Developments in post-registration education and practice.
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Education, Nursing, Continuing↗
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Role expansion. Performance punishment or professional opportunity?
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Education, Nursing, Continuing↗
Improving performance at the local level: implementing a public health learning workforce intervention.
In an effort to continually improve performance of the essential public health services with community partners, the diverse public health workforce in a major metropolitan area engaged in an organizational learning process. Core public health organizational competencies, identified in a multi-year collaborative applied research initiative, provided the curricula content for the public health learning experience. All members (about 600) of the Columbus and Franklin County (Ohio) Health Departments participated in four one-half day small group, highly interactive modules conducted during a 2-year period. The purpose of this article is to describe the design and implementation of this workforce intervention, the lessons learned, and implications for developing organizational capacity and improved performance.
Competency-Based Education↗
The incidence of malignant melanoma in the United States: issues as we approach the 21st century.
The risk of malignant melanoma developing in an American in the United States has now reached 1 in 87 (up more than 1800% since the 1930s). This rising incidence of malignant melanoma is, in fact, real because (1) it is not due to increased surveillance; (2) it is not due to better cancer-counting methods in general; (3) it is not due to changes in histologic diagnostic criteria; (4) it is being noted worldwide; and (5) most importantly, despite rising survival percentages, the mortality rate from malignant melanoma also continues to rise. On the basis of these trends, incidence rates for malignant melanoma will continue to rise for at least the next 10 to 20 years, although the demographics of those affected may change. Effective programs to improve public and professional education must be developed to enhance early clinical detection and behavioral changes. An establishment of a National Melanoma Registry is needed to more effectively assess the magnitude and impact of future incidence and the success of prevention program efforts into the next century.
Adult↗
Genetic testing and informed consent.
OBJECTIVES: To discuss unique issues related to cancer predisposition genetic testing and informed consent. DATA SOURCES: Published professional articles, review articles, research articles, clinical practice, position statements, websites, and textbooks. CONCLUSIONS: The discovery of germline mutations that confer a predisposition for the development of cancer will continue. The provision of adequate information is central to the process of genetic counseling and testing so that individuals may give informed consent and make choices appropriate to their own specific circumstances. IMPLICATIONS FOR NURSING PRACTICE: The use of genetic information for the management of cancer will impact the practice of all oncology nurses in the coming years. Knowledge of genes that predispose for cancer and standards that delineate essential components of quality care during the informed consent process is vital.
Confidentiality↗
Better safe than sorry--why patients prefer to stop using selective serotonin reuptake inhibitor (SSRI) antidepressants but are afraid to do so: results of a qualitative study.
BACKGROUND: Patients need to be informed not only about the effects and side-effects of their prescribed antidepressants such as selective serotonin reuptake inhibitors (SSRIs), but also about the consequences of stopping treatment with this medication. However, the professional guidelines on how to inform patients about stopping are not well developed and no consensus has yet been reached. This study focuses on the dilemmas involved in continuing or stopping the use of SSRIs from the perspective of the users and explores why these dilemmas tend to be solved by continuing rather than stopping. METHODS: A qualitative study of the views of 16 SSRI users in The Netherlands was performed. Most interviews were conducted at the subject's own home, and all were tape-recorded with permission, and transcribed verbatim. The analysis is based on grounded theory, aiming at the systematic development of theories and hypotheses through the inspection of interview responses. Emerging themes were discussed and refined using the constant comparative method. RESULTS: The SSRI users in this study had reached a certain balance after a period of trial and error. Feeling good could mean doing without these medicines, but could equally be because of the continuing use of these medicines. The SSRI users explained that it would be normal to stop at some time in the future. Some tried to stop but did not succeed, because they experienced serious drawbacks, so they continued, although they feared addiction and hoped that they would be able to stop at a later date. Others had never tried to stop, but said that they would like to because it is not normal to stay on this treatment forever. However, they were afraid that they would lose the balance that they had achieved in living a normal life. To support their choice of continuing SSRI use, they presented reasons why, in their case, this continuation was necessary. They all feared or had experiences with drawbacks, and were concerned and uncertain because of contradictory professional and lay messages about stopping the use of antidepressants, especially SSRIs. The fear and uncertainty about stopping without sufficient guidance were stronger than the fear and uncertainty about continuing. Users tended to stay on the safe side: better safe than sorry. DISCUSSION: The fact that users mentioned their arguments for continuing so explicitly implies that they regarded their SSRI use as problematic and ambivalent. They feared that there would be problems in stopping, and mentioned disagreements on this subject among professionals and in the media. Users saw doctors as important in tackling their fears. Doctors could play an active role in the process of discontinuation, but they have to be aware that as soon as users lose their balance and are unable to live a normal life they will probably decide to continue. Greater agreement on guidelines is needed to support doctors in this matter, when both the patient and the doctor have decided to stop treatment.
