Clinical Training Facilities Research Articles

Exploring interprofessional collaboration in the intensive care unit

Background: Critical care units require an interprofessional management approach to optimise patients’ health. Clinical education and training delivered in remote healthcare settings are vital for fostering interprofessional collaboration (IPC) among health science students for future team functioning.Objectives: Our study explored the IPC among clinicians in the intensive care unit (ICU) setting at two South African decentralised clinical training facilities to understand the existing collaborative practices that students are exposed to during their clinical training.Method: A qualitative study design, utilising semi-structured interviews, was used to gather information on the experiences of 40 purposively selected participants working in the ICU settings at the two clinical sites. Data collected from the interviews were transcribed verbatim and thematically analysed.Results: Four major themes were identified from the data, namely, scope-of-practice dispute, teamwork disruption, organisational obstacles and future aspirations.Conclusion: Participants believed that a lack of professional regard by medical doctors and an inadequate understanding of the role of other professionals impeded appropriate referral practice and collaborative team functioning. Under-exposure to interprofessional education (IPE) at an undergraduate level and the pervasive medical hierarchy were perceived as a primary attributable cause of this phenomenon. Moreover, the coronavirus disease 2019 (COVID-19) pandemic and persistent staff shortages purportedly obstructed potential opportunities to collaborate in multidisciplinary meetings. Participants believed that improving undergraduate IPE and compulsory multidisciplinary meetings to promote communication would improve team functioning in these clinical settings.Clinical Implications: Undergraduate IPE is a feasible approach to improve collaborative care in ICUs to achieve better patient outcomes.

Making a Case for Hypnosis: Using the RE-AIM Framework to Recognize Hypnosis as a Stand-Alone Therapeutic Intervention within Healthcare and Educational Systems

Hypnosis is emerging as a valuable therapeutic tool with significant potential for recognition and application across medical settings. Of particular note are the evidenced benefits when addressing pervasive challenges such as chronic pain, anxiety, and emotional distress, which are often exacerbated by medical procedures. However, despite its potential for wide utilization in medical contexts, recognition of hypnotherapy's efficacy remains slow and hypnosis is often a second choice, last resort or offered as an adjuvant or supporting role alongside other treatments. One reason is that hypnosis lacks a well-defined role within the healthcare system. This gap persists even as mounting evidence suggests that hypnosis offers the capacity to bring about relief and positive outcomes across diverse issues and populations. Author Sheila Menon, Principal and Administrator of a clinical hypnosis Training and Clinical Facility draws upon extensive experience in clinical intervention and administration to extract scientific values from empirically driven experiences and data. In this paper the RE-AIM Framework is utilised to explore the multifaceted potential of hypnosis in medical settings, shedding light on the need for a more clearly defined integration of this intervention into mainstream healthcare practices. The authors draw from the evidence to make a case that the time is right to recognise hypnosis as a stand-alone psychotherapy and that this will enhance its adoption, reach and efficacy. It is further suggested that rebranding or relabeling this intervention will remove unnecessary biases and make it easier to implement and maintain for the benefit of patients and to improve treatment outcomes. Purpose: the purpose of this study is to use the RE-AIM Framework to evaluate the existing research that consistently provides evidence for better inclusion of hypnosis and to identify new insights into how this useful treatment can be more easily adopted and utilized in the healthcare system based on its interventional strength. Methodology: This is a descriptive study based on secondary data collected from literature following a descriptive analysis. The RE-AIM Framework is used as a mechanism for evaluating hypnosis interventions and to establish a rationale for relabeling them as psychotherapy based on treatment outcomes, interventional strengths and its operative usage in the healthcare system The literature search extracts information from the electronic database to make the study more robust and the literature selected is drawn from those published in the past two decades using keywords such as hypnosis intervention, RE-AIM, hypnosis in health care, mental health, and hypnosis interventions in a medical setup. Conclusion: This study uses the RE-AIM to present a case for relabeling or rebranding hypnosis as a psychotherapy in its own right to enhance its adoption and reach within a wide range of healthcare settings. The research supports the interventional strength of hypnosis as ready for this form of evolution and suggests that the rebranding will encourage healthcare providers to use hypnosis as a primary treatment option rather than as an adjuvant or secondary treatment option. Best care practices will be advanced as a result and better adoption of hypnosis will encourage more research leading to enhanced efficacy and resulting in improved implementation models. The authors suggest that once hypnosis is relabeled as psychotherapy, its implementation becomes simple and cost-effective. The authors recommend rebranding hypnotherapy as Conscious–State Alteration Therapy to remove any residual biases associated with the name hypnosis (and to avoid the outdated practice of using it as a supporting therapy). They suggest that this process of rebranding follows the evolutionary wave that can occur within psychotherapy progression. The benefit is that the potential of hypnosis as a treatment option will be further extended into healthcare settings extending its use in the treatment of pain management, anxiety, stress, and emotional distress, expanding the benefits to a wider and more diverse group of patients and giving hypnosis a rightful place as a primary treatment option.

