Clinical Training Programs Research Articles

Exploring the use of problem-based learning in clinical embryology training

ABSTRACT Problem-Based Learning (PBL) is an effective teaching method in many fields, in particular the medical disciplines. Clinical embryology deals with all aspects of assisted conception including insemination and embryo transfer. Clinical embryologists deal with daily issues that require troubleshooting and problem solving. The aim of this study was to explore and share the use of PBL teaching in a clinical embryology training programme. Students were given real-case scenarios and tasked with formulating a solution. A survey of questions to evaluate the PBL session was developed using a 5-point Likert scale. The scores obtained from these tests were assessed and analysed using Mann-Whitney U-tests (p = 0.05). The PBL teaching offered a format for students to develop critical problem-solving skills in a safe environment, which encourages learning through problem solving by creating a usable body of knowledge and clinical skill, which are imperative for clinical practice.

A Sierra Leone 2021 Midwifery Clinical Training Needs Assessment: A Call to Action to Augment Clinical Precepting.

Sierra Leone has one of the highest maternal mortality and infant mortality rates globally. We share findings from a Midwifery Clinical Training Needs Assessment, conducted in 2021 as a collaboration between the Government of Sierra Leone and Seed Global Health. The assessment identified existing needs and gaps in midwifery clinical training at health facilities in Sierra Leone from various stakeholders' perspectives. The descriptive needs assessment utilized mixed methods, including surveys, focus group discussions (FGDs), interviews, and reviews of maternal medical records. The following showed needs and gaps in labor and delivery management; record keeping; triage processes; clinical education for students, recent graduates, and preceptors; and lack of infrastructure and resources. The knowledge gained from this needs assessment can further the development of midwifery clinical training programs in Sierra Leone and other low-income countries facing similar challenges. We discuss the implication of our findings.

A study on the standard setting, validity, and reliability of a standardized patient performance rating scale – student version

Introduction The quality of the performances of standardized patients plays a significant role in the effectiveness of clinical skills education. Therefore, providing standardized patients with constant feedback is essential. It is especially important to get students’ perspectives immediately following their encounters with standardized patients. In the literature, there is no scale for use by students to evaluate the performance of standardized patients. Thus, the three main goals of this study were to: (1) develop a scale for use by students to evaluate the performance of standardized patients, (2) examine the psychometric properties of the scale, and (3) determine a cut-off score for the scale in a standard-setting Materials and methods Seven hundred and two medical students participated in the scale- development process, the pilot test, and the validation process, and seven educators took part in the standard-setting process. After the evaluation of content validity, construct validity was assessed via exploratory and confirmatory factor analyses. For the standard-setting study, the extended Angoff method was used. Results The exploratory factor analysis revealed that the scale had a single-factor structure, which was confirmed by confirmatory factor analysis. The Cronbach’s alpha internal consistency coefficient was 0.91. The scale consists of nine items. The cut-off score was determined to be 24.11/45, which represents the minimum acceptable standard for standardized patient performance. Conclusions Our study outlined the critical steps in developing a measurement tool and produced a valid and reliable scale that allows medical students to assess the performance of standardized patients immediately following their interaction with the standardized patient. This scale constitutes an important contribution to the literature as it provides a tool for standardized patient trainers to assess standardized patients’ weaknesses and help them improve their performance. KEY MESSAGES Evaluation of SP performance is essential to ensure the educational quality of clinical skills training programs. Students are the most relevant stakeholders to give feedback about SP performance immediately after encounters. The ‘Standardized Patient Performance Rating Scale – Student Version’ is a valid, reliable scale that can be used by students for the evaluation of standardized patients’ strengths and weaknesses at individual-performance levels quickly.

Guidelines for resident training in veterinary clinical pathology. IV: Laboratory quality management-Teaching domains, competencies, and suggested learning outcomes.

