Examining the Educational Value of Student-Run Clinics for Health Care Students.

PURPOSE: Student-run clinics (SRCs) are increasingly recognized as an educational experience in many health professions' curricula. Several benefits have been documented, including students with SRC experience using patient-centered approaches to care, showing interest in working with marginalized populations, and more fully appreciating the care provided by interprofessional teams. Yet, few studies have explored student experiences within SRCs or examined how these experiences affect and shape these documented attitudes. This study explored the experiences of students at an SRC and the effect of these experiences on their learnings. METHOD: From November 2016 to July 2017, 23 students in the Community Health Initiative by University Students SRC at the University of British Columbia participated in 2 focus group interviews: the first after their first clinic day and the second on their final clinic day. Open- and closed-ended questions were used to explore participants' learnings from the SRC. Using a grounded theory approach, the authors iteratively analyzed the transcribed interviews, adjusting questions for subsequent focus groups as new themes evolved. Three investigators each separately coded the data; the full team then collectively consolidated the themes and developed explanatory models for each theme. RESULTS: Two themes were identified from the focus group input: (1) through managing real, complex patients-in situations unlike those offered in classroom and case-based learning environments-students gained insights into the intricacies of incorporating the patient's perspective into their definition and management of the patient's problem, and (2) by working as a team instead of focusing on delineating scopes of practice, students gained a meaningful understanding of the roles of practitioners from other health professions. CONCLUSIONS: This study provides insights into the unique opportunities SRCs offer health care students early in their training, enabling them to develop a richer understanding and appreciation of holistic and interprofessional approaches to patient care.

Using the 4Ms framework to teach geriatric competencies in a community clinical experience.

BACKGROUND: As the population of older adults in the US steadily increases and becomes more diverse, there is an urgent need to integrate geriatric competencies into baccalaureate nursing education. PURPOSE: To integrate the Institute for Healthcare Improvement 4 Ms Framework into an existing baccalaureate nursing community clinical experience to build geriatric and interprofessional competencies and promote positive health outcomes. METHODS: As part of the Geriatric Workforce Enhancement Program, 15 students worked with bilingual social workers and community health workers in an affordable housing urban highrise, assessed building residents and implemented personalized plans of care using the 4Ms framework (what matters to the individual, medications, mentation, and mobility). RESULTS: Students demonstrated competence conducting cognition and depression screening, medication review, and functional and fall risk assessments. Student self-rated achievement of learning objectives ranged from 4.3 to 4.8 (1-5 scale). A retrospective pretest-posttest survey suggested learning about the importance of interprofessional teamwork, and integration of person-centered values when providing care to older adults in the community. Students reflected on barriers to health for older adults in low socioeconomic states and the importance of improving care across the continuum. CONCLUSION: The 4Ms framework provided a valuable construct to guide the community experience and teach geriatric evidence-based practice to nursing students.

Abordagens de aprendizado e sua correlação com ambiente educacional e características individuais em escola médica / Learning approaches and their correlation with the teaching environment and individual characteristics in medical school

Resumo: Introdução: A qualidade de aprendizado de estudantes de escolas médicas tem sido tema recorrente da literatura mundial nas últimas décadas, mas há escassez de estudos nacionais acerca do assunto. O ambiente de ensino deve favorecer o aprendizado profundo, por estar intimamente relacionado com uma aprendizagem significativa. Metodologias ativas de aprendizagem são vinculadas a maior qualidade de aprendizado, por propiciarem ambiente favorável ao aprendizado profundo. Objetivo: Este estudo teve como objetivos avaliar a qualidade do aprendizado de estudantes de Medicina de um curso que adota metodologias ativas de aprendizagem e correlacioná-la com as percepções dos alunos acerca do ambiente educacional e com dados sociodemográficos. Método: Trata-se de estudo descritivo transversal realizado com estudantes do curso de Medicina da Universidade Federal de São Carlos (UFSCar), do primeiro ao sexto ano. Foram utilizados os instrumentos R-SPQ-2F, DREEM e questionário sociodemográfico. Realizou-se análise descritiva, e compararam-se as frequências por meio do teste do qui-quadrado ou teste exato de Fisher. As diferenças entre médias foram avaliadas por meio de teste t de Student ou teste de Mann-Whitney, quando se compararam somente dois grupos, ou por meio de análise de variância (ANOVA) ou teste de Kruskal-Wallis, quando comparados mais de dois grupos. As associações entre as variáveis quantitativas foram verificadas por meio do coeficiente de correlação de Pearson ou de Spearman. A análise estatística foi realizada com auxílio do programa IBM SPSS Statistics versão 25.0, e adotou-se como parâmetro de significância um valor de p < 0,05. Resultado: Entrevistaram-se 226 alunos. A pontuação média para abordagem profunda foi de 33,52 e, para a abordagem superficial, 17,42. Em relação à percepção do ambiente educacional, a média foi de 129,77 pontos. As variáveis objetivas que demonstraram influência sobre o aprendizado foram: sexo, idade de início do curso, contato prévio com metodologias ativas, prática de idiomas, ter graduação ou pós-graduação prévia, receber auxílio financeiro de familiares e ano da graduação. Conclusão: As metodologias ativas de aprendizagem podem estimular a adoção de estratégias de aprendizado profundo. O estudo dos fatores que influenciam na abordagem de aprendizado é complexo e envolve questões individuais subjetivas.

