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Meeting the non-clinical education and training needs of new consultants.

This review highlights the non-clinical training needs of new consultants, identifying strategies for meeting these needs. Non-clinical activities are integral to the consultant's role and senior clinicians need training in these areas. Concerns over the quantity and quality of current provision are compounded by changes the European Working Time Directive and Modernising Medical Careers initiative will bring. Accelerated progression to senior level and reduction in time for training suggest a pressing need to respond to the needs of new consultants. Ad hoc initiatives in a range of healthcare contexts offer examples of how training needs may be met, including mentoring and continuing professional development schemes. A multi-professional strategy, incorporating elements of higher professional education in general practice and other NHS initiatives (particularly management/leadership training), may offer an appropriate framework within which to capitalise on existing opportunities. There are, however, resource implications that need to be addressed.

Education, Medical, Graduate↗

Three visual techniques to enhance interprofessional learning.

Many changes in the delivery of healthcare in the UK have highlighted the need for healthcare professionals to learn to work together as teams for the benefit of patients. Whatever the profession or level, whether for postgraduate education and training, continuing professional development, or for undergraduates, learners should have an opportunity to learn about and with, other healthcare practitioners in a stimulating and exciting way. Learning to understand how people think, feel, and react, and the parts they play at work, both as professionals and individuals, can only be achieved through sensitive discussion and exchange of views. Teaching and learning methods must provide opportunities for this to happen. This paper describes three small-group teaching techniques which encourage a high level of learner collaboration and team-working. Learning content is focused on real-life health-care issues and strong visual images are used to stimulate lively discussion and debate. Each description includes the learning objectives of each exercise, basic equipment and resources, and learning outcomes.

Audiovisual Aids↗

Experience with assessing the quality of comments on clinical biochemistry reports.

We assess a previously described scoring system for the appropriateness of interpretative comments on clinical biochemistry reports over 21 distributed cases and over a group of 41 UK-based participants. The distributed cases covered a range of clinical scenarios and included pre- and post-analytical problems. The UK-based participants had all registered an interest in using this case participation for their continuing professional development; all had higher professional qualifications in clinical biochemistry, and the group included participants based in teaching hospitals and district general hospitals as well as those with a medical or a scientific background. Although the present scoring system favours participants who mention more than one possible outcome and who include several ideas for further investigation, its advantages seem to outweigh its disadvantages. The scored cases are currently unique, and are seen to be of major educational value not only by active participants but also by those who are using them for teaching or in discussion groups.

Chemistry, Clinical↗

Primary health care and general practice--a comparison between Australia and Malaysia.

The Australian and Malaysian systems of general practice were examined and compared. The issues of similarity and difference identified are discussed in this paper. Quality clinical practice and the importance of compulsory vocational training prior to entry into general practice and continuing professional development is one important area. A move towards preventive health care and chronic disease management was observed in both countries. Practice incentive programmes to support such initiatives as improved rates of immunisation and cervical smear testing and the implementation of information technology and information management systems need careful implementation. The Medicare system used in Australia may not be appropriate for general practitioners in Malaysia and, if used, a pharmaceutical benefit scheme would also need to be established. In both countries the corporatisation of medical practice is causing concern for the medical profession. Rural and aboriginal health issues remain important in both countries. Graduate medical student entry is an attractive option but workforce requirements mean that medical education will need individual tailoring for each country. Incorporating nurses into primary health care may provide benefits such as cost savings. The integration model of community centres in Malaysia involving doctors, nurses and allied health professionals, such as physiotherapists, in a single location deserves further examination.

Australia↗

The information sources and journals consulted or read by UK paediatricians to inform their clinical practice and those which they consider important: a questionnaire survey.