The 2019 ASVCP Education Committee Forum for Discussion, presented at the annual ASVCP/ACVP meeting, identified a need to develop recommendations for teaching laboratory quality management principles in veterinary clinical pathology residency training programs. To present a competency-based framework for teaching laboratory quality management principles in veterinary clinical pathology residency training programs, including entrustable professional activities (EPAs), domains of competence, individual competencies, and learning outcomes. A joint subcommittee of the ASVCP Quality Assurance and Laboratory Standards (QALS) and Education Committees executed this project. A draft guideline version was reviewed by the ASVCP membership and shared with selected ACVP committees in early 2022, and a final version was voted upon by the full QALS and Education Committees in late 2022. Eleven domains of competence with relevant individual competencies were identified. In addition, suggested learning outcomes and resource lists were developed. Domains and individual competencies were mapped to six EPAs. This guideline presents a framework for teaching principles of laboratory quality management in veterinary clinical pathology residency training programs and was designed to be comprehensive yet practical. Guidance on pedagogical terms and possible routes of implementation are included. Recommendations herein aim to improve and support resident training but may require gradual implementation, as programs phase in necessary expertise and resources. Future directions include the development of learning milestones and assessments and consideration of how recommendations intersect with the American College of Veterinary Pathologists training program accreditation and certifying examination.

Preparing clinicians to be site investigators in multicenter clinical trials: A training program at an academic medical center.

Clinical trials are essential in the translation of biomedical discoveries to new clinical interventions and therapeutics. Successful multisite clinical trials require qualified site investigators with an understanding of the full spectrum of processes and requirements from trial identification through closeout. New site investigators may be deterred by competing demands on their time, the complexity of administrative and regulatory processes for trial initiation and conduct, and limited access to experienced mentor networks. We established a Clinical Trialist Training Program (CTTP) and complimentary Clinical Trials Bootcamp at our institution to address these barriers and increase the number of local site investigators enabled to lead successful clinical trials. An initial cohort of four CTTP scholars received salary support with protected time, didactic training, assistance with study identification and start-up navigation, and quarterly progress meetings. By the end of the 12-month program, this initial cohort identified 33 new trials, utilized feasibility assessments, and reported being on target to sustain their protected time from new clinical trials. Bootcamp attendees demonstrated increased knowledge of resources, offices, and processes associated with clinical trial conduct. Our results support providing compensated protected time, training, and access to experienced clinical research professionals to enable clinicians to become successful site investigators.

Developing an engaging and accessible clinical research training program for new investigators - ADDENDUM.

Developing an engaging and accessible clinical research training program for new investigators - ADDENDUM.

Reflexivity on medicalisation of the mind and the biomedical invasion on being human

Clinical psychology practice is characterised by three core functions; assessment, diagnosis, and treatment. We challenge the biomedical imperative in clinical psychology through our shared personal experiences in training as clinical psychologists in South Africa. We pose that the training of clinical psychologists historically was and continues to be focused through a biomedical lens. Alluding to the perennial debate on the relevance of psychology and current arguments around the contemporary relevance of clinical psychologists’ training; we propose clinical-community psychology as the main way forward for psychology practice in South Africa. Our position is that in South Africa, clinical psychology training and services should be appropriate and equitable in response to the needs of individuals and communities. We highlight the lack of contextual relevance that has been perpetuated in most of the clinical psychology training programmes. This misplaced historical legacy does not serve the people within the South African context. Current and future clinical psychology training should be re-aligned toward the service of members of the South African communities and settings.

Using Simulation-Based Learning with Standardized Patients (SP) in an Implicit Bias Mitigation Clinician Training Program.

