What does consumer and community involvement in health-related education look like? A mixed methods study.

Consumer and community involvement (also referred to as patient and public involvement) in health-related curricula involves actively partnering with people with lived experience of health and social care systems. While health professions education has a long history of interaction with patients or consumers, a shift in the way consumer and community engage in health-related education has created novel opportunities for mutual relationships valuing lived experience expertise and shifting traditional education power relations. Drawing on a mixed methods design, we explored consumer and community involvement practices in the design and delivery of health-related education using the capability, opportunity, motivation and behaviour framework (COM-B). In our results, we describe educator capabilities, opportunities and motivations, including identifying barriers and enablers to consumer and community involvement in health-related education. Educators have varying philosophical reasons and approaches for involving consumers and community. There is a focus on augmenting student learning through inclusion of lived and living experience, and on mutual transformative learning through embedding lived experience and co-creating learning. How these philosophical positionings and motivations shape the degree by which educators involve consumers and community members in health-related curricula is important for further understanding these educational partnerships within universities.

Using contribution analysis to evaluate health professions and health sciences programs.

Introduction/background: Course evaluation in health education is a common practice yet few comprehensive evaluations of health education exist that measure the impact and outcomes these programs have on developing health graduate capabilities. Aim/objectives: To explore how curricula contribute to health graduate capabilities and what factors contribute to the development of these capabilities. Methods: Using contribution analysis evaluation, a six-step iterative process, key stakeholders in the six selected courses were engaged in an iterative theory-driven evaluation. The researchers collectively developed a postulated theory-of-change. Then evidence from existing relevant documents were extracted using documentary analysis. Collated findings were presented to academic staff, industry representatives and graduates, where additional data was sought through focus group discussions - one for each discipline. The focus group data were used to validate the theory-of-change. Data analysis was conducted iteratively, refining the theory of change from one course to the next. Results: The complexity in teaching and learning, contributed by human, organizational and curriculum factors was highlighted. Advances in knowledge, skills, attitudes and graduate capabilities are non-linear and integrated into curriculum. Work integrated learning significantly contributes to knowledge consolidation and forming professional identities for health professional courses. Workplace culture and educators' passion impact on the quality of teaching and learning yet are rarely considered as evidence of impact. Discussion: Capturing the episodic and contextual learning moments is important to describe success and for reflection for improvement. Evidence of impact of elements of courses on future graduate capabilities was limited with the focus of evaluation data on satisfaction. Conclusion: Contribution analysis has been a useful evaluation method to explore the complexity of the factors in learning and teaching that influence graduate capabilities in health-related courses.

A systematic review of dengue outbreak prediction models: Current scenario and future directions.

Dengue is among the fastest-spreading vector-borne infectious disease, with outbreaks often overwhelm the health system and result in huge morbidity and mortality in its endemic populations in the absence of an efficient warning system. A large number of prediction models are currently in use globally. As such, this study aimed to systematically review the published literature that used quantitative models to predict dengue outbreaks and provide insights about the current practices. A systematic search was undertaken, using the Ovid MEDLINE, EMBASE, Scopus and Web of Science databases for published citations, without time or geographical restrictions. Study selection, data extraction and management process were devised in accordance with the 'Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies' ('CHARMS') framework. A total of 99 models were included in the review from 64 studies. Most models sourced climate (94.7%) and climate change (77.8%) data from agency reports and only 59.6% of the models adjusted for reporting time lag. All included models used climate predictors; 70.7% of them were built with only climate factors. Climate factors were used in combination with climate change factors (13.4%), both climate change and demographic factors (3.1%), vector factors (6.3%), and demographic factors (5.2%). Machine learning techniques were used for 39.4% of the models. Of these, random forest (15.4%), neural networks (23.1%) and ensemble models (10.3%) were notable. Among the statistical (60.6%) models, linear regression (18.3%), Poisson regression (18.3%), generalized additive models (16.7%) and time series/autoregressive models (26.7%) were notable. Around 20.2% of the models reported no validation at all and only 5.2% reported external validation. The reporting of methodology and model performance measures were inadequate in many of the existing prediction models. This review collates plausible predictors and methodological approaches, which will contribute to robust modelling in diverse settings and populations.

Methods of teaching evidence-based practice: a systematic review.

