Competent Health Professionals Research Articles

Culturally adapted mental healthcare: evidence, problems and recommendations.

Evidence suggests disparities in the prevalence of mental health problems and access to mental healthcare for a number of minority groups. The main response from mental health services falls into two related categories: (a) cultural adaptations of existing evidence-based interventions (EBIs) and/or (b) cultural competence of mental health professionals. This editorial looks at the evidence on culturally adapted EBIs and argues that although such interventions can be effective, they also carry the risk of alienating members of the groups they are aimed at. Recommendations focus on identifying issues that pertain to being from a racial minority and/or possessing other stigmatised identities that can have an impact on mental health problems, which may be overlooked by mental health services by assuming an overarching predominant cultural identity.

Do Health Professionals Need Additional Competencies for Stratified Cancer Prevention Based on Genetic Risk Profiling?

There is growing evidence that inclusion of genetic information about known common susceptibility variants may enable population risk-stratification and personalized prevention for common diseases including cancer. This would require the inclusion of genetic testing as an integral part of individual risk assessment of an asymptomatic individual. Front line health professionals would be expected to interact with and assist asymptomatic individuals through the risk stratification process. In that case, additional knowledge and skills may be needed. Current guidelines and frameworks for genetic competencies of non-specialist health professionals place an emphasis on rare inherited genetic diseases. For common diseases, health professionals do use risk assessment tools but such tools currently do not assess genetic susceptibility of individuals. In this article, we compare the skills and knowledge needed by non-genetic health professionals, if risk-stratified prevention is implemented, with existing competence recommendations from the UK, USA and Europe, in order to assess the gaps in current competences. We found that health professionals would benefit from understanding the contribution of common genetic variations in disease risk, the rationale for a risk-stratified prevention pathway, and the implications of using genomic information in risk-assessment and risk management of asymptomatic individuals for common disease prevention.

Effect of a Novel Interdisciplinary Teaching Program in the Care-continuum on Medical Student Knowledge and Self-Efficacy

ObjectivesMedical students report that they receive inadequate training in different levels of care, including care transitions to and from post-acute (PA) and long-term care (LTC). The authors implemented the Medical Students as Teachers in Extended Care (MedTEC) program as an educational innovation at the Cleveland Clinic to address training in the care-continuum, as well as the new medical student and physician competencies in PA/LTC. DesignMedTEC is a 7-hour interactive program that supplements standard geriatric didactics during the medical student primary care rotation. This study evaluated the performance of the program in improving medical student knowledge and attitudes on levels and transitions of care. SettingThe program occurs in a community facility that includes subacute/skilled nursing, assisted living, and nursing home care. ParticipantsFive to 8 students completing their primary care rotation at the Cleveland Clinic are required to participate in the MedTEC program each month. InterventionThe program includes up to 3 hours of interactive discussion and opportunities to meet facility staff, residents, and patients. The highlight of the program is a student-led in-service for facility staff. MeasurementsWith institutional review board approval as an exempt educational research project, pre- and postactivity surveys assessed self-efficacy and knowledge regarding levels of care for students who participated in the program and a student comparison group. The post-program knowledge test also was administered to hospital medicine staff, and test performance was compared with medical students who participated in the MedTEC program. ResultsBetween October 2011 and December 2013, approximately 100 students participated in 20 sessions of MedTEC. All students reported improved self-efficacy and attitudes regarding care of older adults and care transition management. Mean percentage correct on the knowledge test increased significantly from 59.8% to 71.2% (P = .004) for the MedTEC participants but not for the comparison group students (63.1%–58.3%, P = .47). There was no significant difference in mean percentage correct on the post-program knowledge test between MedTEC medical students and hospitalists (71.0% versus 70.3%, P = .86). Students led 8 in-service sessions for facility staff on various topics relating to the care of older adults in PA/LTC. ConclusionThe MedTEC program appears to be a successful innovation in medical student education on levels of care. It could serve as a model for building competency of health professionals on managing care transitions and determining appropriate levels of care for older adults.