To describe the development and refinement of an implicit bias recognition and management training program for clinical trainees. In the context of an NIH-funded clinical trial to address healthcare disparities in hypertension management, research and education faculty at an academic medical center used a participatory action research approach to engage local community members to develop and refine a "knowledge, awareness, and skill-building" bias recognition and mitigation program. The program targeted medical residents and Doctor of Nursing Practice students. The content of the two-session training included: didactics about healthcare disparities, racism and implicit bias; implicit association test (IAT) administration to raise awareness of personal implicit bias; skill building for bias-mitigating communication; and case scenarios for skill practice in simulation-based encounters with standardized patients (SPs) from the local community. The initial trial year enrolled n = 65 interprofessional participants. Community partners and SPs who engaged throughout the design and implementation process reported overall positive experiences, but SPs expressed need for greater faculty support during in-person debriefings following simulation encounters to balance power dynamics. Initial year trainee participants reported discomfort with intensive sequencing of in-person didactics, IATs, and SP simulations in each of the two training sessions. In response, authors refined the training program to separate didactic sessions from IAT administration and SP simulations, and to increase safe space, and trainee and SP empowerment. The final program includes more interactive discussions focused on identity, race and ethnicity, and strategies to address local health system challenges related to structural racism. It is possible to develop and implement a bias awareness and mitigation skills training program that uses simulation-based learning with SPs, and to engage with local community members to tailor the content to address the experience of local patient populations. Further research is needed to measure the success and impact of replicating this approach elsewhere.

Assessing the Effectiveness Between Nurse Educator and Clinical Coach Critical Care Training Programs for New Graduate Nurses in the ICU

The aim of this study was to assess the differences in effectiveness between nurse educator-led and clinical coach-led intensive care unit (ICU) training programs for new graduate nurses. New graduate ICU nurses require substantial clinical training, which is often provided by peers serving as clinical coaches who have not been formally trained for an educator role. Our medical center successfully transitioned from a nurse educator-led to clinical coach-led model for initial ICU education after formally training the clinical coaches. Nurses enrolled in nurse educator-led (n = 114) or clinical coach-led (n = 166) ICU clinical training programs were compared on program pass rate, satisfaction, preparedness, turnover, and competence. There were no statistically significant differences between the groups on any of the identified measures of program effectiveness. Both educator-led and clinical coach-led models, with appropriate training, effectively prepared ICU nurses in this setting. Implementing a clinical coaching model for ICU training of new graduate nurses could assuage common resource issues, such as a shortage of nurse educators, as well as address the increasing demand for well-trained ICU nurses.

Psychiatric semiology in postmodernity

This article intends to reflect on the validation of psychiatric semiology and nosography that is taught in clinical psychologists and psychiatrists training programs. The vision of academic psychiatry of our times, strongly influenced by scientific narrative, seeks to consolidate an universal nosography that aims to erase the culture marks. However, the prevalence of certain diagnoses over others is determined by the social context and cultural changes that determine, in turn, the classifying standards of professionals. For this reason, it is important to include the contributions of public intellectuals and cultural theorists for an updated and culturalized semiology of clinical phenomena. We will use the developments of Mark Fisher on Capitalist Realism to rethink the main symptoms of depression.

Using Video Simulations for Assessing Clinical Skills in Speech-Language Pathology Students

A common challenge for clinical training programs is helping students apply academic knowledge to clinical settings. Authentic assessment using simulation offers a unique approach to bridging this gap. Miller’s pyramid provides a framework for competency-based education that integrates formative assessment and feedback at each stage of student learning. A multi-part assignment that builds from gathering data following a specific protocol (i.e., basic level), moves through interpretation of data (i.e., intermediate level), and then using that data to direct next steps (i.e., advanced level) scaffolds student learning toward clinical practice. Review of past student assignments indicated better performance on intermediate and advanced skills when using a video-based, multi-component assignment as compared to the original assignment design. Incorporating video components allows simulation of rare clinical populations, while also replicating current telepractice service provision. By simulating patient interactions, the instructor replicates real world challenges, allowing the students to demonstrate in-the-moment problem solving and clinical responsiveness.

Determining Counseling Self-efficacy of Indian Students of Speech Language Pathology.

