The Canadian clinician-scientist training program must be reinstated

Clinical investigators within the Canadian and international communities were shocked when the Canadian Institutes of Health Research (CIHR) announced that their funding for the MD/PhD program would be terminated after the 2015–2016 academic year. The program has trained Canadian clinician-scientists for more than two decades. The cancellation of the program is at odds with the CIHR’s mandate, which stresses the translation of new knowledge into improved health for Canadians, as well as with a series of internal reports that have recommended expanding the program. Although substantial evidence supports the analogous Medical Scientist Training Program in the United States, no parallel analysis of the MD/PhD program has been performed in Canada. Here, we highlight the long-term consequences of the program’s cancellation in the context of increased emphasis on translational research. We argue that alternative funding sources cannot ensure continuous support for students in clinician-scientist training programs and that platform funding of the MD/PhD program is necessary to ensure leadership in translational research.The clinician-scientist community was shocked in June when the Canadian Institutes of Health Research (CIHR) announced that its funding for the MD/PhD program would be terminated. In a letter to MD/PhD program directors at Canadian medical schools, the CIHR cited budgetary constraints as the primary motivation for the cancellation of the program, which, at $1.8 million (all figures are in Canadian dollars), constitutes approximately 0.15% of the agency’s 2015 budget. Despite several internal reports that have recommended expanding clinical and translational research programs, and contrary to the CIHR’s own mandate, the CIHR has not yet outlined a new approach to clinician-scientist trainee program funding. Moreover, despite substantial evidence supporting American MD/PhD programs, no parallel evaluation of the MD/PhD program has been performed within Canada that would justify this funding decision (1). The cancellation of this program represents a blow to Canadian and international medical research.     

Innovative strategic Canadian research training from TomorrOw's Research Cardiovascular Health Care Professionals (TORCH)

Cardiovascular research training is experiential, and "skills" are traditionally acquired through a master-apprentice paradigm. The complexity of contemporary clinical research requires a new model for research training. Facilitated through a Strategic Training Program Initiative, the Canadian Institutes of Health Research (CIHR), with its partners the Alberta Heritage Foundation for Medical Research and the Heart and Stroke Foundation, supported the Universities of Alberta and Calgary to create a new and innovative training model. Tomorrow's Research Cardiovascular Health Professionals (TORCH) is an integrated 2-year program for health care professionals from diverse disciplines to be mentored toward careers as leaders in translational cardiovascular research, applying discovery to human health. This report describes the vision, mission, core values, objectives, design and curriculum of the program. Our vision is the development of a new generation of cardiovascular research clinician-scientists, with particular emphasis on thought, leadership and collaboration. The program incorporates 4 core values: innovation and discovery, a translational and transdisciplinary focus, an emphasis on collaboration and integration of research concepts, and the teaching of a core body of research knowledge coupled with real-world "survival" skills. The core curriculum, organized according to a cluster concept, traverses the 4 pillars of the CIHR. Through the medium of 1-hour weekly videoconferences, the curriculum cycles through case studies, seminars and a journal club in focused areas of cardiovascular research. Mentors in the TORCH program have diverse backgrounds that epitomize the transdisciplinary translational aspects of the program and are chosen for their proven record of research accomplishment and prior history of successful mentoring. The program has recruited 19 trainees from a broad cross-section of disciplines, integrating 2 University of Alberta campuses. The preliminary experience has been both favourable and gratifying.     

Canadian research fellowship training programs in digestive sciences: achievements and challenges

BACKGROUND: The Canadian Association of Gastroenterology (CAG) is committed to fostering the development of future Canadian investigators. Up to 1986, research fellowship support was obtained from the Medical Research Council (MRC) of Canada. Since that time, several peer-reviewed, industry-sponsored, CAG-supported research fellowships and a variety of independently funded awards have augmented this effort. In the same period, peer-reviewed operating grants (OGs) from the MRC and other agencies have been constrained. The aim of this study was to determine the success of CAG, MRC or any other Canadian research fellowships in the development of career investigators in digestive sciences and to identify factors influencing the outcomes of such training. METHODS: MRC records and the minutes of CAG annual meetings were reviewed to identify research fellowship support. Canadian program directors were requested to list research fellows affiliated with their groups between 1986 and 1997. Only fellowships providing at least 1 year of training were included. A 7-page questionnaire detailing biographic characteristics, the site and duration, and specific issues related to the quality of research training was sent to identified trainees. Significant associations between success in achieving an academic appointment or OG support and several variables of training were identified. RESULTS: Eighty-six research fellows were trained. Responses were obtained from 43 of them. The demographic characteristics of the whole group and the respondents were similar. Of the respondents, 81% of trainees obtained academic appointments. Fellowships longer than 1 year were associated with higher rates of academic posting, and MRC-funded fellows had greater success rates of academic appointments. Of eligible trainees 63% have obtained OG support. None of the other variables examined predicted success. Of the trainees responding, 85% valued the fellowship very highly. CONCLUSIONS: The establishment of the additional research fellowships has fostered the development of career investigators in digestive sciences. The high success rate of former trainees in obtaining academic appointments and OG support suggests that the fellowship programs are effective and appropriately oriented. The structure of the current programs does not require substantial revision. OG support for new investigators appears now to lag substantially.     

