Do in-service training materials for midwifery care providers in sub-Saharan Africa meet international competency standards? A scoping review 2000-2020.

BACKGROUND: Levels of maternal and neonatal mortality remain high in sub-Saharan Africa, with an estimated 66% of global maternal deaths occurring in this region. Many deaths are linked to poor quality of care, which in turn has been linked to gaps in pre-service training programmes for midwifery care providers. In-service training packages have been developed and implemented across sub-Saharan Africa in an attempt to overcome the shortfalls in pre-service training. This scoping review has aimed to summarize in-service training materials used in sub-Saharan Africa for midwifery care providers between 2000 and 2020 and mapped their content to the International Confederation of Midwives (ICM) Essential Competencies for Midwifery Practice. METHODS: Searches were conducted for the years 2000-2020 in Cumulative Index of Nursing and Allied Health Literature, PubMed/MEDLINE, Social Science Citation Index, African Index Medicus and Google Scholar. A manual search of reference lists from identified studies and a search of grey literature from international organizations was also performed. Identified in-service training materials that were accessible freely on-line were mapped to the ICM Essential Competencies for midwifery practice. RESULTS: The database searches identified 1884 articles after removing duplicates. After applying exclusion criteria, 87 articles were identified for data extraction. During data extraction, a further 66 articles were excluded, leaving 21 articles to be included in the review. From these 21 articles, six different training materials were identified. The grey literature yielded 35 training materials, bringing the total number of in-service training materials that were reviewed to 41. Identified in-service training materials mainly focused on emergency obstetric care in a limited number of sub-Saharan Africa countries. Results also indicate that a significant number of in-service training materials are not readily and/or freely accessible. However, the content of in-service training materials largely met the ICM Essential Competencies, with gaps noted in the aspect of woman-centred care and shared decision making. CONCLUSION: To reduce maternal and newborn morbidity and mortality midwifery care providers should have access to evidence-based in-service training materials that include antenatal care and routine intrapartum care, and places women at the centre of their care as shared decision makers.

Effectiveness of safety training interventions for supervisors: A systematic review and narrative synthesis.

A wealth of research demonstrates that work unit supervisors serve a critical function in protecting the safety and health of workers. A systematic review examined the effectiveness of workplace safety training interventions intended for various supervisor populations published from 2000 to 2019. A search of seven electronic databases was supplemented with hand searches from the reference lists of identified publications, relevant scientific journals, and the gray literature. This review included an assessment of the methodological quality using a modified version of the Quality Assessment Tool for Quantitative Studies. A total of 22 peer-reviewed studies met a set of inclusion criteria and were subsequently assessed for methodological quality. Training interventions were grouped into five topical domains: ergonomics, leadership, supervisor-worker interaction, injury, and disability management, and general safety education. Consistent evidence was found for the effectiveness of supervisory training interventions across several outcome measures. To our knowledge, this is the first study to synthesize the literature on supervisory training interventions in the area of occupational safety. While the results are encouraging, they must be viewed with caution due to the fact that the methodological rigor of the reviewed studies was low.

Creating an Environment to Support Transitioning New APRNs into Practice.

Registered nurses (RNs) are leaving the bedside to become advanced practice registered nurses (APRNs). Failure to successfully transition APRNs into clinical practice represents a substantial financial burden to healthcare organizations. Organizations can use the standards of the Magnet Recognition Program to help support, develop, and transition APRNs into their advanced practice role.

Effectiveness of a psychoeducational intervention for caregivers of People With Dementia with regard to burden, anxiety and depression: A systematic review.

