Improving the skills of health professionals in engaging patients in diabetes-related problem solving

INTRODUCTION: Despite instruction, many patients do not employ diabetes-related self-management skills recommended by health professionals. One problem suggested by research is that many health professionals do not often use teaching and counseling skills widely considered to be effective. Among these are specific skills that help health professionals conduct adherence-related assessments, brainstorm workable solutions to obstacles, collaborate during long-term follow-up, and provide effective direct instruction. METHODS: "Effective Patient Teaching and Problem Solving" was developed and taught in a block of 24 hours over 3 days to groups of health professionals. Course content emphasized 13 operationally defined skills in four major categories: (A) assessment, (B) brainstorming, (C) collaboration, and (D) direct instruction skills. To evaluate participants' (n = 33) use of the various skills, a standardized patient teaching exercise was videotaped at both the beginning and end of the course. RESULTS: Total mean scores increased significantly (t = 7.7, p < .001) from 1.8 to 2.5 on a scale that ranged from 1 to 5. Skills improved in all four major categories (p < .003). The length of teaching sessions did not change, lasting 13.2 minutes before the course and 13.6 minutes after the intervention. DISCUSSION: Health professionals play a crucial role in patient education but rarely receive training in effective teaching and counseling techniques. The "Effective Patient Teaching and Problem Solving" course improved several kinds of important skills. As standards of diabetes care for improved glycemic control become more widespread, and as health providers attempt not just to teach but also to help patients overcome considerable obstacles to consistent diabetes self-management, a premium will be placed on the ability of health professionals to counsel efficiently and effectively.     

Wrestling with ethnic diversity: toward empowering health educators

The importance of training health professionals for work in an ethnically diverse society is increasingly recognized. However, health educators may lack confidence or experience in delivering such teaching, contributing to a self-perpetuating inertia. OBJECTIVES: To identify current experience and challenges perceived by educators of different health professionals, and to facilitate and debate the development of teaching in this field. METHODS: Educators (n=61) from 42 different organizations, participated in facilitated workshops in three different UK settings. They included clinician teachers of medical undergraduates and postgraduates, and educators of nurses, primary care and hospital physicians, physiotherapists, occupational therapists and paramedical staff. Opportunities were provided for educators to discuss experiences; to participate as "learners" in examples of interactive training exercises; to anticipate challenges they might encounter in developing and providing training themselves; and to discuss ways of negotiating them. Qualitative data generated from the workshops were analysed for common themes. RESULTS: Participants had received little relevant training themselves. For many, the workshops provided a first formal opportunity to consider their own responses to ethnic diversity in health care. Current provision of such training in their institutions was limited. Educators lacked specific training to facilitate the learning of others in this field. They wrestled with a wide range of issues: from critical dilemmas about the philosophy of teaching, through to the practicalities and personal challenges of face to face teaching. Strategies to address these were generated that may merit consideration. CONCLUSION: Educators will need help to overcome their uncertainty in approaching this topic and be empowered to develop training. Developing teachers' own awareness and skills, followed by appropriate support, are likely to be prerequisites for successful training.     

Twenty years of care for persons living with HIV/AIDS in Brazil: the health professionals' perspective

The aim of this study was to describe the meaning ascribed by health professionals to the care they provide for persons with HIV/AIDS. Data were collected through recorded interviews with 10 health professionals providing care to AIDS patients in different institutions in S?o Paulo State, Brazil. Three themes emerged from the analysis: (a) the overall scenario of healthcare provision for AIDS patients; (b) the relationship between healthcare professionals and patients; and (c) ethical aspects related to care. Despite significant advances, the study identified discriminatory behavior in the treatment. Such behaviors were related to feelings of insecurity and fear of infection on the part of healthcare professionals, which could be explained by the lack of appropriate training in general services and hospitals. Specific training for treating the patients mainly targeted health professionals in centers specializing in HIV/AIDS, resulting in difficulties for integrating the care of these patients with other services under the Unified National Health System. The data related to characteristics of professional training in the health field as a whole, leading one to reflect on the skills expected of health professionals in caring for (and relating to) persons with HIV/AIDS, as well as the impact on AIDS prevention.     

Improving health care communication for persons with mental retardation.

