Continuing Professional Development in Response to COVID-19: Knowledge Mobilization for Occupational Therapy and Physiotherapy via a Curated Web Site.

Purpose: Once the COVID-19 pandemic was declared, clinicians were redeployed to prepare for increased hospitalizations. This disruption necessitated rapid continuing professional development (CPD) resources for health care providers. This mixed-method study explored the experiences of occupational therapists and physiotherapists who accessed a CPD Web site that provided educational resources related to the pandemic to refresh their clinical knowledge and skills. Methods: Faculty from the Michener Institute of Education at the University Health Network and University of Toronto along with 60 collaborators created a Web site to support the need for rapid CPD. An occupational therapist and physiotherapist advisory group informed the evolving design of the occupational therapy and physiotherapy content. Results: In the occupational therapy profession 535 users created an account between April and November 2020 (236 practicing, 283 students, and 16 did not specify) and in the physiotherapy profession 829 created an account (532 practicing, 278 students and 19 did not specify). Each user viewed an average of 53 Web pages. Three themes emerged: (1)To prepare for practice changes, clinicians value a single repository of information; (2) Web site features can either facilitate or hinder access to the needed information; and (3) Participants described diverse learning needs. Conclusions: The Web site design features assisted participants in preparing for redeployment and patient care. Features to encourage self-directed learning, such as the grouping of relevant topics and self-check quizzes, can enhance the user experience.

Objectif: lorsque la pandémie de COVID-19 s'est déclarée, les cliniciens ont été redéployés pour se préparer à une recrudescence d'hospitalisations. Ce bouleversement a exigé la prestation rapide de ressources de perfectionnement professionnel continu (PPC) aux dispensateurs de soins. La présente étude à méthodologie mixte a exploré les expériences des ergothérapeutes et des physiothérapeutes qui ont accédé à un site Web de PPC contenant des ressources de formation liées à la pandémie pour mettre leurs connaissances et habiletés cliniques à niveau. Méthodologie: les professeurs du Michener Institute of Education du Réseau universitaire de santé et de l'Université de Toronto et 60 collaborateurs ont créé un site Web pour répondre au besoin de PPC rapide. Un groupe consultatif d'ergothérapeutes et de physiothérapeutes a éclairé la conception évolutive de la matière en ergothérapie et en physiothérapie. Résultats: En ergothérapie, 535 utilisateurs ont créé un compte entre avril et novembre 2020 (236 en exercice, 283 étudiants et 16 ne l'ont pas précisé) et en physiothérapie, ce chiffre est passé à 829 (532 en exercice, 278 étudiants et 19 ne l'ont pas précisé). Chaque utilisateur a visualisé une moyenne de 53 pages Web. Trois thèmes ont émergé : 1) pour se préparer aux changements de pratique, les cliniciens préfèrent un seul centre d'information; 2) les caractéristiques du site Web peuvent soit faciliter, soit freiner l'accès à l'information nécessaire et 3) les participants ont décrit des besoins d'apprentissage diversifiés. Conclusions: les caractéristiques de conception du site Web ont aidé les participants à se préparer au redéploiement et aux soins des patients. Des caractéristiques visant à encourager l'apprentissage autonome, comme le regroupement des sujets pertinents et les questionnaires d'autoévaluation, peuvent optimiser l'expérience de l'utilisateur.

Measuring the added value of virtual communities of practice for developing the educator role of critical care professionals.

In healthcare settings, workplace learning is often supported by clinicians who strive to combine service provision and educator roles. We evaluated an international 12-month programme that supports widely distributed critical care health professional educators (HPEs) through a virtual community of practice (vCoP). Specifically, we evaluate if and how the vCoP approach affects learning experiences using an innovative evaluation framework in medical education-the value-creation framework (VCF). We used a mixed-methods approach to evaluation, including an anonymous survey and semistructured interviews. Themes from data sources were identified using the VCF as the common thread. Themes discussed by at least two-thirds of interview participants were analysed using narrative inquiry. 27 of 66 participants responded to the survey, and 15 participated in interviews. Positive and negative indicators of value creation were extracted and organised according to the framework's eight value cycles. Framework analysis made value-creation and potential flow-on effects in one value-creation cycle to another visible, offering insight into relationships. Themes from narrative inquiry elaborated on the results of the framework analysis. Using the VCF to evaluate the Incubator programme brings to bear the complexity of boundary-crossing HPE faculty development for critical care educators. The framework can be a valuable tool for evaluating a vCoP associated with faculty development programmes.

Improving healthcare student experience of clinical placements.

There is an expanding workforce gap in the NHS. Alongside national programmes to train, recruit and retain staff, efforts are needed on a local level. Clinical placements can make up to a third of healthcare student's time while at university thus placement experience is an important factor to reducing attrition rates at universities and increase conversion rates from student to qualified professional. This quality improvement project aimed to increase reported rates of students' satisfaction to 100% for each item of the student experience survey by March 2024 within Berkshire Healthcare National Health Service (NHS) Foundation Trust.To gain a deeper understanding of the experience and problems within healthcare student clinical placements interviews of students and staff were conducted alongside a literature review, which revealed six key themes around student placement experience: belonging and acceptance, familiarity and continuity, confidence and competence, preparation and preparedness, supervision and support, feeling overwhelmed/stress/impact on social and emotional health. These themes were translated into a student experience survey to achieve baseline and subsequent measurements.Changes were introduced to improve student satisfaction with clinical placements based on the baseline data of student satisfaction reported in the first student experience survey. Changes included introducing student inductions, better access to IT, student induction packs and newsletters. While the quantitative measurements of the items on the student experience survey remained positive, the nature of the qualitative feedback reflected the impact of the changes. Additionally, the improved communication and collaboration across teams because of the process highlighted the need for clear streamlined administrative processes. Regular review of student feedback has enabled timely feedback processes to placements and visible follow-up for students, highlighting the investment in them as the future workforce.

Interactive clinical supervision training added to self-education leads to small improvements in the effectiveness of clinical supervision of physiotherapists: a randomised trial.

