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1.  A Multilevel Assessment of Barriers to Adoption of Dietary Approaches to Stop Hypertension (DASH) among African Americans of Low Socioeconomic Status 
Background
We examined perceptions of Dietary Approaches to Stop Hypertension (DASH) and the food environment among African Americans (AA) with high blood pressure living in two low-income communities and objectively assessed local food outlets.
Methods
Focus groups were conducted with 30 AAs; participants discussed DASH and the availability of healthy foods in their community. Sessions were transcribed and themes identified. Fifty-four stores and 114 restaurants were assessed using the Nutrition Environment Measures Survey (NEMS).
Results
Common themes included poor availability, quality, and cost of healthy foods; tension between following DASH and feeding other family members; and lack of congruity between their preferred foods and DASH. Food outlets in majority AA census tracts had lower NEMS scores (stores: −11.7, p=.01, restaurants: −8.3, p=.001) compared with majority White areas.
Conclusions
Interventions promoting DASH among lower income AAs should reflect the food customs, economic concerns, and food available in communities.
doi:10.1353/hpu.2011.0142
PMCID: PMC3769217  PMID: 22080704
Hypertension; diet; food deserts; African American
2.  Workshops to disseminate the Canadian Thoracic Society guidelines for chronic obstructive pulmonary disease to health care professionals in Ontario: Impact on knowledge, perceived health care practices and participant satisfaction 
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.
PMCID: PMC2706674  PMID: 19557214
Clinical practice guideline; COPD; Dissemination
3.  Formative Evaluation for a Healthy Corner Store Initiative in Pitt County, North Carolina: Assessing the Rural Food Environment, Part 1 
Introduction
Obesity prevalence in the rural United States is higher than in urban or suburban areas, perhaps as a result of the food environment. Because rural residents live farther from supermarkets than their urban- and suburban-dwelling counterparts, they may be more reliant on smaller corner stores that offer fewer healthful food items.
Methods
As part of a Communities Putting Prevention to Work (CPPW) healthy corner store initiative, we reviewed audit tools in the fall of 2010 to measure the consumer food environment in eastern North Carolina and chose the NEMS-S-Rev (Nutrition Environment Measures Survey-Stores-Revised) to assess 42 food stores. During the spring and summer of 2011, 2 trained graduate assistants audited stores, achieving interrater reliability of at least 80%. NEMS-S-Rev scores of stores in rural versus urban areas were compared.
Results
Overall, healthful foods were less available and of lower quality in rural areas than in urban areas. NEMS-S-Rev scores indicated that healthful foods were more likely to be available and had similar pricing and quality in rural corner stores than in urban corner stores.
Conclusion
Food store audit data provided a baseline to implement and evaluate a CPPW healthy corner store initiative in Pitt County. This work serves as a case study, providing lessons learned for engaging community partners when conducting rural food store audits.
doi:10.5888/pcd10.120318
PMCID: PMC3716336  PMID: 23866165
4.  Effect of Rater Training on Reliability and Accuracy of Mini-CEX Scores: A Randomized, Controlled Trial 
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.
doi:10.1007/s11606-008-0842-3
PMCID: PMC2607488  PMID: 19002533
medical education; faculty development; rater training; clinical competence; assessment; randomized trial
5.  Evaluation of a Train-the-Trainer Program for Cultural Competence 
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.
PMCID: PMC2690913  PMID: 19503694
cultural competence; pharmacy education; assessment; faculty development; train-the-trainer program
6.  Assessing the Food Environment of a Rural Community: Baseline Findings From the Heart of New Ulm Project, Minnesota, 2010–2011 
Introduction
Changes in the food environment in the United States during the past few decades have contributed to increased rates of obesity, diabetes, and heart disease. Improving the food environment may be an effective primary prevention strategy to address these rising disease rates. The purpose of this study was to assess the consumer food environment of a rural community with high rates of obesity and low levels of fruit and vegetable consumption. Findings were used to identify food environment intervention strategies to be implemented as part of a larger community-based heart disease prevention program.
Methods
We used the Nutrition Environment Measures Survey for Restaurants (NEMS-R) and Stores (NEMS-S) to assess 34 restaurants, 3 grocery stores, and 5 convenience stores in New Ulm, Minnesota.
Results
At least half of the restaurants offered nonfried vegetables and 100% fruit juice. Only 32% had at least 1 entrée or 1 main dish salad that met standards for “healthy.” Fewer than half (41%) had fruit available and under one-third offered reduced-size portions (29%) or whole-grain bread (26%). Grocery stores had more healthful items available, but findings were mixed on whether these items were made available at a lower price than less healthful items. Convenience stores were less likely to have fruits and vegetables and less likely to carry more healthful products (except milk) than grocery stores.
Conclusion
Baseline findings indicated opportunities to improve availability, quality, and price of foods to support more healthful eating. A community-wide food environment assessment can be used to strategically plan targeted interventions.
doi:10.5888/pcd11.130291
PMCID: PMC3944948  PMID: 24602590
7.  Neighborhood Impact on Healthy Food Availability and Pricing in Food Stores 
Journal of community health  2010;35(3):315-320.
