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1.
BMC Med Educ ; 24(1): 110, 2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-38302962

RESUMO

INTRODUCTION: Collaboration between nurses and doctors is necessary for offering care to patients. Using team performance assessment tools and surveying them can be effective in promoting inter-professional collaboration, and the lack of a credible tool to assess inter-professional collaboration competency between the two groups is a major challenge in the healthcare sector. The present study aimed to translate and conduct a psychometric investigation on the inter-professional education collaboration (IPEC) tool for the students of medicine and nursing. METHODS: The present study was a cross-sectional one conducted as a psychometric investigation of the IPEC tool at the Iran University of Medical Sciences in 2022. The initial tool contained 42 items developed according to a 5-point Likert scale, which was translated into Persian with the consent of the original researcher. The validity index and the content validity ratio were investigated by a panel of 11 specialists in medical and clinical education, and its construct validity was evaluated using confirmatory factor analysis. Also, the second population of the study included medical and nursing students of Iran University of Medical Sciences and simple random sampling method. Moreover, the reliability of the instrument was investigated using internal consistency, Cronbach's Alpha, and test-retest methods. RESULTS: Based on the indicators calculated to perform a psychometric investigation over the above tool, it had acceptable reliability and validity according to the specialists. The tool evaluates inter-professional collaboration competency between the students of medicine and nursing across four areas (values and ethics, roles and responsibilities, inter-professional communication, and team-based care and teamwork). Moreover, Cronbach's Alpha coefficient for the tool was determined at 0.84. CONCLUSION: The results of the study showed that the above tool could evaluate inter-professional competency as a valid and reliable questionnaire, and its results could be utilized in planning and education.


Assuntos
Educação Profissionalizante , Estudantes de Medicina , Estudantes de Enfermagem , Humanos , Psicometria , Estudos Transversais , Reprodutibilidade dos Testes , Inquéritos e Questionários
2.
J Tissue Viability ; 33(1): 75-88, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37977894

RESUMO

AIM: Surgical site infections (SSIs) are common healthcare associated infections with serious consequences for patients and healthcare organisations. It is critical that healthcare professionals implement prevention strategies to reduce the incidence of such infections. Prevention strategies are key to reducing the incidence of SSIs. The aim of this systematic review is to describe the effect of interventions conducted in acute care settings on the incidence of SSIs (primary outcome), length of stay, intensive care unit admission, and mortality rate (secondary outcomes). MATERIALS AND METHODS: This review is reported using the Preferred Reporting Items for Systematic review and Meta-Analysis checklist. A search was undertaken in Academic Search Complete, CINAHL, ERIC, MEDLINE, PsycARTICLES, PsycINFO and Web of Science for studies published between January 2017 and March 2022. Studies that focused on interventions within acute hospital settings in patients undergoing elective surgery with the aim of reducing the incidences of SSIs were included. Due to heterogeneity results were synthesised narratively. RESULTS: In total, 23 studies were included. Findings show that interventions that are effective in reducing the incidences of SSIs have multiple components including care bundles, stakeholder engagement, targeted surveillance and education. Few studies were identified that evaluated the effect of SSI prevention interventions on length of stay and mortality, and none assessed intensive care admission rates. CONCLUSIONS: The included interventions varied widely, which made it difficult to draw definitive conclusions regarding specific interventions that reduce SSI. Multicomponent interventions and care bundles showed promise in reducing the occurrence of SSIs. Further studies should focus on standardised evidence-based interventions and compliance using randomised controlled designs.


