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The UKCC code of practice stipulates the importance of professional competence. The ENB framework offers a means of developing competence in a way that is structured and focused. In this paper, the author describes how she used the framework as a basis for developing her practice and improving the quality of care she gives.
The 1970s saw the development of a mandatory continuing education system as a result of actions by state legislatures and professional organizations. Although the actions of these bodies imply a relationship between participation in continuing education activities and the maintenance of professional competency, such a relationship has never been clearly and consistently demonstrated. This article reviews studies of the effectiveness of continuing education in the health professions, notes weaknesses in the continuing education system, and suggests strategies for improving it.
A questionnaire survey was conducted on the nature of the oral examinations in different disciplines in the medical schools in Sri Lanka. A total of 352 students from Peradeniya and Jaffna medical faculties and pre-registration house officers, including Colombo faculty graduates of the two teaching hospitals, responded to the questionnaire. The results of the survey, which included twelve disciplines, reveal that the time duration of the oral encounter ranged from 10 to 20 minutes. The number of questions asked ranged from five to nine. Detailed analysis of the intellectual level of the questions showed that more than 63% of the questioning was at simple recall level and none at the level of problem-solving. These results show that the oral examination in addition to its inherent weakness of low reliability and objectivity also lacks validity in terms of content sampling. Its predictive validity of professional competence, which requires problem-solving skills, is questionable. Content analysis of the items also revealed that all the abilities tested in the orals could best be tested in a pen-and-paper examination or a structured practical or clinical examination.
More than 1 million Medicare beneficiaries have enrolled in health maintenance organizations (HMOs) and competitive medical plans under a new program in which beneficiaries can freely enroll in a risk-based HMO in their area or remain in the fee-for-service sector under Medicare. Based on a randomly selected nationwide sample of beneficiaries, we analyzed differences in patient satisfaction between 2091 beneficiaries who were continuously enrolled in an HMO plan for 1 year and 1000 beneficiaries in the fee-for-service sector. We also studied the reasons for disenrollment. No significant difference in overall satisfaction was found between HMO enrollees and fee-for-service beneficiaries. However, HMO enrollees expressed less satisfaction compared with fee-for-service beneficiaries regarding the professional competence of their health care providers and the willingness of the HMO staff to discuss problems. On the other hand, HMO enrollees were more satisfied than fee-for-service beneficiaries with waiting times and claims processing. Approximately half of the disenrollment from an HMO within 1 year was attributed to misunderstanding the terms of enrollment.
Registered nurses (RNs) attending a national conference were surveyed to find out what motivated their participation in continuing professional education. Eight hundred sixty-six RNs completed the Participation Reasons Scale (PRS) and the Respondent Information Form (RIF). Five factors emerged from a factor analysis and several significant relationships were found between person-related and profession-related variables. These findings indicate that nurses are concerned with professional competence and participate in continuing education for complex reasons. This study can serve as the basis for further research and should be useful to those who teach or plan continuing education activities, promote them, select instructional techniques, and evaluate learning experiences. If, as current research indicates, continuing education contributes to quality practice, then reasons that influence participation take on an increasingly greater significance for the entire nursing profession.
Evidence based medicine is rightly at the core of current medicine. If patients and society put trust in medical professional competency, and on the basis of that competency delegate all kinds of responsibilities to the medical profession, medical professionals had better make sure their competency is state of the art medical science. What goes for the ethics of clinical trials goes for the ethics of medicine as a whole: anything that is scientifically doubtful is, other things being equal, ethically unacceptable. This particularly applies to so called orphaned fields of medicine, those areas where medical research is weak and diverse, where financial incentives are lacking, and where the evidence regarding the aetiology and treatment of disease is much less clear than in laboratory and hospital based medicine. Examples of such orphaned fields are physiotherapy, psychotherapy, medical psychology, and occupational health, which investigate complex syndromes such as RSI, whiplash, chronic low back pain, and chronic fatigue syndrome. It appears that the primary ethical problem in this context is the lack of attention to the orphaned fields. Although we agree that this issue deserves more attention as a matter of potential injustice, we want to argue that, in order to do justice to the interplay of heterogeneous factors that is so typical of the orphaned fields, other ethical models than justice are required. We propose the coordination model as a window through which to view the important ethical issues which relate to the communication and interaction of scientists, health care workers, and patients.
