Broad Scope Of Practice Research Articles

Residency Program Characteristics and Individual Physician Practice Characteristics Associated With Family Physician Scope of Practice.

A family physician's ability to provide continuous, comprehensive care begins in residency. Previous studies show that patterns developed during residency may be imprinted upon physicians, guiding future practice. The objective was to determine family medicine residency characteristics associated with graduates' scope of practice (SCoP). The authors used (1) residency program data from the 2012 Accreditation Council for Graduate Medicine Education Accreditation Data System and (2) self-reported data supplied by family physicians when they registered for the first recertification examination with the American Board of Family Medicine (2013-2016)-7 to 10 years after completing residency. The authors used linear regression analyses to examine the relationship between individual physician SCoP (measured by the SCoP for primary care [SP4PC] score [scale of 0-30; low = small scope]) and individual, practice, and residency program characteristics. The authors sampled 8,261 physicians from 423 residencies. The average SP4PC score was 15.4 (standard deviation, 3.2). Models showed that SCoP broadened with increasing rurality. Physicians from unopposed (single) programs had higher SCoP (0.26 increase in SP4PC); those from major teaching hospitals had lower SCoP (0.18 decrease in SP4PC). Residency program characteristics may influence family physicians' SCoP, although less than individual characteristics do. Broad SCoP may imply more comprehensive care, which is the foundation of a strong primary care system to increase quality, decrease cost, and reduce physician burnout. Some residency program characteristics can be altered so that programs graduate physicians with broader SCoP, thereby meeting patient needs and improving the health system.

Educational Psychology in Yukon

Directly employed by the territorial government, Yukon’s educational psychologists are moving away from “refer-test-place” services by actively clarifying a broader scope of practice within a non-categorical model of special education services. Yukon’s educational psychologists provide a variety of services, such as consultation, intervention support, emergency response, and assessment, and participate in multi-disciplinary fetal alcohol spectrum disorder diagnostic assessments. Despite no registration or licensure requirement to practice psychology in Yukon, newer educational psychologists are personally initiating registration procedures and advocating for ethical and professional practice.

Enabling participation of students through school-based occupational therapy services: Towards a broader scope of practice

Both students with disabilities and their typically-developing peers exhibit alarming participation deficits that involve many occupational areas of their school experience. Enabling participation in school-related occupations as the goal of school-based occupational therapy services invokes practice breadth. However, the documented focus of practice appears narrow, and there is an apparent paucity of evidence to describe how school participation is enabled. This paper discusses the complex concept of participation and how it can be applied in the school setting, while drawing upon occupational therapy elements. Redirecting attention towards participation can expand the scope of school-based occupational therapy to its intended broad perspective.

Radiation via Intracavitary-Interstitial Pelvic Implants for Gynecological Cancers: Clinical Nurse Specialists Affecting Change.

This article describes the value of a clinical nurse specialist (CNS) team in partnering with interdisciplinary stakeholders to improve care for women with gynecological cancers receiving radiation via intracavitary-interstitial pelvic implants (IPI). Intracavitary-interstitial pelvic implants can prolong survival but is associated with significant impacts on quality of life. Intracavitary-interstitial pelvic implants is a complex and invasive intervention that requires patients to be immobile for 3 days and creates challenges related to dignity, hygiene, nutrition, pain management, emotional health, skin care, and overall patient satisfaction. The nursing staff shared concerns with their respective CNSs regarding patients' quality of care. Lack of standardized practice/orders and gaps in knowledge created challenges. Clinical nurse specialist practice requires collaborative efforts within the 3 spheres of influence to improve the care of patients receiving IPI therapy. The CNSs recognized and addressed needs of patients/families, staff, and the organization across the continuum. The team's efforts relied on reflection of nurses' concerns, collaboration, and a unified vision for exceptional care. This CNS-led initiative was successful in establishing processes to ensure quality care. Improvement in patient care was achieved through creation of standardized order sets, a focused plan of care, and patient/family/staff education. Nurse satisfaction, confidence, and empowerment to provide patient care with dignity and sensitivity have been verbalized. The CNS team's broad scope of practice, across inpatient, outpatient, and evidence-based practice, is a strength. Key to the team's success was the recognition of challenges and a unified vision to bring together stakeholders to facilitate improvement of care. Future direction includes evaluating nutritional choices and examining psychosocial aspects of the patient's experience. An interdisciplinary nursing grand rounds is planned to highlight the outcomes of this team. The leadership of CNS teams with varied scopes is critical to affecting change within the spheres of influence and improving patient care across the continuum.