AIM: To assess the effectiveness of psychoeducational interventions with respect to burden, anxiety and depression in family caregivers of People With Dementia living at home. BACKGROUND: In dementia, the family assumes the role of main caregiver, maintaining the patient in a good state of health. Nevertheless, burden, anxiety and depression may have negative repercussions in caregivers. Therefore, professional supports through psychoeducational programmes are recommended as interventions for improving caregivers' health. DESIGN: A quantitative systematic review. DATA SOURCES: Electronic searches were performed in CINAHL/AMED/CENTRAL/Web of Science/LILACS/PUBMED from January 2005-August 2018. REVIEW METHODS: The review was conducted using the JADAD scale to assess bias risk and the quality of the randomized controlled trials (RCTs) and the CONSORT instrument to assess study quality report. The extracted data were reviewed by independent reviewer pairs. The review was reported using PRISMA. RESULTS: A total of 18 RCTs met inclusion criteria. Seven were classified as Technology-based Interventions and 11 as Group-based Interventions. CONCLUSION: Psychoeducational interventions for caregivers allow them to increase their knowledge of the illness, develop problem-solving skills and facilitate social support. Technology-based Interventions significantly affect burden while Group-based Interventions affect anxiety, depression, insomnia and burden and quality of life and self-efficacy. IMPACT: Research findings can be used to classify caregivers in future interventions according to illness stage to obtain more precise results.

A Junior Doctor's Perspective on Oncology and Palliative Medicine Education in Western Australia: Comparison Between Graduation and Completion of Internship.

Cancer is a leading cause of death in Australia and is also the leading cause of disease burden as survivorship continues to improve. Given the prevalence of oncology patients in the community, it is likely to be a condition encountered by every junior doctor. Despite this oncology and in conjunction with that, palliative care has not been a core component of medical curriculum until recently. This means that the junior doctor experience is often complicated by lack of knowledge, poor understanding of the disease process, treatment options and complications and therefore makes managing these patients complicated and often an uncessarily stressful process. This reflective article explores current issues in cancer education, a reflection and comparison between pre- and post-internship experience and offers some potential solutions to these issues.

Training Needs of Clinical and Research Professionals to Optimize Minority Recruitment and Retention in Cancer Clinical Trials.

The study of disparities in minority recruitment to cancer clinical trials has focused primarily on inquiries among minority patient populations. However, clinical trial recruitment is complex and requires a broader appreciation of the multiple factors that influence minority participation. One area that has received little attention is minority recruitment training for professionals who assume various roles in the clinical trial recruitment process. Therefore, we assessed the perspectives of cancer center clinical and research personnel on their training and education needs toward minority recruitment for cancer clinical trials. Ninety-one qualitative interviews were conducted at five U.S. cancer centers among four stakeholder groups: cancer center leaders, principal investigators, referring clinicians, and research staff. Interviews were recorded and transcribed. Qualitative analyses focused on response data related to training for minority recruitment for cancer clinical trials. Four prominent themes were identified: (1) Research personnel are not currently being trained to focus on recruitment and retention of minority populations; (2) Training for minority recruitment and retention provides for a specific focus on factors influencing minority research participation; (3) Training on cultural awareness may help to bridge cultural gaps between potential minority participants and research professionals; (4) Views differ regarding the importance of research personnel training designed to focus on recruitment of minority populations. There is a lack of systematic training for minority recruitment. Many stakeholders acknowledged the benefits of minority recruitment training and welcomed training that focuses on increasing cultural awareness to increase the participation of minorities in cancer clinical trials.

Seizure Identification by Critical Care Providers Using Quantitative Electroencephalography.

