Evaluation of the Congruence Between Students' Postencounter Notes and Standardized Patients' Checklists in a Clinical Skills Examination

Background and Purpose: Questions remain about the congruence between students' written notes and checklists as summaries of encounters. Methods: Students examined standardized patients and summarized findings in postencounter notes. The patients completed checklists. A physician read the students' notes and completed parallel checklists to document the history and physical items performed. Rates of under- and overdocumentation were calculated. Results: Students documented findings for 71% of items performed—an underdocumentation rate of 29%. Approximately 94% of their documented findings were consistent with what they had done. Their rate of overdocumentation was 6%, in which they documented findings inconsistent with the checklists. About half the students had no instances of overdocumentation. Conclusion: Students' rate of underdocumentation was comparable to experienced clinicians. Although their overdocumentation rate was low overall, it was high for a few students. Evaluation of the congruence between checklists and postencounter notes provides useful information and informs checklist development.     

Implementation of an interprofessional health education course on abortion care

BackgroundContent on abortion history and methods is notably absent from many health care education programs in Canada. A team of multi-disciplinary professionals and academics launched a minicourse on abortion at a Canadian university as part of the interprofessional education requirement for health professional students. The minicourse covered the legal history of abortion in Canada, clinical guidelines for medication and aspiration abortion, socio-emotional and therapeutic support, and information on contraception.ResultsStudents gained knowledge through both didactic instruction and small group discussion, giving attendees an opportunity to understand their role in supporting patients in collaboration with other health professionals. In response to student feedback, facilitators added content about Indigenous and LGBTQ+ health to the course.ConclusionStudents learned the clinical content and history of abortion with their peers through a framework of social determinants of health. The course will continue to adapt to reflect best practices and socio-political changes.     

What Do Medical Students Do for Self-Care? A Student-Centered Approach to Well-Being

Phenomenon: Despite the promotion of medical student health and wellness through recent program and curricular changes, research continues to show that medical education is associated with decreased well-being in medical students. Although many institutions have sought to more effectively assess and improve self-care in medical students, no self-care initiatives have been designed using the explicit perspectives of students themselves. Approach: Using concept mapping methodology, the research team created a student-generated taxonomy of self-care behaviors taken from a national sample of medical students in response to a brainstorming prompt. The research team examined how students’ conceptualizations of self-care may be organized into a framework suitable for use in programming and curricular change in medical education. Findings: Ten clusters of self-care activities were identified: nourishment, hygiene, intellectual and creative health, physical activity, spiritual care, balance and relaxation, time for loved ones, big picture goals, pleasure and outside activities, and hobbies. Using results of the two-dimensional scaling analysis, students’ individual self-care behaviors were organized within two orthogonal dimensions of self-care activities. Insights: This concept map of student-identified self-care activities provides a starting point for better understanding and ultimately improving medical student self-care. Students’ brainstormed responses fit within a framework of varying levels of social engagement and physical-psychological health that included a wide range of solitary, social, physical, and mental health behaviors. As students’ preferred self-care practices did not often include programmatic activities, medical educators may benefit from consulting this map as they plan new approaches to student self-care and in counseling individual students searching for more effective ways to ease the burdens of medical school.     

‘Health equity through action on the social determinants of health’: taking up the challenge in nursing

REUTTER L and KUSHNER KE. Nursing Inquiry 2010; 17 : 269–280
‘Health equity through action on the social determinants of health’: taking up the challenge in nursing Reducing health inequities is a priority issue in Canada and worldwide. In this paper, we argue that nursing has a clear mandate to ensure access to health and health‐care by providing sensitive empowering care to those experiencing inequities and working to change underlying social conditions that result in and perpetuate health inequities. We identify key dimensions of the concept of health (in)equities and identify recommendations to reduce inequities advanced in key global and Canadian documents. Using these documents as context, we advocate a ‘critical caring approach’ that will assist nurses to understand the social, political, economic and historical context of health inequities and to tackle these inequities through policy advocacy. Numerous societal barriers as well as constraints within the nursing profession must be acknowledged and addressed. We offer recommendations related to nursing practice, education and research to move forward the agenda of reducing health inequities through action on the social determinants of health.     

