Exploring knowledge gaps and research needs in respiratory therapy: a qualitative description study.

Background: Respiratory therapists (RTs) are expected to stay updated on technology, treatments, research, and best practices to provide high-quality patient care. They must possess the skills to interpret, evaluate, and contribute to evidence-based practices. However, RTs often rely on research from other professions that may not fully address their specific needs, leading to insufficient guidance for their practice. Additionally, there has been no exploration of knowledge gaps and research needs from RTs' perspectives to enhance their practice and patient outcomes. The research questions guiding this study were: (i) what are the perceived practice-oriented knowledge gaps? and (ii) what are the necessary research priorities across the respiratory therapy profession according to experts in respiratory therapy? Methods: A qualitative description study was conducted using semi-structured focus groups with 40 expert RTs from seven areas of practice across Canada. Data was analyzed using qualitative content analysis. Results: We identified four major themes relating to what these experts perceive as the practice-oriented gaps and necessary research priorities across the respiratory therapy profession: 1) system-level impact of RTs, 2) optimizing respiratory therapy practices, 3) scholarship on the respiratory therapy profession and 4) respiratory therapy education. Discussion: The findings establish a fundamental understanding of the current gaps and the specific needs of RTs that require further investigation. Participants strongly emphasized the significance of research priorities that consider the breadth and depth of the respiratory therapy profession, which underscores the complex nature of respiratory therapy and its application in practice. Conclusion: The unique insights garnered from this study highlight the knowledge gaps and research needs specific to RTs. These findings pave the way for further exploration, discourse, and research aimed at understanding the specific contributions and requirements of RTs.

Scholarly practice in healthcare professions: findings from a scoping review.

Scholarly practitioners are broadly defined as healthcare professionals that address critical practice problems using theory, scientific evidence, and practice-based knowledge. Though scholarly practice is included in most competency frameworks, it is unclear what scholarly practice is, how it develops and how it is operationalized in clinical practice. The aim of this review was to determine what is known about scholarly practice in healthcare professionals. We conducted a scoping review and searched MEDLINE, EMBASE, CINAHL from inception to May 2020. We included papers that explored, described, or defined scholarly practice, scholar or scholarly practitioner, and/or related concepts in healthcare professionals. We included a total of 90 papers. Thirty percent of papers contained an explicit definition of scholarly practice. Conceptualizations of scholarly practice were organized into three themes: the interdependent relationship between scholarship and practice; advancing the profession's field; and core to being a healthcare practitioner. Attributes of scholarly practitioners clustered around five themes: commitment to excellence in practice; collaborative nature; presence of virtuous characteristics; effective communication skills; and adaptive change ethos. No single unified definition of scholarly practice exists within the literature. The variability in terms used to describe scholarly practice suggests that it is an overarching concept rather than a definable entity. There are similarities between scholarly practitioners and knowledge brokers regarding attributes and how scholarly practice is operationalized. Individuals engaged in the teaching, research and/or assessment of scholarly practice should make explicit their definitions and expectations for healthcare professionals.

Exploring professional identity in rehabilitation professions: a scoping review.

Professional identity is believed to foster self-confidence and resilience in health care professionals. While literature exists describing professional identity in medicine, the relevance of this evidence to rehabilitation professionals (occupational therapy (OT), physical therapy (PT) and speech-language pathology (S-LP)) is limited due to differences between professions in decision-making authority (patient care), professional autonomy and understanding of their scope of practice. The objective was to determine the extent, range and nature of the literature on professional identity/professional identity formation in rehabilitation professionals. Findings from the scoping review based on Arksey and O'Malley's methodological framework are presented. A search was conducted on MEDLINE (Ovid), Embase (Ovid), AMED, CINAHL, and ProQuest Dissertations and Theses from 1996 to October 2020 for empirical and conceptual studies on OT, PT, and S-LP clinicians or students. Of 4983 retrieved records, 53 papers were selected for data extraction. Data were organised into themes for professional identity/professional identity formation: conceptual descriptors (dynamic state, multiple identities); influences (person, professional education/environments, profession-at-large). Findings are consistent with the professional identity literature in medicine. However, they point to gaps for further empirical inquiry in the role of symbols and rituals in the professional identity/professional identity formation of rehabilitation professionals, profession-specific differences between OT, PT and S-LP, and influences related to the profession-at-large on the professional identity/professional identity formation of rehabilitation professionals. These findings may help to inform professional education programs and health care and professional systems in developing resources to support professional identity formation of rehabilitation professionals.

