Clinician-Level Knowledge and Barriers to Hepatocellular Carcinoma Surveillance.

Importance: Surveillance for hepatocellular carcinoma (HCC) in patients with cirrhosis is underused. Identifying potentially modifiable factors to address barriers in HCC surveillance is critical to improve patient outcomes. Objective: To evaluate clinician-level factors contributing to underuse of HCC surveillance in patients with cirrhosis. Design, Setting, and Participants: This survey study included primary care clinicians (PCCs) and gastroenterology and hepatology clinicians at 5 safety-net health systems in the US. Clinicians were surveyed from March 15 to September 15, 2023, to assess knowledge, attitudes, beliefs, perceived barriers, and COVID-19-related disruptions in HCC surveillance in patients with cirrhosis. Data were analyzed from October to November 2023. Main Outcome and Measures: HCC surveillance knowledge was assessed with 6 questions querying the respondent's ability to correctly identify appropriate use of HCC surveillance. Attitudes, perceived barriers, and beliefs regarding HCC surveillance and perceived impact of the COVID-19 pandemic-related disruptions with HCC surveillance were assessed with a series of statements using a 4-point Likert scale and compared PCCs and gastroenterology and hepatology clinicians. Results: Overall, 347 of 1362 clinicians responded to the survey (25.5% response rate), among whom 142 of 237 (59.9%) were PCCs, 48 of 237 (20.3%) gastroenterology and hepatology, 190 of 236 (80.5%) were doctors of medicine and doctors of osteopathic medicine, and 46 of 236 (19.5%) were advanced practice clinicians. On HCC knowledge assessment, 144 of 270 (53.3%) scored 5 or more of 6 questions correctly, 37 of 48 (77.1%) among gastroenterology and hepatology vs 65 of 142 (45.8%) among PCCs (P < .001). Those with higher HCC knowledge scores were less likely to report barriers to HCC surveillance. PCCs were more likely to report inadequate time to discuss HCC surveillance (37 of 139 [26.6%] vs 2 of 48 [4.2%]; P = .001), difficulty identifying patients with cirrhosis (82 of 141 [58.2%] vs 5 of 48 [10.4%]; P < .001), and were not up-to-date with HCC surveillance guidelines (87 of 139 [62.6%] vs 5 of 48 [10.4%]; P < .001) compared with gastroenterology and hepatology clinicians. While most acknowledged delays during the COVID-19 pandemic, 62 of 136 PCCs (45.6%) and 27 of 45 gastroenterology and hepatology clinicians (60.0%) reported that patients with cirrhosis could currently complete HCC surveillance without delays. Conclusions and Relevance: In this survey study, important gaps in knowledge and perceived barriers to HCC surveillance were identified. Effective delivery of HCC education to PCCs and health system-level interventions must be pursued in parallel to address the complex barriers affecting suboptimal HCC surveillance in patients with cirrhosis.

Ward-based in situ simulation: lessons learnt from a UK District General Hospital.

INTRODUCTION: In situ simulation (ISS) enables multiprofessional healthcare teams to train for real emergencies in their own working environment and identify latent patient safety threats. This study aimed to determine ISS impact on teamwork, technical skill performance, healthcare staff perception and latent error identification during simulated medical emergencies. MATERIALS AND METHODS: Unannounced ISS sessions (n=14, n=75 staff members) using a high-fidelity mannequin were conducted in medical, paediatric and rehabilitation wards at Stepping Hill Hospital (Stockport National Health Service Foundation Trust, UK). Each session encompassed a 15 min simulation followed by a 15 min faculty-led debrief. RESULTS: The clinical team score revealed low overall teamwork performances during simulated medical emergencies (mean±SEM: 4.3±0.5). Linear regression analysis revealed that overall communication (r=0.9, p<0.001), decision-making (r=0.77, p<0.001) and overall situational awareness (r=0.73, p=0.003) were the strongest statistically significant predictors of overall teamwork performance. Neither the number of attending healthcare professionals, their professional background, age, gender, degree of clinical experience, level of resuscitation training or previous simulation experience statistically significantly impacted on overall teamwork performance. ISS positively impacted on healthcare staff confidence and clinical training. Identified safety threats included unknown location of intraosseous kits, poor/absent airway management, incomplete A-E assessments, inability to activate the major haemorrhage protocol, unknown location/dose of epinephrine for anaphylaxis management, delayed administration of epinephrine and delayed/absence of attachment of pads to the defibrillator as well as absence of accessing ALS algorithms, poor chest compressions and passive behaviour during simulated cardiac arrests. CONCLUSION: Poor demonstration of technical/non-technical skills mandate regular ISS interventions for healthcare professionals of all levels. ISS positively impacts on staff confidence and training and drives identification of latent errors enabling improvements in workplace systems and resources.

