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Medical education in Southeast Asia: emerging issues, challenges and opportunities.

CONTEXT: Medical education in Southeast Asian countries is undergoing rapid changes, with the realignment of medical schools' curricula to meet national needs and priorities, the adoption of and experimentation with innovations, and greater emphasis on staff development initiatives. The Medical Education Unit of the National University of Singapore undertook a project to compile the educational processes taking place in these medical schools. METHOD: This was a process-focused initiative. We developed a custom-made questionnaire that emphasised narrative description. We compiled profiles of 30 selected medical schools in the Southeast Asian region and, after editing and review, published these profiles. This report summarises the key findings from the project. FINDINGS: Medical schools in Southeast Asia are in a dynamic state. Schools are gradually adopting student-centred learning approaches, including problem-based learning. Many schools offer their students early clinical training, opportunities for out-of-hospital postings, and student-selected electives. Multiple-choice questions and oral examinations are almost universally used in student assessment. Portfolios and self- and peer-assessments are seldom used. Major challenges faced by the schools involve shortages of qualified staff and financial constraints. Major goals for the future include the implementation of student-centred learning, the revamping of the assessment process, and staff training. CONCLUSIONS: This is a compilation of self-reported profiles of selected medical schools where we encouraged self-reflection and analysis. As with other surveys, there could be potential self-selection bias. Nevertheless, the profiles of these selected schools provide a broad overview of the status of medical schools in Southeast Asia.

Asia, Southeastern↗

Assessing the quality of pharmacist answers to telephone drug information questions.

A quality assurance (QA) program is described in which frontline pharmacists were asked test drug information questions via anonymous telephone calls. The program was instituted at a university hospital that began providing decentralized pharmaceutical services in 1985. Questions were developed on the basis of a pilot study conducted to determine the types and complexity of drug information questions received by frontline pharmacists at the hospital. Data on departmental clinical productivity were used to determine the number of questions that would be posed during each shift in the various service areas. The questions were posed during a 10-day period; the pharmacists were aware of the program, but the callers did not identify their affiliation with it. In response to 105 questions asked, 86 were judged to have been answered correctly, 13 answers were deemed incomplete, and 6 were judged incorrect. Pharmacists were more likely to respond incorrectly to complex questions and questions posed during the night shift. As a result of the audit, staff members with advanced clinical knowledge were asked to help less experienced pharmacists, the position of assistant director for drug information and staff development was created, and educational programs were instituted. The QA audit has been repeated twice. Posing test drug information questions via anonymous telephone calls is effective in assessing the quality of drug information provided by pharmacists in patient-care areas.

Drug Information Services↗

A strategic plan for implementing nursing diagnosis into daily practice.

Staff development educators are instrumental as change agents in identifying the need for change, developing and implementing a strategic plan to unfreeze, change, and refreeze learning behavior, and evaluating its effectiveness. This article examines an attempt at one facility to implement nursing diagnosis into daily practice through the use of Lewin's change theory. The impact of driving and restraining forces is discussed as they facilitated or hindered adaptation to change throughout the process.

Education, Nursing, Continuing↗

A rating scale for tutor evaluation in a problem-based curriculum: validity and reliability.

An instrument has been developed to assess tutor performance in problem-based tutorial groups. This tutor evaluation questionnaire consists of 13 statements reflecting the tutor's behaviour. The statements are based on a description of the tasks set for the tutor. This study reports results on the validity and reliability of the instrument. Confirmatory factor analysis showed that a three-factor model fitted the data reasonably well. The three factors are: (1) guiding students through the learning process, (2) content knowledge input, and (3) commitment to the group's learning. Generalizability studies indicated that the rating scales provide reliable information with student responses of existing tutorial group sizes. It is concluded that the tutor evaluation questionnaire is a fairly valid and reliable instrument that can be used in staff development programmes.

Curriculum↗

Aminoglycoside dosing service provided by baccalaureate-level pharmacists.