Clinical tutoring meant as guidance and support for the achievement of professional competency (which includes attitudes, knowledge, and skills) has proved itself as a critical opportunity for nursing students' clinical learning. The tutor's skill develops itself especially through the acquisition of clinical and psychopedagogical expertise unquestionably necessary to meet students' educational needs. For the third year the Università "Campus Bio-Medico" di Roma, has started a Specialisation course for Clinical Tutors. The course objective is to achieve psychopedagogical, clinical, ethical and managerial competency. Although the course always maintains the same cultural, methodological, and managerial setting, each year it develops different key aspect linked to the participants' interests and educational needs. In fact, the students as active participants of their learning and well aware of the tutors' role, determine themselves such objectives. This paper is based on the principal themes of this year's course as they have been discussed and developed in final papers by the students.
AIMS: To provide an overview of the extent of drug and alcohol misuse in Brazil and the policies and approaches in tackling substance misuse. An examination of the challenges facing the nursing profession in working with substance misusers is presented. BACKGROUND: Alcohol, cocaine, and cannabis are the most commonly misused psychoactive substances in Brazil. One of the biggest public health problems is the interface between the misuse of psychoactive substances and HIV prevalence and other sexually transmitted diseases. Findings from a recent study suggest that undergraduate nurses in Brazil are not adequately prepared in the care and management of substance misuse problems. The nursing profession in Brazil faces numerous challenges in the development of professional competence of nurses in this field. CONCLUSION: A strategy proposed is the creation of regional centres in Brazil to study the integration of substance use and misuse in the nursing undergraduate curriculum and the giving of specific support in teaching and research to nurse teachers. Nurses have a key role to play in the early recognition, assessment, prevention, and treatment of substance misuse.
We are living in an extraordinary time in human history punctuated by the convergence of major scientific and technological progress in the physical, chemical, and biological ways of knowing. Equally extraordinary are the sparkling intellectual developments at the interface between fields of study. One major example of an emerging influence on the future of oral health education is at the interface between the human genome, information technology, and biotechnology with miniaturizations (nanotechnology), suggesting new oral health professional competencies for a new century. A great deal has recently been learned from human and non-human genomics. Genome databases are being "mined" to prompt hypothesis-driven "postgenomic" or functional genomic science in microbial models such as Candida albicans related to oral candidiasis and in human genomics related to biological processes found in craniofacial, oral, and dental diseases and disorders. This growing body of knowledge is already providing the gene content of many oral microbial and human genomes and the knowledge of genetic variants or polymorphisms related to disease, disease progression, and disease response to therapeutics (pharmacogenomics). The knowledge base from human and non-human genomics, functional genomics, biotechnology, and associated information technologies is serving to revolutionize oral health promotion, risk assessment using biomarkers and disease prevention, diagnostics, treatments, and the full range of therapeutics for craniofacial, oral, and dental diseases and disorders. Education, training, and research opportunities are already transforming the curriculum and pedagogy for undergraduate science majors, predoctoral health professional programs, residency and specialty programs, and graduate programs within the health professions. In the words of Bob Dylan, "the times they are a-changing."
Daily, we are reminded that the public's investment in attaining quality health and medical care is among the most important priorities of our nation's citizens. Central to realizing that attainment is the level of professional competence of those charged with managing the nation's health resources. The not-for-profit Accrediting Commission on Education for Health Services Administration is the sole national organization governing the standards by which future health managers, administrators, and executives are educated and trained in accredited graduate programs. The impact of the ACEHSA is growing as health and medical leaders, government and regulatory policy-makers, insurance executives, special interest groups, and, of course, members of the public increasingly realize that top-flight healthcare delivery requires excellence in the management of health resources.