GOOD TEACHER

Background: The enriched learning and effective teaching is one of necessaryaspect to develop competent health professionals. In literature number of studies presentsthe best qualities of an effective teacher. There are different descriptive surveys depictingthe rating of student and expert professional opinion. Objectives: The purpose of this studywas to determine the top qualities of a good teacher in health sciences. Materials and StudyDesign: A descriptive cross sectional study. Methods: Setting: Riphah College of rehabilitationsciences. Period: January – February 2014. Methods: 179 students were recruited in sample.A structured questionnaire was prepared and twenty qualities were selected after the detailreview of literature. A scale ranging from 1 to 5 were described against each qualities fromstrongly disagree to strongly agree. Results: The result showed that the top qualities rankedby the students were effective communication skills score 112, encourage students 103, soundknowledge 100 and good presentation skills 99. The lowest score qualities were constructivecriticism 28 and sense of humor 53. The 49% students want to be teacher while 51% don’twant to be teacher in future. Conclusion: A good teacher has vital role in producing a goodstudent. According to the perception of students a good teacher must have strong and effectivecommunication skill, ability to motivate students and must have sound knowledge of subjects.This study suggests the basic training program for teacher to enhance the student teacherrelationship. Further study should be done to explore the teacher’s perception of a good teacher.

'Right' for publication: strategies for supporting novice writers across health and medical disciplines.

The idea that scholarly writing is an integral part of academic and clinical work is not new; however, increasing expectations that health professionals contribute to research output through publication, regardless of level of employment or experience, creates anxiety and dissonance for many novice and sometimes not-so-novice writers. Publications and the impact of scholarly work have become the key indicators not only of the performance of individual health academics, but also of health disciplines and universities more broadly. In Australia, as in many other countries, publications as the measure of research impact and outputs are expected in professional disciplines, universities and schools. Research impact is assessed and rated against other institutions and used as a means of allocating scarce research funding. Publishing has become a matter of professional reputation and sustainability. This paper reports on a project designed to enhance publication rates across health disciplines based at a rural university, where many staff members combine academic work with ongoing clinical roles. Without deliberate and focused support to enhance skills and confidence in writing it was unlikely that these academics and clinical staff members would be able to develop the kind of track record required for a successful academic career or promotion. This paper outlines the development, delivery and outcomes of this university-funded project, which drew on evidence in the literature to increase the publication rates across two Schools (Health and Medicine) at a rural university.

Career Planning in Public Health

Career Planning in Public Health

Immunizing Children

This article addresses the complex contexts within which Canadian health professionals engage in immunizing children and focuses on the Canadian practice guidelines and current scientific evidence that direct Canadian health professional competencies. The article begins by presenting two current global vaccine initiatives and links these to immunization in Canada. A selected literature review identifies current best immunization practices. With the purpose of promoting quality improvement, three key Canadian immunization competencies for health professional are highlighted: communication with parents, including those who are experiencing vaccine hesitancy; administration of immunizing agents; and documentation of immunizations. Health professionals are encouraged to reflect on immunization competencies and ensure evidence-based practices underpin vaccine delivery in their primary care settings.

Future directions for public health education reforms in India.

Health systems globally are experiencing a shortage of competent public health professionals. Public health education across developing countries is stretched by capacity generation and maintaining an adequate ‘standard’ and ‘quality’ of their graduate product. We analyzed the Indian public health education scenario using the institutional and instructional reforms framework advanced by the Lancet Commission report on Education of Health Professionals. The emergence of a new century necessitates a re-visit on the institutional and instructional challenges surrounding public health education. Currently, there is neither an accreditation council nor a formal structure or system of collaboration between academic stakeholders. Health systems have little say in health professional training with limited dialogue between health systems and public health education institutions. Despite a recognized shortfall of public health professionals, there are limited job opportunities for public health graduates within the health system and absence of a structured career pathway for them. Public health institutions need to evolve strategies to prevent faculty attrition. A structured development program in teaching–learning methods and pedagogy is the need of the hour.

