Appropriate Level Of Supervision Research Articles

"I have hope, but I'm worried": Perspectives on parenting adolescents and young adults living with perinatally-acquired HIV.

Youth with perinatally-acquired HIV (PHIV) are living well into young adulthood. There has been extensive research on the social impacts of PHIV on adolescents and young adults (AYA). However, little research has examined their broader family system. This qualitative exploratory project examined the perspectives of caregivers raising AYA with PHIV. Eighteen caregivers who cared for adolescents and young adults with PHIV over the age of 14 completed semistructured audio-recorded interviews. Questions focused on salient aspects of adolescent development and parenting experiences over the course of their child's life. Transcripts were coded for emergent themes. Past and present caregiving experiences were consistently contextualized by the stigmatized nature of HIV. Daily concerns related to medication adherence and sexual behavior were common. Future-oriented expectations were marked by hope, as well as an acknowledgment of continued struggle. Negative experiences with the health care system underscore the need for ongoing education about HIV-related stigma. Findings suggest that caregivers, like other parents of typically developing youth, may need support addressing sexuality. Additionally, caregivers expressed concerns over the appropriate levels of supervision to offer their AYA as they assumed more responsibility for their own health. Collaboration among psychosocial and health care professionals to identify support strategies will benefit both caregivers and AYA living with PHIV. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Hospital-based assistant in Midwifery role for undergraduate midwifery students: A survey exploration

ProblemLittle is known about the experiences of undergraduate midwifery students employed as Assistants in Midwifery (AIM) in Australia. BackgroundAssistants in Nursing have been embedded in the Australian health system for many years, but the AIM role is relatively new. Undergraduate Bachelor of Midwifery students, in second or third year, can gain employment as an AIM at hospital maternity units. Little is known about the scope of practice for these roles and the experiences of AIM. AimThis study aimed to explore the experiences and scope of practice of AIM in New South Wales (NSW), Australia, over the last five years. MethodsA Qualtrics online survey enabled collection of quantitative and qualitative data from 128 respondents in late 2019. This was accompanied with the analysis of position descriptions for all AIM jobs advertised between September 2019 and February 2020. FindingsAnalysis of AIM position descriptions reflected nursing language rather than midwifery. Survey responses demonstrated ambiguity about the AIM scope of practice and the appropriate level of supervision required to perform the role. Qualitative data revealed the many benefits of the role for midwifery students. DiscussionOpportunities to participate in midwifery assistant work enhances student confidence and improves job readiness. However, a clearly defined scope of practice is one of the most important components of any employment model for undergraduate students. Clarification of the role and scope of practice of the AIM role is long overdue. There is ongoing need for advocacy to ensure that students working as AIM are employed to carry out midwifery activities and are supervised by midwives. ConclusionThis project provides insight into the advantages and disadvantages of working as an AIM whilst studying for a Bachelor of Midwifery degree. While the AIM position reaps many rewards for students, appropriate supervision in the workplace requires availability of adequate numbers of employed registered midwives.

932 Delivering Excellence in Orthopaedic Training - A Five Year Qualitative Study of Characteristics Valued by Trainees Voting for Trainer of The Year

Abstract Background Previous studies have described attributes of successful trainers. Dean et al’s (2017) systematic analysis found 12 commonly cited positive characteristics in medical literature. This paper and Nisar et al’s (2011) study which had a more exhaustive list of desirable qualities in surgical trainers formed the basis of our thematic analysis to identify trainer characteristics/behaviours valued by trainees on an orthopaedic training programme. Method We evaluated qualitative data from votes on the North West Thames rotation for Trainer of the Year over a 5-year period (2016-2020). We applied thematic analysis to identify 15 characteristics commonly cited by trainees in their nominations and logged how frequently each characteristic was raised. Results The five most popular qualities possessed by nominees are 1) prioritisation of training needs and endeavouring to create more training opportunities for trainees 2) being a source of support 3) willingness to allow trainees to operate 4) setting and facilitating the achievement of educational goals/targets 5) providing appropriate levels of supervision. All 15 valued characteristics and their frequency of mention are listed in the table presented. Conclusions To the best of our knowledge this is the only study which focuses exclusively on desirable qualities orthopaedic specialist trainees’ value in their trainers. ‘Advocating for trainees’ is a valued quality, also highlighted in ASIT’s 2018 analysis of the Silver Scalpel Award nominations, which is not otherwise well described in the literature. We hope our work will allow aspiring orthopaedic trainers insight into what trainee’s value most in a surgical mentor.

