Postgraduate Training Curricula Research Articles

Assessment of Professionalism among Postgraduate Medical Students: A Cross-Sectional Study from Patna, Bihar.

Professionalism is a core quality which has to be developed and imbibed by medical students. However, training in professionalism was not a part of the medical curriculum until recently when the Competency-Based Medical Education system was introduced for undergraduate medical students in India, by the National Medical Commission. However, there has been no formal training on professionalism, in the curriculum of postgraduate (PG) medical students in India. Therefore, in this study, we have done a quantitative assessment of the attitude towards professionalism among PG medical students. A cross-sectional study was conducted among 200 PG medical students of an autonomous institute in Patna, Bihar over a period of six months using the Learners' Attitudes on Medical Professionalism Scale (LAMPS) questionnaire. Data entry was done on Microsft Excel 2015 (Microsoft Corporation, Redmond, Washington, United States) and data analysis was done using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States). Out of 200 study subjects, 55% (n=110) were PG students from clinical departments and 45% (n=90) were from pre-clinical and para-clinical departments; 25.5% (n=51) of them were from first year, 57% (n=114) of them were from second year, and 17.5% (n=35) were from third year PG training. The overall mean score for the LAMPS scale across all domains was found to be 2.78±0.178(mean±S.D). Clinical PG students (2.99 ± 0.217) received significantly higher scores than pre/paraclinical PG students (2.68 ± 0.176) (T-test value = 10.9262, p < 0.0001). This study highlights the disparity in professionalism scores between clinical and pre/para-clinical students, suggesting a tailored approach might be beneficial. In order to improve the attitude towards professionalism, structured courses/workshops should be inculcated into the PG training curriculum. Continuous evaluation of professionalism throughout medical training can lead to better preparedness for future professional roles.

What Multi-Level Solutions Can Enhance the Financial Literacy of Healthcare Professionals in Kenya?

Financial literacy is a crucial asset within the human capital pool, whether individuals are working within or outside the hospital setting. Professionals in various fields benefit from financial literacy, and the main recipients include individuals, the broader economy, businesses, and the overall financial system. In the context of medical professionals, the expectation is often that they make informed business decisions and effectively manage healthcare facilities. However, a notable challenge is the potential lack of essential skills in financial literacy among these professionals. In Kenya, a considerable number of healthcare professionals face a deficiency in financial literacy skills, hindering their ability to proficiently handle even small businesses in private practices and oversee financial matters in hospital departments, both in public and private healthcare facilities. Consequently, the objective of this study is to present healthcare professionals with a roadmap to identify and address gaps to enhance their financial literacy. A survey was conducted from June to July 2023, involving 339 doctors, including medical doctors, dentists, and pharmacists. The findings were interesting concerning gender performance and global comparisons. Unlike previous studies, female doctors demonstrated a higher financial knowledge, behavior, and attitude, suggesting a well-rounded financial proficiency compared to their male counterparts. At the global level, the descriptive analysis revealed strong financial knowledge, positive attitudes, and prudent financial behaviors among the Kenyan participating doctors compared to the OECD global averages. For example, unlike the OECD global average of 52.5% in financial knowledge and literacy, the findings for the Kenyan counterparts stood at 77%; while the OECD global average for financial attitude was 70%, that of the Kenyan counterparts was at 75%; and compared to the OECD global average of prudent financial behavior of 59%, that of the Kenyan counterparts was 69%. It seems that socio-demographic factors, coupled with financial knowledge, attitudes, and behaviors, intricately influence the financial literacy of healthcare professionals. The findings highlight the importance of implementing multi-level solutions to enhance overall financial literacy among healthcare professionals. These solutions include tailored financial programs, self-paced online courses with interactive elements, and the integration of financial literacy into medical undergraduate and postgraduate training curricula. Keywords: healthcare professionals, financial literacy, Kenya, multi-level solutions

Undergraduate deficits in plastic surgery exposure and awareness of the specialty: a systematic review.