Tendências e prioridades das pesquisas na saúde do idoso no contexto da enfermagem brasileira

Tendências e prioridades das pesquisas na saúde do idoso no contexto da enfermagem brasileira

Interprofessional socialization as a way to introduce collaborative competencies to first-year health science students

Interprofessional education (IPE) is the cornerstone of preparing future health care providers but remains to be a challenge for many health science programs. We aimed to develop and evaluate an interprofessional conference for first-year health science students with goals to provide students with interprofessional socialization opportunity and introduce IPE principles. A half-day conference was based upon core competencies for health professionals and involved 277 first-year health sciences, nursing, pharmacy, physical therapy, and speech language pathology and audiology students. Alcohol and substance misuse was chosen as a topic for its relevance to college students and health professionals. Results from program evaluation revealed that the conference was successful in exposing students to core interprofessional competencies and provided useful information about alcohol and substance misuse. This study advocates for early inclusion of IPE in the health professions curricula in the form of interprofessional socialization.

Milestones of Critical Thinking

Critical thinking is essential to a health professional's competence to assess, diagnose, and care for patients. Defined as the ability to apply higher-order cognitive skills (conceptualization, analysis, evaluation) and the disposition to be deliberate about thinking (being open-minded or intellectually honest) that lead to action that is logical and appropriate, critical thinking represents a "meta-competency" that transcends other knowledge, skills, abilities, and behaviors required in health care professions. Despite its importance, the developmental stages of critical thinking have not been delineated for nurses and physicians. As part of a task force of educators who considered different developmental stage theories, the authors have iteratively refined and proposed milestones in critical thinking. The attributes associated with unreflective, beginning, practicing, advanced, accomplished, and challenged critical thinkers are conceived as independent of an individual's level of training. Depending on circumstances and environmental factors, even the most experienced clinician may demonstrate attributes associated with a challenged thinker. The authors use the illustrative case of a patient with abdominal pain to demonstrate how critical thinking may manifest in learners at different stages of development, analyzing how the learner at each stage applies information obtained in the patient interaction to arrive at a differential diagnosis and plan for evaluation. The authors share important considerations and provide this work as a foundation for the development of effective approaches to teaching and promoting critical thinking and to establishing expectations for learners in this essential meta-competency.

A comprehensive representation of the birth-experience: identification and prioritization of birth-specific domains based on a mixed-method design.

BackgroundIn obstetrics, effectiveness and cost-effectiveness studies often present several specific outcomes with likely contradicting results and may not reflect what is important for women. A birth-specific outcome measure that combines the core domains into one utility score would solve this problem. The aim of this study was to investigate which domains are most relevant for women’s overall experience of labor and birth and should be included in such a measure.MethodsA sequential mixed-method design with three steps was applied. First, the domains were identified by literature review and online focus groups consisting of pregnant women, women who recently gave birth, and their partners. Second, in a prioritizing task, women who recently gave birth and professionals (midwives, gynecologists, and researchers) selected and ranked their top seven domains. Third, the domains that were most frequently selected and had the highest ranking scores determined the basis for a consensus discussion with experts, whereby the definitive list of domains was formed.ResultsIn the first step, 34 birth-specific domains were identified, which cover domains regarding the caregivers, intrapersonal aspects of the mother, partner support, and contextual and medical aspects of birth. Based on the prioritizing task results (step 2) of 96 women and 89 professionals, this list was reduced to 14 most relevant domains. In a consensus discussion, the final seven domains were selected by combining several of the 14 remaining domains and giving priority to the domains indicated to be relevant by mothers. The seven definite domains were: 1) availability of competent health professionals; 2) health professionals’ support; 3) provision of information; 4) health professionals’ response to needs and requests; 5) feelings of safety; 6) worries about the child’s health; and 7) experienced duration until the first contact with the child.ConclusionsThe experienced availability and quality of received care, concerns about safety and the baby’s health, and first contact with the baby are regarded as key aspects for a mother’s overall birth experience. Therefore, these domains are considered to be the most crucial for inclusion in a birth-specific outcome measure.

Helping Improve Dissemination of Research: Toastmasters Is a Novel Mechanism

Competencies for health professionals and students often include the ability to transfer knowledge to different audiences in a variety of ways. Consultation, presentation, teaching, multimedia, and posters are some examples. A recent question on a national listserv about writing, editing, and proofreading services in health sciences libraries prompted this column about a potentially novel way of helping students and faculty in health disciplines to improve their abilities to communicate professionally. In addition to the poster design and review services that one library offers, it is also the host of two Toastmasters International clubs that provide participants a nonthreatening, real-world environment to improve the content, structure, methods, and delivery of their written and spoken messages. A librarian on staff is a member of and serves as liaison to the two clubs.