Counseling self-efficacy is the view that counselors have of their capability to practice certain abilities that contribute to good clinical service. Speech Language Pathologists (SLPs) require to possess strategic counseling skills for effective service delivery. Although counseling is mostly considered an essential component during rehabilitation, many SLPs receive no explicit training on the same. The current study aims to explore self-efficacy measures in counseling among Indian students of speech-language pathology. The Counselor Activity Self-Efficacy Scales (CASES), which is a 6-point Likert rating scale developed by Victorino and Hinkle (2019) was adopted to assess the self-efficacy of 105 student clinicians (undergraduates and graduates) of speech-language pathology. The study comprised of two phases. Phase one included the administration of the CASES questionnaire on the target population, and Phase two included performing frequency-based analysis on Helping Skills (HS), Emotional Support Skills (ESS), and Session Management Skills (SMS) domains. The majority of participants felt somewhat confident over questions in the HS and ESS domain, while a large proportion felt very confident over the questions in the SMS domain. Although the student clinicians felt somewhat confident and very confident in most of the domains, none of the participants were completely confident in any of the domains. Having a counseling self-efficacy tool will help estimate the level of counseling competency one may possess. The results of the study can be used to design effective counseling-based training programs for student clinicians and practicing professionals, to achieve productive therapeutic connections with patients and caregivers.

Nurse educators clinical skill competence in Ethiopia: A phenomenological study

BackgroundThough literature focuses on how nurses become an educator and assume the educator’s role, little is known about their experience in relation to clinical skill competencies. Thus, the main aim of this study was to explore nurse educators’ experience of clinical skill competencies after assuming educator role. MethodsA descriptive phenomenological study was conducted on twelve purposely selected nurse educators in Ethiopian public universities from September to December 2021. Their prior clinical teaching experience (>=5years) and total teaching experience (>=5years) were taken as selection criteria. Colaizzi's seven-step analysis method was applied. ResultsThis study included four female and eight male nurse educators. Their clinical teaching experience ranged from 6 to 14 years, with an average of 11.2 years. Five of the participants had never worked in a clinical setting before becoming clinical educators. The experience of a nurse educator’s clinical skill competencies identified four themes and 24 sub-themes. The themes include; (1) Feelings of incompetence (2) Seeking Support (3) Self-development (4) Decline of clinical skills. ConclusionNurse educators in Ethiopia have been working through difficult conditions to obtain and maintain clinical skill competency. This is related to a poor role transition strategy, a lack of adequate clinical engagement and a lack of systems level support to sustain clinical competence. We recommend launching a full-time clinical educator training program; school-service integrations; the development of a mandatory continuing professional development activity; and regulating the educational activity.

Intensive care nurse practitioners in Australia: A description of a service model in an adult tertiary intensive care unit

BackgroundAlthough well-established internationally, nurse practitioners (NPs) in Australian adult intensive care units (ICUs) are rare. Australian literature clearly highlights the importance of creating ICU NP roles to meet emerging demands. An ICU NP model of care at a metropolitan hospital in Sydney provides care in four core practice areas: complex case management, vascular access, tracheostomy management, and intrahospital transport of critically ill patients. The ICU NPs also provide training and assessment for ICU nurses and medical officers in these same core practice areas and can efficiently meet service gaps in crisis such as the most recent COVID-19 pandemic. ResultsThe ICU NP program described is an innovative model of care that has demonstrated potential benefits to patients and their families. Potential benefits to the healthcare system including supporting advanced practice nursing development in regional and rural Australia and in addressing future ICU workforce issues are also identified. This model of care provides a clear role and structure for the integration of NPs in the adult ICU. Research to evaluate the impact of the role is required and is underway. ConclusionsThis model is being used to develop a national adult ICU NP fellowship training program for ICU transitional NPs preparing for endorsement or endorsed NPs who require additional ICU-specific training. This immersive clinical training program combined with didactic learning modules offers a framework to support the implementation of the adult ICU NP role as well as a framework for NP fellowship programs in other specialties.

A national study of the psychological theories and therapies covered within clinical psychology training programs in Australia