Beyond the surface: unveiling gaps in medical education through eyes of diverse learners.

Inadequate education regarding disease manifestations in diverse skin colors hinders diagnosis and exacerbates health disparities. All levels of medical trainees report low confidence in accurately identifying disease in skin of color (SOC). To help further elucidate these concerns, our research aims to assess medical student confidence in recognizing cutaneous diseases in SOC and their viewpoints regarding SOC education within their institution. An eight-question, open-ended survey was provided to medical students before and after a SOC presentation. The survey assessed participants' confidence in their diagnostic ability and perspectives on educational material. Among the 70 attendees, 58 (82.8%) and 64 (91.4%) completed the pre- and post-seminar surveys, respectively. There was a significant discrepancy in confidence levels when assessing cutaneous manifestations of internal pathology in light (Monk Skin Colors 1-5) versus dark (Monk Skin Colors 6-10) skin (p < 0.009). Notably, 78.7% (37/47) perceived the institutional learning materials as insufficient for SOC. Post-seminar reflections indicated that 87.2% (40/46) of students lacked confidence in diagnosing SOC, with 78.7% (32/46) citing inadequate curriculum coverage as the cause. An additional 8.5% (6/46) identified the predominance of white-centric medical descriptions as a hindrance. Students collectively called for improved educational approaches, including better visual representation of diseases in darker skin. Medical education must continue to strive for increased SOC representation to train competent physicians in treating a diverse patient population and reduce disparities in SOC patients.

Assessing the Knowledge and Comfort Level of US Family Medicine Residents Regarding Consenting and Confidentiality in Adolescent Health Care.

OBJECTIVES: Organizations recommend providing confidential adolescent health care to reduce the consequences of high-risk health behaviors such as substance use, unhealthy eating patterns, and high-risk sexual behaviors. Family physicians are uniquely positioned to provide confidential counseling and care to this vulnerable population but must be trained to provide such care. This study describes the impact of formal and informal training on the knowledge of and comfort level in providing confidential adolescent healthcare among a sample of US Family Medicine residents. METHODS: Electronic surveys were distributed to all Family Medicine residents throughout the United States. We used descriptive statistics and χ2 analysis where appropriate to determine the association between resident-reported receipt of training, confidence, and frequency in providing confidential adolescent health care. RESULTS: A total of 714 Family Medicine residents completed the survey. The majority reported no formal training in residency (50.3%). The receipt of formal and informal training in both medical school and residency was associated with a greater degree of comfort in providing confidential adolescent care and a higher likelihood of providing confidential time alone. Those reporting formal training were more likely to always provide confidential care (P = 0.001). CONCLUSIONS: Training focused on confidential adolescent health care in medical school or residency was associated with a greater degree of comfort and a higher likelihood of providing confidential adolescent health care.

Determining the psychometric properties of a written test to assess safe dental practice.

INTRODUCTION: Safe practice in medicine and dentistry has been a global priority area in which large knowledge gaps are present.Patient safety strategies aim at preventing unintended damage to patients that can be caused by healthcare practitioners. One of the components of patient safety is safe clinical practice. Patient safety efforts will help in ensuring safe dental practice for early detection and limiting non-preventable errors.A valid and reliable instrument is required to assess the knowledge of dental students regarding patient safety. OBJECTIVE: To determine the psychometric properties of a written test to assess safe dental practice in undergraduate dental students. MATERIAL AND METHODS: A test comprising 42 multiple-choice questions of one-best type was administered to final year students (52) of a private dental college. Items were developed according to National Board of Medical Examiners item writing guidelines. The content of the test was determined in consultation with dental experts (either professor or associate professor). These experts had to assess each item on the test for language clarity as A: clear, B: ambiguous and relevance as 1: essential, 2: useful, not necessary, 3: not essential. Ethical approval was taken from the concerned dental college. Statistical analysis was done in SPSS V.25 in which descriptive analysis, item analysis and Cronbach's alpha were measured. RESULT: The test scores had a reliability (calculated by Cronbach's alpha) of 0.722 before and 0.855 after removing 15 items. CONCLUSION: A reliable and valid test was developed which will help to assess the knowledge of dental students regarding safe dental practice. This can guide medical educationist to develop or improve patient safety curriculum to ensure safe dental practice.