Assuntos
Cuidados Críticos , Infecção da Ferida Cirúrgica , Humanos , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Incidência
3.
BMC Med Educ ; 23(1): 307, 2023 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-37131157

RESUMO

BACKGROUND: In healthcare practice, ethical challenges are inevitable and their optimal handling may potentialy improve patient care. Ethical development in medical education is critical for the transition from a medical and health sciences student to an ethical healthcare practitioner. Understanding the health professions students' approaches towards practice-driven ethical dilemmas could harness i the effective ethical development in their medical education. This study attempts to identify the health professions students' approaches towards practice-driven ethical dilemmas. METHODS: An inductive qualitative evaluation was conducted on six recorded videos of health professions students' case-based online group discussions, followed by a one-hour online ethics workshop. The online ethics workshop was organized with students from the College of Medicine, College of Dental Medicine and College of Pharmacy at the University of Sharjah, and the College of Medicine at the United Arab Emirates University. . The recorded videos were transcribed verbatim and imported to the qualitative data analysis software of MAXQDA 2022. Data were analyzed applying four stages of review, reflect, reduce and retrieve and two different coders triangulated the findings. RESULTS: Six themes emerged from the qualitative analysis of the health professions students' approaches to the practice-based ethical dilemmas; (1) emotions, (2) personal experiences, (3) law and legal system, (4) professional background, (5) knowledge of medical research and (6) inter-professional education. In addition, during the case-based group discussions in the ethics workshop, students efficiently applied the relevant ethical principles of autonomy, beneficence, non-maleficence and justice in their reasoning process to reach an ethical decision. CONCLUSION: The findings of this study explained how health professions students resolve ethical dilemmas in their ethical reasoning process. This work sheds light on ethical development in medical education by gaining students' perspectives in dealing with complex clinical scenarios. The findings from this qualitative evaluation will aid academic medical institutions in developing medical and research-based ethics curriculum to transform students to ethical leaders.


Assuntos
Educação Médica , Estudantes de Ciências da Saúde , Estudantes de Medicina , Humanos , Pesquisa Qualitativa , Resolução de Problemas , Ocupações em Saúde
4.
Med Humanit ; 49(1): 134-138, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35688617

RESUMO

The growth of Health and Medical Humanities baccalaureate and master's degrees in recent decades makes the present moment ideal for initiating field-defining conversations among health humanities constituents about the boundaries of this transdisciplinary field. Focusing on accreditation at the programme level rather than the individual level, we explore four models with different advantages for Health and Medical Humanities: a certification for practice; a network (umbrella organisation); a programme of merit (POM) model; and consultancy. We conclude that for a young field like health humanities that is transdisciplinary, does not have an established canon and does not lead to entry to a specific professional path (ie, gatekeeping), the POM model is the best fit. In contrast to a full accreditation model, POM credentialling leaves room for creativity, expansiveness, and diversity of approaches and will not restrict programmes from calling themselves health humanities programmes; POM enhances visibility rather than decides who can teach in the field and what they must teach. To implement this model, we suggest the creation of a semi-independent Health and Medical Humanities Program Accreditation Commission (HMHPAC) that would be administered by the Health Humanities Consortium. The HMHPAC should have three goals: ensure that health humanities educational programmes are of the highest quality, assist programmes in acquiring the resources they need from their institutions and help programmes attract potential students.


Assuntos
Currículo , Educação Médica , Humanos , Ciências Humanas/educação , Acreditação , Estudantes
5.
Med Humanit ; 49(4): 583-592, 2023 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-37208190

