First Year Of Training Research Articles

Masculinity and nursing care: A narrative analysis of male students′ stories about care

Nursing education programmes and the nursing curriculum have been criticised for presenting an outdated and feminised description of care, which has had the effect of marginalising men, as well as hindering a more modern outlook for the profession. This article uses interview-based data from a qualitative study on Norwegian students' experiences in the first year of training. Using a narrative analysis method, the paper explores how male nursing students use stories to describe care and shows how their storytelling illustrates a way for men to negotiate their role in a feminised profession. The paper aims to deepen our understanding of the ways in which male students can challenge this historically female profession to broaden itself by including male-based caregiving as part of nursing care. In addition, the paper highlights the potential of stories and storytelling as a teaching and learning strategy in nursing education.

University versus Practice

This study aims to determine the skills shortages in first-year trainee accountants entering practice in South Africa and to recommend ways to address and overcome those shortages. Questionnaires were administered to registered audit firms in Gauteng Province to gather the perceptions of senior trainees, managers and partners on the skills shortages in first-year trainee accountants. The overall view was that universities did not equip first-year trainees sufficiently with the skills to be successful in practice, especially with regard to professional communication and exposure to computer accounting software packages. It is argued that professional bodies and universities should work together to overcome these skills shortages.

Validated Chinese Translation of the Fresno Test for Evidence-based Health Care Training

To elevate quality of care for the ever-increasing number of elderly patients in Taiwan, staff in geriatric medicine frequently attend training to promote evidence-based health care. However, such training programs must be effective. Evaluation of evidence-based health care training requires a valid instrument to assess learners' competence. The Fresno test has robust psychometric properties, but there is no validated Chinese translation of this tool yet available. The English Fresno test was translated into Chinese and then back-translated to English to ensure equivalence of concepts and semantics. First-year postgraduate physician trainees (novices) recruited from an evidence-based medical training program completed the Chinese Fresno test prior to and after the program. Experienced instructors (experts) in the program also completed the test for comparison. The correlation and consistency of the Chinese version were analyzed and validated. Forty (20 experts and 20 novices) completed the tests. The inter-rater correlation ranged from 0.65 to 0.98. Internal consistency was good (Cronbach's α = 0.98). Item difficulty ranged from 23% to 72%. Item discrimination indices ranged from 0.40 to 0.90. Experts scored significantly higher than novices (experts = 165, novices = 93; p < 0.001). Test–retest correlation 2 weeks after the first test was 0.98 ( p < 0.001). This Chinese version of the Fresno test is a reliable and valid instrument for evaluating evidence-based health care knowledge and skills.

Development of knowledge tests for multi-disciplinary emergency training: a review and an example.

The literature is sparse on written test development in a post-graduate multi-disciplinary setting. Developing and evaluating knowledge tests for use in multi-disciplinary post-graduate training is challenging. The objective of this study was to describe the process of developing and evaluating a multiple-choice question (MCQ) test for use in a multi-disciplinary training program in obstetric-anesthesia emergencies. A multi-disciplinary working committee with 12 members representing six professional healthcare groups and another 28 participants were involved. Recurrent revisions of the MCQ items were undertaken followed by a statistical analysis. The MCQ items were developed stepwise, including decisions on aims and content, followed by testing for face and content validity, construct validity, item-total correlation, and reliability. To obtain acceptable content validity, 40 out of originally 50 items were included in the final MCQ test. The MCQ test was able to distinguish between levels of competence, and good construct validity was indicated by a significant difference in the mean score between consultants and first-year trainees, as well as between first-year trainees and medical and midwifery students. Evaluation of the item-total correlation analysis in the 40 items set revealed that 11 items needed re-evaluation, four of which addressed content issues in local clinical guidelines. A Cronbach's alpha of 0.83 for reliability was found, which is acceptable. Content and construct validity and reliability were acceptable. The presented template for the development of this MCQ test could be useful to others when developing knowledge tests and may enhance the overall quality of test development.

Acting as standardized patients enhances family medicine residents' self-reported skills in palliative care.

