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Background

Mini-CEX scores assess resident competence. Rater training might improve mini-CEX score interrater reliability, but evidence is lacking.

Objective

Evaluate a rater training workshop using interrater reliability and accuracy.

Design

Randomized trial (immediate versus delayed workshop) and single-group pre/post study (randomized groups combined).

Setting

Academic medical center.

Participants

Fifty-two internal medicine clinic preceptors (31 randomized and 21 additional workshop attendees).

Intervention

The workshop included rater error training, performance dimension training, behavioral observation training, and frame of reference training using lecture, video, and facilitated discussion. Delayed group received no intervention until after posttest.

Measurements

Mini-CEX ratings at baseline (just before workshop for workshop group), and four weeks later using videotaped resident–patient encounters; mini-CEX ratings of live resident–patient encounters one year preceding and one year following the workshop; rater confidence using mini-CEX.

Results

Among 31 randomized participants, interrater reliabilities in the delayed group (baseline intraclass correlation coefficient [ICC] 0.43, follow-up 0.53) and workshop group (baseline 0.40, follow-up 0.43) were not significantly different ( = 0.19). Mean ratings were similar at baseline (delayed 4.9 [95% confidence interval 4.6–5.2], workshop 4.8 [4.5–5.1]) and follow-up (delayed 5.4 [5.0–5.7], workshop 5.3 [5.0–5.6];  = 0.88 for interaction). For the entire cohort, rater confidence (1 = not confident, 6 = very confident) improved from mean (SD) 3.8 (1.4) to 4.4 (1.0),  = 0.018. Interrater reliability for ratings of live encounters (entire cohort) was higher after the workshop (ICC 0.34) than before (ICC 0.18) but the standard error of measurement was similar for both periods.

Conclusions

Rater training did not improve interrater reliability or accuracy of mini-CEX scores.

Clinical trials registration

clinicaltrials.gov identifier NCT00667940

Electronic supplementary material

The online version of this article (doi:10.1007/s11606-008-0842-3) contains supplementary material, which is available to authorized users.

BACKGROUND:

The Canadian Thoracic Society (CTS) has developed a clinical practice guideline (CPG) regarding the management of patients with chronic obstructive pulmonary disease (COPD). Implementation of this CPG in the primary care setting requires an effective dissemination strategy.

OBJECTIVES:

To examine the change in knowledge, participant satisfaction and perceived changes in clinical practice among health care professionals working in the primary care setting following attendance at a workshop to disseminate the CTS CPG for COPD.

METHODS:

A 2.5 h workshop was conducted in three community health sites within Ontario. Each workshop comprised a didactic presentation and interactive case study discussions. Before, and one month following the workshop, a structured knowledge assessment questionnaire was administered. A structured satisfaction questionnaire and evaluative form that examined the impact of the workshop on the clinical management of COPD patients were administered immediately and three months following completion of the workshop, respectively.

RESULTS:

Sixty-nine participants attended the workshop. The mean score for the structured knowledge assessment questionnaire increased from 8.5±2.7 to 10.6±2.0 following the workshop (P=0.008). Eighty-nine per cent and 96% of participants indicated that they would recommend the workshop to a colleague and had greater confidence in their management of COPD patients, respectively. Following attendance of the workshop, 73%, 69% and 46% described increased patient education, patient monitoring and the use of objective testing in clinical practice, respectively.

CONCLUSIONS:

Workshop attendance was associated with high levels of satisfaction and important self-reported changes in clinical practice, which may reflect improved knowledge of the CTS CPG for COPD.

Availability and price of healthy foods in food stores has the potential to influence purchasing patterns, dietary intake, and weight status of individuals. This study examined whether demographic factors of the store neighborhood or store size have an impact on the availability and price of healthy foods in sample of grocery stores and supermarkets. The Nutrition Environment Measures Study-Store (NEMS-S) instrument, a standardized observational survey, was utilized to evaluate food stores (N=42) in a multi-site (Vermont and Arkansas) study in 2008. Census data associated with store census tract (median household income and proportion African-American) were used to characterize store neighborhood and number of cash registers was used to quantify store size. Median household income was significantly associated with the NEMS healthy food availability score (r=0.36, p<0.05); neither racial composition (r=−0.23, p=0.14) nor store size (r=0.27, p=0.09) were significantly related to the Availability score. Larger store size (r=0.40, p<0.01) was significantly associated with the NEMS-S Price scores, indicating more favorable prices for healthier items; neither racial composition nor median household income were significantly related to the Price score (ps>0.05). Even among supermarkets, healthier foods are less available in certain neighborhoods, although, when available, the quality of healthier options did not differ, suggesting that targeting availability may offer promise for policy initiatives. Furthermore, increasing access to larger stores that can offer lower prices for healthier foods may provide another avenue for enhancing food environments to lower disease risk.