New pharmacists: Take care of those babies

As a hospital pharmacy resident in 1979–80, I never missed an opportunity to round in pediatrics. Even though "clinical" was just a few weeks of my yearlong experience at the University of Texas Medical Branch (UTMB) at Galveston, I followed one of the pediatric teams all year, changing service when they did and showing up for rounds at 7:00am on any morning when I could take the beeper and slip away from my assigned area.

Core Competencies for Health Professionals' Training in Pediatric Behavioral Sleep Care: A Delphi Study

The need to train non-sleep-specialist health professionals in evidence-based pediatric behavioral sleep care is well established. The objective of the present study was to develop a list of core competencies for training health professionals in assisting families of 1- to 10-year old children with behavioral insomnia of childhood. A modified Delphi methodology was employed, involving iterative rounds of surveys that were administered to 46 experts to obtain consensus on a core competency list. The final list captured areas relevant to the identification and treatment of pediatric behavioral sleep problems. This work has the potential to contribute to the development of training materials to prepare non-sleep-specialist health professionals to identify and treat pediatric behavioral sleep problems, ideally within stepped-care frameworks.

The Tennessee Department of Health WORKshops on Use of Secondary Data for Community Health Assessment, 2012

Community health assessment is a core function of public health departments, a standard for accreditation of public health departments, and a core competency for public health professionals. The Tennessee Department of Health developed a statewide initiative to improve the processes for engaging county health departments in assessing their community’s health status through the collection and analysis of secondary data. One aim of the Tennessee Department of Health was to position county public health departments as trusted leaders in providing population data and engaging community stakeholders in assessments. The Tennessee Department of Health’s Division of Policy, Planning, and Assessment conducted regional 2-day training workshops to explain and guide completion of computer spreadsheets on 12 health topics. Participants from 93 counties extracted data from multiple and diverse sources to quantify county demographics, health status, and resources and wrote problem statements based on the data examined. The workshops included additional staff development through integration of short lessons on data analysis, epidemiology, and social-behavior theory. Participants reported in post-workshop surveys higher degrees of comfort in interpreting data and writing about their findings on county health issues, and they shared their findings with health, hospital, school, and government leaders (including county health council members) in their counties. Completion of the assessments enabled counties and the Tennessee Department of Health to address performance-improvement goals and assist counties in preparing to meet public health accreditation prerequisites. The methods developed for using secondary data for community health assessment are Tennessee’s first-phase response to counties’ request for a statewide structure for conducting such assessments.

Work‐based assessment: qualitative perspectives of novice nutrition and dietetics educators

The assessment of competence for health professionals including nutrition and dietetics professionals in work-based settings is challenging. The present study aimed to explore the experiences of educators involved in the assessment of nutrition and dietetics students in the practice setting and to identify barriers and enablers to effective assessment. A qualitative research approach using in-depth interviews was employed with a convenience sample of inexperienced dietitian assessors. Interviews explored assessment practices and challenges. Data were analysed using a thematic approach within a phenomenological framework. Twelve relatively inexperienced practice educators were purposefully sampled to take part in the present study. Three themes emerged from these data. (i) Student learning and thus assessment is hindered by a number of barriers, including workload demands and case-mix. Some workplaces are challenged to provide appropriate learning opportunities and environment. Adequate support for placement educators from the university, managers and their peers and planning are enablers to effective assessment. (ii) The role of the assessor and their relationship with students impacts on competence assessment. (iii) There is a lack of clarity in the tasks and responsibilities of competency-based assessment. The present study provides perspectives on barriers and enablers to effective assessment. It highlights the importance of reflective practice and feedback in assessment practices that are synonymous with evidence from other disciplines, which can be used to better support a work-based competency assessment of student performance.