Plastic surgery is an important specialty that involves widespread medical knowledge, some of which is taught in undergraduate curricula. The General Medical Council provides a well-defined plastic surgery curriculum for postgraduate training. However, there is no consensus on the provision for undergraduates in this specialty, potentially giving rise to a deficit in undergraduate medical education and a suboptimal basis for plastic surgery postgraduate training. Our aim was to identify the gap in undergraduate plastic surgery teaching and to understand student perceptions of the specialty as well as any trialled interventions. A prospectively registered systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The MEDLINE®, Embase™, PubMed® and Google Scholar™ databases were searched for literature relating to undergraduate exposure to plastic surgery and relevant teaching interventions. Ten studies were included in this review, categorised into three main themes: exposure during medical school, determining factors and perceptions for pursuing a plastic surgery career, and teaching interventions. Surveys assessing medical student perceptions indicate a significant deficit in exposure to plastic surgery in the undergraduate curriculum. Medical students' interest in the specialty is affected by multiple factors, including the amount of surgical exposure in medical school. Interventions to address the deficit mostly involve one-day courses. Although the literature is currently limited, studies are needed to effectively assess the outcomes of plastic surgery teaching methods in undergraduate training. Moreover, there is a need for consensus around the provision of undergraduate teaching in plastic surgery. This should be reflected in the latest undergraduate curricula in medical education.

Assessment of Basic Laparoscopic Skills for Surgical Residents on Simulation Based Endotrainer

INTRODUCTION Minimal invasive surgery revolution has bestowed surgeons the power to gain maximum access in surgical area of interest while inflicting minimal trauma. Simulator based training develops cognitive and psychomotor skills which identifies the limitations and strength of learner. AIM To assess the role of endotrainer for development of laparoscopic skills amongst surgical residents. MATERIALS AND METHODS A structured endotrainer program was conducted among 18 surgical residents for a period of 2 months from May – July22 in the department of general surgery in RRMCH, Bangalore, consisting of various tasks which each resident performed regularly for 2 months. The tasks performed were evaluated by a mentor on the basis of Global Rating Scale and the time taken to perform each task and feedback was taken from the subjects. RESULTS T test for 2 dependent mean using SPSS version23 with P value of &lt;0.05 was considered significant. Significant improvement observed in the performance of each participant from DAY1 to DAY30 and further to DAY60 both with respect to time taken as well as GRS score. Day 1, Day 30 and Day 60 GRS mean percentage growth exhibits 45% to 75% to 80% respectively. CONCLUSION Short term training not only proved to show significant improvement in the cognitive performance alongside exploring feedbacks, limitations and building perseverance. We conclude that simulation based training is the need of the hour in this laparoscopy era and should be incorporated as a compulsory module in the curriculum of postgraduate training.

19 General practitioners’ perspectives on advance care planning: a qualitative study

Abstract Background An Advance Care Plan (ACP) outlines patient preferences for future treatment for a time when capacity is lacking. With our ageing population and rising dementia prevalence, ACPs are of increasing relevance and importance; however, very few are created each year. This study aims to explore General Practitioner (GP) perspectives on ideal timing, facilitators, and barriers to ACPs. Methods To date, ten GPs with a range of clinical experience have been purposely sampled from the Irish College of General Practitioners database. Semi-structured interviews were conducted by phone, video call, or in person, concurrently recorded, and subsequently transcribed. The Braun and Clarke method of thematic analysis was utilised, and coding was performed using NVivo software. Results All GPs spoke to the importance of ACPs for care of those with dementia and believed GPs are ideally placed to have these discussions. Two themes arose regarding timing of discussion: (1) routine proactive discussion prior to potential cognitive issues arising and (2) discussion within a few appointments of diagnosis. Identified barriers to ACP include: (1) lack of patient awareness of ACPs, (2) lack of GP education on ACPs, (3) difficulty predicting disease progression, (4) poor family dynamics, (5) short appointment times, and (6) lack of remuneration. Identified facilitators include: (1) patient’s acceptance of death and understanding of diagnosis, (2) use of an established template to guide discussion, (3) presence of a trusted family member, (4) long appointment times and (5) remuneration. Conclusion There was universal agreement on the importance of ACPs. Inclusion of ACP teaching in the curriculum for undergraduate medical education and postgraduate GP training should be strongly considered. There is need for heightened public awareness of the Assisted Decision-Making Act and ACPs. Further qualitative and quantitative research is needed to explore this issue nationally and identify how it has been resolved internationally.

