Maternal and Child Health Graduate and Continuing Education Needs: A National Assessment

Objectives: The purpose of this report is to describe the methodology and results of a recent national assessment of long-term graduate and short-term continuing education needs of public health and health care professionals who serve or are administratively responsible for the U.S. maternal and child health population and also to offer recommendations for future training initiatives. Methods: The target of this needs assessment was all directors of state MCH, CSHCN and Medicaid agencies, as well as a 20% random sample of local public health departments. A 7-page needs assessment form was used to assess the importance of and need for supporting graduate and continuing education training in specific skill and content areas. The needs assessment also addressed barriers to pursuing graduate and continuing education. Respondents (n = 274) were asked to indicate the capacity of their agency for providing continuing education as well as their preferred modalities for training. Results: Regardless of agency type, i.e., state MCH, CSHCN, Medicaid or local health department, having employees with a graduate education in MCH was perceived to be of benefit by more than 70% of the respondents. Leadership, systems development, management, administration, analytic, policy and advocacy skills, as well as genetics, dentistry, nutrition and nursing, were all identified as critical unmet needs areas for professionals with graduate training. Education costs, loss of income, and time constraints were the identified barriers to graduate education. More than 90% of respondents from each agency viewed continuing education as a benefit for their staff, although the respondents indicated that their agencies have limited capacity to either provide such training or to assess their staff's need for continuing education. Program managers and staff were perceived in greatest need of continuing education and core public health skills, leadership, and administration were among the most frequently listed topics to receive continuing education training support dollars. Time away from work, lack of staff to cover functions, and cost were the top barriers to receiving continuing education. While attending on-site, in-state, small conferences was the continuing education modality of first preference, there was also considerable interest expressed in web-based training. Conclusions: Six recommendations were developed on the basis of the findings and address the following areas: the ongoing need for continued support of both graduate and continuing education efforts; the development of a national MCH training policy analysis center; the incorporation of routine assessments of training needs by states as part of their annual needs assessments; the promotion of alternative modalities for training, i.e., web-based; and, the sponsorship of academic/practice partnerships for cross-training.     

Designing education to improve care

BACKGROUND: Educators in all health care disciplines are increasingly aware of the importance and value of teaching improvement as an integral part of health professional development. Although faculty and learners can often identify needed changes in the clinical setting, many educators are not sure how to teach the improvement principles and methods needed to achieve and sustain those changes. DEFINING AND DEVELOPING COMPETENCY IN QI: Five developmental levels apply to physicians, nurses, and other members of an interprofessional quality improvement (QI) team: novice, advanced beginner, competent, proficient, and expert. For example, the expert develops a vast repertoire of skills and a capacity for situational discrimination, performs tasks on a more intuitive level, and recognizes and immediately addresses essential problems. Improvement is an action, and learning about improvement must be action based. Certain skills and knowledge are required at each stage in this learning process so that students in the health professions achieve competence in QI before entering practice. GENERAL PRINCIPLES FOR EDUCATIONAL EXPERIENCES IN HEALTH CARE IMPROVEMENT: Four principles, which apply at any developmental level, can help answer educators' questions about where to start: (1) The Learning Experience Should Be a Combination of Didactic and Project-Based Work; (2) Link with Health System Improvement Efforts; (3) Assess Education Outcomes; and (4) Role Model QI in Educational Processes. CONCLUSION: As educators teach future health professionals about improving care, the dissemination of exemplary models and emerging best practices will be increasingly important. Sustainability of improvements in patient outcomes will be dependent on both the value systems and skills of health professionals entering practice.     