Demographics, Training Satisfaction, and Career Plans of Canadian Oral and Maxillofacial Surgery Residents

The purpose of this study was to evaluate the demographics, training satisfaction, and career plans of Canadian oral and maxillofacial surgery (OMS) residents. A cross-sectional study was conducted using an anonymous online survey that was distributed via e-mail to all current Canadian OMS residents. The completion rate of this survey was 88.9%. Eighty percent of residents were satisfied with their surgical education overall. Residents were most satisfied with their training in the areas of facial trauma and orthognathic surgery. Satisfaction was lowest in the areas of facial cosmetic surgery, maxillofacial reconstructive surgery, cleft and craniofacial surgery, and dental implantology. A majority of residents, 78.1%, indicated that they would prefer to be trained in an MD-integrated OMS certificate program. Seventy-two percent of residents indicated that they would like to complete a fellowship following graduation. The most desirable career path was a combination of private practice and academic practice, with 75.0% of residents selecting this option. Overall, Canadian OMS residents were pleased with their training in the traditional scope of OMS, apart from dental implantology. Among the current generation of trainees, there appears to be a proclivity for a broader scope of practice, dual-degree training, and post-graduate fellowship training.

Public perceptions of pharmacist expanded scope of practice services in Nova Scotia

Community pharmacists have been transitioning from traditional dispensing roles toward a much broader scope of practice. The objective of this research was to explore public perceptions of expanded scope of practice (ESOP) services as they relate to pharmacy and pharmacist characteristics. The Survey on New Services Offered by Nova Scotia Pharmacists was developed and deployed using in-pharmacy intercept surveys and online public surveys in Nova Scotia. The survey focused on 4 key ESOP elements/services: 1) prescribing for minor ailments (ambulatory conditions), 2) injections and vaccinations, 3) prescription renewals and 4) medication reviews. Data were analyzed using comparisons between groups (multivariate analysis of variance) and principal component analysis. A total of 385 surveys were obtained from the public regarding their perceptions and use of ESOP services (online n = 237, in-pharmacy intercept n = 148). A number of significant differences were found on the basis of respondent sex, age and the location of survey deployment. Overall, public perceptions of pharmacists' knowledge and skills in providing ESOP services are positive. A pharmacist's ability to communicate, protect confidentiality and provide quality information regarding medications is important to the public. Respondents who already have a good relationship with their pharmacist are more likely to see value in ESOP services. Future public education strategies should focus on factors positively affecting the public's perceptions of ESOP services and should encourage public use of these services through intentional patient education of the benefits of ESOP services and strengthening of the patient-provider relationship.

Family physicians' scope of practice and American Board of Family Medicine recertification examination performance.

Previous research indicated that rural family physicians were more likely to pass the American Board of Family Medicine (ABFM) Maintenance of Certification for Family Physicians (MC-FP) examination. One possible explanation is that rural family physicians may have a broader scope of practice. This was a cross-sectional study of family physicians taking the ABFM MC-FP examination in 2013. Examination results were linked with the Scope of Practice for Primary Care (SP4PC) scale. Linear and logistic regression models, with and without SP4PC score, determined associations between scope of practice and examination results. Among 10,978 examinees, rural physicians had a higher passing rate (90.7% vs 86.8%, P < .05) and higher SP4PC score (16.1 vs 14.3 P < .05) compared with urban physicians. Regression models without SP4PC score confirmed that urban physicians were less likely to pass (OR = 0.73; 95% CI, 0.62-0.87) and scored lower, -15.6 points, compared with rural physicians. Including SP4PC score completely attenuated the relationship between practice location and passing (OR = 0.86; 95% CI, 0.73-1.02) and decreased the relationship between score and practice location (-5.8 points). Each point increase on the SP4PC score was associated with 9% higher odds of passing (OR = 1.09; 95% CI, 1.07-1.11) and 4.9 more points. A broader scope of practice rather than rural or urban practice location, was associated with increased likelihood of passing the MC-FP examination. If higher board scores are associated with providing higher quality of care, then maintaining a broad scope of practice may enable the delivery of higher quality primary care.

