A Scoping Review of Retrieval Practice (Test-Enhanced Learning) in Nursing Education.

AIM: The aim of this study was to determine the status of retrieval practice in original research of nursing education. BACKGROUND: The science of learning is an emerging interdisciplinary field that offers evidence-based strategies to improve learning. One of the most highly effective strategies is retrieval practice, which involves recalling previously learned information from long-term memory prior to additional study. METHOD: Searching PubMed, CINAHL, Scopus, Psych INFO, and ERIC, an interprofessional team followed a formal scoping review framework and utilized the PRISMA Extension for Scoping Reviews to report the findings. RESULTS: The review included 25 research studies, with all but one at the prelicensure level. Quantitative designs were most common, and outcomes reflected objective and subjective measures. If present, terms were varied and inconsistent with supporting research. Documentation of many characteristics was lacking. CONCLUSION: Retrieval practice is an increasingly common strategy being studied at the prelicensure level. Opportunities for improvement include consistent use of standard terminology, documentation of important characteristics, and more attention to subjective outcomes and to graduate and continuing education levels.

Implementation of Return to Learn Protocols for Student Athletes with Sport and Recreation Related Concussion: An Integrative Review of Perceptions, Challenges and Successes.

Concussion or mild traumatic brain injury (mTBI) is a common phenomenon in the United States, with up to 3.6 million sport-related mTBIs diagnosed annually. Return to learn protocols have been developed to facilitate the reintegration of students into school after mTBI, however, the implementation of return to learn protocols varies significantly across geographic regions and school districts. An integrative review of the literature was performed using Whittemore and Knalf's methodology. A search of published literature was conducted using the PRISMA checklist. Database searches were conducted from March 2,019 to October 2,021 using the terms "mild traumatic brain injury" and "return to learn." Twenty-eight publications were included. Three themes were derived from this review: lack of policy, poor staff education on concussion symptoms and stakeholder communication breakdown. The development of communication patterns and use of a return to learn protocol could facilitate a gradual return to full academic workload after concussion.

Policy Analysis of Return to Learn After Sport and Recreational Related Concussion for Secondary Schools in New England: Relevance to School Nurses and Nursing Practice.

Return to learn (RTL) is the individualized process of coordinating cognitive care and reintegration for students into the academic setting after any sport and recreational-related concussion (SRRC). The guidelines for RTL are based on empirical evidence, however, implementation differs by institution. The purpose of the policy analysis is to evaluate RTL guidelines after SRRC of student-athletes in New England secondary school public school systems. A review of the six New England states' policies surrounding RTL was conducted. The Comprehensive Analysis of Physical Activity Framework was referenced to identify the analytic components of existing legislation and because of the relatively new implementation of RTL-specific policy, a novel policy analysis tool was utilized. States with RTL-specific language scored on average 7.9 to 11.1 points higher when compared to states without RTL-specific language. This difference was associated with disparities in access to RTL resources for residents according to their geographic location. Lobbying efforts should be targeted toward states without RTL-specific language to provide equal care and opportunities for student-athletes to receive RTL services. RTL policy provides a responsibility to assist students who have suffered from an SRRC and can serve to improve health outcomes and academic achievement.

Scoping Review of Distributed Practice in Nursing Education.

AIM: The aim of this study was to describe the status of distributed practice in research of nursing education. BACKGROUND: The science of learning has compiled evidence-based strategies that should be integral to nursing education. One long-standing strategy, distributed practice, involves spacing, placing cognitive breaks between study or practice sessions with priority information. METHOD: Reviewing literature published over 20 years at every level of nursing education, the authors conducted a scoping review to determine the extent to which research of nursing education includes attention to distributed practice. RESULTS: In the 13 articles meeting criteria, distributed practice was most common in continuing professional development, with an emphasis in learning psychomotor skills. Study authors used a variety of terms and descriptions in referring to the strategy. CONCLUSION: By way of research, distributed practice appears underutilized in nursing education, especially at prelicensure and graduate levels, and could benefit from clear and consistent use of terminology.

Constructing a Sensitizing Definition of Certification in Nursing for Research Purposes: A Hybrid Methodology Using Consensus-Building Approach.