Teaching research and epidemiology to undergraduate students in the health sciences

OBJECTIVE: To identify and address particular challenges in the teaching of epidemiological concepts to undergraduate students in non-clinical health disciplines. METHODS AND RESULTS: Relevant pedagogical literature was reviewed to identify a range of evidence-based teaching approaches. The authors also drew on their experience in curriculum development and teaching in this field to provide guidelines for teaching epidemiology in a way that is engaging to students and likely to promote deep, rather than surface, learning. Discussion of a range of practical strategies is included along with applied examples of teaching epidemiological content. CONCLUSIONS AND IMPLICATIONS: Increasingly, there is a greater emphasis on improved learning outcomes in higher education. Graduates from non-clinical health courses are required to have a core understanding of epidemiology and teachers of epidemiology need to be able to access resources that are relevant and useful for these students. A theoretically grounded framework for effective teaching of epidemiological principles to non-clinical undergraduates is provided, together with a range of useful teaching resources (both paper and web-based). Implementation of the strategies discussed will help ensure graduates are able to appropriately apply epidemiological skills in their professional practice.     

Enhancing Technology Skills of Maternal and Child Health Professionals

Objective: Information technology skills are essential for effective and efficient practice in maternal and child health (MCH). Methods: Prior to the beginning of a web-based analytic skills training course, enrolled MCH professionals confidence in using e-mail and other Internet skills and beliefs about their usefulness were assessed. Results: The assessment showed that participants believed strongly in the value of the specific technology skills but confidence in the ability to use these skills was low. Conclusion: An online technology skills training module was developed based on skills needed for the course to ensure that course participants learned and practiced the technology skills necessary to successfully complete the online analytic skills course. We describe the development, implementation, and results of the online technology skills module.All work for this paper was carried out at the University of North Carolina at Chapel Hill, School of Public Health, Department of Maternal and Child Health, Chapel Hill, North Carolina     

Techniques for teaching electrocardiogram interpretation: self-directed learning is less effective than a workshop or lecture

Medical Education 2011: 45 : 347–353 Context Teaching 12‐lead electrocardiogram (ECG) interpretation to students and residents is a challenge for medical educators. To date, few studies have compared the effectiveness of different techniques used for ECG teaching. Objectives This study aimed to determine if common teaching techniques, such as those involving workshops, lectures and self‐directed learning (SDL), increase medical students’ ability to correctly interpret ECGs. It also aimed to compare the effectiveness of these formats. Methods This was a prospective randomised study conducted over a 28‐month period. Year 4 medical students were randomised to receive teaching in ECG interpretation using one of three teaching formats: workshop, lecture or SDL. All three formats covered the same content. Students were administered three tests: a pre‐test (before teaching); a post‐test (immediately after teaching), and a retention test (1 week after teaching). Each tested the same content using 25 questions worth 1 point each. A mixed‐model repeated‐measures analysis of variance (anova ) with least squares post hoc analysis was conducted to determine if differences in test scores between the formats were statistically significant. Results Of the 223 students for whom data were analysed, 79 were randomised to a workshop, 82 to a lecture‐based format and 62 to SDL. All three teaching formats resulted in a statistically significant improvement in individual test scores (p < 0.001). Comparison of the lecture‐ and workshop‐based formats demonstrated no difference in test scores (marginal mean [MM] for both formats = 12.4, 95% confidence interval [95% CI] 11.7–13.2]; p = 0.99). Test scores of students using SDL (MM = 10.7, 95% CI 9.8–11.5) were lower than those of students in the workshop (p = 0.003) and lecture (p = 0.002) groups. Conclusions Compared with those taught using workshop‐ and lecture‐based formats, medical students learning ECG interpretation by SDL had lower test scores.     

Caring for the underserved: blending service learning and a web-based curriculum

BACKGROUND: Recognition of health disparities among underserved individuals, whose demographic, geographic, or economic characteristics impede access to health-related services, has led to calls for the development of medical school curricula that address care for the underserved, but reports of the development and evaluation of such curricula are limited. METHODS: Two formats of a curriculum addressing care for the underserved were developed and implemented during the 6-week pediatric clerkship for third-year medical students during the 2003-2004 academic year. One format was faculty-led; the other was web-based. Skills for providing care to underserved families were taught through didactic, experiential, and service-learning curriculum components. Novel core curriculum elements included a screening tool for recognizing underserved patients and an independent clinical project through which students linked underserved families with community health resources. Analyses from 2004-2005 compared pre- and post-curriculum knowledge and attitudes of web-based students (n = 29) to those receiving either the faculty-led (n = 36) or the established "readings-only" curriculum (n = 35). Qualitative data from service learning projects were analyzed to assess clinical skills. RESULTS: Compared to students in the established curriculum, both web-based and faculty-led students demonstrated improved knowledge (p < 0.001) and attitudes (p < 0.05) about caring for the underserved. Both web-based and faculty-led students were successful in recognizing and addressing underserved health issues in the clinical setting. CONCLUSIONS: Faculty-led and web-based curricula can equally improve student knowledge, attitudes, and skills about caring for the underserved.     

