Gastrointestinal endoscopy training in the United States: Program structure and competence assessment.

The general principles of gastrointestinal endoscopy training in the United States were formulated and summarized more than a decade ago and the principles have been consistent until now. To summarize, trainees should be prepared to (i) appropriately recommend endoscopic procedures as indicated by the findings of the consultative evaluation, with an explicit understanding of accepted specific indications, contraindications, and diagnostic/therapeutic alternatives, (ii) perform procedures safely, completely, and expeditiously, including possessing a thorough understanding of the principles of conscious sedation/analgesia techniques, the use of anesthesia-assisted sedation where appropriate, and pre-procedure clinical assessment and patient monitoring, (iii) correctly interpret endoscopic findings and integrate them into medical or endoscopic therapy, (iv) identify risk factors for each procedure, understand how to minimize each, and recognize and appropriately manage complications when they occur, (v) acknowledge the limitations of endoscopic procedures and personal skills and know when to request help, and (vi) understand the principles of quality measurement and improvement. This article provides an overview of the endoscopy training system and structure, evaluation scheme, and competence and credentialing process in the United States.

Enhancing Infection Preventionist Certification Success Through a Structured Training Program.

BACKGROUND: Certification in infection control and prevention (CIC) is a standardized indicator of the knowledge and competencies essential for effective infection prevention practice. Evidence measuring success of training programs for infection control certification is limited. METHODS: From 2017 through 2023, 51 novice infection preventionists (IP) were enrolled in a training program which combined didactic learning, application of knowledge in practice, and mentorship from advanced practice and near-peer IPs. Participants were tracked through completion of certification examination and pass rates were compared to rates for 2023 CIC candidates. RESULTS: All participants engaged in the training program attempted the CIC examination. The training group had a pass rate of 98%. This is 27% higher than the most recent rate published by Certification Board of Infection Control and Epidemiology (CBIC) of 71%. DISCUSSION: Participants were significantly more likely to pass the CIC exam on the first try, showing that a supported, competency-based training program can be successful in supporting novice IPs in certification success. CONCLUSIONS: Building foundational knowledge on key concepts in infection prevention and control and enhancing learning through supervised, direct application of skills improves CIC certification exam pass rates and supports progression of early career IPs to more independent practice.

Comparison of characteristic competencies of public health nurses working at a community general support center and health and welfare in public administration in Japan.

Objectives: To compare the characteristic competencies of public health nurses working for the older adult's health and welfare in public administration ("PA") with those at community general support centers ("CGSC") in Japan. Methods: We conducted a questionnaire survey by mail for PA and CGSC public health nurses. A competency list that was developed to compare three groups (PA, CGSC experts with ≥5 years of experience, and CGSC newcomers with ≤2 years of experience) was used. The following characteristics were examined: (1) competencies acquired early after arriving at the CGSC, (2) competencies acquired through a certain amount of CGSC experience, (3) common competencies, (4) competencies that even experts lacked, and (5) competencies that the newcomers lacked. Results: We examined the responses of 171 PA nurses, 185 CGSC expert public health nurses, and 165 CGSC newcomer public health nurses. The results of comparison of the three groups showed that (1) had no applicable items; (2) had nine items for individual support associated with preventive care management; (3) had 14 items including teamwork among three professionals (social workers, senior care manager, public health nurse)/other professionals and self-improvement; (4) had three items for community development, (5) had two items for individual support and 16 items for community development. Conclusion: Initiatives for preventive care and coordination of care teams should be supported and suggested as characteristic competencies for CGSC public health nurses.

Perceptions of Stakeholders and the Way Forward to Implementing the Family Adoption Programme in Medical Education: A Study From Assam, India.

