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PubMed2004

Assessment of resident professionalism using high-fidelity simulation of ethical dilemmas.

OBJECTIVES: To examine the responses of emergency medicine residents (EMRs) to ethical dilemmas in high-fidelity patient simulations as a means of assessing resident professionalism. METHODS: This cross-sectional observational study included all EMRs at a three-year training program. Subjects were excluded if they were unable or unwilling to participate. Each resident subject participated in a simulated critical patient encounter during an Emergency Medicine Crisis Resource Management course. An ethical dilemma was introduced before the end of each simulated encounter. Resident responses to that dilemma were compared with a professional performance checklist evaluation. Multi-response permutation procedure analysis was used to compare performance measures between resident classes, with the a priori hypothesis that mean performance should increase as experience increases. RESULTS: Of the 30 potential subjects, 90% (27) participated. The remaining three residents were unavailable due to scheduling conflicts. It was observed that senior residents (second and third year) performed more checklist items than did first-year residents (p < 0.028 for each senior class). Omnibus comparison of mean critical actions completed across all three years was not statistically significant (p < 0.13). Residents performed a critical action with 100% uniformity across training years in only one ethical scenario ("Practicing Procedures on the Recently Dead"). Residents performed the fewest critical actions and overall checklist items for the "Patient Confidentiality" case. CONCLUSIONS: Senior residents had better overall performance than incoming interns, suggesting that professional behaviors are learned through some facet of residency training. Although limited by small sample size, the application of this performance-assessment tool showed the ability to discriminate between experienced and inexperienced EMRs with respect to a variety of aspects of professional competency. These findings suggest a need for improved resident education in areas of professionalism and ethics.

Accreditation↗

PubMed1999

Effectiveness of cognitive therapy training.

Despite growing demands for effective training there remains a lack of convincing evaluations. Reviews of the training literature specify the need for multiple measures, homogeneous therapies, generalization assessments and longitudinal designs. The present analysis responds by evaluating the training of 20 mental health professionals in cognitive therapy (CT). The evaluation focussed on changes in the professionals' competence and its generalization to their patients' coping strategies (N = 20). Results indicated that a 40 day training programme led to significantly higher post-training competence scores and to improved patient coping. The implications for professional training and its evaluation are discussed.

Adult↗

PubMed2006

Conflict in the preceptorship or field experience: a rippling tide of silence.

A major component of the educative process in the professional disciplines is the field education/preceptorship experience in which students are afforded opportunities to develop professional competence under the tutelage of a practising professional and/or a university instructor. During this time students are exposed to competing discourses about what it means to think and act as nurses, teachers, doctors and social workers. Frequently, field teaching is characterized by conflictual situations involving students, field instructors and university faculty. Such conflict is poorly understood as indicated by the lack of literature available in the professional disciplines. The purpose of this study was to explore the phenomenon of conflict within the context of field teaching in professional education. Pivotal to this study was the issue of making sense of the conflict that prospective nurses, teachers, social workers and doctors experience in professional education within the practice realm and how such discourses shape their professional identities, practices and ultimate social values. At issue is the social construction of meaning that takes place within professional education. This study was conducted from the perspective of four professional programs including education, medicine, nursing and social work. The researchers focused on the final year of each program at a time when students were engaged in a major field/preceptorship experience in hospitals, schools, communities and social agencies. The experiences derived from the nursing data are presented in this paper.

Conflict, Psychological↗

PubMed2006

Patients' views of nurses' competence.

This study examines, from the patients' perspective, what is meant by competent nursing and how, with this perspective in mind, patients would view the prospect of assessing the competence of nurses. There is a little empirical research that clarifies professional competence from the patient's perspective. Nursing curricula in the UK have shifted attention to 'competencies' as the outcome of nurse education and, in an era of patient involvement, their views are important to investigate. The study utilises a grounded theory approach. Data were collected in Central Scotland between 2001 and 2003. Twenty-seven patients participated. Data were analysed, in keeping with the grounded theory tradition, utilising the constant comparative method. Patients described the foundation of competent nursing practice as technical care and nursing knowledge. Patients assume that technical care is competent as safe guards are considered to be in place to protect patients. When technical competence is assumed, interpersonal attributes become the most important indicator of the quality of nursing care. The results of this study highlight uncertainty about whether patients feel able to assess the competence of nurses. The results of this study may have implications for nurses internationally when trying to involve patients in the assessment of nurses.

Adult↗

PubMed2000

Mastering the new public health.