Objectives

To develop, implement, and evaluate the impact of a cultural competence train-the-trainer workshop for pharmacy educators.

Methods

A 2-day train-the-trainer workshop entitled Incorporating Cultural Competency in Pharmacy Education (1.65 CEUs) was provided to pharmacy faculty from schools across the United States. Baseline, posttraining, and 9-month follow-up surveys assessed participants' (n = 50) characteristics and self-efficacy in developing and teaching content.

Results

At baseline, 94% of faculty members reported no formal training in teaching cultural competence. After completing the workshop, participants' self-rated confidence for developing and teaching workshop content significantly increased. The number of participants who rated their ability to teach cultural competence as “very good” or “excellent” increased from 13% to 60% posttraining. Participants reported teaching 1 or more aspects of the workshop curriculum to nearly 3,000 students in the 9-months following training.

Conclusions

The workshop significantly increased faculty members' perceived and documented ability to teach cultural competence. The train-the-trainer model appears to be a viable and promising strategy for meeting the American Council for Pharmacy Education accreditation standards relating to the teaching of diversity, cultural issues, and health literacy.

ABSTRACT

OBJECTIVE

To determine if participation in a procedural skills workshop during family practice residency affects future use of these skills in postgraduate clinical practice.

DESIGN

Survey involving self-assessment of procedural skills experience and competence.

SETTING

British Columbia.

PARTICIPANTS

Former University of British Columbia family practice residents who trained in Vancouver, BC, including residents who participated in a procedural skills workshop in 2001 or 2003 and residents graduating in 2000 and 2002 who did not participate in the procedural skills workshop.

MAIN OUTCOME MEASURES

Self-assessed experience and competence in the 6 office-based procedural skills that were taught during the procedural skills workshops in 2001 and 2003.

RESULTS

Participation in a procedural skills workshop had no positive effect on future use of these skills in clinical practice. Participation in the workshop was associated with less reported experience (P = .091) in injection of lateral epicondylitis. As with previous Canadian studies, more women than men reported experience and competence in gynecologic procedures. More women than men reported experience (P = .001) and competence (P = .004) in intrauterine device insertion and experience (P = .091) in endometrial aspiration biopsy. More men than women reported competence (P = .052) in injection of trochanteric bursae. A third year of emergency training was correlated with an increase in reported experience (P = .021) in shoulder injection.

CONCLUSION

Participation in a procedural skills workshop during family practice residency did not produce a significant increase in the performance of these skills on the part of participants once they were in clinical practice. The benefit of a skills workshop might be lost when there is no opportunity to practise and perfect these skills. Sex bias in the case of some procedures might represent a needs-based acquisition of skills on the part of practising physicians. Short procedural skills workshops might be better suited to graduated physicians with more clinical experience.

Background

Patient, or parent/guardian, satisfaction with health care provision is important to health outcomes. Poor relationships with health workers, particularly with nursing staff, have been reported to reduce satisfaction with care in Africa. Participatory research approaches such as the Health Workers for Change initiative have been successful in improving provider-client relationships in various developing country settings, but have not yet been reported in the complex environment of hospital wards. We evaluated the HWC approach for improving the relationship between nurses and parents on a paediatric ward in a busy regional hospital in Tanzania.

Methods

The intervention consisted of six workshops, attended by 29 of 31 trained nurses and nurse attendants working on the paediatric ward. Parental satisfaction with nursing care was measured with 288 parents before and six weeks after the workshops, by means of an adapted Picker questionnaire. Two focus-group discussions were held with the workshop participants six months after the intervention.

Results

During the workshops, nurses demonstrated awareness of poor relationships between themselves and mothers. To tackle this, they proposed measures including weekly meetings to solve problems, maintain respect and increase cooperation, and representation to administrative forces to request better working conditions such as equipment, salaries and staff numbers. The results of the parent satisfaction questionnaire showed some improvement in responsiveness of nurses to client needs, but overall the mean percentage of parents reporting each of 20 problems was not statistically significantly different after the intervention, compared to before it (38.9% versus 41.2%). Post-workshop focus-group discussions with nursing staff suggested that nurses felt more empathic towards mothers and perceived an improvement in the relationship, but that this was hindered by persisting problems in their working environment, including poor relationships with other staff and a lack of response from hospital administration to their needs.

Conclusion

The intended outcome of the intervention was not met. The priorities of the intervention – to improve nurse-parent relationships – did not match the priorities of the nursing staff. Development of awareness and empathy was not enough to provide care that was satisfactory to clients in the context of working conditions that were unsatisfactory to nurses.