RESUMO

This paper describes the learning framework for an innovative narrative-based training platform for healthcare professionals based on older patients' narratives. The aim of Caring Stories is to place patients' desires and needs at the heart of healthcare and by doing so to promote person-centred care (PCC). It is argued that this narrative-based approach to training in healthcare education will provide professionals from different fields with competencies to better understand how to interpret the lifeworlds of older people, as well as facilitate better communication and navigation through increasingly complex care trajectories. The spiral learning framework supports narrative-based training to be accessible to a broad range of healthcare practitioners. We suggest this is a theoretically sophisticated methodology for training diverse healthcare professionals in PCC, alongside core tenets of narrative medicine, with applicability beyond the patient group it was designed for. The learning framework takes into account professionals' mindsets and draws on the epistemic tenets of pragmatism to support interprofessional education. Being informed by narrative pedagogy, narrative inquiry, and expansive learning and transformative learning theories, ensures that a robust pedagogical foundation underpins the learning framework. The paper sets out the conceptual ideas about narrative that we argue should be more widely understood in the broad body of work that draws on patient narratives in healthcare education, alongside the learning theories that best support this framing of narrative. We suggest that this conceptual framework has value with respect to helping to disseminate the ways in which narrative is most usefully conceptualised in healthcare education when we seek to foster routes to bring practitioners closer to the lifeworlds of their patients. This conceptual framework is therefore generic with respect to being a synthesis of the critical orientations to narrative that are important in healthcare education, then adaptable to different contexts with different patient narratives.


Assuntos
Narração , Medicina Narrativa , Humanos , Idoso , Aprendizagem , Comunicação , Atenção à Saúde
6.
Med Humanit ; 48(4): 461-470, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35595473

RESUMO

In this article we explore the historical antecedents and ongoing perpetuation of the idea that medical professionals must adhere to a specific 'character'. In the late nineteenth century, an ideal of the medical student as 'born not made' was substantiated through medical school opening addresses and other medical literature. An understanding prevailed that students would have a natural inclination that would suit them to medical work, which was predicated on class structures. As we move into the twentieth-century context, we see that such underpinnings remained, even if the idea of 'character' becomes 'characteristics'. This was articulated through emerging psychological and sociological perspectives on education, as well as medical school admission processes. The significance ascribed to character and characteristics-based suitability continues to exclude and limits who can access medical careers. In the final part of the article, we argue that a framework of uncertainty can and should be mobilised to re-evaluate the role of doctors' education and critique long-standing notions of professional identity, via the integration of medical humanities and clearer professionalism teaching within medical curricula.


Assuntos
Educação de Graduação em Medicina , Educação Médica , Estudantes de Medicina , Humanos , Profissionalismo , Ciências Humanas/educação , Estudantes de Medicina/psicologia , Currículo , Emoções
7.
Med Humanit ; 48(1): 85-93, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34035179

RESUMO

In this paper, we consider the role of conversations in contributing to healthcare quality improvement. More specifically, we suggest that conversations can be important in responding to what we call 'normative complexity'. As well as reflecting on the value of conversations, the aim is to introduce the dimension of normative complexity as something that requires theoretical and practical attention alongside the more recognised challenges of complex systems, which we label, for short, as 'explanatory complexity'. In brief, normative complexity relates to the inherent difficulty of deciding what kinds of changes are 'improvements' or, more broadly, what is valuable in healthcare. We suggest that explanatory and normative complexity intersect and that anyone interested in healthcare improvement needs to be sensitive to both. After briefly introducing the idea of normative complexity, we consider some contrasting examples of conversations, reflecting on how they do and might contribute to healthcare quality. We discuss both conversations that are deliberately organised and facilitated ('orchestrated conversations') and more informally occurring and routine conversations. In the first half of the paper, we draw on some examples of orchestrated and routine conversations to open up these issues. In the second half of the paper, we bring some more theoretical lenses to bear on both conversations and normative complexity, summarise what we take to be the value of conversations and draw together some of the implications of our discussion. In summary, we argue that conversations can play a crucial role in negotiating the normative complexity of healthcare quality improvement because of their capacity to hold together a plurality of perspectives, to contribute and respond to emergence and to help underpin institutional conditions for empathy and imagination.