A feasibility study of utilizing a cadaveric training model for novel robotic bladder cancer brachytherapy techniques

PurposeThe current standard of care for muscle-invasive bladder cancer is neoadjuvant chemotherapy followed by radical cystectomy with lymph node dissection. Although this treatment provides therapeutic benefit, it is associated with notable morbidity. Bladder sparing techniques, such as concurrent chemo-radiation, are less invasive and prioritize organ preservation in individuals with invasive bladder cancer and offer comparable disease control. High-dose-rate brachytherapy is an emerging paradigm in the management of muscle-invasive bladder cancer. During high-dose-rate brachytherapy, radioactive sources are introduced to the area of the primary tumor through specialized catheters. The specific placement of brachytherapy catheters results in heightened effectiveness of the radiation treatment with less radiation damage to surrounding structures. For bladder-sparing therapies such as brachytherapy to rival radical cystectomy, these techniques need to be refined further by radiation oncologists. ProcedureOne such modality for developing and practicing these techniques is the use of cadaveric models in innovation-focused clinical training facilities, which provide a simulated sterile surgical environment without the concern for extending intraoperative time. Findings and conclusionsThe objective of this technical note is to demonstrate how clinical training facilities such as the Houston Methodist Institute for Technology, Innovation & Education are ideal for the development, testing, and training of novel brachytherapy techniques using cadaveric models. By utilizing a network of similarly innovative training centers, research and development of brachytherapy techniques can be expedited, and novel bladder-sparing treatment methods can be implemented as the standard of care for bladder cancer.

Health Service delivery and training at Makerere University College of Health Sciences: The role of the academic health centers' network.

Academic Health Centers provide a network of clinical training facilities for high quality service delivery, within clinical training and research settings. At an academic health/medical center, education, research, and clinical care are combined to provide the best possible clinical care, which uses cutting-edge technologies, resources and therapies other community hospitals may not have available. This paper summarizes the network of teaching hospitals for health care training in the last century of Makerere University College of Health Sciences, its local and regional impact, lessons learned and future of actively engaging the network of academic health centers to expand clinical training and research opportunities to meet the needs of the 21st Century populations. Medical schools and training hospitals need to integrate of their roles in research, education, and patient care to provide evidence-based interventions and innovations to both treat illness and improve health.

Simulated Clinical Skills for Veterinary Students Supplement Limited Animal and Clinical Resources in Developing Countries.

As part of an OIE Veterinary Education Twinning Project linking The University of Queensland, Australia and Nong Lam University, Vietnam, the limited access to animal and clinical resources was identified as an impediment to high quality veterinary education at Nong Lam University. However, student focused, simulated learning spaces, which have been widely adopted in veterinary training, are a cost-effective opportunity to provide initial clinical skills to students in countries where resourcing is constrained. In clinical skills training facilities, students use models and simulators to practice their clinical skills to develop the confidence, competence and muscle memory to enter the clinical phase of their training. While high-fidelity veterinary simulators and models are expensive, effective models for foundational clinical skills development can be built in-house for students to practice their skills authentically. This article outlines the cost effective establishment of a veterinary clinical skills training facility at Nong Lam University.

The Frank H. Netter MD School of Medicine at Quinnipiac University.

The Frank H. Netter MD School of Medicine at Quinnipiac University.