Abstract: Introduction: The quality of learning of medical students has been a recurring subject of research in recent decades, but there are scarce national studies on it. The learning environment should encourage deep learning, as it is intimately related to meaningful learning. Active learning methods are linked to better quality of learning, since they provide a favorable environment for deep learning. Objective: The aim of this study was to evaluate the quality of learning of students at a medical school that adopts active learning methods for all course years and correlate it to students' views on educational environment and sociodemographic data. Method: This is a cross-sectional descriptive study with 1st to 6th-year medical students from the Federal University of São Carlos. The R-SPQ-2f, DREEM and sociodemographic questionnaires were applied. Descriptive analysis was performed, and frequencies were compared using chi-square test or Fisher's exact test. Differences between means were evaluated with either Student's t-test or Mann-Whitney's test, when comparing only two groups, and with one-way analysis of variance (ANOVA) or Kruskal-Wallis' test, when comparing more than two groups. Associations between quantitative variables were verified with either Pearson's or Spearman's correlation coefficient. Statistical analysis was performed with IBM SPSS Statistics version 25.0. For significance, p-value<0.05 was adopted. Result: 226 students were interviewed. The average deep learning score was 33.52 points, and, for superficial learning, 17.42 points. As for how the environment was perceived, the average score was 129.77. The objective variables that showed influence in learning were sex, course start age, previous contact with active learning methods, language study, previous undergraduate training, or post-graduate degree, receiving financial help from family and current course year. Conclusion: Active learning methods may stimulate the adoption of deep learning strategies. The evaluation of factors that influence study approaches is complex, involving subjective individual parameters.

Assessment of a Scholars Program Designed to Enhance Pharmacy Students' Competitiveness for Postgraduate Residency Training.

Objective. To assess pharmacy residency match/placement rates and student perceptions of a program designed to enhance Doctor of Pharmacy (PharmD) student competitiveness for postgraduate residency positions. Methods. The Scholars Program was developed to provide advanced training to select PharmD students who had an interest in postgraduate residency training and was completed during the third and fourth professional years. The program consisted of mentoring; elective coursework encompassing clinical practice, teaching, and leadership; modified experiential education; journal club meetings; teaching assistant duties; conducting research and/or scholarship; and delivering professional presentations. Residency match/placement rates of students who had completed the program were compared to national data and to students in the school who were not enrolled in the program. Perceptions of the program were assessed using an online survey. Results. Sixty-four students enrolled in and completed the Scholars Program from 2013 to 2019. Of these, 58 (91%) pursued postgraduate residency training. Students enrolled in the program had a higher combined phase 1/phase 2 match rate (91.4% vs 67.4%) than students in other PharmD programs across the United States. Similarly, students enrolled in the Scholars Program had a higher combined phase 1/phase 2 match rate (91.4% vs 62.9%) and overall residency placement rate (96.6% vs 67.0%) compared to students in the school who were not enrolled in the program. More than 85% of students enrolled in the Scholars Program who pursued residency training agreed that the program prepared them for and helped them attain a postgraduate residency. Conclusion. Pharmacy students enrolled in the Scholars Program experienced high residency match/placement rates and viewed the program as valuable preparation for postgraduate training.