P164 Back to school - Supporting invasively ventilated children to return to the classroom

Abstract Introduction Integration of children with high health needs into the education system, such as those who are invasively ventilated, requires careful planning. Methods We retrospectively reviewed data bases and medical records from January 2004 until December 2020 to profile school age children who, following insertion of a tracheostomy to facilitate invasive ventilation, required assistance in entering or returning to the education system. Results 44 children received invasive respiratory support. Five (11%) remain under the legal school age of 6 years. Fourteen (32%) children entered main stream education – Private or state schools. Three (7%) children attended main stream schools with extra assistance in a support unit. Eighteen (41%) children attended Special Schools that met their individual underlying health care needs. Four (9%) children received either home schooling or attended hospital school. All children received appropriate education according to cognitive ability and none were placed in an inappropriate school setting due to their need for extra support with respiratory health. Discussion High use of health technologies can be perceived as a barrier to the normal classroom so negotiation with education authorities should be part of the patient journey. Support for (re-)integration to the school system includes recruitment and training of support staff and appropriate assessments of ability to provide a safe environment whilst maintaining appropriate level of supervision. Collaboration between the hospital and the education facility is key to the successful integration of children into the education system.

Learning to drive: resident physicians\u2019 perceptions of how attending physicians promote and undermine autonomy

BackgroundProviding appropriate levels of autonomy to resident physicians is an important facet of graduate medical education, allowing learners to progress toward the ultimate goal of independent practice. While studies have identified the importance of autonomy to the development of resident physicians, less is known about resident perspectives on their “lived experiences” with autonomy and ways in which clinical educators either promote or undermine it. The current study aims to provide an empirically based practical framework based on resident perspectives through which supervising physicians can attempt to more adequately foster resident physician autonomy.MethodsResidents completed open ended surveys followed by facilitated group discussions of their perspectives on autonomy. Qualitative thematic analysis identified key themes in resident definitions of autonomy and how clinical educators either promote or undermine resident autonomy during supervision. Fifty-nine resident physicians representing six different specialties from two institutions participated.ResultsLearners felt that autonomy was critical to their development as independent physicians. Leading the approach to care, a sense of ownership for patients, and receiving appropriate levels of supervision were identified as key components of autonomy. Attending physicians who promoted this active involvement with patient care were felt to have a strong positive influence on resident autonomy. Autonomy was undermined when decisions were micromanaged and resident input in decision-making process was minimized.ConclusionsFostering autonomy is a critical aspect of medical education. Allowing residents to take the lead in the delivery of patient care while supporting them as important members of the health care team can help to promote resident autonomy in the clinical setting.

P011: A pre-clerkship procedural curriculum designed for the future of Canadian medical education: a pilot and feasibility study

Introduction: Procedural skills training varies significantly across Canadian medical schools, and there is currently no standardized assessment tool to evaluate its benefits. This project aims to develop a curriculum that teaches 2nd-year medical students to perform and evaluate procedural skills. The goals of this program include decreasing anxiety, increasing confidence, and achieving competence for students and also allowing staff to judge the appropriate level of supervision when delegating learners to perform basic procedures in the team setting. Our curriculum incorporates, near-peer teaching as well as near peer formative assessment. Methods: Each of the twelve 2nd year participants completed a State Trait Anxiety Inventory and self-reported confidence questionnaire related to procedural skills. Students participated in four sessions taught by expert physicians over a five month period. A new skill was taught at each monthly workshop and an opportunity to practice previously taught skills was provided. Skills were assessed in a skills integration simulation OSCE, and the anxiety and confidence questionnaire was repeated. Results: Students who completed this pilot program showed a significant decrease in mean anxiety state (2.48 vs 1.74, p-value <0.001), while the control group did not (p-value = 0.408). When assessing confidence, students who completed this program showed increased self-assessed knowledge and confidence in each of the program's assessed skills. An increased level of competency was achieved in each skill by each student as assessed by the expert physicians. Conclusion: There is evidence to suggest that implementation of this procedural skills training model within the Canadian medical school curriculum may improve student anxiety, confidence, and competency for success in clerkship and could be the foundation for developing milestones for EPAs.

