Factors Influencing Effective Communication between Stakeholder Groups during DVM Work-Based Learning Program in Bangladesh.

This study aimed to review the existing communication systems between the universities, placement providers, and students during the DVM final year work-based learning (WBL) program in Bangladesh. The intention was to identify what factors impact the effectiveness of the communication system and to explore ways to enhance communication to better support the program. A questionnaire was used to collect details about the WBL program and the communication systems from all universities in Bangladesh. The questionnaire was completed on paper at a meeting of the National Veterinary Dean Council and online with a member of each university's WBL coordination team. A summary of the current WBL programs in Bangladesh was produced. Focus group discussions were used to collect more detailed information about the communication systems and were held via Zoom with recent graduates (n = 16) and placement providers (n = 7). Effective means of communication between all stakeholders were identified as an initial letter, phone calls, and spot visits by teachers. However, the frequency of formal communication before and during placements was variable and the ways of providing feedback on the communication systems were insufficient. These issues sometimes undermined the student learning experience. Suggestions for improvements included increased resourcing, greater use of online communication systems, and a national committee to oversee WBL. Other ways to motivate placement providers included a better honorarium and continuing education courses. The results suggest that existing communication systems for veterinary WBL in Bangladesh are not completely satisfactory. Measures are needed to improve communication to optimize the student learning experience and capitalize on the many benefits of the WBL program for all stakeholders.

FITRI's four steps in developing primary health cares' interprofessional collaborative: an intervention for fostering IPCP competencies.

It is important to fill the gaps in collaborative practice due to the lack of the healthcare professionals' ability to work in collaboration with other disciplines. However, the current team training does not routinely address this important issue. This study aimed to identify how interactive interprofessional collaborative practice (IPCP) learning materials in a virtual course and community implementation called FITRI's four steps in developing primary health cares' interprofessional collaborative practice can be used in primary healthcare settings to address IPCP competencies of healthcare providers. This research was a quasi-experimental study with an untreated control group design using a dependent pretest and posttest sample. A purposive sample of 50 primary healthcare providers consisting of general physicians, dentists, nurses, dietitians, and pharmacists were nonrandomly divided into the control and intervention groups. This study showed that IPCP competencies measured by the Interprofessional Collaborator Assessment Rubric (ICAR) in the intervention group were significantly higher after the training and implementation than before. The Mann-Whitney tests indicated that IPCP competencies were better in the intervention group than the control group. Based on effect size analysis, the intervention had a very strong impact and could significantly improve the participants' competencies, especially in the collaborative patient/client-family centered approach domain. The FITRI's four steps in developing primary health cares' interprofessional collaborative practice can be implemented and provide positive impacts in primary healthcare settings to improve and foster competencies of IPCP in primary healthcare.

Perspectives of general practitioners towards their supervisors over the past ten years in China.

OBJECTIVES: Doctors who wish to become general practitioners (GPs) in China are required to attend and complete general practice resident training. In the early stages of the standardized GP training system, GP training supervisors play important roles. This study aims to explore how GP residents perceive their GP supervisors, factors that affect GP residents' satisfaction level, as well as to offer suggestions based on the implications of this study. DESIGN: We conducted a mixed quantitative and qualitative study. Firstly, with respect to the quantitative research, we conducted a survey to investigate training satisfaction through questionnaires, then extracted and analyzed the factors that influence training satisfaction. In the qualitative study, we conducted in-depth, semistructured interviews using qualitative research criteria (COREQ)--a 32-item checklist for interviews. PARTICIPANTS: Participants in the quantitative survey included 1172 GPs whose training time wasbetween 2008 and 2017. Afterwards, 100 participants were selected from this sample , filtered by stratified random sampling and by having provided extreme answers on the quantitative survey (less than 5% of the total sample). They were chosen for the qualitative research to conduct a more detailed investigation., This stratified random sampling was based on residents' grades, regions, and training levels (city level or county level). Extreme answers were identified as answers of "extremely good" or "extremely bad" to questions from the initial comprehensive survey of 1172 participants. Consequently, 30 participants with extreme answers were found, while the remaining 70 participants in the interviews were selected by stratified random sampling. Ultimately, this sample of participants met our information collection and sample estimation requirements. RESULTS: The results show that satisfaction with GP theoretical training supervisors, GP hospital-based training supervisors, and GP community-based training supervisors differed. Considering long-term averages, the hierarchy of satisfaction is as follows: GP theoretical training supervisors > GP community-based training supervisors > GP hospital-based training supervisors. GP hospital-based training supervisors need to improve their conception of GPs, teaching methods and conscientiousness. GP community-based training supervisors need to improve their teaching methods, knowledge of clinical theory and practice ability. CONCLUSIONS: On the one hand, teams of GP supervisors in China have gradually been established over time. On the other hand,the satisfaction tendencies of residents with respect to their GP supervisors are quite different, and teams of GP supervisors must be promoted and improved.

