Mean Post-intervention Scores Research Articles

A pilot quasi-experimental study to determine the feasibility of implementing a partograph e-learning tool for student midwife training in Nairobi

Objectivethe partograph is a tool used globally to record labour progress. Although it has the potential to improve maternal and neonatal outcomes, some midwives struggle with using it in practice. Training in partograph use is limited, and the theory is often divorced from practice. Innovative ways of improving training are urgently required. We therefore aimed to determine whether the use of an e-learning tool is beneficial for learning partograph skills. Designan uncontrolled before-and-after study was conducted, informed by Kirkpatrick's four-stage model of evaluation; we report on the first two stages. We included a cohort of third and fourth year midwifery students who were studying at one university in Nairobi. The same hypothetical case scenario was used, pre- and post-implementation of the World Health Organization partograph e-learning tool, to assess students' partograph completion ability. Views on the tool were also sought, using semi-structured questionnaires. Data were analysed using standard statistical techniques and framework analysis. Findings92 (88%) students participated. Students expressed positive views about the e-learning tool. However, the mean post-intervention score (27.21) was less than half of the maximum obtainable score. There was some improvement in test scores; year three mean score pre-intervention was 21.39 (SD 5.72), which increased to 25.10 (5.41) post-intervention (paired-t=3.47, p=0.001); year four mean score pre-intervention was 24.39 (5.98) which increased to 29.30 (6.77) post-intervention (paired t=3.85, df=91, p<0.001). In the post-test, year four students scored higher than year three students (unpaired t=3.28, df=90, p=0.001). Students were unable to plot cervical dilatation correctly, once established labour had been confirmed. Key conclusione-Learning training is acceptable to student midwives and has the potential to be an effective means of teaching the practical application of the partograph. However, in this study, their inability to correctly plot transference from the latent to active phase of labour suggests that the partograph itself may be too complicated. Modifications and further evaluation of the e-learning tool would be required before any widespread implementation. Furthermore, students need the clinical support to operationalise their learning; educating qualified midwives and obstetricians to be positive role models when completing the partograph would be one potential solution. Further research is required, taking on board the recommendations from our pilot study, to investigate the impact of partograph e-learning on practice and clinical outcomes.

The Efficacy of a Targeted Remediation Process for Students Who Fail Standardized Patient Examinations

Background: Current remediation strategies for students failing standardized patient examinations represent poorly targeted approaches since the specific nature of clinical performance weaknesses has not been defined. Purpose: The purpose is to determine the impact of a specifically targeted clinical performance course required of students who failed a clinical performance examination. Methods: A month-long clinical performance course, targeted to treat specific types of clinical performance deficiencies, was designed to remediate students failing standardized patient examinations in 2007 (n = 8) and 2008 (n = 5). Participating students were assessed on pre- and postperformance measures, including multiple-choice tests that measured diagnostic pattern recognition and clinical data interpretation and clinical performance measures using standardized clinical encounters. Comparisons between average pre- and postintervention performance scores were computed using paired sample t tests. Results were adjusted for regression toward the mean. Results: In both 2007 and 2008, the mean preintervention clinical data interpretation and standardized patient examination scores were below the criterion referenced passing standard set for the clinical competency exam. In both years the mean postintervention scores for the participants were above the passing standard for these two examinations. Pre- and postintervention differences were statistically significant in both cases. Conclusions: This study provides insight into the reasons that students fail clinical performance examinations and elucidates one method by which such students may be successfully remediated.

Improving Professionalism: Making the Implicit More Explicit

Professionalism is one of the most challenging of the Accreditation Council for Graduate Medical Education Competencies to define, teach and evaluate. At University of Washington we assessed whether defining professionalism, and training faculty and residents in the evaluation process would improve professional behavior. In 2003 the Accreditation Council for Graduate Medical Education Global Resident Competency Rating Form was distributed to faculty after each rotation to evaluate residents. The project included all 16 residents and 18 clinical faculty during a total of 15 rotations for 3 years at 4 Seattle area hospitals. After 21 months a training lecture on professionalism was presented to faculty and residents. Following this intervention all trained faculty completed a Graduate Medical Education Global Resident Competency Rating Form on every resident after each rotation. Three specific professionalism questions from the Graduate Medical Education Global Resident Competency Rating Form were chosen as representations of standard professional behaviors. These questions were used to assess the change in resident professional behavior. Pre-intervention and post-intervention scores were compared. Mean post-intervention scores were higher by 0.4 to 0.5 points for each of the 3 questions (each p <0.01). There was less variation in scores after the intervention, suggesting that 1) residents were more consistent in their professional behavior and/or 2) the faculty observation of resident professional behaviors was more focused. These results suggest that training faculty and residents in professionalism may have a significant positive influence on improving resident professional behavior as well as the faculty ability to more objectively evaluate resident professional behaviors based on defined standards.

A comparison of two teaching strategies on nutrition knowledge, attitudes and food behavior of preschool children

The purpose of this study was to investigate the effect of two teaching strategies, benefit appeal and threat appeal, on the nutrition knowledge, attitudes and food behavior of 103 preschool children. Nutrition information was conveyed using three traditional fairy tales that were rewritten to present basic nutrition concepts. The fairy tales modified for the benefit appeal group emphasized the positive, favorable results of eating a variety of vegetables, while those modified for the threat appeal group focused on the health and nutrition risks arising from not eating vegetables. Classes of preschool children were randomly assigned to a control group or to one of two experimental groups (the benefit appeal or threat appeal). The researcher used a flannel board to illustrate the fairy tales as they were presented to the two experimental groups. One fairy tale was presented on each of three consecutive school days. Control group children did not hear the modified fairy tales. Nutrition knowledge, attitude and behavior were assessed prior to and after the story presentations. Results revealed that the benefits appeal group had higher adjusted mean posttest knowledge scores than the threat appeal group, and that both experimental groups had significantly higher adjusted mean post-test knowledge scores than the control group. Both experimental groups had similar significantly higher adjusted mean post-assessment attitude scores than the control group, but the experimental groups did not differ significantly. Results of the food behavior assessment varied with the snack choice offerings. Children in the benefit appeal group had significantly higher adjusted mean post-intervention scores than the control group for all snack choices and significantly higher adjusted mean post-intervention scores than those of the threat appeal group for half of the snack food choices; the adjusted mean post-intervention scores for the threat appeal group were significantly higher than those of the control group for only half of the snack food choices.Further research is needed, with a more demographically diverse sample, to validate the positive effect of the benefit appeal teaching strategy with preschool children.