A integração ensino-serviço-gestão-comunidade na percepção de preceptores de graduandos na Atenção Primária à Saúde / The teaching-service-management-community integration in the perception of undergraduate students' preceptors in Primary Health Care

Resumo Orientações, normativas e incentivos nacionais como as Diretrizes Curriculares Nacionais, o Pró-Saúde e o PET-Saúde, contribuíram para fomentar um importante arranjo formativo conhecido como "integração ensino-serviço-gestão-comunidade". Nesse contexto, a preceptoria na atenção primária à saúde (APS) se destaca. Assim, é relevante conhecer, sob a ótica de preceptores, qual é a participação de cada ator desta integração e quais são as barreiras antipedagógicas e de processo de trabalho que dificultam a preceptoria. Este estudo teve como objetivo compreender fatores facilitadores e dificultadores da integração na perspectiva de preceptores de graduandos no âmbito da APS no município de São Paulo-SP. Trata-se de um estudo qualitativo, do tipo descritivo-exploratório, que utilizou entrevistas semiestruturadas com 14 preceptores, interpretadas pela análise de conteúdo temática. Como barreiras principais foram identificadas: sobrecarga de trabalho, desvalorização da saúde pública, falta de apoio pedagógico e distanciamento da comunidade no processo formativo. Entre as contribuições, destacam-se o trabalho interprofissional e a aproximação entre as instituições de ensino e a gestão quando planejam o estágio. A integração tem importantes questões a serem aperfeiçoadas ao olhar dos preceptores, tendo em vista facilitar a articulação entre os atores e transpor as barreiras formativas.

Abstract National guidelines, regulations and incentives such as the National Curricular Guidelines, Pró-Saúde and PET-Saúde, contributed to fostering an important training arrangement known as "teaching-service-management-community integration". In this context, preceptorship in primary health care (PHC) stands out. Thus, it is relevant to know, from the perspective of preceptors, what is the participation of each actor in this integration and what are the anti-pedagogical and work process barriers that make preceptorship difficult. This study aimed to understand factors that facilitate and hinder integration from the perspective of preceptors of undergraduates within the scope of PHC in the city of São Paulo-SP, Brazil. This is a qualitative, descriptive-exploratory study, which used semi-structured interviews with 14 preceptors, interpreted by thematic content analysis. As main barriers were identified: work overload, devaluation of public health, lack of pedagogical support and distance from the community in the training process. Among the contributions, interprofessional work and the approximation between educational institutions and management when planning the internship stand out. Integration has important issues to be improved from the point of view of preceptors, with a view to facilitating articulation between actors and overcoming training barriers.

Occupational therapy entry-level education scholarship in Australia from 2000 to 2019: A systematic mapping review.

INTRODUCTION: The number of occupational therapy degree programs in Australia has increased substantially over the last decade. During this time, Australian academics have produced a significant amount of scholarship focussed on entry-level education; however, the landscape of this scholarship has not been examined. The aim of this study was to review the literature on the scholarship of entry-level Australian occupational therapy education programs, specifically the topics explored and methods employed. METHODS: An extensive search of nine databases produced 1,002 papers related to occupational therapy education. Two researchers screened each paper using inclusion and exclusion criteria. Seventy-six articles, published between 2000 and September 2019, were included. Data were extracted using a coding tool, and entered into NVivo, where data were analysed using queries and tallies of the characteristics of the articles. RESULTS: Sixty-eight articles were research and eight were other peer reviewed literature. Articles primarily focussed on student characteristics and perceptions. Quantitative research designs were predominant with surveys the most frequently used method. There were few articles that addressed the topic of teaching methods and approaches, and of these none addressed occupation-centred teaching. No articles addressed the learning environment. Four articles reported on an educational intervention that targeted participation, and attitudes/perceptions or knowledge/skills of students and/or academics. These findings inform understanding about what has been completed so far in the scholarship; and what topic focus and research designs could address gaps in existing knowledge. CONCLUSIONS: This review elucidated topics that have been well researched (student focus), as well as gaps in the scholarship (teaching methods and approaches including occupation-centred teaching, and the learning environment). It showed that quantitative designs were predominant, with qualitative approaches less frequently adopted. The results of this review could assist academics and researchers to focus their scholarship on topics that require further investigation and diversify research methods.

Meeting Health Care Needs in Rural Alabama: The Power of Partnerships.

