Clinical Confidence Research Articles

Anaesthesia and climate change: time to wake up? A rapid qualitative appraisal exploring the views of anaesthetic practitioners regarding the transition to TIVA and the reduction of desflurane

BackgroundThe National Health Service (NHS) has pledged to reach carbon net-zero by 2040. In alignment with this goal, a London hospital’s anaesthesia department is actively reducing desflurane use and transitioning towards total intravenous anaesthesia (TIVA) as a sustainable alternative, contributing to environmentally responsible practices within the healthcare sector.MethodsWe conducted a rapid qualitative appraisal through online interviews with 17 anaesthetic practitioners to explore their perspectives regarding this climate change mitigation strategy. Data analysis was undertaken through the use of rapid appraisal sheets and a framework analysis method.ResultsParticipants highlighted the disadvantages of TIVA, including the increased effort, heightened monitoring requirements, operational challenges, and a lack of clinical confidence associated with its use. Despite these reservations, participants acknowledged TIVA’s potential to reduce postoperative nausea. There were perceptions that senior staff members might resist this change due to habits and scepticism over its impact on climate change. To facilitate greater TIVA adoption, participants recommended enhanced training, the implementation of a dashboard to raise awareness of greenhouse gas (GHG) emissions, and the presence of strong climate change leadership within the department. Participants believed that a shift to TIVA should be followed by specific measures such as addressing waste management which is crucial for GHG reduction, emphasising the perceived link between waste and emissions.ConclusionsThe evaluation examines stakeholder attitudes, perceptions, and behaviours, focusing on transitioning from desflurane to TIVA. The study highlights the importance of staff engagement, organisational support, and underscores the crucial role that healthcare practitioners and leadership play in fostering sustainability within the healthcare sector.

Building sustainable local training capacity for maternal and newborn health within the public health system: A training intervention in Palghar District, India

Continuing professional development for the health workforce is of paramount importance and can be implemented using locally available, competent trainers. However, guidelines for the selection, development, and mentorship of such trainers are lacking. Training intervention research conducted in Western Maharashtra, India, aimed to address these gaps by focusing on skills for maternal and newborn health (MNH). In this study, selected trainers from a pilot project in the Pune district received advanced training to become core trainers (CTs) for a scale-up project in Palghar district (2019 – 2022). The CTs trained master trainers (MTs) in Palghar (n = 32) with support from the United Kingdom-based technical partners, following a six-step approach: selection of trainers, training of trainers (ToT) (including knowledge and skills assessment), staggered induction as trainers, continuous support, regular quality assessment, and virtual refresher training. The process and outcomes of this six-step approach were evaluated using mixed-methods research. The skills of local trainers were augmented through hands-on training and further supported by long-term mentorship to develop training excellence. The CTs’ competency as mentors improved due to appreciative feedback. Regular assessments conducted by the expert team also contributed to maintaining quality control. Online learning has emerged as an effective method for refresher training. There was considerable improvement in the clinical knowledge and skills of the health providers from Palghar (n = 505), which attests to the quality of the training delivered by the Palghar MTs. This intervention enhanced both clinical competency and confidence. The approach demonstrated the importance of recruiting suitable participants who could consciously shift their teaching style to become more adult-learner-centric facilitators. However, there is a need for a systematic, long-term evaluation of this model, its application to MNH care, and its institutionalization within the public health system.

Simulation training improves resident physicians’ confidence in managing first trimester bleeding in the emergency department

First trimester bleeding is commonly encountered in pregnancy and can be potentially life-threatening. Simulation training provides an ideal opportunity for resident medical learners to improve clinical knowledge and gain confidence in managing life-threatening causes of first trimester bleeding in a realistic but safe clinical environment. The objective of this study was to assess the effectiveness of simulation in improving family medicine residents’ confidence and knowledge in identifying and managing first trimester bleeding in the emergency department (ED). The intervention was a two-hour educational simulation focusing on management of unstable first trimester bleeding. Twenty-one family medicine residents (67% female) at the University of Toronto participated in the simulation and completed pre- and post-simulation questionnaires assessing their confidence and knowledge in management of first trimester bleeding. This study demonstrates that simulation training improves resident physicians’ confidence in managing first trimester bleeding in the ED. Additionally, it improves their objective history taking skills. Post-graduate medical programs should consider developing structured simulation, particularly for high-yield clinical cases residents may not otherwise have acute exposure to and are required to be competent in managing.