Competencies, Milestones, and a Level of Supervision Scale for Entrustable Professional Activities for Scholarship.

Scholarship is an important element of both undergraduate and graduate medical education, and scholarly activity is required for all pediatric fellows. However, despite the creation of entrustable professional activities (EPAs) for scholarship, the specific progressive levels of performance and the appropriate level of supervision for a given performance level have not been defined. The authors developed competencies and milestones for the scholarship EPA to provide a framework for assessment across the continuum; a level of supervision scale was also developed. The Vitae Researcher Development Framework served as a template to create the competencies and milestones for the scholarship EPA. Beginning in September 2015 and using a modified Delphi approach, three drafts were circulated to individuals with expertise in various types of scholarship until broad agreement was achieved. Then, in October 2016, the Steering Committee of the Subspecialty Pediatrics Investigator Network created a level of supervision scale, modeled after one it had previously developed. Eight competencies were identified as important in making entrustment decisions related to scholarship. For each competency, five milestone levels that span the continuum from novice to expert were created. A supervision scale with five progressive levels of entrustment was also created. Next steps include a study to obtain validity evidence for the supervision scale and determine the correlation between milestone and supervision levels. These competencies, milestones, and supervision levels can potentially serve as a road map for trainees and junior faculty and also play a role in the assessment of physician-scientists.

Entrusting internal medicine residents to use point of care ultrasound: Towards improved assessment and supervision

Background: Internal medicine physicians and trainees are increasingly using, and seeking training in, diagnostic point of care ultrasound (POCUS). Numerous internal medicine training programs have described their curricula, but little has been written about how learners should be assessed, supervised, and allowed to progress toward independent practice, yet these practices are imperative for safe and effective use. Entrustable professional activities (EPAs) offer a practical method to assess observable units of professional work and make supervision decisions.Methods: An EPA for POCUS is used as a framework to assess and determine appropriate levels of supervision in an internal medicine residency program.Results: All learners have been able to advance to level 2 with a mandatory introductory boot camp course. Learners have been able to advance to higher levels of independence, often after taking formal elective programmatic coursework. However, not all learners taking the same coursework have been granted the same level of independence.Conclusions: It is feasible to assess and supervise internal medicine residents’ ability to use diagnostic point of care ultrasound using an EPA.

The Role of Adult Perceptions and Supervision Behavior in Preventing Child Injury.

Supervision is an important factor in reducing injury risk. There are multiple factors that can affect the appropriate level of supervision including risk perception, anticipation of injury, and distracted behaviors. This study examined the perceived risks of child injury among parents and child caregivers and their supervision behavior among adults in an urban playground. Participant data from 25 individuals were collected through observations and anonymous self-reported surveys. More than half of the participants indicated practice of appropriate supervisory behavior, including attentiveness to their child's behavior and proximity to their child during play. Caregivers were more likely to report more careful levels of supervision. One-fourth of participants reported a change in the supervisory behavior during periods of distraction, specifically with phone use. Of the variables tested, there was a significant association between the variable 'talking to other adults' during supervision and 'prior injury' (P value = 0.04, 95% CI 0.03-0.91). Parents were more likely to report that they would leave their child unattended if they believed that the playground was a safe environment for play. There was a difference between self-reported behaviors and actual observed behavior, which is likely due to varying perspectives regarding child safety and injury prevention. In regards to injury risk, findings highlight the important role of appropriate supervisory behaviors and risk perceptions in preventing child injuries.

Education of parents in Pavlik harness application for developmental dysplasia of the hip using a validated simulated learning module.

