Level Of Clinical Skills Research Articles

From supportive care to trauma: training integrative practitioners in the treatment of acute stress disorder

ObjectiveThe present conflict in Israel has led to a surge in cases of acute stress disorder (ASD). The study examined a training program for integrative medicine (IM) providers working in supportive and palliative care settings, teaching clinical skills for treating ASD.MethodsA 10-h online training program, designed by supportive care trained IM and mental health professionals was attended by a group of 32 IM providers. The impact of the course was assessed using pre- and post-training questionnaires, which underwent qualitative evaluation. Three open-ended questions addressed expectations from the program, anticipated barriers to combining IM with mental health interventions, and explored willingness for multi-disciplinary collaboration. A conventional content analysis was used, where coding categories are derived directly from the text data. Narratives were analyzed using ATLAS.ti software for systematic coding.ResultsNarrative themes identified within the group of 32 trainees included expectations regarding facilitating a multi-disciplinary integrative model of care, enriching the ASD-related clinical “toolbox,” increasing the effectiveness of IM treatments, and reducing IM treatment-associated risks. Insights were provided for bridging communication gaps between IM practitioners and mental health providers, supporting the multi-disciplinary collaboration.ConclusionsASD-focused training for IM practitioners may increase their level of clinical skills and advance collaboration with mental health providers. Future research examining the feasibility of the integrative model and its implementation in supportive care setting is warranted.

Nursing/midwifery students' perceptions of caring pedagogy and online learning during the COVID-19 pandemic.

This study aimed to gain a better understanding of nursing/midwifery students' perspectives on a pedagogy of caring and online learning during the COVID-19 pandemic. In addition, it aimed to determine if the COVID-19 pandemic impacted students' perceptions and experience of online learning and students' desire to enter the nursing/midwifery workforce. Mixed methods. A multi-centre cross-sectional survey of Australian nursing and midwifery students was undertaken to explore students' experience of learning during the COVID-19 pandemic. There are several key findings from this study that may be relevant for the future delivery of undergraduate health education, students transitioning to practice and healthcare workforce retention. The study found that although students were somewhat satisfied with online learning during COVID-19, students reported significant issues with knowledge/skill acquisition and barriers to the learning process. The students reported feeling less prepared for practice and identified how clinical staff were unable to provide additional guidance and support due to increased workloads and stress. The textual responses of participants highlighted that connection/disconnection, empathy and engagement/disengagement had an impact on learning during COVID-19. Connection, engagement and isolation were key factors that impacted nursing students' online learning experiences. In addition, graduates entering the workforce felt less prepared for entry into practice due to changes in education delivery during COVID-19 that they perceived impacted their level of clinical skills, confidence and ability to practice as new graduate nurses/midwives. Not applicable. Attention must be given to the transition of new graduate nurses and midwives whose education was impacted by pandemic restrictions, to support their professional career development and to ensure retention of future healthcare workforce. Connection, engagement and isolation were key factors that impacted nursing students' online learning experiences. Educators should consider how connection and engagement can be actively embedded in the online learning environment.

Evaluation of Prosthetic Procedural Skills in Senior Dental Students Using the Self-Assessment Method

Introduction: Student self-assessment is one of the methods of assessing procedural skills that complements existing assessments in dentistry. This study was designed to evaluate prosthetic procedural skills in senior dental students using the self-assessment method. Methods: In this descriptive cross-sectional study, the level of practical skills of 127 senior dental students of Yazd, Esfahan and Kashan faculties were selected and their procedural skills were assessed by a researcher-made questionnaire. The validity of the questionnaire was confirmed through content validity and its reliability through Cronbach's alpha test (r=0.8).To analyze the data, SPSS 16 statistical software and t-test, Chi-square, ANOVA and non-parametric statistical tests were used at the significance level of 0.05. Results: Dental students with a mean age of (25.15 ±1.74) were included in this study. The mean of procedural skills score was 115.51 ±11.78 out of 175, which was at an average level. Procedural skills score was not significantly associated with age, gender, marriage, entrance exam rank, university, the level of anxiety during prosthetic application (P>0.05), but the mean score of procedural skills in complete and partial prosthesis was significantly higher in people who interested in prosthesis (P˂ 0.05). Conclusion: Due to the limitations of the present study, the procedural skills levels in dental prosthesis of senior dental students of Yazd, Esfahan and Kashan faculties was evaluated at an average level. Revision of curriculum- based teaching methods in clinical departments and implementation of new methods for evaluating procedural skills such as DOPS test can be effective in improving the level of clinical skills of learners.