An aminoglycoside pharmacokinetic dosing service operated primarily by baccalaureate-level pharmacists is described. The service was initiated gradually by the clinical pharmacy coordinator. After detailed policies and procedures were developed, staff pharmacists received 14 hours of training in pharmacokinetics. The training program consisted of written study material and application to actual patient cases. The pharmacokinetic dosing service is initiated upon the written request of a physician. Nurses on the pharmacy i.v. team administer aminoglycoside doses, collect blood samples, and record sample collection and drug infusion times whenever possible; when workload is heavy, floor nurses and laboratory personnel assist in these functions. The entire dosing consult requires approximately one hour of pharmacist time per patient. A $20 fee is assessed for completed dosing consults. Approximately 50 consults are provided per months, and a survey showed that 50-70% of all hospital patients (except newborns in intensive care) receiving aminoglycosides had their dosages calculated by the service. A carefully developed limited aminoglycoside dosing service provided primarily by baccalaureate-level pharmacists has given the pharmacy department at this hospital an opportunity to further expand its involvement in clinical pharmacokinetics.

Aminoglycosides↗

Humor: a teaching strategy to promote learning.

Staff development educators strive to identify methods to facilitate learners' receptivity to information presented, willingness to explore new ideas, and ability to analyze relationships among concepts. This article focuses on the value of humor as a teaching strategy and suggests methods for its incorporation into educational offerings. A "Humor Profile" is provided to give nurse educators an indication of the degree to which they need to improve their use of humor as a teaching strategy.

Education, Nursing, Continuing↗

The implementation of an integrated on-line health education system at RMIT.

The Faculty of Biomedical and Health Sciences at RMIT has been developing an on-line health education system using a systems thinking approach, to create a learning environment whose basis is supported by Information Technology (IT). The centre-piece of this system is the Faculty Learning Centre, which has been created, both in space and layout, to promote collaborative learning between the students, so that the educator is physically assimilated with the student body. This facility is supplemented by the Faculty WWW server, which has been the main vehicle for course material dissemination to students. To ensure an effective on-line teaching environment, the position of an on-line facilitator has been created, whose responsibilities include both the continual evaluation of the system and the implementation of appropriate system changes. Aspects have included the production of a staff development training program and extensive user documentation. This paper discusses the systems thinking approach used to implement this integrated on-line system, and the establishment of explicit educational rationales in the use of IT to support learning strategies. Some examples of the on-line educational programs are also presented.

Australia↗

Improving patient care through work-based learning.

AIM: To record post-registration community nurses' perceptions of the impact of work-based learning on the quality of patient care. METHOD: Ten nurses were interviewed. Each interviewee, who had successfully completed work-based learning programmes, was asked to describe their impact on the quality of patient care. FINDINGS: The participants valued work-based learning. Four themes emerged where work-based learning contributed to improving the quality of care: increased health promotion, increased access to services, increased patient choice and reduced risk of infection. The relevance of studies and distance learning materials were perceived to be the main aspects that influenced changes in practice. CONCLUSION: The study provides insight into how work-based learning helped staff develop practice. It highlights that time for learning and mentoring are paramount for changes in practice to occur through work-based learning. Further studies are required to establish the best structure and style of distance learning materials needed to meet the needs of post-registration community nurses.

Attitude of Health Personnel↗

Evaluating teaching effectiveness in nursing education: an Iranian perspective.

BACKGROUND: The main objective of this study was to determine the perceptions of Iranian nurse educators and students regarding the evaluation of teaching effectiveness in university-based programs. METHODS: An exploratory descriptive design was employed. 143 nurse educators in nursing faculties from the three universities in Tehran, 40 undergraduate, and 30 graduate students from Tehran University composed the study sample. In addition, deans from the three nursing faculties were interviewed. A researcher-developed questionnaire was used to determine the perceptions of both faculty and students about evaluating the teaching effectiveness of nurse educators, and an interview guide was employed to elicit the views of deans of faculties of nursing regarding evaluation policies and procedures. Data were analyzed using parametric and nonparametric statistics to identify similarities and differences in perceptions within the Iranian nurse educator group and the student group, and between these two groups of respondents. RESULTS: While faculty evaluation has always been a major part of university based nursing programs, faculty evaluation must be approached more analytically, objectively, and comprehensively to ensure that all nursing educators receive the fairest treatment possible and that the teaching-learning process is enhanced. CONCLUSION: Educators and students stressed that systematic and continuous evaluation as well as staff development should be the primary goals for the faculty evaluation process. The ultimate goals is the improvement of teaching by nurse educators.