Clinicians' confidence in diagnosing atypical anorexia nervosa: An experimental study of the role of patient and clinician characteristics.

This experimental study investigated the weight loss parameters and resulting end weight that influence clinician confidence in diagnosing atypical anorexia nervosa (AAN). Clinicians (N=67) read a series of vignettes where patient weight loss and end weight varied, then rated their confidence in an AAN diagnosis and alternatives. Using repeated measures ANOVAs, we examined patient (weight loss, end weight) and the possible relationship between clinician (e.g., age, profession) characteristics and confidence in diagnosing AAN. Clinicians were most confident in an AAN diagnosis when patients had lost 10% or 15% of their body weight, leaving them at a high or normal weight. Clinicians considered 5% as significant weight loss for AAN, but only when the patient ended at a high or normal weight. However, they did not clearly differentiate AAN from unspecified feeding and eating disorder (UFED) when there was a 5% weight loss resulting in high or normal end weight. Clinician characteristics did not impact on confidence in diagnoses. The DSM's 'significant weight loss' criterion leaves room for clinicians to interpret it idiosyncratically. The lack of a clear pattern of UFED and AAN diagnosis has important clinical implications, as UFED tends to be dismissed as being less serious.

Safety in spinal surgery-Empowering clinicians to report concerns in motor function.

Timely identification of neurological deterioration in patients with spinal disorders, through spinal motor assessment, is paramount in achieving early intervention to reduce the risk of permanent deficits. This project was initiated to meet the requirement for safe, timely spinal motor assessment through establishing and addressing clinician's educational needs. Mixed methods study conducted through online survey and concurrent focus groups June 2022-April 2023. Pre-intervention online survey and focus groups identified insufficient provision of education targeted at identifying changes in motor function and as a result, clinicians lacked confidence and competence in completing assessments and caring for patients with spinal disorders. An e-learning package was created and shared widely along with additional interventions to support assessment completion. To establish the success of the project a post-intervention online survey was distributed. Survey respondents reported that the e-learning package has influenced their practice to either some extent or to a great extent with 91% reporting increased confidence in completing a spinal motor assessment. Post-intervention results also demonstrated an increase in confidence in caring for spinal surgery patients. Through engaging with clinicians to establish and address educational needs, this quality improvement project has successfully increased competence and confidence in this area of spinal care. This study highlights the importance of targeted education to ensure that clinicians are appropriately skilled to identify neurological deterioration and demonstrates the effectiveness of digital education in providing this. This study addressed concerns around timely identification of deterioration of spinal patients. Study findings were the success in utilizing digital education to increase clinician's confidence and competence and thus enhance patient safety. This research will have an impact on clinical areas caring for patients with spinal disorders. SQUIRE guidelines. No patient or public contribution.

Utilization and consequences of CRP point-of-care-testing in primary care practices: a real-world multicentre observational study with 1,740 patient cases in Germany.

Point-of-care tests (POCTs) for C-reactive protein can support clinical decision-making of general practitioners (GPs) but are not widely used in German general practices. To investigate the utilization of semi-quantitative CRP-POCTs in routine primary care. Prospective observational study in 49 general practices in Germany (Nov/2022 to Apr/2023). GPs were provided with CRP-POCTs and collected data for each CRP-POCT use using standardized data collection sheets. Data from 1,740 CRP-POCT uses were recorded. GPs employed CRP-POCTs mainly for patients with respiratory tract infections (RTIs, 70.9% of all cases) and to a lesser extent for gastrointestinal infections (GIs, 10.3%). In RTIs, CRP-POCTs were frequently used to distinguish between bacterial and viral aetiology (60.8%) and to guide decisions on antibiotic prescribing (62.8%). In GIs, CRP-POCTs were mainly used to rule out severe disease progressions (53.2%) and for decisions on further diagnostic procedures (45.6%). In RTIs, CRP-POCTs influenced antibiotic prescribing in 77.5 % of the cases (32.3% in favour vs. 45.2% waiver). In GIs, CRP levels mainly affected decisions on further diagnostic procedures. GPs reported that CRP-POCTs were helpful in 88.6% of all cases. When available, German GPs predominantly use semi-quantitative CRP-POCTs to guide decisions on antibiotic prescribing in patients with RTI. CRP-POCT use improves clinical decision-making and increases the GPs' clinical confidence.

