The influence of near-peer teaching on undergraduate health professional students' self-efficacy beliefs: A systematic integrative review.

BACKGROUND: Near-peer teaching, a type of peer teaching traditionally used in medical education, has gained popularity as a way of enhancing students' learning in undergraduate health disciplines such as nursing, physiotherapy and paramedicine. Research has established the positive impact of near-peer teaching on health professional students' cognitive and psychomotor outcomes; however, little is known about its influence on students' self-efficacy beliefs, which are important predictors of future clinical performance. AIM: To determine the influence, if any, of near-peer teaching participation on undergraduate health professional students' self-efficacy beliefs. DESIGN: Whittemore and Knafl's integrative review framework was used as a guide to synthesise diverse literature including quantitative, qualitative, and mixed methods peer-reviewed studies and grey literature. REVIEW METHODS AND DATA SOURCES: A search was conducted of published literature prior to October 2023 using the MEDLINE, Embase, SCOPUS, ERIC, PsycINFO and CINAHL databases; 1376 non-duplicate studies were identified. Following independent screening by two authors, nine studies were included in the review. Critical appraisal of studies was performed using the Mixed Methods Appraisal Tool. Data were extracted and compared to generate themes related to students' self-efficacy outcomes. RESULTS: Seven included studies were quantitative survey-based; five were from medicine. Two studies met all methodological quality criteria. In seven studies, near-peer teaching participation positively influenced junior (i.e., first- and second-year) health professional students' self-efficacy in three domains - psychomotor skills, interprofessional skills and critical thinking. In four studies, near-peer teaching participation enhanced senior (i.e., final- or penultimate-year) health professional students' self-efficacy in teaching. CONCLUSIONS: Few high-quality studies with a focus on near-peer teaching's influence on health professional students' self-efficacy beliefs were found. Available evidence suggests that near-peer teaching may positively impact health professional students' self-efficacy beliefs across several domains. More rigorous, multi-perspective investigations are needed from various health disciplines to build upon this evidence.

Examining the psychometric properties of the self-efficacy in clinical teaching scale with undergraduate nursing students: A cross-sectional study.

AIM: This paper aimed to examine the psychometric properties of a modified version of the Self-Efficacy in Clinical Teaching Scale with a sample of undergraduate nursing students. BACKGROUND: Enhancing nursing students' self-efficacy in clinical teaching is important for developing their clinical teaching capabilities, which ultimately contributes to safe quality healthcare. Little is known about nursing students' self-efficacy in clinical teaching, potentially due to a lack of validated instruments to measure their self-efficacy in clinical teaching. DESIGN: This study used a cross-sectional survey design. METHODS: In 2022, a convenience sample of Year 2 and Year 3 nursing students in an Australian Bachelor of Nursing Program completed the modified Self-Efficacy in Clinical Teaching Scale. The scale's construct validity was assessed using known-group measures (year level and peer teaching experience) and confirmatory factor analysis. Concurrent validity was established through correlation with a visual analogue scale and reliability was tested with Cronbach's alpha. RESULTS: Three hundred and nineteen surveys were analysed. The mean total self-efficacy in clinical teaching score for Year 2 participants was significantly lower than that of Year 3 participants (mean difference = -11.13, 95 % CI [-16.33, -5.93]). Participants with peer teaching experience had a significantly higher mean total score compared with those without peer teaching experience (mean difference = 15.32, 95 % CI [8.74, 21.91]). The scale's relative chi-square test was acceptable (CMIN/df = 4.69); other fit indices were within or just outside acceptable parameters (RMSEA =.11; SRMR =.039; NFI =.89; RFI =.88; IFI =.91; TLI =.90; CFI =.91). There was a strong correlation between participants' total self-efficacy in clinical teaching scores and their visual analogue scale scores (r =.83, n = 314, p <.001 [two-tailed]). Cronbach's alpha for the total scale was .98. CONCLUSIONS: The modified Self-Efficacy in Clinical Teaching Scale was sensitive to student year level and peer teaching experience. When subjected to confirmatory factor analysis, the scale's model was an acceptable fit across several indices. These findings support an argument for the scale's construct validity. Total self-efficacy scores were strongly correlated with visual analogue scales, suggesting concurrent validity. Using Cronbach's alpha, the scale was found to be reliable, however may benefit from a reduction of item numbers. The modified Self-Efficacy in Clinical Teaching Scale may support future investigations of undergraduate nursing students' self-efficacy in clinical teaching and contribute to an understanding of health professional students' self-efficacy in clinical teaching across disciplines.

Remediation in clinical practice for student nurses - A scoping review.

