2000 and 2019. Reservoir (LAr), conduit (LAcd) and booster (LAcont) function were assessed according to current guidelines. LA stiffness (LAstiff) was estimated as the ratio between E/e' and LAr. The presence and extent of amyloid infiltration was assessed in two autopsied hearts from patients ATTR-CM with congo red staining and TTR antibodies.

Results

936 patients with ATTR-CM were included, 567 with wtATTR-CM and 346 with hATTR-CM, of whom 246 had the V122I variant and 100 the T60A variant. LA indexed area was similar across the 3 genotypes, whilst LAr, LAcd and LAcont were significantly reduced in V122I patients compared to Wt and T60A patients (LAr: 10.4±6.4 vs 12.8±8.5 vs 8.59±5.7%, p<0.0001; LAcd: 5.6±5.0 vs 6.9±5.7 vs 4.0±3.6%, p<0.0001; LAcont 7.5±4.1 vs 8.2±4.9 vs 6.7±4.2%, p=0.023; in Wt, T60 and V122I respectively). Similarly, LAstiff was significantly worse in V122I compared to Wt and T60A (LAstiff: 2.39±2.62 vs 2.59±4.83 vs 2.96±2.88, p<0.0001, in Wt, T60 and V122I respectively). In the overall population, LAstiff remained independently associated with mortality, after adjusting for rhythm, systolic and diastolic functional parameters, ventricular longitudinal strain, genotypes, clinical variables and NAC staging system (lnLA stiff: HR=1.26, CI: 1.07–1.57; p=0.009). In the overall population, 584 patients were in sinus rhythm and 344 in atrial fibrillation, atrial flutter or atrial tachycardia (non-sinus rhythm group – NSR). Among patients in SR, 21.6% did not show a measurable LA mechanical contraction on strain analysis (LAcont). Patients in SR without LAcont on strain analysis showed similar structural and functional LA changes, NTproBNP, NYHA class, and 6MWT to NSR patients. Mortality of patients in SR with no LAcont was significantly reduced compared to patients in SR with LAcont and similar to patients in AF (Figure 1). On the two autopsies hearts there was extensive amyloid infiltration of TTR type in the atrial wall as confirmed with CR and TTR antibodies (Figure 1).

Conclusions

ATTR-CM is characterized by primary infiltration of the atrial walls with progressive loss of atrial function and increased stiffness. LA stiffness is a strong independent predictor of mortality after adjusting for known predictors. Atrial electro-mechanical dissociation emerged as a distinctive functional phenotype identifying patients in SR with worse prognosis.

Figure 1

Funding Acknowledgement

Type of funding source: None

Global longitudinal strain predicts survival and response in patients with systemic AL amyloidosis. analysis of 915 patients from the ALchemy prospective trial

Background

Cardiac involvement determines prognosis in systemic AL amyloidosis. The extent is assessed by biomarker-based staging systems. This a prospective report of a large cohort of patients assessing the utility of changes in longitudinal function by 2D strain (GLS%), impairment - a hallmark of amyloidosis.

Purpose

To evaluate the prognostic role of GLS% and other echocardiographic parameters in systemic AL amyloidosis.

Methods

915 newly diagnosed patients seen at the UK National Amyloidosis Centre (February 2010–August 2017) were included. All patients underwent 6-monthly comprehensive assessments inclusive of echocardiogram. The European modification of the Mayo 2004 staging was used with Mayo stage III patients stratified into IIIa (NT-proBNP <8500ng/L) and IIIb (NT-proBNP ≥8500ng/L).