Background The Family Adoption Programme (FAP) has been introduced under the competency-based medical education curriculum wherein each medical student adopts families. The objective of this study was to determine the stakeholders' perspective and to suggest measures to make it relevant for Indian medical graduates. Methodology A mixed-method study was conducted among the faculty, undergraduate students, and community using prestructured, validated instruments. The quantitative data were entered into Microsoft Excel (Microsoft Corp., Redmond, WA) and analysed, while the qualitative data were coded and analysed thematically. Results All faculty members (12, 100%), the majority of students (49, 44.30%), and the community members strongly agreed that the policy decision to introduce the FAP was 'right'. The benefits mentioned were that FAP helps improve knowledge, psychomotor skills, attitudes and communication, attitude and behaviour skills, understanding of the social structures, health status of the community, and health-seeking behaviour of the families and provides an appropriate early clinical exposure. The challenges mentioned were selecting a site, gaining cooperation from family, communication, arrangement of logistics and transportation, getting support from teachers, difficulties in managing students in the community and coordinating among faculty, staff and students. Most faculty members recommended that the FAP should be started later in the curriculum and there should be restrictions on the number of families to be adopted. The students suggested that adequate logistics be provided as well as a reduction in the number of family visits. Conclusion The programme has been welcomed by most stakeholders. It requires the necessary support from the institution authorities, prior planning of visits, judicious utilization of social media, and coordination with government field-level health workers e.g. Accreditated Social Health Activists (ASHA). A comprehensive program evaluation and formulation of a standard operating module will further strengthen the programme.

Trainee Insight into Pain Fellowship Programs: A Critical Evaluation of the Current Educational System by the APPD.

BACKGROUND: Since 1992, when the Accreditation Council of Graduate Medical Education (ACGME) acknowledged pain medicine as a subspecialty, the field has experienced significant growth in its number of programs, diversity of sponsoring specialties, treatment algorithms, and popularity among applicants. These shifts prompted changes to the educational model, overseen by program directors (PDs) and the ACGME. The pool of pain fellowship applicants also changed during that period. OBJECTIVES: This study aims to investigate trainees' reasons for applying to pain medicine fellowship programs as well as the applicants' specific expectations, interests, and motivations, thereby contributing to the remodeling and universal improvement of programs across the country. STUDY DESIGN: Online survey via SurveyMonkey. The online questionnaire targeted pain fellowship applicants in 2023 and current fellows in the US. METHODS: Our study was designed by board members of the Association of Pain Program Directors (APPD). The board disseminated a survey to those who applied to ACGME Pain Medicine fellowships in 2023 as well as to existing fellows. The survey was emailed to residency and fellowship PDs for dissemination to their trainees. The participants answered a 12-question survey on their reasons for pursuing pain medicine fellowships, expectations of and beyond those fellowships, and educational adjustments. RESULTS: There were 283 survey participants (80% applicants in residency training and 20% fellows). Participants ranked basic interventional procedures and a strong desire to learn advanced procedures as the most significant factors in pursuing a pain fellowship. Most trainees (70%) did not wish to pursue a 2-year fellowship, and 50% desired to go into private practice. LIMITATIONS: The relatively small number of respondents is a limitation that could introduce sampling error. Since most of the respondents were from the fields of physical medicine and rehabilitation (PM&R) and anesthesia, the use of convenience sampling reduced our ability to generalize the results to the wider community. Furthermore, approximately 80% of the trainees were residents, who might have had less experience in or knowledge of the survey's particulars than did the fellows. CONCLUSION: This survey demonstrated that procedural volume and diversity were important factors in trainees' decisions to apply to the field of pain medicine; however, extending the duration of a pain fellowship was not an option survey participants favored. Therefore, PDs and educational stakeholders in pain fellowship training need to develop creative strategies to maintain competitive applicants' interest while they adapt to our evolving field.

The development of Logix - An application for component-based case logging and surgical trainee assessment.

