Non-technical skills in nursing education: effectiveness of a high-fidelity simulation-based course / Competências não-instrumentais no ensino de estudantes de enfermagem: eficácia de um programa em contexto de simulação de alta-fidelidade

Literature refers that patients are commonly affected by preventable adverse events associated with non-technical skills failures. Non-technical skills training programs address to prepare for, respond to, and mitigate adverse events in healthcare. This study took place at Center for Clinical Simulation of Aveiro University. Third year prelicensure nursing students were included in two groups: control group (N=27), and experimental group (N=20, who participated in the training course developed, focusing on non-technical skills and crisis resource management acting principles). The study was divided in two different moments, before the implementation of the course, and after the implementation of the course. The course was then divided in three sessions: one four-hour theoretical session; and two three-hour practical sessions, each including two high-fidelity simulation-based different scenarios, four in total.Regarding non-technical skills, we found significant differences in the experimental group in eleven items after intervention. As per participants' self-confidence levels, those who participated seem to have significantly increased confidence in their skills. Regarding social-demographic variables, it seems that students from primary healthcare tend to present better non-technical skills than students from maternal health specialty. Overall these results seem to suggest that the course developed was effective in increasing students' knowledge and awareness on non-technical skills. It was demonstrated that the development and application of the structured course is feasible and positive changes in behavior can be measured through the instru-ments developed. Then, consideration must be given in integrating non-technical skills training into nursing education

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Design and validation of a questionnaire to assess cooperative learning in educational contexts / Diseño y validación de un cuestionario de medición del aprendizaje cooperativo en contextos educativos

The goal of the present study was to design and validate an instrument to assess the basic elements of cooperative learning, as well as a cooperation index. 11.202 primary education (grades 5, 6), secondary education and baccalaureate students (5.838 males, 5.364 females) from 68 different schools in 62 cities all over Spain agreed to participate. The age range was 11-18 years. The participating students had experienced several cooperative learning techniques during the last six months. The first version of the questionnaire was assessed by a group of experts. A pilot study with 60 students similar to the target sample was conducted on the second version of the instrument. The final version underwent several statistical tests. The Cooperative Learning Questionnaire included five subscales: Promotive Interaction, Positive Interdependence, Individual Accountability, Group Processing and Interpersonal skills. Factorial and confirmatory analysis showed that all reliability indices were acceptable, even under the most difficult conditions. The questionnaire showed adequate convergent, discriminant and concurrent validity. Results showed that it is an easy instrument to assess all the basic elements of cooperative learning in primary, secondary and baccalaureate students and obtain a global cooperation factor (AU)

El objetivo del estudio fue elaborar y validar un instrumento que pudiera evaluar los elementos fundamentales del aprendizaje cooperativo, así como proporcionar un factor de cooperación. Participaron 11.202 estudiantes de educación primaria (5º-6º curso), secundaria y bachillerato (5.838 varones, 5.364 mujeres) de 68 centros educativos en 62 ciudades españolas repartidas por toda su geografía. Las edades oscilaron entre los 11 y los 18 años. El único requisito para participar era haber experimentado varias técnicas de aprendizaje cooperativo en los últimos 6 meses. Tras elaborar una primera versión y ser sometida sucesivamente a un juicio de expertos y un estudio piloto se realizó un segundo estudio en el que se sometió la versión definitiva a diferentes pruebas estadísticas. El Cuestionario de Aprendizaje Cooperativo está formado por cinco sub-escalas: Interacción Promotora, Interdependencia Positiva, Responsabilidad Individual, Procesamiento Grupal y Habilidades Sociales. Los análisis factoriales confirmatorios mostraron que todos los índices de fiabilidad eran aceptables, incluso bajo las condiciones más exigentes. El cuestionario mostró una adecuada validez convergente, discriminante y concurrente. Se confirma como un instrumento sencillo para evaluar todos los elementos fundamentales del aprendizaje cooperativo en estudiantes de primaria, secundaria y bachillerato y proporcionar un factor de cooperación global (AU)

Implementing a minimal intervention for chronic fatigue syndrome in a mental health centre: a randomized controlled trial.