The dramatic changes in the field of public health are reverberating in schools of public health in a number of ways, not the least of which is action by the deans of the Association of Schools of Public Health (ASPH) to ensure that graduates with master's of public health degrees are competent to meet the current challenges of practice. The conceptual framework at the center of this activity describes 3 domains--skills, perspectives, and applications--in which alumni of schools of public health may be required to demonstrate competency. ASPH work in this area is grounded in previous national and professional competency definitions and school- and department-specific competency development; it is distinct from earlier work, however, because its focus is on competency at the master's level across the graduate schools of public health.

Curriculum↗

PubMedDate not supplied

On being ethical in unethical places: the dilemmas of South African clinical psychologists.

Practicing under the social and economic conditions created by apartheid, South African clinical psychologists face the task of questioning both the traditional values and the traditional social role of their profession. Dilemmas of trust, confidentiality, and professional competence highlight the limits of professional ethical codes.

Black or African American↗

PubMed1985

Black mental health client's preference for therapists: a new look at an old issue.

Thirty black clients from a community mental health center in the Los Angeles City were interviewed to determine whether black Clients prefer black therapists or therapists from other ethnic backgrounds, and the factors associated with their preferences. Both quantitative and qualitative analyses were employed. The results indicated that 60% of the respondents preferred black therapists. With the small sample size this difference between responders and non-responders was within the normal range expected. However, preference of blacks for blacks is an important finding. When a black client preferred a black therapist, the major reasons depended on the therapist's professional competence and attitudes, not just the cultural, race, and linguistic compatibility.

Black or African American↗

PubMed1999

Transitions in pharmacy practice, part 2: who does what and why.

The competencies required by the five practice models that constitute the total pharmacy care (TPC) model are discussed. Understanding the differences among the competencies required by the five practice models can help pharmacy's leaders estimate the extent of change that may be necessary whenever a change in practice is contemplated. Professional competence in any of the practice models is defined as the sum of skills, professional socialization, and judgment rooted in experience pertinent to the model. Possibilities for practice change are ideational and do not necessarily follow a straight line from other practice models to pharmaceutical care. The key competencies for each of the five practice models--drug information, self-care, clinical pharmacy, pharmaceutical care, and distribution--demonstrate a clear distinction among the five models. The models draw on different knowledge and skills, are characterized by different attitudes and values about the work of pharmacy, and are grounded in different practice experience. While sharing a common underpinning of theory and practice, professional competence within each of the five models that make up TPC requires distinctly different knowledge and skills, professional attitudes, and values, as well as judgment that is developed through experience.

Humans↗

PubMed1998

Professional autonomy.

Professional autonomy may represent the first step to implementing measures that will allow CRNAs to attain a level of independent practice consistent with their clinical and educational training. Autonomy is regarded as an essential ingredient of professionalism and confers independent function at the individual practitioner level. The principle of autonomy refers to the individual's capacity to make independent decisions based on the assumption that he or she possesses the cognitive, psychological, and emotional faculties to make rational decisions. Nursing practice meets the first two criteria of professionalism--competence and dedication to an important social good. The third criterion of professionalism, autonomy, has been a focal point for controversy since the late nineteenth century, in which obedience to supervisors and physicians remained a central focus of nursing ethics teaching until the advent of feminism in the 1970s. This article presents a thorough analysis of these concepts with some thoughts on how understanding the fundamental precepts and further research may not only help maintain the current level of CRNA professional autonomy but serve to guide us to become more autonomous in the future.

Humans↗

PubMed2002

Professional development in undergraduate medical curricula--the key to the door of a new culture?

CONTEXT: One of the most pressing requirements for contemporary medical education is to develop a framework for theory and practice of professional development which results in the attainment of professional competencies suitably robust for a lifetime's practice. The proposed content of a professional development curriculum may be reasonably straightforward to establish from policy documents and public expectations, but the process of achieving the desired outcomes is more complex, because professional development is largely based on attitudinal learning. Attitudes are at the interface between the personal and public psyche, relying more on individual experience and the accumulated impact of social and cultural interpretations than on propositional knowledge, and are therefore less amenable to factual or didactic teaching. AIMS: The purpose of this discussion paper is to develop thinking on the conceptual frameworks which need to underpin curriculum decision-making for professional development, especially in undergraduate medical training where models of good practice are less well-established. It brings together work from educational, sociological and psychological perspectives to elucidate the key principles which are most likely to result in acquisition of desirable professional attributes. IMPLICATIONS: The literature suggests that successful professional development needs to be based on explicit values, which are repeatedly demonstrated in the learning environment, and modelled by senior colleagues and tutors; that the curriculum should incorporate a clear model of emotional as well as cognitive development; should be a major component of summative assessment; and needs to include formative mentorship at all stages of training.

