Can Team-Based Learning (TBL) Be Used to Deliver Postgraduate Education in Transfusion Medicine for UK Physicians?

BACKGROUND: There is global need for evidence-based methodologies to effectively deliver transfusion training. This research critically assesses both efficacy and the practicalities of introducing team-based learning (TBL) to deliver transfusion medicine education to UK postgraduate doctors (residency equivalence). STUDY DESIGN AND METHODS: One TBL orientation session and three transfusion medicine sessions, mapped to the 2012 Foundation Programme curriculum, were designed adhering to TBL principles. These were delivered by one tutor during 'compulsory' (except rota commitments and leave) educational sessions. Team continuity plus trainee reaction, knowledge acquisition and behaviour were evaluated. RESULTS: Forty-eight doctors received a mean 2.5 TBL sessions. Five teams were developed with average team membership of 5.85 doctors per session. Overall team continuity (total team members attending/potential team members × 100) was 65% over the four sessions. Qualitative and quantitative trainee reaction to TBL was positive. Objective knowledge acquisition showed improved team knowledge over individual knowledge. Mean team readiness assurance testing (RAT) score exceeded maximum individual RAT score in 90% of cases. Subjective knowledge acquisition significantly improved, although confidence concerning prescribing declined. The reported time spent preparing for sessions correlated with enjoyment, subjective knowledge gain and clinical confidence. Preparation time was reported as 'adequate' or 'excellent' in 86% of anonymous feedback. CONCLUSION: TBL is an enjoyable and effective approach to deliver transfusion education to doctors, particularly when preparation is adequate. Team continuity is poor despite 'compulsory' education sessions. This must be considered when designing and delivering TBL sessions in the UK postgraduate medical setting.

Assessing transfusion competency in junior doctors: a retrospective cohort study.

BACKGROUND: There is scope to further improve the safety of transfusion practice within the United Kingdom. This study aims to identify the current role of junior doctors in the transfusion process and to assess their competency to appropriately prescribe blood and blood products to patients. STUDY DESIGN AND METHODS: Transfusion competency in junior doctors training in a single region was addressed through anonymized questionnaires assessing factual knowledge, personal reflection, and documented evidence of competency. Factual knowledge comprised 33 true-false questions (competency score) covering indications for transfusion, special requirements, risks of transfusion, and guidelines for testing in transfusion. Background data on current practice and education in transfusion medicine were addressed using multiple-choice and single-response questions. RESULTS: A total of 787 newly qualified doctors, comprising 79% of first-year (F1) and 62% of second-year (F2) Foundation doctors, completed the assessment over a 3-week period. There was no improvement in competency score between F1 and F2 doctors (p = 0.1). Competency scores correlated most strongly with undergraduate education in transfusion medicine and attendance at hospital induction (p < 0.01). Junior doctors had a high confidence level with regard to prescribing blood, although only 78% were aware they had been competency assessed against national standards. CONCLUSION: Junior doctors are involved in sampling, prescribing, consenting, and documenting transfusion practice frequently enough to maintain competency. They are rarely involved in the collection, bedside checking, or administration of blood despite current curriculum requirements. There is scope to significantly improve both the training and the assessment of transfusion competency in doctors.

Nurses' discharge planning and risk assessment: behaviours, understanding and barriers.

AIMS AND OBJECTIVES: To examine nurses' discharge planning understanding, adherence and barriers. BACKGROUND: Discharge planning commenced at admission by nurses plays a key role in improving patient outcomes,but policies in place to maintain effective discharge planning are often not followed by nurses. DESIGN: This is a descriptive study. METHODS: Nurses (n = 64) working in acute wards undertook a self-report survey of discharge planning understanding, adherence and barriers. RESULTS: Adherence to discharge planning policy is low (23%), despite a general awareness of the reduced quality of patient outcomes that may result. The most common barriers to discharge planning identified were lack of time and patient factors. Further contradictions occurred in that nurses understood the importance of discharge planning, yet did not comply with discharge planning policies. CONCLUSIONS: Nurses require additional encouragement and support in complying with discharge planning policies, and discharge planning policies should be adapted to better handle unpredictable illness trajectories. RELEVANCE TO CLINICAL PRACTICE: Completion of discharge planning is important for the safe transition of patients from one care setting to the next. Before a systematic approach to discharge planning can be implemented, a greater understanding of nurses' discharge planning practice in acute care wards is required. Greater incorporation of discharge planning activities into nurses' daily practice may also occur if nurses are involved in the development and implementation of the discharge processes and then provided with education and regular feedback on monthly audit results.

Early completion of the discharge risk screen by nurses in acute care wards.

The aim of this study was to investigate nurses' compliance with discharge risk screening (DRS) policy, the accuracy of this screening, and factors associated with its completion. An audit of 99 acute care patients' medical records revealed that compliance with DRS completion was very low (24%), although accuracy was high, and the 2 factors associated with completion of the DRS were patient diagnosis and day of week admitted. Further research on nurses' attitudes, beliefs, and perceived barriers to DRS is needed as a foundation to increase the use of the tool.

Differential effect of Rhizoma coptidis and its main alkaloid compound berberine on TNF-alpha induced NFkappaB translocation in human keratinocytes.

The Chinese medicine Rhizoma coptidis (RC) is well established in the treatment of common dermatological disorders although the mechanism of its' anti-inflammatory effects have previously remained elusive. We stimulated an inflammatory state in human keratinocyte cultures using TNF-alpha in the presence of RC extract (RCE) and berberine, to identify the dose-dependent anti-inflammatory role of these compounds. Control data demonstrates significant translocation of NFkappaB into the nucleus after stimulation with TNF-alpha. This translocation can be inhibited, and hence anti-inflammatory effects inferred, by RCE but not by berberine. We conclude that in dermatological disorders berberine exerts its anti-inflammatory effects by inhibiting signal transduction pathways other than the NFkappaB dependent pathway, while the RCE complex acts partially by blocking the NFkappaB dependent pathway. Rhizoma coptidis extract therefore appears to be a potent inhibitor of TNF-alpha induced inflammation in dermatological conditions.

Community care or therapeutic stalking: two sides of the same coin?

Although the government of the United Kingdom strives to address the needs of individuals engaged in mental health services, its policies must, by their nature, reflect a utilitarian approach. When a client chooses to disengage from services, mental health professionals can find themselves in an ethical dilemma in which adhering to policies can lead them to hyperactive conduct, whereby the client may experience what feels more like stalking behavior than therapeutic care.

A new approach to training in intravenous drug therapy.

A multidisciplinary team organised an intravenous infusion training day for nurses on the preceptorship programme at Chesterfield and North Derbyshire Royal Hospital. Theoretical and practical sessions were set up to provide instruction and supervision of safe practice principles for an activity that is widely acknowledged as being a source of risk. The results of the training day showed that more than 90 per cent of the participants evaluated the experience positively and this helped to improve both their competence and confidence in the procedures involved.