National consensus on entrustable professional activities for competency-based training in anaesthesiology.

Entrustable Professional Activities (EPA) are specialty specific tasks or responsibilities, combining the clinical workplace and the long-demanded competency-based medical education. The first step to transform time-based into EPA-based training is to reach consensus on core EPAs that describe sufficiently the workplace. We aimed to present a nationally validated EPA-based curriculum for postgraduate training in anaesthesiology. Using a predefined and validated list of EPAs, we applied a Delphi consensus approach, involving all German chair directors of anaesthesiology. We then conducted a subsequent qualitative analysis. Thirty-four chair directors participated in the Delphi survey (77% response) and twenty-five completed all the questions (56% overall response). Reflected by the intra-class-correlation, the consensus on the importance (ICC: 0.781, 95% CI [0.671, 0.868]) and the year of entrustment (ICC: 0.973, 95% CI [0.959, 0.984]) of each EPA reached high levels of agreement among the chair directors. The comparison of data assessed in the preceding validation and present study showed excellent and good levels of agreement (ICC entrustment: 0.955, 95% CI [0.902, 0.978]; ICC importance: 0.671, 95% CI [-0.204, 0.888]). The adaptation process, based on the qualitative analysis, resulted in a final set of 34 EPAs. We present an elaborate, fully described and nationally validated EPA-based curriculum, reflecting a broad consensus among different stakeholders of anaesthesiology. We hereby provide a further step towards competency-based postgraduate anaesthesiology training.

Domestic abuse education in UK GP training schemes: cross-sectional study

ABSTRACT Background Domestic abuse (DA) is a violation of human rights that damages physical and mental health. Healthcare services is the most common agency a woman experiencing DA may present to. DA is part of the GP postgraduate training curriculum in the UK, but we do not know how this is being implemented in registrar training. Aim To investigate the implementation of domestic abuse education in GP training schools across the UK. Design and Setting Cross-sectional survey of UK postgraduate GP training groups. Method Digital surveys were emailed to all UK postgraduate GP training groups. The survey contained quantitative and free-text questions about descriptive features of education provided and self-reported perceptions. The survey was sampled by programme directors (PDs) and trainees. Data was collected and analysed descriptively. Results Seventy of the 115 (52%) GP postgraduate training groups responded. 44.2% of the groups did not offer DA education. If available, DA education sessions had different lengths of teaching, facilitators, content and methods. When asked if training was adequate, 47.4% of trainees disagreed and 36.8% strongly disagreed. Throughout the questions, PDs ranked the quality of education higher than trainees. PD’s reasons for not providing DA education included lack of time and resources, but also cultural perceptions of DA being a taboo subject and not clinical. Conclusion Our survey shows that the provision of DA education in UK postgraduate GP training is absent in almost half the programmes and varies in length, content and quality, with a high proportion of respondents rating it inadequate.

