Evaluations of Continuing Health Provider Education Focused on Opioid Prescribing: A Scoping Review.

PURPOSE: Continuing health provider education (HPE) is an important intervention supported by health policy to counter the opioid epidemic; knowledge regarding appropriate program design and evaluation is lacking. The authors aim to provide a comprehensive understanding of evaluations of opioid-related continuing HPE programs and their appropriateness as interventions to improve population health. METHOD: In January 2020, the authors conducted a systematic search of 7 databases, seeking studies of HPE programs on opioid analgesic prescribing and overdose prevention. Reviewers independently screened the titles and abstracts of all studies and then assessed the full texts of all studies potentially eligible for inclusion. The authors extracted a range of data using categories for evaluating complex programs: the use of theory, program purpose, inputs, activities, outputs, outcomes, and industry involvement. Results were reported in a narrative synthesis. RESULTS: Thirty-nine reports on 32 distinct HPE programs met inclusion criteria. Of these 32, 31 (97%) were U.S./Canadian programs and 28 (88%) were reported after 2010. Measurements of changes in knowledge and confidence were common. Performance outcomes were less common and typically self-reported. Most studies (n = 27 [84%]) used concerns of opioid-related harms at the population health level to justify the educational intervention, but only 5 (16%) measured patient- or population-level outcomes directly related to the educational programs. Six programs (19%) had direct or indirect opioid manufacturer involvement. CONCLUSIONS: Continuing HPE has been promoted as an important means of addressing population-level opioid-related harms by policymakers and educators, yet published evaluations of HPE programs focusing on opioid analgesics inadequately evaluate patient- or population-level outcomes. Instead, they primarily focus on self-reported performance outcomes. Conceptual models are needed to guide the development and evaluation of continuing HPE programs intended to have population health benefits.

Gestão do trabalho de equipes da saúde da família / Family health team work management

RESUMO: Objetivos Descrever o perfil, formação complementar, aspectos sobre educação permanente, vínculo e plano de carreira de profissionais de equipes da Saúde da Família. Método Pesquisa descritiva de abordagem quantitativa. Participaram 78 membros de equipes multiprofissionais. Os dados foram coletados em 2016, por meio de um instrumento para caracterizar o profissional e as dimensões de tempo de atuação e qualificação dos profissionais das equipes, formas de contratação e modalidades de vínculos profissionais, plano de carreira e remuneração variável e educação permanente. As análises foram geradas no software IBM SPSS versão 21. Resultados A distribuição de médicos e enfermeiros é homogênea, percebe-se uma redução de agentes comunitários de saúde. Foram mais frequentes as características: vínculo trabalhista regulado pela Consolidação das Leis Trabalhistas, baixa formação complementar para a atenção primária à saúde, até um ano de trabalho na equipe, com baixa formação complementar para área e iniciativas de ações de educação pela gestão. Conclusões e implicações para a prática Existem fragilidades que podem interferir na organização do processo de trabalho influenciada pelos eixos da formação e formas de contratação.

RESUMEN Objetivos Describir el perfil, la capacitación complementaria, los aspectos sobre la educación permanente, el vínculo y el plan de carrera de los profesionales de los equipos de salud familiar. Método Investigación descriptiva con enfoque cuantitativo. Participaron 78 miembros de equipos multidisciplinarios. Los datos se recopilaron en 2016, utilizando un instrumento para caracterizar al profesional y las dimensiones de tiempo de actuación y calificación de los profesionales del equipo, formas de contratación y modalidades de vinculo profesional, plan de carrera y remuneración variable y la educación permanente. Los análisis se generaron en el software IBM SPSS versión 21. Resultados La distribución de médicos y enfermeras es homogénea, se observa una reducción en los agentes comunitarios de salud. Las características más frecuentes fueron: vinculo de trabajo través de la Consolidación de las Leyes del Trabajo, baja capacitación complementaria para la atención primaria en salud, hasta un año de trabajo en el equipo, con baja capacitación complementaria para el área e iniciativas de acciones educativas por parte de la gerencia. Conclusiones e implicaciones para la práctica Existen debilidades que pueden interferir en la organización del proceso de trabajo influenciado por los ejes de la capacitación y las formas de contratación.

