Shared Decision Making in Common Chronic Conditions: Impact of a Resident Training Workshop

Problem: Physicians must be competent in several different kinds of communication skills in order to implement shared decision making; however, these skills are not part of routine medical student education, nor are they formally taught during residency training. Intervention: We developed a 1- and 2-hour workshop curriculum for internal medicine residents to promote shared decision making in treatment decisions for four common chronic conditions: diabetes, depression, hypertension, and hyperlipidemia. The workshops included a written case exercise, a short didactic presentation on shared decision-making concepts and strategies for risk communication, and two role-playing exercises focused on decision making for depression and hyperlipidemia treatment. Context: We delivered the workshop as a required component of the resident curriculum in ambulatory medicine. To evaluate the impact of the workshop, we used written course evaluations, tracked the use of the newly introduced Decision Worksheets, and asked preceptors to perform direct observation of treatment decision conversations. Outcome: Residents were involved in the development of the workshop and helped identify key content, suggested framing for difficult topics, and confirmed the need for the skills workshop. One hundred thirty internal medicine and medicine-pediatrics residents attended 8 workshops over a 4-month period. In written cases completed before the workshop, the majority of residents indicated that they would discuss medications, but few mentioned other treatment options or documented patients’ goals and preferences in a sample encounter note with a patient with new depression symptoms. Overall, most participants (89.7%) rated the workshop as excellent or very good, and 93.5% said that they would change their practice based on what they learned. Decision Worksheets addressing diabetes, depression, hyperlipidemia, and hypertension were available on a primary care-focused intranet site and were downloaded almost 1,200 times in the first 8 months following the workshops. Preceptors were able to observe only one consult during which one of the four topics was discussed. Lessons Learned: Internal medicine residents had considerable gaps in shared decision-making skills as measured in a baseline written exercise. Residents provided valuable contributions to the development of a Decision Worksheet to be used at the point of care. Participants rated the skills workshop highly, though interns rated the exercise more useful than PGY-2 and PGY-3 residents did. The Decision Worksheets were accessed often following the sessions; however, observing the Decision Worksheets in use in real time was a challenge in the resident-faculty clinic. Additional studies are warranted to examine whether the workshop was successful in increasing residents’ ability to implement skills in practice.     

Closing the gap: training for healthcare workers and people with disabilities on the interrelationship of HIV and disability

Abstract

Background: HIV and disability are interrelated providing a double burden to HIV endemic countries in East and Southern Africa and their already fragile health systems. Although literature reveals that people with disabilities are particularly vulnerable to HIV and that HIV, its opportunistic infections and treatments can cause disability, only few interventions target this issue and none have been evaluated in this region. Methods: Formative evaluation was undertaken with regard to the effectiveness of a workshop-based intervention for healthcare workers and people with disabilities on the intersection of disability and HIV in order to inform the further development of this intervention. The formative evaluation assessed participants’ perception of the inclusion of disability in HIV services and of opportunities to initiate change after the workshops. It also captured their experiences in utilising knowledge and skills after the workshops using quantitative (short checklist and ranking exercise) and qualitative (semi-structured interviews) methods of inquiry. Frequencies and conventional content analysis were used in the analysis of the data. This study presents an example of applied research conducted under real-world conditions. Results: 60 healthcare workers and people with disabilities took part in this pilot workshop training and participated in the formative evaluation. Healthcare workers and people with disabilities alike identified various barriers to access health services. Reasonable accommodation was perceived as being mainly absent by most participants, while some participants indicated a lack of physical accessibility in the form of universal design. Participants also identified a lack of integration of services and disability-related skills within the healthcare staff. Participants reported a number of enablers, success and challenges while implementing the knowledge from the workshops related to structural issues, service provision and integration. While participants worked on health workers’ attitudes and accessibility of services, screening and referrals practice was not improved through the workshops. Conclusions: Formative evaluation indicates that the workshops can be effective not only in sensitising healthcare workers and people with disabilities to opportunities to improve services for people with disabilities but also to provide knowledge and skills to initiate improvements. Skills that need more practical training (e.g. screening for disability) need to be trained in more detail, and this will inform the adaptation of the workshops. However, the workshop evaluation also revealed that without policy implementation and budget allocations this change would only be limited.