The McMaster Advanced Communication Competencies Model for Psychiatry (MACC Model).

OBJECTIVE: Communication is a core competency for all physicians in training. In Canada, the importance of communication during residency is recognized through the CanMEDS framework. Although literature exists around teaching communication skills to residents, research in psychiatry residents is lacking. The purpose of this study was to explore how faculty members conceptualize the development of communication skills in psychiatry residents and develop a model reflecting this. METHODS: The authors used a constructivist grounded theory approach. Purposive sampling was used to select 14 faculty educators who regularly supervise psychiatry residents in a single university-based residency training program. Semi-structured interviews were conducted to explore educators' perceptions of how communication skills develop during residency. Constant comparative analysis occurred concurrently with data collection until thematic theoretical sufficiency was reached and relationships between themes determined. RESULTS: Five themes underlie the McMaster Advanced Communication Competencies model, describing the progressive development of communication abilities in residents. Three themes identify foundational sets of abilities including: refining common foundational relational abilities, developing foundational specific psychiatric communication abilities, and learning to reflect upon and manage internal reactions. These foundational pillars then allow residents to develop a personalized art of flexible psychiatric interviewing, and skillfully partner with patients in co-creating care plans. CONCLUSIONS: This research describes a preliminary communication competency model for teaching and assessing psychiatry residents. It defines the core communication abilities required for residents to progress to independent practice. Future research could explore and test the model's validity and transferability.

Exploring the professionalization of respiratory therapy in Canada.

INTRODUCTION: A recurrent challenge facing respiratory therapists (RTs) is their legitimacy as professionals. RTs are often referred to as technologists, vocationalists, or technicians and must often justify their status as full professionals rather than "professional technicians". There is currently little exploration of what it means to be a profession and the process of professionalization in respiratory therapy. APPROACH: Drawing from sociological theory, the purpose of this paper is to discuss the professionalization of respiratory therapy in Canada using Andrew Abbott's theory, the "system of professions". We will use this theory as a lens to propose areas of consideration for professional development regarding two pervasive themes in the respiratory therapy community, RTs' specialized body of knowledge and professional autonomy. FINDINGS: Abstract knowledge is believed to be essential in the evolution from occupation to profession and is valuable to a profession in three ways: it can influence the profession's legitimacy, it can be used for conducting research, and it promotes higher education. RTs possess jurisdictional professional autonomy within Canada. The privilege of self-regulation allows RTs to act according to their knowledge and judgement without direct oversight from other professions. CONCLUSION: Based on Abbott's theoretical position, RTs can rightly justify their position as professionals. However, RTs need to acknowledge that professionalization is a dynamic and continuous process that requires creative changes to innovate within the profession and support future efforts to reinforce their position as professionals. Throughout this paper, we offer suggestions for how RTs can contribute to the ongoing professionalization of respiratory therapy.

Features of scholarly practice in health care professionals: A scoping review protocol.