ABSTRACT Objectives To describe the profile, complementary training, aspects about permanent education, bond and career plan of professionals from Family Health teams. Method Descriptive research with a quantitative approach. Seventy-eight members of multi-professional teams participated. Data were collected in 2016, using a tool to characterize the professional and the dimensions of time of work and qualification of the team's professionals, ways of hiring and modalities of professional bonds, career plan and variable remuneration and permanent education. The analyzes were generated by using IBM SPSS software version 21. Results The distribution of physicians and nurses is homogeneous, one notices a reduction of community health agents. The most frequent characteristics were: legal and formal employment relationship, low complementary training for primary health care, up to one year of work in the team, with low complementary training for the area and initiatives of educational actions by management. Conclusions and implications for practice There are weaknesses that can interfere in the organization of the work process influenced by the training axes and forms of hiring.

An End-of-Life Care Educational Series to Improve Staff Knowledge and Comfort Levels.

Nursing staff play a key role in enhancing a patient's quality of life during end of life; however, they perceive lack of knowledge to be the largest barrier in providing quality end-of-life (EOL) care. Literature suggests that implementation of palliative and EOL care education can improve nursing EOL care practices. In order to address the gap in nursing knowledge and comfort, a quasi-experimental study was conducted; this study included the implementation of a multimodal EOL care educational series on an inpatient pediatric hematology oncology floor over 6 months. Prior to implementation, nursing staff completed a survey to measure perceived knowledge and comfort level regarding EOL care. The series included didactic sessions, in-services, case studies, practice exercises, and interactive discussions led by an interprofessional team of nurses, child-life specialists, and social workers. Educational topics included EOL symptom management, child-life services, supportive care resources, COMFORT communication, and an End-of-Life Nursing Education Consortium course. Following the educational series, the survey was repeated. Results of the survey demonstrated an increase in nursing knowledge and comfort levels. Significant improvements were observed across several items including medication management of dyspnea (χ1,83 =5.1, P = .023), comfort with implementing interventions (χ1,93 = 3.9, P = .049), and knowledge of hospital resources (χ1,93 = 6.1, P = .014). These results suggest that while EOL education strategies can vary, a combination of learner engagement tactics can increase knowledge and comfort regarding EOL concepts and potentially positively impact nursing practice.

Physician Assistant Students' Competency to Identify and Diagnose Autism Spectrum Disorder.

PURPOSE: Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by deficits in communication and reciprocal social interactions. Little research has focused on the evaluation of developmental/behavioral pediatric education in the physician assistant (PA) curriculum. Therefore, the aims of this study were to evaluate whether PA students received training in identifying the red flags of ASD, using screening tests such as the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F). Additionally, the study sought to determine if PA students received education on the evaluation and management of children with ASD along with the methods to communicate effectively with their caretakers. METHODS: A survey open to PA students was administered by the American Academy of PAs. Demographic information along with questions on knowledge and perceptions related to ASD were asked. Perceptions of preparation to discuss ASD with patient caregivers were assessed, along with vaccination beliefs, and training information was collected. RESULTS: A total of 213 PA students answered the survey. Students received training regarding the red flags for ASD as well as ASD-related skills. Of note, 58.2% did not receive training on administration of the M-CHAT-(R/F) and 54.9% did not receive training to provide care to patients with ASD; 77.8% received training to understand pediatric developmental milestones. PA students overwhelmingly rejected the suggestion that there is a link between vaccines and ASD. CONCLUSION: The importance of diagnosing ASD as early as possible has been demonstrated by years of research; yet, this study concludes that many students still do not feel comfortable recognizing the red flags or using screening tools. Although the majority of PA students received training to understand developmental milestones, many did not know how to administer the M-CHAT-(R/F), which is key to making an early diagnosis.

An Evaluation of a Continuing Education Workshop for Audiologists on the Assessment and Management of Tinnitus.