Intervention-based mental health training for community level workers in India -A systematic review.

Community-level workers (CLWs) are frontline workers who function as mediators between the government and the community. They effectively and efficiently distribute government policies and welfare schemes directly to the public, especially health aspects. They play a vital role in primary care access and quality. Many recent studies demonstrate that physical health training of CLWs is indeed effective and increases access to services. However, there are no recent reviews that systematically understand the training of CLWs concerning mental health interventions, and reviews on CLW's understanding about mental health issues and implementation at the community level is inadequate. CLWs are underutilized in aspects of mental health interventions despite having more potential for the same. They are the ones who need to know much about mental health issues and treatment availabilities. To understand this gap, a systematic review on training on mental health interventions to the CLWs in India, the method and content of mental health training in such studies was done. Our systematic search following the PRISMA guidelines included eight studies that met the eligibility criteria. The review of the studies that satisfied inclusion criteria suggests that training on mental health interventions with CLWs sounds effective. The researcher also provides recommendations to strengthen the CLWs mental health knowledge and discusses implications of mental health interventions through trained CLWs for the community. Based on the review findings, the researcher recommends ideas about how CLWs can be utilized accordingly in mental health aspects during the current pandemic.

Leveraging E-Learning and Community Assets to "TEACH" Residents to Address Child Poverty.

OBJECTIVE: To evaluate the effectiveness of a multimodal child poverty curriculum for pediatric residents. METHODS: The Trainee Education in Advocacy and Community Health (TEACH) curriculum trains residents to recognize and address the effects of child poverty, utilizing learning objectives modified from the US Child Poverty Curriculum, new interactive web-based modules, experiential learning, and reflection. This mixed-methods evaluation of the first component, "Epidemiology of Child Poverty," includes nearly 2 years of resident participation. Pre/post knowledge and attitudes regarding child poverty were assessed. Behavior change was evaluated in a subset of participants using an Objective Structured Clinical Examination (OSCE), comparing intervention and control groups of residents. Residents' experience with the curriculum was assessed using qualitative analysis of debrief sessions with faculty. RESULTS: Fifty-two residents completed the curriculum between June 2018 and March 2020. Residents increased in knowledge (P < .001) and confidence (P < .0001) in recognizing and addressing poverty. They also self-reported greater preparedness (P < .001) and effectiveness (P < .001) in addressing social determinants of health. Early data from the OSCE have not shown a statistically significant change in skills compared with a control group. Qualitative themes included an increase in empathy for, understanding of, and responsibility to address the effects of poverty in caring for patients. CONCLUSIONS: The multimodal "Epidemiology of Child Poverty" portion of the TEACH curriculum increased resident knowledge, confidence, and empathy. Given the ubiquitous nature of poverty and the generalizability of the online modules, the TEACH curriculum can be a resource for other residency programs.

Perceptions on the impact of a structured community-based training model in undergraduate medical training during the first phase of clinical exposure: A qualitative study from Kerala.

The new competency-based undergraduate medical curriculum advocates early clinical exposure in medical training for adequate orientation to societal and patient needs. The present study aimed to explore the experiences of medical students about community-based training in rural hospitals during the first phase of clinical exposure. An exploratory qualitative study was conducted among 75 Bachelor of Medicine and Bachelor of Surgery students who underwent the training program as part of their undergraduate medical training using "most significant change" technique. The responses collected were analyzed using the inductive approach of thematic analysis. Majority of the participants opined that the program not only has enabled them to better understand their academic learning but also has provided a social learning experience. The student feedback throws light on the potential of such community-based learning programs to inspire the students to become a more humane version of themselves. This study observed that the remote hospital-based training has positively influenced the students.

Lessons from a community based interdisciplinary learning exposure: benefits for both students and communities in Uganda.