Psihometrijska procena istraživanja kvaliteta i zadovoljstva kliničke simulacije i kratke skale percepcije o kvalitetu objektivno struktuiranih kliničkih ispitivanja kod studenata sestrinstva u Čileu

Introduction: Nursing education has been incorporating different teaching and learning methodologies to achieve the development of competencies for nurses. Clinical simulation is a strategy that allows the development of these tools and has been incorporated into the undergraduate and postgraduate training curricula. In this sense, a broad evaluation of the insertion of these methodologies is necessary. Aim: To assess the psychometric properties of the quality and satisfaction survey of clinical simulation and brief scale perception of the quality of the objective structured clinical examination in Chilean nursing students. Methods: A cross-sectional study with a self-administrated survey was applied in a convenience sample of 96 Chilean nursing students. Through internal consistence was determined the reliability of the instruments. Validities were established by content and construct. To compare the means, one-way analyses of variance with post hoc Tukey HSD were performed. Results: The quality and satisfaction survey of clinical simulation entire scale obtained a Cronbach's alpha of 0.942, and the Corrected Item-Total Correlations ranged from 0.356 to 0.817. The brief scale of perception of the quality of objective structured clinical examination entire scale obtained a Cronbach's alpha of 0.810, and the Corrected Item-Total Correlations ranged from 0.325 to 0.701. No significant statistical differences between groups were found. Conclusions: The quality and satisfaction survey of clinical simulation and brief scale of perception of the quality of objective structured clinical examination demonstrated sound psychometric properties for assessing the perception of the quality and satisfaction about clinical simulation and perception of the quality of objective structured clinical examination, each one. Both in Chilean nursing students.

О целесообразности внедрения цикла специальной подготовки врачей-токсикологов по теме «Химикаты двойного назначения — потенциал для создания современного химического оружия»

Актуальность. Химикаты двойного назначения и их потенциальное воздействие являются постоянным объектом наблюдения со стороны многих международных организаций, однако данная информация до сих пор не нашла должного отражения в учебных программах подготовки военных токсикологов. Цель. Подтверждение актуальности расширения спектра знаний по токсикологии химикатов двойного назначения и разработки цикла тематического усовершенствования по этому вопросу. Материалы и методы. Проанализированы материалы Организации по запрещению химического оружия, Австралийской группы, Организации по безопасности и сотрудничеству в Европе по вопросам международного регулирования химического и токсичного оружия. Результаты. Автором обобщены ключевые компоненты системы международного наблюдения за химическими веществами — компонентами химического оружия, дана характеристика химикатов двойного назначения. Представленные списки химикатов подразделяются в зависимости от степени потенциального риска и масштаба коммерческого применения. Подчеркивается, что в учебных программах последипломной подготовки военных врачей преимущественно уделяется внимание изучению оружия массового поражения на основе методологии, разработанной еще во времена Второй мировой войны. Учитывая вышеизложенное, существует необходимость пересмотра учебных программ последипломной подготовки военных врачей с целью создания возможности приобретения слушателями знаний по токсикологии химикатов двойного назначения и современных международных норм их наблюдения и регулирования. Выводы. В современных условиях существует необходимость совершенствования учебных программ последипломной подготовки военных врачей в аспекте изучения токсикологии химикатов двойного назначения и международных норм их контроля.

Differences in clinical knowledge levels between residents in two post\u2010graduate rotation programmes in Japan