Assessment of structured classroom debate to teach an antimicrobial stewardship elective course.

BACKGROUND AND PURPOSE: The main aim of this study was to evaluate the effect of a structured classroom debate format on teaching antimicrobial stewardship. EDUCATIONAL ACTIVITY AND SETTING: An active learning approach using a debate format was implemented to engage students in infectious diseases concepts to further develop critical thinking skills. This was a one-group, pre- and posttest design conducted in third year pharmacy students enrolled at the Philadelphia College of Osteopathic Medicine School of Pharmacy Georgia campus. A ten-item assessment survey was used prior to and after the course to evaluate student knowledge. Student perception of skill development was assessed by a survey using a five-point Likert scale. The skills assessed included critical thinking, communication, public speaking, research/drug information, and teamwork. FINDINGS: Thirty-three students participated in the six debates over the course of the semester. There was a statistically significant increase in post-knowledge assessment mean score (75%) compared to pre-knowledge assessment mean score (45%). The post-course survey showed improved confidence in perception of skills in all of the areas assessed. SUMMARY: The structured classroom debate format has a positive association with increasing students' knowledge level and perception of skills assessed.

Evaluation of Bachelor's Degree Nursing Program Assessment by Nurses Working at A University Hospital: A Cross-Sectional Study from Turkey.

The aim of this study was to examine the evaluation of integrated program, traditional and problem based programs in nursing by nurses working in a university hospital. The population of the study consisted of the 288 nurses. In the collection of research data, use was made of a Nurses' Description Form and the Bachelor's Degree Nursing Program Assessment Scale (BNPAS). It was found that the total mean BNPAS scores of nurses graduating from the integrated educational program were higher than those of nurses graduating from traditional and problem-based learning educational programs (p < 0.05). The total mean BNPAS scores of nurses who followed professional scientific publications after graduation were higher than the scores of those who did not, and the difference was found to be significant (p < 0.05). It was concluded that nurses had positive assessment of the bachelor's degree programs from which they graduated.

Adverse Childhood Experiences: A Case-Based Workshop Introducing Medical Students to Trauma-Informed Care.

Introduction: A large body of evidence implicates adverse childhood experiences (ACEs) as significant factors in shaping adult health outcomes. Despite their wide-ranging impact on health, training on ACEs is lacking in most medical school curricula. As part of a required health equity course for first-year medical students, we developed a novel workshop on ACEs with an introduction to protective effects of resilience and trauma-informed care. Methods: This educational module on ACEs incorporated a didactic session on the science and health consequences of ACEs and best practices for trauma-informed care, followed by a facilitated case discussion in small groups exploring an ACE survey tool and a resilience questionnaire. Results: A total of 535 first-year medical students participated in the workshop in academic years 2016-2017, 2017-2018, and 2018-2019. In the session evaluation, students reported that the small-group, case-based discussion provided the richest learning experience. Areas identified by the students for improvement included delving more deeply into how to incorporate asking about ACEs in clinical care and how to involve multidisciplinary services in addressing ACEs. Discussion: The focus on raising awareness of the health impact of ACEs as well as enhancing resilience using a case-based approach was successful in meeting the stated objectives for the workshop. Future work will consist of building on this introductory content by designing curricular elements that explore multidisciplinary approaches to ACEs and trauma-informed care interventions in the clinical clerkships.

Stress among medical students during clinical courses: a longitudinal study using contextual activity sampling system.