Recent publications have confirmed the use of standardized patients (SPs) in improving clinical skills and enhancing competency. Little research has studied the benefits residents may themselves gain in palliative care playing the role of SPs. Nineteen Family Medicine residents were recruited as standardized patients (FMR-SPs) for a mandatory palliative care workshop in communication for incoming, first-year trainees. Four months later, FMR-SPs reflected upon their own experiences. Two independent researchers performed thematic analysis of these interviews. Most of the residents were satisfied with their roles. Twelve reported improved understanding of self, their patients, the doctor-patient relationship, and the underlying philosophy of palliative care. They also described improved verbal and non-verbal communication skills. Eleven of 14 residents reflected upon behavioral changes in problem coping styles. All residents indicated an intention to apply the learning in their future work. Encouraging Thai Family Medicine residents, in years one through three, to portray SPs in palliative care appears to be a valuable learning experience for the resident. Future studies to validate whether this learning has been applied in subsequent practice are planned.

Medical school handoff education improves postgraduate trainee performance and confidence

Objectives: Determine postgraduate first-year (PGY-1) trainees ability to perform patient care handoffs and associated medical school training.Methods: About 173 incoming PGY-1 trainees completed an OSCE handoff station and a survey eliciting their training and confidence in conducting handoffs. Independent t-tests compared OSCE performance of trainees who reported receiving handoff training to those who had not. Analysis of variance examined differences in performance based on prior handoff instruction and across levels of self-assessed abilities, with significance set at p < 0.05.Results: About 35% of trainees reported receiving instruction and 51% reported receiving feedback about their handoff performance in medical school. Mean handoff performance score was 69.5%. Trainees who received instruction or feedback during medical school had higher total and component handoff performance scores (p < 0.05); they were also more confident in their handoff abilities (p < 0.001). Trainees with higher self-assessed skills and preparedness performed better on the OSCE (p < 0.05).Conclusions: This study provides evidence that incoming trainees are not well prepared to perform handoffs. However, those who received instruction during medical school perform better and are more confident on standardized performance assessments. Given communication failures lead to uncertainty in patient care and increases in medical errors, medical schools should incorporate handoff training as required instruction.

Person‐Centred and Experiential Psychotherapy Scale: Development and reliability of an adherence/competence measure for person‐centred and experiential psychotherapies

Aims: This study aimed to assess the reliability of the Person‐Centred and Experiential Psychotherapy Scale (PCEPS), a new adherence/competence measure of person‐centred and experiential psychotherapies. The PCEPS consists of 15 items with two subscales: Person-Centred Process and Experiential Process. Method: One‐hundred twenty audio‐recorded segments of therapy sessions were rated independently by two teams of three raters using the PCEPS. Half of the segments were 10 minutes long and the other half were 15 minutes long. Six therapists were experienced therapists and four were counsellors in training. Seven of the therapists identified their work as ‘person‐centred’, and three identified their work as ‘process‐experiential’. Three raters were qualified and experienced person‐centred therapists and three raters were person‐centred counselling trainees in their first year of training. Results: Interrater reliabilities were good (alpha: .68–.86), especially when ratings were averaged across items (alpha: .87); interitem reliabilities were quite high (alpha: .98). Exploratory factor analyses revealed a 12‐item facilitative relationship factor that cuts across Person‐Centred and Experiential subscales (alpha: .98), and a nonfacilitative directiveness factor (3 items, alpha: .89). Conclusions/Implications: The PCEPS has potential for use in RCT research as well as in counselling training and supervision, but will require further testing and validation.

