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Harvey A, Paget M, McLaughlin K, Busche K, Touchie C, Naugler C, Desy J. How much is enough? Proposing achievement thresholds for core EPAs of graduating medical students in Canada. Med Teach 2023; 45:1054-1060. [PMID: 37262177 DOI: 10.1080/0142159x.2023.2215910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE The transition towards Competency-Based Medical Education at the Cumming School of Medicine was accelerated by the reduced clinical time caused by the COVID-19 pandemic. The purpose of this study was to define a standard protocol for setting Entrustable Professional Activity (EPA) achievement thresholds and examine their feasibility within the clinical clerkship. METHODS Achievement thresholds for each of the 12 AFMC EPAs for graduating Canadian medical students were set by using sequential rounds of revision by three consecutive groups of stakeholders and evaluation experts. Structured communication was guided by a modified Delphi technique. The feasibility/consequence models of these EPAs were then assessed by tracking their completion by the graduating class of 2021. RESULTS The threshold-setting process resulted in set EPA achievement levels ranging from 1 to 8 across the 12 AFMC EPAs. Estimates were stable after the first round for 9 of 12 EPAs. 96.27% of EPAs were successfully completed by clerkship students despite the shortened clinical period. Feasibility was predicted by the slowing rate of EPA accumulation overtime during the clerkship. CONCLUSION The process described led to consensus on EPA achievement thresholds. Successful completion of the assigned thresholds was feasible within the shortened clerkship.[Box: see text].
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Affiliation(s)
- Adrian Harvey
- Departments of Surgery & Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Michael Paget
- Director of Academic Technologies, Undergraduate Medical Education, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kevin McLaughlin
- Department of Internal Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kevin Busche
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Claire Touchie
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Christopher Naugler
- Departments of Pathology & Laboratory Medicine, Community Health Sciences and Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Janeve Desy
- Clinical Assistant Professor, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Masava B, Nyoni CN, Botma Y. Standards for Scaffolding in Health Sciences Programmes: A Delphi Consensus Study. J Med Educ Curric Dev 2023; 10:23821205231184045. [PMID: 37476159 PMCID: PMC10354826 DOI: 10.1177/23821205231184045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 06/07/2023] [Indexed: 07/22/2023]
Abstract
Introduction Health sciences programmes operate in complex, unpredictable contexts, underscoring the need for comprehensive scaffolding of the learning processes. Yet, the scaffolding approaches remain fragmented, and lack a shared approach to how programmes could integrate scaffolding across the curricula. The literature argues that standards result in the comprehensive implementation of educational practices. There are no reported standards related to scaffolding practices in these programmes. OBJECTIVES To develop standards for scaffolding in health sciences programmes utilising a consensus approach through a modified Delphi Technique. METHODS Following the recommendations on Conducting and REporting of DElphi Studies (CREDES), an online modified Delphi technique was applied. Evidence on the application of scaffolding in health sciences programmes, obtained through an integrative review, was synthesised to draft standards. Using purposive and snowball sampling, an international panel from diverse geographical and professional backgrounds refined and validated the standards. Descriptive statistics was utilised to analyse demographic data and consensus agreements to include standards and criteria. Qualitative analysis of textual comments ensured the synthesis and inclusion of critical divergent views and additions. RESULTS A total of 22 experts from around the globe agreed to participate in the study and one did not complete Delphi surveys. Most experts (n = 18) held a PhD; and an average of 19 years of teaching in health sciences programmes. Four standards and 27 criteria were included after achieving consensus during the two Delphi surveys rounds. The included standards focused on four areas: structuring and sequencing educational activities, resources/tools for scaffolding, structuring the programme and instructional strategies to support learning. CONCLUSION The principle-based standards developed in this study could direct and support scaffolding practices in health sciences programmes. The standards' emphases on macro-, meso- and micro-scaffolding present numerous opportunities for designing and applying contextually sensitive scaffolding strategies at every level of curriculum implementation.