BackgroundThe Pavlik harness is the most common initial treatment for developmental dysplasia of the hip worldwide. During treatment, parents are required to re-apply the harness at home. Teaching parents how to apply the harness is therefore paramount to success. While simulated learning for medical training is commonplace, it has not yet been trialed in teaching parents how to apply a Pavlik harness.MethodsA group of parents underwent a simulated learning module for Pavlik harness application. Parents were evaluated pre- and post-exposure and at one month after testing. A validated objective structured assessment of technical skill (OSATS) and a global rating scale (GRS) specific to Pavlik harness application were used for evaluation. A control group of parents was also tested at both time points. A clinical expert group was used to determine competency. ANOVA and t tests were used to assess differences between groups and over time.ResultsParent scores on the OSATS improved to the level of expert clinicians both immediately post-intervention and at retention testing. However, on the GRS, only half were considered competent due to their inability to achieve the required hip positions. The control group did not improve nor were they considered competent.ConclusionsThe use of a simulated learning module improves both the confidence and skill level of parents in the application of the Pavlik harness. However, the challenges parents face in understanding the more detailed subtleties of medical care suggest that they still require an appropriate level of supervision by clinicians to ensure effective treatment.Electronic supplementary materialThe online version of this article (doi:10.1007/s11832-016-0751-7) contains supplementary material, which is available to authorized users.

The American Journal of Psychiatry Residents' Journal: Training the Next Generation of Academic Psychiatrists.

The American Journal of Psychiatry Residents' Journal: Training the Next Generation of Academic Psychiatrists.

Child Maltreatment Fatalities Related to Inadequate Caregiver Supervision.

More than 1,500 children died in the United States in 2011 due to child maltreatment. A substantial portion of these deaths were due to neglect. Previous research has found that a large percentage of child neglect cases involve supervisory neglect; however, the role of inadequate caregiver supervision (ICS) in child maltreatment deaths is unknown. The present study reviewed files from the Child Death Review Board in the state of Oklahoma for the years 2000 to 2003 to examine (a) how many deaths were due to inadequate caregiver supervision and (b) which child, caregiver, family, alleged perpetrator, and incident characteristics predicted risk for death related to ICS. Results indicated that almost half of the child maltreatment deaths were related to ICS. Older children and those living in homes with greater numbers of children were more likely to die from causes related to ICS. In addition, the alleged perpetrators of deaths related to ICS were more likely to be biological parents than alleged perpetrators of non-ICS-related deaths. These findings suggest that interventions to assist caregivers in providing appropriate levels of supervision for their children may be important for reducing children's risk for death.

The role of environmental hazard in mothers’ beliefs about appropriate supervision

Understanding factors that influence mothers’ beliefs about appropriate levels of supervision for their children may assist in efforts to reduce child injury rates. This study examined the interaction of child (i.e. age, gender, and injury risk behavior) and maternal perception of environmental hazard (i.e. hazard level, injury likelihood, and potential injury severity) variables in predicting mothers’ beliefs about appropriate levels of supervision for their children. Participants were 58 mothers of 2- to 8-year-old community children who were interviewed about their beliefs regarding child injury risk and appropriate supervision. Results indicated that perceived environmental hazard level interacted with child age, gender, and injury risk behavior to predict mothers’ beliefs about supervision. Perceived injury likelihood also interacted with child injury risk behavior to predict beliefs about supervision. Findings underscore the complexity of factors influencing mothers’ beliefs about appropriate supervision and indicate the importance of environmental hazard level in such beliefs.

Frequency of nursing tasks in medical and surgical wards

To explore the frequency of different nursing tasks in medical and surgical wards. The time nurses spend on direct patient care is important for both patients and nurses. However, little is known about the time nurses spend on various nursing tasks. A real-time, repeated measures design conducted amongst 67 (n=39 medical, n=28 surgical) UK hospital nurses. Between September 2011 and August 2012 participants completed an electronic diary version of a classification of nursing tasks (WOMBAT) during shifts. A total of 961 real-time measures of nursing task were obtained. Direct patient care [median=37.5%, interquartile range=27.8], indirect care (median=11.1%, interquartile range=19.4) and medication (median=11.1%, interquartile range=18.8) were most commonly reported. Participants were interrupted in 62% of entries (interquartile range=35), reported adequate time in 78% (interquartile range=31) and adequate resources in 89% (interquartile range=36). Ward-related tasks were significantly more frequent on medical wards than surgical wards but otherwise there were no significant differences. Nurses spend the highest proportion of time in direct patient care and majority of this on core nursing activities. Interruptions to tasks are common. Nurses tend to report adequate time/resources. The frequency of nursing tasks is similar in medical and surgical wards. Nurse managers should review the level of interruptions to nurses' work and ensure appropriate levels of supervision.