Health Literacy Practices and Educational Competencies for Health Professionals: A Consensus Study

Health care professionals often lack adequate knowledge about health literacy and the skills needed to address low health literacy among patients and their caregivers. Many promising practices for mitigating the effects of low health literacy are not used consistently. Improving health literacy training for health care professionals has received increasing emphasis in recent years. The development and evaluation of curricula for health professionals has been limited by the lack of agreed-upon educational competencies in this area. This study aimed to identify a set of health literacy educational competencies and target behaviors, or practices, relevant to the training of all health care professionals. The authors conducted a thorough literature review to identify a comprehensive list of potential health literacy competencies and practices, which they categorized into 1 or more educational domains (i.e., knowledge, skills, attitudes) or a practice domain. The authors stated each item in operationalized language following Bloom's Taxonomy. The authors then used a modified Delphi method to identify consensus among a group of 23 health professions education experts representing 11 fields in the health professions. Participants rated their level of agreement as to whether a competency or practice was both appropriate and important for all health professions students. A predetermined threshold of 70% agreement was used to define consensus. After 4 rounds of ratings and modifications, consensus agreement was reached on 62 out of 64 potential educational competencies (24 knowledge items, 27 skill items, and 11 attitude items), and 32 out of 33 potential practices. This study is the first known attempt to develop consensus on a list of health literacy practices and to translate recommended health literacy practices into an agreed-upon set of measurable educational competencies for health professionals. Further work is needed to prioritize the competencies and practices in terms of relative importance.

An evaluation of case formulation training and consultation with probation officers

Formulation is a core competency of mental health professionals, drawing on a variety of sources of information. In England and Wales, the current strategy for offenders with personality disorder places formulation-led management, generally by probation staff, at its core, but reliability and validity of the process remain unclear. The first aim was to evaluate a checklist previously designed to establish quality of formulation, and the second to measure the impact of training and consultation on the ability of probation officers to formulate cases. The inter-rater reliability, test-re-test reliability and internal consistency of the McMurran formulation checklist were calculated from the scores derived from randomised formulations completed by probation officers from fictitious case vignettes. The impact of training was measured by comparing pre- and post-training formulations of these vignettes. Practice cases formulated by probation officers at psychologist-facilitated consultation meetings over a 6-month period were used to measure the impact of consultation. All formulations were scored blind by independent experts. Inter-rater reliability, test-re-test reliability and internal consistency of the scale were all acceptable. Training and practice did not significantly improve the probation officers' formulations. The purpose and utility of formulation may vary according to the context in which it is applied. Progress in developing formulation skills may depend on the nature and length of the previous experience of this skill. Future research should take account of such variance, with this scale as a potentially useful aid in monitoring progress. The capacity for teaching formulation to probation officers could be investigated further by comparing the process with formulation development by mental health experts with previously extensive formulation experience. Formulation will probably need to be adapted to meet the needs of the context in which it is developed. The relationship between formulation and management outcome was not investigated here and would be a further important step.

Influence of the leaders on cultural competences of health professionals: a social network analysis of the COMETH project in Belgium

Background: In most European metropolitan areas, health services are required to provide culturally competent health care to ethnic minority patients. So far this goal has remained elusive because the cultural competences have been mostly considered as an individual competence. We aimed at investigating the role of inter-professionals ties on the diffusion of cultural competence within health care organisations. We tested the following hypothesis: An individual is more likely to be culturally competent if his leader is culturally competent himself. Methods: We carried out a social network analysis of 24 inpatient and outpatient health services, selected according to their geographic localisation and their degree of patient-centeredness. All healthcare professionals were requested to fill in a questionnaire tapping their level of cultural competences and their inter-professionals ties. We identified the most central actors within each health service according to the in-degree centrality. We regressed the individual cultural competences on the leader cultural competences. Results: Bivariate regression indicated that the cultural competences of the individuals increased with the cultural competences of the leaders (beta=0.24, p<0.01). After controlling for contextual and individual variables, individual cultural competences increased with the cultural competences of the leaders (beta=0.20, p<0.01). We found that the leadership effect was higher for older leaders than for younger leaders. Conclusions: Cultural competences are spread among health professionals through role-modelling. Implementation of the cultural competences requires an appraisal of social ties and leadership within the health services.