INTRODUCTION: Tinnitus assessment and management is an important component of audiology. The benefits of continuing education (CE) workshops in the field of tinnitus have not been published. This study evaluated the outcomes of a workshop centered around a Sound Therapy and Aural Rehabilitation for Tinnitus (START) framework. Our hypotheses were that a CE workshop would (1) be useful, (2) improve clinician's knowledge and willingness to undertake tinnitus practice, and (3) result in learners using knowledge gained in their practice. METHODS: Twenty-five participants attending a 3-day tinnitus workshop were invited to complete an evaluation immediately and 3 months after the workshop's completion. The workshop consisted of seminars and practical sessions. The pedagogical approaches employed were experiential (theory building, reflection, and testing) and community of practice (shared experiences). RESULTS: Participants reported on a 5-point Likert scale (1 = not useful-5 = excellent) a high level of satisfaction both immediately after the workshop (ratings of usefulness: mean, 4.8; SD, 0.4; willingness to practice: 4.6; SD. 0.6; ability to manage: 4.6; SD, 0.5; all "excellent" ratings) and 3 months later (ratings of usefulness: mean, 4.2; SD, 0.9, "very useful;" willingness to practice: 4.6; SD, 0.6, "excellent;" ability to manage: 4.1; SD. 0.5, "very useful"). Open-ended questions indicated participants made changes in their practice that reflected material provided in the CE. CONCLUSION: The workshop was successful in improving knowledge and confidence of audiologists in undertaking tinnitus assessment and management, but the need for ongoing support and supervision was a common theme.

Continuing professional development requirements for UK health professionals: a scoping review.

OBJECTIVES: This paper sets out to establish the numbers and titles of regulated healthcare professionals in the UK and uses a review of how continuing professional development (CPD) for health professionals is described internationally to characterise the postqualification training required of UK professions by their regulators. It compares these standards across the professions and considers them against the best practice evidence and current definitions of CPD. DESIGN: A scoping review. SEARCH STRATEGY: We conducted a search of UK health and social care regulators' websites to establish a list of regulated professional titles, obtain numbers of registrants and identify documents detailing CPD policy. We searched Applied Social Sciences Index and Abstracs (ASSIA), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, EMCare and Scopus Life Sciences, Health Sciences, Physical Sciences and Social Sciences & Humanities databases to identify a list of common features used to describe CPD systems internationally and these were used to organise the review of CPD requirements for each profession. RESULTS: CPD is now mandatory for the approximately 1.5 million individuals registered to work under 32 regulated titles in the UK. Eight of the nine regulators do not mandate modes of CPD and there is little requirement to conduct interprofessional CPD. Overall 81% of those registered are required to engage in some form of reflection on their learning but only 35% are required to use a personal development plan while 26% have no requirement to engage in peer-to-peer learning. CONCLUSIONS: Our review highlights the wide variation in the required characteristics of CPD being undertaken by UK health professionals and raises the possibility that CPD schemes are not fully incorporating the best practice.

Structure for the work and composition of Family Health Support Unit teams: national survey - Program for Improving Primary Health Care Access and Quality (PMAQ), 2013. / Estrutura para o trabalho e composição de equipes do Núcleo de Apoio à Saúde da Família: pesquisa nacional - Programa de Melhoria do Acesso e da Qualidade (PMAQ), 2013.

OBJECTIVE: to describe the structure of Family Health Support Unit (FHSU) teams with regard to physical space, training received, continuing education and professionals that support Primary Health Care (PHC) teams in Brazil, in 2013. METHODS: this is a descriptive study using data from the external evaluation stage of the Program for Improving Primary Health Care Access and Quality (PMAQ). RESULTS: the 1,773 FHSU teams mainly used shared clinics at primary health care centers (85.7%); 63.4% of professionals were offered specific training when they started work at their FHSU, while 67.4% were offered continuing education; the teams received support mainly from physiotherapists (87.4%) and Physical Education professionals (87,0%). CONCLUSION: the structure available for FHSU teams is in accordance with the guidelines; some FHSU professionals have not received any specific training for the job.

12-hr shifts in nursing: Do they remove unproductive time and information loss or do they reduce education and discussion opportunities for nurses? A cross-sectional study in 12 European countries.

