Changing the channel: a qualitative analysis of an innovative video intervention to explore resident attitudes towards interprofessional collaboration on a Geriatric Medicine Unit.

Background: Medical learners develop a more positive attitude toward Interprofessional Collaboration (IPC) following Interprofessional Education (IPE) programs. However, IPE is not standardized, and the most effective teaching tool is unclear. The purpose of our study was to develop an IPE teaching tool for medical residents during an inpatient geriatric medicine rotation at an academic hospital, evaluate and explore the impact of the program on resident attitudes towards teamwork, and identify barriers and facilitators to interprofessional collaboration. Methods: An innovative video was developed which simulated a common IPC scenario. Near the start of the rotation, learners watched the video then participated in a facilitated discussion around principles of IPE, using the Canadian Interprofessional Health Collaborative (CIHC) framework, which highlights interprofessional communication, patient-centered care, role clarification, team functioning, collaborative leadership, and interprofessional conflict resolution. At the end of their four-week rotation, focus groups were conducted to explore resident attitudes towards IPE. The Theoretical Domain Framework (TDF) was used for qualitative analysis. Results: Data from 23 participants in five focus groups were analyzed using the TDF framework. Residents were able to identify barriers and facilitators to IPC in five TDF domains: environmental context and resources, social/professional role and identity, knowledge, social influences, and skills. Their observations correlated with the CIHC framework. Conclusion: The use of a scripted video and facilitated group discussion gave insights into residents' attitudes, perceived barriers, and facilitators towards IPC on a geriatric medicine unit. Future research could explore the use of this video intervention in other hospital services where team-based care is important.

Contexte: Les apprenants en médecine développent une attitude plus positive à l'égard de la collaboration interprofessionnelle (CIP) après avoir suivi un programme de formation interprofessionnelle (FIP). Toutefois, la FIP n'est pas standardisée et on ne sait pas quel outil d'enseignement est le plus efficace. Le but de notre étude était d'élaborer un outil de FIP pour les résidents en stage de gériatrie dans un hôpital universitaire, d'évaluer et d'explorer les effets du programme sur les attitudes des résidents à l'égard du travail d'équipe, et de recenser les facteurs qui entravent ou facilitent la collaboration interprofessionnelle. Méthodes: Une capsule vidéo innovante simulant un scénario courant de CIP a été créée. Au début de leur stage de résidence, les apprenants ont regardé la capsule et participé à une discussion animée sur les principes de la CIP, conformément au référentiel du Consortium pancanadien pour l'interprofessionnalisme en santé (CPIS), qui prône notamment la communication interprofessionnelle, les soins centrés sur le patient, la clarification des rôles, le fonctionnement de l'équipe, le leadership collaboratif et la résolution des conflits interprofessionnels. À la fin de leur stage de quatre semaines, des groupes de discussion ont été organisés pour explorer les attitudes des résidents à l'égard de la CIP. Un cadre de domaines théoriques (Theoretical Domains Framework) a été appliqué pour réaliser l'analyse qualitative. Conclusion: Au moyen d'une capsule scénarisée et d'une discussion de groupe dirigée, nous avons pu cerner les attitudes des résidents d'une unité de gériatrie par rapport à la CIP ainsi que leurs perceptions quant aux facteurs qui peuvent l'entraver ou la faciliter. Des travaux futurs pourraient explorer le recours à cette formule d'enseignement de la CIP dans d'autres services hospitaliers où les soins en équipe sont importants.

Contamination of environmental surfaces with Staphylococcus aureus in households with children infected with methicillin-resistant S aureus.

IMPORTANCE: Household environmental surfaces may serve as vectors for the acquisition and spread of methicillin-resistant Staphylococcus aureus (MRSA) among household members, although few studies have evaluated which objects are important reservoirs of MRSA. OBJECTIVES: To determine the prevalence of environmental MRSA contamination in households of children with MRSA infection; define the molecular epidemiology of environmental, pet, and human MRSA strains within households; and identify factors associated with household MRSA contamination. DESIGN, SETTING, AND PARTICIPANTS: Fifty children with active or recent culture-positive community-associated MRSA infection were enrolled from 2012 to 2013 at St Louis Children's Hospital and at community pediatric practices affiliated with the Washington University Pediatric and Adolescent Ambulatory Research Consortium in St Louis, Missouri. MAIN OUTCOMES AND MEASURES: Samples of participants' nares, axillae, and inguinal folds were cultured to detect S aureus colonization. Samples of 21 household environmental surfaces, as well as samples obtained from pet dogs and cats, were cultured. Molecular typing of S aureus strains was performed by repetitive-sequence polymerase chain reaction to determine strain relatedness within households. RESULTS: Methicillin-resistant S aureus was recovered from samples of environmental surfaces in 23 of the 50 households (46%), most frequently from the participant's bed linens (18%), television remote control (16%), and bathroom hand towel (15%). It colonized 12% of dogs and 7% of cats. At least 1 surface was contaminated with a strain type matching the participant's isolate in 20 households (40%). Participants colonized with S aureus had a higher mean (SD) proportion of MRSA-contaminated surfaces (0.15 [0.17]) than noncolonized participants (0.03 [0.06]; mean difference, 0.12 [95% CI, 0.05-0.20]). A greater number of individuals per 1000 ft 2 (93 m2) were also associated with a higher proportion of MRSA-contaminated surfaces (ß = 0.34, P = .03). The frequency of cleaning household surfaces was not associated with S aureus environmental contamination. CONCLUSIONS AND RELEVANCE: Methicillin-resistant S aureus strains concordant with infecting and colonizing strains are present on commonly handled household surfaces, a factor that likely perpetuates MRSA transmission and recurrent disease. Future studies are needed to determine methods to eradicate environmental contamination and prevent MRSA transmission in households.

Student reflections on unexpected work transitions due to natural disaster in Chile.

OBJECTIVE: This article presents a reflection on four students' experiences on unexpected work transitions due to natural disaster in Chile. PARTICIPANTS: Discussions with locals encountered while traveling throughout Chile prompted the authors to explore the ideas of occupational identity and global stigma attached to unexpected work transitions. METHODS: The authors present here, excerpts from reflective journaling and an exploration of factors affecting certain individual's ability to adapt and regain occupational identity that has either shifted or been lost due to the effects of natural disaster. The authors explore both micro and macro level factors that may affect this occupational shift, and how attempts to maintain occupation after natural disaster is influenced not only by person factors, but largely by global perceptions of the country affected by natural disaster. RESULTS AND CONCLUSIONS: Lastly, the authors reflect on this experience from a student perspective, the impact it has on emerging occupational therapists, and the need for more focused research concerning global stigma and its cascading effects.