Mt Everest Base Camp Medical Clinic “Everest ER”: Epidemiology of Medical Events During the First 10 Years of Operation

As the highest peak on the planet, Mt Everest provides a truly austere environment in which to practice medicine. We examined records of all visits to the Everest Base Camp Medical Clinic (Everest ER) to characterize the medical problems that occur in these patients. A retrospective analysis of medical records from the first 10 years of operation (2003 to 2012) was performed. Medical reasons accounted for 85.3% (3045) of diagnoses, whereas 14.0% (500) were for trauma. The most common medical diagnoses were pulmonary causes such as high altitude cough and upper respiratory infection, comprising more than 38% of medical diagnoses. For traumatic diagnoses, 56% were for dermatologic causes, most commonly for frostbite and lacerations. Pulmonary and dermatologic diagnoses were also the most frequent causes for evacuation from Everest Base Camp, most commonly for high altitude pulmonary edema and frostbite, respectively. Medical professionals treating patients at extreme altitude should have a broad scope of practice and be well prepared to deal with serious trauma from falls, cold exposure injuries, and altitude illness.

Teaching Health in the 21st Century

School nurses have a broad scope of practice, including direct clinical care, as well as teaching health lessons. Students in the 21st century require educators who understand the current global needs of these learners. Effective health teaching meets these 21st-century needs. This article presents a background of 21st-century learning, with specific recommendations for teaching this generation of students.

What Surgical Skills Rural Surgeons Need to Master

As new technology is developed and scientific evidence demonstrates strategies to improve the quality of care, it is essential that surgeons keep current with their skills. Rural surgeons need efficient and targeted continuing medical education that matches their broader scope of practice. Developing such a program begins with an assessment of the learning needs of the rural surgeon. The aim of this study was to assess the learning needs considered most important to surgeons practicing in rural areas. A needs assessment questionnaire was administered to surgeons practicing in rural areas. An additional gap analysis questionnaire was administered to registrants of a skills course for rural surgeons. Seventy-one needs assessment questionnaires were completed. The self-reported procedures most commonly performed included laparoscopic cholecystectomy (n = 44), hernia repair (n = 42), endoscopy (n = 43), breast surgery (n = 23), appendectomy (n = 20), and colon resection (n = 18). Respondents indicated that they would most like to learn more skills related to laparoscopic colon resection (n = 16), laparoscopic antireflux procedures (n = 6), laparoscopic common bile duct exploration/ERCP (n = 5), colonoscopy/advanced techniques and esophagogastroscopy (n = 4), and breast surgery (n = 4). Ultrasound, hand surgery, and leadership and communication were additional topics rated as useful by the respondents. Skills course participants indicated varying levels of experience and confidence with breast ultrasound, ultrasound for central line insertion, hand injury, and facial soft tissue injury. Our results demonstrated that surgeons practicing in rural areas have a strong interest in acquiring additional skills in a variety of general and subspecialty surgical procedures. The information obtained in this study may be used to guide curriculum development of further postgraduate skills courses targeted to rural surgeons.

Including nurses in care models for older people with mild to moderate depression: an integrative review

The aim of this integrative literature review was twofold: (1) to investigate different collaborative programmes for older people with depression living at home with diverse access to care and (2) to describe conceptualisation of the nurses' role and interventions within these care models. One in four older people who visits a General Practitioner suffers from depression. Depression is a concern for 15% of all older home-care service clients. Detecting and managing depression in older people is highlighted as a key role of nurses. A literature review has been conducted to investigate collaborative models of care, aimed at ensuring low-threshold access to care and exploring the scope of nurse practice within these models. Literature review comprising 14 studies and reviews. Three different collaborative care programmes (Collaborative Care Model, Community Mental Health Team and Psychogeriatric Assessment and Treatment in City Housing programme) were identified. In all programmes, the essential aspects were complex and multifaceted interventions, provided by a variety of healthcare professionals, but the access to care differed. All studies described the role of nurses differently and with wide variations. Despite a broad scope of practice, nurses play a pivotal role within the different models of care. Nurses have to have the educational background and expertise in mental health issues to recognise depression and eventually be able to provide more comprehensive interventions to alleviate depression in older people. Collaboration is needed to meet the needs of older people with depression. New forms of work divisions are pivotal to achieve this objective.

Pharmacist Prescribing: Has the Momentum Started?

