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PubMed1992

Culturally competent occupational therapy in a diversely populated mental health setting.

Cultural sensitivity is a crucial component of health care provision, particularly in psychiatric settings. As society becomes more multicultural, it is essential for occupational therapists to continue to develop cultural competence, which is defined in this paper as an awareness of, sensitivity to, and knowledge of the meaning of culture. At San Francisco General Hospital, an innovative multicultural model consisting of special focus programs is used. The key to the success of such programs is a culturally competent professional staff.

Clinical Competence↗
PubMed2003

Primary care nurse practitioners and the interface with secondary care: a qualitative study of referral practice.

In the United Kingdom nurse practitioners are assuming responsibilities traditionally considered to be within the domain of general practitioners. Important amongst these is the referral of patients to medical consultants in secondary care, a responsibility commonly associated with the general practitioner's role as 'gatekeeper' to health care. This paper describes a study designed to identify issues raised by the challenge that a developing nursing role presents to interprofessional working at the interface between primary and secondary care. When invited to comment, study participants (nurse practitioners, nurse educators, medical consultants and general practice registrars) related nursing referrals to issues associated with professional boundary changes, namely: teamwork, regulation of practice, communication, professional conflict and professional relationships. This paper discusses the views of primary and secondary care practitioners about who should take responsibility for the referral of patients in the light of concerns raised about professional competence and accountability. Individual nurse practitioners and their colleagues have found pragmatic ways to manage their work however, although UK government policy supports development of advanced clinical nursing, there remains much work to be done to provide the professional and legal infrastructure to support the role.

Adult↗
PubMed1997

Complementary medicine: legal status of the non-licensed provider in the USA.

European providers of complementary medicine may be surprised by the formal strictures which their US counterparts face. A major hurdle to holistic practice in the USA is the statutory prohibition against the unlicensed practice of medicine. State statutes define 'medicine' broadly, creating a legal risk for unlicensed providers of holistic health care, as well as for licensed providers whose services are deemed to exceed their legislatively authorized scope of practice and cross into 'diagnosis' and 'treatment' of disease. This paper does not address scope of practice; rather, it focuses on the legal status of non-licensed (or 'unenfranchised') providers. For these providers, seeking occupational licensure will provide some protection against medical practice acts, as well as opportunity to elevate professional competence and prestige. However, many holistic providers prefer to remain outside the regulatory scheme. Mandatory licensure, title licensure and registration offer means of upgrading professional status and achieving state sanction for professional practice.

Complementary Therapies↗
PubMed2000

Complementary medicine: legal status of the non-licensed provider in the USA.

European providers of complementary medicine may be surprised by the formal structures which their US counterparts face. A major hurdle to holistic practice in the USA is the statutory prohibition against the unlicensed practice of medicine. State statutes define 'medicine' broadly, creating a legal risk for unlicensed providers of holistic healthcare, as well as for licensed providers whose services are deemed to exceed their legislatively authorized scope of practice and cross into 'diagnosis' and 'treatment' of disease. This paper does not address scope of practice; rather, it focuses on the legal status of non-licensed (or 'unenfranchised') providers. For these providers, seeking occupational licensure will provide some protection against medical practice acts, as well as opportunity to elevate professional competence and prestige. However, many holistic providers prefer to remain outside the regulatory scheme. Mandatory licensure, title licensure and registration offer means of upgrading professional status and achieving state sanction for professional practice.

Complementary Therapies↗
PubMed2006

Ethical issues in exercise psychology.

Exercise psychology encompasses the disciplines of psychiatry, clinical and counseling psychology, health promotion, and the movement sciences. This emerging field involves diverse mental health issues, theories, and general information related to physical activity and exercise. Numerous research investigations across the past 20 years have shown both physical and psychological benefits from physical activity and exercise. Exercise psychology offers many opportunities for growth while positively influencing the mental and physical health of individuals, communities, and society. However, the exercise psychology literature has not addressed ethical issues or dilemmas faced by mental health professionals providing exercise psychology services. This initial discussion of ethical issues in exercise psychology is an important step in continuing to move the field forward. Specifically, this article will address the emergence of exercise psychology and current health behaviors and offer an overview of ethics and ethical issues, education/training and professional competency, cultural and ethnic diversity, multiple-role relationships and conflicts of interest, dependency issues, confidentiality and recording keeping, and advertisement and self-promotion.