Background: The optimal training program to transform a new resident into a competent and capable surgeon is constantly evolving. Competency-based evaluation represents a change in mindset from quantitative or chronologic metrics for graduate readiness. As surgery becomes more specialized, more dependent on technology, and more public, we must continue to improve our ability to pass on technical skills. Approaching surgery in a component-based fashion enables even the most complex operation to be broken down into smaller sets of steps that range the entire spectrum of complexity. Treating an operation through the lens of its components, emphasizing stepwise forward progression in a trainee's experience, may provide a way to train competent surgeons more efficiently. Current case-logging products do not provide adequate granularity to apply this methodology. Methods: Application design relied on the involvement of local surgeons from all specialties and subspecialties related to general surgical training. Individual interviews with multiple experts in each field were used to generate a list of most commonly performed operations. Once a consensus was reached, the same surgeons were queried on what they felt were the core steps that make up each operation. This information was utilized to create a novel mobile application which enables the user to record cases by date, attending surgeon, specific operation, and which portions of the operation they were able/allowed to perform. Conclusion: Component-based case logging through the Logix application may be a useful adjunct as we continue to implement competency-based surgical training. Future investigation will assess user experience and compare subjective and objective metrics of training progression between the Logix application and currently utilized products. The information provided by the application stands to benefit not just trainees, but educators, training programs, and regulatory bodies. Key message: Component-based case logging via a novel mobile application stands to increase the efficiency of surgical training and more effectively assess trainee competency.

Impact of an expert-derived, quick hands-on tool on classifying pulmonary hypertension in chest computed tomography: a study on inexperienced readers using RAPID-CT-PH.

PURPOSE: To test the inter-reader agreement in classifying pulmonary hypertension (PH) on chest contrast-enhanced computed tomography (CECT) between a consensus of two cardio-pulmonary-devoted radiologists (CRc) and inexperienced readers (radiology residents, RRs) when using a CECT-based quick hands-on tool built upon PH imaging literature, i.e., the "Rapid Access and Practical Information Digest on Computed Tomography for PH-RAPID-CT-PH". MATERIAL AND METHODS: The observational study retrospectively included 60 PH patients who underwent CECT between 2015 and 2022. Four RRs independently reviewed all CECTs and classified each case into one of the five PH groups per the 2022 ESC/ERS guidelines. While RR3 and RR4 (RAPID-CT-PH group) used RAPID-CT-PH, RR1 and RR2 (control group) did not. RAPID-CT-PH and control groups' reports were compared with CRc using unweighted Cohen's Kappa (k) statistics. RRs' report completeness and reporting time were also compared using the Wilcoxon-Mann-Whitney test. RESULTS: The inter-reader agreement in classifying PH between the RAPID-CT-PH group and CRc was substantial (k = 0.75 for RR3 and k = 0.65 for RR4); while, it was only moderate for the control group (k = 0.57 for RR1 and k = 0.49 for RR2). Using RAPID-CT-PH resulted in significantly higher report completeness (all p < 0.0001) and significantly lower reporting time (p < 0.0001) compared to the control group. CONCLUSION: RRs using RAPID-CT-PH showed a substantial agreement with CRc on CECT-based PH classification. RAPID-CT-PH improved report completeness and reduced reporting time. A quick hands-on tool for classifying PH on chest CECT may help inexperienced radiologists effectively contribute to the PH multidisciplinary team.

Digital Documentation in Healthcare: Empowering Nurses and Patients for Optimal Care.

In response to challenges associated with extensive documentation practices within the NHS, this paper presents the outcomes of a structured brainstorming session as part of the Chief Nurse Fellows project titled 'Digital Documentation in Healthcare: Empowering Nurses and Patients for Optimal Care." Grounded in Dr. Rozzano Locsin's theory of "Technological Competency as Caring in Nursing," this project leverages a Venn diagram framework to integrate Digital Maturity Assessment (DMA) results with the "What Good Looks Like" (WGLL) Framework, the ANCC Pathway to Excellence, and the eHospital EPR program vision of University Hospitals of Leicester NHS Trust. Participants, including Clinical IT facilitators and nursing leaders, engaged in identifying synergies and gaps across digital proficiency, nursing excellence, and patient-centric care, contributing actionable insights towards an optimized digital patient care model. The findings emphasize the need for holistic digital solutions that enhance documentation efficiency, support staff excellence, and improve patient outcomes.

Nursing Informatics Competencies of Graduate Nurse Educator Students: Descriptive Study.

