Hospital-based Training Program Research Articles

Multisite assessment of emergency medicine resident knowledge of evidence-based medicine as measured by the Fresno Test of Evidence-Based Medicine.

Evidence-based medicine (EBM) is the application of scientific evidence while treating a patient. To date, however, there is very little evidence describing how residents in emergency medicine understand and incorporate EBM into practice. The aim of this study was to determine EBM theoretical and quantitative knowledge in emergency medicine residents in community hospital-based training programs. A sample of emergency medicine residents from nine hospitals was enrolled to complete a cross-sectional assessment of EBM skills from April 2021 through June 2021. Performance on the Fresno Test of Evidence-Based Medicine (FTEBM) was assessed utilizing descriptive statistics, t tests, and one-way analysis of variance. A total of 50.8% (124/244) of current emergency medicine residents completed the FTEBM during the study period. No significant difference on FTEBM scores was noted between the different types of medical degrees (DO vs. MD) (p=0.511), holding an advanced research degree (p=0.117), or between each postgraduate year of training (p=0.356). The mean score of those residents who rated their knowledge of EBM as average or higher was 36.0% (32.8-39.1%). The mean score of those residents who rated their programs as having an "average" or higher institutional focus on EBM was 34.9% (32.2-37.6%). Participating emergency medicine residents show an incomplete understanding of EBM both in theory and applied computations despite rating themselves as having an average understanding. Emergency medicine residencies would be well suited to implement a standardized EBM curriculum that focuses on longitudinal reinforcement of key concepts needed for the practicing physician.

The Current Status of Hospital-Based Training Program on Nurse Practitioners in Taiwan

<p>專科護理師在台灣發展近30年，過去的專科護理師培訓以專業知識為主，以符合臨床照護需求。近年來，專科護理師的角色逐漸被重視，開始擔負起在專科護理師領域的領導者角色，但每家醫院對專科護理師的要求標準不一致，除擔任專科護理師行政管理者的工作外，亦須同時兼顧臨床專科護理師的角色，繁重的行政工作造成專科護理師主管相當大的工作負荷，例如處理人力短缺、排班、留任、訓練、考核等，同時執行臨床照護與行政管理的工作，造成專科護理師擔任行政主管的意願不高。因此，專科護理師學會規劃領導系列培訓課程，期望能增進專科護理師行政主管的領導能力，除了在醫院帶領專科護理師的專業發展，也期許發揮影響力能讓世界看見台灣專科護理師。</p> <p> </p><p>The development of nurse practitioner in Taiwan has been more than thirty years. Several reasons were behind the beginning of the nurse practitioner development, including the shortfall of resident doctors, lacking of nursing professional autonomy, and shortage of preceptor in advanced nursing. As a result, the doctors were responsible for the training program. After the laws were established to regulate the role of nurse practitioner with efforts from the government and scholars supporting the nurse practitioner education, many preceptors as trainees of nurse practitioner became important roles as instructors in hospitals. Taiwan’s nurse practitioner education mainly provided in hospital because the demand for nurse practitioner is still increasing in medical system and this phenomenon is a far cry from the overseas nurse practitioner training programs, which are provided in the higher education.The design of the nurse practitioner training program should base on the core competencies, and the advanced nursing curriculum should include 3Ps, such are physical assessment, pathology and pharmacology.Can the short-term hospital training program meet the expectation? Therefore, this study aims to introduce the origins of the hospital training system for nurse practitioners in Taiwan, the content of the training curriculum and the core competencies of the nurse practitioner. By doing so, we hope the readers can extend the discussion on the hospital training program to a wider scope.</p> <p> </p>

Multidisciplinary simulation training for endotracheal intubation during COVID-19 in one Hong Kong regional hospital: strengthening of existing procedures and preparedness

IntroductionIn early 2020, our hospital responded with high alertness when novel coronavirus SARS-CoV-2 appeared. A hospital-based training programme was rapidly arranged to prepare staff for the imminent threat.ObjectiveWe developed a...