Mid-level healthcare workers knowledge on non-communicable diseases in Tanzania: a district-level pre-and post-training assessment.

INTRODUCTION: Over the past two decades, Tanzania's burden of non-communicable diseases has grown disproportionately, but limited resources are still prioritized. A trained human resource for health is urgently needed to combat these diseases. However, continuous medical education for NCDs is scarce. This paper reports on the mid-level healthcare workers knowledge on NCDs. We assessed the knowledge to measure the effectiveness of the training conducted during the initiation of a Package for Essential Management of Severe NCDs (PEN Plus) in rural district hospitals in Tanzania. METHODS: The training was given to 48 healthcare employees from Dodoma Region's Kondoa Town Council District Hospital. For a total of five (5) days, a fundamental course on NCDs featured in-depth interactive lectures and practical workshops. Physicians from Tanzania's higher education institutions, tertiary university hospitals, research institutes, and medical organizations served as trainers. Before and after the training, a knowledge assessment comprising 28 questions was administered. Descriptive data analysis to describe the characteristics of the specific knowledge on physiology, diagnosis and therapy of diabetes mellitus, rheumatic fever, heart disease, and sickle cell disease was done using Stata version 17 (STATA Corp Inc., TX, USA). RESULTS: Complete assessment data for 42 out of the 48 participants was available. Six participants did not complete the training and the assessment. The mean age of participants was 36.9 years, and slightly above half (52%) were above 35 years. Two-thirds (61.9%) were female, and about half (45%) were nurses. The majority had the experience of working for more than 5 years, and the average was 9.4 years (+/- 8.4 years). Overall, the trainees' average scores improved after the training (12.79 vs. 16.05, p < 0.0001) out of 28 possible scores. Specifically, trainees' average scores were better in treatment than in diagnosis, except for sickle cell disease (1.26 vs. 1.83). Most were not able to diagnose rheumatic heart disease (47.6% able) compared to diabetes mellitus (54.8% able) or sickle cell disease (64.3% able) at baseline. The proportion of trainees with adequate knowledge of the treatment of sickle cell disease and diabetes mellitus was 35% and 38.1%, respectively, and there was a non-statistical difference after training. Those working for less than 5 years had a higher proportion of adequate knowledge (30.8%) compared to their more experienced colleagues (6.9%). After the training, participants' knowledge of NCDs increased by three times (i.e., aPR 3, 95% CI = 1.1, 1.5, and 6.0). CONCLUSION AND RECOMMENDATIONS: PEN Plus training improved the knowledge of healthcare workers at Kondoa Town Council District Hospital. Training is especially needed among nurses and those with a longer duration of work. Continuing education for human resources for health on the management of NCDs is highly recommended in this setting.

Implementation of standard setting for high-stakes objective structured clinical examinations.

BACKGROUND AND PURPOSE: To describe one institution's approach to transformation of high-stakes objective structure clinical examinations (OSCEs) from norm-referenced to criterion-referenced standards setting and to evaluate the impact of these changes on OSCE performance and pass rates. EDUCATIONAL ACTIVITY AND SETTING: The OSCE writing team at the college selected a modified Angoff method appropriate for high-stakes assessments to replace the two standard deviation method previously used. Each member of the OSCE writing team independently reviewed the analytical checklist and calculated a passing score for active stations on OSCEs. Then the group met to determine a final pass score for each station. The team also determined critical cut points for each station, when indicated. After administration of the OSCEs, scores, pass rates, and need for remediation were compared to the previous norm-referenced method. Descriptive statistics were used to summarize the data. FINDINGS: OSCE scores remained relatively unchanged when switched to a criterion-referenced method, but the number of remediators increased up to 2.6 fold. In the first year, the average score increased from 86.8% to 91.7% while the remediation rate increased from 2.8% to 7.4%. In the third year, the average increased from 90.9% to 92% while the remediation rate increased from 6% to 15.6%. Likewise, the fourth-year average increased from 84.9% to 87.5% while the remediation rate increased from 4.4% to 9%. SUMMARY: Transition to a modified Angoff method did not impact average OSCE score but did increase the number of remediations.

