Felt Confident Research Articles

Evaluating the effectiveness and feasibility of nurse-led distant and face-to-face interviews programs for promoting behavioral change and disease management in patients with diabetic nephropathy: a triangulation approach

BackgroundWe examined whether telecommunication-device-based distance interviews are inferior to face-to-face interviews in terms of facilitating behavioral changes and disease management in patients with diabetic nephropathy. We also examined the feasibility of a newly designed six-month telenursing program.MethodsThis study represents a post-hoc analysis of data from a randomized controlled trial, in which we compared the efficacy of remote self-management education with that of direct education for patients with diabetic nephropathy. The participants were 40 company employees, who were randomly divided into two groups. Over 6 months, the intervention group (n = 21) received three distance interviews using a tablet computer. Meanwhile, the control group (n = 19) received three face-to-face interviews. In addition, both groups received biweekly nine telephone calls. A triangulation approach was used. We first compared the two groups in inferiority tests. Then, we analyzed data from semi-structured interviews with all participants and nurses, examining whether trusting relationships and motivation were developed, and the accuracy of the information exchanges. Further, for the intervention group, we also enquired about the overall operability of the telenursing device.ResultsThe completion rates for the program were 81.0 and 78.9% for the participants in the intervention and control groups, respectively. Both groups showed similar behavioral changes, and the participants verified the feasibility of the distance interviews. The participants in the intervention group felt that they understood the severity of their diseases and the necessity of self-management, and felt confidence in the nurses. On the other hand, their degree of behavioral change regarding self-monitoring was lower than that shown by the control group.ConclusionOur findings show that both interview methods are effective for encouraging the adoption of self-management; further, in terms of taking medication and improving the main clinical indicators, we found that the distance method is not inferior to the direct face-to-face method. However, when considering long-term effects, based on the respective degrees of improvement in behavioral change, the direct method seems to be more effective.Trial registrationThe trial was registered with the University Hospital Medical Information Network clinical trial registry (No. UMIN000026568) on March 15, 2017, retrospectively.

Age differences in patterns and confidence of using internet and social media for cancer-care among cancer survivors

ObjectivesThe internet and social media provide information and support to cancer survivors, and adolescent and young adults (AYA, age < 40 years), adults, and older (age 65+ years) cancer survivors may have different needs. We evaluated the impact of age on cancer-related internet and social media use and confidence in evaluating online information for cancer-care decision making. Materials and MethodsCancer survivors completed a convenience cross-sectional survey evaluating their cancer-related internet and social media use and their confidence in using these resources for decision making. Multivariable regression models evaluated the impact of age on usage patterns and confidence. ResultsAmong 371 cancer survivors, 58 were older adults and 138 were AYA; 74% used the internet and 39% social media for cancer care; 48% felt confident in using online information for cancer-care decisions. Compared to adult survivors, there was a non-significant trend for older survivors to be less likely to use the internet for cancer-care information(aOR = 0.49, 95% CI[0.23–1.03], P = .06), while AYA were more likely to use social media for cancer-care (aOR = 1.79[1.08–2.99], P = .03). Although confidence at using online information for cancer-care decision making did not differ between age groups, increasing age had a non-significant trend towards reduced confidence (aOR = 0.99 per year [0.97–1.00], P = .09). Most commonly researched and desired online information were causes/risk factors/symptoms, treatment options, and prognosis/outcomes. ConclusionsAge may influence the use of internet and social media for cancer-care, and older cancer survivors may be less confident at evaluating online information for cancer-care decision making. Future research should explore other strategies at meeting the informational needs of older cancer survivors.

Knowledge, attitude, and practice regarding obstructive sleep apnea among primary care physicians.

Obstructive sleep apnea (OSA) has been linked with inflammation, hypertension, and higher cardiovascular risk which cause substantial morbidity and mortality worldwide. However, OSA is underdiagnosed and its prevalence is increasing. Primary care doctors are the first contact for most patients and primary care providers play an important role in promoting, screening, and educating patients regarding OSA. This study aims to determine the knowledge, attitudes, and practices regarding OSA among primary care doctors in Kuala Lumpur, Malaysia. A cross-sectional survey was conducted among physicians who were currently working in primary care clinics in the capital state of Kuala Lumpur. The validated "Obstructive Sleep Apnea Knowledge and Attitudes Questionnaire" (OSAKA) and nine additional practice questions were used as the survey instrument. Of 207 physicians queried, the response rate was 100%. The mean (± SD) total knowledge score was 11.6 (± 2.8) (range 1-18). The majority of respondents had a positive attitude towards the importance of OSA but lacked confidence in managing OSA. Primary care doctors' most common practice for patients with suspected OSA was referral to the ear, nose, and throat (ENT) clinic. The study shows that primary care doctors demonstrated adequate knowledge about OSA and were aware of the importance of OSA as a core clinical problem. However, only a minority felt confident in managing patients with OSA. The results of the study may encourage improvement of primary care doctors' efforts to prevent and manage OSA.