Nursing students’ knowledge,attitude and readiness to work for clients with sexual health concerns

Aims. To investigate nursing students’ knowledge, attitude and readiness to work for clients with sexual health concerns and to identify strategies to help students develop as they take up their role in sexual health‐related care. Background. There is an increasing global demand for improving sexual health. A better understanding of nursing students’ attitude and readiness to work for clients with sexual health concerns is the beginning of this endeavour. The need to explore strategies for developing competent health care practitioners is timely. Design. A cross‐sectional survey. Methods. Nursing students (n = 377) studying in pre‐ and postregistration programmes were surveyed at a university in Hong Kong using a questionnaire with open‐ and closed‐ended questions about their knowledge, attitude and self‐perception on readiness to work for clients with sexual health concerns. Results. Students’ knowledge of sexual health was satisfactory. They were positive in acknowledging the nursing role in sexual health care, but hesitant in taking up an active role in practice. Students’ readiness to participate in related activities was below satisfactory. Their perception of inadequate knowledge, feelings of anxiety, worries about colleagues’ and clients’ possible adverse responses and inadequate exemplars were major factors affecting their readiness. This paper also highlighted some important learning areas and strategies that could help in enhancing students’ knowledge and confidence in sexual health care practices. Conclusion. Improving the educational programme and clinical practice for nursing students is necessary but may not be adequate. Valuing the affective aspect of education, formal recognition of this extended role and advancing related education to a postexperience level would also benefit the development of sexual health care. Relevance to clinical practice. Preparing more mentors as exemplars, inviting clinicians and managers as partners in sexual health‐related care would help nursing students to work efficiently for clients with sexual health concerns.     

Photo-essay as an assessment strategy for learning about the determinants of health: Students’ experiences

Background

An understanding of determinants of health is critical for nurses to be able to develop effective care plans for their patients; however little work has been published which evaluates learning opportunities for students around the determinants of health.

Implementing and evaluating a community-based,inter-institutional,interprofessional education pilot programme

Many health professions programmes have begun integrating interprofessional learning into their curricula; however, community-based interprofessional education (IPE) initiatives are relatively scarce. The Meharry-Vanderbilt Alliance IPE Faculty Collaborative, comprised of faculty from five institutions, developed a community-based IPE programme that allowed students to engage in meaningful interprofessional activities while exposing them to social determinants of health. Thirty students from ten professions were divided into six teams and paired with three community organisations. Each team engaged community organisation staff and clients to develop practical solutions to their priorities. Teams participated in debriefings and team-building exercises to further support interprofessional learning. Students’ comfort working with others (CWO), value in working with others (VWO), and self-perceived ability (SPA) to work with others were assessed using the Interprofessional Socialisation and Valuing Scale (ISVS). Mean rank scores in all three subcategories increased significantly from baseline (CWO: z = ?4.11, p < 0.0001; VWO: z = ?3.41. p = 0.001; SPA: z = ?2.79, p = 0.005). In addition, programme evaluations suggest the programme improved students’ understanding of social determinants of health. Our findings align with those of two other community-based IPE initiatives and support the expansion of IPE efforts beyond traditional settings.     

Embedding Socio-Behavioral Frameworks in Community Rehabilitation: Evaluation of a Service Change Program

Background: Paradigms which emphasize the social determinants of health and client self-management, and approaches which promote health behavior change, are rarely operationalized within rehabilitation settings. The aim of this study was to investigate the processes required for this model of care change within an existing allied health community rehabilitation service. Methods: The service change program consisted of training elements in the areas of the social determinants of health, client self-management and health behavior change techniques as well as associated operational changes to reflect this paradigm shift. Results: The training packages implemented appear to have improved staff knowledge and skills within these socio-behavioral areas. Clinicians self-reported improvement with client care; however, these changes were not reflected in the chart audit. Conclusions: Clinician training is required to build both knowledge and skills in the areas of the social determinants of health, client self-management and health behavior change principles. In addition, clinicians should be equipped with frameworks to assist with operationalizing these principles.     

What Do Medical Students Do and Want When Caring for “Difficult Patients”?