Kekurangan energi makanan tidak berefek negatif terhadap pertambahan tinggi badan laki-laki usia 18-21 tahun: Studi di Akademi Angkatan Laut Surabaya

This research was carried out to know increase of growth of males attending Indonesian Naval Academy in order to found the normal growth of healthy males for reference of Indonesia population, especially those in 18 to 21 years age. The variables measured were body height, weight, grip strength, and subscapular, biceps, triceps, and suprailiac skinfold thicknesses, while undergoing the first year of training. This research also analysed the difference between more activities and less activities group, while they were given the same kind and amount of food every day. The sample consisted of 50 male cadets aged 18-21 years. The sample was divided into two groups. Group 1: the group that was enrolled in CC (Cross Country) extra-curricular activity, and Group 2: the group that did not enrol in CC (Cross Country) extra-curricular activity. The two groups experienced the same treatment of basic physical exercises, and both received the same quality and amount of food every day. The Group 1 was arranged to get several additional hours of training in the morning and in the afternoon, related to the CC activities. The individuals within the two groups were measured twice—at the beginning of their training year, and a year later. Paired Sample T Test was used in seeing the difference between the two measurements. This research revealed that the physical exercise that was carried out in the Naval academy for a year did not cause any significant increases in the right and left grip strength of both groups. Both of the groups had a high intensity of physical exercise, consequently the significant declined in skinfold thicknesses. A difference in the increase of weight after a year was found between the two groups. The unsignificant increase of weight was found in Group 1. This was caused by the fact that they were subjected to extra physical training compared to Group 2. Although individuals in Group 1 were having tougher training, evidently they experienced significant increase in body height. Moreover, Group 1 experienced that significant increase in body height even though they did not experience significant increases in body weight. The increase of body height in the two groups possibly was caused by the fact that they were still at the age of growth in length. It might as well caused by good nutritive supplies throughout the year, and regular workouts. A further study comparing the cadets with common people must be carried out to further understand the influence of physical exercise and nutritive supplies to the increase of body height among males within the range of this age group.

Early Prediction of Medical Student Performance on Initial Licensing Examinations

Many medical schools can successfully predict overall performance on the initial licensing examination by the end of the second year. Unfortunately, the time left to remediate students before students take exams is short. The goal of this project was to determine the feasibility of predicting licensing examination scores at the end of the first year of training. Data from three cohorts of medical students, each made up of about 230 individuals from the graduating classes of 2013 to 2015 were used. A series of prediction equations for licensing examination scores, based on class performance, was developed from the first cohort of students. The best predictive equation was applied to the second cohort of students to generate a predicted examination score which was then compared to the actual examination score. This approach was cross-validated with another cohort of students. The R-values for the selected predictive equations ranged from 0.691 to 0.814, accounting from about 48 to 66 % of the variance in actual scores. The mean difference between predicted and actual examination scores was 19 points on a three-digit scale ranging from 200 to 800 for the second cohort and 25 points for the third cohort. The data show that initial licensing examination scores can be successfully predicted 1 year before students take the exam. Success at this task would give medical schools the ability to utilize their available resources efficiently to provide additional assistance to those students in need.

"PADding" My Career with Dr. Mary Ellen Avery.

OPINION article Front. Pediatr., 07 April 2014Sec. Neonatology Volume 2 - 2014 | https://doi.org/10.3389/fped.2014.00029

What's All this Talk About Emotion? Developing Emotional Intelligence in Social Work Students

The capacity to manage emotional reactions effectively, frequently in complex care settings, is central to the role of a social worker. Nonetheless, there is evidence that social work students frequently find their placements emotionally demanding and stressful. It is proposed that emotional intelligence may help students manage their emotional reactions more effectively during placements and their subsequent career. To date, however, little systematic research has explored whether emotional intelligence and associated competencies can be enhanced during social work training and the implications for wellbeing. This paper presents a mixed-methods two-stage study which aimed to increase emotional competencies in social work students during the first year of training. More specifically, it assesses the impact of a workshop designed to enhance emotional competencies and an emotional writing task on levels of emotional intelligence, reflective ability and empathy which were assessed via questionnaire and reflective logs pre- and post-intervention (Times 1 and 2). Levels of reflective ability and empathy increased significantly between Times 1 and 2 and psychological distress decreased. Content analysis of reflective logs found evidence that reflective ability, empathy and emotional intelligence were enhanced following the interventions. The implications of the findings for the development of the curriculum are considered.