BackgroundIn Japan, between 2010 and 2020, there were two post-graduate training curricula for post-graduate medical education, as follows: comprehensive rotation programmes (CRPs), which require rotation in at least seven clinical departments; and limited rotation programmes (LRPs), which require rotation in fewer clinical departments. The curriculum that should be used for standardized Japanese post-graduate training has long been debated. Multiple studies show that post-graduate trainees who trained with CRPs were more satisfied and confident and gained more clinical experience than those who trained with LRPs. However, a comparison of objective measurements of the clinical knowledge of Japanese post-graduate trainees has not been reported. The aim of this study is to objectively measure and compare the clinical knowledge of trainees in CRPs and LRPs using a component of the Professional and Linguistic Assessment Board test (PLAB test).MethodsA nationwide cross-sectional study was conducted in February and March 2020. Post-graduate trainees who graduated from medical school were voluntarily recruited from general hospitals in Japan. To objectively measure the trainees’ basic clinical knowledge, the PLAB test was adapted from the UK. The cut-off point was set at 63%, as recommended by the UK General Medical Council. A statistical analysis was conducted to determine whether post-graduate programme differences contributed to the trainees’ test scores.ResultsTwenty-two facilities volunteered to participate after recruitment, and 97 trainees from 19 facilities participated in the study. Thirty-one participants (32%) were in a CRP, and 66 participants (68%) were in an LRP. According to multiple logistic regression, the adjusted odds ratio of CRP trainees being in the high-scoring group was 5.16 (95% CI: 1.28-20.73, p<0.05). Mean differences in the scores in paediatrics, mental health and neurology were statistically higher among CRP trainees than LRP trainees.ConclusionPost-graduate trainees who were in a CRP had better basic clinical competence knowledge (PLAB test) scores and performed better when tested in a wider range of subspecialties. Not only exam performance but also clinical performance and the longitudinal trend of trainees’ competency in post-graduate medical training should be evaluated in future studies.

Designing a curriculum for postgraduate training in family medicine in India.

Context:Family physicians, trained in handling primary care problems through the principles of family medicine (FM), were needed in India. The training required a comprehensive and detailed curriculum that could be implemented across the country.Aim:The aim was to create a document that includes rationale, goals, subject-based objectives, educational methods and assessment methods that align to the objectives.Design and Methods:Kern's Six-Step-method was used to create a curriculum document. The six steps are (a) problem identification and general needs assessment, (b) targeted needs assessment, determining and prioritizing content, (c) writing goals and objectives, (d) selecting teaching/education strategies,(e) implementation of the curriculum and (f) evaluation and application of the lessons learnt.Results and Conclusions:Based on the given steps, a team of faculty identified needs, requirements and barriers, wrote goals and objectives along with aligned educational and assessment methods. The curriculum document was created for FM resident training. The first set of residents have been trained based on this curriculum and an evaluation is being planned.

Psychotherapy training in Iran: A survey of Iranian early career psychiatrists and psychiatric trainees.

Psychiatry's postgraduate training curriculum in Iran has been revised and one of the core revisions has been the incorporation of full-time 9-months of psychotherapy training. However, little is known about psychotherapy training in Iran. An online anonymous survey was developed by the Early Career Psychiatrists (ECP) Section of the World Psychiatric Association (WPA). The survey included 16 questions about the: (a) quality of psychotherapy training (supervision, type of psychotherapy training available, barriers in accessing training); (b) organizational aspects of psychotherapy training (compulsoriness, payment, and assessment); (c) satisfaction with training in psychotherapy; (d) self-confidence in the use of psychotherapy. This survey was circulated to Iranian early career psychiatrists and psychiatric trainees. 112 early career psychiatrists and psychiatric trainees from across Iran responded to the survey; 98.2% of which stated that psychotherapy training is included in their psychiatry training, and cognitive behavioral therapy and psychodynamic psychotherapy were the most reported modalities integrated into their psychiatric training. Moreover, 43.3% of the participants reported that they were satisfied or very satisfied with their psychotherapy training during the training years. Psychotherapy is integrated into psychiatric training programs in most educational centers in Iran. The modalities and satisfaction of trainees are similar to that of high-income countries in other continents. Supervision and training in modalities like family therapy could be further implemented and adapted to the Iranian culture.

Online Meditation Program Builds Resilience and Competencies Among Social Work Students Working With Older Adults

ABSTRACT This article reports the results of a study on the impact of an online meditation (OMP) program in building resilience and geriatric social work competencies among postgraduate social work students across contexts. The OMP was fairly effective (Cohen’s d range=4.84–5.49, p≤.012), and students who participated in it exhibited greater resilience and geriatric social work competencies compared to the wait-list control group. Posttest resilience scores were higher for female students and Christians. Female students studying in the United States and Sweden with non-social-work subjects at the undergraduate level and doing field placement in assisted living settings demonstrated greater geriatric social work competencies posttest. Adherence through regular attendance of the OMP lessons and self-practice mediated the relation between sociodemographic predictors and outcomes. The OMP is a useful addition in the postgraduate field training curriculum with some refinements for male students from different cultures with a social work undergraduate degree and doing fieldwork in community or hospice settings.