QUESTION: Does adding an interactive clinical supervision training program to self-education improve the effectiveness of clinical supervision of physiotherapists, reduce burnout, decrease intention to leave and increase participation in clinical supervision? DESIGN: Randomised controlled trial with concealed allocation, assessor blinding and intention-to-treat analysis. PARTICIPANTS: Physiotherapists (n = 58) working at a publicly funded health service. INTERVENTION: Participants in both groups received a self-education clinical supervision training package. In addition, participants in the experimental group received interactive clinical supervision training consisting of three 90-minute workshops. OUTCOME MEASURES: The primary outcome measure was effectiveness of clinical supervision 4 months after training measured using the Manchester Clinical Supervision Scale (MCSS-26). Secondary outcomes were the Maslach Burnout Inventory, the Intention to Leave Scale, and participation in supervision. Focus groups were also used to gauge impressions of the intervention. RESULTS: The addition of interactive clinical supervision training slightly improved effectiveness of clinical supervision, with a between-group mean difference of 6.3 units (95% CI 0.3 to 12.3) on the MCSS-26. The estimate of the effect on the proportion of physiotherapists reporting effective clinical supervision (ie, MSCC-26 score ≥ 73) was unclear (OR 1.97, 95% CI 0.50 to 7.81). Physiotherapists in the experimental group reported slightly lower levels of depersonalisation (MD -3.0 units, 95% CI -4.6 to -1.3). There were negligible or uncertain effects on the other burnout domains, intention to leave and participation in clinical supervision. Qualitatively, participants reported that the workshops made them realise that supervisees could take greater ownership of where supervision focused. CONCLUSION: Adding interactive clinical supervision training to self-education leads to small improvements in the effectiveness of clinical supervision of physiotherapists. REGISTRATION: osf.io/yz3kx.

Characterization of teaching-learning tutors in public health services and topics of interest for their work / Caracterización de los tutores de enseñanza-aprendizaje en los servicios de salud pública y temas de interés para su actuación / Caracterização dos tutores de ensino-aprendizagem em serviços públicos de saúde e temas de interesse para atuação

ABSTRACT Objective: To describe the profile of teaching-learning tutors in public health services and investigate which topics are of greatest interest in development spaces for these actors. Method: Cross-sectional study. Eligible tutors of Health Care Planning. Data collection using an electronic questionnaire composed of closed questions on sociodemographic characteristics, training and performance. Chi-square test used to compare proportions according to tutor typologies. Results: A total of 614 tutors worked in Brazil's five geographic regions, the majority in primary care (82%), followed by state/regional work (13%) and specialized outpatient care (5%). The majority reported being female, of brown skin color, from the nursing field, having worked as a tutor for less than a year, and with no previous experience in preceptorship or similar. The most important topics were Health Care Networks, risk stratification for chronic conditions and the functions of specialized outpatient care. Conclusion: The predominance of certain characteristics among tutors was identified, with differences between the types of work. The findings can support managers in the process of selecting and developing tutors in Health Care Planning.

RESUMEN Objetivo: Describir el perfil de los tutores de enseñanza-aprendizaje de los servicios de salud pública e investigar los temas de mayor interés en espacios de desarrollo de estos actores. Método: Se trata de un estudio transversal con Tutores Elegibles de Planificación de la atención en salud; con datos recopilados mediante cuestionario electrónico de preguntas cerradas sobre características sociodemográficas, formación y actuación. Se utilizó la prueba de Chi-cuadrado para comparar las proporciones según las tipologías del tutor. Resultados: Se consideraron 614 tutores que trabajaban en las cinco regiones geográficas del Brasil, la mayoría en Atención Primaria (82%), seguido de actuación estatal/regional (13%) y Atención Ambulatoria Especializada (5%). La mayoría declaró ser mujer, de piel morena, del ámbito de la enfermería, con menos de un año de actuación como tutora y sin experiencia previa como preceptora o similar. Los temas más importantes fueron las Redes de la Atención en Salud, la estratificación del riesgo de las enfermedades crónicas y el papel de la Atención Ambulatoria Especializada. Conclusión: Se identificó el predominio de ciertas características entre los tutores, distintas según los tipos de actuación. Las conclusiones pueden servir de apoyo a los gestores en el proceso de selección y desarrollo de los tutores en Planificación.

RESUMO Objetivo: Descrever o perfil de tutores de ensino-aprendizagem em serviços públicos de saúde e investigar quais são os temas de maior interesse em espaços de desenvolvimento desses atores. Método: Estudo transversal. Elegíveis tutores da Planificação da Atenção à Saúde. Coleta de dados por questionário eletrônico composto por questões fechadas sobre características sociodemográficas, formação e atuação. Teste Qui-quadrado utilizado para comparar proporções segundo tipologias de tutor. Resultados: Considerados 614 tutores, que atuavam nas cinco regiões geográficas brasileiras, sendo a maioria na Atenção Primária (82%), seguido por atuação estadual/regional (13%) e na Atenção Ambulatorial Especializada (5%). A maioria referiu ser mulher, de cor da pele parda, da área de enfermagem, atuação como tutor há menos de 1 ano, e sem experiência prévia em preceptoria ou similar. Temas considerados mais importantes destacam-se Redes de Atenção à Saúde, estratificação de risco de condições crônicas e funções da Atenção Ambulatorial Especializada. Conclusão: Identificou-se a predominância de algumas características entre tutores, com diferenças entre as tipologias de atuação. Os achados podem apoiar gestores no processo de seleção e desenvolvimento de tutores na Planificação.

Qualification of Prenatal Care and Management in the Context of Primary Health Care

Introduction: Collaboration between different health professionals is essential to ensure safe and quality prenatal care and favorable birth outcomes. Objective: To describe interprofessional prenatal care and management strategies in the context of primary health care. Materials and method: Qualitative research conducted between August and December 2022. Data was collected using an instrument to analyze the content of infographics produced by 26 professionals working in primary health care in southern Brazil, as an evaluation activity for a qualification course. The content of the infographics was analyzed using the coding process proposed by Minayo. Results: The data analyzed enabled three thematic categories to be identified: "The necessary intersectoral and interprofessional coordination;" "Responsibilities built and shared between pregnant women and professionals;" "Planning and qualification of workflows and processes." Conclusions: Interprofessional prenatal care and management strategies in the context of primary health care are associated with overcoming fragmented and dichotomous approaches, as well as the prospect of more participatory, dialogic, and interactive prenatal care and management processes, with the inclusion of various health actors.