BACKGROUND: Cognitive behaviour therapy (CBT) for chronic fatigue syndrome (CFS) is an effective but intensive treatment, requiring trained therapists. A minimal intervention based on CBT for CFS, guided self-instruction, was shown to be an effective treatment when delivered in a tertiary treatment centre. Implementing this intervention in a community-based mental health centre (MHC) will increase the treatment capacity for CFS patients. This study evaluated the effectiveness of guided self-instruction for CFS implemented in an MHC, delivered by nurses. METHOD: One hundred and twenty-three patients were randomly assigned to either guided self-instruction (n=62) or a waiting list (n=61). Randomization was computer generated, with allocation by numbered sealed envelopes. Group allocation was open to all those involved. Patients fulfilled US Centers for Disease Control and Prevention (CDC) criteria for CFS. Primary outcome variables were fatigue severity and physical and social functioning, measured with the Checklist Individual Strength (CIS) and the Medical Outcomes Survey Short Form-36 (SF-36) respectively. RESULTS: After 6 months, patients who followed guided self-instruction reported a significantly larger decrease in fatigue compared to the waiting list [mean difference -8.1, 95% confidence interval (CI) -3.8 to -12.4, controlled effect size 0.70]. There was no significant difference in physical and social functioning. However, post-hoc analyses showed a significant decrease in fatigue and physical disabilities following the intervention in a subgroup of patients with physical disabilities at baseline (SF-36 physical functioning ⩽70). CONCLUSIONS: Implementation of guided self-instruction in a community-based MHC was partially successful. The minimal intervention can be effectively implemented for CFS patients with physical impairments.

¿Qué opinan los residentes de reumatología sobre su formación? Una encuesta de la Comisión Nacional de Reumatología / What do rheumatology residents think of their training? A survey of the National Rheumatology Commission

La Comisión Nacional de Reumatología ha elaborado una encuesta sobre la satisfacción de los residentes respecto a su periodo formativo. Contestaron un 37% de los 176 invitados a participar. Un 71% manifestó que estaba satisfecho o muy satisfecho de la influencia de la actividad asistencial en su formación. El 38% estaba insatisfecho o muy insatisfecho de la supervisión por parte de la plantilla. El 39% estaba insatisfecho o muy insatisfecho del adiestramiento en microscopía de luz polarizada. El 52% contestó que no existían reuniones periódicas estructuradas de monitorización de su formación. El 66% declaró que no había existido ningún tipo de evaluación efectiva de su formación. El 39% se mostró insatisfecho o muy insatisfecho respecto a las facilidades para publicar que le brindó su unidad docente. La satisfacción global sobre la formación asistencial de los residentes de reumatología es elevada. Existen oportunidades de mejora referentes al entrenamiento en determinadas técnicas, la monitorización y evaluación del periodo formativo y la formación en habilidades de investigación (AU)

The National Commission of Rheumatology has developed a satisfaction survey for residents concerning their training period. 37% of the 176 invited to participate answered the survey. 71% said they were satisfied or very satisfied with the influence of the assistance activities during their training. 38% were dissatisfied or very dissatisfied with supervision by staff. 39% were dissatisfied or very dissatisfied with their training in polarized light microscopy. 52% said no regular meetings were structured to monitor their training. 66% said that there had been no effective evaluation of their training. 39% were dissatisfied or very dissatisfied on the tools they were given to publish at their teaching unit. Overall satisfaction on classroom training for residents of Rheumatology is high. There are opportunities for improvement relating to training in certain techniques, monitoring and evaluation of the training period and training in research skills (AU)

Garrison's model of self-directed learning: preliminary validation and relationship to academic achievement.

In this project, 119 undergraduates responded to a questionnaire tapping three psychological constructs implicated in Garrison's model of self-directed learning: self-management, self-monitoring, and motivation. Mediation analyses showed that these psychological constructs are interrelated and that motivation mediates the relationship between self-management and self-monitoring. Path modeling analyses revealed that self-management and self-monitoring significantly predicted academic achievement over two semesters with self-management being the strongest predictor. Motivation significantly predicted academic achievement over the second semester only. Implications of these findings for self-directed learning and academic achievement in a traditional classroom setting are discussed.

The quality of questions and use of resources in self-directed learning: personal learning projects in the maintenance of certification.