Resilience and coping experiences among master's professional psychology students in South Africa

A longitudinal, five year study, with a qualitative, phenomenological approach, investigated resilience and coping experiences of 47 professional psychology master's degree students in their first year of training in South Africa. There were 12 men and 31 women, with a mean age of 26 years and an age range from 21 to 51 years. Findings revealed four main resilience themes of struggle experiences, personal resilience experiences, life management experiences and study experiences, and eight overlapping coping themes involving support from peers, friends, family and spouses; time management; personal skills; study skills; exercise, sport and recreation; personal therapy; spiritual and religious activities; and rest and relaxation. The applicability and value of the findings are discussed in relation to similar local and international studies.

Assessment of the Clinical Trainer as a Role Model

PurposePositive role modeling by clinical trainers is important for helping trainees learn professional and competent behavior. The authors developed and validated an instrument to assess clinical trainers as role models: the Role Model Apperception Tool (RoMAT).MethodOn the basis of a 2011 systematic review of the literature and through consultation with medical education experts and with clinical trainers and trainees, the authors developed 17 attributes characterizing a role model, to be assessed using a Likert scale. In 2012, general practice (GP) trainees, in their first or third year of postgraduate training, who attended a curriculum day at four institutes in different parts of the Netherlands, completed the RoMAT. The authors performed a principal component analysis on the data that were generated, and they tested the instrument’s validity and reliability.ResultsOf 328 potential GP trainees, 279 (85%) participated. Of these, 202 (72%) were female, and 154 (55%) were first-year trainees. The RoMAT demonstrated both content and convergent validity. Two components were extracted: “Caring Attitude” and “Effectiveness.” Both components had high reliability scores (0.92 and 0.84, respectively). Less experienced trainees scored their trainers significantly higher on the Caring Attitude component.ConclusionsThe RoMAT proved to be a valid, reliable instrument for assessing clinical trainers’ role-modeling behavior. Both components include an equal number of items addressing personal (Heart), teaching (Head), and clinical (Hands-on) qualities, thus demonstrating that competence in the “3Hs” is a condition for positive role modeling. Educational managers (residency directors) and trainees alike can use the RoMAT.

Bias in assessing trainees' clinical competence: the influence of assessors' recent experiences of other performances on present assessment scores

BackgroundFair assessment of clinical trainees' competence is crucial to both education and patient safety. Our previous research indicated that assessment judgments might be biased by assessors' recent experiences of judging preceding performances. In two studies, we aimed to assess whether such an effect might bias scores towards (cognitive assimilation) or away from (contrast effect) preceding performances. Additionally we examined whether inducement to consider typical performances could mitigate the effect (robustness), and whether confidence in judgments predicted susceptibility to the effect (insight). MethodsIn two separate studies, consultant doctors were randomised to two groups in an internet-based experimental design. Participants viewed identical, scripted, validated videos of doctors in their first year of training. In study one, participants viewed either three good performances or three poor performances before viewing three borderline performances. In study two, participants viewed six performances in either ascending (two poor, two borderline, two good) or descending (two good, two borderline, two poor) order. Competence scores were compared between groups with 6-point Mini-CEX assessment scales. Additionally, in study two, 7-point confidence ratings, and percent-better ratings (judgments of the proportion of a cohort expected to outperform the currently considered performance) were collected. FindingsWe included 90 consultant doctors (41 in study one, 49 in study two). Both studies showed contrast effects—ie, scores were biased away from preceding performances. In study one, the mean score for borderline videos was 2·7 out of 6 (SD 0·69, 95% CI 2·4–3·0) when preceded by good videos compared with 3·4 out of 6 (0·55, 3·1–3·7, p=0·001) when preceded by poor videos. Failing scores were allocated by 55% and 24% of participants in these groups, respectively (p<0·001). In study two, percent-better ratings did not mitigate the effect (mean ratings 43·4 [13·7, 95% CI 38·4–48·5] vs 57·4 [104, 52·5–62·3] for poor-to-good and good-to-poor groups, respectively; p<0·001). Confidence was unrelated to susceptibility. InterpretationAssessors' scores repeatedly showed moderate-strength contrast effects sufficient to alter pass or fail decisions. Continued susceptibility to this effect despite use of the percent-better rating (designed to stimulate long-term memory of other trainees) indicates robustness. Equal susceptibility to the effect for participants reporting both high and low confidence in their scores indicates lack of insight. This potentially unconscious influence might importantly affect the fairness of clinical examinations. FundingThe Academy at UHSM, Association for the Study of Medical Education.