Addressing Couple Violence in Therapy Training Clinics: A Human-Centered Approach to Systems Intervention Design

This report describes the development and implementation of a multitiered intake-to-treatment pipeline system at a clinical training facility to bridge a gap in the service needs of clients seeking couples’ therapy who experience varying degrees of violence by ensuring that all couples receive some form of assistance. Prospective clients undergo multiple checkpoints for separate screening and assessment protocols and obtain individualized referrals and treatment options. We discuss the application of a human-centered program design and the use of task-shifting to increase adaptability of this system to other clinical settings and lessen the barriers to quality care experienced by couples who seek treatment.

Evaluating the use of exposure indicators in digital x-ray imaging system: Gauteng South Africa

IntroductionExposure indicators (EIs) are the only indicator of correct exposure technique in digital x-ray imaging systems but the use of such indicators remains largely unexplored in a South African setting. With exposure creep in the digital radiography age being a worldwide phenomenon, the study investigated radiographers’ familiarity and use of EIs, providing insight into current exposure technique practices in this setting. MethodsAn explorative and descriptive quantitative study was conducted at 10 randomly selected radiography clinical training facilities in Gauteng, South Africa. The study used a questionnaire consisting of 26 questions based on familiarity with and use of EIs and radiographers’ attitude to ionising radiation. ResultsA response of rate of 49.3% was achieved. Results show a low number of respondents (54.3%) had a perfectly correct understanding of the exposure indicator (EI) and only 55.7% of respondents made correct use of the EI. ConclusionObservable lack of familiarity and use of the EI suggests that improvements could be made to the training radiographers receive on digital imaging systems. Moreover radiographers need to be vigilant against making decisions in digital radiography using knowledge that may relate exclusively to analogue radiography.

Specialty Areas Experienced at Two Clinical Training Facilities: Investigation at Department of Physical Therapy, International University of Health and Welfare, Japan

Specialty Areas Experienced at Two Clinical Training Facilities: Investigation at Department of Physical Therapy, International University of Health and Welfare, Japan

A Questionnaire Survey on Specialists Enrolled in the Same Clinical Training Facility

<b>A Questionnaire Survey on Specialists Enrolled in the Same Clinical Training Facility</b>

Physical Therapy School and Clinical Training Facilities Cooperate in Verifying Rubric: Analysis of User’s Feedbacks by Content Analysis to Clarify Tasks and Improvements

Physical Therapy School and Clinical Training Facilities Cooperate in Verifying Rubric: Analysis of User’s Feedbacks by Content Analysis to Clarify Tasks and Improvements

Intentions and Factors Regarding Selection of Workplace by Postgraduate Dental Trainees after Clinical Training.

The purpose of the present study was to investigate the reasons governing selection of geographical location of workplace by postgraduate dental trainees. We believe that such data would aid in the development of measures aimed at reducing regional disparities in the number of dentists. A total of 10 dental colleges and faculties in Japan were invited to participate in the study. Anonymous, self-completed questionnaire surveys were given to 739 dentists at 13 clinical training facilities following training in 2012 and 2013; 713 responses were analyzed. The items surveyed included the local population in the area in which they wished to work and whether they wanted to work in rural areas or remote islands. The most common response to the question regarding population was "medium-size cities" with a population of 100,000 to 300,000 people (67.3%). The largest number of respondents stated that they hoped to work in their hometown or a neighboring area (49.9%). A large percentage wished to work in medium-size cities, which may reflect the population of their hometowns. The current system allows dentists a free choice in becoming practitioners or hospital dentists on completion of training. This may explain why so many expressed a preference to work in their hometown or a neighboring area here. These results suggest that policies relying on increasing the supply of dentists as the sole solution to rural shortages are flawed.

Supporting dental registrants in difficulty: the service provided by postgraduate dental education teams.