BACKGROUND: Implementation of health research findings is important for medicine to be evidence-based. Previous studies have found variation in the information sources thought to be of greatest importance to clinicians but publication in peer-reviewed journals is the traditional route for dissemination of research findings. There is debate about whether the impact made on clinicians should be considered as part of the evaluation of research outputs. We aimed to determine first which information sources are generally most consulted by paediatricians to inform their clinical practice, and which sources they considered most important, and second, how many and which peer-reviewed journals they read. METHODS: We inquired, by questionnaire survey, about the information sources and academic journals that UK medical paediatric specialists generally consulted, attended or read and considered important to their clinical practice. RESULTS: The same three information sources--professional meetings & conferences, peer-reviewed journals and medical colleagues--were, overall, the most consulted or attended and ranked the most important. No one information source was found to be of greatest importance to all groups of paediatricians. Journals were widely read by all groups, but the proportion ranking them first in importance as an information source ranged from 10% to 46%. The number of journals read varied between the groups, but Archives of Disease in Childhood and BMJ were the most read journals in all groups. Six out of the seven journals previously identified as containing best paediatric evidence are the most widely read overall by UK paediatricians, however, only the two most prominent are widely read by those based in the community. CONCLUSION: No one information source is dominant, therefore a variety of approaches to Continuing Professional Development and the dissemination of research findings to paediatricians should be used. Journals are an important information source. A small number of key ones can be identified and such analysis could provide valuable additional input into the evaluation of clinical research outputs.

Adult↗

The impact of a short course of study on the performance of radiographers when highlighting fractures on trauma radiographs: "The Red Dot System".

This study was set up to determine the effect of a short course of study on radiographers' ability to identify fractures in a trauma context (Red Dot system). The performance of 133 radiographers attending Red Dot courses delivered from April 1999 to September 2003 was evaluated prospectively using a selected sample of radiographs. Assessment of fracture identification occurred before, immediately after and 6 months after the course. The same film set was used and consisted of 30 axial and appendicular cases, 18 with fractures and 12 normal or normal variants. Following a test for normality of the data, a Wilcoxon Signed-Rank Test was selected and paired tests were done between each assessment for sensitivity and specificity. There were significant differences in sensitivity between all three assessments (p<or=0.05), the pre-course/post-course and the post-course/6 month comparison being highly significant (p<or=0.01). Specificity showed significant differences between the pre-course/post-course (p<or=0.01) and the post-course/6 month follow-up scores (p<or=0.05), but no difference was found between the 6 months/pre-course scores. The participants improved their ability to identify fractures and this appears to be as a result of the course. This improvement was not demonstrable after 6 months, although only 30% of participants took part in this follow-up. Radiographers can improve their image interpretation skills from a short course of study, but probably need continuing professional development to maintain these skills.

Clinical Competence↗

Informal peer support: a key to success for nurse prescribers.

A study was conducted in Leicestershire and Rutland (NHS) Healthcare Trust to determine the continuing professional development needs of nurse prescribers. Qualitative and quantitative approaches were applied to the sample frame of 350 nurse prescribers to elicit the most significant factors which have influenced the development of nurse prescribing. The majority of nurse prescribers considered prescribing to be a skill, which is now an essential part of core practice. The study indicated that informal peer support seems to have compensated for the absence of formal clinical supervision. Any development such as nurse prescribing has the added benefit of examining practice from new perspectives. Reflection on how this was achieved highlights important issues as to how the next stage can be even more successful.

Community Health Nursing↗

The RCGP Quality Practice Award for primary care teams.

Accreditation is a means of improving quality through the process of externally reviewing performance against written standards. Following the introduction of clinical governance, participation in quality accreditation schemes has been encouraged. The Royal College of General Practitioners' Quality Practice Award (QPA) is an example of a quality accreditation scheme for primary care practice teams. QPA applies to the wider primary care team and is directly relevant to nursing and midwifery staff employed by or attached to practice teams. QPA supports evidence-based and reflective practice, continuing professional development and team working, all of which are integral to current nursing and midwifery practice. Nurses and midwives working in primary care teams must be aware of QPA and, where necessary, actively and collaboratively participate in this process.

Accreditation↗

Accessing the literature: using bibliographic databases to find journal articles. Part 1.