Assuntos
Comunicação , Atenção à Saúde , Instalações de Saúde , Humanos , Melhoria de Qualidade
8.
J Vet Med Educ ; 49(1): 71-79, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33661086

RESUMO

Educational training in professional programs forms the foundation for how a person problem-solves throughout their career. However, training focused on only one profession ignores the value realized through collaborations among multiple professions for solving health-related problems. This is at the core of inter-professional education (IPE). Effective IPE programs can result in inter-professional collaboration and translation science endeavors across the health sciences and beyond. Recent events such as the COVID-19 pandemic and the opioid crisis highlight the importance of veterinary medicine in advancing One Health through IPE. The prevalence of IPE programs in veterinary curricula, and the process by which these have been established, has not been widely described in the literature. Through an 18-question survey sent to associate deans (ADs) of 50 veterinary schools, we sought to determine the status of IPE in the veterinary curriculum. Thirty-nine schools agreed to participate, representing primarily United States Doctor of Veterinary Medicine public and private programs with some representation from Canadian, United Kingdom, and Australasian programs. Schools that provide IPE courses developed their programs in collaboration with other health sciences programs across the 4-year curriculum. The perceived barriers for IPE offerings were no different between schools with or without opportunities; however, a lack of faculty and student-perceived value and lack of adequate space in the academic schedule were common threads. Our findings provide a snapshot of the current state of IPE in veterinary medical curricula, with a particular emphasis on the United States, and point to areas of programmatic need for the field.


Assuntos
Educação Profissionalizante , Educação em Veterinária , Animais , Canadá , Currículo , Educação Profissionalizante/tendências , Educação em Veterinária/tendências , Relações Interprofissionais , Reino Unido , Estados Unidos
9.
J Vet Med Educ ; 49(2): 267-274, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33970835

RESUMO

Feedback is central to student learning in the veterinary workplace. Feedforward, a related concept, is used to describe the way information about a student's performance may be used to improve their future performance. Feedback and feedforward practices are diverse, with varied student and staff understandings of the nature and purpose of feedback (feedback literacy). This study compared the practices of feedback and feedforward in a range of programs in one institution during student transitions from the classroom to workplace-based learning environments. The study adopted a broad inter-professional approach to include health care programs and social work and theater and performance studies. Profession-specific focus groups were conducted with contribution from 28 students and 31 staff from five different professions. Thematic analysis revealed that students and staff shared an understanding of the feedback and feedforward concepts, and both groups recognized the importance of emotional and relational aspects of the process. Students and staff across all professions recognized the impact of time constraints on the feedback process, although this was particularly highlighted in the health science professions. Social work and theater and performance studies students demonstrated a more nuanced understanding of the emotional and relational aspects of feedback and feedforward. Overall, the approach highlights similarities and differences in practices and experiences in different workplace contexts, creating opportunities for cross-disciplinary learning, which may have relevance more widely in higher education programs with workplace-based elements. The study underpinned the development of the LeapForward feedback training resource (https://bilt.online/the-leapforward-project/).


Assuntos
Educação em Veterinária , Local de Trabalho , Animais , Retroalimentação , Humanos , Aprendizagem , Estudantes
10.
J Vet Med Educ ; 49(5): 610-617, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34351831

RESUMO

This pilot survey study describes student expectations and experiences at WisCARES, a low-cost veterinary medical teaching clinic where students from multiple disciplines collaborate. We hypothesized that prior to the workday, students would describe different expectations of working in an interdisciplinary access to care clinic than what they ultimately experienced. We surveyed 62 students from the School of Veterinary Medicine (46) and pharmacy (16) who spent a clinic day at WisCARES. Before introductory rounds, students completed a short survey consisting of four open-ended questions about their learning expectations; at the end of the day, they reviewed their initial responses and added what they actually learned. Qualitative information was categorized and analyzed using descriptive statistics. Thirteen major themes emerged: diversity, confidence, communication, case lead/case management, financial experience, helping people, teamwork, technical skills, inter-professional experience, mentoring, non-specific positive regard, appreciation for resources, and rounds. Students reported improved confidence in managing and leading cases with specific positive outcomes in communicating with clients, particularly regarding leading financial conversations. Developing greater insight into diversity was a common theme expressed in students' expectations but was less frequently noted as an end-of-day outcome. Veterinary students less frequently described the value of the inter-professional environment and collaboration, but this was a major theme noted among pharmacy students. Student feedback was positive overall. The current study is useful in identifying areas for improving collaborative instruction and access to care professional student learning opportunities.