A description of manual wheelchair skills training: current practices in Canadian rehabilitation centers

Purpose: To describe current practices for manual wheelchair (MWC) skills training in Canadian rehabilitation centers. Methods: An online survey was sent to practice leaders in occupational (OT) and physical therapy (PT) at 87 Canadian rehabilitation centers. Responses were solicited from individuals who could report about wheelchair skills training at facilities with at least 10 beds designated for rehabilitation. Thirty-four questions asked about: (1) demographics, (2) components of MWC training, (3) amount of MWC skills training, (4) use of validated programs and (5) perceived barriers to using validated programs. Data were analyzed using summary statistics. Results: About 68/87 responses were received primarily from OTs (42/68). Basic MWC skills training (e.g. wheel-locks) was consistently part of clinical practice (45/68), while advanced skills training (e.g. curb-cuts) was rare (8/68). On an average, 1–4?h of training was done (29/68). Validated training programs were used by 16/68, most of whom used them “rarely” (7/16). Common barriers to using validated programs were lack of time (43/68) and resources (39/68). Conclusions: Learning to use a wheelchair is important for those with ambulation impairments because the wheelchair enables mobility and social participation. Providing opportunities for advanced wheelchair skills training may enhance mobility and social participation in a safe manner.

• Implications for Rehabilitation

• There is evidence confirming the benefits of a validated wheelchair skills program, yet most clinicians do no not use them. A variety of perceived barriers may help to explain the limited use of existing programs, such as time, resources and knowledge.

• Effective knowledge translation efforts may help alleviate some of these barriers, and novel wheelchair training approaches may alleviate some burden on clinicians to help accommodate the increasing number of older wheelchair users.

     

Pre-entry perceptions of students entering five health professions: implications for interprofessional education and collaboration

ABSTRACT

Dysfunctional interprofessional teams are a threat to health system performance and the delivery of quality patient outcomes. Implementing strategies that prepare future health professionals to be effective collaborators requires a comprehensive understanding of how early professional socialization and professional identity formation occur. We present findings from a qualitative study, grounded in narrative methodology, examining early professional socialization among students across five health professional programs (dentistry, medicine, nursing, pharmacy, physiotherapy) in the first year of health professional training. Between April and September 2015, students (n = 49) entering programs at an Atlantic Canadian University participated in one-on-one, audiotaped interviews starting before formal program orientation. Pre-entry interviews focused on factors influencing students’ career choice and expectations of future profession and interprofessional collaboration (IPC). Findings revealed that many different experiences influenced participants’ career choice and framed the social positioning of their future career (e.g., leadership, prestige, autonomy). Participant narratives revealed the existence of stereotypes pertaining to their chosen and other health professions. Study findings provided insights that may help strengthen initiatives to promote positive professional identity formation within the context of IPC. Implications of this research highlight the need for the early introduction of IPC including pre-entry recruitment messaging for prospective health professionals.     

ICU护士进阶培养的临床实践与效果

目的:探索ICU护士进阶培养模式并评价其效果。方法:以Benner护士职业发展理论与Hamric高级护理实践理论为基础,结合我院的"三轨道五阶梯"层级体系构建ICU护士的进阶培养方案,并在2010—2020年对ICU护士实施五层级进阶培养方案进行职业发展管理。结果:实施ICU护士进阶培养方案后,ICU护士学历有明显提升,专科护士人数比例稳步上升,各专项团队成功构建且发展良好,科研产出也逐年上涨。结论:分层级的ICU护士进阶培养与实践能较好促进临床护理质量提升和专业化发展。     

Ward safety perceived by ward managers in Britain, Germany and Switzerland: identifying factors that improve ability to deal with violence