What influences ambulance clinician decisions to pre-alert emergency departments: a qualitative exploration of pre-alert practice in UK ambulance services and emergency departments

BackgroundAmbulance clinicians use pre-alerts to inform receiving hospitals of the imminent arrival of a time-critical patient considered to require immediate attention, enabling the receiving emergency department (ED) or other clinical...

Evaluation of telehealth in delivering diagnostic developmental assessments for children in South Western Sydney during the COVID-19 pandemic: Clinician and family perspectives.

Children with neuro-developmental disorders faced significant challenges in accessing services during the COVID-19 pandemic. Telehealth has been adopted by health services globally to facilitate access to clinical services. Our aims were to evaluate the utility of the telehealth modality for providing developmental assessment services and explore enablers and barriers to using telehealth, in a culturally diverse and socioeconomically disadvantaged population in Sydney. We reviewed telehealth developmental assessments in South Western Sydney conducted between 1 April and 30 June 2020. Data were collated on demographics; telehealth modality; diagnostic formulation; recommendations; and requested follow up. We conducted retrospective semi-structured telephone interviews with 79 families and 11 clinicians about their telehealth experience. Thematic analysis was carried out on the open text responses. Of 205 children assessed across six sites, median age was 48 months; 45% were assessed with video and 55% with telephone only. Diagnostic formulation and therapeutic recommendations were provided for 203 (99%) children and 138 (67%) were asked to come for face-to-face follow-up. The majority of families (76%) were satisfied or extremely satisfied with telehealth. Median clinician satisfaction was 3.5 out of 5, whilst clinician confidence with diagnostic formulation was 4 out of 5. Qualitative data revealed a range of barriers and enablers. Telehealth was a successful modality for contributing to the assessment journey for children with neuro-developmental disorders in our culturally, linguistically and socioeconomically diverse clinical population in the context of a pandemic lockdown. We discuss the potential for telehealth modalities in child developmental assessments beyond the pandemic.

Effectiveness of a pediatric critical care pilot preceptor program: Improved confidence and competency outcomes among a cohort of professional nurses in Blantyre, Malawi

BackgroundAvailability of high-level pediatric training for nurses in Malawi is limited. To address this gap, a novel pediatric critical care nurse preceptor program was developed and implemented by pediatric nurse specialists. AimEvaluate the effectiveness of a pediatric critical care nurse preceptor program, via change in nurses' knowledge, skills, confidence, and precepting competence. DesignA 12-month pediatric critical care nurse preceptor program with assessments at baseline, end of intensive (3 months), and end of program (6 months). SettingBlantyre, Malawi. ParticipantsNurses with two or more years of pediatric nursing experience (N = 20) nominated by unit managers. MethodsQuantitative data were collected throughout program implementation. Assessments included: (1) multiple choice knowledge test, (2) Objective Structured Clinical Examinations in two areas (vital signs and airway, breathing, circulation, disability, exposure assessments; and blood gas and electrolyte analysis), (3) group simulations (cardiopulmonary resuscitation or respiratory distress), (4) Likert-scale clinical confidence survey, and (5) Likert-scale precepting competence survey. Data were analyzed using repeated measures ANOVA with pairwise comparisons. For Likert-scale surveys, median confidence scores were compared using a Friedman test with post hoc pairwise comparisons using Wilcoxon signed-rank tests. ResultsParticipants demonstrated significant improvement in clinical knowledge (p < .001), vital signs and airway, breathing, circulation, disability, exposure assessment (p = .001), blood gas and electrolyte analysis (p = .001), CPR (p < .001) and respiratory distress (p < .001) simulations, clinical confidence (p = .002), and precepting competence (p = .041). ConclusionThis pediatric critical care nurse preceptor program was effective in improving participants' confidence and competence (knowledge and skills) in pediatric critical care nursing and precepting. Results suggest the program's potential to address the shortage of highly trained pediatric critical care nurses in Malawi. This lays groundwork for refining and expanding preceptorship, ultimately improving pediatric critical care nursing education in resource-limited settings.