Clinical Competence↗
PubMed2005

The missing curriculum: experience with emotional competence education and training for premedical and medical students.

Medical education has long overlooked teaching the normal psychodynamics of everyday adult life (psychonormality) in favor of training in psychopathology. Proficiency in psychonormality skills (i.e., emotional competence) includes skilled management of internal emotions, external situations and relationships, and promotes patient satisfaction and healthcare outcomes as well as better mental health for practitioners. In particular, teaching psychonormality skills can be helpful to underrepresented minority (URM) students whose psychonormality experiences may differ from the culture of mainstream medical education. This paper outlines a clinically derived, pragmatic, five-step course designed to educate and train students for emotionally competent medical practice. A real-life example taken from an introductory workshop presentation of this course at a Student National Medical Association meeting is presented to illustrate the student-oriented application of the concepts. The enthusiastic reception accorded such workshops suggests an unmet need for this type of training in medical curricula. Benefits could include improved doctor-patient relationships and associated healthcare outcomes as well as higher retention of competent, professional, satisfied and healthier physicians, particularly URMs. Medical schools and residencies are encouraged to carefully evaluate the impact of incorporating psychonormality education and emotional competence training into their present curricula and faculty development.

Curriculum↗
PubMed2002

A loss of faith: the sources of reduced political legitimacy for the American medical profession.

The political legitimacy and policymaking influence of the medical profession have greatly declined in American society over the past 30 years. Despite speculation about the causes, there has been little empirical research assessing the different explanations. To address this gap, data collected in 1995 are used to compare attitudes of the American public and policy elites toward medical authority. Statistical analyses reveal that (1) elites are more hostile to professional authority than is the public; (2) the sources of declining legitimacy are different for the public than they are for policy elites; and (3) the perceptions that most threaten the legitimacy of the medical profession pertain to doubts about professional competence, physicians' perceived lack of altruism, and limited confidence in the profession's political influence. This article concludes with some speculations about the future of professional authority in American medicine.

Attitude to Health↗
PubMed1983

Physician attitudes toward the competence of general diagnostic radiologists: survey and implications.

Responses to a questionnaire were obtained from 1,539 physicians in 15 medical specialties to measure their attitudes toward general diagnostic radiologists in regard to their medical knowledge and professional competence as consultants. The data were evaluated in terms of the demographic profile of the respondents. Among the detailed results obtained, it was determined that only 8.1% of all physicians believe general diagnostic radiologists are poorly informed about disease processes, but 25% believe that these radiologists need more subspecialty training to be valuable as consultants to them. Physicians who do their own radiographic/sonographic examinations believe general diagnostic radiologists to be unimportant twice as often as do physicians who refer their patients to radiologists (28.2% vs. 14.5%). Most physicians (78%) believe that diagnostic radiologists perform unique functions in hospitals, while only 38% believe this to be true in the office setting. Consistent with this is that physicians practicing primarily in hospitals believe diagnostic radiologists need more training than do the primarily office-based physicians (29.6% vs. 16.8%). Of the specialists surveyed, orthopedic surgeons, neurosurgeons, cardiologists, and neurologists consistently had the lowest opinion of general diagnostic radiologists as consultants. In each of these specialties, less than 30% believed that general diagnostic radiologists are indispensable in the hospital setting. Also, younger (less than 45 years) physicians feel less dependent on general diagnostic radiologists than do older physicians. For example, twice as many younger physicians (17.3% vs. 7.9%) believe that diagnostic radiologists perform few or no unique functions which they cannot do themselves.

Ambulatory Care↗
PubMed1984

Change through continuing education: an unproven strategy.