The effectiveness of virtual reality technology in student nurse education: A systematic review and meta-analysis.

AIM: The purpose of this study was to analyze the effectiveness of virtual reality technology in nursing education. BACKGROUND: Virtual reality technology is regarded as one of the advanced and significant instructional tools in contemporary education. However, its effectiveness in nursing education remains a subject of debate, and there is currently limited comprehensive research discussing the impact of varying degrees of virtual technology on the educational effectiveness of nursing students. DESIGN: Systematic review and meta-analysis. METHODS: The present systematic review and meta-analysis were applied according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. The PubMed, Embase, CINAHL, ProQuest, Cochrane Library, Web of Science, and Scopus were searched for relevant articles in the English language. The methodologies of the studies evaluated were assessed using Cochrane Risk of Bias2 (ROB 2) tool and Joanna Briggs Institute (JBI) assessment tool. We took the learning satisfaction, knowledge, and skill performance of nursing students as the primary outcomes, and nursing students' self-efficacy, learning motivation, cognitive load, clinical reasoning, and communication ability were assessment as secondary outcomes. The meta-analysis was performed using R 4.3.2 software according to PRISMA guidelines. Heterogeneity was assessed by I2 and P statistics. Standardized mean difference (SMD) and 95 % confidence intervals (CIs) were used as effective indicators. RESULTS: Twenty-six studies were reviewed, which involved 1815 nursing students. The results showed that virtual reality teaching, especially immersive virtual reality, was effective in improving nursing students' learning satisfaction (SMD: 0.82, 95%CI: 0.53-1.11, P < 0.001), knowledge (SMD: 0.56, 95%CI: 0.34-0.77, P < 0.001), skill performance (SMD: 1.13, 95 % CI: 0.68-1.57, P < 0.001), and self-efficacy (SMD: 0.64, 95%CI: 0.21,1.07, P < 0.001) compared to traditional teaching methods. However, the effects of virtual reality technology on nursing students' motivation, cognitive load, clinical reasoning, and communication ability were not significant and require further research. CONCLUSIONS: The results of this study show that virtual reality technology has a positive impact on nursing students. Nonetheless, it is crucial not to underestimate the effectiveness of traditional education methods, and future research could analyze the impact of different populations on nursing education while improving virtual reality technology, to more comprehensively explore how to improve the quality of nursing education. Moreover, it is imperative to emphasize the integration of virtual education interventions with real-world experiences promptly. This integration is essential for bridging the gap between the virtual learning environment and real-life scenarios effectively. REGISTRATION NUMBER: CRD42023420497 (https://www.crd.york.ac.uk/PROSPERO/#recordDetails).

How lack of support and recognition for RN preceptors is affecting nursing students' learning on placement.

The clinical placement environment plays a pivotal role in shaping the learning experiences and outcomes of nursing students. In this article, the challenges and dynamics within the clinical placement environment are examined, with a particular focus on the role of registered nurse preceptors. The multifaceted nature of the clinical landscape is highlighted with consideration given to the impact on both students and preceptors. Key to the success of any placement is the relationship between nursing students and their preceptors. The quality of this relationship directly influences the learning journey of students, with positive interactions contributing to enhanced learning outcomes and professional growth. However, within the literature, a range of challenges faced by nurse preceptors are captured, including limited support, recognition, and formal training. This lack of preparation and support not only impacts the well-being of preceptors but also compromises the quality of education provided to nursing students. In this article, the complexities of the clinical environment, including high patient acuity, demanding workloads and limited teaching time, are highlighted. If we are serious about preparing quality nurses, then we need to get serious about supporting those who are key to their learning and transition into practice.

Nurses' competency on electrocardiography interpretation in adult emergency room: Addis Ababa, Ethiopia, 2021. Multicenter cross-sectional study.