Results

653/915 (71.4%) patients had cardiac involvement. Mayo stage 1, 2, 3a and 3b in 144 (15.7%), 302 (33.0%) 344 (37.6%) and 125 (13.7%) respectively. The median NT-proBNP was 2228ng/L and TNT was 0.54ng/ml. The GLS% significantly worsened with increasing Mayo stage (p<0.0001 between GLS% for each Mayo stage). Poorer baseline GLS% associated with significantly worse OS and stratified patients into three groups: GLS% <−12.8%: OS 69.1 months; GLS% −12.8% to −9%: OS 54.5 months; GLS% >−9%: OS 45.3 months (p<0.0001). On univariate analysis, 11/14 parameters predicted survival (LV wall thickness, LV ejection fraction, systolic velocities of the septal (s'sep) and lateral mitral annulus (s' lat), mitral annulus movement at the lateral corner (e' lat), transmitral early peak flow velocity (E) divided by tissue Doppler mitral annular motion velocity (e') – E/e' and mitral annular plane systolic excursion (MAPSE)). Baseline GLS% >−17% was independent of Mayo stage in predicting survival [Mayo II: Hazard ratio (HR) 2.10 (95% CI: 1.12–3.92) p=0.02, Mayo III: HR 3.94 (95% CI: 2.13–7.32) p<0.0001, Mayo IV: HR 7.49 (95% CI: 3.94–14.21) p<0.0001, GLS <17%: HR 2.14 (95% CI: 1.59–2.88) p<0.0001]. At 12 months, only patients in a haematological complete response (CR) had significant improvement in overall GLS% (p=0.02) as well as baso-lateral (p=0.0004) and baso-septal (p=0.0001) GLS% and MAPSE (p=0.002). The OS was significantly better in patients who achieved a minimum absolute improvement in GLS% of 1.5% improvement (not reached in those with improved GLS% vs. 72 mo in those without) (p=0.034)).

Conclusion

These data show that baseline GLS% is an independent predictor of survival in AL amyloidosis. GLS% is the first functional marker that is independent of the Mayo staging in predicting outcomes and should be incorporated in prognostic staging for patients with AL amyloidosis. GLS% shows improvement in patients who achieve a complete haematologic response to treatment and improvement in GLS% of 1.5% is associated with improved outcomes. An absolute improvement in GLS% should be considered as a criterion for cardiac response in AL amyloidosis.

Funding Acknowledgement

Type of funding source: None

Personality and learning styles in relation to attitudes towards interprofessional education: a cross-sectional study on undergraduate medical students during their clinical courses

BACKGROUND

Interprofessional Education (IPE) is now included in curricula in universities worldwide. It is known that there are differences in attitudes towards IPE among students, but less is known regarding how students' personalities and learnings styles correspond with those attitudes. The aim of this study was to investigate whether personality traits and learning styles have any impact on medical students' attitudes towards IPE.

METHODS

Seventy nine medical students in their 9th term (63% females, mean age 29 years) were questioned regarding their attitudes towards IPE according to the Interdisciplinary Education Perception Scale questionnaire, the Kolb's learning style and Big Five Inventory questionnaires. For all three instruments we used the Swedish translated versions.

RESULTS

When investigated with a logistic regression, adjusting for age and gender, there were no significant associations between Big Five inventory, Kolb's learning style and IEPS, except for the Reflective-Pragmatic learning style that was moderately associated with a higher IEPS score.

CONCLUSION

There was no clear correlation between personality, learning style and attitude towards IPE as measured by the IEPS among medical students in our study population. Further investigations would benefit from a combination of qualitative and quantitative design.

The learning environment on a student ward: an observational study

INTRODUCTION

Worldwide, a growing number of healthcare students require clinical environments for learning. Some wards have become adapted 'student wards' to meet this demand. Benefits have been reported from the students', supervisors' and patients' perspectives. There is no definition of a student ward, and little research on what the term means. A deeper understanding of the characteristics of student wards is needed to support their use. The aim of this study is to describe what characterises the learning environment on one student ward.

METHODS

An ethnographic approach was used for an observational study on a student ward in a hospital in Sweden. Student nurses, supervisors and others on the ward were observed. Field notes were thematically analysed.

RESULTS

Four themes were identified: 'Student-led learning' described students learning by actively performing clinical tasks and taking responsibility for patients and for their own learning. 'Learning together' described peer learning and supervision. 'Staff's approach to learning' described personalised relationships between the students and staff and the build-up of trust, the unified inter-professional approach to teaching, and the supervisors' motivation for teaching and for their own learning. 'Student-dedicated space' described the effect of the student room on the learning environment.

DISCUSSION AND CONCLUSIONS

This study describes the characteristics of a student ward that centred around a community of practice that shared a view of learning as a priority, allowing staff to provide clinical care without compromising students' learning. This qualitative study at a single centre lays the groundwork for future research into other student wards.

Stress among medical students during clinical courses: a longitudinal study using contextual activity sampling system

OBJECTIVES

To investigate medical students' experiences of stress and other emotions related to their professional roles, as defined by the CanMEDS framework, by using the Contextual Activity Sampling System (CASS).