AIMS AND OBJECTIVES: To examine the association between registered nurses' (referred to as "nurses" for brevity) shifts of 12 hr or more and presence of continuing educational programmes; ability to discuss patient care with other nurses; assignments that foster continuity of care; and patient care information being lost during handovers. BACKGROUND: The introduction of long shifts (i.e., shifts of 12 hr or more) remains controversial. While there are claims of efficiency, studies have shown long shifts to be associated with adverse effects on quality of care. Efficiency claims are predicated on the assumption that long shifts reduce overlaps between shifts; these overlaps are believed to be unproductive and dangerous. However, there are potentially valuable educational and communication activities that occur during these overlaps. DESIGN: Cross-sectional survey of 31,627 nurses within 487 hospitals in 12 European countries. METHODS: The associations were measured through generalised linear mixed models. The study methods were compliant with the STROBE checklist. RESULTS: When nurses worked shifts of 12 hr or more, they were less likely to report having continuing educational programmes; and time to discuss patient care with other nurses, compared to nurses working 8 hr or less. Nurses working shifts of 12 hr or more were less likely to report assignments that foster continuity of care, albeit the association was not significant. Similarly, working long shifts was associated with reports of patient care information being lost during handovers, although association was not significant. CONCLUSION: Working shifts of 12 hr or more is associated with reduced educational activities and fewer opportunities to discuss patient care, with potential negative consequences for safe and effective care. RELEVANCE TO CLINICAL PRACTICE: Implementation of long shifts should be questioned, as reduced opportunity to discuss care or participate in educational activities may jeopardise the quality and safety of care for patients.

A Low-Fidelity, High-Functionality Ultrasound-Guided Serratus Plane Block Model.

BACKGROUND: Thoracic injuries present many challenges for management in the acute and inpatient settings, including achieving appropriate pain control. Traditional modalities, such as opioids and spinal epidural anesthesia, are associated with multiple complications. Ultrasound-guided regional nerve blocks are becoming more prevalent, and they have been shown to be an effective modality of pain control for other traumatic injuries. Models comprised of animal tissue to simulate human anatomy are widely utilized to facilitate training of needle-guided procedures, but no such model for the serratus anterior plane block has yet been defined in the literature. OBJECTIVES: Our goal was to produce a high-functionality serratus anterior plane block model with reasonable anatomic fidelity from low-cost materials. DISCUSSION: We describe the creation of an inexpensive high-functionality serratus anterior plane block model from common materials, including pork ribs and chicken breasts, to realistically simulate human anatomy, including multiple muscle and fascial planes, as well as to allow hydrodissection. CONCLUSIONS: This model will facilitate training and can improve success when caring for patients with thoracic trauma.

Does initial postgraduate career intention and social demographics predict perceived career behaviour? A national cross-sectional survey of UK postgraduate doctors.

OBJECTIVE: Studies indicate that initial career intentions and personal characteristics (eg, gender) can influence medical career decision-making. However, little is known about how personal characteristics and intention interact with career decision-making. To address this gap, we examined the link between career intention at the start of the 2-year UK Foundation Programme (FP) and career intentions on its completion. METHODS: Data came from the 2017 UK National Career Destination Survey, a cross-sectional study completed by all second year foundation doctors. We included respondents' demographics (gender, graduate status on entry to medical school, career intention on starting the FP) and career intention as an outcome measure (eg, specialty (residency) training (UK), NHS non-training posts/further study, career break, working abroad). Multinomial regression was used to assess the independent relationship between background characteristics and career intention. RESULTS: There were 6890 participants and 5570 usable responses. 55.9% of respondents were female and 43.1% were male, 77.1% were non-graduates and 22.9% were graduate entrants to medical school. Approximately two-thirds (62.3%, n=2170) of doctors who had an original intention to pursue specialty training after F2, still intended to do so on completion. Most of those who stated at the start of F2 that they did not want to pursue specialty indicated at the end of F2 they would be undertaking other employment opportunities outwith formal training. However, 37.7% of respondents who originally intended to pursue specialty training on FP completion did something different. Graduate entrants to medicine were more likely to immediately progress into specialty training compared with their peers who did medicine as a primary first degree. CONCLUSION: Original intention is a strong predictor of career intentions at the end of the FP. However, a considerable proportion of doctors changed their mind during the FP. Further research is needed to understand this behaviour.

Evaluating Online Continuing Professional Development Regarding Weight Management for Pregnancy Using the New World Kirkpatrick Model.