Curriculum↗

PubMed2005

Healthcare librarians and learner support: a review of competences and methods.

OBJECTIVES: London Health Libraries (LHL) are undertaking a project in order to develop the role of their library and knowledge services staff in supporting learners within the NHS in the London area (LHL Learner Support Project). This paper reports on the first phase of the project. METHODOLOGY: A literature analysis was carried out to provide guidance on the skills and competences needed for library and knowledge staff to perform this function. RESULTS: A variety of competences are identified, and structured in a model incorporating both training skills and general professional competencies. Library and knowledge staff will themselves need to have a high-level of information literacy and to be active lifelong learners. CONCLUSIONS: A 'blended learning' approach, involving e-learning together with other methods, is identified as the most appropriate way for skills to be acquired.

Curriculum↗

PubMed2003

The importance of active involvement in learning: a qualitative study on learning results and learning processes in different traineeships.

INTRODUCTION: In order to gain more insight into learning in different traineeships we sought students' opinions on their experiences. METHOD: 24 students of Maastricht University, the Netherlands, were interviewed: 8 medical students, and 16 students in the mental health science programme of the Faculty of Health Sciences (8 research trainees (MHS-res.) and 8 trainees in mental health care practice (MHS-prac.). Students' perceptions about instructive, difficult and less instructive learning experiences were recorded on audiotape. The literal transcripts of the interviews were analysed and categorised. RESULTS: The most frequently mentioned learning process was "learning by doing" followed by "actively overcoming gaps in knowledge and skills". These processes occurred with instructive and difficult experiences. Other processes were "learning by seeing things in practice" and "preparation and evaluation". Learning outcomes were categorised as learning about: working, professional competences and personal growth. Most frequently mentioned - in most cases with difficult experiences - were "professional knowledge and skills", "learning about personal growth" and "learning about working". The latter was mentioned most often by MHS-res. students. Medical students' responses suggested that they occasionally perceived the clerkship environment as stressful. DISCUSSION AND CONCLUSIONS: Although the small sample size precludes any firm conclusions, the overwhelming impression is that students prefer being actively involved in their learning process. In addition, traineeships appear to introduce students to professional working life the hard way. Investigating how teachers and supervisors can stimulate active learning and facilitate the introduction to professional practice might be subjects for fruitful further investigation.

Adult↗

PubMed2003

Defining biomedical informatics competency: the foundations of a profession.

Is biomedical informatics a science or a profession? This question has been asked of many members in the biomedical informatics community, yet we still lack a response that galvanizes our community. We debate the issues over lunch. We create long, multi-threaded e-mail discussions, we write papers on the topic, and still we aren't able to convince ourselves-let alone the rest of the scientific community. In this paper, I will describe a curriculum model for biomedical informatics and research that is developing at Columbia University, Department of Biomedical Informatics (DBMI). We believe that a strong educational foundation creates competent professionals who, in turn, comprise a bioinformatics culture. The outcome of DBMI's curriculum design and competency project will be a set of biomedical informatics competencies which we believe will define the core knowledge and skills of the field.

Computational Biology↗

PubMed1988

Mentoring in doctoral education.

Mentoring has historically been common among men. Recently, however, mentoring has emerged as a popular concept in nursing and more and more references in the nursing literature describe the importance of a mentor to the nurse. Mentoring is also an important concept in doctoral education in nursing. This paper discusses both the development of mentoring relationship which can vitally contribute to the development of the nurse leader are discussed. A mentoring relationship between a doctoral student and a more experienced professional can enable the development of leadership potential and significantly contribute to the development of competent professionals in nursing.

Education, Nursing, Graduate↗

PubMed1984

The liberal arts connection.

Occupational therapists need to be critical of who teaches, what is taught, how it is taught, how it is applied, and to whom it is taught in the entire education program of prospective occupational therapists. Further, I recommend that occupational therapy educators on campus take the lead in initiating meetings and discussions that facilitate a functional conjoining of occupational therapy practice, occupational therapy theory, and liberal arts studies. An initial effort in this regard might be for the three mutually interdependent and equal partners in the education of occupational therapy students to read and discuss Ernest L. Boyer's work entitled, A Quest for Common Learning--The Aims of General Education. I believe that all occupational therapists would benefit from reading this text, individually and collectively, and the profession and our community would benefit. The question is not whether or not this subject should be incorporated into an occupational therapy student's curriculum. The question for discussion should be at what point in the student's education--the student's intellectual growth and development and professionalization--would this topic and this treatment be best applied? Perhaps from this beginning the three partners--practice, theory, and liberal arts--would recognize and respond to their mutually interdependent and equally important role and responsibility in the design and implementation of the entire occupational therapy educational program, which is future responsive and ensures the highest probability that graduates will be professionally competent.