Assuntos
Educação em Veterinária , Estudantes de Farmácia , Animais , Acessibilidade aos Serviços de Saúde , Hospitais Veterinários , Humanos , Motivação
11.
J Vet Med Educ ; 49(5): 568-574, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34351842

RESUMO

One Health is an approach to studying health by recognizing the interconnections between people, animals, plants, and their shared environment. This article describes the process of designing a new course on One Health at the University of Illinois at Urbana-Champaign (UIUC). We brought together faculty and students from across campus to develop a multidisciplinary course dedicated to One Health and infectious diseases. This group met over 9 months to brainstorm course goals, objectives, and ideas. The group also organized a workshop to explore One Health's existing knowledge and ongoing work on the UIUC campus. We solicited the help of experts throughout the university to co-teach the course. The course curriculum and course materials included 13 unique case studies. The course was offered in fall 2019, and its goals were to add to the existing training and coursework on One Health at the University of Illinois campus, offer a course that would be suitable for students from all fields of study, and develop helpful case studies to be made available to other educators. Student feedback highlights the course's successes as well as areas for future improvement. This article describes this entire process of course development, provides recommendations to guide improvements in the next offering of the course, and details our contributions to the field of One Health education.


Assuntos
Educação em Veterinária , Saúde Única , Animais , Currículo , Humanos , Estudantes , Universidades
12.
Nurs Outlook ; 69(2): 202-211, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33158560

RESUMO

BACKGROUND: The Department of Veterans Affairs (VA) Quality Scholars (VAQS) program, an interprofessional fellowship that includes pre- and postdoctoral nurses, aims to inspire practice change leaders. Fellows participate in a national curriculum, lead improvement/research teams, and establish professional development plans with expert mentor guidance. PURPOSE: To describe the distinctive elements of the VAQS program, nurse fellow outcomes, and accomplishments of nurse alumni as leaders, researchers, and educators. METHODS: Data were reviewed and aggregated from past and current fellow surveys. FINDINGS: Nurse fellows completed research and improvement projects that benefitted both the VA and the local health systems. Scholarly outcomes include publications, conference presentations, grant submissions, teaching/leading quality improvement, and research initiatives. Graduates transition to positions as nurse scientists, academic faculty, and operational leaders. DISCUSSION: Fellows contribute to the strategic priorities of local and national VA and external health care organizations providing a pipeline of health system expert leaders, educators, and researchers. CONCLUSION: Doctoral nursing fellowship experiences build human capital for enhancing the science of improvement and implementation, interprofessional collaboration, and leadership.


Assuntos
Escolaridade , Bolsas de Estudo/métodos , United States Department of Veterans Affairs/estatística & dados numéricos , Emprego/métodos , Emprego/estatística & dados numéricos , Bolsas de Estudo/tendências , Humanos , Liderança , Desenvolvimento de Programas/métodos , Melhoria de Qualidade/estatística & dados numéricos , Estados Unidos , United States Department of Veterans Affairs/organização & administração
13.
Med Humanit ; 47(3): 323-332, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32859651

RESUMO

Systems for improving public health and organisations for providing national education were two of the great reforming achievements of 19th-century Britain. Despite the overlapping personnel and historical contemporaneity, scholars have rarely considered the two projects in tandem. This essay shows that developments in public health were at the heart of two foundational moments in the rise of 19th-century mass schooling. The originators of the monitorial system, a method of peer-educating working-class children cheaply that dominated British mass schooling at the turn of the 19th century, were deeply invested in the origin and spread of vaccination. Similarly, the first state teacher training system was conceived by a medical doctor in the 1830s, who first rose to prominence investigating cholera in Manchester earlier in the decade. Using archives of school providers, training institutions and the educational state apparatus, I show that medical prophylactic interventions of vaccination and sanitary reform helped galvanise the government into educational reform, by imagining the working class as pathological and providing templates for their palliation. By showing that the roots of the modern school system were deeply imbricated in attempts to combat smallpox and cholera, both in form and in epistemology, this paper argue that critical medical humanists should consider the role of epidemiological thinking in institutions and disciplines which seem, on first sight, removed from the clinic and the lab.