Little is known about how safe nurses feel on psychiatric wards across different European countries. This paper is aim to evaluate how ward safety is perceived by ward managers in Great Britain, Germany and Switzerland. We replicated a Swiss questionnaire study in Germany and Britain, which asked ward managers on adult psychiatric wards to give details about their ward including data on the management of aggression, staffing levels, staff training, standards and type of restraint used, alarm devices, treatment and management of aggression and the existence and perceived efficacy of standards (protocols, guidelines). The British sample had by far the highest staffing levels per psychiatric bed, followed by Switzerland and Germany. The British ward managers by far perceived violence and aggression least as a problem on their wards, followed by Germany and then Switzerland. British ward managers are most satisfied with risk management and current practice dealing with violence. German managers were most likely to use fixation and most likely to have specific documentation for coercive measures. Swiss wards were most likely to use non-specific bedrooms for seclusion and carry alarm devices. British wards were far more likely to have protocols and training for the treatment and management of violence, followed by Switzerland and Germany. British ward managers by far perceived violence and aggression to be a small problem on their wards compared with Swiss and German ward managers. This was associated with the availability of control and restraint teams, regular training, clear protocols and a lesser degree risk assessments, but not staffing levels.     

Use of target temperature management after cardiac arrest in Germany – A nationwide survey including 951 intensive care units

Introduction

Target temperature management (TTM) after cardiac arrest is recommended by international guidelines, which have been last updated in 2010. Here we investigate the status of implementation in a nationwide survey in Germany which took place in 2012.

Methods

We conducted a nationwide telephone survey including a total of 951 German intensive care units (ICUs). ICUs were identified by using the online registry for hospitals in Germany. A questionnaire was used for the interview about basic data of the intensive care unit and about details concerning use and implementation of TTM after cardiac arrest.

Results

The overall response rate was 91% (865/951). 86% (742/865) of ICUs used TTM after cardiac arrest and implementation peaked in 2010. 95% (702/736) of the ICUs using TTM perform treatment independently of the initial rhythm and 48% (355/738) apply TTM with the use of a feedback device for cooling and controlled re-warming. However, 22% (166/742) still use conventional methods like ice and cold infusion and only 61% (453/742) of the participants provided a written standard operating procedure (SOP).

Conclusion

With a delay of several years, TTM after cardiac arrest is now implemented in the majority of German ICUs. The moderate proportion of ICUs using SOPs for TTM and feedback-controlled cooling devices indicates the need of further improvement in post cardiac arrest care.     

Learning strategies of general practitioners striving to achieve point-of-care ultrasound competence: a qualitative study

BackgroundPoint-of-care ultrasonography (POCUS) is increasingly used in general practice despite the lack of official educational programmes or guidelines for general practitioners (GPs).AimTo explore how GPs have learnt to use POCUS and which barriers they have encountered in their learning process.Design and settingQualitative study conducted in office-based general practice in Denmark.MethodsSemi-structured interviews were conducted with 13 GPs who had implemented POCUS without supporting guidelines or regulations. Analysis was carried out using systematic text condensation. The interview data for this study were collected along with data used in a previous study.ResultsThe participating GPs described having composed their own ultrasound education following a continuous learning process. Basic POCUS competences were achieved through formalized training sessions at hospital departments or courses. The GPs further developed and expanded their scanning skills through additional courses and continuous self-study practice on patients often while consulting internet sources, textbooks or colleagues. Lack of available ultrasound courses, supervision, and clinical guidelines together with time constraints and financial aspects were mentioned as barriers to their ultrasound training.ConclusionThis study showed how GPs had composed their own ultrasound education individually and differently, guided by their own experiences and beliefs about good clinical practice. Formalized ultrasound training was considered a prerequisite for achieving basic ultrasound competences while continuous practice was considered paramount to develop and maintain scanning skills. There were several obstacles to overcome in the learning process including lack of supervision, guidance, and opportunity for practicing skills.

Key points

• Little is known about the educational needs of general practitioners striving to achieve ultrasound competences.
• General practitioners described using formalized training to achieve basic scanning competences and continuous self-study and practice to further develop their skills.
• Lack of time, supervision, clinical guidelines and ultrasound courses were considered barriers in the learning process together with financial aspects.