INTRODUCTION: Health care professionals are expected to embrace and enact the scholarly practitioner role. Scholarly practitioners demonstrate a lifelong commitment to excellence in practice through continuous learning, engagement in evidence-informed decision-making, contributions to scholarship, and knowledge translation. However, the specific features and requirements associated with this role are not uniform. The absence of well-defined and delineated conceptualizations of scholarly practice and the scarcity of empirical research on how scholarly practice is operationalized contribute to a lack of a shared understanding of this complex role. AIM: The purpose of this scoping review is to map the breadth and depth of the literature on what is known about scholarly practice in licensed health care professionals. METHODS: Arksey and O'Malley's 6-stage scoping review framework will be used to examine the breadth and depth of the literature on the definitions and conceptualizations of the scholar role in health care professionals. We will conduct a comprehensive search from inception to present in MEDLINE (Ovid), EMBASE (Ovid), and CINAHL using scholarly practitioner terms and related synonyms, including a grey literature search. Following a calibration exercise, two independent reviewers will screen retrieved papers for inclusion and extract relevant data. Included papers will: (i) explore, describe, or define scholarly practice, scholar or scholarly practitioner, and/or related concepts in the licensed health care professionals; (ii) be conceptual and/or theoretical in nature; (iii) use quantitative, qualitative, or mixed methodologies; and (iv) be published in English or French. Numeric and thematic analysis will characterize the data and address the research objectives.

Assessing noncognitive domains of respiratory therapy applicants: Messick's framework appraisal of the multiple mini-interview.

Educators who assess incoming applicants into a health professional training program are looking for a wide array of cognitive and noncognitive skills that best predict success in the program and as a future practicing professional. While aptitude tests generally measure cognitive skills, noncognitive constructs are more difficult to measure appropriately. The traditional method of measuring noncognitive constructs has been the panel interview. Panel interviews have been described as inconsistent in measuring noncognitive domains and consistently reported as unreliable and susceptible to bias. An alternate interview method used in many health professions schools is the multiple mini-interview (MMI) that was specifically designed to assess noncognitive domains in health professions education. This paper discusses the purpose of using the MMI, how the MMI is conducted, specific domains of focus for the MMI, and the feasibility of creating an MMI. Finally, the paper uses Messick's framework on validity to guide the consideration of the MMI.

The impact of a research elective on a respiratory therapy student's perspective.

As the infrastructure of the healthcare landscape continues to change, Registered Respiratory Therapists (RRTs) may be required to assume nontraditional roles in health care. One such role is RRTs as researchers. However, there are few opportunities for students to explore research as a career option given current rigidly structured didactic curriculums. One possible solution to this dilemma is the addition of a summertime research elective. The following article will discuss the general importance of research, followed by an overview of RRTs involved in research. We conclude this article with a narrative recount of an RRT researcher and a respiratory therapy student's initiative to organize and execute a summertime research elective.

The impact of a research elective on a respiratory therapy student's perspective.

As the infrastructure of the healthcare landscape continues to change, Registered Respiratory Therapists (RRTs) may be required to assume nontraditional roles in health care. One such role is RRTs as researchers. However, there are few opportunities for students to explore research as a career option given current rigidly structured didactic curriculums. One possible solution to this dilemma is the addition of a summertime research elective. The following article will discuss the general importance of research, followed by an overview of RRTs involved in research. We conclude this article with a narrative recount of an RRT researcher and a respiratory therapy student's initiative to organize and execute a summertime research elective.

How to Conduct a Systematic Review and Meta-Analysis: A Guide for Clinicians.

Evidence-based practice relies on using research evidence to guide clinical decision-making. However, staying current with all published research can be challenging. Many clinicians use review articles that apply predefined methods to locate, identify, and summarize all available evidence on a topic to guide clinical decision-making. This paper discusses the role of review articles, including narrative, scoping, and systematic reviews, to synthesize existing evidence and generate new knowledge. It provides a step-by-step guide to conducting a systematic review and meta-analysis, covering key steps such as formulating a research question, selecting studies, evaluating evidence quality, and reporting results. This paper is intended as a resource for clinicians looking to learn how to conduct systematic reviews and advance evidence-based practice in the field.

Exploring stakeholder perspectives regarding the implementation of competency-based medical education: a qualitative descriptive study.