Recruiting and retaining rural primary care providers is challenging. The Graduate Nursing Education Primary Care Scholars (GNEPCS) is a partnership between a philanthropic organization and a school of nursing to recruit, educate, train, and retain primary care advanced practice registered nurses (APRNs) for practice in rural Alabama with a focus on improving the state's health outcomes. In its initial four years, the GNEPCS partnership has been successful in identifying 60 registered nurses interested in becoming rural primary care APRNs. These students have received mentoring, individualized content on rural health, preceptorships with rural providers, and opportunities for professional and leadership development. Pilot philanthropic funding has allowed us to develop sustainable curricula, attract additional complementary federal funds, and create a critical mass of practice-ready APRNs who are improving primary care access for some of the state's most rural and underserved populations.

A Method to Study the Effect of a Physician Assistant Student on Preceptor Productivity.

PURPOSE: Guided clinical experience is a critical component of a physician assistant (PA) student's education. However, clinical precepting is strongly perceived to have deleterious effects on productivity. In this study, we sought to test a method for evaluating the effect that PA students have on clinical productivity. METHODS: We recruited 14 family medicine preceptors and second-year PA students from 2 programs, the University of Washington (UW) and the University of Texas Health Science Center San Antonio (UT). We collected productivity data during 3 weeks of preceptor clinical practice-one week without a PA student present and 2 weeks with a PA student present (one week early in the student's family medicine clinical rotation and a second week late in the rotation). We collected preceptor demographic data, patient characteristics, and the primary outcome-relative value units (RVUs) per preceptor per half-day during the 3 data collection weeks. At the end of the study, we asked preceptors about the ease of data collection and any negative effects of the study itself on their clinical productivity. RESULTS: No significant differences were found in preceptor demographics or in patient characteristics, numbers of patients, or RVUs per patient seen in any of the weeks or between UW and UT. In this pilot study, no significant differences were seen in RVUs per preceptor per half-day between the 3 weeks of observation or between UW and UT. CONCLUSION: In this pilot study, the protocol was straightforward, unintrusive, and preliminarily showed no significant effects of a PA student on preceptor productivity.

Leading and Participating in International Medical Service Trips.

In communities around the world, health professionals and students preparing for health careers are increasingly responding to global health needs stemming from natural disasters, infectious disease outbreaks, and inadequate resources. This has resulted in a wide range of faith-based and nonfaith-based health care organizations establishing international medical service programs. This article provides guidance for nursing professional development educators and faculty on leading and participating in these programs. The emphasis is on using best practice guidelines while engaging with the community and providing culturally appropriate and sustainable health care services within an international context. J Contin Educ Nurs. 2018;49(6):251-253.

Using Training Needs Assessment to Develop a Nurse Preceptor-Centered Training Program.

BACKGROUND: Studies reveal that most nurse preceptor preparation programs do not meet nurse preceptors' training needs. This study thus developed a nurse preceptor-centered training program (NPCTP) in Taiwan. METHOD: The ADDIE model was used for the instructional design. On the basis of the nurse preceptors' training needs assessment, the research team developed the NPCTP. Content was adopted from the authentic experiences of preceptors and new graduate nurses (NGNs) using interview data to make 81 videos with computer avatars and 10 live actor films. Each course was taught as nine instructional events. The NPCTP was evaluated using reflection quizzes, preceptors' self-evaluations, NGNs' evaluations, and focus group interviews. RESULTS: The NPCTP enhanced preceptors' clinical teaching behaviors and had a positive influence on NGNs. The NGN evaluation was even better than the preceptors' self-evaluation. CONCLUSION: This article provides the what and how for an NPCTP in Taiwan. J Contin Nurs Educ. 2017;48(5):220-229.

Reframing Nursing Preceptor Development: A Comprehensive Approach to Improve Education, Standardize Processes, and Decrease Costs.

High preceptor turnover and mandates for cost efficiency in a rapidly changing healthcare environment require innovative approaches for developing and supporting nurse preceptors. Responding to new organizational strategic and cost containment initiatives, a quality improvement project was initiated that combined several evidence-based approaches to align traditional processes and programs. The resultant preceptor development program decreased costs and standardized processes. It also showed improved learning and preceptor satisfaction and increased educational, networking, and recognition opportunities.

Six-Month Follow-up of a Regional Evidence-based Practice Fellowship Program.