Adult↗
Current state of distance continuing medical education in North America.
BACKGROUND: Every continuing medical education (CME) provider is confronted one day or another with deciding whether to develop distance education programs that may enhance access to CME for health professionals. To make a judicious decision, one needs to understand the features of distance education and the experiences of other providers. METHODS: Since there was a lack of information in the literature regarding the actual state of distance CME in North America, a Web-based survey aimed at CME providers was conducted including a description of the providers, the users, the activities offered, the technologies employed, and the administration of the systems. RESULTS: The results from this study indicate that the majority (68%) of CME providers had not developed distance education programs at the time of the survey; 30% of the providers, mainly from private companies, were offering nondegree distance education programs, and 2% of the university providers were offering degree programs. The technologies mainly used to develop distance education programs were printed material (69%), videoconferencing (58%), and, to a lesser degree, videotape. The revenue sources to develop degree programs were government funding, tuition, and fees. Other sources such as commercial support and sales were used for nondegree programs. IMPLICATIONS: This study revealed that there was considerable interest in distance education, especially from the organizations not offering this type of program. Since distance CME features are now better known, this is a step toward the advancement and development of more and better distance education programs.
Education, Distance↗
Practitioner competency assessment and career ladders as a recruiting and retention tool.
The assessment of competency for respiratory care practitioners involves a thorough understanding of what defines competence, the development of a well-planned, continuous process that starts with new employee orientation, and a clearly communicated set of staff expectations. Career ladders are a tool that can be used to aid staff retention and recruitment, thereby reducing multiple costs associated with a high employee turnover rate, and to encourage professional development and accountability while achieving important departmental objectives.
Career Mobility↗
Management coursework in graduate behavioral health programs.
Many behavioral health professionals eventually assume managerial roles; therefore the extent to which graduate behavioral health programs adequately prepare them for these roles is of concern. To examine this issue, directors from graduate behavioral health training programs were surveyed about whether organizational behavior coursework was routinely provided to their students. Results indicated that while this coursework was provided in most social work and psychiatric nursing programs, only a minority of clinical psychology and psychiatry residency programs offered it. These findings suggest that psychiatrists and psychologists may need more preparation than their non-doctoral-level colleagues to assume administrative positions, and that health administration programs may do well to develop continuing education programs geared specifically toward these groups.
Administrative Personnel↗
British nurses in behavioural psychotherapy: a 25-year follow-up.