BACKGROUND: Clinical practice provides an opportunity for undergraduate nursing students to develop the professional attitudes, knowledge and skills required for the delivery of safe competent care. Some students, however, are challenged to consolidate learning in clinical practice and are therefore at risk of failing courses or programmes. Supporting these students requires remediation strategies specific to clinical practice. This is challenging, however, as remediation approaches frequently centre on supporting students in theoretical components of courses/programmes, rather than clinical practice. OBJECTIVES: A scoping review was conducted to explore and summarise literature in undergraduate nurse education related to remediation support for clinical practice. METHODS: The research question was developed using the Population/Concept/Context model. Following the identification of keywords, five databases (CINHAL Plus, MEDLINE, ProQuest, Scopus and Informit) were searched. Abstracts and full-text articles were independently screened by two authors. Data from included studies was extracted and then thematically analysed. RESULTS: Twenty papers met inclusion/exclusion criteria (five literature reviews, one concept analysis, six commentary papers and eight original research studies). Research studies used qualitative, quantitative, or mixed methods research designs. Populations included nurse academics, mentors/preceptors, health professional students (including nursing students) and nursing students exclusively. Three themes were identified: pre-placement remediation strategies; on-placement remediation strategies and post-placement remediation strategies. All authors highlighted the importance of remediation for at-risk students in clinical practice. CONCLUSIONS: This review identified several remediation strategies that may support undergraduate nursing students in clinical practice. Few, however, were well-defined or rigorously evaluated, highlighting the need for additional research on nursing student remediation in clinical practice. A partnership-based approach to remediation that engages students, educators, and healthcare providers and is underpinned by clear processes may be of further benefit to nursing students in clinical practice.

A program quality framework: a collaborative teaching team approach to quality assurance, quality enhancement and staff capacity building.

A global shortage of registered nurses provides a further impetus to retain nursing students and graduate safe nurses. While various frameworks support curriculum design and describe the need for ongoing curriculum evaluation and monitoring, there is little in the literature to support the enactment and ongoing quality enhancement of curricula. Translation of the curriculum plan into the delivered curriculum relies on academics who may or may not be adequately prepared for course writing and teaching in higher education settings, despite their discipline expertise. Additionally, there are well recognized issues of curriculum drift where curriculum innovations and changes are whittled away over time by incremental changes to courses that interfere with the integrity of the accredited curriculum. We propose an evidence-based Program Quality (ProQual) Framework that takes a holistic, collaborative, and systematic approach to monitoring and enhancing curriculum quality and program delivery over the life of the curriculum while developing staff capability and scholarship.

Are Split Flow and Provider in Triage Models in the Emergency Department Effective in Reducing Discharge Length of Stay?

A quality improvement (QI) project was completed early in 2015 to evaluate the split flow model of care delivery and a provider in triage model within a newly constructed emergency department. The QI project compared 2 emergency departments of similar volumes, one that splits the patient flow and employs a provider in triage model and the other that blends the patient flow and employs a traditional nurse triage model. A total of 68,603 patients were included in this project. The purpose of the split flow model is to create a second flow stream of patients through the emergency department, parallel to the regular acute/critical care flow stream, for patients with problems that are not complex. Specific patient outcomes that were evaluated for the purpose of this QI project were door to discharge or discharge length of stay (DLOS) for all ED patients. The provider in triage model enhances patient triage assessment, as well as patient flow within the emergency department, by allowing patients to be evaluated by an ED provider immediately at the point of triage when the patient first presents to the emergency department. The QI project demonstrated that the split flow model alone reduced DLOS for all ED patients, and when coupled with the provider in triage model, a greater reduction in DLOS, as well as an improvement in front-end throughput metrics, was realized.

Diverse seizure presentation of acute Mycoplasma pneumoniae encephalitis resolving with immunotherapy.

We report 3 previously normal children that presented for evaluation of new onset seizures. Case 1, a 7-year-old female, presented with refractory left frontal lobe seizures associated with right arm simple motor seizures refractory to 6 antiepileptic medications at sufficient doses and levels. Case 2, a 15-year-old female, presented with left frontotemporal lobe seizures and nonconvulsive seizures, associated with neuropsychiatric symptoms refractory to 5 antiepileptic medications. Both patients received intravenous steroids and intravenous immunoglobulin. Case 3, an 11-year-old male, presented with a generalized tonic clonic seizure and worsening hallucinations responding to intravenous corticosteroids and 1 antiepileptic medication. All 3 patients had extensive infectious and metabolic evaluation and were found to be serum immunoglobulin M positive for mycoplasma pneumoniae. Despite their prolonged severe symptoms, all patients had virtually complete recovery with excellent seizure control after aggressive seizure management with immunotherapy and antiepileptic medication.