Introducción: la colaboración entre diferentes profesionales del área de la salud es esencial para garantizar atención prenatal segura y de calidad, y resultados favorables en el parto. Objetivo: describir estrategias interprofesionales de la gestión y atención prenatal en el contexto de la atención primaria de salud. Materiales y método: investigación cualitativa realizada entre agosto y diciembre de 2022. Los datos se recogieron mediante un instrumento de análisis del contenido de infografías producidas por 26 profesionales que trabajan en la atención primaria de salud en el sur de Brasil, como actividad de evaluación de un curso de cualificación. El contenido de las infografías se analizó mediante el proceso de codificación propuesto por Minayo. Resultados: los datos analizados permitieron identificar tres categorías temáticas: "La necesaria coordinación intersectorial e interprofesional"; "Responsabilidades construidas y compartidas entre gestantes y profesionales"; "Planificación y cualificación de flujos y procesos de trabajo". Conclusiones: las estrategias interprofesionales de gestión y atención prenatal en el contexto de la atención primaria de salud se asocian a la superación de enfoques fragmentados y dicotómicos, así como a la perspectiva de procesos de gestión y atención prenatal más participativos, dialógicos e interactivos con la inclusión de diversos actores de la salud.

Introdução: a colaboração entre os diversos profissionais da saúde é essencial para garantir um pré-natal seguro e de qualidade, bem como desfechos favoráveis no parto. Objetivo: descrever estratégias interprofissionais de gestão e atenção pré-natais no contexto da atenção primária à saúde. Materiais e método: pesquisa qualitativa realizada entre agosto e dezembro de 2022. Os dados foram coletados a partir de um instrumento de análise do conteúdo de infográficos produzidos por 26 profissionais que atuam na atenção primaria à saúde, no sul do Brasil, como atividade avaliativa de um curso de qualificação. O conteúdo dos infográficos foi analisado com base no processo de codificação proposto por Minayo. Resultados: os dados analisados possibilitaram a delimitação de três categorias temáticas: "A necessária articulação intersetorial e interprofissional"; "Responsabilidades construídas e compartilhadas entre gestantes e profissionais"; "Planejamento e qualificação dos fluxos e dos processos de trabalho". Conclusões: as estratégias interprofissionais de gestão e atenção pré-natais no contexto da atenção primária à saúde estão associadas à superação de abordagens fragmentadas e dicotômicas, bem como à prospecção de processos de gestão e atenção pré-natais mais participativos, dialógicos e interativos, com a inclusão dos diversos atores da saúde.

Contribuições da educação permanente para os conselhos de saúde: um estudo de revisão integrativa / Contributions of continuingeducation tothehealth councils: an integrative review study / Contribuciones de la educación continua a los consejos de salud: un estudio de revisión integradora

Introdução:Aeducação permanente propicia uma reflexão contínua frente à realidade posta e nos instiga a buscar soluções criativas para a superação dos problemas de saúde e, por conseguinte, qualificar as ações dos conselheiros de saúde, no intuito de aumentar a resolubilidade, a qualificação técnica e a eficiência do sistema de saúde.Objetivo:Analisar as contribuições da educação permanente para os Conselhos de Saúde.Metodologia:Trata-se de uma revisão integrativa da literatura científicaguiada pelo checklistIndicativos de Qualidade para Artigos de Revisão Integrativa, realizada em julho de 2021 e atualizada em junho de 2023.Resultados:Os 15 artigos incluídos na amostra final versam, em sua maioria, sobre os Conselhos Municipais de Saúde (73%), são decorrentes de estudos realizados no Sudeste do Brasil (60%) e foram publicados nos últimos vinte anos, com maior frequência em 2011 (20%). As congruências identificadas nos artigos foram organizadas em três categorias: 1) O papel do conselheiro de saúde; 2) Desafios encontrados no exercício do controle social; 3) A qualificação para o aperfeiçoamento dos processos decisórios dos Conselhos de Saúde. Os achados do estudo mostram que a falta de conhecimentos específicos e a ausência de ações de educação permanente para os conselheiros de saúde dificultam os processos decisórios e deliberativos dos Conselhos de Saúde.Conclusões:As consequências da falta de conhecimento sobre os temas pertinentes ao exercício do controle social têm grande influência na condução de políticas públicas e do sistema de saúde no Brasil (AU).

Introduction:Continuing education provides continuous reflection in the face of the imposed reality and encourages us to seek creative solutions to overcome health problems and, consequently, qualify the actions of health counselors, in order to increase solvability, technical qualification and efficiency of the health system. Objective:To analyze the contributions of continuing education to the Health Councils.Methodology:This is an integrative review of the scientific literature guided by the Quality Indicators forIntegrative Review Articles checklist, carried out in July 2021 and updated in June 2023. Results:Most of the 15 articles included in the final sample are about Municipal Health Councils (73%), are the result of studies carried out in the southeast of Brazil (60%) and were published in the last 20 years, most frequently in 2011 (20%). The congruences identified in the articles were organized into three categories: 1) The role of the health counselor; 2) Challenges found in the exercise of social control; 3) The qualification for the improvement of the decision-making processes of the Health Councils. The study findings show that the lack of specific knowledge and the absence of continuing education actions for health counselors hinder the decision-making and deliberative processes of the Health Councils. Conclusions:The consequences of the lack of knowledge about issues related to the exercise of social control have a great influence on the conduct of public policies and the health system in Brazil (AU).

Introducción: La educacióncontinua proporciona una reflexión continua frente a la realidad planteada y nos impulsa a buscar soluciones creativaspara superar los problemas de salud y, por lo tanto, calificar las acciones de los consejeros de salud, con el fin de aumentar la resolutividad, la calificación técnica y la eficiencia del sistema de salud. Objetivo: Analizar las contribuciones de la educación continua a los Consejos de Salud.Metodología: Esta es una revisión integradora de la literatura científica guiada por la lista de verificación Indicadores de Calidad para Artículos de Revisión Integradora, realizada en julio de 2021 y actualizada enjunio de 2023. Resultados: Los 15 artículos incluidos en la muestra final son en su mayoría sobre Consejos Municipales de Salud (73%), son resultado de estudios realizados en el Sudeste de Brasil (60%) y fueron publicados en los últimos 20 años, con mayorfrecuencia en 2011 (20%). Las congruencias identificadas en los artículos fueron organizadas en tres categorías: 1) El papel del consejero de salud; 2) Desafíos encontrados en el ejercicio del control social; 3) La capacitación para la mejora de los procesos de toma de decisiones de los Consejos de Salud. Los hallazgos del estudio muestran que la falta de conocimientos específicos y la ausencia de acciones de educación continua para los consejeros de salud dificultan la toma de decisiones y los procesos deliberativos de los Consejos de Salud.Conclusiones: Las consecuencias de la falta de conocimiento sobre cuestiones relacionadas con el ejercicio del control social tienen una gran influencia en la conducción de las políticas públicas y el sistema de salud en Brasil (AU).