INTRODUCTION: To engage effectively and efficiently in self-directed learning and knowledge-seeking practices, it is important that physicians construct well-formulated questions; yet, little is known about the quality of good questions and their relationship to self-directed learning or to change in practice behavior. METHODS: Personal learning projects (PLPs) submitted to the Canadian Maintenance of Certification program were examined to include underlying characteristics, quality of therapeutic questions (population, intervention, comparator, outcome [PICO] mnemonic), and relationships between stage of change and level of evidence used to resolve questions. RESULTS: We assessed 1989 submissions (from 559 Fellows of the Royal College of Physicians and Surgeons of Canada [RCPSC]). The majority of submissions were by males (69.2%) aged 40-59 (59.4%) with an average of 24.3 (range 6-58, SD 11.1) years since graduation. The most frequent submissions were treatment (36.6%) and diagnosis (22.3%) questions. Half of all questions described > or =2 components (PICO), and only 3.7% of questions included all 4 components. Cross tabulations indicated only 1 significant trend for the use of narrative reviews and the outcome "integrating new knowledge' (P < .000). DISCUSSION: Self-directed learning skills comprise an important strategy for specialists maintaining or expanding their expertise in patient care, but an important obstacle to answering patient care questions is the ability to formulate good ones. Engagement in most major learning activities is stimulated by management of a single patient: formal accredited group learning events are of limited value in starting episodes of self-directed learning. Low levels of evidence used to address learning projects. Future research should determine how best to improve the quality of questions submitted and whether or not these changes result in increased efficiencies, more appropriate uses of evidence, and increased changes in practice behaviors.

Staff nurses writing for their peers: development of self-learning modules.

Self-learning modules (SLMs) provide an educational format that is easily portable and can be incorporated into the nurse's day at the nurse's convenience. Self-learning modules are a flexible teaching modality than can enhance not only nurse's knowledge and skill but also the unit's educational programs. Incorporating the bedside nurses in the development of SLMs has provided an opportunity for staff to work on writing skills, produce a professional product, and receive contact hours. The use of author guidelines, content expert and peer review is described in detail.

Free text versus structured format: information transfer efficiency of radiology reports.

OBJECTIVE: We discuss the effect of radiology report format on the accuracy and speed with which reviewers can extract case-specific information. MATERIALS AND METHODS: A Web-based testing mechanism was used to present radiology reports to each of 16 senior medical students and record their answers to 10 multiple choice questions about specific medical content for each of 12 cases. Subjects were randomly assigned to view the reports in either free text or structured format. In addition to number of answers correct for each case, we recorded the time taken for each case and an efficiency score (correctly answered questions per minute). These three outcomes were tested for differences on report format using multifactorial analysis of variance. A postexperimental questionnaire and a mediated focus group elicited subject preference as to radiology report format. RESULTS: There were no significant differences in the three outcomes (score, time, and efficiency) between the free text and structured format conditions. The power of the experiment was sufficient to detect small differences in these outcomes by format. Subjects strongly and consistently expressed a preference for the structured version. CONCLUSION: We assert that free text and itemized (structured) forms of radiology reports are equally efficient and accurate for transmitting case-specific interpretative content to reviewers of the document.

Reporting instruction for radiology residents.

RATIONALE AND OBJECTIVES: To determine the amount of formal instruction and evaluation about reporting given to radiology residents in the U.S.A., to document report generation methods and to quantify the performance of physician coding. MATERIALS AND METHODS: E-mail requests with links to a web-based, anonymous survey were sent to program directors of all accredited radiology residencies in the USA. Demographic questions included university or private affiliation, number of residents, geographic location, and number of hospitals covered. Subject-specific items covered the amount of didactic instruction, formal evaluation of reports, and use of structured reports. A didactic activity index (DAI) was calculated as the sum of answers to domain-specific questions and tested for relation to demographic variables. We also asked about dictation methods and International Classification of Diseases (ICD) or Common Procedural Terminology (CPT) coding of examinations by radiologists. RESULTS: Of the 191 active radiology residencies, 151 (79%) completed the survey. Responses for hours of didactic instruction in reporting given more than a 4-year residency were distributed as follows: 0-1 = 40%, 2-4 = 46%, >4 = 14%. The percentage of resident reports formally graded was distributed as follows: 0-1 = 82%, 2-4 = 8%, >4 = 10%. The extent to which faculty-designed, structured reports were used by residents was distributed as follows: none = 16%, minimal = 25%, few = 17%, some = 33%, most = 9%. The DAI was normally distributed with a mean of 14.8 and a standard deviation of 2.4. Military programs had higher DAIs than university residencies (P = .03). There was no significant relation between any other program demographic variables and the DAI (P > .05). A substantial number of programs reported that physicians performed coding for some or most studies: ICD-9 = 30%, CPT = 26%. The dominant method for report generation was human transcription in 79% followed by speech recognition at 19%. Speech recognition penetration (departments reporting use of the technology for at least some dictation) was estimated to be 38%. CONCLUSION: In 86% of sampled radiology residencies, trainees receive no more than one hour of didactic instruction in radiology reporting per year. An aggregate measure of didactic activity about interpretative reporting was identical across all program demographic variables except that military residencies seemed to do slightly more than those located at universities.