OBJECTIVES: To investigate medical students' experiences of stress and other emotions related to their professional roles, as defined by the CanMEDS framework, by using the Contextual Activity Sampling System (CASS). METHODS: Ninety-eight medical students agreed to participate of whom 74 completed this longitudinal cohort study. Data was collected between 6th and 8th term via CASS methodology: A questionnaire was e-mailed to the participants every 3rd week(21questionnaires/measurements) during clinical rotations and scientific project work term. Emotions were measured by a 7-point Likert scale (e.g., maximum stress = 7). Answers were registered through mobile technology. We used a linear mixed-model regression approach to study the association between stress over time in relation to socio-demographic and learning activities related to CanMEDS roles. RESULTS: Participants completed 1390 questionnaires. Mean stress level over all time points was 3.6. Stress was reported as highest during the scientific project term. Learning activities related to 'Communicator,' 'Collaborator,' 'Scholar,' 'Manager' and 'Professional' were associated with increased stress, e.g. 'Scholar' increased stress with 0.5 points (t(1339)=3.91, p<0.001). A reduced level of stress was associated with 'Health Advocate' of 0.39 points (t(1338)=-2.15, p=0.03). No association between perceived stress and demographic factors, such as gender or age was found. CONCLUSIONS: An association between different learning activities related to CanMEDS Roles and feelings of stress were noted. The CASS methodology was found to be useful when observing learning experiences and might support educational development by identifying course activities linked to stress.

Incorporation of a multi-modal interactive exercise on student pharmacists' perceptions of lifestyle modification in weight loss promotion.

BACKGROUND AND PURPOSE: The purpose of this project was to evaluate the impact of a calorie tracking and dietary modification activity on students' perceptions of the challenges associated with weight loss. EDUCATIONAL ACTIVITY AND SETTING: Students maintained a two-day paper calorie log, then received a weight management lecture, followed by four additional days of calorie tracking using a mobile application. Demographics, self-evaluation of obesity-related knowledge, perceptions on weight loss difficulties, utility of mobile technology, and overall program value were evaluated. FINDINGS: A total of 79% of students completed all three surveys (n = 150). Students' perceptions regarding their knowledge and comfort with respect to weight loss counseling and dietary modification strategies increased following the lecture and mobile technology-based calorie counting activity. Seventy-eight percent of students either agreed or strongly agreed that this activity was valuable to their professional development while 86% of students agreed or strongly agreed this activity helped them understand the challenges faced by patients trying to lose weight. DISCUSSION: Student attitudes regarding weight loss, including nutritional tracking, and comfort in establishing a weight loss goal, as well as student's perceived knowledge of the types of dietary fats and empathy, all significantly improved over the course of activity participation. SUMMARY: This activity improved student pharmacists' understanding of lifestyle modifications necessary for weight loss, exposed them to novel technologies available to help support patient's weight loss attempts, and provided them with first-hand experience in tracking calories.

Online instructional anatomy videos: Student usage, self-efficacy, and performance in upper limb regional anatomy assessment.

Allied health professionals concur that a sound knowledge of practical gross anatomy is vital for the clinician, however, human anatomy courses in allied health programs have been identified as high-risk for attrition and failure. While anatomists and clinicians agree that learning anatomy via human cadaveric instruction is the preferred method, students vary in their reaction to the cadaveric learning experience and have differing levels of anatomy self-efficacy. This study investigated whether student self-efficacy had an effect on student usage of supplemental instructional videos and whether the use of videos had an impact on student self-efficacy and/or learning. Anatomy self-efficacy differed based on gender and prior performance. Student usage of the videos varied widely and students with lower self-efficacy were more inclined to use the resources. The provision of the videos did not improve overall cohort performance as compared to a historical cohort, however, those students that accessed all video sets experienced a greater normalized learning gain compared to students that used none or one of the four sets of videos. Student reports and usage patterns indicate that the videos were primarily used for practical class preparation and revision. Potentially, the videos represent a passive mode of teaching whereas active learning has been demonstrated to result in greater learning gains. Adapting the videos into interactive tutorials which will provide opportunity for feedback and the development of students' self-evaluation may be more appropriate. Anat Sci Educ 11: 461-470. © 2017 American Association of Anatomists.

Five years of lesson modification to implement non-traditional learning sessions in a traditional-delivery curriculum: A retrospective assessment using applied implementation variables.