Oncology Nurse Managers' Perceptions of Palliative Care and End-of-Life Communication.

The purpose of this study was to describe pediatric oncology nurse managers' (NMs) perspectives of palliative care/end-of-life (PC/EOL) communication. The study, guided by group-as-a-whole theory and empirical phenomenology, was part of a larger, multisite study aimed at understanding pediatric oncology nurses' experiences of PC/EOL communication. Nurses were assigned to focus groups based on length or type of experience (i.e., nurses with <1, 2-5, or >5 years' work experience and NMs). Eleven NMs from three Midwestern pediatric hospitals with large oncology programs participated in one focus group. The participants' mean years of experience was 15.8 in nursing and 12 in pediatric oncology; 90% had a BSN or higher degree; all had supervisory responsibilities. The authors identified 2,912 meaning statements, which were then analyzed using Colaizzi's method. Findings include NMs' overall experience of "Fostering a Caring Climate," which includes three core themes: (1) Imprint of Initial Grief Experiences and Emotions; (2) Constant Vigilance: Assessing and Optimizing Family-Centered Care; and (3) Promoting a Competent, Thoughtful, and Caring Workforce. Findings indicate that pediatric oncology NMs draw on their own PC/EOL experiences and their nursing management knowledge to address the PC/EOL care learning needs of nursing staff and patient/family needs. NMs need additional resources to support nursing staff's PC/EOL communication training, including specific training in undergraduate and graduate nursing programs and national and hospital-based training programs.

Simulation-based educational package to improve delivery of the deeply impacted fetal head at caesarean section.

Deeply impacted fetal head at caesarean section at full dilation is a rare obstetric emergency, and exposure for trainees can be limited. We aimed to pilot and evaluate a hospital-based training program incorporating mastery learning principles for trainees performing caesarean section at full dilation. We demonstrated improvements in knowledge, skills and self-confidence, and feel that this educational package shows promise as an important component of obstetric training, and warrants further exploration in the future.

Trauma care in India: A review of the literature

We reviewed the published literature related to prehospital and hospital trauma care in India to identify how trauma care is defined in the literature and what factors limit the delivery of appropriate trauma care. In summarizing the evidence and recommendations regarding trauma care, this review identifies essential research and development goals to address the burden of injury in India. A review of the literature was conducted between August 2014 and September 2014. The literature was sorted into 3 categories: prehospital care, hospital clinical care, and hospital administrative care. The characteristics of trauma care were explored using the Essential Trauma Care Project of the World Health Organization. A total of 38 studies were included. Prehospital care lacked care provided at the scene of the injury, timely transport to a hospital, and transport via ambulance. With regard to hospital care, we found a lack of capabilities of basic clinical care, such as airway management, insertion of chest tubes, and efforts at resuscitation. There was a lack of administrative capabilities, including trauma data systems, trauma-specific training, quality improvement, and development of designated trauma teams. The high rate of injury-related deaths and disabilities in India could be in part due to the absence of integrated and organized systems of trauma care. In the prehospital setting, a multisector approach must be implemented to address the training of emergency medical service providers and community members. Prehospital transport time can be decreased through improved communication and transport modalities. The Indian trauma care system could also be strengthened through hospital-based training programs and trauma response teams.

What has happened to the practice of short term dynamic psychotherapy in Australia's mental health services? A multidisciplinary training programme in Western Sydney.