ABSTRACT

OBJECTIVE

To increase primary care providers’ awareness and use of genetic services; increase their knowledge of genetic issues; increase their confidence in core genetic competencies; change their attitudes toward genetic testing for hereditary diseases; and increase their confidence as primary care genetic resources.

DESIGN

Participants completed a workshop and 3 questionnaires: a baseline questionnaire, a survey that provided immediate feedback on the workshop itself, and a follow-up questionnaire 6 months later.

SETTING

Ontario.

PARTICIPANTS

Primary care providers suggested by deans of nursing, midwifery, family medicine, and obstetric programs, as well as coordinators of nurse practitioner programs, in Ontario and by the Ontario College of Family Physicians.

INTERVENTION

A complex educational intervention was developed, including an interactive workshop and PowerPoint educational modules on genetic topics for participants’ use (available at www.mtsinai.on.ca/FamMedGen/).

MAIN OUTCOME MEASURES

Awareness and use of genetic services, knowledge of genetics, confidence in core clinical genetic skills, attitudes toward genetic testing, and teaching activities related to genetics.

RESULTS

The workshop was attended by 29 participants; of those, 21 completed the baseline questionnaire and the 6-month follow-up questionnaire. There was no significant change found in awareness or reported use of genetic services. There was significant improvement in self-assessed knowledge of (P = .001) and confidence in (P = .005) skills related to adult-onset genetic disorders. There were significant increases in confidence in many core genetic competencies, including assessing risk of hereditary disorders (P = .033), deciding who should be offered referral for genetic counseling (P = .003), discussing prenatal testing options (P = .034), discussing benefits, risks, and limitations of genetic testing (P = .033), and describing what to expect at a genetic counseling session (P = .022). There was a significant increase in the number of primary care providers agreeing that genetic testing was beneficial in the management of adult-onset diseases (P = .031) and in their confidence in being primary care genetic resources for adult-onset genetic disorders (P = .006).

CONCLUSION

Educational interventions that include interactive peer resource workshops and educational modules can increase knowledge of and confidence in the core competencies needed for the delivery of genetic services in primary care.

Objective

To design a training intervention and then test its effect on nurse leaders' perceptions of patient safety culture.

Study Setting

Three hundred and fifty-six nurses in clinical leadership roles (nurse managers and educators/CNSs) in two Canadian multi-site teaching hospitals (study and control).

Study Design

A prospective evaluation of a patient safety training intervention using a quasi-experimental untreated control group design with pretest and posttest. Nurses in clinical leadership roles in the study group were invited to participate in two patient safety workshops over a 6-month period. Individuals in the study and control groups completed surveys measuring patient safety culture and leadership for improvement prior to training and 4 months following the second workshop.

Extraction Methods

Individual nurse clinical leaders were the unit of analysis. Exploratory factor analysis of the safety culture items was conducted; repeated-measures analysis of variance and paired t-tests were used to evaluate the effect of the training intervention on perceived safety culture (three factors). Hierarchical regression analyses looked at the influence of demographics, leadership for improvement, and the training intervention on nurse leaders' perceptions of safety culture.

Principal Findings

A statistically significant improvement in one of three safety culture measures was shown for the study group (p<.001) and a significant decline was seen on one of the safety culture measures for the control group (p<.05). Leadership support for improvement was found to explain significant amounts of variance in all three patient safety culture measures; workshop attendance explained significant amounts of variance in one of the three safety culture measures. The total R2 for the three full hierarchical regression models ranged from 0.338 and 0.554.

Conclusions

Sensitively delivered training initiatives for nurse leaders can help to foster a safety culture. Organizational leadership support for improvement is, however, also critical for fostering a culture of safety. Together, training interventions and leadership support may have the most significant impact on patient safety culture.

OBJECTIVE

The National Cancer Institute (NCI) developed a manual to guide primary care practices in structuring their office environment and routine visits so as to enhance nutrition screening, advice/referral, and follow-up for cancer prevention. The adoption of the manual's recommendations by primary care practices was evaluated by examining two strategies: physician training on how to implement the manual's recommendations versus simple mailing of the manual. This article reports on the results of a randomized controlled trial to evaluate the effectiveness of these two strategies.

DESIGN

A three-arm, randomized, controlled study.

SETTING

Free-standing primary care physician practices in Pennsylvania and New Jersey.

INTERVENTION

Each study practice was randomly assigned to one of three groups. The training group practices were invited to send one member from their practice of their choosing to a 3-hour “train-a-trainer” workshop, the manual-only-group practices were mailed the nutrition manual, and the control group practices received no intervention. For training group practices, training was provided in the four major components of the nutrition manual: how to organize the office environment to support cancer prevention nutrition-related activities; how to screen patient adherence to the NCI dietary guidelines; how to provide dietary advice/referral; and how to implement a patient follow-up system to support patients in making changes in their nutrition-related behaviors.