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Affiliation(s)
- Beloved Masava
- School of Nursing, University of the Free State, Bloemfontein, South Africa
| | - Champion N Nyoni
- School of Nursing, University of the Free State, Bloemfontein, South Africa
| | - Yvonne Botma
- School of Nursing, University of the Free State, Bloemfontein, South Africa
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Miglani G, Kumar A, Pandey V, Pareek P, Nair SK. Chemotherapy administration checklist for patients receiving chemotherapy: Development and validation. J Educ Health Promot 2022; 11:397. [PMID: 36824403 PMCID: PMC9942124 DOI: 10.4103/jehp.jehp_587_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 06/16/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND With the increase in the number of new cancer cases, the number of patients receiving chemotherapy increases. The administration of chemotherapy is a very significant task. Unfortunately, the availability of a chemotherapy administration checklist still lags behind. The aim is to develop a chemotherapy administration checklist for patients receiving chemotherapy. MATERIALS AND METHODS This study was conducted at the oncology day care and in-patient department (IPD) wards of the All India Institute of Medical Sciences, Jodhpur, Rajasthan. Methodological research design was used in this study. It took place in five phases: preliminary phase includes literature review, focussed group discussion, assessment of current practices, generation of item pool, and preparation of preliminary draft; then its validation by modified Delphi technique, pilot testing; final try out, and evaluation phase. A total of 260 patients were enrolled. RESULTS The content validity index was 0.97. To perform factor analysis and principal component analysis KMO and Bartlett's test of sphericity was used, which allows the data for factor analysis to yield eight components. A total of 26 items were formulated. The scoring was done dichotomously; a score of 1 is for done and 0 for not done and not applicable. Cronbach's alpha was used to find out the internal consistency of the checklist was found to be 0.72. For interrater reliability, the Cohen kappa's value was found to be 0.91. CONCLUSIONS Chemotherapy administration checklist was a valid and reliable checklist. This checklist is feasible and easy to incorporate into clinical practices.
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Affiliation(s)
| | - Ashok Kumar
- College of Nursing, AIIMS, Jodhpur, Rajasthan, India
| | - Vandna Pandey
- College of Nursing, AIIMS, Jodhpur, Rajasthan, India
| | - Puneet Pareek
- Department of Radiation Oncology, AIIMS, Jodhpur, Rajasthan, India
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O’Connor L, McAuliffe E, Casey M, Rogers L, Gallen A, Finnegan L, Glasgow ME, White M, White C, Kavanagh P, Bell M, Killeen A, Barnard M. Operationalising a modified Delphi study to progress quality care process nursing metrics for acute care. J Res Nurs 2022; 27:655-676. [PMID: 36405804 PMCID: PMC9669935 DOI: 10.1177/17449871211021138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023] Open
Abstract
Background Despite representing the largest occupational group within the healthcare workforce, evidence suggests that due to the complexity of nursing practice, nurses' contribution remains 'invisible'. Quality Care Metrics aligned to standards can offer valuable numerical information that quantify input, output and dimensions of nursing care processes in complex clinical and interprofessional milieus. Aims and objectives Progress an evidence-based metric system to measure the quality and clinical safety of nursing care within acute care in Ireland. The objectives were to: classify quality care process nursing metrics and corresponding indicators pertinent to acute care; reach agreement on a selected set of robust metrics and corresponding indicators; and implement the findings of the study. Design A modified four-round Delphi study. Methods The modified Delphi study integrated a four-round survey of 422 nurses, face-to-face meetings with a patient representative and key stakeholders within acute services with a final consensus meeting inclusive of a panel of 26 expert nurse clinicians. Results There was consensus on 11 quality care process nursing metrics and 53 corresponding indicators for the acute care setting. Despite the rating of 'critical' in the Delphi rounds, a concern was reported by participants on the subjective nature of three of the developed metrics: 'patient experience', 'patient engagement' and 'professional and ethical approach to care' based on the absence of objective measurement tools that include patient input. Conversely, this led to the conundrum for the panel of experts at the final consensus meeting who were divided in their views on objectively observing, recording and subsequent auditing of those three developed metrics in real-time clinical practice. Conclusion This paper describes the operationalisation of a modified Delphi technique that progressed a set of 11 quality care process metrics and 53 corresponding indicators. The challenge now is the implementation of these quality care process metrics so that nurses' contribution to patient-centred care is tangible in acute care.