BACKGROUND: Makerere University implemented a One Health Institute (OHI) in 2016 involving undergraduate students selected from different disciplines. The students were first taken through theoretical principles of One Health followed by a field attachment in communities. The field attachment aimed to expose students to experiential educational opportunities in the communities in a One Health approach. In this paper, we present students' experiences and their contributions to the communities of attachment. METHODS: This was a cross-sectional study, utilizing qualitative data collection methods. The study involved students who participated in the OHI field attachment and community members in a One Health demonstration site-Western Uganda. Four focus group discussions (FGDs) and four in-depths interviews (IDIs) were conducted among the students, while four FGDs and twelve IDIs were conducted among community members. All interviews were audio-recorded, transcribed and analysed manually. RESULTS: The four themes that emerged are: students' understanding and appreciation of One Health concept, their experiences and gains from the multi-disciplinary field attachment, students' contributions to the community, and challenges faced by the students. Students had good knowledge of One Health. They appreciated that health cannot be achieved by one discipline or sector and thus the need to collaborate across sectors. Regarding experiences and gains during the multi-disciplinary field attachment, the students appreciated that each discipline had a role to play in achieving health in the community. They appreciated the training citing skills gained in communication, team work and collaboration. They also reported a feeling of gratitude and accomplishment because they felt they made a positive change to the community by putting in place interventions to address some of the community challenges. Similarly, the communities appreciated the students' contribution in solving their health challenges, ranging from conducting health education to improving sanitation and hygiene. CONCLUSIONS: Through the OHI, students gained One Health competencies including communication, teamwork, and collaboration. Adopting an interdisciplinary model in university teaching system especially during field placement would strengthen skills of collaboration, team work and communication which are critical for a multi-disciplinary approach which is needed among the future workforce in order to solve the current health challenges.

Building a Child Mental Health Workforce for the 21st Century: Closing the Training Gap.

Of the children and adolescents with mental health concerns who receive treatment, most do so in outpatient community mental health service sites, systems of care which have largely failed to produce significant clinical outcomes. Suggested strategies to improve care in child mental health treatment include improving families' access to services, increasing use of evidence-based practices (EBPs), and holding service sites accountable for demonstrating outcomes. Producing a workforce to implement these strategies will require cultivating providers who have developed specific competencies within a range of agencies that naturally interface with the daily lives of families and their children. The authors report on a recently developed interprofessional child community fellowship for psychiatry residents and psychiatric mental health nurse practitioners aimed at training providers to deliver child mental health services in a variety of community settings. Activities that focus the fellowship are outlined along with the development of the related competencies: EBP translation, collaboration skills, and outcome measurement. Evaluation strategies for fellows' competency development are discussed.

Decentralised clinical training in optometry: a developmental strategy for eye health in KwaZulu Natal?

BACKGROUND: Decentralised clinical training (DCT) in optometry is an emerging concept in South Africa. In 2016, the University of KwaZulu Natal (UKZN) implemented this adaptive model of clinical training for undergraduate health professions. The initiative, which emanated through an agreement between UKZN's College of Health Sciences and the KwaZulu Natal Department of Health, centres on the placement of undergraduate optometry students within public health facilities for clinical training purposes. Optometry services in South Africa have, however, had a historical bias towards a private sector model of training and a curative practice approach resulting in access barriers for the rural poor and high levels of unmet need. It has further contributed to a general state of underdevelopment of eye health services within the public sector. DISCUSSION: DCT challenges historical undergraduate programme structures and modes of teaching and learning in optometry. It is largely underpinned by a need to strengthen health service delivery through a primary health care-centred, community-based training approach and produce 'fit-for-purpose' graduates who have contextually appropriate competencies for effective, local health service delivery. The historical absence of optometry services within the public sector has, however, contributed to limited planning for, and development of eye health services in this sector. This has inadvertently contributed to the burden of avoidable vision impairment in the country. The public health system in South Africa, therefore, faces various developmental challenges which impact eye health services and student clinical training. CONCLUSION: While the model is still in a developmental state and resourcing challenges potentially affecting DCT are noted, early experiences of the Discipline of Optometry at the UKZN are that DCT shows promise in terms of its potential contribution towards the development of eye health services within the public health sector from graduate readiness, resource strengthening, access improvement and health service development perspectives.

The National Resuscitation Council, Singapore, and 34 years of resuscitation training: 1983 to 2017.