BACKGROUND: To identify the effectiveness of different teaching modalities on student evidence-based practice (EBP) competency. METHODS: Electronic searches were conducted in MEDLINE, Cochrane central register of controlled trials, PsycINFO, CINAHL, ERIC, A + Education and AEI through to November 2021. We included randomised-controlled trials comparing EBP teaching modes on EBP knowledge, skills, attitudes or behaviour in undergraduate and post-graduate health professions education. Risk of bias was determined using the Cochrane risk of bias tool. RESULTS: Twenty-one studies were included in the review. Overall, no single teaching modality was identified as being superior to others at significantly increasing learner competency in EBP. Changes in learner knowledge, skills, attitudes and behaviour were conflicting, with studies either reporting no change, or a moderate increase in EBP behavioural outcomes when directly compared to another intervention. CONCLUSION: Current evidence highlights the lack of a single teaching modality that is superior than others regarding learner competency in EBP, regardless of health professions discipline or graduate status. The poor quality, heterogeneity of interventions and outcome measures limited conclusions. Further research should focus on the development of high-quality studies and use of psychometrically validated tools to further explore the impact of different EBP teaching modalities.

When the wheels fall off - Medical students' experiences of interrupted academic progression.

INTRODUCTION: There is limited published research on medical students' perspectives of a significant interruption to their academic progression. This study sought to identify the factors that contribute to difficulties with academic progression and to understand how medical students successfully respond. METHODS: This interpretive phenomenological study reports on the findings from in-depth interviews of 38 final year medical students who had experienced a significant academic interruption. RESULTS: The two superordinate themes were: the factors contributing to the interruption and their experience of the interruption. Factors identified as contributing to the interruption were: workload, learning in medicine, motivation for medicine, isolation, adapting to local culture, health and external factors. Their experience of the interruption focused on stages of working through the process: 'what happened,' 'how it felt,' 'managing the failure,' 'accepting the failure' and 'making some changes.' DISCUSSION: Each factor affected how the participants reacted and responded to the interruption. Regardless of the origins of the interruption, most reacted and responded in a comparable process, albeit with varying timespans. These reactions and responses were in a state of fluctuation. In order to succeed many stated they shifted their motivation from external to internal, in direct response to the interruption, resulting in changed learning behaviours. CONCLUSIONS: The process of working through an interruption to academic progression for students may benefit from a model of interval debriefing, restorative academic and personal development support. Facilitation of this process could enable students to face an interruption constructively rather than as an insurmountable emotionally burdensome barrier. Medical schools could utilise these findings to implement further support strategies to reduce the number of significant academic disruptions.

Twelve tips for medical students experiencing an interruption in their academic progress.

For every commencing cohort of medical students, a small but significant number will experience an interruption to their academic progression because of academic difficulties, health concerns or external influences outside of the students' control. During the process of researching the factors surrounding difficulties with academic progression, students told us many ways that they have learned from that experience, which then allowed most of them to graduate. This paper combines the shared experiences of students who have had an interruption, and those of the authors as medical educators.

A realist review of scholarly experiences in medical education.

CONTEXT: Scholarly experiences have been increasingly employed to support the development of scholarly skills for medical students. How the characteristics of the various scholarly experiences contributes to scholarly outcomes or the complexities of how the experiences build skills warrants further exploration. OBJECTIVES: To identify how medical students' scholarly experiences lead to scholarly outcomes under what circumstances. METHODS: A realist review was conducted with a search of Ovid MEDLINE, CINAHL, Scopus and ERIC databases using the terms "medical student" and "scholarly experience" and related synonyms. Studies involving the engagement of medical students in a range of compulsory scholarly experiences including quality improvement projects, literature reviews and research projects were included. Key data were extracted from studies, and realist analysis was used to identify how contexts and mechanisms led to different outcomes. RESULTS: From an initial 4590 titles, 28 studies of 22 scholarly experiences were identified. All were primarily focused on research-related scholarly experiences. Organisational research culture that valued research, dedicated time, autonomy and choice of experience were found to be key contexts. Adequately supported and structured experiences where students can see the value of research and quality supervision that builds student's self-efficacy were identified as mechanisms leading to outcomes. Outcomes included increased research skills and attitudes, scholarly outputs (eg publications) and future interest in research or other scholarly endeavours. CONCLUSIONS: The design of scholarly experiences for medical students needs to ensure protected time, adequate supervision and autonomy, to achieve scholarly outcomes. Much of the focus is on research and traditional outcomes with little known about the role or outcomes associated with other scholarly work.

