Secrets of a Head Chef: Exploring Factors Influencing Success in Irish Kitchens

One-hundred and seventy head chefs from the Republic of Ireland scored 59 variables for success on two scales: (a) competencies needed for success (NS), and (b) personal ownership of these competencies (PO). Results showed that variables were rated with means of 1.18 (extremely important) to 3.23 (moderately important). The top three were an ability to work hard, commitment to quality, and knowledge of Hazard Analysis and Critical Control Points (HACCP). Variables rated lower in ownership than importance highlight areas for culinary educators to develop training programs. Average wages of head chefs (objective success) mirror the average industrial wage, but higher wages were gained with longer time working. Eighty percent of head chefs were satisfied (subjective success) in their current jobs. Factor analysis showed the factors needed to succeed in the culinary industry include professionalism, individual characteristics, leadership skills, management skills, and interaction with the job context. Applications for industry include talent management, mentoring future leaders, reducing staff turnover, and curriculum development.     

Competencies in Swedish emergency departments – The practitioners’ and managers’ perspective

The task of emergency departments (EDs) is to provide safe emergency healthcare while adopting a caring, cost-effective approach. Patients attending EDs have different medical and caring needs and it is assumed that practitioners have the requisite competencies to meet those needs. The aim of the present study is to explore what kind of competencies practitioners and managers describe as necessary for the practitioners to perform their everyday work in EDs.MethodsThis study used a qualitative, exploratory design. Interviews were conducted in two EDs. Data were analysed using inductive content analysis.ResultsThe competence focus in everyday work in EDs is on emergency and life-saving actions. There is a polarisation between medical and caring competencies. There is also tension between professional groups in EDs as well as hierarchical boundaries that influence the ability to develop competencies in everyday work. Medical competencies are valued more and caring competencies are subsequently downgraded. A medical approach to competencies consolidates the view of necessary competencies in everyday work in EDs.ConclusionsThe study shows that the competencies that are valued consolidate the prevailing medical paradigm. There is a traditional, one-sided approach to competencies, a hierarchical distinction between professional groups and unclear occupational functions.     

Roles and competencies in the nutritional domain for the management of the metabolic diseases and in the hospital setting: A position paper of the Italian College of Academic Nutritionists,MED-49 (ICAN-49)

Epidemiological evidence has confirmed the potential causal relationship between specific dietary factors and non-communicable diseases. However, currently nutrition was shown to be insufficiently integrated into medical education, regardless of the country. Without an adequate nutrition education, it is reasonable to assume that future physicians, as well as other health care professionals, will be not able to provide the highest quality care to patients in preventing and treating non-communicable diseases. Furthermore, the insufficient availability of physicians with specializations in nutrition has posed the basis for the development of non-medical careers in the field of nutrition. The present document was drafting by the Italian College of Academic Nutritionists, MED-49 (ICAN-49), with the aim to provide an overview on the nutritional competency standards covered by several health care professionals (Physicians Clinical Nutrition Specialists, Clinical Dietitians, Professional Clinical Nutrition Specialists, etc) for the prevention of diseases and/or support of pharmacological therapies. The aim of the ICAN 49 is to suggest a major shift in practice opportunities and roles for many nutritionists, especially for the management of the metabolic diseases, and promote a paradigm change: a clinical and educational leadership role for Physician Clinical Nutrition Specialists in the hospital setting.     

Narrative medicine as a means of training medical students toward residency competencies

Objective

This study sought to explore the perceived influence of narrative medicine training on clinical skill development of fourth-year medical students, focusing on competencies mandated by ACGME and the RCPSC in areas of communication, collaboration, and professionalism.

Methods

Using grounded-theory, three methods of data collection were used to query twelve medical students participating in a one-month narrative medicine elective regarding the process of training and the influence on clinical skills. Iterative thematic analysis and data triangulation occurred.

Results

Response rate was 91% (survey), 50% (focus group) and 25% (follow-up). Five major findings emerged. Students perceive that they: develop and improve specific communication skills; enhance their capacity to collaborate, empathize, and be patient-centered; develop personally and professionally through reflection. They report that the pedagogical approach used in narrative training is critical to its dividends but misunderstood and perceived as counter-culture.

Conclusion/Practice implications

Participating medical students reported that they perceived narrative medicine to be an important, effective, but counter-culture means of enhancing communication, collaboration, and professional development. The authors contend that these skills are integral to medical practice, consistent with core competencies mandated by the ACGME/RCPSC, and difficult to teach. Future research must explore sequelae of training on actual clinical performance.     