Educação permanente em saúde sobre estomias intestinais com enfermeiros de São Bento do Sul (SC): relato de experiência / Permanent health education on intestinal ostomy with nurses from São Bento do Sul (SC): Experience report / Educación permanente en salud sobre estomales intestinales con enfermeros de São Bento do Sul (SC): Informe de experiencia

Introdução:No Brasil a pessoa estomizadaé contemplada com diretrizes e políticas públicas, além de ser entendida como uma deficiência, sendo necessário assim um cuidado integral, exigindo do profissional que presta a assistência e/ou orientação educação permanente. Objetivo:Relatar uma experiência sobre cuidados de enfermagem com estomias intestinais aos enfermeiros atuantes na Secretaria Municipal de São Bento do Sul/Santa Catarina Metodologia: Trata-se deum estudo descritivo qualitativo do tipo relato de experiência, que se deu através de capacitação realizada em Junho de 2022, com os enfermeiros que atuam na secretaria municipal de saúde de São Bento do Sul, o qual conta com 44 enfermeiros atuantes em 21 unidades básicas de saúde , com a temática cuidados de enfermagem com estomia de eliminação', tendo o mesmo sido ministrado por enfermeira estomaterapeuta no formato presencial com discussão teórica e prática.Resultados e discussão: O Ministério da Saúde vem incentivando práticas formativas aos profissionais inseridos nos serviços, amparadasna Política Nacional de Educação Permanente. Uma vez que a formação de enfermeiros no Brasil é generalista, os cursos e capacitação se tornam uma ferramenta fundamental para uma atuação reflexiva. Dos 44 enfermeiros atuantes no município, participaram do treinamento 21 (47,72%), atendendo ao critério de ao menos um profissional por UBS, podendo este ser um multiplicador de conhecimento, estratégia importante da educação permanente em saúde. Ao final do curso, foram desenvolvidos fluxos de atendimento com os participantes, buscando a descentralização do cuidado para as unidades básicas de cada enfermeiro, favorecendo a criação de vínculo dos pacientes com a equipe. Conclusões:Umprofissional orientado e seguro em sua prática implica diretamente na segurança do paciente, nesse sentido a realização de atividades como cursos, capacitações e eventos, principalmente quando se trata de pacientes estomizados se tornam importantes ferramentas de aprimoramento profissional (AU).

Introduction:In Brazil, people with a stoma are covered by guidelines and public policies, in addition to being understood as a disability, thus requiring comprehensive care, requiring permanent education from the professional who provides assistance and/or guidance. Objective:To report an experience on nursing care with intestinal ostomies to nurses working at the Municipal Secretariat of São Bento do Sul/Santa Catarina. Methodology:This is a qualitative descriptive study of the experience report type, which took place through training carried out in June 2022, with nurses who work at the municipal health department of São Bento do Sul, which has 44 nurses working in 21 basic health units, with the theme of nursing care with elimination stoma', with the same being taught by a stoma therapy nurse in a face-to-face format with theoretical and practical discussion. Results and discussion:The Ministry of Health has been encouraging training practices for professionals working in services, supported by the National Permanent Education Policy. Since the training of nurses in Brazil is generalist, courses and training become a fundamental tool for reflective action. Of the 44 nurses working in the city, 21 (47.72%) participated in the training, meeting the criteria of at least one professional per UBS, which could be a knowledge multiplier, an important strategy for continuing health education. At the end of the course, care flows were developed with the participants, seeking to decentralize care to each nurse's basic units, favoring the creation of a bond between patients and the team.Conclusion: A professional who is oriented and confident in his practice directly implies patient safety, in this sense, carrying out activities such as courses, training and events, especially when dealing with stoma patients, become important tools for professional improvement (AU).

Introducción:En Brasil, las personas ostomizadasestán cubiertas por directrices y políticas públicas, y entendidas como una discapacidad, por lo que requieren atención integral y profesionales que brinden asistencia y/o orientación en educación continua. Objetivo:Relatar la experiencia como enfermerostrabajando en la Secretaría Municipal de São Bento do Sul/Santa Catarina en la atención de ostomías intestinales. Metodología:Estudio cualitativo descriptivo, del tipo relato de experiencia, realizado a través de una capacitación realizada en junio de 2022, con cuarenta y cuatro enfermeros que actúan en la Secretaría Municipal de Salud de São Bento do Sul, con el tema "Asistencia de enfermería a la eliminación del estoma". Impartido por una enfermera estomatóloga en formato presencial con discusión teórica y práctica. Resultados y discusión:El Ministerio de Salud viene incentivando prácticas de formación de profesionales que actúan en los servicios, apoyados en la Política Nacional de Educación Permanente. Dado que la formación de enfermeros en Brasil es generalista, los cursos y capacitaciones se convierten en una herramienta fundamental para la acción reflexiva. De los 44 enfermeros que actúan en la ciudad, 21 (47,72%) participaron de la capacitación, cumpliendo con el criterio de al menos un profesionalpor UBS, lo que podría ser un multiplicador de conocimientos, una estrategia importante para la educación continua en salud. Al final del curso, se desarrollaron flujos de atención con los participantes, buscando descentralizar la atención hacia las unidades básicas de cada enfermero, favoreciendo la creación de vínculo entre los pacientes y el equipo. Conclusiones:Un profesional orientado y confiado en su práctica implica directamente la seguridad del paciente, en este sentido, la realización de actividades como cursos, capacitaciones y eventos, especialmente cuando se trata de pacientes estomáticos se convierten en importantes herramientas de superación profesional (AU).