The advancement of technology and Artificial Intelligence applied health information systems demand high informatics competencies from nurses. To prepare nursing students to meet this demand, informatics courses are designed to increase informatics competencies. We offered an online informatics course to graduate students in a Nurse Educator program and assessed their informatics competency, including subdomains. Survey data were collected between Fall 2020 and Fall 2022 using an online Self-Assessment of Informatics Competency Scale for Health Professionals. We analyzed 109 responses and found that students were competent in overall informatics competency and the subdomains of "basic computer skills" and "applied computer skills (clinical informatics)." They were proficient in the 'role' subdomain. However, students reported less competency in managing data and incorporating standard terminology into practice. These findings provide detailed insights of the current nursing students' informatics competencies and can guide informatics faculty in improving their courses.

What Is the Level of Nursing Informatics Competency of ChatGPT?

Nurses must excel in using Artificial Intelligence (AI) - applied hospital systems, making their informatics competency crucial. ChatGPT has been trained with extensive amounts of informatics- and technology-related health data and has gained popularity. Nurses could have the opportunity to enhance their informatics competency through the knowledge generated by ChatGPT. However, its informatics competency has not been evaluated. We used the Self-Assessment of Informatics Competency Scale to measure the level of informatics competency of ChatGPT. ChatGPT fell within the range of 'somewhat competent' and 'competent,' lower than that of students in graduate programs. One subdomain, applied computer skills (clinical informatics), demonstrated competency levels close to that of students. Although the results presented certain limitations and concerns, we recognize the potential of ChatGPT to help researchers and healthcare practitioners. Nursing is advancing and continuously integrating AI technology; therefore, we should now embrace both the benefits and risks associated with ChatGPT.

A Survey of Nurse Informatics Competencies of Professional Nurses in Clinical Practice Public Hospitals in South Africa.

Competence in Nursing Informatics (NI), is vital for efficient nursing care in today's technologically-enabled healthcare environment. In South Africa, little is known on the competence of professional nurses in clinical practice in nursing informatics. METHODS: This study used a cross-sectional descriptive survey to examine self-rated competence in nursing informatics among 205 nurses in clinical practice across two hospitals in the Western Cape. The TANIC© scale was used to rate the skills of participants in computer literacy, clinical information management, and information literacy. RESULTS: The highest rating was received for computer literacy, approaching a 'comfortable' competency level. Lower scores were received for clinical information management and information literacy, indicating 'novice' to 'advanced beginner' levels. CONCLUSION: The study showed that practicing nurses have a limited level of nursing informatics competence, especially in the domains of clinical information management and information literacy. These findings support the need for educational programmes to extend beyond basic computer skills and prioritize continuous professional development in nursing informatics.

Evaluating ChatGPT's Performance in the EU*US eHealth Work Foundational Curriculum Using the HITCOMP Self-Assessment Quiz.

This study investigated the performance of OpenAI's Chat Generative Pre-trained Transformer (ChatGPT) in responding to the EU*US eHealth Work Foundational Curriculum. This curriculum, a collaborative effort between European and U.S. institutions, provides an extensive framework for eHealth learning. The assessment involved 321 questions from the online Health Information Technology Competencies (HITCOMP) self-assessment quiz. Using GPT-3.5 model, the study presented each question three times to assess ChatGPT's consistency. Findings revealed an accuracy of 70.7%, indicating a reasonable grasp of eHealth topics, although performance was uneven across the 21 modules. These results underscore ChatGPT's potential in health information technology education and highlight the need for further model enhancements to fully encompass eHealth competencies.

Enhancing the Central Venous Catheterization Competency of Medical Students through a Specialized Team and an Interactive Response System: A pre-post study.