ABSTRACT Objective Recent advancements in the field of psychotherapy have included a diversification in Cognitive Behaviour Therapies (CBTs), often referred to as the “third wave”, yet relatively little is known about their coverage in Australian postgraduate clinical psychology training. Data were gathered to study the relationships between training program theoretical orientation, therapies covered, and factors determining the coverage of therapies. Method Responses to a semi-structured interview of 28 Directors of Clinical Training (DCT) or equivalent of Australian Psychology Accreditation Council (APAC) approved clinical psychology training programs (representing 72% of all accredited programs) were examined. Results Behaviour and cognitive theories were identified as dominant in programs. Coverage of Beck’s CBT was not correlated with other CBTs, and the number of therapies covered did not distinguish integrative (64.3%) from non-integrative programs. In an examination of the factors guiding the adoption of insight orientated therapies (i.e., Cognitive Analytic Therapy, Interpersonal Psychotherapy, Humanistic Therapy, Psychoanalytic Therapy, Process Experiential/Emotion-Focused Therapy, Gestalt Therapy, and Existential Therapy), the focus of clinical research, and student interest emerged as significant predictors (β = −.16, SE =.06, p < .05, 95% Boot CI [−.27, −.03]). Conclusions Beck’s CBT, and its undergirding theories emerged as dominant and was not associated with coverage of more recent CBTs, suggesting that there is opportunity to diversify therapies covered considering their evidence base.

Editorial introductions.

Current Opinion in Gastroenterology was launched in 1985. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of gastroenterology is divided into 12 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Jocelyn A. SilvesterJocelyn A. SilvesterDr Jocelyn A. Silvester, MD PhD, is Assistant Professor of Pediatrics at Harvard Medical School, USA, and Director of Research for the Celiac Disease Program at Children's Hospital (BCH) in Boston, Massachusetts, USA. She also maintains a general pediatrics practice in Northern Manitoba and Nunavut through the Ongomiizwin Health Services JA Hildes Northern Medical Unit. Dr Silvester completed her PhD in Biology at the University of Cambridge in England, UK, where she studied mitochondrial ATP synthase under the supervision of Professor Sir John E. Walker. She earned her medical degree from Dalhousie University in Canada and completed her residency in general pediatrics at the University of Manitoba, Canada. She came to the United States for pediatric gastroenterology fellowship training at Boston Children's Hospital. Dr Silvester is co-Chair of the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) Celiac Disease Special Interest Group and serves on the American Gastroenterological Association Council for section for basic and clinical intestinal disorders. Her research interests include the diagnosis and management of celiac disease with a particular interest in what happens after the diagnosis of celiac disease is made. She is co-Investigator on the Manitoba Celiac Disease Cohort Study, involved in clinical trials for alternative therapies to a gluten-free diet and is leading a consortium of pediatric celiac centers across the United States to develop tools to improve follow-up care. Tilak U. ShahTilak U. ShahDr Shah is an Associate Professor of Medicine at Virginia Commonwealth University (VCU) Health Science Center, USA, as well as Director of Endoscopy and Interventional Endoscopy at the Central Virginia VA Healthcare system in Richmond, VA, USA. He serves as Associate GI Fellowship Program Director at VCU, and is a member of the Development and Therapeutics section of VCU Massey Cancer Center. Dr Shah graduated from the University of North Carolina (UNC) at Chapel Hill, USA, in 1997, and UNC School of Medicine in 2006. He completed internal medicine residency and fellowship training in gastroenterology at Duke University Medical Center, USA. Dr Shah also obtained a master's degree in clinical research from the Duke-NIH Clinical Research Training Program, and underwent formal training in Advanced Endoscopy at Emory University Medical Center, USA. He joined the medical faculty at Virginia Commonwealth University in 2014. Dr Shah has served on American College of Gastroenterology (ACG), American Society of Gastrointestinal Endoscopy (ASGE), and Veterans Administration (VA) Committees. He has served as a reviewer for several journals including American Journal of Gastroenterology, Clinical Gastroenterology and Hepatology, Digestive Diseases and Sciences, World Journal of Gastroenterology, and Cochrane Database of Systematic reviews, and is section editor for Current Opinion in Gastroenterology. Dr Shah's research interests involve endoscopic approaches to diagnose and treat esophageal and colorectal neoplasia, including advanced imaging, artificial intelligence, endoscopic resection, and cryotherapy. Dr Shah is the recipient of research awards from the ASGE and McGuire Research Institute, and is site investigator for VA Co-Operative and Merit studies. He is an author on over 30 original papers, and has authored two board preparation textbooks, “NMS Medicine Casebook,” and “Acing the Pancreaticobiliary Questions on the GI Boards.”