Knowledge and Experiences of Final Year Medical and Nursing Students with Regard to Palliative Care at Government University in Oman: A Questionnaire Based Study.

Palliative care (PC) is an essential part of the healthcare system, aiming to improve the quality of life of terminally ill patients and their families through prevention, relief of suffering, and providing psychosocial and spiritual support. To achieve high-quality PC, medical education should encompass PC training, including knowledge of PC, and skills and attitudes towards PC, at the undergraduate level. The aim of this study is to identify PC knowledge and experience among undergraduate medical and nursing students at Sultan Qaboos University (SQU), a government university in Oman. A validated questionnaire that measures knowledge and experiences of PC was administered to all final year medical and nursing students (N = 196) at SQU. The majority of the students (93.4%) were aware of the term PC, but most of them (68.9%) did not have any experience of PC. Around half of the students (54.9%) had a vague notion of how to implement PC, and only 41.3% felt confident in providing PC for terminally ill patients. Less than half of the students (44.8%) were aware that the patient's family should be included in PC, as well as the patient. The majority of students (71.3%) thought that PC should be included in the undergraduate teaching curriculum, though few students (17.9%) knew that PC is currently a specialized medical unit (sub-department) in Oman. Most of the students (73.0%) thought that terminally ill patients have the right to choose "do not resuscitate," but few students agreed that patients should be able to request a lethal dose (24.0%) or consent to a physician-assisted suicide (35.7%). Most of the students (84.7%) believed that special psychological support should be provided for doctors and nurses working in PC. Bivariate analysis showed no significance in the knowledge of applied PC in relation to which of the colleges the students were from (p = 0.283) or gender of the students (p = 0.068). Despite the fact that SQU students had favorable attitudes towards PC, they have insufficient knowledge and lack of experience. As the number of geriatric and terminal cancer patients increases across Oman, there is a need for the healthcare system to provide high-quality and effective PC services. Thus, there is an urgent need to integrate PC teaching courses as part of the undergraduate medical education for medical and nursing students.

Usability assessment of seven HIV self-test devices conducted with lay-users in Johannesburg, South Africa.

IntroductionThe first 90 of the 90-90-90 initiative introduced by the World Health Organization(WHO) in 2015 requires 90% of people with HIV be aware of their status by 2020. In South Africa, conventional facility-based testing had reached 84.9% in 2018; innovative new methods, like HIV self-testing(HIVST) may close the testing gap. This study aimed to determine the usability of seven HIVST kits among untrained South Africans.MethodsThis cross-sectional study of 1400 adults in Johannesburg evaluated the usability of five blood fingerstick and two oral fluid HIVSTs, using WHO prequalification criteria, from June 2016 to June 2018. Participants were handed one kit, with no further information about the device or test procedure, and asked to perform the test in front of an observer. The observer used product-specific semi-structured questionnaires organized into a composite usability index(UI) using a HIVST process checklist, a contrived results interpretation and a post-test interview that expanded on participant experiences with the device and instructions-of-use(IFU). Participants were not tested themselves, but provided with contrived results to interpret.ResultsThe average UI was 92.8%(84.2%-97.6%); the major difficulty was obtaining and transferring the specimen. Participants correctly interpreted 96.1% of the non-reactive/negative, 97.0% of the reactive/positive, 98.0% of the invalid and 79.9% of the weak positive results. Almost all participants(97.0%) stated they would visit a clinic or seek treatment for positive results; with negative results, half(50.6%) stated they should re-test in the next three months while one-third(36.1%) said they should condomize. Nearly all found the devices easy to use(96.6%), the IFUSs easy to understand(97.9%) and felt confident using the test unassisted(95.9%) but suggested improvements to packaging/IFUs to further increase usability; 19.9% preferred clinic-based testing to HIVST.ConclusionThe UI and interpretation of results was high and in-line with previous usability studies, suggesting that these kits are appropriate for use in the general, untrained and unsupervised public.