Non-traditional learning (NTL), including aspects of self-directed learning (SDL), may address self-awareness development needs. Many factors can impact successful implementation of NTL. OBJECTIVES: To share our multi-year experience with modifications that aim to improve NTL sessions in a traditional curriculum. To improve understanding of applied implementation variables (some of which were based on successful SDL implementation components) that impact NTL. METHODS: We delivered a single lesson in a traditional-delivery curriculum once annually for five years, varying delivery annually in response to student learning and reaction-to-learning results. At year 5, we compared student learning and reaction-to-learning to applied implementation factors using logistic regression. RESULTS: Higher instructor involvement and overall NTL levels predicted correct exam responses (p=0.0007 and p<0.0001, respectively). Exam responses were statistically equivalent between the most traditional and highest overall NTL deliveries. Students rated instructor presentation skills and teaching methods higher when greater instructor involvement (p<0.0001, both) and lower overall NTL levels (P<0.0001, both) were used. Students perceived that teaching methods were most effective when lower student involvement and higher technology levels (p<0.0001, both) were used. CONCLUSION: When implementing NTL sessions as a single lesson in a traditional-delivery curriculum, instructor involvement appears essential, while the impact of student involvement and educational technology levels varies.

Top-Cited Articles in Problem-Based Learning: A Bibliometric Analysis and Quality of Evidence Assessment.

The aims of this study were to identify characteristics of the top-cited articles in problem-based learning (PBL) and assess the quality of evidence provided by these articles. The most frequently cited articles on PBL were searched in April 2015 in the Science Citation Index Expanded database (List A) and Google Scholar database (List B). Eligible articles identified were reviewed for key characteristics. The Oxford Centre for Evidence-Based Medicine guidelines were used in assessing the level of evidence. The number of citations varied (62 to 923 on List A and 218 to 2,859 on List B). Countries that contributed the majority of articles in both lists were the United States, Netherlands, United Kingdom, and Canada. No significant correlations were found between number of citations and number of years since published (p=0.451), number of authors (p=0.144), females in authorship (p=0.189), non-medical authors (p=0.869), number of institutions (p=0.452), and number of grants (p=0.143), but a strong correlation was found with number of countries involved (p=0.007). Application of the Oxford hierarchy of evidence showed that 36 articles were at levels 4 and 5 of evidence. This study found that research articles represented approximately one-third of PBL articles assessed and reported mainly on questionnaire-based studies. The most highly cited articles occupied top-ranking positions in the journals in which they were published. The lower level of evidence observed in most top-cited articles may reflect the significance of innovative ideas or content of these articles. These findings have implications for dental educators and dental researchers.

The effect of introducing a Trauma Network on patient flow, hospital finances and trainee operating.

In April 2012 the National Health Service in England introduced the Trauma Network system with the aim of improving the quality of trauma care. In this study we wished to determine how the introduction of the Trauma network has affected patient flow, hospital finances and orthopaedic trauma training across our region. The overall pattern of trauma distribution was not greatly affected, reflecting the relative rarity of major trauma in the UK. A small decrease in the total number of operations performed by trainees was noted in our region. Trainees at units designated as Major Trauma Centres gained slightly more operative experience in trauma procedures overall, and specifically in those associated with high energy, such as long bone nail insertion and external fixation procedures. However, there have been no significant changes in this pattern since the introduction of the Trauma Networks. Falling operative numbers presents a challenge for delivering high quality training within a surgical training programme, and each case should be seen as a vital educational opportunity. Best practice tariff targets for trauma were delivered for 99% of cases at our MTCs. Future audit and review to analyse the evolving role of the MTCs is desirable.

A snapshot of the status of problem-based learning (PBL) in Chinese medical schools.

INTRODUCTION: In North America, where it was born, problem-based learning (PBL) has seen dips and rises in its popularity, but its inherent strengths have led to its spread to medical schools all over the world. Although its use at medical schools in some Western countries has already been examined, no one has looked at its status in many other countries, including China. The aim of this study is to determine the number of schools currently using PBL in China, the degree to which they use it, and the reasoning behind such usage. METHODS: We used survey and internet search to examine PBL usage at Chinese medical schools. We were able to collect data from 43 first-class Chinese medical schools that are geographically diverse and thus representative of medical schools all across China. RESULTS: 34 (79.1%) of the 43 medical schools use PBL in the preclinical curriculum. Of the 34, data were collected from 24 (70.6%) medical schools regarding the extent of their PBL usage. Nine (37.5%) schools use PBL for less than 10% of preclinical hours, 14 (58.3%) schools use PBL for 10-50% of preclinical hours, and one (4.2%) school uses PBL for more than 50% of preclinical hours. CONCLUSION: In our sample of Chinese medical institutions, a large majority of schools use PBL, however, most schools use it for less than 50% of total preclinical curricular hours. Our results suggest that schools are interested in increasing the number of curricular hours devoted to PBL but are constrained by resources.