AIM: This study aimed to assess the proficiency of nurses in interpreting electrocardiogram within the adult emergency units of Addis Ababa, Ethiopia, during the year 2021. METHODS: This institutional-based descriptive, cross-sectional study involved 175 nurses from five randomly selected hospitals' adult emergency units. Semi-structured, self-administered questionnaires were used for data collection. Data were entered into Epi-Data and analyzed using SPSS version 26. Fisher's exact test identified statistical significance between dependent and independent variables at a p-value < 0.05. RESULTS: Out of 203 respondents, 175 participated actively, yielding a response rate of 86.2%. Among these nurses, 159 (90.9%) were deemed not competent (scoring < 65%), with a mean score of 6.82 ± 3.65 SD. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution was included in this study. CONCLUSION: The overall competency level in electrocardiogram interpretation among nurses is significantly poor. This indicates that most nurses in the emergency units are unable to accurately interpret ECG monitoring, potentially leading to the failure to recognize signs of arrhythmias, electrolyte disturbances, and other cardiac abnormalities. Consequently, this may result in inappropriate patient care and increased mortality rates. Education and training were identified as key factors in enhancing their competency.

Exploring variations in IPC competencies: a cross-sectional study among healthcare professionals in Northwest China.

BACKGROUND: This cross-sectional study investigates infection prevention and control (IPC) competencies among healthcare professionals in northwest China, examining the influence of demographic factors, job titles, education, work experience, and hospital levels. METHODS: Data from 874 respondents across 47 hospitals were collected through surveys assessing 16 major IPC domains. Statistical analyses, including Mann-Whitney tests, were employed to compare competencies across variables. RESULTS: Significant differences were identified based on gender, job titles, education, work experience, and hospital levels. Females demonstrated higher IPC competencies, while senior positions exhibited superior performance. Higher educational attainment and prolonged work experience positively correlated with enhanced competencies. Variances across hospital levels underscored context-specific competencies. CONCLUSION: Demographic factors and professional variables significantly shape IPC competencies. Tailored training, considering gender differences and job roles, is crucial. Higher education and prolonged work experience positively impact proficiency. Context-specific interventions are essential for diverse hospital settings, informing strategies to enhance IPC skills and mitigate healthcare-associated infections effectively.

Attitudes toward communication skills with learner needs assessment within radiology residency programs in China: a cross-sectional survey.

BACKGROUND: Communication skills (CS) represent a core competency in radiology residency training. However, no structured curriculum exists to train radiology residents in CS in China. The aim of this study was to evaluate the status and prevalence of doctor-patient communication training among radiology residents in nine Chinese accredited radiology residency training programs and to determine whether there is a perceived need for a formalized curriculum in this field. METHODS: We administered a cross-sectional online survey to radiology residents involved in CS training at nine standard residency training programs in China. The questionnaire developed for this study included CS training status, residents' demographics, attitudes toward CS training, communication needs, and barriers. Residents' attitudes toward CS training were measured with the Communication Skills Attitude Scale (CSAS) and its subscales, a positive attitude scale (PAS) and negative attitude scale (NAS). RESULTS: A total of 133 (48.36%) residents participated in the survey. The mean total scores on the two dimensions of the CSAS were 47.61 ± 9.35 in the PAS and 36.34 ± 7.75 in the NAS. Factors found to be significantly associated with the PAS included receiving previous training in CS, medical ethics, or humanities and the doctor's attire. We found that first-year residents and poor personal CS were the most influential factors on the NAS. Only 58.65% of participants reported having previously received CS training during medical school, and 72.93% of respondents reported failure in at least one difficult communication during their residency rotation. Most of those surveyed agreed that CS can be learned through courses and were interested in CS training. Some of the most common barriers to implementing formal CS training were a lack of time, no standardized curriculum, and a lack of materials and faculty expertise. CONCLUSIONS: Most residents had a very positive attitude toward CS training and would value further training, despite the limited formal CS training for radiology residents in China. Future efforts should be made to establish and promote a standard and targeted CS curriculum for Chinese radiology residents.

Caring for people with intellectual disabilities: Insights from a cross-sectional study among nursing students.