Telesimulation for Training in Infant Feeding: A Randomized Controlled Trial.

Simulation is an education modality known to support clinical skill development. Unfortunately, access to simulation has been challenging, both prior to and during the pandemic. Simulation via telepractice, i.e., "telesimulation", has emerged, but little is known about whether outcomes are comparable to in-person simulation. This study compared in-person versus telesimulation learner outcomes in an infant feeding scenario. The secondary aim was to compare outcomes between novice and experienced participants.This pragmatic randomized controlled trial included speech pathologists who could attend if randomized to the in-person modality. Block randomization matched participants with < 6 months' infant feeding experience to those with > 6 months experience (2:1 ratio) into telesimulation or in-person simulation. Measures of clinical reasoning, confidence/anxiety, and satisfaction were collected, pre-, post-, and 4-weeks post-simulation.Overall, 39 clinicians completed either in-person simulation (n = 17) or telesimulation training (n = 22), including 16 experienced and 23 novice learners. Both in-person and telesimulation groups achieved significant improvements across time in clinical reasoning, self-reported confidence, and anxiety. The extent of change in clinical reasoning, confidence and anxiety was comparable between the telesimulation and in-person simulation groups. Comparing by experience, novice-level participants reported significantly greater changes in confidence and anxiety than experienced participants. Satisfaction levels were high regardless of simulation modality or experience.Participants in telesimulation and in-person simulation achieved similar improvements in the primary outcome measure of clinical reasoning, had comparable improvements in self-perceived confidence and anxiety, and demonstrated high satisfaction levels. Telesimulation is a promising means to improve clinician access to simulation training in infant feeding.

Preparedness and Anxiety of Dental Students in the Transition from Preclinical to Clinical Practice

Aim: This study aimed to investigate the preparedness and anxiety levels of dental students transitioning to clinical practice and to examine the effects of sex, university, and observations. Material and Method: A total of 182 students (58 male, 124 female) transitioning from preclinical to clinic participated in the study. The survey consisted of sections covering socio-demographic data, students' opinions on their preparedness for clinical practice, anxiety levels measured by the State-Trait Anxiety Inventory (STAI), and confidence levels in various skill areas. Spearman's Rank correlation test was used for correlation analysis, while the Mann Whitney-U test for pairwise group comparisons. Results: No differences were found in preparedness between sexes, but males exhibited significantly higher confidence in various dental skills. Conversely, females reported significantly higher levels of state and trait anxiety. State university students (n=48) reported heightened workload expectations and elevated levels of state and trait anxiety. Conversely, private university students (n=134) demonstrated increased confidence and preparedness in dental practice-related knowledge and skills. Students who participated in observations (n=96) had lower preparedness and confidence levels in several dental areas, coupled with higher trait anxiety levels, compared to their peers who did not participate in observations (n=86). Finally, STAI scores were positively correlated with workload, negatively correlated with knowledge, skills, and confidence. Conclusion: Sex, school, and observation status have an impact on students' preparedness for clinical education, anxiety, and confidence in their professional abilities. Therefore, assessments and orientation programs that take these aspects into account can benefit students at this time of change.

Paternal Exposure: Two patients' perspectives in an evolving landscape of therapeutics. Can we now provide reassurance?

There is now substantial evidence of safety in pregnancy for several newer medications, particularly biologic disease-modifying antirheumatic drugs, although clinician confidence varies. There is much less information available regarding paternal exposure. This article provides insight from two patients who describe the impact of family planning on their therapeutic decision making.

Evaluation of postgraduate foundation training for dental therapists: does participation enhance career prospects?