The evaluation of an evidence-based model of feedback implemented on an undergraduate dental clinical learning environment

ObjectivesDental graduates must graduate with high levels of clinical skills. Education in the clinical environment needs to be more than didactic supervision of practice by clinical teachers. Appropriate feedback in this context, is therefore critical to the development of student competence and confidence. This study was conducted to enhance and develop the assessment and feedback processes during clinical sessions in a Dental University Hospital in an effort to contribute to the development of students’ self-assessment skills, reflective ability and clinical competence.MethodsA new evidence-based model of feedback was introduced between clinical teachers and dental students. The implementation of this model was evaluated by students through a survey and focus groups. Descriptive and inferential statistics were applied to the quantitative data, while thematic analysis applied to the qualitative data.ResultsFindings from the survey indicated that students perceived the new model of feedback to be a positive addition to their learning experiences. The majority indicated a preference to continue using it. Quantitative analysis also demonstrated that students placed a high value on the feedback they received through the new model and associated it with improved individual performance. Five themes generated from the qualitative analysis echoed the perception that the model of feedback enhanced learning opportunities, especially when it was focused on individual performance and incorporated peer feedback. Students’ preferences in relation to feedback processes were also gleamed from quantitative and qualitative analyses, that is, provision of positive and constructive feedback, both in dialogue and in written formats, delivered during and after each clinical session and addressing their individual competency learning goals for the future. Some challenges to be addressed were also identified (e.g., time constraints, inter-personal issues, and non-conducive environments).ConclusionsFeedback is central to learning and remains a complex and challenging area. By adopting effective and evidence-based feedback practices through the introduction of a feedback model, students can be supported in regulating their own learning in the clinical learning environment.

Australian chiropractic and osteopathic graduates' perceptions of readiness for transition to practice.

This is the second phase of a project. The aim was to explore Australian chiropractic and osteopathic new graduates' readiness for transition to practice concerning their clinical skills, professional behaviors, and interprofessional abilities. Phase 1 explored final year students' self-perceptions, and this part uncovered their opinions after 6 months or more in practice. Interviews were conducted with a self-selecting sample of phase 1 participant graduates from 2 Australian chiropractic and 2 osteopathic programs. Results of the thematic content analysis of responses were compared to the Australian Chiropractic Standards and Osteopathic Capabilities, the authority documents at the time of the study. Interviews from graduates of 2 chiropractic courses (n = 6) and 2 osteopathic courses (n = 8) revealed that the majority had positive comments about their readiness for practice. Most were satisfied with their level of clinical skills, verbal communication skills, and manual therapy skills. Gaps in competence were identified in written communications such as case notes and referrals to enable interprofessional practice, understanding of professional behaviors, and business skills. These identified gaps suggest that these graduates are not fully cognizant of what it means to manage their business practices in a manner expected of a health professional. This small study into clinical training for chiropractic and osteopathy suggests that graduates lack some necessary skills and that it is possible that the ideals and goals for clinical education, to prepare for the transition to practice, may not be fully realized or deliver all the desired prerequisites for graduate practice.

Evolution of Post Graduate Curricula in Pakistan

Evolution of Post Graduate Curricula in Pakistan

Multifaceted Approach to Evaluation in a Pediatric and Adolescent Gynecology Rotation for Medical Students