• Implications for Rehabilitation

• HIV, its co-morbidities and treatments cause health conditions and impairments that have the potential to develop into disability.

• People with disabilities are at increased risk of exposure to HIV.

• Rehabilitation professionals, healthcare workers and people with disabilities can be sensitised in a three-day workshop on the relationship of disability and HIV.

• However, the trained participants can only implement no or low-cost elements of interventions, while high-cost interventions need budget allocations at provincial and national level.

     

Indonesian students’ participation in an interprofessional learning workshop

Abstract

Interprofessional learning activities, such as workshops allow students to learn from, with and about each other. This study assessed the impact on Indonesian health students’ attitudes towards interprofessional education (IPE) from participating in a workshop on medication safety. The students attended a two-day IPE workshop on medication safety. Thirty-five (48.6%) students completed pre-/post-workshop surveys using a modified Readiness for Interprofessional Learning Scale (RIPLS) survey. The post-workshop survey also had a series of open-ended questions. Students’ responses to each RIPLS statement pre-/post-workshop were compared, whilst their responses to open-ended questions in post-workshop survey were thematically analysed. Students reported positive attitudinal changes on statements of shared learning and teamwork sub-scale (Wilcoxon p value <0.05). Analysis of the open-ended questions indicated that students perceived the workshop as having improved their understanding on the importance of teamwork and communication skills. This study found that learning with other health students through an IPE workshop improved medical, nursing and pharmacy students’ attitudes towards the importance of shared learning, teamwork and communication in healthcare service.     

An Innovative Program to Provide Adequate Women's Health Education to Residents with VA-Based Ambulatory Care Experiences

Background: The Accreditation Council for Graduate Medical Education (ACGME) requires internal medicine residents to spend 25% continuity clinic time seeing patients of each gender. This requirement is a challenge for programs that use a Veterans Administration Hospital (VA) as the sole site for residents' continuity clinic, because of its predominately a male patient population.

Purpose: To ensure VA- clinic-based residents meet the ACGME requirement regarding gender care and receive adequate training in women's-health issues and to assess and evaluate a novel program designed to fulfill these needs?

Methods: We developed a program that allows VA-based residents to spend 75% continuity practice time in VA clinic and 25% in a university-based clinic. We surveyed program participants annually regarding their experiences and in post graduate years (PGY) 1 and 3 assessed all residents' knowledge of women's health (WH).

Results: Thirty-five residents were paired with faculty preceptors over 3 years. In annual program surveys, program residents reported seeing a gender mix of patients and feeling more comfortable with women's health. In knowledge surveys, mean score of all residents improved from 46% to 54% (p = .002). Factors associated with improvement were female resident gender (p = .004), having VA continuity clinic (p = .001), having specialized women's health preceptors (p = .006), and seeing at least 30% female patients (p = .01). In the multivariable model, resident gender and having a VA continuity clinic remained significant.

Conclusions: Our program provides a novel, effective method to ensure VA-based internal medicine residents receive adequate educational experiences in gender-specific care.     

Teaching the Teacher: The Impact of a Workshop Developed for Radiation Therapists