Performance assessment of higher order thinking.

This article describes a study investigating the effect of intervention on student problem solving and higher order competency development using a series of complex numeracy performance tasks (Airasian and Russell, 2008). The tasks were sequenced to promote and monitor student development towards hypothetico-deductive reasoning. Using Rasch partial credit analysis (Wright and Masters, 1982) to calibrate the tasks and analysis of residual gain scores to examine the effect of class and school membership, the study illustrates how directed intervention can improve students' higher order competency skills. This paper demonstrates how the segmentation defined by Wright and Masters can offer a basis for interpreting the construct underlying a test and how segment definitions can deliver targeted interventions. Implications for teacher intervention and teaching mentor schemes are considered. The article also discusses multilevel regression models that differentiate class and school effects, and describes a process for generating, testing and using value added models.

Improved interobserver variability and accuracy of echocardiographic visual left ventricular ejection fraction assessment through a self-directed learning program using cardiac magnetic resonance images.

BACKGROUND: Although not recommended in isolation, visual estimation of echocardiographic ejection fraction (EF) is widely applied to confirm quantitative EF. However, interobserver variability for EF estimation has been reported to be as high as 14%. The aim of this study was to determine whether self-directed education could improve the accuracy and interobserver variability of visual estimation of EF and whether a multireader estimate improves measurement precision. METHODS: Thirty-one participants provided single-point EF estimates for 30 echocardiograms with a spectrum of EFs, image quality, and clinical contexts in patients undergoing cardiac magnetic resonance (CMR) within 48 hours. Participants received their own case-by-case variance from CMR EF, and the 10 cases with the largest reader variability were discussed along with corresponding CMR images. Self-directed learning was undertaken by side-by-side review of echocardiographic and CMR images. Two months later, 20 new cases were shown to the same 31 participants, using the same methodology. RESULTS: The baseline interobserver variability of ±0.120 improved to ±0.097 after the intervention. EF misclassification (defined as ±0.05 of CMR EF) was reduced from 56% to 47% (P < .001), and the intervention also resulted in a decrease in the absolute difference between CMR and echocardiography for all cases and all readers (from 0.07 ± 0.01 to 0.06 ± 0.01, P = .0001). This improvement was most prominent for the readers with lower baseline accuracy. A combined physician-sonographer EF estimate improved the precision of EF determination by 25% compared with individual reads. CONCLUSIONS: In readers with varying levels of experience, a simple, mostly self-directed intervention modestly decreased interobserver variability and improved the accuracy of EF measurements. Combined physician-sonographer EF reporting improved the precision of EF estimates.

Aprendizaje autodirigido en estudiantes de primer año de medicina de la Universidad de Concepción y su relación con el perfil sociodemográfico y académico / Association between self-directed learning behaviors, socio-demographic and academic variables among medical students

Medical education must encourage autonomous learning behaviors among students. However the great income profile disparity among university students may influence their capacity to acquire such skills. Aim: To assess the association between self-directed learning, socio-demographic and academic variables. Material and Methods: The self-directed learning readiness scale was applied to 202 medical students aged between 17 and 25 years (64% males). Simultaneously information about each surveyed participant was obtained from the databases of the medical school. Results: There is an association between socio-demographic and academic variables with the general scale of self-directed learning and the subscales learning planning and willingness to learn. Participants coming from municipal schools have a greater willingness to learn than their counterparts coming from subsidized and private schools. High school grades are related to self-directed learning and the subscales learning planning and self-assessment. Conclusions: Among the surveyed medical students, there is a relationship between self-directed learning behaviors, the type of school where they come from and the grades that they obtained during high school.

Factors affecting learning and teaching for medicines supply management training in Pacific Island Countries--a realist review.

