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PubMed2003

Attributes of trainers for postgraduate training in general surgery--a national consensus.

BACKGROUND: The aim of this study was to obtain consensus amongst consultant surgeons on the attributes of a good surgical trainer that can be used to inform continuing professional development programmes for trainers. METHODS: good trainer attributes were generated from an intensive qualitative study using a participative inquiry process with consultant general surgeons and specialist registrars in the Tayside region. These good trainer attributes were then used as the basis of a modified Delphi study; the early rounds of the Delphi simultaneously sought participants' views concerning stated attributes and sought to generate new attributes. A final Delphi questionnaire was sent to all 180 consultant general surgeons in Scotland to identify consensus. RESULTS: The first two rounds of the Delphi process produced 45 attributes covering seven themes: interest in training, trainer as a team member, communication, receptiveness to trainee needs, trainer as a role model, reflection on practice and clinical and operative competence. The final survey identified significant consensus among surgeons. Clinical and operative competence achieved the highest consensus with 89.2% of surgeons believing it to be an essential attribute. CONCLUSIONS: The results indicate that there is consensus on the seven themes identified as essential for a trainer in general surgery. The recognition of the importance by trainers of non-surgical trainer attributes in the changed training structure is encouraging. Surgeons' level of awareness of their roles as a trainer will help inform the level and direction of trainer training and support required as part of a flexible and continuing developmental process.

Education, Medical, Graduate↗
PubMedDate not supplied

A university accredited renal nursing course delivered by distance learning.

Continuous professional development (CPD) is limited in some regions of the UK and within Europe generally. This is compounded for all by limited resources for course fees and the lack of study leave granted away from the clinical area for full-time courses. This is set against recommendations from national and European governments and renal clinical guidelines concerning expectations of CPD and competency levels of renal nurses. In the past renal nurses have been trained in all areas of the speciality by local Schools of Nursing linked to renal units. However, since the formation of Trusts in 1990 education delivery has been ring-fenced and separated from the control of local hospitals by Schools of Nursing being incorporated into Institutes of Higher Education. That has led in some instances to a rationalising of post registration education delivery for some geographical areas. This paper will discuss the development and implementation of a distance learning renal care course taking into consideration the clinical, academic and educational requirements necessary for effective education and training at the post basic level.

Accreditation↗
PubMed2005

The impact of a distance learning death and dying course: an analysis of student self-reported changes.

Educational programmes are under way to improve knowledge, awareness and skills in holistic end-of-life care. Not all people can access education and continued professional development in a conventional face-to-face setting. The UK Open University's distance learning course entitled 'Death and Dying' (K260) attracts a broad spectrum of British and foreign students, including those who undertake the course for work-related purposes, and those who have a personal or academic interest in the area. This study explored students' self-reported satisfaction with the course primarily whether respondents perceived changes in their attitudes or practices. Two questionnaires were posted to students registered on K260, the first at the beginning of the course and the second, to those who returned the first questionnaire, following the final examination. Most respondents reported satisfaction with the quality and content of K260. Irrespective of whether respondents worked with dying or bereaved people, most felt that the course: encouraged reflection on personal beliefs and/or attitudes towards death and dying; furthered their knowledge of palliative care; increased their understanding of relevant ethical, legal and moral issues; raised their awareness of religious and cultural issues; and helped them develop skills to deal more effectively with dying and bereaved people.

Attitude of Health Personnel↗
PubMed2003

Learning throughout life: can a progress file help?

UNLABELLED: Modern dentistry demands continuous professional development. This paper reports part of a project to develop a lifelong learning tool known as a progress file for members of the dental team. AIM: To elucidate the views of dentists (as employers/managers) and dental therapists (as employees) on the potential use at work of a progress file. To obtain feedback from these groups on a prototype progress file for dental therapists. METHOD: Consultations were conducted with an opportunistic sample of 15 dentists and 32 dental therapists. Twenty eight dental therapists trialled the prototype for 6 months and 15 dentists appraised it. Opinion was obtained through interview and questionnaire, yielding largely qualitative data, which was content-analysed. FINDINGS: Both dentists and therapists were positively disposed towards a progress file at work but considered its success conditional upon factors including input from the team leader and rewarding dentists for time spent on supporting file users. Evaluation of the prototype was mainly positive. Trial data bore out many impressions from the consultations. CONCLUSION: A progress file that addresses the needs of both employers and employees has potential to help all members of the dental team meet the demands of lifelong learning.