IntroductionEnhancing the teaching skills of radiation therapists is of benefit to both students and therapists and is ultimately important for patient outcomes. However, there is a paucity of evidence-based interventions for improving the teaching skills of radiation therapists. An intervention was developed to tackle this initiative. In accordance with a local, quality improvement initiative, a two-part workshop was developed for radiation therapists to improve their ability to (1) effectively communicate with students, (2) provide meaningful feedback to students, (3) increase consistency in conducting competency assessments, and (4) increase an understanding of cultural competency as it pertains to both teaching and health care more broadly.MethodsParticipants included 67 radiation therapists (18 males and 49 females) currently working at an urban, tertiary care center in Ontario. Not all therapists attended both the workshops (48 attended both workshops, 67 attended A only, and 49 attended B only). The sessions were divided into workshop A, targeting communication and evaluation, and workshop B, targeting competency assessment and cultural competency. Self-report questionnaires assessing clinician ratings of their confidence in these skills were administered before workshop A and B, after workshop A and B, and at a follow-up after 75 days. For radiation therapists who completed the questionnaire at all three time points, changes in their confidence ratings were analyzed using repeated measures analysis of variance (ANOVA) before workshop, after workshop, and at follow-up (for workshop A: n = 29 and for workshop B: n = 24). It was hypothesized that teaching skills of communication and evaluation would improve after workshop A. Similarly, teaching skills of competency assessment and cultural competency would both improve after workshop B.ResultsAll four repeated measures ANOVAs indicated significant improvements in clinician self-assessment in the four teaching skills targeted in the workshops.DiscussionRadiation therapists reported being significantly more confident in their teaching skills after the intervention.ConclusionThere is preliminary evidence for the efficacy of this teaching intervention in improving the confidence of radiation therapists in the assessed skills.     

Wheeled mobility skills of wheelchair basketball players: a randomized controlled study

Purpose: The aim of this study was to assess the influence of wheelchair basketball sport on the functional abilities of wheelchair users.

Method: This is a randomized controlled study. Wheelchair basketball players (n?=?111) and non-player (n?=?85) were included in this study. We administered the questionnaire version of the wheelchair skills test questionnaire (WST_Q), recording the participants’ capacity and performance scores on each of 32 skills.

Results: Player group have the baseline values of WST_Q higher than control group. The mean total percentage score of player group was significantly greater than control group (p?<?0.05). The get over 15?cm level (respectively, rations of capacity and performance of groups: player/control: 50.5–20% and 54.1–24.7%) and the ascends 10° incline (player/control 96.4–48.2% and 98.2–54.1%).

Conclusions: Participation in regular wheelchair basketball sport may preserve and augment functional abilities in with wheelchair user

• Implications for rehabilitation

• The skills-sports relationship is reciprocal. With increased wheelchair skills, people may be more inclined to engage in sports; subsequently, with greater sports, wheelchair skills could improve.

• Wheelchair mobility skills during clinical rehabilitation should reflect the daily activities and needs of each wheelchair user. WST-Q provides advantages in terms of requiring less time and material in using of clinical.

     

A condensed wheelchair skills training ‘bootcamp’ improves students’ self-efficacy for assessing,training, spotting,and documenting manual and power wheelchair skills

Abstract

Objectives: To determine the influence of a bootcamp training approach on students’ self-efficacy for assessing, training, spotting, documenting, and performing manual and power wheelchair skills.

Methods: In a pre-post design, students in their final year of an entry-to-practice master of occupational therapy program completed a two-day manual (6.5?h) and power (6.5?h) wheelchair skills bootcamp. Outcomes for self-efficacy (in assessing, training, spotting and documenting manual and power wheelchair skills; primary) and capacity (manual and power wheelchair skills; secondary) were collected at baseline and immediately after the bootcamp.

Results: Participants (n?=?44) were 27.3?±?4.3?years of age (41 female). Most students (81.8%) reported little previous experience using manual and power wheelchairs at baseline. Students’ self-efficacy for assessing, training, spotting, and documenting manual and power wheelchair skills improved by between 28.4% and 35.3%, representing a change from ‘somewhat confident’ to ‘fairly confident’. Students’ manual and power wheelchair skills capacity increased by 47.2% and 37.1% respectively.

Conclusions: Wheelchair skills training bootcamps may help prepare occupational therapy students to assess, train, spot, and document manual and power wheelchair skills of future clients, while improving students’ wheelchair skills capacity; thus may provide an option for integrating wheelchair skills training into the curriculum of time-intensive programs.

• Implications for rehabiliation

• A two-day condensed wheelchair skills training workshop improves occupational therapy

• students’ self-efficacy for assessing, training, spotting and documenting power and

• manual wheelchair skills.