OBJECTIVES: To compare the performance of critical care providers with that of electroencephalography experts in identifying seizures using quantitative electroencephalography display tools. DESIGN: Diagnostic accuracy comparison among healthcare provider groups. SETTING: Multispecialty quaternary children's hospital in Canada. SUBJECTS: ICU fellows, ICU nurses, neurophysiologists, and electroencephalography technologists. INTERVENTION: Two-hour standardized one-on-one training, followed by a supervised individual review of 27 continuous electroencephalography recordings with the task of identifying individual seizures on eight-channel amplitude-integrated electroencephalography and color density spectral array displays. MEASUREMENTS AND MAIN RESULTS: Each participant reviewed 27 continuous electroencephalograms comprising 487 hours of recording containing a total of 553 seizures. Performance for seizure identification was compared among groups using a nested model analysis with adjustment for interparticipant variability within groups and collinearity among recordings. Using amplitude-integrated electroencephalography, sensitivity for seizure identification was comparable among ICU fellows (83.8%), ICU nurses (73.1%), and neurophysiologists (81.5%) but lower among electroencephalographic technologists (66.7%) (p = 0.003). Using color density spectral array, sensitivity was comparable among ICU fellows (82.4%), ICU nurses (88.2%), neurophysiologists (83.3%), and electroencephalographic technologists (73.3%) (p = 0.09). Daily false-positive rates were also comparable among ICU fellows (2.8 for amplitude-integrated electroencephalography, 7.7 for color density spectral array), ICU nurses (4.2, 7.1), neurophysiologists (1.2, 1.5), and electroencephalographic technologists (0, 0) (p = 0.41 for amplitude-integrated electroencephalography; p = 0.13 for color density spectral array). However, performance varied greatly across individual electroencephalogram recordings. Professional background generally played a greater role in determining performance than individual skill or electroencephalogram recording characteristics. CONCLUSIONS: Following standardized training, critical care providers and electroencephalography experts displayed similar performance for identifying individual seizures using both amplitude-integrated electroencephalography and color density spectral array displays. Although these quantitative electroencephalographic trends show promise as a tool for bedside seizure screening by critical care providers, these findings require confirmation in a real-world ICU environment and in daily clinical use.

Rheumatologists' guideline adherence in rheumatoid arthritis: a randomised controlled study on electronic decision support, education and feedback.

OBJECTIVES: To assess the effects of education, feedback and a computerised decision support system (CDSS) versus education and feedback alone on rheumatologists' rheumatoid arthritis (RA) guideline adherence. METHODS: A single-centre, randomised controlled pilot study was performed among clinicians (rheumatologists, residents and physician assistants; n=20) working at the study centre, with a 1:1 randomisation of included clinicians. A standardized sum score (SSS) on guideline adherence was used as the primary outcome (patient level). The SSS was calculated from 13 dichotomous indicators on quality of RA monitoring, treatment and follow-up. The randomised controlled design was combined with a before-after design in the control group to assess the effect education and feedback alone. RESULTS: Twenty clinicians (mean age 44.3±10.9 years; 55% female) and 990 patients (mean age 62 ± 13 years; 69% female; 72% rheumatoid factor and/or anti-CCP positive) were included. Addition of CDSS to education and feedback did not result in significant better quality of RA care than education and feedback alone (SSS difference 0.02; 95%-CI -0.04 to 0.08; p=0.60). However, before/after comparison showed that education and feedback alone resulted in a significant increase in the SSS from 0.58 to 0.64 (difference 0.06; 95%-CI 0.02 to 0.11; p<0.01). CONCLUSIONS: Our results suggest that CDSS did not have added value with regard to guideline adherence, whereas education and feedback can lead to a small but significant improvement of guideline adherence.

Assessment of barriers and facilitators in the implementation of appropriate use criteria for elective percutaneous coronary interventions: a qualitative study.

BACKGROUND: The use of inappropriate elective Percutaneous Coronary Intervention (PCI) has decreased over time, but hospital-level variation in the use of inappropriate PCI persists. Understanding the barriers and facilitators to the implementation of Appropriate Use Criteria (AUC) guidelines may inform efforts to improve elective PCI appropriateness. METHODS: All hospitals performing PCI in Washington State were categorized by their use of inappropriate elective PCI in 2010 to 2013. Semi-structured, qualitative telephone interviews were then conducted with 17 individual interviews at 13 sites in Washington State to identify barriers and facilitators to the implementation of the AUC guidelines. An inductive and deductive, team-based analytical approach, drawing primarily on Matrix analysis was performed to identify factors affecting implementation of the AUC. RESULTS: Specific facilitators were identified that supported successful implementation of the AUC. These included collaborative catheterization laboratory environments that allow all staff to participate with questions and opinions; ongoing AUC education with catheterization laboratory teams and referring providers; internal AUC peer review processes; interventional cardiologist be directly involved with the pre-procedural review process; checklist-based algorithms for pre-procedural documentation; systems redesign to include insurance companies; and AUC educational information with patients. Barriers to implementation of the AUC included external pressures, such as competition for patients, and the lack of shared medical records with sites that referred patients for coronary angiography. CONCLUSIONS: The identified facilitators enabled sites to successfully implement the AUC. Catheterization laboratories struggling to successfully implement the AUC may consider utilizing these strategies to improve their processes to improve patient selection for elective PCI.