OBJECTIVE: This study examined a 6-month follow-up of a regional evidence-based practice (EBP) fellowship program and the predictors of EBP adoption at hospital units. BACKGROUND: The immediate beneficial effects of a regional EBP program are known, but the medium-term effects are not certain. METHODS: A matched pretest/posttest study was conducted using a mailed questionnaire 6 months after the completion of a 9-month regional EBP fellowship program among 3 annual cohorts of participants. RESULTS: Statistically significant improvements in the mean scores of EBP beliefs, EBP implementation, and group cohesion were found (P < .05). Of the 47 participants who completed their EBP projects, more than three-quarters reported EBP adoption at their own hospital units, and EBP beliefs were a positive predictor of EBP adoption (odds ratio, 1.12; 95% confidence interval, 1.02-1.22; P = .017). CONCLUSIONS: The outcome improvements continued 6 months after the fellowship program, and strong EBP beliefs predicted EBP adoption in the participants' units.

Preceptorship in Family and Community Medicine: challenges and achievements in a Primary Health Care in progress. / Preceptoria em Medicina de Família e Comunidade: desafios e realizações em uma Atenção Primária à Saúde em construção.

Strengthening Primary Health Care (PHC) relies directly on training medical specialists in primary care. This text aims to report the Family Medicine training experiences in Rio de Janeiro between 2008 and 2016. It brings to reflection the development of preceptors in medical specialization through an experience report on three Family Medicine medical residency programs, namely, the Municipal Health Secretariat program, the Federal University of Rio de Janeiro program and the National School of Public Health program. The PHC reform in Rio de Janeiro created a demand for medical specialists working in networks, leading to the expansion of already established medical residency programs and the establishment of a new program sponsored by the Municipal Health Secretariat, providing new teaching positions in several health facilities within the municipal network. These three residency programs progressed through different paths to provide training to their preceptors, offering permanent courses and local actions seeking higher professional qualification and better balance between care and education responsibilities. Permanent investments to strengthen medical residency programs and preceptors training are essential to consolidate the PHC reform nationwide.

Commitment to Change and Challenges to Implementing Changes After Workplace-Based Assessment Rater Training.

PURPOSE: Faculty development for clinical faculty who assess trainees is necessary to improve assessment quality and impor tant for competency-based education. Little is known about what faculty plan to do differently after training. This study explored the changes faculty intended to make after workplace-based assessment rater training, their ability to implement change, predictors of change, and barriers encountered. METHOD: In 2012, 45 outpatient internal medicine faculty preceptors (who supervised residents) from 26 institutions participated in rater training. They completed a commitment to change form listing up to five commitments and ranked (on a 1-5 scale) their motivation for and anticipated difficulty implementing each change. Three months later, participants were interviewed about their ability to implement change and barriers encountered. The authors used logistic regression to examine predictors of change. RESULTS: Of 191 total commitments, the most common commitments focused on what faculty would change about their own teaching (57%) and increasing direct observation (31%). Of the 183 commitments for which follow-up data were available, 39% were fully implemented, 40% were partially implemented, and 20% were not implemented. Lack of time/competing priorities was the most commonly cited barrier. Higher initial motivation (odds ratio [OR] 2.02; 95% confidence interval [CI] 1.14, 3.57) predicted change. As anticipated difficulty increased, implementation became less likely (OR 0.67; 95% CI 0.49, 0.93). CONCLUSIONS: While higher baseline motivation predicted change, multiple system-level barriers undermined ability to implement change. Rater-training faculty development programs should address how faculty motivation and organizational barriers interact and influence ability to change.

Nursing Student Work-Study Internship Program: An Academic Partnership.

BACKGROUND: A large northern California-based integrated health system and five universities partnered to conduct an innovative work-study internship program designed to address the education-to-practice gap for nursing students. METHOD: The nursing student work-study intern-ship program provides prelicensure nursing students with a paid internship in the health system. Interns are exposed to the realities of clinical practice and master learned skills working under the supervision of an RN preceptor. RESULTS: Work-study interns reported that participation in the program exposed them to new clinical situations, helped them integrate clinical knowledge and critical thinking skills, improved prioritization and time management skills, and expanded their communication skills within the interprofessional team. Interns cited feeling better equipped to safely and effectively transition into the new graduate role. CONCLUSION: The nursing student work-study program shows how an academic practice partnership can address the education-to-practice gap in an innovative manner. [J Nurs Educ. 2016;55(6):357-359.].

EpiAssist: Service-learning in public health education.