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.
doi:10.1007/s10900-010-9224-y
PMCID: PMC3071013  PMID: 20127506
diet; obesity; built environment; economics; race
8.  Genetic education for primary care providers 
Canadian Family Physician  2009;55(12):e92-e99.
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.
PMCID: PMC2793208  PMID: 20008584
9.  Conflicting priorities: evaluation of an intervention to improve nurse-parent relationships on a Tanzanian paediatric ward 
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.
doi:10.1186/1478-4491-7-50
PMCID: PMC2706791  PMID: 19549319
10.  Do procedural skills workshops during family practice residency work? 
Canadian Family Physician  2010;56(8):e296-e301.
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.
PMCID: PMC2920796  PMID: 20705868
11.  Effect of Training on Adoption of Cancer Prevention Nutrition-Related Activities by Primary Care Practices: Results of a Randomized, Controlled Study 
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.
doi:10.1046/j.1525-1497.2000.03409.x
PMCID: PMC1495352  PMID: 10718895
nutrition education; nutrition counseling; cancer prevention; primary care physicians
12.  Community Based Participatory development, implementation and evaluation of a cancer screening educational intervention among American Indians in the Northern Plains 
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.
doi:10.1007/s13187-011-0211-5
PMCID: PMC3162121  PMID: 21431984
13.  Optimizing data collection for public health decisions: a data mining approach 
BMC Public Health  2014;14:593.
Background
Collecting data can be cumbersome and expensive. Lack of relevant, accurate and timely data for research to inform policy may negatively impact public health. The aim of this study was to test if the careful removal of items from two community nutrition surveys guided by a data mining technique called feature selection, can (a) identify a reduced dataset, while (b) not damaging the signal inside that data.
Methods
The Nutrition Environment Measures Surveys for stores (NEMS-S) and restaurants (NEMS-R) were completed on 885 retail food outlets in two counties in West Virginia between May and November of 2011. A reduced dataset was identified for each outlet type using feature selection. Coefficients from linear regression modeling were used to weight items in the reduced datasets. Weighted item values were summed with the error term to compute reduced item survey scores. Scores produced by the full survey were compared to the reduced item scores using a Wilcoxon rank-sum test.
Results
Feature selection identified 9 store and 16 restaurant survey items as significant predictors of the score produced from the full survey. The linear regression models built from the reduced feature sets had R2 values of 92% and 94% for restaurant and grocery store data, respectively.
Conclusions
While there are many potentially important variables in any domain, the most useful set may only be a small subset. The use of feature selection in the initial phase of data collection to identify the most influential variables may be a useful tool to greatly reduce the amount of data needed thereby reducing cost.
doi:10.1186/1471-2458-14-593
PMCID: PMC4077265  PMID: 24919484
Community survey methods; Data mining; Data collection; Ecological and environmental concepts; Nutrition
14.  Evaluation of an inter-professional workshop to develop a psychosocial assessment and child-centred communication training programme for paediatricians in training 
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.
doi:10.1186/1472-6920-4-25
PMCID: PMC535901  PMID: 15555066
15.  Training and Consultation to Promote Implementation of an Empirically Supported Treatment: A Randomized Trial 
Objective
The study evaluated the efficacy of three training modalities and the impact of ongoing consultation after training. Cognitive-behavioral therapy (CBT) for anxiety among youths, an empirically supported treatment, was used as the exemplar. Participants were randomly assigned to one of three one-day workshops to examine the efficacy of training modality: routine training (training as usual), computer training (computerized version of training as usual), and augmented training (training that emphasized active learning). After training, all participants received three months of ongoing consultation that included case consultation, didactics, and problem solving.
Methods
Participants were 115 community therapists (mean age of 35.9 years; 90% were women). Outcome measures included the Adherence and Skill Checklist, used to rate a performance-based role-play; a knowledge test; and the Training Satisfaction Rating Scale.
Results
All three training modalities resulted in limited gains in therapist adherence, skill, and knowledge. There was no significant effect of modality on adherence, skill, or knowledge from pretraining to posttraining. Participants were more satisfied with augmented and routine training than with computer training. Most important, number of consultation hours after training significantly predicted higher therapist adherence and skill at the three-month follow-up.
Conclusions
The findings suggest that training alone did not result in therapist behavior change. The inclusion of ongoing consultation was critical to influencing therapist adherence and skill. Implications for implementation science and mental health services research are discussed.
doi:10.1176/appi.ps.201100401
PMCID: PMC3432154  PMID: 22549401
16.  A Research Mentor Training Curriculum for Clinical and Translational Researchers 
Purpose
To design and evaluate a research mentor training curriculum for clinical and translational researchers. The resulting eight hour curriculum was implemented as part of a national mentor training trial.
Method
The mentor training curriculum was implemented with 144 mentors at 16 academic institutions. Facilitators of the curriculum participated in a train-the-trainer workshop to ensure uniform delivery. The data used for this report were collected from participants during the training sessions through reflective writing, and following the last training session via confidential survey with a 94% response rate.
Results
88% of respondents reported high levels of satisfaction with the training experience, and 90% noted they would recommend the training to a colleague. Participants also reported significant learning gains across six mentoring competencies as well as specific impacts of the training on their mentoring practice.