• A two-day condensed wheelchair skills training workshop improves occupational

• therapy students’ power and manual wheelchair skills.

• Self-efficacy is an indicator of future behaviours. Therefore, improving students’ selfefficacy

• for assessing training and documenting wheelchair skills may influence their future practice.

     

Disruptions and Satisfaction in Internal Medicine Resident Continuity Clinic Differ Between Inpatient and Outpatient Rotations

Abstract

Background: Little is known about whether assignment to simultaneous inpatient and outpatient clinical duties causes disruptions during internal medicine resident continuity clinic and impacts trainee satisfaction.

Purpose: Our purpose was to determine whether dual inpatient and continuity clinic responsibilities impact resident stress and document the number, type, and immediacy of interruptions in continuity clinics.

Methods: Methods included a prospective 2-residency survey of 70 internal medicine residents performing 240 half-day continuity clinic sessions.

Results: More than half (52%) of trainees on inpatient rotations felt pressured to return to their ward duties. Half (50%) of residents thought clinic increased work hours, and the majority (70%) did not think continuity clinic detracted from their education on inpatient or elective rotations. Disturbances were more likely to occur on inpatient rotations (odds ratio 4.52, 95% confidence interval = 2.29-8.92) than on outpatient rotations. The time required to address an interruption was 3.9 ± 4.51 min. Residents thought many (46%) problems addressed during clinic could have waited until clinic completion.

Conclusions: Residents on inpatient rotations who were commonly interrupted in clinic felt pressured to return to ward duties and unable to focus on their clinic patients. Internal medicine faculty should modify curriculum to minimize the interference of other duties in resident clinics.     

Potentially severe drug–drug interactions among older people and associations in assisted living facilities in Finland: a cross-sectional study

Objective: This study aims to assess potentially severe class D drug–drug interactions (DDDIs) in residents 65 years or older in assisted living facilities with the use of a Swedish and Finnish drug–drug interaction database (SFINX).

Design: A cross-sectional study of residents in assisted living facilities in Helsinki, Finland.

Setting: A total of 1327 residents were assessed in this study. Drugs were classified according to the Anatomical Therapeutic Chemical (ATC) classification system and DDDIs were coded according to the SFINX.

Main outcome measures: Prevalence of DDDIs, associated factors and 3-year mortality among residents.

Results: Of the participants (mean age was 82.7 years, 78.3% were females), 5.9% (N?=?78) are at risk for DDDIs, with a total of 86 interactions. Participants with DDDIs had been prescribed a higher number of drugs (10.8 (SD 3.8) vs. 7.9 (SD 3.7), p?p?=?0.030). The most frequent DDDIs were related to the concomitant use of potassium with amiloride (N?=?12) or spironolactone (N?=?12). Carbamazepine (N?=?13) and methotrexate (N?=?9) treatments were also frequently linked to DDDIs. During the follow-up, no differences in mortality emerged between the participants exposed to DDDIs and the participants not exposed to DDDIs.

Conclusions: Of the residents in assisted living, 5.9% were exposed to DDDIs associated with the use of a higher number of drugs. Physicians should be trained to find safer alternatives to drugs associated with DDDIs.

• KEY POINTS

• Potentially severe, class D drug–drug interactions (DDDIs) have been defined in the SFINX database as clinically relevant drug interactions that should be avoided.

• ???Of the residents in assisted living, 5.9% were exposed to DDDIs that were associated with the use of a higher number of drugs.

• ???The most frequent DDDIs were related to the concomitant use of potassium with amiloride or spironolactone. Carbamazepine and methotrexate were also linked to DDDIs.

• ???No difference in mortality was observed between residents exposed to DDDIs and residents not exposed to DDDIs.

