Intentions of Kentucky School Nurses to Delegate Diabetes-Related Tasks to Unlicensed Assistive Personnel.

Many children have diagnosed diabetes that must be safely managed at school. New laws have created the potential for school systems to rely more heavily on unlicensed assistive personnel (UAP) than on nurses to deliver health services, including administration of insulin injections. Using the theory of planned behavior as a framework, aims were to (1) determine the nature and extent to which health services related to diabetes were being delegated to UAP in Kentucky schools, (2) describe the attitudes of Kentucky school nurses regarding the delegation of diabetes health services to UAP, and (3) examine the relationship of selected variables to school nurses' intentions to delegate diabetes health services. Survey results revealed that school nurses in Kentucky intended to delegate some diabetes-related tasks despite their lack of support for delegation of those tasks.

The Role of School Nurses, Challenges, and Reactions to Delegation Legislation: A Qualitative Approach.

Passage of new laws, national standards regarding delegation, and the recommendation for at least one full-time nurse in every school have provided more visibility to the role of school nurses. Recent legislative amendments in Kentucky presented an opportunity to examine how the role of the school nurse is changing. Aims were to describe the (1) role of school nurses in Kentucky, (2) impact of school nurses, (3) challenges faced by school nurses, and (4) impact of budget cuts and legislation. Three focus groups were conducted. School nurses faced challenges of limited time and resources, communication barriers, and multiple documentation requirements. Nurses' greatest impacts were their availability, recognition of psychosocial problems and health concerns, and connection with resources. Nurses had not yet encountered many changes due to new legislation that expanded delegation of diabetes-related tasks to unlicensed school personnel, but some had concerns about possible negative effects while others expressed support.

The role and impact of nurses in American elementary schools: a systematic review of the research.

School nurses are tasked with the critical job of keeping students safe and well. Due to competing demands for resources in schools, the impact of school nurses must be demonstrated to secure their jobs. A systematic review of the literature from 1937 to 2013 was conducted to show the efficacy of school nursing activities in American elementary schools. While some studies of immunization compliance, attendance rates, body mass index screening, vision screening, and follow-up are promising, results are mixed and additional evidence is needed. The impact of school nurses on educational and health outcomes must continue to be evaluated and more rigorous evaluation methods should be explored. Suggestions for future research and collaborations are discussed.

A complementary and alternative medicine workshop using standardized patients improves knowledge and clinical skills of medical students.

OBJECTIVES: As the use of complementary and alternative medicine (CAM) has increased in the general population, so has the interest in CAM education among medical students and medical educators. The purpose of this study is to determine the impact of a CAM workshop using standardized patients (SP) on knowledge and clinical skills of third-year medical students. DESIGN: A 4-hour CAM workshop was developed as part of a new curriculum for a required third-year 4-week primary care internal medicine clerkship. The CAM workshop and 3 other novel workshops were randomized for delivery to half of the rotational groups. The CAM workshop incorporates 4 SP cases representing different clinical challenges. All students in every rotation group are assigned CAM readings. At the end of the rotation, all students take a 100-item written exam (7 CAM items) and 9-station SP exam (1 CAM station) including a post-SP encounter open-ended written exercise. Scores on the written exam CAM items, CAM SP checklist, and CAM open-ended written exercise of workshop participants and nonparticipants were analyzed with simple means, standard deviations, and multiple regression approaches. RESULTS: The CAM workshop was delivered to 12 of the 24 rotation groups during the 2004-2005 and 2005-2006 academic years. Ninety-two students participated in the workshop, and 94 did not. Workshop participants performed significantly better than nonparticipants on the CAM-specific SP checklist items (58 vs 36.6%, P<.0001), post-SP encounter written exercise (76.9 vs 63.3%, P<.0001), and 7 CAM written exam items (84.8 vs 76.3%, P<.0001). CONCLUSIONS: Students participating in a 4-hour SP workshop exhibit superior CAM knowledge as assessed by SP checklist, open-ended exercises, and multiple choice items. It appears that practice with SPs assists in acqusition and application of CAM knowledge and deferential counseling skills.

Sexual history inquiry and HIV counseling: improving clinical skills and medical knowledge through an interactive workshop utilizing standardized patients.

BACKGROUND: Sexual history and HIV counseling (SHHIVC) are essential clinical skills. Our project's purpose was to evaluate a standardized patient educational intervention teaching third-year medical students SHHIVC. METHODS: A four-hour standardized patient workshop was delivered to one-half of the class each of three consecutive years at one medical school. Approximately 3.5 weeks later, all students engaged in a standardized patient examination including one station assessing SHHIVC, answered an open-ended written exercise following the standardized patient encounter, and completed a written examination including sexual history and HIV-related questions. RESULTS: Workshop participants scored higher than non-participants on SHHIVC items on the standardized patient station (P < .0001), written exam (P < .0001), and open-ended written exercise after the standardized patient encounter (P = .024). CONCLUSIONS: Our SHHIVC curriculum was associated with students demonstrating better clinical skills on a SHHIVC standardized patient examination station and more SHHIVC knowledge on two measures of medical knowledge than students not participating in the SHHIVC educational intervention.