The number of dental registrants in difficulty (DRiDs) has increased significantly in recent years and the General Dental Council or National Health Service organisations tasked with the management of dental services will, if appropriate, instruct the registrant to contact postgraduate dental teams (PgDT) based in regional offices of Health Education England and equivalent postgraduate deaneries in Wales and Scotland for assistance in meeting their conditions for continued registration. We surveyed DRiDs Leads within the PgDT with a view to understanding the current development of this important service. Results revealed that these managers had considerable relevant previous experience which underpinned their responsibility for DRiDs. Their responses indicated that there were notable differences between PgDT in the number of DRiDs seeking their help and that the development of the service and the resources deployed to help DRIDs also differed significantly. Those responsible were generally happy with the service they were providing and all were able to see DRiDs for an initial interview within four weeks of being contacted. However, weaknesses were identified such as insufficient time to support individual registrants, lack of consistent process across PgDT teams and a need for clinical training facilities.

Feasibility Study for a Satellite Program of an Established School of Dentistry

Creative thinking is required to solve the many challenges the oral health care delivery system faces in meeting the needs of the U.S. Access to oral health care services varies widely across the country based on a host of factors including individual patient characteristics, demographic variables, and distribution of professionals by locale. There is also significant variability of need, so that many new solutions have been proposed to meet the needs of specific areas. In late 2012, the University of Missouri-Kansas City School of Dentistry embarked on a feasibility study to determine whether its existing DDS program could be extended closer to underserved areas of Missouri and surrounding regions by utilizing distance education and a clinical training facility in conjunction with another public university. This article describes the study and its outcomes. Other institutions may find this process useful as they assess factors that could impact the success of future programming and seek new solutions to long-standing problems.

Assessment of neonatal care in clinical training facilities in Kenya

ObjectiveAn audit of neonatal care services provided by clinical training centres was undertaken to identify areas requiring improvement as part of wider efforts to improve newborn survival in Kenya.DesignCross-sectional study...

Recommendations for the establishment of a clinical simulation unit to train South African medical students

Background. The burden of HIV and tuberculosis epidemics in South Africa (SA), Africa and developing countries in other parts of the world has an influence on the change in case mix. Shortages of beds in training hospitals and the need to train more healthcare professionals contribute to the saturation of the teaching platform. Clinical simulation as a tool to enhance the education and training of medical students in SA and recommendations in this regard were investigated. Objective. To obtain recommendations regarding the development of simulation training, assessment facilities and programmes, and determine whether simulation training could enhance medical education and training in the developing world. Methods. Qualitative research methods, including semi-structured interviews with international simulation experts and focus group interviews with heads of department and lecturers of the local medical school, were used to generate data. Results. A set of recommendations regarding the introduction of simulation training at an SA medical school was developed to improve patient safety, create a better training environment, and address the healthcare education challenges in SA hospitals. Conclusion. The incorporation of simulation into medical curricula and the development of clinical simulation training facilities for healthcare professionals in SA could bridge the gap currently experienced in health sciences education in the country. The recommendations outlined in our study may assist other medical training institutions in the developing world in setting up simulation training facilities.

Reliability of the OSCE for Physical and Occupational Therapists.

[Purpose] To examine agreement rates between faculty members and clinical supervisors as OSCE examiners. [Subjects] The study subjects were involved physical and occupational therapists working in clinical environments for 1 to 5 years after graduating from training schools as OSCE examinees, and a physical or occupational therapy faculty member and a clinical supervisor as examiners. Another clinical supervisor acted as a simulated patient. [Methods] The agreement rate between the examiners for each OSCE item was calculated based on Cohen’s kappa coefficient to confirm inter-rater reliability. [Results] The agreement rates for the behavioral aspects of the items were higher in the second than in the first examination. Similar increases were also observed in the agreement rates for the technical aspects until the initiation of each activity; however, the rates decreased during the middle to terminal stages of continuous movements. [Conclusion] The results may reflect the recent implementation of measures for the integration of therapist education in training schools and clinical training facilities.