MEASUREMENTS

The primary outcomes of the study were derived from two evaluation instruments. The observation instrument documented the tools and procedures recommended by the nutrition manual and adopted in patient charts and the office environment. The in-person structured interview evaluated the physician and staff's self-reported nutrition-related activities reflecting the nutrition manual's recommendations. Data from these two instruments were used to construct four adherence scores corresponding to the areas: office organization, nutrition screening, nutrition advice/referral, and patient follow-up.

MAIN RESULTS

The adoption of the manual's recommendations was highest among the practices in the training group as reflected by their higher adherence scores. They organized their office ( P =.005) and screened their patients regarding their eating habits ( P =.046) significantly more closely to the recommendations of the nutrition manual than practices in the manual-only group. However, despite being the highest in compliance, the training group practices were only 54.9% adherent to the manual's recommendations regarding nutrition advice/referral, and 28.5% adherent to its recommendations on office organization, 23.5% adherent to its recommendations on nutrition screening, and 14.6% adherent to its patient follow-up recommendations.

CONCLUSIONS

Primary care practices exposed to the nutrition manual in a training session adopted more of the manual's recommendations. Specifically, practices invited to training were more likely to perform nutrition screening and to structure their office environment to be conducive to providing nutrition-related services for cancer prevention. The impact of the training was moderate and not statistically significant for nutrition advice/referral or patient follow-up, which are important in achieving long-term dietary changes in patients. The overall low adherence scores to nutrition-related activities demonstrates that there is plenty of room for improvement among the practices in the training group.

Objective

Despite the increased emphasis on obesity and diet-related diseases, nutrition education remains lacking in many internal medicine training programs. We evaluated the attitudes, self-perceived proficiency, and knowledge related to clinical nutrition among a cohort of internal medicine interns.

Methods

Nutrition attitudes and self-perceived proficiency were measured using previously validated questionnaires. Knowledge was assessed with a multiple-choice quiz. Subjects were asked whether they had prior nutrition training.

Results

Of the 114 participants, 61 (54%) completed the survey. Although 77% agreed that nutrition assessment should be included in routine primary care visits, and 94% agreed that it was their obligation to discuss nutrition with patients, only 14% felt physicians were adequately trained to provide nutrition counseling. There was no correlation among attitudes, self-perceived proficiency, or knowledge. Interns previously exposed to nutrition education reported more negative attitudes toward physician self-efficacy (p = 0.03).

Conclusions

Internal medicine interns’ perceive nutrition counseling as a priority, but lack the confidence and knowledge to effectively provide adequate nutrition education.

Introduction

Patient handoffs are common during residency and are often performed with little or no training. We devised a simple intervention to improve the readiness of interns to perform handoffs.

Methods

We administered a 90-minute interactive workshop during intern orientation in 2009 and 2010. It consisted of a discussion, a case presentation, and a trigger video, followed by debriefing and a role-play exercise. The workshop required minimal technology and materials. Interns were surveyed on their readiness to perform handoffs before and after the workshop as well as 3 to 6 months after the workshop.

Results

Eighty-nine interns participated in the workshop during a 2-year period. Seventy-four survey responses were collected. Self-reported readiness to perform a handoff increased by 26%. A total of 91% and 81% of respondents in 2010 and 2009, respectively, reported using aspects of the workshop up to 6 months later.

Conclusion

A brief workshop can improve interns' readiness to perform handoffs.

Background

The lack of standardization of clinical diagnostic criteria, classification and severity scores of chronic graft-versus-host disease led the National Institutes of Health to propose consensus criteria for the purpose of clinical trials.

Method

Here we describe a one-day workshop model conducted by the Chronic Graft-versus-Host Disease Brazil-Seattle Consortium Study Group to train investigators interested in participating in multicenter clinical trials in Brazil. Workshop participants included eight transplant physicians, one dermatologist, two dentists, three physical therapists and one psychologist from five institutions. Workshop participants evaluated nine patients with varying degrees of severity of mucocutaneous lesions and other manifestations of the disease followed by a training session to review and discuss the issues encountered with the evaluation and scoring of patients and in the methods used to evaluate grip strength and the 2-minute walk test.

Results

Most participants had difficulties in rating the percentage of each type of mucocutaneous lesion and thought 20 minutes was insufficient to evaluate and record the scores of each patient using the National Institutes of Health criteria and other cutaneous assessments. Several specific areas of difficulties encountered by the evaluators were: 1) determining the percentage of erythema in movable and non-movable sclerosis, 2) whether to score all cutaneous findings in a particular area or just the dominant lesion; 3) clarification of the definition of poikiloderma in chronic graft-versus-host disease; 4) discrepant interpretation of the mouth score and 5) clarification on the methodology used for the evaluation of grip strength and the 2-minute walk tests.