Adult↗

Secondary school health education related to nutrition and physical activity--selected sites, United States, 2004.

Eating a healthful diet and engaging in physical activity have important health benefits for youths, such as reducing overweight, a condition that affected 17% of those aged 12-19 years during 2003-2004. School health education that includes information about nutrition and physical activity is an important component of a comprehensive approach to improving dietary behavior, reducing sedentary behavior, and increasing physical activity among youths. A previous study suggested that professional development for health education teachers helps ensure the quality of health education instruction. To identify which nutrition and physical activity topics are being taught in school health education courses and what percentage of lead health education teachers have received professional development on nutrition and physical activity, CDC analyzed data from the 2004 School Health Profiles for public secondary schools (i.e., middle, junior high, and senior high schools) serving students in grades 6-12 in 25 states and 10 large urban school districts. This report summarizes the results of that analysis, which indicated that in 2004, approximately one half to three fourths of schools in the participating states and school districts taught all 15 nutrition and dietary behavior topics listed in the School Health Profiles questionnaire in a required health education course, and approximately one third to two thirds taught all 12 physical activity and fitness topics. State and local education agencies should continue to encourage schools to provide education on nutrition and physical activity as part of a coordinated school health program and promote staff development for health education teachers.

Adolescent↗

School health guidelines to prevent unintentional injuries and violence.

Approximately two thirds of all deaths among children and adolescents aged 5-19 years result from injury-related causes: motor-vehicle crashes, all other unintentional injuries, homicide, and suicide. Schools have a responsibility to prevent injuries from occurring on school property and at school-sponsored events. In addition, schools can teach students the skills needed to promote safety and prevent unintentional injuries, violence, and suicide while at home, at work, at play, in the community, and throughout their lives. This report summarizes school health recommendations for preventing unintentional injury, violence, and suicide among young persons. These guidelines were developed by CDC in collaboration with specialists from universities and from national, federal, state, local, and voluntary agencies and organizations. They are based on an in-depth review of research, theory, and current practice in unintentional injury, violence, and suicide prevention; health education; and public health. Every recommendation is not appropriate or feasible for every school to implement. Schools should determine which recommendations have the highest priority based on the needs of the school and available resources. The guidelines include recommendations related to the following eight aspects of school health efforts to prevent unintentional injury, violence, and suicide: a social environment that promotes safety; a safe physical environment; health education curricula and instruction; safe physical education, sports, and recreational activities; health, counseling, psychological, and social services for students; appropriate crisis and emergency response; involvement of families and communities; and staff development to promote safety and prevent unintentional injuries, violence, and suicide.

Adolescent↗

Infection control as a topic for ward-based nursing education.

The link between nursing theory and practice remains a topic of ongoing debate. Related to this issue is the best place to effectively combine the two. The solution may be ward-based teaching programmes as part of formal continuing staff development, involving collaboration between college-based lecturers and acknowledged clinical experts. Using infection control as an example of a topic in need of regular and continual updating for qualified practitioners, it is argued that such programmes would be desirable because they would afford sufficient flexibility to fulfil individual learning needs and could be assessed to indicate whether nursing practice had been enhanced. Participants could be accredited for successful completion of ward-based programmes.

Accreditation↗

Nurses' death anxiety, comfort level during communication with patients and families regarding death, and exposure to communication education: a quantitative study.

The first purpose of this study was to determine if a nurse's death anxiety is related to the comfort level of the nurse during communication with patients and families regarding death. The second purpose was to explore whether nurses reported having been exposed to communication education regarding dealing with difficult subjects such as death and whether this exposure was related to comfort level of the nurse during communication with patients and families regarding death. Findings of this study benefit nurse educators and nurses involved in staff development because the results indicate that comfort level of the nurse during communication with patients and families is adversely affected by an increase in the nurse's own death anxiety, and positively affected by exposure to communication education. Thus, these results indicate a need for education in this area. The next step is to identify the most effective type, objectives, and content of this type of education.