Palliative care volunteerism across the healthcare system: A survey study.

BACKGROUND: Volunteers fulfil several roles in supporting terminally ill people and their relatives and can positively influence quality of care. Healthcare in many countries faces resource constraints and some governments now expect communities to provide an increasing proportion of palliative care. However, systematic insights into volunteer presence, tasks and training and organisational challenges for volunteerism are lacking. AIM: Describe organised volunteerism in palliative direct patient care across the Flemish healthcare system (Belgium). DESIGN: A cross-sectional postal survey using a self-developed questionnaire was conducted with 342 healthcare organisations. SETTING/PARTICIPANTS: The study included full population samples of palliative care units, palliative day-care centres, palliative home care teams, medical oncology departments, sitting services, community home care services and a random sample of nursing homes. RESULTS: Responses were obtained for 254 (79%) organisations; 80% have volunteers providing direct patient care. Psychosocial, signalling and existential care tasks were the most prevalent volunteer tasks. The most cited organisational barriers were finding suitable (84%) and new (80%) volunteers; 33% of organisations offered obligatory training (75% dedicated palliative care, 12% nursing homes). Differences in volunteer use were associated with training needs and prevalence of organisational barriers. CONCLUSION: Results suggest potential for larger volunteer contingents. The necessity of volunteer support and training and organisational coordination of recruitment efforts is emphasised. Organisations are encouraged to invest in adequate volunteer support and training. The potential of shared frameworks for recruitment and training of volunteers is discussed. Future research should study volunteerism at the volunteer level to contrast with organisational data.

The needs of informal caregivers and barriers of primary care workers toward dementia management in primary care: a qualitative study in Beijing.

BACKGROUND: Informal caregivers of people with dementia in Beijing are increasingly called upon to provide home-based care for their patients due to the increasing number of dementia patients and the shortage of standardized institutional solutions of care for patients in China. This study aimed to clarify the needs of informal caregivers and barriers of primary care workers toward dementia management in primary care in Beijing to provide references that may help to improve the care and services provided to individuals with dementia and their family caregivers residing in urban China. METHODS: A mixed-methods approach was used in this study. We performed individual in-depth interviews with 10 informal caregivers. Moreover, we carried out focus group interviews with 29 primary care workers. Content analysis was used to separately identify themes and codes. Discrepancies were discussed until final agreement was achieved. RESULTS: Three themes representing the core attitudes of informal caregivers and primary care workers were identified: care knowledge and skills, psychological counseling, and collaborative management. Most primary care workers believed that the management of dementia patients in primary care was necessary. However, due to the heavy work load and different medical specialties involved, these workers were unable to manage it. CONCLUSIONS: Professional training focused on dementia for primary care workers should be strengthened. At the same time, the establishment of a community-based dementia team management model that includes specialists, community health service centers (CHSCs), and community committees should be explored.

Diagnostic flexible pharyngo-laryngoscopy: development of a procedure specific assessment tool using a Delphi methodology.