We evaluated whether and to what extent a novel medical student rotation in pediatric and adolescent gynecology (PAG) increases clinical knowledge and skills and meets student needs and expectations. Constructivist prospective pre-post study and post-rotation student survey SETTING: Academic medical center PARTICIPANTS: Pilot study of 9 medical students, which represents the entire population of those who completed the rotation. Four-week clinical rotation in PAG MAIN OUTCOME MEASURES: Changes in clinical knowledge were measured by a pre- and post-intervention multiple-choice assessment, and clinical skills were assessed before and after the intervention using entrustable professional activities (EPAs); these data were analyzed with paired Student's t tests. Student evaluations of the rotation were measured through an anonymous, end-of-rotation, closed- and open-ended survey and were analyzed using descriptive statistics. A statistically significant increase in clinical knowledge was observed post-rotation, with a mean pretest score of 67.0% (standard deviation [SD] 1.7%) and a mean posttest score of 75.2% (SD 3.2%, P=0.02). Statistically significant increases were observed for all EPAs between the first and final day of the rotation. Eight students who completed the post-rotation survey rated the rotation favorably (5 on a scale from 1 to 5). A multipronged evaluation showed that a new PAG clinical rotation significantly increased medical students' clinical skills and knowledge. This multifaceted evaluation method provides valuable insights to educators on how best to tailor a rotation to individual learners' levels of clinical skills and knowledge. If comparable rotations could be instituted and similarly evaluated in other medical schools, a noticeable knowledge/skill gap among trainees might be addressed.

Evaluation of Viewpoints of final-year Students of Qazvin Dental School on Clinical Skills Based on Educational Program in 2015

Introduction: Self-assessment is one of the methods of benchmarking dental graduates of the acquired skills and identify the strengths and weaknesses of the current student and educational system. The purpose of this study was to evaluate the viewpoints of final-year students of Qazvin Dental School regarding their acquired clinical skills based on the educational program. Methods: The type of study was descriptive cross-sectional. In this study, the clinical skill level of dental students was evaluated using a 45-item questionnaire (from the skills of 9 clinical departments). Data were analyzed by SPSS software version 16 using t-test. Results: 24 students (10 males and 14 females) were included in the study. In general, the mean of students (out of 5 scores) was 3.41±0.30 which was in good level. There was a significant difference between the students' ability in different departments (P = 0.000). The highest ability was in endodontics (4.00) and the lowest in oral disease and diagnosis (2.98). There was no significant difference in total abilities between men and women, but the ability of women in the endodontics ward was higher than men (P = 0.002). Conclusion: The level of ability of the students from their point of view in this study was good. There was also a difference in the skills of girls and boys in educational settings. The results of this study can be used for evaluation of strengths and weaknesses and planning for promoting education in Qazvin Dental School.

Effectiveness of Simulation Training on Graduate Audiology Students' Auditory Brainstem Response Testing Skills.

Purpose Simulation is a tool commonly used in the clinical training of students within the health professions fields, such as medicine and nursing. The effectiveness of simulation as a teaching technique has been extensively documented in numerous health care professions; however, little is known about the effectiveness of simulation techniques in audiology education. This study assesses the effectiveness of a simulation activity focused on auditory brainstem response (ABR) testing conducted with students of an applied doctoral program in audiology. Method Twelve 2nd year audiology graduate students enrolled in the auditory electrophysiology course at Towson University in Fall 2018 participated in this pre-post study. Over a 3-week period, each student (a) received didactic instruction in ABR testing, (b) underwent a presimulation exercise skills assessment, (c) participated in a simulation exercise, and (d) underwent a postsimulation exercise skills assessment. Results Significant improvements were observed in clinical skill level for the ABR tasks evaluated in terms of both accuracy and efficiency (time in seconds needed to complete the task). The tasks evaluated included skin preparation, identification of scalp electrode placement sites, and scalp electrode placement in a variety of configurations (single- and two-channel arrays, horizontal and vertical electrode montages). Benefits associated with simulation-based instruction varied by clinical skill as well as by student. Conclusions The data described in this study reinforce the need to incorporate simulation in audiology training programs, especially for complex clinical skills. It also emphasizes the need for additional research that can be useful in the design and implementation of simulation-based exercises.

