Working Definitions of the Roles and an Organizational Structure in Health Professions Education Scholarship: Initiating an International Conversation.

PROBLEM: Health professions education scholarship (HPES) is an important and growing field of inquiry. Problematically, consistent use of terminology regarding the individual roles and organizational structures that are active in this field are lacking. This inconsistency impedes the transferability of current and future findings related to the roles and organizational structures of HPES. APPROACH: Based on data collected during interviews with HPES leaders in Canada, Australia, New Zealand, the United States, and the Netherlands, the authors constructed working definitions for some of the professional roles and an organizational structure that support HPES. All authors reviewed the definitions to ensure relevance across multiple countries. OUTCOMES: The authors define and offer illustrative examples of three professional roles in HPES (clinician educator, HPES research scientist, and HPES administrative leader) and an organizational structure that can support HPES participation (HPES unit). These working definitions are foundational and not all-encompassing and, thus, are offered as stimulus for international dialogue and understanding. NEXT STEPS: With these working definitions, scholars and administrative leaders can examine HPES roles and organizational structures across and between national contexts to decide how lessons learned in other contexts can be applied to their local contexts. Although rigorously constructed, these definitions need to be vetted by the international HPES community. The authors argue that these definitions are sufficiently transferable to support such scholarly investigation and debate.

The development of the nursing profession in a globalised context: A qualitative case study in Kerala, India.

In the paper, we are looking at the relationship between globalisation and the professional project, using nursing in Kerala as an exemplar. Our focus is on the intersection of the professional project, gender and globalisation processes. Included in our analysis are the ways in which gender affects the professional project in the global south, and the development of a professional project which it is closely tied to global markets and global migration, revealing the political-economic, historical, and cultural factors that influence the shape and consequences of nurse migration. The phenomenon that enabled our analysis, by showing these forces at work in a particular time and place, was an outbreak of strikes by nurses working in private hospitals in Kerala in 2011-2012.

[Construction of a professionnal juridiction in Adapted Physical Activity in the medical world]. / Construction du territoire professionnel de l'enseignant en Activité Physique Adaptée dans le monde médical.

Analysis of interactions between professionals and patients with chronic diseases reveals a space invested by professional expertise in which APA teachers occupy their own distinctive position..

Los estudiantes de Grado en Enfermería y su compromiso con los estudios / Students in graduate programs in nursing and commitment to studies

El engagement o compromiso con los estudios es un estado afectivo positivo del estudiante con todo lo relacionado con los estudios. Objetivo: El objetivo de este trabajo era conocer el nivel de engagement de los estudiantes de Grado en Enfermería del Centro adscrito de Diputación de Málaga de la UMA, así como su relación con las variables sociodemográficas y socioeducativas. Método: Se ha realizado un estudio descriptivo, transversal y correlacional. Se utilizó el instrumento UWES-S para medir el compromiso o engagement con sus estudios. Los datos se obtuvieron mediante cuestionario enviado on-line. Resultados: Respondieron al cuestionario 170 alumnos y la participación fue del 52,99%. Los valores medios de engagement obtenidos fueron: puntuación global (media 58,52 SD 11,852 ), vigor (media 17,93 SD 5,087 ), dedicación (media 25,54 SD 3,980) y absorción (media 15,09 SD 4,079 ). Conclusiones: Hemos detectado correlaciones entre la puntuación global de engagement, el vigor y la absorción con el rendimiento académico. Así mismo hemos detectado diferencias de medias estadísticamente significativas entre ambos sexos en dedicación y puntuación global. Las medias en absorción son mayores en aquellos alumnos que viven en pareja y en aquellos que tienen otras obligaciones de cuidados. La edad ha correlacionado con la absorción de forma positiva. The engagement or commitment to studies is a positive affective state of the student with everything related to the studies(AU)

Objective: The objective of this work was to determine the level of engagement of students assigned Degree Nursing Council of Malaga Center of UMA and its relationship with socio-demographic and socio-educational variables. Methods: We performed a descriptive, cross-sectional and correlational study. The UWES-S instrument was used to measure the commitment or engagement with their studies. The data were obtained by questionnaire on line. Results: 170 students responded to the questionnaire and the turnout was 52.99% . The mean values of engagement were obtained: overall score (mean 58.52 SD 11,852 ), vigor (mean 17.93 SD 5,087) (mean 25.54 SD 3.980) and dedication (mean 15.09 SD 4,079) absorption. Conclusions: We have detected correlations between the overall score of engagement, vigor and absorption with academic performance. Likewise, we detected statistically significant mean differences between the sexes in dedication and overall score. Means in absorption are higher in those students who live with a partner and those who have other duties of care. The age has been correlated with positive absorption (AU)