Phenomenon: Medical students, like physicians, experience negative emotions such as frustration when interacting with some patients, and many of these interactions occur for the first time during clinical clerkships. Students receive preclinical training in the social and behavioral sciences, often including learning about “difficult patient” interactions, yet little is known about their desire for training during clinical education. We explored students’ strategies in these difficult clinical interactions, whether they felt prepared by the curriculum, and what support they would have liked. These data inform proposed strategies for supporting clinical learning. Approach: We interviewed 4th-year students about interactions with patients toward whom they felt negative emotions and sought to identify strategies and supports needed in these interactions. Interviews ended when theoretical sufficiency was achieved. We used qualitative content analysis to organize strategies into themes about areas benefiting from curricular supports. We mapped students’ desired curricular support examples to cognitive apprenticeship teaching methods—modeling, coaching, reflection, scaffolding, exploration, and articulation—and aligned them with traditional pedagogical techniques. Findings: We interviewed 26 medical students (44 volunteered/180 invited). Their strategies formed five themes: finding empathy (with a subtheme of focusing on social determinants of health), using learned communication approaches, anticipating challenging interactions, seeking support, and considering it an opportunity for more responsibility. Students described ideal clinical teaching, including postinteraction debriefs with an emphasis on validating their emotional reactions and challenges. Students mentioned all cognitive apprenticeship teaching methods, most prominently modeling (observing supervisors in such interactions) and supported oral reflection. They also identified a need for faculty and resident development to enact these teaching methods. Insights: Although students use some learned strategies in interactions in which they feel negative emotions toward patients, they desire more preparation and support during their clinical rotations. Their desires map to traditional pedagogical techniques and to methods of cognitive apprenticeship. Our findings point to the need to use these techniques to enhance clinical learning for students who experience emotionally challenging patient interactions.     

Enhancing students' perspectives of health through non-traditional community experiences

• ? The shift in emphasis to community-based health care necessitates that opportunities be provided for nursing students to acquire an understanding of the complex nature of health.
• ? A qualitative study was used to demonstrate the benefits accrued by junior baccalaureate nursing students in non-traditional community settings.
• ? Key themes that emerged from data analysis included definitions of health and illness as context specific, and environmental factors influencing health.
• ? The study demonstrated that learning experiences with diverse communities can broaden students' perspectives and understanding of health behaviours. Students gained an appreciation of the sociocultural variation in meanings of health and illness as well as of the social and political dimensions of health.

     

Preparation for becoming members of health care teams: findings from a 5-year evaluation of a student interprofessional training ward

Setting.?An orthopaedic interprofessional training ward manned by students at a University Hospital.Objective.?To assess to what extent students from different undergraduate programmes evaluated the effects of a 2-week rotation at the ward on their professional roles and the value of teamwork within health care.Method.?A questionnaire was filled in by 841 students by the end of a 2-week rotation at the ward over 5 years. Questions concerned students’ estimate of how the rotation had strengthened their insight into their own future professional role, into other students’ professional roles and into the value of teamwork within health care. Differences between the different student categories and possible associations between the different estimates were statistically analysed.Results.?Students from all programmes reported that the rotation at the student ward had dramatically strengthened their insight about their own future professional role as well as the roles of the other professions and the value of teamwork within health care.Conclusion.?Health care is a complicated system based on cooperation and professionalism. We suggest that interprofessional training of students from all professions within health care should be a part of their education as a worthwhile preparation for their future professional work and to ensure high-quality health care.     

Patterns of use of nonbiomedical medicine services by nonbiomedical medicine providers

OBJECTIVES: The aim of this study was to characterize the patterns of use of nonbiomedical medicine compared to biomedical medicine among providers of nonbiomedical medicine in order to assess the degree of confidence the providers have in nonbiomedical medicine. MATERIALS AND METHODS: Anonymous, self-administered questionnaires were distributed among the providers of care in nonbiomedical medicine clinics in Israel. RESULTS: Ninety-two (92) of 127 questionnaires were completed (73% response rate). Fifty-four percent (54%) were women and 76% were Israeli-born. Nineteen percent (19%) had M.D. degrees and 83% received training in nonbiomedical medicine in Israel. In the course of the 12 months preceding the survey, 62% of the providers were treated by nonbiomedical medicine techniques; of these, 54% chose these techniques as their first treatment of choice. The vast majority (97%) expressed satisfaction with the results of this treatment. Fifty-five percent (55%) stated that they would turn to both nonbiomedical and biomedical medicine in the future for acute medical problems; 28% declared that they would turn first to nonbiomedical medicine, compared to 14%, who said they would turn first to biomedical medicine. A similar result was seen for chronic medical problems. More than two thirds of those who turned to nonbiomedical medicine treatment asked for acupuncture. Eighty-seven percent (87%) of acupuncture providers also preferred this mode of treatment. CONCLUSIONS: Providers of nonbiomedical medicine care prefer to combine nonbiomedical and biomedical medicine treatment for their own acute and chronic medical problems. The preferred method of therapy was acupuncture. These patterns of use demonstrate that providers have confidence in these methods of treatment alongside biomedical medicine.     