At a March 2012 session in Calgary on legal liability related to expanded scope of practice, numerous pharmacists vehemently criticized the Alberta government for implementing, on July 1, 2012, payment to pharmacists for renewing prescriptions. The pharmacists were not criticizing the amount of the fee but, rather, the fact that they would have to perform the activity (i.e., renew prescriptions) to keep any clients who might ask for this service and also the fact that pharmacists would have to comply with standards of practice for this activity. Imagine pharmacists prescribing and being paid, by the government, to do so! This scenario was unimaginable when I graduated in 1977. Both clinical pharmacy in general and pharmacists making recommendations for prescription changes were emerging concepts at that time. Pharmacist prescribing still seemed an impossible dream in the early 2000s when I and other pharmacists in Alberta strongly advocated for pharmacists to be given independent prescribing privileges through legislation. Pharmacists had been prescribing dependently for decades, both formally (e.g., through therapeutic substitution and other hospital-based policies) and informally (e.g., in the community, through agreements with physicians). I wrote background papers for the Alberta College of Pharmacists, participated in working groups, lobbied politicians and government officials, and spent most of my free time trying to convince fellow pharmacists that this expanded scope of practice was essential for the profession to grow, and even for the profession to survive. I did not think it would happen in my lifetime, but on April 1, 2007, Alberta pharmacists gained authorization to independently prescribe drugs. It has been over 5 years since that “miracle” occurred, yet the uptake of prescribing by pharmacists has been very limited, even with payment for services. In addition to having authorization to adapt prescriptions and prescribe in emergencies, Alberta pharmacists can also apply to the Alberta College of Pharmacists to obtain “additional prescribing authorization”, which allows them to initiate therapy. However, of the almost 4300 practising pharmacists registered with the Alberta College of Pharmacists as of February 29, 2012, only 155 had additional prescribing authori zation, most of them in community-based practices. I find this very disappointing, in terms of both the overall number of pharmacists and the relative dearth from hospital practice. This expanded scope of practice would have been extremely useful when I was in hospital practice, which is why I advocated for independent pharmacist prescribing. The current lack of interest shown by hospital pharmacists is not surprising to me, as only 2 of the 9 regional health authorities endorsed pharmacist prescribing before the 2008 merger that created the provincial agency, Alberta Health Services. Around that time, I talked with a hospital-based pharmacist whose clinical practice I admired. He was applying for the additional prescribing authorization, but only because his hospital had made it mandatory for his position. He greatly resented the application process as too much extra, unnecessary work, given that he had been doing drug therapy management for years, without this official recognition. What he failed to recognize was that the status quo would not be in compliance with the new legislation. Alberta Health Services supports pharmacist prescribing and has made additional prescribing authorization a requirement for many positions, and many pharmacists in primary care networks and family care clinics are now obtaining this authorization. When examining the acceptance of prescribing by pharmacists, I find it useful to compare pharmacists’ attitudes with those of nurse practitioners who have received prescriptive authority, often earlier than pharmacists. In most jurisdictions, nurse practitioners have a broader scope of practice as it pertains to prescribing drugs than do pharmacists. For example, they will soon be able to prescribe narcotics and controlled drugs. I have

316 EMF Scope of Practice and Autonomy of Physician Assistants in Rural versus Urban Emergency Departments

Study Objectives: Physician assistants (PAs) are being utilized in greater numbers in both rural and urban EDs to mitigate the emergency medicine workforce shortages, improve efficiency of emergency physicians, and reduce the cost of emergency care. We sought to compare the scope of practice and autonomy of emergency medicine PAs practicing in rural versus urban EDs, and hypothesized rural PAs would have a broader scope of practice and higher reported autonomy, while receiving less direct supervision.

Shaping the future of Scandinavian anaesthesiology: a position paper by the SSAI

Traditionally, Scandinavian anaesthesiologists have had a very broad scope of practice, involving intensive care, pain and emergency medicine. European changes in the different medical fields and the constant reorganising of health care may alter this. Therefore, the Board of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI) decided to produce a Position Paper on the future of the speciality in Scandinavia. The training in the various Scandinavian countries is very similar and provides a stable foundation for the speciality. The Scandinavian practice in anaesthesia and intensive care is based on a team model where the anaesthesiologists work together with highly educated nurses and should remain like this. However, SSAI thinks that the role of the anaesthesiologists as perioperative physicians is not fully developed. There is an obvious need and desire for further training of specialists. The SSAI advanced educational programmes for specialists should be expanded and include formal assessment leading to a particular medical competency as defined by the European Union of Medical Specialists (UEMS). In this way, Scandinavian anaesthesiologists will remain leaders in perioperative, intensive care, pain and critical emergency medicine.