Research in primary dental care, recertification, continuing professional development, lifelong learning, peer review and quality healthcare are all informed by the published literature. Dental practitioners can find out about reliable and up-to-date information available in the published literature by searching bibliographic databases. Published in two parts, this article describes the databases relevant to clinical dental practice and explains the generic skills required to search them effectively, focusing on MEDLINE, the database most relevant for the majority of dental practitioners, which is freely available via the World Wide Web (WWW). The article differentiates between sensitivity (maximum recall) and specificity (relevance of recall), and suggests how to identify a manageable number of relevant citations, how to save the citations, and how to obtain the full text. In part 2, the article concludes by alerting readers to some of the limitations and pitfalls of database-searching.

Abstracting and Indexing↗

Obtaining an evidence-base for clinical dentistry through clinical trials.

Ideally, all clinical practice should be based on the best available evidence; however, in general dental practice even a very routine issue, such as the appropriate management of the carious primary dentition, is hampered by the lack of a sound evidence-base from high quality clinical trials run in general dental practices. Furthermore, the use of the evidence that is available may be confounded by inadequate reporting. This paper reviews the difficulties reported in successfully completing such clinical trials, and reports on the authors' own experiences. Suggestions are made for overcoming the challenge of patient recruitment in randomised controlled clinical trials in primary dental care. These include: regular contact with a principal investigator, who is viewed as a peer; ensuring the relevance of the research topic to the dentists' daily practice; appropriate remuneration; acknowledgement of the contribution made and recognition of the contribution of research activity to continuing professional development. Use of the CONSORT statement to improve planning and reporting of clinical trials is recommended.

Attitude of Health Personnel↗

From research to practice: teacher and pediatrician awareness of phenotypic traits in neurogenetic syndromes.

Pediatricians' and teachers' knowledge of physical, cognitive, and behavioral features associated with three genetic syndromes were assessed and the effectiveness of information sources about these syndromes evaluated. The surveyed sample included 53 pediatricians and 69 teachers from Northern and Central California. Respondents demonstrated limited knowledge regarding the physical phenotype of fragile X syndrome and significantly less knowledge of velo-cardio-facial syndrome (VCFS). In the cognitive and behavioral domains, significantly more was known about Down and fragile X syndromes than VCFS. Pediatricians and teachers make critical treatment and education decisions for children with these syndromes and would benefit from continued professional development about these syndromes through conferences, professional/association publications, in-service teacher training, and journals.

Awareness↗

A guide to defining the competence required of a consultant in clinical chemistry and laboratory medicine.

A definition has been agreed for the most senior professional (consultant) in clinical chemistry and laboratory medicine. A model job description for a consultant has been determined, which is intended to act as a toolkit to assist employing authorities and professional bodies to define the role of individual consultant posts. A total of 86 competences for a consultant have been designated and expressed in the form of simple generic proficiency standards. These competences have been allocated to six broad areas: clinical [13]; scientific [15]; technical [12]; communication [12]; management and leadership [20]; professional autonomy and accountability [14]. The competences are intended to be illustrative rather than definitive and to enable the duties of any consultant post to be defined. Assessment of competence is likely to entail consideration of qualifications, registration status, continuing professional development and performance review. The project is intended as a guide to European societies of clinical chemistry and laboratory medicine. The guide should be capable of local interpretation to encourage a greater degree of commonality in the role of the consultant whilst protecting national identity. The guide should stimulate international understanding and collaboration and contribute to an overall improvement in the quality of practice.

Chemistry, Clinical↗

Economics and planning in the veterinary undergraduate programme: a model for sub-Saharan Africa.

Veterinarians in sub-Saharan Africa work in resource-deficient environments. Decisions taken by veterinarians in this sub-region, on animal health, animal husbandry and public health issues, are therefore influenced by economic factors including macro-economic considerations related to the current structural adjustment programmes being implemented in the sub-region. In turn, decisions or advice given by veterinarians have socio-economic consequences on clients, on the effectiveness of the delivery systems for veterinary services and on the growth of national economies. For these reasons, economics and planning should be essential components of all modern veterinary undergraduate programmes in sub-Saharan Africa, in order to give veterinarians a basis for making decisions and giving advice which is both technically and economically sound. The authors argue that principles of livestock economics, livestock enterprise management, livestock investment analysis and economics of animal health care are necessary elements in economics and planning courses. They propose a division of these elements into discrete course units to allow for flexibility and adaptability to the different curriculum structures of schools in sub-Saharan Africa and, possibly, continuing professional development courses. The resource requirement for teaching the courses, the integration of the units in the undergraduate programme and the problems which are likely to be encountered in developing the courses are discussed.