OPIOIDS: cultivating interprofessional collaboration to find solutions to public health problems

This study evaluated perceived effectiveness of an interprofessional case-based activity that allowed medical and pharmacy students to engage in problem-solving around the role of social determinants of health (SDOH) in opioid misuse. Students participated in a case-based activity, and then completed a post-activity survey that included five open-ended questions and the Interprofessional Collaborative Competency Attainment Survey. Twelve pharmacy students (100%) and 47 medical students (75%) completed the post-activity survey. Results indicate the activity resulted in a statistically significant increase in student ability to: 1) recognize interprofessional team members’ knowledge, skills, and contributions to the interprofessional team; 2) communicate effectively across professions; and 3) learn with, from, and about interprofessional team members to develop a patient care plan. Students also reported enhanced understanding of treatment considerations with opioid misuse, the role of SDOH, and recognition of the value of interprofessional collaboration in their future practice. This interprofessional case-based activity appeared to promote collaboration among students from different professional programs as they engaged in problem-solving around a contemporary public health issue that intersects their future practices. This activity may serve as a model for health professional programs, practitioners, healthcare systems, and communities that seek interprofessional solutions to combat opioid misuse.     

Organizational determinants of high-quality routine diabetes care

Abstract

Objective. Randomized trials showed that changes in healthcare organization improved diabetes care. This study aimed to identify which organizational determinants were associated with patient outcomes in routine diabetes care. Design. Observational study, in which multilevel regression analyses were applied to examine the impact of 12 organizational determinants on diabetes care as separate measures and as a composite score. Setting. Primary care practices in the Netherlands. Subjects. 11,751 patients with diabetes in 354 practices. Main outcome measures. Patients’ recorded glycated hemoglobin (HbA1c), systolic blood pressure, and serum cholesterol levels. Results. A higher score on the composite measure of organizational determinants was associated with better control of systolic blood pressure (p = 0.017). No effects on HbA1C or cholesterol levels were found. Exploration of specific organizational factors found significant impact of use of an electronic patient registry on HbA1c (OR = 1.80, 95% CI 1.12–2.88), availability of patient leaflets on systolic blood pressure control (OR = 2.59, 95% CI 1.06–6.35), and number of hours’ nurse education on cholesterol control (OR = 2.51, 95% CI 1.02–6.15). Conclusion. In routine primary care, it was found that favorable healthcare organization was associated with a number of intermediate outcomes in diabetes care. This finding lends support to the findings of trials on organizational changes in diabetes care. Notably, the composite measure of organizational determinants had most impact.     

International news

Background: Students often enter graduate healthcare/biomedical schools with insufficient undergraduate instruction in effective writing, yet the ability to write well affects their career opportunities in health care and in scientific research. Purpose: The present study was conducted to determine the value and effectiveness of instruction by faculty with expertise in teaching writing at a writing center at an academic health science center. Methods: Two separate sources of data were collected and analyzed. First, an anonymous campus-wide survey assessed students’ satisfaction and utilization of the university's Writing Center. Second, a nonexperimental objective study was conducted comparing a subsample of students who used versus those who did not receive instruction at the Writing Center on quality of writing, as determined by an evaluator who was blind to students’ utilization status. Results: From the campus-wide survey, more than 90% of respondents who used the center (which was 26% of the student body) agreed that it was a valuable and effective resource. From the objective study of writing quality, students who used the Writing Center were twice as likely as students who did not to receive an A grade on the written assignment, and the blinded evaluator accurately estimated which students

used the Writing Center based on the clarity of writing. Conclusions: The instruction at the Writing Center at our university is highly valued by students, and its value is further supported by objective evidence of efficacy. Such a center offers the opportunity to provide instruction that medical and other healthcare students increasingly need without requiring additions to existing curricula. By developing competency in writing, students prepare for scholarly pursuits, and through the process of writing, they engage critical thinking skills that can make them more attuned to narrative and more reflective and empathetic in the clinical setting.