A conceptual framework for developing teaching cases: a review and synthesis of the literature across disciplines

Case-based teaching is regarded as a superior instructional method compared with lectures in promoting a learner's critical thinking skills. While much is known about the role a discussion facilitator plays in case-based teaching, the debate on the influence of the format and structure of cases on learning is controversial. We sought to identify strategies for constructing cases based on studies from multiple disciplines, which report the development and use of cases in teaching and learning. The purpose was to offer the medical and other educational communities a conceptual framework that can be examined in future research. Based on a review of 100 studies, we synthesised 17 strategies around 5 core attributes of cases: relevant (level of learner, goals and objectives, setting of case narrative); realistic (authenticity, distractors, gradual disclosure of content); engaging (rich content, multiple perspectives, branching of content); challenging (difficulty, unusual cases, case structure, multiple cases), and instructional (build upon prior knowledge, assessment, feedback, and teaching aids). Despite the wide use of cases in disparate disciplines, there has been no overarching study that synthesises strategies of case development or tests these strategies in research settings. The framework we developed can serve as a menu of case development options that educators and researchers can pilot and evaluate in their local settings.     

Video recording feedback: a feasible and effective approach to teaching history-taking and physical examination skills in undergraduate paediatric medicine

Medical educators have always recognized the need to teach and train medical graduates and undergraduates the skills of conducting a consultation. Several authors have established the efficacy of using constructive feedback on videotape of each student's interaction with a patient to teach and enhance such skills. This study reports `students' perceptions' of the feedback process used in the Junior Paediatric Clerkship at the Faculty of Medicine of the United Arab Emirates University. An unexpected 73% of the respondents believed that self-observation influenced development of their clinical skills. More than 80% said that the feedback from instructors and peers helped them to improve their clinical skills, but they would have liked to have more than one of their consultations recorded and reviewed. It was found that 75% of the students felt that self-critique of their performance made them aware of their strengths and weaknesses and their skills in analysing and evaluating consultations had been enhanced. It was found from Kruskal Wallis one-way ANOVA that the students' professional attitude, empathy, and warmth towards the patients differed highly significantly ( P  = 0·0062, 0·0089, 0·0007, respectively) from self-assurance, self-confidence and competence. They were also deficient in certain areas of history-taking, interviewing skills, and physical examination techniques and perceived they needed more training in order to be proficient.     

Structured teaching methods enhance skill acquisition but not problem-solving abilities: an evaluation of the 'silent run through'

OBJECTIVES: We aimed to evaluate whether a structured teaching technique (the silent run through) was of benefit in the learning of a skill sequence, and whether it would affect students' ability to improve their problem-solving skills or ability to make judgements. DESIGN: Students from one hospital were taught two different complex skills using a highly structured teaching method involving the breakdown of complex tasks into smaller components and the utilization of an internal, silent 'commentary'. Their subsequent ability to reproduce these skills was compared with a second group of students taught at another hospital. All students were assessed during a common end of attachment Objective Structured Clinical Examination on the two skills, by raters blind to the teaching techniques the students had received. SETTING: School of Medicine, University of Leeds, UK. SUBJECTS: Medical students. RESULTS: Students who received the structured teaching were significantly better at reproducing a complex, sequential clinical skill (examination of a squint). There was no demonstrable improvement in problem-solving skills as assessed on an X-ray interpretation station. Students expressed high levels of satisfaction with learning skills in such a structured way and reported increased confidence in their examination skills. CONCLUSIONS: This study provides some evidence to support the hypothesis that different teaching techniques may be more effective for improving different elements of skills learning. In particular, a highly structured technique involving breaking complex tasks down into smaller components and utilizing an internal 'commentary' may be an effective way of teaching the sequential motor components of complex clinical skills.     