Conclusions
The data suggest the described research mentor training curriculum is an effective means of engaging research mentors to reflect upon and improve their research mentoring practices. The training resulted in high satisfaction, self-reported skill gains as well as behavioral changes of clinical and translation research mentors. Given success across 16 diverse sites, this training may serve as a national model.
doi:10.1111/cts.12009
PMCID: PMC3572855  PMID: 23399086
17.  Impact of a provincial asthma guidelines continuing medical education project: The Ontario Asthma Plan of Action’s Provider Education in Asthma Care Project 
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.
PMCID: PMC2676382  PMID: 17372639
Asthma; Continuing medical education; Guidelines
18.  An Educational Intervention to Enhance Nurse Leaders' Perceptions of Patient Safety Culture 
Health Services Research  2005;40(4):997-1020.
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.
doi:10.1111/j.1475-6773.2005.00401.x
PMCID: PMC1361187  PMID: 16033489
Patient safety; safety culture; leadership; training intervention
19.  A system of networks and continuing education for physical therapists in rheumatology: a feasibility study 
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.
PMCID: PMC1393271  PMID: 16773150
physical therapy (specialty)/education; rheumatic diseases; community networks; continuing medical education; program evaluation
20.  Train the Trainer for general practice trainer - a report of the pilot within the programme Verbundweiterbildungplus 
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.
doi:10.3205/zma000813
PMCID: PMC3374139  PMID: 22737198
General Practice; Train the Trainer; Feedback Training; Management; Postgraduate Medical Training
21.  Development and evaluation of a medication counseling workshop for physicians: can we improve on ‘take two pills and call me in the morning’? 
Medical Education Online  2011;16:10.3402/meo.v16i0.7133.
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.
doi:10.3402/meo.v16i0.7133
PMCID: PMC3171175  PMID: 21915162
medication adherence; health literacy; health communication
22.  Effectiveness of an evidence-based chiropractic continuing education workshop on participant knowledge of evidence-based health care 
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.
doi:10.1186/1746-1340-14-18
PMCID: PMC1560147  PMID: 16930482
23.  Motivational Interviewing for Adherence Problems in Cystic Fibrosis; Evaluation of Training Healthcare Professionals 
Background
Motivational interviewing (MI) offers effective strategies for enhancing behaviour change and is particularly useful for patients who exhibit poor adherence. This study evaluated MI training for cystic fibrosis (CF) teams, which comprised of one 4-hour workshop on MI principles, followed 6 months later by another on applying MI during brief consultations.
Methods
Health professionals (N = 60) from 7 teams completed questionnaires on learning outcomes 6 months after the first workshop, but before the second. Eleven participated in telephone-interview, 3 months after the second workshop.
Results
Quantitative analysis showed all participants used MI with a patient at least once after the first workshop and felt the approach was potentially helpful. Although self-appraisal of skill and confidence in MI was ‘moderate’, all felt confident in their ability to develop their skills and almost all intended to use MI in the future. Qualitative analysis confirmed the positive experiences of training and of using MI in practice, particularly in relationship building. However MI was utilised depending on team support and workload pressures.
Conclusions
This study showed that initial MI training with CF team-members resulted in increased knowledge and confidence about acquiring and applying MI techniques. However, this was balanced with consideration of barriers to application, further training needs and ongoing team-based support.
doi:10.4021/jocmr1603w
PMCID: PMC3808266  PMID: 24171060
Motivational interviewing; Training; Adherence; Cystic fibrosis
24.  Managing dental emergencies: A descriptive study of the effects of a multimodal educational intervention for primary care providers at six months 
BMC Medical Education  2012;12:103.
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.
doi:10.1186/1472-6920-12-103
PMCID: PMC3534540  PMID: 23110579
Dental; Emergencies; Education; Medical; Proficiency; Confidence; Model
25.  Sustained change in didactic skills - does teacher training last? 
Teacher training programmes are necessary assets in faculty development. Few data exist on their long-term effects on participants’ teaching skills. Our aim was to study participants’ didactic competencies up to four years after attending a newly established faculty development workshop at Hamburg Medical School. Of the 322 participants who attended our teacher training between 2006 and 2009, 313 received a self-assessment and evaluation questionnaire in 2010. This follow-up self-assessment (t2) was compared with their self-assessment of the same didactic competencies before (t0) and directly after (t1) the training. Correlations between participants’ personal reasons to attend the workshop and their assessment of didactic competencies were investigated. Self-assessment was significantly higher at the time of follow-up (t2) for all cohorts compared to the assessment before the workshop (t0). Personal reasons for participation differed greatly between voluntary and mandatory. However, self-assessment of the didactic competencies (t2) was not different between these groups. Participants involved in objective structured clinical examinations (OSCE) rated their competency in this field higher than participants without OSCE involvement. In conclusion, teacher training can be effective in the long run even when participation is mandatory. Competencies seem to be retained best when the content of the training fits participants’ teaching activities.
doi:10.3205/zma000880
PMCID: PMC3778536  PMID: 24062817
didactic methods; faculty development; OSCE; PBL; teacher training

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