PURPOSE: Proper training and assessment of skill in flexible pharyngo-laryngoscopy are central in the education of otorhinolaryngologists. To facilitate an evidence-based approach to curriculum development in this field, a structured analysis of what constitutes flexible pharyngo-laryngoscopy is necessary. Our aim was to develop an assessment tool based on this analysis. METHODS: We conducted an international Delphi study involving experts from twelve countries in five continents. Utilizing reiterative assessment, the panel defined the procedure and reached consensus (defined as 80% agreement) on the phrasing of an assessment tool. RESULTS: FIFTY PANELISTS COMPLETED THE DELPHI PROCESS. THE MEDIAN AGE OF THE PANELISTS WAS 44 YEARS (RANGE 33-64 YEARS). MEDIAN EXPERIENCE IN OTORHINOLARYNGOLOGY WAS 15 YEARS (RANGE 6-35 YEARS). TWENTY-FIVE WERE SPECIALIZED IN LARYNGOLOGY, 16 WERE HEAD AND NECK SURGEONS, AND NINE WERE GENERAL OTORHINOLARYNGOLOGISTS. AN ASSESSMENT TOOL WAS CREATED CONSISTING OF TWELVE DISTINCT ITEMS.: Conclusion The gathering of validity evidence for assessment of core procedural skills within Otorhinolaryngology is central to the development of a competence-based education. The use of an international Delphi panel allows for the creation of an assessment tool which is widely applicable and valid. This work allows for an informed approach to technical skills training for flexible pharyngo-laryngoscopy and as further validity evidence is gathered allows for a valid assessment of clinical performance within this important skillset.

Standardized Tracheostomy Education Across the Enterprise.

PURPOSE: The purpose of this quality improvement project was to create a Tracheostomy Subject Matter Expert (Trach SME) Committee to standardize tracheostomy care, education, and the discharge process across Boston Children's Hospital. DESIGN AND METHODS: Boston Children's Hospital (BCH) is a free-standing urban tertiary pediatric hospital with 15 inpatient units. The newly formed Trach SME Committee evaluated the discharge process across the enterprise including hospital satellites and intra-hospital practice. Education materials were centralized, and policies were reviewed, revised and standardized to reflect current best practice. The Trach SME provided education to Trach Champions from each area that became resources for their respective units. The Trach SME also developed measurement outcomes to assess the effectiveness of the education process. RESULTS: In the implementation year of 2104, our 7-day unplanned readmission rate for tracheostomy patients was 18.18%. This rate decreased to 6.67% in 2015 and to 0% in 2016. In 2015, we began to monitor 30-day unplanned readmissions and the rate was 6.67% in 2015 and decreased to 0% in 2016. CONCLUSIONS AND PRACTICE IMPLICATIONS: Standardization of policies, procedures and caregiver educational materials for the management of patients with a tracheostomy tube improved tracheostomy care across the enterprise and reduced tracheostomy readmission rates.

Validation of the Healthy Foot Screen: A Novel Assessment Tool for Common Clinical Abnormalities.

GENERAL PURPOSE: The purpose of this learning activity is to provide information about the Healthy Foot Screen, a new tool for assessment of common foot abnormalities. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After completing this continuing education activity, you should be able to:1. Recognize prevalence, causes, risk factors, signs, and types of common foot problems.2. Identify the results of this study about the new foot screening tool and its implications in primary care. ABSTRACT: Foot health is a key component of general health and well-being. Nevertheless, feet are often overlooked by healthcare providers and patients. Common foot problems include infections or inflammatory conditions, abnormal nail disorders (eg, onychomycosis), structural bony abnormalities, circulation disorders, and other conditions. The development of an easy-to-use, rapid, clinical tool to assess foot health can facilitate primary care provider recognition and treatment of common foot problems. This study ascertained interrater item reliability and validity from the preliminary version of one such tool called the Healthy Foot Screen.A total of 18 patients from a community dermatology clinic were individually screened by 11 interprofessional healthcare assessors using the preliminary tool. The assessors included a dermatologist/internist, family physicians, nurses, and podiatrists. The initial draft of the Healthy Foot Screen was created through an extensive literature review, complemented by the clinical judgment of the study team. Cronbach α was calculated for each item to determine interrater reliability. A minimum value of 0.6 was set for an item to be included in the final tool. Where applicable, scores for each item on the screen were calculated for right and left lower limbs and then averaged. Assessors were asked to complete a short survey.Interrater reliability scores for items on the screen were as follows: diabetes and smoking, 1.0; neuropathy, 0.988; palpable foot pulse, 0.916; abnormal fourth to fifth toe web space, 0.905; previous ulcer/amputation, 0.869; pitting edema, 0.872; bony abnormality, 0.804; dry bottom of foot, 0.799; toenail infection, 0.793; other spots/lesions,0.688; and red areas/blisters/pustules, 0.659. Generally, assessors found the tool easy to use, although some areas for improvement were noted.The Healthy Foot Screen can facilitate primary care provider diagnosis and treatment of common foot problems.