COVID-19 pandemic and implications for graduate medical training.

Sir, The COVID-19 pandemic has forced sweeping, and probably durable, changes in personal habits, lifestyles, and patterns of social interaction. The education system, too, has seen many changes with the need for social distancing forcing the suspension of traditional classroom teaching and a rise in adoption of remote learning approaches such as virtual classrooms, e-learning, and m-learning. The current times, though indeed distressing, also offer a unique opportunity to revamp medical education so as to equip budding doctors with the necessary skills to respond to changing demands of the society with confidence and enthusiasm. Below, we outline a few key areas in medical training that need to be revisited: Bedside clinics in medicine, an integral part of medical training, may need to be modified so as to ensure social distancing and minimize face to face contact. In a recent guideline statement,[1] the Association of American Medical Colleges, suggested that medical schools temporarily suspend clinical rotations for trainees. This will free up some additional time which may be utilized to finish the didactic components of training till the situation normalizes. To implement this, administrators will have to consolidate and restructure the academic calendar appropriately. A less disruptive strategy would be to have virtual clinics with real or simulated patients which can even be recorded to facilitate asynchronous “anytime-anywhere” learning. Clearly, the challenge for medical educators is to design clinical immersion experiences while adhering to the requirements of the “new normal” environment, where quarantines and social distancing will be needed. There is virtually no focus on organized epidemic or disaster training and public health preparedness in the ongoing medical curriculum. This may make many doctors feel inadequate about responding to the care needs of disaster victims. An Indian study of undergraduate medical trainees[2] showed that 95% of respondents never got any training or demonstration in disaster medicine and only 16% felt confident of tackling public health emergencies. There is wide variability in disaster training methods adopted by different medical schools. One medical school described a comprehensive 8-h course comprising lectures, simulation exercises, and full-scale hospital disaster drills in which the students participate as the victims.[3] Introducing disaster medicine training early in the curriculum, having brief but mandatory rotations with the National Disaster Management Authority, and exposure to hospital administration and management to inculcate planning and leadership skills have also been mooted.[2] Inter-professional training of health-care workers and collaboration, essential for high-quality patient care, is not emphasized enough in the current medical curriculum. The current pandemic has brought this lacuna to the fore, and this has contributed to the lack of organized response to the COVID-19 pandemic. Pilot studies involving medical and nursing students have described the use of experiential learning techniques to teach necessary inter-professional skills in areas such as shared decision making and problem-solving, inter-disciplinary communication skills, conflict resolution, identification, and development of individual learning needs and professional roles.[4] Administrators must value and encourage the implementation of inter-disciplinary education and practice. Since the turn of the century, this is the third pandemic that the world has seen. History will judge us by the way we utilized this opportunity to reflect, learn, and make changes to be better prepared for future. These recommendations will assist doctors in adjusting their workplaces to meet the changing demands of the society while simultaneously maintaining the quality of medical training and patient care. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Healthcare charging for migrants in the UK: awareness and experience of clinicians within sexual and reproductive health and HIV.

Forced migration is at record levels, leading many European countries to seek to limit immigration or control access to public services. The UK has introduced upfront healthcare charging for overseas patients, with exceptions for certain groups and services. Confusion over these regulations amongst healthcare professionals risks care being inappropriately delayed or denied. This is pertinent within sexual and reproductive health and HIV care where sensitivity and timely management are essential. We conducted a survey exploring clinicians' knowledge of healthcare charging regulations and terminology, their confidence and experience on this topic and their ability to evaluate case-based scenarios. Of 343 valid responses, 78% reported encountering refugees, asylum seekers or undocumented migrants in practice. Only 39% felt confident in their understanding of healthcare entitlements. Terminology was appropriately defined by 66%, but only 53% of case-based scenarios were answered correctly. About 71% reported needing further training in this area, and many comments indicated a desire for educational resources. SRH and HIV professionals demonstrated limited knowledge of healthcare charging for migrants, despite working with these groups. This could undermine their ability to deliver appropriate advice and care to these potentially vulnerable patients. Training and support for these staff is essential.

Teacher training for rheumatology fellows: a national needs assessment of fellows and program directors.