Development and validation of a postgraduate anaesthesiology core curriculum based on Entrustable Professional Activities: a Delphi study.

Background: Postgraduate training curricula should not be based on time-spans or predefined numbers of performed procedures. One approach to link competencies to clinical tasks is the concept of Entrustable Professional Activities (EPA). The goal of this study was the definition, ranking and validation of EPAs for anaesthesiology postgraduate training and the creation of an anaesthesiologic core curriculum. Methods: Anaesthesiologists of different levels of training participated in the study (single-center, cross-sectional) . First, an expert group defined a preliminary list of EPAs. Then a first Delphi round (n= 47 participants) was applied to identify daily anaesthesiology tasks with the goal to define EPAs. From the first Delphi round a new set of EPAs was defined, using the template and mapping method. Through an alignment process, conducted by the expert group, the preliminary EPAs and the new set of EPAs from the first Delphi round were summarised into a new list of EPAs. This list was presented to the study participants in a second Delphi round (n=80 participants), with the goal to validate and rank each EPA and to define the year of entrustment. For this purpose, participants were asked in the second Delphi round if each EPA should be included into an anaesthesiology core curriculum and in which year of training entrustment should take place. Furthermore, they were asked to rank each EPA on a numeric scale, defining its importance. From this numeric scale, the content validity index (CVI) for each EPA was calculated.Consensus of the results from the second Delphi round was calculated, using the one-way random effects model to calculate Intra-Class-Correlations (ICC). Percentages of agreement among the whole set of EPAs of this study and a previously published set of EPAs were computed.Results: A core-curriculum comprising of 39 EPAs was developed. The EPAs were subdivided into superior/high and inferior/low scoring EPAs, reflecting their importance and were mapped to the year of entrustment. The results reached high consensus among the different participating anaesthesiologist groups (overall agreement was 0.96 for the CVI of each EPA and 0.83 for the year in which the EPAs should be entrusted). Agreement with the previously defined set of EPAs was 73.3%.Conclusion: This study provides a further step in transforming postgraduate anaesthesiology training into a more contemporary approach. Other studies are necessary to complete and amend the presented core curriculum of EPA based postgraduate anaesthesiology training.

Practice, Perception, and Associations of Peer Learning Among Resident Doctors in Nigeria: Charting Study

Abstract Introduction: Peer learning is an important component of the postgraduate medical curriculum, and it is considered as an integral part of learning in some countries. The practice of peer learning among postgraduate trainees, especially the resident doctors, is an area that has not been explored in Nigeria and other third world countries. This study aims to examine the practice, perception, and drivers of peer-to-peer training in Nigeria. Methodology: This study was a national multi-centre and multi-disciplinary cross-sectional survey, conducted among resident doctors in Nigeria. Semi-structured questionnaires were used to obtain respondents’ biodata, perception and practice on peer learning. Data were analysed using SPSS version 23 software. Results were presented as frequency table and proportion, means, and standard deviation. Inferential statistics such as bivariate analysis was performed. Results: Majority, 287 (73.2%), considered the peer education programme as an appropriate learning practice, 173 (45.9%) considered peer education programme integrated part of the training, while 350/383 (88.2%) engaged in a peer education programme. Statistically, a significant association was found between those who considered peer training as appropriate (p = 0.038) and those who considered peer education as an integral part of postgraduate medical training curriculum (p =0.009). Conclusion: Peer learning is popular among resident doctors in Nigeria. Concerted efforts are needed to re-structure the residency training curriculum in order to maximize the benefits of this learning approach for an effective training programme.