Introduction: Competency-based medical education (CBME) offers perceived advantages and benefits for postgraduate medical education (PGME) and the training of competent physicians. The purpose of our study was to gain insights from those involved in implementing CBME in two residency programs to inform ongoing implementation practices. Methods: We conducted a qualitative descriptive study to explore the perspectives of multiple stakeholders involved in the implementation of CBME in two residency programs (the first cohort) to launch the Royal College's Competence by Design model at one Canadian university. Semi-structured interviews were conducted with 17 participants across six stakeholder groups including residents, department chairs, program directors, faculty, medical educators, and program administrators. Data collection and analysis were iterative and reflexive to enhance the authenticity of the results. Results: The participants' perspectives organized around three key themes including: a) contextualizing curriculum and assessment practices with educational goals of CBME, b) coordinating new administrative requirements to support implementation, and c) adaptability toward a competency-based program structure, each with sub-themes. Conclusion: By eliciting the perspectives of different stakeholder groups who experienced the implementation processes, we developed a common understanding regarding facilitators and challenges for program directors, program administrators and educational leaders across PGME. Results from our study contribute to the scholarly conversation regarding the key aspects related to CBME implementation and serve to inform its ongoing development and application in various educational contexts.

Introduction: La formation médicale axée sur les compétences (FMAC) offre des avantages et des bénéfices perçus pour les études médicales postdoctorales et la formation de médecins compétents. Le but de notre étude était d'apprendre des personnes impliquées dans l'implantation de la FMAC dans deux programmes de résidence afin d'informer les pratiques de mise en œuvre en cours. Méthodes: Nous avons réalisé une étude qualitative descriptive pour explorer les perspectives de plusieurs parties prenantes impliquées dans la mise en œuvre de la FMAC dans deux programmes de résidence (la première cohorte) visant à mettre en place le modèle Compétence par conception du Collège royal dans une université canadienne. Des entrevues semi-structurés ont été menés auprès de 17 participants issus de six groupes de parties prenantes, notamment des résidents, des chefs de département, des directeurs de programme, des membres de la faculté, des éducateurs médicaux et des administrateurs de programme. La collecte et l'analyse des données étaient itératives et réflexives afin d'enrichir l'authenticité des résultats. Résultats: Les perspectives des participants se sont organisées autour de trois thèmes clés, à savoir : a) contextualiser les pratiques de curriculum et d'évaluation avec les objectifs d'apprentissage de la FMAC, b) coordonner les nouvelles exigences administratives pour soutenir la mise en œuvre, et c) s'adapter à une structure de programme axée sur les compétences, chacun avec des sous-thèmes. Conclusion: En recueillant les perspectives des différents groupes de parties prenantes ayant vécu les processus de mise en œuvre, nous avons développé une compréhension commune des facilitateurs et des défis pour les directeurs de programme, les administrateurs de programme et les leaders éducatifs dans la formation médicale postdoctorale. Les résultats de notre étude contribuent à la conversation savante concernant les aspects clés liés à la mise en œuvre de la FMAC et servent à informer son développement et son application en cours dans différents contextes éducatifs.

Adolescent medicine training in postgraduate family medicine education: a scoping review.

INTRODUCTION: Adolescents and young adults require age-appropriate healthcare services delivered by clinicians with expertise in adolescent medicine. However, resident family physicians report a low perceived self-efficacy and under-preparedness to deliver adolescent medical care. We conducted a scoping review to map the breadth and depth of the current evidence about adolescent medicine training for family medicine residents. CONTENT: We followed Arksey and O'Malley's framework and searched seven electronic databases and key organizations' webpages from inception to September 2020. Informed by the CanMEDS-FM, we analyzed the extracted data concerning basic document characteristics, competencies and medical topics using numerical and qualitative content analysis. SUMMARY: We included 41 peer-reviewed articles and six adolescent health competency frameworks (n=47). Most competencies taught in family medicine programs were organized under the roles of family medicine expert (75%), communicator (11.8%), and professional roles (7.9%). Health advocate and leader were rarely included (1.3%), and never scholar. OUTLOOK: The omission of multiple competency roles in family medicine resident education on adolescents is insufficient for family physicians to deliver optimal care to adolescents. The combined efforts of family medicine stakeholders to address adolescent medicine competency gaps may positively impact the perceived competence reported by family medicine residents.