Clinical Outcomes Associated with Medication Regimen Complexity in Older People: A Systematic Review.

OBJECTIVES: To systematically review clinical outcomes associated with medication regimen complexity in older people. DESIGN: Systematic review of EMBASE, MEDLINE, International Pharmaceutical Abstracts, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane library. SETTING: Hospitals, home, and long-term care. PARTICIPANTS: English-language peer-reviewed original research published before June 2016 was eligible if regimen complexity was quantified using a metric that considered number of medications and at least one other parameter, regimen complexity was calculated for participants' overall regimen, at least 80% of participants were aged 60 and older, and the study investigated a clinical outcome associated with regimen complexity. MEASUREMENTS: Quality assessment was conducted using an adapted version of the Joanna Briggs Institute critical appraisal tool. RESULTS: Sixteen observational studies met the inclusion criteria. Regimen complexity was associated with medication nonadherence (2/6 studies) and higher rates of hospitalization (2/4 studies). One study found that participants with less-complex medication administration were more likely to stop medications when feeling worse. One study each identified an association between regimen complexity and higher ability to administer medications as directed, medication self-administration errors, caregiver medication administration hassles, hospital discharge to non-home settings, postdischarge potential adverse drug events, all-cause mortality, and lower patient knowledge of their medication. Regimen complexity had no association with postdischarge medication modification, change in medication- and health-related problems, emergency department visits, or quality of life as rated by nursing staff. CONCLUSION: Research into whether medication regimen complexity is associated with nonadherence and hospitalization has produced inconsistent results. Moderate-quality evidence from four studies (two each for nonadherence and hospitalization) suggests that medication regimen complexity is associated with nonadherence and higher rates of hospitalization.

What are the attributes of a good health educator?

OBJECTIVE: The purpose of this study was to examine the attributes that students and educators believe are important to being a good health educator in a non-clinical setting. METHODS: A cross-sectional survey of first-year health science students and educators involved with a Health Science course in Melbourne, Australia was performed. A convenience sampling approach was implemented, with participants were required to rate the importance of teaching attributes on a previously developed 15-item written questionnaire. Descriptive statistics were generated, with Pearson's chi-square statistics used to examine differences between groups. In total 94/147 (63.9%) of students and 15/15 (100%) of educators participated in the study. RESULTS: Of the 15 attributes, only 'scholarly activity' was not deemed to be not as an important attribute to define a good educator. Knowledge base (50% vs. 13.3%) and feedback skills (22.3% vs. 0%) were rated as important attributes by students in comparison to educators. Professionalism (20% vs. 5.3%), scholarly activity (20% vs. 3.2%) and role modelling (26.7% vs. 3.2%) were rated as the most important attributes by educators in comparison to students. CONCLUSIONS: No single attribute makes a good health educator; rather health educators are required to have a rounded approach to teaching. Students have greater focus on the educator providing a transfer of knowledge. Educators are additionally focused on professionalism attributes, which may not be valued by students. Students and educators must enter into a clearer understanding of expectations, from both parties, to obtain optimal education outcomes.

Spontaneously reported haemorrhagic adverse events associated with rivaroxaban and dabigatran in Australia.

OBJECTIVES: The objective of our study was to describe spontaneously reported haemorrhagic adverse events associated with rivaroxaban and dabigatran in Australia. METHODS: Data were sourced from the Australian Therapeutic Goods Administration (TGA) Database of Adverse Event Notifications between June 2009 and May 2014. Records of haemorrhagic adverse events in which rivaroxaban or dabigatran was considered as a potential cause were analysed. RESULTS: There were 240 haemorrhagic adverse events associated with rivaroxaban and 504 associated with dabigatran. Age was specified for 164 (68%) haemorrhages associated with rivaroxaban, of which 101 occurred in people aged ⩾75 years. Age was specified for 437 (87%) haemorrhages associated with dabigatran, of which 300 occurred in people aged ⩾75 years. Time from treatment initiation to haemorrhage was specified for 122 (51%) haemorrhages associated with rivaroxaban, with 69 (57%) haemorrhages occurring within 30 days of rivaroxaban initiation. Time from treatment initiation to haemorrhage was specified for 253 (50%) haemorrhages associated with dabigatran, with 123 (49%) haemorrhages occurring within 30 days of dabigatran initiation. Gastrointestinal (GI) haemorrhages were the most frequent type of haemorrhages associated with both rivaroxaban (n = 105, 44%) and dabigatran (n = 302, 60%). Data were available on the severity of haemorrhage for 101 (42%) haemorrhages associated with rivaroxaban, with haemorrhage leading to death in 17 people. The severity of haemorrhage was specified for 384 (76%) haemorrhages associated with dabigatran, with haemorrhage leading to death in 61 people. CONCLUSIONS: Our study highlights the need for research on the haemorrhagic complications of anticoagulation in clinical care. A considerable proportion of reported haemorrhagic events occurred within 30 days of rivaroxaban and dabigatran initiation. This highlights the importance of considering bleeding risk at the time of treatment initiation.