Vulnerabilidad socioeconómica en un vecindario como determinante de la utilización y frecuentación de servicios sanitarios / The socio-economic vulnerability in a neighborhood determines the use and frequentation of health services

Objetivo: Analizar en un entorno comunitario la relación entre vulnerabilidad socioeconómica y utilización y frecuentación de servicios sanitarios, usando una aproximación multidimensional del concepto de vulnerabilidad. Material y Métodos: Estudio transversal en adultos del barrio de Casablanca (Zaragoza). Se seleccionó una muestra representativa de 1032 personas mediante muestreo aleatorio estratificado. Mediante encuesta se obtuvo información sociodemográfica del estado de salud y utilización de servicios sanitarios. Se clasificó a los individuos como vulnerables en función del nivel educativo, ocupación e ingresos. Se describió el uso de servicios y perfil de los usuarios. Se estudiaron los determinantes socioeconómicos de utilización y frecuentación con análisis de regresión recogiendo la vulnerabilidad mediante sus tres componentes clave y un indicador agregado. Resultados: El 30% de los residentes en Casablanca habían tenido contacto con los servicios sanitarios durante las dos últimas semanas. El perfil de usuario fue: mujer, =60 años, con mala salud percibida y alguna enfermedad diagnosticada. Las personas vulnerables visitaron más al médico que las no vulnerables, con especial impacto en hombres. Existieron diferencias entre la utilización de indicadores de vulnerabilidad por separado y combinados, tanto para predecir la consulta médica como la frecuentación. Un bajo nivel de estudios y la inactividad económica reforzaron en varones la probabilidad de visita médica, mientras que la vulnerabilidad socioeconómica frenó la frecuentación. Conclusiones: Aunque las personas vulnerables visitaron más al médico que las no vulnerables, no trabajar o tener bajos ingresos se correlacionó con una menor frecuencia de visitas, principalmente en mujeres y edades medias de la vida (AU)

Objectives: To analyze the association between socioeconomic vulnerability and use and frequentation of health care attention in a neighbourhood, by using a multidimensional operative definition of socioeconomic vulnerability. Material and Methods: A transversal survey was implemented in Casablanca neighborhood (Zaragoza, Spain). 1032 people were selected by stratified random sampling. Information about demographic and socioeconomic characteristics, health perceived status and health care visits was obtained using a personal survey. Formal educational level, employment status and income level were integrated in unique classification criteria (socioeconomic vulnerability). Health care visits and user profile were described. Socioeconomic determinants of use and frequentation of health care services were studied by regression methods, controlled by three independent measures of socioeconomic vulnerability and by a single integrative indicator. Results: 30% Casablanca neighbors used health care resources during the two weeks previous to the interview. The user profile was: women, older than 60 years, with low self-rated health and diagnosed illnesses. Vulnerable people used medical resources with higher frequency than non-vulnerable people did, and a higher association was found in men. Statistically significant differences could be observed among the three socioeconomic independent measures, and the integrative unique vulnerability measure. For men, low formal educational level and unemployment predicted health care visit. However, socioeconomic vulnerability does not imply greater demand for health care. Conclusions: Although vulnerable people used with higher frequency the sanitary services than the non-vulnerable, unemployment and low income was correlated with a low frequency of visits, mainly in women and middle aged (AU)

Assessing the adequacy of the HL7/LOINC Document Ontology Role axis.

The healthcare landscape is changing, driven by innovative care models and the emergence of new roles that are inter-professional in nature. Currently, the HL7/LOINC Document Ontology (DO) aids the use and exchange of clinical documents using a multi-axis structure of document attributes for Kind of Document, Setting, Role, Subject Matter Domain, and Type of Service. In this study, the adequacy of the Role axis for representing the type of author documenting care was assessed. Experts used a master list of 220 values created from seven resources and established mapping guidelines. Baseline certification, licensure, and didactic training were identified as key parameters that define roles and hence often need to be pre-coordinated. DO was inadequate in representing 82% of roles, and this gap was primarily due to lack of granularity in DO. Next steps include refinement of the proposed schema for the Role axis and dissemination within the larger standards community.

Professional development is enhanced by serving as a mini-CEX preceptor.