BACKGROUND: The National Service Framework for Mental Health has emphasized the need to prioritize the provision of cognitive behaviour therapy as the central evidence-based non-pharmacological intervention for mental health problems. For 25 years one programme (English National Board Course No. 650--Diploma in Behavioural Cognitive Therapy, formerly called Nursing in Behavioural Psychotherapy) has trained nurses in such methods. This is the only programme in nursing which qualifies graduates to be fully certified as a cognitive behaviour therapist by the British Association of Behavioural Psychotherapy and by the United Kingdom Council for Psychotherapy. The practice of these nurse therapists (most commonly known as nurse behaviour therapists, NBTs) is the most rigorously evaluated in mental health nursing, with several randomized controlled trials to testify to clinical and economic efficacy. AIM: The aim of this study is to continue the systematic follow-up of all NBT graduates previously undertaken in two earlier surveys published in 1986 and 1994. These previous surveys examined clinical practice, organizational context and career and professional development issues. This up-to-date picture of NBTs will provide useful baselines for the implementation of the National Service Framework, and may be used by the Department of Health, education providers and services. METHOD: A postal survey (using the same template for categories of information as the two earlier surveys) was used and questionnaires were sent to 237 of the 274 trained NBTs whose name appears on the Central NBT Register, maintained at the Institute of Psychiatry/Maudsley Training Centre. RESULTS: One hundred and five of 230 eligible respondents (45.6%) returned questionnaires and additional data were obtained from 27 NBTs who provided information to the Register in the year before the survey. Thus, some data were available for 57% of the sample. As in earlier surveys, it was found that the majority of therapists remain in clinical practice, undertake substantial further education and training and are involved in research and teaching as part of their overall role. The two central developments are an increasing move towards working in primary care and an increased emphasis on cognitive interventions. NBTs complete a substantial number of treatments per year and increasingly treat clients with difficulties not encountered during their basic training. NBTs now receive much more supervision than in previous surveys and continue to use valid and reliable measures of change in practice. However, the number of NBTs remains small and the impact on potential populations who would benefit from effective psychological interventions is minimal. This paper discusses the implications for service delivery.
Behavior Therapy↗
Patient group directions: training practitioners for competency.
Since the mid-1990s, three new initiatives have been introduced by the government to allow the prescribing of medicines by practitioners other than doctors: extended nurse prescribing, supplementary prescribing and patient group directions. Professional education and assessment is vital to ensure that these systems operate safely. After the implementation of patient group directions within a regional cancer centre, a training programme was developed, incorporating an assessment framework for competency development.
Clinical Competence↗
Early speech- and language-impaired children: linguistic, literacy, and social outcomes.
The aim of this study was to follow-up prospectively a cohort of preschool children originally recruited from successive referrals to speech and language therapy community clinics and to investigate their linguistic, literacy, and social outcomes at 7 to 10 years of age. Three hundred and fifty children aged 84 to 113 months (mean age 99.9mo [SD 5.4mo]) were singletons from monolingual backgrounds where there was concern about their speech and language development. Children who had severe learning difficulties, autism, oromotor deficits, dysfluency, or dysphonia were excluded. Altogether 196 (56%), 134 males and 62 females, were seen at follow-up. A control group of children who had never been referred for speech and language therapy, 57% of whom were males, was also recruited (n=94; mean age 104.4mo [SD 6.8mo]). All children were assessed on standardized measures of speech, language, and literacy. Teachers and parents completed questionnaires on educational and social outcomes. In total, 139 children in the cohort were within the normal range on standardized language assessments. About 30% of the original cohort of children continue to struggle with language, literacy, and social difficulties. The study demonstrates the long-term nature of language impairment and reinforces the need for awareness among professionals in child development and education of the ongoing needs of this population of children.
Age Factors↗
[Profile of the physician registered in the National Program of Continuous Academic Development for the General Physician].
A descriptive, transversal study was done on 881 physicians taking the National Program of Continuous Academic Development for the General Physician (PRONADAMEG) at 27 sites during the second semester of 2002. The general purpose of the study was to determine the sociodemographic, academic, and professional profile of the physician enrolled in the program, as well as their opinion on the program and their need for education. Age of enrolled physicians is between 35 and 54 years (70.6%), sex distribution is equal, and 66% of physicians are married. Ninety four percent have a medical practice that takes up the majority of their time. The study showed that 66.4% of physicians worked at public institutions, mainly at the Mexican Institute of Social Security (IMSS) and the Mexican Health Ministry (SSa). One physician trainied outside of Mexico, and 12.2% have a speciality in family medicine. Of physicians in the study, 32% participated informal continuous medical education and used medical journals for this purpose. The program was seen as helpful by 89% of physicians in the study, and the study suggests that knowing the profile of physicians enrolled in the program will allow academic planning for the program and the true needs for education general physicians.