INTRODUCTION: Limited human resources are a major impediment to achieving the UN health-related Millennium Development Goals in a number of Pacific Island Countries (PICs). Lack of education capacity to support competency development in medicine supply management is one of the main issues affecting workforce development in this region, which is characterised by disparate service delivery due to the range of environments in which supply occurs (ie urban, rural and remote), geographical challenges and cultural practices associated with teaching and learning. The supply of medicines, and an adequate pharmacy workforce with appropriate competencies is crucial to ensuring a well-functioning pharmaceutical system. In this region approximately 80% of patients access healthcare in rural areas without a pharmacist, thus local health personnel must be competent in pharmaceutical management relevant to the local context and culture. A new approach involves a partnership between the UN Population Fund Suva Sub-Regional Office, University of Canberra, Ministry of Health officials and the heath personnel within identified PICs, starting with the need to understand local culture and its impact on learning and teaching, and the mapping of competency requirements and an understanding of currently available information and materials. This information will be used to develop and trial new pedagogical approaches to training health personnel involved in essential medicines supply management, to improve medicines availability for patients in their own environment. The focus of this review was to determine what cultural and learning factors need to be considered when developing a curriculum for South Pacific pharmaceutical health personnel who work across a range of practice environments. METHODS: A 'realist methodology' consisting of a systematic investigation of the published literature and a targeted review of the 'grey' literature was used. All relevant literature was retrieved and coded manually using broad thematic analysis. RESULTS: The combined bibliographic and 'grey' literature search strategy resulted in the inclusion of 17 full text articles, 44 documents and 10 books. The five themes identified as key to optimising the cultural and learning approaches for the study population included recognition of: (1) past regional experiences of health related training; (2) the impact of South Pacific culture on learning styles; (3) the impact of external influences on curriculum; (4) the challenges of open and distance education in the Pacific; and (5) a distinct South Pacific student learning approach. CONCLUSIONS: The results of this 'realist methodology' review provide insights into learning approaches and cultural influences on student learning within PICs. The themes generated will be used to develop a set of principles to inform educators and health personnel involved in pharmaceutical training within PICs.

[Association between self-directed learning behaviors, socio-demographic and academic variables among medical students]. / Aprendizaje autodirigido en estudiantes de primer año de medicina de la Universidad de Concepción y su relación con el perfil sociodemográfico y académico.

BACKGROUND: Medical education must encourage autonomous learning behaviors among students. However the great income profile disparity among university students may influence their capacity to acquire such skills. AIM: To assess the association between self-directed learning, socio-demographic and academic variables. MATERIAL AND METHODS: The self-directed learning readiness scale was applied to 202 medical students aged between 17 and 25 years (64% males). Simultaneously information about each surveyed participant was obtained from the databases of the medical school. RESULTS: There is an association between socio-demographic and academic variables with the general scale of self-directed learning and the subscales learning planning and willingness to learn. Participants coming from municipal schools have a greater willingness to learn than their counterparts coming from subsidized and private schools. High school grades are related to self-directed learning and the subscales learning planning and self-assessment. CONCLUSIONS: Among the surveyed medical students, there is a relationship between self-directed learning behaviors, the type of school where they come from and the grades that they obtained during high school.

Team safety and innovation by learning from errors in long-term care settings.

BACKGROUND: Team safety and team innovation are underexplored in the context of long-term care. Understanding the issues requires attention to how teams cope with error. Team managers could have an important role in developing a team's error orientation and managing team membership instabilities. PURPOSE: The aim of this study was to examine the impact of team member stability, team coaching, and a team's error orientation on team safety and innovation. METHODOLOGY: A cross-sectional survey method was employed within 2 long-term care organizations. Team members and team managers received a survey that measured safety and innovation. Team members assessed member stability, team coaching, and team error orientation (i.e., problem-solving and blaming approach). The final sample included 933 respondents from 152 teams. FINDINGS: Stable teams and teams with managers who take on the role of coach are more likely to adopt a problem-solving approach and less likely to adopt a blaming approach toward errors. Both error orientations are related to team member ratings of safety and innovation, but only the blaming approach is (negatively) related to manager ratings of innovation. Differences between members' and managers' ratings of safety are greater in teams with relatively high scores for the blaming approach and relatively low scores for the problem-solving approach. Team coaching was found to be positively related to innovation, especially in unstable teams. PRACTICAL IMPLICATIONS: Long-term care organizations that wish to enhance team safety and innovation should encourage a problem-solving approach and discourage a blaming approach. Team managers can play a crucial role in this by coaching team members to see errors as sources of learning and improvement and ensuring that individuals will not be blamed for errors.