There has been little effort directed at training health care professionals in behaviors and attitudes that are effective in communicating with persons with mental retardation. Such training would be beneficial not only to assist those with congenital cognitive deficits but for those with acquired central nervous system conditions as well, for example, dementia. Persons with mental retardation are living in community settings in greater numbers and increasingly participating in vocational, residential, and health care programs. Yet, most health care professionals are not routinely offered an opportunity to gain experience interacting with people who have limited ability to express and understand health care information. An education program was focused on health care professionals' use of basic communication skills when providing health information to an adult who is mentally retarded. A self-study instructional text and a 20-minute companion video provided methods of communicating with a patient with mental retardation in medical and dental care settings. Resident physicians, medical students, nurses, and nursing assistants improved their communication skills, knew more about mental retardation, and were more proactive in health care interviews following training. Health care training needs to incorporate educational opportunities focusing on skills to assist special populations. Brief, structured, and interactive skill training in communication offered early in the health care professional's career has positive benefits for the recipient and the provider.     

The WISDOM project: training primary care professionals in informatics in a collaborative ''virtual classroom''

OBJECTIVES: The WISDOM project applies Internet technologies to create a virtual classroom in health informatics for primary care professionals. Participants use a facilitated E-mail discussion list supported by a web site which provides on-line resources and an archive of teaching materials. DESIGN: The project took an adult-learning model in which participants identify their learning needs, emphasized using informatics skills in practice, and focused on skills likely to enhance evidence-based practice. The paper describes the project and an evaluation of the first programme which ran in 1997 with 28 participants. Pre- and post-intervention questionnaires were used to assess perceived skills in informatics and evidence-based practice. SETTING: University of Sheffield. SUBJECTS: Primary care professionals. RESULTS: Participants reported statistically significant increases in eight informatics skills. There were no significant changes in evidence-based practice skills. The web-site, seminar programme and discussion list were highly rated as useful in delivering informatics training. CONCLUSIONS: The WISDOM approach is effective for the delivery of informatics training to primary care professionals, and may be used more widely for other subjects and professional groups. There is a need for further research into facilitating virtual classrooms.     

The Management Academy for Public Health: a new paradigm for public health management development.

Research has established a need to develop management skills among public health professionals. The University of North Carolina-Chapel Hill created the Management Academy for Public Health as a pilot program for this specialized training need. This article describes why a management academy for public health managers was formed, its curriculum and instructional methods, and the evaluation findings from its first year. The program sponsors hope to effect individual and organization level change, eventually leading to improved community health. Results suggest that this innovative program gives public health professionals needed skills and improves their job performance.     

Health education for kindergarten children.

A health education program for kindergarten children was jointly planned and conducted by health and education professionals. The program demonstrates an application of an approach based on skill development for health behavior. It is presented as an example of how a school district can take beginning steps in developing a foundation for teaching health skills. A unique activity of the program included medical students as a means of involving health care professionals as part of school health education.     

Teaching and learning the science of qualitative research in the health area

Qualitative research constitutes a necessary perspective of knowledge within the field of health services. Healthcare always occurs in complex contexts and its enhancement requires research methodologies that address this complexity. Nevertheless, the knowledge and use of qualitative research in health services is still very limited. Among the different factors that affect its development, the teaching and learning of qualitative research proves to be fundamental, even beyond undergraduate education. Healthcare professionals and health services present certain specific aspects that must be considered in the design and development of the teaching and learning of qualitative research. Based on an eight-year online training experience with Primary Healthcare professionals, the main challenges are indentified and discussed.     

Communication skills competencies: definitions and a teaching toolbox

BACKGROUND: Doctors' interpersonal and communication skills correlate with improved health care outcomes. International medical organisations require competency in communication skills. The Accreditation Council for Graduate Medical Education (ACGME) developed a toolbox for assessing this competency and 5 others, yet none initially for teaching these skills. PURPOSE AND METHODS: The original focus in the development of the ACGME competencies was evaluation. This paper represents a significant step toward defining methods for teaching communication skills competencies. A total of 16 medical education leaders from medical schools worldwide, participating in the 2003 Harvard Macy Institute Program for Physician Educators, worked together to: (1) further define the ACGME competency in interpersonal and communication skills; (2) delineate teaching strategies for each level of medical education; and (3) create a teaching toolbox to integrate communication skills competencies into medical curricula. Four subgroups defined subcompetencies, identified teaching strategies for undergraduate, graduate and postgraduate medical training and brought their work to the larger group. The expanded communication competencies and teaching strategies were determined by a consensus of the larger group, presented to 80 Harvard Macy Scholars and Faculty for further discussion, then finalised by consensus. CONCLUSION: The teaching toolbox expands the ACGME core communication competencies, adds 20 subcompetencies and connects these competencies to teaching strategies at each level of medical training. It represents the collaboration and consensus of a diverse international group of medical education leaders in a variety of medical specialities and institutions, all involved in teaching communication skills. The toolbox is applicable globally across different settings and specialities, and is sensitive to different definitions of health care.     