BACKGROUND: Caring for people with intellectual disabilities poses substantial challenges. Nursing students' emotions, thoughts, and behaviors during their education in the context of people with intellectual disabilities, remain relatively unexplored. OBJECTIVES: To examine nursing students' emotions, thoughts, competence, and expected professional behaviors in care provision for people with intellectual disabilities, as well as to identify factors associated with their expected professional behaviors with this population. DESIGN: A cross-sectional study using a closed self-report questionnaire and one open-ended question. SETTING: The largest academic nursing department in Israel. PARTICIPANTS: Of 245 sophomore nursing students, 177 agreed to participate (71.4 % response rate). METHODS: The study measured feelings, thoughts, competence, and expected professional behaviors in care provision for people with intellectual disabilities based on the Multidimensional Attitudes Scale. One open-ended question addressed how students believe their competence in caring for people with intellectual disabilities could be improved during their nursing studies. A hierarchical linear regression analysis was performed to investigate the contribution of emotions, thoughts, and competence to explaining expected behaviors in care provision. The significance of the model and the R2 were calculated. The open-ended question was analyzed by the constant comparative method. RESULTS: Negative emotions and thoughts (ß = -0.37, 95 % CI -0.47; -0.15 and ß = -0.33, 95 % CI -0.39; -0.13, respectively), along with positive emotions (ß = 0.25, 95 % CI 0.07;0.33), showed significant associations with expected professional behaviors. Qualitative analysis revealed three key themes: communication concern, knowledge gap, and curiosity. The findings of the open-ended question corroborate the quantitative findings. CONCLUSION: It is important to realize that in order to develop quality professional skills for caring for people with intellectual disability, nursing educators must adopt a deep discussion of negative emotions and thoughts with their students regarding people with intellectual disabilities. Ignoring these negative emotions and thoughts can exacerbate the neglect of people with intellectual disabilities' health needs.

An active-learning laboratory focused on critical care topics.

BACKGROUND AND PURPOSE: To describe an active-learning laboratory on critical care topics including advanced cardiac life support (ACLS), rapid sequence intubation (RSI), and toxicology and its effect on students' knowledge, skills, and confidence. EDUCATIONAL ACTIVITY AND SETTING: Third year pharmacy students (n = 88) participated in a critical care focused laboratory with four stations focused on ACLS review, ABBOJECTⓇ syringe assembly, ACLS simulations, RSI cases, and toxicology. Prior to the critical care focused skills laboratory, students completed an optional assessment composed of six confidence and eight knowledge questions. After the laboratory, students completed the same confidence and knowledge assessment. Descriptive statistics assessed pre/post-assessment responses. Paired pre/post-assessment Likert data were analyzed using the Wilcoxon signed-rank test and paired pre/post-test multiple choice responses were analyzed using the McNemar test. FINDINGS: Of the 88 students in the cohort, 76 students completed both the pre/post-assessments (response rate: 86.4%). Students demonstrated a significant increase in their overall knowledge and confidence scores on the post-assessment. All students successfully assembled an ABBOJECTⓇ syringe. The majority of respondents rated the critical care laboratory as excellent or good with regards to how enjoyable and effective the activity was to help understand critical care topics. SUMMARY: A hands-on, active-learning laboratory devoted to teaching and reinforcing common critical care concepts allowed students to gain knowledge and confidence regarding ACLS, RSI, and toxicology.

UK student midwives' theoretical knowledge, confidence, and experience of intermittent auscultation of the fetal heart rate during labour: An online cross-sectional survey.

AIM: This study aimed to explore student midwives' theoretical knowledge of intrapartum intermittent auscultation, their confidence in, and their experience of this mode of fetal monitoring. DESIGN AND SETTING: An online cross-section survey with closed and open questions. Descriptive statistics were used to analyse participants' intermittent auscultation knowledge, confidence, and experience. Reflexive thematic analysis was used to identify patterns within the free text about participants' experiences. PARTICIPANTS: Undergraduate midwifery students (n = 303) from Nursing and Midwifery Council-approved educational institutions within the United Kingdom. FINDINGS: Most participants demonstrated good theoretical knowledge. They had witnessed the technique being used in clinical practice, and when performed, the practice was reported to be in line with national guidance. In closed questions, participants reported feeling confident in their intermittent auscultation skills; however, these data contrasted with free-text responses. CONCLUSION: This cross-sectional survey found that student midwives possess adequate knowledge of intermittent auscultation. However, reflecting individual clinical experiences, their confidence in their ability to perform intermittent auscultation varied. A lack of opportunity to practice intermittent auscultation, organisational culture, and midwives' preferences have caused student midwives to question their capabilities with this essential clinical skill, leaving some with doubt about their competency close to registration.

Contextual determinants impacting final year nursing students' emergency team communication during deteriorating patient simulations: A grounded theory study.