Attitude of Health Personnel↗
PubMed2005

Report of working group 1: public health challenges.

There is a need to improve surveillance systems in order to recognise emerging threats, both in the community and in hospitals, in a timely manner. The laboratory arm of surveillance must be complemented by hospital and primary care components. We also need more training at all levels: undergraduate and postgraduate medical training, specialist training, as well as continuing professional development schemes. Core training programmes for infectious disease specialists and medical microbiologists must be established. The contribution of general practitioners, infection specialists, microbiology laboratories, and public health specialists/agencies to response systems should be defined as clearly as possible and should be either empirically based or derived from scenario-guided calamity models. The success of surveillance hinges on sufficient long-term resources and dedicated coordination. The European Centre for Disease Prevention and Control (ECDC) may assume this role. However, structural and administrative constraints of the diverse healthcare systems throughout Europe may represent an impediment to a harmonised response. Also, the funding of the ECDC cannot cover the operational demands. The ECDC may well work as a small coordinating unit; however, without a laboratory-based scientific status, it remains doubtful whether the ECDC will achieve the competence and authority needed for effective leadership in healthcare. The ESCMID, together with other national and international scientific societies, should put emphasis on the fact that infectious diseases have not received the necessary degree of attention from governments in the European region. The ESCMID should strengthen its role in harmonising and supporting the highest standards of training in the infection disciplines.

Communicable Disease Control↗
PubMed2004

Setting a standard for performance assessment of doctor-patient communication in general practice.

CONTEXT: Continuing professional development (CPD) of general practitioners. OBJECTIVE: Criterion-referenced standards for assessing performance in the real practice of general practitioners (GPs) should be available to identify learning needs or poor performers for CPD. The applicability of common standard setting procedures in authentic assessment has not been investigated. METHODS: To set a standard for assessment of GP-patient communication with video observation of daily practice, we investigated 2 well known examples of 2 different standard setting approaches. An Angoff procedure was applied to 8 written cases. A borderline regression method was applied to videotaped consultations of 88 GPs. The procedures and outcomes were evaluated by the applicability of the procedure, the reliability of the standards and the credibility as perceived by the stakeholders, namely, the GPs. RESULTS: Both methods are applicable and reliable; the obtained standards are credible according to the GPs. CONCLUSIONS: Both modified methods can be used to set a standard for assessment in daily practice. The context in which the standard will be used - i.e. the specific purpose of the standard, the moment the standard must be available or if specific feedback must be given - is important because methods differ in practical aspects.

Clinical Competence↗
PubMed1999

Public health physicians who contribute to on-call communicable disease control duties: national comparative clinical audit by questionnaire survey.

BACKGROUND: In most health authorities in the UK, general public health physicians provide out-of-hours cover for specialists in communicable disease control. Although communicable disease control was part of their specialist training, there is no current formal mechanism to enable these doctors to keep up to date. The Faculty of Public Health Medicine has an active Continuing Professional Development Programme. A new initiative aimed to assess the knowledge of general public health physicians who take part in on-call communicable disease control rotas, or may do so in the future, by means of an educational clinical audit exercise. METHODS: Experts in communicable disease control developed a questionnaire containing a selection of scenarios, covering six different situations that might arise on-call. This was circulated to all members of the Faculty, but participation was voluntary. Answers were marked against model answers agreed by the experts. Results were analysed by positions held by participants. RESULTS: Response was unacceptably low. Overall scores ranged from 15 per cent to 89 per cent with a mean of 63 per cent. There was a trend of improvement in marks from those not normally involved in on-call (mean score 56.1 per cent (95 per cent confidence interval 51.6-60.7 per cent)) through Directors of Public Health (58.4 (54.9-62.0) per cent), Consultants (62.8 (60-65.6) per cent), and specialist registrars (67.9 (65.2-70.6) per cent), to Consultants in Communicable Disease Control (70.9 (68.1-73.6) per cent). CONCLUSION: The public health physicians who took part in this audit appear to be competent in their knowledge of communicable disease control, and particularly good at dealing with meningitis and salmonella, which are frequently encountered out of hours.