Objectives This study explored the value of dental therapy foundation training (DTFT) in the UK and how participation influenced career prospects.Aims To examine the efficacy of postgraduate foundation training for dental therapists (DTs) and evaluate whether participation increased clinical confidence. To investigate whether participation in the scheme enhanced career prospects and to determine barriers encountered by DTs in securing suitable positions, inclusive of COVID-19 restrictions.Methods The study used a survey incorporating open, closed, Likert-scale and multiple-choice questions. Quantitative data were analysed with IBM SPSS Statistics v26. Analysis of qualitative data was undertaken by two researchers. Final themes and subthemes were confirmed following round table discussions.Results A total of 94 survey responses were received: 61 from DTs who had not undertaken DTFT (Group A) and 33 who had undertaken DTFT (Group B). Most respondents were female (95%) with a mean age of 33.8 and 32.9 years, respectively. In total, 58.3% of Group A respondents did not believe that completing DTFT would have enhanced their career prospects, whereas 63.6% of Group B said that they gained a position as a result of completing DTFT. Participation in DTFT increased perceived clinical confidence in Group B and 81.8% were likely to recommend DTFT to their peers. A total of 12 major themes and 13 subthemes were identified.Conclusions DTFT schemes were considered a valuable educational experience which increased clinical confidence. Participation may have enhanced career prospects. Barriers were encountered by DTs when seeking work, regardless of participation in DTFT.

Game Products: Innovative Pathways for Nursing Education and Clinical Training

To excel in their work, nurses must have specialized tools to support their tasks and professional development. Games, as a crucial pathway to achieving nursing education and clinical training goals, demonstrate significant potential and application value, making them an innovative product. Nursing education games come in various forms, including virtual reality, augmented reality, tabletop, and digital, and may be designed as needed for individual, two-player, or team play (Avşar et al., 2023; Bermejo et al., 2023; Tsai et al., 2024). These games, beyond their entertainment value, have clear educational objectives embedded in their design. Through levels, challenging tasks, and reward mechanisms, they stimulate learning enjoyment and promote nursing development. In this column, experts and scholars in the field of nursing engaged in game development share their experiences and achievements. Integrating games into nursing delivers a wealth of tools and resources for nursing education and clinical practice, offering immersive learning experiences, instant feedback, and individualized learning paths. For nursing students, gamified products offer safe and risk-free learning environments in which they can practice critical tasks and make decisions in simulated medical scenarios, increasing their clinical experience and confidence and enhancing their clinical judgment and decision-making skills (Wu et al., 2023). For patients, many therapeutic games have already been designed that use gameplay to improve health by facilitating user engagement in rehabilitation exercises, promoting healthy eating, and fostering social interactivity (Tsai et al., 2024). For nurses, various games are being used to promote continuous professional growth in an interactive and enjoyable learning environment, improving overall quality of care and job satisfaction (Hsieh et al., 2023). In summary, the application of game products in nursing education and clinical training has introduced new learning and training models that provide multifaceted benefits for nurses, nursing students, and patients. We hope that readers will gain a deeper understanding of related game products after reading this column and use games effectively to enhance nursing quality.

Evaluating Student Satisfaction and Self-Confidence in Simulation-Based Anesthesiology Training among Final-Year Medical Students.

Simulation-based training (SBT) is increasingly recognized in medical education for enhancing clinical skills and confidence. This study evaluated the impact of SBT on satisfaction and self-confidence among final-year medical students at Jazan University, Saudi Arabia. A total of 117 students participated in a cross-sectional study after attending SBT sessions focused on anesthesiology. Data were collected via a questionnaire assessing satisfaction and self-confidence. Statistical analyses included descriptive and inferential statistics. Results showed mean satisfaction and self-confidence scores of 3.64 ± 0.79 and 3.70 ± 0.90, respectively, with no significant differences by gender or age. A strong association was noted between the learning experience ratings and both satisfaction and self-confidence (p < 0.001). The highest satisfaction was with the instructor's teaching style, whereas the lowest was with the motivation provided by teaching materials. For self-confidence, the highest scores related to the instructor's guidance, while the lowest concerned the application of SBT to critical skills learning. A strong positive correlation was found between satisfaction and self-confidence (R = 0.847, p < 0.001). The study concludes that SBT significantly enhances student satisfaction and self-confidence, emphasizing the importance of learner-centered methods and interactive learning in medical education.

How, when and who should ask about pregnancy intentions in primary care? A qualitative study of primary health care professionals' preferences.