Teaching is an integral part of what we do as physicians, and exposure to training on how to effectively teach is not consistently implemented in the curricula within medical training. We administered anonymous, in-person surveys to fellows and program directors (PDs) at the 2017 American College of Rheumatology national conference to evaluate fellow and PD attitudes regarding development of programs dedicated to teaching fellows on how to teach. One hundred seven of 150 fellows returned surveys (response rate 71%). About 60% demonstrated interest in pursuing a teaching-focused career. About 97% felt their teaching skills can be improved; 88% felt improved teaching skills will be valuable for their career. With 61% response rate (57/94 PD surveys), most PDs agreed their fellows could use additional instruction in teaching. About 90% noted this would be an asset for fellows' careers. When compared, 56% of fellows reported no structured training in education during fellowship, while 64% of PDs said this type of training was available. All agreed fellow teaching skills can be improved but significantly more fellows than faculty felt confident in the fellows' ability to give feedback (p = 0.03). Both groups identified time constraints and other faculty interest as barriers. There is significant need to develop effective fellow-as-teacher programs aimed at enhancing fellows' teaching skills, with focus on giving feedback and working within fellow and faculty time constraints. The program can help address a curriculum gap identified by fellows as well as PDs before fellowship-to-faculty transition.Key Points• There is a notable gap between faculty physicians' expectations to teach as clinician-educators and the lack of training dedicated to learning how to teach during medical training. Despite the fact that past clinical educators have identified instructional design and assessment as low-confidence areas, there is a paucity of structured program dedicated to developing these teaching skills during fellowship training.• With 97% fellows and 84% program directors, both groups agreed fellows could use additional instruction in teaching skills, but there was a significant discrepancy between fellow and program director perspectives regarding fellows' ability to give feedback.• Consistent with past needs assessments in other medical specialties, lack of time and potential faculty interest were recognized as potential barriers, calling for a structured training program dedicated to education on didactics that takes into account trainee and faculty time constraints.• Our needs assessment can direct future research on analyzing effectiveness of fellow-as-teacher program implementation by focusing on improvement of fellow teaching and feedback skills.

“How can you be allergic to peas?” – A qualitative study to explore food handler’s knowledge, attitudes and understanding of food allergens

Abstract It is clear that there is an increasing proportion of the United Kingdom (UK) population who are suffering with food allergies and this combined with an increase in the frequency of eating away from home (where there is less control over the content of food) poses a significant risk. In December 2014, the European Union (EU) introduced legislation which aimed to ensure that customers with food allergens could make informed choices and safely consume food, without the risk of a potentially life-threatening reaction. The research used semi-structured interviews with staff from a BCB, located in the North West of the UK, as the aim of the research was to explore food handlers’ knowledge, attitudes and understanding of food allergens. The findings of the semi-structured interviews identified five themes: E-learning training programmes: the staff felt that these were ineffective and did not take into account individual learning styles. Responsibility: there is a lack of clarity as to who is responsible, with staff believing the key responsibility lies with the customer. Communication: similarly, communication, both within the kitchen and within the company was not clear and likely to give rise to confusion. Need to make a profit: the staff felt that the drive for profit meant that customer safety was being compromised, especially when staff numbers were reduced. Staff awareness: the staff felt confident in their own ability to prepare a safe meal but indicated that staff may be dismissive towards claims of allergen sufferers. In conclusion, these themes illustrate that a significant risk exists for allergen suffers, who rely upon the knowledge, attitudes and understanding of BCB staff to ensure their meals are safely prepared.

Food allergy management in Early Childhood Education and Care Services in Australia.

To assess Australian Early Childhood Education and Care Services (ECEC) staff on their preparedness to manage children with food allergy (FA) and anaphylaxis. An online survey addressing training, knowledge, skills and staff confidence to manage FA and anaphylaxis was emailed to 5956 ECEC services nationally (excluding Western Australia, where this survey had been previously implemented); 494 surveys were completed and analysed. One in 10 (9.5%) ECEC services did not require staff to undertake anaphylaxis training, indicating non-compliance with current legislation. Staff felt confident in managing FA and anaphylaxis, regardless of their level of training. Against recommendations, 37% of participating ECEC services stored adrenaline autoinjectors (AAI) in a locked location. Only 51.4% of ECEC services reported having an AAI trainer device. Victoria reported the highest level of anaphylaxis management training (P < 0.05), and staff were significantly less likely to store their AAI devices in a locked location compared to New South Wales and Queensland (P < 0.001). New South Wales and Queensland had a significantly lower proportion of services with AAI training devices than Victoria (P < 0.001). ECEC staff self-reported high levels of training, knowledge, skills and confidence in FA and anaphylaxis management. However, we identified gaps in staff knowledge and skills, particularly in how to correctly store and administer an AAI device. Compliance with appropriate FA and anaphylaxis policies and emergency response plans need to be prioritised.