Short term psychodynamic psychotherapies have been markedly phased out of Australia's mental health services. This paper aims to describe the successful introduction of a Conversational Model of Short Term Intensive Psychodynamic Psychotherapy into a public health service in an attempt to revive its practice. A brief review of relevant papers in the Royal Australian & New Zealand College of Psychiatrists journals since 1980 gives a background to the decline of dynamic psychotherapy in Australia. The development of a Conversational Model of Short Term Intensive Psychodynamic Psychotherapy in the author's private practice over 20 years, and its introduction into a hospital-based training programme are described. A structured programme by scholarship has been offered yearly since 2011 to 10 multidisciplinary mental health clinicians of the Western Sydney Health District. Trainees see two patients from their own service. Over three years, 29 trainees have treated 57 patients with weekly supervision provided. The model has been easily learned. Trainees report a sense of re-invigoration, refinement of existing skills and acquisition of new skills. Resolution of problems in a significant number of patients is noted and improvement and satisfaction reported by others. A valuable service is provided and research is underway.

Internal Medicine Residency Training on Topics in Ambulatory Care: A Status Report

Internal Medicine Residency Training on Topics in Ambulatory Care: A Status Report

Excellent Laparoscopic Gastric Bypass Outcomes Can be Achieved at a Community-Based Training Hospital With Moderate Case Volume

Our objective was to assess laparoscopic gastric bypass outcomes in a moderate case volume setting. Laparoscopic gastric bypass remains one of the most advanced laparoscopic procedures currently performed worldwide. The following represents a single institutional series from a community hospital-based training program with a minimally invasive bariatric surgical program. Data from all patients undergoing laparoscopic gastric bypass since the inception of the program were entered into a prospective database. Measured outcomes included length of operation, length of stay, major and minor complications, and percentage excess weight loss. Results were compared with published outcomes from a review of the literature encompassing more than 3400 cases using chi and Fisher exact tests. Between September 2001 and October 2008, 700 consecutive patients underwent laparoscopic gastric bypass. The mean age was 43.1 +/- 9.5 years, and 83% were female. The mean initial weight was 135.5 +/- 22.4 kg. The initial body mass index was 47.9 +/- 6 kg/m. The mean length of stay was 2.2 +/- 0.9 days. The length of operation was 147.8 +/- 31.8 minutes. The mean percent excess weight loss at 1-year postoperative was 72.4%. There were no mortalities. Compared with the literature, we achieved a lower rate of anastomotic leak (0.3% vs. 2%, P = 0.001) and stomal stenosis (1% vs. 4.7%, P = 0.001). Excellent outcomes following laparoscopic gastric bypass can be achieved in a community hospital-based program with moderate case volume. Reimbursement decisions should take into consideration a program's actual outcomes rather than volume.

Teaching Community Pediatrics: A Community Resource Fair for Residents

Pediatric residency programs are required to provide community and child advocacy experiences, but providing such community knowledge within the context of a busy, largely hospital-based training program can be challenging. To assess the effectiveness of a community resource fair as a tool for increasing residents' knowledge of community-oriented care resources. We organized a community resource fair for pediatrics and family medicine residents. Exhibitors (n = 31) represented a wide range of pediatric resources. An anonymous preassessment and postassessment was administered. Thirty-two trainees participated in the resource fair. On the basis of the preassessment, 62% (8 of 13) of the pediatrics residents reported that they had little or no knowledge about community resources, while 38% (5 of 13) were neutral; none felt somewhat or very knowledgeable. After the fair, 91% (10 of 11) of residents felt somewhat knowledgeable and 9% (1 of 11) felt very knowledgeable about community resources. Of the resident participants, 92% (12 of 13) found this to be a "worthwhile experience." The community resource fair provides an interactive format that brings residents and community organizations face-to-face to discuss what services are offered and how they can work together to coordinate patient care.

Development of an instrument to measure the clinical learning environment in diagnostic radiology

A clinical learning environment survey instrument was developed that provided insights into diagnostic radiology trainees' perceptions of the culture and context of the hospital-based training programme. The survey was completed by trainees allocated to 37 important training hospitals in Australia, New Zealand and Singapore in 2006. The main findings were that most obvious strengths of the diagnostic radiology programme are the wide variety of work-based learning opportunities and the social atmosphere. These were well regarded in all training sites. Work overload was seen as a significant problem in most hospitals and will probably remain a challenge. The areas that are most likely to repay efforts to bring about change are supervision and feedback. The study provides baseline data against which the influence of changes to the training programme may be evaluated.