BACKGROUND: Ability to focus on development of students' team communication and non-technical skills may be reduced in content saturated nursing curricula. Even when communication and simulation-based education is provided, students' utilisation of non-technical skills remains challenging. Although simulation is a recognised means to learn communication skills, little is known about nursing students' team communication in simulated settings. OBJECTIVE: To understand the process by which final year undergraduate nursing students communicate in simulated team emergencies. DESIGN: Using constructivist grounded theory, data was collected using semi-structured interviews and student observations and analysed using constant comparative analysis. SETTING: Simulation laboratories in one university nursing school in Australia. PARTICIPANTS: 21 final year nursing students in seven teams. METHODS: Data were gathered from interviews and video observations of final year nursing students during simulated team emergencies. RESULTS: Interview data and observations of video-recordings revealed contextual determinants that influence communication within teams: the simulation context, the student context and the team context. Team member characteristics, such as cultural and linguistic background, life experiences, gender and age, the ability to shift from leadership to followership as well as environmental factors such as mask wearing and simulation fidelity, contributed to uncertainty in communicating that nursing team effectiveness. CONCLUSIONS: Improvement of contextual conditions necessitates implementation of supportive strategies. These include development of educational initiatives, and further research in experiential learning as a modality for learners to experience team communication. Further, simulation context, student context and team context are important considerations. Meeting clinical communication learning needs of students allows better preparation to care for deteriorating patients as graduates.

Nutrition employability and graduate readiness: The Australian Working in Nutrition study.

BACKGROUND: Nutrition science graduates contribute to the nutrition workforce by bringing specialist knowledge and skills needed to address future food challenges. This study aims to provide a snapshot of the current employment landscape for nutrition science graduates in Australia and how well their degrees prepare them for employment. METHOD: A cross-sectional survey of Australian tertiary nutrition graduates was conducted to explore tertiary training, employment pathways and their perceived preparedness for practice. RESULTS: This study included a final sample of 119 graduates from 17 Australian tertiary institutions. Almost two-thirds of respondents had completed further training. Most graduates (77%, n = 91) had worked in a food, nutrition science or health-related role after their degree; the most frequently cited employment settings were government or public health organisations; research, not-for-profit or nongovernment organisations; and the food industry. Work-integrated learning was identified as a key predictor of graduates working in a role that differed from their expectations as a student. The skill categories developed during nutrition training that were most valued in the workplace included nutrition and scientific knowledge, and professional and communication skills. CONCLUSIONS: This study offers first insights into the current employment landscape for nutrition graduates across Australia. Findings show that current nutrition science professionals are highly qualified and prepared to navigate the evolving demands of nutrition practice. Regular review of graduate employment will inform nutrition science curriculum to enable graduates to be well equipped in the face of dynamic practice settings.

Trends in gastric surgery operative experience among general surgery residents in the United States: A nationwide retrospective analysis.

BACKGROUND: Gastric surgery is a crucial component of general surgery training. However, there is a paucity of high-quality data on operative volume and the diversity of surgical procedures that general surgery residents are exposed to. METHODS: We conducted a retrospective analysis of operative case logs of all general surgery residents graduating from the American College of Graduate Medical Education-accredited program from 2009 to 2022. Data on the mean number of gastric procedures, including the mean in each subcategory, were retrieved. A Mann-Kendall trend test was used to investigate trends in operative volume. RESULTS: Between 2009 and 2022, the mean overall logged gastric procedures rose significantly (τ = 0.722, P < .001) from 36.2 in 2009 to 49.2 in 2022 (35.9% increase). The most substantial growth was seen in laparoscopic gastric reduction for morbid obesity (mean 1.9 in 2017 to 19 in 2022; τ = 0.670, P = .009). A statistically significant increase was also seen in laparoscopic partial gastric resections, repair of gastric perforation, and "other major stomach procedures" (P < .05 for all comparisons). Open gastrostomy, open partial gastric resections, and open vagotomy all significantly decreased (P < .05 for all comparisons). There was no significant change in the volume of laparoscopic gastrectomy, total gastric resections, and non-laparoscopic gastric reductions for morbid obesity (P > .05 for all comparisons). CONCLUSION: There has been a substantial increase in the volume of gastric surgery during residency over the past 14 years, driven mainly by an increase in laparoscopic gastric reduction. However, there may still be a need for further gastric surgical training to ensure well-rounded general surgeons.

Successful Implementation of the AIUM Standardized 4-Year Residency Ultrasound Curriculum in Obstetrics and Gynecology: Lessons Learned and Way Forward.