Shifting boundaries in professional care.

The nature of the work undertaken by different health professionals and inter-professional boundaries are constantly shifting. The greater knowledge of users of health care, and the increasing technical and organizational complexity of modern medicine, have partly eroded the control of health professionals over the substance of their work. The definition of a field of work as lying within the province of any one profession is culturally rather than scientifically determined. It is evident that care of good quality should be delivered at the lowest possible cost. This might include delivery of care by a less trained person than heretofore, or by someone with limited but focused training. Sharing of skills is a more sensible subject for discussion than transfer of tasks. We review a number of studies which show the effectiveness of inter-professional substitution in various care settings, and also the effectiveness of substitution by those other than health professionals. The views of users of health services on inter-professional substitution need to be considered. Health professionals and others need to work together to devise innovative ways of delivering effective health care. The legal issues need clarification.     

康复医学科在综合医院中如何定位的现状调研

根据近年病残人的康复需求状况,对本市已建或拟建昨医学科的综合医院,从学科设置、康复专业人员梯队、医教研业务运转现状以及医疗卫生改革对学科影响进行调研分析,表明社会对康复需求日益增大,但康复专业人员紧缺,康复医疗面窄,社区康复网络不健全,康复医学科发展的层次将是衡量一个医院现代医学诊疗水平的重要标志之一。     

Providing Comprehensive Sexual Health Care in Spinal Cord Injury Rehabilitation: Implementation and Evaluation of a New Curriculum for Health Care Professionals

A grant from the Paralyzed Veterans of America funded the development, implementation, and evaluation of a three-day interdisciplinary continuing education and training program in comprehensive sexual health care. The program was targeted toward health care professionals working in spinal cord injury (SCI) rehabilitation. The major goal of the program was to offer participants an opportunity to increase the knowledge, comfort, and skills necessary to understand and manage the sexual health care needs of people with SCI. The curriculum included clearly stated goals, behavioral objectives in operational terms, and multiple quantitative and qualitative program evaluations. In addition, the comprehensive curriculum incorporated extensive skills training including state-of-the-art standardized patient training techniques. Evaluation results indicated statistically significant and qualitatively important positive gains in knowledge, comfort, and skills. The five month follow-up study indicated that skills learned over the three-day workshop were successfully transferred to the work environment.     

Goodness of fit: social work education and practice in health care

This study addresses the fit between social work education and practice in health care. A random sample of NASW members identifying with health care (N = 179) responded to a mail survey about the utility of core knowledge and roles that we had identified by reviewing seven commonly used health care social work texts. Quantitative data revealed knowledge and roles most frequently used in health care settings as well as differences in roles used dependent upon department name; and different professionals supervising social workers. Qualitative data from four open-ended questions provided suggestions for what knowledge and skills should be taught in social work programs, the best forums/methods for teaching this content, and topics for continuing education. Findings are discussed in relation to six key areas of the peer-reviewed literature: vulnerable populations/diversity, ethical dilemmas, interdisciplinary collaboration, mental health, managed care/accountability, and advocacy. Implications for social work practice, education, and research are discussed.     

Using a dual method needs assessment to evaluate the training needs of public health professionals.

A dual method research approach was used to identify the training needs of the public health professionals in Washington. A mail questionnaire was implemented, followed by focus groups with Washington State Department of Health (DOH) and local health department (LHD) professionals. Focus groups were used successfully to enhance and clarify the survey findings by identifying the specific content of the highest rated training needs (interpersonal communication, cross-culture and cross-age communication, participatory teaching/training skills, and electronic communication) and by pinpointing preference for different modes of training delivery for different training needs.     

The role of oral health care professionals in preventing and managing obesity: A systematic review of current practices and perceived barriers

IntroductionThere is a growing interest to expand the role of oral health care professionals in obesity prevention and management. The aim of this systematic review was to synthesise the evidence on current practices of, and perceived barriers to, oral health care professionals’ involvement in obesity screening and management.MethodsKey search strings were developed and used in seven databases from inception through February 6, 2019. Data were screened against inclusion criteria, independently extracted, and quality appraised by two reviewers based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.ResultsTen studies were included in this review. The practices of oral health care professionals in relation to obesity assessment, counseling, and specialist referrals were found to be very limited. Oral health care professionals believed in their role to support patients for achieving weight-loss goals, however just over one-third were trained in anthropometry. Perceived barriers included lack of time, limited knowledge or training, patients’ unwillingness to listen to oral health care professionals’ advice, and lack of appropriate specialist referrals.ConclusionOral health care professionals are well-positioned and supportive in undertaking healthy weight interventions in their clinical practice; however, their practices are limited due to barriers such as lack of time, limited training and lack of referrals.     