Meeting the challenge of prescribing and administering medicines safely: structured teaching and assessment for final year medical students

OBJECTIVES: To promote safe prescribing and administration of medicines in the pre-registration house officer (PRHO) year through a programme of structured teaching and assessment for final year medical students. DESIGN: Forty final year medical students from two medical schools were randomly allocated either to participate in a pharmacist facilitated teaching session or to receive no additional teaching. Teaching comprised five practical exercises covering seven skills through which students rotated in small groups. One month later, a random sample of 16 taught and 16 non-taught students participated in a nine-station objective structured clinical examination (OSCE) to assess the impact of the teaching. SETTING: Manchester School of Medicine (MSM), and Kings College School of Medicine and Dentistry (KCSMD). PARTICIPANTS: Final year medical student volunteers. MAIN OUTCOME MEASURES: The need for teaching as indicated by student prior experience; questionnaire rating of student acceptability of teaching and assessment; self-rating of student confidence post-assessment, and student performance assessed by OSCE. RESULTS: The study demonstrated that the taught group achieved higher scores in eight OSCE stations. Four of these were statistically significant (P < or= 0.005). Taught students felt more confident performing the skills on five stations. From 0 to 47.5% students had prior experience of the skills taught. The post-teaching questionnaire evaluated exercises positively on several criteria, including provision of new information and relevance to future work. CONCLUSIONS: Structured teaching provided an effective and acceptable method of teaching the medicines management skills needed in the PRHO year. The structured approach complemented variable precourse clinical experience.     

Identifying characteristics that students, interns and residents look for in their role models

OBJECTIVE: To identify characteristics which students, interns and residents look for in their role models. METHODS: A 45-item self-administered questionnaire was sent to a sample (n=96, response rate 80%) consisting of three groups: (1) students in years 3-6 of the medical curriculum (n=66); (2) interns (n=17) and (3) residents (n=13). The questionnaire contained characteristics that participants might use to describe excellent role models, grouped under five general headings: personality, clinical, research and teaching skills, and community service. Other characteristics mentioned by study subjects were qualitatively analysed using content analysis. RESULTS: Personality and teaching and clinical skills were ranked as the top three factors, and research skills and community service as the least important factors by 79 (82%) respondents. Qualitative analysis of characteristics described by respondents for their role models yielded 21 characteristics. These were clustered into three main themes: role models as teacher, physician and person. The most frequently mentioned characteristics were personal characteristics such as positive, respectful attitudes toward patients and their families, and staff and colleagues; honesty; politeness; enthusiasm; competence, and knowledge. Females rated nine personal characteristics significantly higher than males (P < 0.05). Interns and residents valued teaching enthusiasm and competence significantly more than students (P=0.01). Role models had a strong influence on the specialty choice of 53 (55%) respondents. CONCLUSION: Knowing the characteristics of excellent role models should help medical educators to formulate strategies to recruit, retain and develop them. Increasing exposure of a variety of excellent role models to aspiring medical practitioners should be encouraged.     

The MCH Certificate Program: A New Path to Graduate Education in Public Health

Objective: The purpose of the MCH Certificate Program was threefold: to develop a new educational initiative in response to national and local demands for increased MCH workforce capacity, to eliminate key financial and nonfinancial barriers to advanced MCH academic preparation, and to improve rates of recruitment and retention of students from minority communities, thus enhancing the quality of MCH services available to the region. Methods: An MCH Certificate Program, designed for clinicians (e.g., nurses, occupational therapists and nutritionists) and public health practitioners as a bridge to graduate programs in public health, combined a competency based curriculum with skills workshops, leadership seminars, mentoring, small group activities, and an interactive teaching format. Results: Students from the first two cohorts (n = 45) report an expansion of core public health knowledge (issues, policies, and strategies), enhanced self-confidence, and efficacy. Half have experienced job changes that represent increased responsibility, leadership, and professional advancement. A third are enrolled in or have completed a formal program of graduate study in MCH. Conclusions: This innovative MCH Certificate Program, now in its fourth year, is a new approach to increasing workforce capacity and a successful model of instruction for adult learners. It has the potential for adaptation to a variety of educational settings and MCH populations, and helps to expand the continuum of MCH training experiences in schools of public health.     