INTRODUCTION: The mini-clinical evaluation exercise (mini-CEX) is widely used for the evaluation of medical trainees' clinical competence. To our knowledge, no study has examined the effect of mini-CEX on the preceptors. Based on the principle of "to teach is to learn twice," we hypothesized that the act of precepting a mini-CEX would enhance preceptors' own learning and performance. METHODS: A 21-item questionnaire incorporating the 3 out of 4 levels of Kirkpatrick's model was completed by experienced mini-CEX preceptors. Data collected from the questionnaire included ratings of Kirkpatrick's level of "Reaction" (level 1) and "Behavior" (level 3) and the frequencies of relearning the clinical skills related to mini-CEX, which assessed Kirkpatrick's "Learning" (level 2). RESULTS: A majority of the respondents either strongly agreed or agreed that precepting the mini-CEX both increased reflection on their own clinical practice and had a positive impact on their clinical skills. More than 80% of preceptors reported relearning one or more of the mini-CEX clinical skills. Experienced preceptors relearned the clinical skills more frequently than the less experienced preceptors. About one-third of respondents indicated that being a preceptor of mini-CEX increased both self-confidence and health care quality in their own clinical practice. DISCUSSION: These findings provide preliminary evidence suggesting that participating as a preceptor in a mini-CEX has a positive impact on the preceptor's professional development. Further studies are needed, including analyzing mechanisms of mini-CEX on the clinical skills of preceptor, and assessing whether similar effects can be observed in other teaching hospitals in different cultural contexts.

Establishing cause for developing and implementing a broad-based marketing effort for the health education field.

What exactly is health education? Professionals with advanced degrees in health education have most likely encountered questions such as these either during introductory coursework or from those inquiring about the field. These queries can prove quite perplexing when asked by individuals who are unaware of the health education profession. Because the act of marketing health education is crucial to the sustainability of the field, the purpose of this article is to (a) explore the issue of describing and promoting health education, (b) establish ideas that can facilitate the provision of coordinated marketing efforts, and (c) offer marketing management and implementation principles that can assist in marketing both health education and health educators. Based on this discussion, the authors suggest building mainstream consensus in regards to marketing message development and implementation to better position health education.

The taxonomy of professionalism: reframing the academic pursuit of professional development.

Student professionalism continues to be an elusive goal within colleges and schools of pharmacy. Several reports have described the nature of professionalism and enumerated the characteristic traits of a professional, but educational strategies for inculcating pharmacy students with attitudes of professionalism have not been reliably effective. Some authors have suggested the need for a standard definition. If the goal can be more clearly conceptualized by both faculty members and students, and the moral construct of the fiduciary relationship between pharmacist and patient better understood, the development of professional values and behaviors should be easier to achieve. This paper describes a new approach to defining professionalism that is patterned after Bloom's Taxonomy of Educational Objectives. It includes the general concept of patient care advocacy as an underlying paradigm for a new pharmacy practice model, and defines 5 behavioral elements within each of the 3 domains of professionalism: competence, connection, and character.

The scope of naturopathic medicine in Canada: an emerging profession.

In Canada, naturopathic medicine is an emerging profession that is gaining formal recognition, including provincial/territorial regulation. While naturopathic medicine has undergone significant growth and legitimization, it still faces substantial challenges to acceptance as a full-fledged health care profession within the Canadian health care system. For example, professionalization theories indicate the importance of clear professional boundaries as well as the need for 'new' groups to find a place in the system of professions. This has been problematic for naturopathic practitioners who continue to practice within a broad scope of practice that encompasses many different therapeutic modalities. Development of statutory regulation also requires delineation of a specific, well-defined scope of practice. The purpose of this study was to describe naturopathic practitioners' perception of their training and their current scope of practice. Two thirds (n = 315) of all licensed Canadian naturopathic practitioners responded to the survey. The results showed that naturopathic practitioners are trained in, and practice, a wide range of therapeutic modalities and diagnostic procedures. Practitioners disagreed about their scope of practice, as 57% thought it was too restrictive, 31% felt it was about right and 13% thought it was too broad. A large majority felt there was some or a great deal of overlap with other practitioners' scope of practice. We conclude that multiple challenges are facing naturopathic medicine, including scope of practice, overlap with other professions, social closure, scarcity of vacancies and lack of cohesion. The future of naturopathic medicine will depend on how effectively the profession will use available strategies to overcome barriers to statutory self-regulation.

Training for terrorism-related conditions in hospitals: United States, 2003-04.