BACKGROUND: Significant disparities in sonographic education exist in Obstetrics and Gynecology programs in the United States. To address the lack of standardization in ultrasound teaching, the American Institute of Ultrasound in Medicine (AIUM) assembled a multi-society task force in 2018 that resulted in the publication of a Consensus Report outlining a standardized ultrasound curriculum and competency assessment. OBJECTIVES: The primary objective of the study was to implement the AUIM standardized curriculum within an Obstetrics and Gynecology residency program at a tertiary medical center, and report on the early implementation experience. The secondary objective was to assess current national practices in ultrasound training in Obstetrics and Gynecology residency programs. STUDY DESIGN: Study design was an effectiveness-implementation hybrid study of a structured ultrasound educational program based on the 2018 AIUM Consensus Report. The theoretical portion of the curriculum consisted of 26 hours of didactic lectures distributed over 4 years. For the practical component, residents received instruction from faculty and sonographers and independently acquired the required images as part of their regular clinical work. Simulator app access was also provided for additional opportunities to practice and acquire images. Deidentified images for the required competencies were uploaded to a WhatsApp group for review. Theoretical knowledge was assessed with a series of multiple-choice exams. Practical skills were assessed through grading of images submitted through WhatsApp as well as direct observations of resident scans. At the completion of 4 years, the assessment of both theoretical knowledge and practical skills was carried out using the ISUOG Basic Training Examination. National patterns in the area of ultrasound education were assessed with a four-question electronic survey of Obstetrics and Gynecology program directors in the United States. Analysis of both portions of the study was primarily descriptive. RESULTS: Four Obstetrics and Gynecology residents completed the curriculum spanning postgraduate years 1 through 4. The number of competencies completed ranged from 7 to 19 out of 41. All of the residents passed the theoretical and practical components of the ISUOG Basic Training Examination. For the residency program director survey portion of the study, response rate was 20% (59 of 290). Among the respondents, 55.9% reported having a structured curriculum and 34.4% reported implementing the AIUM curriculum. The two most commonly cited obstacles to implementation of structured ultrasound teaching were uncertainty with how to start the process (49.2%) and lack of faculty engagement (49.2%). CONCLUSIONS: Implementation of the AIUM Curriculum within the framework of an Obstetrics and Gynecology residency program at a tertiary medical center is feasible. In our experimental group, completion of the curriculum resulted in passing of an internationally recognized validated assessment. Obstacles to implementation in our program included a wide range of engagement and participation among residents, and limited opportunities to obtain some of the required competencies. Identification of obstacles to implementation from the perspective of residency program directors is critical for developing targeted approaches to ensure widespread implementation. Successful standardized validated sonographic training of graduating Obstetrics and Gynecology residents is crucial for this operator-dependent modality that has tremendous implications on patient safety and clinical care.

Factors affecting the rates of incidental parathyroidectomy during thyroidectomy.

BACKGROUND: The most important factors affecting the development of postoperative hypocalcaemia (PH) include intraoperative trauma to the parathyroid glands, incidental parathyroidectomy (IP), and the surgeon's experience. In this study, we aimed to determine the incidence of IP, evaluate its effect on postoperative calcium levels and investigate the effect of surgeon experience and volume on IP incidence and postoperative calcium levels. METHODS: This retrospective study included 645 patients who underwent thyroid surgery at the Department of General Surgery, Kütahya Health Sciences University between September 2016 and March 2020. All patients underwent surgery at a single clinic by general surgeons experienced in thyroid surgery and their residents (3-5 years). RESULTS: Normal parathyroid glands were reported in 58 (8.9%) of 645 patients. In 5 (8.6%) of 58 patients the parathyroid gland was detected in the intrathyroidal region. PH developed in ten patients (17.2%) with incidental removal of the parathyroid glands. A statistically significant difference was found between the number of incidentally removed parathyroid glands and the development of hypocalcaemia (p<0.05). Normal parathyroid glands were reported in the pathology of 37 (7.9%) patients operated on by general surgeons and 22 (12.6%) patients operated on by their residents. PH developed in 39 (8.2%) patients operated on by general surgeons and in 8 (4.5%) patients operated on by their residents. CONCLUSIONS: We found that the complication rate during the resident training process was the same as that of experienced general surgeons. A thyroidectomy can be safely performed by senior residents during residential training.