Conclusions

Results of this workshop support the need to train investigators participating in clinical trials on chronic graft-versus-host disease.

Objectives

The study describes the creation and implementation of a culturally appropriate cancer education intervention, and assesses its efficacy among Native Americans in a community with documented cancer-related disparities.

Methods

Education workshops were developed and conducted on three reservations in Western South Dakota and Rapid City by trained community representatives. Over four-hundred individuals participated in the two-hour workshops. Participants answered demographic questions, questions about previous cancer screening (to establish baseline screening rates), and completed a pre and post workshop quiz to assess learning.

Results

Participants demonstrated significant increases in cancer screening-related knowledge levels. Surveys reveal that participants found the information of high quality, great value and would recommend the program to friends. Pre-workshop data reveals cancer screening rates well below the national average.

Conclusions

Workshop participants increased their knowledge about cancer etiology and screening. This intervention may represent an effective tool for increasing cancer screening utilization among Native Americans.

Background

The quality of psychosocial assessment of children in consultations varies widely. One reason for this difference is the variability in effective mental health and communication training at undergraduate and post-qualification levels. In recognition of this problem, the Royal College of Paediatrics and Child Health in the United Kingdom have developed the Child in Mind Project that aims to meet this deficit in medical training. This paper describes the evaluation of a workshop that explored the experiences and expectations of health care professionals in the development of a training programme for doctors.

Methods

The one-day inter-professional workshop was attended by 63 participants who were invited to complete evaluation forms before and immediately after the workshop.

Results

The results showed that the workshop was partially successful in providing an opportunity for an inter-professional group to exchange ideas and influence the development of a significant project. Exploring the content and process of the proposed training programme and the opportunity for participants to share experiences of effective practice were valued. Participants identified that the current culture within many health care settings would be an obstacle to successful implementation of a training programme. Working within existing training structures will be essential. Areas for improvement in the workshop included clearer statement of goals at the outset and a more suitable environment for the numbers of participants.

Conclusions

The participants made a valuable contribution to the development of the training programme identifying specific challenges. Inter-professional collaborations are likely to result in more deliverable and relevant training programmes. Continued consultation with potential users of the programme – both trainers and trainees will be essential.

Objective

To evaluate the cost and cost-effectiveness of three strategies for teaching community program clinicians motivational interviewing (MI): self-study (SS), expert-led (EX), and train-the-trainer (TT).

Methods

This economic analysis was conducted as part of a three-arm clinician training trial comprising 12 community treatment programs randomly assigned to the three conditions (n = 92 clinician participants). EX and TT conditions used skill-building workshops and three monthly supervision sessions. SS provided clinicians MI training materials only. The primary outcome measure was the number of clinicians meeting MI performance standards at 12-week follow-up. Unit costs were obtained via surveys administered at the 12 participating programs. Resource utilizations and clinician outcomes were obtained from the training trial. Costs and outcomes were normalized to account for differing numbers of clinicians across programs and conditions. Incremental cost-effectiveness ratios and cost-effectiveness acceptability curves were used to evaluate the relative cost-effectiveness of the three training strategies.

Results

SS is likely to be the most cost-effective training strategy if the threshold value to decision makers of an additional clinician meeting MI performance standards at 12-week follow-up is less than approximately $2,870, and EX is likely to be the most cost-effective strategy when the threshold value is greater than approximately $2,870.

Conclusions

This study provides accurate estimates of the economic costs and relative cost-effectiveness of three different strategies for training community program clinicians in motivational interviewing and should be of interest to decision makers seeking to implement empirically supported addiction treatments with scarce resources.

Abstract

Purpose

To evaluate the feasibility of regional physical therapy networks including continuing education in rheumatology. The aim of these networks was to improve care provided by primary care physical therapists by improving specific knowledge, technical and communicative skills and the collaboration with rheumatologists.

Methods

In two regions in The Netherlands continuing education (CE) programmes, consisting of a 5-day postgraduate training course followed by bimonthly workshops and teaching practices, were organised simultaneously. Network activities included consultations, newsletters and the development of a communication guideline. Endpoint measures included the participation rate, compliance, quality of the CE programme, teaching practices, knowledge, network activities, communication, number of patients treated and patient satisfaction.

Results

Sixty-three physical therapists out of 193 practices (33%) participated in the project. They all completed the education programmes and were formally registered. All evaluations of the education programmes showed positive scores. Knowledge scores increased significantly directly after the training course and at 18 months. A draft guideline on communication between physical therapists and rheumatologists was developed, and 4 newsletters were distributed. A substantial proportion of physical therapists and rheumatologists reported improved communication at 18 months. The mean number of patients treated by physical therapists participating in the networks increased significantly. Patients' satisfaction scores within the networks were significantly higher than those from outside the networks at 18 months.