Clinical Competence↗
PubMed2001

Journal provision and the prevalence of journal clubs: a survey of physiotherapy departments in England and Australia.

BACKGROUND AND PURPOSE: Evidence-based journal clubs can promote evidence-based practice and continuing professional development (CPD). Although studies have evaluated the impact of journal clubs in medical and nursing departments, there is little information concerning journal clubs or journal provision in physiotherapy departments. The present survey was conducted to address this deficit. METHOD: A postal questionnaire, designed to ascertain the type and extent of journal provision, and prevalence and attributes of journal clubs in physiotherapy departments, was distributed to physiotherapy managers in 150 facilities in England and in south-east Australia. Sixty-two per cent of facilities approached in England and 55% of those approached in Australia responded to the survey. RESULTS: The provision of journals in physiotherapy departments was limited, and alternative access to physiotherapy journals was generally poor. Certain facilities were innovative in providing additional journal literature for physiotherapy staff. Physiotherapy journal clubs existed in 42% of responding facilities in England and 18% of those surveyed in Australia. Several facilities provided alternative forms of journal review as part of in-service training. Relatively few journal clubs utilized a 'problem-based' format, which fosters the teaching of critical appraisal skills. Evidence of enthusiasm emerged in some facilities, but in contrast, barriers and a degree of apathy were also revealed in others. CONCLUSIONS: Physiotherapy managers, hospital administrators and academic institutions should jointly agree a strategy to both promote evidence-based journal clubs and to facilitate journal provision within physiotherapy departments.

Australia↗
PubMed2004

Access to continued professional education among health workers in Blantyre, Malawi.

OBJECTIVE: To describe the current status of continued professional development (CPD) of healthcare personnel within the Ministry of Health (MoH) health centres in Blantyre, Malawi. DESIGN: A cross-sectional descriptive study utilizing an interviewer-administered questionnaire. SUBJECTS: Healthcare workers in public health centers in Blantyre District, Malawi. RESULTS: Fifty-seven healthcare workers participated of whom 47 (82.5%) were nurses, 8 (14.0%) were either medical assistants or clinical officers, and one laboratory technician and a dental therapist. At the time of the study, 50(87.7%) were prescribers and 54 (94.7%) had ever issued a prescription for medications. Participation in workshops and seminars within the past 12 months was reported by 54 (94.7%) of the participants and 49 (86.0%) reported that their health facilities had clinical hand-over meetings. All participants indicated desire to receive professional journals for free while only 35 (61.4%) were willing to pay for a journal subscription. Current personal and institutional subscription to a journal was low, at 2 (3.5%) each. About 30% had been trained to conduct research and 23 (40.1%) had ever conducted research with only 3 (5.3%) ever written a journal or newsletter article. 47.4% had access to a working phone at work and only 3 (5.3%) had access to internet facilities at all. Only 21% were satisfied with their own knowledge on health matters. CONCLUSIONS: Healthcare professionals in Blantyre's DHO zone are using mostly clinical hand-over meetings, seminars and workshops for their CPD. There is need to improve access to relevant professional journals. The regulatory or licensing boards for healthcare professional in Malawi should seriously consider mandatory CPD credits for re-registration.

Adult↗
PubMed1998

Planning flexible learning to match the needs of consumers: a national survey.