Continuing education for forensic medical analysis of the constitutional appeals in Costa Rica / Formação acadêmica contínua para análise médico forense de recursos de amparo na Costa Rica / Formación académica continua para el análisis médico forense de recursos de amparo en Costa Rica

Introduction: Judicially demanding the right to health involves different elements and can lead to changes in continuing education programs. The current trend is to follow this pathway to access low-frequency and high-cost medications. In addition, the Constitutional Court of Costa Rica requests a technical concept from forensic doctors. Objective: To raise the need for continuous updating in specific theoretical-practical academic knowledge required by forensic doctors to guarantee the right to health services. Reflection: The training of forensic medical doctors is focused on evidence and encourages continuous education. Nevertheless, a commitment is necessary in continuing medical education programs such as literature search strategies, critical assessment of evidence, and academic practices that incorporate particular circumstances comparing them with scientific studies. These programs must take into account prevalent medications and pathologies as well as technical-scientific factors that differ in each service provider. Conclusion: A continuing education program about the interpretation and assessment of scientific evidence for proper decision making on health issues would allow medical doctors to judge existing health problems and choose a medication that is the most beneficial for a patient.

Introducción: La judicialización del derecho a la salud involucra a distintos actores y puede propiciar cambios en programas de educación continua; pues la tendencia actual es recurrir a esta vía para acceder a medicamentos de baja frecuencia y alto costo. Adicionalmente, en Costa Rica la Sala Constitucional solicita el criterio técnico a médicos forenses. Objetivo: Plantear la necesidad de actualización continua en conocimientos académicos teóricos-prácticos específicos que requiere el médico forense para garantizar el derecho a los servicios de salud. Reflexión: El médico forense cuenta con formación basada en evidencias y se incentiva su formación continua, sin embargo, es necesario un compromiso con los programas de educación médica continua: en estrategias de búsqueda de literatura, valoración crítica de la evidencia encontrada y práctica académica que incorpore las circunstancias particulares, comparándolo con los resultados de estudios científicos; tomando en cuenta medicamentos y patologías prevalentes y los factores técnico-científicos de divergencia entre los prestadores de servicios. Conclusión: Un programa de formación continua sobre interpretación y valoración de la evidencia científica para la toma de decisiones en salud, permitiría a estos especialistas responder con mejor criterio si un medicamento es el tratamiento más beneficioso para un paciente debido a sus problemas de salud.

Introdução: A judicialização do direito à saúde envolve diferentes atores e pode promover mudanças nos programas de educação continuada; porque a tendência atual é recorrer a esta via para ter acesso a medicamentos de baixa frequência e alto custo. Além disso, na Costa Rica, o Tribunal Constitucional solicita critérios técnicos aos médicos forenses. Objetivo: Levantar a necessidade de atualização contínua em conhecimentos acadêmicos teórico-práticos específicos que o médico forense necessita para garantir o direito aos serviços de saúde. Reflexão: O médico forense tem formação baseada em evidências e sua formação continuada é incentivada, porém é necessário o compromisso com programas de educação médica continuada: em estratégias de busca bibliográfica, avaliação crítica das evidências encontradas e prática acadêmica que incorpore as circunstâncias particulares , comparando-o com resultados de estudos científicos; levando em consideração medicamentos e patologias prevalentes e fatores técnico-científicos de divergência entre prestadores de serviços. Conclusão: Um programa de formação contínua sobre interpretação e avaliação de evidências científicas para a tomada de decisões em saúde, permitiria a estes especialistas responder com melhores critérios se um medicamento é o tratamento mais benéfico para um paciente devido aos seus problemas de saúde.

Lifelong learning entre profissionais de enfermagem: Desafios contemporâneos / Lifelong learning in nursing: Modern challenges / Lifelong learning entre los profesionales de enfermería: Retos contemporáneos

Resumo Enquadramento: A construção do processo educativo deve ocorrer de forma ininterrupta na trajetória de vida profissional. Objetivo: Refletir sobre os desafios da aprendizagem ao longo da vida (lifelong learning) de profissionais de enfermagem no mundo contemporâneo. Principais tópicos em análise: avanços na prática de enfermagem depende da incorporação de conhecimentos, envolvendo aspetos profissionais, pessoais, culturais e socioeconómicos. Importantes mudanças no saber teórico e prático, exigem maior complexidade nas ações e serviços assistenciais, exigindo dos enfermeiros, aprendizagem para o ajustamento contínuo às novas tecnologias. O processo educativo e a aprendizagem perpassam diferentes gerações, com características e interesses diversos. Enfermeiros precisam de gerir de forma ativa os seus próprios conhecimentos, habilidades e atitudes, compatibilizando exigências e desafios profissionais com qualidade de vida. Conclusão: O profissional inovador reúne habilidades técnicas e comportamentais.O principal desafio é a articulação entre ambiente de trabalho, contexto social e estratégias educacionais, potencializando o sucesso na aprendizagem, resultando em práticas seguras prestadas aos pacientes e à coletividade, colaborando para o alcance da saúde universal.

Abstract Background: Education is a process that must be continuously developed throughout professional life. Objective: To reflect on the challenges of lifelong learning in modern nursing. Main topics under analysis: The advancement of nursing practice depends on integrating professional, personal, cultural, and socioeconomic knowledge. The fundamental changes occurring in theoretical and practical knowledge require more complex care actions and services, which demand that nurses learn to adapt continuously to new technologies. Different generations with distinctive characteristics and interests undergo the learning and educational process. Nurses must actively manage their knowledge, skills, and attitudes and harmonize professional demands and challenges with quality of life. Conclusion: The innovative nursing professional combines technical and behavioral skills. The main challenge is the combination of work environment, social context, and educational strategies, which should stimulate learning success, allow safe care delivery to patients and communities, and contribute to universal health.

Resumen Marco contextual: La construcción del proceso educativo debe producirse de forma ininterrumpida en la trayectoria de la vida profesional. Objetivo: Reflexionar sobre los retos del aprendizaje a lo largo de la vida (lifelong learning) para los profesionales de enfermería en el mundo contemporáneo. Principales temas en análisis: Los avances en la práctica enfermera dependen de la incorporación de conocimientos, que implican aspectos profesionales, personales, culturales y socioeconómicos. Los importantes cambios en los conocimientos teóricos y prácticos exigen una mayor complejidad en las acciones y los servicios asistenciales, lo que requiere que los enfermeros tengan que aprender a adaptarse continuamente a las nuevas tecnologías. El proceso educativo y el aprendizaje atraviesan distintas generaciones, con características e intereses diferentes. Los enfermeros necesitan gestionar activamente sus propios conocimientos, habilidades y actitudes, y compatibilizar las exigencias y los retos profesionales con la calidad de vida. Conclusión: El profesional innovador reúne competencias técnicas y comportamentales. El principal desafío es la articulación entre ambiente de trabajo, contexto social y estrategias educativas, lo que potencia el éxito en el aprendizaje, resulta en prácticas seguras proporcionadas a los pacientes y a la colectividad, y contribuye a alcanzar la universalización de la salud.