Preceptors' perceptions of the elements of a successful and an unsuccessful orientation period for newly graduated nurses.

AIM: To identify existing orientation patterns and to find elements that may enhance or impede successful orientation of newly graduated nurses. BACKGROUND: Preceptors have first-hand information concerning orientation and their opinions should not be forgotten when organisations develop their orientation processes. METHOD: An open-ended questionnaire was undertaken to collect data from preceptors (n = 172) about the current orientation patterns. Data were analysed by using deductive content analysis and by quantifying the phrases. RESULTS: Communal commitment to the orientation process, strong professional orientation know-how and supportive leadership were the enhancing elements of successful orientation. Complex interpersonal relationship problems during orientation, inadequate orientation resources and the organisation's structural and functional problems were the impeding elements of successful orientation. CONCLUSIONS: With the elements of successful orientation we ensure a supportive transition to practice for newly graduate nurses and possibilities to focus on good orientation practices for preceptors. IMPLICATION FOR NURSING MANAGEMENT: Nurse leaders play an important part in ensuring newly graduated nurses have a safe nursing career starting point and, for preceptors, opportunities to provide orientation that is as good as possible. Supportive leadership, sufficient resources and good interpersonal relationships should be the leading principles during newly graduated nurses' orientation period.

Workers with hand dermatitis and workplace training experiences: A qualitative perspective.

BACKGROUND: Workplace training may help to prevent contact dermatitis, a common work-related disease. Information on the characteristics of existing workplace training programs and worker perceptions of this training is limited. METHODS: Fourteen workers with suspected occupational contact dermatitis participated in one-on-one, semi-structured interviews. An inductive thematic analysis approach was used to identify interview themes. RESULTS: Workers expressed a desire for hands-on training with content relevant to their job tasks, favored training from supervisors who had practical experience, and were conflicted about employer motivations for providing training. Few workers had received training on skin protection. In many cases, the training workers had received differed greatly from their desired training. CONCLUSIONS: Although, workers with contact dermatitis describe having received workplace training, some question its value and effectiveness. This perspective may be attributed not only to the content and methods of training but also the health and safety culture of the workplace. Am. J. Ind. Med. 60:69-76, 2017. © 2016 Wiley Periodicals, Inc.

Root Cause Analysis of ICU Adverse Events in the Veterans Health Administration.

BACKGROUND: ICUs' provision of complex care for critically ill patients results in an environment with a high potential for adverse events. A study was conducted to characterize adverse events in Veterans Health Administration (VHA) ICUs that underwent root cause analysis (RCA) and to identify the root causes and their recommended actions. METHODS: This retrospective observational study of RCA reports concerned events that occurred in VHA ICUs or as a result of ICU processes from January 1, 2013, through December 31, 2014. The type of event, root causes, and recommended actions were measured. RESULTS: Some 70 eligible RCAs were identified in 47 of the 120 facilities with an ICU in the VHA system. Delays in care (30.0%) and medication errors (28.6%) were the most common types of events. There were 152 root causes and 277 recommended actions. Root causes often involved rules, policies, and procedure processes (28.3%), equipment/supply issues (15.8%), and knowledge deficits/education (15.1%). Common actions recommended were policy, procedure, and process actions (34.4%) and training/education actions (31.4%). Of the actions implemented, 84.4% had a reported effectiveness of "much better" or "better." CONCLUSION: ICU adverse events often had several root causes, with protocols and process-of-care issues as root causes regardless of event type. Actions often included standardization of processes and training/education. Several recommendations can be made that may improve patient safety in the ICU, such as standardization of care process, implementation of team training programs, and simulation-based training.

Using Gamification to Improve Productivity and Increase Knowledge Retention During Orientation.