The injection of market forces into the National Health Service (NHS) has led to nurse education being viewed as a commodity which educational institutions supply and NHS employers purchase. Conscious of the costs of paying for courses within this new consumer culture, NHS trusts and other health service employers are increasingly looking for cost-effective flexible training to educate their workforce quickly and efficiently. Parallel to this is the accelerated demand for continuing professional development (CPD) brought about by the inception of the UKCC's Post-Registration Education and Practice Project (PREPP). Both registered and enrolled nurses are finding they need professional updating and skills and thus increased access to courses. The increased demand for education and training brought about by these changes cannot be met through traditional methods alone, requiring educational institutions to re-appraise their methods of delivery and introduce more flexible approaches to learning. There is every evidence that this is now the case with open learning, distance learning and flexible approaches to learning ever growing in popularity as providers of nurse education recognize the benefits such approaches offer. The emphasis is on meeting the diverse needs of the health care employers and individuals by providing education that is flexible, learner-centred and customer focused. This paper presents the findings of a national survey to ascertain how providers of flexible education plan educational programmes to meet the needs of their customers. Based on data collected from 120 educational institutions within the higher education, health and social care and private sectors, it highlights: the ways in which flexible learning programmes and courses are delivered; what aspects of flexibility are considered important when designing programmes to meet the needs of prospective customers; and what approaches are used to assess demand for flexible education. The study stresses the need for providers of flexible education to take into account the dual perspectives of those who have a stake in the flexibility of nurse education; NHS employers as funders of students and individual healthcare professionals themselves.

Curriculum↗
PubMed2002

Support needs of veterinary surgeons during the first few years of practice: perceptions of recent graduates and senior partners.

Postal surveys or personal interviews of 76 recent veterinary graduates and their 49 employers were undertaken to establish their perceptions of good practice when integrating a new graduate into a business and their preferred methods of assessment and development. Practice type and location were the main influences on graduates looking for their first job. Interviews were mostly informal. Employers expected basic veterinary competence and candidates expected good quality support. Most graduates (93 per cent) had their own consultations on the first day. During early consultations 2 per cent of senior vets accompanied the new graduate, 95 per cent of practices provided senior back-up either in person or by telephone but in 3 per cent no back-up was available. Most new graduates (90 per cent) were satisfied with their workload. Three-fifths were on-call within the first week, and 95 per cent within a month. Graduates received calls directly in 45 per cent of practices, in 9 per cent seniors screened the calls, and the remainder used a third party. Assistance from experienced lay staff varied greatly. Discussion of problems was mainly informal. There was little spontaneous feedback and problems resulted from inadequate communication. One in three new graduates left their first job within two years, and one in six identified lack of support, heavy workload, stress or clashes with staff as a primary reason. This high turnover was a problem for employers. From the new graduates' perspectives, initial problems included: being on call (59 per cent), financial aspects (47 per cent) and surgery (43 per cent). Communicating with clients and learning to prioritise jobs were also difficult. New graduates took longer over procedures (79 per cent of employers commented) and required extra back-up (91 per cent) both of which reduced income (59 per cent). Nearly all the seniors felt that their current new graduates had coped 'quite well', although it was claimed that new graduates lacked the ability to talk to clients at the appropriate level, wanted to bring all their scientific knowledge to bear on every case, and often failed to consider the obvious or to appreciate clients' needs. Only 18 per cent of practices had formal and regular review procedures but all monitored the response of clients and watched the new graduate perform. Feedback to their new colleague was considered 'adequate' by 85 per cent of seniors, although 45 per cent of graduates felt they had not received enough. Eighty-three per cent of new graduates felt 'moderately prepared' by their undergraduate course, and 76 per cent of senior vets were 'generally satisfied' Both wanted improvements in extramural studies and increased exposure to routine cases. Senior partners sought greater commitment in the undergraduate curriculum to financial/legal issues and communication skills. Over a third of employers (38 per cent) had a 'great influence' on the choice of continuing professional development courses for their recent graduates. New graduates chose courses to deal with a perceived weakness, or to specialise, and welcomed opportunities to meet other new graduates and share early experiences. It was concluded that turnover and staff problems would be reduced if practices became more effective in coping with new arrivals, especially by supporting their development.

Attitude of Health Personnel↗
PubMed1995

Practicing with the urban underserved. A qualitative analysis of motivations, incentives, and disincentives.