Background: Central venous catheterization (CVC) is a critical clinical procedure. To avoid complications, possessing good knowledge regarding the CVC care bundle and skills for the proper insertion and maintenance of CVC are important. Objectives: To evaluate the effectiveness of an educational intervention and the use of an interactive response system in enhancing the CVC bundle care and insertion skills of medical students undergoing critical care medicine training. Materials and Methods: Sixth-year medical students (equivalent to fourth-year students in the United States) engaged in didactic lessons, interactive demonstrations, and simulator training facilitated by a CVC team comprising three thoracic and two vascular surgeons (all with a minimum 5 years of experience in central venous access) during their intensive care unit (ICU) rotation. Self-reported knowledge and confidence levels were assessed using pre-and posttests administered through the Zuvio App, an interactive response system. Results: A total of 60 students underwent the educational intervention, of which 54 completed the pretest and 40 completed the posttest. In the posttest, significant improvement was found in the CVC bundle care competency and understanding (P = 0.002), preprocedural preparation (P = 0.002), insertion procedures (P = 0.004), complications (P = 0.003), and insertion depth decisions (P = 0.001). Staff and students reported that assessment and interaction via the Zuvio App were valuable, practical, and feasible in a clinical setting, providing trainees with an individual competency portfolio of receiving precise medical education. Conclusions: Integrating the training provided by a specialized team with an interactive response system enhanced the knowledge and competency level in CVC insertion among medical students in this study.

EmpowerHER: A Pilot Study to Increase Physical Activity and Strength Through Powerbuilding.

Engaging in empowering exercise develops movement competency (MC) and strength and supports physical health, mental well-being, and quality of life. Powerbuilding combines powerlifting and bodybuilding to increase physical activity (PA), MC, and strength. To our knowledge, powerbuilding has not been explored as an exercise intervention. This pilot study investigated the impact of an eight-week powerbuilding intervention on women's PA, MC, strength, and empowerment. Eighteen women aged 25.1±9.8 with no powerbuilding experience participated in the intervention, meeting three times weekly for one hour. PA and MC were assessed pre- and post-intervention. Three-repetition maximum (3-RM) tests in the squat, bench press, and deadlift were completed in weeks one and eight of the intervention. Data were checked for normality; the Wilcoxon signed-rank test was used for non-normally distributed data. The McNemar test was used to analyze differences in dichotomous variables. Effect size was calculated and interpreted as follows small (r=0.1, d=0.2, ω=0.1), medium (r=0.3, d=0.5, ω=0.3), and large (r=0.5, d=0.8, ω=0.5) Total PA ([t(17)=3.52, p=0.003, d=0.83]) and participants who met the PA guidelines (Z=6.13, p=0.008, ω=0.82) increased significantly from pre- to post-intervention. Participants' MC scores improved significantly from pre- (24.3±3.5) to post-intervention (29.5±2.5; [t(17)=10.04, p<0.001; d=2.37]). Significant increases in strength were observed (squat [Z=-3.73, p<0.001, r=0.88], bench press [Z=-3.73, p<0.001, r=0.88], and deadlift [t(17)=16.41, p<0.001; d=3.87]). Empowerment in exercise scores averaged 56.3±6.6 (on a scale of 5-65). The intervention significantly increased total PA, improved MC, increased strength, and facilitated empowerment. Women's participation in powerbuilding may enhance their quality of life.

Reject the "Practice Readiness Myth": Ask if systems are ready for nursing graduates instead.

The nursing profession is engaged in robust national dialogue on how to implement competency-based education. This dialogue often conflates the concept of "competency-based education" with nursing "competence" or "practice readiness." Our aim is to discuss the potential harms of conflating "competency-based education" with "competence" or "practice readiness." This commentary explores the possible risks of issue conflation. Risks include (a) suggesting that nurses who have successfully obtained licensure are not "competent" or "ready to practice," and (b) de-emphasizing the importance of safe and sustainable work environments for new graduate nurses. We discuss the need to separate conversations about "competency-based education" and "practice readiness"; the need to increase the clarity and specificity of discourse surrounding competency-based education; and the need for strategic alignment across academia and practice.

Implementation status of the nationally harmonized competency-based, integrated, modular medical curriculum in Ethiopia: opportunities and challenges.

