Redefining Pain and Addiction: Creation of a Statewide Curriculum.

OBJECTIVES: In response to a declared statewide public health emergency due to opioid-related overdose deaths, the Arizona Department of Health Services guided the creation of a modern, statewide, evidence-based curriculum on pain and addiction that would be relevant for all health care provider types. METHODS: The Arizona Department of Health Services convened and facilitated 4 meetings during 4 months with a workgroup comprising the deans and curriculum representatives of all 18 medical, osteopathic, physician assistant, nurse practitioner, dental, podiatry, and naturopathic programs in Arizona. During this collaborative and iterative process, the workgroup reviewed existing curricula, established a philosophical framework, and developed a flexible and practical structure for a curriculum that would suit the needs of all program types. RESULTS: The Arizona Pain and Addiction Curriculum was finalized in June 2018. The curriculum aims to redefine pain and addiction as multidimensional public health issues and is structured as 10 core components, each supported by a detailed set of evidence-based objectives. The curriculum includes a set of annual metrics to collect from both programs (focused on implementation progress and barriers) and learners (focused on knowledge, attitudes, and practice plans). CONCLUSIONS: To our knowledge, this is the first example of a statewide collaboration among diverse health professional education programs to create a single, standard curriculum. This collaborative process and the nonproprietary Arizona Pain and Addiction Curriculum may serve as a useful template for other states to enhance pain and addiction education.

A Quasi-Experimental Evaluation of an Education Program for the Use of Electrical Stimulation Therapy to Heal Pressure Injuries.

Electrical stimulation (E-Stim) involves applying low levels of electrical current. Despite high-level recommendations for E-stim use in many pressure injury (PrI) best practice treatment guidelines, clinicians seldom use E-Stim. PURPOSE: This quasi-experimental design study aimed to determine whether an educational program could improve health care providers' knowledge and attitudes regarding the use of E-Stim for treating PrIs in community-dwelling individuals with spinal cord injury living in 1 region of Ontario, Canada. METHODS: An educational intervention based on a university-level continuing education program was developed as part of a multifaceted knowledge mobilization project. Health care providers (eg, nurses, physicians, and allied health professionals) from multiple agencies were invited to participate. The instructional series included 8 online modules on background theory and knowledge and a hands-on workshop that familiarized participants with the equipment necessary to deliver E-Stim. Knowledge (percentage of correct answers using a knowledge test developed by the research team) and attitudes (assessed using the E-Stim Attitude Survey in which items were scored using a 5-point Likert scale (where 0 indicated a negative attitude and 5 a positive attitude) were evaluated 3 times (pre-education, post-online, and post-workshop). Data were aggregated into unit-weighted averaged composites of 3 attitude subscales (resources, evidence-based practice, and education), which were compared before and after educational sessions using a linear mixed effect model. RESULTS: Among the 83 participants, a significant increase in knowledge scores was noted from pre-education (55.9%) to post-online (78.4%) and post-workshop (78.0%) (X² [2] = 89.34; P <.001). A significant increase in attitude scores was noted across time points (resources: X² [2] = 27.32, P <.0001; evidence-based practice: X² [2] = 38.93, P <.0001; and education: X² [2] = 92.88, P <.0001). For the evidence-based practice subscale, attitude increased significantly post-online (t[127] = 6.03, P <.0001). For the resources subscale, a significant increase was detected after post-workshop (t[113] = 5.23, P <.001]. CONCLUSIONS: Online education increased health care providers' knowledge about E-Stim; however, hands-on workshops were required to change certain attitudes about the use of E-Stim for wound healing. Further research is required to evaluate 1) whether a change in knowledge and attitude scores translates to a practice change for health care providers and 2) the potential importance of ongoing coaching and mentorship for a sustainable change in the clinical setting.

An online community of practice to support evidence-based physiotherapy practice in manual therapy.

INTRODUCTION: The purpose of this study was to explore how a community of practice promoted the creation and sharing of new knowledge in evidence-based manual therapy using Wenger's constructs of mutual engagement, joint enterprise, and shared repertoire as a theoretical framework. METHODS: We used a qualitative approach to analyze the discussion board contributions of the 19 physiotherapists who participated in the 10-week online continuing education course in evidence-based practice (EBP) in manual therapy. The course was founded on community of practice, constructivism, social, and situated learning principles. RESULTS: The 1436 postings on 9 active discussion boards revealed that the community of practice was a social learning environment that supported strong participation and mutual engagement. Design features such as consistent facilitation, weekly guiding questions, and collaborative assignments promoted the creation and sharing of knowledge. Participants applied research evidence to the contexts in which they worked through reflective comparison of what they were reading to its applicability in their everyday practice. Participants' shared goals contributed to the common ground established in developing collective knowledge about different study designs, how to answer research questions, and the difficulties of conducting sound research. DISCUSSION: An online longitudinal community of practice utilized as a continuing education approach to deliver an online course based on constructivist and social learning principles allowed geographically dispersed physiotherapists to be mutually engaged in a joint enterprise in evidence-based manual therapy. Advantages included opportunity for reflection, modeling, and collaboration. Future studies should examine the impact of participation on clinical practice.