PR_278: The Efficacy of a Home-Based Cognitive Rehabilitation Program in Patients With Cognitive Dysfunction After Stroke

Objective: To evaluate the efficacy of a home-based cognitive rehabilitation program (HCRP) for chronic stroke patients with cognitive dysfunction. Design: Before-after trial (case series). Setting: General community-based cognitive rehabilitation program. Participants: 6 patients with cognitive dysfunction at least 6 months after stroke onset participated in this study. Inclusion criteria were under age of 65, Korean version of the Mini-Mental Status Examination (K-MMSE) scores between 10 to 24 points, no aphasia and depression, and the participants who had a responsible caregiver for continuous monitoring of individual HCRP. Interventions: We had provided basic instructions and individualized HCRP, which consisted of a total of 2 hours of daily activities, such as study with structured cognitive training materials, reading newspapers, magazines or books, aerobic exercise, and mental exercise (card game, chess, or computer game) and other meta-cognitive activities. Total duration of programs was 12 weeks and patient’s performance was monitored by the same caregiver using a checklist. During the program the occupational therapist communicated with the caregivers once a week to check patient progress, to help resolve any problems, or to provide additional instructions or programs. Main Outcome Measures: K-MMSE, Neurobehavioral Cognitive Status Examination (K-NCSE), cognitive function evaluation for attention, memory, executive function using the Computerized Neuropsychological Test, Lowenstein Occupational Therapist Cognitive Assessment, Korean version of Modified Barthel Index (K-MBI), and Korean instrumental activity of daily living (K-IADL) at the time of initiation and after completion of programs. Results: After completing the 12-week training program, the trained patients showed significantly higher performance in K-IADL (P<.05) and a trend of improvement in K-MMSE (P=.058), K-NCSE (P=.078), K-MBI (P=.068). Conclusions: The individualized HCRP has beneficial effects on chronic stroke patients with cognitive dysfunction, especially on IADL, and HCRP is an effective cognitive rehabilitation method with relatively lower cost than hospital-based training programs.

What do residents learn by meeting with families of children with disabilities?: A qualitative analysis of an experiential learning module

Attitudes of medical providers towards persons with disabilities can affect the quality of care their patients receive. The authors evaluated an experiential learning module to investigate what Paediatric and Medicine/Paediatric residents at the University of Miami/Jackson Memorial Hospital learn from visiting the homes of families with children who have disabilities. Families were recruited through a community-based parent organization. The families were instructed to discuss what it is like to have a child with a disability and to think about a primary message to give to residents during a 1-2 hour home visit. Since 1998, residents participated as part of the required Developmental Paediatrics rotation. They were instructed to write a one-page narrative description of their visit. The authors utilized the grounded theory of qualitative research and content analysis to count the key themes identified in the residents' descriptions. Twenty-four families and 63 residents participated in the learning module. The resident observations yielded four major themes. Twenty-four per cent stated families needed more information; 79% noted that families face various obstacles, including financial (33%), medical providers' pessimism (29%), inter-personal family conflicts (27%) and medical system problems (22%); 49% of residents commented that families adjust and cope with their child's disability; and 27% of residents stated that the experience changed their insight about children with disabilities. The authors' study suggests that a single home visit with the family of a child with a disability provides paediatrics and medicine/paediatrics residents with insights into the family's perspective on disability otherwise unattainable in a hospital-based training programme.