OBJECTIVE: This study estimates baseline data to determine which hospital characteristics are associated with providing terrorism preparedness training to clinical staff. METHODS: Information from a Bioterrorism and Mass Casualty Supplement to the 2003 and 2004 National Hospital Ambulatory Medical Care Surveys was used to provide national estimates of variations in terrorism preparedness training by eight hospital characteristics. Of 874 hospitals in scope, 739 (84.6 percent) responded. Estimates are presented with 95 percent confidence intervals. RESULTS: Hospitals with Joint Commission accreditation were more likely to provide terrorism preparedness training to all types of clinical staff (staff physicians, residents, nurse practitioners, physician assistants, and laboratory staff). Teaching hospitals, medical school affiliation, bed capacity, and urban location were also associated with training staff physicians, residents, nurse practitioners, and physician assistants. Hospitals with residency programs were associated with training only staff physicians and residents. There was more parity across hospital characteristics in training nurses and laboratory staff than for physicians, residents, nurse practitioners, and physician assistants. Joint Commission accreditation was the most consistent factor associated with providing training for all nine exposures studied (smallpox, anthrax, chemical and radiological exposures, botulism, plague, tularemia, viral encephalitis, and hemorrhagic fever).

El burnout en los profesionales sanitarios: una aproximación bibliométrica / Burnout in the healthcare setting: a bibliometric approach

Objetivo: El objetivo de este estudio es integrar los datos acumulados sobre burnout (BO), para iniciar un proceso de planificación de riesgos psicosociales en el ámbito sanitario. Para ello nos hemos propuesto determinar cuantitativamente: (a) las tendencias de productividad y (b) el perfil genérico de los estudios sobre burnout en personal sanitario. Método: Se han utilizado procedimientos derivados del análisis bibliométrico y de las técnicas de análisis de contenido. El tratamiento de los datos se ha realizado con el gestor bibliográfico EBLA 3.0 y el paquete de análisis estadístico SPSS 11.0. Resultados: Se han seleccionado 11.620 registros en un período de revisión situado entre 1990 y 2001. La mayor parte de los autores y más de la mitad de las revistas indexadas tan sólo han publicado un artículo durante el intervalo considerado. Muchas de esas publicaciones van dirigidas al sector de la enfermería, y no examinan la profesión médica. Analizando el contenido de los resúmenes se observa que casi las dos terceras partes aportan datos empíricos al estudio del BO, el 90 por ciento de los cuales analiza su impacto, el 6 por ciento evalúa tratamientos y sólo el 3,6 por ciento desarrolla instrumentos para su medición. Conclusiones: El perfil predominante de la producción sobre BO en personal sanitario es el trabajo empírico, encaminado a evaluar factores de riesgo, prevalencia o consecuencias del síndrome, basado en un diseño transversal y realizado con muestras inferiores a los 200 casos. La profesión sanitaria más presente en la literatura científica hasta el momento es la enfermería (AU)

Linking Appraisal of On-the-Job Professional Competencies with Education

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An interprofessional problem-based learning course on rehabilitation issues in HIV.

This study examined students' perceptions of their learning through participation in an interprofessional problem-based course on rehabilitation and HIV. Students representing five health professions participated in an eight-week tutorial course. Qualitative analysis of journals that the students completed throughout the course, and of interviews of the students at completion of the course, revealed that they valued their learning experience. Students gained an appreciation of the roles of others and developed a sense of confidence through justifying their professional role. Through the interprofessional discussions, students were able to increase the breadth and depth of their learning and also gained a rehabilitation perspective. Learning related to HIV and rehabilitation is ideally suited to an interprofessional, problem-based environment.

No care for the caregivers: declining health insurance coverage for health care personnel and their children, 1988-1998.

OBJECTIVES: This study examined trends in health insurance coverage for health care workers and their children between 1988 and 1998. METHODS: We analyzed data from the annual March supplements of the Current Population Survey (CPS), a Census Bureau survey that collects information about health insurance from a nationally representative sample of noninstitutionalized US residents. RESULTS: Of the health care personnel younger than 65 years, 1.36 million (90% confidence interval [CI] = 1.28 million, 1.45 million) were uninsured in 1998, up 83.4% from 1988; the proportion uninsured rose from 8.4% (90% CI = 7.8%, 9.1%) to 12.2% (90% CI = 11.5%, 12.9%). Declining coverage rates in the growing private-sector health care workforce---and declining health employment in the public sector, which provided health insurance benefits to more of its workers---accounted for the increases. Households with a health care worker included 1.12 million (90% CI = 1.05 million, 1.20 million) uninsured children, accounting for 10.1% (90% CI = 9.5%, 10.8%) of all uninsured children in the United States. CONCLUSIONS: Health care personnel are losing health insurance coverage more rapidly than are other workers. Increasingly, the health care sector is consigning its own workers and their children to the ranks of the uninsured.