Resources for Advancing Family Gerontology Education and Practice*

Abstract: The unprecedented growth in the older adult population combined with increased scholarly interest in family dynamics has resulted in the gradual expansion of family gerontology as its own area of study. Consisting of both university faculty and practitioners, family gerontology educators integrate multiple disciplines in order to teach about later life families and are responsible for training diverse audiences. To increase awareness about family gerontology and encourage the advancement of this interdisciplinary field, we conducted a comprehensive review of educational resources specific to family gerontology. Our goal was to enable a wide range of educators to introduce or expand their emphasis on families in later life and to incorporate new resources, topics, and teaching strategies that promote family gerontology education.     

Communication skills for behaviour change in dietetic consultations

Background: Both the UK’s National Health Service (NHS) and the National Institute of health and Clinical Excellence (NICE) have recommended increased training for health professionals in communication skills. There is evidence to suggest that communication skills are important in helping people to change health‐related behaviour, which is a key role for dietitians. This study investigated the views of UK dietitians about their training needs and experience in relation to communication skills in dietetic practice. Methods: In October 2007, a cross‐sectional survey was mailed to all British Dietetic Association members (n = 6013). The survey gathered quantitative data and free‐text comments to ascertain the level, type and effect of communication skills training received by dietitians at both the pre‐ and post‐registration level. Results: There were 1158 respondents; a response rate of 19.3%. Ninety‐eight percent (n = 1117) rated communication skills as either very or extremely important in client consultations. Post‐registration training had been undertaken by 73% (n = 904). Of these, over 90% of respondents perceived that post‐registration training had led to improvements in their relationships with patients, their confidence in client interviews and their ability to cope with challenging clients. However, 248 (21.4%) felt time keeping in interviews had worsened. Lack of time for client interviews was also the most commonly identified barrier (19%, n = 216) to implementing the skills. Conclusions: This study has explored an important and under‐researched area. Respondents strongly endorsed the importance of good communication skills and the benefits of post‐registration training in this area. Some felt that good communication was time consuming but others felt that time management had improved. Further research and training is required to support the implementation of these skills into dietetic practice.     

Utilization of Maternal and Child Health handbook in Japan

OBJECTIVES: In Japan, Maternal and Child Health (MCH) handbook have been widely used for more than fifty years. However, there has been no evaluation research from the users' point of view. We therefore conducted a questionnaire survey of guardians to evaluate how they utilize MCH handbooks. METHODS: A well-structured questionnaire survey was carried out in 231 municipalities, towns and villages of four prefectures (Gifu, Hiroshima, Niigata and Shizuoka) and one city (Yokohama) in November and December 1999. The targets were 13,271 guardians who visited health stations for 18-month examinations of their children and agreed to participated in our research. The questionnaire covered situation of usage and loss by guardians, utility from the users' perspective, and suggestions for improvement. RESULTS: We obtained answers from 10,900 guardians. As for reading rate and writing rate, 98.3% of respondents had read and 97.8% of them had written down something in relation. Only 0.9% of respondents had lost this MCH handbook. Generally, 87.0% of respondents answered that MCH handbook was helpful for child bearing and 81.6% of them said the record for immunization was useful. However, 34.1% of respondents answered it was not simple to utilize MCH handbook and 60.6% of them requested more detail on child bearing. As for dental health, the completion rate for information was low and only 21.3% of respondents reported for the dental record was useful. CONCLUSIONS: The research shows MCH handbook are highly utilized in Japan by almost all guardians. However, there are still problems to be solved; many guardians feel that they are not simple to use and the section on dental health is not highly particularly helpful. Improvements should be made in future in light of the viewpoints of guardians and parents.     

