Continuing education—a study of dietitians participation in and attitudes to continuing education

It is now generally acknowledged that education and training is a continuing and lifelong process. It is also increasingly clear that education may take many forms, not all of them traditional. No longer can a person's education be associated exclusively with the period of induction and learning which occurs in the first 20 or so years of life. Nowhere is this more evident than in the professions.
The pace of scientific, technological, social and political change is now so rapid and intense that an initial period of professional training can only provide the foundations of knowledge, skills and attitudes on which further education and training must be built, if they are to remain current and valid.
This study seeks to inform the current debate within the profession, on the development of an education and training strategy for State Registered Dietitians. It reviews current participation in and attitudes towards continuing education among a random sample of British Detetic Association members.
The authors conclude from the results that dietitians are aware of the need for continuing education but need to be more actively involved in initiating and directing their own professional development. Some suggestions as to how this may be achieved are included at the end of this article.     

Evaluating the use of a modified CAHPS® survey to support improvements in patient-centred care: lessons from a quality improvement collaborative

Objectives To evaluate the use of a modified Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey to support quality improvement in a collaborative focused on patient‐centred care, assess subsequent changes in patient experiences, and identify factors that promoted or impeded data use. Background Healthcare systems are increasingly using surveys to assess patients’ experiences of care but little is established about how to use these data in quality improvement. Design Process evaluation of a quality improvement collaborative. Setting and participants The CAHPS team from Harvard Medical School and the Institute for Clinical Systems Improvement organized a learning collaborative including eight medical groups in Minnesota. Intervention Samples of patients recently visiting each group completed a modified CAHPS® survey before, after and continuously over a 12‐month project. Teams were encouraged to set goals for improvement using baseline data and supported as they made interventions with bi‐monthly collaborative meetings, an online tool reporting the monthly data, a resource manual called The CAHPS® Improvement Guide, and conference calls. Main outcome measures Changes in patient experiences. Interviews with team leaders assessed the usefulness of the collaborative resources, lessons and barriers to using data. Results Seven teams set goals and six made interventions. Small improvements in patient experience were observed in some groups, but in others changes were mixed and not consistently related to the team actions. Two successful groups appeared to have strong quality improvement structures and had focussed on relatively simple interventions. Team leaders reported that frequent survey reports were a powerful stimulus to improvement, but that they needed more time and support to engage staff and clinicians in changing their behaviour. Conclusions Small measurable improvements in patient experience may be achieved over short projects. Sustaining more substantial change is likely to require organizational strategies, engaged leadership, cultural change, regular measurement and performance feedback and experience of interpreting and using survey data.     

Acculturation and education level in relation to quality of the diet: a study of Surinamese South Asian and Afro-Caribbean residents of the Netherlands

BACKGROUND: To consider the changes in overall diet quality following migration we examined the associations of acculturation variables and education level with diet in Surinamese South Asian and Surinamese Afro-Caribbean origin on the one hand, and ethnic Dutch residents of the Netherlands on the other. Surinam is a former Dutch colony in South America. METHODS: We randomly selected men and women aged 35-60 years: ethnic Dutch, n = 552; South Asian, n = 306; Afro-Caribbean, n = 660. Intakes of fruit, vegetables, red meat, fish, vegetable oils, breakfast and salt were measured using a short questionnaire that formed the basis for a 'diet quality indicator' score. Highest education was measured and acculturation of the Surinamese groups was assessed by age at migration, number of resident years and a scale measure of social contacts with ethnic Dutch. RESULTS: Compared with ethnic Dutch, both Surinamese groups scored higher on overall diet quality (P < or = 0.001) but some aspects of diet (breakfast and salt use) were less prudent. Education was positively associated with diet quality in ethnic Dutch (P < or = 0.01), but not consistently so in Surinamese. Associations with social contact with ethnic Dutch varied for different quality aspects of the diet. Residence duration (mean = 22 years) and age at migration (mean = 21 years) were not associated with diet. CONCLUSIONS: A greater degree of acculturation does not necessarily lead to a less healthful diet in migrants. In addition, the association of education level with diet may differ for migrant groups. The diet of migrants differ from host populations, suggesting that migrant groups should be considered in the development of nutrition health promotion activities.     

Development of clinical reasoning from the basic sciences to the clerkships: a longitudinal assessment of medical students' needs and self-perception after a transitional learning unit

BACKGROUND: To facilitate students' transition from basic, science-oriented, problem-based learning (PBL) to clinical reasoning-oriented PBL, the University of Geneva School of Medicine introduced a 12-week unit of Introduction to Clinical Reasoning (ICR) at the beginning of its fourth or clerkship year. PURPOSE: The aims of the present study were to determine, after 12 weeks in the ICR unit, to what extent students had: (1) identified the learning content set by the faculty while adapting to the hypothetico-deductive reasoning approach; (2) familiarised themselves with the clinical reasoning-oriented learning process, and (3) transferred and further developed this process during the clinical years. METHOD: Students' derived objectives from the problems were compared to the objectives preset by the faculty to determine acquisition of intended learning content. To assess their adaptation to the clinical reasoning-oriented PBL approach, students (n = 124) were asked to list and freely comment on aspects of the unit they felt most at ease with or had difficulty with, and to complete a questionnaire on the clinical reasoning process (CRP). The same questionnaire was administered 6 and 12 months later to assess the evolution of the students' self-perception during clerkships. RESULTS: On average, student objectives matched 62% of faculty objectives. Half of the missed (38%) objectives were in basic sciences. Students generated 16% additional objectives, also predominantly in the basic sciences category (41%). Free comments indicated that the difficulties perceived by students were very similar to those previously reported in studies on reasoning and errors, such as difficulty in gathering, interpreting and weighting relevant data, synthesising information, and organising it hierarchically. These results were confirmed with the CRP questionnaire administered at the end of the unit. For most of the competencies assessed on the CRP questionnaire, a gradual improvement was seen to have occurred by 6 and 12 months after the unit. CONCLUSIONS: To ease students' transition from the preclinical to clinical years, a learning unit should give them the opportunity to train their clinical reasoning processes on standardised and prototypical problems, before encountering real patients with more ill-structured problems during clerkships. Such a transitional structure should particularly emphasise a developed repertoire of problem representations, recognition of key findings and a hierarchical classification of working hypotheses. It should foster the creation of links between the acquired basic clinical knowledge and the diagnostic, management and therapy steps of problem solving.