Continuing education is the strategy most favoured to ensure professional competence and maintain standards of patient care. This paper questions the effectiveness of current continuing education programs with their emphasis on the structure and process of professional practice. Problems with assessment using course participants' views and the educational content of programs are examined. The assumptions that knowledge is translated into improved performance and that continuing education improves outcomes, notably patient care, are questioned. It is essential that continuing education be evaluated in terms of outcomes. Without a demonstrable improvement in the practical application of skills such programs cannot be viewed as cost effective.

Australia↗
PubMed2001

Action research in action: reflections on a project to introduce Clinical Practice Facilitators to an acute hospital setting.

AIMS OF THE PAPER: The process and philosophical basis of action research are discussed in this article by reviewing the insights that were gained from a study designed to enhance the support available to junior nursing staff in an acute hospital setting. RATIONALE: It has been well documented that newly qualified nurses require help to develop professional competencies. With this in mind, the role of Clinical Practice Facilitator was established within a National Health Service (NHS) Trust to enhance clinical skill acquisition and the professional development of newly registered nurses and health care assistants. DESIGN: In order to facilitate the inception, development and subsequent evaluation of these new roles, an action research approach was adopted. Strategies used to encourage collaboration and flexibility during the project are also discussed. RESULTS: The primary aims of the project were achieved and the authors suggest that the choice of action research was significant to the successful outcome. However, a number of issues arose which deserve more attention including the importance of the interpersonal skills of the action researcher and the value of action research to facilitate change which is relevant at both an individual and organizational level.

Humans↗
PubMed1982

Hospital dietitians in mid-career. II. Continuing education experiences and plans.

An objective of continuing education is to assist in maintaining professional competency. This research examined continuing education experiences and plans of hospital dietitians in mid-career in three practice areas: administrative, general, and clinical dietetics. Data were collected on continuing education hours accumulated, attendance at professional dietetic meetings, time devoted to professional reading, topics of seminars attended, and plans for graduate study. Data indicated that mid-career hospital dietitians specialize in one area of dietetic practice and attempt to maintain their competence in that area through continuing education.

Adult↗
PubMed2006

Task transfer: another pressure for evolution of the medical profession.

Since the 1960s, Australian society and the medical profession have undergone enormous change. Our society has moved from a relatively homogeneous and conservative community, supported by limited government services, to one that is multicultural, focused on the individual and consumerism, and supported by extensive government programs, with health care a top public and political priority. A defining feature of contemporary society is its mistrust of institutions, professionals, public servants and politicians. The medical profession has changed from a cohesive entity, valuing generalism and with limited specialisation, to one splintered by ultra-specialisation and competing professional agendas. The medical workforce shortage and efforts to maintain the safety and quality of health services are putting acute pressure on the profession. Task transfer or role substitution of medical services is mooted as a potential solution to this pressure. This has the potential to drastically transform the profession. How task transfer will evolve and change medicine depends on the vision and leadership of the profession and a flexible pragmatism that safeguards quality and safety and places patient priorities above those of the profession.

Australia↗
PubMedDate not supplied

How do older nurses perceive their clinical competence and the effects of age?

In 1996, the first of the baby boomer population bulge that includes registered nurses (RNs) will reach age 50. Considering the prevailing negative stereotypes about women, nurses, and older adults in general, it is necessary to understand the abilities and needs of older nurses. This qualitative study was the first stage of a needs assessment of professionally mature RNs. Eight female RNs, employed full-time in an acute care setting and over age 50, were interviewed to determine their perceptions, attitudes, and beliefs about their own professional competence and how they believed they were perceived by others. Results indicated that older RNs felt good about themselves and the profession, and valued traditional bedside nursing and professional behaviors. Of the eight recurring themes found, the need for continuing education generated the most discussion. Will the methods and resources of the past meet the educational needs of the older nurses? Further study is recommended to discover their needs and the needs of their employers.

Age Factors↗
PubMed2006

Professionalism in general practice: development of an instrument to assess professional behaviour in general practitioner trainees.