Legislative alchemy: the US state chiropractic practice acts

AbstractChiropractors claim the ability to detect ‘subluxations’, an ill‐defined, unproved spinal pathology of no known clinical significance. Patients are advised that subluxations can adversely affect organ function and general health even if the patient is asymptomatic. The removal of vertebral subluxations through chiropractic treatment is posited to restore ‘neural integrity’, facilitating the body's self‐healing ability. Despite the deficiencies of these concepts, the 50 state chiropractic practice acts essentially define chiropractic as the detection and correction of subluxations and assume their significance to human health, allowing a broad scope of practice. Because the chiropractic profession seems unwilling to abandon these discredited concepts, reform of the state chiropractic practice acts to eliminate subluxation‐based chiropractic practice may be the only viable solution to the perpetration of unscientific and unproved healthcare practices.

Emerging Roles, Functions, Specialty Areas, and Employment Settings for Contemporary Rehabilitation Practice

Traditional rehabilitation counseling has focused primarily on serving persons with disabilities in state-federal agencies, using a specific skill set. In recent years, this focus has shifted from the traditional and often narrowed focus of rehabilitation counseling, to a more contemporary and broader scope of practice. This article attempts to summarize and discuss the new emerging roles and functions of rehabilitation counselors, new specialty areas, and new employment settings within the field. Conclusions and recommendations are also discussed.

The community involvement of nursing and medical practitioners in KwaZulu-Natal

AbstractBackgroundThe basis of the health system in South Africa in purported to be primary health care (PHC), as defined by the Alma Ata Declaration of 1978. This approach emphasises community involvement in all health-related activities, but it would appear that a very limited or selective PHC approach in actually being pursued in South Africa, without meaningful community participation or ownership. This study explores the involvement of exemplary medical and nursing clinical practitioners in non-clinical community-wide activities in terms of the primary health care approach, which demands a broader scope of practice than primary medical care.MethodsThe objectives of the study were to identify exemplary medical and nurse practitioners in primary health care, to document their practices and perceptions with regard to their community involvement, to analyse the common themes arising from the findings, and to present recommendations based on the findings. Seventeen primary care clinicians in KwaZulu-Natal...

The scope of naturopathic medicine in Canada: An emerging profession

In Canada, naturopathic medicine is an emerging profession that is gaining formal recognition, including provincial/territorial regulation. While naturopathic medicine has undergone significant growth and legitimization, it still faces substantial challenges to acceptance as a full-fledged health care profession within the Canadian health care system. For example, professionalization theories indicate the importance of clear professional boundaries as well as the need for ‘new’ groups to find a place in the system of professions. This has been problematic for naturopathic practitioners who continue to practice within a broad scope of practice that encompasses many different therapeutic modalities. Development of statutory regulation also requires delineation of a specific, well-defined scope of practice. The purpose of this study was to describe naturopathic practitioners’ perception of their training and their current scope of practice. Two thirds ( n = 315 ) of all licensed Canadian naturopathic practitioners responded to the survey. The results showed that naturopathic practitioners are trained in, and practice, a wide range of therapeutic modalities and diagnostic procedures. Practitioners disagreed about their scope of practice, as 57% thought it was too restrictive, 31% felt it was about right and 13% thought it was too broad. A large majority felt there was some or a great deal of overlap with other practitioners’ scope of practice. We conclude that multiple challenges are facing naturopathic medicine, including scope of practice, overlap with other professions, social closure, scarcity of vacancies and lack of cohesion. The future of naturopathic medicine will depend on how effectively the profession will use available strategies to overcome barriers to statutory self-regulation.

Comprehensive Training for Sport: Implications for the Strength and Conditioning Professional

Continued evolution of the strength and conditioning profession may require a broader scope of practice. Comprehensive assessment of the athlete to identify limiting factors, which may optimize training by making it uniquely individualized, is necessary. Factors such as strength symmetry, joint stability, coordination, dynamic balance, and visual and perceptual skills are important limiting factors that should be addressed to a greater extent in the modern training program.

Maintenance of Skills for Today's Family Physician: The SAGE Approach to Physician Learning

Physicians need practical ways to maintain and augment clinical skills after residency training. The problem is amplified when a physician encounters a new practice environment that requires retraining in particular skills. With their broad scope of practice, family physicians are especially prone to deterioration of infrequently used skills. The SAGE model for lifelong learning provides a simple solution for today's military family physicians. Scan, assess, gather, and experience are four key steps physicians should take when maintaining or upgrading clinical skills. This approach allows physicians to identify available resources and to develop action plans to improve skills. Supervisors must encourage physicians to be honest in self-assessment of patient care skills and should support the acquisition of improved skills. System-based solutions, in keeping with suggestions from the Institute of Medicine, are introduced.