Education, Medical, Continuing↗
Evaluation of the ACRRM national radiology program for Australian rural and remote medical practitioners.
INTRODUCTION: In 2000, the Australian College of Rural and Remote Medicine (ACRRM) developed a national radiology quality assurance (QA) and continuing medical education (CME) program for rural and remote non-specialist Australian doctors. The program commenced on 1 January 2001. It required rural doctors to obtain 30 radiology QA/CME points over a 4 year period. At least 15-20 of these points had to be obtained by one of two mandatory options of the program, either: (1) film interpretation, report and review clinical audit activity; or (2) a radiology clinical attachment. METHOD: Doctors submitted their completed film review forms and clinical attachment logbooks to the program manager as confirmation of their educational activity to receive their professional development points. Data from film review forms and clinical attachment logbooks were de-identified and entered into two Microsoft EXCEL spreadsheets. The data were categorised and analysed in EXCEL. RESULTS: From 1 January 2001 to September 2004, 823 rural and remote doctors enrolled in the ACRRM radiology program. This included 281 locums who enrolled in the short-term locum option of the program and 563 doctors who enrolled in the full program. In September 2004, 419 doctors had completed a radiology film review with a radiologist and 41 doctors completed a radiology clinical attachment in 31 different public and private radiology practices. One hundred and ninety-five doctors completed the short-term locum activity. Ninety-two different specialist radiologists participated in the program and assisted rural and remote doctors to enhance their radiology knowledge, confidence and skills. This article describes results from the two mandatory activities. CONCLUSION: The evaluation of the ACRRM radiology program after its first 3 years and 9 months shows there are a large number of rural and remote Australian doctors undertaking professional development and quality assurance activities in radiology.
Attitude of Health Personnel↗
[Liberal medicine and the labor market in health care. What is liberal medicine?].
This article analyses the practice of what is termed "liberal medicine"--which has paralleled developments in how society is organized--and examines its historical and social determinants. The evolution of the term "liberal" over the centuries, to its present meaning of "practicing the profession as a self-employed physician," is discussed. The author continues the analysis by describing the liberal practice of medicine in the context of the terms of trade in the market for health services and professionals, which lead them to become small-businessmen in their profession. Liberal medicine develops when the unrestricted supply and demand for goods and services reaches the point where production and consumption are determined by systematic trade in a free market, without the restrictions and ties of an outdated social order. But legitimacy and controls related to the rules and regulations of the State, and of professional organizations do exist. This field of study will be examined further in future publications by the author, and by others interested in the problems of the labor force in the health sector.
Health Services Needs and Demand↗
Time for hard decisions on patient-centred professionalism.
Patients want doctors who are competent, respectful, honest and able to communicate with them. That is patient-centred professionalism. Professional self-regulation, as practised hitherto, has failed to achieve this for all patients. In the United Kingdom, a new way of looking at professional regulation has been developed--as a partnership between public and doctors. At its heart is a code of good practice, agreed between public and profession, in which doctors' licence to practise is conditional on regularly demonstrating continuing compliance. That means revalidation-relicensure.
Clinical Competence↗
The role of staff development in promoting BSN programs.
Staff development is undergoing rapid change in the current health care environment. One issue of critical importance is providing access to credit courses for nurses who want to obtain a Bachelor of Nursing (BSN) degree. A university and hospital collaborated to provide learning opportunities jointly for nurses to work toward completion of a BSN using the off-campus concept.
Education, Continuing↗
Novice to expert: an application of the Dreyfus model to management development in health care.
It has been the intent of the authors to describe a management development method which has as its basis a way to differentiate methods for skill development based on levels of skill acquisition. The intent is to provide an efficient and effective framework within which management development can occur as well as to test the utility of the Drefus model in the critical arena of developing management talent in health care environments. Further work and experience with both the model and the skills identified will continue.
Hospital Administrators↗