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Affiliation(s)
- Laserina O’Connor
- Professor, UCD School of Nursing Midwifery
& Health Systems, University College Dublin, Ireland
| | - Eilish McAuliffe
- Full Professor, UCD School of Nursing Midwifery
& Health Systems, University College Dublin, Ireland
| | - Mary Casey
- Associate Professor, UCD School of Nursing
Midwifery & Health Systems, University College Dublin, Ireland
| | - Lisa Rogers
- Lecturer, UCD School of Nursing Midwifery &
Health Systems, University College Dublin, Ireland
| | - Anne Gallen
- Director, Nursing & Midwifery Planning
Development Unit, Health Service Executive, Ireland
| | - Leonie Finnegan
- Quality Care Metrics Project Officer, Nursing
& Midwifery Planning Development Unit, Health Service Executive,
Ireland
| | | | - Mark White
- Vice-President, Department of Nursing,
Waterford Institute of Technology, Ireland
| | - Ciara White
- Assistant Lecturer, School of Nursing,
Psychotherapy, and Community Health, Dublin City University, Ireland
| | - Paula Kavanagh
- Quality care Metrics Project Officer, Nursing
& Midwifery Planning Development Unit, Health Service Executive,
Ireland
| | - Miriam Bell
- Quality Care Metrics Project Officer, Nursing
& Midwifery Planning Development Unit, Health Service Executive,
Ireland
| | - Angela Killeen
- Quality Care Metrics Project Officer, Nursing
& Midwifery Planning Development Unit, Health Service Executive,
Ireland
| | - Marlize Barnard
- Research Assistant, UCD School of Nursing
Midwifery & Health Systems, University College Dublin, Ireland
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Van Cleve R, Edmond S, Snow J, Black AC, Pomeranz JL, Becker W. Classification of Patients for Whom Benefit of Long-term Opioid Therapy No Longer Outweighs Harm: Protocol for a Delphi Study. JMIR Res Protoc 2022; 11:e33310. [PMID: 35254277 PMCID: PMC8933798 DOI: 10.2196/33310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/30/2021] [Accepted: 12/31/2021] [Indexed: 11/25/2022] Open
Abstract
Background Patients with chronic pain prescribed long-term opioid therapy may come to a point where the benefits of the therapy are outweighed by the risks and tapering is indicated. At the 2019 Veterans Health Administration State of the Art Conference, there was an acknowledgment of a lack of clinical guidance with regard to treating this subset of patients. Some of the participants believed clinicians and patients would both benefit from a new diagnostic entity describing this situation. Objective The aim of this study was to determine if a new diagnostic entity was needed and what the criteria of the diagnostic entity would be. Given the ability of the Delphi method to synthesize input from a broad range of experts, we felt this technique was the most appropriate for this study. Methods We designed a modified Delphi technique involving 3 rounds. The first round is a series of open-ended questions asking about the necessity of this diagnostic entity, how this condition is different from opioid use disorder, and what its possible diagnostic criteria would be. After synthesizing the responses collected, a second round will be conducted to ask participants to rate the different responses offered by their peers. These ratings will be collected and analyzed, and will generate a preliminary definition for this clinical phenomena. In the third round, we will circulate this definition with the aim of achieving consensus. Results The modified Delphi study was initiated in July of 2020 and analysis is currently underway. Conclusions This protocol has been approved by the Internal Review Board at the Connecticut Veterans Affairs and the study is in process. This protocol may assist other researchers conducting similar studies. International Registered Report Identifier (IRRID) DERR1-10.2196/33310
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Affiliation(s)
- Raymond Van Cleve
- Center for Innovation to Implementation, Menlo Park, CA, United States.,Stanford University, Palo Alto, CA, United States
| | - Sara Edmond
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States.,Pain Research, Informatics, Multimorbidities, and Education Center, VA Connecticut Healthcare System, New Haven, CT, United States
| | - Jennifer Snow
- Pain Research, Informatics, Multimorbidities, and Education Center, VA Connecticut Healthcare System, New Haven, CT, United States
| | - Anne C Black
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Jamie L Pomeranz
- Department of Occupational Therapy, University of Florida, Gainsville, FL, United States
| | - William Becker
- Pain Research, Informatics, Multimorbidities, and Education Center, VA Connecticut Healthcare System, New Haven, CT, United States.,Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
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Zhang M, Chen W, Liu C, Sui J, Wang D, Wang Y, Meng X, Wang Y, Yue C. Nursing-sensitive quality indicators for pernicious placenta previa in obstetrics: A Delphi study based across Chinese institutions. Nurs Open 2021; 8:3461-3468. [PMID: 33960732 PMCID: PMC8510706 DOI: 10.1002/nop2.895] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/24/2021] [Accepted: 03/29/2021] [Indexed: 11/17/2022] Open
Abstract
AIM To identify a set of scientific, systematic and clinically applicable nursing-sensitive quality indicators for pernicious placenta previa (PPP). DESIGN A modified Delphi-Consensus Technique. METHODS According to literature retrieval published between 2009-2019, 38 nursing-sensitive quality indicators were chosen and a questionnaire was designed. An online survey was conducted in 20 hospitals in China, and data of experts' opinions were collected and analysed by improved Delphi method. RESULTS 38 nursing-sensitive quality indicators were identified. The response rates in the two rounds of expert consultation were 97.4% and 100%, and the authoritative coefficients were 0.89 and 0.92. The coefficients of variation ranged from 0.04-0.28. The nursing-sensitive quality indicators were successfully constructed based on the modified Delphi technique.