Knowing people's pregnancy intentions would help health care professionals (HCPs) to take a holistic approach to reproductive health, and particularly to providing preconception care. To assess the feasibility of implementation of questions about pregnancy preferences in a range of primary care settings in Great Britain, including digital implementation. Qualitative study using online semi-structured interviews with primary care professionals across Great Britain in 2022. Twelve online interviews were conducted with GPs (n=3), practice nurses (n=3), sexual and reproductive health professionals (n=4) and health visitors (n=2). Framework analysis was conducted in Nvivo, adapting a coding frame from complementary interviews with women. HCPs perceived asking about pregnancy preferences as valuable in meeting patients' reproductive health needs and most suited to women's health consultations, medication and disease reviews, baby checks, or as an addition to lifestyle questions leading to health promotion advice. An introductory, non-discriminatory signposting sentence was well-liked, and the preferred question in a face-to-face clinical encounter was asking how the person would feel about a pregnancy in the next year, in line with women's preference. Guidance and training would give clinicians confidence in knowing how to ask about pregnancy preferences and advise their patients accordingly. Asking about pregnancy intentions is acceptable to women and HCPs and feasible in primary care, but implementation needs to be adapted to the patient and context. Digital options that enable patients to self-manage can reduce the need for HCP input and avoid medicalising a normal process.

Association Between Clinician Confidence and Making Guideline-Recommended Decisions in the Management of Abnormal Cervical Cancer Screening Results.

Guidelines for managing abnormal cervical cancer screening results are complex and adherence is challenging for clinicians. Previous studies have identified gaps in knowledge as a possible cause; few have explored the confidence clinicians have in their management decisions. Confidence in decision-making may influence management practices, particularly when guidelines are complex and evolving. Assess whether confidence in decision-making is associated with making guideline-concordant recommendations for abnormal cervical cancer screening results. A clinician survey used vignettes to ask clinicians to make a management recommendation for different abnormal results and rate their level of confidence in their response. Physicians and advanced practice providers (APPs) at three diverse health systems in Washington, Texas, and Massachusetts. Correct response to each vignette based on either the 2012 or 2019 American Colposcopy and Cervical Pathology (ASCCP) management guidelines. In total, 501 clinicians completed the survey between October and December 2020 (response rate 53.7%). Overall, most clinicians made guideline-recommended management decisions for two vignettes (73.2 and 73.7%), but fewer were confident in their selection (48.3% and 46.6%, respectively). Clinicians who reported high levels of confidence were more often correct than those who reported lower levels of confidence (85.8% vs. 62.2% and 87.5% vs. 60.7%, both p<0.001). After adjusting for clinician and practice characteristics, confidence remained significantly associated with selecting the correct answer. Clinician confidence in management decisions for abnormal cervical cancer screening results was significantly associated with knowing guideline-concordant recommendations. Given the complexity of cervical cancer management guidelines, solutions to improve clinician confidence in decision-making are needed.

Community Point of Care Testing in Diagnosing and Managing Chronic Kidney Disease.

Chronic kidney disease (CKD) poses a significant global health challenge with increasing prevalence and associated morbidity. Point-of-care testing (POCT) provides an opportunity to improve CKD management and outcomes through early detection and targeted interventions, particularly in underserved communities. This review evaluates the roles of POCT in CKD, focusing on utility (through screening programs, monitoring of kidney function, and assessing participants on renally excreted medications), accuracy, and acceptability. Screening programs employing POCT have demonstrated promising outcomes, with improved rates of CKD diagnosis in groups with disparate health outcomes, offering a vital avenue for early intervention in high-risk populations. These have been conducted in rural and urban community or pharmacy settings, highlighting convenience and accessibility as important facilitators for participants. In addition, POCT holds significant promise in the monitoring of CKD, particularly in groups requiring frequent testing, such as kidney transplant recipients and patients on renin-angiotensin-aldosterone inhibitors. The consideration of the variable analytical performance of different devices remains crucial in assessing the utility of a POCT intervention for CKD. While the convenience and improved accessibility of home self-testing versus healthcare professional management is important, it must be balanced with acceptable levels of accuracy and precision to maintain patient and clinical confidence. Despite challenges including variability in accuracy and the user-friendliness of devices, patient feedback has generally remained positive, with studies reporting increased patient satisfaction and engagement. However, challenges regarding wider uptake are limited by healthcare professional confidence (in test reliability), the potential for increased workload, and early prohibitive costs. In conclusion, POCT represents a growing and valuable tool in enhancing CKD care, particularly in resource-limited settings, but careful consideration of device selection and implementation strategies is essential to achieve desired outcomes.