Poster 153 a hospital-based training program for caregivers of rehabilitation patients. Peter A. Lim, MD (Singapore Gen Hosp, Singapore, Singapore), e-mail: grulac@sgh.com.sg

Poster 153 a hospital-based training program for caregivers of rehabilitation patients. Peter A. Lim, MD (Singapore Gen Hosp, Singapore, Singapore), e-mail: grulac@sgh.com.sg

Nursing School Curricula and Hospital-based Training Programs

Perioperative nursing is at the threshold of an unprecedented shortage that may affect the profession for years to come as the existing workforce ages and nursing schools continue to marginalize perioperative curricula. The purpose of this study is to investigate perioperative staffing issues, preceptorship training programs, and nursing school curricula in the metropolitan area surrounding the city of San Jose, Calif. Results show that 77% of the ORs surveyed had vacant positions and experienced moderate to severe difficulty in filling these vacancies. Results for the schools of nursing show that 83% do not offer preceptorships or clinical internships in the perioperative setting. Recommendations regarding the development of professional, community, and academic partnerships to help address the perioperative nursing shortage are presented.

Discourses on Downsizing: Structure and Sentiment in an Organizational Dispute

Abstract: Downsizing, sometimes accompanied by staff amalgamation, has become a grim but pervasive cost-cutting device in Western societies of the 1990s. This article focusses on two hospital-based nursing schools, in an economically marginal Maritime community, that faced merger and the loss of a number of much-prized teaching jobs in the early 1990s. Although both staffs approved, in principle, of raising educational standards for nursing employment, they held distinctly different positions on how educational qualifications should figure in the layoff formula. Downsizing provoked a discourse that unveiled the significance of interpersonal loyalties and workgroup identitiesThe case presented here concerns cultural activity played out in a formal-organizational setting. Concretely, the study compares the way nursing instructors in two hospital-based training programs (in Stelton, a small Maritime city) differentially and creatively interpreted job qualifications in a situation of competition for continued employment. The conditions that provoked competition -- program amalgamation and staff downsizing -- were ultimately rooted in forces of political economy and mediated by formal-organizational factors. The study is thus set against a sketch of that backdrop. But these contextual features are not determinative. Rather, I focus on how the instructors acted as human agents, responding in terms of their grounded (i.e., localized, day-to-day, direct) experience. With respect to layoff criteria, each staff generated its own position, which reflected interpersonal loyalties and in-group identities. These polarized positions will be analyzed as a discourse, generated in terms of interpersonal dynamics and personal meanings that played themselves out in the narrative context of everyday work life, one in which extraorganizational roles figured.The case analysis arises from a prior critique of the popular notion of culture.(f.1) Specifically, organizational culture (OC) is a misnomer disguising cultural variation within bureaucracies. Secondly, as a reification, it glosses over cultural process and, thirdly, it creates artificial boundaries between intra- and extraorganizational statuses that are relevant to the way cultured actors interpret structural principles (values, norms and institutions). That critique highlights important methodological issues and creates an alternative framework that is used here for the analysis of organizational behaviour.Cultural Complexity in OrganizationsAnthropologists have noted that the burgeoning OC literature from management studies mishandles intraorganizational cultural complexity (e.g., Gregory 1983). It does so largely by conflating the organization's culture with the business ideology of senior management. It is, in brief, management-centric, and has been rigorously taken to task for it (Alvesson and Berg, 1992; Baba, 1989; Davis, 1985; deRoche, 1997 and 1994; Gamst, 1989; Hochwald, 1990; Kunda, 1992). The critique does not suggest that subordinates reject all bureaucratic authority. The nursing instructors I studied do not contest the hospital administration's right to make budgetary decisions that effect layoffs. This does not mean, however, that they agree with officially sanctioned decisions about layoff criteria. Nor does it mean that each staff's perception of these decisions is uniform. On the question of educational qualifications, in fact, the women employed at each of the schools (St. Martha's and Stelton General, respectively) differed dramatically.The OC literature gives some limited attention to professional subcultures within organizations (see, among others, Deal and Kennedy, 1982:150 ff.; Kilmann, 1985: 352; Kilmann, Saxton and Serpa, 1985: 11-12; Schein, 1989: 7). It does not, however, examine intraprofessional differences in the workplace. It also recognizes that subcultural variations arise through mergers, which bring together separate organizations and thus cultures. …

Attitudes and education of pediatric house staff concerning breast-feeding.