Assuntos
Governo , Saúde Pública , Criança , História do Século XIX , História do Século XX , Humanos , Instituições Acadêmicas , Vacinação
14.
J Pak Med Assoc ; 71(Suppl 1)(1): S77-S82, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33582728

RESUMO

The healthcare environment in surgery is complex, dynamic and often ambiguous. Besides subject knowledge and technical skills, other competencies, such as team work, communication skills and situation awareness, are required to ensure better patient-related outcome. Teams that demonstrate poor non-technical skills make more technical errors, often resulting in patient morbidity or mortality. Different hospital-based locations, such as operating rooms, intensive care units, emergency rooms and surgical wards, are the areas where poor team dynamics prevail. Simulation-based team training is a strategy to provide inter-professional training and experiential learning opportunities for surgeons, anaesthetists and allied health professionals. It helps them to effectively respond in complex situations in complex surgical environment. Simulation-based team training has 3 components; didactics, simulation itself, and debriefing. Literature has shown that simulation-based team training in surgery improves identification of team-based behaviours, improves team performance and overall patient safety.


Assuntos
Equipe de Assistência ao Paciente , Treinamento por Simulação , Competência Clínica , Simulação por Computador , Humanos , Salas Cirúrgicas
15.
J Vet Med Educ ; 48(1): 8-13, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33594955

RESUMO

The veterinary workplace consists of different professionals working together in inter-professional teams. Previous work has explored the benefits of effective veterinary teamwork for multiple stakeholders. In this teaching tip article, we outline the underlying educational theories and tips for developing inter-professional teaching to foster students' appreciation of the different roles and responsibilities of veterinarians and veterinary nurses/vet techs. Inter-professional education (IPE) requires students to learn with, about, and from each other and implies recognition of social learning as an underpinning approach. It involves developing learning opportunities to address students' potential misunderstandings of each other's motivations, to allow them to explore issues present in the other profession's practice, and to clarify sometimes overlapping roles and responsibilities. Students are given opportunities to explore the complexity of inter-professional teamwork in a safe environment using real-life topics as context for their collaboration. Two veterinary examples of IPE at the Royal Veterinary College (RVC) are provided to explore different teaching methods and topics that have proved successful in our context: dentistry and directed learning scenarios. We describe how RVC has developed an IPE team consisting of faculty members who champion IPE, which has, in turn, inspired students to create a student-led IPE club, hosting extracurricular educational events. This is an example of an effective student-teacher partnership. A number of challenges exist in embedding IPE, but the benefits it offers in integrating clinical and professional elements of the curricula make it worthy of consideration.


Assuntos
Técnicos em Manejo de Animais , Educação Profissionalizante , Educação em Veterinária , Médicos Veterinários , Animais , Currículo , Humanos , Relações Interprofissionais
16.
Med J Armed Forces India ; 77(Suppl 1): S173-S179, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33612950