TU-C-211-01: How to Obtain the Resources Needed for Your Program and Ensure That Work is Performed by Qualified Professionals

Managing a medical physics practice requires much more than diligent attention to the standard range of medical physics duties. Obtaining the appropriate resources to operate a quality program is not always easy, and delegating duties while maintaining an appropriate level of supervision can present many challenges. The former requires interacting with health‐system administrators to justify the request for resources and to ensure that budgets provide the support needed for the program. An understanding of financial models for new services, capitalized assets and operational budgets is essential in this regard. The latter requires a clear system of credentialing for each role in the physics group, scope of practice for each job description, delegation and supervision levels, and defining and managing performance expectations. Learning Objectives: 1. Understand how financial models are used to project return on investment in capital assets and how to build an operational budget for a physics group; 2. Understand how to implement a credentialing program in medical physics; 3. Understand how to clearly define delegation of tasks and appropriate supervision levels and how to define and manage performance expectations.

Negotiating transformational leadership: A key to effective collaboration

Transformational leadership is important because it provides not only direction but it also creates opportunities for professional development. This qualitative investigation explored how medical doctors, in order to be transformative, should negotiate with advanced practice nurses while working in collaboration with them. The results first suggest that medical doctors and advanced practice nurses should negotiate appropriate levels of supervision in their working relationship commensurate with the education and experience that the advanced practice nurses bring to the practice. Second, mentoring should be a reciprocal communication process between medical doctors and advanced practice nurses, where thoughtful feedback facilitates appropriate adjustments in respective communication and time management styles. Third, educating necessitates mutual learning, with each party acknowledging the possibility of learning from the other and being sensitive to the value of what the other contributes to the working relationship. The authors conclude that effective leadership involves negotiating along these dimensions, which will contribute to effective team-building.

A Student's Reflection on Her First Clinical Practicum

As a student at the Dalhousie University School of Health Sciences, I have recently completed my first year of the radiological technology program. Although I already had 4 years of university education, the clinical component of this program was a new experience for me. My initial clinical practicum, an 8-week clinical placement at the Queen Elizabeth II Health Sciences Centre in Halifax, proved to challenge my academic knowledge, develop my clinical skills, and enhance my understanding of the role of a radiological technologist in today’s health care system. As I have come to realize, the first-year clinical experience is a crucial one for students; it is here that our knowledge and confidence significantly increases and that the tone for future experiences is set. In this column I hope to shed light on the importance of the technologist-student relationship, discuss some obstacles I have encountered, and pass on some helpful advice to other first-year students. During clinical placements at large hospitals, it is common for every student to work with different technologists and for every technologist to work with different students. This relationship is the backbone of the clinical experience; thus its influence on student learning must be understood. Academic literature reveals that the quality of teaching in the clinical setting is a strong predictor of student performance [1]. Students who experience a higher quality of clinical teaching tend to exhibit a higher level of performance during their clinical education [2]. Conversely, poor clinical teaching can have significant negative influence on student learning [1]. Quality of supervision, along with number and variety of patients, is also a deciding factor in how students perceive their personal clinical effectiveness [2]. These research findings were confirmed for me during my clinical placement. I had the opportunity to work with many different technologists; some were more supportive of my learning than others. I found that those who were more aware of the program’s clinical learning expectations and the knowledge level of a first-year student were able to facilitate my learning in a more effective manner. Accordingly my clinical skills and confidence were raised when working with technologists who were able to encourage my independent decision making and problem solving while maintaining the appropriate level of supervision for a first-year student. More importantly, those who created a friendly and supportive environment, provided constructive feedback, and shared their expertise made me feel comfortable in my surroundings and allowed me to self-evaluate and set goals. On the other hand, those who were in a rush, were unfriendly, reluctant to let me participate, or provided no feedback left me with a negative experience in which I lost confidence and learned very little. A common obstacle for first-year radiological technology students is the reality that technologists’ work habits and preferences vary significantly, both among each other and from what we are taught in school. Examples of this include technologists preferring upright or recumbent positions for certain procedures, favoring automatic exposure control or manual exposure factors, variations in the order in which projections for examinations are completed, and use of different positioning techniques. I have experienced this myself; it is difficult to digest all of the variation. It can be overwhelming and can create confusion when we, as first-year students, are already dealing with such a large base of knowledge that is new (at least, to us). To overcome this obstacle, it is helpful if technologists explain why certain techniques (rather than others) work for them, and to allow us to attempt these different techniques. This enables us to begin to understand our options and to develop techniques that work for us.