INTRODUCTION: Clinical practice guidelines advocate the importance of continuing professional development (CPD) that supports health professionals (HPs) to discuss the sensitive topic of maternal weight management with women. However, there is a lack of accredited CPD related to this important area of preconception and antenatal care. Therefore, aims were to evaluate HPs' reactions to accredited online CPD regarding weight management for pregnancy and their knowledge, attitudes, confidence, and commitment to provide women with advice after completing the course. METHODS: A mixed-methods evaluation was based on the New World Kirkpatrick Model (NWKM). Accredited online CPD was developed by experts in maternal nutrition and weight management. Participants completed a questionnaire before (n = 136) and after (n = 65) the weight management components of the course. McNemar and Wilcoxon signed-rank tests were used to evaluate paired data (n = 36) (p < .05). Deductive content analyses explored free-text responses (n = 65). RESULTS: Participants' reactions to the online CPD were encouraging, facilitating increases in perceptions of the importance of weight management for pregnancy and confidence to provide advice. Quantitative measures assessed no change in participants' knowledge; however, qualitative analyses revealed an increase in participants' knowledge of communication strategies that they intend to apply in practice. DISCUSSION: The NWKM facilitated an evaluation of HPs' encouraging reactions to online CPD and the affective constructs of education including attitudes, confidence, and commitment to provide advice. Online CPD should be developed with collaboration between universities/professional associations and health care providers, so that evaluation of organizational change and clinical outcomes is possible.

Interprofessional Learning to Improve Communication in Challenging Healthcare Conversations: What Clinicians Learn From Each Other.

INTRODUCTION: Although contemporary health care involves complex interactions among clinicians of varying professions, opportunities to learn together are relatively few. The authors assessed participants' views about the educational value of learning with colleagues of mixed health care professions in communication and relational skills training focused on challenging conversations. METHODS: Between 2010 and 2013, 783 participants enrolled in 46 workshops hosted by the Institute for Professionalism and Ethical Practice at Boston Children's Hospital, Boston, USA. Participants received pre-, post-, and 3-month follow-up questionnaires with quantitative and qualitative questions about their experiences learning with clinicians of varying professions ("interprofessional learning"). Descriptive statistics and chi-square tests were used to compare participant groups. Responses to open-ended questions were coded according to standard principles of content analysis. RESULTS: Seven hundred twenty-two (92%) participants completed surveys. Previous interprofessional learning was reported by 60% of respondents, but generally comprised <30% of their education. Clinicians with <3 years of work experience were least likely to have previous interprofessional learning. Nearly all (96%) participants reported interprofessional colleagues contributed valuably to their learning. Asked specifically what they learned, participants described five themes: Stronger Teamwork, Patient-Centered Focus, Specific Communication Skills, Content-Specific Knowledge, and Shared Global Values. After 3 months, 64% of respondents reported that workshop participation helped make their interactions with interprofessional colleagues more collaborative. DISCUSSION: Communication skills training for challenging health care conversations is a valuable opportunity for interprofessional learning and generates sustained positive attitudes about collaboration. Clinicians learn from their colleagues a deeper understanding of each other's professional roles, challenges, and unique contributions; specific communication approaches; and a sense of belonging to a collaborative community reinforcing the patient at the center of care.

Impact of weekly case-based tele-education on quality of care in a limited resource medical intensive care unit.