What scholarly practice means to respiratory therapists: An interpretive description study.

RATIONALE: Engagement in scholarly practice has been associated with professional empowerment, role satisfaction and improvements in care delivery and patient outcomes across many healthcare professions. However, in evolving professions like respiratory therapy, scholarly practice is excluded from competency frameworks, resulting in a gap in education and subsequent application of this competency in practice. An exploration of scholarly practice in respiratory therapy may provide insights into evolving professions that face tensions between meeting competency requirements as outlined in frameworks and providing quality healthcare to the populations they serve. AIMS AND OBJECTIVES: The aim of the study was to explore what scholarly practice means, and how it manifests in practice from respiratory therapists' (RTs) perspectives. METHODS: We used interpretive description methodology. We purposively sampled participants to obtain varied perspectives of scholarly practice in respiratory therapy. We conducted 26 semistructured interviews with RTs in different roles (clinicians, educators, researchers, leaders and managers) across Canada and analysed the data using inductive analysis. Data collection and analysis proceeded concurrently. RESULTS: We developed five main themes: (i) the identity of a scholarly practitioner in RTs; (ii) factors influencing scholarly practice; (iii) one's impression of their professional self-image; (iv) scholarly practice as a vehicle for changing practice and (v) the complex interconnections between knowledges and practices. CONCLUSION: Scholarly practice appears to be a multifaceted phenomenon encompassing a wide range of activities and skills including conducting research, reflective practice, application of research to practice, and contributing to the advancement of the profession and healthcare. Scholarly practice is influenced by organisational context and culture, available resources, intrinsic motivation and external political context. We identified similarities between professional identity and the description of the scholarly practitioner, suggesting that these two phenomena may be interconnected. Furthermore, participants believed that scholarly practice could enhance the image, credibility, legitimacy and professionalisation of the profession.

Barriers to Respiratory Care Research in the United States.

BACKGROUND: Respiratory therapists (RTs) are in a unique position to positively impact patient outcomes through respiratory care research. Research plays a key role in evidence-based medicine; however, few RTs perform and publish research. Identification of barriers experienced by RTs may help increase RT-driven research. Thus, we aimed to identify barriers and research interests for RTs. METHODS: American Association for Respiratory Care (AARC) members were invited to anonymously complete a survey via an electronic link posted on AARC Connect. Survey domains included research training, experience, reasons for doing research, important respiratory topics, and barriers to conduct research. RESULTS: Responses from 82 surveys were analyzed. The majority were female (56%), and most had a graduate degree (61%), with a mean working experience of 25.3 ± 13.6 y. Fifty-seven percent of respondents reported at least one publication in a peer-reviewed journal. The desire to improve patient outcomes was the top-ranked reason for doing research. Most received research training through a graduate-level program (56%), but few had a formal research mentor (26%). Clinical research (67%) and quality improvement (63%) were the most common types of research. Data collection was the most common research role (51%). Invasive ventilation, advanced monitoring, and airway clearance were identified as the most important research topics. The primary barriers for RTs to conduct research were lack of protected time for research, opportunities to participate, training, departmental support, and mentorship. CONCLUSIONS: Lack of time, resources, and opportunities were identified as the primary barriers to RT research, and many RTs have not received formal research training. Resources such as formal mentorship, funding, and protected time may help increase RT participation in research.

Challenges and future directions in the measurement of evidence-based practice: Qualitative analysis of umbrella review findings.