Conclusions

Setting up a system of networks for continuing education for physical therapists regarding the treatment of patients with rheumatic diseases is feasible. Further research will focus on the effectiveness of the system and its implementation on a larger scale.

BACKGROUND:

The Ontario Ministry of Health and Long-Term Care funded the Ontario Lung Association to develop and implement a continuing medical education program to promote implementation of the Canadian asthma guidelines in primary care.

OBJECTIVES:

To determine baseline knowledge, preferred learning format, satisfaction with the program and reported impact on practice patterns.

METHODS:

A 3 h workshop was developed that combined didactic presentations and small group case discussions. Outcome measures included a workshop evaluation, baseline assessment of asthma management knowledge and three-month postreflective evaluations.

RESULTS:

One hundred thirty-seven workshops were delivered to 2783 primary care providers (1313 physicians, 1470 allied health) between September 2002 and March 2005. Of the 2133 participants, 1007 physicians and 1126 allied health professionals submitted workshop evaluations. Most (98%) of the attendees indicated they would recommend the workshop to a colleague. The majority preferred the combination of didactic lecture plus interactive case discussions. A subset of physicians provided consent to use these data for research (n=298 pediatric and 288 adult needs assessments; n=349 postreflective evaluations). Important needs identified included appropriate medication for chronic asthma and development of written action plans. On the postreflective evaluations, 88.7% remained very satisfied, 95.5% reported increased confidence, 91.9% reported an influence on practice and 67.2% reported using a written action plan.

CONCLUSIONS:

This continuing medical education program addresses identified needs of primary care providers. Participants reported improvements in asthma care, including prescribing practices, use of spirometry and written action plans. Similar programs should be considered as part of multifaceted asthma guidelines dissemination and implementation initiatives in other provinces and nationally.

Background

Physicians often do not provide adequate medication counseling.

Purpose

To develop and evaluate an educational program to improve physicians’ assessment of adherence and their medication counseling skills, with attention to health literacy.

Methods

We compared internal medicine residents’ confidence and counseling behaviors, measured by self-report at baseline and one month after participation in a two-hour interactive workshop.

Results

Fifty-four residents participated; 35 (65%) completed the follow-up survey. One month after training, residents reported improved confidence in assessing and counseling patients (p<0.001), including those with low health literacy (p<0.001). Residents also reported more frequent use of desirable behaviors, such as assessing patients’ medication understanding and adherence barriers (p<0.05 for each), addressing costs when prescribing (p<0.01), suggesting adherence aids (p<0.01), and confirming patient understanding with teach-back (p<0.05).

Conclusion

A medication counseling workshop significantly improved residents’ self-reported confidence and behaviors regarding medication counseling one month later.

Objectives

Problems such as hospital malnutrition (∼40% prevalence in the UK) may be managed better by improving the nutrition education of ‘tomorrow's doctors’. The Need for Nutrition Education Programme aimed to measure the effectiveness and acceptability of an educational intervention on nutrition for medical students in the clinical phase of their training.

Design

An educational needs analysis was followed by a consultative process to gain consensus on a suitable educational intervention. This was followed by two identical 2-day educational interventions with before and after analyses of Knowledge, Attitudes and Practices (KAP). The 2-day training incorporated six key learning outcomes.

Setting

Two constituent colleges of Cambridge University used to deliver the above educational interventions.

Participants

An intervention group of 100 clinical medical students from 15 medical schools across England were recruited to attend one of two identical intensive weekend workshops.

Primary and secondary outcome measures

The primary outcome measure consisted of change in KAP scores following intervention using a clinical nutrition questionnaire. Secondary outcome measures included change in KAP scores 3 months after the intervention as well as a student-led semiqualitative evaluation of the educational intervention.

Results

Statistically significant changes in KAP scores were seen immediately after the intervention, and this was sustained for 3 months. Mean differences and 95% CIs after intervention were Knowledge 0.86 (0.43 to 1.28); Attitude 1.68 (1.47 to 1.89); Practice 1.76 (1.11 to 2.40); KAP 4.28 (3.49 to 5.06). Ninety-seven per cent of the participants rated the overall intervention and its delivery as ‘very good to excellent’, reporting that they would recommend this educational intervention to colleagues.

Conclusion

Need for Nutrition Education Programme has highlighted the need for curricular innovation in the area of clinical health nutrition in medical schools. This project also demonstrates the effectiveness and acceptability of such a curriculum intervention for ‘tomorrow's doctors’. Doctors, dietitians and nutritionists worked well in an effective interdisciplinary partnership when teaching medical students, providing a good model for further work in a healthcare setting.