Disease prevention and health promotion: a study of medical students and teachers

All students at the Royal Free Hospital School of Medicine (n = 508 ) were surveyed on their self-reported smoking and drinking habits, attitudes to disease prevention and health promotion in general, attitudes towards the teaching of disease prevention and health promotion, and their perception of what was taught at the beginning of the 1993–1994 academic year (response rate 75.2%). The teaching staff (n = 271 ) were also surveyed on their attitudes towards the teaching of disease prevention and health promotion, and their perception of what was taught (response rate 74.2%). Seventeen per cent of the students reported they were current smokers and 81% drank alcohol. Four factors were extracted from the responses to the items on disease prevention and health promotion in general and these represented the importance of health, a patient-centred approach, patient responsibility and a doctor-centred approach. Clinical students and those who were older were more likely to have a ‘patient-centred’ approach to disease prevention and health promotion. Sixty per cent of clinical and 44% of pre-clinical teachers aimed to teach about disease prevention and health promotion. The topics reported by students as most likely to have been taught in detail are smoking and health, alcohol and health, immunization, and breast and cervical screening. However, all these topics were reported as having been taught in detail by less than 50% of the students. The majority of students and teachers believe that teaching about disease prevention and health promotion should be integrated into all years of the curriculum and all clinical firms. Teachers were significantly less likely than students to believe that students should learn more about disease prevention and health promotion, and that learning about prevention is as important as learning about diagnosis and treatment. We believe that, in order to build on the positive features highlighted in this study, agreed aims and objectives should be developed and teaching about disease prevention and health promotion should be integrated both horizontally and vertically throughout the curriculum.     

What should we teach about disability? National consensus on disability competencies for health care education

BackgroundHealth care providers are unprepared to meet the health needs of patients who have disabilities. Disability training is needed, yet there is little agreement about what should be taught.ObjectiveEstablish a national consensus on what healthcare providers across disciplines need to know to provide quality care to patients with all types of disabilities (e.g., mobility, sensory, developmental, mental health).MethodsPeople with disabilities, disability advocates, family members of people with disabilities, disability and health professionals, and inter-disciplinary health educators systematically evaluated and provided feedback on a draft set of disability competencies. Based on this feedback, competencies were iteratively refined.ResultsAfter two waves of feedback, six competencies, 49 sub-competencies, and 10 principles and values emerged that addressed topics such as respect, person-centered care, and awareness of physical, attitudinal, and communication health care barriers. An overwhelming majority (89%) agreed or strongly agreed that the disability competencies reflected the core understandings needed to provide quality care for patients with disabilities, were relevant across disability types (85%), and across health care disciplines (96%). Averaging evaluative feedback across competencies, participants reported that the competencies were important (98%) and clear (96%).ConclusionsThis consensus on what to teach is an important milestone in preparing a disability competent health care workforce. Future directions for research, training, and policy are discussed. When disability is included in health care education, the health care workforce will be prepared to deliver accessible, patient-centered, quality health care to patients with disabilities.     

Teachers' Beliefs Concerning Teaching about Testicular Cancer and Testicular Self-Examination

ABSTRACT: This study compared high school health teachers' beliefs concerning teaching about testicular cancer (TC) and testicular self-examination (TSE) to actual instruction. The Teachers' Testicular Cancer Beliefs Survey was developed, using the Health Belief Model (HBM) as a theoretical framework. Multiple regression analysis of HBM subscales determined perceived seriousness of TC was the most significant predictor (p < .05) of TC instruction. Perceived barriers to teaching about TSE was the most significant predictor (p < .05) of TSE instruction. Male health educators were more likely (p < .001) than females to teach about TC and TSE. Teachers having previous preparation in TC and TSE provided more instruction (p < .001) than those without. Less than half of respondents provided TC instruction, while TSE instruction was provided by less than one-third. Comprehensive cancer prevention and early detection education, including strategies for teaching about TC and TSE, should be part of each health teacher's training.