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Affiliation(s)
- Meng Zhang
- Department of ObstetricsAffiliated Hospital of Qingdao UniversityQingdaoChina
| | - Weiping Chen
- Department of ObstetricsAffiliated Hospital of Qingdao UniversityQingdaoChina
| | - Cuiping Liu
- School of NursingQingdao UniversityQingdaoChina
| | - Jing Sui
- Department of ObstetricsAffiliated Hospital of Qingdao UniversityQingdaoChina
| | - Dawei Wang
- Department of ObstetricsAffiliated Hospital of Qingdao UniversityQingdaoChina
| | - Yan Wang
- Department of ObstetricsAffiliated Hospital of Qingdao UniversityQingdaoChina
| | - Xin Meng
- Department of ObstetricsAffiliated Hospital of Qingdao UniversityQingdaoChina
| | - Yiqian Wang
- Department of ObstetricsAffiliated Hospital of Qingdao UniversityQingdaoChina
| | - Chongyu Yue
- Department of ObstetricsAffiliated Hospital of Qingdao UniversityQingdaoChina
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Verberne WR, Das-Gupta Z, Allegretti AS, Bart HAJ, van Biesen W, García-García G, Gibbons E, Parra E, Hemmelder MH, Jager KJ, Ketteler M, Roberts C, Al Rohani M, Salt MJ, Stopper A, Terkivatan T, Tuttle KR, Yang CW, Wheeler DC, Bos WJW. Development of an International Standard Set of Value-Based Outcome Measures for Patients With Chronic Kidney Disease: A Report of the International Consortium for Health Outcomes Measurement (ICHOM) CKD Working Group. Am J Kidney Dis 2018; 73:372-384. [PMID: 30579710 DOI: 10.1053/j.ajkd.2018.10.007] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 10/14/2018] [Indexed: 12/14/2022]
Abstract
Value-based health care is increasingly promoted as a strategy for improving care quality by benchmarking outcomes that matter to patients relative to the cost of obtaining those outcomes. To support the shift toward value-based health care in chronic kidney disease (CKD), the International Consortium for Health Outcomes Measurement (ICHOM) assembled an international working group of health professionals and patient representatives to develop a standardized minimum set of patient-centered outcomes targeted for clinical use. The considered outcomes and patient-reported outcome measures were generated from systematic literature reviews. Feedback was sought from patients and health professionals. Patients with very high-risk CKD (stages G3a/A3 and G3b/A2-G5, including dialysis, kidney transplantation, and conservative care) were selected as the target population. Using an online modified Delphi process, outcomes important to all patients were selected, such as survival and hospitalization, and to treatment-specific subgroups, such as vascular access survival and kidney allograft survival. Patient-reported outcome measures were included to capture domains of health-related quality of life, which were rated as the most important outcomes by patients. Demographic and clinical variables were identified to be used as case-mix adjusters. Use of these consensus recommendations could enable institutions to monitor, compare, and improve the quality of their CKD care.
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Affiliation(s)
| | - Zofia Das-Gupta
- International Consortium for Health Outcomes Measurement, London, United Kingdom
| | | | - Hans A J Bart
- patient representative, Dutch Kidney Patients Association (NVN), Bussum, the Netherlands
| | - Wim van Biesen
- Renal Division, Ghent University Hospital, Ghent, Belgium
| | - Guillermo García-García
- University of Guadalajara Health Sciences Center, Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Jalisco, Mexico
| | - Elizabeth Gibbons
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom (EG)
| | - Eduardo Parra
- Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Marc H Hemmelder
- Dutch Renal Registry (Renine), Nefrovisie, Utrecht; Medical Center Leeuwarden, Leeuwarden
| | - Kitty J Jager
- ERA-EDTA Registry, Amsterdam UMC, University of Amsterdam, Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Markus Ketteler
- Klinikum Coburg, Coburg, Germany; University of Split School of Medicine, Split, Croatia
| | - Charlotte Roberts
- International Consortium for Health Outcomes Measurement, London, United Kingdom
| | | | - Matthew J Salt
- International Consortium for Health Outcomes Measurement, London, United Kingdom
| | - Andrea Stopper
- European Renal Care Providers Association, Brussels, Belgium
| | | | - Katherine R Tuttle
- Providence Medical Research Center, Providence Health Care Kidney Research Institute, Nephrology Division and Institute for Translational Health Sciences, University of Washington, Spokane, WA
| | - Chih-Wei Yang
- Chang Gung Memorial Hospital, Linkou; Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - David C Wheeler
- Centre for Nephrology, University College London, London, United Kingdom
| | - Willem Jan W Bos
- St Antonius Hospital, Nieuwegein; Leiden University Medical Center, Leiden, the Netherlands
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