Article summary

Article focus

Hospital malnutrition has been a challenge for decades in the UK due to its cost and impact on patient care.

The focus was to examine whether a novel 2-day course could make a significant improvement in the understanding of clinical nutrition, among senior medical students.

Key messages

This study summarised the need for improved training in clinical nutrition among medical students in England, a need noted in other countries too.

Statistically significant changes in KAP scores were seen immediately after the intervention among the 98 students, and this was sustained for 3 months.

Ninety-seven per cent of the participants rated the overall intervention and its delivery as ‘very good to excellent’, reporting that they would recommend this educational intervention to colleagues.

Strengths and limitations of this study

The learning outcomes seemed appropriate and the teaching intervention appeared effective.

A multidisciplinary teaching team helped emphasise the roles of various team members, in dealing with nutrition-related problems in a healthcare setting.

Comparing change to a parallel student control group would have been preferable to monitoring within-group change.

Background

Clinicians providing primary emergency medical care often receive little training in the management of dental emergencies. A multimodal educational intervention was designed to address this lack of training. Sustained competency in managing dental emergencies and thus the confidence to provide this care well after an educational intervention is of particular importance for remote and rural healthcare providers where access to professional development training may be lacking.

Methods

A descriptive study design with a survey instrument was used to evaluate the effectiveness of a brief educational intervention for primary care clinicians. The survey was offered immediately before and at six months following the intervention. A Wilcoxon signed rank test was performed on pre and six month post-workshop matched pair responses, measuring self-reported proficiency in managing dental emergencies. The level of significance was set at p < 0.001. Confidence intervals (CI) were calculated for participants who scored an improved proficiency.

Results

The educational intervention was associated with a significant and sustained increase in proficiency and confidence to treat, especially in oral local anaesthesia, management of avulsed teeth and dental trauma, as reported by clinicians at six months after the education. This was associated with a greater number of cases where dental local anaesthesia was utilised by the participants. Comments from participants before the intervention, noted the lack of dental topics in professional training.

Conclusions

The sustained effects of a brief multimodal educational intervention in managing dental emergencies on practice confidence and proficiency demonstrates its value as an educational model that could be applied to other settings and health professional groups providing emergency primary care, particularly in rural and remote settings.

Aim

To present the experience of running workshops for members of research ethics committees (REC) in Spain from 2001-2008 by a non-profit institution.

Methods

We analyzed data from 7 sessions of the course, involving 165 health professionals. Data were taken from an opinion survey conducted at the end of each seminar and a deferred questionnaire sent after the workshops.

Results

Opinions of 122 participants who completed the first questionnaire (84% of the 146 attendees) on these training courses were very positive (median, ≥4.5 out of 5). The second questionnaire was administered a few months after each session, and a total of 43 participants responded (36% of 118). The participants improved their knowledge, attitude, and skills (median, 4.0 out of 5) in most of the areas evaluated. Furthermore, they believed that training for REC members should be mandatory (median, 5.0 out of 5) and carried out regularly (median, 4.0 out of 5). The lack of communication between RECs and limitations in monitoring clinical trials (median, 4.5 out of 5) were the main problems according to respondents. Training was rated as a strong necessity (median, 4.0 out of 5).

Conclusion

The courses were well received, they contributed to the overall learning of the participants, and served to highlight some of the major problems faced by REC members. These results emphasize the importance of training.

Background: Since 2008 the Verbundweiterbildungplus programme of the Competence Centre General Practice Baden-Wuerttemberg offers continual improvement with regards to content and structure of general practice training. The programme uses the didactical concept of the CanMEDs competencies, which were developed in Canada, as a postgraduate medical training framework. Train the trainer (TTT)-programmes are an additional important element of these contentual optimisations of postgraduate training. Within this article we describe the conception and evaluation of the first TTT-workshop within the programme Verbundweiterbildungplus.

Methods: The conception of the first TTT-workshop was influenced by results of a survey of general practitioner (GP) trainers and by experiences with teaching GP trainers involved in medical undergraduate teaching. A questionnaire was designed to get a self-assessment about organisational and didactic aspects oriented on the CanMEDs competencies of postgraduate medical training. In addition, the workshop was evaluated by the participants.

Results: The workshop lasted 12 teaching units and included the following elements: introduction into the CanMEDs competencies, feedback training, fault management, legal and organisational aspects of post graduate training. From the 29 participating trainers 76% were male and on average 57 years old. The evaluation showed a good to very good acceptance of the workshop. Initial self-rating showed the need of improving in the fields of determining learning objectives, providing formative feedback and incorporation of a trainee. Most trainers rated themselves as very good in procure CanMEDs competencies with the exclusion of the competencies “Manager“ and “Scholar“.