High‐Intensity Progressive Resistance Training Improves Flat‐Ground Walking in Older Adults with Symptomatic Peripheral Arterial Disease

To assess the efficacy of whole-body progressive resistance training (PRT) as a treatment for the symptoms of peripheral arterial disease (PAD) in older adults. Randomized controlled pilot trial. University clinical weight training facility in Sydney, Australia. Twenty-two older adults with symptomatic PAD. The efficacy of supervised whole-body high-intensity PRT (H-PRT) with low-intensity nonprogressive resistance training (L-RT) and a usual care control group that performed unsupervised walking for 6 months was compared. Pilot outcome measures included 6-minute walk (6 MW) outcomes, body composition, dynamic muscle strength and endurance, and performance-based tests of function. Mean age was 71.1 ± 7.2. Mean ankle brachial index was 0.55 ± 0.13. Exercise adherence was similar in all groups (P = .29). H-PRT (n = 8) improved total 6MW distance (mean difference (MD) 62.6 ± 58.0 m, P = .02) significantly more than L-RT (n = 7; MD=-48.2 ± 67.6 m) and controls (n = 7; MD=-9.9 ± 52.9 m). Change in 6MW onset of claudication was significantly and independently related to change in bilateral calf endurance (correlation coefficient (r) = 0.65, P = .03), and change in 6MW distance was significantly and independently related to change in bilateral hip extensor endurance (r = 0.71, P = .02) in all groups. H-PRT significantly improved 6MW ability in older adults with intermittent claudication from PAD, whereas L-RT and unsupervised walking did not. Improvement in walking ability was significantly related to improvements in bilateral calf and hip extensor endurance, supporting further investigations targeted at musculoskeletal impairment in this cohort.

Trends in Percentage of Postgraduate Dental Trainees at Dental Clinics

A facilities-group system designed to provide clinical training at dental clinics was developed after postgraduate clinical training became mandatory for dentists in Japan in 2006. As a result, there has been a steady increase in the number of dental clinics collaborating with dental school hospitals under this program. A larger number of dental clinics have also been designated as single-system facilities, program management facilities or collaborating facilities. However, it remains to be determined whether this increase in the number of dental clinics designated as clinical training facilities has led to an increase in the amount of training offered. Therefore, the purpose of this study was to investigate trends in the percentage of postgraduate dental trainees at dental clinics between fiscal years 2006 and 2010. The results showed no significant correlation among (1) the percentage of dental clinics designated as single-system collaborating facilities, (2) the percentage of training programs at dental clinics, and (3) the proportion of training program recruitment offers by dental clinics compared to the total number of recruits. These findings showed that increasing the number of collaborating dental clinics did not lead to an increase in the amount of clinical training at dental clinics. The findings also suggest that increasing the number of single-system or program management dental clinics is important in promoting clinical training at dental clinics.

Analysis of Dental Treatment Performed by Dental Residents at General Dentistry Department of Tokyo Dental College Chiba Hospital Over 6 Years Following Introduction of Mandatory Dental Clinical Training System

Six years have passed since the introduction of legislation mandating at least 1 year of clinical training for those who have passed the national dentist examination. To determine whether clinical training has been appropriately implemented at the General Dentistry Department of Tokyo Dental College Chiba Hospital, a managed-type clinical training facility, the number of patients treated and types of dental and dental technical work performed by dental residents trained by the department were summarized and analyzed. The number of patients treated per dental resident increased from 11 in 2006 to 15 in 2011. By treatment type, periodontic treatment was the most frequently performed throughout the study period, followed by endodontic treatment. Conservation treatment, prosthodontic treatment with crowns/bridges, and prosthodontic treatment with dentures were performed at a similar moderate frequency, while oral surgical treatment was performed least frequently throughout the study period. The frequency of periodontic treatment increased slightly, whereas that of endodontic treatment decreased slightly or remained almost unchanged after introduction of the mandatory clinical training system. When the distribution of dental treatment performed at our department was compared with that of dental treatment performed by general dentists across Japan in 2011, our department showed a slightly lower frequency of periodontic treatment and higher frequency of endodontic treatment than the national total, whereas the frequency of other types of treatment was similar between the two populations. These results demonstrated that appropriate clinical training has been provided by our department to meet the purpose of offering dentists the opportunity to acquire the basic diagnostic and treatment abilities that would enable them to provide appropriate treatment for injuries and diseases frequently encountered in daily practice. The study also revealed some problems, such as a decreasing number of residents engaging in dental technical work each year. For additional improvement in the quality of dental clinical training, more analyses are needed to further identify and address potential problems in the system.