BACKGROUND: Limited critical care subspecialty training and experience is available in many low- and middle-income countries, creating barriers to the delivery of evidence-based critical care. We hypothesized that a structured tele-education critical care program using case-based learning and ICU management principles is an efficient method for knowledge translation and quality improvement in this setting. METHODS AND INTERVENTIONS: Weekly 45-min case-based tele-education rounds were conducted in the recently established medical intensive care unit (MICU) in Banja Luka, Bosnia and Herzegovina. The Checklist for Early Recognition and Treatment of Acute Illness (CERTAIN) was used as a platform for structured evaluation of critically ill cases. Two practicing US intensivists fluent in the local language served as preceptors using a secure two-way video communication platform. Intensive care unit structure, processes, and outcomes were evaluated before and after the introduction of the tele-education intervention. RESULTS: Patient demographics and acuity were similar before (2015) and 2 years after (2016 and 2017) the intervention. Sixteen providers (10 physicians, 4 nurses, and 2 physical therapists) evaluated changes in the ICU structure and processes after the intervention. Structural changes prompted by the intervention included standardized admission and rounding practices, incorporation of a pharmacist and physical therapist into the interprofessional ICU team, development of ICU antibiogram and hand hygiene programs, and ready access to point of care ultrasound. Process changes included daily sedation interruption, protocolized mechanical ventilation management and liberation, documentation of daily fluid balance with restrictive fluid and transfusion strategies, daily device assessment, and increased family presence and participation in care decisions. Less effective (dopamine, thiopental, aminophylline) or expensive (low molecular weight heparin, proton pump inhibitor) medications were replaced with more effective (norepinephrine, propofol) or cheaper (unfractionated heparin, H2 blocker) alternatives. The intervention was associated with reduction in ICU (43% vs 27%) and hospital (51% vs 44%) mortality, length of stay (8.3 vs 3.6 days), cost savings ($400,000 over 2 years), and a high level of staff satisfaction and engagement with the tele-education program. CONCLUSIONS: Weekly, structured case-based tele-education offers an attractive option for knowledge translation and quality improvement in the emerging ICUs in low- and middle-income countries.

The Development of an Active Learning Program for the Medical Responders in a Nuclear Disaster.

OBJECTIVE: In Japan, with the revision of the Nuclear Emergency Response Guidelines in 2015, nuclear emergency medical assistance teams responsible for the medical treatment in the acute phase of nuclear disaster have been developed nationwide. The purpose of this research is to develop active learning materials for the education of medical staff, to confirm the educational effect of the materials, and to identify the gaps in nuclear disaster risk reduction in Japan. METHODS: We established a working group and created active learning materials. We trained members of the nuclear emergency medical assistance team using the developed active learning materials and then conducted a questionnaire survey for trainees who participated in the training. RESULTS: Regarding the developed teaching materials, out of 33 trainees, 33 (100%) answered "easy to understand" or "a little understandable" to the item dealing with how to use the radiation detectors and attaching/detaching personal protective equipment. Regarding the simulation about practicing hospital support and medical provision, 3 (8%) answered "a little confusing." CONCLUSION: The study demonstrated that the developed materials have an educational effect. Additionally, the results of the trainee questionnaire showed the necessity for improvement in the triage system and new protocols to help both the patients and responders.

Spirituality in the continuing education of healthcare professionals: An approach to palliative care.

OBJECTIVE: A major barrier to the adoption of an approach that integrates spirituality into palliative care is the lack of preparation/education of healthcare professionals on the topic. This study aimed to evaluate the effectiveness of a continuing education activity for healthcare professionals addressing spirituality and spiritual care provision to patients and families within palliative care. METHOD: We conducted an intervention study using a quantitative pre- and posttest design in a convenience sample of 52 healthcare professionals. Participants completed the Brazilian version of the Spiritual Care Competence Scale before and after attending a four-hour continuing education activity. RESULT: Significant differences were observed between pre- and postintervention scores in the following dimensions: assessment and implementation of spiritual care, professionalization and improving the quality of spiritual care, personal support, and patient counseling (p < 0.001), and referral (p = 0.003). SIGNIFICANCE OF RESULTS: The results of this study provide preliminary evidence of a positive effect of this educational intervention on the development of the competences needed by healthcare professionals to deliver a comprehensive approach centered on the patient/family, which includes attention to spirituality and spiritual care in the decision-making process.

Physiotherapy clinical education in Australia: an exploration of clinical educator characteristics, confidence and training requirements.