Global Risk Factors and the Prediction of Recidivism Rates in a Sample of First-Time Misdemeanant Offenders

This article examines the prediction of recidivism using the Global Risk Assessment Device (GRAD), a reliable and valid measure of dynamic factors associated with family characteristics, peers, mental health, substance abuse, trauma exposure, educational concerns, accountability, and health risks. Using a sample of adult caregivers of first-time misdemeanant offenders, two factors-education and accountability-were significantly associated with recidivistic behavior, supporting the use of GRAD data in correctly identifying first-time offenders who have the greatest and the least likelihood for future offending behavior. Additional analyses utilizing parent reports on African American males indicate that the GRAD provides discrimination in the prediction of recidivism in a group typically seen as being high risk simply because of their gender and race. The assessment drives intervention approach of the GRAD is discussed in terms of using reports from adults to accurately place youth into appropriate levels of supervision and treatment.

The Radiologist Assistant: What Radiologists Need to Know Now

States are increasingly considering legislative and regulatory avenues to establish the role of radiologist assistants (RAs) under current state medical practice acts or state radiation control regulatory programs. It is critical that radiology practices be cautious to comply with federal and state laws and regulations to ensure that these advanced practice professionals provide the appropriate services under the appropriate level of supervision. For quality-of-care reasons, the ACR remains concerned about the scope of practice of radiology practitioner assistants and some misinformation that has spread to state officials about the assistants' role in radiology practice. Another potential source of confusion may be the fact that physician assistants and nurse practitioners are being increasingly used in many areas of health care (including radiology) and may derive delegated authority (from physicians) to perform services that physicians determine nurse practitioners or physician assistants to be qualified to perform. The authors in particular emphasize current federal and state legislative activities and describe possible exposure and risks associated with the extension of the scope of practice by radiologic technologists without commensurate changes in state statutes and regulations.

A national audit of paediatric service provision in otolaryngology in England and Wales

Otolaryngology is the surgical speciality with the highest paediatric workload, accounting for 29% of the total. Children are not miniature adults and require specially trained staff, equipment, facilities and an environment appropriate to their needs. Documents from the Department of Health and the Royal Colleges of Surgeons and Anaesthetists have been published outlining national standards and recommendations for paediatric surgical service provision. We undertook an audit to assess the current state of paediatric services in ENT in England and Wales and how they conform to these guidelines. A database of ENT departments in England and Wales was constructed and a postal questionnaire sent to a named consultant in each unit. The questionnaire encompassed the areas of recommendation outlined in the aforementioned reports. Respondents were also asked to state the kind of hospital in which they worked so a further breakdown of the results could be made. One hundred and eighty-nine units were included in the audit with a response rate of 56%. Structurally the documents recommend that each unit has a dedicated named paediatric ENT consultant and a designated clinical lead for children's surgery. This is being met in 54.7% and 56.6%, respectively. Omitting the specialist stand alone group the paediatric facilities in theatre were of a lower standard and overall only 30% met the requirements set by the reports. This theme continues when analysing the data of the provision of anaesthetic services with only 50% of the small district general hospitals having the appropriate level of supervision and expertise. One of the worst met targets is that of acute pain service being provided in only 26% of the hospitals that responded. Overall there is a common theme with the specialist stand alone units scoring the highest and the small district general hospitals scoring the lowest. This audit reveals that we are not meeting the guidelines in nearly 50% of the targeted areas. Paediatric care should be "child centred" and if we are not able to provide this specialised care then paediatric surgical services could be forced into centralisation.