The impact of clinical maturity on competency in evidence-based medicine: a mixed-methods study.

OBJECTIVE: To identify whether the clinical maturity of medical trainees impacts upon the level of trainee competency in evidence-based medicine (EBM). MATERIALS AND METHODS: Undergraduate and graduate-entry medical trainees entering their first year of training in the clinical environment were recruited for this study. Competency in EBM was measured using a psychometrically validated instrument. EBM competency scores were analysed using Student's t tests, in order to differentiate between undergraduate and graduate-entry trainee performance. Ten focus group discussions were conducted with undergraduate and graduate-entry trainees. Audio transcripts were thematically analysed. RESULTS: Data on a total of 885 medical trainees were collected over a 5-year period. Undergraduate trainees had significantly higher EBM competency scores during years in which the programme was presented in a didactic format (mean difference (MD)=1.24 (95% CI)CI 0.21 to 2.26; 1.78 (0.39 to 3.17); 2.13 (1.16 to 3.09)). Graduate trainee EBM competency scores increased when a blended learning approach to EBM was adopted, demonstrating no significant difference in EBM competency scores between undergraduate and graduate cohorts (-0.27 (-1.38 to 0.85); -0.39 (-1.57 to 0.79). Qualitative findings indicated that differences in learning and teaching preference among undergraduate and graduate-entry trainees influenced the level of competency obtained in EBM. CONCLUSIONS: Clinical maturity is the only one factor that may influence medical trainees' competency in EBM. Other predictors of EBM competency may include previous training and exposure to epidemiology, biostatistics and information literacy. While graduate-entry medical students may have more 'life' experience, or maturity, it does not necessarily translate into clinical maturity and integration into the clinical environment.

Evaluating the use of twitter as a tool to increase engagement in medical education.

BACKGROUND: Social media is regularly used by undergraduate students. Twitter has a constant feed to the most current research, news and opinions of experts as well as organisations. Limited evidence exists that examines how to use social media platforms, such as Twitter, effectively in medical education. Furthermore, there is limited evidence to inform educators regarding social media's potential to increase student interaction and engagement. AIM: To evaluate whether social media, in particular Twitter, can be successfully used as a pedagogical tool in an assessment to increase student engagement with staff, peers and course content. METHODS: First year biomedical science students at Monash University completing a core public health unit were recruited into the study. Twitter-related activities were incorporated into the semester long unit and aligned with both formative and summative assessments. Students completed a structured questionnaire detailing previous use of social media and attitudes towards its use in education post engagement in the Twitter-specific activities. Likert scale responses compared those who participated in the Twitter activities with those who did not using student's t-test. RESULTS: A total of 236 (79.4%) of invited students participated in the study. Among 90% of students who reported previous use of social media, 87.2% reported using Facebook, while only 13.1% reported previous use of Twitter. Social media was accessed most commonly through a mobile device (49.1%). Students actively engaging in Twitter activities had significantly higher end-of-semester grades compared with those who did not [Mean Difference (MD) = 3.98, 95% CI 0.40, 7.55]. Students perceived that the use of Twitter enabled greater accessibility to staff, was a unique method of promoting public health, and facilitated collaboration with peers. DISCUSSION: Use of social media as an additional, or alternate, teaching intervention is positively supported by students. Specific use of micro-blogs such as Twitter can promote greater student-staff engagement by developing an ongoing academic conversation.

Recruiting elderly patients for non-interventional research - successful strategies and lessons learnt.