Developing a Curriculum for Emergency Medicine Residency Orientation Programs

BackgroundNew residents enter emergency medicine (EM) residency programs with varying EM experiences, which makes residency orientation programs challenging to design. There is a paucity of literature to support best practices. ObjectiveWe report on a curriculum development project for EM residency orientation using the Kern Model. CurriculumComponents of the revised curriculum include administrative inculcation into the program; delivering skills and knowledge training to ensure an entering level of competence; setting expectations for learning in the overall residency curriculum; performing an introductory performance evaluation; and socialization into the program. ResultsPost-implementation resident surveys found the new curriculum to be helpful in preparing them for the first year of training. ConclusionsThe Kern Model was a relevant and useful method for redesigning a new-resident orientation curriculum.

Perceived Effects of a Somatic Psychopedagogy (SPP) Program in Nurse Training: An Exploratory Study

Background: Developed in Europe in the 1980’s, somatic psychopedagogy (SPP) is a formative practice geared toward care giving and support. Characterized as a type of mind-body medicine, it examines how the use of the body and its movement allows for the development of one’s conscience, one’s sense of self and of others, which are all desirable qualities for professionals within the health care sector.Purpose: To explore if and how SPP training followed by nurses modifies their perception of the quality of their self awareness, their presence in regard to others, as well as their relationship with respect to health and their professional practice.Methods: Qualitative research based on two types of semi-structured interviews: comprehensive and elicitation. Exploratory interviews with three nurses trained (or in training) in SPP. The content of the interviews was first analyzed thematically then grouped by categories.Findings: The three participants perceived a change in the quality of their presence with respect to themselves and to others as well as changes within the nature of their relationships with their patients, colleagues and healthcare team members. Content analysis of the interviews has allowed us to conclude that relationships with the health care team evolved into a better ability to give recognition and a better quality of interaction between members. Participants also reported an increased ability to express their opinions in both their personal and professional lives. A second level of analysis has allowed for the identification of differences between nurses just finishing their first year of training and those having completed the full four-year course.Conclusion: Interesting transformations are reported at different levels confirming the relevance of a second phase of the project. The latter will permit to identify whether physicians trained in SPP experience changes similar to those of the nurses, and if so, whether they perceive these as having an impact on their practice.

Board 368 - Research Abstract Does Physical Stress Alter Provider Performance? (Submission #1358)