Mentoring and Education: A Lifetime of Experience and Learning.

As recipient of the 2018 Robert M. Nerem Education and Mentorship Medal from the ASME, I was asked to prepare an article to contribute my reflections on these topics, that arise whenever we offer advice and guidance to our younger colleagues. This represents my personal views on Bob Nerem, after whom the award is named, my experiences that have impacted me as a mentor, and some words of advice, offered cautiously and with qualifications, with regard to best practices in mentoring.

BUILDING CAPACITY IN CRITICAL CARE NURSES TO IMPROVE INDIVIDUAL AND TEAM PERFORMANCE IN CARDIOPULMONARY ARREST EVENTS: AN EDUCATIONAL INITIATIVE AND SIMULATION TRAINING

The cardiovascular intensive care unit (CICU) at St. Michael’s Hospital is a small ICU (n=10 beds) staffed by 6 nurses on days and 5 nurses on nights. Patients in the CICU often manifest cardiopulmonary emergencies (Code blues) which require highly coordinated and effective performance of the CICU team. There was previously no data available regarding team performance during cardiopulmonary arrest events in the CICU. Additionally, it was not known whether nurses in the unit felt confident in their skills when responding to such events. This performance improvement project set out to measure and improve how nurses respond to code blues in the unit. Nurses’ perceptions and confidence with different skills were assessed through a self-administered questionnaire. Responses revealed gaps in nurses’ technical and non-technical skills necessary to manage a cardiopulmonary arrest event. In addition, team performance was evaluated after each cardiopulmonary arrest by use of the Team Emergency Assessment Measure (TEAM). Various interventions were developed and implemented to target the gaps identified during the initial survey. Code blue simulations were utilized as suggested by the literature. A positive change was noted in nurses’ perceptions post interventions when assessed with the same questionnaire. Observations by team members show increased knowledge and insight regarding effective teamwork. Targeted interventions and code-blue simulations were effective in building individual and team capacity in managing cardiopulmonary arrest events in the CICU. Data on team performance during cardiopulmonary arrest events is being collected continuously and its trend monitored overtime.

Palliative Radiotherapy Education for Hospice and Palliative Medicine Fellows: A National Needs Assessment.

Background: Insufficient knowledge of palliative radiotherapy (PRT) among hospice and palliative medicine (HPM) physicians is thought to be a barrier to the provision of high-quality palliative care. Objective: To assess the need for PRT education in HPM fellowship. Design: A cross-sectional survey of HPM fellows was conducted in June 2018. Setting/Subjects: The survey was distributed to accredited HPM fellowship programs in the United States for distribution to enrolled fellows; 114 fellows responded to the survey. Results: Nearly all respondents agreed that the principles of PRT should be taught in HPM fellowship, yet 51% had received no PRT education and 35% had received only one or two hours. Only 25% of respondents rated their working knowledge of PRT as sufficient, 40% felt confident in identifying radiation oncology emergencies or managing radiotherapy side effects, and 52% felt confident in assessing which patients to refer for radiotherapy. More than 75% agreed that were they more knowledgeable about PRT, they would be more likely to consider referral to radiation oncology, to collaborate with radiation oncologists, and to advocate for a short course of treatment based on a patient's prognosis or goals or care. Fellows who received PRT education in fellowship had significantly greater knowledge of and more favorable attitudes toward the use of radiotherapy. This difference was the greatest among fellows who had received at least five hours of PRT education. Conclusion: There is a need for PRT education in HPM fellowship. Efforts to address this need may lead to more appropriate utilization of PRT for patients with advanced cancer.

Perspectives on the use of aromatherapy from clinicians attending an integrative medicine continuing education event

BackgroundThe use of essential oils is growing in the United States, but clinician attitudes, experience, and beliefs regarding their use have not previously been studied.MethodsOne hundred five of 106 clinician attendees (99.1%) of an integrative medicine continuing education conference were surveyed using an audience response system to obtain baseline information. Response frequencies of each item were reported. Nonparametric correlations were assessed comparing the statement “In the last 12 months, I have used essential oils for myself and/or my family” with the other agree/disagree statements using Spearman’s rho.ResultsA majority of participants personally used integrative medicine approaches other than aromatherapy (92.6%) and recommended them clinically (96.8%). Most had personally used essential oils (61%) and wished to offer essential oil recommendations or therapies to their patients (74.0%). Only 21.9% felt confident in their ability to counsel patients on safe use. Personal use of essential oils was highly correlated with confidence in the ability to counsel patients on safe use (Spearman coefficient 0.376, P = 0.000).ConclusionsThis study indicates that clinicians interested in integrative medicine desire to provide aromatherapy recommendations, but do not feel confident in their ability to do so.