     

A systematic review and survey of the management of unexpected neonatal alloimmune thrombocytopenia

BACKGROUND: Unexpected neonatal alloimmune thrombocytopenia (NAIT) may have devastating consequences and its management is challenging. To design future trials, evidence from the literature and existing best practice need review. STUDY DESIGN AND METHODS: This study was a cross-sectional survey of neonatal units in Germany and Canada to determine management strategies of NAIT and a systematic search for randomized controlled trials (RCTs). RESULTS: Management of NAIT differs substantially between countries with regard to platelet (PLT) thresholds for screening, initiation of therapy, and treatment. Seventy-seven percent of Canadian physicians versus 68 percent of German physicians screen preterm and term infants, at a PLT threshold of 30 x 10(9) to 100 x 10(9) per L. In preterm infants, 60 percent of Canadian neonatologists commence treatment at a PLT count of between 30 x 10(9) and 50 x 10(9) per L. In Germany 32 percent of the physicians start treatment at this level and 25 percent use a threshold of between 10 x 10(9) and 20 x 10(9) per L. In term infants, 6 percent of the Canadian physicians and 16 percent of the German physicians use even lower treatment triggers of between 5 x 10(9) and 10 x 10(9) per L. In the presence of bleeding, 61 percent of German physicians await the arrival of antigen-negative PLTs, while 64 percent of Canadian neonatologists prefer intravenous immunoglobulin or random-donor PLTs (81%). Maternal PLTs are utilized by 31 percent of physicians in both countries. No RCTs were identified. CONCLUSION: In the absence of RCTs, management of unexpected NAIT differs between countries. Clinicians and transfusion services may use the results of our study to develop collaborative protocols, redefine preferred hospitalwide strategies, and design future controlled trials.     

Which competencies are necessary for clinical perfusion in Germany? Interviews with perfusionists

BACKGROUND: The professional education of cardiovascular perfusionists in Germany and the expertise required for successful practice have not often been studied. Here, the necessary skills for clinical cardiovascular perfusion-ists are described. METHOD: The prerequisites for the practice of the profession, expected future developments and the question of the positioning of a future professional perfusionist training within the educational system were discussed with ten experienced perfusionists. These individuals were interviewed in a semi-standardized fashion following an interview manual and the interviews were evaluated using qualitative research methods. RESULTS: The professional skills currently required of per-fusionists correspond to the list of activities published by the German Society of Cardiovascular Enginering. New areas are knowledge of management and, increasingly, social competence and self-management skills. Future tasks for perfusionists will be more diversified than at present. CONCLUSION: Training for perfusionists should be made broader than it is today. The current restructuring taking place in the profession makes interdisciplinary orientation and increased emphasis on practical training necessary. Academic level education is both feasible and desirable.     

Pain Management Education in Long-Term Care: It Can Make a Difference

Acute and chronic pain management for persons residing in long-term care settings is a serious problem. In an effort to change practice in pain management and improve resident outcomes, the Campaign Against Pain education program was instituted at Beatitudes Health Care Center in Phoenix, Arizona. In this pilot study, professional and certified nursing assistant (CNA) staff were surveyed before and after the training program to ascertain change in knowledge, attitudes, and barriers about pain. After the intensive training program and onsite consultation with the concomitant changes in policies, procedures, and documentation, professional and CNA staff knowledge improved after 6 months (F = 6.273; p = .02), attitudes changed (F = 12.26; p = .002), and barriers were mitigated. With a comprehensive quality improvement pain plan in place, the findings suggest that education in pain management in long-term care and program changes that adopt best practices in pain can make a difference.     

Characteristics of physicians engaged in basic science: a questionnaire survey of physicians in basic science departments of a medical school in Japan

The number of physicians engaged in basic science and teaching is sharply decreasing in Japan. To alleviate this shortage, central government has increased the quota of medical students entering the field. This study aimed to determine the characteristics of physicians who are engaged in basic science in efforts to recruit talent. A questionnaire was distributed to all 30 physicians in the basic science departments of Juntendo University School of Medicine. Question items inquired about sex, years since graduation, years between graduation and time entering basic science, clinical experience, recommending the career to medical students, expected obstacles to students entering basic science, efforts to inspire students in research, increased number of lectures and practical training sessions on research, and career choice satisfaction. Correlations between the variables were examined using χ(2) tests. Overall, 26 physicians, including 7 female physicians, returned the questionnaire (response rate 86.7%). Most physicians were satisfied with their career choice. Medical students were deemed not to choose basic science as their future career, because they aimed to become clinicians and because they were concerned about salary. Women physicians in basic science departments were younger than men. Women physicians also considered themselves to make more efforts in inspiring medical students to be interested in research. Moreover, physicians who became basic scientists earlier in their career wanted more research-related lectures in medical education. Improving physicians' salaries in basic science is important to securing talent. In addition, basic science may be a good career path for women physicians to follow.