In contrast to many traditional professions, toxicologists form a group with very different backgrounds, i.e. they may have been educated to become medical doctors, veterinarians, pharmacists, chemists, biochemists or biologists. Professional competence can be gained in different ways by candidate toxicologists, and according to the European system, their training can be divided into two parts. (i) Theoretical training on several topics such as analytical methods, organ toxicity, mutagenicity, carcinogenicity can be obtained by attending courses organised by the national societies of toxicology. (ii) Spending several years on active experimental work in the fields of modern toxicology (e.g. analytical methods, toxic and genotoxic mechanisms, reproductive toxicity) is necessary to develop the capability to design and carry out experimental studies and to evaluate one's own and other people's research results. Candidate toxicologists should learn to evaluate data with a strictly scientific 'plausibility above numbers' approach.
Earlier studies have shown that dental patients concern themselves with the personality characteristics of their dentists as well as with their professional competence. The present study is part of a wider survey which compared the characteristics of regular and irregular or non-attenders for dental check-ups. In this article patients' characteristics such as sex, age, level of dental anxiety and certain previous dental experiences were related to their perceptions of dentists' positive and negative attributes. The results confirmed previous findings that dentists were seen generally by their patients in a favourable light. Respondents who admitted to higher levels of dental anxiety were more likely to choose more negative attributes and less positive ones than respondents who admitted to lower levels; women, younger subjects and the dentally anxious consistently chose unsympathetic and indifferent as the two top negative characteristics of their dentists.
The Professional Competence Assurance Program (PROCAP) is an individualized educational program that examines physicians' performance in ambulatory practice. It uses medical record review to identify deficiencies in the care process that guides development of the educational intervention. Medical care is reassessed one year later. This program was used with 51 private practitioners to assess the care of 1,229 hypertensive patients. The educational program included a computer printout comparing one physician's performance with that of peers, readings targeted to management problems, and a conference call or group seminar with an expert stressing issues relevant to each physician's performance. Postintervention assessment showed that physicians prescribed beta-blockers (P<.01) and vasodilators (P<.01) more often. Improvement (P<.05) occurred in the control of diastolic blood pressure (</=90 mm of mercury) and in several other criteria. These results show that well-designed, individualized continuing medical education addressing specific deficiencies can change physicians' performance and patients' intermediate outcome.
The extent to which recent (1978-1981) graduates of one medical school received low ratings on 10 items concerning noncognitive aspects of professional behavior is presented and related to ratings on items dealing with knowledge, data-gathering skills, and clinical judgment. Overall, only 3 percent of the graduates had low ratings on the noncognitive items. Despite high correlations among ratings in the four areas of professional competence (knowledge, data-gathering, clinical judgment, and professional attitudes), 40 percent of the graduates with low ratings on noncognitive items had high ratings in at least two of the areas. The validity of the ratings is tested by relating them to the willingness of residency supervisors to offer the graduates further postgraduate training and to clinical ratings received in the third year of medical school. Substantial relationships are shown both with the residency offer and medical school ratings for graduates with high and low ratings.
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OBJECTIVES: To determine the labour satisfaction of primary care nursing professionals and find the related associated factors. DESIGN: Cross-sectional, descriptive, observation study. SETTING: Primary care in the counties of the Alt and Baix Empordà. PARTICIPANTS: All those with nursing diplomas who work in the primary care centres of this geographical area (131 professionals). MEASUREMENTS AND MAIN RESULTS: A self-administered questionnaire had a 79.3% response rate. The instrument had 9 dimensions on work satisfaction. The statistical analysis employed univariate and bivariate descriptive techniques (p = 0.05). The general lack of satisfaction was medium (2.18 +/- 0.45). The dimension with the highest score was "professional competence" (1.72 +/- 0.44), and with the lowest was "professional promotion" (2.80 +/- 0.89). The greatest number of significant differences occurred between the two classes of primary care, reformed and unreformed. CONCLUSIONS: The conditions in which professional nurses work in non-reformed primary care causes lack of satisfaction in their work post, in its content and in their professional promotion.
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