Curso de investigación en Atención Primaria de la Salud: experiencia sobre módulo de búsqueda bibliográfica y gestores de citas / Research course in Primary Health Care: experience with the bibliographic search module and citation managers

La Federación Argentina de Medicina Familiar y General apoyó el desarrollo, la difusión y la implementación de una propuesta educativa sobre investigación en atención primaria. Consiste en 4 módulos independientes, destinado para miembros interesados/as, con 2 encuentros virtuales teórico-prácticos, que favorecieran el intercambio de opiniones y experiencias entre colegas. El objetivo del primer módulo fue proporcionar conocimiento, brindar pautas y ofrecer herramientas para la búsqueda bibliográfica y el uso de gestores de citas. Se realizó difusión mediante sociedades y redes sociales. Se incluyó una evaluación individual, que diera cuenta de lectura complementaria y la aplicación práctica de los contenidos. Se llevó a cabo en Junio, con 39 preinscripto/as, mayoritariamente residentes. Hubo 24 participantes efectivos (61%), asistieron 17 y 20 personas respectivamente, y 11 (46%) obtuvieron el certificado de aprobación por responder la consigna en tiempo y forma. En cuanto a los/as asistentes, hubo predominio de mujeres (79%), provenientes de Asociación Metropolitana de Medicina Familiar (25%), Asociación Cordobesa de Medicina Familiar y Comunitaria (16%), Asociación Misionera de Medicina General/Familiar y del Equipo de Salud (16%), Asociación Tucumana de Medicina Familiar, General y Comunitaria (12%), y otras minorías. Expresaron satisfacción, agradecimiento y reconocimiento por la actividad, destacando la buena predisposición de organizadores y equipo docente, la utilidad práctica de la temática, la evidente planificación, y el apoyo político-económico. Esta valiosa experiencia educativa (planteada como necesidad pendiente) resultó exitosa, ya que los/as participantes demostraron un alto nivel de interés, de asistencia de diferentes provincias, y de compromiso. Los certificados emitidos otorgan créditos educativos válidos para la recertificación (AU)

The Federación Argentina de Medicina Familiar y General supported the development, dissemination and implementation of an educational proposal on research in primary care. It consists of 4 independent modules, intended for interested members, with 2 virtual theoretical-practical meetings, which favored the exchange of opinions and experiences among colleagues. The objective of the first module was to provide knowledge, guidelines and tools for bibliographic search and the use of citation managers. Dissemination was carried out through societies and social networks. An individual evaluation was included, to account for complementary reading and the practical application of the contents. It was carried out in June, with 39 pre-registered participants, mostly residents. There were 24 effective participants (61%), 17 and 20 people attended respectively, and 11 (46%) obtained the certificate of approval for answering the instructions in due time and form. As for the attendees, there was a predominance of women (79%), coming from Asociación Metropolitana de Medicina Familiar (25%), Asociación Cordobesa de Medicina Familiar y Comunitaria (16%), Asociación Misionera de Medicina General/Familiar y del Equipo de Salud (16%), Asociación Tucumana de Medicina Familiar, General y Comunitaria (12%), and other minorities. They expressed satisfaction, gratitude, and recognition for the activity, highlighting the good predisposition of the organizers and teaching team, the practical usefulness of the subject matter, the evident planning, and the political-economic support. This valuable educational experience (raised as a pending need) was successful since the participants showed a high level of interest, attendance from different provinces, and commitment. The certificates issued grant educational credits valid for recertification (AU)

Randomised trial of general practitioner online education for prescribing and test ordering.

INTRODUCTION: Potentially inappropriate medicine prescriptions and low-value diagnostic testing pose risks to patient safety and increases in health system costs. The aim of the Clinical and Healthcare Improvement through My Health Record usage and Education in General Practice study was to evaluate a scalable online quality improvement intervention, integrating online education regarding a national shared electronic health record and rational prescribing, pathology and imaging ordering by Australian general practitioners (GPs). METHODS: The study was a parallel three-arm randomised trial comprising a prescribing education arm, a pathology education arm and an imaging education arm. Currently practising GPs in Australia were eligible to participate and randomised on a 1:1:1 basis to the study arms after consenting. The response to the intervention in reducing potentially unnecessary medicine prescriptions and tests in each arm was assessed using the other two arms as controls. The primary outcome was the cost per 100 consultations of predefined medication prescriptions, pathology and radiology test ordering 6 months following the intervention, compared with 6 months prior. Outcomes were assessed on intention-to-treat and post hoc per-protocol bases using multilevel regression models, with the analysts blinded to allocation. RESULTS: In total, 106 GPs were enrolled and randomised (prescribing n=35, pathology n=36, imaging n=35). Data were available for 97 GPs at the end of trial (prescribing n=33, pathology n=32, imaging n=32) with 44 fully completing the intervention. In intention-to-treat analysis, there were no significant differences in the rates of change in costs across the three arms. Per protocol, there was a statistically significant difference in the rate of change in pathology costs (p=0.03). In the pathology arm, the rate of increase in pathology costs was significantly lower by $A187 (95% CI -$A340, -$A33) than the prescribing arm, and non-significantly $A9 (95% CI -$A128, $A110) lower than the imaging arm. DISCUSSION: This study provides some evidence for reductions in costs for low-value pathology test ordering in those that completed the relevant online education. The study experienced slow uptake and low completion of the education intervention during the COVID-19 pandemic. Changes were not significant for the primary endpoint, which included all participants. Improving completion rates and combining real-time feedback on prescribing or test ordering may increase the overall effectiveness of the intervention. Given the purely online delivery of the education, there is scope for upscaling the intervention, which may provide cost-effectiveness benefits. TRIAL REGISTRATION NUMBER: ACTRN12620000010998.

Building lean improvement sckills at scale: an evaluation of a massive open online course in the English NHS.