Pediatricians are expected to offer information and advice on breast-feeding to expectant and lactating mothers, but the educational experience for pediatric residents may not adequately prepare them for this responsibility. To examine knowledge and confidence regarding breast-feeding gained by pediatric house staff during their residency, a survey was administered to pediatric residents in a large, hospital-based training program. Of 108 program residents, 87 (81%) participated. Forty-one percent of the respondents were postgraduate level I (PL-I), 29% were PL-II, and 30% were PL-III. There was no evidence that PL-III residents were more competent or comfortable with routine breast-feeding counseling or intervention than their PL-I counterparts. Residents who had breast-fed, those with spouses who had breast-fed, and those with children of their own had the greatest knowledge and confidence base in several areas, such as their ability to teach breast-feeding techniques and to treat cracked nipples. They were also more familiar with different types of breastpumps. There were no significant differences among those who were or were not breast-fed as a child nor among men versus women. Residency programs must provide comprehensive education on breast-feeding to prepare future pediatricians to meet the needs of patients and their parents.

Hospital-Based Training for Pharmaceutical Manufacturers’ Representatives

A hospital-based training program for pharmaceutical manufacturers' representatives is described. The pharmacy department of a large teaching institution established a training program for new sales representatives of a major pharmaceutical company. Goals were outlined by the sales training manager and the pharmacy department. The sales training personnel, department of pharmacy, and the cooperating departments of medicine, surgery, and nursing worked together to formulate objectives for the sessions, and teaching responsibilities were delegated to members of all these departments. The program length varied from one to five days. A formal contract was developed specifying content, program dates, and reimbursement. The institution is reimbursed for the use of the facility, materials, and administrative overhead. The program's success has led to the development of similar programs with several other companies. The extra income has enabled the pharmacy to create a new division within the department. Evaluations from more than 500 sales representatives who have participated in the programs have been consistently positive. The pharmacy department in a teaching institution has the resources to provide a training program for sales representatives that can be an additional source of income.

Geriatric medicine: a multidisciplinary training and education model in an acute care medical center.

A description of a comprehensive multidisciplinary education and training program in geriatrics in an acute care hospital is presented. A brief review of the history of medical education in geriatrics is examined, and the need for and potential of a hospital-based training program is discussed. The methods used in implementing an education program that attracts house staff physicians and other health professionals are described. The program incorporates the application of a multidisciplinary team model of patient assessment and treatment, which is augmented by clinical bedside teaching and a broad-based educational program. Using hospital-wide faculty, the program includes a geriatrics/gerontology lecture series incorporating presentations on the biopsychosocial aspects of aging and a diversity of subjects relevant to aging. Other programs such as weekly house staff topic sessions on aging, interdisciplinary research seminars, orientations, and special symposia are all part of the education program.

Evaluating the Performance of Technician Trainees

The development and use of a behavioral performance evaluation form for pharmacy technicians in a hospital-based training program is described. The behavior anchors for the evaluation form were derived from a task analysis of the technician position and a modified critical-incident technique. The appraisal factors were classified under six basic work areas: (1) procurement, (2) intravenous admixtures and sterile solutions, (3) automatic replenishment, (4) manufacturing and prepacking, (5) outpatient dispensing, and (6) inpatient dispensing or unit dose. Five rating categories ranging from exceptional to unsatisfactory were given point values. After an evaluation is completed, the supervising pharmacist reviews it with the trainees and sets objectives for the next appraisal period. The form can be used at regular intervals to assess the trainees' progress, and it can be used in the annual review of a technician's performance. The performance evaluation of technician trainees can determine the proficiency gained from a training program and identify areas where further instruction is needed.