Introduction/Background Anesthesia providers are required to manage emergency situations all over the hospital. Clinicians are generally notified of a crisis without prior warning and expected to arrive within minutes, to rapidly assess the situation and to act immediately and appropriately while still under physical stress from running to the site of the emergency. The necessary measures to respond to the emergency typically require short and long term memory, executive function and technical manual skills. There are conflicting reports in the literature if physical stress affects these skills and if it does so in a positive or negative way.1-8 We therefore designed a study to test the hypothesis that physical stress alters the response of providers to an emergency. Methods The Hypothesis of this study was that physical stress prior to management of a simulated crisis influences clinician performance. The following Specific Aims were investigated: 1) To determine whether the physical stress of running to a crisis affects clinician cognitive performance; 2) To determine whether the physical stress of running to a crisis affects clinician technical performance. Anesthesia providers were prospectively randomized to undergo either physical stress (PS) or no physical stress (NPS) prior to managing one of two randomly assigned simulated operating room crisis events. Physical stress was induced by running a defined distance (1/8 mile at 5% incline) on a treadmill. Running speed was left at the discretion of the provider. Vital signs (HR, RR, SpO2, BP) were recorded before and after the exercise and task performance periods. Both simulated crises incorporated measures of cognitive challenges (short term memory using al list of 10 diagnoses and key factors of the diagnoses) and technical tasks (intubation), as well as focus and executive function (memorizing key parameters of the procedure and the case vignette). At least two weeks later, the same clinicians were subjected to the other scenario (either physical stress or no physical stress) prior to managing the other simulated crisis event. Power analysis indicated a necessary sample of 34 subjects with a power of 80% and a significance level of 0.05. Results Forty subjects were recruited, 38 subjects completed the study. Average running times of 123 (54)s at a speed of 4.86 (1.70) mph were recorded. This caused average heart rate increases from baseline 70 (12)s-1 to 123 (30) s-1 compared to performing the procedure without exercise. The differences in the time that the subjects needed to perform the intubation task after stress was 36 (19)s vs. 37 (18)s (p+ n.s.) without stress. Providers forgot non-significantly more diagnoses from the patient’s history after physical stress (1.56 vs.1.38 parameters; p=n.s.). This trend was more pronounced but not statistically significant (p<0.1) in the 20% of the subjects who took longest to run the distance. There were no significant differences for the subgroups trainee status, first year of training, years of experience, age above 50, CRNA or MD, age, gender, or heart rate percentiles. Conclusion Our Results indicate that both technical and cognitive performance is maintained in the setting of moderate physical stress when providers are allowed to run at their own speed to the site of the intervention. Further research is needed to determine if different degrees of physical and other stress will cause impediment in technical skills and cognitive function.

Starting out - Inpatients with dementia showed me how much we need to improve care.

I was on a gastroenterology ward placement during my first year of training when I read a poem by an unknown author with dementia.

Peer mentoring: evaluation of a novel programme in paediatrics

BackgroundMentoring is important for personal and professional development of doctors. Peer mentoring is a core skill in the UK paediatric postgraduate curriculum. However, there is a paucity of peer mentoring...

Qualité des soins, gestion du risque et technologie obstétricale (QUARITE) : un essai contrôlé en grappe pour réduire la mortalité maternelle hospitalière au Sénégal et au Mali

to assess the level, type and content of pre-service education curricula of health workers providing maternity services against the ICM global standards for Midwifery Education and Essential competencies for midwifery practice. We reviewed the quality and relevance of pre-service education curricula of four cadres of health-care providers of maternity care in Northern Nigeria.we adapted and used the ICM global standards for Midwifery Education and Essential competencies for midwifery practice to design a framework of criteria against which we assessed curricula for pre-service training. We reviewed the pre-service curricula for Nurses, Midwives, Community Health Extension Workers (CHEW) and Junior Community Health Extension Workers (JCHEW) in three states. Criteria against which the curricula were evaluated include: minimum entry requirement, the length of the programme, theory: practice ratio, curriculum model, minimum number of births conducted during training, clinical experience, competencies, maximum number of students allowable and proportion of Maternal, Newborn and Child Health components (MNCH) as part of the total curriculum.four pre-service education programmes were reviewed; the 3 year basic midwifery, 3 year basic nursing, 3 year Community Health Extension Worker (CHEW) and 2 year Junior Community Health Extension Worker (JCHEW) programme. Findings showed that, none of these four training curricula met all the standards. The basic midwifery curriculum most closely met the standards and competencies set out. The nursing curriculum showed a strong focus on foundations of nursing practice, theories of nursing, public health and maternal newborn and child health. This includes well-defined modules on family health which are undertaken from the first year to the third year of the programme. The CHEW and JCHEW curricula are currently inadequate with regard to training health-care workers to be skilled birth attendants.although the midwifery curriculum most closely reflects the ICM global standards for Midwifery Education and Essential competencies for midwifery practice, a revision of the competencies and content is required especially as it relates to the first year of training. There is an urgent need to modify the JCHEW and CHEW curricula by increasing the content and clinical hands-on experience of MNCH components of the curricula. Without effecting these changes, it is doubtful that graduates of the CHEW and JCHEW programmes have the requisite competencies needed to function adequately as skilled birth attendants in Health Centres, PHCs and MCHs, without direct supervision of a midwife or medical doctor with midwifery skills.