Successful Integration of Advanced Practice Providers Into a Pediatric Academic Community Intensive Care Unit

Advanced practice providers (APPs) are providing high-quality care in hospital settings. The scope of practice of nurse practitioners (NPs) and physician assistants (PAs) has evolved to integrate them into the acute and critical care areas ( Meissen, 2019 Meissen H.H. Integrating advanced practice providers into the multiprofessional critical care team. Critical Care Medicine. 2019; 47: 737-738 Crossref PubMed Scopus (4) Google Scholar ; Simone, McComiskey and Andersen, 2016 Simone S. McComiskey C.A. Andersen B. Integrating nurse practitioners into intensive care units. Critical Care Nurse. 2016; 36: 59-69 Crossref PubMed Scopus (17) Google Scholar ; Sorce, Simone and Madden, 2010 Sorce L. Simone S. Madden M. Educational preparation and postgraduate training curriculum for pediatric critical care nurse practitioners. Pediatric Critical Care Medicine. 2010; 11: 205-212 Crossref PubMed Scopus (28) Google Scholar ). Nurse practitioners who pursue careers in pediatric critical care in Texas are mandated to hold an acute-care certification. Select PA programs offer extended specialty training; however, there is no PA acute certification option ( Association of Postgraduate PA Programs 2019 Association of Postgraduate PA Programs. (2019). Post graduate PA programs listing. Retrieved fromhttps://appap.org/programs/pa-programs-listing/ Google Scholar ). Advanced practice providers employed in an intensive care unit must function at a high level to care for the critically ill patient, and the opportunity for designing job specific clinical competencies is not yet well described. ( Grabenkort, Meissen, Gregg and Coopersmith, 2017 Grabenkort W.R. Meissen H.H. Gregg S.R. Coopersmith C.M. Acute care nurse practitioners and physician assistants in critical care: Transforming education and practice. Critical Care Medicine. 2017; 45: 1111-1114 Crossref PubMed Scopus (15) Google Scholar ; Meissen, 2019 Meissen H.H. Integrating advanced practice providers into the multiprofessional critical care team. Critical Care Medicine. 2019; 47: 737-738 Crossref PubMed Scopus (4) Google Scholar ; Simone, McComiskey and Andersen, 2016 Simone S. McComiskey C.A. Andersen B. Integrating nurse practitioners into intensive care units. Critical Care Nurse. 2016; 36: 59-69 Crossref PubMed Scopus (17) Google Scholar ). Jenilea K. Thomas, Director of Advance Practice Providers-Community Pediatric Intensive Care Unit, Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX. Brian J. Rissmiller, Associate Director of Texas Children's Hospital, West Campus, Pediatric Intensive Care Unit, Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX. Mark J. Riccioni, Associate Director of Woodlands Pediatric Intensive Care Unit Advance Practice Providers, Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX. Jeanine M. Graf, Chief Medical Officer of Texas Children's Hospital, West Campus, Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX.

Evaluating learning and change in orthopaedics: What is the evidence-base?

Learning and change are key elements of clinical governance and are responsible for the progression of our specialty. Although orthopaedics has been slow to embrace quality improvement, recent years have seen global developments in surgical education, quality improvement, and patient outcome research. This review covers recent advances in the evaluation of learning and change and identifies the most important research questions that remain unanswered. Research into proxies of learning is improving but more work is required to identify the best proxy for a given procedure. Learning curves are becoming commonplace but are poorly integrated into postgraduate training curricula and there is little agreement over the most appropriate method to analyse learning curve data. With various organisations promoting centralisation of care, learning curve analysis is more important than ever before. The use of simulation in orthopaedics is developing but is yet to be formally mapped to resident training worldwide. Patient outcome research is rapidly changing, with an increased focus on quality of life measures. These are key to patients and their care. Cost-utility analysis is increasingly seen in orthopaedic manuscripts and this needs to continue to improve evidence-based care. Large-scale international, multi-centre randomised trials are gaining popularity and updated guidance on sample size estimation needs to become widespread. A global lack of surgeon equipoise will need to be addressed. Quality improvement projects frequently employ interrupted time-series analysis to evaluate change. This technique’s limitations must be acknowledged, and more work is required to improve the evaluation of change in a dynamic healthcare environment where multiple interventions frequently occur. Advances in the evaluation of learning and change are needed to drive improved international surgical education and increase the reliability, validity, and importance of the conclusions drawn from orthopaedic research.