RATIONALE, AIMS AND OBJECTIVES: An important aspect of scholarly discussions about evidence-based practice (EBP) is how EBP is measured. Given the conceptual and empirical developments in the study of EBP over the last 3 decades, there is a need to better understand how to best measure EBP in educational and clinical contexts. The aim of this study was to identify and describe the main challenges, recommendations for practice, and areas of future research in the measurement of EBP across the health professions as reported by systematic reviews (SRs). METHODS: We conducted a secondary analysis of qualitative data obtained in the context of a previously published umbrella review that aimed to compare SRs on EBP measures. Two reviewers independently extracted excerpts from the results and discussion/conclusion sections of the 10 included SRs that aligned with the three research aims. An iterative six-phase reflexive thematic analysis according to Braun and Clarke was conducted. RESULTS: Our thematic analysis produced five themes describing the main challenges associated with measuring EBP, four themes outlining main recommendations for practice, and four themes representing areas of future research. Challenges include limited psychometric testing and validity evidence for existing EBP measures; limitations with the self-report format; lack of construct clarity of EBP measures; inability to capture the complexity of the EBP process and outcomes; and the context-specific nature of EBP measures. Reported recommendations for practice include acknowledging the multidimensionality of EBP; adapting EBP measures to the context and re-examining the validity argument; and considering the feasibility and acceptability of measures. Areas of future research included the development of comprehensive, multidimensional EBP measures and the need for expert consensus on the operationalization of EBP. CONCLUSIONS: This study suggests that existing measures may be insufficient in capturing the multidimensional, contextual and dynamic nature of EBP. There is a need for a clear operationalization of EBP and an improved understanding and application of validity theory.

Portfolios with Evidence of Reflective Practice Required by Regulatory Bodies: An Integrative Review.

Purpose: Regulatory bodies impose continuing professional development (CPD) requirements on health care professionals (HCPs) as a condition for license revalidation. Many regulatory bodies require annual evidence of CPD activities that are informed by reflective practices, guided by learning plans, and compiled into a portfolio. The purpose of this integrative review is to summarize the literature discussing how regulatory bodies use portfolios with evidence of reflection for licensure renewal. Method: We reviewed English-language articles published until May 2020 discussing evidence of CPD and reflective practice in portfolios in the context of licensure renewal. Results: We located 17 articles for the review. None reported or measured outcomes beyond submission of reflective evidence. Sixteen articles (93%) included information about passive learning resources that regulatory bodies provided to help guide HCPs' reflective learning activities. HCPs' feedback about using reflective learning activities indicated mixed opinions about their utility. Conclusions: Few publications reported how jurisdictions expected HCPs to provide evidence of reflective practices for licensure renewal. None of the regulatory bodies required evidence regarding the impact of reflective practice on patient or organizational outcomes. HCPs reported both benefits and challenges of a mandated reflective process.

Objectif : les organismes de réglementation imposent des exigences de perfectionnement professionnel continu (PPC) aux professionnels de la santé (PdS) afin qu'ils puissent renouveler leur permis. Bon nombre exigent des preuves annuelles d'activités de PPC éclairées par des pratiques réflexives, orientées par des plans d'apprentissage et compilées dans un portfolio. La présente analyse intégrative vise à résumer les publications qui expliquent l'utilisation que font les organismes de réglementation des portfolios contenant des preuves de pratiques réflexives dans le processus de renouvellement des permis. Méthodologie : articles de langue anglaise publiés jusqu'en mai 2020 sur des portfolios contenant des preuves de PPC et de pratiques réflexives pour renouveler le permis. Résultats : les chercheurs ont extrait 17 articles. Aucun ne portait sur les résultats mesurés après la soumission des preuves réflexives. Au total, 16 articles (93 %) contenaient de l'information sur les ressources d'apprentissage passif que les organismes de réglementation fournissaient pour contribuer à orienter les activités d'apprentissage réflexif des PdS. Les commentaires des PdS sur les activités de pratique réflexive faisaient foi d'avis mitigés quant à leur utilité. Conclusions : Peu de publications indiquaient la manière dont les régions sociosanitaires voulaient recevoir les preuves de pratiques réflexives des PdS en vue du renouvellement du permis. Aucun organisme de réglementation n'avait besoin de données probantes sur les répercussions de la pratique réflexive pour le patient ou sur les résultats organisationnels. Selon les PdS, le processus réflexif obligatoire comportait à la fois des avantages et des inconvénients.