Educating health science students about disability: Teachers’ perspectives on curricular gaps

BackgroundPeople living with disabilities are significantly more likely than their peers to find health professionals’ skills and facilities inadequate. The 66th World Health Assembly called for better health care for people with disabilities including more inclusive health services and a stronger focus on professional training.ObjectiveTo explore how teachers at a New Zealand university perceived the need, approaches, and systemic challenges to enhance disability education for health professionals in training.MethodsQualitative analysis of interviews with 11 key informants teaching in population health, medicine, nursing, pharmacy, and optometry training programmes. Transcribed interview recordings were analysed using a general inductive approach.ResultsThe participants described a range of teaching approaches that they used to increase disability awareness among their students. However, these were largely ad hoc individually driven initiatives reflecting personal interests. Participants identified a critical need to develop and implement a systematic, integrated approach to enhance disability education particularly from a social justice perspective among students in health disciplines. Engaging people with lived experience of disability in teaching and course design, and senior administrative commitment were identified as necessary to address current gaps in education.ConclusionsIn order to develop a health professional workforce competent to respond to the needs of people with disabilities, greater attention is required at a strategic level to enhance the profile of disability education in health curricula. Meaningful engagement of people with disability and senior leadership commitment are critical components that can enable effective progression of this agenda.     

Nutrition advice in primary care: evaluation of practice nurse nutrition training programmes

Primary health care teams (PHCT), including the practice nurse (PN), now have a significant role in health promotion in the UK, which includes the dissemination of advice relating to food and health. However, reports suggest there is a lack of nutritional knowledge among PHCT members and/or problems in communicating dietary advice effectively. Dorset Healthcare Trust employs two full-time primary care dietitians (PCDs). Their remit is to provide training in the field of nutrition to members of the PHCT, primarily PNs, in order to facilitate their role in delivering effective and consistent healthy eating advice. This small research study was designed to evaluate the impact of nutrition training from a primary care dietitian on the attitudes, practice and knowledge of practice nurses. There have been few studies or reports documenting this, which highlighted the need to evaluate the practice nurse training programmes in Dorset. Five practices of varying size were included in the study. Evaluation was undertaken by means of semi-structured interviews with one practice nurse from each practice conducted before and after training. In addition a questionnaire was used as a tool to assess perceived nutrition knowledge and confidence when giving dietary advice. True/false statements and a case history formed part of the questionnaire which was completed both pre- and post-training. Three 1-h training sessions covering the topics of obesity, diabetes mellitus and coronary heart disease were planned. They were presented by the primary care dietitian to each practice nurse together with other members of their PHCT over a 3-month period. The primary care dietitian collected feedback on each training session in order to monitor teaching methods and presentation skills. The study suggests that dietitian-led training sessions are well received by PNs and can have an impact on increasing or updating practice nurses» knowledge about diet, particularly where their initial knowledge was low.     

A successful guide in understanding Latino immigrant patients: an aid for health care professionals

The recent growth of Latino immigrants in the United States has presented great challenges to the health care system, particularly in "emerging Latino states." An educational DVD was developed to aid professionals in providing culturally competent care to Latino immigrants and better understand their expectations when seeking care, as well as common cultural beliefs and practices. Knowledge and confidence was assessed through pre- and posttest measurements among 515 health care professionals nationwide. Results indicated significant increase (P < .001) in overall knowledge/confidence in Latino cultural beliefs as they relate to health care seeking, differences in health care systems between the United States and Latin America, and barriers to health care. Such multimedia training may be a promising approach to improving health care with Latino immigrants in the United States.     

E-health and the Universitas 21 organization: 4. Professional portability

Professional portability is the ease with which health-care professionals can move in person or virtually across barriers, and among and between jurisdictions, to transfer their knowledge, skills and care. As part of the Universitas 21 (U21) project on e-health, professional portability was examined using a SWOT analysis (strengths, weaknesses, opportunities and threats). The analysis showed that many factors hamper the development of global professional portability; on the other hand, the potential exists to substantially improve access to health care and its quality around the world. The study suggests that professional portability can be advanced in a number of ways. These include exploring policy, technology and medical training. The field of professional portability, while of considerable relevance to health and other professions, is undeveloped and is clearly an area that would benefit from discussion, research and global collaboration.