In the Front Line: The Impact of Specialist Training for Hospital Physicians in Children at Risk on Their Collaboration With Social Workers

Until recently, dealing with children at risk in Israeli hospitals was almost exclusively the domain of medical social workers. Suspected cases of abuse or neglect must be identified in real-time, during the child’s short stay in the hospital, and the decision of whether or not to report the case, and to whom (law enforcement or welfare authorities), must be made. The recognition that effective treatment also demands the involvement of physicians led to the development of an intensive training program for hospital-pediatricians. The current study, based on in-depth interviews with the doctors who participated in the program and the social workers who work with them at 14 hospitals in Israel, examined the impact of the training on cooperation between the two groups, seeking to determine whether the doctors’ increased familiarity with the social work profession enhanced team-work.

Phenomenological analysis of the interviews revealed several themes, indicating greater collaboration between the doctors and social workers. However, the participants also noted increased friction between the two groups. Possible explanations and practical recommendations for enhancing the potential effectiveness of such collaborations are offered. The study has implications for designing similar training programs as well as for improving the dynamics between the two professions.     

Evaluación de un programa comunitario para reducir el aislamiento de personas mayores debido a barreras arquitectónicas

Objective

Social isolation impairs health. An intervention to reduce isolation due to architectural barriers in elderly persons was carried out in Barcelona (Spain). This study aimed to evaluate its effects on health.

Methods

We conducted a quasi-experimental before-after study. Isolated older people were identified in three deprived urban areas from 2009 to 2011. Participants had twice-weekly outings with volunteers in a stair-climbing power wheelchair. User satisfaction was evaluated and perceived health status, quality of life, and mental health before and after four outings were compared with McNemar tests.

Results

There were 74 participants (median age: 83 years; IQR: 78-89). Perceived health improved by 21%, mental health by 24%, and psychological distress was reduced by 16%. Most participants (98%) were satisfied.

Conclusion

The intervention improved perceived health and mental health. Elderly people with impaired mobility should not live in buildings with architectural barriers and, if this cannot be avoided, similar programs should be implemented.     

Benchmarking the strategies for assessing clinical reasoning in osteopathic curricula

BackgroundBenchmarking between educational institutions is a vital component of quality assurance and contributes to greater consistency and quality in teaching and learning practices. The investigation of clinical reasoning in osteopathy has only recently begun to be explored in depth. Benchmarking builds confidence in our education practices and processes and demonstrates a maturing of the osteopathic academic profession.ObjectiveThe aim of this project was to benchmark the assessment strategy used for clinical reasoning across the final two years of the clinical components of four osteopathic programs.MethodsLearning objectives and clinical assessments from the final two years in each of the four programs were analysed to identify the types and frequency of assessments and the degree of alignment between learning objectives and Bloom's taxonomy and Miller's heirarchy.ParticipantsRepresentatives from Southern Cross University, Australia, Victoria University, Australia, Unitec, New Zealand and the British School of Osteopathy, UK.ResultsAll institutions assess clinical reasoning in a variety of ways such as the assessment of student's actual performance during real-time, in-situ clinical consultations; the assessment of simulated performance; the clinical supervisors' report and; oral or written reports - on simulated case study. The results show that the osteopathy teaching institutions in the present study do not scaffold the expected learning objectives to reflect an increase in difficulty as the student's progress; the learning objectives tend to be clustered and relatively stable. However, this may be a reflection of only investigating the final years of an osteopathy teaching program. This opens the field for future research.ConclusionsIt would be worthwhile if future studies benchmarked the criteria used in clinical assessments and made explicit the key professional values related to assessing clinical competencies in line with the Core Competencies outlined in the World Health Organization's Benchmarks for Training in Osteopathy.     

Structural approaches for prevention of sexually transmitted HIV in general populations: definitions and an operational approach

Introduction

Although biomedical HIV prevention efforts have seen a number of recent promising developments, behavioural interventions have often been described as failing. However, clear lessons have been identified from past efforts, including the need to address influential social, economic and legal structures; to tailor efforts to local contexts; and to address multiple influencing factors in combination. Despite these insights, there remains a pervasive strategy to try to achieve sexual behaviour change through single, decontextualized, interventions or sets of activities. With current calls for structural approaches to HIV as part of combination HIV prevention, though, there is a unique opportunity to define a structural approach to HIV prevention as one which moves beyond these past limitations and better incorporates our knowledge of the social world and the lessons from past efforts.

Discussion

A range of interlinked concepts require delineation and definition within the broad concept of a structural approach to HIV. This includes distinguishing between “structural factors,” which can be seen as any number of elements (other than knowledge) which influence risk and vulnerability, and “structural drivers,” which should be reserved for situations where an empirically established relationship to a target group is known. Operationalizing structural approaches similarly can take different paths, either working to alter structural drivers or alternatively working to build individual and community resilience to infection. A “structural diagnostic approach” is further defined as the process one undertakes to develop structural intervention strategies tailored to target groups.

Conclusions

For three decades, the HIV prevention community has struggled to reduce the spread of HIV through sexual risk behaviours with limited success, but equally with limited engagement with the lessons that have been learned about the social realities shaping patterns of sexual practices. Future HIV prevention efforts must address the multiple factors influencing risk and vulnerability, and they must do so in ways tailored to particular settings. Clarity on the concepts, terminology and approaches that can allow structural HIV prevention efforts to achieve this is therefore essential to improve the (social) science of HIV prevention.