Training in the modern form of cardiopulmonary resuscitation (CPR) started in Singapore in 1983. For the first 15 years, the expansion of training programmes was mainly owing to the interest of a few individuals. Public training in the skill was minimal. In an area of medical care where the greatest opportunity for benefit lies in employing core resuscitation skills in the prehospital environment, very little was being done to address such a need. In 1998, a group of physicians, working together with the Ministry of Health, set up the National Resuscitation Council (NRC). Over the years, the NRC has created national guidelines on resuscitation and reviewed them at five-yearly intervals. Provider training manuals are now available for most programmes. The NRC has set up an active accreditation system for monitoring and maintaining standards of life support training. This has led to a large increase in the number of training centres, as well as recognition and adoption of the council's guidelines in the country. The NRC has also actively promoted the use of bystander CPR through community-based programmes, resulting in a rise in the number of certified providers. Improving the chain of survival, through active community-based training programmes, will likely lead to more lives being saved from sudden cardiac arrest.

The National Resuscitation Council, Singapore, and 34 years of resuscitation training: 1983 to 2017

Training in the modern form of cardiopulmonary resuscitation (CPR) started in Singapore in 1983. For the first 15 years, the expansion of training programmes was mainly owing to the interest of a few individuals. Public training in the skill was minimal. In an area of medical care where the greatest opportunity for benefit lies in employing core resuscitation skills in the prehospital environment, very little was being done to address such a need. In 1998, a group of physicians, working together with the Ministry of Health, set up the National Resuscitation Council (NRC). Over the years, the NRC has created national guidelines on resuscitation and reviewed them at five-yearly intervals. Provider training manuals are now available for most programmes. The NRC has set up an active accreditation system for monitoring and maintaining standards of life support training. This has led to a large increase in the number of training centres, as well as recognition and adoption of the council's guidelines in the country. The NRC has also actively promoted the use of bystander CPR through community-based programmes, resulting in a rise in the number of certified providers. Improving the chain of survival, through active community-based training programmes, will likely lead to more lives being saved from sudden cardiac arrest.

Report on Ambulatory Teaching : A Japanese Look at the Canadian Educational System / General Medicine

BACKGROUND: Japanese medical education has undergone dramatic changes over the last 5 years. Clinical exercises and ambulatory-care training are now stressed to prepare medical students and residents for work in primary and continuing-care settings. For comparative purposes, we conducted a review of the undergraduate and residency training programs for ambulatory care at the University of Toronto in Canada. This report will examine the problems of training programs for ambulatory care in Japan by comparing the Canadian and Japanese models.<BR>METHOD: From December 2004 to March 2005, the first author observed the ambulatory training systems at the University of Toronto.<BR>OUTLINE OF CANADIAN AMBULATORY TRAINING PROGRAMS: There are three typical types of ambulatory training programs in Canada: community-office based programs for undergraduate students in family and community medicine; hospital/clinic based programs for junior residents in internal medicine; and consultation service programs for senior residents in internal medicine. Undergraduate and residency training programs are largely consistent with each other. The current trend in medical education is towards increased consolidation and efficiency in teacher and student training systems, with a reduction in the number of teaching hospitals and integration of teaching staff and curricula. Moreover, team-based training for ambulatory care appears effective.<BR>DISCUSSION: To improve the Japanese ambulatory training system, it is desirable to increase communication and contact between undergraduate-program educators and residency-training program educators in order to achieve integration and consistency between programs.

Community-based training and employment: an effective program for persons with traumatic brain injury.

Occupational entry is an important issue for persons with disabilities, as many become or remain unemployed after their injury. After traumatic brain injury (TBI), individuals exhibit high unemployment rates, especially those persons with injuries of greater severity, a limited premorbid work history and/or persons from economically disadvantaged backgrounds. Vocational rehabilitation programs have been developed to improve employability. Traditional vocational rehabilitation approaches, based on integrating work skills with cognitive rehabilitation models have proven only minimally effective with TBI. The supported employment model has been demonstrated to be much more effective with this group, as has an approach that combines vocational and psychosocial skills training along with job support. Even with these generally successful approaches, the literature on vocational rehabilitation in clients from economically disadvantaged environments who are diagnosed with TBI is limited. An approach for the economically disadvantaged, which combines work skills training in a real work community along with supported employment is presented.