Adult↗

Collaboration not competition: a model for nursing continuing education.

It can be stated that Nursing Staff Development and the Continuing Nursing Educational Department of a university can collaboratively produce effective continuing education for nurses. Their similarities, differences, and duplications can be utilized constructively rather than in a competitive manner. To accomplish this, the two departments could collaborate through a joint committee that has equal representation, equal respect and an equal workload from both departments. The joint committee can reduce the cost and effort of providing continuing education and improve the efficiency and effectiveness of meeting the educational needs of the nursing community.

Education, Nursing, Continuing↗

Communication patterns and group composition: implications for patient-centered care team effectiveness.

To assess how diversity affects team communication and to identify strategies to improve communication and patient care, focus groups of care production team members were held in two case study hospitals that have implemented the patient-centered care model. Results indicate that care production team members generally support patient-centered care as a model that can work effectively in practice, even in an urban environment in which diversity concerns can affect team cohesiveness and communication. Successful implementation of the model, however, requires that hospitals consistently employ management strategies and reward structures that reinforce the value of teamwork and emphasize training and staff development. Key steps that healthcare executives can undertake to improve the performance of care production teams are detailed in this article and center around the following themes: team involvement in process improvement; a heightened emphasis on training (i.e., team and diversity training for all team members, task focused training for nonlicensed care givers; and leadership training for RNs); and the implementation of team-based reward and incentive structures.

Adult↗

Nursing informatics knowledge and competencies: a national survey of nursing education programs in the United States.

An online survey of deans/directors of 266 baccalaureate and higher nursing programs in the U.S. was developed by informatics expert nurses. Participants (1) identified nursing informatics (NI) competencies and knowledge of undergraduate and/or graduate students in their nursing programs; (2) determined faculty preparedness to teach NI and to use informatics tools; and (3) provided perceptions of NI requirements of local practicing nurses. Frequency data and qualitative responses were analyzed. Approximately half of undergraduate nursing programs were teaching information literacy skills and required students to enter with word-processing and email skills. Least visible informatics content at all levels included the use of information system data standards, the Nursing Information and Data Set Evaluation Center criteria, the unified medical language system (UMLS), and the nurse's role in the life cycle of an information system. Almost 50% of respondents perceived faculty as "novice" and "advanced beginners" in teaching and using NI applications. Participants reported no future plans to offer NI training in their region. Findings have major implications for nurse faculty, staff developers, and program administrators who are planning continuing education opportunities and designing nursing curricula that prepare nurses for use of the electronic health record and 21st century professional practice.

Clinical Competence↗

Do nurses perceive that there is a need for defusing and debriefing following the resuscitation of a patient in the accident and emergency department?

Defusing and debriefing are techniques that have been used to prevent staff developing psychological problems such as post traumatic stress disorder (Mitchell, 1988). It has been identified that nurses may be susceptible to a form of post-traumatic stress disorder known as prolonged duration stress disorder (Scott and Stradling, 1994). This study employs a non-experimental survey to identify the current practice of defusing and debriefing in an accident and emergency department and explores nurses' perceptions of the need for defusing and debriefing following the resuscitation of a patient. A theoretical framework of cognitive therapy is utilised to structure the study.

Attitude of Health Personnel↗

Hospitals and medical staffs: the concept of planning takes on new meaning.

Broad trends in health care are redefining medical staff planning. Hospital CEOs are recognizing the critical need to involve their physicians in hospital strategic planning at many levels. Gone are the days when it was sufficient to invite medical staff members to annual planning retreats and add individual physicians to boards; hospitals that thrive in the 1990s will be those that have created strong strategic links with their physicians. At the same time, medical staff development planning is changing in important ways. Recent federal government alerts on fraud and abuse and inurement in physician-recruiting activities are leading hospitals to document community benefit in their recruitment efforts. And hospital executives now realize that changes in the physician market will require them to plan carefully in order to ensure a strong base of primary care and other much-needed physicians. These two trends present CEOs with multilayered challenges. Following are reports on what leading-edge hospitals are doing in both areas.

Community-Institutional Relations↗