An integrated simulation-based early clinical exposure module in cardiovascular physiology

Objectives: A good conceptual understanding of physiology is very important to build a strong foundation for medical students. It is a daunting job for teachers to emphasise the clinical relevance of basic science subjects as exposure to patients invariably starts after these subjects have been taught. With the introduction of early clinical exposure in the newly revised Indian undergraduate medical curriculum, this problem can be addressed to a certain extent. We developed an integrated simulation module for teaching cardiovascular physiology to pre-clinical students as a part of early clinical exposure. Materials and Methods: We included 145 medical students of a Private Medical College of a Deemed to be University in Mangalore, Karnataka, India. The teaching module covered the topics of cardiovascular physiology such as functional anatomy, cardiac cycle, normal electrocardiogram (ECG), arrhythmia, arterial pulse examination, heart sounds and hands-on cardiovascular examination using a variety of simulators. The assessment was done by pre-test and post-test. A retro-pre questionnaire was used to assess their self-perceived knowledge gain and level of clinical skills. Feedback on overall experience was collected from the participants. Results: The student feedback showed that learning experience was life-like (98.6%), effective, innovative and enjoyable (99.3%) and making the overall experience of learning easier (95.2%). It also improved participation, communication (93.8%), clinical skills and a better understanding of patient care (99.3%). The results of the retro- pre questionnaire to assess their self-perceived knowledge gain (95%) and level of clinical skills (96%) were highly satisfactory. The assessment of knowledge domain showed 100% of the students achieved pass percentage (>50%) with significant difference among pre- and post-test scores. Faculty (100%) opined that simulation-based teaching resulted in effected learning. Conclusions: The use of simulation-based teaching in cardiovascular physiology as part of early clinical exposure leads to enhanced learning and clinical application. This will stimulate interest in subject and promote better learning.

Analysis of knowledge and clinical skill competition results in general practitioners attending grass-roots health post training

The knowledge and clinical skill competition scores of 331 general practitioners (GPs), who attended the grassroots health posts training in Sichuan Province and Chengdu Municipality in 2016 and 2017, were documented. The factors influencing the competition results were analyzed. The mean knowledge test score of 331 participants were higher than the clinical skill score [(76.89±6.56) vs. (54.13±10.91) , P 0.05). The levels of clinical skills of general practitioners at the grass-roots level need to be further improved, according to relevant influencing factors. Key words: General practitioner; Clinical knowledge; Clinical skill

Commentaries on health services research

Commentaries on health services research

Using Clinically Based Vignettes to Further Develop a Mass Gathering Triage Tool

Introduction:This research builds on a previously developed triage: Mass Gathering Triage Scale (MaGaTT) by Cannon, et al (2017). This tool was targeted towards non-health care professional first responders within mass-gathering events (MGEs). However, this tool had not been evaluated.Aim:To further develop the previously designed MaGaTT using vignettes of clinical cases to: 1) determine variation in decision-making, and 2) inform further tool development prior to real-world testing.Methods:Volunteer members of St. John Ambulance Australia were surveyed using 18 vignettes of de-identified real patient record forms from MGEs covered by St. John Ambulance Australia (NSW) in 2013-2014. Participants were given the MaGaTT and written instructions on its use. Participants triaged 18 patients, recording their decisions on the online survey. Responses against the vignettes were analyzed using Fleiss Kappa [p-bar] measure. A score of 0.61 – 0.8 represented substantial agreement and a score of between 0.41 and 0.6 represented moderate agreement between participants.Results:There were 110 completed responses. The majority of participants were male (n =66, 60%), having completed a Bachelor’s Degree (n =38, 34.5%), and holding the clinical skill level of “first responder” (n=42, 38.2%). The overall agreement [p-bar] for the 18 items was moderate at 0.55. When examined by triage category, the “Resuscitation” category had substantial agreement (0.69), when compared with moderate agreement for “Urgent” (0.52) and “Minor” (0.52) categories.Discussion:This research demonstrates that the MaGaTT can be used with moderate agreement, and substantial agreement within the resuscitation category. This is similar to triage tools internationally, where high levels of agreement relate to triage categories for patients requiring resuscitation when compared to patients requiring lower levels of clinical care. Slight changes have been made to the original MaGaTT as a result of this research.

Research on the Realization of Remote Clinical Skills Training.

According to the analysis of investigation, there are many problems in the current clinical skills training for medical education, such as large demand, high difficulty and less opportunity. With the development and application of computer network technology, it has provided new directions for the training in the medical field. Using modern management techniques, it has combined computer technology, biochemical science and microbiology principles with traditional clinical medical education experience, which has promoted the development of advanced clinical medicine concepts and skill levels. The combination of distance education and medical education is a process of integrating theoretical knowledge into practice, which not only improve the medical management capabilities of medical staff, but also improve the overall level of clinical skills.