Africa↗

The application of student-centred learning approaches to clinical education.

This paper explores current thinking on adult learning and discusses its application to the clinical education of speech and language therapy students. It is based on evidence from a two-year project funded by the Trent Regional Consortium, which is trialling an innovative means of providing paediatric placements. The educational literature has recognised for some time the importance of student-centred teaching and learning and has encouraged movement away from a didactic teacher-student model to one where students are seen as active in the learning process. This paper offers a model as to how these principles may be applied to clinical placements to promote self-directed lifelong learning and to prepare speech and language therapists to meet the challenges of continuing professional development and the ever-changing working environment.

Humans↗

Reflections upon the trends of education and research in small animal reproduction in Europe.

An open questionnaire-based survey was performed among 86 institutions of veterinary education in 32 European countries: 15 within the European Union (EU) and 17 outside the EU, in Central and Eastern Europe and the European Free Trade Association (EFTA). The survey aimed to provide a view of the general status of education and research in small animal reproduction (SAR) in Europe. It further aimed to disclose whether ongoing trends in organization (e.g., from the classical animal reproduction discipline orientation [DO] toward a species-oriented [SO] organization) among veterinary colleges responsible for undergraduate education and research in SAR have affected the provision of clinical services, continuing professional development (CPD), specialization, post-graduate education, and research. Response rates reached 80% among EU institutions and 48.4% in other countries (overall response rate = 68.6%). A clear, significant majority of institutions (> 60%) were DO, with a well-defined comparative subject in the veterinary curriculum. No differences were reported for either orientation in their ability to provide undergraduate education or clinical services in SAR. However, more DO institutions reported active research in SAR than their SO counterparts. Similar (and stronger) differences were seen for post-graduate education, CPD, and participation in specialization programs (national or European). Finally, more DO than SO institutions provided assisted reproductive technologies (ARTs), such as AI with frozen semen, to customers. The analysis of the data emanating from the respondents' perceptions, supports the advantages of the more classical, DO-based approach. The results highlight the need for caution when institutions abandon the comparative benefits of the classical DO animal reproduction subject for a SO approach, which tends to prioritize clinical specialized service rather than research and research education. In the author's opinion, in the absence of the data generated by comparative research and used in research education and the development of new technologies in SAR, there is a risk that sound science-based academic preparation for undergraduates and candidates for post-graduate research education is constrained. To counteract these negative trends, SAR must be recognized as a very important branch of the department of animal reproduction. Access to resources, personnel for teaching and research, and curriculum space should be made available in order to provide the basis for relevant post-graduate training, specialization, and research.

Animals↗

A new vision for health promotion and nutrition education.

Increased integration and collaboration of health promotion and nutrition education professionals to effectively engage consumers, debunk nutrition and health information, and mitigate the effect of chronic diseases is the vision presented for success in the future. Current and optimal roles of educators are discussed in relation to societal trends and their inherent opportunities and barriers. Recommendations for strengthening the role of health promotion in settings where nutrition educators work are provided and include the need for strong academic preparation, field-based training, and continual professional development. The overall goal of these recommendations is to enable nutrition educators and health promotion professionals to advance their professions and develop effective strategies that support the achievement of improved health for all.

Chronic Disease↗

'Research positively embraces questions and challenges'.

RCN general secretary Beverly Malone recalls a former colleague and mentor, and explains why, in the belief that research is integral in helping to shape and deliver care, she continues to campaign hard for nurses to have three days every year for continuing professional development.

Attitude of Health Personnel↗

Injection site safety.

Practice profiles are reflective pieces written by nurses in practice and based on continuing professional development articles. This week Nicola Soanes discusses injection sites. Article no. 498. Workman B (1999) Safe injection techniques.

Health Knowledge, Attitudes, Practice↗