Maintaining peri-implant health: an evaluation of understanding among dental hygienists and therapists in Wales.

Objectives To describe the approach taken by dental hygienists and therapists (DH/Ts) in Wales regarding dental implant maintenance. To gather their opinions about the current level of implant education.Materials and methods Online questionnaires were distributed to 257 DH/Ts within Wales.Results The response rate was 35%. Dental implant care was within the remit of service for 92% of respondents. All respondents that provided implant care stated that they performed oral hygiene instruction, while 98% performed supragingival debridement, 85% subgingival debridement, and 64% clinical assessment of peri-implant health. A high proportion of DH/Ts in Wales did not feel entirely confident in carrying out procedures relating to peri-implant maintenance and only 27% felt confident in clinically assessing dental implants. The majority (83%) felt that postgraduate training in peri-implant maintenance should be obligatory. 'No available courses' was the main reason for not attending further postgraduate training in implantology.Conclusions A high proportion of responding DH/Ts practising in Wales do not feel entirely confident in carrying out procedures relating to peri-implant maintenance. Postgraduate training may be useful in addressing this issue and undergraduate training programmes may need to consider increasing trainees' exposure to dental implant maintenance.

A digital resource to assess clinical competency

Objective structured clinical examinations (OSCEs) are integral to clinical competency-based assessment in health care disciplines. Traditional paper-based OSCEs require considerable administration time and students typically receive an assessment outcome with minimal feedback. We developed and implemented an iPad-based OSCE assessment system in optometry that delivered timely and specific e-feedback. The electronic assessment system contains all of the features of a paper-based OSCE format, including a checklist score, a global score section and pre-written feedback. It was trialed in a year-3 OSCE assessment. We evaluated students and examiners' perceptions of this digital resource via surveys and focus group interviews. Over 90% of the students reported that the e-feedback was timely, facilitated self-reflection and was appropriate for assessment. Students' focus group interviews highlighted the importance of the timeliness of feedback, and students found both verbal and written feedback useful. All examiners were satisfied with the features of the assessment system and felt confident using it for assessment. The iPad-based OSCE assessment system has enabled timely feedback to be delivered efficiently. This study has provided a model of what constitutes good e-feedback. The technology was well received by both students and examiners. It has helped to close the assessment loop by delivering usable and developmental feedback to meet students' learning needs.

P026: Dominating the vent: A flipped classroom approach to enhance emergency medicine resident ventilator management

Innovation Concept: Ventilator management is an essential skill and a training objective for emergency medicine (EM) specialists in Canada. EM trainees obtain the majority of this training during off-service rotations. Previous attempts to strengthen ventilator knowledge include lectures and simulation – both of which are time and resource intensive. Given the unique features of ventilator management in the ED, we developed an ED-specific ventilator curriculum. The purpose of this study is to 1) identify resident needs regarding ventilator curricula and 2) assess resident response to this pilot curriculum. Methods: A needs-assessment survey administered to RCPSC- and CCFP-EM residents at The Ottawa Hospital (TOH) showed the majority of residents (87%, n = 31 respondents) believe there is a need for more ED-focused ventilator management training, and only 13% felt confident in ventilator management. Ten on-line modules were prepared by an EM-Critical Care attending, and distributed on-line to all EM trainees at TOH (n = 52). Mid- and post-implementation surveys are used to assess residents’ confidence in ventilator management, and perceived usefulness of the curriculum. User feedback from focus groups constitutes part of the curriculum evaluation. Curriculum, Tool or Material: Employing a flipped classroom approach, ten on-line modules were distributed to RCPSC- and CCFP-EM trainees at TOH. Each module requires less than ten minutes to complete and focuses on a single aspect of ventilation. The modules are available for residents to complete at their own pace and convenience. At curriculum completion, an EM-Critical Care attending physician facilitates an interactive session. Conclusion: Mid-implementation survey results demonstrate increased confidence in independently managing ventilated patients in the ED (13% pre- vs. 56% mid-implementation), and an increased perception of having sufficient ventilator training (26% pre- vs. 78% mid-implementation). All respondents felt the modules were of appropriate length, content was easy to follow, and that the modules should be part of the residency curriculum. Our ED-specific online ventilator modules area a viable tool to increase residents’ confidence in ventilator management. This novel curriculum could be adopted by other residency programs and continuing professional development initiatives. Future work will include post-implementation data-gathering, and formal curriculum evaluation.