(16) Establishing a Comprehensive Behavioral Health Clinician Training Program for Collaborative Care in a large New England Health System

(16) Establishing a Comprehensive Behavioral Health Clinician Training Program for Collaborative Care in a large New England Health System

Data-Informed Case Formulation with the Trier Treatment Navigator

The current article presents a way of practising case formulation using technology augmentation in the context of data-informed psychotherapy. First, we explain how case formulation guides the decision-making processes in psychotherapy and how decisions made under an intuitive clinical judgement can be biased. The use of actuarial methods is pointed out as a way of addressing these biases, mainly through clinical decision support systems based on statistical tools and machine learning algorithms. We present the Trier Treatment Navigator (TTN), a clinical decision support system developed in a University research-based clinical training programme. We show how the TTN can contribute to an initial case formulation and its dynamic adaptations during treatment with a clinical case. Finally, we discuss how case formulation and data-informed psychotherapy are aimed at the same goal: treatment personalisation. We argue that case formulation and data-informed psychotherapy enrich and feedback on each other.

An exploratory model of advance care planning clinical training for oncology nurses: A constructivist grounded theory study

AimThe purpose of this study was to explore and construct the ACP clinical training model for oncology nurses to provide the theoretical references for nursing educators to develop ACP clinical training program for oncology nurses. BackgroundOncology nurses are the primary forces of advance care planning (ACP) clinical practice. However, the systematic ACP clinical training for clinical nurses, especially oncology nurses, is still not visible in mainland China. DesignA constructivist grounded theory study. SettingsThis study included participants from three tertiary hospitals in northeastern China. ParticipantsA total of 23 oncology nurses who directly care for cancer patients. MethodsA constructivist grounded theory approach was adopted to explore the ACP clinical training model for oncology nurses. Semi-structured interviews were completed to collect qualitative data for constructing the theoretical model. A three-level coding procedure with continuous comparisons was adopted to analyze the qualitative data. ResultsAs a result of the study, a total of 32 open coding categories and 13 axial coding categories were extracted and four selective coding categories were formed, namely, external driving forces, self-development, training needs and training key elements. Based on the above categories, the demand-driven ACP clinical training model for oncology nurses was finally developed. ConclusionsOncology nurses have a strong desire for ACP clinical training and their ACP training needs are diverse. The ACP clinical training model provide the theoretical references for nursing educators to develop ACP clinical training programs for oncology nurses to promote high-quality ACP clinical practice.

Enabling mental health task-sharing: a collective case study of undergraduate clinical associate training programmes in South Africa

BackgroundThere is a shortage of the human resources needed to deliver mental health services which is likely to be exacerbated by COVID-19. Due to mental health workforce shortages, task-shifting and task-sharing approaches have been implemented in a number of countries. Clinical associates, a mid-level cadre working under the supervision of medical practitioners, could play a role in delivering mental health services but it is not clear if they are adequately prepared. This study explored the mental health curriculum content of the undergraduate clinical associate training programmes in South Africa and the views of key informants of the adequacy of training in mental health.MethodsA qualitative collective case study approach was utilised for this multisite study at the three universities in South Africa offering clinical associate degrees. The study consisted of in-depth interviews utilising videoconferencing of individuals involved in each programme and a document review. Thematic analysis of the data was conducted.ResultsNineteen interviews were conducted. Mental health formed part of the curriculum in all three programmes with the bulk of the training taking place in the final year of the three-year degree. Facility-based training ranged from two weeks to four weeks with one university only using hospitals with mental health units while two universities used hospitals at which the students were based for the year regardless of potential mental health exposure they would receive. The list of curricula inclusions extended to seldom-seen conditions. The quality of training and supervision appeared site-dependant and only one university set minimum experiential targets.ConclusionThere is a basis on which to build the competencies and skills regarding mental health in this cadre. A training model that integrates mental health early in the undergraduate curriculum, focuses on common conditions and those with high disease burden, includes time in a mental health unit, provides facility-based trainers with detailed guidance to improve standardisation, and includes specific experiential targets that are monitored will enhance the potential utility of this cadre.