Analysis of the level of clinical skills of physician assistants tested with simulated intensive care patients.

Rationale, aims, and objectivesSince adequate staffing in intensive care units (ICUs) is an increasing problem worldwide, we investigated whether physician assistants (PAs) are able to substitute medical residents (MR) in ICUs with at least the same quality of clinical skills. In this study, we analysed the level of clinical skills of PAs in direct comparison with those who traditionally performed these tasks, ie, MR with 6 to 24 months of work experience in the ICU.MethodPhysician assistants and MRs in the ICUs were observed on their clinical skills by means of a simulated ICU comprising 2 scenarios on a human patient simulator with typical ICU cases. The level of clinical skills of PAs and MRs was videotaped and scored with predefined checklists by 2 independent intensivists per scenario. Percentage of the total score was calculated, and means were compared by Student t test.ResultsA total of 11 PAs and 10 MRs participated in the study. Physician assistants and MRs scored equal (PA 66% ± 13% vs MR 68% ± 9%, P = .86) on their clinical performance in the simulated ICU setting.ConclusionThis study showed equal performance of PAs and MRs on clinical skills in the simulated ICU setting.

Assessment of hospital pharmacists' clinical knowledge and practical skill levels for pharmaceutical care in Madinah, Saudi Arabia

Purpose: To evaluate hospital pharmacists’ clinical knowledge and practical skill levels for pharmaceutical care.Methods: A quasi-experimental prospective longitudinal study design was used to evaluate the level of clinical skills with problem-based learning (PBL) sessions. Pharmacists’ in three different government hospitals in Madinah, Saudi Arabia recorded their responses or assessments in their work manuals for preparing reports. Instructors encouraged interactive learning by presenting case studies, in which pharmacists had to interpret medical history and clinical assessments of various body systems. Course learning design also focused on drug use evaluation, monitoring plans, and reaching clinical evidencebased decision-making.Results: A total of two hundred and fifty-five (255) hospital pharmacists participated in the study. The study sample was comprised of 128 (50.9 %) males and 127 (49.1 %) females. A significant (p < 0.01) difference was noticed between genders (male: 47.91 ± 7.15, female: 50.31 ± 4.88) for total mean scores of clinical skills. Cronbach’s alpha reliability coefficient for case data recitation was 0.91, while clinical assessment skills coefficient was 0.89. Overall, pharmacists reported that they “agree” (4.01 ± 0.67) that they acquired the ability to use case data recitation taught in the PBL; they also reported a positive evaluation (4.48 ± 0.58) of their ability to perform clinical data assessment.Conclusion: The findings indicate that pharmacist’s self-confidence to perform clinical assessment activities is low. Lack of confidence remains a critical education issue among pharmacists in the study setting.Keywords: Clinical pharmacy, Problem-based learning, Clinical skills, Pharmacist focus group, Therapeutics, Pharmaceutical care

A Review on Models of Evidence-Based Practice

Evidence-based practice is a paradigm and life-long problem solving approach to clinical decision-making that involves the conscientious use of the best available evidence (including a systematic search for and critical appraisal of the most relevant evidence to answer a clinical question) with one's own clinical expertise and patient values and preferences to improve outcomes for individuals, groups, communities and systems. EBP is defined as integration of the best available research evidence with information about patient preferences, clinical skill level and available resources to make decisions about care. In this paper, review on models of Evidence-Based Practice is discussed.