METHODS

Ninety-eight medical students agreed to participate of whom 74 completed this longitudinal cohort study. Data was collected between 6th and 8th term via CASS methodology: A questionnaire was e-mailed to the participants every 3rd week(21questionnaires/measurements) during clinical rotations and scientific project work term. Emotions were measured by a 7-point Likert scale (e.g., maximum stress = 7). Answers were registered through mobile technology. We used a linear mixed-model regression approach to study the association between stress over time in relation to socio-demographic and learning activities related to CanMEDS roles.

RESULTS

Participants completed 1390 questionnaires. Mean stress level over all time points was 3.6. Stress was reported as highest during the scientific project term. Learning activities related to 'Communicator,' 'Collaborator,' 'Scholar,' 'Manager' and 'Professional' were associated with increased stress, e.g. 'Scholar' increased stress with 0.5 points (t₍₁₃₃₉₎=3.91, p<0.001). A reduced level of stress was associated with 'Health Advocate' of 0.39 points (t₍₁₃₃₈₎=-2.15, p=0.03). No association between perceived stress and demographic factors, such as gender or age was found.

CONCLUSIONS

An association between different learning activities related to CanMEDS Roles and feelings of stress were noted. The CASS methodology was found to be useful when observing learning experiences and might support educational development by identifying course activities linked to stress.

Translation and psychometric evaluation of the Swedish version of the Interdisciplinary Education Perception Scale

Interprofessional education (IPE) is widely accepted worldwide, as a key part of training for health professionals and critical to an effective, patient-centred healthcare system. Several tools have been developed to evaluate IPE programmes and interventions globally. Many of the widely-used tools have been successfully adapted to suit specific cohorts and different languages; the Interdisciplinary Education Perception Scale (IEPS), however, has not yet been translated and validated for use in Sweden. The aim of this study was to translate the IEPS into Swedish and validate the psychometric properties of this new version. The 12-item IEPS underwent translation into Swedish and back-translation into English by suitable independent translators to ensure items retained their meaning. The new Swedish version was completed by 164 medical and nursing, occupational therapy and physiotherapy students on clinical placements in Stockholm. Principal Axis Factoring (PAF) and Oblique Oblimin Rotation confirmed a three-factor structure, that explained 77.4% of variance. The new 10-item Swedish version IEPS displayed good internal consistency with an overall Cronbach's alpha of a = .88 and subscale values of .89, .88 and .66. The exclusion of two-items limits the transferability of this scale; however, the factor makeup was very similar to the original 12-item English version. It is suspected that minor differences were due to unavoidable deviations in meaning following translation (i.e. certain English words have no equivalent in Swedish). Nevertheless, the results imply that the Swedish version of the IEPS is a valid and reliable tool for assessing students' perceptions and attitudes towards IPE within the Swedish health education system.

Medical students' experiences of their own professional development during three clinical terms: a prospective follow-up study

BACKGROUND

A modern competency-based medical education is well implemented globally, but less is known about how the included learning activities contribute to medical students' professional development. The aim of this study was to explore Swedish medical students' perceptions of the offered learning activities and their experiences of how these activities were connected to their professional development as defined by the CanMEDS framework.

METHODS

A prospective mixed method questionnaire study during three terms (internal medicine, scientific project, and surgery) in which data were collected by using contextual activity sampling system, i.e., the students were sent a questionnaire via their mobile phones every third week. All 136 medical students in the 6th of 11 terms in the autumn of 2012 were invited to participate. Seventy-four students (54%) filled in all of the required questionnaires (4 per term) for inclusion, the total number of questionnaires being 1335. The questionnaires focused on the students' experiences of learning activities, especially in relation to the CanMEDS Roles, collaboration with others and emotions (positive, negative, optimal experiences, i.e., "flow") related to the studies. The quantitative data was analysed statistically and, for the open-ended questions, manifest inductive content analysis was used.

RESULTS

Three of the CanMEDs Roles, Medical Expert, Scholar, and Communicator, were most frequently reported while the four others, e.g., the role Health Advocate, were less common. Collaboration with students from other professions was most usual during the 8th term. Positive emotions and experience of "flow" were most often reported during clinical learning activities while the scientific project term was connected with more negative emotions.

CONCLUSIONS

Our results showed that it is possible, even during clinical courses, to visualise the different areas of professional competence defined in the curriculum and connect these competences to the actual learning activities. Students halfway through their medical education considered the most important learning activities for their professional development to be connected with the Roles of Medical Expert, Scholar, and Communicator. Given that each of the CanMEDS Roles is at least moderately important during undergraduate medical education, the entire spectrum of the Roles should be emphasised and developed during the clinical years.