Medical students' use of information resources: is the digital age dawning?

PURPOSE: One of the many challenges clinicians face is applying growing medical knowledge to specific patients; however, there is an information gap between information needs and delivery. Digital information resources could potentially bridge this gap. Because most medical students are exposed to personal computers throughout their education, this study postulated that students may be more comfortable using computer-based information resources within clinical interactions. METHOD: In 2001, the authors monitored second-year medical students' use of a unique digital textbook, UpToDate, as they transitioned from preclinical to clinical years at the University of Iowa Roy J. and Lucille A. Carver College of Medicine. In 2002, at the end of their third year, students were surveyed about their preferred clinical information resources. RESULTS: Medical students rapidly adopted UpToDate as a clinical resource during their clinical clerkship as evidenced by a rapid growth in the electronic textbook's use. One hundred sixteen of a possible 154 students (75%) responded to the survey. More than 85% of respondents identified electronic sources as their primary resource (UpToDate 53%, MDConsult 33%; p <.001 when compared to paper resources). They also reported using the information resources on a daily basis and requiring less than 15 minutes to answer most of their clinical questions. CONCLUSIONS: This study clearly demonstrates that medical students embrace and use electronic information resources much more than has been reported among practicing clinicians. The current generation of students may be the leaders in a medical culture shift from paper to electronic resources.

[Usefulness of teaching how to manage the pressurized canister and the Turbuhaler system in hospitalized patients]. / Utilidad de la enseñanza del manejo del cartucho presurizado y el sistema Turbuhaler en los pacientes hospitalizados.

OBJECTIVE: [corrected] To assess knowledge of how to use a pressurized canister (PC) or Turbuhaler (TB) systems and to evaluate the usefulness of giving technical instruction to hospitalized patients, analyzing chronic obstructive pulmonary disease (COPD) patients according to degree of obstruction. METHOD: We evaluated the use of the PC by 107 consecutive patients and the TB by 79 patients upon their admission to the respiratory medicine ward, with reference to the guidelines of the Spanish Society of Respiratory Medicine and Thoracic Surgery. We then evaluated the usefulness of instruction PC or TB technique. We recorded age, sex, underlying respiratory disease, the patient's opinion and time in years the patient had been using the inhaler, FEV1, and technique upon admission and after instruction during the hospital stay. RESULTS: Only 19% of the patients used the PC and 32% of the TB patients used their inhaler correctly at first. After instruction, the rates of correct use improved to 42% and 70% for the PC and TB, respectively, over the course of an approximately 4-day hospital stay. Among the PC users, 77% believed they were performing the maneuver correctly. All steps for both inhalers improved, as the number of errors decreased, particularly errors considered most relevant (coordination of the trigger and inspiration from the PC or full expiration and breath holding with both systems). The number of correct techniques at the end of the study was similar for all levels of COPD obstruction, and particularly for those using the TB. CONCLUSIONS: Most patients admitted to our ward were unable to use either inhaler correctly, with incorrect use of the PC being particularly evident. It is possible to improve performance, however, if we take care to teach patients in short instruction sessions. This is true for all COPD patients, regardless of level of obstruction. Our results demonstrate that a program of instruction during a patient's hospital stay is both feasible and important.

Factors affecting the use of self-instructional material by patients with ischemic heart disease.

This study addressed three questions concerning the feasibility of self-instruction by patients with ischemic heart disease in an acute-care teaching hospital. (1) Do patients complete a linear self-instructional booklet under conditions normally prevailing on a hospital ward? (2) Do patients perceive that activity in the ward environment and symptoms of illness affect use? (3) What aspects of activity and symptoms do patients report affect use? One hundred patients, 60 men and 40 women with an average age of 59 years, hospitalized with ischemic heart disease (acute myocardial infarction or unstable angina) were interviewed an average of six days after distribution of a self-instructional booklet as a component of a standard teaching program. Three subjects claimed not to have received the booklet; nine made no use of it; 73 made partial use of it; and 15 made complete use of it. Fifteen subjects claimed activity in the ward environment and 25 subjects claimed symptoms of illness affected use. Interruption, a noisy, busy atmosphere on the ward, and physical symptoms of ischemic heart disease were reported most frequently as factors affecting use. Results of the study suggest that a small percentage of patients will complete a self-instructional booklet. In addition to activity in the environment and symptoms of illness, factors not identified in this study also appear to influence the use of self-instructional material.