     

Threats or violence from patients was associated with turnover intention among foreign-born GPs – a comparison of four workplace factors associated with attitudes of wanting to quit one’s job as a GP

Objective: General practitioners (GPs) are crucial in medical healthcare, but there is currently a shortage of GPs in Sweden and elsewhere. Recruitment of GPs from abroad is essential, but foreign-born physicians face difficulties at work that may be related to turnover intention, i.e. wanting to quit one’s job. The study aims to explore the reasons to why foreign-born GPs may intend to quit their job.

Design: Survey data were used to compare four work-related factors that can be associated with turnover intentions; patient-related stress, threats or violence from patients, control of work pace, and empowering leadership, among native-born and foreign-born GPs. These work-related factors were subsequently examined in relation to turnover intention among the foreign-born GPs by means of linear hierarchical regression analyses. The questionnaire consisted of items from the QPS Nordic and items constructed by the authors.

Setting: A primary care setting in a central area of Sweden.

Subjects: Native-born (n?=?208) and foreign-born GPs (n?=?73).

Results: Turnover intention was more common among foreign-born GPs (19.2% compared with 14.9%), as was the experience of threats or violence from patients (22% compared with 3% of the native-born GPs). Threats or violence was also associated with increased turnover intention. Control of work pace and an empowering leadership was associated with reduced turnover intention.

Practice implications: The organisations need to recognise that foreign-born GPs may face increased rates of threats and/or violence from patients, which may ultimately cause job turnover and be harmful to the exposed individual.     

Increasing Patient Acceptance of Medical Student Participation: Using Interactive Theatre for Faculty Development

Background : Interactive theatre (IT) has been used to train faculty the skills and strategies to address challenging dynamics in educational settings. Purpose : This study described the development, implementation, and evaluation of an IT approach to improve preceptors' skills for increasing patients' acceptance of medical student participation in clinical care. Methods : Focus groups were conducted with faculty, residents, medical students, and clinic staff to discuss issues related to patients declining medical student participation. Findings were used to develop a faculty development session using an IT approach. At a Family Medicine grand rounds presentation, faculty and resident preceptors (n = 42) participated in the IT workshop and completed a pre–post survey assessing skills specific to increasing students' training opportunities in patient care and educational impact of the session. Results : Following the IT session, preceptors reported greater self-efficacy for helping patients feel more comfortable with medical students in the exam room (p =.031, d = 0.338) and increased comfort level with talking to patients about medical students performing sensitive exams (p =.010, d = 0.357). Eighty-eight percent of preceptors agreed or strongly agreed that the session was relevant to improving clinical precepting skills and helped them develop strategies for enhancing medical student involvement in care. Conclusions : Findings suggest that the interactive theatre approach to faculty development is an innovative and effective method to increase preceptors' comfort with discussing medical student involvement with patients.     

Assessing Advanced Communication Skills via Objective Structured Clinical Examination: A Comparison of Faculty Versus Self,Peer, and Standardized Patient Assessors

Abstract

Construct: The construct addressed in this study is assessment of advanced communication skills among senior medical students. Background: The question of who should assess participants during objective structured clinical examinations (OSCEs) has been debated, and options discussed in the literature have included peer, self, standardized patient, and faculty assessment models. What is not known is whether same-level peer assisted learning can be utilized for formative assessment of advanced communication skills when no faculty, standardized patients, or other trained assessors are involved in providing feedback. If successful, such an educational model would optimize resource utilization and broaden the scope of topics that could be covered in formative OSCEs. Approach: The investigators developed a 4-station formative OSCE focused on advanced communication skills for senior medical students, and evaluated the concordance of assessment done by same-level peers, self, standardized patients, and faculty for 45 students. After each station, examinees completed a self-assessment checklist and received checklist-based assessment and verbal feedback from same-level peers only. Standardized patients completed checklist-based assessments outside the room, and faculty did so after the OSCE via video review; neither group provided direct feedback to examinees. The investigators assessed inter-rater agreement and mean difference scores on the checklists using faculty score as the gold standard. Findings: There was fair to good overall agreement among self, same-level peer, standardized patient, and faculty-assessment of advanced communication skills. Relative to faculty, peer and standardized patient assessors overestimated advanced communication skills, while self-assessments underestimated skills. Conclusions: Self and same-level peer-assessment may be a viable alternative to faculty assessment for a formative OSCE on advanced communication skills for senior medical students.     