OBJECTIVE: To investigate the personal characteristics and professional experiences of medical providers working with medically underserved urban populations. DESIGN: Focus groups of primary care providers. SETTING: Public and private clinics in Salt Lake City, Utah, in which the providers had ongoing relationships with medically underserved patients. PARTICIPANTS: Twenty-four providers (11 men and 13 women), including 12 physicians (three family physicians, seven pediatricians, and two psychiatrists), one dentist, three physician assistants, and eight nurse practitioners participated in three focus groups. MAIN OUTCOME MEASURE: Interpretative analysis of verbatim quotations regarding personal beliefs, feelings, and practice experiences. RESULTS: Participants revealed a strong sense of service to humanity and pride in making a difference. They thrive on the challenge of creatively dealing with their patients' complex human needs with limited health care resources. Factors critical to survival in an urban underserved setting include a hardy personality style, flexible but controllable work schedule, and multidisciplinary practice team. The camaraderie and synergy of teams generate personal support and opportunities for continuing professional development. CONCLUSIONS: Increasing the numbers of health care professionals wanting to work with the medically underserved may be facilitated through refining admissions criteria to schools for health care professionals to include values and personality characteristics, emphasizing within curricula the important skills and practice styles necessary to work with underserved patients, and ensuring that underserved practice environments provide support through multidisciplinary teams and structured work hours. These potentially effective approaches could increase success in recruiting and retaining health care professionals to work with medically underserved patients.

Adult↗
PubMed1998

Burnout: current knowledge and relevance to old age psychiatry.

OBJECTIVES: To review the literature on burnout and consider its relevance to old age psychiatry and the role of the consultant. DATA SOURCES: Medline and PsychLit computerized databases. DATA SYNTHESIS: Burnout is a syndrome of emotional exhaustion, depersonalization and decreased sense of personal accomplishment which is recognized in people working in the human service professions and can have adverse effects on the workforce. There is little evidence of unique stressors related to care of elderly mentally ill people. Burnout is likely to be modified by workplace interventions. Relevant areas for intervention are political and social, organizational and management, training and personal issues. Support to consultants and their continuing professional development need to be radically reviewed.

Aged↗
PubMed2000

Physical morbidity in elderly psychiatric inpatients: prevalence and possible relations between the major mental disorders and physical illness.

BACKGROUND: This study examines the prevalence of physical morbidity in elderly psychiatric inpatients and the possible relationships between major psychiatric disorders (organic mental disorders, schizophrenic and mood disorders) and physical illnesses. The clinical implications of such relationships are discussed. METHOD: Data were obtained from two old age psychiatry wards over a six month period. Seventy-nine subjects were studied and information was obtained from their medical files. Demographic characteristics, psychiatric diagnosis, number of physical illnesses and number of body systems affected were collected. Analysis of variance (ANOVA) was used to compare the psychiatric groups on continuous outcome data and chi(2) test to compare psychiatric groups on categorical data. RESULTS: Seventy-five per cent of subjects had at least one physical illness. The number of medical illnesses was independent from the psychiatric disorder. Subjects with mood disorders, and especially depression, were more likely to suffer from hypertension, diabetes and cardiovascular illnesses than subjects with schizophrenic or organic disorders. Subjects with organic disorders had the lowest prevalence of endocrine disease and diabetes. CONCLUSIONS: It was concluded the link between mood disorders (depression), cardiovascular diseases and hypertension could be of a 'cause/effect' type or are the results of a survivor effect. The high prevalence of physical morbidity has implications for training and continuing professional development of those in Old Age Psychiatry Services. It should also be taken into consideration when the location of services is being decided.

Aged↗
PubMed2001

Teaching critical appraisal skills in health care settings.