Objectives The aim of this study was to describe physiotherapists' involvement, confidence and training needs in the provision of student clinical education (CE) in Australia. Methods A valid and reliable cross-sectional online survey instrument was used to collect data from physiotherapists employed in public and private healthcare facilities in Australia. Survey questions included participant personal and professional characteristics, participation in CE-related continuing professional development (CPD) and confidence in components of CE. Results In all, 170 (34%) physiotherapists (mean age 37 years; mean years clinical experience 13 years) completed the survey. Most participants (68%) were currently involved in CE, over half (56%) had completed CE-related CPD and many (56%) reported a need for more CPD. Participants with no previous CE experience were less confident (P≤0.05) in all components of CE. Participants with less clinical experience were less confident in managing challenging students (P=0.003), multiple students (P=<0.001) and competing workplace and education duties (P=<0.001). Conclusions Physiotherapists with varying professional characteristics were involved in CE. Although many participants had attended CE-related CPD, many reported that more training was required. Future training for clinical educators should be tailored to participants' level of experience and focus on the components of CE in which they feel least confident. What is known about the topic? The ability of physiotherapists to confidently assume a clinical educator role may affect their willingness to be clinical educators in the future and the students' perceptions of clinical placement quality. CPD relating to CE may help prepare physiotherapists for the clinical educator role. What does this paper add? There is a lack of information regarding physiotherapists' involvement in CE, completion of CE-related CPD or perceived levels of confidence in various aspects of the clinical educator role, such as placement organisation, teaching, assessment and the provision of feedback. This study describes the involvement of physiotherapists in CE in Australia, including their demographic and professional characteristics, participation in CE-related CPD and confidence in various components of CE. What are the implications for practitioners? Several recommendations regarding future CE-related CPD have resulted from this study, including tailoring CPD to the needs of physiotherapists based on their level of clinical or CE experience, focusing CPD on the aspects of CE in which physiotherapists feel least confident and raising the awareness of and improving accessibility to CPD opportunities in this area.

Educação permanente em cuidados paliativos: uma proposta de pesquisa-ação / Continuous education in palliative care: an action research proposal / Ducación permanente en la atención de hospicio: una propuesta de investigación-acción

Objetivo: Compreender como uma proposta de educação permanente pode contribuir para a melhora do conhecimento profissional de saúde sobre cuidados paliativos. Métodos: estudo qualitativo do tipo pesquisa-ação desenvolvido em um hospital de referência em oncologia no sul do Brasil. Os dados foram coletados por meio da aplicação de um questionário com questões abertas antes e após a atividade de educação e analisados a partir da análise de conteúdo, do tipo temática. Resultados: Participaram 213 profissionais. Categorias temáticas construídas: Conhecimento profissional antes da ação: cuidado ao paciente terminal; Conhecimento profissional antes da ação: cuidado ao paciente fora de possibilidades de cura e tratamento; Sensibilização para os princípios dos cuidados paliativos: o ponto de partida; Segurança para cuidar: entendendo a proposta e suas indicações; e Sentindo a necessidade de educar-se. Conclusão: identificou-se a diminuição da insegurança dos profissionais e a melhora do conhecimento. Destaca-se a maior divulgação sobre esta filosofia de cuidado

Objetivo: Comprender cómo una propuesta de educación permanente puede contribuir a la mejora del conocimiento profesional de salud sobre cuidados paliativos. Métodos: estudio cualitativo del tipo investigaciónacción desarrollado en un hospital de referencia en oncología en el sur de Brasil en el período de abril y mayo de 2015 a través de la aplicación de cuestionario con preguntas abiertas antes y después de la actividad de educación. Se realizó análisis de contenido, del tipo temático. Resultados: Participaron 213 profesionales. Se construyeron 5 categorías temáticas: Conocimiento profesional antes de la acción: cuidado al paciente terminal; Conocimiento profesional antes de la acción: cuidado al paciente fuera de posibilidades de curación y tratamiento; Sensibilización para los principios de los cuidados paliativos: el punto de partida; Seguridad para cuidar: entendiendo la propuesta y sus indicaciones; Y sintiendo la necesidad de educarse. Conclusión: se identificó la disminución de la inseguridad de los profesionales y la mejora del conocimiento. Se destaca la mayor divulgación sobre esta filosofía de cuidado