BACKGROUND: Internationally, healthcare systems face challenges from population demographics and rising care costs. Systematic methods of quality improvement (QI) are considered key to delivering needed transformation and change. Large-scale training in QI skills is required.Massive open online courses (MOOCs) are an inexpensive strategy for QI training across large regions and countries. The Lean Fundamentals MOOC was developed in the English NHS to train health and care staff in Lean QI methods. It supported participants to learn and apply process improvement skills through a free-to-access, practical, learning-in-action approach. METHODS: Lean Fundamentals' cost-effectiveness and its impact on participants' knowledge and confidence to apply Lean to improve processes were assessed. Using the Kirkpatrick framework, participant reaction, knowledge and confidence change, results and overall return-on-investment (ROI) were evaluated. Quantitative data were collected via pre and postcourse surveys to analyse participants' knowledge and confidence change using the Wilcoxon signed rank test. Qualitative learning platform and postcourse survey data demonstrated participants' results from application. RESULTS: Over 18 months, Lean Fundamentals attracted 6617 enrolments and supported 3462 active participants. 97.6% (n=829) of participants completing the postcourse survey indicated Lean Fundamentals met their expectations and 97.2% (n=823) indicated they would recommend it. Self-reported changes in knowledge and confidence to apply Lean showed significant differences (p<0.001). Learning was applied to operational healthcare priorities (such as post-COVID recovery of services) and participants shared 511 project improvement reports. CONCLUSION: Lean Fundamentals helped large numbers of participants to develop Lean process improvement skills-avoiding costs associated with commercial Lean training in the range £1.7 m to £3.4 m and generating ROI of between £11 and £23 per every pound spent on delivery. This demonstrates that massive online is an effective and efficient method for building improvement knowledge and skills at scale.

Sharing the Details: Implementing and Evaluating the Integration of New York State AIDS Institute Health Equity Competencies for Health Care Providers into Clinical Training Activities.

Background: The New York State (NYS) Department of Health (DOH) AIDS Institute (AI) Clinical Education Initiative (CEI) trains the NYS health care workforce to improve health outcomes related to HIV, sexual health, hepatitis C, and for people who use drugs. Methods: In 2019, CEI began consistently integrating health equity into CEI activities through a working group that mapped NYS DOH AI health equity competencies for providers onto planned clinical education. We conducted a convergent mixed methods study on qualitative and quantitative participant feedback form (PFF) data to evaluate these competencies between April 1, 2021, and September 30, 2022, and conducted an annual survey of NYS clinician needs in 2021 and 2022. Results: The CEI Health Equity Working Group analyzed 25 measures within 4 health equity competencies that were grouped into 4 interventions: resources, internal tools, activity creation, and evaluation. Eighty-nine percent of PFF respondents (n=20,166) strongly agreed/agreed that CEI activities included multiple viewpoints; qualitative comments described informative and helpful activities. When asked how they address patient-identified social determinants of health (SDOH) needs, 84% and 71% of annual survey respondents reported they made the highest number of referrals for health insurance coverage assistance in 2021 and 2022, respectively. Discussion: CEI continues to address participant feedback and seamless incorporation of health equity components into their work. Health Equity Implications: Health equity in clinical practice and trainings is crucial in acknowledging and addressing SDOH that continue to impact NYS clinicians and their patients.

Effect of a targeted quality improvement education on opioid prescribing.

BACKGROUND: The opioid epidemic is a serious social, economic and public health problem. This study was designed to evaluate the effectiveness of individual institutional opioid prescriber training on prescriber adherence to the Centers for Disease Control and Prevention (CDC's) guidelines for responsible opioid prescribing practices to treat acute pain. METHODS: Opioid prescribing data were collected from an academic medical centre and its associated outpatient clinics. A baseline for opioid prescribing practices was collected for 2 years and 2 months prior to the planned intervention. Departments responsible for 5% or more of the total institutional opioid prescriptions were chosen to study in detail. A number of opioid prescriptions per department per day and their compliance with the maximum daily dose (MDD) recommendations put out by the CDC were determined. INTERVENTION: The hospital administration implemented a mandatory opioid prescriber training as part of their standard annual provider education for all medical staff, who were all required to attest having read it and pass a quiz by 30 September 2019, which was chosen as the end date for the pre-intervention data. Data were analysed preintervention and postintervention to assess the effect of this intervention on opioid prescribing. RESULTS: Overall opioid prescribing rates decreased by 18.3% and there were significant decreases in opioid prescribing rate in five out of the seven departments/divisions. Overall, there was a statistically significant decrease in the compliance with MDD before (71.3%) and after (67.3%) the intervention (4%, 95% CI 3.13% to 4.87% difference, p<0.001). Additionally, there were statistically significant increases in compliance with CDC guidelines in three departments/divisions. However, there was a statistically significant decrease in compliance with CDC guidelines after intervention in two departments. CONCLUSIONS: The results of this study were largely encouraging for the effectiveness of this institutional mandatory prescriber training.

[Strengthening regional governance and the health care network in small municipalities in BrazilFortalecimiento de la gobernanza regional y de la red de atención de salud en municipios pequeños de Brasil]. / Fortalecimento da governança regional e da rede de atenção à saúde em municípios pequenos no Brasil.

In Brazil, 67.7% of the municipalities are characterized as small, with a population of less than 20 thousand. The objective of this article is to systematize the experience and identify the challenges and lessons learned in the implementation of the model for strengthening regional governance and organizing the health care network (HCN) in a region of Brazil composed of these municipalities, which present low technical and budgetary capacity, in addition to various fragilities related to the organization of the HCN. With a view to strengthening regional governance and the organization of the primary health care (PHC) work process and, consequently, the workflow with other levels of care, a strategy entitled More Care More Health (Mais Cuidado Mais Saúde) was proposed, developed in partnership with the Pan American Health Organization/World Health Organization (PAHO/WHO) and the Ministry of Health. The project was developed through permanent health education and institutional capacity building in the region of Ivaiporã, state of Paraná, based on workshops and addressing three priority axes: HCN integration, capacity building and information management. The target audience were the extended PHC teams. The project made it possible to develop local and governance capacities through joint reflections on the health care model, its components and the necessary changes in work processes for health promotion with a focus on the quality of life of users. Because it is an experience that considers the weaknesses, needs and autonomy of local actors, the project has a high potential for replication and customization for other regions with similar characteristics inside and outside Brazil.