The AMBIT approach: working with hard to reach youth

Purpose – MBIT is a manualised mentalization-based approach to working with hard to reach young people at risk of a wide range of life adversities including severe mental illness, substance misuse, family breakdown, school exclusion, offending and homelessness. The on-line manual (www.tiddlymanuals.com) describes how Adolescent Mentalization-Based Integrative Therapy (AMBIT) is a systemic intervention requiring attention to four different domains of intervention simultaneously; much emphasis is placed on the support systems for workers to maintain this balance in what are often chaotic working conditions. The purpose of this paper is to illustrate how these four main components of the AMBIT approach link together in actual clinical practice. Design/methodology/approach – The authors illustrate the core techniques of the AMBIT approach, namely, “working with your client”, “working with your team”, “ working with your network” and “learning as a team” with a series of case vignettes, demonstrating the inter-relationship of these components rather than seeing them as separate strands. Findings – A range of mentalization-based techniques such as “thinking together”, mentalized formulation, “disintegration grids” and web-based manualising are described and illustrated in relation to a series of case vignettes in order to address barriers to effective practice. The vignettes emphasise how these components must be linked together and held in balance, and how easily they become disconnected in working with young people’s ambivalent or even hostile relationships to help. Practical implications – First, developing a shared, mentalized formulation of a young person’s difficulties is an important aspect of working with highly troubled young people. Second, mentalizing is a relational process and is easily disrupted, for both workers and young people, by raised anxiety and affect, a common feature of working with this client group. AMBIT provides specific methods, for example, “thinking together” for supporting the mentalizing of individual workers in their team in an explicit way. Third, workers from different agencies may often find it difficult to make sense of each other’s behaviour and decision making. AMBIT proposes the use of a mentalizing approach to this difficulty using a technique called a disintegration grid. Finally, AMBIT proposes a new practitioner focused approach to manualising as a method by which a team can become more explicit about its methods of working in order to support systematic practice and evaluate outcomes. Originality/value – The innovative AMBIT approach proposes that clinicians need to attend to team and network relationships at least as much as their relationship with the client, in addition to adopting a stance of learning as a team from their casework. A high level of clinical skill is needed to support a team to achieve this balanced approach to casework. This work is of interest to all multi-disciplinary teams working with hard to reach young people.

Highlights for ESMO 40: celebration review for lifetime achievement awards

My work, my crucial achievement, has been in the management of the transition of the conduct of cancer research/management from basic researchers/surgeons to medical oncologists (figure 1). Figure 1 The Flower of Hope—the ESMO Lifetime Achievement Award. This transition can be divided into four categories: 1. The development, progression and consolidation of global Medical Oncology in Asian countries, especially in Japan. 2. Building a close collaboration with European Society of Medical Oncology (ESMO) and receiving strong support from ESMO, through (A) Adaptation of the ESMO/ASCO Core Curriculum in Medical Oncology,1 (B) Mutual ESMO/ Japanese Society of Medical Oncology (JSMO) joint symposia during their respective meetings, (C) making Annals of Oncology JSMO's official scientific publication,2 along with (D) my own work as an Associate Editor of Annals of Oncology (2011–2014), (E) my work as ESMO's National/Regional Representative and Membership Committee member (2005–2011). 3. Leadership of clinical research in Japan as a key opinion leader and primary investigator in IND (investigational new drug) trials and a chairman of the Japanese Clinical Oncology Group (JCOG; 2000–2009), organising a governmental clinical trial group; and the development of new gold standards in the treatment of malignant diseases, especially in thoracic malignancy by investigator-initiated randomised controlled clinical trials. 4. Encouraging translational research and the publication of numerous articles, especially in the area of the identification of molecular targets for anticancer drugs, as Chief of the Pharmacology Division in the National Cancer Center Research Institute. When I began my training in Medical Oncology, cancer research, including translational research, was conducted by basic researchers, and cancer treatment, including chemotherapy, was conducted by surgeons. There was no place for medical oncologists to play an active part in cancer research and treatment. ESMO was established 40 years ago and now has more than 10 000 professionals as members, and medical oncology has been recognised as …

Teaching mode exploration for eight-year program interns in the out-patient department of general internal

Clinical practice teaching in out-patient department is an important part of general internal clinical teaching for medical students. From 2010, eight-year program medical students in Huazhong University of Science and Technology began their clinical rotation practice in the out-patient department of general internal medicine. The one-on-one tutoring style was used in clinical teaching. We combined teacher demonstration teaching method with teacher supervision teaching method in clinical practice, and carried out periodical case discussion. At the end of each rotation stage, regular teaching evaluation and examination was taken. It has been proved that our teaching mode can not only help the students improve their professional and practical levels of clinical skills, and also help them gain the clinical working abilities and the professional spirits, which is worthy of further promotion. Key words: Eight-year program; Medical education; General internal; Clinic practice teaching