BACKGROUND: Nursing administrators must provide cost-effective and efficient ways of orientation training. Traditional methods including classroom lecture can be costly with low retention of the information. Gamification engages the user, provides a level of enjoyment, and uses critical thinking skills. PURPOSE: The aim of this study is to explore the effectiveness, during orientation, of 3 different teaching methods: didactic, online modules, and gamification. Specifically, is there a difference in nurses' clinical knowledge postorientation using these learning approaches? METHODS: A quasi-experimental study design with a 115-person convenience sample split nurses into 3 groups for evaluation of clinical knowledge before and after orientation. RESULTS: The gamification orientation group had the highest mean scores postorientation compared with the didactic and online module groups. CONCLUSIONS: Findings demonstrate gamification as an effective way to teach when compared with more traditional methods. Staff enjoy this type of learning and retained more knowledge when using gaming elements.

Consensus-building on developing dysphagia competence: a North West of England perspective.

BACKGROUND: Dysphagia has been an increasing area of practice for speech and language therapists (SLTs) for over 20 years, and throughout that period there has been debate about how practical skills in dysphagia can best be developed. The implementation of the new Royal College of Speech and Language Therapists (RCSLT) framework was considered from a regional perspective seeking to establish consensus across different speech and language therapy settings. AIM: To explore practical solutions to the development of dysphagia competency in new graduates whilst acknowledging the wide variation in staffing and clinical dysphagia experience across the geographical and clinical landscape in the North West of England. METHODS & PROCEDURES: A four-phase study involved a literature search; interviews with experts in the field of dysphagia; a survey to identify current practice; and a two-round Delphi process. OUTCOMES & RESULTS: Five themes emerged for dysphagia competency development: development of practical skills; supervision; clinical excellence networks; workforce planning; and postgraduate formal training. Challenges, and solutions to these, were identified through the phases of the study. A model for dysphagia competency development relevant to the North West context was achieved by consensus. CONCLUSIONS & IMPLICATIONS: There are many practical ways of developing dysphagia competency. The themes and model generated provide constructive support to services in adopting the most appropriate methods for their own settings.

Do coursework summative assessments predict clinical performance? A systematic review.

BACKGROUND: Two goals of summative assessment in health profession education programs are to ensure the robustness of high stakes decisions such as progression and licensing, and predict future performance. This systematic and critical review aims to investigate the ability of specific modes of summative assessment to predict the clinical performance of health profession education students. METHODS: PubMed, CINAHL, SPORTDiscus, ERIC and EMBASE databases were searched using key terms with articles collected subjected to dedicated inclusion criteria. Rigorous exclusion criteria were applied to ensure a consistent interpretation of 'summative assessment' and 'clinical performance'. Data were extracted using a pre-determined format and papers were critically appraised by two independent reviewers using a modified Downs and Black checklist with level of agreement between reviewers determined through a Kappa analysis. RESULTS: Of the 4783 studies retrieved from the search strategy, 18 studies were included in the final review. Twelve were from the medical profession and there was one from each of physiotherapy, pharmacy, dietetics, speech pathology, dentistry and dental hygiene. Objective Structured Clinical Examinations featured in 15 papers, written assessments in four and problem based learning evaluations, case based learning evaluations and student portfolios each featured in one paper. Sixteen different measures of clinical performance were used. Two papers were identified as 'poor' quality and the remainder categorised as 'fair' with an almost perfect (k = 0.852) level of agreement between raters. Objective Structured Clinical Examination scores accounted for 1.4-39.7% of the variance in student performance; multiple choice/extended matching questions and short answer written examinations accounted for 3.2-29.2%; problem based or case based learning evaluations accounted for 4.4-16.6%; and student portfolios accounted for 12.1%. CONCLUSIONS: Objective structured clinical examinations and written examinations consisting of multiple choice/extended matching questions and short answer questions do have significant relationships with the clinical performance of health professional students. However, caution should be applied if using these assessments as predictive measures for clinical performance due to a small body of evidence and large variations in the predictive strength of the relationships identified. Based on the current evidence, the Objective Structured Clinical Examination may be the most appropriate summative assessment for educators to use to identify students that may be at risk of poor performance in a clinical workplace environment. Further research on this topic is needed to improve the strength of the predictive relationship.