En Brasil, 67,7% de los municipios se clasifican como pequeños, puesto que tienen menos de 20 000 habitantes. El objetivo de este artículo es sistematizar la experiencia adquirida y determinar cuáles son los desafíos y las enseñanzas extraídas en la implementación del modelo de fortalecimiento de la gobernanza regional y de la organización de la red de atención de salud en una región de Brasil compuesta por municipios de este tipo, que tienen poca capacidad técnica y presupuestaria y diversas debilidades relacionadas con la organización de dicha red. Desde la perspectiva del fortalecimiento de la gobernanza regional y de la organización del proceso de trabajo en el campo de la atención primaria de salud y, por consiguiente, de los flujos asistenciales con los demás niveles de atención, se propuso la estrategia Más cuidado, más salud, formulada junto con la Organización Panamericana de la Salud/Organización Mundial de la Salud (OPS/OMS) y el Ministerio de Salud. El proyecto se ejecutó por medio de procesos de educación permanente en salud y fortalecimiento de las capacidades institucionales en la región de Ivaiporã, Estado de Paraná, con talleres descentralizados, dentro de tres ejes prioritarios, a saber, integración de red de atención de salud, capacitación y gestión de la información. El público destinatario fueron los equipos de atención primaria de salud ampliada. El proyecto permitió el desarrollo de las capacidades locales y la gobernanza regional por medio de reflexiones conjuntas sobre el modelo de atención de salud, sus elementos constitutivos y los cambios necesarios en los procesos de trabajo para impulsar la promoción de la salud centrada en la calidad de vida de los usuarios. Por tratarse de una experiencia en la cual se tienen en cuenta las debilidades, las necesidades y la autonomía de los actores locales, el proyecto tiene un alto poder de repetición y adaptación en otras regiones con características similares dentro y fuera de Brasil.

Atuação fonoaudiológica em equipe multiprofissional hospitalar e nas políticas públicas de doenças crônicas: relato de experiência em um Programa de Residência / Speech-language pathology performance in the multi professional hospital team and in public policies for chronic diseases: experience report in a Residency Program / Desempeño de la fonoaudiología en el equipo multiprofesional hospitalario y en las políticas públicas de enfermedades crónicas: relato de experiencia en un Programa de Residencia

Objetivo: Apresentar a experiência profissional de um fonoaudiólogo em um Programa de Residência inserido em equipe multiprofissional em um Hospital Universitário e nas políticas de Saúde das doenças crônicas de um município de interior do estado. Método: Trata-se de um relato de experiência, com reflexões e discussão com base na literatura relacionando às práticas vivenciadas pela equipe multiprofissional com ênfase na atuação fonoaudiológica em um Programa de Residência Multiprofissional, com duração de dois anos. Relato de experiência: A Residência Multiprofissional se dá como um processo de formação pelo e para o trabalho em saúde, com possibilidade de atuação em equipe e que se conecta às rotinas diárias de serviços de saúde. A prática fonoaudiológica nos espaços hospitalares e nas políticas públicas é relativamente nova e algumas vezes ainda é desconhecida por membros da equipe multiprofissional. A Residência Multiprofissional possibilita um vasto espaço de formação ao fonoaudiólogo, permitindo um olhar ampliado sobre os processos de saúde e incentivando cada vez mais os profissionais a buscar qualificação e novas formas de fazer saúde e pensar além do núcleo, sendo isso vivenciado no contexto hospitalar, inclusive durante a pandemia pela COVID-19, e também no contexto de gestão em uma Coordenadoria Regional de Saúde. Conclusão: A Fonoaudiologia tem um papel muito importante na equipe multiprofissional de um Programa de Residência, seja nos ambientes hospitalares ou nas políticas públicas, pois pode contribuir ativamente na melhoria dos processos assistenciais e no cuidado ao paciente com doenças crônicas. (AU)

Objective: To present an experience of a speech therapist in a professional residency program inserted within a multidisciplinary team at a University Hospital and in the health policies of chronic diseases in the municipality in the interior of the state. Method: It is an experience report, with and discussion based on literature relating to practices by the multiprofessional team with emphasis on speech therapy in a two-year multiprofessional residency. Experience: The multiprofessional residency takes place as a training process through and for health work, with the possibility of teamwork and which is connected to the daily routines of health services. The speech therapy practice in hospital spaces and in public policies is still relatively new, and sometimes it is unknown by members of a multiprofessional team. The multidisciplinary residency creates a broad training space, which allows an expanded look at health processes, and which increasingly encourages health professionals to qualify and seek new ways of doing health and thinking beyond the nucleus, this being experienced in the hospital context, including during the pandemic experienced by COVID-19, and in the context of management in a regional health coordination office. Conclusion: Speech therapy plays a very important role within multiprofessional team of a residency program, whether in hospital environments or in important public policies, as it can actively contribute to the improvement of care processes and care for patients with chronic diseases. (AU)

Objetivo: Presentar una experiencia de un fonoaudiólogo en un programa de residencia multiprofesional inserto en un equipo multidisciplinario en un Hospital Universitario y en las políticas de salud de enfermedades crónicas en el municipio del interior del estado. Método: Es un relato de experiencia, con discusión basado en la literatura referente a las prácticas del equipo multiprofesional con énfasis en logopedia en una residencia multiprofesional de dos años. Experiencia: La residencia multiprofesional se da como un proceso de formación por y para el trabajo en salud, con posibilidad de trabajo en equipo y que se vincula a la rutina diaria de los servicios de salud. La práctica logopédica en los espacios hospitalarios y en las políticas públicas es todavía relativamente nueva, y en ocasiones desconocida por los integrantes de un equipo multiprofesional. La residencia multiprofesional crea un amplio espacio de formación, que permite una visión ampliada de los procesos de salud e incentiva cada vez más a los profesionales de la salud a cualificarse y buscar nuevas formas de hacer salud y pensar más allá del núcleo, siendo esto vivido en el contexto hospitalario, incluso durante la pandemia vivida por el COVID-19, y también en el contexto de gestión en una coordinación regional de salud. Conclusión: La fonoaudiología juega un papel muy importante dentro de lo equipo multiprofesional de un Programa de Residencia, ya sea en ambientes hospitalarios o en importantes políticas públicas, ya que puede contribuir activamente a la mejora de los procesos de atención y atención a los pacientes con enfermedades crónicas. (AU)