OBJECTIVE: The aim of this study was to construct a sensitizing definition of certification in nursing for research purposes that can provide a foundation from which to further develop a coherent research program building evidence about the impact of certification on healthcare outcomes. BACKGROUND: The lack of a single definition of certification in nursing makes it difficult to draw conclusions about the relationship between specialty certification and patient outcomes. METHODS: This study was guided by the Delphi-Chaffee hybrid methodology proposed by Grant et al. DISCUSSION: Constructing a single, sensitizing definition of certification: 1) provides coherency for direction of certification research; 2) serves as a guide for researchers; and 3) facilitates multimethodological approaches to exploring the relationship among the different components of the definition of certification. CONCLUSION: A sensitizing definition of certification provides an opportunity for researchers to study the relationship between nursing certification and patient outcomes.

Learning science as a potential new source of understanding and improvement for continuing education and continuing professional development.

Learning science is an emerging interdisciplinary field that offers educators key insights about what happens in the brain when learning occurs. In addition to explanations about the learning process, which includes memory and involves different parts of the brain, learning science offers effective strategies to inform the planning and implementation of activities and programs in continuing education and continuing professional development. This article provides a brief description of learning, including the three key steps of encoding, consolidation and retrieval. The article also introduces four major learning-science strategies, known as distributed learning, retrieval practice, interleaving, and elaboration, which share the importance of considerable practice. Finally, the article describes how learning science aligns with the general findings from the most recent synthesis of systematic reviews about the effectiveness of continuing medical education.

Conceptualization and Operationalization of Certification in the US and Canadian Nursing Literature.

OBJECTIVE: To identify how certification is defined, conceptualized, and discussed in the nursing literature. BACKGROUND: Although it is hypothesized that credentialing is associated with better patient outcomes, the evidence is relatively limited. Some authors have suggested that the lack of consistency used to define certification in nursing literature may be one of the dominant obstacles in credentialing research. METHODS: This scoping review was guided by Arksey and O'Malley's framework, and quantitative and qualitative analyses were conducted. RESULTS: The final data set contained a total of 36 articles, of which 14 articles provided a referenced definition of certification. Thematic analysis of the definitions yielded 8 dominant themes. CONCLUSION: The lack of a common definition of certification in nursing must be addressed to advance research into the relationship between certification processes in nursing and healthcare outcomes.

Using an expanded outcomes framework and continuing education evidence to improve facilitation of patient-centered medical home recognition and transformation.

BACKGROUND: The patient-centered medical home is a model for delivering primary care in the United States. Primary care clinicians and their staffs require assistance in understanding the innovation and in applying it to practice. PURPOSES: The purpose of this article is to describe and to critique a continuing education program that is relevant to, and will become more common in, primary care. METHODS: A multifaceted educational strategy prepared 20 primary care private practices to achieve National Committee for Quality Assurance Level 3 recognition as Patient-Centered Medical Homes. RESULTS: Eighteen (90%) practices submitted an application to the National Committee for Quality Assurance. On the first submission attempt, 13 of 18 (72%) achieved Level 3 recognition and 5 (28%) achieved Level 1 recognition. CONCLUSION: An interactive multifaceted educational strategy can be successful in preparing primary care practices for Patient-Centered Medical Homes recognition, but the strategy may not ensure transformation. Future educational activities should consider an expanded outcomes framework and the evidence of effective continuing education to be more successful with recognition and transformation.

Systematic Review and Critical Appraisal of Role Definition and Responsibility Within the Concussion Management Team for Secondary Schools.

ABSTRACT: BACKGROUND: Sports- and recreation-related concussions impact the cognitive function of secondary school students during the recovery process. They can cause symptoms such as headache, difficulty concentrating, and memory impairment, which pose a challenge for students during the return to learn (RTL) after injury. Concussion management teams (CMTs) assist the student in managing symptoms and develop an individualized RTL process; however, the ideal composition of professionals involved in the CMT has not been fully evaluated. METHODS: A systematic review was conducted to assess current research on CMTs in secondary schools. A search of the databases CINAHL, MEDLINE, and PsycINFO was conducted using the search terms "concussion management team" AND "school" OR "return to learn." RESULTS: Twenty-four articles were included for review. The CMT structure was highly variable in all studies. Identified themes from the literature were confusion of role definition and function, and communication gaps among interdisciplinary team members. Half of the articles viewed the school nurse as the leader in coordinating the CMT and RTL process. CONCLUSION: Evidence from this review suggests further consensus in this field is needed to clarify the school nurse's role and standardize the CMT structure.

Opportunities to improve colorectal and breast cancer screening in Connecticut.