Conclusion: A TTT-programme is an important method to improve GP training which has not been used in Germany so far. Such a GP TTT-programme should highlight especially training in providing feedback and teaching in management aspects. Results of this article add information that can be used for developing TTT-programmes also in other specialties.

Background

Chiropractors must continue to learn, develop themselves professionally throughout their careers, and become self-directed and lifelong learners. Using an evidence-based approach increases the probability of optimal patient outcomes. But most chiropractors lack knowledge and interest in evidence-based approaches. The purpose of this study was to develop and measure the effectiveness of evidence-based training for chiropractic practitioners in a continuing education setting.

Methods

We developed and evaluated a continuing education workshop on evidence-based principles and methods for chiropractic practitioners. Forty-seven chiropractors participated in the training and testing. The course consisted of 12.5 hours of training in which practitioners learned to develop focused questions, search electronic data bases, critically review articles and apply information from the literature to specific clinical questions. Following the workshop, we assessed the program performance through the use of knowledge testing and anonymous presentation quality surveys.

Results

Eighty-five percent of the participants completed all of the test, survey and data collection items. Pretest knowledge scores (15-item test) were low (47%). Post intervention scores (15-item test) improved with an effect size of 2.0. A 59-item knowledge posttest yielded very good results (mean score 88%). The quality of presentation was rated very good, and most participants (90%) would "definitely recommend" or "recommend" the workshop to a colleague.

Conclusion

The results of the study suggest that the continuing education course was effective in enhancing knowledge in the evidence-based approach and that the presentation was well accepted.

Natural Eggshell Membrane (NEM®) is a new novel dietary supplement that contains naturally occurring glycosaminoglycans and proteins essential for maintaining healthy articular cartilage and the surrounding synovium. The randomized, multicenter, double-blind, placebo-controlled Osteoarthritis Pain Treatment Incorporating NEM® clinical study was conducted to evaluate the efficacy and safety of NEM® as a treatment for pain and stiffness associated with osteoarthritis of the knee. Sixty-seven patients were randomly assigned to receive either oral NEM® 500 mg (n = 34) or placebo (n = 33) daily for 8 weeks. The primary endpoint was the change in overall Western Ontario and McMasters Universities (WOMAC) Osteoarthritis Index as well as pain, stiffness, and function WOMAC subscales measured at 10, 30, and 60 days. The clinical assessment was performed on the intent-to-treat population. Supplementation with NEM® produced an absolute rate of response that was statistically significant (up to 26.6%) versus placebo at all time points for both pain and stiffness, but was not significantly improved for function and overall WOMAC scores, although trending toward improvement. Rapid responses were seen for mean pain subscores (15.9% reduction, P = 0.036) and mean stiffness subscores (12.8% reduction, P = 0.024) occurring after only 10 days of supplementation. There were no serious adverse events reported during the study and the treatment was reported to be well tolerated by study participants. Natural Eggshell Membrane (NEM®) is an effective and safe option for the treatment of pain and stiffness associated with knee osteoarthritis. Supplementation with NEM®, 500 mg taken once daily, significantly reduced both joint pain and stiffness compared to placebo at 10, 30, and 60 days. The Clinical Trial Registration number for this study is NCT00750477.

Objectives: to describe a bench model (workshop of abilities) for sinus floor elevation (SFE) training that simulates the surgical environment and to assess its effectiveness in terms of trainees’ perception. Study design: thirty-six randomly selected postgraduate students entered this cross-sectional pilot study and asked to fill in an anonymous, self-applied, 12-item questionnaire about a SFE workshop that included a study guide containing the workshop’s details, supervised practice on a simulated surgical environment, and assessment by means of specific check-lists. Results: Thirtiy-six fresh sheep heads were prepared to allow access to the buccal vestible. Using the facial tuber, third premolar and a 3D-CT study as landmarks for trepanation, the sinus membrane was lifted, the space filled with ceramic material and closed with a resorbable membrane. The participants agreed on their ability to perform SFE in a simulated situation (median score= 4.5; range 2-5) and felt capable to teach the technique to other clinicians or to undertake the procedure for a patient under supervision of an expert surgeon (median= 4; range 1-5 ). There were no differences on their perceived ability to undertake the technique on a model or on a real patient under supervision of an expert surgeon (p=0.36). Conclusions: Clinical abilities workshops for SFE teaching are an essential educational tool but supervised clinical practice should always precede autonomous SFE on real patients. Simulation procedures (workshop of abilities) are perceived by the partakers as useful for the surgical practice. However, more studies are needed to validate the procedure and to address cognitive and communication skills, that are clearly integral parts of surgical performance.

Key words:Sinus-floor elevation, animal model, dental education, dental implants, teaching, simulation.