Classificação Brasileira de Ocupações ­ 2002 perspectivas para análise do mercado de trabalho em Saúde com o foco na Enfermagem / Brazilian Classification of Occupations ­ 2002 perspectives for analysis of labor market in Health focusing on Nursing

Resumo: A Classificação Brasileira de Ocupações (CBO) é um documento que reconhece, nomeia e codifica títulos e conteúdos das ocupações do mercado de trabalho brasileiro. Tem como função, tanto servir como instrumento básico de informação para indicar a conformação do mercado de trabalho, como para definição e execução de políticas e programas de equilíbrio deste mercado. Destina-se ao desenvolvimento de estudos e pesquisas sobre mercado de trabalho, política de emprego e de formação profissional, orientação para definição e investimentos tecnológicos e como base informativa para os censos demográficos. Neste artigo buscou-se estabelecer uma comparação entre a CBO 1994 e a CBO 2002, focando a atenção nas ocupações da saúde. Resgatou-se, em parte, a sua historicidade, a justificativa de sua atualização bem como a metodologia utilizada neste processo. Foram feitos destaques nas mudanças estruturais observados na nova CBO, particularmente aquelas que poderiam interferir na análise das ocupações da saúde. O estudo procurou estabelecer um paralelo entre os títulos ocupacionais da saúde que são referidos no mercado de trabalho com as especialidades reconhecidas pelos órgãos reguladores do exercício das profissões. Colocou em destaque as ocupações da área de Enfermagem, apontando os sinais indicativos de mudanças na configuração deste mercado. Pretendeu, assim, por fim, evidenciar as mudanças mais significativas que podem sinalizar transformações no mercado de trabalho em saúde, centrando a análise nas ocupações de enfermagem e levantando questões prospectivas sobre o conjunto destas ocupações(AU)

Abstract: The Brazilian Classification of Occupation is a document that recognizes, assigns and codifies titles and contents to the Brazilian labor market occupations. It is aimed at serving as basic information tool for pointing out the labor market conformation, as well as at defining and executing policies and programs on balance to that market. It is addressed to the development of studies and researches on labor market, job policy and professional qualification, guidance for the technological definition and investments, as well as an informative basis for demographic pools. This article seeks for establishing a comparison between the 94 and the 2002 Brazilian Classification of Occupation, focusing the attention on health field occupations. It has partially rescued CBO history, the rationale for its updating, as well as the methodology used for such process. It stressed out significant structural changes observed in the new BCO, especially those that might come to interfere on the analysis on health occupations. The study pursued tracing a parallel between the health occupational titles referred to in the labor market, and the specialties recognizes by the regulating bodies for exercising the professions. The nursing field was highlighted, pointing out those signals indicating changes on the configuration of such market. Finally, it intended to evidence the most significant changes that may point out changes in the health labor market, focusing the analysis on nursing occupations and raising prospective issues on the set of such occupations.(AU)

Risk of exposure to bloodborne infection for Italian healthcare workers, by job category and work area. Studio Italiano Rischio Occupazionale da HIV Group.

OBJECTIVE: To analyze the rate of occupational exposure to blood and body fluids from all sources and specifically from human immunodeficiency virus (HIV)-infected sources among hospital workers, by job category and work area. DESIGN: Multicenter prospective study. Occupational exposure data (numerator) and full-time equivalents ([FTEs] denominator) were collected over a 5-year period (1994-1998) and analyzed. SETTING: 18 Italian urban acute-care hospitals with infectious disease units. RESULTS: A total of 10,988 percutaneous and 3,361 mucocutaneous exposures were reported. The highest rate of percutaneous exposure per 100 FTEs was observed among general surgery (11%) and general medicine (10.6%) nurses, the lowest among infectious diseases (1.1%) and laboratory (1%) physicians. The highest rates of mucocutaneous exposure were observed among midwives (5.3%) and dialysis nurses (4.7%), the lowest among pathologists (0%). Inadequate sharps disposal and the prevalence of sharps in the working unit influence the risk to housekeepers. The highest combined HIV exposure rates were observed among nurses (7.8%) and physicians (1.9%) working in infectious disease units. The highest rates of high-risk percutaneous exposures per 100 FTE were again observed in nurses regardless of work area, but this risk was higher in medical areas than in surgery (odds ratio, 2.1; 95% confidence interval, 1.9-2.5; P<.0001). CONCLUSION: Exposure risk is related to job tasks, as well as to the type and complexity of care provided in different areas, whereas HIV exposure risk mainly relates to the prevalence of HIV-infected patients in a specific area. The number of accident-prone procedures, especially those involving the use of hollow-bore needles, performed by job category influence the rate of exposure with high risk of infection. Job- and area-specific exposure rates permit monitoring of the effectiveness of targeted interventions and control measures over time.