BACKGROUND: Our aims were to profile individuals unable to be recruited to a community based non-interventional study investigating warfarin safety, and to share the lessons learnt. METHODS: The target population comprised community-based adults stabilised on warfarin. Recruitment strategies included partnering with a third party pathology provider, an 'opt out' approach, and minimising the timeframe to recruitment. De-identified data for patients who could and could not be successfully recruited were analysed according to gender, age and reason for declining/inability to participate. RESULTS: Of 734 eligible patients, 486 were recruited successfully (66%). Of the 247 patients not able to be recruited, the median age was 79 years; 60% were female. Reasons for unsuccessful recruitment included: 115 (47%) 'opted out', 57 (23%) were too unwell, 39 (16%) due to health professional's recommendation, and 36 (14%) were not contactable. Successful strategies included the 'opt out' approach and using a known and trusted third party during patient recruitment. DISCUSSION: Lessons learnt are that multi-dimensional partnerships, including a familiar third party such as a pathology provider or doctor, could be of benefit. An 'opt out' approach, when not used as a substitute for consent, can also be beneficial for recruitment and decreasing administrative burden for GPs.

The unrecognized psychosocial factors contributing to bleeding risk in warfarin therapy.

BACKGROUND AND PURPOSE: Warfarin is an effective drug for the prevention of thromboembolism in the elderly. The major risk for patients taking warfarin is bleeding. We aimed to assess the impact of psychosocial factors, including mood, cognition, social isolation, and health literacy on warfarin instability among community-based elderly patients. METHODS: A case-control study was conducted between March 2008 and June 2009 in a community-based setting. Cases were patients previously stabilized on warfarin who recorded an international normalized ratio≥6.0. Control subjects were patients whose international normalized ratio measurement was maintained within the therapeutic range. Patient interviews investigated potential predisposing factors to elevated International Normalized Ratio levels. RESULTS: A total of 486 patients were interviewed: 157 cases and 329 control subjects, with an approximate mean age of 75 years. Atrial fibrillation was the most common primary indication. Adjusted multivariate logistic regression revealed impaired cognition (OR, 1.9; 95% CI, 1.0 to 3.6), depressed mood (OR, 2.2; 95% CI, 1.2 to 3.9), and inadequate health literacy (OR, 4.0;95% CI, 2.1 to 7.4) were associated with increased risk of an elevated International Normalized Ratio. CONCLUSIONS: This study identified impaired cognition, depressed mood, and inadequate health literacy as risk factors for warfarin instability. These had a similar impact to well-recognized demographic, clinical, and medication-related factors and are prevalent among the elderly. These findings suggest that elderly patients prescribed warfarin should be reviewed regularly for psychosocial deficits.

Who is responsible for the care of patients treated with warfarin therapy?

OBJECTIVE: To identify potential weaknesses in the system of managing warfarin therapy. DESIGN, PARTICIPANTS AND SETTING: A structured interview-based study of 40 community-dwelling patients taking warfarin and with an international normalised ratio > or = 6.0 and 36 of their treating doctors (35 general practitioners and 1 specialist), conducted between July and November 2007. Patients all received services from and were recruited sequentially by a large, private metropolitan pathology provider in Melbourne. MAIN OUTCOME MEASURES: Patients' demographic, clinical, cognitive and psychosocial characteristics, warfarin knowledge, medication complexity and adherence; and doctors' experience with, approach to and involvement in warfarin management, and their perception of responsibility for warfarin management and patient education. RESULTS: Interviews revealed multiple difficulties, including cognitive dysfunction, possible depression, and medication non-adherence, in 30 of 40 patients. Of 36 doctors interviewed, 12 were unaware of these difficulties in their patients. Five doctors considered they had sole responsibility for their patients' anticoagulation, while 15 confirmed a mutual relationship with the pathology service, and 16 deferred total responsibility to the pathology provider. Only 14/36 doctors reported conducting patient education at commencement of warfarin therapy, with the other 22 stating this was the responsibility of the initiating specialist, pathology service or dispensing pharmacist. CONCLUSIONS: There is a need for improved role clarification in coordinating warfarin management. We propose exploring the possibility of a Warfarin Suitability Score to assist better recognition of patients in whom treatment may be problematic, along with a model of care using practice nurses with GPs to facilitate optimal patient care.