Role of Medical Education in Cultivating Lifelong Learning Skills for Future Doctors

Medical knowledge, skills, and social requirements for patient care are quickly changing, thus, doctors are anticipated to be life-long learners to provide effective care for the patients. This paper addresses instructional issues how to prepare medical students to be self-directed learners and how to improve medical school and postgraduate training curricula. Now the big question is self-directed learning (SDL) an agent in cultivating lifelong learning skills for medical students as claimed by educational experts? This will be the focus of my critical reflection on lifelong learning.

Pediatric anesthesia after APRICOT (Anaesthesia PRactice In Children Observational Trial): who should do it?

This review highlights the requirements for harmonization of training, certification and continuous professional development and discusses the implications for anesthesia management of children in Europe. A large prospective cohort study, Anaesthesia PRactice In Children Observational Trial (APRICOT), revealed a high incidence of perioperative severe critical events and a large variability of anesthesia practice across 33 European countries. Relevantly, quality improvement programs have been implemented in North America, which precisely define the requirements to manage anesthesia care for children. These programs, with the introduction of an incident-reporting system at local and national levels, could contribute to the improvement of anesthesia care for children in Europe. The main factors that likely contributed to the APRICOT study results are discussed with the goal of defining clear requirement guidelines for anesthetizing children. Emphasis is placed on the importance of an incident-reporting system that can be used for both competency-based curriculum for postgraduate training as well as for continuous professional development. Variability in training as well as in available resources, equipment and facilities limit the generalization of some of the APRICOT results. Finally, the impact on case outcome of the total number of pediatric cases attended by the anesthesiologist should be taken into consideration along with the level of expertise of the anesthesiologist for complex pediatric anesthesia cases.

Innovations in Doctoral Training and Research on Tinnitus: The European School on Interdisciplinary Tinnitus Research (ESIT) Perspective.

Tinnitus is a common medical condition which interfaces many different disciplines, yet it is not a priority for any individual discipline. A change in its scientific understanding and clinical management requires a shift toward multidisciplinary cooperation, not only in research but also in training. The European School for Interdisciplinary Tinnitus research (ESIT) brings together a unique multidisciplinary consortium of clinical practitioners, academic researchers, commercial partners, patient organizations, and public health experts to conduct innovative research and train the next generation of tinnitus researchers. ESIT supports fundamental science and clinical research projects in order to: (1) advancing new treatment solutions for tinnitus, (2) improving existing treatment paradigms, (3) developing innovative research methods, (4) performing genetic studies on, (5) collecting epidemiological data to create new knowledge about prevalence and risk factors, (6) establishing a pan-European data resource. All research projects involve inter-sectoral partnerships through practical training, quite unlike anything that can be offered by any single university alone. Likewise, the postgraduate training curriculum fosters a deep knowledge about tinnitus whilst nurturing transferable competencies in personal qualities and approaches needed to be an effective researcher, knowledge of the standards, requirements and professionalism to do research, and skills to work with others and to ensure the wider impact of research. ESIT is the seed for future generations of creative, entrepreneurial, and innovative researchers, trained to master the upcoming challenges in the tinnitus field, to implement sustained changes in prevention and clinical management of tinnitus, and to shape doctoral education in tinnitus for the future.