Colorectal and breast cancer represent serious and common public-health problems in the United States. While effective screening tests exist for both types of cancer, Connecticut lacks a consistent source of data about screening rates to guide improvement efforts. Beginning in 2011, the Connecticut Department of Public Health commissioned Qualidigm, the state's Medicare Quality Improvement Organization, to conduct an analysis of the most recent fee-for-service Medicare claims data to determine screening rates for colorectal cancer (2000-2009) and breast cancer (2008-2009). This article highlights key findings of this analysis in order to increase awareness of opportunities for improvement in colorectal and breast cancer screening. The article also offers recommendations about next steps that primary care clinicians can consider to improve cancer screening among their patient populations.

Science of Learning Strategy Series: Article 3, Interleaving.

ABSTRACT: Interleaving is an evidence-based, learning-science strategy that is relevant to the planning and implementation of continuing professional development (CPD). Mixing related but different areas of study forces the brain to reconcile the relationship between the areas while understanding each area well. By doing so, interleaving increases the likelihood of mastery and memory. Research from cognitive psychology and neuroscience provides the rationale for interleaving, and examples of its implementation in health profession education have begun to appear in the literature. If utilized appropriately, some common CPD interventions can leverage interleaving. Through increased understanding, CPD participants can benefit from interleaving by making more-informed educational choices, and CPD planners can benefit in efforts to improve educational activities.

Educational needs assessment identifying opportunities to improve sepsis care.

INTRODUCTION: In 2015, the Centers for Medicare and Medicaid Services developed a national quality bundle for the management of patients with severe sepsis and septic shock (SEP-1). Despite performance improvement measures, compliance remains low. This needs assessment is the first stage of a quality improvement initiative to improve SEP-1 compliance. Using a conceptual outcomes framework, this needs assessment analyses SEP-1 compliance data, knowledge, and competence to identify gaps in care and educational opportunities. METHODS: The needs assessment began with a review of national and statewide SEP-1 compliance data to identify a need for improvement. The needs assessment proceeded with a retrospective chart review to evaluate process measures and identify which providers would most likely benefit from educational interventions. A focus group provided perspective on the chart review findings. RESULTS: During the period of 1 April 2017-31 March 2018, national SEP-1 compliance was 51% and compliance at the studied institution was 19%. The chart review included 51 patients (66.7% severe sepsis, 33.3% septic shock). Frequently missed SEP-1 measures included administration of intravenous fluids (0% severe sepsis, 58.8% septic shock), repeat lactate levels (52.6% severe sepsis, 60% septic shock), documentation of volume and tissue perfusion assessment (58.8%), vasopressor administration (73.3%) and administration of broad-spectrum antibiotics (76.5%, severe sepsis). Focus group perceptions identified themes related to gaps in declarative and dispositional knowledge. CONCLUSIONS: This educational needs assessment highlights gaps in SEP-1 clinician performance, competence and knowledge. A multifaceted education programme is the next step for this performance improvement project. Education should include a series of meetings, activities, and workshops that include declarative knowledge, procedural knowledge and dispositional knowledge. Simulation activities can provide an opportunity for providers to demonstrate competence. Point-of-care prompts and performance measurement and feedback of patient care data can support clinician performance. This needs assessment underscores the need for a multifaceted approach to clinician education and performance to improve SEP-1 compliance.

A role for atmospheric CO2 in preindustrial climate forcing.

Complementary to measurements in Antarctic ice cores, stomatal frequency analysis of leaves of land plants preserved in peat and lake deposits can provide a proxy record of preindustrial atmospheric CO(2) concentration. CO(2) trends based on leaf remains of Quercus robur (English oak) from the Netherlands support the presence of significant CO(2) variability during the first half of the last millennium. The amplitude of the reconstructed multidecadal fluctuations, up to 34 parts per million by volume, considerably exceeds maximum shifts measured in Antarctic ice. Inferred changes in CO(2) radiative forcing are of a magnitude similar to variations ascribed to other mechanisms, particularly solar irradiance and volcanic activity, and may therefore call into question the concept of the Intergovernmental Panel on Climate Change, which assumes an insignificant role of CO(2) as a preindustrial climate-forcing factor. The stomata-based CO(2) trends correlate with coeval sea-surface temperature trends in the North Atlantic Ocean, suggesting the possibility of an oceanic source/sink mechanism for the recorded CO(2) changes.

Opportunities to improve colorectal cancer screening in Connecticut through Medicare claims data.