Clinician Perceptions of Family-Centered Care in Pediatric and Congenital Heart Settings

Family-centered care recognizes families as central to child health and well-being and prioritizes clinician collaboration with families to ensure optimal pediatric care and outcomes. Clinician interpersonal sensitivity and communication skills are key to this approach. To examine perceptions of and factors associated with family-centered care among clinicians working in pediatric and congenital heart care. In this cross-sectional study, participants from diverse clinical disciplines (pediatric cardiology, cardiothoracic surgery, nursing, anesthesia, neonatology, intensive care, psychology, and others), completed an online survey between June 2020 and February 2021. Participants included physicians, surgeons, nurses, and allied and mental health professionals at an Australian quaternary pediatric hospital network. Statistical analysis was performed from August 2022 to June 2023. Family-centered care across 4 domains (showing interpersonal sensitivity, treating people respectfully, providing general information, and communicating specific information) was measured using the validated Measure of Processes of Care for Service Providers. Clinician burnout (emotional exhaustion, depersonalization, and personal accomplishment), confidence responding to families' psychosocial needs, and psychological, clinical role, and sociodemographic factors were also assessed. Informed by theory, hierarchical linear regression was used to identify factors associated with family-centered care. There were 212 clinicians (177 women [84.3%]; 153 nurses [72.2%], 32 physicians [15.1%], 22 allied and mental health professionals [10.4%], 5 surgeons [2.3%]; 170 [80.2%] aged 20-49 years) who participated (55% response rate). Of the 4 family-centered care domains, scores for treating people respectfully were highest and associated with greater clinician confidence responding to families' psychosocial needs (effect size [β], 0.59 [95% CI, 0.46 to 0.72]; P < .001), lower depersonalization (β, 0.04 [95% CI, -0.07 to -0.01]; P = .02), and a greater sense of personal accomplishment at work (β, 0.02 [95% CI, 0.01 to 0.04]; P = 0.04). Greater interpersonal sensitivity was associated with greater confidence responding to families' psychosocial needs (β, 0.80 [95% CI, 0.62 to 0.97]; P < .001), a greater sense of personal accomplishment at work (β, 0.03 [95% CI, 0.01 to 0.05]; P = .04), and lower use of approach-based coping, such as problem-solving (β, 0.37 [95% CI, -0.71 to -0.02]; P = .04). In this cross-sectional study, burnout and confidence responding to families' psychosocial needs were associated with clinicians' perceptions of family-centered care. These findings suggest that targeted interventions to address these factors may benefit clinicians and also potentially strengthen the practice of family-centered care in pediatric and congenital heart settings.

Improving Self-Perceived Competencies of Second-Year Pharmacy Students Through an Introductory Medication Reconciliation Rotation

ObjectiveMedication reconciliation (MedRec) is an essential health care function that is particularly relevant to pharmacists’ expertise and a learning opportunity for pharmacy students. Our objective was to assess change across clinical competence, confidence, and communication skills after the completion of a MedRec rotation by second-year pharmacy students. MethodsA retrospective post-then-pre-survey including 29 questions was developed/delivered to students after the completion of required MedRec hours. The primary end point was the change in 3 domains via summed scores from individual questions. Cohen’s difference (d) was used to determine group effect size change. The secondary end points included individual question change, perceived patient impact, and subgroup analyses. ResultsOf 115 second-year pharmacy students, 81.7% (n = 94) participated in the study. Students self-reported increases on the Likert scale (0–10) of 2.49 ± 1.90 in clinical competency domain, 3.57 ± 2.13 in confidence domain , and 3.12 ± 2.15 in communication skills domain, representing statistically significant and large group effect changes across all 3. A total of 21 of the 22 individual questions had large group effect changes; 1 question (nursing communications) had a moderate group effect change. Student perception of MedRec impact on patient care (Likert scale 0–10) was positive: post-rotation score 7.39 ± 1.57. ConclusionTo the best of our knowledge, this is the first larger-scale study that examines student-evaluated outcomes of a MedRec-based rotation. Students self-reported high levels of post-rotation competency across all domains; students from ethnic minorities and with less work/MedRec experience increased their lower pre-rotation scores to statistically similar post-rotation scores, compared with non-minority and more experienced peers. Further study of the model and outcomes is advised.