RESUMO

BACKGROUND: Inter-professional Education (IPE) has been identified as an educational program aimed at increasing collaboration among health professionals, and improving health care outcomes. IPE programs have been incorporated in several countries and have shown positive results. The same may not be true for Asian cultures which are typically more hierarchical than others. The purpose of this study was to examine the impact of IPE on undergraduate health professional students' attitudes and perceptions in an Indian context. METHODS: Following an IPE experience undergraduate health professional students (n = 96) from three professions (Medicine, Nursing and Physiotherapy) completed a validated retro-pre questionnaire. Paired-sample t test was used to compare pre-test and post-test scores and ANOVA was used to compare the magnitude of change. Qualitative analysis was done for the open ended questions. RESULTS: The three professions showed a significant improvement in attitude (p < 0.001). The physiotherapists were more comfortable (p = 0.021) with questioning and being questioned and the nurses showed a significantly (p = 0.012) greater increase in extent of reliability as compared to the other two professionals. Participants identified the concepts of "team work", "knowledge of roles of other professionals" and "communication" as important to their learning and practice. CONCLUSIONS: The study identified a positive attitude among students and the given intervention resulted in a significant improvement in their comfort levels and reliability on other professionals. It would be reasonable to conclude therefore that acceptability for Inter professional education in the Indian context is high in spite of the cultural differences and hierarchical nuances.

17.
Teach Learn Med ; 32(2): 231-237, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31682469

RESUMO

Issue: Medical assistance in dying (MAID) became legal in Quebec on December 10, 2015, and in the rest of Canada on June 17, 2016. This enabled 6,749 deaths through physician-assisted suicide or euthanasia between December 10, 2015 and October 31, 2018. While the death of a patient is a common experience for medical trainees, those that occur through MAID have unique features related to the methods, the timeline, the intended role of the physician in causing the death, and the request of the patient that initiates the process. These aspects necessitate a distinct approach to MAID medical education. Evidence: Despite the legalization of MAID in a growing number of jurisdictions, there is virtually no literature to guide MAID education in clinical practice. The cumulative evidence regarding the impact of patient death on medical students, residents, and attending physicians suggests a need for supported discussion and debriefing to process and reflect on the emotional experiences that follow patient death. This is especially important with MAID, in which there are unique ethical and psychological issues related to the physician's direct role in causing the death of a patient. There is little published research on the impact such deaths have on physicians who provide MAID, or on others who are indirectly involved. However, there is evidence that learners desire MAID-specific education tailored to their unique needs. Didactic education about the medical and legal domains of MAID alone is insufficient to support learners' needs. Experiential case-based learning with supervisory support has the potential to enhance training in end-of-life care in general, and specifically in MAID. The authors' first clinical experience with a patient requesting MAID on an internal medicine clinical teaching unit (CTU) highlighted gaps in their preparedness to meet the associated professional and personal demands. Reflecting on these perceived gaps, and on the needs of learners identified in the literature on patient death and MAID education, the authors created a framework to guide learning at the point of care of a patient requesting MAID. Represented in a MAID Education Cogwheel and discussion guide, this framework specifies learning objectives and methods in six domains: medical, legal, moral, ethical, cultural, and psychosocial. Implications: Following a MAID request, attending physicians can use the framework to guide learners in ongoing conversations addressing these domains. Inter-professional participation can include such disciplines as psychiatry, palliative care, bioethics, pharmacy, nursing, physical and occupational therapy, social work, and spiritual care. Further research is necessary to test this framework to determine its' feasibility, efficacy, and generalizability.


Assuntos
Médicos/psicologia , Suicídio Assistido , Assistência Terminal , Canadá , Currículo , Educação Médica , Humanos , Suicídio Assistido/legislação & jurisprudência
18.
Gerontol Geriatr Educ ; 41(1): 52-62, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31148517

RESUMO

Ten thousand Americans turn 65 daily. With age, individuals are confronted by complex medical modalities which can be difficult to understand and potentially burdensome. Historically, clinicians lacked the education, skill, and comfort level to identify the need for and address the patient's goals of care (GoC). Inter-professional content experts convened to develop a comprehensive program to educate and increase the comfort level of clinicians when having GoC conversations. The goal was to provide structured guidance to increase the practitioners' level of confidence in engaging patients/families in these conversations. A multimodal educational methodology using simulation was chosen as a learning strategy permitting clinicians to practice GoC conversations while receiving immediate feedback. A five hour inter-professional educational program called Goals of Care Conversation Education Program® (GoCCEP™) was developed and piloted. The GoCCEPTM's evaluations demonstrate success giving clinicians necessary tools and a safe practice environment increasing knowledge and confidence to have substantive GoC conversations.