Impact of language barrier on quality of patient care,resident stress,and teaching

Background: 1990 U.S. Census data reveal that nearly 14 million people in the United States have poor to no English language skills, limiting their access to health care.

Purpose: This study evaluated the effect of language barriers on quality of patient care, a resident's ability to learn and teach, and also the effect on length of workday and daily stress.

Methods: Data were collected from a 25‐item standardized questionnaire. We used a 5‐point Likert scale ranging from 1 (very significant) to 5 (no influence). Data were cross‐tabulated with biographical attributes of residents and were tested for significance.

Results: Language barriers had significant negative impact on quality of patient care, lengthened resident workday (average 52 min), and increased daily stress. With bedside teaching encounters, residents reported compensating by shifting the focus to issues not requiring patient participation. Language barriers had significant negative influence on the resident's ability to role model (i.e., demonstrate for more junior residents) and on the acquisition and practice of good patient‐physician interaction skills.

Conclusions: Language barriers significantly impact the daily activity of surgical residents, and we believe that they similarly impact residents in all specialties. All teaching hospitals should have adequate and available medical translators as a tool to bridge the language barrier. Translators should receive specialized training in medical terminology and cultural awareness.     

Faculty facilitators’ and standardized family members (SFMs) perceptions of student teamwork during an interprofessional education simulation workshop

ABSTRACT

Standardized patients can be trained to portray standardized family members (SFMs) for interprofessional education (IPE) initiatives to maximize student learning. To date, studies of IPE often focus on student learning outcomes rather than on the feedback and perspectives of SFMs and faculty facilitators (FFs), The purpose of our study was to examine SFMs’ and FFs’ perspectives immediately after participating in an IPE workshop. SFMs and FFs completed a semi-structured questionnaire consisting of open-ended questions to identify positive and challenging aspects of interactions with health professions students during an IPE workshop. A directed content analysis approach was used to assess written feedback (N = 29) from SFMs and FFs. Study findings highlight many similar themes between SFMs and FFs as well as minor differences regarding recognition of emotion and communication transitions. SFMs and FFs both agreed, however, that these are areas for further development by students to improve communication. Our study adds insight into SFMs’ and FFs’ feedback immediately after an IPE workshop.     

Promoting language and social communication development in babies through an early storybook reading intervention

Purpose: This study examined the effectiveness of low- and high-intensity early storybook reading (ESR) intervention workshops delivered to parents for promoting their babies language and social communication development. These workshops educated parents on how to provide a stimulating home reading environment and engage in parent–child interactions during ESR.

Method: Parent–child dyads (n?=?32); child age: 3–12 months, were assigned into two intervention conditions: low and high intensity (LI versus HI) groups. Both groups received the same ESR strategies; however, the HI group received additional intervention time, demonstrations and support. Outcome measures were assessed pre-intervention, one and three months post-intervention and when the child turned 2 years of age.

Result: A significant time–group interaction with increased performance in the HI group was observed for language scores immediately post-intervention (p?=?0.007) and at 2-years-of-age (p?=?0.022). Significantly higher broader social communication scores were associated with the HI group at each of the time points (p?=?0.018, p?=?0.001 and p?=?0.021, respectively). Simple main effect revealed that both groups demonstrated a significant improvement in language, broader social communication and home reading practices scores.

Conclusions: ESR intervention workshops may promote language and broader social communication skills. The HI ESR intervention workshop was associated with significantly higher language and broader social communication scores.     