INTRODUCTION: The aim of this study is to develop a new tool to assess professional behaviour in general practitioner (GP) trainees: the evaluation of professional behaviour in general practice (EPRO-GP) instrument. METHODS: Our study consisted of 4 phases: (1) development of a model of professionalism in general practice based on a literature review on professionalism, competency models of general practice and the overall educational objectives of postgraduate training for general practice; (2) development of the EPRO-GP instrument in collaboration with a sounding board; (3) establishing the content validity of the EPRO-GP instrument using a nominal group technique; and (4) establishing the feasibility of the EPRO-GP instrument in 12 general practice trainees and their general practice trainers. RESULTS: The model of professionalism in general practice encompassed 4 themes within professionalism: (a) professionalism towards the patient; (b) professionalism towards other professionals; (c) professionalism towards the public; and (d) professionalism towards oneself. These 4 themes covered 26 elements of professionalism. This model provided the framework of the EPRO-GP instrument, which we developed further by operationalising the 26 elements in 127 behavioural items. The expert ratings confirmed the content validity of the instrument with one exception: the element "altruism" was removed as a stand-alone category but it remained throughout the tool in items giving primacy to patient welfare. The results on the feasibility of the EPRO-GP instrument were very encouraging. All tutorials yielded professional behaviour learning points. DISCUSSION: Our results support the content validity of the EPRO-GP instrument as well as its feasibility as a tool to educate for professionalism in general practice.

Clinical Competence↗
PubMedDate not supplied

Integrating clinical education into the curriculum development process.

Radiologic technology education consists of three components--didactic, laboratory, and clinical. For effective education to take place and for each program to meet its goal of preparing practitioners who have a firm theoretical foundation and are proficient technologically in radiologic technology, the three components must be integrated. Integration facilitates the transfer of theoretical and practical knowledge into the intellectual, psychomotor, and affective skills necessary for patient care. The totality of the integrated educational experience makes the competent professional. Integration of the educational components is best achieved by a systematic approach to curriculum development. The steps in the curriculum development process consist of (1) the formulation of a philosophy; (2) the establishment of competencies; (3) the identification of resources; (4) the development and sequencing of courses; (5) the identification of teaching strategies; and (6) evaluation. When the clinical component of the educational program is weighted appropriately and well-integrated into a systematic process of curriculum development, student learning is maximized and graduate professional performance is enhanced.

Curriculum↗
PubMed1976

A survey of the attitudes of Sydney pet owners to veterinary services.

One thousand questionnaires were distributed to a random sample of Sydney pet owners in 1974 by a market research organisation. A response rate of 37.5% was obtained. Respondents were most likely to use a veterinary practice because it was conveniently located (27%), recommended by someone (22%),or they had been dissatisfied elsewhere (8%). The majority of pet owners preferred veterinary practices to be multiman (65%), unassociated with other services (61%), and run on an open clinic system (52%) with consultation hours between 6 pm and 8 pm on weekdays (45%), and 9 am and 11 am at weekends (about 50%). 91% had no preference regarding the sex of practitioner who treated their pet. 46% of cat owners and 25% of dog owners said that they would be unwilling to spend over +30 to save their pets life while 34% of cat owners and 55% of dog owners were willing to spend over $100. Professional competence and concern for animals were the qualities pet owners desired most in veterinary surgeons and veterinary practices. After these, pet owners rated prompt attention, 24 hour emergency service and modern professional equipment as the next most important features.

Animals↗
PubMed1986

An introduction to interactive videodisc technology: implications for medical education.

Interactive video technology is a unique and innovative way to maintain professional competency in health care. Its capabilities for individualization and trainee feedback complement its institutional flexibility and make this a truly revolutionary method for continuing education and initial instruction of all health professionals. Interactive video can be employed to evaluate objectively hospital staff performance standards and as such may help satisfy the hospital's burden of staff quality control. In addition, it may be a cost-saving measure by reducing training personnel expenditures. The following article describes the benefits of this budding technology and its application in health care.

Computer-Assisted Instruction↗