Assuntos
Planejamento Antecipado de Cuidados , Pessoal de Saúde/educação , Planejamento de Assistência ao Paciente , Relações Médico-Paciente , Comunicação , Humanos , Projetos Piloto , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa , Estados Unidos
19.
J Pediatr Nurs ; 49: 72-78, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31670140

RESUMO

BACKGROUND: Simulation is an evidenced based strategy which has been shown to impact office-based readiness to respond in a medical emergency. Medical emergencies occur in the primary care setting on a less frequent basis than in the inpatient setting. Clinicians working in primary care may benefit from an opportunity to refresh their skills. METHODS: This descriptive pre and post survey design evidenced based project examined staff reported levels of competence and confidence when responding to an emergency in a pediatric primary care office. Simulation educators partnered with ambulatory nursing and medical leaders to create a mock code program for staff in a care network. During a 14-month period, simulations were conducted in 30 primary care sites. Staff completed pre- and post-simulation surveys to assess levels of confidence in decision-making skills and competence when managing medical emergencies. FINDINGS: A statistically significant increase in the mean scores for both confidence and competence was demonstrated when comparing pre- and post-simulation survey results. DISCUSSION AND APPLICATION TO PRACTICE: Simulation as an educational technique resulted in an increased level of competence and confidence of primary care office staff to respond to an emergency. Additionally, staff developed an overall heightened awareness of emergency processes and recognized of the value of simulation as an educational tool.


Assuntos
Defesa Civil/educação , Prática Clínica Baseada em Evidências/métodos , Atenção Primária à Saúde/métodos , Melhoria de Qualidade , Treinamento por Simulação/métodos , Inquéritos e Questionários , Criança , Atenção à Saúde/métodos , Emergências , Feminino , Humanos , Masculino , Estados Unidos
20.
Eur J Dent Educ ; 23(1): e12-e16, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30294830

RESUMO

PURPOSE: The purpose of the current study was to evaluate the impact of integrating the teaching of Bachelor of Dental Surgery (BDS) and Bachelor of Dental Therapy and Hygiene (BScDTH) students in enquiry-based learning (EBL) sessions, using performance on multiple related integrated dental science (IDS) multiple-choice question assessments. METHOD: IDS assessments are sat twice in the first stages of both the BDS and BScDTH programmes. IDS scores from integrated and non-integrated cohorts were collated and compared across test occasions (first or second assessment of the stage) and programmes (BDS and BScDTH). RESULTS: The results revealed that IDS scores were, overall, significantly higher for students in integrated (M = 63.46, SD = 13.06) than non-integrated EBL groups (M = 60.75, SD = 13.67; F(1,207)  = 4.277, P = 0.040, < ! [ C D A T A [ η p 2 ] ] >  = 0.020). Although this effect was not statistically significant when each programme was considered separately, the effect of integration on both programmes was nevertheless positive, with a more pronounced improvement for BScDTH (+7.88) than BDS (+0.63) students. CONCLUSIONS: Integrating students from different programmes for the teaching of core dental knowledge in team environments improves student performance in subsequent dental science assessments-and more so for BScDTH than BDS students. The fact that both groups benefit from integration should go some way towards reassuring institutions that are considering integration but are cautious of threats to "established" programmes.


Assuntos
Currículo , Educação em Odontologia , Avaliação Educacional/métodos , Estudos Interdisciplinares , Conhecimento , Higiene Bucal/educação , Estudantes de Odontologia/psicologia , Estudantes/psicologia , Humanos , Aprendizagem Baseada em Problemas , Inquéritos e Questionários
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