Introduction of a modified obstetric early warning system ­(­MOEWS­)­ at an Ethiopian referral hospital: a feasibility assessment

Early warning scores are points-based or colour-coded systems used to detect changes in physiological parameters and prompt earlier recognition and management of deteriorating patients. Vital signs recorded within a coloured...

Ophthalmology specialist trainee survey in the United Kingdom.

Currently there are a total of 780 post-graduate ophthalmology trainees in the United Kingdom (UK). Post-graduate ophthalmology training in the UK is 7 years in duration, and follows a comprehensive competency-based curriculum. Changes to training have been proposed as part of the government's Shape of Training paper. UK ophthalmic trainees and trainers, in partnership with the Royal College of Ophthalmologists, designed a national questionnaire to explore the confidence of trainees in different clinical and non-clinical aspects of ophthalmology. The questions and possible responses underwent a process of refinement through the Royal College of Ophthalmologists Training Committee and Trainee Group. An online survey platform was used for the questionnaire, which was sent to all ophthalmology trainees within the UK. Reminders were sent via the Royal College of Ophthalmologists and Regional Training Programme Directors. A 4-week period was allowed for responses. Quantitative data were analysed, and qualitative data analysis included collation and thematisation of free-text responses. A total of 188 trainees (24.1% response rate) replied. Ninety-four percent of trainees were in full-time training posts. The most popular career choice was oculoplastics (31.4%), followed by vitreo-retina (25.1%), glaucoma (24.6%) and cornea (24.0%). One-quarter had opted out of the European working time directive (EWTD), and 54.8% agreed that their work contract reflected the number of hours actually worked. In total, 34.4% of trainees thought that ophthalmic specialist training should be shortened from the current 7-year programme. Overall, 79.9% of respondents felt confident in performing phacoemulsification cataract surgery independently. For more senior trainees in years 4-7, 100% felt confident in phacoemulsification. However, overall, only 47.9% were confident in independently performing an anterior vitrectomy (91.1% of final-year trainees). Overall, 77.6% thought that all surgical ophthalmologists should be trained to perform cataract surgery. For non-clinical skills, trainees felt least confident in 'preparing a business case', with 64.5% disagreeing that they felt confident in this task. The most confidence was felt for communication with patients: 100% of trainees (all of whom have completed at least 2 years of medical work following qualification) reported feeling confident. Most doctors in post-graduate specialist training in ophthalmology in the UK aim to specialise in surgical sub-specialities. The subjective reports collected in this survey suggest targets for strengthening of the UK's highly rated training system. Further research is necessary to determine overall satisfaction with training, the effect of changing training within the recent Shape of Training review; and how recent newly imposed junior doctor contracts as well as Brexit affects training.

Suicide in older people, attitudes and knowledge of emergency nurses: A multi-centre study

IntroductionSuicide in older people is a public health concern. Emergency nurses are ideally placed to identify suicide risk. Therefore, the aim of this research was to explore emergency nurses’ knowledge, confidence and attitudes about suicide in older people. MethodsThis descriptive exploratory study was conducted in four emergency departments in Sydney, Australia. Data were collected using a 28-item survey from a convenience sample of emergency nurses. Descriptive quantitative statistics and conventional content analysis were performed. Ethics approval was provided. ResultsThe response rate was 58% (n = 136); the majority were female with an average of seven years emergency experience. The majority (n = 124, 91%) reported that they frequently managed suicidal behaviour and recognized suicide as a common event (80%). 51% (n = 69) recognized that suicide was a common event for older people. Only 16% (n = 22) reported receiving suicide prevention training with 11% feeling confident in managing suicidal behaviour. ConclusionThe findings contribute to the discourse on how suicide in older people is recognised by emergency nurses. Few nurses considered it a problem for older people and were not confident about their knowledge. There is a need for suicide prevention training as a priority particularly to identify risks in older people.