[Continuing education in cattle practice - results of a survey]. / Fortbildung für die Rinderpraxis - Ergebnisse einer Umfrage.

OBJECTIVE: Continuing education is mandatory for veterinarians in Germany and Austria. The objective of this study was to analyse interests and preferences of veterinarians in cattle practice as well as to elucidate framework requirements for continuing education, including e-learning. Results should help to improve and to optimise continuing education programs. MATERIAL AND METHODS: A survey was conducted as a questionnaire via internet and shared at two local meetings as well as by email to members of the Farm Animal Health Service Styria (Tiergesundheitsdienst Steiermark). All responses were analysed anonymously. RESULTS: A total of 259 questionnaires were returned and 195 were included in the final analyses. The majority of participants (59.0%) were in farm animal practice for more than 10 years. Of the participants, 50.8% declared to have attended up to five continuing education events per year, 27.7% more than five. The majority (71.5%) had no experience with e-learning at that time. With regard to framework requirements for attending continuing education events, the majority (62.8%) of participants preferred events of 2 days over weekends. Total expenses, including costs for travelling and lodging, should not exceed 500 € per event (62.8% of participants). The favourite topics were animal reproduction (87.2%), metabolic disorders (85.6%) and mastitis (79.4%). Participants with less than 5 years of professional experience chose significantly more often the topics feed analyses, acupuncture, pregnancy diagnosis and homoeopathy/phytotherapy than participants with longer professional experience. CONCLUSION: The results of this study provide important information about the interests and framework requirements for continuing education for cattle practitioners that should help to improve the offers in continuing education programs.

The impact of a computer assisted learning programme on the ability to interpret cardiotochography. A before and after study.

OBJECTIVE: To evaluate if a computer assisted learning programme could bring about a higher degree of individuals who correctly classified cardiotochography (CTG) recordings in a non-selected population of midwives and physicians. STUDY DESIGN: A before and after study. SETTING: Södersjukhuset, Stockholm, Sweden. SUBJECTS: One hundred and thirty midwives and 49 physicians at the maternity unit, September 2009-April 2010. A computer assisted learning programme for interpreting CTG patterns has been created. All 179 individuals included made the first interpretation and the 135 individuals also completing the education made the second interpretation. A third randomly selected interpretation was performed immediately following the second; permitting two participants to classify a CTG together. Comparison between the before and after-test was based on the Fisher exact test. MAIN OUTCOME MEASURE: The proportion of individuals who correctly classified CTGs before and after the training. RESULTS: Sixty four percentage of the individuals classified the CTGs correctly before and 66% after the training (P=0.76). There was no difference between the two professional groups. Normal CTGs were correctly identified by 36% of the individuals before and in 80% after the training (P=0.065). Corresponding figures for pathological CTGs were 83% and 85% (P=1.00), respectively. CONCLUSION: We found no improvement in the proportion of individuals who classified CTGs correctly after the completion of a computer assisted learning programme in fetal monitoring. The baseline level of competence was higher than expected.

The summit on healing: honoring diversity, finding common ground.

The issue of languaging became an important point of discussion because the lack of definitions makes it difficult to objectively explore phenomena that occur during healing work. There were many more questions raised than answered. The opportunity to share in this dialogue created an increased awareness of and respect for the complexities of this work and the healers that devote their lives to it.

Maximize learning through wellness.

By achieving wellness to some degree in all five components of health, the self-concept of the health care employee can be raised. If the worker begins with physical health, this can in turn affect the emotional, mental, social, and spiritual health of the individual. All of these elements of well-being have been shown to have a profound effect on learning abilities and performance levels of the adult. Health care professionals are dealing with life or death decisions on a daily basis. Hopefully, everyone would agree that the health care team should be performing at its peak ability. To do this, each member of the health care team should strive for wellness. The health care facility should promote wellness for its employees first, so they in turn can deliver quality health care services. Keeping current with the constant changes in the health care industry and learning new information is a critical part of that delivery of quality care.