Colorectal cancer represents a serious public-health problem in the United States, with important geographic differences and disparities of care evident in its detection and treatment. While effective screening tests exist, Connecticut lacks current data about rates of colorectal cancer screening. The Connecticut Department of Public Health commissioned Qualidigm, the federally designated Quality Improvement Organization, to conduct an analysis of 2008 fee-for-service Medicare claims data to determine screening rates. This article reports the findings of this analysis to increase awareness of opportunities for improvement in colorectal cancer screening and to highlight demographic and geographic variations that may require particular attention in Connecticut.

Science of Learning Strategy Series: Article 2, Retrieval Practice.

ABSTRACT: Retrieval practice is an evidence-based, science of learning strategy that is relevant to the planning and implementation of continuing professional development (CPD). Retrieval practice requires one to examine long-term memory to work with priority information again in working memory. Retrieval practice improves learning in two ways. It improves memory for the information itself (direct benefit), and retrieval practice provides feedback about what needs additional effort (indirect). Both benefits contribute significantly to durable learning. Research from cognitive psychology and neuroscience provides the rationale for retrieval practice, and examples of its implementation in health professions education are increasingly available in the literature. Through appropriate utilization, CPD participants can benefit from retrieval practice by making more-informed educational choices, and CPD planners can benefit in efforts to improve educational activities.

Science of Learning Strategy Series: Article 1, Distributed Practice.

ABSTRACT: Distributed practice is an evidence-based, learning-science strategy that is relevant to the planning and implementation of continuing professional development (CPD). Spacing-out study or practice over time allows the brain multiple opportunities to process new and complex information in an efficient way, thus increasing the likelihood of mastery and memory. Research from cognitive psychology and neuroscience provide the rationale for distributed practice, and examples of its implementation in health professions education have begun to appear in the literature. If used appropriately or extended creatively, some common CPD interventions can fully leverage distributed practice. Through increased understanding, CPD planners can benefit from distributed practice in efforts to improve educational activities, and CPD participants can benefit by making more informed educational choices.

The Equity and Quality (EQual) Health-Care Project: A Connecticut Health Foundation initiative with Qualidigm.

In response to the growing incidence and prevalence of diabetes, quality and disparity of care concerns, and the increasing diversity of the US and Connecticut's populations, the Connecticut Health Foundation funded Qualidigm to implement the Equity and Quality (EQual) Health-Care Project. Now in its second full year, the EQualHealth-CareProject is helping eight primary-care practices in Connecticut improve the equity and quality of diabetes care through technology, education, and quality improvement.

Definitions of Physician Certification Used in the North American Literature: A Scoping Review.

INTRODUCTION: The authors sought to identify how physician specialty certification is defined in the North American literature. METHODS: A rigorous, established six-stage scoping review framework was used to identify the North American certification literature published between January 2006 and May 2016 relating to physician specialty certification. Data were abstracted using a charting form developed by the study team. Quantitative summary data and qualitative thematic analysis of the purpose of certification were derived from the extracted data. RESULTS: A two stage screening process identified 88 articles that met predefined criteria. Only 14 of the 88 articles (16%) contained a referenced purpose of certification. Eighteen definitions were identified from these articles. Definitional concepts included lifelong learning and continuous professional development, assessment of competence and performance, performance improvement, public accountability, and professional standing. DISCUSSION: Most articles identified in this scoping review did not define certification or describe its purpose or intent. Future studies should provide a definition of certification to further scholarly examination of its intent and effects and inform its further evolution.

A descriptive study of educational outreach to promote use of quality improvement tools in primary care private practice.

The objective of this study was to describe the experience of a Quality Improvement Organization (QIO) providing educational outreach to promote use of quality improvement (QI) tools in primary care private practice. Two QIO outreach workers conducted visits with physicians and targeted staff. Data were analyzed on physician demographics, visits, and use of QI tools using standard quantitative and qualitative methods. QIO staff frequently encountered difficulty in accessing physicians and administrative staff and reported many barriers to QI. Despite these challenges, outreach visits were associated with adoption of QI tools, and certain physician characteristics were associated with greater numbers of outreach visits and tools adopted. QIOs and other external parties who seek to improve quality of care in private practice primary care physician offices face challenges in gaining access to physicians and administrative personnel. Additional study is needed to better understand associations between physician characteristics, educational outreach visits, and adoption of QI tools.

CME planning series: article four of five, promoting interaction within educational activities.

Interaction refers to what happens within the minds of individuals participating in a CME activity. While peer-to-peer and peer-to-presenter discussion maybe helpful, internal engagement of the learner with the material is the type of interaction that is necessary for deep learning and change. The choice of which interactive method to use depends on the learning objectives of the specific CME program being planned.