A needs assessment of complementary and alternative medicine education at the University of Kentucky College of Medicine.

INTRODUCTION: Complementary and alternative medicine (CAM) encompasses a wide variety of increasingly popular therapies not generally taught in allopathic medical schools but of apparent interest to medical trainees. However, little is known about the learners' specific needs for improving their CAM clinical skills. METHODS: Third-year medical students and internal medicine resident-physicians at the University of Kentucky were invited to participate in a voluntary questionnaire to assess CAM knowledge, skills, attitudes as well as their desired learning methods. RESULTS: Medical students (n = 22) and resident-physicians (n = 39) generally hold favorable attitudes toward CAM but admit to significant knowledge deficits and do not feel adept at counseling their patients about CAM. Students indicate observation and hands-on experiences as their preferred pedagogy while residents favor textbooks, articles, and lectures to learn about CAM. Nevertheless, one resident noted, "any information in any format would be helpful as we get no teaching in this area". CONCLUSIONS: In our sample, learner-driven CAM education at undergraduate and graduate levels is indeed necessary and wanted. In constructing CAM education interventions, attitudes, perceived knowledge deficits, and preferred learning strategies should be considered for the trainees and thus ultimately responsive to the needs of their patients.

Is time spent with the physician associated with parent dissatisfaction due to long waiting times?

The objectives of this study were to assess the relationship between wait time and parent satisfaction and determine whether time with the physician potentially moderated any observed negative effects of long wait time. Data were collected from parents in a pediatric outpatient clinic. Parent satisfaction with the clinic visit was significantly negatively related to wait times. More time spent with the physician was positively related to satisfaction independent of wait times. Furthermore, among clinic visits with long wait times, more time with the physician showed a relatively strong positive relationship with parent satisfaction. Therefore, although long wait times was related to decreased parent satisfaction with pediatric clinic visits, increased time with the physician tended to moderate this relationship.

Enhancing knowledge and clinical skills through an adolescent medicine workshop.

OBJECTIVE: To determine the effect of a medical school adolescent medicine workshop on knowledge and clinical skills using standardized patients. DESIGN: Randomized controlled trial. SETTING: The University of Kentucky College of Medicine, Lexington. PARTICIPANTS: A total of 186 third-year medical students. Intervention Medical students assigned to the intervention group (n = 95) participated in a 4-hour adolescent medicine workshop using standardized patients to practice interviewing and counseling skills. Medical students assigned to the control group (n = 91) participated in an alternative workshop. OUTCOME MEASURES: Medical student adolescent interviewing and counseling skills were assessed using adolescent standardized patient encounters during the end-of-clerkship examination and during the end of the third-year Clinical Performance Examination. Medical student knowledge was assessed at the end of the clerkship using an open-ended postencounter written exercise and the questions specific to adolescent medicine on the clerkship written examination. RESULTS: Both groups had comparable baseline characteristics. Medical students in the intervention group scored significantly higher on both measures of clinical skills, the standardized patient stations during the end-of-clerkship examination and the Clinical Performance Examination. Intervention medical students also scored significantly higher on both measures of knowledge, the open-ended postencounter written exercise and the written examination. CONCLUSIONS: A brief adolescent medicine workshop using standardized patients improved medical students' knowledge and skills at the end of a 4-week clerkship, and the improvement in clinical skills persisted at the end of the third year of medical school.

A randomized controlled trial using insinuated standardized patients to assess residents' domestic violence skills following a two-hour workshop.

BACKGROUND: Residents feel inadequately trained to treat domestic violence victims. PURPOSE: The purpose was to assess clinical skills of residents participating in a domestic violence workshop. METHODS: Twenty-seven internal medicine residents were randomized to receive one of two workshops (domestic violence or control workshop). Standardized patients were trained to two domestic violence cases (depressed; injured). The two cases were randomized and insinuated into each resident's continuity clinic at either 1 to 3 months or more than 3 months after the workshops. RESULTS: The domestic violence workshop residents did not identify the standardized patients as domestic violence victims any more often than residents participating in the control workshop; 16/25 (64%) versus 13/23 (56%), p=.86. However, domestic violence workshop residents were more likely to score 75% or higher on the domestic violence checklist items compared to control workshop residents; 9/25 (36%) versus 2/23 (9%), p=.04. CONCLUSIONS: Once a standardized patient was identified in clinic as a domestic violence victim, domestic violence workshop participating residents demonstrated better clinical skills than a control group.