Evaluación de competencias en residentes de pediatría en el primer nivel de atención mediante la utilización del Mini-CEX

BackgroundA residency is a professional training system based on supervised clinical practice. The Mini Clinical Evaluation Exercise (Mini-CEX) is a method of assessment through direct observation that enables the design of strategies to improve professional performance.The purpose of this study is to analyze the results of implementing the Mini-CEX to assess pediatric residents during their rotation at the first level of care while exploring differences according to the training site to which they belong.MethodsWe conducted an analytical cross-sectional study that included 2nd-year pediatric residents on rotation at the first level of care in pediatric and general hospitals. Each resident underwent two Mini-CEX encounters for the assessment of 8 domains: history taking, communication skills with patients and with caregivers, physical examination, clinical judgment, clinical management, professionalism, and organization.ResultsThirty-four residents participated in the study. The total overall rating of residents from pediatric hospitals and general hospitals was 4.20 (4.07-4.34) and 4.14 (3.94-4.34), respectively. We found no statistically significant differences in the areas assessed according to the residents’ training site.ConclusionThe Mini-CEX as an assessment tool within the first level of care allowed the detection of strengths and weaknesses in residents’ training. Implementation was affected by limitations inherent to this setting. Standardization of assessors was a key element for criteria unification.     

Gaps in exposure to essential competencies in hand surgery fellowship training: a national survey of program directors

Background

Graduate medical education has moved towards competency-based training. The aim of this study was to assess hand surgery program directors’ opinions of exposure gaps in core competencies rated as essential for hand surgery training.

Methods

We surveyed the 74 ACGME hand surgery fellowship program directors. Respondents rated their opinion of 9 general areas of practice, 97 knowledge topics, and 172 procedures into one of three categories: essential, exposure needed, or unnecessary. Program directors also rated trainee exposure of each component at their respective program. Moderate and large exposure gaps were respectively defined as presence of at least 25 and 50 % of programs rating trainees as not having proficiency in the component at the end of training.

Results

Sixty-two of 74 program directors (84 %) responded to the survey. For the 76 knowledge topics and 98 procedures rated as essential, a majority of the knowledge topics (61 %; n = 46) and procedures (72 %; n = 71) had at least a moderate exposure gap. In addition, 22 % (n = 17) of the essential knowledge topics and 26 % (n = 25) of the essential procedures had a large exposure gap.

Conclusion

This study illuminates the discrepancies between what is believed to be important for practicing hand surgeons and graduates’ proficiency as perceived by program directors. The field of hand surgery must work to determine if program directors have unrealistic expectations for what is essential for practicing hand surgeons or if reforms are needed to improve exposure to essential skills in hand surgery training.     

Competencies of specialised wound care nurses: a European Delphi study

Health care professionals responsible for patients with complex wounds need a particular level of expertise and education to ensure optimum wound care. However, uniform education for those working as wound care nurses is lacking. We aimed to reach consensus among experts from six European countries as to the competencies for specialised wound care nurses that meet international professional expectations and educational systems. Wound care experts including doctors, wound care nurses, lecturers, managers and head nurses were invited to contribute to an e‐Delphi study. They completed online questionnaires based on the Canadian Medical Education Directives for Specialists framework. Suggested competencies were rated on a 9‐point Likert scale. Consensus was defined as an agreement of at least 75% for each competence. Response rates ranged from 62% (round 1) to 86% (rounds 2 and 3). The experts reached consensus on 77 (80%) competences. Most competencies chosen belonged to the domain ‘scholar’ (n = 19), whereas few addressed those associated with being a ‘health advocate’ (n = 7). Competencies related to professional knowledge and expertise, ethical integrity and patient commitment were considered most important. This consensus on core competencies for specialised wound care nurses may help achieve a more uniform definition and education for specialised wound care nurses.     

Non‐medical prescribing in prostate cancer care: a case study reflection

There are approximately 54 000 nurse and midwife prescribers across the United Kingdom (UK), with 19 000 nurse independent and supplementary prescribers. Prostate cancer specialist nurses are ideally suited to implement advanced levels of practice in non‐medical prescribing, but little has been detailed in the literature about the prescribing practice in this clinical context. This paper set out to critically review evidence‐based recommendations for Prostate Cancer Specialist Nurses using a case study reflection to contextualize the role of non‐medical prescribing. A structured literature review was conducted in a range of electronic databases (DARE, Cochrane, MEDLINE, BNI, PsychINFO, EMBASE and CIHAHL), and a grey literature search in google, to identify studies employing a qualitative and/or quantitative methods. National (UK) and European clinical guidelines and legislative frameworks were also included. Methodological evaluation was conducted and evidence‐based recommendations were integrated into a narrative synthesis. A multidisciplinary and proactive approach to the management of men with metastatic prostate cancer ensures safe and effective prescribing practice, and optimizes supportive care delivery. A reflective case study has illuminated the key features necessary to maximize the success of non‐medical prescribing in prostate cancer care and captures the importance of good working relationships. While different practice models will emerge, the Prostate Cancer Model of Consultation may facilitate a structured framework for safe practice, embedded in effective communication strategies. Non‐medical prescribers must be committed to continual professional development, and prescribe safely within individual competencies and scope of professional practice. There is a pressing need for further research to evaluate prescribing practices with a particular focus on the nature of influencing factors on prescribing decisions, cost‐effectiveness and a more detailed understanding of how team working and inter‐team referral affects prescribing decisions between the Multidisciplinary Team (MDT) members.