Objective: The study's purpose has been to further understand how a continuous education proposal could contribute to the improvement of professional health knowledge with regards to the palliative care. Methods: It is an action research type with a qualitative approach, which was carried out at a referral hospital in oncology that is locaded in the Southern region of Brazil during the period from April to May 2015. The study was performed through the application of a questionnaire with open questions before and after the education activity, then being analyzed from content analysis of the thematic type. Results: 213 professionals participated. Five thematic categories were constructed, as follows: Professional knowledge before the action: care towards the terminal patient; Professional knowledge before the action: care to the patient without both cure and treatment possibility; Sensitization to the principles of palliative care: the starting point; Safety care: understanding the proposal and its indications; and, Feeling the need to self-learning. Conclusion: It was identified the reduction of professionals insecurity and the improvement of the knowledge. It is important to highlight the larger propagation about this philosophy of care

Komplementäre und Integrative Medizin in der Facharztweiterbildung Allgemeinmedizin: Ergebnisse einer Bedarfserhebung bei Ärzten in Weiterbildung.

Hintergrund: Inhalte aus den Bereichen der klassischen Naturheilverfahren und Komplementärmedizin sind im Rahmen der ärztlichen Approbationsordnung curricular verankert. Im Gegensatz dazu werden in den Weiterbildungsordnungen zum Facharzt für Allgemeinmedizin keine komplementärmedizinischen Inhalte abgebildet. Bisher ist nicht bekannt, ob Ärzte in Weiterbildung (ÄiW) zum Facharzt für Allgemeinmedizin innerhalb ihrer Weiterbildung mit komplementärmedizinischen Verfahren in Kontakt kommen und ob sie solche erlernen bzw. erlernen möchten. Das Ziel der vorliegenden Studie war die Erhebung der Einstellung zum und des Weiterbildungsbedarfs im Bereich Komplementärmedizin bei ÄiW zum Facharzt für Allgemeinmedizin. Methoden: In Rahmen einer Querschnittsstudie erfolgte eine Fragebogen-gestützte Umfrage unter ÄiW zum Facharzt für Allgemeinmedizin innerhalb des Weiterbildungsprogramms «Verbundweiterbildungplus Baden-Württemberg¼. Diese wurde onlinebasiert initiiert und durch eine papierbasierte Umfrage komplettiert. Ergebnisse: Insgesamt nahmen 138 Teilnehmer der Verbundweiterbildungplus Baden-Württemberg an der Umfrage teil. Der Gesamtrücklauf betrug damit 28%. Dabei zeigte sich, dass die Teilnehmenden ein hohes Interesse an Komplementärmedizin hatten. Gleichzeitig gaben sie an, Unsicherheiten sowohl inhaltlicher als auch formaler Art wahrzunehmen (z.B. Evidenz der einzelnen Methoden und Kostenübernahme durch gesetzliche Krankenkassen). Die große Mehrheit der befragten Ärzte befürwortete, dass in der Weiterbildung zum Facharzt Allgemeinmedizin Kompetenzen aus dem Bereich Komplementärmedizin vermittelt werden. Schlussfolgerungen: Vor dem Hintergrund der weiten Verbreitung komplementärmedizinischer Methoden im hausärztlichen Alltag muss diskutiert werden, ob im Rahmen der Weiterbildung zum Facharzt für Allgemeinmedizin Basiskompetenzen für diesen Bereich definiert werden sollten. Diese könnten beispielsweise in das «Kompetenzbasierte Curriculum Allgemeinmedizin¼ der Deutschen Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM) einfließen.

Prenatal consultation: perspectives on training, relevance, and utilization among pediatric subspecialty program directors.

OBJECTIVE: To characterize the experience and training of house officers in prenatal consultation, and to assess program directors' perceptions regarding adequacy of training, and relevance and utilization of prenatal consultation in their field. STUDY DESIGN: An online survey was distributed to program directors of all ACGME-accredited programs in the United States in relevant pediatric subspecialties. RESULTS: Ninety-five percent (142/150) of respondents agreed that prenatal consultation from their field can impact decision-making, yet 46% (69/149) believe their prenatal consult services are underutilized. The majority (56%, 86/152) reported no formal curriculum related to prenatal consultation in their program. Nine percent (14/150) rated their trainees as not adequately trained to perform competent prenatal consultation upon graduation; 35% (52/150) rated trainees as only "somewhat" competent. CONCLUSION: Our study, the first of its kind, reveals widespread lack of formal training curricula, which may explain the finding that many graduating trainees are perceived as inadequately prepared to perform competent prenatal consultation.