BACKGROUND: Although public health degree programs typically require practica and other field experiences, service-learning courses, with a focus on civic engagement and the application of classroom learning in real world settings, can go beyond these requirements and provide benefits to students and community-based practice partners. The goal of this paper is to assess potential benefits of service-learning programs for both graduate-level public health students and state and local public health agency partners. METHODS: EpiAssist is a new service-learning program developed at the School of Public Health of the Texas A and M University Health Science Center, USA, in January 2015. EpiAssist was integrated into a new course, Methods in Field Epidemiology. The integration of service-learning was guided by a partnership with the Texas A and M Center for Teaching Excellence. RESULTS: State, regional, and local public health partners requested EpiAssist via email or telephone. A listserv was used to recruit student volunteers to meet requests. 54 of 86 registered EpiAssist students (63%) participated in at least one of ten service-learning and three training activities between January and June, 2015. Service-learning activities included questionnaire development, in-person and telephone data collection, and data analysis. Training topics for students included the Epi Info™ software, community assessment and communicable disease reporting. Students and partner organizations provided generally positive assessments of this service learning program through an online evaluation. DISCUSSION: Service-learning provides students with enhanced classroom learning through applied public health experience in state, regional and local health departments. These experiences provide both needed surge capacity to public health departments and valuable hands-on field experience to students.

Is there a relationship between the diversity characteristics of nursing students and their clinical placement experiences? A literature review.

BACKGROUND: There has been an increase in ethno-cultural, linguistic, and socio-demographical diversity in students enrolling in undergraduate nursing programs. Diversity also involves other characteristics, but little is known about how diversity impacts on the clinical experiences of nursing students. AIM: The aim of this review is to identify studies which describe the clinical placement experiences of nursing students who have a broad range of diversity characteristics. METHODS: Major databases were searched and original studies published from 2003 to 30 June 2013 were eligible for inclusion. An expanded definition of diversity was used to include characteristics such as ethnicity, language, age, religion, gender, socioeconomic status, carer responsibilities, sexual orientation and special needs/disability. FINDINGS: Male gender and speaking English as a second language are diversity characteristics associated with a less positive clinical experience. These students are also more likely to leave their nursing program. Mature-aged students and those from ethnic minority groups were also noted to have a less positive clinical experience and in some cases, this also increased attrition. However, it was difficult to determine the impact of these characteristics alone as they appeared to be linked with other characteristics such as financial difficulties and carer responsibilities in the case of mature-aged students, and language and international student status in the case of ethnicity. CONCLUSIONS: Given the significant benefits associated with preparing a diverse nursing workforce, it is an imperative to better understand the impact of diversity on nursing students to ensure that every placement becomes a positive and valuable learning experience.

Residency and Fellowship Programs for RNs and Advanced Practice RNs.

In this month's column, the Senior Accreditation Operations Manager of the American Nurses Credentialing Center (ANCC) discusses the value of nursing residency programs and current discussion in the profession, along with criteria offered by the ANCC to support this imperative for both RNs and advanced practice RNs including new graduates and those transitioning between clinical settings.

Health Care in the Community: Developing Academic/Practice Partnerships for Care Coordination and Managing Transitions.

The delivery of health care is quickly changing from an acute care to a community-based setting. Faculty development and mastery in the use of new technologies, such as high-definition simulation and virtual communities are crucial for effective student learning outcomes. Students' benefits include opportunities for hands-on experience in various patient care scenarios, realtime faculty feedback regarding their critical reasoning and clinical performance, interdisciplinary collaboration, and access to a nonthreatening learning environment. The results of this study provide some evidence of the benefits of developing faculty and nursing curricula that addresses the shift from an ilness-based, acute hospital model, to a community and population health-based preventive model.

Increasing quality and quantity of student placements in smaller rural health services: It can be done.

PROBLEM: Future rural nursing and midwifery workforce shortage and current shortage of placements for undergraduate nursing and midwifery students. DESIGN: Developmental evaluation. SETTING: Five small hospitals and a regional community health service. KEY MEASURES OF IMPROVEMENT: Increased number of placements available for students; sustainable, quality clinical placement system in place for the future. STRATEGIES FOR CHANGE: Clinical facilitators developed a clinical facilitation model and resources that increased quality and quantity of student placements, assisted clinicians to provide higher quality teaching to students, enabled students to develop skills in rural health care service provision and enhanced knowledge around future career options. EFFECTS OF CHANGE: Placement targets were met and all health services involved chose to continue the model of clinical facilitation developed after project funding ceased. The clinical education skills developed by staff under the project remain in the region to support future students. LESSONS LEARNT: It is possible to create a sustainable, high-quality, rural placement experience for larger numbers of nursing and midwifery students. Funding sources are available to continue the clinical facilitation model in to the future, but for it to work optimally, a steady supply of students across the year is required.