Curriculum↗

PubMed2004

Competencies for effective public health nutrition practice: a developing consensus.

OBJECTIVES: To assess the level of consensus amongst an international panel of public health nutrition leaders regarding the essential competencies required for effective public health nutrition practice. DESIGN: A modified Delphi study involving three rounds of questionnaires. SUBJECTS: A panel of 20 public health nutrition experts from seven countries in the European Union, the USA and Australia. RESULTS: Expert panellists completed three rounds of the study relating to competencies. A literature review conducted as a prelude to the expert panel survey identified common competency units from the fields of public health, health promotion, nutrition and dietetics, and health education. These were categorised into seven competency areas including analytical, socio-cultural and political, public health service, communication, management and leadership, nutrition science and professional competency categories. There was strong initial agreement (> or = 90% of panellists at Round 1) that developing internationally recognised competencies for public health nutrition specialists was a priority. Twenty-six of an initial listing of 52 competency units were rated as essential competencies by > or = 80% of the panellists after Round 1. Iteration rounds resulted in the addition of five extra competency units suggested by panellists after Round 1 and an increase by 13 in the number of competencies rated as essential to consensus levels. From a total of 57 competency units rated after the final survey round, 41 competency units were rated as essential competencies by > or = 80% of the panellists (consensus), with 21 of these unanimously rated as essential competencies. CONCLUSIONS: There is strong international agreement amongst public health nutrition leaders in Europe, the USA and Australia about a range of competencies required for effective public health nutrition practice. Essential competency units identified can be used to develop and review competency standards for public health nutrition.

Australia↗

PubMed1991

Convergence and divergence: assessing criteria of consumer satisfaction across general practice, dental and hospital care settings.

This paper describes the results of the first-stage of a study carried out in the spring of 1988 in the South East of England. The study looked at general and specific aspects of consumer satisfaction with general practitioner services, general dental care services and hospital in-patients care. It also examined which specific consumer criteria were the key predictors of overall satisfaction within each of these particular medical care settings. A related aim was to assess the degree of congruence or divergence of consumer criteria across these differing medical care settings. The evidence suggests that whilst general levels of consumer satisfaction are high (i.e. 83-97%), questions of a more detailed and specific nature revealed greater levels of expressed dissatisfaction (e.g. 38% of the sample felt that they could not discuss personal problems with their GP, 51% felt their dentist was not easy to reach at weekends/holidays, whilst 35% felt hospital doctors did not give sufficient information). Whilst different areas of dissatisfaction were found in each specific medical care setting examined, what was particularly striking was the degree of convergence of the key predictors of overall consumer satisfaction across the medical care settings. That is to say, our findings clearly suggest that issues concerning 'professional competence', together with the nature and quality of the patient-professional relationship, are the key predictors of overall consumer satisfaction with general practice, dental and hospital care [e.g. GP giving sufficient information correlated 0.64 (P less than 0.001) with overall GP satisfaction scores; competent dentist 0.52 (P less than 0.001) with overall dental satisfaction scores; and full confidence in hospital doctors 0.49 (P less than 0.001) with overall hospital satisfaction scores]. The theoretical importance and policy implications of these findings, particularly in the light of the recent NHS reforms, are discussed.

Adolescent↗

PubMed2001

Clinical care of gambling disorders: training, experience, and competence among VHA psychologists.

Problem gambling is a common, highly destructive disorder which is often overlooked by clinicians. Levels of clinical training, clinical experience, and professional competence for providing clinical services for problem gambling were examined in a survey of 181 clinical psychologists working in the Veterans Healthcare Administration (VHA). The results suggest that the majority of clinical psychologists have little or no formal training and little or no past or current clinical experience in the treatment of disordered gambling, nor do they see themselves as competent to evaluate or treat patients with disordered gambling. Most have not referred patients for treatment of problem gambling and do not know of a competent provider to whom they can refer. There is an identifiable subgroup, representing 9% of respondents, who do have more training, provide services, and see themselves as competent to provide care for patients with problem gambling. The amount of formal training is positively correlated with care provided and self-ratings of competence. Despite the lack of training and experience, most respondents expressed interest in receiving additional training. These data suggest that to improve rates of diagnosis and treatment of patients with problem gambling in mental health settings, additional training needs to be made available for mental health providers as a group, with specialized training for clinicians interested in specializing in this area.

Adult↗