Using simulation pedagogy to teach clinical education skills: A randomized trial

Introduction: Supervision of students is a key role of senior physiotherapy clinicians in teaching hospitals. The objective of this study was to test the effect of simulated learning environments (SLE) on educators’ self-efficacy in student supervision skills. Methods: A pilot prospective randomized controlled trial with concealed allocation was conducted. Clinical educators were randomized to intervention (SLE) or control groups. SLE participants completed two 3-hour workshops, which included simulated clinical teaching scenarios, and facilitated debrief. Standard Education (StEd) participants completed two online learning modules. Change in educator clinical supervision self-efficacy (SE) and student perceptions of supervisor skill were calculated. Between-group comparisons of SE change scores were analyzed with independent t-tests to account for potential baseline differences in education experience. Results: Eighteen educators (n = 18) were recruited (SLE [n = 10], StEd [n = 8]). Significant improvements in SE change scores were seen in SLE participants compared to control participants in three domains of self-efficacy: (1) talking to students about supervision and learning styles (p = 0.01); (2) adapting teaching styles for students’ individual needs (p = 0.02); and (3) identifying strategies for future practice while supervising students (p = 0.02). Conclusions: This is the first study investigating SLE for teaching skills of clinical education. SLE improved educators’ self-efficacy in three domains of clinical education. Sample size limited the interpretation of student ratings of educator supervision skills. Future studies using SLE would benefit from future large multicenter trials evaluating its effect on educators’ teaching skills, student learning outcomes, and subsequent effects on patient care and health outcomes.     

The efficacy of cognitive behavioural therapy and advocacy interventions for women who have experienced intimate partner violence: A systematic review and meta-analysis

Abstract

Objective. To determine the efficacy of Advocacy and Cognitive Behavioural Therapy interventions (CBT) in reducing physical, psychological, sexual, or any intimate partner violence (IPV).

Methods. A systematic review and meta-analysis were conducted using randomized control trials (RCTs) published in MEDLINE, PsycINFO, Scopus, Cochrane, and Clinical trials. The occurrence of physical, psychological, sexual, and/or any IPV measured efficacy.

Results. Twelve RCTs involving 2666 participants were included. Advocacy interventions resulted in significant reductions in physical (standardized mean difference (SMD) –0.13; 95% confidence interval (CI) –0.25, –0.00) and psychological (SMD –0.19; 95% CI –0.32, –0.05) but not in sexual (SMD –0.20; 95% CI –0.43, 0.02) or any IPV (SMD –0.32; 95% CI –0.69, 0.04). CBT interventions showed a significant reduction in physical (SMD –0.79; 95% CI –1.26, –0.33) and psychological (SMD –0.80; 95% CI –1.25, –0.36) but not sexual (SMD –0.35; 95% CI –1.73, 1.03) or any IPV (SMD 0.09; 95% CI –0.05, 0.23).

Conclusions. Both advocacy and CBT interventions reduced physical and psychological IPV but not sexual or any IPV. Limitations include the low number of studies and the heterogeneity of interventions.     

A short,structured skills training course for critical care physiotherapists in a lower-middle income country

Objectives: The aim of this article is to describe the delivery and acceptability of a short, structured training course for critical care physiotherapy and its effects on the knowledge and skills of the participants in Sri Lanka, a lower-middle income country.

Methods: The two-day program combining short didactic sessions with small group workshops and skills stations was developed and delivered by local facilitators in partnership with an overseas specialist physiotherapist trainer. The impact was assessed using pre/post-course self-assessment, pre/post-course multiple-choice-question (MCQ) papers, and an end-of-course feedback questionnaire.

Results: Fifty-six physiotherapists (26% of critical care physiotherapists in Sri Lanka) participated. Overall confidence in common critical care physiotherapy skills improved from 11.6% to 59.2% in pre/post-training self-assessments, respectively. Post-course MCQ scores (mean score = 63.2) and percentage of passes (87.5%) were higher than pre-course scores (mean score = 36.6; percentage of passes = 12.5%). Overall feedback was very positive as 75% of the participants were highly satisfied with the course’s contribution to improved critical care knowledge.

Conclusions: This short, structured, critical care focused physiotherapy training has potential benefit to participating physiotherapists. Further, it provides an evidence that collaborative program can be planned and conducted successfully in a resource poor setting. This sustainable short course model may be adaptable to other resource-limited settings.