BACKGROUND: Well-designed curriculums are crucial for quality education. This study aimed to assess the implementation status of a harmonized competency-based medical curriculum (CBMC) in Ethiopia, as well as identify the associated challenges and benefits. METHODS: A mixed-method approach was used. Data collection took place from September 1, 2023, to October 15, 2023. Eleven medical schools were randomly selected from a list of 28 public medical schools in Ethiopia. Participants were purposively chosen from selected medical schools using a controlled sampling method. A total of 121 participants took part in the survey. Interviews and focus group discussions were conducted with key informants to complement the quantitative findings. Descriptive statistics, such as frequencies and percentages, were used to summarize the quantitative survey responses. Thematic content analysis was used to analyze the qualitative data. RESULTS: The implementation of a CBMC in Ethiopian public universities faces various challenges and provides opportunities. Around 22% of respondents mentioned that the whole group session (WGS) had never been implemented in their school. Regarding community-based learning (CBL), 64.6% of respondents noted that it was intermittently implemented in their institution. Only 32% of respondents considered students' clinical exposure during preclerkship years to be reasonable. Interestingly, approximately 73% of respondents stated that problem-based learning (PBL) activities were regularly conducted in their school. Around 68% of respondents believed that competency-based assessment methods were moderately utilized. While many participants perceive the curriculum as having positive content alignment and structure with intended learning outcomes, challenges related to practical sessions, resource limitations, and uneven access to training opportunities persist. Resource constraints are a prominent challenge. The opportunities identified include early clinical exposure and enhanced communication skills. CONCLUSIONS: This survey highlights the need for ongoing curriculum evaluation and fine-tuning to ensure its success.

Evolutionary Implications of Self-Assembling Cybernetic Materials with Collective Problem-Solving Intelligence at Multiple Scales.

In recent years, the scientific community has increasingly recognized the complex multi-scale competency architecture (MCA) of biology, comprising nested layers of active homeostatic agents, each forming the self-orchestrated substrate for the layer above, and, in turn, relying on the structural and functional plasticity of the layer(s) below. The question of how natural selection could give rise to this MCA has been the focus of intense research. Here, we instead investigate the effects of such decision-making competencies of MCA agential components on the process of evolution itself, using in silico neuroevolution experiments of simulated, minimal developmental biology. We specifically model the process of morphogenesis with neural cellular automata (NCAs) and utilize an evolutionary algorithm to optimize the corresponding model parameters with the objective of collectively self-assembling a two-dimensional spatial target pattern (reliable morphogenesis). Furthermore, we systematically vary the accuracy with which the uni-cellular agents of an NCA can regulate their cell states (simulating stochastic processes and noise during development). This allows us to continuously scale the agents' competency levels from a direct encoding scheme (no competency) to an MCA (with perfect reliability in cell decision executions). We demonstrate that an evolutionary process proceeds much more rapidly when evolving the functional parameters of an MCA compared to evolving the target pattern directly. Moreover, the evolved MCAs generalize well toward system parameter changes and even modified objective functions of the evolutionary process. Thus, the adaptive problem-solving competencies of the agential parts in our NCA-based in silico morphogenesis model strongly affect the evolutionary process, suggesting significant functional implications of the near-ubiquitous competency seen in living matter.

Occupational health nursing and political action.

BACKGROUND: Occupational health and safety are central elements of work. Throughout its history as a speciality, occupational health nursing (OHN) has been expanding the development of academic competencies and the improvement of clinical skills. SOURCES OF EVIDENCE: The literature highlights that OHN is more involved in the application of policies with a public health perspective focused on the well-being of the worker than in their design and development. REFLECTIONS FROM A SOCIO-OCCUPATIONAL AND PROFESSIONAL PERSPECTIVE OF OCCUPATIONAL HEALTH NURSING: From this premise, the current reality contributes to establishing priorities for action, generates consensus as a discipline, induces self-criticism and favours development as a profession. The article points out the strategies that favour political participation in companies, the factors that limit public representation and some of the benefits of establishing this type of initiative in organisations. CONCLUSIONS AND IMPLICATIONS FOR NURSING AND HEALTH POLICY: The OHN is a key agent of change in the design and development of health policies in the workplace. From a panoramic view of how health strategies can influence companies, and the care of the working population, political awareness and civic participation in its different aspects are part of the commitment to this nursing speciality.