BACKGROUND: Critical appraisal is the process of assessing and interpreting evidence by systematically considering its validity, results and relevance to an individual's work. Within the last decade critical appraisal has been added as a topic to many medical school and UK Royal College curricula, and several continuing professional development ventures have been funded to provide further training. OBJECTIVES: To assess the effects of teaching critical appraisal skills to health professionals, on the process of care, patient outcomes and knowledge of health professionals. SEARCH STRATEGY: We searched The Cochrane Library (to Issue 2 2000), MEDLINE (1966 to 1997), EMBASE (1980 to 1997), Eric (1966 to 1997), Cinahl (1982 to 1997), Lisa (1976 to 1997), Sigle (1980 to 1997), Science Citation Index (1981 to 1997), PsycLit (1974 to 1997), the world-wide-web, and reference lists of articles. We also contacted major medical education centres. SELECTION CRITERIA: Randomised trials, controlled clinical trials, controlled before and after studies and interrupted time series analyses of educational interventions teaching critical appraisal to health professionals. The outcomes were: process of care; patient mortality, quality of life, and satisfaction; and health professional knowledge/awareness based upon objective, standardised, validated instruments. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and three reviewers independently assessed study quality. MAIN RESULTS: One USA hospital-based randomised trial was included involving 44 doctors. The outcome assessed was critical appraisal knowledge. Process of care, patient health or attitude/awareness outcomes were not assessed. Critical appraisal teaching was reported to have resulted in a 25% improvement (adjusted figure) in critical appraisal knowledge in the intervention group compared to a 6% improvement in the control group, which was statistically significant (p=0.02). REVIEWER'S CONCLUSIONS: There is evidence that critical appraisal teaching has positive effects on participants' knowledge, but as only one study met the inclusion criteria the validity of drawing general conclusions about the effects of teaching critical appraisal is debatable. There are large gaps in the evidence as to whether teaching critical appraisal impacts on decision-making or patient outcomes. It is also unclear whether the size of benefit seen is large enough to be of practical significance, or whether this varies according to participant background or teaching method. The evidence supporting all outcomes is weakened by the generally poorly designed, executed and reported studies that we found.

Decision Making↗
PubMed2006

Online learning: the potential for occupational therapy education.

Online learning continues to have a significant impact on higher education. Increasingly students seek a combination of online learning and face-to-face instruction at undergraduate and graduate levels and occupational therapists ask for online continuing professional development opportunities. However, occupational therapy educators have been slow to adopt web-based instructional technology. This paper presents background information on the use of web-based learning in the general sphere of higher education and outlines the current range of usage in occupational therapy education. Research findings are presented to stimulate discussion regarding online learning and occupational therapy professional socialisation, student satisfaction and outcomes. There is a fine line between full and partial online course delivery, so research on technology-enhanced campus-based delivery is also included in the review. Evidence suggests that blending combinations of technologies with computer mediated learning enhances interaction and could address the higher order learning needs of professional programmes such as occupational therapy.

Computer Literacy↗
PubMed2001

Mechanisms to improve teamworking in neurosurgery.

Team-working has been seen as an important essential in the delivery of modern medical care and quality. It should increase the range of skills and knowledge in dealing with clinical problems and needs to make better use of scarce professional resources. In addition many see the team as reducing the risk of the harmful consequences of idiosyncratic practice. Team-working requires a named consultant to be responsible for individual patients with corporate responsibility for the practice. Doctors and managers will need to work together. The structure of teams will by necessity change but the requirements are constant. These are to provide a basis for continuing professional development, the monitoring of standards of performance and capacity, and above all, to improve patient care and outcome. An essential prerequisite is the provision of resources to provide a supportive environment if clinical excellence is to be the norm.

Humans↗
PubMed1995

Educating the health care team.

How can health professional teams provide patient-centred care in the treatment of chronic disease? What education and training is needed to achieve this? Patient-centred care means helping people living with a condition make informed choices to maximise their quality of life. The health professional's role is to facilitate, to ensure patients and those around them take effective and appropriate self-management of the condition. To achieve this, high quality team working is needed amongst people who do not interact in the course of their day-to-day work. Education for this should begin with students, expand when staff are newly qualified, become a feature of specialist training, and extend through continuing professional development. A unified philosophy and strategy then is needed for life-long professional education and training. Generalised principles are proposed for what should happen and who can best provide it, and these can be widely applied in many fields of health professional education.

Chronic Disease↗